Cardiac remodelling after valvular replacement in patients with aortic stenosis: A substudy from Translink

Abstract

Reverse cardiac remodelling is a major goal of aortic valve replacement (AVR). Global longitudinal strain (GLS) currently allows a more sensitive evaluation of systolic function than left ventricle ejection fraction (LVEF). The European Translink FP7 project prospectively included patients with aortic stenosis scheduled for surgical or percutaneous AVR. The present substudy included patients enrolled in Nantes University Hospital. Patients were separated in two groups according to baseline left ventricle (LV) GLS value (normal ≤ or altered > −16%). Changes in LV GLS and cardiac morphology were evaluated 6 months after AVR. Two hundred patients (64% men, mean age 74 ± 9 years) were included and the follow up at 6 months was completed in 127. LVEF at baseline was 62 ± 10% and GLS −16.1 ± 3.7%. Patients with impaired GLS at baseline ( n = 85, 43%) were more often diabetics and obese, and had higher NT-proBNP levels. Cardiac cavities remodelling was more pronounced, LVEF was moderately decreased (57.1 ± 10.9% vs. 65.9 ± 7.3%; P < 0.001), and valvulo-arterial impedance was higher. These patients experienced a significant improvement in GLS at 6 months (−15.3 ± 3.8% vs. −12.9 ± 2.3%; P < 0.001), in contrast with patients with normal GLS at baseline (-18.7 ± 1.6% vs. −18.1 ± 2.6%; P = 0.07). Baseline LVEF and septal E/Ea were significantly associated with GLS value at 6 months in multivariate analysis. There was no significant change in left atrium size but a decrease in E/Ea at 6 months. Despite a significant decrease in pulmonary artery pressure, there was a significant alteration of right ventricle strain at 6 months (−20.7 ± 4.7% vs. −23.2 ± 5.8%; P < 0.001), in correlation with tricuspid annulus dilatation ( Fig. 1 ). Left ventricle presented a significant reverse remodelling after surgical or percutaneous AVR, especially in patients with altered GLS before procedure. This favourable LV remodelling contrast with unfavourable right cavities remodelling.