Abstract 14593: Impact of Trans-Catheter Aortic Valve Implantation on Left Ventricular Systolic and Diastolic Properties: Real-time One-beat 3-dimensional Speckle Tracking Echocardiography Study
Background: Left ventricle (LV) with aortic stenosis (AS) has severe remodeling due to pressure overload, resulting in systolic and diastolic dysfunction. LV endocardium is most susceptible to deleterious effect of LV remodeling and LV outer muscle plays a predominant role in torsion which contributes a part of ejection fraction (EF), followed by rapid untorsion which contributes to LV filling. We sought to evaluate the impact of trans-catheter aortic valve implantation (TAVI) on LV properties by 3-dimensional speckle tracking echocardiography (3D-STE).
Methods: LV properties were assessed by 3D-STE before and after TAVI in 60 patients with severe AS (age: 85±5). LVEF, peak strain and torsion (°/cm) were assessed as index of systolic function. Tau and LV untorsion rate (°/cm/sec) which was measured as a tangent of downward slope of time-torsion curve from top to early diastole 40msec after mitral valve opening were assessed as index of relaxation. The ratio between torsion and stroke volume (Torsion / SV) was calculated to estimate the effect of torsion compensation for LV volume change. The ratio between torsion and strain (Torsion / strain) was adopted to estimate torsion relative to myocardial dysfunction.
Results: Peak pressure gradient and LV systolic stress decreased significantly 1 week after TAVI from 84±30 to 19±7mmHg and 67±15 to 49±11dyne/cm2. LVEF was increased after TAVI (before: 47±11 vs after: 50±11*%, *p<0.05 vs before) associated with increased strain in all three directions (longitudinal; -10±3 vs -12±3*, radial; 26±7 vs 29±8*, circumferential; -15±4 vs -17±4*) and increased torsion (1.1±0.3 vs 1.2±0.3*°/cm) despite no reduction in LV mass (146±37 vs 144±34g/m2). LV untorsion rate increased (-3.0±1.4 vs -3.9±1.7* °/cm/sec) and tau improved after TAVI (57±8 vs 52±8* msec). Torsion / SV was increased after TAVI (0.026±0.011 vs 0.030±0.011* °/cm/ml) with no difference in Torsion / radial strain (0.048±0.016 vs 0.047±0.016 °/cm).
Conclusions: LV systolic and diastolic function were improved one week after TAVI associated with decreased systolic stress without reduction of LV mass, suggesting that LV functional reverse remodeling may occur at early stage after TAVI due to release from pressure overload before structural remodeling begins.
Author Disclosures: I. Kawamura: None. M. Saeki: None. M. Kawasaki: None. R. Tanaka: None. T. Kato: None. T. Yoshizane: None. K. Ono: None. S. Watarai: None. M. Yamamoto: None. M. Nagaya: None. M. Arai: None. K. Tsuchiya: None. H. Matsuo: None. T. Noda: None. T. Suzuki: None. H. Ohashi: None. S. Minatoguchi: None.
- © 2016 by American Heart Association, Inc.