Meyer Christian G, Frick Michael, Lotfi Shahram, Altiok Ertunc, Koos Ralf, Kirschfink Annemarie, Lehrke Michael, Autschbach Rüdiger, Hoffmann Rainer
Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany.
Department of Cardiac and Thoracic Surgery, University RWTH Aachen, Aachen, Germany.
Eur Heart J Cardiovasc Imaging. 2014 Oct;15(10):1168-76. doi: 10.1093/ehjci/jeu103. Epub 2014 Jun 6.
This study analysed the impact of transapical (TA) vs. transfemoral (TF) access site transcatheter aortic valve implantation (TAVI) on post-procedural regional left ventricular (LV) function using cardiac magnetic resonance (CMR) feature tracking (FT).
CMR was performed 3 months after TAVI on 44 consecutive patients with normal LV ejection fraction prior to TAVI. Twenty patients had TA-TAVI, and 24 had TF-TAVI. Standard cine imaging was performed in three standard cardiac long-axis views (two-, four- and three-chamber views). Myocardial peak systolic radial strain (PSRS) and peak systolic longitudinal strain (PSLS) were analysed based on CMR-FT considering 49 segments in each of the three views. There were no differences in PSRS and PSLS for the basal and mid-ventricular segments between TA- and TF-TAVI groups. In contrast, PSRS and PSLS of apical segments and apical cap were reduced in the TA- compared with the TF-TAVI group (PSRS: 15.7 ± 6.4 vs. 35.9 ± 15.7%, respectively, P < 0.001; PSLS: -8.9 ± 5.3 vs. -16.9 ± 4.3%, respectively, P < 0.001). Comparison of all non-apical segments vs. apical segments and apical cap demonstrated no difference in the TF group (PSRS: 34.6 ± 9.0 vs. 35.9 ± 15.7%; respectively, P = 0.702; PSLS: -17.8 ± 4.6 vs. -16.9 ± 4.3%; respectively, P = 0.802). After TA-TAVI, PSRS and PSLS of the apical segments were reduced compared with the non-apical segments (PSRS: 15.7 ± 6.4 vs. 33.5 ± 7.0%, respectively, P < 0.001; PSLS: -8.9 ± 5.3 vs. -15.5 ± 3.5%, respectively, P < 0.001).
Apical LV function abnormalities can be detected at 3-month follow-up in all TA-TAVI patients using CMR-FT. TA-TAVI results in significant impairment of apical LV function compared with TF-TAVI.
本研究使用心脏磁共振（CMR）特征追踪（FT）分析经心尖（TA）与经股动脉（TF）入路行经导管主动脉瓣植入术（TAVI）对术后局部左心室（LV）功能的影响。
对44例TAVI术前左心室射血分数正常的连续患者在TAVI术后3个月进行CMR检查。20例患者接受TA-TAVI，24例接受TF-TAVI。在三个标准心脏长轴视图（两腔、四腔和三腔视图）中进行标准电影成像。基于CMR-FT分析三个视图中每个视图的49个节段的心肌收缩期峰值径向应变（PSRS）和收缩期峰值纵向应变（PSLS）。TA-TAVI组和TF-TAVI组之间基底部和心室中部节段的PSRS和PSLS无差异。相比之下，与TF-TAVI组相比，TA-TAVI组心尖节段和心尖帽的PSRS和PSLS降低（PSRS分别为15.7±6.4%对35.9±15.7%，P<0.001；PSLS分别为-8.9±5.3%对-16.9±4.3%，P<0.001）。所有非心尖节段与心尖节段和心尖帽的比较显示TF组无差异（PSRS分别为34.6±9.0%对35.9±15.7%，P = 0.702；PSLS分别为-17.8±4.6%对-16.9±4.3%，P = 0.802）。TA-TAVI术后，心尖节段的PSRS和PSLS与非心尖节段相比降低（PSRS分别为15.7±6.4%对33.5±7.0%，P<0.001；PSLS分别为-8.9±5.3%对-15.5±3.5%，P<0.001）。
使用CMR-FT在所有TA-TAVI患者术后3个月随访时可检测到左心室心尖功能异常。与TF-TAVI相比，TA-TAVI导致左心室心尖功能显著受损。
