D'Andrea Antonello, Padalino Roberto, Cocchia Rosangela, Di Palma Enza, Riegler Lucia, Scarafile Raffaella, Rossi Giovanni, Bianchi Renato, Tartaglione Donato, Cappelli Bigazzi Maurizio, Calabrò Paolo, Citro Rodolfo, Bossone Eduardo, Calabrò Raffaele, Russo Maria Giovanna
Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
Department of Radiology, Monaldi Hospital, Naples, Italy.
Echocardiography. 2015 Jun;32(6):928-36. doi: 10.1111/echo.12808. Epub 2014 Oct 17.
Transcatheter aortic valve implantation (TAVI) is an alternative treatment in surgically high-risk or inoperable patients with severe aortic stenosis (AS). The objective of this study was to analyze the effects of TAVI on left ventricular (LV) and left atrial (LA) longitudinal function assessed by speckle tracking echocardiography (2DSTE) in patients with AS.
In our prospectively conducted study, a total of 55 symptomatic (New York Heart Association class II or higher) patients with severe AS, considered to be at increased risk for undergoing surgical aortic valve replacement, were recruited (age: 78.6 ± 7.4 year). Patients underwent a complete clinical and laboratory evaluation, in addition to standard echocardiography and 2DSTE. Echocardiographic analysis was performed before and 6 months after TAVI. 2DSTE measured segmental and global longitudinal strain (GLS) and radial strain.
All the patients received the CoreValve self-expanding prosthesis. Six months after TAVI, patients showed a significant reduction in mean transaortic gradient (52.1 ± 15.8 vs. 11.2 ± 3.3 mmHg, P < 0.0001), LV mass, LA volume index, and an improvement of ejection fraction (P < 0.0001). In addition, LV GLS (-11.8 ± 3.2 vs. -16.3 ± 4.2%; P < 0.0001) and LA longitudinal strain (14.2 ± 5.4 vs. 26.6 ± 10.8%, P < 0.0001) significantly increased after TAVI. In a stepwise forward multiple logistic regression analysis, LV mass before TAVI (P < 0.001) and peak CK MB mass after TAVI (P < 0.0001) were powerful independent predictors of lower improvement of LV GLS. Moreover, LV mass index (P < 0.001) and LV GLS strain (P < 0.001) before TAVI were powerful independent predictor of LA longitudinal strain after TAVI CONCLUSIONS: TAVI in patients with AS resulted in geometric changes known as "reverse remodelling," and improved LV and LA function assessed by 2DSTE.
经导管主动脉瓣植入术（TAVI）是外科手术高危或无法手术的严重主动脉瓣狭窄（AS）患者的一种替代治疗方法。本研究的目的是分析TAVI对AS患者左心室（LV）和左心房（LA）纵向功能的影响，采用斑点追踪超声心动图（2DSTE）进行评估。
在我们前瞻性开展的研究中，共纳入55例有症状（纽约心脏协会II级或更高）的严重AS患者，这些患者被认为接受外科主动脉瓣置换术的风险增加（年龄：78.6±7.4岁）。患者除了接受标准超声心动图和2DSTE检查外，还进行了全面的临床和实验室评估。在TAVI术前和术后6个月进行超声心动图分析。2DSTE测量节段性和整体纵向应变（GLS）以及径向应变。
所有患者均接受了CoreValve自膨胀式人工瓣膜。TAVI术后6个月，患者的平均跨主动脉压差显著降低（52.1±15.8 vs. 11.2±3.3 mmHg，P<0.0001），左心室质量、左心房容积指数降低，射血分数改善（P<0.0001）。此外，TAVI术后左心室GLS（-11.8±3.2 vs. -16.3±4.2%；P<0.0001）和左心房纵向应变（14.2±5.4 vs. 26.6±10.8%，P<0.0001）显著增加。在逐步向前多元逻辑回归分析中，TAVI术前的左心室质量（P<0.001）和TAVI术后的肌酸激酶同工酶峰值质量（P<0.0001）是左心室GLS改善程度较低的有力独立预测因素。此外，TAVI术前的左心室质量指数（P<0.001）和左心室GLS应变（P<0.001）是TAVI术后左心房纵向应变的有力独立预测因素。结论：AS患者的TAVI导致了被称为“逆向重构”的几何形态变化，并改善了通过2DSTE评估的左心室和左心房功能。
