Abstract
Aims: To assess left ventricular (LV) function before and after transcatheter aortic valve implantation (TAVI) using conventional echocardiographic parameters and global longitudinal LV strain (GLS) and compare outcomes between Edwards S3 and Evolut R valves.Methods and results: Data were collected for consecutive patients undergoing TAVI at Hammersmith hospital between 2015 and 2018. Of the 303 patients, those with coronary artery disease and atrial fibrillation were excluded leading to a total of 85 patients, which constituted our study group. The mean follow-up was 49 ± 39 days. In total, 60% of patients were treated with Edwards S3 and 40% Evolut R. TAVI resulted in an early improvement of GLS (−13.96 to −15.25%, P = 0.01) but not ejection fraction (EF) (47.6 to 50.1%, P = 0.09). LV mass also improved, especially in patients with marked baseline LV hypertrophy (P < 0.001). There were no appreciable differences of LV function improvement and overall LV remodelling after TAVI between the two types of valves used (P = 0.14).Conclusions: TAVI results in reverse remodelling and improvement of GLS, especially in patients with impaired baseline LV function. There were no differences in the extent of LV function improvement between Edwards S3 and Evolut R valves but there was a greater incidence of aortic regurgitation with Evolut R.
Highlights
Degenerative calcific aortic stenosis represents one of the commonest causes of valvular heart disease in developed countries (1)
The main findings of this study were as follows: (1) in patients with severe AS undergoing transcatheter aortic valve implantation (TAVI), there is an early improvement in left ventricular (LV) systolic function as detected by global longitudinal LV strain (GLS) but not with ejection fraction (EF); and (2) the type of valve used did not influence the outcome, as LV function and LV mass improved to the same extent in both groups
TAVI in patients without significant coronary artery disease, AF or other valvular lesions results in significant improvement of the LV systolic function as assessed by GLS. This improvement is more pronounced in patients with more severe baseline LV systolic function
Summary
Degenerative calcific aortic stenosis represents one of the commonest causes of valvular heart disease in developed countries (1). TAVI has emerged as a less invasive alternative treatment for the patients with high (2, 3), intermediate (4, 5, 6) and low (7, 8) surgical risk. With the advantages of faster recovery and reduced peri-operative mortality, TAVI offers a significant improvement in LV haemodynamics, symptoms and prognosis in those groups (8). We investigated the impact of TAVI on GLS and further examined the potential interaction of valve type (Edwards S3 vs Medtronic Evolut R) using speckle tracking echocardiography.
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