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. 2020 Sep;7(3):29-38.
doi: 10.1530/ERP-20-0009. Epub 2020 Sep 1.

Left ventricular speckle tracking echocardiographic evaluation before and after TAVI

Vasiliki Tsampasian  1 , Vasileios Panoulas  2   3   4 , Richard J Jabbour  2   3 , Neil Ruparelia  2 , Iqbal S Malik  2 , Nearchos Hadjiloizou  2 , Angela Frame  2 , Sayan Sen  2 , Nilesh Sutaria  2 , Ghada W Mikhail  2   3 , Petros Nihoyannopoulos  2   3
Affiliations

Left ventricular speckle tracking echocardiographic evaluation before and after TAVI

Vasiliki Tsampasian et al. Echo Res Pract. 2020 Sep.

Abstract

Aims: To assess left ventricular (LV) function before and after transcatheter aortic valve implantation (TAVI) using conventional echocardiographic parameters and global longitudinal LV strain (GLS) and compare outcomes between Edwards S3 and Evolut R valves.

Methods and results: Data were collected for consecutive patients undergoing TAVI at Hammersmith hospital between 2015 and 2018. Of the 303 patients, those with coronary artery disease and atrial fibrillation were excluded leading to a total of 85 patients, which constituted our study group. The mean follow-up was 49 ± 39 days. In total, 60% of patients were treated with Edwards S3 and 40% Evolut R. TAVI resulted in an early improvement of GLS (-13.96 to -15.25%, P = 0.01) but not ejection fraction (EF) (47.6 to 50.1%, P = 0.09). LV mass also improved, especially in patients with marked baseline LV hypertrophy (P < 0.001). There were no appreciable differences of LV function improvement and overall LV remodelling after TAVI between the two types of valves used (P = 0.14).

Conclusions: TAVI results in reverse remodelling and improvement of GLS, especially in patients with impaired baseline LV function. There were no differences in the extent of LV function improvement between Edwards S3 and Evolut R valves but there was a greater incidence of aortic regurgitation with Evolut R.

Keywords: aortic stenosis; global longitudinal strain; speckle tracking echocardiography; transcatheter aortic valve implantation.

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Figures

Figure 1
Figure 1
Correlation of improvement in LV mass with baseline LV mass. Patients with greater baseline LV mass had a more significant reduction of the LV mass regression (P < 0.001, r = −0.65).
Figure 2
Figure 2
GLS before and after TAVI. GLS before and after TAVI for the total study population. There was a statistically significant improvement of the GLS after TAVI (P = 0.01).
Figure 3
Figure 3
Case example of GLS improvement before and after TAVI. Speckle tracking analysis of the LV function of a patient with severe AS before (A) and after (B) TAVI.
Figure 4
Figure 4
EF before and after TAVI. There was no significant improvement of the EF before and after TAVI for the total study population.
Figure 5
Figure 5
Correlation of outcome with baseline EF. Baseline EF had a significant impact on the outcome. Patients with reduced baseline EF had a greater improvement after TAVI in terms of left ventricular global longitudinal strain (GLS) (r = −0.3, P = 0.001).
Figure 6
Figure 6
Correlation of outcome with baseline GLS. Patients with lower baseline GLS demonstrated a more significant improvement after TAVI, that is, greater (more negative) GLS difference after TAVI (P value < 0.0001, r = −0.6).
Figure 7
Figure 7
Improvement in GLS according to type of valve. The change in the left ventricular global longitudinal strain after TAVI was not found to be significantly affected by the type of valve used in the procedure, as there were similar changes in the two groups (P = 0.136).
Figure 8
Figure 8
Paravalvular Regurgitation after TAVI according to the type of valve used. Percentage of patients with various degrees of paravalvular regurgitation after TAVI. A significantly higher proportion of patients treated with the Evolut R had moderate paravalvular regurgitation (P = 0.019).
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