Original Scientific Articles
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Journal of Structural Heart Disease, December 2019, Volume 5, Issue 6:254-262
DOI: 10.12945/j.jshd.2020.008.19
Incremental Prognostic Utility of Myocardial Fibrosis Imaging By Speckle Tracking Echocardiography Post Transcatheter Aortic Valve Replacement
Mohamad Hemu, MD2*, Kyaw Zaw Hein, MD2, Ahmad S. Manshad, MD2, Fatima Ballout, MD2, Fareed M. Collado, MD2, Clifford J. Kavinsky, MD, PhD1
1 Department of Interventional Cardiology, Rush University Medical Center, Chicago, Illinois, USA
2 Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
Abstract
Background: Long-standing aortic stenosis (AS) results in fibrotic changes that often persist after TAVR. Fibrosis in AS preferentially affects the left ventricular (LV) basal segments and can lead to ventricular desynchrony.
Objective: Determine the prognostic utility of strain parameters as measured by speckle-tracking echocardiography in patients undergoing transcatheter aortic valve replacement (TAVR). We hypothesize that basal longitudinal strain (BLS) and mechanical dispersion (MD) measured after TAVR will predict all-cause mortality in severe AS.
Methods: 159 patients (51% men, 81±9 years) with severe AS (aortic valve area 0.7±0.2 cm2, mean gradient 46±16mmHg) who underwent TAVR at our institution were retrospectively analyzed. 2D speckle-tracking echocardiography was used to assess myocardial deformation and MD (SD of time from Q/R on the ECG to peak strain in 16 LV segments) immediately after TAVR (median, 1 day). Images were analyzed offline using a vendor-independent software (TomTec).
Results: At 1-year post-TAVR, 28 (17.6%) patients died. Non-survivors demonstrated impaired global longitudinal strain (GLS, -11.2±3% vs -14.2±4%, p=0.001), impaired BLS (-10.9±2% vs -13.3±3%, p=0.001), and pronounced MD (86±33 ms vs 70±26 ms p=0.006) compared to survivors. Baseline multivariable Cox regression model (Figure) included age, STS, NYHA, renal disease, AV mean gradient, and post-TAVR paravalvular leak as significant univariates (model 1, p<0.001). An incremental prognostic value was achieved by adding BLS to model 1+ GLS (p=0.001). Addition of MD to the model 1 + GLS + BLS provided further incremental prognostic increase (p=0.008). For the measurement of GLS, the Interobserver Intraclass Correlation Coefficient was 0.87.
Conclusion: In severe AS, post-TAVR myocardial fibrosis assessed by strain imaging was significantly associated with cardiovascular events. This finding may provide incremental prognostic value in patients with AS.
Cite this article as: Hemu M, Hein KZ, Manshad AS, Ballout F, Collado FM, Kavinsky CJ. Incremental Prognostic Utility of Myocardial Fibrosis Imaging By Speckle Tracking Echocardiography Post Transcatheter Aortic Valve Replacement. Structural Heart Disease 2019;5(6):254-262. DOI: 10.12945/j.jshd.2020.008.19
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Original Scientific Articles
Journal of Structural Heart Disease, December 2019, Volume 5, Issue 6:254-262
DOI: 10.12945/j.jshd.2020.008.19
Incremental Prognostic Utility of Myocardial Fibrosis Imaging By Speckle Tracking Echocardiography Post Transcatheter Aortic Valve Replacement
Mohamad Hemu, MD2*, Kyaw Zaw Hein, MD2, Ahmad S. Manshad, MD2, Fatima Ballout, MD2, Fareed M. Collado, MD2, Clifford J. Kavinsky, MD, PhD1
1 Department of Interventional Cardiology, Rush University Medical Center, Chicago, Illinois, USA
2 Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
Abstract
Background: Long-standing aortic stenosis (AS) results in fibrotic changes that often persist after TAVR. Fibrosis in AS preferentially affects the left ventricular (LV) basal segments and can lead to ventricular desynchrony.
Objective: Determine the prognostic utility of strain parameters as measured by speckle-tracking echocardiography in patients undergoing transcatheter aortic valve replacement (TAVR). We hypothesize that basal longitudinal strain (BLS) and mechanical dispersion (MD) measured after TAVR will predict all-cause mortality in severe AS.
Methods: 159 patients (51% men, 81±9 years) with severe AS (aortic valve area 0.7±0.2 cm2, mean gradient 46±16mmHg) who underwent TAVR at our institution were retrospectively analyzed. 2D speckle-tracking echocardiography was used to assess myocardial deformation and MD (SD of time from Q/R on the ECG to peak strain in 16 LV segments) immediately after TAVR (median, 1 day). Images were analyzed offline using a vendor-independent software (TomTec).
Results: At 1-year post-TAVR, 28 (17.6%) patients died. Non-survivors demonstrated impaired global longitudinal strain (GLS, -11.2±3% vs -14.2±4%, p=0.001), impaired BLS (-10.9±2% vs -13.3±3%, p=0.001), and pronounced MD (86±33 ms vs 70±26 ms p=0.006) compared to survivors. Baseline multivariable Cox regression model (Figure) included age, STS, NYHA, renal disease, AV mean gradient, and post-TAVR paravalvular leak as significant univariates (model 1, p<0.001). An incremental prognostic value was achieved by adding BLS to model 1+ GLS (p=0.001). Addition of MD to the model 1 + GLS + BLS provided further incremental prognostic increase (p=0.008). For the measurement of GLS, the Interobserver Intraclass Correlation Coefficient was 0.87.
Conclusion: In severe AS, post-TAVR myocardial fibrosis assessed by strain imaging was significantly associated with cardiovascular events. This finding may provide incremental prognostic value in patients with AS.
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Cite this article as: Hemu M, Hein KZ, Manshad AS, Ballout F, Collado FM, Kavinsky CJ. Incremental Prognostic Utility of Myocardial Fibrosis Imaging By Speckle Tracking Echocardiography Post Transcatheter Aortic Valve Replacement. Structural Heart Disease 2019;5(6):254-262. DOI: 10.12945/j.jshd.2020.008.19
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