Changes in left ventricular function in patients with aortic regurgitation 12 months after transapical transcatheter aortic valve implantation

Transcatheter aortic valve implantation (TAVI) is an established treatment for high surgical risk aortic stenosis patients; in recent years, it has also been used in patients with pure/dominant aortic regurgitation (AR). This study aimed to determine the impact of transapical TAVI on left ventricle myocardial mechanics in AR patients. Thirty AR patients (70% men; mean age, 72.8 +/- 4.3years) were enrolled. Conventional echocardiography was performed on all patients before and 12months after TAVI. Three-dimensional speckle tracking was accomplished in 20 AR patients for the evaluation of global longitudinal strain, global circumferential strain, twist, torsion, apical rotation and basal rotation. Preoperative left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), twist, torsion and apical rotation were impaired in AR patients compared with controls. Mean left ventricular (LV) end-diastolic diameter (from 62.9 +/- 7.3 to 52.0 +/- 6.8mm, p<0.001), LV end-diastolic volume (from 199.4 +/- 55.0 to 130.1 +/- 48.9mL, p<0.001), and LV mass index (179.8 +/- 52.2-134.4 +/- 42.5g/m(2), p=0.001) decreased 12months after TAVI. Interestingly, GLS (from -17.2 +/- 3.2 to -18.9 +/- 3.7, p=0.007) and GCS (from -23.9 +/- 4.9 to -25.7 +/- 5.0, p=0.008) improved significantly, but LVEF did not significantly improve. In terms of the rotational mechanics, twist, rotation and basal rotation remained almost unchanged, whereas apical rotation (from 7.4 +/- 4.0 to 5.5 +/- 3.9, p=0.009) was significantly impaired after transapical TAVI. Our results indicate that LV function was improved in terms of myocardial deformation but worsened in terms of apical rotation 12months after TAVI in AR patients. Three-dimensional speckle tracking echocardiography appears to be a sensitive method for detecting subtle cardiac remodeling after TAVI.