Key result
High Echo-Risk atrial cardiomyopathy is linked to ~4.2-fold higher death or HF hospitalization risk.
Why the study?
In patients with severe AS and preserved EF, the interplay between echocardiographic and electrocardiographic atrial cardiomyopathy remodeling and their impact on clinical outcomes after TAVI remained poorly defined.
Does combined echocardiographic and electrocardiographic staging of atrial cardiomyopathy predict all-cause mortality, heart failure hospitalization, and new-onset atrial fibrillation in patients with severe aortic stenosis and preserved ejection fraction undergoing TAVI?
Cohort (n=122)
Does combined echocardiographic and electrocardiographic staging of atrial cardiomyopathy predict all-cause mortality, heart failure hospitalization, and new-onset atrial fibrillation in patients with severe aortic stenosis and preserved ejection fraction undergoing TAVI?
In patients with severe aortic stenosis and preserved ejection fraction undergoing TAVI, echocardiographic atrial cardiomyopathy staging predicts heart failure and mortality, whereas electrocardiographic staging specifically predicts new-onset atrial fibrillation.
Background Atrial cardiomyopathy (AtCM) is common in patients with severe aortic stenosis (AS), even when left ventricular ejection fraction (EF) is preserved. However, the interplay between structural (echocardiographic) and electrical (electrocardiographic) remodeling and their impact on clinical outcomes after Transcatheter Aortic Valve Implantation (TAVI) remain poorly defined. This study aims to evaluate the prognostic value of a combined echocardiographic and electrocardiographic staging of AtCM in patients without a history of atrial fibrillation (AF). Methods We analyzed 122 consecutive patients with severe AS and preserved EF who underwent TAVI between 2017 and 2024. Patients were stratified based on two AtCM risk domains: The primary composite endpoint was all-cause mortality and heart failure (HF) hospitalization. The risk goup secondary endpoint was new-onset AF. Results Mean age was 82.3 ± 5.6 years. At baseline, 54.1% of patients had High Echo-Risk (Stage 3-4) and 19.7% had High ECG-Risk (Score 2). Multivariate analysis showed divergent predictive capabilities:Composite Endpoint (Death/HF): High Echo-Risk was a strong independent predictor (HR 4.17; 95% CI 1.46–11.95; p=0.0079), whereas High ECG-Risk was not significant (HR 1.46; p=0.604).New-Onset AF: High ECG-Risk was the sole predictor of AF (HR 3.00; 95% CI 1.02–8.76; p=0.045), while High Echo-Risk was not predictive (HR 1.02; p=0.960).Combined analysis identified distinct phenotypes: High Echo-Risk/Low ECG-Risk patients had significantly increased risk of HF/Death (HR 4.86, p=0.0078), while Low Echo-Risk/High ECG-Risk patients had the highest risk of AF (HR 8.99, p=0.0045). A double-risk profile (High Echo/High ECG) conferred the worst prognosis for both outcomes (figure 1, 2) Conclusion In patients with severe AS and preserved EF, atrial cardiomyopathy manifests through distinct pathophysiological domains. Echocardiographic staging (based on LAVI and strain) predominantly identifies the risk of "pump failure" (HF/mortality), while specific ECG scoring (focusing on advanced inter-atrial block) stratifies arrhythmic risk (AF). A comprehensive multimodal approach is essential for accurate pre-TAVI prognostic stratification and may help identify patients who require more intensive evaluation.
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Mistrulli et al. (2026) conducted a cohort in Severe aortic stenosis with preserved ejection fraction undergoing TAVI (n=122). High Echo-Risk (Stage 3-4) and High ECG-Risk (Score 2) atrial cardiomyopathy staging vs. Low Echo-Risk and Low ECG-Risk atrial cardiomyopathy staging was evaluated on Composite of all-cause mortality and heart failure hospitalization (HR 4.17, 95% CI 1.46-11.95, p=0.0079). High Echo-Risk atrial cardiomyopathy staging predicted all-cause death or HF hospitalization (HR 4.17; 95% CI 1.46-11.95; p=0.0079), while High ECG-Risk predicted new-onset AF (HR 3.00; p=0.045).
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