Change in the prognostic utility of regional left ventricular longitudinal strain values in patients undergoing transcatheter aortic valve implantation

Background To evaluate the difference in prognostic utility of echocardiographic parameters between pre- and post-transcatheter aortic valve implantation (TAVI) periods. Methods and Results This study enrolled 189 patients who underwent TAVI at Kumamoto University Hospital between 2015 and 2023 and had available echocardiographic data for the pre- and post-TAVI periods. Thirty-seven deaths occurred within the follow-up period (median 574 [357–934] days after post-TAVI period). Apical longitudinal strain (LS) in the pre- and post-TAVI periods and mid LS in the post-TAVI period were significantly associated with all-cause death after adjusting for various factors (pre-TAVI apical LS, hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.85–0.99, p<0.05; post-TAVI apical LS, HR 0.88, 95%CI 0.82–0.95, p<0.01; post-TAVI mid LS, HR 0.87, 95%CI 0.78–0.97, p<0.05). Receiver operating characteristics analysis showed that the area under the curve for mid LS was significantly higher post-TAVI than pre-TAVI (0.65 vs. 0.54, p<0.05). For prediction of all-cause death, the optimal post-TAVI cutoff value for mid LS was 12.5% (sensitivity 75%, specificity 51%). Kaplan–Meier survival analysis revealed significantly higher all-cause mortality in patients with low mid LS (<12.5%) than in those with high mid LS (≥12.5%) (p<0.01, log-rank test). Conclusion Pre-TAVI apical LS was an important prognostic factor in patients undergoing TAVI. In contrast, mid LS and apical LS were significant prognostic factors in the post-TAVI period, indicating a change in the prognostic significance of left ventricular longitudinal strain parameters according to the timepoint in the TAVI procedure.