Stolz Lukas, Schmid Simon, Steffen Julius, Doldi Philipp M, Weckbach Ludwig T, Stocker Thomas J, Löw Kornelia, Fröhlich Carolin, Fischer Julius, Haum Magda, Theiss Hans D, Stark Konstantin, Rizas Konstantinos, Peterss Sven, Näbauer Michael, Hagl Christian, Massberg Steffen, Hausleiter Jörg, Deseive Simon
Medizinische Klinik und Poliklinik I, LMU Klinikum, 81377 Munich, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
Eur Heart J Cardiovasc Imaging. 2025 Mar 27;26(4):664-673. doi: 10.1093/ehjci/jeae322.
Data on the prognostic value of left- and right-atrial strain after transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) are limited. Aim of this study was to evaluate outcomes of patients undergoing TAVR stratified by left- and right-atrial strain.
Using data from a high-volume academic centre, left- and right-atrial reservoir strain (LASr and RASr) was obtained in patients who underwent TAVR for severe AS from 2018 until 2021. Patients were stratified into groups with normal atrial function (LASr and RASr normal), uni-atrial strain impairment (LASr or RASr impaired), and bi-atrial strain impairment (LASr and RASr impaired). Endpoints were 3 year survival, symptomatic improvement as assessed by New York Heart Association functional class (NYHA class) as well as technical and device success defined by the Valve Academic Research Consortium composite endpoints. The study included 1888 patients at a mean age of 81.0 ± 7.8 years (44.3% women). Mean LASr and RASr were 16.5 ± 9.4% and 21.6 ± 12.4%, respectively. Optimized cut-offs for mortality prediction were 15.5% for LASr and 15.0% for RASr. LASr and RASr were normal in 751 patients (39.8%). Impairment of either right-atrium (RA) or left-atrium (LA) strain was observed in 633 patients (33.5%) and 504 patients (26.7%) presented with reduced LA and RA strain. While impairment of either LASr or RASr was associated with a 1.7-fold increased risk of 3 year all-cause mortality after adjustment for multiple confounders (95% confidence interval [CI] 1.2-2.5, P = 0.005), bi-atrial strain impairment exhibited an even higher 3 year mortality risk (Hazard ratio 2.5, 95% CI 1.7-3.6, P < 0.001).
Pre-procedural assessment of atrial strain is associated with increased 3 year mortality and might facilitate outcome prediction and patient selection in patients undergoing TAVR for severe AS.
关于经导管主动脉瓣置换术（TAVR）治疗重度主动脉瓣狭窄（AS）后左心房和右心房应变的预后价值的数据有限。本研究的目的是评估根据左心房和右心房应变分层的接受TAVR患者的预后。
利用一家大型学术中心的数据，对2018年至2021年因重度AS接受TAVR的患者进行左心房和右心房储存器应变（LASr和RASr）测量。患者被分为心房功能正常组（LASr和RASr正常）、单心房应变受损组（LASr或RASr受损）和双心房应变受损组（LASr和RASr受损）。终点指标为3年生存率、根据纽约心脏协会功能分级（NYHA分级）评估的症状改善情况以及由瓣膜学术研究联盟综合终点定义的技术和器械成功率。该研究纳入了1888例患者，平均年龄为81.0±7.8岁（44.3%为女性）。LASr和RASr的平均值分别为16.5±9.4%和21.6±12.4%。预测死亡率的最佳临界值为LASr 15.5%，RASr 15.0%。751例患者（39.8%）的LASr和RASr正常。633例患者（33.5%）观察到右心房（RA）或左心房（LA）应变受损，504例患者（26.7%）表现为LA和RA应变降低。在校正多个混杂因素后，LASr或RASr受损与3年全因死亡率风险增加1.7倍相关（95%置信区间[CI] 1.2 - 2.5，P = 0.005），双心房应变受损的3年死亡率风险更高（风险比2.5，95% CI 1.7 - 3.6，P < 0.001）。
术前评估心房应变与3年死亡率增加相关，可能有助于预测重度AS患者接受TAVR的预后和患者选择。
