Recovery of left ventricular and left atrial mechanics in various entities of aortic stenosis 12 months after TAVI

Abstract

BackgroundTranscatheter aortic valve implantation (TAVI) has been shown to improve prognosis of high-risk patients. Data, however, concerning the impact of TAVI on regional and global left atrial (LA) and left ventricular (LV) mechanics in varying entities of severe aortic stenosis (AS) are sparse, particularly in patients with paradoxical low-flow (PLF) AS or with reduced LV ejection fraction (LVEF). This study evaluated the effects of TAVI on LA and LV mechanics in varying entities of AS 12 months after implantation. Methods and resultsA total of 54 consecutive patients with severe AS (24 with a normal LVEF and normal flow, 16 with PLF, and 14 with a reduced LVEF) were included. Speckle tracking echocardiography was performed before and 12 months after TAVI to determine LV global and regional longitudinal deformation as well as LA function (reservoir function, conduit phase, and active contraction). In all the three entities of AS, there was a significant improvement in global and regional LV longitudinal function (average global longitudinal strain: 214.1 + 3.9% at baseline vs. 216.5 + 4.0% after TAVI, P , 0.001). Interestingly, the beneficial effects were most pronounced in patients with PLF (214.0 + 2.9 vs. 217.0 + 4.4%, P , 0.031). Moreover, the atrial reservoir and conduit function recovered significantly after TAVI in all patients. ConclusionIn conclusion, regardless of the underlying AS entity, TAVI improves global and regional LV and LA mechanics within 12 months.--

Short-term effects of transcatheter aortic valve implantation on left atrial appendage function

“…Recent studies reported an improvement in LA functions after the TAVI procedure in high-risk patients with systolic and diastolic dysfunction [5][6][7]. In the present study, the amelioration of LAA functions soon after the TAVI procedure may have been due to the marked and beneficial effects of the procedure on hemodynamic and echocardiographic parameters.…”

“…Spethmann et al [7] demonstrated that a global and regional LV and LA mechanics improved 12 months after TAVI. LA function was evaluated with speckle-tracking echocardiography in previous TAVI studies [5][6][7]. To the best of our knowledge, this is the first study to assess LAA functions after TAVI procedure in patients with severe AS.…”

“…Recent studies that used speckle-tracking echocardiography reported an improvement in some LA functions after TAVI in high-risk AS patients [5][6][7]. Although the beneficial effect of TAVI on clinical and echocardiographic hemodynamic parameters is well known, there are no data in the literature regarding the effect of this procedure on LAA functions.…”

Left Atrial Phasic Function and Its Association With Atrial Fibrillation in Patients After Transcatheter Aortic Valve Implantation

“…(8) Progressive AS eventually leads to LA failure with decrease in all three strain-derived phasic functions (8), which was also shown here. In other mid-term post-TAVI studies assessing LA remodeling, reservoir (11)(12)(13) and conduit (13) functions improved while contractile function either improved (12) or remained unchanged (13). In our cohort, STE demonstrated some amelioration in both LA compliance and contractility, which might contribute to restoring stroke volume and functional capacity after the TAVI.…”

“…The fact that changes in LA function were best appreciated by measures of LA deformation (i.e. STE) rather than volumetric methods, also documented by Spethmann et al (13), demonstrates the better sensitivity of STE-based methods. New-onset atrial fibrillation NAF after TAVI is a common complication and is associated with higher rates of cerebrovascular events.…”