Impact of Prosthesis-Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement

Frédéric Poulin, Teerapat Yingchoncharoen, William M. Wilson, Eric M. Horlick, Philippe Généreux, E. Murat Tuzcu, William Stewart, Mark D. Osten, Anna Woo, Paaladinesh Thavendiranathan

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Abstract

Background--The aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis-patient mismatch (PPM). Methods and Results--In a retrospective study, speckle-tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid-term follow-up post-TAVR. Moderate and severe PPM were defined as an effective orifice area =0.85 and <0.65 cm2/m2, respectively. A total of 102 patients (median age, 83 years [77-88]) with severe AS were included. At 6±3 months post-TAVR, moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m2; P=0.001) at follow-up whereas those with PPM did not. There was a significant improvement in LV GLS (-12.8±4.0 to ±14.3±4.3%; P=0.01), GLSR (-0.61±0.20 to -0.73±0.25 second-1; P<0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second-1; P<0.001) in patients without PPM, but not in those with PPM. After adjustment for pre-TAVR ejection fraction and post-TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM. After a median follow-up of 46.1 months (interquartile range, 35.4-60.8), there was no difference in survival between patients with and without PPM. Conclusions--TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM. Presence of PPM was not associated with mortality.

Original languageEnglish (US)
Article numbere002866
JournalJournal of the American Heart Association
Volume5
Issue number2
DOIs
StatePublished - Jan 1 2016

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Mechanics
Prostheses and Implants
Transcatheter Aortic Valve Replacement
Ventricular Remodeling
Aortic Valve Stenosis
Aortic Valve Insufficiency

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Poulin, Frédéric ; Yingchoncharoen, Teerapat ; Wilson, William M. ; Horlick, Eric M. ; Généreux, Philippe ; Tuzcu, E. Murat ; Stewart, William ; Osten, Mark D. ; Woo, Anna ; Thavendiranathan, Paaladinesh. / Impact of Prosthesis-Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement. In: Journal of the American Heart Association. 2016 ; Vol. 5, No. 2.
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title = "Impact of Prosthesis-Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement",
abstract = "Background--The aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis-patient mismatch (PPM). Methods and Results--In a retrospective study, speckle-tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid-term follow-up post-TAVR. Moderate and severe PPM were defined as an effective orifice area =0.85 and <0.65 cm2/m2, respectively. A total of 102 patients (median age, 83 years [77-88]) with severe AS were included. At 6±3 months post-TAVR, moderate and severe PPM were found in 32 (31{\%}) and 9 (9{\%}) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m2; P=0.001) at follow-up whereas those with PPM did not. There was a significant improvement in LV GLS (-12.8±4.0 to ±14.3±4.3{\%}; P=0.01), GLSR (-0.61±0.20 to -0.73±0.25 second-1; P<0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second-1; P<0.001) in patients without PPM, but not in those with PPM. After adjustment for pre-TAVR ejection fraction and post-TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM. After a median follow-up of 46.1 months (interquartile range, 35.4-60.8), there was no difference in survival between patients with and without PPM. Conclusions--TAVR was associated with an incidence of PPM of 40{\%}. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM. Presence of PPM was not associated with mortality.",
author = "Fr{\'e}d{\'e}ric Poulin and Teerapat Yingchoncharoen and Wilson, {William M.} and Horlick, {Eric M.} and Philippe G{\'e}n{\'e}reux and Tuzcu, {E. Murat} and William Stewart and Osten, {Mark D.} and Anna Woo and Paaladinesh Thavendiranathan",
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Poulin, F, Yingchoncharoen, T, Wilson, WM, Horlick, EM, Généreux, P, Tuzcu, EM, Stewart, W, Osten, MD, Woo, A & Thavendiranathan, P 2016, 'Impact of Prosthesis-Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement', Journal of the American Heart Association, vol. 5, no. 2, e002866. https://doi.org/10.1161/JAHA.115.002866

Impact of Prosthesis-Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement. / Poulin, Frédéric; Yingchoncharoen, Teerapat; Wilson, William M.; Horlick, Eric M.; Généreux, Philippe; Tuzcu, E. Murat; Stewart, William; Osten, Mark D.; Woo, Anna; Thavendiranathan, Paaladinesh.

In: Journal of the American Heart Association, Vol. 5, No. 2, e002866, 01.01.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Impact of Prosthesis-Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement

AU - Poulin, Frédéric

AU - Yingchoncharoen, Teerapat

AU - Wilson, William M.

AU - Horlick, Eric M.

AU - Généreux, Philippe

AU - Tuzcu, E. Murat

AU - Stewart, William

AU - Osten, Mark D.

AU - Woo, Anna

AU - Thavendiranathan, Paaladinesh

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background--The aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis-patient mismatch (PPM). Methods and Results--In a retrospective study, speckle-tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid-term follow-up post-TAVR. Moderate and severe PPM were defined as an effective orifice area =0.85 and <0.65 cm2/m2, respectively. A total of 102 patients (median age, 83 years [77-88]) with severe AS were included. At 6±3 months post-TAVR, moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m2; P=0.001) at follow-up whereas those with PPM did not. There was a significant improvement in LV GLS (-12.8±4.0 to ±14.3±4.3%; P=0.01), GLSR (-0.61±0.20 to -0.73±0.25 second-1; P<0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second-1; P<0.001) in patients without PPM, but not in those with PPM. After adjustment for pre-TAVR ejection fraction and post-TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM. After a median follow-up of 46.1 months (interquartile range, 35.4-60.8), there was no difference in survival between patients with and without PPM. Conclusions--TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM. Presence of PPM was not associated with mortality.

AB - Background--The aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis-patient mismatch (PPM). Methods and Results--In a retrospective study, speckle-tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid-term follow-up post-TAVR. Moderate and severe PPM were defined as an effective orifice area =0.85 and <0.65 cm2/m2, respectively. A total of 102 patients (median age, 83 years [77-88]) with severe AS were included. At 6±3 months post-TAVR, moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m2; P=0.001) at follow-up whereas those with PPM did not. There was a significant improvement in LV GLS (-12.8±4.0 to ±14.3±4.3%; P=0.01), GLSR (-0.61±0.20 to -0.73±0.25 second-1; P<0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second-1; P<0.001) in patients without PPM, but not in those with PPM. After adjustment for pre-TAVR ejection fraction and post-TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM. After a median follow-up of 46.1 months (interquartile range, 35.4-60.8), there was no difference in survival between patients with and without PPM. Conclusions--TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM. Presence of PPM was not associated with mortality.

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