Background: Transcatheter Aortic Valve Replacements (TAVR) has become
widespread throughout the world. To date there are no echocardiographic
study of TAVR patients from Southeast Asia (SEA). We sought to evaluate
1) changes in echocardiographic and strain values pre and post TAVR 2)
relationship between aortic stenosis (AS) severity and strain values, 3)
left ventricle geometry in severe AS 4) relationship of flow rate to
dimensionless index (DVI) and acceleration time (AT) and 5) effect of
strains on outcome. Methods: Retrospective study of 112 TAVR patients in
our center from 2009 to 2020. The echocardiographic and strain images
pre (within 1 months), post (day after) and 6 months post TAVR were
analyzed by expert echocardiographer. Results: The ejection fraction
(EF) increased at 6 months (53.02 ± 12.12% to 56.35 ± 9.00%)
(p=0.044). Interventricular septal thickness in diastole (IVSd)
decreased (1.27 ± 0.21cm to 1.21 ± 0.23cm) (p=0.038) and left ventricle
internal dimension in diastole (LVIDd) decreased from 4.77 ± 0.64cm to
4.49 ± 0.65cm (p = 0.001). No changes in stroke volume index (SVI pre vs
6 months p =0.187), but the flow rate increases (217.80 ± 57.61mls/s to
251.94 ± 69.59mls/s, p<0.001). Global Longitudinal Strain
(GLS) improved from -11.44 ± 4.23% to -13.94 ± 3.72% (p
<0.001), Left Atrial Reservoir strain (Lar-S) increased from
17.44 ± 9.16% to 19.60 ± 8.77% (p=0.033). 8 patients (7.5%) had IVSd
< 1.0cm, and 4 patients (3.7%) had normal left ventricle (LV)
geometry. There was linear relationship between IVSd and mean PG
(r=0.208, p=0.031), between GLS to aortic valve area (AVA) and aortic
valve area index (AVAi) (r = – 0.305, p=0.001 and r= – 0.316, p =
0.001). There was also relationship between AT (r=-0.20, p=0.04) and DVI
(r=0.35, p< 0.001) with flow rate. Patients who died late
(after 6 months) had lower GLS at 6 months. (Alive; -13.94 ± 3.72% vs
Died; -12.43 ± 4.19%, p= 0.001) Conclusion: At 6 months TAVR cause
reverse remodeling of the LV with reduction in IVSd, LVIDd and
improvement in GLS and LAr-S. There is linear relationship between GLS
and AVA and between IVSd and AVA.
Left ventricle geometry, atrial strain, ventricle strain and hemodynamics across aortic valve before and after transcatheter aortic valve replacements
