Abstract 11414: Changes in Speckle-Tracking Echocardiography Measures of Ventricular Function After Percutaneous Implantation of the Edwards SAPIEN Transcatheter Heart Valve in the Pulmonary Position
Background: Patients with free pulmonary regurgitation and severely dilated right ventricles (RV) show little improvement in ventricular function after pulmonary valve replacement when assessed by traditional echocardiographic markers. We evaluated changes in right and left ventricular function using speckle-tracking and conventional two-dimensional echocardiography (2DE) before and after SAPIEN transcatheter pulmonary valve (TPV) placement.
Methods: Echocardiograms were evaluated at baseline, discharge, 1 and 6 months after TPV placement in 24 patients from 4 centers. A single, blinded observer performed offline analysis of DICOM images using vendor-independent software (Tomtec 2D Cardiac Performance Analysis). Speckle-tracking measures of function from the apical 4-chamber view included peak longitudinal strain, strain rate, and early diastolic strain rate. Using 2DE, RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and left ventricular (LV) ejection fraction (EF) from single plane Simpson’s method were assessed. Doppler and tissue Doppler (TDI) velocities and derived ratios (E:A, E:E’) were measured.
Results: At baseline, all patients demonstrated moderate to severe pulmonary regurgitation, which improved significantly after TPV. No significant changes were detected in RV FAC, TAPSE, tricuspid Doppler and TDI diastolic velocities and ratios, LV EF, or mitral inflow Doppler and septal TDI diastolic velocities and ratios. Speckle-tracking measures of ventricular function improved significantly; these and other significant changes are shown in the Table.
Conclusion: Improvements in RV and LV peak longitudinal strain and RV strain rate are seen at six months post TPV. Parameters of diastolic function do not appear to change at six month follow-up. Speckle-tracking echocardiography may be more sensitive than traditional measures in detecting changes in systolic function after TPV implantation.
- © 2013 by American Heart Association, Inc.