Date Published: October 11, 2018
Publisher: Public Library of Science
Author(s): Noriko Suzuki-Eguchi, Mitsushige Murata, Yuji Itabashi, Kousuke Shirakawa, Memori Fukuda, Jin Endo, Hikaru Tsuruta, Takahide Arai, Kentaro Hayashida, Hideyuki Shimizu, Keiichi Fukuda, Gabor Erdoes.
Transcatheter aortic valve implantation (TAVI) is an alternative therapy for surgically high-risk patients with severe aortic stenosis (AS). Although TAVI improves survival of patients with severe AS, the mechanism of this effect remains to be clarified. We investigated the effects of TAVI on left ventricular (LV) function and identified the predictive parameters for cardiac events after TAVI.
We studied 128 patients with severe symptomatic AS who underwent TAVI. Echocardiographic assessments were performed before and after TAVI. In addition to the conventional echocardiographic parameters such as LV ejection fraction (LVEF) and LV mass index (LVMI), the LV global longitudinal strain (GLS) and early diastolic peak strain rate (SR_E) using two-dimensional speckle tracking echocardiography were also evaluated. All patients were assessed for clinical events including major adverse cardiac events and stroke according to Valve Academic Research Consortium-2 criteria. GLS, early diastolic peak velocity (eʹ), aortic regurgitation (AR) severity, and SR_E were significantly improved after TAVI. Thirteen patients had an event during the observational period of 591 days (median). Patients with events had higher LVMI, more severe AR, and worse GLS compared to those without events. Furthermore, receiver-operating curve analysis revealed that GLS was the strongest predictor for clinical events (p = 0.009; area under the curve, 0.73).
Preoperative LV geometric deformation and dysfunction, as a consequence of the cumulative burden of pressure overload, improved after TAVI and could predict cardiac events after TAVI.
Aortic stenosis (AS) is a common valvular heart disease, and conventional surgical aortic valve replacement (SAVR) is the therapy of choice for the majority of patients. However, for patients considered to be at surgically high risk, transcatheter aortic valve implantation (TAVI) has emerged as a less invasive option than surgical valve replacement over the past decade. Several recent studies have shown the feasibility and safety of TAVI during short-term and mid-term follow-up periods [1–3]. Lefevre et al. reported that all-cause 30-day mortality was lower in recent years and that there were significantly less major vascular complications, life-threatening bleedings, and major bleedings after TAVI compared to when TAVI was first introduced . The early results are encouraging, with reported 30-day mortality rates less than 10% and 1-year survival rates more than 70% [4–9].
Baseline characteristics of the study population are presented in Table 1. The mean age of the study population was 84±4.2 years and 65.6% of patients were female. Trans-femoral (TF)-TAVI was used in 113 cases, trans-apical (TA)-TAVI in 14 cases and direct-aortic (DA)-TAVI in 1 case.
The present study revealed that in patients with severe AS, TAVI improved LV diastolic function (eʹ and SR_E) and LV systolic function (GLS) within 1 week of intervention, and that pre-procedural GLS is a useful predictor for clinical events following TAVI.