Apical longitudinal strain: A Key prognostic echocardiographic marker in patients undergoing transcatheter aortic valve implantation

Background: Although the association between global longitudinal strain (GLS), a marker of myocardial systolic function, and prognosis in patients undergoing transcatheter aortic valve implantation (TAVI) is well-documented, the prognostic association of regional longitudinal strain (LS), such as apical LS, on patients undergoing TAVI remains underexplored. Methods and Results: From 2015 to 2023, a total of 303 patients with aortic stenosis (AS) who underwent TAVI at Kumamoto University Hospital were screened, and excluding 4 patients with in-hospital deaths, 299 were analyzed. The median follow-up period after TAVI was 693 days (interquartile range, 435-1189 days), during which 63 deaths occurred. Pre-TAVI echocardiographic findings showed that apical LS was significantly higher in the survival group compared to the all-cause death group (15.1 ± 4.7％ vs. 13.7 ± 4.4 %, p = 0.02). Multivariable Cox proportional hazards analysis, adjusted for body mass index, aortic valve peak velocity, atrial fibrillation, high-sensitivity troponin T, tricuspid regurgitation, demonstrated that apical LS was independently associated with all-cause mortality (hazard ratio: 0.91, 95 % confidence interval: 0.88-0.99, p = 0.02). Time-dependent receiver operating characteristic (ROC) curve analysis identified apical LS to discriminate all-cause mortality (area under the curve, 0.69), with the predictive ability peaking within the first two years after TAVI. Kaplan-Meier analysis revealed significantly higher mortality rates in patients with low apical LS group (<15.4 %) (p = 0.01). Conclusions: measurement of apical LS in patients with AS provides valuable associational prognostic information, even after adjusting for multiple clinical and echocardiographic factors, highlighting its value in enhancing risk stratification for patients undergoing TAVI.