Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography, Volume 32, Issue 9, 13 July 2019, Pages 1058-1066.e2 Changes in Left Ventricular Global Longitudinal Strain after Transcatheter Aortic Valve Implantation according to Calcification Burden of the Thoracic Aorta. Gegenava T, Vollema EM, van Rosendael A, Abou R, Goedemans L, van der Kley F, de Weger A, Ajmone Marsan N, Bax JJ, Delgado V

Background

After transcatheter aortic valve replacement (TAVR), changes in left ventricular (LV) function are partly influenced by the vascular afterload. The burden of thoracic aorta calcification is a component of vascular afterload.

Objective

To assess changes in LV systolic function measured with global longitudinal strain (GLS) in relation to the burden of thoracic aorta calcification in patients with severe aortic stenosis treated with TAVR.

Methods

Calcification of the thoracic aorta was estimated on noncontrast computed tomography in 210 patients (50% male, 80 ± 7 years) undergoing TAVR. Conventional and speckle-tracking echocardiography were performed at baseline (prior to TAVR) and 3-6 months and 12 months after TAVR. Patients were divided according to tertiles of calcification burden of the thoracic aorta.

Results

At baseline, patients within the first tertile of thoracic aorta calcification (0-1,395 Hounsfield Units, HU) had better LV systolic function (LV ejection fraction [LVEF], 47% ± 9%; and LV GLS, -15% ± 5%) as compared with the second tertile (1,396-4,634 HU; LVEF, 46% ± 10%; and LV GLS, -14% ± 4%), and the third tertile (>4,634 HU; LVEF, 44% ± 10%; and LV GLS, -12% ± 4%). During follow-up, patients within tertile 1 of calcification of thoracic aorta achieved significantly better LV systolic function and larger regression of LV mass at 12 months of follow-up than patients within the other tertiles. This pattern was more pronounced in patients with reduced LVEF at baseline.

Conclusions

After TAVR, LVEF and GLS improves and LV mass index is reduced significantly at 3-6 and 12 months of follow-up. Patients within the lowest burden of thoracic aorta calcification achieved the best values of LVEF and LV GLS at 1-year follow-up.

Keywords: left ventricular mass, Transcatheter Aortic Valve Replacement, Global Longitudinal Strain, Thoracic Aorta Calcification

J Am Soc Echocardiogr. 2019 Jul;32(9):1058-1066.e2