Evolution of non-invasive myocardial work variables after transcatheter aortic valve implantation in patients with severe aortic stenosis
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Louis Quinio1, Marion Taconne1, Virginie Le Rolle1
1University of Rennes, CHU Rennes, Inserm, LTSI - UMR 1099, 35000 Rennes, France.
Insights
Transcatheter aortic valve implantation (TAVI) significantly alters myocardial work in patients with aortic stenosis. Post-TAVI, global work index, constructive work, and efficiency decrease, offering insights into left ventricular function.
Area of Science:
- Cardiology
- Biomedical Engineering
- Echocardiography
Background:
- Severe aortic stenosis guidelines recommend intervention at late disease stages.
- Global longitudinal strain is load-dependent; myocardial work is a newer metric.
- Assessing myocardial work offers prognostic insights.
Purpose of the Study:
- To evaluate acute changes in myocardial work following transcatheter aortic valve implantation (TAVI).
Main Methods:
- Echocardiography was performed on 125 patients before and after TAVI.
- Myocardial work indices (global work index, constructive work, efficiency, wasted work) were calculated.
- Calculations integrated mean transaortic pressure gradient and brachial cuff systolic pressure.
Main Results:
- Successful TAVI significantly reduced the mean transaortic gradient.
- Left ventricular ejection fraction remained unchanged post-TAVI.
- Global work index, constructive work, and efficiency significantly decreased after TAVI.
Conclusions:
- Myocardial work variables show potential for understanding left ventricular consequences of aortic stenosis and its correction.
- These variables may have clinical value in discriminating New York Heart Association status and global longitudinal strain evolution.
Introduction:
Guidelines recommend aortic valve replacement in patients with severe aortic stenosis who present with symptoms or left ventricular ejection fraction<50%, both conditions representing a late stage of the disease. Whereas global longitudinal strain is load dependent, but interesting for assessing prognosis, myocardial work has emerged.
Aim:
To evaluate acute changes in myocardial work occurring in patients undergoing transcatheter aortic valve implantation (TAVI).
Methods:
Patients who underwent TAVI were evaluated before and after by echocardiography. Complete echocardiographies were considered. Myocardial work indices (global work index, global constructive work, global work efficiency, global wasted work) were calculated integrating mean transaortic pressure gradient and brachial cuff systolic pressure.
Results:
One hundred and twenty-five patients underwent successful TAVI, with a significant decrease in mean transaortic gradient (from 52.5±16.1 to 12.2±5.0; P<0.0001). There was no significant change in left ventricular ejection fraction after TAVI. Myocardial work data after TAVI showed a significant reduction in global work index (1389±537 vs. 2014±714; P<0.0001), global constructive work (1693±543 vs. 2379±761; P<0.0001) and global work efficiency (85.0±7.06 vs. 87.1±5.98; P=0.0034). The decrease in global work index and global constructive work after TAVI was homogeneous among different subgroups, based on global longitudinal strain, left ventricular ejection fraction and New York Heart Association status before TAVI. We observed a significant association between global work index and global constructive work before TAVI, and global longitudinal strain degradation after TAVI.
Conclusions:
Myocardial work variables show promising potential in best understanding the left ventricular myocardial consequences of aortic stenosis and its correction. Given their ability to discriminate between New York Heart Association status and global longitudinal strain evolution, we can hypothesize about their clinical value.
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