Impact of transcutaneous aortic valve implantation on myocardial deformation

To define the impact of transcutaneous aortic valve implantation (TAVI) using the CoreValve prosthesis on myocardial deformation in a serial echocardiographic study with analysis of strain and strain rate.

In 36 patients (83 ± 6 years; EuroScore: 26 ± 13%) with severe aortic stenosis scheduled for CoreValve implantation serial echocardiographic studies pre- and postintervention (within 1 month) were performed. Midparasternal short-axis and three apical views were acquired. Using customized computer software which allows automatic frame-by-frame tracking of acoustic markers during the heart cycle circumferential, radial, and longitudinal strain (CS, RS, and LS) and strain rate (CSR, RSR, and LSR) were calculated for each segment in a 16 segment model of the left ventricle.

Longitudinal strain, systolic, and early diastolic longitudinal strain rate increased significantly within 1 month after TAVI (LS from -15.8 ± 3.6% to -17.6 ± 3.1%; P < 0.001; LSR(S) from -1.03 ± 0.21 s(-1) to -1.21 ± 0.19 s(-1); P < 0.001 and LSR (E) from -1.15 ± 0.42 s(-1) to 1.51 ± 0.44 s(-1); P < 0.001). Circumferential strain and strain rate values remained unchanged after CoreValve implantation. RS (29.1 ± 17.1 to 34.0 ± 15.8%; ns), RSR (S) (1.56 ± 0.69 to 1.91 ± 0.87 s(-1); ns) and RSR(E) (-1.56 ± 0.78 to -1.81 ± 0.82 s(-1); ns) increased only nonsignificantly after TAVI. Analysis of covariance showed only chronic kidney disease to have a relevant impact on early diastolic LSR (P = 0.01).

Mainly longitudinal mechanics respond to unloading of the left ventricle after TAVI for severe aortic stenosis while radial and circumferential deformation is substantially unchanged. Pacemaker implantation or onset of left bundle brunch block after TAVI do not influence early myocardial deformation parameters.