Abstract 17723: The Effect of Trans-Catheter Aortic Valve Replacement on Left Ventricular Systolic and Diastolic Function Measured by Speckle Tracking Echocardiography

Abstract

Background: Symptomatic aortic stenosis is associated with a high rate of death in untreated patients. In the PARTNER trial, patients randomized to transcatheter aortic valve replacement (TAVR) had a survival benefit as compared to “standard care”. Speckle tracking echocardiography (STE) is a novel quantitative method for assessing global left ventricular function which is more sensitive to subtle changes over time. The aim of this study was to compare LV function before and after TAVR using STE.

Methods: Patients (n=166) undergoing randomization for TAVR from 11/15/2007 until 1/1/2011 were included in our study. Pre and post-procedure echoes between 6 -12months and beyond 12 months after TAVR were evaluated. Speckle tracking was performed using Tomtec software. Paired T-tests were used to compare average strain rates at differing points in time. The degree of para-valvular leak, transfemoral vs. transapical approach and age were separately weighted in analysis.

Results: 357 transthoracic echoes were analyzed. Table 1 shows paired T-tests of systolic and diastolic strain rates over time. The average systolic and late diastolic strain rates at 1 year were significantly improved when compared to baseline. When adjusted for age, late diastolic function continued to be significant (p=0.021) over time.

Discussion: This is the largest cohort of TAVR patients to be analyzed in this manner, and the first to analyze diastolic parameters after TAVR. This study demonstrates a lasting improvement in systolic and late diastolic strain rates at 1 year in all patients. When adjusted for age, improvement in late diastolic strain rates, which correlate to the atrial kick in diastole, is the only significant change seen. Although there is an improvement of both systolic and diastolic components in all patients by one year, it is perhaps the re-emergence of the diastolic atrial kick that ultimately contributes to the survival benefit after TAVR.