The Prognostic Value of Left Atrial Global Longitudinal Strain and Left Atrial Phasic Volumes in Patients Undergoing Transcatheter Valve Implantation for Severe Aortic Stenosis

Cardiology ◽  
2021 ◽  
pp. 1-12
Author(s):  
Jonathan Weber ◽  
Kristine Bond ◽  
Joseph Flanagan ◽  
Michael Passick ◽  
Florentina Petillo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Sufficient Evidence ◽  
Imaging Biomarkers ◽  
Peak Longitudinal Strain ◽  
Valve Implantation ◽  
Global Peak

Introduction: The changes and the prognostic implications of left atrial (LA) volumes (LAV), LA function, and vascular load in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) are less known. Methods: We enrolled 150 symptomatic patients (mean age 82 ± 8 years, 58% female, and pre-TAVI aortic valve area 0.40 ± 0.19 cm/m2) with severe AS who underwent 2D transthoracic echocardiography and 2D speckle tracking echocardiography at average 21 ± 35 days before and 171 ± 217 days after TAVI. The end point was a composite of new onset of atrial fibrillation, hospitalization for heart failure and all-cause death (major adverse cardiac events [MACE]). Results: After TAVI, indexed maximal LA volume and minimum volume of the LA decreased by 2.1 ± 10 mL/m2 and 1.6 ± 7 mL/m2 (p = 0.032 and p = 0.011, respectively), LA function index increased by 6.8 ± 11 units (p < 0.001), and LA stiffness decreased by 0.38 ± 2.0 (p = 0.05). No other changes in the LA phasic volumes, emptying fractions, and vascular load were noted. Post-TAVI, both left atrial and ventricular global peak longitudinal strain improved by about 6% (p = 0.01 and 0.02, respectively). MACE was reached by 37 (25%) patients after a median follow-up period of 172 days (interquartile range, 20–727). In multivariable models, MACE was associated with both pre- and post-TAVI LA global peak longitudinal strain (hazard ratio [HR] 0.75, CI 0.59–0.97; and HR 0.77, CI 0.60–1.00, per 5 percentage point units, respectively), pre-TAVI LV global endocardial longitudinal strain (HR 1.37, CI 1.02–1.83 per 5 percentage point units), and with most of the LA phasic volumes. Conclusion: Within 6 months after TAVI, there is reverse LA remodeling and an improvement in LA reservoir function. Pre- and post-TAVI indices of LA function and volume remain independently associated with MACE. Larger studies enrolling a greater diversity of patients may provide sufficient evidence for the utilization of these imaging biomarkers in clinical practice.

scholarly journals P753 Impact of transcatheter aortic valve implantation on concomitant mitral regurgitation in patients with severe aortic stenosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Lembo ◽  
R Sorrentino ◽  
C Santoro ◽  
R Esposito ◽  
M Scalamogna ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Left Atrial ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Valve Surgery ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Severe aortic stenosis (AS) and functional mitral regurgitation (MR) frequently coexist. There is no consensus about the optimal therapeutic strategy for patients with combined valve disease. Evidence has shown that double valve surgery is associated with high complication rates and mortality, whereas MR severity may improve after transcatheter aortic valve implantation (TAVI). Purpose Aim of our study was to evaluate hemodynamic parameters and cardiac function in patients with severe AS and concomitant MR undergoing TAVI. Methods We prospectively enrolled consecutive TAVI patients with concomitant MR. Exclusion criteria were primary cardiomyopathies, prior valve surgery, permanent atrial fibrillation and inadequate echocardiographic imaging. Echo-Doppler assessment, including global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS) (absolute value), was performed before TAVI and after 1-3 months. MR grading was assessed according to quantitative methods (vena contracta and/or PISA). Changes (Δ) of the main echo parameters before and after intervention were computed. On the basis of MR grading changes, the study population was divided in two groups: no improvement in MR grading (NIMR) and improvement in MR grading (IMR). Results Of 49 included patients (M/F = 20/29, age 80.7 ± 5.6 years), 23 had mild MR and 26 moderate to severe MR before TAVI. After the procedure, MR grading improved in 11 (IMR) and remained stable in 38 (NIMR) patients. The two groups were comparable for sex, age, body mass index, blood pressure and heart rate. After TAVI, both groups showed an improvement in GLS (17.8 ± 4.7 to 20.1 ± 4.4%, p &lt; 0.0001 and 16.8 ± 3.8 to 19.0 ± 3.1%, p &lt; 0.01, in NIMR and IMR respectively) and in PALS (20.4 ± 7.4 to 24.2 ± 7.3%, p &lt; 0.0001 in NIMR and 19.5 ± 4.5 to 26.7 ± 6.1%, p &lt; 0.001, in NIMR and IMR respectively), without significant changes in ejection fraction (p = 0.12). Only in IMR group, a significant decrease of systolic pulmonary arterial pressure (sPAP) (45.5 ± 10.6 to 36.3 ± 6.9 mmHg, p &lt; 0.001) and left atrial volume index (54.9 ± 14.8 to 48.9 ± 13.3 ml/m², p &lt; 0.01) was observed after TAVI. Changes of sPAP (ΔsPAP) (9.1 ± 6.4 vs. -0.07 ± 6.7, p &lt; 0.0001) was higher and ΔPALS (-7.2 ± 5.1 vs. -3.8 ± 4.3, p &lt; 0.03) lower in IMR compared with NIMR group (Figure). By a multiple linear regression analysis performed in the pooled population, after adjusting for ΔPALS, Δ aortic valve area and ΔGLS, the association between ΔsPAP and MR grading improvement remained significant (beta = 0.53, p &lt; 0.001) (cumulative R²=0.31, SEE = 6.9 mmHg, p = 0.007). Conclusion Afterload reduction following TAVI may induce hemodynamic changes determining also a reduction in MR severity. This mechanism implies a reduction in left atrial pressure, whose PALS is a reliable marker, and a consequent reduction of post-capillary pulmonary hypertension. The association between MR improvement and ΔsPAP reduction is independent on echocardiographic confounders. Abstract P753 Figure. ΔsPAP and ΔPALS in NIMR and IMR

scholarly journals 676 Impact of transcatheter aortic valve implantation in patients with severe aortic stenosis and concomitant mitral regurgitation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Lina Manzi ◽  
Federica Ilardi ◽  
Fiorenzo Simonetti ◽  
Nicola Verde ◽  
Anna Franzone ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Valve Surgery ◽  
Transcatheter Aortic Valve ◽  
Before And After ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Aims Severe aortic stenosis (AS) and functional mitral regurgitation (MR) frequently coexist. There is no consensus about the optimal therapeutic strategy for patients with combined valve disease. Evidence has shown that double valve surgery is associated with high complication rates and mortality, whereas MR severity may improve after transcatheter aortic valve implantation (TAVI). To date, little is known on prognostic parameters associated with MR improvement after TAVI. Recently, a new echocardiographic parameter based on the ratio between peak E velocity and peak atrial longitudinal strain (E/PALS) has demonstrated to be accurate and sensitive in the prediction of elevated filling pressure. Its role in the setting of AS patients undergoing TAVI has never been investigated. Our study aims to evaluate haemodynamic conditions and left ventricular (LV) systolic and diastolic function in patients with severe AS and concomitant MR undergoing TAVI and to identify new echocardiographic parameters associated with MR improvement 1 month after the aortic valve replacement. Methods We prospectively enrolled 87 consecutive patients (mean age 80 ± 6 years) with severe symptomatic AS and concomitant MR undergoing TAVI between 2016 and 2021, for whom a complete echocardiographic assessment was available at baseline and 1 month after the procedure, selected from the EffecTAVI registry. Exclusion criteria were prior valve surgery, severe mitral stenosis, permanent atrial fibrillation, and poor ultrasound acoustic window. Echo-Doppler assessment, including global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS), was performed before and after 1 month to TAVI procedure. Changes (Δ) of the main echo parameters before and after intervention were computed. Results A month after the procedure, 20 (23%) patients had a reduction of at least one degree of MR (P &lt;0.001). Dividing study population in two groups, based on whether or not MR was reduced after TAVI, we found that patients with MR improvement had higher LV end-diastolic volume (P = 0.036) and left atrial volume (P = 0.015) at baseline compared with those without MR reduction. After TAVI no significant differences were found in heart chambers size between the two groups, but a significant increase in PALS (23.2 ± 7.3 vs. 22.3 ± 7, P=0.028), together with a reduction in E/A ratio (0.69 ± 0.14 vs. 0.90 ± 0.46, P = 0.046) were detected in patients with MR reduction. Furthermore, Δ E/PALS (−17.3±34.4% vs. 3.9±35.0% P=0.027), Δ E/A (−12.6±33.9% vs. 24.7±64.3%, P=0.018) and Δ systolic pulmonary artery pressure (sPAP) (−13.0±20.2% vs. −2.0±18.3, P=0.031) were significantly higher in patients with MR improvement to compared those without MR reduction. By the multivariate logistic regression analysis performed in the pooled population, Δ E/PALS (OR 0.968, 95% CI: 0.947–0.990, P=0.005), together with LV mass at baseline (OR 1.056, 95% CI: 1.007–1.107, P = 0.024) appeared to be independently associated with MR reduction post-TAVI. Conclusions Our study demonstrated that: after TAVI in a significant percentage of patients a relevant improvement in concomitant MR was detected; in the group of patients with improved MR a parallel improvement of sPAP, E/A and E/PALS ratio post TAVI was found; Δ E/PALS appears to be the main parameter independently associated with the reduction of MR severity.

scholarly journals Clinical usefulness of relative apical sparing pattern for predicting functional recovery after transcatheter aortic valve implantation in patients with severe aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Matsuda ◽  
H Okayama ◽  
T Kazatani ◽  
H Okabe ◽  
S Kido ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Relative apical sparing pattern (RASP) is thought to be associated with prognosis in patients with cardiac amyloidosis or left ventricular hypertrophy (LVH). Although almost all patients with severe aortic stenosis (AS) have LVH, little is known about the effect of transcatheter aortic valve implantation (TAVI) in patients with severe AS exhibiting a RASP. Purpose This study aimed to elucidate the effect of TAVI on left ventricular global longitudinal strain (LS; LVGLS) in patients with severe AS exhibiting a RASP. Methods Eighty-four patients who underwent transfemoral or subclavian TAVI were evaluated. They were divided into the RASP and non-RASP groups. The average apical LS divided by the sum of the average mid and basal LS values of &gt;1.0 was defined as the RASP. We analyzed the difference between pre- and post-TAVI LVGLS (ΔGLS = post-TAVI LVGLS − pre-TAVI LVGLS). Results Of the 84 patients (mean age, 84.5±3.9 years; 24 men), 15 (17.9%) exhibited a RASP. No significant difference in mean pre-TAVI LVGLS was found between the RASP and non-RASP groups (−16.6% ± 3.8% vs. −15.8% ± 3.9%). The ΔGLS in the RASP group was significantly higher than that in the non-RASP group (−0.97% ± 2.5% vs. −2.6% ± 3.0%; P&lt;0.05). Multivariate analysis revealed that relative apical longitudinal strain was an independent predictor of ΔGLS (β = 0.35, p=0.002). Conclusion Relative apical longitudinal strain was associated with LVGLS recovery. The effect of TAVI on LVGLS in patients with a RASP is inferior to that in patients without a RASP. Funding Acknowledgement Type of funding source: None

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