Poulin Frédéric, Thavendiranathan Paaladinesh, Carasso Shemy, Rakowski Harry, Horlick Eric M, Osten Mark D, Cusimano Robert J, Woo Anna
Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
Can J Cardiol. 2017 Jul;33(7):925-932. doi: 10.1016/j.cjca.2017.04.005. Epub 2017 Apr 20.
Left atrial (LA) size is a marker of prognosis in severe aortic stenosis (AS). The aims of this retrospective study were to assess the impact of transcatheter aortic valve implantation (TAVI) on the recovery of LA phasic function and to assess the relationship between LA function and new-onset atrial fibrillation (NAF) after TAVI.
In this retrospective cohort study, LA function was measured using biplane volumes and 2-dimensional (2D) speckle tracking echocardiography (STE) in 52 patients (median age, 81 years) with severe AS before TAVI and at midterm follow-up. Twenty healthy individuals ≥ 75 years were used as controls.
Before TAVI, the 3 phasic volumetric emptying fractions and all STE-derived parameters of LA function were significantly reduced. At 5 ± 3 months after TAVI, there was an improvement in LA reservoir and contractile function. However, LA phasic volumes and emptying fractions showed minimal changes. Fourteen patients had NAF in the early postprocedural period after TAVI. These patients experienced longer hospitalization (11 days vs 6 days; P = 0.002). By bivariable logistic regression analysis, the use of a transapical approach and the LA early diastolic strain rate (SR) before TAVI were significantly associated with NAF immediately after TAVI.
Severe AS is associated with LA dysfunction. Intrinsic LA compliance and LA contractile properties by STE improved at midterm follow-up after TAVI. Preprocedural LA early diastolic SR may predict the development of NAF after TAVI pending confirmation by larger prospective evaluations.
左心房（LA）大小是重度主动脉瓣狭窄（AS）预后的一个指标。这项回顾性研究的目的是评估经导管主动脉瓣植入术（TAVI）对LA相位功能恢复的影响，并评估TAVI后LA功能与新发房颤（NAF）之间的关系。
在这项回顾性队列研究中，对52例（中位年龄81岁）重度AS患者在TAVI术前及中期随访时使用双平面容积和二维（2D）斑点追踪超声心动图（STE）测量LA功能。20名年龄≥75岁的健康个体作为对照。
TAVI术前，LA的3个相位容积排空分数和所有STE衍生的LA功能参数均显著降低。TAVI术后5±3个月，LA储存和收缩功能有所改善。然而，LA相位容积和排空分数变化极小。14例患者在TAVI术后早期发生NAF。这些患者住院时间更长（11天对6天；P = 0.002）。通过双变量逻辑回归分析，经心尖途径的使用和TAVI术前LA早期舒张应变率（SR）与TAVI术后立即发生的NAF显著相关。
重度AS与LA功能障碍有关。TAVI术后中期随访时，STE测量的LA固有顺应性和LA收缩特性有所改善。术前LA早期舒张SR可能预测TAVI术后NAF的发生，有待更大规模前瞻性评估证实。
