Winkler N E, Anwer S, Rumpf P M, Tsiourantani G, Donati T G, Michel J M, Kasel A M, Tanner F C
Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Kardiologische Gemeinschaftspraxis, Penzberg, Germany.
Int J Cardiol. 2024 Jan 15;395:131403. doi: 10.1016/j.ijcard.2023.131403. Epub 2023 Sep 28.
This study aims at investigating left atrial (LA) deformation by left atrial reservoir (LARS) and pump strain (LAPS) and its implications for long-term survival in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
Speckle tracking echocardiography was performed in 198 patients with severe AS undergoing TAVI. Association of strain parameters with cardiovascular mortality was determined.
Over a follow-up time of 5 years, 49 patients (24.7%) died. LAPS was more impaired in non-survivors than survivors (P = 0.010), whereas no difference was found for LARS (P = 0.114), LA ejection fraction (P = 0.241), and LA volume index (P = 0.292). Kaplan-Meier analyses yielded a reduced survival probability according to the optimal threshold for LAPS (P = 0.002). A more impaired LAPS was associated with increased mortality risk (HR 1.12 [95% CI 1.02-1.22]; P = 0.014) independent of LVEF, LAVI, age, and sex. Addition of LAPS improved multivariable echocardiographic (LVEF, LAVI) and clinical (age, sex) models with potential incremental value for mortality prediction (P = 0.013 and P = 0.031, respectively). In contrast, LARS and LAVI were not associated with mortality.
In patients undergoing aortic valve replacement for severe AS, LAPS was impaired in patients dying during long-term follow-up after TAVI, differentiated survivors from non-survivors, was independently associated with long-term mortality, and yielded potential incremental value for survival prediction after TAVI. LAPS seems useful for risk stratification in severe AS and timely valve replacement.
本研究旨在通过左心房储存功能应变（LARS）和泵功能应变（LAPS）来研究严重主动脉瓣狭窄（AS）患者经导管主动脉瓣植入术（TAVI）后的左心房（LA）变形情况及其对长期生存的影响。
对198例接受TAVI的严重AS患者进行斑点追踪超声心动图检查。确定应变参数与心血管死亡率之间的关联。
在5年的随访期内，49例患者（24.7%）死亡。非幸存者的LAPS受损程度比幸存者更严重（P = 0.010），而LARS（P = 0.114）、左心房射血分数（P = 0.241）和左心房容积指数（P = 0.292）在两者之间未发现差异。根据LAPS的最佳阈值进行的Kaplan-Meier分析显示生存概率降低（P = 0.002）。LAPS受损程度越严重，与死亡风险增加相关（HR 1.12 [95% CI 1.02 - 1.22]；P = 0.014），且独立于左心室射血分数（LVEF）、左心房容积指数（LAVI）、年龄和性别。添加LAPS可改善多变量超声心动图（LVEF、LAVI）和临床（年龄、性别）模型，对死亡率预测具有潜在的增量价值（分别为P = 0.013和P = 0.031）。相比之下，LARS和LAVI与死亡率无关。
在接受主动脉瓣置换术治疗严重AS的患者中，TAVI术后长期随访期间死亡的患者LAPS受损，可区分幸存者和非幸存者，与长期死亡率独立相关，并为TAVI后的生存预测提供潜在的增量价值。LAPS似乎对严重AS的风险分层和及时进行瓣膜置换有用。
