P318Positive left ventricular remodeling after TAVI assessed by high resolution electrocardiography

Abstract

Abstract Introduction Transcatheter aortic valve replacement (TAVI) is a novel treatment method for sever aortic stenosis that has a positive impact on reverse left ventricular (LV) remodeling. The morphology and function of the LV can be assessed by transthoracic echocardiography (TTE) and high resolution electrocardiography (HR-ECG). Purpose The purpose of our study was to investigate whether morphological and functional myocardial changes after TAVI seen on TTE can be tracked by advanced ECG parameters using HR-ECG. Methods Consecutive TAVI patients with transfemoral approach were included in this pilot prospective study. A 5 minute HR-ECG and TTE were performed before and one year after TAVI. Spatial QRS vector amplitude (3D_QRSm), total 12-lead QRS amplitude (12leadV), spatial QRS-T angle (QRST_aM) and spatial ventricular gradient (SVG) were measured using HR-ECG and interventricular septum diastolic diameter (IVSd), left posterior wall diameter (LVPWd), left ventricular ejection fraction (LVEF) and tissue Doppler peak septal systolic velocity (Sm) were obtained by TTE. Student"s test was used for pairs to analyze the differences in sets of variables before and after TAVI and Pearson correlation coefficient to analyze the relationship between TTE and HR-ECG parameters. Results 15 patients (5 male; 33.3%) were included in the study. At one year follow-up we found statistically significant reduction in LV wall thickness and increase in LVEF (61.6 ± 6.50 % vs. 66.9 ± 7.84 %, p = 0.043). In the subgroup with narrow QRS (8 patients), we found a statistically significant correlation between change of left posterior wall thickness (deltaLVPW) and spatial QRS vector amplitude (delta3D_QRSm) (r = 0.795; p = 0.018), and between change of left ventricular ejection fraction (deltaLVEF) and spatial QRS-T angle (deltaQRST_aM) (r = 0.604; p = 0.038). No significant correlations were found in the subgroup of patients with wide QRS complex. Conclusions Our pilot study showed that morphological and functional myocardial changes after TAVI in patients with narrow QRS complex can be followed with advanced ECG parameters using HR-ECG. HR-ECG could prove to be a simple and inexpensive method of follow-up after TAVI in patients with narrow QRS. To ascertain the usefulness and reliability of HR-ECG, a study on a larger number of patients would be required.