Left ventricular functional recovery and remodeling in low-flow low-gradient severe aortic stenosis after transcatheter aortic valve implantation

J Am Soc Echocardiogr. 2014 Aug;27(8):817-25. doi: 10.1016/j.echo.2014.04.021. Epub 2014 Jun 3.


Background: Speckle-tracking-derived global longitudinal strain (GLS) is a more sensitive method of detecting left ventricular (LV) functional recovery after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis. However, it remains unknown whether LV function improves in patients with low-flow, low-gradient severe aortic stenosis (LFLGSAS) after TAVI. The aim of the present was to evaluate LV functional recovery and remodeling after TAVI in patients with LFLGSAS.

Methods: Sixty-eight patients (57% men; mean age, 79.1 ± 7.1 years) with LFLGSAS treated with TAVI were evaluated. LV function and remodeling were investigated before TAVI and at 6 and 12 months after TAVI. All echocardiographic data were prospectively collected, and GLS was retrospectively analyzed.

Results: Among patients with LFLGSAS, 35 (52%) had low LV ejection fraction (LVEF) (<50%), and 33 (48%) had preserved LVEF (≥50%). The low-LVEF group had significantly more impaired GLS than the group with preserved LVEF (-8.3 ± 2.6% vs -13.3 ± 3.5%, P < .001). LV systolic function improved after TAVI in both groups. Although in the group of patients with low LVEF, all functional parameters improved, in the group of patients with preserved LVEF, only strain-derived parameters significantly improved. There were significant decreases in absolute LV wall thickness and relative wall thickness and a trend toward decreased LV mass index in both LVEF groups. LV volumes decreased significantly in those with low LVEF but not in those with preserved LVEF. Baseline GLS but not LVEF group was independently associated to GLS improvement at 12 months after TAVI.

Conclusions: Patients with LFLGSAS with low and preserved LVEF had a significant improvement in LV function after TAVI, as assessed by GLS. Absolute and relative LV wall thickness decreased in both groups of patients, but only those with low LVEF had reductions in LV volumes.

Keywords: Aortic valve stenosis; Low-flow low-gradient; Speckle-tracking; Strain; Transcatheter aortic valve implantation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery*
  • Cardiac Catheterization
  • Echocardiography, Doppler, Color / methods*
  • Echocardiography, Three-Dimensional
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis*
  • Humans
  • Male
  • Postoperative Period
  • Recovery of Function*
  • Retrospective Studies
  • Severity of Illness Index
  • Stroke Volume
  • Transcatheter Aortic Valve Replacement*
  • Treatment Outcome
  • Ventricular Function, Left / physiology*
  • Ventricular Remodeling / physiology*