Top

Journal of Cardiovascular Magnetic Resonance

Published in:

Open Access 01-12-2017 | Research

Cardiovascular magnetic resonance evaluation of symptomatic severe aortic stenosis: association of circumferential myocardial strain and mortality

Authors: Tarique Al Musa, Akhlaque Uddin, Peter P. Swoboda, Timothy A. Fairbairn, Laura E. Dobson, Anvesha Singh, Pankaj Garg, Christopher D. Steadman, Bara Erhayiem, Ananth Kidambi, David P. Ripley, Adam K. McDiarmid, Philip Haaf, Daniel J. Blackman, Sven Plein, Gerald P. McCann, John P. Greenwood

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

Abstract

Background

It is unknown whether circumferential strain is associated with prognosis after treatment of aortic stenosis (AS). We aimed to characterise strain in severe AS, using myocardial tagging cardiovascular magnetic resonance (CMR), prior to and following Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR), and determine whether abnormalities in strain were associated with outcome.

Methods

CMR was performed pre- and 6 m post-intervention in 98 patients (52 TAVI, 46 SAVR; 77 ± 8 years) with severe AS. TAVI patients were older (80.9 ± 6.4 vs. 73.0 ± 7.0 years, p < 0.01) with a higher STS score (2.06 ± 0.6 vs. 6.03 ± 3.4, p < 0.001). Tagged cine images were acquired at the basal, mid and apical LV levels with a complementary spatial modulation of magnetization (CSPAMM) pulse sequence. Circumferential strain, strain rate and rotation were calculated using inTag© software.

Results

No significant change in basal or mid LV circumferential strain, or of diastolic strain rate, was seen following either intervention. However, a significant and comparable decline in LV torsion and twist was observed (SAVR: torsion 14.08 ± 8.40 vs. 7.81 ± 4.51, p < 0.001, twist 16.17 ± 7.01 vs.12.45 ± 4.78, p < 0.01; TAVI: torsion 14.43 ± 4.66 vs. 11.20 ± 4.62, p < 0.001, twist 16.08 ± 5.36 vs. 12.36 ± 5.21, p < 0.001) which likely reflects an improvement towards normal physiology following relief of AS. Over a maximum 6.0y follow up, there were 23 (16%) deaths following valve intervention. On multivariable Cox analysis, baseline mid LV circumferential strain was significantly associated with all-cause mortality (hazard ratio, 1.03; 1.01–1.05; p = 0.009) independent of age, LV ejection fraction and STS mortality risk score. ROC analysis indicated a mid LV circumferential strain > −18.7% was associated with significantly reduced survival.

Conclusion

TAVI and SAVR procedures are associated with comparable declines in rotational LV mechanics at 6 m, with largely unchanged strain and strain rates. Pre-operative peak mid LV circumferential strain is associated with post-operative mortality.

Available only for authorised users

Iung B, Vahanian A. Degenerative calcific aortic stenosis: a natural history. Heart. 2012;98 Suppl 4:iv7–13.CrossRefPubMed

Ozkan A, Kapadia S, Tuzcu M, Marwick TH. Assessment of left ventricular function in aortic stenosis. Nat Rev Cardiol. 2011;8:494–501.CrossRefPubMed

Kaden JJ, Dempfle CE, Grobholz R, et al. Interleukin-1 beta promotes matrix metalloproteinase expression and cell proliferation in calcific aortic valve stenosis. Atherosclerosis. 2003;170:205–11.CrossRefPubMed

Wang B, Chen H, Shu X, et al. Emerging role of echocardiographic strain/strain rate imaging and twist in systolic function evaluation and operative procedure in patients with aortic stenosis. Interact Cardiovasc Thorac Surg. 2013;17:384–91.CrossRefPubMedPubMedCentral

Swoboda PP, Larghat A, Zaman A, et al. Reproducibility of myocardial strain and left ventricular twist measured using complementary spatial modulation of magnetization. J Magn Reson Imaging. 2014;39:887–94.CrossRefPubMed

Singh A, Steadman CD, Khan JN, et al. Intertechnique agreement and interstudy reproducibility of strain and diastolic strain rate at 1.5 and 3 Tesla: a comparison of feature-tracking and tagging in patients with aortic stenosis. J Magn Reson Imaging. 2015;41:1129–37.CrossRefPubMed

Galli E, Lancellotti P, Sengupta PP, Donal E. LV mechanics in mitral and aortic valve diseases: value of functional assessment beyond ejection fraction. J Am Coll Cardiol Img. 2014;7:1151–66.CrossRef

Carasso S, Cohen O, Mutlak D, et al. Relation of myocardial mechanics in severe aortic stenosis to left ventricular ejection fraction and response to aortic valve replacement. Am J Cardiol. 2011;107:1052–7.CrossRefPubMed

Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012;42:S1–44.CrossRefPubMed

10.

Vaquette B, Corbineau H, Laurent M, et al. Valve replacement in patients with critical aortic stenosis and depressed left ventricular function: predictors of operative risk, left ventricular function recovery, and long term outcome. Heart. 2005;91:1324–9.CrossRefPubMedPubMedCentral

11.

Hachicha Z, Dumesnil JG, Bogaty P, Pibarot P. Paradoxical low-flow, low-gradient severe aortic stenosis despite preserved ejection fraction is associated with higher afterload and reduced survival. Circulation. 2007;115:2856–64.CrossRefPubMed

12.

Piazza N, Grube E, Gerckens U, et al. Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. EuroIntervention. 2008;4:242–9.CrossRefPubMed

13.

Meredith IT, Worthley SG, Whitbourn RJ, et al. Transfemoral aortic valve replacement with the repositionable Lotus Valve System in high surgical risk patients: the REPRISE I study. EuroIntervention. 2014;9:1264–70.CrossRefPubMed

14.

Fairbairn TA, Steadman CD, Mather AN, et al. Assessment of valve haemodynamics, reverse ventricular remodelling and myocardial fibrosis following transcatheter aortic valve implantation compared to surgical aortic valve replacement: a cardiovascular magnetic resonance study. Heart. 2013;99:1185–91.CrossRefPubMedPubMedCentral

15.

Pibarot P, Dumesnil JG. Longitudinal myocardial shortening in aortic stenosis: ready for prime time after 30 years of research? Heart. 2010;96:95–6.CrossRefPubMed

16.

Attias D, Macron L, Dreyfus J, et al. Relationship between longitudinal strain and symptomatic status in aortic stenosis. J Am Soc Echocardiogr. 2013;26:868–74.CrossRefPubMed

17.

Becker M, Kramann R, Dohmen G, et al. Impact of left ventricular loading conditions on myocardial deformation parameters: analysis of early and late changes of myocardial deformation parameters after aortic valve replacement. J Am Soc Echocardiogr. 2007;20:681–9.CrossRefPubMed

18.

Iwahashi N, Nakatani S, Kanzaki H, Hasegawa T, Abe H, Kitakaze M. Acute improvement in myocardial function assessed by myocardial strain and strain rate after aortic valve replacement for aortic stenosis. J Am Soc Echocardiogr. 2006;19:1238–44.CrossRefPubMed

19.

Lancellotti P, Donal E, Magne J, et al. Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study. Eur J Echocardiogr. 2010;11:537–43.CrossRefPubMed

20.

Ross Jr J. Afterload mismatch and preload reserve: a conceptual framework for the analysis of ventricular function. Prog Cardiovasc Dis. 1976;18:255–64.CrossRefPubMed

21.

Carasso S, Mutlak D, Lessick J, Reisner SA, Rakowski H, Agmon Y. Symptoms in severe aortic stenosis are associated with decreased compensatory circumferential myocardial mechanics. J Am Soc Echocardiogr. 2015;28:218–25.CrossRefPubMed

22.

Kaku K, Takeuchi M, Tsang W, et al. Age-related normal range of left ventricular strain and torsion using three-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr. 2014;27:55–64.CrossRefPubMed

23.

Biederman RW, Doyle M, Yamrozik J, et al. Physiologic compensation is supranormal in compensated aortic stenosis: does it return to normal after aortic valve replacement or is it blunted by coexistent coronary artery disease? An intramyocardial magnetic resonance imaging study. Circulation. 2005;112:I429–36.PubMed

24.

Grabskaya E, Becker M, Altiok E, et al. Impact of transcutaneous aortic valve implantation on myocardial deformation. Echocardiography. 2011;28:397–401.CrossRefPubMed

25.

Carasso S, Cohen O, Mutlak D, et al. Differential effects of afterload on left ventricular long- and short-axis function: insights from a clinical model of patients with aortic valve stenosis undergoing aortic valve replacement. Am Heart J. 2009;158:540–5.CrossRefPubMed

26.

Delgado V, Tops LF, van Bommel RJ, et al. Strain analysis in patients with severe aortic stenosis and preserved left ventricular ejection fraction undergoing surgical valve replacement. Eur Heart J. 2009;30:3037–47.CrossRefPubMed

27.

Meimoun P, Elmkies F, Benali T, et al. Assessment of left ventricular twist mechanics by two-dimensional strain in severe aortic stenosis with preserved ejection fraction. Ann Cardiol Angeiol (Paris). 2011;60:259–66.CrossRef

28.

Rost C, Korder S, Wasmeier G, et al. Sequential changes in myocardial function after valve replacement for aortic stenosis by speckle tracking echocardiography. Eur J Echocardiogr. 2010;11:584–9.CrossRefPubMed

29.

Poulin F, Carasso S, Horlick EM, et al. Recovery of left ventricular mechanics after transcatheter aortic valve implantation: effects of baseline ventricular function and postprocedural aortic regurgitation. J Am Soc Echocardiogr. 2014;27:1133–42.CrossRefPubMed

30.

Sengupta PP, Tajik AJ, Chandrasekaran K, Khandheria BK. Twist mechanics of the left ventricle: principles and application. J Am Coll Cardiol Img. 2008;1:366–76.CrossRef

31.

Nagel E, Stuber M, Burkhard B, et al. Cardiac rotation and relaxation in patients with aortic valve stenosis. Eur Heart J. 2000;21:582–9.CrossRefPubMed

32.

Stuber M, Scheidegger MB, Fischer SE, et al. Alterations in the local myocardial motion pattern in patients suffering from pressure overload due to aortic stenosis. Circulation. 1999;100:361–8.CrossRefPubMed

33.

Lindqvist P, Zhao Y, Bajraktari G, Holmgren A, Henein MY. Aortic valve replacement normalizes left ventricular twist function. Interact Cardiovasc Thorac Surg. 2011;12:701–6.CrossRefPubMed

34.

Pasipoularides A. LV twisting and untwisting in HCM: ejection begets filling. Diastolic functional aspects of HCM. Am Heart J. 2011;162:798–810.CrossRefPubMed

35.

van Dalen BM, Tzikas A, Soliman OI, et al. Left ventricular twist and untwist in aortic stenosis. Int J Cardiol. 2011;148:319–24.CrossRefPubMed

36.

Young AA, Cowan BR. Evaluation of left ventricular torsion by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2012;14:49.CrossRefPubMedPubMedCentral

37.

Monin JL, Quere JP, Monchi M, et al. Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation. 2003;108:319–24.CrossRefPubMed

38.

Sannino A, Gargiulo G, Schiattarella GG, et al. Increased mortality after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis and low ejection fraction: a meta-analysis of 6898 patients. Int J Cardiol. 2014;176:32–9.CrossRefPubMed

39.

Dahl JS, Videbaek L, Poulsen MK, Rudbaek TR, Pellikka PA, Moller JE. Global strain in severe aortic valve stenosis: relation to clinical outcome after aortic valve replacement. Circ Cardiovasc Imaging. 2012;5:613–20.CrossRefPubMed

40.

Kusunose K, Goodman A, Parikh R, et al. Incremental prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis and preserved ejection fraction. Circ Cardiovasc Imaging. 2014;7:938–45.CrossRefPubMed

41.

Mahmod M, Bull S, Suttie JJ, et al. Myocardial steatosis and left ventricular contractile dysfunction in patients with severe aortic stenosis. Circ Cardiovasc Imaging. 2013;6:808–16.CrossRefPubMed

Title: Cardiovascular magnetic resonance evaluation of symptomatic severe aortic stenosis: association of circumferential myocardial strain and mortality
Authors: Tarique Al Musa
Akhlaque Uddin
Peter P. Swoboda
Timothy A. Fairbairn
Laura E. Dobson
Anvesha Singh
Pankaj Garg
Christopher D. Steadman
Bara Erhayiem
Ananth Kidambi
David P. Ripley
Adam K. McDiarmid
Philip Haaf
Daniel J. Blackman
Sven Plein
Gerald P. McCann
John P. Greenwood
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI: https://doi.org/10.1186/s12968-017-0329-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cardiovascular magnetic resonance evaluation of symptomatic severe aortic stenosis: association of circumferential myocardial strain and mortality

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2017

CMR fluoroscopy right heart catheterization for cardiac output and pulmonary vascular resistance: results in 102 patients

Patterns of CMR measured longitudinal strain and its association with late gadolinium enhancement in patients with cardiac amyloidosis and its mimics

Hemorrhage promotes inflammation and myocardial damage following acute myocardial infarction: insights from a novel preclinical model and cardiovascular magnetic resonance

Aortic length measurements for pulse wave velocity calculation: manual 2D vs automated 3D centreline extraction

Feasibility of detecting myocardial infarction in the sheep fetus using late gadolinium enhancement CMR imaging

Assessing exercise cardiac reserve using real-time cardiovascular magnetic resonance