Abstract 10940: Left Ventricular Functional Recovery and Remodeling in Low Flow, Low Gradient Severe Aortic Stenosis After Transcatheter Aortic Valve Implantation
Objectives: To evaluate left ventricular (LV) functional recovery and remodelling after transcatheter aortic valve implantation (TAVI) in low flow, low gradient severe aortic stenosis (LFLGAS) patients.
Background: It has been suggested that speckle-tracking derived global longitudinal strain (GLS) may be a more sensitive method of detecting LV functional recovery after TAVI in aortic stenosis (AS) patients. However it remains unknown whether LV function improves in LFLGAS patients after TAVI.
Methods: Of 253 patients treated with TAVI, 68 (79±7 years, 57% men) had LFLGAS and were retrospectively evaluated. LV function, assessed with GLS and remodelling, assessed with LV mass index (LVMi), were investigated pre and 6 and 12 months after TAVI. All parameters are expressed as mean [standard error of the mean].
Results: Among LFLGAS patients, 35 (52%) had low LV ejection fraction (LVEF<50%) pre-TAVI and 33 (48%) had preserved LVEF (≥50%). The low LVEF group had significantly more impaired GLS (-8.2 [0.4] vs. -13.2 [0.6] %; p<0.001) than the group with preserved LVEF. LFLGAS patients after TAVI had significantly improved LV GLS over the 12 month follow-up (-10.7 [0.4] to -12.6 [0.6]%; p=0.002) although they had no significant change in LVEF over time (45.8 [1.9] to 49.8 [2.2]%; p=0.08). LVMi reduced significantly over time (138.8 [4.8] to 126.1 [4.7] g/m2; p=0.01). However, LV end-diastolic volume index and LV end-systolic volume index remained unchanged. All changes are summarised in the figure. GLS improved significantly over 12-months independently of the LVEF group at baseline (p=0.003). GLS and LVMi changed significantly during the first 6-months after TAVI (p for both <0.05) and remained stable for the following 6-months.
Conclusions: LFLGAS patients display significantly improved LV function after TAVI, regardless of baseline LVEF category. In addition, reverse remodelling, as a significant LV mass reduction, was observed.
- © 2013 by American Heart Association, Inc.