Abstract 13258: 3d Speckle Tracking Analysis of Left Ventricular Function after Transcatheter Aortic Valve Implantation

Abstract

Background: The acute and long-term effects of transcatheter aortic valve implantation (TAVI) in patients with aortic valve stenosis (AVS) on left ventricular (LV) function are controversial. We aimed to determine the effect of TAVI on LV function with 2 and 3 dimensional speckle tracking (3DST) analysis of LV deformation capability.

Methods: Patients underwent standardized 2 and 3 dimensional (2D, 3D) transthoracic echocardiography (TTE) before TAVI and after 6 months of follow up (FU) including 3D and 2D LV deformation imaging.

Results: 44 patients (81.7 ± 5.5 years; 21 [47.7%] male; body mass index [BMI] 26.3 ± 5.1; logistic EuroSCORE, 24.4 ± 13.7%) undergoing TAVI were prospectively included. After FU 3DLV ejection fraction (3DEF) (35.4 ± 13.1%, 40.6 ± 12.6%; P=0.004), 3DLV volumes (endsystolic volume [ESV]: 85.9 ± 41.8 ml, 65.9 ± 33.7 ml; P<0.001, enddiastolic volume [EDV]: 127.6 ± 40.7 ml, 106.4 ± 40.9 ml; P=0.001), 3D global longitudinal strain (GLS) (-9.9 ± 3.7%, -12.6 ± 4.2%; P<0.001), and 3DLV twist (6.1 ± 4.3°, 8.5 ± 6.9°; P=0.025) were relevantly improved. LV improvement was pronounced in patients with decreased baseline LV function (AUC 0.78, P<0.001) with a cut off value (COV) for 3DEF of ≤ 37% to identify functional responders to TAVI. After FU, patients with 3DEF ≤ COV showed a significant improvement in 3DEF (26.0 ± 7.6%, 35.9 ± 11.7%; P<0.001), 3DLV volumes (EDV: 147.4 ± 40.6 ml, 117.1 ± 45.5 ml; p=0.001, ESV: 110.9 ± 39.2 ml, 77.5 ± 37.2 ml; P<0.001), 3D GLS (-7,8 ± 2,7%, -11.3 ± 4.2%; P COV only 3DGLS was relevantly altered (-12.5 ± 3.1%, -14.2 ± 3.8%; P=0.04). Compared to 2D TTE, 3DLV function imaging allowed for significant faster image acquisition and data analysis (P<0.0001). A significant decrease of NT-pro-BNP was observed only in patients with baseline 3DEF ≤ COV (10314.64 ± 11682.2 pg/ml, 3398.7 ± 3598.9 pg/ml, P=0.02; 3DEF > COV: 10306.4 ± 32000.5 pg/ml, 2868.0 ± 3816.7 pg/ml, P=0.12).

Conclusions: Our results indicate on a significant improvement of LV global and longitudinal function and clinical parameters 6 months after TAVI that is pronounced in patients with impaired baseline LV function. As compared with 2DLV function imaging, 3DST allowed for significant faster image acquisition and data analysis.