Medizinische Klinik für Kardiologie und Angiologie, Campus Mitte, Charité-Universitätsmedizin Berlin, Charitéplatz 1, Berlin D-10117, Germany.
Eur Heart J Cardiovasc Imaging. 2014 Apr;15(4):389-98. doi: 10.1093/ehjci/jet166. Epub 2013 Sep 12.
Transcatheter aortic valve implantation (TAVI) has been shown to improve prognosis of high-risk patients. Data, however, concerning the impact of TAVI on regional and global left atrial (LA) and left ventricular (LV) mechanics in varying entities of severe aortic stenosis (AS) are sparse, particularly in patients with paradoxical low-flow (PLF) AS or with reduced LV ejection fraction (LVEF). This study evaluated the effects of TAVI on LA and LV mechanics in varying entities of AS 12 months after implantation.
A total of 54 consecutive patients with severe AS (24 with a normal LVEF and normal flow, 16 with PLF, and 14 with a reduced LVEF) were included. Speckle tracking echocardiography was performed before and 12 months after TAVI to determine LV global and regional longitudinal deformation as well as LA function (reservoir function, conduit phase, and active contraction). In all the three entities of AS, there was a significant improvement in global and regional LV longitudinal function (average global longitudinal strain: -14.1 ± 3.9% at baseline vs. -16.5 ± 4.0% after TAVI, P < 0.001). Interestingly, the beneficial effects were most pronounced in patients with PLF (-14.0 ± 2.9 vs. -17.0 ± 4.4%, P < 0.031). Moreover, the atrial reservoir and conduit function recovered significantly after TAVI in all patients.
In conclusion, regardless of the underlying AS entity, TAVI improves global and regional LV and LA mechanics within 12 months.
经导管主动脉瓣植入术（TAVI）已被证明可改善高危患者的预后。然而，关于 TAVI 在不同严重程度主动脉瓣狭窄（AS）患者中对左心房（LA）和左心室（LV）局部和整体力学的影响的数据很少，尤其是在存在反常低流量（PLF）AS 或 LV 射血分数（LVEF）降低的患者中。本研究评估了 TAVI 在植入后 12 个月对不同严重程度 AS 患者的 LA 和 LV 力学的影响。
共纳入 54 例严重 AS 患者（24 例 LVEF 和流量正常，16 例 PLF，14 例 LVEF 降低）。在 TAVI 前后进行斑点追踪超声心动图检查，以确定 LV 整体和局部纵向变形以及 LA 功能（储器功能、输送相和主动收缩）。在所有三种 AS 实体中，LV 整体和局部纵向功能均有显著改善（平均整体纵向应变：植入前-14.1±3.9%，植入后-16.5±4.0%，P<0.001）。有趣的是，PLF 患者的获益最为显著（植入前-14.0±2.9%，植入后-17.0±4.4%，P<0.031）。此外，所有患者的 LA 储器和输送功能在 TAVI 后均显著恢复。
总之，无论 AS 实体如何，TAVI 可在 12 个月内改善 LV 和 LA 的整体和局部力学。
