Predictive Value of Left Ventricular Myocardial Deformation for Left Ventricular Remodeling in Patients With Classical Low-Flow, Low-Gradient Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is an alternative treatment in surgically intermediate-or high-risk patients with classical low-flow, low-gradient (LFLG) aortic stenosis (AS). The objective of this study was to investigate whether two-dimensional (2D) speckle-tracking echocardiography (STE) can predict left ventricular (LV) flow reserve during dobutamine stress echocardiography (DSE) and remodeling after TAVR in patients with LFLG AS. Methods: Seventy-five symptomatic patients with severe LFLG AS were recruited (mean age, 77.6 6 8.4 years). Patients underwent a complete clinical evaluation, standard echocardiography, 2D STE, and DSE. Echocardiographic analysis was performed before and 6 months after TAVR using global longitudinal strain (GLS) measured on 2D STE. Results: All patients received self-expanding transcatheter prosthetic valves. Six months after TAVR, LV GLS (12.8 6 3.2% vs 16.3 6 4.2%, P < .0001) significantly increased. In a multivariate analysis, LV GLS before TAVR (P < .0001) was an independent predictor of LV flow reserve during DSE. By receiver operating characteristic curve analysis, a cutoff value for LV GLS of #12% well distinguished patients without significant flow reserve and with lack of positive remodeling after TAVR at follow-up. These results support the hypothesis that myocardial analysis by 2D STE at baseline can be useful for the identification of patients with LFLG AS who would benefit from TAVR. Conclusions: The results of this study underline the predictive value of LV GLS on flow reserve during DSE and on global LV remodeling after TAVR in patients with LFLG AS. Cutoff values for LV GLS could be used to identify patients responding better to TAVR.

The role of stress echocardiography in transcatheter aortic valve implantation and transcatheter edge-to-edge repair era: A systematic review

“…Saevik et al ( 22 ) demonstrated safety and feasibility of low-dose dobutamine SE in 50 patients with high gradient AS, showing reduced CR in 40% of them ( 22 ). Finally D’Andrea et al ( 23 ) showed that a cutoff value for left ventricle global longitudinal strain (LV GLS) of >−12% well distinguished patients without significant CR and with lack of positive remodeling after TAVI at follow-up ( 23 ) ( Table 2 ).…”

“…In this setting, DSE demonstrated low (≤65%) specificity and sensitivity in predicting it ( 28 ). Finally, left ventricular global longitudinal strain (LVGLS) was analyzed as a parameter useful to predict the presence of CR and the post-TAVI reverse remodeling ( 23 ), showing that a pre-procedural LVGLS > −12% was a strong predictor of pre-procedural CR absence (sensitivity 84%; specificity 93%; AUC 0.92 [95% CI, 0.86–0.99], p < 0.00001) and lack of post-procedural remodeling ( p < 0.0001) ( 23 ). A greater increase in the absolute value of LVGLS after TAVI has been highlighted in patients with pre-procedure CR (+3.9%, p < 0.0001 vs. + 2.3%, p = 0.01) ( 23 ).…”

Left Ventricular Mechanics Differ in Subtypes of Aortic Stenosis Following Transcatheter Aortic Valve Replacement

“…In their study, change in GLS correlated with improvement in NYHA class but did not show significant association with major adverse cardiovascular events or 30-day mortality. D'Andrea et al ( 19 ) calculated an LV GLS cutoff of −12.0% to identify LFLG AS patients with lack of remodeling post-TAVR. A recent meta-analysis observed a cutoff of −14.7% as a trigger to consider early interventions ( 20 ).…”

Comparison of the results in Normal Flow High Gradient and Low Flow Low Gradient patients after correction of pronounced aortic stenosis with Ozaki procedure in the long-term observation

“…Другим не менее важным предиктором отдаленной летальности является показатель GLS. В нескольких крупных исследованиях сообщалось, что GLSзначимый фактор риска летальных событий у пациентов с LFLG в отдаленном периоде наблюдения [26,27]. Показатель GLS ЛЖ может быть более чувствительным маркером к изменениям систолической функции ЛЖ, чем ФВ ЛЖ у пациентов c LFLG.…”