Abstract
AIM: This study was performed to evaluate the association between left atrial (LA) stiffness and outcomes in patients undergoing transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: This study involved 279 patients with aortic stenosis (AS) who underwent TAVI at Kumamoto University Hospital between 2015 and 2023. During a median follow-up of 468 days (interquartile range: 258-825 days), 42 deaths occurred. Pre-TAVI echocardiography showed that the LA stiffness index (E/e' ratio/LA strain during the reservoir phase [LASr]) was significantly higher in the all-cause death group than in the survival group (2.80 ± 2.56 vs. 1.70 ± 1.23, p < 0.01). Multivariate Cox proportional hazard analysis identified LA stiffness as significantly and independently associated with all-cause death after adjusting for body mass index, trans-aortic valve velocity, atrial fibrillation, log-transformed high-sensitivity cardiac troponin T (hazard ratio [HR]: 1.31, 95 % confidence interval [CI]: 1.14-1.51, p < 0.01), tricuspid regurgitation, left ventricular global longitudinal strain (HR: 1.24, 95 % CI: 1.06-1.44, p < 0.05), and LASr (HR: 1.27, 95 % CI: 1.05-1.60, p < 0.05). Receiver operating characteristic analysis showed that the optimal cutoff value of the LA stiffness index for predicting all-cause mortality was 1.69 (sensitivity: 60 %, specificity: 62 %, area under the curve: 0.64). Kaplan-Meier analysis demonstrated that patients with a high LA stiffness index (≥1.69) had a significantly higher probability of all-cause death (p < 0.05). CONCLUSION: Estimation of LA stiffness provides significant prognostic value in patients with AS undergoing TAVI, even after adjusting for multiple predictive factors.