Aims To investigate the changes in left atrial strain (LAS) after correction of severe aortic stenosis (AS) with transcatheter aortic valve replacement (TAVR) and assess its prognostic impact. Methods and results One hundred consecutive patients with severe symptomatic AS who underwent TAVR at the Magna Graecia University of Catanzaro underwent echocardiographic examination including assessment of LAS before and after TAVR. Independent investigators collected outcome data and information. The primary study outcome was the difference in ΔLAS (postTAVR–preTAVR) between patients those met the main clinical endpoint (a composite of cardiovascular mortality and heart failure hospitalisation) and those not meeting the endpoint. During a median follow-up of 31 months, 35 patients (35%) met the combined clinical endpoint. The difference between LAS post-TAVR and LAS pre-TAVR (ΔLAS) was significantly larger in patients who met the combined endpoint (HR=0.76 (0.67–0.86); p<0.001). Multivariate logistic regression analysis including ΔLAS, EuroSCORE II and left ventricular ejection fraction showed that ΔLAS (HR=0.80, p<0.001) was the only independent predictor of the combined clinical endpoint. Finally, a Kaplan-Maier analysis showed that patients with a ΔLAS above its median value had a significantly better event-free survival compared with those below the median (p<0.001). Conclusions A lower reduction in ΔLAS after TAVR was an independent predictor of the primary composite outcome of cardiovascular death and hospitalisation for heart failure. De-identified participant data are available upon request from Dr Jolanda Sabatino (jolesbt@hotmail.it).

中文翻译：

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早期左心房功能降低可预测接受经导管主动脉瓣置换术的重度主动脉瓣狭窄患者的不良临床结果

目的 探讨经导管主动脉瓣置换术 (TAVR) 矫正严重主动脉瓣狭窄 (AS) 后左心房应变 (LAS) 的变化并评估其对预后的影响。方法和结果 在卡坦扎罗 Magna Graecia 大学接受 TAVR 的 100 名连续患有严重症状的 AS 患者接受了超声心动图检查，包括在 TAVR 前后评估 LAS。独立调查人员收集了结果数据和信息。主要研究结果是达到主要临床终点（心血管死亡率和心力衰竭住院综合）的患者与未达到终点的患者之间的 ΔLAS（后 TAVR-前 TAVR）差异。在 31 个月的中位随访期间，35 名患者 (35%) 达到了联合临床终点。在达到联合终点的患者中，LAS 后 TAVR 和 LAS 前 TAVR (ΔLAS) 之间的差异显着更大（HR=0.76 (0.67–0.86)；p<0.001）。包括 ΔLAS、EuroSCORE II 和左心室射血分数在内的多变量逻辑回归分析表明，ΔLAS（HR=0.80，p<0.001）是联合临床终点的唯一独立预测因子。最后，Kaplan-Maier 分析显示，ΔLAS 高于中值的患者与低于中值的患者相比，无事件生存率显着提高（p<0.001）。结论 TAVR 后较低的 ΔLAS 降低是心血管死亡和心力衰竭住院的主要复合结局的独立预测因子。Jolanda Sabatino 博士 (jolesbt@hotmail.it) 可应要求提供去标识化的参与者数据。