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

Session Poster Session 4

Speaker Roberta De Rosa

Event : ESC Congress 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Aortic Valve Stenosis
  • Session type : Poster Session

Authors : R De Rosa (Salerno,IT), M-I Murray (Frankfurt am Main,DE), D Schranz (Frankfurt am Main,DE), S Mas-Peiro (Frankfurt am Main,DE), A Esmaeili (Frankfurt am Main,DE), AM Zeiher (Frankfurt am Main,DE), S Fichtlscherer (Frankfurt am Main,DE), M Vasa-Nicotera (Frankfurt am Main,DE)

R. De Rosa1 , M.-I. Murray2 , D. Schranz3 , S. Mas-Peiro2 , A. Esmaeili3 , A.M. Zeiher2 , S. Fichtlscherer2 , M. Vasa-Nicotera2 , 1University of Salerno - Salerno - Italy , 2Goethe University Hospital - Frankfurt am Main - Germany , 3Hessen Pediatric Heart Center Giessen & Frankfurt - Frankfurt am Main - Germany ,

Aortic Valve Stenosis

European Heart Journal ( 2019 ) 40 ( Supplement ), 2301

Background: Increased left atrium (LA) size is a hallmark of severe aortic stenosis (AS) and is associated with adverse patients' cardiovascular outcome. Whether transcatheter aortic valve replacement (TAVR) may lead to a decrease in LA size is not known. Aim: We investigated whether TAVR results in a short-term decrease in LA size and whether such decrease may predict patients' clinical outcome.

Methods: 104 consecutive patients with severe symptomatic AS and dilated LA undergoing TAVR were enrolled. LA volume was assessed by echocardiography before and shortly after TAVR (median time: 7 days). Composite rate of death and hospitalization for acutely decompensated heart failure (HF) was recorded and clinical status was assessed through NYHA- class evaluation at 12 months median follow-up.

Results: After TAVR, 49 patients (47%) demonstrated a decrease in LA volume. Despite a similar baseline NYHA class, patients with decrease in LA size had significant better improvement in clinical status respect to patients with unvaried LA size (NYHA post: 1.2±0.6 vs 1.8±1.1, p=0.001; NYHA reduction: −1.6±0.9 vs −0.9±1.0, p=0.002, respectively). Moreover, these patients had a significantly reduced rate of death or HF-hospitalization (4 vs 29%, p=0.001) and a significantly longer event-free-survival from Kaplan-Meier curves (p=0.003). COX regression analysis showed that, among echocardiographic parameters, decrease in LA-size was an independent predictor of clinical outcome (HR: 0.149, CI: 0.034–0.654, p=0.012).

Conclusions: The lack of decrease in LA size shortly after TAVR is associated with significantly higher rates of death and HF-hospitalization, as well as with impaired improvement in clinical status during long-term follow-up.

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