Prognostic Implications of Clinically Attributed Left Atrial Enlargement Subtypes in Patients Undergoing Transcatheter Aortic Valve Implantation

Q: What are the key findings of this study?

In patients undergoing TAVI, AF/MR-associated left atrial enlargement was associated with a higher unadjusted risk of all-cause death compared to AS-associated enlargement (30.7% vs 19.0%, HR 1.93).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Symptomatic severe aortic stenosis with preserved LVEF and left atrial enlargement (n=317). Intervention: AF/MR-associated left atrial enlargement vs. AS-associated left atrial enlargement. Primary outcome: All-cause death (HR 1.93, 95% CI 1.17-3.19, p=0.010).

Q: What does this research mean for the field?

The prognostic implications of left atrial enlargement in patients undergoing TAVI with preserved LVEF vary according to the clinical drivers of atrial remodeling. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Tatsuya Sato; Asahiro Ito; Yuki Kitagawa; Shinji Ito; Hiroki Yamaura; Akihiro Okamoto; Nanaka Nomura; Tomohiro Yamaguchi; Shunsuke Kagawa; Mana Ogawa; Takenobu Shimada; Sera Ishikawa; Yusuke Hayashi; Atsushi Shibata; Kenichiro Otsuka; Daiju Fukuda

doi:10.1253/circrep.cr-26-0181

September 1, 2026Circulation ReportsOpen Access

Prognostic Implications of Clinically Attributed Left Atrial Enlargement Subtypes in Patients Undergoing Transcatheter Aortic Valve Implantation

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Key result

AF/MR-associated left atrial enlargement is linked to ~93% higher post-TAVI mortality than AS-associated enlargement.

HR 1.93
95% CI 1.17-3.19
P=0.010
n=317

Why the study?

Left atrial enlargement is common in patients undergoing TAVI, but its prognostic significance may vary according to the clinical drivers of atrial remodeling.

Does the clinically attributed left atrial enlargement subtype (AF/MR-associated vs AS-associated) predict all-cause mortality in patients undergoing TAVI with preserved LVEF?

Study Design

Type

Cohort (n=317)

Multicenter

No

Structured PICO

Does the clinically attributed left atrial enlargement subtype (AF/MR-associated vs AS-associated) predict all-cause mortality in patients undergoing TAVI with preserved LVEF?

P

Population

317 elderly patients (median age 83, 71.9% female) with symptomatic severe aortic stenosis, preserved LVEF, and left atrial enlargement undergoing TAVI, followed for a median of 2.7 years.

E

Exposure

AF/MR-associated left atrial enlargement (presence of atrial fibrillation and/or ≥moderate mitral regurgitation)

C

Comparator

AS-associated left atrial enlargement (no atrial fibrillation and <moderate mitral regurgitation)

O

Outcome

All-cause death after TAVIhard clinical

Main Result

Hazard Ratio: 1.93 (95% CI 1.17–3.19)

Absolute Event Rate: 30.7% vs 19%

p-value: p=0.010

Limitations

Single-center retrospective analysis with a limited sample size, limiting generalizability.
Extensive exclusion criteria may introduce selection bias.
LAE subtyping was based on clinical information, leaving residual heterogeneity within the AF/MR-associated group.
Right ventricular systolic function was primarily assessed using TAPSE due to missing data for other indices.
Unmeasured confounding remains possible despite multivariable adjustment.
Cause-specific death was considered exploratory due to few adjudicated cardiovascular deaths and many undetermined causes.
Single-center retrospective analysis
Limited sample size
Limited number of adjudicated cardiovascular deaths and presence of deaths of undetermined cause
Residual confounding and reverse causation cannot be excluded
Potential selection bias

Implication

LAE subtype shows no independent mortality link after adjustment; leaves open whether etiology-specific remodeling affects TAVI prognosis.

Abstract

Background: Left atrial enlargement (LAE) is common in patients undergoing transcatheter aortic valve implantation (TAVI), but its prognostic significance may vary according to the clinical drivers of atrial remodeling. We examined whether prognostic factors differ by clinically attributed LAE subtype in patients undergoing TAVI with preserved left ventricular ejection fraction (LVEF).

Discussion

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Cite This Study

Sato et al. (2026) conducted a cohort in Symptomatic severe aortic stenosis with preserved LVEF and left atrial enlargement (n=317). AF/MR-associated left atrial enlargement vs. AS-associated left atrial enlargement was evaluated on All-cause death (HR 1.93, 95% CI 1.17-3.19, p=0.010). In patients undergoing TAVI, AF/MR-associated left atrial enlargement was associated with a higher unadjusted risk of all-cause death compared to AS-associated enlargement (30.7% vs 19.0%, HR 1.93).

synapsesocial.com/papers/6a993592636c6408cfa7ded9 https://doi.org/10.1253/circrep.cr-26-0181

View Full Paper

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Prognostic Implications of Clinically Attributed Left Atrial Enlargement Subtypes in Patients Undergoing Transcatheter Aortic Valve Implantation

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Prognostic Implications of Clinically Attributed Left Atrial Enlargement Subtypes in Patients Undergoing Transcatheter Aortic Valve Implantation

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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