MedStar Health Research Institute, Washington, District of Columbia; MedStar Washington Hospital Center, Washington, District of Columbia.
MedStar Washington Hospital Center, Washington, District of Columbia.
Am J Cardiol. 2019 Jul 15;124(2):253-261. doi: 10.1016/j.amjcard.2019.04.029. Epub 2019 Apr 23.
Remodeling after transcatheter aortic valve implantation (TAVI) has been well characterized for the left ventricle (LV) but not for the other cardiac chambers. We aimed to describe conventional indices of cardiac remodeling and novel longitudinal strain (LS) in all 4 cardiac chambers post-TAVI and to explore gender remodeling disparities. Consecutive patients with significant aortic stenosis who underwent TAVI were included if echocardiograms in sinus rhythm before and 1-year postprocedure were available. Speckle tracking analysis was performed retrospectively to evaluate size and function of the 4 cardiac chambers. Baseline and 1-year data were compared. From a total of 612 patients who underwent TAVI, 213 were included in this study (82 ± 9 years old, 42% men). Although no significant size or function changes were seen for right cardiac chambers at follow-up, significant improvements were seen for ejection fraction (EF) and LS in both the LV and left atrium (LA) (p < 0.05 for both). The absolute percentage of LV and LA function improvement was higher for LS than for EF (p < 0.05). Women had smaller LV and right ventricular (RV) size, whereas parameters of LV and RV function were higher. All 1-year remodeling parameters were similar for men and women. Conventional LV remodeling parameters (LV mass) failed to improve 1 year after TAVI. However, novel strain-derived parameters of size and function showed remodeling of left chambers but not of RV or right atrium. The degree of LV and LA remodeling by LS is almost twice that of EF. Remodeling was similar for both genders.
经导管主动脉瓣置换术（TAVI）后的左心室（LV）重塑已得到充分描述，但其他心腔的重塑尚未得到充分描述。我们旨在描述 TAVI 后所有 4 个心腔的常规心脏重塑指数和新的纵向应变（LS），并探讨性别重塑差异。如果窦性心律的超声心动图在术前和术后 1 年均可用，则连续患有严重主动脉瓣狭窄的患者被纳入研究。回顾性进行斑点追踪分析以评估 4 个心腔的大小和功能。比较基线和 1 年的数据。在总共接受 TAVI 的 612 例患者中，213 例患者纳入本研究（82±9 岁，42%为男性）。尽管在随访时右心腔的大小或功能没有明显变化，但 LV 和左心房（LA）的射血分数（EF）和 LS 均有显著改善（均 p<0.05）。与 EF 相比，LS 改善的 LV 和 LA 功能的绝对值百分比更高（均 p<0.05）。女性的 LV 和右心室（RV）较小，而 LV 和 RV 功能的参数较高。男性和女性的所有 1 年重塑参数均相似。常规 LV 重塑参数（LV 质量）在 TAVI 后 1 年未能改善。然而，大小和功能的新型应变衍生参数显示左心室腔的重塑，但 RV 或右心房无重塑。LS 测量的 LV 和 LA 重塑程度几乎是 EF 的两倍。两种性别之间的重塑相似。
