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Left ventricular twist predicts mortality in severe aortic stenosis
Ladina Erhart1, Thierry Donati1, Shehab Anwer1
1Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland.
Heart (British Cardiac Society)
|May 11, 2021
Summary
Left ventricular twist and torsion before and after transcatheter aortic valve implantation (TAVI) predict 2-year mortality. These mechanics offer prognostic value beyond traditional measures like LV ejection fraction and global longitudinal strain.
Area of Science:
- Cardiology
- Cardiac Mechanics
- Echocardiography
Background:
- Left ventricular (LV) twist is crucial for cardiac mechanics, reflecting myocardial fiber orientation and compensating for afterload mismatch.
- The prognostic role of LV twist in patients undergoing transcatheter aortic valve implantation (TAVI) remains unclear.
Purpose of the Study:
- To investigate short-term changes in LV twist after TAVI.
- To determine if LV twist predicts outcomes following TAVI.
Main Methods:
- 146 patients with severe aortic stenosis undergoing TAVI were analyzed.
- LV rotation and twist were measured using speckle tracking echocardiography pre-TAVI and 2 weeks post-TAVI.
- Two-year all-cause mortality was the primary endpoint.
Main Results:
- Survivors had higher pre-TAVI apical peak systolic rotation (APSR), twist, and torsion compared to non-survivors.
- Post-TAVI, survivors showed decreased APSR, twist, and torsion, while non-survivors had no significant change.
- Pre-TAVI and post-TAVI changes in APSR, twist, and torsion independently predicted 2-year mortality, outperforming LV ejection fraction and global longitudinal strain.
Conclusions:
- LV twist, torsion, and APSR before and after TAVI are significant predictors of 2-year mortality.
- These echocardiographic parameters provide incremental prognostic information beyond conventional measures like LVEF and GLS.
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