Key result
TAVR without PPM is linked to improved LV GLS and LV mass regression.
Why the study?
Does the absence of prosthesis-patient mismatch after TAVR improve left ventricular myocardial mechanics in patients with severe aortic stenosis?
Cohort (n=102)
Does the absence of prosthesis-patient mismatch after TAVR improve left ventricular myocardial mechanics in patients with severe aortic stenosis?
p-value: p=0.01
Absence of prosthesis-patient mismatch after TAVR is associated with greater reverse left ventricular remodeling and improved myocardial strain, although it does not appear to impact mid-term survival.
May support minimizing PPM during TAVR planning; extends observational data on LV remodeling but leaves clinical outcomes open.
BACKGROUND: The aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis-patient mismatch (PPM). METHODS AND RESULTS: In a retrospective study, speckle-tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid-term follow-up post-TAVR. Moderate and severe PPM were defined as an effective orifice area ≤0.85 and <0.65 cm(2)/m(2), respectively. A total of 102 patients (median age, 83 years [77-88]) with severe AS were included. At 6±3 months post-TAVR, moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m(2); P=0.001) at follow-up whereas those with PPM did not. There was a significant improvement in LV GLS (-12.8±4.0 to -14.3±4.3%; P=0.01), GLSR (-0.61±0.20 to -0.73±0.25 second(-1); P<0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second(-1); P<0.001) in patients without PPM, but not in those with PPM. After adjustment for pre-TAVR ejection fraction and post-TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM. After a median follow-up of 46.1 months (interquartile range, 35.4-60.8), there was no difference in survival between patients with and without PPM. CONCLUSIONS: TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM. Presence of PPM was not associated with mortality.
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Poulin et al. (2016) conducted a cohort in Severe aortic stenosis (n=102). Prosthesis-patient mismatch (PPM) vs. No prosthesis-patient mismatch was evaluated on Left ventricular global longitudinal strain (GLS) (p=0.01). Absence of prosthesis-patient mismatch after TAVR was associated with significant improvement in LV global longitudinal strain (-12.8% to -14.3%; P=0.01) and LV mass regression (P=0.001).
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