Change in the prognostic utility of regional left ventricular longitudinal strain values in patients undergoing transcatheter aortic valve implantation

Abstract

BACKGROUND: To evaluate the difference in prognostic utility of echocardiographic parameters between pre- and post-transcatheter aortic valve implantation (TAVI) periods. METHODS AND RESULTS: This study enrolled 189 patients who underwent TAVI at Kumamoto University Hospital between 2015 and 2023 and had available echocardiographic data for the pre- and post-TAVI periods. Thirty-seven deaths occurred within the follow-up period (median 574 [357-934] days after post-TAVI period). Apical longitudinal strain (LS) in the pre- and post-TAVI periods and mid LS in the post-TAVI period were significantly associated with all-cause death after adjusting for various factors (pre-TAVI apical LS, hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.85-0.99, p<0.05; post-TAVI apical LS, HR 0.88, 95%CI 0.82-0.95, p<0.01; post-TAVI mid LS, HR 0.87, 95%CI 0.78-0.97, p<0.05). Receiver operating characteristics analysis showed that the area under the curve for mid LS was significantly higher post-TAVI than pre-TAVI (0.65 vs. 0.54, p<0.05). For prediction of all-cause death, the optimal post-TAVI cutoff value for mid LS was 12.5% (sensitivity 75%, specificity 51%). Kaplan-Meier survival analysis revealed significantly higher all-cause mortality in patients with low mid LS (<12.5%) than in those with high mid LS (≥12.5%) (p<0.01, log-rank test). CONCLUSION: Pre-TAVI apical LS was an important prognostic factor in patients undergoing TAVI. In contrast, mid LS and apical LS were significant prognostic factors in the post-TAVI period, indicating a change in the prognostic significance of left ventricular longitudinal strain parameters according to the timepoint in the TAVI procedure.