Prognostic Value of Left Atrial Stiffness in Patients Undergoing Transcatheter Aortic Valve Implantation

Overview

Journal Int J Cardiol Heart Vasc

Date 2025 Jan 15

PMID 39811398

Authors

Hiroki Usuku

Eiichiro Yamamoto

Ryudai Higashi

Atsushi Nozuhara

Yuichiro Shirahama

Fumi Oike

Noriaki Tabata

Masanobu Ishii

Shinsuke Hanatani

Tadashi Hoshiyama

Hisanori Kanazawa

Yuichiro Arima

Hiroaki Kawano

Yasuhiro Izumiya

Yasuhito Tanaka

Kenichi Tsujita

Affiliations

Soon will be listed here.

Abstract

Aim: This study was performed to evaluate the association between left atrial (LA) stiffness and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods And Results: This study involved 279 patients with aortic stenosis (AS) who underwent TAVI at Kumamoto University Hospital between 2015 and 2023. During a median follow-up of 468 days (interquartile range: 258-825 days), 42 deaths occurred. Pre-TAVI echocardiography showed that the LA stiffness index (E/e' ratio/LA strain during the reservoir phase [LASr]) was significantly higher in the all-cause death group than in the survival group (2.80 ± 2.56 vs. 1.70 ± 1.23, p < 0.01). Multivariate Cox proportional hazard analysis identified LA stiffness as significantly and independently associated with all-cause death after adjusting for body mass index, -aortic valve velocity, atrial fibrillation, log-transformed high-sensitivity cardiac troponin T (hazard ratio [HR]: 1.31, 95 % confidence interval [CI]: 1.14-1.51, p < 0.01), tricuspid regurgitation, left ventricular global longitudinal strain (HR: 1.24, 95 % CI: 1.06-1.44, p < 0.05), and LASr (HR: 1.27, 95 % CI: 1.05-1.60, p < 0.05). Receiver operating characteristic analysis showed that the optimal cutoff value of the LA stiffness index for predicting all-cause mortality was 1.69 (sensitivity: 60 %, specificity: 62 %, area under the curve: 0.64). Kaplan-Meier analysis demonstrated that patients with a high LA stiffness index (≥1.69) had a significantly higher probability of all-cause death (p < 0.05).

Conclusion: Estimation of LA stiffness provides significant prognostic value in patients with AS undergoing TAVI, even after adjusting for multiple predictive factors.

References

Lancellotti P, Donal E, Magne J, OConnor K, Moonen M, Cosyns B . Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study. Eur J Echocardiogr. 2010; 11(6):537-43. DOI: 10.1093/ejechocard/jeq014. View

Weidemann F, Herrmann S, Stork S, Niemann M, Frantz S, Lange V . Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation. 2009; 120(7):577-84. DOI: 10.1161/CIRCULATIONAHA.108.847772. View

Kurt M, Wang J, Torre-Amione G, Nagueh S . Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging. 2009; 2(1):10-5. DOI: 10.1161/CIRCIMAGING.108.813071. View

Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M . Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound. 2009; 7:6. PMC: 2652427. DOI: 10.1186/1476-7120-7-6. View

Iung B, Baron G, Butchart E, Delahaye F, Gohlke-Barwolf C, Levang O . A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease. Eur Heart J. 2003; 24(13):1231-43. DOI: 10.1016/s0195-668x(03)00201-x. View

Bonow R, Carabello B, Chatterjee K, de Leon Jr A, Faxon D, Freed M . 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing.... Circulation. 2008; 118(15):e523-661. DOI: 10.1161/CIRCULATIONAHA.108.190748. View

Badano L, Kolias T, Muraru D, Abraham T, Aurigemma G, Edvardsen T . Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2018; 19(6):591-600. DOI: 10.1093/ehjci/jey042. View

Cohn J, Ferrari R, Sharpe N . Cardiac remodeling--concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol. 2000; 35(3):569-82. DOI: 10.1016/s0735-1097(99)00630-0. View

Zoghbi W, Adams D, Bonow R, Enriquez-Sarano M, Foster E, Grayburn P . Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017; 30(4):303-371. DOI: 10.1016/j.echo.2017.01.007. View

10.

Schneider C, Malisius R, Krause K, Lampe F, Bahlmann E, Boczor S . Strain rate imaging for functional quantification of the left atrium: atrial deformation predicts the maintenance of sinus rhythm after catheter ablation of atrial fibrillation. Eur Heart J. 2008; 29(11):1397-409. DOI: 10.1093/eurheartj/ehn168. View

11.

DAscenzi F, Cameli M, Henein M, Iadanza A, Reccia R, Lisi M . Left atrial remodelling in patients undergoing transcatheter aortic valve implantation: a speckle-tracking prospective, longitudinal study. Int J Cardiovasc Imaging. 2013; 29(8):1717-24. DOI: 10.1007/s10554-013-0265-z. View

12.

Fries B, Liu D, Gaudron P, Hu K, Nordbeck P, Ertl G . Role of Global Longitudinal Strain in the Prediction of Outcome in Patients With Severe Aortic Valve Stenosis. Am J Cardiol. 2017; 120(4):640-647. DOI: 10.1016/j.amjcard.2017.05.032. View

13.

Amundsen B, Helle-Valle T, Edvardsen T, Torp H, Crosby J, Lyseggen E . Noninvasive myocardial strain measurement by speckle tracking echocardiography: validation against sonomicrometry and tagged magnetic resonance imaging. J Am Coll Cardiol. 2006; 47(4):789-93. DOI: 10.1016/j.jacc.2005.10.040. View

14.

Leon M, Smith C, Mack M, Makkar R, Svensson L, Kodali S . Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016; 374(17):1609-20. DOI: 10.1056/NEJMoa1514616. View

15.

Kokubu N, Yuda S, Tsuchihashi K, Hashimoto A, Nakata T, Miura T . Noninvasive assessment of left atrial function by strain rate imaging in patients with hypertension: a possible beneficial effect of renin-angiotensin system inhibition on left atrial function. Hypertens Res. 2007; 30(1):13-21. DOI: 10.1291/hypres.30.13. View

16.

Galli E, Fournet M, Chabanne C, Lelong B, Leguerrier A, Flecher E . Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study. Eur Heart J Cardiovasc Imaging. 2015; 17(5):533-41. DOI: 10.1093/ehjci/jev230. View

17.

Kearney L, Lu K, Ord M, Patel S, Profitis K, Matalanis G . Global longitudinal strain is a strong independent predictor of all-cause mortality in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging. 2012; 13(10):827-33. DOI: 10.1093/ehjci/jes115. View

18.

Oike F, Usuku H, Yamamoto E, Marume K, Takashio S, Ishii M . Utility of left atrial and ventricular strain for diagnosis of transthyretin amyloid cardiomyopathy in aortic stenosis. ESC Heart Fail. 2022; 9(3):1976-1986. PMC: 9065867. DOI: 10.1002/ehf2.13909. View

19.

Nagueh S, Smiseth O, Appleton C, Byrd 3rd B, Dokainish H, Edvardsen T . Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2016; 29(4):277-314. DOI: 10.1016/j.echo.2016.01.011. View

20.

Hirasawa K, Singh G, Kuneman J, Gegenava T, van der Kley F, Hautemann D . Feature-tracking computed tomography left atrial strain and long-term survival after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging. 2022; 24(3):327-335. DOI: 10.1093/ehjci/jeac157. View