Why the study?
Atrial cardiomyopathy is highly prevalent in patients with severe AS and preserved LVEF, yet the integrated prognostic role of structural, functional, and electrical atrial remodeling after TAVI remained unclear.
Does multimodal atrial cardiomyopathy risk profiling identify distinct phenotypes associated with adverse outcomes (all-cause mortality, heart failure hospitalization, and new-onset atrial fibrillation) in patients with severe aortic stenosis and sinus rhythm undergoing TAVI?
Cohort (n=122)
Does multimodal atrial cardiomyopathy risk profiling identify distinct phenotypes associated with adverse outcomes (all-cause mortality, heart failure hospitalization, and new-onset atrial fibrillation) in patients with severe aortic stenosis and sinus rhythm undergoing TAVI?
Integrating echocardiographic and electrocardiographic markers of atrial cardiomyopathy identifies distinct risk phenotypes for heart failure/death versus new-onset atrial fibrillation in severe aortic stenosis patients undergoing TAVI.
Multimodal AtCM markers may delineate post-TAVI risk phenotypes in severe AS with preserved LVEF; leaves open prospective validation before clinical use.
Background Atrial cardiomyopathy (AtCM) is highly prevalent in patients with severe aortic stenosis (AS), even in the presence of preserved left ventricular ejection fraction (LVEF). Structural, functional, and electrical atrial remodeling may differentially influence outcomes after transcatheter aortic valve implantation (TAVI), although their integrated prognostic role remains unclear. Objectives To assess whether multimodal markers of AtCM identify distinct risk phenotypes associated with adverse outcomes after TAVI in patients without prior atrial fibrillation (AF). Methods We retrospectively analyzed 122 consecutive patients with severe AS, preserved LVEF, and sinus rhythm undergoing TAVI. Structural/functional AtCM (Echo-AtCM Risk) was assessed using indexed left atrial volume (LAVI) and left atrial reservoir strain (LASr), whereas electrical AtCM (ECG-AtCM Risk) was defined according to P-wave duration and morphology. Patients were followed for all-cause mortality, heart failure (HF) hospitalization, and new-onset AF. Prognostic associations were evaluated using multivariable Cox regression analyses. Results Mean age was 82.3±5.6 years. High Echo-Risk was present in 54.1% of patients and High ECG-Risk in 19.7%. During a median follow-up of 13.6 months, the composite endpoint of all-cause mortality or HF hospitalization occurred in 39 patients (32.0%), while new-onset AF developed in 17 (13.9%). High Echo-Risk independently predicted death/HF hospitalization (HR 4.17, p=0.008), whereas High ECG-Risk independently predicted incident AF (HR 3.07, p=0.034). Combined profiling identified distinct phenotypes: High Echo/Low ECG predicted HF/death (HR 4.86, p=0.008), Low Echo/High ECG predicted AF (HR 8.99, p=0.004), and combined High Echo/High ECG conferred the worst prognosis (HR 6.23, p=0.015). Conclusions Structural, functional, and electrical AtCM represent complementary domains with distinct prognostic implications in AS patients undergoing TAVI. Their integration may refine post-TAVI risk stratification; these exploratory findings require external validation before clinical management can be guided by AtCM phenotype.
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Mistrulli et al. (2026) conducted a cohort in Severe aortic stenosis undergoing TAVI (n=122). High Echo-AtCM Risk and High ECG-AtCM Risk phenotypes vs. Low Echo-AtCM Risk and Low ECG-AtCM Risk was evaluated on Composite of all-cause mortality or heart failure hospitalization (HR 4.17, p=0.008).
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