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

Antonello D'Andrea; Andreina Carbone; Eustachio Agricola; Lucia Riegler; Simona Sperlongano; Giampaolo Tocci; Raffaella Scarafile; Tiziana Formisano; Cristina Capogrosso; Maurizio Cappelli Bigazzi; Eduardo Bossone; Maurizio Galderisi; Paolo Golino

doi:10.1016/j.echo.2019.03.002

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

J Am Soc Echocardiogr. 2019 Jun;32(6):730-736. doi: 10.1016/j.echo.2019.03.002.

Affiliations

¹ Luigi Vanvitelli University - Naples, Monaldi Hospital, Naples, Italy; Department of Cardiology, Umberto I° Hospital Nocera Inferiore, Salerno, Italy. Electronic address: antonellodandrea@libero.it.
² Luigi Vanvitelli University - Naples, Monaldi Hospital, Naples, Italy.
³ San Raffaele Hospital, Milan, Italy.
⁴ Department of Cardiology, Umberto I° Hospital Nocera Inferiore, Salerno, Italy.
⁵ University of Salerno, Salerno, Italy.
⁶ Federico II University of Naples, Naples, Italy.

PMID: 31171107
DOI: 10.1016/j.echo.2019.03.002

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 ± 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 ± 3.2% vs 16.3 ± 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.

Keywords: Aortic stenosis; Contractile reserve; Low flow; Low gradient; Transcatheter aortic valve replacement; Two-dimensional strain.

MeSH terms

Aged
Aortic Valve Stenosis / diagnostic imaging*
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / surgery*
Echocardiography / methods*
Echocardiography, Stress
Electrocardiography
Female
Humans
Male
Prospective Studies
Tomography, X-Ray Computed
Transcatheter Aortic Valve Replacement*
Ventricular Dysfunction, Left / diagnostic imaging*
Ventricular Dysfunction, Left / physiopathology
Ventricular Remodeling*