Left Ventricular Mechanical Dispersion by Speckle Tracking Echocardiography is a predictor of Atrioventricular Block after Transcatheter Aortic Valve Implantation
Esra Kaya, Kristoffer Andresen, Øyvind H. Lie, Lars Aaberge, Kristina H. Haugaa, Thor Edvardsen, Helge Skulstad.
Department of Cardiology, Institute for Surgical Research, PROCARDIO – Center for Innovation. Division of Cardiovascular and Pulmonary Diseases, Rikshospitalet, Oslo University Hospital, Oslo Norway. Institute of Clinical Medicine, University of Oslo, Norway.
ESC 365 - All about echocardiography in aortic stenosis (escardio.org)
Event: ESC Congress 2022
Topic: Valvular Heart Disease
Session type: Moderated ePosters
Date: 27 August 2022
Time: 11:15 - 12:00
Atrioventricular block (AVB) necessitating permanent pacemaker (PM) implantation, is a common complication of Transcatheter Aortic Valve Implantation (TAVI). Direct mechanical effect, electrical disturbances and myocardial fibrosis are proposed mechanisms for AVB after TAVI. Left ventricular mechanical dispersion (LVMD) by Speckle Tracking Echocardiography is an index of contraction heterogeneity and a marker of myocardial fibrosis. We aimed to evaluate the association between LVMD,QRS duration and risk of AVB after TAVI.
Methods: In 163 consecutive patients, echocardiograms and electrocardiograms were recorded the day before TAVI to assess global longitudinal strain (GLS), LVMD and QRS duration. PM implantation information was obtained after 3 months. Patients were stratified into AVB and No-AVB groups.
Results: Ten patients were excluded due to poor image quality. Mean age was 80±7 years and 45% were female. Within 3 months after TAVI, 16% of the patients received PM. GLS and QRS duration was not different between AVB group and No-AVB group (-15.8±4.5% vs -16.9±4.4%, p=0.26 and 107±31ms vs 102±18ms, p=0.24 respectively). LVMD was prolonged in patients with AVB compared to patients in No-AVB group (60±19ms vs 48±13ms, p<0.001). LVMD predicted AVB after TAVI with area under the curve 0.71. LVMD predicted AVB independently of QRS duration (odds ratio duration (odds ratio 1.68; 95% confidence interval 1.23-2.3; p=0.001 by 10ms increments).
This poster presented by Esra Kaya, MD, PhD builds on the observational study published in Open Heart in February 2020. The study adds information regarding changes in mechanical dispersion related to transcatheter aortic valve replacement. Mechanical dispersion appears to be a reproducible and robust measure of contractile heterogeneity under different loading conditions. – According to authors of the study. It also indicates that prognostic information may be retained from mechanical dispersion after transcatheter aortic valve implantation, thus having a potential impact on current clinical practice.
Knowledge regarding the physiological determinants of mechanical dispersion in AS is emerging. Previously, older age, lower LVEF, larger LV mass and AS severity have been associated with increasing mechanical dispersion in AS. Whether afterload influences heterogeneity of ventricular contractions, however, is subject to discussion.Transcatheter aortic valve implantation (TAVI) causes abrupt haemodynamic changes and provides an opportunity to explore whether significant afterload reduction influences mechanical dyssynchrony. Furthermore, patients undergoing TAVI frequently acquire new-onset left bundle branch block (LBBB), enabling investigation of the separate and combined effects of changes in afterload and ventricular conduction on mechanical dispersion.
The primary aim of this study was to explore whether afterload and ventricular conduction are physiological determinants of LV dyssynchrony by assessing the immediate effect of TAVI on LV mechanical dispersion. Although such an experiment would require a selected group of patients without vascular TAVI complications that might affect loading conditions or require pacemakers, we wanted to evaluate whether prognostic information could be retained from mechanical dispersion after an uncomplicated procedure, since previous studies have linked pre-interventional mechanical dispersion to adverse outcome in AS.
Read more in;
Open Heart. 2020 Feb 26;7(1):e001199.
Impact of transcatheter aortic valve implantation on mechanical dispersion - PubMed (nih.gov)
Lars Gunnar Klaeboe, Pål Haugar Brekke, Lars Aaberge, Kristina Haugaa, Thor Edvardsen
Resynchronization of the left atrium may play an important role in cardiac resynchronization therapy
Lars-Egil Hammersbøen, Marie Stugaard, Alexis Puvrez, Camilla Larsen, Espen Remme, Erwan Donal, Jürgen Duchenne, Jens-Uwe Voigt, Elena Galli, Faraz Khan, Ole Jakob Sletten, Martin Penicka, John Aalen, Otto Smiseth
Institute for Surgical Research, Oslo University Hospital Rikshospitalet. Institute of Clinical Medicine, University of Oslo. University Hospitals (UZ) Leuven; Department of Cardiovascular Sciences, Leuven, Belgium. Laboratory Signal Processing and Image, Department of Cardiology, Rennes, France. Cardiovascular Center Aalst, OLV Clinic, Aalst, Belgium.
ESC 365 - The importance of left atrial assessment with echocardiography (escardio.org)
Session: The importance of left atrial assessment with echocardiography
Topic: Tissue Doppler, Speckle Tracking and Strain Imaging
Session type: Moderated ePosters
Date: 27 August
Start time: 08:15
End time: 09:00
Background: Left atrial (LA) dyssynchrony is a predictor of response to cardiac resynchronization therapy (CRT). It is unknown, however, if LA resynchronization contributes to response to CRT. We hypothesize that there is a relationship between correction of LA dyssynchrony and response to CRT.
Purpose: To investigate the association between LA resynchronization and response to CRT.
Methods: In a prospective study of 171 heart failure patients with LBBB, myocardial strain was measured by speckle-tracking echocardiography, before and 6 months after CRT. As indicated by the white arrows in Figure 1, LA dyssynchrony was measured as the time delay between onset systolic stretch of the interatrial septum and the LA lateral wall. Response to CRT was defined as at least 15 % reduction in left ventricular (LV) end systolic volume at 6 months follow up.
Results: 120 (70%) patients responded to CRT. The panels in Figure 1 show LA strain traces in a representative LBBB patient that did respond (upper panels), and a patient that did not respond (lower panels). The white arrows in the left panels indicate that both the responder and the non-responder had marked LA dyssynchrony before CRT (198 and 171 ms, respectively). However, after 6 months with CRT, there was recovery of LA synchrony only in the responder (time delay -60 ms), and still marked LA dyssynchrony of 191 ms in the non-responder (right panels).
Figure 2 confirms similar results for the whole study population: CRT response was associated with marked reduction of LA dyssynchrony (p<0.0001). In non-responders, however, there was no significant reduction in LA dyssynchrony.
Conclusions: Positive CRT response is associated with resynchronization of the left atrium. These findings suggest LA resynchronization as a potential additional target for CRT.
This poster presented by Lars-Egil Hammersbøen, MD, provides novel insights into the association between LA resynchronization and CRT response, suggesting LA resynchronization as a potential additional target for CRT. It draws upon the study material in Imaging predictors of response to cardiac resynchronization therapy: left ventricular work asymmetry by echocardiography and septal viability by cardiac magnetic resonance published in European Heart Journal in October 2020.
The study aimed to investigate if septal and LW function measured as myocardial work, alone and combined with assessment of septal viability, identifies responders to cardiac resynchronization therapy (CRT). A total of 236 heart failure patients referred for CRT were prospectively included from Oslo University Hospital, Norway (n = 101), University Hospitals Leuven, Belgium (n = 50), Rennes University Hospital, France (n = 71), OLV Hospital Aalst, Belgium (n = 11), and Karolinska University Hospital, Sweden (n = 3) between August 2015 and November 2017. This constitutes about one-third of patients who received CRT in the main contributing centres during the study period.
The authors concluded that assessment of myocardial work and septal viability identified CRT responders with high accuracy.
Read more in:
Eur Heart J. 2020 Oct 14;41(39):3813-3823.
Imaging predictors of response to cardiac resynchronization therapy: left ventricular work asymmetry by echocardiography and septal viability by cardiac magnetic resonance - PubMed (nih.gov)
John M Aalen, Erwan Donal, Camilla K Larsen, Jürgen Duchenne, Mathieu Lederlin, Marta Cvijic, Arnaud Hubert, Gabor Voros, Christophe Leclercq, Jan Bogaert, Einar Hopp, Jan Gunnar Fjeld, Martin Penicka, Cecilia Linde, Odd O Aalen, Erik Kongsgård, Elena Galli, Jens-Uwe Voigt, Otto A Smiseth