Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University Hospital Essen, Medical Faculty, University Duisburg-Essen, 45122, Essen, Germany.
BMC Cardiovasc Disord. 2020 Jun 3;20(1):267. doi: 10.1186/s12872-020-01556-4.
Parameters that mark the timing of left ventricular (LV) reverse remodeling following transcatheter aortic valve replacement (TAVR) are incompletely defined. This study aims to identify the dynamics of LV strain derived from speckle tracking echocardiography in a cohort of patients with severe aortic stenosis (AS) who underwent TAVR and its correlation with postprocedural outcomes.
We selected 150 consecutive patients (82 ± 4 years old, STS score 6.4 ± 6.2) who underwent transfemoral TAVR between 07/2016 and 12/2017 at our tertiary care center. All patients were evaluated at baseline, 1 week after TAVR, and 3 months following TAVR.
The global longitudinal strain (GLS) 1 week following TAVR was comparable to that at baseline (- 15,9 ± 4.3 vs - 16.8 ± 4.1; p = NS) but significantly improved at 3 months following TAVR (- 15.9 ± 4.3% vs. -19.5 ± 3.5%; p < 0.001). No significant changes in global circumferential strain (GCS) and global radial strain (GRS) were detectable. The ejection fraction was significantly improved 1 week after the TAVR procedure. The baseline GLS correlated directly with the complication rate (R = 0.36, p = 0.005). The linear regression analysis showed that the main predictors of the improvement in the GLS at 3 months in our cohort were baseline GRS and GCS.
GLS improves at 3 months after TAVR, while LV ejection fraction does not show a substantial change, signaling an early recovery of LV longitudinal function after the intervention. Additionally, GLS has a direct correlation with the postprocedural outcomes. GLS improvement might emerge as a valuable parameter for a tailored follow-up in TAVR patients.
经导管主动脉瓣置换术（TAVR）后左心室（LV）逆向重构时机的标志参数尚未完全定义。本研究旨在确定经股 TAVR 治疗严重主动脉瓣狭窄（AS）患者的斑点追踪超声心动图衍生的 LV 应变的动力学及其与术后结果的相关性。
我们选择了 2016 年 7 月至 2017 年 12 月在我们的三级保健中心接受经股 TAVR 的 150 例连续患者（82±4 岁，STS 评分 6.4±6.2）。所有患者均在基线、TAVR 后 1 周和 TAVR 后 3 个月进行评估。
TAVR 后 1 周的整体纵向应变（GLS）与基线时相似（-15.9±4.3%对-16.8±4.1%；p=NS），但在 TAVR 后 3 个月时显著改善（-15.9±4.3%对-19.5±3.5%；p<0.001）。整体周向应变（GCS）和整体径向应变（GRS）无明显变化。TAVR 术后 1 周射血分数显著提高。基线 GLS 与并发症发生率直接相关（R=0.36，p=0.005）。线性回归分析显示，本队列中 3 个月 GLS 改善的主要预测因子是基线 GRS 和 GCS。
TAVR 后 3 个月 GLS 改善，而 LV 射血分数无明显变化，提示干预后 LV 纵向功能早期恢复。此外，GLS 与术后结果直接相关。GLS 的改善可能成为 TAVR 患者个体化随访的一个有价值的参数。
