The Predictive Value of Left Atrial Strain Following Transcatheter Aortic Valve Implantation on Anatomical and Functional Reverse Remodeling in a Multi-Modality Study

Borbála Vattay, Anikó Ilona Nagy, Astrid Apor, Márton Kolossváry, Aristomenis Manouras, Milán Vecsey-Nagy, Levente Molnár, Melinda Boussoussou, Andrea Bartykowszki, Ádám L Jermendy, Tímea Kováts, Emese Zsarnóczay, Pál Maurovich-Horvat, Béla Merkely, Bálint Szilveszter, Borbála Vattay, Anikó Ilona Nagy, Astrid Apor, Márton Kolossváry, Aristomenis Manouras, Milán Vecsey-Nagy, Levente Molnár, Melinda Boussoussou, Andrea Bartykowszki, Ádám L Jermendy, Tímea Kováts, Emese Zsarnóczay, Pál Maurovich-Horvat, Béla Merkely, Bálint Szilveszter

Abstract

Introduction: Transcatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and survival. Data on the predictive value of left atrial (LA) strain following TAVI are scarce. We aimed to evaluate the association of LA strain measured shortly post-TAVI with functional and anatomical reverse remodeling of the LA and LV, and its association with mortality.

Methods: We prospectively investigated 90 patients who underwent TAVI. Transthoracic echocardiography including strain analysis was performed shortly after TAVI and repeated 6 months later. CT angiography (CTA) was performed for pre-TAVI planning and 6 months post-TAVI. Speckle tracking echocardiography was used to determine LA peak reservoir strain (LASr) and LV global longitudinal strain (LV-GL), LA volume index (LAVi) was measured by TTE. LV mass index (LVMi) was calculated using CTA images. LA reverse remodeling was based on LASr and LAVi changes, whereas LV reverse remodeling was defined as an improvement in LV-GLS or a reduction of LVMi. The association of severely reduced LASr (<20%) at baseline with changes (Δ) in LASr, LAVi, LV-GLS and LVMi were analyzed using linear regression, and Cox proportional hazard model for mortality.

Results: Mean LASr and LV-GLS were 17.7 ± 8.4 and -15.3 ± 3.4% at baseline and 20.2 ± 10.2 and -16.6 ± 4.0% at follow-up (p = 0.024 and p < 0.001, respectively). Severely reduced LASr at baseline was associated with more pronounced ΔLASr (β = 5.24, p = 0.025) and LVMi reduction on follow-up (β = 5.78, p = 0.036), however, the majority of the patients had <20% LASr on follow-up (44.4%). Also, ΔLASr was associated with ΔLV-GLS (adjusted β = 2.10, p < 0.001). No significant difference in survival was found between patients with baseline severely reduced LASr (<20%) and higher LASr (≥20%) (p = 0.054).

Conclusion: LV reverse remodeling based on LVMi was present even in patients with severely reduced LASr following TAVI, although extensive LA damage based on LA strain was demonstrated by its limited improvement over time.

Clinical trial registration: (ClinicalTrials.gov number: NCT02826200).

Keywords: CT angiography; left atrial function; reverse remodeling; speckle tracking echocardiography; transcatheter aortic valve implantation.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Vattay, Nagy, Apor, Kolossváry, Manouras, Vecsey-Nagy, Molnár, Boussoussou, Bartykowszki, Jermendy, Kováts, Zsarnóczay, Maurovich-Horvat, Merkely and Szilveszter.

Figures

Figure 1
Figure 1
Flowchart of patients through the study. CTA, CT angiography; ECG, Electrocardiography; LA, Left atrium; LASr, Left atrial peak reservoir strain; LAVi, Left atrial volume index; LV-GLS, Left ventricular global longitudinal strain; LVMi, Left ventricular mass index; TAVI, Transcatheter aortic valve implantation; TTE, Transthoracic echocardiography.
Figure 2
Figure 2
Changes in functional and anatomical LA and LV parameters following TAVI. Box and whisker plots represent the baseline vs. the follow-up values (6 months after TAVI) for LA and LV parameters. LV-GLS, Left ventricular global longitudinal strain; LASr, Left atrial peak reservoir strain; LAVi, Left atrial volume index; LVMi, Left ventricular mass index.
Figure 3
Figure 3
Representative images of LA strain assessment of patients with baseline LASr

Figure 4

Kaplan-Meier curve for all-cause mortality…

Figure 4

Kaplan-Meier curve for all-cause mortality in patients with

Figure 4
Kaplan-Meier curve for all-cause mortality in patients with

Figure 5

Patients with severe, symptomatic aortic…

Figure 5

Patients with severe, symptomatic aortic valve stenosis who underwent TAVI experienced atrial and…

Figure 5
Patients with severe, symptomatic aortic valve stenosis who underwent TAVI experienced atrial and ventricular reverse remodeling after 6-months. The magnitude of anatomical LV and functional LA reverse remodeling was numerically larger in patients with severely reduced baseline LASr (
Similar articles
Cited by
References
    1. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, et al. . A Prospective survey of patients with valvular heart disease in Europe: the euro heart survey on valvular heart disease. Eur Heart J. (2003) 24:1231–43. 10.1016/S0195-668X(03)00201-X - DOI - PubMed
    1. Heuvelman HJ, van Geldorp MW, Eijkemans MJ, Rajamannan NM, Bogers AJ, Roos-Hesselink JW, et al. . Progression of aortic valve stenosis in adults: a systematic review. J Heart Valve Dis. (2012) 21:454–62. 10.1007/s12471-012-0362-y - DOI - PubMed
    1. Rassi AN, Pibarot P, Elmariah S. Left ventricular remodelling in aortic stenosis. Can J Cardiol. (2014) 30:1004–11. 10.1016/j.cjca.2014.04.026 - DOI - PubMed
    1. Treibel TA, Kozor R, Schofield R, Benedetti G, Fontana M, Bhuva AN, et al. . Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J Am Coll Cardiol. (2018) 71:860–71. 10.1016/j.jacc.2017.12.035 - DOI - PMC - PubMed
    1. O'Connor K, Magne J, Rosca M, Pierard LA, Lancellotti P. Left Atrial function and remodelling in aortic stenosis. Eur J Echocardiogr. (2011) 12:299–305. 10.1093/ejechocard/jer006 - DOI - PubMed
Show all 48 references
Associated data
Related information
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Figure 4
Figure 4
Kaplan-Meier curve for all-cause mortality in patients with

Figure 5

Patients with severe, symptomatic aortic…

Figure 5

Patients with severe, symptomatic aortic valve stenosis who underwent TAVI experienced atrial and…

Figure 5
Patients with severe, symptomatic aortic valve stenosis who underwent TAVI experienced atrial and ventricular reverse remodeling after 6-months. The magnitude of anatomical LV and functional LA reverse remodeling was numerically larger in patients with severely reduced baseline LASr (
Similar articles
Cited by
References
    1. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, et al. . A Prospective survey of patients with valvular heart disease in Europe: the euro heart survey on valvular heart disease. Eur Heart J. (2003) 24:1231–43. 10.1016/S0195-668X(03)00201-X - DOI - PubMed
    1. Heuvelman HJ, van Geldorp MW, Eijkemans MJ, Rajamannan NM, Bogers AJ, Roos-Hesselink JW, et al. . Progression of aortic valve stenosis in adults: a systematic review. J Heart Valve Dis. (2012) 21:454–62. 10.1007/s12471-012-0362-y - DOI - PubMed
    1. Rassi AN, Pibarot P, Elmariah S. Left ventricular remodelling in aortic stenosis. Can J Cardiol. (2014) 30:1004–11. 10.1016/j.cjca.2014.04.026 - DOI - PubMed
    1. Treibel TA, Kozor R, Schofield R, Benedetti G, Fontana M, Bhuva AN, et al. . Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J Am Coll Cardiol. (2018) 71:860–71. 10.1016/j.jacc.2017.12.035 - DOI - PMC - PubMed
    1. O'Connor K, Magne J, Rosca M, Pierard LA, Lancellotti P. Left Atrial function and remodelling in aortic stenosis. Eur J Echocardiogr. (2011) 12:299–305. 10.1093/ejechocard/jer006 - DOI - PubMed
Show all 48 references
Associated data
Related information
[x]
Cite
Copy Download .nbib
Format: AMA APA MLA NLM
Figure 5
Figure 5
Patients with severe, symptomatic aortic valve stenosis who underwent TAVI experienced atrial and ventricular reverse remodeling after 6-months. The magnitude of anatomical LV and functional LA reverse remodeling was numerically larger in patients with severely reduced baseline LASr (

References

    1. Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, et al. . A Prospective survey of patients with valvular heart disease in Europe: the euro heart survey on valvular heart disease. Eur Heart J. (2003) 24:1231–43. 10.1016/S0195-668X(03)00201-X
    1. Heuvelman HJ, van Geldorp MW, Eijkemans MJ, Rajamannan NM, Bogers AJ, Roos-Hesselink JW, et al. . Progression of aortic valve stenosis in adults: a systematic review. J Heart Valve Dis. (2012) 21:454–62. 10.1007/s12471-012-0362-y
    1. Rassi AN, Pibarot P, Elmariah S. Left ventricular remodelling in aortic stenosis. Can J Cardiol. (2014) 30:1004–11. 10.1016/j.cjca.2014.04.026
    1. Treibel TA, Kozor R, Schofield R, Benedetti G, Fontana M, Bhuva AN, et al. . Reverse myocardial remodeling following valve replacement in patients with aortic stenosis. J Am Coll Cardiol. (2018) 71:860–71. 10.1016/j.jacc.2017.12.035
    1. O'Connor K, Magne J, Rosca M, Pierard LA, Lancellotti P. Left Atrial function and remodelling in aortic stenosis. Eur J Echocardiogr. (2011) 12:299–305. 10.1093/ejechocard/jer006
    1. Rusinaru D, Bohbot Y, Kowalski C, Ringle A, Marechaux S, Tribouilloy C. Left atrial volume and mortality in patients with aortic stenosis. J Am Heart Assoc. (2017) 6:11. 10.1161/JAHA.117.006615
    1. Lancellotti P, Donal E, Magne J, Moonen M, O'Connor K, Daubert JC, et al. . Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay. Heart. (2010) 96:1364–71. 10.1136/hrt.2009.190942
    1. Genereux P, Head SJ, Wood DA, Kodali SK, Williams MR, Paradis JM, et al. . Transcatheter aortic valve implantation 10-year anniversary: review of current evidence and clinical implications. Eur Heart J. (2012) 33:2388–98. 10.1093/eurheartj/ehs220
    1. Rahhab Z, El Faquir N, Tchetche D, Delgado V, Kodali S, Mara Vollema E, et al. . Expanding the indications for transcatheter aortic valve implantation. Nature reviews Cardiology. (2020) 17:75–84. 10.1038/s41569-019-0254-6
    1. Ali A, Patel A, Ali Z, Abu-Omar Y, Saeed A, Athanasiou T, et al. . Enhanced left ventricular mass regression after aortic valve replacement in patients with aortic stenosis is associated with improved long-term survival. J Thorac Cardiovasc Surg. (2011) 142:285–91. 10.1016/j.jtcvs.2010.08.084
    1. Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J. (2016) 37:1196–207. 10.1093/eurheartj/ehv529
    1. Xu R, Luo R, Tan B, Gan T, Li G. Early changes of left atrial function in chronic asymptomatic alcoholics by two-dimensional speckle-tracking echocardiography. Acta Cardiol. (2017) 72:28–35. 10.1080/00015385.2017.1281548
    1. Cameli M, Sparla S, Losito M, Righini FM, Menci D, Lisi M, et al. . Correlation of left atrial strain and doppler measurements with invasive measurement of left ventricular end-diastolic pressure in patients stratified for different values of ejection fraction. Echocardiography. (2016) 33:398–405. 10.1111/echo.13094
    1. Cameli M, Lisi M, Righini FM, Massoni A, Natali BM, Focardi M, et al. . Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol. (2013) 111:595–601. 10.1016/j.amjcard.2012.10.049
    1. Brecht A, Oertelt-Prigione S, Seeland U, Rucke M, Hattasch R, Wagelohner T, et al. . Left atrial function in preclinical diastolic dysfunction: two-dimensional speckle-tracking echocardiography-derived results from the befri trial. J Am Soc Echocardiogr. (2016) 29:750–8. 10.1016/j.echo.2016.03.013
    1. Morris DA, Belyavskiy E, Aravind-Kumar R, Kropf M, Frydas A, Braunauer K, et al. . Potential usefulness and clinical relevance of adding left atrial strain to left atrial volume index in the detection of left ventricular diastolic dysfunction. JACC Cardiovasc Imaging. (2018) 11:1405–15. 10.1016/j.jcmg.2017.07.029
    1. Cameli M, Lisi M, Focardi M, Reccia R, Natali BM, Sparla S, et al. . Left Atrial Deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes. Am J Cardiol. (2012) 110:264–9. 10.1016/j.amjcard.2012.03.022
    1. Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP. Left atrial structure and function, and left ventricular diastolic dysfunction: jacc state-of-the-art review. J Am Coll Cardiol. (2019) 73:1961–77. 10.1016/j.jacc.2019.01.059
    1. Szilveszter B, Oren D, Molnar L, Apor A, Nagy AI, Molnar A, et al. . Subclinical leaflet thrombosis is associated with impaired reverse remodelling after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging. (2020) 21:1144–51. 10.1093/ehjci/jez256
    1. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. . Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the european association of cardiovascular imaging. J Am Soc Echocardiogr. (2015) 28:1–39 e14. 10.1016/j.echo.2014.10.003
    1. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, 3rd, Dokainish H, Edvardsen T, et al. . Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the american society of echocardiography and the european association of cardiovascular imaging. J Am Soc Echocardiogr. (2016) 29:277–314. 10.1016/j.echo.2016.01.011
    1. Voigt JU, Pedrizzetti G, Lysyansky P, Marwick TH, Houle H, Baumann R, et al. . Definitions for a common standard for 2d speckle tracking echocardiography: consensus document of the eacvi/ase/industry task force to standardize deformation imaging. J Am Soc Echocardiogr. (2015) 28:183–93. 10.1016/j.echo.2014.11.003
    1. Singh A, Medvedofsky D, Mediratta A, Balaney B, Kruse E, Ciszek B, et al. . Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures. Int J Cardiovasc Imaging. (2019) 35:23–32. 10.1007/s10554-018-1425-y
    1. Kurt M, Wang J, Torre-Amione G, Nagueh SF. Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging. (2009) 2:10–5. 10.1161/CIRCIMAGING.108.813071
    1. Budoff MJ, Ahmadi N, Sarraf G, Gao Y, Chow D, Flores F, et al. . Determination of left ventricular mass on cardiac computed tomographic angiography. Acad Radiol. (2009) 16:726–32. 10.1016/j.acra.2008.12.022
    1. Kawakami H, Ramkumar S, Nolan M, Wright L, Yang H, Negishi K, et al. . Left atrial mechanical dispersion assessed by strain echocardiography as an independent predictor of new-onset atrial fibrillation: a case-control study. J Am Soc Echocardiogr. (2019) 32:1268–76 e3. 10.1016/j.echo.2019.06.002
    1. Freed BH, Daruwalla V, Cheng JY, Aguilar FG, Beussink L, Choi A, et al. . Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imaging. (2016) 9:e003754. 10.1161/CIRCIMAGING.115.003754
    1. Habibi M, Samiei S, Ambale Venkatesh B, Opdahl A, Helle-Valle TM, Zareian M, et al. . Cardiac magnetic resonance-measured left atrial volume and function and incident atrial fibrillation: results from mesa (multi-ethnic study of atherosclerosis). Circ Cardiovasc Imaging. (2016) 9:e004299. 10.1161/CIRCIMAGING.115.004299
    1. Cameli M, Mandoli GE, Mondillo S. Left Atrium: The last bulwark before overt heart failure. Heart Fail Rev. (2017) 22:123–31. 10.1007/s10741-016-9589-9
    1. Santos AB, Kraigher-Krainer E, Gupta DK, Claggett B, Zile MR, Pieske B, et al. . Impaired left atrial function in heart failure with preserved ejection fraction. Eur J Heart Fail. (2014) 16:1096–103. 10.1002/ejhf.147
    1. Frydas A, Morris DA, Belyavskiy E, Radhakrishnan AK, Kropf M, Tadic M, et al. . Left atrial strain as sensitive marker of left ventricular diastolic dysfunction in heart failure. ESC Heart Fail. (2020) 7:1956–65. 10.1002/ehf2.12820
    1. Tomlinson S, Scalia GM, Appadurai V, Edwards N, Savage M, Lam AK, et al. . Left atrial reservoir strain provides incremental value to left atrial volume index for evaluation of left ventricular filling pressure. Echocardiography. (2021). 10.1111/echo.15157
    1. Singh A, Addetia K, Maffessanti F, Mor-Avi V, Lang RM. La Strain for categorization of Lv diastolic dysfunction. JACC Cardiovasc Imaging. (2017) 10:735–43. 10.1016/j.jcmg.2016.08.014
    1. Kuppahally SS, Akoum N, Burgon NS, Badger TJ, Kholmovski EG, Vijayakumar S, et al. . Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement mri. Circ Cardiovasc Imaging. (2010) 3:231–9. 10.1161/CIRCIMAGING.109.865683
    1. Sarvari SI, Haugaa KH, Stokke TM, Ansari HZ, Leren IS, Hegbom F, et al. . Strain echocardiographic assessment of left atrial function predicts recurrence of atrial fibrillation. Eur Heart J Cardiovasc Imaging. (2016) 17:660–7. 10.1093/ehjci/jev185
    1. Melenovsky V, Hwang SJ, Redfield MM, Zakeri R, Lin G, Borlaug BA. Left atrial remodeling and function in advanced heart failure with preserved or reduced ejection fraction. Circ Heart Fail. (2015) 8:295–303. 10.1161/CIRCHEARTFAILURE.114.001667
    1. Goette A, Kalman JM, Aguinaga L, Akar J, Cabrera JA, Chen SA, et al. . Ehra/Hrs/Aphrs/Solaece expert consensus on atrial cardiomyopathies: definition, characterisation, and clinical implication. J Arrhythm. (2016) 32:247–78. 10.1016/j.joa.2016.05.002
    1. Medvedofsky D, Koifman E, Miyoshi T, Rogers T, Wang Z, Goldstein SA, et al. . Usefulness of longitudinal strain to assess remodeling of right and left cardiac chambers following transcatheter aortic valve implantation. Am J Cardiol. (2019) 124:253–61. 10.1016/j.amjcard.2019.04.029
    1. D'Andrea A, Padalino R, Cocchia R, Di Palma E, Riegler L, Scarafile R, et al. . Effects of transcatheter aortic valve implantation on left ventricular and left atrial morphology and function. Echocardiography. (2015) 32:928–36. 10.1111/echo.12808
    1. D'Ascenzi F, Cameli M, Henein M, Iadanza A, Reccia R, Lisi M, et al. . Left atrial remodelling in patients undergoing transcatheter aortic valve implantation: a speckle-tracking prospective, longitudinal study. Int J Cardiovasc Imaging. (2013) 29:1717–24. 10.1007/s10554-013-0265-z
    1. Spethmann S, Baldenhofer G, Dreger H, Stuer K, Sanad W, Saghabalyan D, et al. . Recovery of left ventricular and left atrial mechanics in various entities of aortic stenosis 12 months after tavi. Eur Heart J Cardiovasc Imaging. (2014) 15:389–98. 10.1093/ehjci/jet166
    1. Spethmann S, Dreger H, Baldenhofer G, Stuer K, Saghabalyan D, Muller E, et al. . Short-term effects of transcatheter aortic valve implantation on left atrial mechanics and left ventricular diastolic function. J Am Soc Echocardiogr. (2013) 26:64–71 e2. 10.1016/j.echo.2012.10.002
    1. Sabatino J, De Rosa S, Leo I, Strangio A, La Bella S, Sorrentino S, et al. . Early reduction of left atrial function predicts adverse clinical outcomes in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Open Heart. (2021) 8:e001685. 10.1136/openhrt-2021-001685
    1. Weber J, Bond K, Flanagan J, Passick M, Petillo F, Pollack S, et al. . The prognostic value of left atrial global longitudinal strain and left atrial phasic volumes in patients undergoing transcatheter valve implantation for severe aortic stenosis. Cardiology. (2021) 146:489–500. 10.1159/000514665
    1. Dobson LE, Musa TA, Uddin A, Fairbairn TA, Swoboda PP, Erhayiem B, et al. . Acute reverse remodelling after transcatheter aortic valve implantation: a link between myocardial fibrosis and left ventricular mass regression. Can J Cardiol. (2016) 32:1411–8. 10.1016/j.cjca.2016.04.009
    1. Alenezi F, Fudim M, Rymer J, Dunning A, Chiswell K, Swaminathan M, et al. . Predictors and changes in cardiac hemodynamics and geometry with transcatheter aortic valve implantation. Am J Cardiol. (2019) 123:813–9. 10.1016/j.amjcard.2018.11.038
    1. Marwan M, Ammon F, Bittner D, Rother J, Mekkhala N, Hell M, et al. . Ct-derived left ventricular global strain in aortic valve stenosis patients: a comparative analysis pre and post transcatheter aortic valve implantation. J Cardiovasc Comput Tomogr. (2018) 12:240–4. 10.1016/j.jcct.2018.01.010
    1. Shiino K, Yamada A, Scalia GM, Putrino A, Chamberlain R, Poon K, et al. . Early changes of myocardial function after transcatheter aortic valve implantation using multilayer strain speckle tracking echocardiography. Am J Cardiol. (2019) 123:956–60. 10.1016/j.amjcard.2018.12.008

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅