Impact of right atrial remodeling on mortality after transcatheter aortic valve implantation

Introduction

Aortic stenosis is highly prevalent in the elderly population, and transcatheter aortic valve implantation (TAVI) is increasingly used for symptomatic severe disease. While left heart remodeling after TAVI has been extensively studied, the prognostic implications of right atrial (RA) functional adaptation remain poorly defined.

Aims

We aimed to evaluate the association between right atrial remodeling following TAVI and all-cause mortality during follow-up.

Methods

A retrospective analysis was conducted on a prospective and consecutive cohort of patients treated with TAVI at a tertiary hospital between 2022 and 2023. Baseline and 1-year follow-up echocardiographic parameters were collected. RA remodeling (RAR) was defined as an improvement in RA reservoir strain (RArS) >15%. The association between changes in RA strain following TAVI and the incidence of all-cause mortality during follow-up was assessed.

Results

A total of 185 patients were analyzed (median age: 83 years, 45.9% female, median EuroSCORE II: 2.4 [1.7-4.0].

Mean RArS at baseline was 20.7% (10.3), and median RArS at 1-year follow-up was 25.1% (12.6), and 98 patients (53%) experienced significant RAR.

The association of clinical and echocardiographic parameters with the occurrence of significant RAR is presented in Figure 1. LAVI and LArS were the only variables significantly associated with RAR.

During a mean follow-up of 18 months, 29 patients (15.7%) died. On univariable analysis, baseline mitral regurgitation, right-ventricular arterial coupling, left ventricular function, and biatrial function at 1-y follow-up, were associated with outcomes. After adjustment on multivariable analysis, variables independently associated with all-cause mortality during follow-up include significant mitral regurgitation, 1-y postTAVI LV GLS, and the occurrence of RAR (Figure 2).

Conclusions

Approximately half of patients undergoing TAVI exhibited significant RAR at follow-up. RAR was strongly associated with markers of left atrial function, suggesting interatrial coupling. In multivariable Cox analysis, RAR after TAVI was significantly associated with lower mortality. These findings highlight RA functional adaptation as a potential marker of post-procedural risk deserving further investigation in larger prospective studies.Figure 1Figure 2