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Effects of Transcatheter Aortic Valve Implantation on Left Ventricular and Left Atrial Morphology and Function
Author(s) -
D'Andrea Antonello,
Padalino Roberto,
Cocchia Rosangela,
Di Palma Enza,
Riegler Lucia,
Scarafile Raffaella,
Rossi Giovanni,
Bianchi Renato,
Tartaglione Donato,
Cappelli Bigazzi Maurizio,
Calabrò Paolo,
Citro Rodolfo,
Bossone Eduardo,
Calabrò Raffaele,
Russo Maria Giovanna
Publication year - 2015
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.12808
Subject(s) - medicine , cardiology , ejection fraction , stenosis , aortic valve stenosis , aortic valve replacement , speckle tracking echocardiography , heart failure
Aims Transcatheter aortic valve implantation ( TAVI ) is an alternative treatment in surgically high‐risk or inoperable patients with severe aortic stenosis ( AS ). The objective of this study was to analyze the effects of TAVI on left ventricular ( LV ) and left atrial ( LA ) longitudinal function assessed by speckle tracking echocardiography (2 DSTE ) in patients with AS . Methods In our prospectively conducted study, a total of 55 symptomatic ( New York Heart Association class II or higher) patients with severe AS , considered to be at increased risk for undergoing surgical aortic valve replacement, were recruited (age: 78.6 ± 7.4 year). Patients underwent a complete clinical and laboratory evaluation, in addition to standard echocardiography and 2 DSTE . Echocardiographic analysis was performed before and 6 months after TAVI . 2 DSTE measured segmental and global longitudinal strain ( GLS ) and radial strain. Results All the patients received the CoreValve self‐expanding prosthesis. Six months after TAVI , patients showed a significant reduction in mean transaortic gradient (52.1 ± 15.8 vs. 11.2 ± 3.3 mmHg, P < 0.0001), LV mass, LA volume index, and an improvement of ejection fraction (P < 0.0001). In addition, LV GLS (−11.8 ± 3.2 vs. −16.3 ± 4.2%; P < 0.0001) and LA longitudinal strain (14.2 ± 5.4 vs. 26.6 ± 10.8%, P < 0.0001) significantly increased after TAVI . In a stepwise forward multiple logistic regression analysis, LV mass before TAVI (P < 0.001) and peak CK MB mass after TAVI (P < 0.0001) were powerful independent predictors of lower improvement of LV GLS . Moreover, LV mass index (P < 0.001) and LV GLS strain (P < 0.001) before TAVI were powerful independent predictor of LA longitudinal strain after TAVIConclusions TAVI in patients with AS resulted in geometric changes known as “reverse remodelling,” and improved LV and LA function assessed by 2 DSTE .