Changes in right ventricular systolic function after transcatheter aortic valve implantation assessed by two-dimensional speckle tracking echocardiography.

Evolución de la función sistólica ventricular derecha tras implante de válvula aórtica percutánea con ecocardiografı´a speckle tracking bidimensional To the Editor, In recent years, left ventricular function has been shown to improve in patients with severe aortic stenosis treated with transcatheter aortic valve implantation (TAVI), 1 and a reduction of left ventricular hypertrophy has also been reported, 2 with the unquestionable prognostic implications this has over the medium term. On the other hand, it has been demonstrated that right ventricular systolic dysfunction develops soon after aortic valve replacement surgery. However, few studies have evaluated right ventricular systolic function (RVF) in patients who had undergone TAVI, and these studies involved conventional echocardiographic methods, the results of which are subject to the limitations associated with these techniques. 3,4 Thus, our objective is to analyze the short-and medium-term course of RVF following TAVI using novel, more accurate echocardiographic methods that are less subject to technical limitations. 5 This study had a case series design. RVF was quantified using the apical four-chamber view by means of tricuspid annular plane systolic excursion in M mode echocardiograms, tricuspid annular velocity was assessed by tissue Doppler imaging, and 2-dimensional speckle tracking echocardiography (2DSTE) was employed to determine 2 parameters: longitudinal strain in right ventricular free wall and tricuspid annular motion. 5 Moreover, we analyzed the pulmonary artery systolic pressure using the tricuspid regurgitant jet velocity assessed by continuous-wave Doppler ultrasound, adding 10 mmHg to the systolic pressure gradient between right ventricle and right atrium. Echocardiography (Philips iE33) was performed prior to, immediately after, and 1 and 6 months after implantation, and Philips QLAB software was employed to analyze the measurements obtained with 2DSTE. we enrolled 37 patients (age, 76 [7] years; 49% men; logistic EuroSCORE, 14.5% [5.9%]) with severe symptomatic aortic stenosis and high surgical risk, treated by means of percutaneous TAVI, with 6 months of follow-up. Informed consent had been obtained prior to inclusion. Categorical variables were expressed as percentages, and continuous variables mean (standard deviation). The changes in continuous variables throughout follow-up were analyzed using repeated measures analysis of variance, and Bonferroni post hoc tests were performed when significant differences were found. The SPSS 18.0 statistical software package was employed. A P value less than .05 was considered to indicate statistical significance. In the analysis of the results at hospital discharge, we observed a significant improvement in all the echocardiographic parameters associated with RVF, and …