Introduction Aortic stenosis (AS) is causing myocardial damages and replacement is mainly indicated based on symptoms. Non-invasive estimation of myocardial work (MW) provide a less afterload dependent tool that, we sought to look at the impact of transcatheter aortic valve implantation (TAVI) on the myocardium at long-term follow-up and according to current indications. Methods We conducted an observational, cross-sectional, single-center study. Patients were selected based on the validated indication for a TAVI. Standardized echocardiographies were repeated. Results 102 patients were included. Mean age was 85-year-old, 45% were female, 68% get high-blood pressure and 52% had a coronary disease. One fifth was suffering from low-flow low-gradient aortic stenosis. Follow-up was performed at 22 ± 9.5 months after the TAVI. No TAVI-dysfunction was observed. LVEF was stable (62 ± 8%), and global longitudinal strain get improved (-14.0% ± 3.7 vs -16.0% ± 3.6, p-value <0.0001). No improvement of the MW-parameters was noticed (Global Work Index (LV GWI) 2099 ± 692mmHg% vs 2066 ± 706mmHg%, p=0.8, Global Constructive (LV GCW) 2463 ± 736mmHg% vs 2463 ± 676mmHg%, p=0.8). Global Wasted Work increased (214 [149; 357] mmHg% vs 247 [177; 394] mmHg%, p= 0.0008). Conclusion In a population of severe symptomatic AS-patients who had undergone a TAVI, the non-invasive myocardial indices that assess the LV performance at long term follow-up did not improve. These results are questioning the timing of the intervention and the need for a more attention in the pharmacological management of these AS-patients.

中文翻译：

---

经导管主动脉瓣植入对左心室心肌损伤的影响：长期随访

简介 主动脉瓣狭窄 (AS) 会导致心肌损伤，主要根据症状进行置换。心肌做功 (MW) 的无创估计提供了一种较少依赖后负荷的工具，我们试图根据当前的适应症，在长期随访中研究经导管主动脉瓣植入 (TAVI) 对心肌的影响。方法 我们进行了一项观察性、横断面、单中心研究。根据经验证的 TAVI 适应症选择患者。重复标准化超声心动图检查。结果纳入102名患者。平均年龄为85岁，45%为女性，68%患有高血压，52%患有冠心病。五分之一的人患有低流量低梯度主动脉瓣狭窄。TAVI 后 22 ± 9.5 个月进行随访。没有观察到 TAVI 功能障碍。LVEF 稳定 (62 ± 8%)，整体纵向应变得到改善（-14.0% ± 3.7 与 -16.0% ± 3.6，p 值 <0.0001）。未发现MW参数改善（全局工作指数（LV GWI）2099 ± 692mmHg% vs 2066 ± 706mmHg%，p=0.8，全局建设性（LV GCW）2463 ± 736mmHg% vs 2463 ± 676mmHg%，p=0.8 ）。全球浪费工作增加（214 [149; 357] mmHg% vs 247 [177; 394] mmHg%，p= 0.0008）。结论 在接受 TAVI 的严重症状 AS 患者群体中，长期随访时评估 LV 性能的非侵入性心肌指数没有改善。这些结果对干预的时机以及对这些强直性脊柱炎患者的药物管理给予更多关注的必要性提出了质疑。