Prognostic impact of left- and right-atrial strain in patients undergoing transcatheter aortic valve replacement

Data on the prognostic value of left- and right-atrial strain after transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) are limited. Aim of this study was to evaluate outcomes of patients undergoing TAVR stratified by left- and right-atrial strain.

Using data from a high-volume academic centre, left- and right-atrial reservoir strain (LASr and RASr) was obtained in patients who underwent TAVR for severe AS from 2018 until 2021. Patients were stratified into groups with normal atrial function (LASr and RASr normal), uni-atrial strain impairment (LASr or RASr impaired), and bi-atrial strain impairment (LASr and RASr impaired). Endpoints were 3 year survival, symptomatic improvement as assessed by New York Heart Association functional class (NYHA class) as well as technical and device success defined by the Valve Academic Research Consortium composite endpoints. The study included 1888 patients at a mean age of 81.0 ± 7.8 years (44.3% women). Mean LASr and RASr were 16.5 ± 9.4% and 21.6 ± 12.4%, respectively. Optimized cut-offs for mortality prediction were 15.5% for LASr and 15.0% for RASr. LASr and RASr were normal in 751 patients (39.8%). Impairment of either right-atrium (RA) or left-atrium (LA) strain was observed in 633 patients (33.5%) and 504 patients (26.7%) presented with reduced LA and RA strain. While impairment of either LASr or RASr was associated with a 1.7-fold increased risk of 3 year all-cause mortality after adjustment for multiple confounders (95% confidence interval [CI] 1.2-2.5, P = 0.005), bi-atrial strain impairment exhibited an even higher 3 year mortality risk (Hazard ratio 2.5, 95% CI 1.7-3.6, P < 0.001).

Pre-procedural assessment of atrial strain is associated with increased 3 year mortality and might facilitate outcome prediction and patient selection in patients undergoing TAVR for severe AS.