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Left atrial remodeling in patients undergoing transcatheter aortic valve implantation: a speckle tracking prospective study.

Session Valvular heart remodelling

Speaker Assistant Professor Flavio D'Ascenzi

Event : ESC Congress 2013

  • Topic : imaging
  • Sub-topic : Echocardiography
  • Session type : Abstract Session

Authors : F D'ascenzi (Siena,IT), M Cameli (Siena,IT), A Iadanza (Siena,IT), R Reccia (Siena,IT), M Lisi (Siena,IT), V Curci (Siena,IT), G Sinicropi (Siena,IT), M Henein (Umea,SE), C Pierli (Siena,IT), S Mondillo (Siena,IT)

F. D'Ascenzi1 , M. Cameli1 , A. Iadanza2 , R. Reccia1 , M. Lisi1 , V. Curci1 , G. Sinicropi2 , M. Henein3 , C. Pierli2 , S. Mondillo1 , 1University of Siena, Department of Cardiovascular Diseases - Siena - Italy , 2Santa Maria alle Scotte Polyclinic, Invasive Cardiology - Siena - Italy , 3Umea University Hospital, Heart Centre, Department of Cardiology - Umea - Sweden ,

European Heart Journal ( 2013 ) 34 ( Abstract Supplement ), 338

Background: Aortic Stenosis (AS) results in several Left Ventricular (LV) disturbances as well as progressive Left Atrial (LA) enlargement and dysfunction. Transcatheter Aortic Valve Implantation (TAVI) reverses LV remodelling and improves overall systolic function but its effect on LA function remains undetermined. The aim of this prospective study was to investigate the effects of TAVI on LA structure and function.

Material and methods: We studied thirty-two patients with severe symptomatic AS and high surgical risk who underwent TAVI, using standard and 2-dimensional speckle-tracking echocardiography before, at 40-day and at 3-month follow-up.

Results: Following TAVI, mean transvalvular gradient reduced (p<0.001). Both LA mean area index and LA mean volume index decreased at 40-day (16.2±6.4 vs. 12.5±2.9 cm2/m2, and 47.3±12.0 vs. 42.8±12.5 mL/m2, respectively, p<0.05) and values remained unchanged at 3 months. The reduction of LA size was accompanied by a significant increase in global PALS (14.4±3.9% vs. 19.1±4.7%, p<0.001) and global PACS (8.4±2.5% vs. 11.0±4.1%, p<0.05) at 3-month. After the procedure, LA stiffness measurements decreased and became significant at 3-month follow up (p<0.001). Pre-procedural trans-aortic mean gradient and pre-procedural LA volume were identified as predictors of global PALS increase (p<0.0001) while the delta drop in trans-aortic mean gradient as predictors of LA volume index reduction 3 months after TAVI (p<0.0001).

Conclusion: TAVI is associated with significant recovery of LA structure and function suggesting a reverse cavity remodelling. Such functional recovery is determined by the severity of pre-procedural valve stenosis.

Atrial remodelling after TAVI

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