Loïc Biere1, Frédéric Pinaud2, Stéphane Delépine3, Sylvain Grall3, Nathalie Viot3, Victor Mateus3, Frédéric Rouleau3, Jean-Jacques Corbeau4, Fabrice Prunier3, Jean-Louis De Brux5, Serge Willoteaux6, Alain Furber3. 1. L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France. Electronic address: lobiere@chu-angers.fr. 2. L'UNAM Université, Angers, France; Université d'Angers, CHU d'Angers, Service de Chirurgie Cardio-vasculaire et Thoracique, Angers, France; UMR-CNRS 6214, INSERM 1083, faculté de médecine, Angers, France. 3. L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France. 4. Université d'Angers, CHU d'Angers, Département d'anesthésie-réanimation, Angers, France. 5. L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France; Université d'Angers, CHU d'Angers, Service de Chirurgie Cardio-vasculaire et Thoracique, Angers, France. 6. L'UNAM Université, Angers, France; Université d'Angers, Laboratoire Cardioprotection, Remodelage et Thrombose, CHU d'Angers, Service de Cardiologie, Angers, France; Université d'Angers, CHU d'Angers, Service de Radiologie, Angers, France.
Abstract
AIMS: To describe the time course of myocardial scarring after transapical-transcatheter aortic valve implantation (TA-TAVI) with the Edwards SAPIEN XT™ and the Edwards SAPIEN™ prosthesis in a 3-month follow-up study using cardiac magnetic resonance imaging (CMR). METHODS: In 20 TA-TAVI patients, CMR was performed at discharge and 3 months (3M). Cine-MRI was used for left ventricular (LV) functional assessment, and late gadolinium enhancement (LGE) imaging was employed for detecting the presence of myocardial scarring. Special attention was given to any artifacts caused by the prosthesis, which were consequently defined using a three-grade artifact scale. RESULTS: We systematically reported the presence of small LGE hyperintensity relating to the apical segment, with no variation found between discharge and 3M (2.8±1.6g vs. 2.35±1.1g). LV ejection fraction, end-diastolic, and end-systolic volumes did not significantly vary. A small area of apical akinesia was observed, with no improvement at follow-up. Whereas the Edwards SAPIEN XT™ prosthesis and the Edwards SAPIEN™ prosthesis are both constituted by metallic stenting structure, the Edwards SAPIEN™ was responsible for a larger signal void, thus potentially limiting the diagnostic performance of CMR. CONCLUSIONS: CMR may be performed safely in the context of TA-TAVI. The presence of a very small apical infarction correlating with focal akinesia was observed. As expected, the Edwards SAPIEN XT™ prosthesis was shown to be particularly suitable for CMR assessment.
AIMS: To describe the time course of myocardial scarring after transapical-transcatheter aortic valve implantation (TA-TAVI) with the Edwards SAPIEN XT™ and the Edwards SAPIEN™ prosthesis in a 3-month follow-up study using cardiac magnetic resonance imaging (CMR). METHODS: In 20 TA-TAVI patients, CMR was performed at discharge and 3 months (3M). Cine-MRI was used for left ventricular (LV) functional assessment, and late gadolinium enhancement (LGE) imaging was employed for detecting the presence of myocardial scarring. Special attention was given to any artifacts caused by the prosthesis, which were consequently defined using a three-grade artifact scale. RESULTS: We systematically reported the presence of small LGE hyperintensity relating to the apical segment, with no variation found between discharge and 3M (2.8±1.6g vs. 2.35±1.1g). LV ejection fraction, end-diastolic, and end-systolic volumes did not significantly vary. A small area of apical akinesia was observed, with no improvement at follow-up. Whereas the Edwards SAPIEN XT™ prosthesis and the Edwards SAPIEN™ prosthesis are both constituted by metallic stenting structure, the Edwards SAPIEN™ was responsible for a larger signal void, thus potentially limiting the diagnostic performance of CMR. CONCLUSIONS: CMR may be performed safely in the context of TA-TAVI. The presence of a very small apical infarction correlating with focal akinesia was observed. As expected, the Edwards SAPIEN XT™ prosthesis was shown to be particularly suitable for CMR assessment.
Authors: Won-Keun Kim; Christoph Liebetrau; Arnaud van Linden; Johannes Blumenstein; Luise Gaede; Christian W Hamm; Thomas Walther; Helge Möllmann Journal: Clin Res Cardiol Date: 2015-12-15 Impact factor: 5.460