Die kardiale Mechanik erfasst mittels Magnetresonanztomographie korreliert mit der Hämodynamik von Patienten mit hochgradiger Aortenklappenstenose und dem positiven Remodeling nach transfemoralem Aortenklappenersatz
InstitutionsUKU. Klinik für Innere Medizin II
UKU. Klinik für Innere Medizin I
Aims: To assess left-ventricular strain parameters before and after transcatheter aortic valve replacement (TAVR) by feature tracking cardiac magnetic resonance imaging (FT CMR) and to correlate the findings to hemodynamic state and left-ventricular remodeling. Methods and results: Patients with symptomatic AS underwent FT CMR before and after TAVR. Patients were carefully evaluated by a comprehensive work-up including CMR, echocardiography and left and right heart catheterization. Thirty patients formed the study population. High-flow/high-gradient (HF/HG) aortic stenosis was diagnosed in 11 patients (36.7%), 6 patients (20.0%) exhibited low-flow/low-gradient AS (LF/LG) and 13 patients (43.3%) were classified to have so-called paradoxical low-flow/low-gradient (PLF/LG) AS. The HF/HG patients had a significantly reduced longitudinal strain which recovered after TAVR (−12.67 ± 4.60 to −15.46 ± 5.61%, p = 0.048). In the LF/LG group, an even more pronounced reduction of longitudinal strain and also an impairment of longitudinal velocity could be observed. Both parameters improved after therapy (strain: −5.06 ± 4.25 to −8.02 ± 3.28%, p = 0.045; velocity: 25.33 ± 9.63 to 37.13 ± 11.64 mm/s, p = 0.042). Patients with PLF/LG showed preserved longitudinal strain but a reduction of longitudinal velocity similar to the LF/LG group. These patients did not show a significant improvement of strain parameters after TAVR. Longitudinal velocity exhibited the highest predictive power for the identification of a low-flow state (sensitivity 75%, specificity 80%). Conclusion: Improvement of longitudinal strain parameters after TAVR is dependent on the initial hemodynamically defined AS subgroup.
Subject HeadingsKernspintomografie [GND]
Magnetic resonance imaging [MeSH]
Aortic valve stenosis [MeSH]
Transcatheter aortic valve replacement [MeSH]