Short-term decrease of left atrial size predicts clinical outcome in patients with severe aortic stenosis undergoing...

Area of Science:

• Cardiology
• Cardiac Surgery
• Echocardiography

Background:

• Increased left atrium (LA) size is a known indicator of severe aortic stenosis (AS) and is linked to adverse cardiovascular outcomes.
• The impact of transcatheter aortic valve replacement (TAVR) on LA size and its prognostic significance remain largely unknown.

Purpose of the Study:

• To determine if TAVR leads to a short-term reduction in LA size.
• To assess whether a decrease in LA size following TAVR can predict clinical outcomes in patients with severe AS.

Main Methods:

• One hundred and four patients with severe symptomatic AS and dilated LA undergoing TAVR were enrolled.
• LA volume was measured by echocardiography before and approximately 7 days after TAVR.
• Clinical outcomes, including death, hospitalization for acute decompensated heart failure (HF), and New York Heart Association (NYHA) class, were assessed at a median 12-month follow-up.

Main Results:

• Nearly half of the patients (47%) showed a decrease in LA volume post-TAVR.
• Patients with reduced LA size experienced significantly better improvement in NYHA class (post-TAVR NYHA: 1.2 vs. 1.8) and a greater reduction in NYHA class (-1.6 vs. -0.9) compared to those with unchanged LA size.
• The group with decreased LA size had a significantly lower rate of death or HF hospitalization (4% vs. 29%) and longer event-free survival (p = .003).

Conclusions:

• A decrease in LA size shortly after TAVR is associated with improved clinical status and reduced mortality and HF hospitalization rates.
• The absence of LA size reduction post-TAVR is an independent predictor of poorer clinical outcomes.
• These findings highlight the prognostic value of LA size changes after TAVR in patients with severe AS.