PMID: 39995730 https://pubmed.ncbi.nlm.nih.gov/39995730/

Abstract

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is a critical approach for treating patients with severe aortic stenosis (AS). A staging cardiac damage has been recently proposed that provided prognostic value in patients underwent TAVR, and left atrial volume index (LAVi) is a significant indicator of left heart damage. This study aimed to investigate the prognostic significance of LAVi in patients with severe AS after TAVR.

METHODS: This retrospective cohort study enrolled 553 consecutive patients with severe AS who underwent TAVR between April 2012 and October 2019 at a single center. Patients with biological valve decay after surgery, moderate-to-severe mitral stenosis, and inadequate echocardiographic image were excluded. The primary outcome was mortality at 4 years after TAVR. Several risk factors for the estimation of 4-year mortality after TAVR were analyzed, and the hazard ratios (HRs) were calculated by univariate and multivariate Cox regression analysis.

RESULTS: A total of 500 patients [age: 74 (interquartile range, 70-78) years, and 44.4% were female] were included in our study, and 64 (12.8%) of these patients were died after the follow-up time. Compared to the survivors, the non-survivors were more likely to be older, male, and have a higher Society of Thoracic Surgeons score, a higher LAVi, and a lower serum albumin level. Results from univariate and multivariate Cox regression analysis indicated that the age [HR =1.072; 95% confidence interval (CI): 1.023-1.124; P=0.004], the LAVi level (HR =1.023; 95% CI: 1.013-1.033; P<0.001) and the serum albumin level (HR =0.862; 95% CI: 0.796-0.934; P<0.001) were the independent risk factors for the estimation of 4-year mortality after TAVR. Moreover, the mortality in patients with the highest category of LAVi (>48 mL/m) was significantly higher than that of patients in other categories (multivariable HR =4.796; 95% CI: 1.137-20.238). In addition, Kaplan-Meier analysis revealed a reduced survival probability for those with the highest category of LAVi (P=0.003).

CONCLUSIONS: LAVi was found to be an independent predictor of mortality in patients with severe AS after TAVR, and LAVi emerged as a risk stratification tool for prognosing the long-term clinical outcome of patients treated with TAVR.