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Prognostic impact of cardiovascular magnetic resonance-derived left atrioventricular coupling Index in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.
Prognostic impact of cardiovascular magnetic resonance-derived left atrioventricular coupling Index in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.
👥 作者
Gersch Svante (Department of Cardiology and Pneumology)
Gronwald Judith (University Medical Center Göttingen)
Schulz Alexander (Göttingen)
Beuthner Bo Eric (Germany.; Department of Cardiology and Pneumology)
Puls Miriam (University Medical Center Göttingen)
Hasenfuß Gerd (Göttingen)
Schuster Andreas (Germany.; Department of Cardiology and Pneumology)
Schmidt Constanze (University Medical Center Göttingen)
Toischer Karl (Göttingen)
Lange Torben (Germany.; Department of Cardiology and Pneumology)
📋 发表信息
📖 Eur Heart J Imaging Methods Pract
📅 2026-01-01
🧬 PMID: 42040888
📂 分类:心脏瓣膜
📝 摘要
Transcatheter aortic valve replacement (TAVR) is an established therapy improving outcome in patients with severe aortic stenosis (AS). Cardiovascular magnetic resonance (CMR)-derived left atrioventricular coupling index (LACI) has demonstrated prognostic value, however, its prognostic utility in severe AS remains unknown. Between January 2017 and September 2023 138 consecutive patients with severe AS (80 years (70-83), 62% male) referred for TAVR were prospectively recruited for pre-procedural CMR imaging. LACI was defined as the ratio of the left atrial (LA) end-diastolic volume index (LA EDVi) and left ventricular (LV) end-diastolic volume index (LV EDVi). The primary endpoint was cardiovascular (CV)-mortality. The cohort was dichotomized at a median of 44.1% (high vs. low LACI). Patients with increased LACI (≥44.1%) had higher symptom burden (NYHA III/IV prevalence (68.1% vs. 44.9%; P = 0.047)), more frequently atrial fibrillation (50.7% vs. 14.5%; P < 0.001), and elevated NT-proBNP (2017 ng/L vs. 1012 ng/L; P = 0.007). Over a median follow-up of 2.7 years (IQR 1.7-3.6), high LACI was associated with higher CV mortality (log-rank P = 0.016). In exploratory multivariable Cox regression models, LACI remained associated with CV-mortality after adjustment for established parameters of left atrial or ventricular function (LA reservoir strain: HR 2.19, 95% CI 1.05-4.57, P = 0.036; LV GLS: HR 2.21 95% CI 1.00-4.9, P = 0.049). In patients with severe aortic stenosis, CMR-derived LACI was associated with cardiovascular mortality and may serve as a structural marker of advanced atrioventricular remodelling. Given its simplicity and routine availability in standard CMR workflows, LACI may serve as a clinically practical risk marker for baseline stratification.
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