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The International Journal of Cardiovascular Imaging

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01-12-2013 | Original Paper

Left atrial remodelling in patients undergoing transcatheter aortic valve implantation: a speckle-tracking prospective, longitudinal study

Authors: Flavio D’Ascenzi, Matteo Cameli, Michael Henein, Alessandro Iadanza, Rosanna Reccia, Matteo Lisi, Valeria Curci, Giuseppe Sinicropi, Andrea Torrisi, Carlo Pierli, Sergio Mondillo

Published in: The International Journal of Cardiovascular Imaging | Issue 8/2013

Abstract

Aortic stenosis (AS) results in several left ventricular (LV) disturbances as well as progressive left atrial (LA) enlargement and dysfunction. Transcatheter aortic valve implantation (TAVI) reverses LV remodelling and improves overall systolic function but its effect on LA function remains undetermined. The aim of this prospective, longitudinal study was to investigate the effects of TAVI on LA structure and function. We studied thirty-two patients with severe symptomatic AS who underwent TAVI, using standard and 2-dimensional speckle-tracking echocardiography before, at 40-day and at 3-month follow-up. Following TAVI, mean transvalvular gradient decreased (p < 0.001). Both LA area index and LA volume index decreased at 40-day follow-up (16.2 ± 6.4 vs. 12.5 ± 2.9 cm²/m², and 47.3 ± 12.0 vs. 42.8 ± 12.5 mL/m², respectively, p < 0.05) and values remained unchanged at 3 months. The reduction of LA size was accompanied by a significant increase in global peak atrial longitudinal strain (14.4 ± 3.9 vs. 19.1 ± 4.7 %, p < 0.001) and in global peak atrial contraction strain (8.4 ± 2.5 vs. 11.0 ± 4.1 %, p < 0.05) at 3-month follow-up. LA stiffness measurements significantly decreased 3 months after TAVI (0.93 ± 0.59 vs. 0.65 ± 0.37, respectively, p < 0.001). Trans-aortic mean gradient change and pre-procedural LA volume were identified as predictors of global peak atrial longitudinal strain increase (β = −0.41, β = −0.35, respectively, p < 0.0001) while pre-procedural LA volume and trans-aortic mean gradient change as predictor of LA volume index reduction 3 months after TAVI (β = −0.37, β = −0.28, respectively, p < 0.0001). TAVI is associated with significant recovery of LA structure and function suggesting a reverse cavity remodelling. Such functional recovery is primarily determined by the severity of pre-procedural valve stenosis.

Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Barwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A (2003) A prospective survey of patients with valvular heart disease in Europe: the Euro heart survey on valvular heart disease. Eur Heart J 24:1231–1243PubMedCrossRef

Lancellotti P, Moonen M, Magne J, O’Connor K, Cosyns B, Attena E, Donal E, Pierard L (2010) Prognostic effect of long-axis left ventricular dysfunction and B-type natriuretic peptide levels in asymptomatic aortic stenosis. Am J Cardiol 106:1157–1162PubMedCrossRef

O’Connor K, Magne J, Rosca M, Piérard LA, Lancellotti P (2011) Left atrial function and remodeling in aortic stenosis. Eur J Echocardiogr 12:299–305PubMedCrossRef

O’Connor K, Magne J, Rosca M, Piérard LA, Lancellotti P (2010) Impact of aortic valve stenosis on left atrial phasic function. Am J Cardiol 106:1157–1162PubMedCrossRef

Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S, Partner Trial Investigators (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363:1597–1607PubMedCrossRef

Zajarias A, Cribier AG (2009) Outcomes and safety of percutaneous aortic valve replacement. J Am Coll Cardiol 53:1829–1836PubMedCrossRef

Clavel MA, Webb JG, Rodés-Cabau J, Masson JB, Dumont E, De Larochellière R, Doyle D, Bergeron S, Baumgartner H, Burwash IG, Dumesnil JG, Mundigler G, Moss R, Kempny A, Bagur R, Bergler-Klein J, Gurvitch R, Mathieu P, Pibarot P (2010) Comparison between transcatheter and surgical prosthetic valve implantation in patients with severe aortic stenosis and reduced left ventricular ejection fraction. Circulation 122:1928–1936PubMedCrossRef

Giannini C, Petronio AS, Talini E, De Carlo M, Guarracino F, Grazia M, Donne D, Nardi C, Conte L, Barletta V, Marzilli M, Di Bello V (2011) 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. Am J Cardiovasc Dis 1:264–273PubMed

Pilgrim T, Wenaweser P, Meuli F, Huber C, Stortecky S, Seiler C, Zbinden S, Meier B, Carrel T, Windecker S (2011) Clinical outcome of high-risk patients with severe aortic stenosis and reduced left ventricular ejection fraction undergoing medical treatment or TAVI. PLoS One 6:e27556PubMedCrossRef

10.

Ewe SH, Ajmone Marsan N, Pepi M, Delgado V, Tamborini G, Muratori M, Ng AC, van der Kley F, de Weger A, Schalij MJ, Fusari M, Biglioli P, Bax JJ (2010) Impact of left ventricular systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation for severe aortic stenosis. Am Heart J 160:1113–1120PubMedCrossRef

11.

Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M, Marino E, Galderisi M (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 7:6PubMedCrossRef

12.

Mondillo S, Galderisi M, Mele D, Cameli M, Lomoriello VS, Zacà V, Ballo P, D’Andrea A, Muraru D, Losi M, Agricola E, D’Errico A, Buralli S, Sciomer S, Nistri S, Badano L (2011) Echocardiography study group of the Italian society of cardiology. speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med 30:71–83PubMed

13.

Mondillo S, Cameli M, Caputo ML, Lisi M, Palmerini E, Padeletti M, Ballo P (2011) Early detection of left atrial strain abnormalities by speckle tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr 24:898–908PubMedCrossRef

14.

Lisi M, Henein MY, Cameli M, Ballo P, Reccia R, Bennati E, Chiavarelli M, Maccherini M, Mondillo S (2012) Severity of aortic stenosis predicts early post-operative normalization of left atrial size and function detected by myocardial strain. Int J Cardiol [Epub ahead of print]

15.

Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TS, Appleton CP (2009) Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility an regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr 22:299–305PubMedCrossRef

16.

Leontyev S, Walther T, Borger MA, Lehmann S, Funkat AK, Rastan A, Kempfert J, Falk V, Mohr FW (2009) Aortic valve replacements in octogenarians: utility of risk stratification with euroscore. Ann Thorac Surg 87:1440–1445PubMedCrossRef

17.

Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H et al (2012) 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 Heart J 33:2451–2496PubMedCrossRef

18.

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W (2006) Recommendations for chamber quantification. Eur J Echocardiogr 7:79–108PubMedCrossRef

19.

Willenheimer R, Cline C, Erhardt L, Israelsson B (1997) Left ventricular atrioventricular plane displacement: an echocardiographic technique for rapid assessment of prognosis in heart failure. Heart 78:230–236PubMed

20.

Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A (2009) Recommendations of evalutation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10:165–193PubMedCrossRef

21.

Galderisi M, Henein MY, D’hooge J, Sicari R, Badano LP, Zamorano JL, Roelandt JR (2011) Recommendation of the European association of echocardiography: how to use echo-Doppler in clinical trials: different modalities for different purposes. Eur J Echocardiogr 12:339–353

22.

Kasner M, Westermann D, Steendijk P, Gaub R, Wilkenshoff U, Weitmann K, Hoffmann W, Poller W, Schultheiss HP, Pauschinger M, Tschöpe C (2007) Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation 116:637–647PubMedCrossRef

23.

Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, Tajik AJ (2000) Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794PubMedCrossRef

24.

Appleton CP, Kovács SJ (2009) The role of left atrial function in diastolic heart failure. Circ Cardiovasc Imaging 2:6–9PubMedCrossRef

25.

Kurt M, Wang J, Torre-Amione G, Nagueh SF (2009) Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging 2:10–15PubMedCrossRef

26.

D’Ascenzi F, Cameli M, Lisi M, Zacà V, Natali B, Malandrino A, Benincasa S, Catanese S, Causarano A, Mondillo S (2012) Left atrial remodelling in competitive adolescent soccer players. Int J Sports Med 33:795–801PubMedCrossRef

27.

Vahanian A, Alfieri O, Al-Attar N, Antunes M, Bax J, Cormier B, Cribier A, De Jaegere P, Fournial G, Kappetein AP, Kovac J, Ludgate S, Maisano F, Moat N, Mohr F, Nataf P, Pierard L, Pomar JL, Schofer J, Tornos P, Tuzcu M, van Hout B, Von Segesser LK, Walther T (2008) Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European association of cardio-thoracic surgery (EACTS) and the European society of cardiology (ESC), in collaboration with the European association of percutaneous cardiovascular interventions (EAPCI). EuroIntervention 4:193–199PubMedCrossRef

28.

Gjertsson P, Caidahl K, Farasati M, Odén A, Bech-Hanssen O (2005) Preoperative moderate to severe diastolic dysfunction: a novel Doppler echocardiographic long-term prognostic factor in patients with severe aortic stenosis. J Thorac Cardiovasc Surg 129:890–896PubMedCrossRef

29.

Lund O, Flo C, Jensen FT, Emmertsen K, Nielsen TT, Rasmussen BS, Hansen OK, Pilegaard HK, Kristensen LH (1997) Left ventricular systolic and diastolic function in aortic stenosis: prognostic value after valve replacement and underlying mechanisms. Eur Heart J 18:1977–1987PubMedCrossRef

30.

Tsang T, Barnes ME, Gersh BJ, Bailey KR, Seward JB (2002) Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol 90:1284–1289PubMedCrossRef

31.

Abhayaratna W, Seward JB, Appleton CP, Douglas PS, Oh JK, Tajik AJ, Tsang TS (2006) Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 47:2357–2363PubMedCrossRef

32.

Pritchett A, Mahoney DW, Jacobsen SJ, Rodeheffer RJ, Karon BL, Redfield MM (2005) Diastolic dysfunction and left atrial volume: a population-based study. J Am Coll Cardiol 45:87–92PubMedCrossRef

33.

Casaclang-Verzosa G, Malouf JF, Scott CG, Juracan EM, Nishimura RA, Pellikka PA (2010) Does left atrial size predict mortality in asymptomatic patients with severe aortic stenosis? Echocardiography 27:105–109PubMedCrossRef

34.

Dahl JS, Videbæk L, Poulsen MK, Pellikka PA, Veien K, Andersen LI, Haghfelt T, Møller JEJ (2011) Noninvasive assessment of filling pressure and left atrial pressure overload in severe aortic valve stenosis: relation to ventricular remodeling and clinical outcome after aortic valve replacement. J Thorac Cardiovasc Surg 142:e77–e83PubMedCrossRef

35.

Kempny A, Diller GP, Kaleschke G, Orwat S, Funke A, Radke R, Schmidt R, Kerckhoff G, Ghezelbash F, Rukosujew A, Reinecke H, Scheld HH, Baumgartner H (2012) Longitudinal left ventricular 2D strain is superior to ejection fraction in predicting myocardial recovery and symptomatic improvement after aortic valve implantation. Int J Cardiol [Epub ahead of print]

36.

Hekimian G, Detaint D, Messika-Zeitoun D, Attias D, Iung B, Himbert D, Brochet E, Vahanian A (2012) Mitral regurgitation in patients referred for transcatheter aortic valve implantation using the Edwards Sapien prosthesis: mechanisms and early postprocedural changes. J Am Soc Echocardiogr 25:160–165PubMedCrossRef

37.

Vizzardi E, D’Aloia A, Fiorina C, Bugatti S, Parrinello G, De Carlo M, Giannini C, Di Bello V, Petronio AS, Curello S, Ettori F, Dei Cas L (2012) Early regression of left ventricular mass associated with diastolic improvement after transcatheter aortic valve implantation. J Am Soc Echocardiogr 25:1091–1098PubMedCrossRef

38.

Nagueh MiddletonKJ, Kopelen HA, Zoghbi WA, Quiñones MA (1997) Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 30:1527–1533PubMedCrossRef

39.

Mullens W, Borowski AG, Curtin RJ, Thomas JD, Tang WH (2009) Tissue Doppler imaging in the estimation of intracardiac filling pressure in decompensated patients with advanced systolic heart failure. Circulation 119:62–70PubMedCrossRef

40.

Dalsgaard M, Kjaergaard J, Pecini R, Iversen KK, Køber L, Moller JE, Grande P, Clemmensen P, Hassager C (2009) Left ventricular filling pressure estimation at rest and during exercise in patients with severe aortic valve stenosis: comparison of echocardiographic and invasive measurements. J Am Soc Echocardiogr 22:343–349PubMedCrossRef

41.

Khouri S, Maly GT, Suh DD, Walsh TE (2004) A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr 17:290–297PubMedCrossRef

42.

Hurrell D, Nishimura RA, Ilstrup DM, Appleton CP (1997) Utility of preload alteration in assessment of left ventricular filling pressure by Doppler echocardiography: a simultaneous catheterization and Doppler echocardiographic study. J Am Coll Cardiol 30:459–467PubMedCrossRef

43.

Oh J, Appleton CP, Hatle LK, Nishimura RA, Seward JB, Tajik AJ (1997) The noninvasive assessment of left ventricular diastolic function with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 10:246–270PubMedCrossRef

Title: Left atrial remodelling in patients undergoing transcatheter aortic valve implantation: a speckle-tracking prospective, longitudinal study
Authors: Flavio D’Ascenzi
Matteo Cameli
Michael Henein
Alessandro Iadanza
Rosanna Reccia
Matteo Lisi
Valeria Curci
Giuseppe Sinicropi
Andrea Torrisi
Carlo Pierli
Sergio Mondillo
Publication date: 01-12-2013
Publisher: Springer Netherlands
Published in: The International Journal of Cardiovascular Imaging / Issue 8/2013
Print ISSN: 1569-5794
Electronic ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-013-0265-z

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Left atrial remodelling in patients undergoing transcatheter aortic valve implantation: a speckle-tracking prospective, longitudinal study

Abstract

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