Background Outcomes after transcatheter aortic valve replacement (TAVR) reflect cumulative myocardial injury beyond stenosis. Left ventricular (LV) and right ventricular (RV) dysfunction may present as overlapping but distinct functional profiles in aortic stenosis; the prognostic significance of their coexistence remains uncertain. Objectives This study evaluated whether quantitative phenotype-based classification integrating LV longitudinal mechanics and RV–pulmonary arterial (PA) coupling identifies distinct preprocedural functional profiles and improves 1-year risk stratification after TAVR. Methods In 280 registry patients undergoing TAVR, LV mechanics were assessed by LV global longitudinal strain (LVGLS), and RV-PA coupling by RV free-wall longitudinal strain–to–pulmonary artery systolic pressure ratio (RVFWLS/PASP). Four LV/RV profiles were defined: no abnormality, isolated LV impairment, isolated RV impairment, and concurrent abnormalities. For modeling, isolated LV and RV impairments were combined as single-axis abnormality. The primary endpoint was 1-year all-cause death or major adverse cardiovascular events. Results The median follow-up was 368 days (IQR: 312-371 days). The 4 profiles included 113/280 (40.4%) no abnormality, 83/280 (29.6%) isolated LV impairment, 22/280 (7.9%) isolated RV impairment, and 62/280 (22.1%) concurrent abnormalities patients. The primary endpoint occurred in 8/113 (7.1%; 95% CI: 3.1-13.5), 16/83 (19.3%; 95% CI: 11.4-29.4), 6/22 (27.3%; 95% CI: 10.7-50.2), and 33/62 (53.2%; 95% CI: 40.1-66.0) (log-rank P < 0.001). Concurrent abnormalities carried the highest adjusted risk (HR: 5.70; 95% CI: 2.37-13.73; P < 0.001) and improved discrimination (C-index: 0.731 [95% CI: 0.682-0.790] to 0.771 [95% CI: 0.724-0.836]). Conclusions Integrating LV longitudinal mechanics and RV-PA coupling identifies distinct preprocedural phenotypes in TAVR patients. Concurrent biventricular impairment denotes a high-risk phenotype and provides incremental risk stratification information for 1-year post-TAVR outcomes.
Ying-Qi Liu, Z. Ge, Wen Liu et al.· JACC: Asia· 1 citation
Background: Left ventricular thrombus (LVT) is a serious complication associated with cardiomyopathy and impaired left ventricular (LV) systolic function. Patients with a resolved LVT remain at risk for recurrence and subsequent thromboembolism. However, the factors influencing the recurrence of LVT are not yet fully understood. The aim of this study was to identify the risk factors and clinical outcomes related to LVT recurrence and to improve follow-up strategies and treatment options. Methods and results: We retrospectively investigated patients confirmed to have a resolved LVT by transthoracic echocardiography from January 2018 to April 2021 at Zhongshan Hospital Fudan University. All patients received anticoagulant therapy for more than 6 months and underwent at least two follow-up transthoracic echocardiograms. No statistically significant differences were observed in baseline characteristics between the LVT recurrence and non-recurrence groups, including gender, age, diabetes, hyperlipidemia, renal function, previous stroke history, other underlying medical conditions, ejection fraction, or left ventricular diameter. Patients in the recurrence group exhibited a higher prevalence of previous myocardial infarction and percutaneous coronary intervention compared to the non-recurrence group (84.6% vs. 61.1%, p = 0.03; 76.9% vs. 52.8%, p = 0.03). Additionally, patients in the recurrence group tended to have more ventricular aneurysms (50.0% vs. 22.2%, p = 0.008) and larger previous thrombus sizes (27.7 ± 12.6 vs. 21.4 ± 9.1 mm, p = 0.008) compared to those in the non-recurrence group. Multivariate logistic regression analysis indicated that the longitudinal diameter of the LVT was an independent risk factor for LVT recurrence (OR 1.058, 95% CI 1.003–1.115, p = 0.04). ROC curve analysis revealed an area under the curve of 0.647 for the longitudinal diameter of the LVT, with an optimal cut-off value of 23.5 mm, a sensitivity of 62%, and a specificity of 64%. After a follow-up duration of 3.0 ± 2.5 years, the incidence of non-fatal myocardial infarction and major adverse cardiovascular events (MACEs) in the recurrence group was significantly higher than that in the non-recurrence group [non-fatal myocardial infarction: 3 (11.5%) vs. 1 (1.4%), p = 0.02; MACE: 7 (26.9%) vs. 7 (9.7%), p = 0.01]. No statistically significant differences were found in bleeding events, systemic embolism, or all-cause death between the two groups. Conclusions: Our study indicates that a history of myocardial infarction, the presence of ventricular aneurysm, and a larger thrombus diameter are significant factors influencing LVT recurrence. Furthermore, the longitudinal diameter of the thrombus is identified as an independent risk factor for recurrence following resolution. The threshold for LVT diameter requiring extended anticoagulation and the required duration of anticoagulation need to be confirmed in future studies.
Lili Xu, Li-Xiang Deng, Zhen-Zhen Huang et al.· Journal of Cardiovascular De...· 0 citations
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