The Effect of TAVI on Left Atrial Function and Hemodynamics

Abstract

Introduction: Aortic stenosis (AS) is a highly prevalent and clinically relevant cause of valvular heart disease worldwide, and, if left untreated, leads to substantial morbidity and mortality This study provides further evidence in support of TAVI as a transformative therapy for severe AS and highlights the importance of comprehensive assessment of the effects of TAVI on both left and right heart function. Study Design: Prospective observational monocentric study. Place and Duration of Study: Apollo Hospitals, Chennai on 30 patients with severe aortic stenosis who have TAVI from April 2022 to October 2023. Methodology: This prospective study included 30 patients with symptomatic severe aortic stenosis (AS) who underwent baseline transthoracic echocardiography (TTE) and transfemoral transcatheter aortic valve implantation (TAVI). Patients were stratified into two groups based on left ventricular ejection fraction (LVEF ≥50% and LVEF <50%) for comparative analysis. Comprehensive echocardiographic and Doppler assessments followed standardized guidelines, including evaluations of left ventricular mass, stroke volume, and diastolic function. Left atrial function was assessed using speckle tracking echocardiography (STE) to evaluate reservoir, conduit, and contractile functions. Inter- and intraobserver variability analyses ensured the reliability of strain measurements. Statistical analysis was performed using SPSS (IBM, 28.0). Summary statistics were presented with Mean ± SD and frequency (percentage) for the continuous and categorical factors respectively. Chi square/Fisher’s exact test was used to determine the association between two independent categorical factors. P-value <0.05 was considered statistically significant. Results: Our study demonstrated significant improvements in left ventricular (LV) systolic and diastolic function three months after transcatheter aortic valve implantation (TAVI), with notable increases in global longitudinal strain (GLS) and reductions in LV mass and filling pressures. Left atrial (LA) function improved, with significant enhancements in reservoir and conduit functions and reductions in LA volumes. Hemodynamic parameters, including aortic valve area and mean gradient, showed substantial recovery. LVEF exhibited modest improvement compared to strain parameters, emphasizing the importance of advanced echocardiographic techniques. These findings underscore the role of TAVI in promoting reverse remodelling and improving myocardial and atrial mechanics in high-risk severe AS patients. Conclusion: TAVI is associated with significant improvements in systolic and diastolic LV function, LA remodelling, and overall hemodynamics in high-risk patients with severe AS.