Abstract Objective The response of the RV following treatment of aortic stenosis is poorly defined, reflecting the challenge of accurate RV assessment. Cardiovascular magnetic resonance (CMR) is the ...established reference for imaging of RV volumes, mass and function. We sought to define the impact of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) upon RV function in patients treated for severe aortic stenosis using CMR. Methods A 1.5T CMR scan was performed preoperatively and 6 months postoperatively in 112 (56 TAVI, 56 SAVR; 76 ± 8 years) high-risk severe symptomatic aortic stenosis patients across two UK cardiothoracic centres. Results TAVI patients were older (80.4 ± 6.7 vs. 72.8 ± 7.2 years, p < 0.05) with a higher STS score (2.13 ± 0.73 vs. 5.54 ± 3.41%, p < 0.001). At 6 months, SAVR was associated with a significant increase in RV end systolic volume (33 ± 10 vs. 37 ± 10 ml/m2 , p = 0.008), and decrease in RV ejection fraction (58 ± 8 vs. 53 ± 8%, p = 0.005) and tricuspid annular plane systolic excursion (22 ± 5 vs. 14 ± 3 mm, p < 0.001). Only 4 (7%) SAVR patients had new RV late gadolinium hyper-enhancement with no new cases seen in the TAVI patients at 6 months. Longer surgical cross-clamp time was the only predictor of increased RV end systolic volume at 6 months. Post-TAVI, there was no observed change in RV volumes or function. Over a maximum 6.3 year follow-up, 18(32%) of TAVI patients and 1(1.7%) of SAVR patients had died (p = 0.001). On multivariable Cox analysis, the RV mass at 6 m post-TAVI was independently associated with all-cause mortality (HR 1.359, 95% CI 1.108–1.666, p = 0.003). Conclusions SAVR results in a deterioration in RV systolic volumes and function associated with longer cross-clamp times and is not fully explained by suboptimal RV protection during cardiopulmonary bypass. TAVI had no adverse impact upon RV volumes or function.
Receiver operating characteristic analysis was used to determine the diagnostic accuracies (SPSS version 20.00 software; IBM Corp., Armonk, New York). To detect the 50 cases of HCM from the 40 ...athletes, the diagnostic accuracy (area under the curve AUC) of maximal segment thickness, native T1, and ECV were 0.986 (95% confidence interval CI: 0.935 to 0.999), 0.847 (95% CI: 0.756 to 0.914), and 0.936 (95% CI: 0.864 to 0.977), respectively (p < 0.001 for all).
Abstract Background Despite the wealth of data showing the positive effects on cardiac reverse remodelling in the long-term, the immediate effects of transcatheter aortic valve implantation (TAVI) on ...the left ventricle are yet to be comprehensively described using cardiovascular magnetic resonance imaging. Also, the link between myocardial fibrosis and acute left ventricular (LV) mass regression is unknown. Methods Fifty-seven patients with severe aortic stenosis awaiting TAVI underwent paired cardiovascular magnetic resonance scans before and early after the procedure (4 interquartile range, 3-5 days). LV mass, volume, and function were measured. Late gadolinium enhancement (LGE) imaging was performed to assess for the presence of and pattern of myocardial fibrosis. Results After the procedure, 53 (95%) patients experienced an immediate (10.1 ± 7.1%) reduction in indexed LV mass (LVMi) from 76 ± 15.5 to 68.4 ± 14.7 g/m2 ( P < 0.001). Those with no LGE experienced the greatest LVMi regression (13.9 ± 7.1%) compared with those with a midwall/focal fibrosis pattern LGE (7.4 ± 5.8%) and infarct pattern LGE (7.2 ± 7.0%; P = 0.005). There was no overall change in LV ejection fraction (LVEF; 55.1 ± 12.1% to 55.5 ± 10.9%; P = 0.867), however a significant improvement in LVEF was seen in those with abnormal (< 55%; n = 24; 42%) baseline LVEF (43.2 ± 8.9 to 46.7 ± 10.5%; P = 0.027). Baseline LVMi ( P = 0.005) and myocardial fibrosis ( P < 0.001) were strong independent predictors of early LVMi regression. Conclusions LV reverse remodelling occurs immediately after TAVI, with significant LV mass regression in the total population and an improvement in LVEF in those with preexisting LV impairment. Those without myocardial fibrosis at baseline experience greater LV mass regression than those with fibrosis.
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