Abstract 11700: Left Ventricular Global Longitudinal Strain After Transcatheter Aortic Valve Implantation in Patients With Preserved Ejection Fraction

Abstract

Background: Left ventricular (LV) global longitudinal strain (GLS), which could assess subtle LV dysfunction, is already deteriorated in a certain number of aortic stenosis (AS) patients with preserved ejection fraction (EF). Although GLS improves after valve replacement, detailed outcome is not well understood. Research Question: In AS patients with preserved EF undergoing transcatheter aortic valve implantation (TAVI), is there a difference in post-procedural GLS between patients with and without reduced pre-procedural GLS? Aim: To elucidate the post-procedural course of GLS after TAVI. Methods: The present study was a single-center retrospective cohort study that included 119 out of 347 consecutive patients undergoing TAVI by excluding EF <50%, atrial fibrillation, inadequate echo image for analysis, and loss to follow-up echocardiography. Subjects were divided into two groups according to pre-procedural GLS: reduced GLS (r-GLS) (> -15%) and preserved GLS (p-GLS) (≤ -15%), and echocardiographic parameters at baseline and changes from baseline to mid-term follow-up (6 months to 1 year) were compared. Results: There was no significant difference in baseline characteristics ( Table ). Before the procedure, higher severity of AS, higher LV mass index and E/e’, and lower EF and peak left atrial longitudinal strain were observed in r-GLS. Both EF and LV mass index improved after TAVI in r-GLS and became comparable in p-GLS ( Figure ). After TAVI, GLS improved in r-GLS, but remained significantly inferior to p-GLS (-14.7 ± 2.3% vs. -16.5 ± 2.8%, P < 0.001; Figure ). Conclusions: In AS patients with preserved EF, GLS improved after TAVI in patients with r-GLS but remained inferior to those with p-GLS, suggesting underlying refractory myocardial damage presumably caused by more severe AS and consequently more severe LV hypertrophy in patients with r-GLS. It might indicate the possibility of GLS for determining optimal timing of TAVI in AS patients with preserved EF.