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.


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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