期刊
JACC-CARDIOVASCULAR INTERVENTIONS
卷 5, 期 12, 页码 1257-1263出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcin.2012.08.011
关键词
aortic stenosis; conduction defect; dyssynchrony; left bundle branch block; valve
Objectives This study sought to evaluate the impact of new conduction defects after transcatheter aortic valve implantation (TAVI) on the evolution of left ventricular (LV) function during 1-year follow-up. Background New left bundle branch block (LBBB) or need for permanent pacing due to atrioventricular (AV) block are frequent after TAVI. Methods A total of 90 consecutive patients treated with TAVI and who had 12-month echocardiographic follow-up were included in the study. In 39 patients, a new conduction defect (new LBBB or need for permanent pacemaker activity.) persisted 1 month after TAVI. In 51 patients, no persistent new conduction defect was observed. Two-dimensional echocardiography using parasternal short-axis, apical 4-chamber, and apical 2-chamber views was performed before TAVI and at 1-year follow-up to determine LV volumes and ejection fraction based on Simpson's rule. Speckle-tracking echocardiography was applied using standard LV short-axis images to assess the effect of new conduction defects on time-to-peak radial strain of different LV segments as a parameter of LV dyssynchrony. Results New conduction defects resulted in marked heterogeneity in time-to-peak strain between the 6 analyzed short-axis segments. During 1-year follow-up after TAVI, there was a significant increase in left ventricular ejection fraction (LVEF) in patients without new LBBB (53 +/- 11% pre TAVI to 59 +/- 10% at follow-up; p < 0.001), whereas there was no change in LVEF in patients with a new conduction defect (52 +/- 11% pre TAVI to 51 +/- 12% at follow-up, p = 0.740). Change in LV endsystolic volume was also significantly different between patient groups (-1.0 +/- 14.2 vs. -11.2 +/- 15.7 ml, p = 0.042). New conduction defect and LVEF at baseline were independent predictors of reduced LVEF at 12-month follow-up after TAVI. Conclusions LVEF improves after TAVI for treatment of severe aortic stenosis in patients without new conduction defects. In patients with a new conduction defect after TAVI, there is no improvement in LVEF at follow-up. (J Am Coll Cardiol Intv 2012;5:1257-63) (C) 2012 by the American College of Cardiology Foundation
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