title: Regional left ventricular function after transapical vs. transfemoral transcatheter aortic valve implantation analysed by cardiac magnetic resonance feature tracking.
abstract: OBJECTIVE
  This study analysed the impact of transapical (TA) vs. transfemoral (TF) access site transcatheter aortic valve implantation (TAVI) on post-procedural regional left ventricular (LV) function using cardiac magnetic resonance (CMR) feature tracking (FT).
  
  
  RESULTS
  CMR was performed 3 months after TAVI on 44 consecutive patients with normal LV ejection fraction prior to TAVI. Twenty patients had TA-TAVI, and 24 had TF-TAVI. Standard cine imaging was performed in three standard cardiac long-axis views (two-, four- and three-chamber views). Myocardial peak systolic radial strain (PSRS) and peak systolic longitudinal strain (PSLS) were analysed based on CMR-FT considering 49 segments in each of the three views. There were no differences in PSRS and PSLS for the basal and mid-ventricular segments between TA- and TF-TAVI groups. In contrast, PSRS and PSLS of apical segments and apical cap were reduced in the TA- compared with the TF-TAVI group (PSRS: 15.7 ± 6.4 vs. 35.9 ± 15.7%, respectively, P < 0.001; PSLS: -8.9 ± 5.3 vs. -16.9 ± 4.3%, respectively, P < 0.001). Comparison of all non-apical segments vs. apical segments and apical cap demonstrated no difference in the TF group (PSRS: 34.6 ± 9.0 vs. 35.9 ± 15.7%; respectively, P = 0.702; PSLS: -17.8 ± 4.6 vs. -16.9 ± 4.3%; respectively, P = 0.802). After TA-TAVI, PSRS and PSLS of the apical segments were reduced compared with the non-apical segments (PSRS: 15.7 ± 6.4 vs. 33.5 ± 7.0%, respectively, P < 0.001; PSLS: -8.9 ± 5.3 vs. -15.5 ± 3.5%, respectively, P < 0.001).
  
  
  CONCLUSIONS
  Apical LV function abnormalities can be detected at 3-month follow-up in all TA-TAVI patients using CMR-FT. TA-TAVI results in significant impairment of apical LV function compared with TF-TAVI.
authors.affiliation: Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Meyer
authors.affiliation: Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Frick
authors.affiliation: Department of Cardiac and Thoracic Surgery, University RWTH Aachen, Aachen, Germany.
authors.forename: Shahram
authors.initials: S
authors.lastname: Lotfi
authors.affiliation: Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany.
authors.forename: Ertunc
authors.initials: E
authors.lastname: Altiok
authors.affiliation: Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Koos
authors.affiliation: Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Kirschfink
authors.affiliation: Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Lehrke
authors.affiliation: Department of Cardiac and Thoracic Surgery, University RWTH Aachen, Aachen, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Autschbach
authors.affiliation: Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, Aachen 52074, Germany rhoffmann@ukaachen.de.
authors.forename: Rainer
authors.initials: R
authors.lastname: Hoffmann
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D055424:Cardiac-Gated Imaging Techniques; D005260:Female; D005268:Femoral Vein; D006350:Heart Valve Prosthesis; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology
keywords: Aortic valve stenosis; Cardiac magnetic resonance imaging; Feature tracking; Transcatheter aortic valve implantation; Ventricular function