title: Early and late improvement of global and regional left ventricular function after transcatheter aortic valve implantation in patients with severe aortic stenosis: an echocardiographic study.
abstract: The recent development of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) treatment offers a viable option for high-risk patient categories. Our aim is to evaluate whether 2D strain and strain rate can detect subtle improvement in global and regional LV systolic function immediately after TAVI. 2D conventional and 2D strain (speckle analysis) echocardiography was performed before, at discharge and after three months in thirty three patients with severe AS. After TAVI, we assessed by conventional echocardiography an immediate reduction of transaortic peak pressure gradient (p<0.0001), of mean pressure gradient (p<0.0001) and a concomitant increase in aortic valve area (AVA: 1.08±0.31 cm(2)/m(2); p<0.0001). 2D longitudinal systolic strain showed a significant improvement in all patients, both at septal and lateral level, as early as 72 h after procedure (septal: -14.2±5.1 vs -16.7±3.7%, p<0.001; lateral: -9.4±3.9 vs -13.1±4.5%, p<0.001; respectively) and continued at 3 months follow-up (septal: -18.1±4.6%, p<0.0001; lateral: -14.8±4.4%, p<0.0001; respectively). Conventional echocardiography after TAVI proved a significant reduction of LV end-systolic volume and of LV mass with a mild improvement of LV ejection fraction (EF) (51.2±11.8 vs 52.9±6.4%; p<0.02) only after three months. 2D strain seems to be able to detect subtle changes in LV systolic function occurring early and late after TAVI in severe AS, while all conventional echo parameters seem to be less effective for this purpose. Further investigations are needed to prove the real prognostic impact of these echocardiographic findings.
authors.affiliation: Cardiac Thoracic and Vascular Department, University of Pisa Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannini
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Enrica
authors.initials: E
authors.lastname: Talini
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Fabio
authors.initials: F
authors.lastname: Guarracino
authors.forename: Maria
authors.initials: M
authors.lastname: Grazia
authors.forename: Delle
authors.initials: D
authors.lastname: Donne
authors.forename: Carmela
authors.initials: C
authors.lastname: Nardi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Conte
authors.forename: Valentina
authors.initials: V
authors.lastname: Barletta
authors.forename: Mario
authors.initials: M
authors.lastname: Marzilli
authors.forename: Vitantonio
authors.initials: V
authors.lastname: Di Bello