TY - JOUR T1 - Successful transcatheter aortic valve implantation (TAVI) is associated with transient left ventricular dysfunction JF - Heart JO - Heart SP - 1641 LP - 1646 DO - 10.1136/heartjnl-2012-302505 VL - 98 IS - 22 AU - Rafal Dworakowski AU - Olaf Wendler AU - Amit Bhan AU - Lindsay Smith AU - Peter Pearson AU - Emma Alcock AU - Kailasam Rajagopal AU - Beth Brickham AU - Tracy Dew AU - Jonathan Byrne AU - Mark J Monaghan AU - Roy Sherwood AU - Ajay M Shah AU - Philip A MacCarthy Y1 - 2012/11/15 UR - http://heart.bmj.com/content/98/22/1641.abstract N2 - Objective To investigate early haemodynamic changes after transfemoral transcatheter aortic valve implantation (TAVI) and the relationship with myocardial injury and neurohormonal activation. Design Single-centre prospective observational study. Setting Tertiary cardiac centre. Patients 42 patients undergoing transfemoral TAVI were included in this study. Main outcome measures Haemodynamic measurements and echocardiography-derived indices characterising myocardial function were recorded at baseline, 6 and 24 h postprocedure. Postprocedural myocardial injury was quantified using serum troponin I and CK-MB levels. In addition, biomarkers of myocardial dysfunction/heart failure and neurohormonal activation were measured. Results 6 h Post-TAVI there was a significant deterioration in both systolic and diastolic function as measured by dP/dtmax/EDV, myocardial performance index and mean E/e' index. Recovery of myocardial function was observed at 24 h. These haemodynamic changes were associated with a significant increase in both troponin I (0.07±0.01 vs 1.59±0.21 μg/l, p<0.005) and CK-MB (1.99±0.19 vs 6.82±0.7 ng/ml, p<0.005). There was a positive correlation among myocardial injury and NT-BNP (r=0.34, p<0.0005), aldosterone (r=0.56, p<0.0001) and ST2 levels (r=0.21, p<0.05). Conclusions This is the first study to demonstrate that procedurally successful TF-TAVI results in a transient depression of both systolic and diastolic left ventricular function within the first 24 postoperative hours, despite impressive relief of previously severe, chronic pressure overload. The rise in the markers of myocardial damage suggests that this may be due to periprocedural myocardial injury. Complete recovery of contractility is generally observed after 24 h. ER -