Abstract 79: The Impact Of Left Atrial And Left Ventricular Size On TAVR Outcomes

Introduction: In severe aortic stenosis, left atrium (LA) and left ventricle (LV) enlargement are common physiologic sequelae but their prognostic value in transcatheter aortic valve replacement (TAVR) outcomes is still being investigated. The purpose of this study is to look at the effect of left atrial and ventricular size on major adverse cardiac events (MACE) following TAVR. Methods: Retrospective analysis of electronic medical records from 2018-2020 at the University of Illinois at Chicago and affiliated Veterans Affairs identified TAVR patients. The cutoff for normal LA diameter was <4.0 cm. Normal LV systolic diameter was <4.1 cm and an enlarged LV based on dilated systolic LV diameter. Primary outcomes included composite MACE (all-cause mortality, myocardial infarction, or cerebrovascular accident) at 6- and 12- months post TAVR. MACE was then stratified based on the number of dilated left-sided chambers. Results: We included 134 patients in the analysis. The study population was 81% (109 of 134) male, 56% (75 of 134) non-white, and 74 ± 12 years old. Patients that experienced MACE at 6 months were found to have a larger systolic LV diameter (3.9 vs 3.3 cm, p=0.02). MACE was stratified based on the number of dilated chambers (neither, LA or LV, both) and was found to be significant at 6 months (4.1% to 10.4% and 35.3% p=0.002) but not at 12 months (12.2% vs 19.1% vs 35.3% p=0.11). Patients with increased LA size (4.8 vs. 4.1 cm; p=0.001) had higher rates of MACE, specifically with respect to mortality (p=0.007). When comparing patients with an enlarged LA (4.8 cm) to normal-sized LA (<4.0 cm), there was no statistically significant difference in ejection fraction <50% (16.7% vs 14.5% of patients, respectively; p=0.8) or enlarged diastolic LV diameter (4.5 vs. 4.6 cm; p=0.7). Conclusion: Our results suggest that patients with an enlarged LA or LV may have an increased risk for mortality and composite MACE following procedure at either 6- or 12-months even when controlling for confounding factors such as depressed LV or enlarged diastolic LV diameter. Our study suggests LA and LV size should be considered in risk stratifying patients prior to TAVR.