Left ventricular functional recovery and remodeling in low-flow low-gradient severe aortic stenosis after transcatheter aortic valve implantation

Vasileios Kamperidis; Emer Joyce; Philippe Debonnaire; Spyridon Katsanos; Philippe J van Rosendael; Frank van der Kley; Georgios Sianos; Jeroen J Bax; Nina Ajmone Marsan; Victoria Delgado

doi:10.1016/j.echo.2014.04.021

Left ventricular functional recovery and remodeling in low-flow low-gradient severe aortic stenosis after transcatheter aortic valve implantation

J Am Soc Echocardiogr. 2014 Aug;27(8):817-25. doi: 10.1016/j.echo.2014.04.021. Epub 2014 Jun 3.

Affiliations

¹ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
² Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
³ Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece.
⁴ Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: v.delgado@lumc.nl.

PMID: 24906801
DOI: 10.1016/j.echo.2014.04.021

Abstract

Background: Speckle-tracking-derived global longitudinal strain (GLS) is a more sensitive method of detecting left ventricular (LV) functional recovery after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis. However, it remains unknown whether LV function improves in patients with low-flow, low-gradient severe aortic stenosis (LFLGSAS) after TAVI. The aim of the present was to evaluate LV functional recovery and remodeling after TAVI in patients with LFLGSAS.

Methods: Sixty-eight patients (57% men; mean age, 79.1 ± 7.1 years) with LFLGSAS treated with TAVI were evaluated. LV function and remodeling were investigated before TAVI and at 6 and 12 months after TAVI. All echocardiographic data were prospectively collected, and GLS was retrospectively analyzed.

Results: Among patients with LFLGSAS, 35 (52%) had low LV ejection fraction (LVEF) (<50%), and 33 (48%) had preserved LVEF (≥50%). The low-LVEF group had significantly more impaired GLS than the group with preserved LVEF (-8.3 ± 2.6% vs -13.3 ± 3.5%, P < .001). LV systolic function improved after TAVI in both groups. Although in the group of patients with low LVEF, all functional parameters improved, in the group of patients with preserved LVEF, only strain-derived parameters significantly improved. There were significant decreases in absolute LV wall thickness and relative wall thickness and a trend toward decreased LV mass index in both LVEF groups. LV volumes decreased significantly in those with low LVEF but not in those with preserved LVEF. Baseline GLS but not LVEF group was independently associated to GLS improvement at 12 months after TAVI.

Conclusions: Patients with LFLGSAS with low and preserved LVEF had a significant improvement in LV function after TAVI, as assessed by GLS. Absolute and relative LV wall thickness decreased in both groups of patients, but only those with low LVEF had reductions in LV volumes.

Keywords: Aortic valve stenosis; Low-flow low-gradient; Speckle-tracking; Strain; Transcatheter aortic valve implantation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aortic Valve Stenosis / diagnostic imaging
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / surgery*
Cardiac Catheterization
Echocardiography, Doppler, Color / methods*
Echocardiography, Three-Dimensional
Female
Follow-Up Studies
Heart Valve Prosthesis*
Humans
Male
Postoperative Period
Recovery of Function*
Retrospective Studies
Severity of Illness Index
Stroke Volume
Transcatheter Aortic Valve Replacement*
Treatment Outcome
Ventricular Function, Left / physiology*
Ventricular Remodeling / physiology*