Author + information
- Frederic Poulin,
- Shemy Carasso,
- Eric Horlick,
- Mark Osten,
- Ki-Dong Lim,
- Heather Finn,
- Christopher Feindel,
- Matthias Greutmann,
- Robert J. Cusimano,
- Harry Rakowski and
- Anna Woo
Aortic stenosis (AS) induces chronic pressure overload on the left ventricle (LV) with alterations in myocardial structure and function. We aimed to study the impact of transcatheter aortic valve implantation (TAVI) on the recovery of myocardial mechanics and the influence of post-procedural aortic regurgitation (AR) on LV remodeling.
In a single-center retrospective cohort, speckle-tracking echocardiography was used to derive parameters of myocardial deformation prior to and at midterm follow-up after TAVI. 21 healthy patients ≥60 yrs served as controls. We examined predictors of myocardial recovery using logistic regression.
64 patients (age 81 ± 7 yrs, 58% male) with severe AS (aortic valve area 0.7± 0.2cm2, mean gradient 50 ± 16 mm Hg) and high surgical risk (EuroSCORE 20 ± 13%) were evaluated. At 5 ± 3 months after TAVI, parameters of longitudinal deformation significantly improved: longitudinal strain −12.8 ± 4.0 to −14.1 ± 4.1%; strain rate −0.61 ± 0.20 to −0.69 ± 0.22 sec-1; and early diastolic strain rate 0.51 ± 0.20 to 0.58 ± 0.21 sec-1 (all p < 0.05). In patients with normal ejection fraction (LVEF), circumferential deformation, apical rotation and LV twist was supraphysiologic at baseline with preserved mechanisms of compensation, restoring towards normal values after the procedure. In patients with LVEF ≤ 55%, circumferential deformation was impaired pre TAVI with improvement post TAVI. Baseline LVEF (OR 0.56/10% increase; p= 0.02) and longitudinal strain (OR 0.65 per 1% improvement; p<0.001) were predictors of positive myocardial recovery (≥ 20% increase in longitudinal strain). LV mass and end-diastolic volume failed to favorably remodel in patients with post TAVI new ≥ mild or residual ≥ moderate AR (mean percent change post TAVI of 3 ± 20% and 20 ± 42%, respectively; p<0.01 compared to none or residual mild AR).
In high-risk patients with end-stage AS, TAVI restores LV function towards more physiologic myocardial mechanics in both normal and depressed LVEF groups. Patients with lower systolic function derive the most benefits in term of longitudinal reverse remodeling. Post-procedural AR adversely affects LV structural remodeling.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Imaging: Echo – Aortic Valve Diseases
Abstract Category: 18. Imaging: Echo
Presentation Number: 1144-368
- 2013 American College of Cardiology Foundation