CL_I_P: Clinical Medicine I. Posters
Borbála Vattay, MD1, Anikó Ilona Nagy, MD, PhD1, Astrid Apor, MD1, Márton Kolossváry, MD, PhD1, Aristomenis Manouras, MD, PhD2, Levente Molnár, MD1, Milán Vecsey-Nagy, MD1, Melinda Boussoussou, MD1, Andrea Bartykowszki, MD, PhD1, Ádám L. Jermendy, MD,PhD1, Emese Zsarnóczay1, Pál Maurovich-Horvat, MD, PhD, MPH3, Béla Merkely, MD, PhD, DSc1, Bálint Szilveszter, MD, PhD1
1 Heart and Vascular Center Semmelweis University, Budapest
2 Karolinska University Hospital, Stockholm
3 Medical imaging Center Semmelweis University, Budapest
Introduction: Data on the prognostic value of left atrial (LA) strain following transcatheter aortic valve implamtation (TAVI) are scarce. LA strain can aid the early detection of diastolic dysfunction and correlates with the extent of fibrosis in atrial remodelling.
Aim: We aimed to evaluate the prognostic value of LA function following TAVI and to further elucidate its association with LV and LA reverse remodelling (RR).
Methods: In this prospective study we investigated 90 patients (mean age 78.5 years, 46.7% female) with severe aortic valve stenosis (AS) who underwent speckle tracking echocardiography (STE) immediately after TAVI and 6 months later. LA and LV global longitudinal strain (GLS) parameters were obtained by STE. CT angiography (CTA) was performed for TAVI planning and repeated at 6 months follow-up (FU). LV mass (LVM) values were derived from CTA images. We defined LV RR as reduction of myocardial mass quantified on CTA and as an improvement of LVGLS. LA RR was assessed based on the peak reservoir strain values (LAGS). The association of LA and LV strain parameters, LA stiffness, systolic and diastolic functional parameters and LVM based RR were analyzed.
Results: The mean LAGS and LVGLS values were 17.7% and 15.3% at discharge and 20.2% and 16.6% at FU, respectively (p=0.024, p<0.001). LA and LV strain values improved in 60.6% and 74.5% of all patients. Reduced LAGS (<20%) was found in 66.7% of all patients at baseline. LA strain at discharge correlated significantly with diastolic parameters (E wave, E/e’, LAVI, all p<0.05). Atrial RR based on LAGS change correlated with LVGLS change (p<0.01, standardized β=0.53) and LAGS at discharge (p=0.012, standardized β=-0.30). LAGS correlated with the extent of morphological LV RR based on LVM reduction (p=0.002, coeff:0.36). Elevated LA stiffness at discharge leads to substantially lower LAGS at 6 months versus patients with lower LA stiffness value: 16.4±10.0 vs 21.9±9.8, p=0.042.
Conclusion: Patients with reduced LAGS immediately after TAVI showed a larger extent of LV RR during FU. Increased LA stiffness at discharge was consistent with irreversible LA damage as demonstrated by a lack of improvement in LA function.
Funding: EFOP-3.6.3-VEKOP-16-2017-00009, “NTP-NFTÖ” (Nemzeti Tehetség Program, Nemzet Fiatal Tehetségeiért Ösztöndíj) program of the Ministry of Human Capacities in Hungary (EMMI).
Semmelweis University, Doctoral School of Theoretical and Translational Medicine