Association between pre-procedural computed tomography angiography-based global longitudinal strain and outcomes in patients undergoing transcatheter aortic valve implantation

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Background: Computed tomography angiography-based global longitudinal strain (CTA-GLS) is feasible for myocardial assessment, but limited data are available for patients undergoing transcatheter aortic valve implantation (TAVI). This study sought to analyze the association between CTA-GLS and perioperative aortic regurgitation (AR), and its prognostic value in TAVI patients. Methods: Consecutive TAVI recipients at Beijing Anzhen Hospital were enrolled in this retrospective study from June 2021 to January 2024. The patients underwent transthoracic echocardiography (TTE), and pre-TAVI CTA. Nonlinear relationships between CTA-GLS and AR were evaluated using restricted cubic splines (RCSs). The performance of the multivariate Cox proportional hazards models were assessed by the concordance index (C-index), integrated discrimination improvement (IDI), and net reclassification improvement (NRI). Results: The study included 369 TAVI patients with a median age of 73.0 years, of whom 56.1% were male. CTA-GLS exhibited a strong nonlinear correlation with pre-procedural AR (P<0.001) and post-operative AR improvement (P=0.004). In the multivariate Cox proportional hazards regression, each 1% absolute decrease in CTA-GLS remained a significant predictor of all-cause mortality and heart failure hospitalization (HFH) post-TAVI [hazard ratio (HR): 1.47; 95% confidence interval (CI): 1.22-1.78; P<0.001]. The following three nested models were developed: Model 1, which included clinical parameters; Model 2, which included CTA-GLS, and Model 3, which combined both. Adding CTA-GLS improved the C-index from 0.66 (95% CI: 0.53-0.79) to 0.81 (95% CI: 0.75-0.87) (P=0.028), which was also reflected in the NRI [0.89 (95% CI: 0.56-1.22), P<0.001] and IDI [0.05 (95% CI: 0.02-0.09), P=0.003]. Conclusions: Pre-TAVI CTA-GLS is nonlinearly linked to pre-procedural AR and its improvement. It can be used to independently predict post-TAVI outcomes and adds incremental value to clinical parameters.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.