Page 30 - Journal of Structural Heart Disease Volume 5, Issue 6

Original Scientific Article
Journal of Structural Heart Disease, December 2019, Volume 5, Issue 6:254-262
DOI: https://doi.org/10.12945/j.jshd.2019.008.19
Received: April 01, 2019 Accepted: April 23, 2019 Published online: December 2019
Incremental Prognostic Utility of Myocardial Fibrosis Imaging By Speckle Tracking Echocardiography Post Transcatheter Aortic Valve Replacement
Mohamad Hemu, MD2*, Kyaw Zaw Hein, MD2, Ahmad S. Manshad, MD2, Fatima Ballout, MD2, Fareed M. Collado, MD2, Clifford J. Kavinsky, MD, PhD1
1 Department of Interventional Cardiology, Rush University Medical Center, Chicago, Illinois, USA 2 Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
Abstract
Background: Long-standing aortic stenosis (AS) re- sults in fibrotic changes that often persist after TAVR. Fibrosis in AS preferentially affects the left ventricular (LV) basal segments and can lead to ventricular desyn- chrony.
Objective: Determine the prognostic utility of strain parameters as measured by speckle-tracking echocar- diography in patients undergoing transcatheter aortic valve replacement (TAVR). We hypothesize that basal longitudinal strain (BLS) and mechanical dispersion (MD) measured after TAVR will predict all-cause mor- tality in severe AS
Methods: 159 patients (51% men, 81±9 years) with severe AS (aortic valve area 0.7±0.2 cm2, mean gradi- ent 46±16mmHg) who underwent TAVR at our institu- tion were retrospectively analyzed. 2D speckle-track- ing echocardiography was used to assess myocardial deformation and MD (SD of time from Q/R on the ECG to peak strain in 16 LV segments) immediately after TAVR (median, 1 day). Images were analyzed offline us- ing a vendor-independent software (TomTec).
Results: At 1-year post-TAVR, 28 (17.6%) patients died. Non-survivors demonstrated impaired global lon- gitudinal strain (GLS, -11.2±3% vs -14.2±4%, p=0.001), impaired BLS (-10.9±2% vs -13.3±3%, p=0.001), and pronounced MD (86±33 ms vs 70±26 ms p=0.006) com- pared to survivors. Baseline multivariable Cox regres-
sion model (Figure) included age, STS, NYHA, renal dis- ease, AV mean gradient, and post-TAVR paravalvular leak as significant univariates (model 1, p<0.001). An incremental prognostic value was achieved by add- ing BLS to model 1+ GLS (p=0.001). Addition of MD to the model 1 + GLS + BLS provided further incremental prognostic increase (p=0.008). For the measurement of GLS, the Interobserver Intraclass Correlation Coeffi- cient was 0.87.
Conclusion: In severe AS, post-TAVR myocardial fibro- sis assessed by strain imaging was significantly associ- ated with cardiovascular events. This finding may pro- vide incremental prognostic value in patients with AS. Copyright © 2019 Science International Corp.
Key Words
Transcatheter aortic valve replacement • Myocardial fibrosis • Speckle-tracking echocardiography • Basal longitudinal strain • Mechanical dispersion • Mortality
Introduction
Aortic stenosis (AS) is a common valvular heart disease that causes serious myocardial dysfunction [1]. Severe AS is often associated with the develop- ment of adverse cardiac symptoms and increased risk of mortality [2]. Untreated symptomatic patients
* Corresponding Author:
Mohamad Hemu, MD
Internal Medicine, PGY-2
Rush University Internists
1700 W. Van Buren St., 5th floor, Chicago, IL 60612
Tel.: +1 312 563 2875; Fax: +1 312 942 3012; E-Mail: mohamad_r_hemu@rush.edu
Fax +1 203 785 3346
E-Mail: jshd@scienceinternational.org http://structuralheartdisease.org/
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