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Changes in left ventricular function in patients with aortic regurgitation 12 months after transapical transcatheter aortic valve implantation

  • Ming-dan Deng
  • Xin Wei
  • Xiao-ling Zhang
  • Xiao-dong Li
  • Gu-yue Liu
  • Da Zhu
  • Ying-qiang Guo
  • Hong TangEmail author
Original Paper
  • 79 Downloads

Abstract

Transcatheter aortic valve implantation (TAVI) is an established treatment for high surgical risk aortic stenosis patients; in recent years, it has also been used in patients with pure/dominant aortic regurgitation (AR). This study aimed to determine the impact of transapical TAVI on left ventricle myocardial mechanics in AR patients. Thirty AR patients (70% men; mean age, 72.8 ± 4.3 years) were enrolled. Conventional echocardiography was performed on all patients before and 12 months after TAVI. Three-dimensional speckle tracking was accomplished in 20 AR patients for the evaluation of global longitudinal strain, global circumferential strain, twist, torsion, apical rotation and basal rotation. Preoperative left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), twist, torsion and apical rotation were impaired in AR patients compared with controls. Mean left ventricular (LV) end-diastolic diameter (from 62.9 ± 7.3 to 52.0 ± 6.8 mm, p < 0.001), LV end-diastolic volume (from 199.4 ± 55.0 to 130.1 ± 48.9 mL, p < 0.001), and LV mass index (179.8 ± 52.2–134.4 ± 42.5 g/m2, p = 0.001) decreased 12 months after TAVI. Interestingly, GLS (from − 17.2 ± 3.2 to − 18.9 ± 3.7, p = 0.007) and GCS (from − 23.9 ± 4.9 to − 25.7 ± 5.0, p = 0.008) improved significantly, but LVEF did not significantly improve. In terms of the rotational mechanics, twist, rotation and basal rotation remained almost unchanged, whereas apical rotation (from 7.4 ± 4.0 to 5.5 ± 3.9, p = 0.009) was significantly impaired after transapical TAVI. Our results indicate that LV function was improved in terms of myocardial deformation but worsened in terms of apical rotation 12 months after TAVI in AR patients. Three-dimensional speckle tracking echocardiography appears to be a sensitive method for detecting subtle cardiac remodeling after TAVI.

Keywords

Aortic regurgitation Transcatheter aortic valve implantation Three-dimensional speckle tracking Strain 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the hospital ethics committee.

Informed consent

Written informed consent was obtained from all participants.

References

  1. 1.
    Forman R, Firth BG, Barnard MS (1980) Prognostic significance of preoperative left ventricular ejection fraction and valve lesion in patients with aortic valve replacement. Am J Cardiol 45(6):1120–1125CrossRefGoogle Scholar
  2. 2.
    Li CM, Li C, Bai WJ, Zhang XL, Tang H, Qing Z, Li R (2013) Value of three-dimensional speckle-tracking in detecting left ventricular dysfunction in patients with aortic valvular diseases. J Am Soc Echocardiogr 26(11):1245–1252.  https://doi.org/10.1016/j.echo.2013.07.018 CrossRefGoogle Scholar
  3. 3.
    Ewe SH, Haeck ML, Ng AC, Witkowski TG, Auger D, Leong DP, Abate E, Ajmone Marsan N, Holman ER, Schalij MJ, Bax JJ, Delgado V (2015) Detection of subtle left ventricular systolic dysfunction in patients with significant aortic regurgitation and preserved left ventricular ejection fraction: speckle tracking echocardiographic analysis. Eur Heart J Cardiovasc Imaging 16(9):992–999.  https://doi.org/10.1093/ehjci/jev019 Google Scholar
  4. 4.
    Enache R, Popescu BA, Piazza R, Muraru D, Calin A, Beladan CC, Rosca M, Nicolosi GL, Ginghina C (2015) Left ventricular shape and mass impact torsional dynamics in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction. Int J Cardiovasc Imaging 31(7):1315–1326.  https://doi.org/10.1007/s10554-015-0684-0 CrossRefGoogle Scholar
  5. 5.
    Broch K, de Marchi SF, Massey R, Hisdal J, Aakhus S, Gullestad L, Urheim S (2017) Left ventricular contraction pattern in chronic aortic regurgitation and preserved ejection fraction: simultaneous stress-strain analysis by three-dimensional echocardiography. J Am Soc Echocardiogr 30(4):422–430 e422.  https://doi.org/10.1016/j.echo.2016.11.012 CrossRefGoogle Scholar
  6. 6.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM 3rd, Thomas JD, Members AATF (2014) 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129(23):e521–e643.  https://doi.org/10.1161/CIR.0000000000000031 Google Scholar
  7. 7.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP 3rd, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O’Gara PT, Rigolin VH, Sundt TM 3rd, Thompson A (2017) 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 135(25):e1159–e1195.  https://doi.org/10.1161/CIR.0000000000000503 CrossRefGoogle Scholar
  8. 8.
    Zhu D, Chen Y, Guo Y, Hu J, Zhang J, Wei X, Tang H, Shi Y (2015) Transapical transcatheter aortic valve implantation using a new second-generation TAVI system—J-Valve for high-risk patients with aortic valve diseases: initial results with 90-day follow-up. Int J Cardiol 199:155–162.  https://doi.org/10.1016/j.ijcard.2015.07.037 CrossRefGoogle Scholar
  9. 9.
    Wendt D, Kahlert P, Pasa S, El-Chilali K, Al-Rashid F, Tsagakis K, Dohle DS, Erbel R, Jakob H, Thielmann M (2014) Transapical transcatheter aortic valve for severe aortic regurgitation: expanding the limits. JACC Cardiovasc Interv 7(10):1159–1167.  https://doi.org/10.1016/j.jcin.2014.04.016 CrossRefGoogle Scholar
  10. 10.
    Seiffert M, Bader R, Kappert U, Rastan A, Krapf S, Bleiziffer S, Hofmann S, Arnold M, Kallenbach K, Conradi L, Schlingloff F, Wilbring M, Schafer U, Diemert P, Treede H (2014) Initial German experience with transapical implantation of a second-generation transcatheter heart valve for the treatment of aortic regurgitation. JACC Cardiovasc Interv 7(10):1168–1174.  https://doi.org/10.1016/j.jcin.2014.05.014 CrossRefGoogle Scholar
  11. 11.
    Kiefer P, Seeburger J, Mohr FW, Holzhey DM (2014) Transcatheter aortic valve replacement for isolated aortic valve insufficiency: experience with the engager valve. J Thorac Cardiovasc Surg 147(4):e37–e38.  https://doi.org/10.1016/j.jtcvs.2013.11.035 CrossRefGoogle Scholar
  12. 12.
    Deng MD, Wei X, Tang H, Cai YY, Liu GY, Zhu D, Guo YQ (2017) Application of echocardiography to support transapical transcatheter aortic valve implantation in patients with aortic regurgitation. Sichuan Da Xue Xue Bao Yi Xue Ban 48(6):941–945Google Scholar
  13. 13.
    Poulin F, Carasso S, Horlick EM, Rakowski H, Lim KD, Finn H, Feindel CM, Greutmann M, Osten MD, Cusimano RJ, Woo A (2014) Recovery of left ventricular mechanics after transcatheter aortic valve implantation: effects of baseline ventricular function and postprocedural aortic regurgitation. J Am Soc Echocardiogr 27(11):1133–1142.  https://doi.org/10.1016/j.echo.2014.07.001 CrossRefGoogle Scholar
  14. 14.
    Schueler R, Sinning JM, Momcilovic D, Weber M, Ghanem A, Werner N, Nickenig G, Grube E, Hammerstingl C (2012) Three-dimensional speckle-tracking analysis of left ventricular function after transcatheter aortic valve implantation. J Am Soc Echocardiogr 25(8):827–834 e821.  https://doi.org/10.1016/j.echo.2012.04.023 CrossRefGoogle Scholar
  15. 15.
    Spethmann S, Baldenhofer G, Dreger H, Stuer K, Sanad W, Saghabalyan D, Muller E, Stangl V, Baumann G, Stangl K, Laule M, Knebel F (2014) Recovery of left ventricular and left atrial mechanics in various entities of aortic stenosis 12 months after TAVI. Eur Heart J Cardiovasc Imaging 15(4):389–398.  https://doi.org/10.1093/ehjci/jet166 CrossRefGoogle Scholar
  16. 16.
    Kamperidis V, Joyce E, Debonnaire P, Katsanos S, van Rosendael PJ, van der Kley F, Sianos G, Bax JJ, Ajmone Marsan N, Delgado V (2014) Left ventricular functional recovery and remodeling in low-flow low-gradient severe aortic stenosis after transcatheter aortic valve implantation. J Am Soc Echocardiogr 27(8):817–825.  https://doi.org/10.1016/j.echo.2014.04.021 CrossRefGoogle Scholar
  17. 17.
    D’Ascenzi F, Cameli M, Iadanza A, Lisi M, Zaca V, Reccia R, Curci V, Torrisi A, Sinicropi G, Pierli C, Mondillo S (2013) Improvement of left ventricular longitudinal systolic function after transcatheter aortic valve implantation: a speckle-tracking prospective study. Int J Cardiovasc Imaging 29(5):1007–1015.  https://doi.org/10.1007/s10554-012-0175-5 CrossRefGoogle Scholar
  18. 18.
    Morbach C, Lin BA, Sugeng L (2014) Clinical application of three-dimensional echocardiography. Prog Cardiovasc Dis 57(1):19–31.  https://doi.org/10.1016/j.pcad.2014.05.005 CrossRefGoogle Scholar
  19. 19.
    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(1):1–39 e14.  https://doi.org/10.1016/j.echo.2014.10.003 CrossRefGoogle Scholar
  20. 20.
    Lang RM, Badano LP, Tsang W, Adams DH, Agricola E, Buck T, Faletra FF, Franke A, Hung J, de Isla LP, Kamp O, Kasprzak JD, Lancellotti P, Marwick TH, McCulloch ML, Monaghan MJ, Nihoyannopoulos P, Pandian NG, Pellikka PA, Pepi M, Roberson DA, Shernan SK, Shirali GS, Sugeng L, Ten Cate FJ, Vannan MA, Zamorano JL, Zoghbi WA, American Society of Echocardiography, European Association of Echocardiography (2012) EAE/ASE recommendations for image acquisition and display using three-dimensional echocardiography. Eur Heart J Cardiovasc Imaging 13(1):1–46.  https://doi.org/10.1093/ehjci/jer316 CrossRefGoogle Scholar
  21. 21.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ, Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee, European Association of Echocardiography (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18(12):1440–1463.  https://doi.org/10.1016/j.echo.2005.10.005 CrossRefGoogle Scholar
  22. 22.
    Regeer MV, Versteegh MI, Klautz RJ, Stijnen T, Schalij MJ, Bax JJ, Ajmone Marsan N, Delgado V (2015) Aortic valve repair versus replacement for aortic regurgitation: effects on left ventricular remodeling. J Card Surg 30(1):13–19.  https://doi.org/10.1111/jocs.12457 CrossRefGoogle Scholar
  23. 23.
    Regeer MV, Versteegh MI, Ajmone Marsan N, Schalij MJ, Klautz RJ, Bax JJ, Delgado V (2016) Left ventricular reverse remodeling after aortic valve surgery for acute versus chronic aortic regurgitation. Echocardiography 33(10):1458–1464.  https://doi.org/10.1111/echo.13295 CrossRefGoogle Scholar
  24. 24.
    Pomerantz BJ, Wollmuth JR, Krock MD, Cupps BP, Moustakidis P, Kouchoukos NT, Davila-Roman VG, Pasque MK (2005) Myocardial systolic strain is decreased after aortic valve replacement in patients with aortic insufficiency. Ann Thorac Surg 80(6):2186–2192.  https://doi.org/10.1016/j.athoracsur.2005.05.095 CrossRefGoogle Scholar
  25. 25.
    Chen Y, Zhang Z, Cheng L, Fan L, Wang C, Shu X (2015) The early variation of left ventricular strain after aortic valve replacement by three-dimensional echocardiography. PLoS ONE 10(10):e0140469.  https://doi.org/10.1371/journal.pone.0140469 CrossRefGoogle Scholar
  26. 26.
    Peteiro J, Bouzas-Mosquera A, Broullon J, Sanchez-Fernandez G, Barbeito C, Perez-Cebey L, Martinez D, Vazquez-Rodriguez JM (2017) Left ventricular torsion and circumferential strain responses to exercise in patients with ischemic coronary artery disease. Int J Cardiovasc Imaging 33(1):57–67.  https://doi.org/10.1007/s10554-016-0976-z CrossRefGoogle Scholar
  27. 27.
    Meyer CG, Frick M, Lotfi S, Altiok E, Koos R, Kirschfink A, Lehrke M, Autschbach R, Hoffmann R (2014) Regional left ventricular function after transapical vs. transfemoral transcatheter aortic valve implantation analysed by cardiac magnetic resonance feature tracking. Eur Heart J Cardiovasc Imaging 15(10):1168–1176.  https://doi.org/10.1093/ehjci/jeu103 CrossRefGoogle Scholar
  28. 28.
    Asthana N, Mantha A, Yang EH, Suh W, Aksoy O, Shemin RJ, Vorobiof G, Benharash P (2018) Myocardial functional changes in transfemoral versus transapical aortic valve replacement. J Surg Res 221:304–310.  https://doi.org/10.1016/j.jss.2017.08.036 CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  • Ming-dan Deng
    • 1
  • Xin Wei
    • 1
  • Xiao-ling Zhang
    • 1
  • Xiao-dong Li
    • 1
  • Gu-yue Liu
    • 1
  • Da Zhu
    • 2
  • Ying-qiang Guo
    • 2
  • Hong Tang
    • 1
    Email author
  1. 1.Department of Cardiology, West China HospitalSichuan UniversityChengduPeople’s Republic of China
  2. 2.Department of Cardiovascular Surgery, West China HospitalSichuan UniversityChengduPeople’s Republic of China

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