Prognostic value of longitudinal strain relative apical sparing in severe aortic stenosis patients undergoing TAVR

Aims

This study evaluated the prognostic value of the relative apical sparing pattern (RASP) of longitudinal strain (LS) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) and investigated whether its combination with pre-procedural biomarkers enhances risk stratification.

Methods and results

This retrospective study included 598 patients (mean age 81.7 ± 5.7 years, 48.8% male) with severe AS undergoing TAVR. Two-dimensional speckle-tracking echocardiography was used to assess LS. RASP was defined as an apical-to-basal LS ratio >3.0 in ≥3 out of six left ventricular walls. The primary endpoint was 2-year cardiovascular (CV) mortality. RASP was present in 19.2% of patients and independently predicted 2-year CV mortality (hazard ratio [HR] 2.01, 95% CI 1.22–3.29, P = 0.006). Low serum albumin (<4.0 g/dL; HR 2.40, 95% CI 1.50–3.84, P < 0.001) and low BMI (≤25.5 kg/m²; HR 1.71, 95% CI 1.07–2.73, P = 0.025) were also independent predictors. A composite risk score (0–3 points) was constructed using these three factors. Two-year CV mortality increased progressively with higher scores: 6.3% for score 0, 11.4% for score 1, 27.2% for score 2 and 35.3% for score 3 (log-rank P < 0.001). High-risk patients (score ≥2) had a more than threefold increase in adjusted mortality risk (HR 3.42, 95% CI 2.14–5.48, P < 0.001).

Conclusions

RASP, particularly when combined with hypoalbuminemia and low BMI, identifies a high-risk phenotype associated with adverse outcomes after TAVR. This integrated risk model may assist in guiding pre-procedural assessment and individualized management.