Application value of echocardiography in pre-procedure evaluation and post-procedure follow-up in transcatheter aortic valve replacement

doi:10.3877/cma.j.issn.1672-6448.2021.10.009

Abstract

Abstract:

Objective

To assess the value of echocardiography in evaluating the cardiac structure and function before and after transcatheter aortic valve replacement (TAVR).

Methods

A total of 47 patients with severe aortic valve stenosis (SAS) who underwent TAVR at the Department of Cardiology, Zhongshan Hospital of Fudan University from September 2014 to July 2019 were retrospectively enrolled. All patients received echocardiography before and 6 months after TAVR, and conventional echocardiography parameters and aortic valve-related parameters were routine recorded. Echocardiographic parameters, including left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (PWT), pulmonary artery systolic pressure (PASP), maximum aortic valve pressure gradient (AVPGmax), mean aortic valve pressure gradient (AVPGmean), aortic valve effective orifice area (AVA), left ventricular ejection fraction (LVEF), aortic root diameter (AORD), and left atrial diameter (LAD) were collected, and left ventricular mass index was calculated according to LVEDD, IVST, and PWT. The changes of TAVR echocardiographic parameters pre- and post-procedure were analyzed.

Results

Compared with the values on admission, LVESD, IVST, PWT, PASP, AVPGmax, and AVPGmean at follow-up were significantly decreased in the patients (P＜0.05). Both AVA and LVEF significantly increased (P＜0.05). The number of cases with moderate or above mitral regurgitation and tricuspid regurgitation decreased significantly post-procedure (8 vs 3, 7 vs 2).

Conclusion

TAVR can correct aortic stenosis (AS) and improve cardiac function. Echocardiography plays a crucial role in evaluating the cardiac construction and function and the prosthesis after TAVR.

Key words: Transcatheter aortic valve replacement, Aortic valve stenosis, Echocardiography

Chunqiang Hu, Wei Li, Weipeng Zhao, Zhenyi Ge, Daxin Zhou, Wenzhi Pan, Xianhong Shu, Cuizhen Pan. Application value of echocardiography in pre-procedure evaluation and post-procedure follow-up in transcatheter aortic valve replacement[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(10): 948-953.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2021.10.009

https://chaosheng.cma-cmc.com.cn/EN/Y2021/V18/I10/948

Figures/Tables 5

参数	3D-TEE	MSCT	t值	P值
主动脉瓣环
最大径（cm）	26.1±2.08	26.2±2.4	-0.12	0.901
最小径（cm）	21.2±2.04	21.1±2.06	0.12	0.902
面积（cm²）	425.8±70.23	418.5±68.65	0.41	0.681
AVA（cm²）	62.3±13.84	61.6±18.66	0.17	0.869

参数	术前（n=47）	术后6个月（n=47）	统计值	P值
AORD（mm， $x ¯$ ±s）	32.6±4.32	32.0±4.53	t=0.57	0.572
LAD（mm， $x ¯$ ±s）	43.9±6.46	42.1±7.51	t=1.23	0.226
LVEDD（mm， $x ¯$ ±s）	49.7±7.94	46.9±6.14	t=1.93	0.059
LVESD（mm， $x ¯$ ±s）	34.8±9.40	30.2±6.11	t=3.04	0.004
IVST（mm， $x ¯$ ±s）	13.3±1.98	12.1±1.93	t=2.72	0.009
PWT（mm， $x ¯$ ±s）	12.2±1.24	11.1±1.45	t=4.13	＜0.001
PASP（mmHg， $x ¯$ ±s）	47.3±14.48	38.6±8.70	t=3.27	0.002
LVEF（%， $x ¯$ ±s）	57±12.4	64±8.3	t=-3.36	0.002
MR中度及以上［例（%）］	8（17）	3（6）	χ²=2.57	0.109
TR中度及以上［例（%）］	7（15）	2（4）	χ²=1.97	0.161
AR中度及以上［例（%）］	14（30）	0	χ²=16.45	＜0.001

参数	术前（n=47）	术后6个月（n=47）	统计值	P值
AORD（mm， $x ¯$ ±s）	32.6±4.32	32.0±4.53	t=0.57	0.572
LAD（mm， $x ¯$ ±s）	43.9±6.46	42.1±7.51	t=1.23	0.226
LVEDD（mm， $x ¯$ ±s）	49.7±7.94	46.9±6.14	t=1.93	0.059
LVESD（mm， $x ¯$ ±s）	34.8±9.40	30.2±6.11	t=3.04	0.004
IVST（mm， $x ¯$ ±s）	13.3±1.98	12.1±1.93	t=2.72	0.009
PWT（mm， $x ¯$ ±s）	12.2±1.24	11.1±1.45	t=4.13	＜0.001
PASP（mmHg， $x ¯$ ±s）	47.3±14.48	38.6±8.70	t=3.27	0.002
LVEF（%， $x ¯$ ±s）	57±12.4	64±8.3	t=-3.36	0.002
MR中度及以上［例（%）］	8（17）	3（6）	χ²=2.57	0.109
TR中度及以上［例（%）］	7（15）	2（4）	χ²=1.97	0.161
AR中度及以上［例（%）］	14（30）	0	χ²=16.45	＜0.001

参数	术前（n=47）	术后6个月（n=47）	t值	P值
AVPGmax（mmHg）	102±31.3	21±7.7	17.14	＜0.001
AVPGmean（mmHg）	59±18.5	11±4.3	16.65	＜0.001
AVA（cm²）	0.67±0.16	1.8±0.24	-24.50	＜0.001
Vmax（m/s）	4.96±0.71	2.26±0.42	21.53	＜0.001

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