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Immediate improvement of left ventricular mechanics following transcatheter aortic valve replacement
Affiliations- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain, Spain
- Cardiology Department, Hospital Universitario Ramón y Cajal, CIBERCV, Madrid, Spain;
- Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
- Hospital Universitario Reina Sofía, Córdoba, Spain
- Echocardiography Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Cardiology Department, Hospital Universitario Donostia, Guipuzoca, Spain
- Cardiology Department, Hôpital de la Timone, France
- Complexo Hospitalario Universitario de Santiago, Santiago de Compostela, Spain
- Cardiology Department, University Hospital Ramón y Cajal, Madrid, Spain
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Abstract
Background: Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has become a widespread technique for patients with severe AS considered inoperable or high risk for traditional open-surgery. This procedure could have a positive impact in LV mechanics. The aim of this study was to evaluate the immediate effect of TAVR on LV function recovery, as assessed by myocardial deformation parameters. Methods: One-hundred twelve consecutive patients (81.4 ± 6.4 years, 50% female) from 10 centres in Europe with severe AS who successfully underwent TAVR with either a self-expanding CoreValve (Medtronic, Minneapolis, MN) or a mechanically expanded Lotus valve (Boston Scientific, Natick, MA) were enrolled in a prospective multi-center study. A complete echocardiographic examination was performed at baseline and immediately before discharge, including the assessment of LV strain using standard two-dimensional images. Results: Echocardiographic examination with global longitudinal strain (GLS) quantification could be obtained in 92 patients, because of echocardiographic and logistic reasons. Between examinations, a modest statistically significant improvement in GLS could be seen (GLS% –15.00 ± 4.80 at baseline;–16.15 ± 4.97 at discharge, p = 0.028). In a stratified analysis, only women showed a significant improvement in GLS and a trend towards greater improvement in GLS according to severity of systolic dysfunction as measured by LV ejection fraction could be noted. Conclusions: Immediate improvement in GLS was appreciated after TAVR procedure. Whether this finding continues to be noted in a more prolonged follow-up and its clinical implications need to be assessed in further studies.
Abstract
Background: Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). Transcatheter aortic valve replacement (TAVR) has become a widespread technique for patients with severe AS considered inoperable or high risk for traditional open-surgery. This procedure could have a positive impact in LV mechanics. The aim of this study was to evaluate the immediate effect of TAVR on LV function recovery, as assessed by myocardial deformation parameters. Methods: One-hundred twelve consecutive patients (81.4 ± 6.4 years, 50% female) from 10 centres in Europe with severe AS who successfully underwent TAVR with either a self-expanding CoreValve (Medtronic, Minneapolis, MN) or a mechanically expanded Lotus valve (Boston Scientific, Natick, MA) were enrolled in a prospective multi-center study. A complete echocardiographic examination was performed at baseline and immediately before discharge, including the assessment of LV strain using standard two-dimensional images. Results: Echocardiographic examination with global longitudinal strain (GLS) quantification could be obtained in 92 patients, because of echocardiographic and logistic reasons. Between examinations, a modest statistically significant improvement in GLS could be seen (GLS% –15.00 ± 4.80 at baseline;–16.15 ± 4.97 at discharge, p = 0.028). In a stratified analysis, only women showed a significant improvement in GLS and a trend towards greater improvement in GLS according to severity of systolic dysfunction as measured by LV ejection fraction could be noted. Conclusions: Immediate improvement in GLS was appreciated after TAVR procedure. Whether this finding continues to be noted in a more prolonged follow-up and its clinical implications need to be assessed in further studies.
Keywords
strain; left ventricular mechanics; echocardiography; aortic stenosis; transcatheter aortic valve replacement
About this articleTitle
Immediate improvement of left ventricular mechanics following transcatheter aortic valve replacement
Journal
Issue
Pages
487-494
Published online
2018-06-14
Page views
5107
Article views/downloads
1491
DOI
Pubmed
Bibliographic record
Cardiol J 2018;25(4):487-494.
Keywords
strain
left ventricular mechanics
echocardiography
aortic stenosis
transcatheter aortic valve replacement
Authors
Vanesa Cristina Lozano Granero
Sara Fernández Santos
Covadonga Fernández-Golfín
María Plaza Martín
Jesús María de la Hera Galarza
Francesco Fulvio Faletra
Martin J. Swaans
Teresa López-Fernández
Dolores Mesa
Giovanni La Canna
Tomás Echeverría García
Gilbert Habib
Amparo Martíne Monzonís
José Luis Zamorano Gómez
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