Three-Dimensional Speckle-Tracking Analysis of Left Ventricular Function after Transcatheter Aortic Valve Implantation

Abstract

The acute and long-term effects of transcatheter aortic valve implantation (TAVI) in patients with aortic valve stenosis on left ventricular (LV) function are controversial. The aim of this study was to determine the effect of TAVI on LV function with two-dimensional (2D) and three-dimensional (3D) speckle-tracking analysis of LV deformation capability. Patients underwent standardized 2D and 3D transthoracic echocardiography before TAVI and after 6 months of follow-up, including 3D and 2D LV deformation imaging. Forty-four patients (mean age, 81.7 ± 5.5 years; 21 men [47.7%]; mean body mass index, 26.3 ± 5.1 kg/m(2); mean logistic European System for Cardiac Operative Risk Evaluation score, 24.4 ± 13.7%) undergoing TAVI were prospectively included. After follow-up, mean 3D LV ejection fraction (LVEF) (35.4 ± 13.1% vs 40.6 ± 12.6%, P = .004), 3D LV volumes (end-systolic volume, 85.9 ± 41.8 vs 65.9 ± 33.7 mL, P < .001; end-diastolic volume, 127.6 ± 40.7 vs 106.4 ± 40.9 mL, P = .001), 3D global longitudinal strain (-9.9 ± 3.7% vs -12.6 ± 4.2%, P < .001), and 3D LV twist (6.1 ± 4.3° vs 8.5 ± 6.9°, P = .025) were relevantly improved. LV improvement was pronounced in patients with decreased baseline LV function (area under the curve, 0.78; P < .001), with a cutoff value for 3D LVEF of ≤37% to identify functional responders to TAVI. After follow-up, patients with 3D LVEFs ≤ 37% showed a significant improvements in 3D LVEF (26.0 ± 7.6% vs 35.9 ± 11.7%, P < .001), 3D LV volumes (end-diastolic volume, 147.4 ± 40.6 vs 117.1 ± 45.5 mL, P = .001; end-systolic volume, 110.9 ± 39.2 vs 77.5 ± 37.2 mL, P < .001), 3D global longitudinal strain (-7.8 ± 2.7% vs -11.3 ± 4.2%, P < .001), and 3D LV twist (5.6 ± 4.2° vs 8.0 ± 5.6°, P = .047), whereas in patients with 3D LVEFs > 37%, only 3D global longitudinal strain was relevantly altered (-12.5 ± 3.1% vs -14.2 ± 3.8%, P = .04). Compared with 2D transthoracic echocardiography, 3D LV functional imaging allowed significantly faster image acquisition and data analysis (P < .0001). New York Heart Association functional class improved significantly in both groups (3D LVEF ≤ 37%, from 3.1 ± 0.5 to 2.0 ± 0.6, P < .001; 3D LVEF > 37%, from 2.7 ± 6.7 to 1.5 ± 0.7, P < .001), whereas a significant amelioration of N-terminal pro-brain natriuretic peptide was observed only in patients with baseline 3D LVEFs ≤ 37% (10,314.64 ± 11,682.2 vs 3,398.7 ± 3,598.9 pg/mL, P = .02; 3D LVEF > 37%, 10,306.4 ± 32,000.5 vs 2,868.0 ± 3,816.7 pg/mL, P = .12). Our results indicate significant improvements of LV global and longitudinal function and clinical parameters 6 months after TAVI that are pronounced in patients with impaired baseline LV function. Compared with 2D LV functional imaging, 3D speckle-tracking imaging allowed significantly faster image acquisition and data analysis.