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Impact of procedure‐related conduction disturbances after transcatheter aortic valve implantation on myocardial performance and survival evaluated by conventional and speckle tracking echocardiography
Author(s) -
Dimitriadis Zisis,
Scholtz Smita,
Scholtz Werner,
Wiemer Marcus,
Piper Cornelia,
Ensminger Stephan,
Fox Henrik,
Horstkotte Dieter,
Faber Lothar
Publication year - 2018
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.13823
Subject(s) - ejection fraction , cardiology , medicine , speckle tracking echocardiography , diastole , stenosis , aortic valve stenosis , diastolic function , heart failure , blood pressure
Objectives Although procedure‐related new cardiac conduction disturbances (CCDs) remain an important issue in transcatheter aortic valve implantation (TAVI), their effect on myocardial function and overall patient outcome remains unclear. The goal of this study was to analyze the influence of procedure‐related CCDs on systolic and diastolic LV performance and on patient survival after TAVI. Methods and results Ninety‐five patients who underwent TAVI for severe symptomatic aortic stenosis (AS) and had a complete follow‐up were evaluated with respect to procedure‐related CCDs. Left ventricular (LV) performance was measured using standard echocardiographic parameters and speckle tracking analysis. Survival was assessed during longer‐term follow‐up (mean: 29.1 ± 16.9 months). After TAVI, the improvement of global LV function expressed as ejection fraction (LVEF; from 45.5 ± 10.0 to 47.8 ± 13.9%, P = .13) was not significant. New CCDs were found in 35.7% of TAVI recipients. A comparison between patients with and without new CCDs showed that LV systolic function improved in those without CCDs, while it tended to deteriorate in patients with CCDs (change in LVEF: 5.5 ± 12.3% vs −4.9% ± 11.5%, P = .001; change in global longitudinal strain (GLS): −1.1 ± 4.6% vs 1.2 ± 4.5%, P = .01). Changes in diastolic function did not differ significantly between the groups (changes in transmitral E/A‐ratio: −0.3 ± 0.6 vs −0.5 ± 0.5, P = .1). Kaplan‐Meier survival analysis revealed no significant differences between the two cohorts ( P = .795). Conclusion Procedure‐related conduction abnormalities after TAVI lead to an LBBB‐related dyssynchrony with impairment of LV performance but not of overall survival.