cardiotomskСибирский журнал клинической и экспериментальной медициныSiberian Journal of Clinical and Experimental Medicine2713-29272713-265XTSU publishing10.29001/2073-8552-2023-39-3-121-127cardiotomsk-1954Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESПоказатели деформации левого желудочка у пациентов пожилого и старческого возраста с аортальным стенозом после транскатетерной имплантации аортального клапанаParameters of left ventricular deformation in elderly and senile patients with aortic stenosis after transcatheter implantation of the aortic valvehttps://orcid.org/0000-0001-6056-835XМатвееваМ. Г.MatveevaM. G.

Матвеева Марина Георгиевна, канд. мед. наук, врач функциональной диагностики

121359, Российская Федерация, Москва, ул. Маршала Тимошенко, 15

Marina G. Matveeva, Cand. Sci. (Med.), Doctor of Functional Diagnostics

15, Marshala Timoshenko str., Moscow, 121359, Russian Federation

mgmatveevf@yandex.ruhttps://orcid.org/0000-0001-6693-3944Тер-АкопянА. В.Ter-AkopyanA. V.

Тер-Акопян Армен Вигенович, д-р мед. наук, заведующий отделением рентгенохирургических методов диагностики и лечения

121359, Российская Федерация, Москва, ул. Маршала Тимошенко, 15

Armen V. Ter-Akopyan, Dr. Sci. (Med), Head of the Department of X-ray Surgical Methods of Diagnosis and Treatment 

15, Marshala Timoshenko str., Moscow, 121359, Russian Federation

terarmen@mail.ruhttps://orcid.org/0000-0002-9725-7528АлехинМ. Н.AlekhinM. N.

Алехин Михаил Николаевич, д-р мед. наук, профессор, заведующий отделением функциональной диагностики

121359, Российская Федерация, Москва, ул. Маршала Тимошенко, 15

Mikhail N. Alekhin, Dr. Sci. (Med), Professor, Head of the Department of Functional Diagnostics 

15, Marshala Timoshenko str., Moscow, 121359, Russian Federation

amn@mail.ruЦентральная клиническая больница с поликлиникой Управления делами Президента Российской ФедерацииРоссияCentral Clinical Hospital with Outpatient Clinic of Department of Presidential AffairsRussian Federation202313102023383121127Copyright © Матвеева М.Г., Тер-Акопян А.В., Алехин М.Н., 20232023Матвеева М.Г., Тер-Акопян А.В., Алехин М.Н.Matveeva M.G., Ter-Akopyan A.V., Alekhin M.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sibjcem.ru/jour/article/view/1954Цель исследования

Цель исследования: оценить показатели деформации миокарда левого желудочка (ЛЖ) (продольной, циркулярной и радиальной) у пациентов с симптоматически тяжелым аортальным стенозом (АС) с сохранной фракцией выброса левого желудочка (ФВ ЛЖ) после транскатетерной имплантации аортального клапана (ТИАК) в раннем послеоперационном периоде.

Материал и методы

Материал и методы. В исследование был включен 31 пациент из 69 с симптоматически тяжелым АС, которым выполнена ТИАК. Эхокардиография (ЭхоКГ) с использованием технологии двухмерной спекл-трекинг выполнялась до ТИАК и в раннем послеоперационном периоде (в течение 5 ± 1,7 дней).

Результаты

Результаты. Достоверно значимых различий при анализе показателей деформации ЛЖ до ТИАК и в раннем послеоперационном периоде не было получено. Наблюдалась тенденция к увеличению продольной деформации ЛЖ, в том числе продольной деформации базальных, средних и апикальных сегментов у отдельных пациентов. Продольная деформация левого предсердия (ЛП) после ТИАК не изменилась.

Заключение

Заключение. У пациентов пожилого и старческого возраста с тяжелым АС и сохранной ФВ ЛЖ, но со сниженными показателями деформации ЛЖ (продольного, циркулярного и радиального) после малоинвазивной ТИАК в раннем послеоперационном периоде достоверных изменений показателей деформации не было. Наблюдается тенденция к увеличению глобальной продольной деформации ЛЖ.

Aim

Aim: To evaluate the parameters of left ventricle (LV) myocardial deformation (longitudinal, circular and radial) in patients with symptomatic severe aortic stenosis (AS) with preserved LV ejection fraction after transcatheter aortic implantation valve (TAVI) in the early postoperative period.

Material and Methods

Material and Methods. The study included 31 patients after TAVI out of 69 with symptomatic severe AS. Echocardiography (EchoCG) using two-dimensional speckle tracking technology was performed before TAVI and in the early postoperative period (within 5 ± 1,7 days).

Results

Results. There were no significant differences in the analysis of deformation parameters before TAVI and in the early postoperative period. There was a tendency to increase the longitudinal deformation of the LV, including the longitudinal deformation of the basal, middle and apical segments in individual patients. The longitudinal deformation of the left atrium did not change after TAVI.

Conclusion

Conclusion. There were no significant changes in deformation parameters in elderly and senile patients with severe AS and preserved LV ejection fraction and with reduced LV deformation (longitudinal, circular and radial) after minimally invasive TAVI in the early postoperative period. There is a tendency to increase the global longitudinal deformation of the LV.

аортальный стенозтранскатетерная имплантация аортального клапанадеформация левого желудочкаaortic stenosistranscatheter aortic implantation valveleft ventricular deformationReferencesBaumgartner H. Aortic stenosis: medical and surgical management. Heart (British Cardiac Society). 2005;91(11):1483–1488. DOI: 10.1136/hrt.2004.056176.Baumgartner H. Aortic stenosis: medical and surgical management. Heart (British Cardiac Society). 2005;91(11):1483–1488. DOI: 10.1136/hrt.2004.056176.Al-Rashid F., Totzeck M., Saur N., Jánosi R.A., Lind A., Mahabadi A.A. et al. Global longitudinal strain is associated with better outcomes in transcatheter aortic valve replacement. BMC. Cardiovasc. Disord. 2020;20(1):267. DOI: 10.1186/s12872-020-01556-4.Al-Rashid F., Totzeck M., Saur N., Jánosi R.A., Lind A., Mahabadi A.A. et al. Global longitudinal strain is associated with better outcomes in transcatheter aortic valve replacement. BMC. Cardiovasc. Disord. 2020;20(1):267. DOI: 10.1186/s12872-020-01556-4.Nishimura R.A., Otto C.M., Bonow R.O., Carabello B.A., Erwin J.P. 3rd, Guyton R.A. et al. 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2014;129(23):e650]. Circulation. 2014;129(23):2440–2492. DOI: 10.1161/CIR.0000000000000029.Nishimura R.A., Otto C.M., Bonow R.O., Carabello B.A., Erwin J.P. 3rd, Guyton R.A. et al. 2014 AHA/ACC Guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2014;129(23):e650]. Circulation. 2014;129(23):2440–2492. DOI: 10.1161/CIR.0000000000000029.Nishimura R.A., Otto C.M., Bonow R.O., Carabello B.A., Erwin J.P. 3rd., Fleisher L.A. et al. AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(25):e1159–e1195. DOI: 10.1161/CIR.0000000000000503.Nishimura R.A., Otto C.M., Bonow R.O., Carabello B.A., Erwin J.P. 3rd., Fleisher L.A. et al. AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(25):e1159–e1195. DOI: 10.1161/CIR.0000000000000503.D’Ascenzi F., Cameli M., Iadanza A., Lisi M., Zacà V., Reccia R. et al. Improvement of left ventricular longitudinal systolic function after transcatheter aortic valve implantation: a speckle-tracking prospective study. Int. J. Cardiovasc. Imaging. 2013;29(5):1007–1015. DOI: 10.1007/s10554-012-0175-5.D’Ascenzi F., Cameli M., Iadanza A., Lisi M., Zacà V., Reccia R. et al. Improvement of left ventricular longitudinal systolic function after transcatheter aortic valve implantation: a speckle-tracking prospective study. Int. J. Cardiovasc. Imaging. 2013;29(5):1007–1015. DOI: 10.1007/s10554-012-0175-5.D’Andrea A., Padalino R., Cocchia R., Di Palma E., Riegler L., Scarafile R. et al. Effects of transcatheter aortic valve implantation on left ventricular and left atrial morphology and function. Echocardiography. 2015;32(6):928–936. DOI: 10.1111/echo.12808.D’Andrea A., Padalino R., Cocchia R., Di Palma E., Riegler L., Scarafile R. et al. Effects of transcatheter aortic valve implantation on left ventricular and left atrial morphology and function. Echocardiography. 2015;32(6):928–936. DOI: 10.1111/echo.12808.Dusenbery S.M., Lunze F.I., Jerosch-Herold M., Geva T., Newburger J.W., Colan S.D. et al. Left ventricular strain and myocardial fibrosis in congenital aortic stenosis. Am. J. Cardiol. 2015;116(8):1257–1262. DOI: 10.1016/j.amjcard.2015.07.042.Dusenbery S.M., Lunze F.I., Jerosch-Herold M., Geva T., Newburger J.W., Colan S.D. et al. Left ventricular strain and myocardial fibrosis in congenital aortic stenosis. Am. J. Cardiol. 2015;116(8):1257–1262. DOI: 10.1016/j.amjcard.2015.07.042.Weidemann F., Herrmann S., Störk S., Niemann M., Frantz S., Lange V. et al. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation. 2009;120(7):577–584. DOI: 10.1161/CIRCULATIONAHA.108.847772.Weidemann F., Herrmann S., Störk S., Niemann M., Frantz S., Lange V. et al. Impact of myocardial fibrosis in patients with symptomatic severe aortic stenosis. Circulation. 2009;120(7):577–584. DOI: 10.1161/CIRCULATIONAHA.108.847772.Fung M.J., Thomas L., Leung D.Y. Alterations in layer-specific left ventricular global longitudinal and circumferential strain in patients with aortic stenosis: a comparison of aortic valve replacement versus conservative management over a 12-month period. J. Am. Soc. Echocardiogr. 2019;32(1):92–101. DOI: 10.1016/j.echo.2018.07.015.Fung M.J., Thomas L., Leung D.Y. Alterations in layer-specific left ventricular global longitudinal and circumferential strain in patients with aortic stenosis: a comparison of aortic valve replacement versus conservative management over a 12-month period. J. Am. Soc. Echocardiogr. 2019;32(1):92–101. DOI: 10.1016/j.echo.2018.07.015.Ng A.C., Delgado V., Bertini M., Antoni M.L., van Bommel R.J., van Rijnsoever E.P. et al. Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: a two-dimensional speckle tracking analysis. Eur. Heart J. 2011;32(12):1542–1550. DOI: 10.1093/eurheartj/ehr084.Ng A.C., Delgado V., Bertini M., Antoni M.L., van Bommel R.J., van Rijnsoever E.P. et al. Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: a two-dimensional speckle tracking analysis. Eur. Heart J. 2011;32(12):1542–1550. DOI: 10.1093/eurheartj/ehr084.Galli E., Leguerrier A., Flecher E., Leclercq C., Donal E. Increased valvulo-arterial impedance differently impacts left ventricular longitudinal, circumferential, and radial function in patients with aortic stenosis: A speckle tracking echocardiography study. Echocardiography. 2017;34(1):37–43. DOI: 10.1111/echo.13407.Galli E., Leguerrier A., Flecher E., Leclercq C., Donal E. Increased valvulo-arterial impedance differently impacts left ventricular longitudinal, circumferential, and radial function in patients with aortic stenosis: A speckle tracking echocardiography study. Echocardiography. 2017;34(1):37–43. DOI: 10.1111/echo.13407.Naeim H.A., Abuelatta R., Alatawi F.O., Khedr L. Assessment of left ventricular mechanics in patients with severe aortic stenosis after transcatheter aortic valve implantation: 2-D speckle tracking imaging study. J. Saudi Heart Assoc. 2020;32(2):248–255. DOI: 10.37616/2212-5043.1065.Naeim H.A., Abuelatta R., Alatawi F.O., Khedr L. Assessment of left ventricular mechanics in patients with severe aortic stenosis after transcatheter aortic valve implantation: 2-D speckle tracking imaging study. J. Saudi Heart Assoc. 2020;32(2):248–255. DOI: 10.37616/2212-5043.1065.Shiino K., Yamada A., Scalia G.M., Putrino A., Chamberlain R., Poon K. et al. Early changes of myocardial function after transcatheter aortic valve implantation using multilayer strain speckle tracking echocardiography. Am. J. Cardiol. 2019;123(6):956–960. DOI: 10.1016/j.amjcard.2018.12.008.Shiino K., Yamada A., Scalia G.M., Putrino A., Chamberlain R., Poon K. et al. Early changes of myocardial function after transcatheter aortic valve implantation using multilayer strain speckle tracking echocardiography. Am. J. Cardiol. 2019;123(6):956–960. DOI: 10.1016/j.amjcard.2018.12.008.Delgado M., Ruiz M., Mesa D., de Lezo Cruz Conde J.S., Pan M., López J. et al. Early improvement of the regional and global ventricle function estimated by two-dimensional speckle tracking echocardiography after percutaneous aortic valve implantation speckle tracking after CoreValve implantation. Echocardiography. 2013;30(1):37–44. DOI: 10.1111/j.1540-8175.2012.01808.x.Delgado M., Ruiz M., Mesa D., de Lezo Cruz Conde J.S., Pan M., López J. et al. Early improvement of the regional and global ventricle function estimated by two-dimensional speckle tracking echocardiography after percutaneous aortic valve implantation speckle tracking after CoreValve implantation. Echocardiography. 2013;30(1):37–44. DOI: 10.1111/j.1540-8175.2012.01808.x.Schattke S., Baldenhofer G., Prauka I., Zhang K., Laule M., Stangl V. et al. Acute regional improvement of myocardial function after interventional transfemoral aortic valve replacement in aortic stenosis: a speckle tracking echocardiography study. Cardiovasc. Ultrasound. 2012;10:15. DOI: 10.1186/1476-7120-10-15.Schattke S., Baldenhofer G., Prauka I., Zhang K., Laule M., Stangl V. et al. Acute regional improvement of myocardial function after interventional transfemoral aortic valve replacement in aortic stenosis: a speckle tracking echocardiography study. Cardiovasc. Ultrasound. 2012;10:15. DOI: 10.1186/1476-7120-10-15.Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2015;28(1):1–39.t14. DOI: 10.1016/j.echo.2014.10.003.Lang R.M., Badano L.P., Mor-Avi V., Afilalo J., Armstrong A., Ernande L. et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2015;28(1):1–39.t14. DOI: 10.1016/j.echo.2014.10.003.Nagueh S.F., Smiseth O.A., Appleton C.P., Byrd B.F. 3rd, Dokainish H., Edvardsen T. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur. Heart J. Cardiovasc. Imaging. 2016;17(12):1321–1360. DOI: 10.1093/ehjci/jew082.Nagueh S.F., Smiseth O.A., Appleton C.P., Byrd B.F. 3rd, Dokainish H., Edvardsen T. et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur. Heart J. Cardiovasc. Imaging. 2016;17(12):1321–1360. DOI: 10.1093/ehjci/jew082.Kempny A., Diller G.P., Kaleschke G., Orwat S., Funke A., Radke R. et al. Longitudinal left ventricular 2D strain is superior to ejection fraction in predicting myocardial recovery and symptomatic improvement after aortic valve implantation. Int. J. Cardiol. 2013;167(5):2239–2243. DOI: 10.1016/j.ijcard.2012.06.012.Kempny A., Diller G.P., Kaleschke G., Orwat S., Funke A., Radke R. et al. Longitudinal left ventricular 2D strain is superior to ejection fraction in predicting myocardial recovery and symptomatic improvement after aortic valve implantation. Int. J. Cardiol. 2013;167(5):2239–2243. DOI: 10.1016/j.ijcard.2012.06.012.Osnabrugge R.L., Mylotte D., Head S.J., Van Mieghem N.M., Nkomo V.T., LeReun C.M. et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J. Am. Coll. Cardiol. 2013;62(11):1002–1012. DOI: 10.1016/j.jacc.2013.05.015.Osnabrugge R.L., Mylotte D., Head S.J., Van Mieghem N.M., Nkomo V.T., LeReun C.M. et al. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J. Am. Coll. Cardiol. 2013;62(11):1002–1012. DOI: 10.1016/j.jacc.2013.05.015.Spethmann S., Dreger H., Baldenhofer G., Stüer K., Saghabalyan D., Müller E. et al. Short-term effects of transcatheter aortic valve implantation on left atrial mechanics and left ventricular diastolic function. J. Am. Soc. Echocardiogr. 2013;26(1):64–71.e2. DOI: 10.1016/j.echo.2012.10.002.Spethmann S., Dreger H., Baldenhofer G., Stüer K., Saghabalyan D., Müller E. et al. Short-term effects of transcatheter aortic valve implantation on left atrial mechanics and left ventricular diastolic function. J. Am. Soc. Echocardiogr. 2013;26(1):64–71.e2. DOI: 10.1016/j.echo.2012.10.002.Sarı C., Aslan A.N., Baştuğ S., Akçay M., Akar Bayram N., Bilen E. et al. Immediate recovery of the left atrial and left ventricular diastolic function after transcatheter aortic valve implantation: A transesophageal echocardiography study. Cardiol. J. 2016;23(4):449–455. DOI: 10.5603/CJ.a2016.0030.Sarı C., Aslan A.N., Baştuğ S., Akçay M., Akar Bayram N., Bilen E. et al. Immediate recovery of the left atrial and left ventricular diastolic function after transcatheter aortic valve implantation: A transesophageal echocardiography study. Cardiol. J. 2016;23(4):449–455. DOI: 10.5603/CJ.a2016.0030.

The authors declare that there are no conflicts of interest present.