Changes in mechanical dyssynchrony in severe aortic stenosis patients undergoing transcatheter aortic valve replacement

Abstract

<jats:sec><jats:title>Introduction</jats:title><jats:p>Aortic stenosis (<jats:styled-content style="fixed-case">AS</jats:styled-content>) imposes a significant afterload on the left ventricle, but regional manifestations of the overall load may not be uniform, leading to mechanical dyssynchrony. Accordingly, we evaluated the prevalence of dyssynchrony in patients with severe <jats:styled-content style="fixed-case">AS</jats:styled-content> at baseline as well as changes after transfemoral aortic valve replacement (<jats:styled-content style="fixed-case">TAVR</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>This study is a retrospective analysis of 225 patients in sinus rhythm who underwent <jats:styled-content style="fixed-case">TAVR</jats:styled-content> for severe <jats:styled-content style="fixed-case">AS</jats:styled-content>, in whom inter‐ventricular and intra‐ventricular dyssynchrony were measured at baseline, discharge, 1 month, and 1 year. Inter‐ventricular dyssynchrony was defined as the difference between left and right ventricular pre‐ejection intervals; intra‐ventricular dyssynchrony was defined as the difference between time to peak systolic velocity of the basal septal and lateral segments. Patients were further stratified into those with <jats:styled-content style="fixed-case">QRS</jats:styled-content> <120 ms or >120 ms.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>At baseline, a quarter of patients met the criterion for significant inter‐ventricular dyssynchrony, and a third had evidence of intra‐ventricular dyssynchrony. Both decreased after <jats:styled-content style="fixed-case">TAVR</jats:styled-content> although only the intra‐ventricular dyssynchrony reached statistical significance. The interplay between <jats:styled-content style="fixed-case">QRS</jats:styled-content> duration and changes in inter‐ and intra‐ventricular dyssynchrony are also explored.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>In patients with severe <jats:styled-content style="fixed-case">AS</jats:styled-content>, there was evidence of mechanical dyssynchrony that is improved post‐<jats:styled-content style="fixed-case">TAVR</jats:styled-content>. Whether dyssynchrony is clinically and prognostically significant, and if it represents a potential target for additional therapy remains to be studied.</jats:p></jats:sec>