Key result
TAVR improves longitudinal strain in high-flow/high-gradient and low-flow/low-gradient AS, but not paradoxical low-flow/low-gradient AS.
Why the study?
Does TAVR improve left-ventricular strain parameters assessed by FT CMR in patients with symptomatic severe aortic stenosis?
Cohort (n=30)
Blinded image analysis
No
Does TAVR improve left-ventricular strain parameters assessed by FT CMR in patients with symptomatic severe aortic stenosis?
Absolute Event Rate: -15.46% vs -12.67%
p-value: p=0.048
Improvement in left ventricular longitudinal strain after TAVR depends on the baseline hemodynamic subtype of aortic stenosis, with significant recovery seen in high-flow/high-gradient and low-flow/low-gradient patients, but not in paradoxical low-flow/low-gradient patients.
Strain recovery post-TAVR is subtype-dependent; leaves open whether paradoxical low-flow/low-gradient patients require distinct management strategies.
AIMS: To assess left-ventricular strain parameters before and after transcatheter aortic valve replacement (TAVR) by feature tracking cardiac magnetic resonance imaging (FT CMR) and to correlate the findings to hemodynamic state and left-ventricular remodeling. METHODS AND RESULTS: Patients with symptomatic AS underwent FT CMR before and after TAVR. Patients were carefully evaluated by a comprehensive work-up including CMR, echocardiography and left and right heart catheterization. Thirty patients formed the study population. High-flow/high-gradient (HF/HG) aortic stenosis was diagnosed in 11 patients (36.7%), 6 patients (20.0%) exhibited low-flow/low-gradient AS (LF/LG) and 13 patients (43.3%) were classified to have so-called paradoxical low-flow/low-gradient (PLF/LG) AS. The HF/HG patients had a significantly reduced longitudinal strain which recovered after TAVR (-12.67 ± 4.60 to -15.46 ± 5.61%, p = 0.048). In the LF/LG group, an even more pronounced reduction of longitudinal strain and also an impairment of longitudinal velocity could be observed. Both parameters improved after therapy (strain: -5.06 ± 4.25 to -8.02 ± 3.28%, p = 0.045; velocity: 25.33 ± 9.63 to 37.13 ± 11.64 mm/s, p = 0.042). Patients with PLF/LG showed preserved longitudinal strain but a reduction of longitudinal velocity similar to the LF/LG group. These patients did not show a significant improvement of strain parameters after TAVR. Longitudinal velocity exhibited the highest predictive power for the identification of a low-flow state (sensitivity 75%, specificity 80%). CONCLUSION: Improvement of longitudinal strain parameters after TAVR is dependent on the initial hemodynamically defined AS subgroup.
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Buckert et al. (2017) conducted a cohort in Severe aortic stenosis (n=30). Transcatheter aortic valve replacement (TAVR) vs. Baseline (before TAVR) was evaluated on Longitudinal strain in high-flow/high-gradient aortic stenosis (p=0.048). Transcatheter aortic valve replacement significantly improved longitudinal strain in patients with high-flow/high-gradient and low-flow/low-gradient aortic stenosis, but not in those with paradoxical low-flow/low-gradient aortic stenosis.
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