Changes in myocardial deformation after transcatheter and surgical aortic valve replacement

Abstract

Speckle tracking echocardiography (STE) has emerged as a novel angle-independent modality in assessing myocardial velocity, deformation, and strain. Its role in assessing change before and after aortic valve replacement in patients with aortic stenosis (AS) has recently generated interest. This review summarizes the practical utility and clinical implications of myocardial deformation by STE after surgical or transcatheter aortic valve replacement (TAVR). Overall, atrial strain and ventricular strain as measured by STE improve after surgical and transcatheter aortic intervention in short- and long-term follow-up with evidence of a more pronounced acute improvement in patients who undergo TAVR. STE assessment of strain, particularly global longitudinal strain, can detect subtle changes in myocardial systolic function prior to conventional variables such as left ventricular ejection fraction and is clinically useful in predicting mortality and symptom development in patients with AS. This underscores the emerging role of STE in monitoring post-procedural improvements in cardiac function as well as the potential value in guiding optimal timing of AS intervention.

Changes in dynamic left ventricular function, assessed by the strain-volume loop, relate to reverse remodeling after aortic valve replacement

“…Valve characteristics. Pre-AVR measurements were performed 8 days before surgery, whilst post-AVR measures were taken at 13 [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] days. Maximal blood flow velocities and mean pressure gradient across the aortic valve significantly decreased post-AVR, whilst the aortic valve area significantly increased (Table 2).…”

“…Post-AVR, however, the E/E' ratio decreases (although not statistically significant) and E' velocity increases, indicating an improvement in diastolic function. The immediate drop in LV filling pressure post-AVR may contribute to normalization of LV twist and untwist, (7,22) restoring LV suction and allowing for a stronger coherence (i.e. coupling) between systolic and diastolic ԑ contribution to volume change.…”

Regression of left ventricular hypertrophy provides an additive physiological benefit following treatment of aortic stenosis: Insights from serial coronary wave intensity analysis

“…27 We would suggest that the incorporation of strain-mapping in future studies would provide further valuable insight into the coronary-myocardial coupling and its dysfunction in aortic stenosis and would be more sensitive than the conventional measures of diastolic function we have reported here. 27 We would suggest that the incorporation of strain-mapping in future studies would provide further valuable insight into the coronary-myocardial coupling and its dysfunction in aortic stenosis and would be more sensitive than the conventional measures of diastolic function we have reported here.…”

“…We also note the effect of aortic valve intervention on strain imaging. 27 We would suggest that the incorporation of strain-mapping in future studies would provide further valuable insight into the coronary-myocardial coupling and its dysfunction in aortic stenosis and would be more sensitive than the conventional measures of diastolic function we have reported here. We also highlight previously reported data demonstrating the impact of diastolic function on the BDW in the context of coronary occlusion 28 and would emphasize the importance of incorporating all these features in futures work.…”

Myocardial functional changes in transfemoral versus transapical aortic valve replacement

“…21 However, literature utilizing GLS to grade functional recovery following percutaneous cardiac interventions such as TAVR remains limited. 22 Moreover, research utilizing STE specifically to compare TF-TAVR to TA-TAVR approaches has been sparse and produced mixed results thus far. In a study of 26 TAVR patients, Bochenek et al found that in contrast to the TF approach, TA patients showed no significant improvement in peak systolic longitudinal strain at a 1-y follow-up.…”