1
|
Myon F, Marut B, Kosmala W, Auffret V, Leurent G, L'official G, Curtis E, Le Breton H, Oger E, Donal E. Transcatheter aortic valve implantation in severe aortic stenosis does not necessarily reverse left ventricular myocardial damage: data of long-term follow-up. Eur Heart J Cardiovasc Imaging 2024; 25:821-828. [PMID: 38236150 DOI: 10.1093/ehjci/jeae017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024] Open
Abstract
AIMS Aortic stenosis (AS) is causing myocardial damage and replacement is mainly indicated based on symptoms. Non-invasive estimation of myocardial work (MW) provides a less afterload-dependent too for assessing myocardial function. 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 AND RESULTS We conducted an observational, cross-sectional, single-centre study. Patients were selected based on the validated indication for a TAVI. Standardized echocardiographies were repeated. A total of 102 patients were included. The mean age was 85 years, 45% were female, 68% had high blood pressure, and 52% had a coronary disease. One-fifth was suffering from low-flow-low-gradient AS. A follow-up was performed at 22 ± 9.5 months after the TAVI. No TAVI dysfunction was observed. Left ventricular (LV) ejection fraction was stable (62 ± 8%), and global longitudinal strain had improved (-14.0 ± 3.7 vs. -16.0 ± 3.6%, P < 0.0001). No improvement of the MW parameters was noticed (LV global work index 2099 ± 692 vs. 2066 ± 706 mmHg%, P = 0.8, LV global constructive 2463 ± 736 vs. 2463 ± 676 mmHg%, P = 0.8). Global wasted work increased [214 (149; 357) 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 more attention in the pharmacological management of these AS patients.
Collapse
Affiliation(s)
- Frederic Myon
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Benjamin Marut
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | | | - Vincent Auffret
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Guillaume Leurent
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Guillaume L'official
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Elizabeth Curtis
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Herve Le Breton
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| | - Emmanuel Oger
- EA Reperes, CHU Rennes, University of Rennes, Rennes, France
| | - Erwan Donal
- Cardiologie, CHU de RENNES, LTSI UMR1099, INSERM, Université de Rennes, Rennes, France
| |
Collapse
|
2
|
Echocardiographic assessment of diastolic dysfunction in elderly patients with severe aortic stenosis before and after aortic valve replacement. Cardiovasc Ultrasound 2021; 19:32. [PMID: 34583696 PMCID: PMC8480046 DOI: 10.1186/s12947-021-00262-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background The 2016 guidelines of the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) for evaluation of left ventricular (LV) diastolic dysfunction by Doppler flow and tissue Doppler- echocardiography do not adjust assessment of high filling pressures for patients with aortic stenosis (AS). However, most of the studies on this patient group indicate age independent specific diastolic features in AS. The aim of this study is to identify disease-specific range and distribution of diastolic functional parameters and their ability to identify high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels as a marker for high filling pressures. Methods In this study, 169 patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Resting echocardiography was performed including Doppler of the mitral inflow, pulmonary venous flow, tricuspid regurgitant flow and tissue Doppler in the mitral ring and indexed volume-estimates of the left atrium (LAVI). Echocardiography, and NT-proBNP levels were assessed before TAVR/SAVR and at two postoperative visits at 6 and 12 months. Results Pre- and postoperative values were septal e′; 5.1 ± 3.9, 5.2 ± 1.6 cm/s; lateral e′ 6.3 ± 2.1; 7.7 ± 2.7 cm/s; E/e′19 ± 8; 16 ± 7 cm/s; E velocity 96 ± 32; 95 ± 32 cm/s; LAVI 39 ± 8; 36 ± 8 ml/m2, pulmonary artery pressure (PAP) 39 ± 8; 36 ± 8 mmHg, respectively. The scoring recommended by ASE/EACVI detected elevated NT pro-BNP with a specificity of 25%. Adjusting thresholds towards PAP ≥ 40 mmHg, E velocity ≥ 100 cm/s, E deceleration time < 220 ms, and E/septal e′ ≥ 20 or septal e′ < 5.0 cm/s increased prediction of NT-proBNP levels ≥500 ng/L with substantially improved specificity (> 85%). Conclusion Diastolic echocardiographic parameters in AS indicate persistent impaired relaxation and NT-proBNP indicate elevated filling pressures in most of the patients, improving only modestly 6–12 months after TAVR and SAVR. Applying the 2016 ASE/EACVI recommendations for detection of elevated filling pressures to patients with AS, elevated NT pro-BNP levels could not be reliably detected. However, adjusting thresholds of the echocardiographic parameters increased specificities to useful diagnostic levels. Trial registration The study was prospectively approved by the regional ethical committee, REK North with the registration number: REK 2010/397-10. Supplementary Information The online version contains supplementary material available at 10.1186/s12947-021-00262-1.
Collapse
|
3
|
Merdler I, Richert E, Hochstadt A, Loewenstein I, Morgan S, Itach T, Topilsky Y, Finkelstein A, Laufer-Perl M, Banai S, Sadeh B. Echocardiographic L-wave as a prognostic indicator in transcatheter aortic valve replacement. Int J Cardiovasc Imaging 2020; 36:1897-1905. [PMID: 32556718 DOI: 10.1007/s10554-020-01903-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022]
Abstract
This study applies L-wave measurements of mid-diastolic trans-mitral flow. Although considered to be a marker of elevated filling pressure or delayed myocardial relaxation, its clinical and prognostic value is yet to be completely elucidated. It has been shown that transcatheter aortic valve replacement (TAVR) induces reverse remodeling and improves diastolic function and prognosis in patients with severe aortic stenosis (AS). Our purpose was to evaluate the prognostic value of L-wave following TAVR. We examined clinical and echocardiographic data of patients undergoing TAVR. L-Wave presence and velocity were recorded at baseline and at 1 month and 6 months following TAVR. The effect of the procedure on L-wave measurements and its impact on mortality and other clinical outcomes were analyzed. A total of 502 patients (mean age 82.58 ± 5.9) undergoing TAVR were included. Patients with baseline L-wave (n = 68, 12%) had a smaller stroke volume index by 5.7 ± 2.3 ml/m2 (p = 0.01) as compared to patients without L-wave at baseline. L-waves disappeared In 35% and 70% of patients at 1 month and at 6 months respectively. Baseline L-wave velocity was 34.8 ± 11.5 (cm/s) and decreased significantly at follow-up examinations. Patients with persistent L-wave following TAVR had higher 3-year adjusted mortality rates (HR 5.7, 95% CI 3.7-8.9, p < 0.001). Multivariate analysis of survival was also statistically significant (p < 0.001). TAVR induces L-wave disappearance and a decrease in L-wave velocity in patients with severe AS. L-wave persistence following TAVR is an independent risk factor for mortality.
Collapse
Affiliation(s)
- Ilan Merdler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel
| | - Eyal Richert
- Tel Aviv University Medical School, Tel-Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel
| | - Itamar Loewenstein
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel
| | - Samuel Morgan
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel
| | - Tamar Itach
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel
| | - Michal Laufer-Perl
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel
| | - Ben Sadeh
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel.
| |
Collapse
|
4
|
Ha SJ, Yoo SY, Hong MK, Hong GR. Immediate and Evolutionary Recovery of Left Ventricular Diastolic Function after Transcatheter Aortic Valve Replacement: Comparison with Surgery. Yonsei Med J 2020; 61:30-39. [PMID: 31887797 PMCID: PMC6938785 DOI: 10.3349/ymj.2020.61.1.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/23/2019] [Accepted: 12/02/2019] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We aimed to compare the effect of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (sAVR) on recovery of left ventricular (LV) diastolic function and afterload through serial echocardiographic examinations in patients with symptomatic high-risk severe aortic stenosis during early follow-up. MATERIALS AND METHODS We included 38 patients undergoing TAVR (mean age, 80±6 years; male:female=18:20) and 27 patients undergoing sAVR (mean age, 78±3 years; male:female=12:15). We compared changes in the LV diastolic function and afterload before, immediately after, and 3 months after the procedure using serial transthoracic echocardiography. RESULTS Immediately after the procedure, 16 (42%) and 3 (11%) patients in the TAVR and sAVR groups, respectively, showed rapid improvement in diastolic filling patterns. E wave to e' ratio (E/e') and right ventricular systolic pressure (RVSP) decreased significantly in the TAVR group (E/e': TAVR, from 24.6±12.9 to 20±9.5, p=0.048 vs. sAVR, from 21.5±9.4 to 20.64±6.4, p=0.361; RVSP: TAVR, 38.4±17.2 vs. 34±12.4, p=0.032 vs. sAVR, 32.2±11.7 vs. 30±6.8, p=0.27). After 3 months, diastolic grade distribution, E/e', and RVSP were similar. Valvuloarterial impedance significantly decreased immediately after the procedure in both groups (TAVR, from 5.1±1.4 to 3.1±1.0 vs. sAVR, from 4.5±1.5 to 3.1±0.8 mm Hg · mL⁻¹ · m⁻², p=0.001), but after 3 months, decreases were greater in the sAVR group (from 3.1±0.8 to 2.2±1.5 mm Hg · mL⁻¹ · m⁻², p=0.093). CONCLUSION LV diastolic function improved more rapidly and earlier in patients treatment with TAVR than in patients treated with sAVR. These results might explicate the remarkable clinical improvement in improvements in advanced diastolic dysfunction immediately after the TAVR procedure than sAVR.
Collapse
Affiliation(s)
- Sang Jin Ha
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang Yong Yoo
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Myeong Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
5
|
Clinical characteristics of elderly patients with aortic stenosis. J Echocardiogr 2015; 13:134-40. [DOI: 10.1007/s12574-015-0264-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/04/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
|