title: Impact of Prosthesis-Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement.
abstract: BACKGROUND
  The aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis-patient mismatch (PPM).
  
  
  RESULTS
  In a retrospective study, speckle-tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid-term follow-up post-TAVR. Moderate and severe PPM were defined as an effective orifice area ≤0.85 and <0.65 cm(2)/m(2), respectively. A total of 102 patients (median age, 83 years [77-88]) with severe AS were included. At 6±3 months post-TAVR, moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m(2); P=0.001) at follow-up whereas those with PPM did not. There was a significant improvement in LV GLS (-12.8±4.0 to -14.3±4.3%; P=0.01), GLSR (-0.61±0.20 to -0.73±0.25 second(-1); P<0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second(-1); P<0.001) in patients without PPM, but not in those with PPM. After adjustment for pre-TAVR ejection fraction and post-TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM. After a median follow-up of 46.1 months (interquartile range, 35.4-60.8), there was no difference in survival between patients with and without PPM.
  
  
  CONCLUSIONS
  TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM. Presence of PPM was not associated with mortality.
authors: Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada Research Center, Hôpital du Sacré-Coeur de Montréal, University of Montreal Montreal Quebec, Canada.
authors: Frédéric
authors: F
authors: Poulin
authors: Cleveland Clinic Foundation, Cleveland, OH.
authors: Teerapat
authors: T
authors: Yingchoncharoen
authors: Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada.
authors: William M
authors: WM
authors: Wilson
authors: Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada.
authors: Eric M
authors: EM
authors: Horlick
authors: Research Center, Hôpital du Sacré-Coeur de Montréal, University of Montreal Montreal Quebec, Canada.
authors: Philippe
authors: P
authors: Généreux
authors: Cleveland Clinic Foundation, Cleveland, OH.
authors: E Murat
authors: EM
authors: Tuzcu
authors: Cleveland Clinic Foundation, Cleveland, OH.
authors: William
authors: W
authors: Stewart
authors: Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada.
authors: Mark D
authors: MD
authors: Osten
authors: Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada.
authors: Anna
authors: A
authors: Woo
authors: Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada dinesh.thavendiranathan@uhn.ca.
authors: Paaladinesh
authors: P
authors: Thavendiranathan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D001696:Biomechanical Phenomena; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009200:Myocardial Contraction; D009820:Ohio; D009864:Ontario; D011474:Prosthesis Design; D011792:Quebec; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013314:Stress, Mechanical; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: aortic stenosis; effective orifice area; prosthesis‐patient mismatch; speckle‐tracking echocardiography; strain; transcatheter aortic valve replacement