Changes in Speckle Tracking Echocardiography Measures of Ventricular Function after Percutaneous Implantation of the Edwards SAPIEN Transcatheter Heart Valve in the Pulmonary Position

BackgroundPatients with free pulmonary regurgitation or mixed pulmonary stenosis and regurgitation and severely dilated right ventricles (RV) show little improvement in ventricular function after pulmonary valve replacement when assessed by traditional echocardiographic markers. We evaluated changes in right and left ventricular (LV) function using speckle tracking echocardiography in patients after SAPIEN transcatheter pulmonary valve (TPV) placement. MethodsEchocardiograms were evaluated at baseline, discharge, 1 and 6months after TPV placement in 24 patients from 4 centers. Speckletracking measures of function included peak longitudinal strain, strain rate, and early diastolic strain rate. RV fractional area change, tricuspid annular plane systolic excursion, and left ventricular LV ejection fraction were assessed. Routine Doppler and tissue Doppler velocities were measured. ResultsAt baseline, all patients demonstrated moderate to severe pulmonary regurgitation; this improved following TPV placement. No significant changes were detected in conventional measures of RV or LV function at 6months. RV longitudinal strain (-16.9% vs. -19.6%, P<0.01), strain rate (-0.87 s(-1) vs. -1.16 s(-1), P=0.01), and LV longitudinal strain (-16.2% vs. -18.2%, P=0.01) improved between baseline and 6month follow-up. RV early diastolic strain rate, LV longitudinal strain rate and early diastolic strain rate showed no change. ConclusionImprovements in RV longitudinal strain, strain rate, and LV longitudinal strain are seen at 6months post-TPV. Diastolic function does not appear to change at 6months. Speckletracking echocardiography may be more sensitive than traditional measures in detecting changes in systolic function after TPV implantation.