Background: Transcatheter Aortic Valve Replacements (TAVR) has become
widespread throughout the world. To date there are no echocardiographic
study of TAVR patients from Southeast Asia (SEA). We sought to evaluate
1) changes in echocardiographic and strain values pre and post TAVR 2)
relationship between aortic stenosis (AS) severity and strain values, 3)
left ventricle geometry in severe AS 4) relationship of flow rate to
dimensionless index (DVI) and acceleration time (AT) and 5) effect of
strains on outcome. Methods: Retrospective study of 112 TAVR patients in
our center from 2009 to 2020. The echocardiographic and strain images
pre (within 1 months), post (day after) and 6 months post TAVR were
analyzed by expert echocardiographer. Results: The ejection fraction
(EF) increased at 6 months (53.02 ± 12.12% to 56.35 ± 9.00%)
(p=0.044). Interventricular septal thickness in diastole (IVSd)
decreased (1.27 ± 0.21cm to 1.21 ± 0.23cm) (p=0.038) and left ventricle
internal dimension in diastole (LVIDd) decreased from 4.77 ± 0.64cm to
4.49 ± 0.65cm (p = 0.001). No changes in stroke volume index (SVI pre vs
6 months p =0.187), but the flow rate increases (217.80 ± 57.61mls/s to
251.94 ± 69.59mls/s, p<0.001). Global Longitudinal Strain
(GLS) improved from -11.44 ± 4.23% to -13.94 ± 3.72% (p
<0.001), Left Atrial Reservoir strain (Lar-S) increased from
17.44 ± 9.16% to 19.60 ± 8.77% (p=0.033). 8 patients (7.5%) had IVSd
< 1.0cm, and 4 patients (3.7%) had normal left ventricle (LV)
geometry. There was linear relationship between IVSd and mean PG
(r=0.208, p=0.031), between GLS to aortic valve area (AVA) and aortic
valve area index (AVAi) (r = – 0.305, p=0.001 and r= – 0.316, p =
0.001). There was also relationship between AT (r=-0.20, p=0.04) and DVI
(r=0.35, p< 0.001) with flow rate. Patients who died late
(after 6 months) had lower GLS at 6 months. (Alive; -13.94 ± 3.72% vs
Died; -12.43 ± 4.19%, p= 0.001) Conclusion: At 6 months TAVR cause
reverse remodeling of the LV with reduction in IVSd, LVIDd and
improvement in GLS and LAr-S. There is linear relationship between GLS
and AVA and between IVSd and AVA.
PurposePercutaneous Transvenous Mitral Commissurotomy (PTMC) is the first line treatment for rheumatic mitral stenosis (MS). We sought to evaluate 1) changes in 2-dimensional (2D) echocardiographic and strain values and 2) differences in these values for patients in atrial fibrillation (AF) and sinus rhythm (SR) pre, immediately and 6 months post PTMC.MethodsRetrospective study of 136 patients who underwent PTMC between 2011 and 2021. We analyzed their 2D echocardiogram, Global Longitudinal Strain (GLS), Left Atrial Reservoir Strain (LAr-S) and Right Ventricle Free Wall Strain (RVFW-S) pre, immediately and 6 months post PTMC.ResultsAt 6 months, mitral valve area increases from 0.94 ± 0.23cm2 to 1.50 ± 0.42cm2. Ejection fraction (EF) did not change post PTMC (pre; 55.56 ± 6.62%, immediate; 56.68 ± 7.83%, 6 months; 56.28 ± 7.00%, p=0.218). Even though EF is preserved, GLS is lower pre-procedure; -11.52 ± 3.74% with significant improvement at 6 months; -15.16 ± 4.28% (p<0.001). Tricuspid annular plane systolic excursion (TAPSE) improved at 6 months from 1.95 ± 0.43 to 2.11 ±0.49 (p=0.004). RVFW-S increases at 6 months from -17.37 ± 6.03% to -19.75 ± 7.19% (p<0.001). LAr-S improved from 11.23 ± 6.83% pre PTMC to 16.80 ± 8.82% at 6 months (p<0.001) post PTMC. Pre-procedure patients with AF have lower strain values (More LV, RV and LA dysfunction) with statistically significant difference for LAr-S (p < 0.001), GLS (p <0.001) and RVFW-S (p <0.001) than patients in SR.ConclusionPatients with severe rheumatic MS have subclinical left and right ventricle dysfunction despite preserved EF and relatively normal TAPSE with significant improvement seen at 6 months post PTMC. AF patients have lower baseline strain values than SR patients.
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