Aims Transcatheter aortic valve replacement (TAVR) procedural planning requires computed tomography angiography (CTA) which allows for the assessment of left ventricular global longitudinal strain (CTA-LVGLS). There is, however, limited data on the feasibility of CTA-LVGLS, and its prognostic value. This study sought to evaluate the incremental prognostic value of baseline CTA-LVGLS, change in CTA-LVGLS after TAVR, and their association with post-TAVR outcomes. Methods and results A total of 431 patients who underwent multiphasic gated CTA using dual-source system for TAVR planning at baseline and 1-month follow-up were included [median (interquartile range) age, 83 (77–87) years; 44% female, STS-PROM score: 3.3 (2.3–5.1)%, Echo-left ventricular ejection fraction (LVEF): 60 (55–65)%, CTA-LVGLS: −18.0 (−21.6 to −14.2)%, feasible in 97% of patients]. CTA-LVGLS was measured using dedicated feature-tracking software. Over a median follow-up of 19 (13–27) months, 99 endpoints of all-cause death or heart failure hospitalization occurred. The relative hazard of the endpoint increased as baseline CTA-LVGLS worsened with −18.2% as the threshold for higher events (P = 0.005). After adjustment for baseline characteristics, CTA-LVGLS remained associated with the endpoint [hazard ratio (HR) (95% confidence interval, CI), 1.08 (1.03–1.14); P = 0.005] and incrementally improved prognostication (C-index difference, 0.026). Although CTA-LVGLS improved after TAVR [−18.3 (−21.6 to −14.3)% vs. −18.7 (−21.9 to −15.4)%, P < 0.001], patients without CTA-LVGLS improvement had higher risk of the endpoint than those with improvement or preserved baseline global longitudinal strain [HR (95% CI), 1.92 (1.19–3.12); P = 0.008]. Conclusions In this predominantly low-risk TAVR cohort of patients, mostly with normal LVEF, assessment of CTA-LVGLS is highly feasible improving risk stratification by providing independent and incremental prognostic value over clinical and echocardiographic characteristics.

中文翻译：

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计算机断层扫描基线和整体纵向应变变化与经导管主动脉瓣置换术后结果的关联

目的 经导管主动脉瓣置换术 (TAVR) 程序规划需要计算机断层扫描血管造影 (CTA)，它允许评估左心室整体纵向应变 (CTA-LVGLS)。然而，关于 CTA-LVGLS 的可行性及其预后价值的数据有限。本研究旨在评估基线 CTA-LVGLS 的增量预后价值、TAVR 后 CTA-LVGLS 的变化以及它们与 TAVR 后结果的关联。方法和结果 共有 431 名在基线和 1 个月随访时使用双源系统进行多阶段门控 CTA 进行 TAVR 计划的患者被纳入 [中位（四分位距）年龄，83（77-87）岁；44% 女性，STS-PROM 评分：3.3 (2.3-5.1)%，回声左心室射血分数 (LVEF)：60 (55-65)%，CTA-LVGLS：-18.0 (-21.6 至 -14.2)%， 97%的患者可行]。CTA-LVGLS 是使用专用的特征跟踪软件测量的。在 19 (13-27) 个月的中位随访期间，出现了 99 个全因死亡或心力衰竭住院终点。随着基线 CTA-LVGLS 恶化，终点的相对危险增加，以 -18.2% 作为更高事件的阈值（P = 0.005）。调整基线特征后，CTA-LVGLS 仍与终点相关 [风险比 (HR) (95% 置信区间，CI)，1.08 (1.03–1.14)；P = 0.005] 并逐渐改善预后（C 指数差异，0.026）。尽管 TAVR 后 CTA-LVGLS 有所改善 [-18.3 (-21.6 至 -14.3)% vs. -18.7 (-21.9 至 -15.4)%，但 P <; 0.001]，没有 CTA-LVGLS 改善的患者的终点风险高于有改善或保留基线全局纵向应变的患者 [HR (95% CI), 1.92 (1.19–3. 12); P = 0.008]。结论 在这个主要为低风险的 TAVR 患者队列中，大多数 LVEF 正常，通过提供临床和超声心动图特征的独立和增量预后价值，CTA-LVGLS 评估是高度可行的，可改善风险分层。