Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 26, 2022; 10(6): 1806-1814
Published online Feb 26, 2022. doi: 10.12998/wjcc.v10.i6.1806
Change and impact of left ventricular global longitudinal strain during transcatheter aortic valve implantation
Han Zhang, Jin-Jie Xie, Rong-Juan Li, Yue-Li Wang, Bao-Rong Niu, Li Song, Jing Li, Ya Yang
Han Zhang, Jin-Jie Xie, Rong-Juan Li, Yue-Li Wang, Bao-Rong Niu, Li Song, Jing Li, Ya Yang, Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
Author contributions: Zhang H, Xie JJ, Li RJ, Wang YL, Niu BR, Song L, Li J, and Yang Y contributed to the writing and revising of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Beijing Anzhen Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ya Yang, PhD, Chief Physician, Echocardiography Medical Center, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing 100029, China. echoyangya6666@163.com
Received: November 24, 2021
Peer-review started: November 24, 2021
First decision: December 9, 2021
Revised: January 4, 2022
Accepted: January 17, 2022
Article in press: January 17, 2022
Published online: February 26, 2022
Abstract
BACKGROUND

Although transcatheter aortic valve implantation (TAVI) is a safe and effective treatment for aortic stenosis, it still carries some risks, such as valve leaks, stroke, and even death. The left ventricular global longitudinal strain (LVGLS) measurement may be useful for the prediction of adverse events during this operation.

AIM

To explore the change of LVGLS during TAVI procedure and the relationship between LVGLS and perioperative adverse events.

METHODS

In this study, 61 patients who had undergone percutaneous transfemoral TAVI were evaluated by transthoracic echocardiography. Before surgery, data on left ventricular ejection fraction (LVEF) and LVGLS were collected separately following balloon expansion and stent implantation. Difference in values of LVGLS and LVEF during preoperative balloon expansion (pre-ex), preoperative stent implantation (pre-im) and balloon expansion-stent implantation (ex-im) were also examined. Adverse events were defined as perioperative death, cardiac rupture, heart arrest, moderate or severe perivalvular leakage, significant mitral regurgitation during TAVI, perioperative moderate or severe mitral regurgitation, perioperative left ventricular outflow tract obstruction, reoperation, and acute heart failure.

RESULTS

The occurrence of perioperative adverse events was associated with differences in pre-ex LVGLS, but not with difference in pre-ex LVEF. There were significant differences between pre-LVGLS and ex-LVGLS, and between pre-LVGLS and im-LVGLS (P = 0.037 and P = 0.020, respectively). However, differences in LVEF were not significant (P = 0.358, P = 0.254); however differences in pre-ex LVGLS were associated with pre-LVGLS (P = 0.045). Compared to LVEF, LVGLS is more sensitive as a measure of left heart function during TAVI and the perioperative period. Moreover, the differences in LVGLS were associated with the occurrence of perioperative adverse events, and changes in LVGLS were apparent in patients with undesirable LVGLS before the surgery. Furthermore, LVGLS is useful to predict changes in cardiac function during TAVI.

CONCLUSION

Greater attention should be paid to the patients who plan to undergo TAVI with normal LVEF but poor LVGLS.

Keywords: Aortic stenosis, Ejection fraction, Longitudinal strain, Transcatheter aortic valve implantation, Left ventricular global longitudinal strain

Core Tip: This study analyzed changes in left ventricular ejection fraction and left ventricular global longitudinal strain in patients with aortic stenosis undergoing transcatheter aortic valve implantation. Changes in left ventricular global longitudinal strain were significant in preoperative balloon expansion and stent implantation sections and it is sensitive to detect subtle change in left ventricle systolic function during the operation. It can also be used as a predictor of adverse events during the perioperative period.