title: Acute regional improvement of myocardial function after interventional transfemoral aortic valve replacement in aortic stenosis: a speckle tracking echocardiography study.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) is a promising therapy for patients with severe aortic stenosis (AS) and high perioperative risk. New echocardiographic methods, including 2D Strain analysis, allow the more accurate measurement of left ventricular (LV) systolic function. The goal of this study was to describe the course of LV reverse remodelling immediately after TAVI in a broad spectrum of patients with symptomatic severe aortic valve stenosis.
  
  
  METHODS
  Thirty consecutive patients with symptomatic aortic valve stenosis and preserved LVEF underwent transfemoral aortic valve implantation. We performed echocardiography at baseline and one week after TAVI. Echocardiography included standard 2D and Doppler analysis of global systolic and diastolic function as well as 2D Strain measurements of longitudinal, radial and circumferential LV motion and Tissue Doppler echocardiography.
  
  
  RESULTS
  The baseline biplane LVEF was 57 ± 8.2%, the mean pressure gradient was 46.8 ± 17.2 mmHg and the mean valve area was 0.73 ± 0.27 cm(2). The average global longitudinal 2D strain of the left ventricle improved significantly from -15.1 (± 3.0) to -17.5 (± 2.4) % (p < .001). This was reflected mainly in improvement in the basal and medial segments while strain in the apex did not change significantly [-11.6 (± 5.2) % to -15.1 (± 5.5) % (p < .001), -13.9 (± 5.1) % to -16.8 (± 5.6) % (p < .001) and -19.2 (± 7.0) % to -20.0 (± 7.2) % (p = .481) respectively]. While circumferential strain [-18.1 (± 5.1) % vs. -18.9 (± 4.2) %, p = .607], radial strain [36.5 (± 13.7) % vs. 39.7 (± 17.2) %, p = .458] and the LVEF remained unchanged after one week [57.0 (± 8.2) % vs. 59.1 (± 8.1) %, p = .116].
  
  
  CONCLUSIONS
  There is an acute improvement of myocardial longitudinal systolic function of the basal and medial segments measured by 2D Strain analysis immediately after TAVI. The radial, circumferential strain and LVEF does not change significantly in all patients acutely after TAVI. These data suggest that sensitive new echo methods can reliably detect early regional changes of myocardial function after TAVI before benefits in LVEF are detectable.
authors.affiliation: Charité - Universitätsmedizin Berlin, Medizinische Klinik m.S. Kardiologie und Angiologie, Charité Campus Mitte, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Schattke
authors.forename: Gerd
authors.initials: G
authors.lastname: Baldenhofer
authors.forename: Ines
authors.initials: I
authors.lastname: Prauka
authors.forename: Kun
authors.initials: K
authors.lastname: Zhang
authors.forename: Michael
authors.initials: M
authors.lastname: Laule
authors.forename: Verena
authors.initials: V
authors.lastname: Stangl
authors.forename: Wasiem
authors.initials: W
authors.lastname: Sanad
authors.forename: Sebastian
authors.initials: S
authors.lastname: Spethmann
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Borges
authors.forename: Gert
authors.initials: G
authors.lastname: Baumann
authors.forename: Karl
authors.initials: K
authors.lastname: Stangl
authors.forename: Fabian
authors.initials: F
authors.lastname: Knebel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D020127:Recovery of Function; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*