title: Effects of transcatheter aortic valve implantation on left ventricular and left atrial morphology and function.
abstract: OBJECTIVE
  Transcatheter aortic valve implantation (TAVI) is an alternative treatment in surgically high-risk or inoperable patients with severe aortic stenosis (AS). The objective of this study was to analyze the effects of TAVI on left ventricular (LV) and left atrial (LA) longitudinal function assessed by speckle tracking echocardiography (2DSTE) in patients with AS.
  
  
  METHODS
  In our prospectively conducted study, a total of 55 symptomatic (New York Heart Association class II or higher) patients with severe AS, considered to be at increased risk for undergoing surgical aortic valve replacement, were recruited (age: 78.6 ± 7.4 year). Patients underwent a complete clinical and laboratory evaluation, in addition to standard echocardiography and 2DSTE. Echocardiographic analysis was performed before and 6 months after TAVI. 2DSTE measured segmental and global longitudinal strain (GLS) and radial strain.
  
  
  RESULTS
  All the patients received the CoreValve self-expanding prosthesis. Six months after TAVI, patients showed a significant reduction in mean transaortic gradient (52.1 ± 15.8 vs. 11.2 ± 3.3 mmHg, P < 0.0001), LV mass, LA volume index, and an improvement of ejection fraction (P < 0.0001). In addition, LV GLS (-11.8 ± 3.2 vs. -16.3 ± 4.2%; P < 0.0001) and LA longitudinal strain (14.2 ± 5.4 vs. 26.6 ± 10.8%, P < 0.0001) significantly increased after TAVI. In a stepwise forward multiple logistic regression analysis, LV mass before TAVI (P < 0.001) and peak CK MB mass after TAVI (P < 0.0001) were powerful independent predictors of lower improvement of LV GLS. Moreover, LV mass index (P < 0.001) and LV GLS strain (P < 0.001) before TAVI were powerful independent predictor of LA longitudinal strain after TAVI CONCLUSIONS: TAVI in patients with AS resulted in geometric changes known as "reverse remodelling," and improved LV and LA function assessed by 2DSTE.
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Padalino
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Rosangela
authors.initials: R
authors.lastname: Cocchia
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Enza
authors.initials: E
authors.lastname: Di Palma
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Riegler
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Scarafile
authors.affiliation: Department of Radiology, Monaldi Hospital, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rossi
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Bianchi
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Donato
authors.initials: D
authors.lastname: Tartaglione
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cappelli Bigazzi
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Calabrò
authors.affiliation: Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.affiliation: Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Calabrò
authors.affiliation: Chair of Cardiology, Second University of Naples, AORN dei Colli, Monaldi Hospital, Naples, Italy.
authors.forename: Maria Giovanna
authors.initials: MG
authors.lastname: Russo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D065467:Transcatheter Aortic Valve Replacement; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000517:prevention & control
keywords: aortic stenosis; left atrium; left ventricle; transcatheter aortic valve implantation; two-dimensional strain imaging