Clin Res Cardiol 101, Suppl 1, April 2012

V145 - Left ventricular remodelling and prosthetic valve function after transcatheter aortic valve implantation: A serial cardiac magnetic resonance imaging study
C. Merten1, H. W. Beurich1, D. Zachow2, A. Mostafa1, V. Geist1, R. Tölg1, G. Richardt1, M. Abdel-Wahab1
1Herzzentrum, Kardiologie, Segeberger Kliniken, Bad Segeberg; 2Segeberger Kliniken, Bad Segeberg;
Background: Transcatheter aortic valve implantation (TAVI) has become a common procedure for high-risk patients with severe aortic stenosis. Aortic regurgitation (AR) is commonly seen after TAVI, but little is known about how it evolves over time. Similarly, the impact of TAVI on left ventricular (LV) function, LV volumes and mass is not well defined.
Methods: Twenty-six patients successfully treated with transfemoral TAVI without contraindications for magnetic resonance imaging (MRI) underwent cardiac MRI three weeks and 6 months after TAVI. LV volumes and function were assessed using standard cine MRI sequences. Additionally, phase-contrast imaging was conducted to quantify the degree of AR. A calculated regurgitant fraction (RF) ≤15% was graded as I (mild), 16-30% as II (moderate), 31-50% as III (moderate to severe) and > 50% as grade IV (severe) AR. A calculated RF <1% was classified as no AR (grade 0).
Results: The mean age of the evaluated patients was 79.0 ± 5.0 years and 54% were women. At baseline MRI, the median LV ejection fraction was 57.3% (range 22.1-71.7%), which improved significantly at follow-up to 63.8% (range 24.0 - 73.5%, p=0.001). In addition, a significant reduction of LV mass (158.5 ± 31.4 g vs. 149.0 ± 39.6 g, p=0.04) and a trend towards reduction of LV end-diastolic volume (156.1 ± 45.8 ml vs. 146.0 ± 50.2, p=0.07) was observed. This was associated with a significant reduction of the median NT-pro-BNP level at follow-up (from 1971 pg/ml, range 345 - 23529 pg/ml, at the time of the first scan, to 1207 pg/ml, range 187 - 30764pg/ml, at follow-up MRI, p=0.03). At both time points, we observed a significant negative correlation between myocardial mass and LV ejection fraction, with r = -0.75 at baseline MRI and r = -0.88 at follow-up.
Baseline MRI identified no AR in 4 patients, grade I AR in 15, grade II in 6 and grade III AR in 1 patient. Over time, median aortic RF increased from 8% (range 0.1 to 39.0%) to 9.5% (range 1.9 to 41.9%, p=0.02), with all patients showing any degree of AR at follow-up (grade I in 19, grade II in 4 and grade III in 3 patients). No significant correlation was seen between the aortic RF and changes in LV function.
Conclusion: Using cardiac MRI in TAVI patients, a significant improvement of left ventricular function, volume and mass can be documented after TAVI. Mild to moderate AR is commonly seen in patients treated with TAVI and AR showed a small increase over time.
Clin Res Cardiol 101, Suppl 1, April 2012
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-012-1100-6