Vol 25, No 4 (2018)
Original articles — Clinical cardiology
Published online: 2018-06-14

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Immediate improvement of left ventricular mechanics following transcatheter aortic valve replacement

Vanesa Cristina Lozano Granero1, Sara Fernández Santos2, Covadonga Fernández-Golfín2, María Plaza Martín1, Jesús María de la Hera Galarza3, Francesco Fulvio Faletra4, Martin J. Swaans5, Teresa López-Fernández6, Dolores Mesa7, Giovanni La Canna8, Tomás Echeverría García9, Gilbert Habib10, Amparo Martíne Monzonís11, José Luis Zamorano Gómez12
Pubmed: 29924376
Cardiol J 2018;25(4):487-494.

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.

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References

  1. Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006; 368(9540): 1005–1011.
  2. Schwarz F, Baumann P, Manthey J, et al. The effect of aortic valve replacement on survival. Circulation. 1982; 66(5): 1105–1110.
  3. Leon MB, Smith CR, Mack M, et al. PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363(17): 1597–1607.
  4. Smith C, Leon M, Mack M, et al. Transcatheter versus Surgical Aortic-Valve Replacement in High-Risk Patients. N Engl J Med. 2011; 364(23): 2187–2198.
  5. Ross J. Afterload mismatch and preload reserve: a conceptual framework for the analysis of ventricular function. Prog Cardiovasc Dis. 1976; 18(4): 255–264.
  6. Gerdts E. Left ventricular structure in different types of chronic pressure overload. Eur Heart J Suppl. 2008; 10(suppl_E): E23–E30.
  7. Chang SA, Park PW, Sung K, et al. Noninvasive estimate of left ventricular filling pressure correlated with early and midterm postoperative cardiovascular events after isolated aortic valve replacement in patients with severe aortic stenosis. J Thorac Cardiovasc Surg. 2010; 140(6): 1361–1366.
  8. Dahl J, Videbæk L, Poulsen M, et al. Noninvasive assessment of filling pressure and left atrial pressure overload in severe aortic valve stenosis: Relation to ventricular remodeling and clinical outcome after aortic valve replacement. J Thorac Cardiovasc Surg. 2011; 142(3): e77–e83.
  9. Delgado V, Tops LF, van Bommel RJ, et al. Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacement. Eur Heart J. 2009; 30(24): 3037–3047.
  10. Weidemann F, Jamal F, Sutherland GR, et al. Myocardial function defined by strain rate and strain during alterations in inotropic states and heart rate. Am J Physiol Heart Circ Physiol. 2002; 283(2): H792–H799.
  11. Weidemann F, Jamal F, Kowalski M, et al. Can strain rate and strain quantify changes in regional systolic function during dobutamine infusion, B-blockade, and atrial pacing--implications for quantitative stress echocardiography. J Am Soc Echocardiogr. 2002; 15(5): 416–424.
  12. Kusunose K, Goodman A, Parikh R, et al. Incremental prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis and preserved ejection fraction. Circulation: Cardiovascular Imaging. 2014; 7(6): 938–945.
  13. Chen Y, Zhang Z, Cheng L, et al. The early variation of left ventricular strain after aortic valve replacement by three-dimensional echocardiography. PLoS One. 2015; 10(10): e0140469.
  14. Leon M, Smith C, Mack M, et al. Transcatheter or Surgical Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016; 374(17): 1609–1620.
  15. Douglas PS, Hahn RT, Pibarot P, et al. Hemodynamic outcomes of transcatheter aortic valve replacement and medical management in severe, inoperable aortic stenosis: a longitudinal echocardiographic study of cohort B of the PARTNER trial. J Am Soc Echocardiogr. 2015; 28(2): 210–217.e1.
  16. Dobson LE, Musa TA, Uddin A, et al. Acute reverse remodelling after transcatheter aortic valve implantation: a link between myocardial fibrosis and left ventricular mass regression. Can J Cardiol. 2016; 32(12): 1411–1418.
  17. Shin S, Park PW, Han WS, et al. Mass reduction and functional improvement of the left ventricle after aortic valve replacement for degenerative aortic stenosis. Korean J Thorac Cardiovasc Surg. 2011; 44(6): 399–405.
  18. Zagrosek A, Wassmuth R, Abdel-Aty H, et al. Relation between myocardial edema and myocardial mass during the acute and convalescent phase of myocarditis--a CMR study. J Cardiovasc Magn Reson. 2008; 10: 19.
  19. Humphries KH, Toggweiler S, Rodés-Cabau J, et al. Sex differences in mortality after transcatheter aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol. 2012; 60(10): 882–886.
  20. Dauerman HL, Reardon MJ, Popma JJ, et al. Early recovery of left ventricular systolic function after corevalve transcatheter aortic valve replacement. Circ Cardiovasc Interv. 2016; 9(6).