The Influence of Transcatheter Aortic Valve Replacement on Left Atrial Mechanics: A Systematic Review and Meta-Analysis

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Abstract
Background: The morphology and function of the left atrium (LA) are intimately tied to left ventricular loading conditions. Data pertaining to the effect of transcatheter aortic valve replacement (TAVR) on LA function and geometry are scarce. Objectives: To quantify associations between TAVR and LA remodelling by pooling available data from published observational studies. Methods: A systematic review and meta-analysis were performed. Eligible studies needed to report serial LA STE data, before and after TAVR. Other outcome data included LA area and indexed volume (LAVi) and standard chamber measurements. Outcomes were stratified by timing of follow-up echocardiography: early (2 following TAVI (95% CI 1.37-4.06, p 2 = 0%). LA reservoir function improved overall by a mean difference of 3.71% (95% CI 1.82-5.6, p2 = 87.3%). Significant improvement in reservoir strain was seen in both early follow up (MD 3.1%, p2 = 65.23% and 94.4%, respectively). Six studies reported change in LA booster/contractile function, which recovered in the early follow-up studies (MD 2.26, p2 = 0%). Conclusion: The afterload reduction afforded by TAVR is associated with significant haemodynamic and morphological up-stream LA changes. Condensed The morphology and function of the left atrium (LA) are intimately tied to left ventricular loading conditions. LA function, measured with speckle-tracking echocardiography (STE), has been demonstrated to provide independent prognostic information for a range of cardiomyopathic states and valvular diseases. We sought to better understand the effect of transcatheter aortic valve replacement (TAVR) on LA function and geometry by performing a systematic review and meta-analysis. Key findings are that, following TAVR, the left atrium negatively remodels (reduces in size), and this is associated with improved distensibility, as quantified by an improvement in reservoir function.

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