Am J Cardiovasc Dis 2011;1(3):264-273

Original Article
Early and late improvement of global and regional left ventricular function
after transcatheter aortic valve implantation in patients with severe aortic
stenosis: an echocardiographic study

Cristina Giannini, Anna Sonia Petronio, Enrica Talini, Marco De Carlo, Fabio Guarracino, Maria Grazia Delle Donne,
Carmela Nardi, Lorenzo Conte, Valentina Barletta,  Mario Marzilli and  Vitantonio Di Bello

Cardiac Thoracic and Vascular Department, University of Pisa, Italy

Received August 8, 2011; accepted August 24, 2011; Epub September 10, 2011; published September 30, 2011

Abstract: The recent development of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) treatment
offers a viable option for high-risk patient categories. Our aim is to evaluate whether 2D strain and strain rate can detect
subtle improvement in global and regional LV systolic function immediately after TAVI. 2D conventional and 2D strain
(speckle analysis) echocardiography was performed before, at discharge and after three months in thirty three patients
with severe AS. After TAVI, we assessed by conventional echocardiography an immediate reduction of transaortic peak
pressure gradient (p<0.0001), of mean pressure gradient (p<0.0001) and a concomitant increase in aortic valve area (AVA:
1.08±0.31 cm2/m2; p<0.0001). 2D longitudinal systolic strain showed a significant improvement in all patients, both at
septal and lateral level, as early as 72 h after procedure (septal: -14.2±5.1 vs -16.7±3.7%, p<0.001; lateral: -9.4±3.9 vs
-13.1±4.5%, p<0.001; respectively) and continued at 3 months follow-up (septal:-18.1±4.6%,p<0.0001; lateral:-14.8±4.4%,
p<0.0001; respectively). Conventional echocardiography  after TAVI proved a significant reduction of LV end-systolic volume
and of LV mass with a mild improvement of LV ejection fraction (EF) (51.2±11.8 vs 52.9±6.4%; p<0.02) only after three
months. 2D strain seems to be able to detect subtle changes in LV systolic function occurring early and late after TAVI in
severe AS, while all conventional echo parameters seem to be less effective for this purpose. Further investigations are
needed to prove the real prognostic impact of these echocardiographic findings. (AJCD1108002).

Keywords: Transcatheter aortic valve implantation; left ventricular function, 2D strain

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Address all correspondence to:
Dr.  Vitantonio Di Bello
Cardiac Thoracic and Vascular Department
University of Pisa, Via Paradisa 2, Cisanello
Pisa, Italy.
Tel: +39 050 995315; Fax : +39 050 995316
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