Preoperative Longitudinal Strain on Computed Tomography Is a Sensitive Marker of Patient Prognosis After Transcatheter Aortic Valve Replacement

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Background: This study evaluated the utility of myocardial strain analysis on computed tomography (CT) using state-of-the-art image analysis software to predict the prognosis of patients who underwent transcatheter aortic valve replacement (TAVR).

Methods and Results: We included 126 patients with severe aortic valve stenosis (AS) who underwent preoperative CT. Major adverse cardiovascular events (MACE) were defined as a composite of cardiac death (including unknown death based on medical records), hospitalization due to heart failure, and fatal arrhythmia. Twenty-four (19%) patients experienced MACE. Global longitudinal strain (GLS), circumferential strain (GCS), radial strain (GRS) of the left ventricular (LV) myocardium (LVM), LV ejection fraction on CT, and the percentage of patients administered aspirin or statins was significantly lower among patients with than without MACE (all P<0.05). The percentage of patients with AF, a history of congestive heart failure, and tolvaptan or oral anticoagulants administration was significantly higher among patients with than without MACE (all P<0.05). In multivariate survival analysis using a Cox proportional hazard model, LV-GLS ≥−9.92% on CT (hazard ratio [HR] 4.45; 95% confidence interval [CI] 1.89–10.48; P=0.0007) and aspirin (HR 0.27; 95% CI 0.10–0.70; P=0.0074) or statin (HR 0.33; 95% CI 0.13–0.84; P=0.02) administration were significant predictors of prognosis after TAVR.

Conclusions: Our findings indicate that LV-GLS on CT is a sensitive predictor of prognosis after TAVR.