Tissue Doppler Assessment of Left Atrial Function and Mortality in TAVR. A Single Center Retrospective Study.

Introduction: Left atrial (LA) function has emerging prognostic value in aortic stenosis (AS). Given the simplicity and widespread availability of Tissue Doppler Imaging (TDI), confirming the prognostic role of TDI-a’ in severe AS could have meaningful clinical implications. Aim: To assess the association between TDI-a’ and all-cause mortality in patients with severe AS undergoing transcatheter aortic valve replacement (TAVR). Methods: We retrospectively analysed 1240 patients with severe AS who underwent elective TAVR between December 2013 and August 2025. After excluding cases with incomplete echocardiographic data or missing survival information, 805 patients were included. The primary endpoint was all-cause mortality. Statistical analyses included univariate and multivariate logistic regression, Cox proportional hazards models, and receiver operating characteristic (ROC) curve analysis. Results: During a median follow-up of 36.5 ± 28.5 months, 196 patients (24.3%) died. In multivariate analysis, only average TDI-a’ was independently associated with all-cause mortality (OR 0.88, 95% CI 0.821–0.944, p < 0.001). Cox regression confirmed TDI-a’ as an independent predictor over time (HR 0.934, 95% CI 0.881–0.991, p = 0.023). A TDI-a’ cut-off ≤ 8.4 cm/s identified patients at higher risk of death. Conclusions: In severe AS patients undergoing TAVR, TDI-a’ emerged as the only echocardiographic variable independently predicting all-cause mortality. Its ease of measurement with standard echocardiography makes TDI-a’ a practical and accessible parameter for risk stratification and follow-up planning.