The use of deformation imaging in the assessment of patients pre and post transcatheter aortic valve implantation

Abstract

Background Deformation imaging represents a method of measuring myocardial function, including global longitudinal strain (GLS), peak atrial longitudinal strain (PALS) and radial strain. This study aimed to assess subclinical improvements in left ventricular function in patients undergoing transcatheter aortic valve implantation (TAVI) by comparing GLS, PALS and radial strain pre and post procedure. Methods We conducted a single site prospective observational study of 25 patients undergoing TAVI, comparing baseline and post-TAVI echocardiograms. Individual participants were assessed for differences in GLS, PALS and radial strain in addition to changes in left ventricular ejection fraction (LVEF) (%). Results Our results revealed a significant improvement in GLS (mean change pre-post of 2.14% [95% CI 1.08, 3.20] p = 0.0003) with no significant change in LVEF (0.96% [95% CI − 2.30, 4.22], p = 0.55). There was a statistically significant improvement in radial strain pre and post TAVI (mean 9.68% [95% CI 3.10, 16.25] p = 0.0058). There was positive trend towards improvements in PALS pre and post TAVI (mean change of 2.30% [95% CI − 0.19, 4.80] p = 0.068). Conclusion In patients undergoing TAVI, measuring GLS and radial strain provided statistically significant information regarding subclinical improvements in LV function, which may have prognostic implications. The incorporation of deformation imaging in addition to standard echocardiographic measurements may have an important role in guiding future management in patients undergoing TAVI and assessing response.

Prognostic value of left atrial strain in aortic stenosis: A systematic review

“…evaluated the use of deformation imaging pre‐ and post‐TAVR in 25 patients with AS. There was a trend towards improved PALS at a mean follow‐up of 85 days 37 …”

“…The included studies reported PALS in patients with AS as summarized in 2. 15,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] LA strain was significantly reduced in AS patients and a PALS <21% was an independent predictor of prognosis. 21 strain (PALS) was independently associated with the primary outcome and an optimal cut-off value of <19% showed the highest diagnostic performance.…”

“…There was a trend towards improved PALS at a mean follow-up of 85 days. 37 We did not report pooled outcomes for the included studies due to high heterogeneity between studies. There was decreased PALS for patients with AS compared to healthy controls as summarized in the forest plot in Figure 2 and funnel plot in Figure 3.…”