Abstract 146 Prognostic significance and utility of left atrial reservoir strain in patients undergoing transcatheter aortic valve implantation.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Prognostic significance and utility of left atrial reservoir strain in patients undergoing transcatheter aortic valve implantation.
M. von Roeder¹, M. Mäder¹, V. Wahl¹, M. Kitamura¹, K.-P. Rommel¹, K.-P. Kresoja¹, J. Rotta Detto Loria¹, O. Dumpies¹, J. Wilde¹, N. Majunke¹, S. Blazek¹, S. Desch¹, H. Thiele¹, P. Lurz¹, M. Abdel-Wahab¹
¹Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig;
Background: Left atrial reservoir strain (LARS) provides prognostic information in patients at risk or with established heart failure and might help to detect elevated filling pressures. Patients with diastolic dysfunction experience worse outcomes after transcatheter aortic valve implantation (TAVI), but Doppler-derived measurements might be hampered by atrial fibrillation, mitral-valve-disease or impaired image quality. Aim of the current study is to elucidate the prognostic value and utility of LARS in patients undergoing TAVI. Methods: All consecutive patients undergoing TAVI between 01/2018 and 12/2018 were included if discharge echo and follow-up was available. LARS was derived from 2-D-speckle-tracking averaged apical 2- and 4-chamber views. Patients were grouped in 3 tertiles according to LARS. Primary outcome was a composite of all-cause death and readmission for worsening heart failure 12 months after TAVI. Results: Overall, 606 patients were available (Age 80 years (IQR 77-84)), including 53% woman. LARS was significantly impaired over tertiles (highest 21.4 (IQR 18.3-24.5)%, middle 13.0 (IQR 11.3-14.6)%, lowest 7.1 (IQR 5.4-8.4)%, p<0.0001) and conventional risk-factors increased with lower LARS (e.g. left ventricular ejection fraction, p<0.0001, atrial fibrillation, p<0.0001, tricuspid regurgitation, p<0.0001). The primary outcome occurred more often with impaired LARS (highest 7,4%, middle 13.4%, lowest 25,7%, p<0.0001). On multivariable Cox-regression analysis controlling for numerous baseline factors, LARS (HR 0.95, CI 0.91-0.99, p=0.02), STS-score (HR 1.07, CI 1.03-1.10, p=0.0003) and tricuspid regurgitation (HR 1.79, CI 1.21-2.64, p=0.003) remained the only significant predictors of the primary endpoint. Interestingly, Doppler-derived diastolic dysfunction was unavailable in 56% of patients (53% atrial fibrillation, 12% missing values, 8% mitral calcification, 6% DD indeterminate), but LARS allowed for reliable risk-stratification in this subgroup as well (HR 0.93, CI 0.88–0.97, p=0.002). Conclusion: Impaired LARS is independently associated with impaired outcomes in patients undergoing TAVI. LARS allows for risk-stratification at discharge even in patients with missing values of Doppler-derived diastolic dysfunction.
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