Aims To investigate the changes in left atrial strain (LAS) after correction of severe aortic stenosis (AS) with transcatheter aortic valve replacement (TAVR) and assess its prognostic impact. Methods and results One hundred consecutive patients with severe symptomatic AS who underwent TAVR at the Magna Graecia University of Catanzaro underwent echocardiographic examination including assessment of LAS before and after TAVR. Independent investigators collected outcome data and information. The primary study outcome was the difference in "LAS (postTAVR-preTAVR) between patients those met the main clinical endpoint (a composite of cardiovascular mortality and heart failure hospitalisation) and those not meeting the endpoint. During a median follow-up of 31 months, 35 patients (35%) met the combined clinical endpoint. The difference between LAS post-TAVR and LAS pre-TAVR ( "LAS) was significantly larger in patients who met the combined endpoint (HR=0.76 (0.67-0.86); p<0.001). Multivariate logistic regression analysis including "LAS, EuroSCORE II and left ventricular ejection fraction showed that "LAS (HR=0.80, p<0.001) was the only independent predictor of the combined clinical endpoint. Finally, a Kaplan-Maier analysis showed that patients with a "LAS above its median value had a significantly better event-free survival compared with those below the median (p<0.001). Conclusions A lower reduction in "LAS after TAVR was an independent predictor of the primary composite outcome of cardiovascular death and hospitalisation for heart failure.

Early reduction of left atrial function predicts adverse clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement

Sabatino J.;De Rosa S.;Leo I.;La Bella S.;Sorrentino S.;Polimeni A.;Indolfi C.
2021-01-01

Abstract

Aims To investigate the changes in left atrial strain (LAS) after correction of severe aortic stenosis (AS) with transcatheter aortic valve replacement (TAVR) and assess its prognostic impact. Methods and results One hundred consecutive patients with severe symptomatic AS who underwent TAVR at the Magna Graecia University of Catanzaro underwent echocardiographic examination including assessment of LAS before and after TAVR. Independent investigators collected outcome data and information. The primary study outcome was the difference in "LAS (postTAVR-preTAVR) between patients those met the main clinical endpoint (a composite of cardiovascular mortality and heart failure hospitalisation) and those not meeting the endpoint. During a median follow-up of 31 months, 35 patients (35%) met the combined clinical endpoint. The difference between LAS post-TAVR and LAS pre-TAVR ( "LAS) was significantly larger in patients who met the combined endpoint (HR=0.76 (0.67-0.86); p<0.001). Multivariate logistic regression analysis including "LAS, EuroSCORE II and left ventricular ejection fraction showed that "LAS (HR=0.80, p<0.001) was the only independent predictor of the combined clinical endpoint. Finally, a Kaplan-Maier analysis showed that patients with a "LAS above its median value had a significantly better event-free survival compared with those below the median (p<0.001). Conclusions A lower reduction in "LAS after TAVR was an independent predictor of the primary composite outcome of cardiovascular death and hospitalisation for heart failure.
2021
echocardiography
heart failure
transcatheter aortic valve replacement
Aged, 80 and over
Aortic Valve
Aortic Valve Stenosis
Atrial Function, Left
Disease Progression
Echocardiography, Doppler
Female
Follow-Up Studies
Heart Atria
Heart Failure
Humans
Incidence
Italy
Male
Prognosis
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Stroke Volume
Transcatheter Aortic Valve Replacement
Treatment Outcome
Early Diagnosis
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.12317/74490
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