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Left Ventricular Global Longitudinal Strain after TAVR with the JenaValve Trilogy system in patients with aortic regurgitation

https://doi.org/10.1007/s00392-024-02526-y

Sara Waezsada (Bad Oeynhausen)1, A. Goncharov (Bad Oeynhausen)2, J.-C. Reil (Bad Oeynhausen)2, H. S. Wienemann (Köln)3, M. Adam (Köln)3, M. Ivannikova (Bad Oeynhausen)4, M. Emelianova (Bad Oeynhausen)4, I. Horn (Bad Oeynhausen)4, V. Rudolph (Bad Oeynhausen)2, T. K. Rudolph (Bad Oeynhausen)2

1Herz- und Diabeteszentrum NRW Bad Oeynhausen, Deutschland; 2Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 3Herzzentrum der Universität zu Köln Klinik III für Innere Medizin Köln, Deutschland; 4Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland

 

  Background 
Transcatheter aortic valve replacement (TAVR) with the JenaValve (JV) Trilogy system is a safe and effective procedure for patients with severe aortic regurgitation and increased surgical risk. As of yet, knowledge on the impact of interventional treatment in patients with aortic regurgitation on left ventricular global longitudinal strain as a marker of left ventricular systolic function is limited. 
 
Methods
85 patients undergoing transfemoral TAVR with the JV system at two centres in Germany were retrospectively included from April 2019 to January 2024. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) analysis was assessed at baseline, before discharge and at a median follow-up of 3 months.
 
Results
While device success was achieved in all patients, LVEF and GLS significantly decreased immediately after intervention compared to baseline (LVEF 50.1 ± 10.1 at baseline vs. 43.9 ± 9.5 at discharge [p = < 0.001]; GLS -14 ± 3.5 at baseline vs. -10.6 ± 3.5 at discharge [p = < 0.001]). This effect persisted through follow-up within 3 months after intervention (LVEF 44.1 ± 10.1 [p = 0.009]; GLS -10.5 ± 3.6 [p = < 0.001]). Contrary to deterioration of left ventricular systolic function, functional status as derived from NYHA functional class improved in the majority of patients (14 [61%] with improved NYHA class, 8 [35%] with no change in NYHA class, 1 [4%] with worsening of NYHA class).
 
Conclusions
LVEF and GLS in patients with severe aortic regurgitation significantly deteriorates after TAVR with the JV system. Considering that both are preload-dependent parameters and that in addition preload is pathologically elevated in patients with aortic regurgitation normalization of preload after intervention and concomitant demasking of a preprocedural underestimated impairment of left ventricular systolic function might be the cause for this observation as similar data has been shown after surgical aortic valve replacement in patients with aortic regurgitation.
 
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