Short-Term Effects of Transcatheter Aortic Valve Implantation on Left Atrial Mechanics and Left Ventricular Diastolic Function
Background Aortic stenosis (AS) leads to remodeling of the left heart. Strain measurements enable the assessment of left atrial (LA) mechanics. The goal of this study was to evaluate the short-term effects of transcatheter aortic valve implantation (TAVI) on LA myocardial deformation as well as left...
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| creator | Spethmann, Sebastian, MD Dreger, Henryk, MD Baldenhofer, Gerd, MD Stüer, Katharina Saghabalyan, Davit, MD Müller, Eda, MD Hättasch, Robert Stangl, Verena, MD Laule, Michael, MD Baumann, Gert, MD Stangl, Karl, MD Knebel, Fabian, MD |
| description | Background Aortic stenosis (AS) leads to remodeling of the left heart. Strain measurements enable the assessment of left atrial (LA) mechanics. The goal of this study was to evaluate the short-term effects of transcatheter aortic valve implantation (TAVI) on LA myocardial deformation as well as left ventricular (LV) diastolic function. Methods Thirty-two patients with severe AS were prospectively enrolled and examined before and 8.2 ± 3.3 days after TAVI. Speckle-tracking echocardiography of the basal septal and lateral segments of the left atrium was performed to determine peak positive strain (RLA ), strain during early diastole (ELA ), and, if feasible, strain during atrial contraction (ALA ). Assessment of LV diastolic function included standard indices, the atrial fraction, and LA volumes. Results Compared with baseline, the mean atrial reservoir (RLA ) (24.0 ± 11.2% vs 32.2 ± 14.0%, P < .001) and conduit function (RLA − ELA ) (13.9 ± 5.5% vs 20.8 ± 8.1%, P < .001) improved significantly after TAVI. There was a significant reduction in deceleration time (242 ± 56 vs 195 ± 65 msec, P < .001) and an improvement of pulsed-wave tissue Doppler–derived E′ (5.5 ± 1.8 vs 7.3 ± 2.3 cm/sec, P = .01). Regarding LA volumes, only the minimal LA volume index changed significantly. In contrast, there was no improvement in atrial contraction, that is, contractile function (ELA − ALA ) and atrial fraction. Moreover, the E/E′ ratio remained unchanged. Conclusions 8.2 ± 3.3 days after TAVI, only the reservoir and conduit function of the left atrium improved, whereas LA contraction and LA volumes, except for the systolic volume index, remained unchanged. This was accompanied by improvement of early LV diastolic function, indicating acute recovery of LV relaxation and LA function. |
| doi_str_mv | 10.1016/j.echo.2012.10.002 |
| format | Article |
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Strain measurements enable the assessment of left atrial (LA) mechanics. The goal of this study was to evaluate the short-term effects of transcatheter aortic valve implantation (TAVI) on LA myocardial deformation as well as left ventricular (LV) diastolic function. Methods Thirty-two patients with severe AS were prospectively enrolled and examined before and 8.2 ± 3.3 days after TAVI. Speckle-tracking echocardiography of the basal septal and lateral segments of the left atrium was performed to determine peak positive strain (RLA ), strain during early diastole (ELA ), and, if feasible, strain during atrial contraction (ALA ). Assessment of LV diastolic function included standard indices, the atrial fraction, and LA volumes. Results Compared with baseline, the mean atrial reservoir (RLA ) (24.0 ± 11.2% vs 32.2 ± 14.0%, P < .001) and conduit function (RLA − ELA ) (13.9 ± 5.5% vs 20.8 ± 8.1%, P < .001) improved significantly after TAVI. There was a significant reduction in deceleration time (242 ± 56 vs 195 ± 65 msec, P < .001) and an improvement of pulsed-wave tissue Doppler–derived E′ (5.5 ± 1.8 vs 7.3 ± 2.3 cm/sec, P = .01). Regarding LA volumes, only the minimal LA volume index changed significantly. In contrast, there was no improvement in atrial contraction, that is, contractile function (ELA − ALA ) and atrial fraction. Moreover, the E/E′ ratio remained unchanged. Conclusions 8.2 ± 3.3 days after TAVI, only the reservoir and conduit function of the left atrium improved, whereas LA contraction and LA volumes, except for the systolic volume index, remained unchanged. This was accompanied by improvement of early LV diastolic function, indicating acute recovery of LV relaxation and LA function.</description><identifier>ISSN: 0894-7317</identifier><identifier>EISSN: 1097-6795</identifier><identifier>DOI: 10.1016/j.echo.2012.10.002</identifier><identifier>PMID: 23140843</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Aged ; Aortic Valve Stenosis - diagnostic imaging ; Aortic Valve Stenosis - physiopathology ; Aortic Valve Stenosis - surgery ; Atrial Function, Left - physiology ; Cardiac Catheterization ; Cardiovascular ; Diastole ; Diastolic function ; Echocardiography, Doppler, Color ; Female ; Follow-Up Studies ; Heart Atria - diagnostic imaging ; Heart Atria - physiopathology ; Heart Atria - surgery ; Heart Valve Prosthesis Implantation - methods ; Humans ; LA mechanics ; Left atrium ; Male ; Myocardial Contraction ; Prospective Studies ; Strain ; TAVI ; Time Factors ; Ventricular Function, Left - physiology</subject><ispartof>Journal of the American Society of Echocardiography, 2013, Vol.26 (1), p.64-71.e2</ispartof><rights>American Society of Echocardiography</rights><rights>2013 American Society of Echocardiography</rights><rights>Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-194237de5e82ac3e08b7bb8c0720c80b54026ec0a10747c7981c2e49f7ccbaa3</citedby><cites>FETCH-LOGICAL-c411t-194237de5e82ac3e08b7bb8c0720c80b54026ec0a10747c7981c2e49f7ccbaa3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.echo.2012.10.002$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,4024,27923,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23140843$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Spethmann, Sebastian, MD</creatorcontrib><creatorcontrib>Dreger, Henryk, MD</creatorcontrib><creatorcontrib>Baldenhofer, Gerd, MD</creatorcontrib><creatorcontrib>Stüer, Katharina</creatorcontrib><creatorcontrib>Saghabalyan, Davit, MD</creatorcontrib><creatorcontrib>Müller, Eda, MD</creatorcontrib><creatorcontrib>Hättasch, Robert</creatorcontrib><creatorcontrib>Stangl, Verena, MD</creatorcontrib><creatorcontrib>Laule, Michael, MD</creatorcontrib><creatorcontrib>Baumann, Gert, MD</creatorcontrib><creatorcontrib>Stangl, Karl, MD</creatorcontrib><creatorcontrib>Knebel, Fabian, MD</creatorcontrib><title>Short-Term Effects of Transcatheter Aortic Valve Implantation on Left Atrial Mechanics and Left Ventricular Diastolic Function</title><title>Journal of the American Society of Echocardiography</title><addtitle>J Am Soc Echocardiogr</addtitle><description>Background Aortic stenosis (AS) leads to remodeling of the left heart. Strain measurements enable the assessment of left atrial (LA) mechanics. The goal of this study was to evaluate the short-term effects of transcatheter aortic valve implantation (TAVI) on LA myocardial deformation as well as left ventricular (LV) diastolic function. Methods Thirty-two patients with severe AS were prospectively enrolled and examined before and 8.2 ± 3.3 days after TAVI. Speckle-tracking echocardiography of the basal septal and lateral segments of the left atrium was performed to determine peak positive strain (RLA ), strain during early diastole (ELA ), and, if feasible, strain during atrial contraction (ALA ). Assessment of LV diastolic function included standard indices, the atrial fraction, and LA volumes. Results Compared with baseline, the mean atrial reservoir (RLA ) (24.0 ± 11.2% vs 32.2 ± 14.0%, P < .001) and conduit function (RLA − ELA ) (13.9 ± 5.5% vs 20.8 ± 8.1%, P < .001) improved significantly after TAVI. There was a significant reduction in deceleration time (242 ± 56 vs 195 ± 65 msec, P < .001) and an improvement of pulsed-wave tissue Doppler–derived E′ (5.5 ± 1.8 vs 7.3 ± 2.3 cm/sec, P = .01). Regarding LA volumes, only the minimal LA volume index changed significantly. In contrast, there was no improvement in atrial contraction, that is, contractile function (ELA − ALA ) and atrial fraction. Moreover, the E/E′ ratio remained unchanged. Conclusions 8.2 ± 3.3 days after TAVI, only the reservoir and conduit function of the left atrium improved, whereas LA contraction and LA volumes, except for the systolic volume index, remained unchanged. This was accompanied by improvement of early LV diastolic function, indicating acute recovery of LV relaxation and LA function.</description><subject>Aged</subject><subject>Aortic Valve Stenosis - diagnostic imaging</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Aortic Valve Stenosis - surgery</subject><subject>Atrial Function, Left - physiology</subject><subject>Cardiac Catheterization</subject><subject>Cardiovascular</subject><subject>Diastole</subject><subject>Diastolic function</subject><subject>Echocardiography, Doppler, Color</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Atria - diagnostic imaging</subject><subject>Heart Atria - physiopathology</subject><subject>Heart Atria - surgery</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Humans</subject><subject>LA mechanics</subject><subject>Left atrium</subject><subject>Male</subject><subject>Myocardial Contraction</subject><subject>Prospective Studies</subject><subject>Strain</subject><subject>TAVI</subject><subject>Time Factors</subject><subject>Ventricular Function, Left - physiology</subject><issn>0894-7317</issn><issn>1097-6795</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUGLFDEQhYMo7rj6BzxIjl56rKQznW4QYVh3dWHEww57DenqaiZjd2dM0gt78bebZlYPHoRAoOq9R9VXjL0VsBYgqg_HNeHBryUImQtrAPmMrQQ0uqh0s3nOVlA3qtCl0BfsVYxHANjUAC_ZhSyFglqVK_br7uBDKvYURn7d94Qpct_zfbBTRJsOlCjwbZY45Pd2eCB-O54GOyWbnJ94fjvqE9-m4OzAv-WB7OQwcjt15849TbmH82AD_-xsTH7IUTfzhEvAa_ait0OkN0__JdvfXO-vvha7719ur7a7ApUQqRCNkqXuaEO1tFgS1K1u2xpBS8Aa2o0CWRGCFaCVRt3UAiWppteIrbXlJXt_jj0F_3OmmMzoItKQFyE_RyOkLpWqm6rKUnmWYvAxBurNKbjRhkcjwCzYzdEs2M2Cfall7Nn07il_bkfq_lr-cM6Cj2cB5SUfHAUT0dGE1LmQmZvOu__nf_rHjoPLnO3wgx4pHv0cpozPCBOlAXO3HH65u5AAupGq_A0Meql7</recordid><startdate>2013</startdate><enddate>2013</enddate><creator>Spethmann, Sebastian, MD</creator><creator>Dreger, Henryk, MD</creator><creator>Baldenhofer, Gerd, MD</creator><creator>Stüer, Katharina</creator><creator>Saghabalyan, Davit, MD</creator><creator>Müller, Eda, MD</creator><creator>Hättasch, Robert</creator><creator>Stangl, Verena, MD</creator><creator>Laule, Michael, MD</creator><creator>Baumann, Gert, MD</creator><creator>Stangl, Karl, MD</creator><creator>Knebel, Fabian, MD</creator><general>Mosby, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2013</creationdate><title>Short-Term Effects of Transcatheter Aortic Valve Implantation on Left Atrial Mechanics and Left Ventricular Diastolic Function</title><author>Spethmann, Sebastian, MD ; Dreger, Henryk, MD ; Baldenhofer, Gerd, MD ; Stüer, Katharina ; Saghabalyan, Davit, MD ; Müller, Eda, MD ; Hättasch, Robert ; Stangl, Verena, MD ; Laule, Michael, MD ; Baumann, Gert, MD ; Stangl, Karl, MD ; Knebel, Fabian, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-194237de5e82ac3e08b7bb8c0720c80b54026ec0a10747c7981c2e49f7ccbaa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Aged</topic><topic>Aortic Valve Stenosis - diagnostic imaging</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Aortic Valve Stenosis - surgery</topic><topic>Atrial Function, Left - physiology</topic><topic>Cardiac Catheterization</topic><topic>Cardiovascular</topic><topic>Diastole</topic><topic>Diastolic function</topic><topic>Echocardiography, Doppler, Color</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart Atria - diagnostic imaging</topic><topic>Heart Atria - physiopathology</topic><topic>Heart Atria - surgery</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Humans</topic><topic>LA mechanics</topic><topic>Left atrium</topic><topic>Male</topic><topic>Myocardial Contraction</topic><topic>Prospective Studies</topic><topic>Strain</topic><topic>TAVI</topic><topic>Time Factors</topic><topic>Ventricular Function, Left - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Spethmann, Sebastian, MD</creatorcontrib><creatorcontrib>Dreger, Henryk, MD</creatorcontrib><creatorcontrib>Baldenhofer, Gerd, MD</creatorcontrib><creatorcontrib>Stüer, Katharina</creatorcontrib><creatorcontrib>Saghabalyan, Davit, MD</creatorcontrib><creatorcontrib>Müller, Eda, MD</creatorcontrib><creatorcontrib>Hättasch, Robert</creatorcontrib><creatorcontrib>Stangl, Verena, MD</creatorcontrib><creatorcontrib>Laule, Michael, MD</creatorcontrib><creatorcontrib>Baumann, Gert, MD</creatorcontrib><creatorcontrib>Stangl, Karl, MD</creatorcontrib><creatorcontrib>Knebel, Fabian, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Society of Echocardiography</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Spethmann, Sebastian, MD</au><au>Dreger, Henryk, MD</au><au>Baldenhofer, Gerd, MD</au><au>Stüer, Katharina</au><au>Saghabalyan, Davit, MD</au><au>Müller, Eda, MD</au><au>Hättasch, Robert</au><au>Stangl, Verena, MD</au><au>Laule, Michael, MD</au><au>Baumann, Gert, MD</au><au>Stangl, Karl, MD</au><au>Knebel, Fabian, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Short-Term Effects of Transcatheter Aortic Valve Implantation on Left Atrial Mechanics and Left Ventricular Diastolic Function</atitle><jtitle>Journal of the American Society of Echocardiography</jtitle><addtitle>J Am Soc Echocardiogr</addtitle><date>2013</date><risdate>2013</risdate><volume>26</volume><issue>1</issue><spage>64</spage><epage>71.e2</epage><pages>64-71.e2</pages><issn>0894-7317</issn><eissn>1097-6795</eissn><abstract>Background Aortic stenosis (AS) leads to remodeling of the left heart. Strain measurements enable the assessment of left atrial (LA) mechanics. The goal of this study was to evaluate the short-term effects of transcatheter aortic valve implantation (TAVI) on LA myocardial deformation as well as left ventricular (LV) diastolic function. Methods Thirty-two patients with severe AS were prospectively enrolled and examined before and 8.2 ± 3.3 days after TAVI. Speckle-tracking echocardiography of the basal septal and lateral segments of the left atrium was performed to determine peak positive strain (RLA ), strain during early diastole (ELA ), and, if feasible, strain during atrial contraction (ALA ). Assessment of LV diastolic function included standard indices, the atrial fraction, and LA volumes. Results Compared with baseline, the mean atrial reservoir (RLA ) (24.0 ± 11.2% vs 32.2 ± 14.0%, P < .001) and conduit function (RLA − ELA ) (13.9 ± 5.5% vs 20.8 ± 8.1%, P < .001) improved significantly after TAVI. There was a significant reduction in deceleration time (242 ± 56 vs 195 ± 65 msec, P < .001) and an improvement of pulsed-wave tissue Doppler–derived E′ (5.5 ± 1.8 vs 7.3 ± 2.3 cm/sec, P = .01). Regarding LA volumes, only the minimal LA volume index changed significantly. In contrast, there was no improvement in atrial contraction, that is, contractile function (ELA − ALA ) and atrial fraction. Moreover, the E/E′ ratio remained unchanged. Conclusions 8.2 ± 3.3 days after TAVI, only the reservoir and conduit function of the left atrium improved, whereas LA contraction and LA volumes, except for the systolic volume index, remained unchanged. This was accompanied by improvement of early LV diastolic function, indicating acute recovery of LV relaxation and LA function.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>23140843</pmid><doi>10.1016/j.echo.2012.10.002</doi></addata></record> |
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| subjects | Aged Aortic Valve Stenosis - diagnostic imaging Aortic Valve Stenosis - physiopathology Aortic Valve Stenosis - surgery Atrial Function, Left - physiology Cardiac Catheterization Cardiovascular Diastole Diastolic function Echocardiography, Doppler, Color Female Follow-Up Studies Heart Atria - diagnostic imaging Heart Atria - physiopathology Heart Atria - surgery Heart Valve Prosthesis Implantation - methods Humans LA mechanics Left atrium Male Myocardial Contraction Prospective Studies Strain TAVI Time Factors Ventricular Function, Left - physiology |
| title | Short-Term Effects of Transcatheter Aortic Valve Implantation on Left Atrial Mechanics and Left Ventricular Diastolic Function |
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