Response of left ventricular strain, strain rate and myocardial twist after transcatheter aortic valve implantation

Type Clinical research. Presentation Type Oral presentation. Introduction Severe aortic stenosis (AS) causes Impairment of left ventricular (LV) myocardial deformation and associated with adverse outcome. The aim of this retrospective study was to assess the impact of TAVI on the recovery of myocardial mechanics. Methodology Speckle-tracking echocardiography was used to assess global longitudinal strain (GLS), circumferential strain (CS) and rotational mechanics (apical rotation, basal rotation and twist) before and at midterm follow-up after TAVI. Predictors of myocardial recovery, defined as a 20% relative increase in the magnitude of GLS compared to baseline, were examined. Results Fifty-nine patients (mean age, 80.2 ± 11.7 years) with severe AS and high surgical risk (mean Euro score, 12.9 ± 5.3%) were evaluated. At 8 ± 3 months after TAVI, GLS had significantly improved in patients with normal and depressed LVEF. The patients with baseline LVEF ⩾50%: GLS improved from 9.5 ± 3% to 12.2 ± 3.3% ( P = .0001). The patients with baseline LVEF >50%: GLS improved from 13.9 ± 3.3% to 15.2 ± 3.3% ( P = .003). In patients with LVEF >50%, LV twist was supraphysiologic at baseline and moved towards normal after TAVI (from 21.2 ± 6.9 to 15.6 ± 7.6, P = .001). In patients with LVEF ⩾50% there is no significant change in LV twist P = .853. In patients with LVEFs ⩾50%, CS was impaired before TAVI and improved after TAVI from −17.3 ± 6.6 to −20.7 ± 6.1, P = .01. Baseline GLS (odds ratio, 0.65, P < .001), base line LVEF (odds ratio, 0.34, P < .01) and LV twist (odds ratio, 0.46, P < .02) were significant predictors of myocardial recovery. Conclusion TAVI restores LV function toward more physiologic myocardial mechanics in both normal and depressed LVEF groups. Patients with lower systolic function derive the most benefit in terms of longitudinal reverse remodeling. Baseline GLS, LVEF and LV twist wear predictors of myocardial recovery.