Open AccessImpact of Prosthesis‐Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement
Author(s) -
Poulin Frédéric,
Yingchoncharoen Teerapat,
Wilson William M.,
Horlick Eric M.,
Généreux Philippe,
Tuzcu E. Murat,
Stewart William,
Osten Mark D.,
Woo Anna,
Thavendiranathan Paaladinesh
Publication year - 2016
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.115.002866
Subject(s) - medicine , cardiology , valve replacement , ejection fraction , stenosis , regurgitation (circulation) , prosthesis , aortic valve stenosis , aortic valve , aortic valve replacement , surgery , heart failure
Background The aim of this study was to compare left ventricular ( LV ) remodeling using myocardial strain between patients with severe aortic stenosis ( AS ) treated with transcatheter aortic valve replacement ( TAVR ) with and without prosthesis‐patient mismatch ( PPM ). Methods and Results In a retrospective study, speckle‐tracking echocardiography was used to measure global longitudinal strain ( GLS ) and strain rate ( GLSR ), circumferential strain, and rotation before and at mid‐term follow‐up post‐ TAVR . Moderate and severe PPM were defined as an effective orifice area ≤0.85 and <0.65 cm 2 /m 2 , respectively. A total of 102 patients (median age, 83 years [77–88]) with severe AS were included. At 6±3 months post‐ TAVR , moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m 2 ; P =0.001) at follow‐up whereas those with PPM did not. There was a significant improvement in LV GLS (−12.8±4.0 to −14.3±4.3%; P =0.01), GLSR (−0.61±0.20 to −0.73±0.25 second −1 ; P <0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second −1 ; P <0.001) in patients without PPM , but not in those with PPM . After adjustment for pre‐ TAVR ejection fraction and post‐ TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM . After a median follow‐up of 46.1 months (interquartile range, 35.4–60.8), there was no difference in survival between patients with and without PPM . Conclusions TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM . Presence of PPM was not associated with mortality.