Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA.
Health Sciences Center, Stony Brook University, Stony Brook, New York, USA.
Cardiology. 2021;146(4):489-500. doi: 10.1159/000514665. Epub 2021 Mar 22.
The changes and the prognostic implications of left atrial (LA) volumes (LAV), LA function, and vascular load in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) are less known.
We enrolled 150 symptomatic patients (mean age 82 ± 8 years, 58% female, and pre-TAVI aortic valve area 0.40 ± 0.19 cm/m2) with severe AS who underwent 2D transthoracic echocardiography and 2D speckle tracking echocardiography at average 21 ± 35 days before and 171 ± 217 days after TAVI. The end point was a composite of new onset of atrial fibrillation, hospitalization for heart failure and all-cause death (major adverse cardiac events [MACE]).
After TAVI, indexed maximal LA volume and minimum volume of the LA decreased by 2.1 ± 10 mL/m2 and 1.6 ± 7 mL/m2 (p = 0.032 and p = 0.011, respectively), LA function index increased by 6.8 ± 11 units (p < 0.001), and LA stiffness decreased by 0.38 ± 2.0 (p = 0.05). No other changes in the LA phasic volumes, emptying fractions, and vascular load were noted. Post-TAVI, both left atrial and ventricular global peak longitudinal strain improved by about 6% (p = 0.01 and 0.02, respectively). MACE was reached by 37 (25%) patients after a median follow-up period of 172 days (interquartile range, 20-727). In multivariable models, MACE was associated with both pre- and post-TAVI LA global peak longitudinal strain (hazard ratio [HR] 0.75, CI 0.59-0.97; and HR 0.77, CI 0.60-1.00, per 5 percentage point units, respectively), pre-TAVI LV global endocardial longitudinal strain (HR 1.37, CI 1.02-1.83 per 5 percentage point units), and with most of the LA phasic volumes.
Within 6 months after TAVI, there is reverse LA remodeling and an improvement in LA reservoir function. Pre- and post-TAVI indices of LA function and volume remain independently associated with MACE. Larger studies enrolling a greater diversity of patients may provide sufficient evidence for the utilization of these imaging biomarkers in clinical practice.
经导管主动脉瓣置换术（TAVI）治疗严重主动脉瓣狭窄（AS）患者的左心房（LA）容积（LAV）、LA 功能和血管负荷的变化及其预后意义尚不清楚。
我们纳入了 150 名有症状的严重 AS 患者（平均年龄 82 ± 8 岁，58%为女性，术前主动脉瓣面积 0.40 ± 0.19 cm/m2），在 TAVI 前平均 21 ± 35 天和 TAVI 后 171 ± 217 天进行了 2 维经胸超声心动图和 2 维斑点追踪超声心动图检查。终点事件是新发心房颤动、心力衰竭住院和全因死亡（主要不良心脏事件 [MACE]）的复合事件。
TAVI 后，LA 最大容积指数和 LA 最小容积指数分别减少了 2.1 ± 10 mL/m2 和 1.6 ± 7 mL/m2（p = 0.032 和 p = 0.011），LA 功能指数增加了 6.8 ± 11 单位（p < 0.001），LA 僵硬度降低了 0.38 ± 2.0（p = 0.05）。未观察到 LA 时相容积、排空分数和血管负荷的其他变化。TAVI 后，左心房和心室整体峰值纵向应变均改善约 6%（p = 0.01 和 0.02）。中位随访 172 天（四分位距，20-727）期间，37 名（25%）患者发生 MACE。多变量模型中，MACE 与 TAVI 前后的 LA 整体峰值纵向应变相关（风险比 [HR] 0.75，CI 0.59-0.97；和 HR 0.77，CI 0.60-1.00，每 5 个百分点单位），TAVI 前的 LV 整体心内膜纵向应变（HR 1.37，CI 1.02-1.83，每 5 个百分点单位），以及大多数 LA 时相容积。
TAVI 后 6 个月内，LA 出现逆向重构，LA 储备功能得到改善。TAVI 前后的 LA 功能和容积指数与 MACE 仍独立相关。纳入更多不同患者的更大规模研究可能为这些影像学生物标志物在临床实践中的应用提供充分的证据。
