A1 Refereed original research article in a scientific journal

Prognostic Implications and Alterations in Left Atrial Deformation Following Transcatheter Aortic Valve Implantation




AuthorsButcher, Steele C.; Hirasawa, Kensuke; Meucci, Maria Chiara; Stassen, Jan; Kuneman, Jurrien H.; Pereira, Ana Rita; van der Kley, Frank; de Weger, Arend; van Rosendael, Philippe J.; Marsan, Nina Ajmone; Playford, David; Delgado, Victoria; Bax, Jeroen J.

PublisherOxford University Press

Publication year2024

JournalEHJ Cardiovascular Imaging / European Heart Journal - Cardiovascular Imaging

Journal name in sourceEuropean heart journal. Cardiovascular Imaging

Journal acronymEur Heart J Cardiovasc Imaging

Volume25

Issue12

First page 1638

Last page1648

ISSN2047-2404

eISSN2047-2412

DOIhttps://doi.org/10.1093/ehjci/jeae170

Web address https://doi.org/10.1093/ehjci/jeae170

Self-archived copy’s web addresshttps://research.utu.fi/converis/portal/detail/Publication/457196313


Abstract

Aims

To evaluate the prognostic implications of the left atrial reservoir strain–defined diastolic dysfunction (LARS-DD) grade in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) and to determine whether post-TAVI LARS was more closely associated with new-onset atrial fibrillation than pre-TAVI LARS.

Methods and results

Pre-TAVI LARS-DD was evaluated by speckle-tracking echocardiography and was assigned as Grade 0 to 1 (LARS ≥24%), Grade 2 (LARS 19–24%), and Grade 3 (LARS <19%). Patients were followed up for the primary endpoint of all-cause mortality from the date of TAVI. For the secondary endpoint, patients with pre- and post-TAVI LARS measurements and no history of atrial fibrillation were evaluated for the occurrence of new-onset atrial fibrillation. A total of 601 patients [median age 81 (76–85) years, 53% males] were included. Overall, 169 patients (28%) were LARS-DD Grade 0/1, 96 patients (16%) were LARS-DD Grade 2, and 336 (56%) were LARS-DD Grade 3. Over a median follow-up of 40 (interquartile range 26–58) months, a total of 258 (43%) patients died. In a comprehensive multivariable Cox regression model, the LARS-DD grade was independently associated with all-cause mortality [adjusted hazard ratio (HR) 1.28 per one-grade increase, 95% confidence interval (CI) 1.07–1.53, P = 0.007]. For the secondary endpoint of new-onset atrial fibrillation, a total of 285 patients were evaluated. Post-TAVI LARS (subdistributional HR 1.14 per 1% <20%, 95% CI 1.05–1.23, P = 0.0009), but not pre-TAVI LARS (P = 0.93), was independently associated with new-onset atrial fibrillation.

Conclusions

An increased LARS-DD grade was independently associated with long-term post-TAVI survival in patients with severe AS. Post-TAVI LARS was closely related to the occurrence of new-onset atrial fibrillation.


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Funding information in the publication
Steele C. Butcher received funding from European Society of Cardiology (ESC Research Grant App000080404). Kensuke Hirasawa received funding from European Society of Cardiology (ESC Research Grant, R-2018-18122).


Last updated on 2025-28-02 at 14:10