Changes of left ventricular mechanics after trans-catheter aortic valve implantation and surgical aortic valve replacement for severe aortic stenosis: A tissue-tracking cardiac magnetic resonance study.
Nucifora G, Tantiongco JP, Crouch G, Bennetts J, Sinhal A, Tully PJ, Bradbrook C, Baker RA, Selvanayagam JB.
Int J Cardiol. 2017 Feb 1;228:184-190. doi: 10.1016/j.ijcard.2016.11.200. Epub 2016 Nov 9.
Abstract
Background: Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). The aim of the present study was to assess their changes early and late after trans-catheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR) using cardiac magnetic resonance (CMR) tissue-tracking imaging.
Results: The TAVI and surgical AVR groups were similar with respect to baseline (p=0.14) and early post-procedure (p=0.16) LV ejection fraction. However, baseline LV GLS was significantly impaired in TAVI patients compared to surgical AVR patients (p=0.025). Early post-procedure, TAVI resulted in a significant improvement of LV GLS (p=0.003), while a significant worsening of LV GLS was observed early after surgical AVR (p=0.012). At longer term follow-up, both TAVI and surgical AVR groups experienced a significant reduction of LV mass and a significant improvement of LV myocardial mechanics in all the three directions.
Conclusion: Treatment-specific differences in the changes of LV myocardial mechanics early after afterload release by TAVI and surgical AVR are present. Later, both interventions are associated with an improvement of LV myocardial deformation, alongside a regression of LV hypertrophy.