A new simplified cardiac damage staging for aortic stenosis: the role of longitudinal global strain and right ventricular arterial coupling

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Transcatheter aortic valve replacement (TAVR) continues to evolve as a treatment for patients with severe aortic stenosis (AS) in different clinical scenarios. As aortic valve disease progresses, secondary cardiac damage sets in; this damage is not always reversible and determines the prognosis by itself. Concerning extra-valvular repercussions, different staging systems of cardiac damage have been published and proposed as a prognostic tool that may help to improve the selection of candidates to TAVR. Purpose The aims of our study were to identify independent risk factors for 1-year mortality in patients with severe AS undergoing TAVR and to develop a new cardiac damage staging system to stratify these patients. Methods patients undergoing TAVR from 2017 to 2021 were included in a single-center prospective registry. Transthoracic echocardiography was performed in all patients before TAVR. Logistic regression analysis and Cox’s regression were used to identify predictors of 1-year all-cause mortality. Applying variables from the regression analyses, a new staging model was proposed. The area under the ROC curve (AUC ROC) was used to measure the discriminatory capacity of different staging models to predict 1-year mortality risk. Results 496 patients (mean age 81.9±6.2 years, 67% men) were included. 1-year mortality in our population was 22.3% (n= 111). Left ventricle ejection fraction (LVEF), moderate mitral regurgitation (MR), severe tricuspid regurgitation (TR), and right ventricular-arterial coupling (RVAc) were found to be independent predictors of all-cause 1-year mortality. A new classification system with three different stages was developed: Stage 0) No cardiac damage: LVEF ≥ 60%; left ventricle global longitudinal strain (LV-GLS) < −15%, RVAc ≥ 0.35 and absence of MR. Stage 1) Left side subclinical damage: LVEF 50–59.9% or LV-GLS ≥ −15% or presence of moderate or severe MR. Stage 2) Left or right ventricular damage: LVEF < 50% or RVAc < 0.35. The area under the ROC curve for this model was 0.67 (95% confidence interval 0.60–0.73), and its predictive performance was superior compared to the previously published systems (p = 0.009). A stepwise increase in 1-year all-cause mortality for each category increment in this new cardiac staging system was found. Conclusion Cardiac damage staging might have an important role in patients’ selection and better timing for TAVR. A model that includes new parameters, such as LV GLS and RVAc, may help to both improve prognostic stratification and contribute to better selection and earlier programming of TAVR.