Global and regional myocardial function and outcomes after transcatheter aortic valve implantation for aortic stenosis and preserved ejection fraction

Abstract

Aim To investigate the effects of transcatheter aortic valve implantation (TAVI) on early recovery of global and segmental myocardial function in patients with severe symptomatic aortic stenosis and preserved left ventricular ejection fraction (LVEF) and to determine if parameters of deformation correlate with outcomes.Methods The echocardiographic (strain analysis) and outcome (hospitalizations because of heart failure and mortality) data of 62 consecutive patients with preserved LVEF (64.54 W 7.97%) who underwent CoreValve prosthesis implantation were examined.Results Early after TAVI (5 W 3.9 days), no significant changes in LVEF or diastolic function were found, while a significant drop of systolic pulmonary artery pressure (PAP) occurred (42.3 W 14.9 vs. 38.1 W 13.9 mmHg, P U 0.028). After TAVI global longitudinal strain (GLS) did not change significantly, whereas significant improvement in global mid-level left ventricular (LV) radial strain (GRS) was found (S16.71 W 2.42 vs. S17.32 W 3.25%; P U 0.33; 16.57 W 6.6 vs. 19.48 W 5.97%, P U 0.018, respectively). Early significant recovery of longitudinal strain was found in basal lateral and anteroseptal segments (P U 0.038 and 0.048). Regional radial strain at the level of papillary muscles [P U 0.038 midlateral, P < 0.001 mid-anteroseptum (RSAS)] also improved.There was a significant LV mass index reduction in the late follow-up (152.42 W 53.21 vs. 136.24 W 56.67 g/m 2 , P U 0.04). Mean follow-up period was 3.5 W 1.9 years. Parameters associated with worse outcomes in univariable analysis were RSAS pre-TAVI, LV end-diastolic diameter after TAVI, relative wall thickness, and mitral E and E/A after TAVI.Conclusion Global and regional indices of myocardial function improved early after TAVI, suggesting the potential of myocardium to recover with a reduced risk for clinical deterioration.

What we have learnt in valvular heart disease from our journal

“…14 Global and regional indices of myocardial function improved early after TAVI. 15 Mitral regurgitation (MR) can also improve; however, high left atrial volume index was found to be a strong predictor of lack of MR recovery after AS treatment. 16 Many patient characteristics and specific conditions or complications are associated with poor prognosis after TAVI.…”

“…In-hospital mortality after TAVI seems to be associated with race since a higher survival was noted in black compared with white subjects; 8 long term mortality was independent of age 14 . Global and regional indices of myocardial function improved early after TAVI 15 . Mitral regurgitation (MR) can also improve; however, high left atrial volume index was found to be a strong predictor of lack of MR recovery after AS treatment 16 …”