Department of Cardiovascular Diseases, University Hospital Santa Maria Alle Scotte, viale M. Bracci, 16, 53100, Siena, Italy,
Int J Cardiovasc Imaging. 2013 Dec;29(8):1717-24. doi: 10.1007/s10554-013-0265-z. Epub 2013 Jul 14.
Aortic stenosis (AS) results in several left ventricular (LV) disturbances as well as progressive left atrial (LA) enlargement and dysfunction. Transcatheter aortic valve implantation (TAVI) reverses LV remodelling and improves overall systolic function but its effect on LA function remains undetermined. The aim of this prospective, longitudinal study was to investigate the effects of TAVI on LA structure and function. We studied thirty-two patients with severe symptomatic AS who underwent TAVI, using standard and 2-dimensional speckle-tracking echocardiography before, at 40-day and at 3-month follow-up. Following TAVI, mean transvalvular gradient decreased (p < 0.001). Both LA area index and LA volume index decreased at 40-day follow-up (16.2 ± 6.4 vs. 12.5 ± 2.9 cm2/m2, and 47.3 ± 12.0 vs. 42.8 ± 12.5 mL/m2, respectively, p < 0.05) and values remained unchanged at 3 months. The reduction of LA size was accompanied by a significant increase in global peak atrial longitudinal strain (14.4 ± 3.9 vs. 19.1 ± 4.7%, p < 0.001) and in global peak atrial contraction strain (8.4 ± 2.5 vs. 11.0 ± 4.1%, p < 0.05) at 3-month follow-up. LA stiffness measurements significantly decreased 3 months after TAVI (0.93 ± 0.59 vs. 0.65 ± 0.37, respectively, p < 0.001). Trans-aortic mean gradient change and pre-procedural LA volume were identified as predictors of global peak atrial longitudinal strain increase (β = -0.41, β = -0.35, respectively, p < 0.0001) while pre-procedural LA volume and trans-aortic mean gradient change as predictor of LA volume index reduction 3 months after TAVI (β = -0.37, β = -0.28, respectively, p < 0.0001). TAVI is associated with significant recovery of LA structure and function suggesting a reverse cavity remodelling. Such functional recovery is primarily determined by the severity of pre-procedural valve stenosis.
主动脉瓣狭窄（AS）可导致左心室（LV）多种异常，以及左心房（LA）进行性扩大和功能障碍。经导管主动脉瓣植入术（TAVI）可逆转 LV 重构，改善整体收缩功能，但对 LA 功能的影响仍不确定。本前瞻性、纵向研究旨在探讨 TAVI 对 LA 结构和功能的影响。我们研究了 32 例患有严重症状性 AS 的患者，这些患者在 TAVI 前、40 天和 3 个月随访时使用标准和 2 维斑点追踪超声心动图进行检查。TAVI 后，跨瓣压差降低（p<0.001）。LA 面积指数和 LA 容积指数在 40 天随访时下降（16.2±6.4 vs. 12.5±2.9 cm2/m2 和 47.3±12.0 vs. 42.8±12.5 mL/m2，均 p<0.05），3 个月时无变化。LA 大小的减少伴随着整体峰值心房纵向应变（14.4±3.9 vs. 19.1±4.7%，p<0.001）和整体峰值心房收缩应变（8.4±2.5 vs. 11.0±4.1%，p<0.05）的显著增加。TAVI 后 3 个月，LA 僵硬度测量显著降低（0.93±0.59 vs. 0.65±0.37，均 p<0.001）。跨主动脉平均梯度变化和术前 LA 容积被确定为整体峰值心房纵向应变增加的预测因子（β=-0.41，β=-0.35，均 p<0.0001），而术前 LA 容积和跨主动脉平均梯度变化是 TAVI 后 3 个月 LA 容积指数减少的预测因子（β=-0.37，β=-0.28，均 p<0.0001）。TAVI 与 LA 结构和功能的显著恢复相关，提示反向腔重构。这种功能恢复主要取决于术前瓣膜狭窄的严重程度。
