title: Does the transapical approach impair early recovery of systolic strain following transcatheter aortic valve replacement?
abstract: BACKGROUND
  In transcatheter aortic valve replacement (TAVR) the trans-apical approach (TA) is associated with apical myocardial injury but it is unknown if this injury impacts myocardial function. This study was performed to assess the impact of TA on apical longitudinal strain (ALS) and global longitudinal strain (GLS) after TAVR.
  
  
  METHODS
  44 consecutive patients (age 81 ± 7 years, 48% male) underwent TAVR via trans-femoral (TF) (n=27) or TA (n=17) approach. Speckle-tracking analysis of left ventricular longitudinal strain was performed on images from peri-procedure transesophageal echocardiograms immediately before and after valve implantation. The primary endpoint was a GLS improvement of at least 25% post-TAVR.
  
  
  RESULTS
  GLS improved significantly above baseline after valve implantation in both TF (p<0.001) and TA (p=0.027) groups. The absolute magnitudes of ALS and GLS improvement were similar between TF and TA patients (ALS: p=0.282; GLS: p=0.248). Peak ALS and GLS achieved post-TAVR were similar between TF and TA patients (ALS: p=0.933; GLS: p=0.365). 47% of patients achieved a GLS improvement of >25%; 16 of which improved their GLS to <-15%. The severity of pre-TAVR GLS impairment was a strong independent predictor of GLS improvement (OR=1.61, p=0.003). A pre-TAVR GLS ≥-13.7% was 82% sensitive and 82% specific for TAVR to confer a GLS improvement >25%.
  
  
  CONCLUSIONS
  Equal improvement in myocardial strain was observed in the TF and TA patients. Pre-TAVR GLS impairment was an independent predictor of post-TAVR GLS recovery, highlighting how it is the patient's baseline GLS dysfunction, not the method of approach, that dictates post-TAVR functional recovery.
authors: Department of Internal Medicine, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai New York, NY, 10003, USA.
authors: Tomo
authors: T
authors: Ando
authors: Department of Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY 10467, USA.
authors: Anthony A
authors: AA
authors: Holmes
authors: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY 10467, USA.
authors: Cynthia C
authors: CC
authors: Taub
authors: Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY 10467, USA.
authors: Joseph J
authors: JJ
authors: DeRose
authors: Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY 10467, USA ; Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine Bronx, NY 10467, USA.
authors: David P
authors: DP
authors: Slovut
keywords: Transcatheter aortic valve replacement; aortic stenosis; speckle tracking analysis; strain