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Park S, Kang DY, Ahn JM, Kim DH, Park DW, Park SJ, Kang JW, Yang DH, Lee SA, Koo HJ. Impact of new-onset arrhythmia on cardiac reverse remodeling following transcatheter aortic valve replacement: computed tomography-derived left ventricular and atrial strains. Eur Radiol 2023; 33:8454-8463. [PMID: 37368107 DOI: 10.1007/s00330-023-09836-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/03/2023] [Accepted: 04/10/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Patients who undergo transcatheter aortic valve replacement (TAVR) are at risk for new-onset arrhythmia (NOA) that may require permanent pacemaker (PPM) implantation, resulting in decreased cardiac function. We aimed to investigate the factors that are associated with NOA after TAVR and to compare pre- and post-TAVR cardiac functions between patients with and without NOA using CT-derived strain analyses. METHODS We included consecutive patients who underwent pre- and post-TAVR cardiac CT scans six months after TAVR. New-onset left bundle branch block, atrioventricular block, and atrial fibrillation/flutter lasting over 30 days after the procedure and/or the need for PPM diagnosed within 1 year after TAVR were regarded as NOA. Implant depth and left heart function and strains were analyzed using multi-phase CT images and compared between patients with and without NOA. RESULTS Of 211 patients (41.7% men; median 81 years), 52 (24.6%) presented with NOA after TAVR, and 24 (11.4%) implanted PPM. Implant depth was significantly deeper in the NOA group than in the non-NOA group (- 6.7 ± 2.4 vs. - 5.6 ± 2.6 mm; p = 0.009). Left ventricular global longitudinal strain (LV GLS) and left atrial (LA) reservoir strain were significantly improved only in the non-NOA group (LV GLS, - 15.5 ± 4.0 to - 17.3 ± 2.9%; p < 0.001; LA reservoir strain, 22.3 ± 8.9 to 26.5 ± 7.6%; p < 0.001). The mean percent change of the LV GLS and LA reservoir strains was evident in the non-NOA group (p = 0.019 and p = 0.035, respectively). CONCLUSIONS A quarter of patients presented with NOA after TAVR. Deep implant depth on post-TAVR CT scans was associated with NOA. Patients with NOA after TAVR had impaired LV reserve remodeling assessed by CT-derived strains. CLINICAL RELEVANCE STATEMENT New-onset arrhythmia (NOA) following transcatheter aortic valve replacement (TAVR) impairs cardiac reverse remodeling. CT-derived strain analysis reveals that patients with NOA do not show improvement in left heart function and strains, highlighting the importance of managing NOA for optimal outcomes. KEY POINTS • New-onset arrhythmia following transcatheter aortic valve replacement (TAVR) is a concern that interferes with cardiac reverse remodeling. • Comparison of pre-and post-TAVR CT-derived left heart strain provides insight into the impaired cardiac reverse remodeling in patients with new-onset arrhythmia following TAVR. • The expected reverse remodeling was not observed in patients with new-onset arrhythmia following TAVR, given that CT-derived left heart function and strains did not improve.
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Affiliation(s)
- Sohee Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Do-Yoon Kang
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Jung-Min Ahn
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dae-Hee Kim
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Duk-Woo Park
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Seung-Jung Park
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Seung-Ah Lee
- Division of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
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Mastrodicasa D, Aquino GJ, Ordovas KG, Vargas D, Fleischmann D, Abbara S, Hanneman K. Radiology: Cardiothoracic Imaging Highlights 2022. Radiol Cardiothorac Imaging 2023; 5:e230042. [PMID: 37404783 PMCID: PMC10316293 DOI: 10.1148/ryct.230042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/07/2023] [Accepted: 05/08/2023] [Indexed: 07/06/2023]
Abstract
Since its inaugural issue in 2019, Radiology: Cardiothoracic Imaging has disseminated the latest scientific advances and technical developments in cardiac, vascular, and thoracic imaging. In this review, we highlight select articles published in this journal between October 2021 and October 2022. The scope of the review encompasses various aspects of coronary artery and congenital heart diseases, vascular diseases, thoracic imaging, and health services research. Key highlights include changes in the revised Coronary Artery Disease Reporting and Data System 2.0, the value of coronary CT angiography in informing prognosis and guiding treatment decisions, cardiac MRI findings after COVID-19 vaccination or infection, high-risk features at CT angiography to identify patients with aortic dissection at risk for late adverse events, and CT-guided fiducial marker placement for preoperative planning for pulmonary nodules. Ongoing research and future directions include photon-counting CT and artificial intelligence applications in cardiovascular imaging. Keywords: Pediatrics, CT Angiography, CT-Perfusion, CT-Spectral Imaging, MR Angiography, PET/CT, Transcatheter Aortic Valve Implantation/Replacement (TAVI/TAVR), Cardiac, Pulmonary, Vascular, Aorta, Coronary Arteries © RSNA, 2023.
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Everett RJ, Leipsic JA. Evaluating the Potential of CT Angiography-derived Left Ventricular Long-Axis Shortening as a Biomarker of Early Decompensation. Radiol Cardiothorac Imaging 2022; 4:e220121. [PMID: 35833166 PMCID: PMC9274307 DOI: 10.1148/ryct.220121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Russell J. Everett
- From Cardiovascular Sciences, St Paul’s Hospital, Vancouver,
Canada (R.J.E.) and Department of Radiology, Providence Health Care, 6387 Larch
St, Vancouver, BC, Canada V6Z 1Y6 (J.A.L.)
| | - Jonathon A. Leipsic
- From Cardiovascular Sciences, St Paul’s Hospital, Vancouver,
Canada (R.J.E.) and Department of Radiology, Providence Health Care, 6387 Larch
St, Vancouver, BC, Canada V6Z 1Y6 (J.A.L.)
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