Sarı Cenk, Aslan Abdullah Nabi, Baştuğ Serdal, Akçay Murat, Akar Bayram Nihal, Bilen Emine, Ayhan Hüseyin, Kasapkara Hacı Ahmet, Durmaz Tahir, Keleş Telat, Bozkurt Engin
Department of Cardiology, Ankara Ataturk Education and R esearch Hospital, Ankara, Turkey.
Cardiol J. 2016;23(4):449-55. doi: 10.5603/CJ.a2016.0030. Epub 2016 Jun 14.
Chronic increased afterload due to severe aortic stenosis (AS) results in com-pensatory concentric left ventricular (LV) hypertrophy and LV dysfunction. These in turn cause remodeling of the left heart. The aim of this study was to investigate the acute effect of transcatheter aortic valve implantation (TAVI) on left atrial (LA) mechanics and LV diastolic function.
The study consisted of a total of 35 consecutive patients (mean age was 77.7 ± 5.0 years, 25 female) undergoing TAVI. All TAVI procedures have been performed under the transesophageal echocardiography (TEE) guidance. Before and 24 h after TAVI, all patients underwent transthoracic echocardiography (TTE) and mitral inflow velocities with pulsed-wave (PW) Doppler including early filling wave (E), late diastolic filling wave (A), and E/A ratio were obtained. LV diastolic function was also explored by pulsed tissue Doppler imaging (TDI). Early (E') and late (A') diastolic annular velocities, E'/A' ratio and E/E' ratio were obtained. In addition, during the procedure before and minutes after the valve implantation, the left atrial appendage-peak antegrade flow velocity (LAA-PAFV) was measured and recorded with TEE.
Compared with baseline, the mean mitral E, septal E' and E'/A' ratio increased significantly after TAVI. In addition, the LAA-PAFV increased significantly within minutes of TAVI (32.45 ± 10.7 cm/s vs. 47.6 ± 12.6 cm/s, p < 0.001).
TAVI improves LV diastolic function and LA performance immediately.
严重主动脉瓣狭窄（AS）导致的慢性后负荷增加会引起代偿性同心性左心室（LV）肥厚和左心室功能障碍。这些反过来又会导致左心重塑。本研究的目的是探讨经导管主动脉瓣植入术（TAVI）对左心房（LA）力学和左心室舒张功能的急性影响。
本研究共纳入35例连续接受TAVI的患者（平均年龄77.7±5.0岁，25例女性）。所有TAVI手术均在经食管超声心动图（TEE）引导下进行。在TAVI术前和术后24小时，所有患者均接受经胸超声心动图（TTE）检查，并通过脉冲波（PW）多普勒获得二尖瓣流入速度，包括早期充盈波（E）、舒张晚期充盈波（A）和E/A比值。还通过脉冲组织多普勒成像（TDI）探讨左心室舒张功能。获得舒张早期（E'）和晚期（A'）的瓣环速度、E'/A'比值和E/E'比值。此外，在手术过程中，在瓣膜植入前和植入后数分钟，用TEE测量并记录左心耳-正向血流峰值速度（LAA-PAFV）。
与基线相比，TAVI术后二尖瓣E、室间隔E'和E'/A比值均显著增加。此外，TAVI术后数分钟内LAA-PAFV显著增加（32.45±10.7cm/s对47.6±12.6cm/s，p<0.001）。
TAVI可立即改善左心室舒张功能和左心房功能。
