The Effect of TAVR on Left Ventricular and Left Atrial Mechanics in Patients with Aortic Stenosis.

Malcolm Anastasius,Gilbert H L Tang,Annapoorna Kini,Stamatios Lerakis,Neil Patel,Samin K Sharma,Parasuram Krishnamoorthy,Richard Ro,Francesca Romana Prandi,Michael Gavalas

doi:10.3390/jcdd9020035

Abstract

Background. Measures of adverse cardiac remodeling, left ventricular global longitudinal strain (LVGLS) and left atrial (LA) phasic function, are predictive of cardiac events in patients with severe aortic stenosis (AS). How these parameters of cardiac function change following TAVR requires further investigation. Methods. A number of 109 consecutive patients with symptomatic severe AS who were seen in the heart valve clinic between 2014 and 2019 for TAVR were included. All patients underwent echocardiographic assessment prior to and 30 days following TAVR, with LVGLS and LA phasic function evaluation using 2D speckle-tracking echocardiography. Heart failure hospitalization, and death were assessed at 12 months. Results. The mean age of the study cohort was 81 ± 7.3 years. Following TAVR, there was a significant reduction in NYHA class III/IV symptoms [89 (82%) vs. 12 (11%), p < 0.01], and median mean aortic valve gradient [44 mmHg (16) vs. 9 mmHg (7), p < 0.01]. There was no significant change in the median LVEF [62% (13) vs. 62% (6.0), p = 0.2]; however, the LVGLS significantly increased following TAVR [15 ± 3.5% vs. 18 ± 3.3%, p < 0.01]. The median LA reservoir, conduit and contractile function significantly improved following TAVR [22.0% (14.0) vs. 18.0% (14.0) p < 0.01, 8.9% (5.4) vs. 7.8% (4.8) p < 0.01, 12% (11.0) vs. 9.6% (11.0) p < 0.01, respectively]. The incidence of death or heart failure hospitalization at 12 months was low, and occurred in eight patients (7.3%). Conclusions. TAVR results in significant short-term reverse LV and LA remodeling, as shown by improvement in LV GLS and all three components of LA phasic function, despite no change in the LVEF. The findings indicate the possible utility of strain imaging for the assessment of global LV and LA function following TAVR.

Highlights

Introduction iationsTranscatheter aortic valve replacement (TAVR) for aortic stenosis (AS) is rapidly advancing, with several devices approved for routine clinical care [1]
The findings indicate the possible utility of strain imaging for the assessment of global left ventricular (LV) and left atrial (LA) function following TAVR
There was no significant change in the median LVEF [62% (13) vs. 62% (6.0), p = 0.2]; the left ventricular global longitudinal strain (LVGLS) significantly increased following TAVR [15 (3.5) vs. 18 (3.3), p < 0.0001] (Table 3)

Summary

Introduction

Transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) is rapidly advancing, with several devices approved for routine clinical care [1]. Any patient population with severe AS presenting for TAVR is heterogeneous, with varying degrees of left ventricular (LV) and left atrial pathology [2]. Through an increase in afterload, results in compensatory left ventricular hypertrophy that, in turn, leads to reduced LV compliance, diastolic dysfunction, elevated end-diastolic pressures, and in some instances, systolic dysfunction [2]. Amongst AS patients, a measure of global LV systolic function and LV global longitudinal strain is predictive of mortality, independent of LVEF [3]. Severe AS results in impaired LA function [4]. Each of the three phases of LA function in AS have been variably investigated, these include: firstly, reservoir function during ventricular systole and isovolumic relaxation; secondly, conduit function

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Conclusion