Influence of cardiac function in TAVI on what examined using myocardial strain

In this study, we examined cardiac function strain in the left ventricular longitudinal axis direction before and after transcatheter aortic valve implantation (TAVI), which is one of the treatments for aortic valve stenosis, using myocardial strain. The subjects were 20 patients who underwent TAVI...

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Published inJapanese Journal of Medical Technology Vol. 68; no. 4; pp. 663 - 670
Main Authors TOJO, Mai, TANIUCHI, Ryosui, UETA, Ayami, MIYAMOTO, Shohei, AOJI, Chiaki, KIYOTO, Yumi
Format Journal Article
LanguageJapanese
Published Japanese Association of Medical Technologists 25.10.2019
一般社団法人 日本臨床衛生検査技師会
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ISSN0915-8669
2188-5346
DOI10.14932/jamt.18-130

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Abstract In this study, we examined cardiac function strain in the left ventricular longitudinal axis direction before and after transcatheter aortic valve implantation (TAVI), which is one of the treatments for aortic valve stenosis, using myocardial strain. The subjects were 20 patients who underwent TAVI at our hospital. We performed echocardiography TAVI at the preoperative, postoperative acute, and postoperative chronic phases, and the indexes of the longitudinal contraction for the left ventricular myocardium global longitudinal strain (GLS) were analyzed. Results of the analysis showed that there were no significant differences in GLS between the preoperative and postoperative acute phases (p = 0.09), with GLS of −11.5% in the 20 patients with TAVI at the preoperative phase and −12.0% in those in the postoperative acute phase. On the other hand, the GLS in the postoperative chronic phase was −14.4%, which is significantly different from that in the preoperative phase (p < 0.01). On the basis of this study, it was considered that the significant improvement in GLS between the TAVI preoperative and postoperative chronic phases and the treatment of the aortic valve continuously improves myocardial function in the left ventricular longitudinal axis direction. Also, before and after TAVI, there was no significant change in the left ventricular ejection fraction (LVEF), but LVEF improved with GLS. With GLS, we were able to detect contraction abnormalities, which was not possible in the case of using LVEF, and myocardial strain was considered to be useful for the evaluation of cardiac function also in valvular disease.
AbstractList In this study, we examined cardiac function strain in the left ventricular longitudinal axis direction before and after transcatheter aortic valve implantation (TAVI), which is one of the treatments for aortic valve stenosis, using myocardial strain. The subjects were 20 patients who underwent TAVI at our hospital. We performed echocardiography TAVI at the preoperative, postoperative acute, and postoperative chronic phases, and the indexes of the longitudinal contraction for the left ventricular myocardium global longitudinal strain (GLS) were analyzed. Results of the analysis showed that there were no significant differences in GLS between the preoperative and postoperative acute phases (p = 0.09), with GLS of −11.5% in the 20 patients with TAVI at the preoperative phase and −12.0% in those in the postoperative acute phase. On the other hand, the GLS in the postoperative chronic phase was −14.4%, which is significantly different from that in the preoperative phase (p < 0.01). On the basis of this study, it was considered that the significant improvement in GLS between the TAVI preoperative and postoperative chronic phases and the treatment of the aortic valve continuously improves myocardial function in the left ventricular longitudinal axis direction. Also, before and after TAVI, there was no significant change in the left ventricular ejection fraction (LVEF), but LVEF improved with GLS. With GLS, we were able to detect contraction abnormalities, which was not possible in the case of using LVEF, and myocardial strain was considered to be useful for the evaluation of cardiac function also in valvular disease.
In this study, we examined cardiac function strain in the left ventricular longitudinal axis direction before and after transcatheter aortic valve implantation (TAVI), which is one of the treatments for aortic valve stenosis, using myocardial strain. The subjects were 20 patients who underwent TAVI at our hospital. We performed echocardiography TAVI at the preoperative, postoperative acute, and postoperative chronic phases, and the indexes of the longitudinal contraction for the left ventricular myocardium global longitudinal strain (GLS) were analyzed. Results of the analysis showed that there were no significant differences in GLS between the preoperative and postoperative acute phases (p = 0.09), with GLS of −11.5% in the 20 patients with TAVI at the preoperative phase and −12.0% in those in the postoperative acute phase. On the other hand, the GLS in the postoperative chronic phase was −14.4%, which is significantly different from that in the preoperative phase (p < 0.01). On the basis of this study, it was considered that the significant improvement in GLS between the TAVI preoperative and postoperative chronic phases and the treatment of the aortic valve continuously improves myocardial function in the left ventricular longitudinal axis direction. Also, before and after TAVI, there was no significant change in the left ventricular ejection fraction (LVEF), but LVEF improved with GLS. With GLS, we were able to detect contraction abnormalities, which was not possible in the case of using LVEF, and myocardial strain was considered to be useful for the evaluation of cardiac function also in valvular disease. 大動脈弁狭窄症に対する,経カテーテル的大動脈弁置換術(transcatheter aortic valve implantation; TAVI)の治療前後における,心機能の変化について,心筋ストレインを用いて検討した。対象はTAVIを施行した20例で,TAVI術前,術後急性期,および術後慢性期に心エコー図検査を施行し,左室心筋全体の長軸方向の収縮指標であるglobal longitudinal strain(GLS)を解析した。解析した結果,TAVI術前の20例平均のGLSは−11.5%,術後急性期のGLSは−12.0%,術前と術後急性期のGLSに有意差を認めなかった(p = 0.09)。一方,術後慢性期のGLSは−14.4%で,術前とのGLSに有意差を認めた(p < 0.01)。また,治療前後において,左室駆出率(left ventricular ejection fraction; LVEF)に著変はなかった。今回の検討により,TAVI術前と術後慢性期とのGLSに有意差を認め,大動脈弁の治療を行うことで,継続的に左室長軸方向の心筋機能は改善するものと思われた。また,TAVI前後ではLVEFに著変はなかったが,GLSでは改善した。GLSはLVEFではわからない収縮異常を検出することが可能であり,心臓弁膜症においても心機能の評価には,心筋ストレインが有用であると思われた。
Author TOJO, Mai
TANIUCHI, Ryosui
UETA, Ayami
KIYOTO, Yumi
MIYAMOTO, Shohei
AOJI, Chiaki
Author_FL 青地 千亜紀
東條 真依
谷内 亮水
清遠 由美
上田 彩未
宮元 祥平
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一般社団法人 日本臨床衛生検査技師会
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References 6) Nahum J et al.: “Impact of longitudinal myocardial deformation on the prognosis of chronic heart failure patients,” Circ Cardiovasc Imaging, 2010; 3: 249–256.
1) 西村 俊亮:「ASの自然歴からガイドラインを見直す」,心エコー,838–845,泉 千里(編),文光堂,東京,2017.
10) Kalam K et al.: “Prognostic implications of global LV dysfunction: A systematic review and meta-analysis of global longitudinal strain and ejection fraction,” Heart, 2014; 100: 1673–1680.
3) 中谷 敏:「弁膜症エコーの最近の話題」,日本内科学会雑誌,2016; 105: 192–198.
5) Stanton T et al.: “Prediction of all-cause mortality from global longitudinal speckle strain: Comparison with ejection fraction and wall motion scoring,” Circ Cardiovasc Imaging, 2009; 2: 356–364.
7) Sawaya H et al.: “Assessment of echocardiography and biomarker for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab,” Circ Cardiovasc Imaging, 2012; 5: 596–603.
9) Sengelow M et al.: “Global longitudinal strain is a superior predictor of all-cause mortality in heart failure with reduced ejection fraction,” Circ Cardiovasc Imaging, 2015; 8: 1351–1359.
2) 小松 博史,山田 聡:「1)大動脈弁狭窄の成因と病態」,新・心臓病診療プラクティス9 弁膜症を解く,156–161,山本 一博,別府 慎太郎(編),文光堂,東京,2007.
13) 山田 聡,加賀 早苗:「左室収縮能―EF? GLS?」,心エコー,726–735,阿部 幸雄,渡辺 弘之(編),文光堂,東京,2017.
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8) Lancellotti P et al.: “Risk stratification in asymptomatic moderate to severe aortic stenosis: The importance of the valvular, arterial and ventricular interplay,” Heart, 2010; 96: 1364–1371.
4) 大門 雅夫:「循環器領域における超音波検査の進歩」,医機学,2014; 84: 448–453.
12) 竹田 泰治,中谷 敏:「経カテーテル的大動脈弁置換術と心エコー図」,新・心臓病診療プラクティス17 大動脈弁・僧房弁疾患を心エコー図で診る・活かす,100–102,中谷 敏,吉川 純一(編),文光堂,東京,2011.
14) Farsalinos KE et al.: “Head-to-head comparison of global longitudinal strain measurements among nine different vendors: The EACVI/ASE Inter-Vendor Comparison Study,” J Am Soc Echocardiogr, 2015; 28: 1171–1181.
References_xml – reference: 5) Stanton T et al.: “Prediction of all-cause mortality from global longitudinal speckle strain: Comparison with ejection fraction and wall motion scoring,” Circ Cardiovasc Imaging, 2009; 2: 356–364.
– reference: 8) Lancellotti P et al.: “Risk stratification in asymptomatic moderate to severe aortic stenosis: The importance of the valvular, arterial and ventricular interplay,” Heart, 2010; 96: 1364–1371.
– reference: 10) Kalam K et al.: “Prognostic implications of global LV dysfunction: A systematic review and meta-analysis of global longitudinal strain and ejection fraction,” Heart, 2014; 100: 1673–1680.
– reference: 3) 中谷 敏:「弁膜症エコーの最近の話題」,日本内科学会雑誌,2016; 105: 192–198.
– reference: 7) Sawaya H et al.: “Assessment of echocardiography and biomarker for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab,” Circ Cardiovasc Imaging, 2012; 5: 596–603.
– reference: 13) 山田 聡,加賀 早苗:「左室収縮能―EF? GLS?」,心エコー,726–735,阿部 幸雄,渡辺 弘之(編),文光堂,東京,2017.
– reference: 2) 小松 博史,山田 聡:「1)大動脈弁狭窄の成因と病態」,新・心臓病診療プラクティス9 弁膜症を解く,156–161,山本 一博,別府 慎太郎(編),文光堂,東京,2007.
– reference: 6) Nahum J et al.: “Impact of longitudinal myocardial deformation on the prognosis of chronic heart failure patients,” Circ Cardiovasc Imaging, 2010; 3: 249–256.
– reference: 4) 大門 雅夫:「循環器領域における超音波検査の進歩」,医機学,2014; 84: 448–453.
– reference: 11) 村田 和也,松崎 益徳:「1)大動脈弁狭窄をきたす疾患とそのみかた」,新・心臓病診療プラクティス17 大動脈弁・僧房弁疾患を心エコー図で診る・活かす,5–13,中谷 敏,吉川 純一(編),文光堂,東京,2011.
– reference: 14) Farsalinos KE et al.: “Head-to-head comparison of global longitudinal strain measurements among nine different vendors: The EACVI/ASE Inter-Vendor Comparison Study,” J Am Soc Echocardiogr, 2015; 28: 1171–1181.
– reference: 1) 西村 俊亮:「ASの自然歴からガイドラインを見直す」,心エコー,838–845,泉 千里(編),文光堂,東京,2017.
– reference: 12) 竹田 泰治,中谷 敏:「経カテーテル的大動脈弁置換術と心エコー図」,新・心臓病診療プラクティス17 大動脈弁・僧房弁疾患を心エコー図で診る・活かす,100–102,中谷 敏,吉川 純一(編),文光堂,東京,2011.
– reference: 9) Sengelow M et al.: “Global longitudinal strain is a superior predictor of all-cause mortality in heart failure with reduced ejection fraction,” Circ Cardiovasc Imaging, 2015; 8: 1351–1359.
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Snippet In this study, we examined cardiac function strain in the left ventricular longitudinal axis direction before and after transcatheter aortic valve implantation...
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StartPage 663
SubjectTerms aortic valve stenosis
echocardiography
global longitudinal strain
myocardial strain
transcatheter aortic valve implantation
大動脈弁狭窄症
心エコー図検査
心筋ストレイン
経カテーテル的大動脈弁置換術
Title Influence of cardiac function in TAVI on what examined using myocardial strain
URI https://www.jstage.jst.go.jp/article/jamt/68/4/68_18-130/_article/-char/en
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