Left Ventricular Remodeling After Transcatheter Mitral Valve Replacement With Tendyne: New Insights From Computed Tomography |
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| Institution: | 1. Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota;2. Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota;3. Minneapolis Heart Institute, Minneapolis, Minnesota;4. The Royal Brompton Hospital, London, United Kingdom;5. St. Vincent’s Hospital Sydney, Darlinghurst, Australia |
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| Abstract: | ObjectivesThe aim of this study was to describe the anatomic and functional changes in left-sided chambers using computed tomographic angiography (CTA) from baseline to 1 month after transcatheter mitral valve replacement (TMVR) with the Tendyne prosthesis.BackgroundData on changes in left atrial and left ventricular (LV) volumes after TMVR implantation are very limited.MethodsPatients who underwent TMVR with the Tendyne prosthesis between 2015 and 2018 were analyzed. Changes in LV end-diastolic volume, ejection fraction, LV mass, left atrial volume, and global longitudinal strain were assessed at baseline and 1 month after TMVR using CTA. Specific Tendyne implant characteristics were identified and correlated with remodeling changes.ResultsA total of 36 patients (median age 74 years; interquartile range IQR]: 69 to 78 years; 78% men; 86% with secondary mitral regurgitation) were included in this study. There were significant decreases in LV end-diastolic volume (281 ml IQR: 210 to 317 ml] vs. 239 ml IQR: 195 to 291 ml]; p < 0.001), LV ejection fraction (37% IQR: 31% to 48%] vs. 30% IQR: 23% to 40%]; p < 0.001), LV mass (126 g IQR: 96 to 155 g] vs. 116 g IQR: 92 to 140 g]; p < 0.001), left atrial volume (171 ml IQR: 133 to 216 ml] vs. 159 ml IQR: 125 to 201 ml]; p = 0.027), and global longitudinal strain (?11% IQR: ?17% to ?8%] vs. ?9% IQR: ?12% to ?6%]; p < 0.001) from baseline to 1-month follow-up. Favorable LV end-diastolic volume reverse remodeling occurred in the majority (30 of 36 patients 83%]). Closer proximity of the Tendyne apical pad to the true apex (24 mm IQR: 21 to 29 mm] vs. 35 mm IQR: 26 to 40 mm]) was predictive of favorable remodeling (p = 0.037).ConclusionsTMVR with Tendyne results in favorable left-sided chamber remodeling in the majority of patients treated, as detected on CTA at 1 month after implantation. CTA identifies favorable post-TMVR changes, which could be related to specific characteristics of the device implantation. |
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