Role of T2 mapping in left ventricular reverse remodeling after TAVR

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Severe aortic stenosis (AS) leads to left ventricular hypertrophy (LVH), increasing patient morbidity and mortality.
• Transcatheter aortic valve replacement (TAVR) is a treatment for severe AS that can induce reverse left ventricular remodeling.
• Cardiovascular magnetic resonance (CMR) and parametric imaging, such as T2 mapping, can monitor these cardiac adaptations.

Purpose of the Study:

• To investigate myocardial T2 relaxation properties during reverse left ventricular remodeling following TAVR.
• To assess the utility of multiparametric CMR in characterizing myocardial hypertrophy and monitoring adaptations post-TAVR.

Main Methods:

• Forty-three patients with severe AS underwent CMR with T2 mapping before and 6 months after TAVR.
• Analyzed parameters included left ventricular ejection fraction (LV-EF), mass (LVMi), interventricular septum thickness (IVS), end-diastolic volume (LVEDV), global longitudinal strain (GLS), peak diastolic strain rate (SRe), and myocardial T2 values.
• A control group of age- and gender-matched volunteers was included for comparison.

Main Results:

• Patients with AS exhibited LVH, elevated myocardial T2 values, and reduced GLS and SRe compared to controls.
• Baseline T2 values above 70.2 ms were associated with eccentric hypertrophy and reduced LV-EF.
• T2 values significantly decreased post-TAVR, indicating reverse remodeling. Elevated baseline T2 values predicted improved LV-EF and reduced LVEDV.

Conclusions:

• Multiparametric CMR, including T2 mapping, effectively characterizes myocardial hypertrophy in severe AS.
• CMR can monitor myocardial adaptations and reverse remodeling after TAVR.
• T2 mapping may offer additional predictive value for left ventricular remodeling post-TAVR.