Regional left ventricular function after transapical vs. transfemoral transcatheter aortic valve implantation analysed by cardiac magnetic resonance feature tracking

• Published in: European heart journal cardiovascular imaging 2014-10, Vol.15 (10), p.1168-1176
• Main Authors: Meyer, Christian G, Frick, Michael, Lotfi, Shahram, Altiok, Ertunc, Koos, Ralf, Kirschfink, Annemarie, Lehrke, Michael, Autschbach, Rüdiger, Hoffmann, Rainer
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Aortic Valve Stenosis - surgery; Cardiac-Gated Imaging Techniques; Female; Femoral Vein; Heart Valve Prosthesis; Humans; Image Interpretation, Computer-Assisted; Magnetic Resonance Imaging, Cine - methods; Male; Postoperative Complications - diagnosis; Postoperative Complications - physiopathology; Transcatheter Aortic Valve Replacement - methods; Treatment Outcome; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - physiopathology
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jeu103

This study analysed the impact of transapical (TA) vs. transfemoral (TF) access site transcatheter aortic valve implantation (TAVI) on post-procedural regional left ventricular (LV) function using cardiac magnetic resonance (CMR) feature tracking (FT). CMR was performed 3 months after TAVI on 44 consecutive patients with normal LV ejection fraction prior to TAVI. Twenty patients had TA-TAVI, and 24 had TF-TAVI. Standard cine imaging was performed in three standard cardiac long-axis views (two-, four- and three-chamber views). Myocardial peak systolic radial strain (PSRS) and peak systolic longitudinal strain (PSLS) were analysed based on CMR-FT considering 49 segments in each of the three views. There were no differences in PSRS and PSLS for the basal and mid-ventricular segments between TA- and TF-TAVI groups. In contrast, PSRS and PSLS of apical segments and apical cap were reduced in the TA- compared with the TF-TAVI group (PSRS: 15.7 ± 6.4 vs. 35.9 ± 15.7%, respectively, P < 0.001; PSLS: -8.9 ± 5.3 vs. -16.9 ± 4.3%, respectively, P < 0.001). Comparison of all non-apical segments vs. apical segments and apical cap demonstrated no difference in the TF group (PSRS: 34.6 ± 9.0 vs. 35.9 ± 15.7%; respectively, P = 0.702; PSLS: -17.8 ± 4.6 vs. -16.9 ± 4.3%; respectively, P = 0.802). After TA-TAVI, PSRS and PSLS of the apical segments were reduced compared with the non-apical segments (PSRS: 15.7 ± 6.4 vs. 33.5 ± 7.0%, respectively, P < 0.001; PSLS: -8.9 ± 5.3 vs. -15.5 ± 3.5%, respectively, P < 0.001). Apical LV function abnormalities can be detected at 3-month follow-up in all TA-TAVI patients using CMR-FT. TA-TAVI results in significant impairment of apical LV function compared with TF-TAVI.