Author + information
- Flavio D'Ascenzi,
- Alessandro Iadanza,
- Matteo Cameli,
- Matteo Lisi,
- Giuseppe Sinicropi,
- Rosanna Reccia,
- Valeria Curci,
- Sergio Mondillo and
- Carlo Pierli
Aortic stenosis (AS) is accompanied by several cardiac changes, as progressive left atrial (LA) enlargement and dysfunction. Several echocardiographic studies have demonstrated that transcatheter aortic valve implantation (TAVI) induces a reverse remodeling of the left ventricle; however, no data are available regarding the effects of TAVI on LA function and morphology. The aim of this prospective study was to investigate the effects of TAVI on the left atrium, using standard and 2–dimensional speckle–tracking echocardiography, a new imaging technique with the ability to assess LA deformation dynamics.
Materials and Methods
Thirty–two patients with severe symptomatic AS undergoing TAVI in our center were enrolled. Echocardiographic evaluation was performed before TAVI, at 40–day, and at 3–month follow–up. All patients were at high or prohibitive risk for standard surgery.
Early after TAVI the mean transvalvular gradient significantly decreased in comparison with pre–procedural values (p<0.001). Both LA mean area index and LA mean volume index significantly decreased at 40–day follow–up as compared to pre–procedural measurements (16.19±6.43 vs.12.48±2.93 cm2/m2, and 47.27±12.04 vs. 42.76±12.53 mL/m2, respectively, p<0.05) with stable values after 3 months. The significant reduction of LA size after TAVI was accompanied also by a significant improvement of LA function. In fact, a significant increase of global PALS, a measure of LA reservoir function, was demonstrated after the procedure (14.39±3.88% vs. 19.08±4.66%, p<0.001); furthermore, a significant increase of global PACS, a measure of LA active contraction, was detected 3 months after TAVI (8.43±2.51% vs. 11.02±4.09%, p<0.05). Interestingly, LA stiffness significantly decreased after the procedure (from 0.93±0.59 to 0.65±0.37, p<0.001).
TAVI is associated with favourable effects on LA recovery and is able to determine a reverse remodeling of LA morphology and function. In patients undergoing TAVI, STE was able to detect LA functional changes usually neglected by standard echocardiography, adding further insights into the hemodynamic benefits of this procedure.
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Structural Heart Disease Intervention
Abstract Category: 49. TCT@ACC–i2: Aortic Valve Disease
Presentation Number: 2114–242
- 2013 American College of Cardiology Foundation