Ciddi Aort Darlığı Olan Hastalarda, Transkateter Aort Kapak İmplantasyonu (TAVİ) Sonrası Ventrikül Sistolik Fonksiyonlarının 2D Strain Ekokardiyografik Görüntüleme İle Değerlendirilmesi

Abstract

KIVRAK A. Evaluation of Left Ventricle Systolic Functions With 2D Strain Echocardiography After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis, Hacettepe University Faculty of Medicine, Thesis in Cardiology, Ankara, 2018. Transcatheter aortic valve implantation is a treatment modality in patients who have severe aortic stenosis. In this study, we aimed to evaluate changes in left ventricle systolic functions and left ventricle geometry after TAVI procedure. Fifty patients who has undergone TAVI in between 1st January 2016 and 31st December 2017 in Hacettepe University Cardiology Clinic were enrolled. The patients were evaluated preprocedurallly and at 1st and 6th month after the procedure. Left ventricle ejection fraction (LVEF) with biplane simpson method, left ventricle global longitudinal strain (LV GLS) with speckle tracking method, left ventricle mass (LVM), left ventricle mass index (LVMI), relative wall thickness (RWT) and left atrial volume index (LAVI) were calculated with 2D transthoracic echocardiography. Serum BNP levels were measured in all patients at each visit. “Kansas City Cardiomyopathy Questionnaire” (KCCQ12) survey was performed to estimate life quality in every visit. TAVI procedures was performed with transfemoral approach in all patients. Periprocedural and postprocedural mortality was not observed during follow up. Mean LVEF measured 54.04±13.48% (range: 25% to 72%), 58.10±11.49% (range: 29% to 68%), 59.36±11.85% (range: 28% to 72%) at preprocedural, 1st month visit and 6th month visit after the procedure respectively. Improvement in mean LVEF after the procedure was statistically significant (p<0.001). Mean LV GLS was measured -15.83±2.78% (range: -21.6% to -10.2%),-18.73±3.49% (range: 24.8% to -10.7%), -19.87±4.05% (range: -25.6% to -11.6%) at preprocedural, 1st month visit and 6th month visit after the procedure respectively. Improvement in mean LV GLS after the procedure was statistically significant (p<0.001). Mean LVM was measured 235.52±60.4 gr, 232.12±60.54 gr, 202.34±59.14 gr at preprocedural, 1st month visit and 6th month visit after the procedure respectively. Mean LVMI was measured 131.16±33.39 gr/m2, 129.32±33.45 gr/m2, 112.68±32.80 gr/m2 at preprocedural, 1st month visit and 6th month visit after the procedure respectively. Changes in LVM and LVMI after the procedure were statistically significant (p<0.001; p<0.001). Mean RWT was measured 0.58±0.11, 0.56±0.11, 0.53±0.11 at preprocedural, 1st month visit and 6th month visit after the procedure respectively. Improvement of RWT after procedure statistically significant (p<0.001). Mean serum BNP level was measured 714.53±849.63 pg/ml (range: 39 to 3097 pg/ml), 454.78±598.83 pg/ml (range: 10 to 3200 pg/ml), 342.16±456.26 pg/ml (range 10 to 1750 pg/ml) at preprocedural, 1st month visit and 6th month visit after the procedure respectively. Decreases in BNP levels after the procedure were statistically significant (p<0.001). Mean KCCQ-12 score was calculated 34.10±11.33 (range: 15 to 61), 60.12±17.02 (range: 21 to 86), 68.02±15.95 (range: 36 to 91) at preprocedural, 1st month visit and 6th month visit after the procedure respectively. Improvement in KCCQ-12 scores after the procedure was statistically significant (p<0.001). Effect of decrease in afterload after the procedure on LAVI was examined. It was observed that decrease in mean LAVI showed statistic significance (p<0.001). Similarly as previous studies, our study showed that TAVI procedure results in improvement in patients left ventricle systolic functions, quality of life measures and results in decreases of left ventricle afterload and LAVI. The improvement in these parameters reflects the reverse remodeling in left atrium and left ventricle after successful TAVI procedure. Further large-scale studies with longer follow up may give more information about hemodynamic effects of TAVI procedure