title: Assessment of valve haemodynamics, reverse ventricular remodelling and myocardial fibrosis following transcatheter aortic valve implantation compared to surgical aortic valve replacement: a cardiovascular magnetic resonance study.
abstract: OBJECTIVE
  To compare the effects of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) on aortic valve haemodynamics, ventricular reverse remodelling and myocardial fibrosis (MF) by cardiovascular magnetic resonance (CMR) imaging.
  
  
  METHODS
  A 1.5 T CMR scan was performed preoperatively and 6 months postoperatively.
  
  
  METHODS
  University hospitals of Leeds and Leicester, UK.
  
  
  METHODS
  50 (25 TAVI, 25 SAVR; age 77±8 years) high-risk severe symptomatic aortic stenosis (AS) patients.
  
  
  METHODS
  Valve haemodynamics, ventricular volumes, ejection fraction (EF), mass and MF.
  
  
  RESULTS
  Patients were matched for gender and AS severity but not for age (80±6 vs 73±7 years, p=0.001) or EuroSCORE (22±14 vs. 7±3, p<0.001). Aortic valve mean pressure gradient decreased to a greater degree post-TAVI compared to SAVR (21±8 mm Hg vs. 35±13 mm Hg, p=0.017). Aortic regurgitation reduced by 8% in both groups, only reaching statistical significance for TAVI (p=0.003). TAVI and SAVR improved (p<0.05) left ventricular (LV) end-systolic volumes (46±18 ml/m2 vs. 41±17 ml/m2; 44±22 ml/m2 vs. 32±6 ml/m2 and mass (83±20 g/m2 vs. 65±15 g/m2; 74±11 g/m2 vs. 59±8 g/m2). SAVR reduced end-diastolic volumes (92±19 ml/m2 vs. 74±12 ml/m2, p<0.001) and TAVI increased EF (52±12% vs. 56±10%, p=0.01). MF reduced post-TAVI (10.9±6% vs. 8.5±5%, p=0.03) but not post-SAVR (4.2±2% vs. 4.1±2%, p=0.98). Myocardial scar (p≤0.01) and baseline ventricular volumes (p<0.001) were the major predictors of reverse remodelling.
  
  
  CONCLUSIONS
  TAVI was comparable to SAVR at LV reverse remodelling and superior at reducing the valvular pressure gradient and MF. Future work should assess the prognostic importance of reverse remodelling and fibrosis post-TAVI to aid patient selection.
authors.affiliation: Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS1 3EX, UK.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Fairbairn
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Steadman
authors.forename: Adam N
authors.initials: AN
authors.lastname: Mather
authors.forename: Manish
authors.initials: M
authors.lastname: Motwani
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Blackman
authors.forename: Sven
authors.initials: S
authors.lastname: Plein
authors.forename: Gerry P
authors.initials: GP
authors.lastname: McCann
authors.forename: John P
authors.initials: JP
authors.lastname: Greenwood
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects; D016009:Chi-Square Distribution; D004739:England; D005260:Female; D005355:Fibrosis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006785:Hospitals, University; D006801:Humans; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008943:Mitral Valve / Q000503:physiopathology; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling