Abstract 17274: Temporal Changes in Myocardial Function after Transcatheter Aortic Valve Replacement for Aortic Stenosis with Speckle Tracking Echocardiography

Abstract

Objectives: Transcatheter aortic valve replacement (TAVR) offers a safer treatment solution for frail and elderly patients with severe aortic stenosis (AS) and significant comorbidities. Although TAVR provides sudden and drastic changes in hemodynamics in less invasive manner, changes in myocardial function accompanied with acute afterload reduction have been well undefined. To investigate them, speckle tracking echocardiography (STE) was applied to evaluate longitudinal, radial, and circumferential function and torsion in patients with AS before and after TAVR.

Methods and results: In 16 patients with optimal echocardiographic images and sinus rhythm out of 24 consecutive patients undergoing TAVR at Osaka university hospital, we acquired apical 4-, 3-, and 2-chamber views and standard short-axis views before and 2 days and one month after TAVR. Global longitudinal (GLS), radial (GRS), and circumferential strain (GCS) and left ventricular (LV) torsion were measured by GE Vivid 7. With TAVR, valve area increased and remained stable at one month follow-up. LV ejection fraction remained unchanged but LV mass decreased in 2days. GRS improved at 2 days and GLS improved at one month. However, GCS did not change significantly during the first month, although it tended to improve. LV torsion tended to normalize over time.

Conclusion: Independent of LV ejection fraction, myocardial function significantly recovers promptly after TAVR. However, there is a considerable difference among the response of longitudinal, radial, and circumferential function. Radial strain seems to be an early sign of myocardial improvement before the improvement of LV ejection fraction. Speckle tracking echocardiographic assessment of regional function is feasible and of potential clinical importance after TAVR.