PhD Scientific Days 2025

Poster Session III. - V: Cardiovascular Medicine and Research

Myocardial Work and Extravalvular Cardiac Damage Stages: Hand-in-Hand Predictors of All-Cause Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement

Name of the presenter

Ladányi Zsuzsanna

Institute/workplace of the presenter

Semmelweis University Heart and Vascular Center, Budapest, Hungary

Authors

Dr. Zsuzsanna Ladányi¹, Dr. Tímea Katalin Turschl¹, Eszter Pál¹, Dr. Tímea Bálint¹, Dr. Alexandra Fábián¹, Dr. Márton Tokodi¹, Dr. Andrea Nagy¹, Dr. Andrea Ágnes Molnár¹, Dr. Astrid Apor¹, Dr. Éva Straub¹, Dr. Csaba Fejér¹, Prof. Dr. Endre Zima¹, Dr. Levete Molnár¹, Dr. Attila Kovács¹, Dr. Mihály Ruppert¹, Prof. Dr. Béla Merkely¹, Dr. Bálint Károly Lakatos¹

1: Semmelweis University Heart and Vascular Center, Budapest, Hungary

Text of the abstract

In aortic stenosis (AS) evaluating left ventricular (LV) function is challenging due to the increased afterload. Myocardial work (MW) analysis adjusts myocardial deformation to instantaneous LV pressure, providing a better reflection of contractility. Prolonged LV pressure overload induces significant backward effects; the classification of this extravalvular cardiac damage effectively represents the cardiopulmonary system's involvement in AS.
We aimed to evaluate the prognostic value of MW and cardiac damage staging in TAVR patients.
We enrolled 314 TAVR patients (79±6 years, 40% female). Echocardiographic exams were performed before TAVR. LV ejection fraction (EF) and global longitudinal strain (GLS) were measured. LV pressure was estimated from systolic blood pressure and transaortic mean gradient, and global constructive work (GCW) was quantified. We determined the extent of cardiac damage associated with AS, categorizing patients into Stage 0 (no cardiac damage), Stage 1 (LV), Stage 2 (mitral valve or left atrial), Stage 3 (pulmonary artery vasculature or tricuspid valve), or Stage 4 (right ventricular). The primary endpoint was all-cause mortality, reached by 69 patients during a median follow-up of 25 months.
Preprocedural EF was 47±13%, GLS was -12.3±4.2%, GCW was 2043±769mmHg%. GCW showed a decline through AS Stages (from Stage 0-4: 2963±652 vs. 2154±621 vs. 2174±706 vs. 2044±827 vs. 1553±757mmHg%; p<0.001). Using univariate Cox analysis GCW (HR 0.968 [0.938-0.998] per 100 unit change; p=0.034) and AS Staging (HR 1.236 [1.016-1.505]; p=0.034) were associated with all-cause mortality, while EF (HR 0.982 [0.964-1.001]; p=NS) and GLS (HR 1.047 [0.989-1.108]; p=NS) were not. In multivariable Cox regression models, both GCW (HR 0.958 [0.923-0.994] per 100 unit change; p=0.022) and AS cardiac damage staging (HR 1.281 [1.040-1.577]; p=0.020) were significant independent predictors of all-cause mortality.
In TAVR patients preoperative GCW continuously decreased across AS Stages. GCW and AS Staging showed association with all-cause mortality, while EF and GLS did not. Furthermore, GCW and AS Staging had higher prognostic value than any other echocardiographic measure.
The research was supported by EKÖP-2024-247 New National Excellence Program Of The Ministry For Culture And Innovation from the source of The National Research, Development And Innovation Fund.