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Instantaneous Decrease in Left Ventricular Afterload during Transcatheter Aortic Valve Implantation Results in

Amy Swan1, Roshan Prakash1, Derek P Chew1,2

  • 1Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, SA, Australia.

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Summary
This summary is machine-generated.

Transcatheter aortic valve implantation (TAVI) significantly improves left ventricular (LV) strain and strain rate immediately after the procedure. This enhanced LV mechanics are detectable by transesophageal echocardiography (TEE) speckle tracking, not traditional measures.

Keywords:
aortic stenosisstraintransesophageal echocardiography

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Area of Science:

  • Cardiology
  • Medical Imaging
  • Cardiac Surgery

Background:

  • Severe aortic stenosis increases left ventricular (LV) afterload, leading to hypertrophy and dysfunction.
  • Transcatheter aortic valve implantation (TAVI) reduces LV afterload by relieving aortic valve pressure gradient.

Purpose of the Study:

  • To evaluate immediate changes in LV mechanics after TAVI using intra-procedural transesophageal echocardiography (TEE).
  • To assess LV circumferential and radial strain and strain rate changes via speckle tracking post-TAVI.

Main Methods:

  • Intra-operative TEE performed during TAVI in 53 patients (mean age 84 ± 8 years).
  • Two-dimensional transgastric images acquired at papillary muscle level.
  • LV strain and strain rate calculated using speckle tracking; valvulo-arterial impedance (Zva) measured for afterload.

Main Results:

  • Significant immediate increase in LV radial strain rate (0.73 to 0.88/sec, P < 0.001) and circumferential strain rate (-0.53 to -0.74/sec, P < 0.001) post-TAVI.
  • Significant improvement in global circumferential strain (-14.5% to -16.0%, P < 0.05), but no change in global radial strain (P = 0.69).
  • No significant change in LV ejection fraction (51.5% to 52.1%, P = 0.77) immediately post-TAVI.

Conclusions:

  • Speckle tracking TEE is feasible for assessing LV mechanics during TAVI.
  • TAVI leads to immediate improvements in LV strain and strain rate, indicating enhanced myocardial function.
  • These improvements in LV mechanics are not detected by conventional LV ejection fraction measurements.