open access

Ahead of print
Research paper
Published online: 2019-05-13
Get Citation

Valve hemodynamic performance and myocardial strain after implantation of a third-generation, balloon-expandable, transcatheter aortic valve

Sara Fernandez-Santos, Alexis Théron, Philippe Pibarot, Frédéric Collart, Martine Gilard, Marina Urena, Tomas Hovorka, Philipp Kahlert, José Luis Zamorano-Gomez
DOI: 10.5603/CJ.a2019.0049
·
Pubmed: 31106841

open access

Ahead of print
Original articles
Published online: 2019-05-13

Abstract

Background: Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS); however, transcatheter aortic valve implantation (TAVI) may positively affect LV mechanics. Assessed herein is the performance of the SAPIEN 3 transcatheter heart valve (THV) and the effect of TAVI on LV function recovery, as assessed by global longitudinal strain (GLS).

Methods: A subset of patients from the SOURCE 3 registry (n = 276) from 16 European centers received SAPIEN 3 balloon-expandable THV. Echocardiography was performed at baseline, post-procedure, and at 1 year, including assessment of GLS using standard two-dimensional images, and was analyzed in a core laboratory Paired analyses between baseline and discharge, baseline and at 1 year were conducted.

Results: Hemodynamic parameters were improved after TAVI and sustained to 1 year. At 1 year, the rate of moderate to severe paravalvular leaks (PVL), and moderate to severe mitral and tricuspid regurgitations were 1.8%, 1.7%, and 8.0%, respectively. The discharge GLS (–15.6 ± 5.1; p = 0.004; n = 149) improved significantly from baseline (–15.1 ± 4.8) following TAVI. This improvement was sustained at 1 year compared with baseline (–17.0 ± 4.6, p < 0.001; n = 100). Conversely, LV ejection fraction (LVEF) did not significantly change following TAVI (p = 0.47).

Conclusions: Following TAVI with a third-generation THV, valve performances were good at 1 year with low PVL rate. The LV mechanics improved immediately after the procedure and were maintained at 1 year. These findings demonstrate the benefit of TAVI on LV mechanics, and suggests that GLS may be superior to LVEF in assessing this benefit.

Clinicaltrial.gov number: NCT02698956.

Abstract

Background: Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS); however, transcatheter aortic valve implantation (TAVI) may positively affect LV mechanics. Assessed herein is the performance of the SAPIEN 3 transcatheter heart valve (THV) and the effect of TAVI on LV function recovery, as assessed by global longitudinal strain (GLS).

Methods: A subset of patients from the SOURCE 3 registry (n = 276) from 16 European centers received SAPIEN 3 balloon-expandable THV. Echocardiography was performed at baseline, post-procedure, and at 1 year, including assessment of GLS using standard two-dimensional images, and was analyzed in a core laboratory Paired analyses between baseline and discharge, baseline and at 1 year were conducted.

Results: Hemodynamic parameters were improved after TAVI and sustained to 1 year. At 1 year, the rate of moderate to severe paravalvular leaks (PVL), and moderate to severe mitral and tricuspid regurgitations were 1.8%, 1.7%, and 8.0%, respectively. The discharge GLS (–15.6 ± 5.1; p = 0.004; n = 149) improved significantly from baseline (–15.1 ± 4.8) following TAVI. This improvement was sustained at 1 year compared with baseline (–17.0 ± 4.6, p < 0.001; n = 100). Conversely, LV ejection fraction (LVEF) did not significantly change following TAVI (p = 0.47).

Conclusions: Following TAVI with a third-generation THV, valve performances were good at 1 year with low PVL rate. The LV mechanics improved immediately after the procedure and were maintained at 1 year. These findings demonstrate the benefit of TAVI on LV mechanics, and suggests that GLS may be superior to LVEF in assessing this benefit.

Clinicaltrial.gov number: NCT02698956.

Get Citation

Keywords

strain, left ventricular mechanics, echocardiography, aortic stenosis, transcatheter aortic valve implantation

Supplementary Files (2)
Suppl. Image 1. Improvement of global longitudinal strain with respect to baseline
Download
641KB
Suppl. Image 2. Improvement of global longitudinal strain at one year
Download
649KB
About this article
Title

Valve hemodynamic performance and myocardial strain after implantation of a third-generation, balloon-expandable, transcatheter aortic valve

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Research paper

Published online

2019-05-13

DOI

10.5603/CJ.a2019.0049

Pubmed

31106841

Keywords

strain
left ventricular mechanics
echocardiography
aortic stenosis
transcatheter aortic valve implantation

Authors

Sara Fernandez-Santos
Alexis Théron
Philippe Pibarot
Frédéric Collart
Martine Gilard
Marina Urena
Tomas Hovorka
Philipp Kahlert
José Luis Zamorano-Gomez

References (19)
  1. 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.
  2. 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.
  3. Ross J. Afterload mismatch and preload reserve: a conceptual framework for the analysis of ventricular function. Prog Cardiovasc Dis. 1976; 18(4): 255–264.
  4. Lozano Granero VC, Fernández Santos S, Fernández-Golfín C, et al. Immediate improvement of left ventricular mechanics following transcatheter aortic valve replacement. Cardiol J. 2018; 25(4): 487–494.
  5. 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.
  6. Dahl JS, Videbæk L, Poulsen MK, 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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. Circ: Cardiovasc Imaging. 2014; 7(6): 938–945.
  11. Wendler O, Schymik G, Treede H, et al. SOURCE 3 Registry: Design and 30-Day Results of the European Postapproval Registry of the Latest Generation of the SAPIEN 3 Transcatheter Heart Valve. Circulation. 2017; 135(12): 1123–1132.
  12. Wendler O, Schymik G, Treede H, et al. SOURCE 3: 1-year outcomes post-transcatheter aortic valve implantation using the latest generation of the balloon-expandable transcatheter heart valve. Eur Heart J. 2017; 38(36): 2717–2726.
  13. Hahn RT, Leipsic J, Douglas PS, et al. Comprehensive echocardiographic assessment of normal transcatheter valve function. JACC Cardiovasc Imaging. 2019; 12(1): 25–34.
  14. Généreux P, Head SJ, Hahn R, et al. Paravalvular leak after transcatheter aortic valve replacement: the new Achilles' heel? A comprehensive review of the literature. J Am Coll Cardiol. 2013; 61(11): 1125–1136.
  15. Lerakis S, Hayek SS, Douglas PS. Paravalvular aortic leak after transcatheter aortic valve replacement: current knowledge. Circulation. 2013; 127(3): 397–407.
  16. Poulin F, Carasso S, Horlick EM, et al. Recovery of left ventricular mechanics after transcatheter aortic valve implantation: effects of baseline ventricular function and postprocedural aortic regurgitation. J Am Soc Echocardiogr. 2014; 27(11): 1133–1142.
  17. D'Andrea A, Padalino R, Cocchia R, et al. Effects of transcatheter aortic valve implantation on left ventricular and left atrial morphology and function. Echocardiography. 2015; 32(6): 928–936.
  18. Vizzardi E, D'Aloia A, Fiorina C, et al. Early regression of left ventricular mass associated with diastolic improvement after transcatheter aortic valve implantation. J Am Soc Echocardiogr. 2012; 25(10): 1091–1098.
  19. Spethmann S, Dreger H, Baldenhofer G, et al. Short-term effects of transcatheter aortic valve implantation on left atrial mechanics and left ventricular diastolic function. J Am Soc Echocardiogr. 2013; 26(1): 64–71.e2.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl