Immediate Improvement in Left Atrial Function After Transcatheter Aortic Valve Replacement on Doppler...

More than 50% of embolic strokes occur >24 hours after transcatheter aortic valve replacement (TAVR) and are therefore not directly procedure related. We aimed to determine immediate changes in left atrial (LA) function after TAVR, that may alter short-term and long-term stroke risk after TAVR.

Transesophageal and transthoracic echocardiography were performed before and immediately after TAVR to evaluate left atrial appendage (LAA) velocities and Doppler echocardiographic markers of LA function.

Eighty-five patients (mean age, 83.1 ± 7.5 years; 54% male) underwent TAVR. Patients in sinus rhythm (n = 57) during TAVR had immediate improvement of LA function, with an increase in A-wave velocity (92.3 ± 33.7 cm/s to 104.9 ± 34.6 cm/s), mitral inflow velocity time integral (VTI; 27.8 ± 3.6 to 29.6 ± 9.5), A-wave VTI (10.8 ± 4.1 to 12.8 ± 4.2), and lateral A´ velocity (8.8 ± 3.6 cm/s to 9.7 ± 3.6 cm/s; P<.05 for all), and a decrease in E/A ratio (1.2 ± 0.73 to 1.05 ± 0.59; P<.01) after TAVR. Low baseline LAA emptying velocities were common (53%), and velocities significantly increased after TAVR (mean change, +4.9 cm/s; P<.01). We identified several clinical and echocardiographic determinants of low LAA emptying velocity at baseline (<35 cm/s).

There is immediate improvement in LA function and an increase in LAA velocities after TAVR. This improvement may benefit hemodynamics immediately after TAVR, but may also increase the short-term stroke risk (as recently shown in two independent studies) in patients with LAA thrombus or low emptying velocities. Therefore, evaluation of LA function and LAA thrombus may be warranted to identify patients at high risk for periprocedural stroke and guide the need for anticoagulation therapy.