Cardiovascular outcomes in patients with left atrial enlargement undergoing transcatheter aortic valve implantation.

Asami, Masahiko; Dobner, Stephan; Stortecky, Stefan; Heg, Dik; Praz, Fabien; Lanz, Jonas; Okuno, Taishi; Tomii, Daijiro; Reineke, David; Windecker, Stephan; Pilgrim, Thomas (2022). Cardiovascular outcomes in patients with left atrial enlargement undergoing transcatheter aortic valve implantation. Catheterization and cardiovascular interventions, 99(6), pp. 1908-1917. Wiley-Blackwell 10.1002/ccd.30132

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BACKGROUND

Increased left ventricular afterload resulting from severe aortic stenosis (AS) leads to progressive cardiac remodeling. Left atrial enlargement (LAE) is an early manifestation in a series of maladaptive changes and may affect clinical outcomes after valvular replacement therapy. The aim of this study is to determine the impact of LAE on clinical outcomes in symptomatic patients with severe AS undergoing transcatheter aortic valve implantation (TAVI).

METHODS

In a prospective single-center TAVI registry, we analyzed LA dimensions measured by echocardiography before intervention. Patients with atrial fibrillation or concomitant mitral valve disease were excluded. LAE was defined as indexed LA volume >34 ml/m2 . The primary endpoint was cardiovascular death (CVD) at 1 year.

RESULTS

Among 1663 patients undergoing TAVI between August 2007 and December 2016, 768 (46.2%) were eligible for the present analysis and 486 patients had LAE. The prevalence of LAE was higher in males (68.3%) as compared to females (58.8%). Patients with LAE were older (82.3 ± 6.7 years vs. 80.0 ± 6.4 years) and had a higher STS-PROM score (6.1 ± 4.7% vs. 4.7 ± 2.9%). After adjustment, patients with LAE had an increased risk of CVD at 1-year compared to patients with normal LA dimensions (49 [10.4%] vs. 8 [2.9%]; HRadj , 3.52; 95% CI, 1.66-7.44)]. In multivariable analysis, LAE was independently associated with an increased risk of CVD at 1-year (HRadj , 3.52; 95% CI, 1.66-7.44).

CONCLUSIONS

LAE secondary to AS was documented in a significant proportion of patients undergoing TAVI and was associated with a more than threefold increased risk of CVD at 1-year.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Heart Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)

UniBE Contributor:

Dobner, Stephan, Stortecky, Stefan, Heg, Dierik Hans, Praz, Fabien Daniel, Lanz, Jonas, Okuno, Taishi, Reineke, David Christian, Windecker, Stephan, Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1522-1946

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Pubmed Import

Date Deposited:

21 Feb 2022 09:34

Last Modified:

27 Feb 2024 14:28

Publisher DOI:

10.1002/ccd.30132

PubMed ID:

35170846

Uncontrolled Keywords:

aortic stenosis clinical outcomes echocardiography left atrial enlargement transcatheter aortic valve implantation

BORIS DOI:

10.48350/165787

URI:

https://boris.unibe.ch/id/eprint/165787

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