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Puls M, Beuthner BE, Topci R, Jacob CF, Steinhaus KE, Paul N, Beißbarth T, Toischer K, Jacobshagen C, Hasenfuß G. Patients with paradoxical low-flow, low-gradient aortic stenosis gain the least benefit from TAVI among all hemodynamic subtypes. Clin Res Cardiol 2024:10.1007/s00392-024-02482-7. [PMID: 38953944 DOI: 10.1007/s00392-024-02482-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Substantial controversy exists regarding the clinical benefit of patients with severe paradoxical low-flow, low-gradient aortic stenosis (PLF-LG AS) from TAVI. Therefore, we compared post-TAVI benefit by long-term mortality (all-cause, CV and SCD), clinical improvement of heart failure symptoms, and cardiac reverse remodelling in guideline-defined AS subtypes. METHODS We prospectively included 250 consecutive TAVI patients. TTE, 6mwt, MLHFQ, NYHA status and NT-proBNP were recorded at baseline and 6 months. Long-term mortality and causes of death were assessed. RESULTS 107 individuals suffered from normal EF, high gradient AS (NEF-HG AS), 36 from low EF, high gradient AS (LEF-HG), 52 from "classic" low-flow, low-gradient AS (LEF-LG AS), and 38 from paradoxical low-flow, low-gradient AS (PLF-LG AS). TAVI lead to a significant decrease in MLHFQ score and NT-proBNP levels in all subtypes except for PLF-LG. Regarding reverse remodelling, a significant increase in EF and decrease in LVEDV was present only in subtypes with reduced baseline EF, whereas a significant decrease in LVMI and LAVI could be observed in all subtypes except for PLF-LG. During a follow-up of 3-5 years, PLF-LG patients exhibited the poorest survival among all subtypes (HR 4.2, P = 0.0002 for CV mortality; HR 7.3, P = 0.004 for SCD, in comparison with NEF-HG). Importantly, PLF-LG was independently predictive for CV mortality (HR 2.9 [1.3-6.9], P = 0.009). CONCLUSIONS PLF-LG patients exhibit the highest mortality (particularly CV and SCD), the poorest symptomatic benefit and the least reverse cardiac remodelling after TAVI among all subtypes. Thus, this cohort seems to gain the least benefit.
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Affiliation(s)
- Miriam Puls
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099, Göttingen, Germany.
| | - Bo Eric Beuthner
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Rodi Topci
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099, Göttingen, Germany
| | | | | | - Niels Paul
- Department of Medical Bioinformatics, University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Tim Beißbarth
- Department of Medical Bioinformatics, University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Karl Toischer
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099, Göttingen, Germany
| | - Claudius Jacobshagen
- Department of Cardiology, Vincentius-Diakonissen Hospital Karlsruhe, 76135, Karlsruhe, Germany
| | - Gerd Hasenfuß
- Clinic of Cardiology and Pneumology, University Medical Center Göttingen, 37099, Göttingen, Germany
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Oikonomou G, Apostolos A, Drakopoulou M, Simopoulou C, Karmpalioti M, Toskas P, Stathogiannis K, Xanthopoulou M, Ktenopoulos N, Latsios G, Synetos A, Tsioufis C, Toutouzas K. Long-Term Outcomes of Aortic Stenosis Patients with Different Flow/Gradient Patterns Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2024; 13:1200. [PMID: 38592019 PMCID: PMC10932005 DOI: 10.3390/jcm13051200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Few data exist on the comparative long-term outcomes of severe aortic stenosis (AS) patients with different flow-gradient patterns undergoing transcatheter aortic valve implantation (TAVI). This study sought to evaluate the impact of the pre-TAVI flow-gradient pattern on long-term clinical outcomes after TAVI and assess changes in the left ventricular ejection fraction (LVEF) of different subtypes of AS patients following TAVI. Methods: Consecutive patients with severe AS undergoing TAVI in our institution were screened and prospectively enrolled. Patients were divided into four subgroups according to pre-TAVI flow/gradient pattern: (i) low flow-low gradient (LF-LG): stroke volume indexed (SVi) ≤ 35 mL/m2 and mean gradient (MG) < 40 mmHg); (ii) normal flow-low gradient (NF-LG): SVi > 35 mL/m2 and MG < 40 mmHg; (iii) low flow-high gradient (LF-HG): Svi 35 mL/m2 and MG ≥ 40 mmHg and (iv) normal flow-high gradient (NF-HG): SVi > 35 mL/m2 and MG ≥ 40 mmHg. Transthoracic echocardiography was repeated at 1-year follow-up. Clinical follow-up was obtained at 12 months, and yearly thereafter until 5-year follow-up was complete for all patients. Results: A total of 272 patients with complete echocardiographic and clinical follow-up were included in our analysis. Their mean age was 80 ± 7 years and the majority of patients (N = 138, 50.8%) were women. 62 patients (22.8% of the study population) were distributed in the LF-LG group, 98 patients (36%) were LF-HG patients, 95 patients (34.9%) were NF-HG, and 17 patients (6.3%) were NF-LG. There was a greater prevalence of comorbidities among LF-LG AS patients. One-year all-cause mortality differed significantly between the four subgroups of AS patients (log-rank p: 0.022) and was more prevalent among LF-LG patients (25.8%) compared to LF-HG (11.3%), NF-HG (6.3%) and NF-LG patients (18.8%). At 5-year follow-up, global mortality remained persistently higher among LF-LG patients (64.5%) compared to LF-HG (47.9%), NF-HG (42.9%), and NF-LG patients (58.8%) (log-rank p: 0.029). At multivariable Cox hazard regression analysis, baseline SVi (HR: 0.951, 95% C.I.; 0.918-0.984), the presence of at least moderate tricuspid regurgitation at baseline (HR: 3.091, 95% C.I: 1.645-5.809) and at least moderate paravalvular leak (PVL) post-TAVI (HR: 1.456, 95% C.I.: 1.106-1.792) were significant independent predictors of late global mortality. LF-LG patients and LF-HG patients exhibited a significant increase in LVEF at 1-year follow-up. A lower LVEF (p < 0.001) and a lower Svi (p < 0.001) at baseline were associated with LVEF improvement at 1-year. Conclusions: Patients with LF-LG AS have acceptable 1-year outcomes with significant improvement in LVEF at 1-year follow-up, but exhibit exceedingly high 5-year mortality following TAVI. The presence of low transvalvular flow and at least moderate tricuspid regurgitation at baseline and significant paravalvular leak post-TAVI were associated with poorer long-term outcomes in the entire cohort of AS patients. The presence of a low LVEF or a low SVi predicts LVEF improvement at 1-year.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University, “Hippokration” General Hospital of Athens, 11527 Athens, Greece; (G.O.); (A.A.); (M.D.); (C.S.); (M.K.); (P.T.); (K.S.); (M.X.); (N.K.); (G.L.); (A.S.); (C.T.)
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Anastasiou V, Daios S, Karamitsos T, Peteinidou E, Didagelos M, Giannakoulas G, Aggeli C, Tsioufis K, Ziakas A, Kamperidis V. Multimodality imaging for the global evaluation of aortic stenosis: The valve, the ventricle, the afterload. Trends Cardiovasc Med 2024:S1050-1738(24)00015-X. [PMID: 38387745 DOI: 10.1016/j.tcm.2024.02.001] [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: 11/26/2023] [Revised: 02/03/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024]
Abstract
Aortic stenosis (AS) is the most common valvular heart disease growing in parallel to the increment of life expectancy. Besides the valve, the degenerative process affects the aorta, impairing its elastic properties and leading to increased systemic resistance. The composite of valvular and systemic afterload mediates ventricular damage. The first step of a thorough evaluation of AS should include a detailed assessment of valvular anatomy and hemodynamics. Subsequently, the ventricle, and the global afterload should be assessed to define disease stage and prognosis. Multimodality imaging is of paramount importance for the comprehensive evaluation of these three elements. Echocardiography is the cornerstone modality whereas Multi-Detector Computed Tomography and Cardiac Magnetic Resonance provide useful complementary information. This review comprehensively examines the merits of these imaging modalities in AS for the evaluation of the valve, the ventricle, and the afterload and ultimately endeavors to integrate them in a holistic assessment of AS.
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Affiliation(s)
- Vasileios Anastasiou
- 1st Department of Cardiology, AHEPA Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Daios
- 1st Department of Cardiology, AHEPA Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karamitsos
- 1st Department of Cardiology, AHEPA Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emmanouela Peteinidou
- 1st Department of Cardiology, AHEPA Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- 1st Department of Cardiology, AHEPA Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Giannakoulas
- 1st Department of Cardiology, AHEPA Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Constantina Aggeli
- 1st Department of Cardiology, Hippokration Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, Hippokration Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonios Ziakas
- 1st Department of Cardiology, AHEPA Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Kamperidis
- 1st Department of Cardiology, AHEPA Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Stalikas N, Anastasiou V, Botis I, Daios S, Karagiannidis E, Zegkos T, Karamitsos T, Vassilikos V, Ziakas A, Kamperidis V, Giannakoulas G, Giannopoulos G. The prognostic impact of diastolic dysfunction after transcatheter aortic valve replacement: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102228. [PMID: 38043876 DOI: 10.1016/j.cpcardiol.2023.102228] [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: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Diastolic dysfunction (DD) is a long-established marker of disease progression in patients with aortic valve stenosis (AS), indicating valvular myocardial damage. Recently, substantial observational data have emerged demonstrating that worse pre-operative DD assessed using echocardiography is associated with adverse long-term clinical outcomes after transcatheter aortic valve replacement (TAVR). AIM To systematically appraise and quantitatively synthesize current evidence on the prognostic impact of echocardiographic severe DD derived by echocardiography before TAVR. METHODS A systemic literature review was undertaken in electronic databases to identify studies reporting the predictive value of severe DD in AS subjects undergoing TAVR. A random-effects meta-analysis was conducted to quantify the adjusted and unadjusted hazard ratios (HRs) for all-cause mortality and major adverse cardiovascular events (MACEs) for the presence of severe DD. RESULTS Ten studies were deemed eligible for inclusion. Of those, 9 provided appropriate quantitative data for the meta-analysis, encompassing a total of 4,619 patients. The presence of severe DD was associated with increased risk for all-cause mortality (pooled unadjusted HR=2.56 [1.46-4.48]; p<0.01; I2=76 %) and MACEs (pooled unadjusted HR=1.82 [1.29-2.58]; p<0.01; I2=86 %). When adjusted for clinically-relevant parameters, the presence of severe DD retained independent association with all-cause mortality (pooled adjusted HR=2.35 [1.26-4.37]; p<0.01; I2=79 %) and MACEs (pooled adjusted HR= 2.52 [1.72-3.65]; p<0.01; I2=0 %). In subgroup analysis there was no difference on post-TAVR risk between the use of different diastolic function grading scores. CONCLUSION Presence of severe DD assessed by echocardiography pre-TAVR is a major determinant of long-term adverse outcomes after the procedure.
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Affiliation(s)
- Nikolaos Stalikas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece.
| | - Vasileios Anastasiou
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Ioannis Botis
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Stylianos Daios
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | | | - Thomas Zegkos
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Theodoros Karamitsos
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Vassilios Vassilikos
- Ippokratio General Hospital, Medical School, Aristotle University, Thessaloniki, Greece
| | - Antonios Ziakas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Vasileios Kamperidis
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - George Giannakoulas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - George Giannopoulos
- Ippokratio General Hospital, Medical School, Aristotle University, Thessaloniki, Greece
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Meredith T, Roy D, Hayward C, Feneley M, Kovacic J, Muller D, Namasivayam M. Strain Assessment in Aortic Stenosis: Pathophysiology and Clinical Utility. J Am Soc Echocardiogr 2024; 37:64-76. [PMID: 37805144 DOI: 10.1016/j.echo.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/09/2023]
Abstract
Contemporary echocardiographic criteria for grading aortic stenosis severity have remained relatively unchanged, despite significant advances in noninvasive imaging techniques over the last 2 decades. More recently, attention has shifted to the ventricular response to aortic stenosis and how this might be quantified. Global longitudinal strain, semiautomatically calculated from standard two-dimensional echocardiographic images, has been the focus of extensive research. Global longitudinal strain is a sensitive marker of subtle hypertrophy-related impairment in left ventricular function and has shown promise as a relatively robust prognostic marker, both independently and when added to severity classification systems. Herein we review the pathophysiological basis underpinning the potential utility of global longitudinal strain in the assessment of aortic stenosis, as well as its potential role in quantifying myocardial recovery and prognostic discrimination following aortic valve replacement.
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Affiliation(s)
- Thomas Meredith
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Roy
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Hayward
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Feneley
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason Kovacic
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Muller
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mayooran Namasivayam
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
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Ko T, Chuang C, Lin M, Chen Y, Chen Y, Huang C, Yeh C, Wang M, Chang K, Ho Y, Kao H. Quantification of cardiac pumping mechanics in TAVI patients: A pilot study utilizing minimally invasive method for pressure-volume analysis. Physiol Rep 2023; 11:e15799. [PMID: 37688417 PMCID: PMC10492004 DOI: 10.14814/phy2.15799] [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: 01/27/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/10/2023] Open
Abstract
The ventriculo-arterial coupling (VAC) and left ventricle (LV) mechanics are crucial and play an important role in the pathophysiology of aortic stenosis (AS). The pressure-volume (PV) analysis is a powerful tool to study VAC and LV mechanics. We proposed a novel minimally-invasive method for PV analysis in patients with severe AS receiving transcatheter aortic valve implantation (TAVI). Patients with severe AS were prospectively enrolled in a single center. LV pressure and cardiac output were recorded before and after TAVI. We constructed the PV loop for analysis by analyzing LV pressure and the assumed flow. 26 patients were included for final analysis. The effective arterial elastance (Ea) decreased after TAVI (3.7 ± 1.3 vs. 2.9 ± 1.1 mmHg/mL, p < 0.0001). The LV end-systolic elastance (Ees) did not change immediately after TAVI (2.4 ± 1.3 vs. 2.6 ± 1.1 mmHg/mL, p = 0.3670). The Ea/Ees improved after TAVI (1.8 ± 0.8 vs. 1.2 ± 0.4, p < 0.0001), demonstrating an immediate improvement of VAC. The stroke work (SW) did not change (7669.6 ± 1913.8 vs. 7626.2 ± 2546.9, p = 0.9330), but the pressure-volume area (PVA) decreased (14469.0 ± 4974.1 vs. 12177.4 ± 4499.9, p = 0.0374) after TAVI. The SW/PVA increased after TAVI (0.55 ± 0.12 vs. 0.63 ± 0.08, p < 0.0001) representing an improvement of LV efficiency. We proposed a novel minimally invasive method for PV analysis in patients with severe AS receiving TAVI. The VAC and LV efficiency improved immediately after TAVI.
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Affiliation(s)
- Tsung‐Yu Ko
- Division of Cardiology, Department of Internal Medicine and Cardiovascular CenterNational Taiwan University HospitalTaipeiTaiwan
- Graduate Institute of Clinical MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Chia‐Chuan Chuang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular CenterNational Taiwan University HospitalTaipeiTaiwan
| | - Mao‐Shin Lin
- Division of Cardiology, Department of Internal Medicine and Cardiovascular CenterNational Taiwan University HospitalTaipeiTaiwan
| | - Yi‐Chang Chen
- Department of RadiologyNational Taiwan University HospitalTaipeiTaiwan
| | - Ying‐Hsien Chen
- Division of Cardiology, Department of Internal Medicine and Cardiovascular CenterNational Taiwan University HospitalTaipeiTaiwan
| | - Ching‐Chang Huang
- Division of Cardiology, Department of Internal Medicine and Cardiovascular CenterNational Taiwan University HospitalTaipeiTaiwan
| | - Chih‐Fan Yeh
- Division of Cardiology, Department of Internal Medicine and Cardiovascular CenterNational Taiwan University HospitalTaipeiTaiwan
| | - Ming‐Jiuh Wang
- Department of AnesthesiologyNational Taiwan University HospitalTaipeiTaiwan
| | - Kuo‐Chu Chang
- Department of Physiology, College of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Yi‐Lwun Ho
- Division of Cardiology, Department of Internal Medicine and Cardiovascular CenterNational Taiwan University HospitalTaipeiTaiwan
| | - Hsien‐Li Kao
- Division of Cardiology, Department of Internal Medicine and Cardiovascular CenterNational Taiwan University HospitalTaipeiTaiwan
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Anastasiou V, Daios S, Bazmpani MA, Moysidis DV, Zegkos T, Karamitsos T, Ziakas A, Kamperidis V. Shifting from Left Ventricular Ejection Fraction to Strain Imaging in Aortic Stenosis. Diagnostics (Basel) 2023; 13:diagnostics13101756. [PMID: 37238238 DOI: 10.3390/diagnostics13101756] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/07/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Adverse ventricular remodeling is an inflexion point of disease progression in aortic stenosis (AS) and a major determinant of prognosis. Intervention before irreversible myocardial damage is of paramount importance to sustain favorable post-operative outcomes. Current guidelines recommend a left ventricular ejection fraction (LVEF)-based strategy to determine the threshold for intervention in AS. However, LVEF has several pitfalls: it denotes the left ventricular cavity volumetric changes and it is not suited to detecting subtle signs of myocardial damage. Strain has emerged as a contemporary imaging biomarker that describes intramyocardial contractile force, providing information on subclinical myocardial dysfunction due to fibrosis. A large body of evidence advocates its use to determine the switch from adaptive to maladaptive myocardial changes in AS, and to refine thresholds for intervention. Although mainly studied in echocardiography, studies exploring the role of strain in multi-detector row computed tomography and cardiac magnetic resonance are emerging. This review, therefore, summarizes contemporary evidence on the role of LVEF and strain imaging in AS prognosis, aiming to move from an LVEF-based to a strain-based approach for risk stratification and therapeutic decision-making in AS.
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Affiliation(s)
- Vasileios Anastasiou
- First Department of Cardiology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Stylianos Daios
- First Department of Cardiology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Maria-Anna Bazmpani
- First Department of Cardiology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Thomas Zegkos
- First Department of Cardiology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Theodoros Karamitsos
- First Department of Cardiology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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8
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Anastasiou V, Daios S, Moysidis DV, Bazmpani MA, Zegkos T, Karamitsos T, Makedou K, Savopoulos C, Efthimiadis G, Ziakas A, Kamperidis V. Clinical Value of Novel Echocardiographic Biomarkers Assessing Myocardial Work in Acute Heart Failure-Rationale and Design of the "Beyond Myo-HF Study". Diagnostics (Basel) 2023; 13:1191. [PMID: 36980498 PMCID: PMC10047101 DOI: 10.3390/diagnostics13061191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Despite ongoing treatment advancements in chronic heart failure (HF), mortality and readmission rates remain high for patients hospitalized for decompensated acute HF. These patients represent a distinct HF group, which requires emergent echocardiographic evaluation in an attempt to provide optimal and individualized acute care. The role of serial advanced echocardiographic assessment in acute HF for risk stratification and treatment guidance has not been thoroughly explored. METHODS The "Beyond Myo-HF Study" is a prospective, non-interventional cohort trial designed to enroll acutely admitted patients with symptoms and/or signs of HF. The aim of this study is to investigate whether intrahospital changes of conventional and novel echocardiographic indices of myocardial function and congestion-related markers can predict early mortality, late mortality, and HF rehospitalization. As per the protocol, all patients undergo a pair of state-of-the-art echocardiographic assessments, with a rigorous protocol including speckle tracking analysis of all cardiac chambers and myocardial work analysis for the left and right ventricle, upon admission and pre-discharge. Their laboratory profile is captured at those two time-points, and their therapeutic management is recorded. Patients will be followed-up for a median period of 12 months after enrollment. CONCLUSIONS The "Beyond Myo-HF" study is an ongoing, prospective trial aspiring to provide deep insight into the pathophysiology of acute HF, to enlighten the reverse cardiac functional and anatomical remodeling during hospitalization, and to recognize echocardiographic patterns capable of predicting adverse outcomes during and post decompensation of acute HF.
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Affiliation(s)
- Vasileios Anastasiou
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Stylianos Daios
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Dimitrios V. Moysidis
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Maria-Anna Bazmpani
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Thomas Zegkos
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Theodoros Karamitsos
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Kali Makedou
- Laboratory of Biochemistry, AHEPA Hospital, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Georgios Efthimiadis
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
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He W, Huang H, Chen X, Yu J, Liu J, Li X, Yin H, Zhang K, Peng L. Radiomic analysis of enhanced CMR cine images predicts left ventricular remodeling after TAVR in patients with symptomatic severe aortic stenosis. Front Cardiovasc Med 2022; 9:1096422. [PMID: 36620627 PMCID: PMC9815113 DOI: 10.3389/fcvm.2022.1096422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to develop enhanced cine image-based radiomic models for non-invasive prediction of left ventricular adverse remodeling following transcatheter aortic valve replacement (TAVR) in symptomatic severe aortic stenosis. Methods A total of 69 patients (male:female = 37:32, median age: 66 years, range: 47-83 years) were retrospectively recruited, and severe aortic stenosis was confirmed via transthoracic echocardiography detection. The enhanced cine images and clinical variables were collected, and three types of regions of interest (ROIs) containing the left ventricular (LV) myocardium from the short-axis view at the basal, middle, and apical LV levels were manually labeled, respectively. The radiomic features were extracted and further selected by using the least absolute shrinkage and selection operator (LASSO) regression analysis. Clinical variables were also selected through univariate regression analysis. The predictive models using logistic regression classifier were developed and validated through leave-one-out cross-validation. The model performance was evaluated with respect to discrimination, calibration, and clinical usefulness. Results Five basal levels, seven middle levels, eight apical level radiomic features, and three clinical factors were finally selected for model development. The radiomic models using features from basal level (Rad I), middle level (Rad II), and apical level (Rad III) had achieved areas under the curve (AUCs) of 0.761, 0.909, and 0.913 in the training dataset and 0.718, 0.836, and 0.845 in the validation dataset, respectively. The performance of these radiomic models was improved after integrating clinical factors, with AUCs of the Combined I, Combined II, and Combined III models increasing to 0.906, 0.956, and 0.959 in the training dataset and 0.784, 0.873, and 0.891 in the validation dataset, respectively. All models showed good calibration, and the decision curve analysis indicated that the Combined III model had a higher net benefit than other models across the majority of threshold probabilities. Conclusion Radiomic models and combined models at the mid and apical slices showed outstanding and comparable predictive effectiveness of adverse remodeling for patients with symptomatic severe aortic stenosis after TAVR, and both models were significantly better than the models of basal slice. The cardiac magnetic resonance radiomic analysis might serve as an effective tool for accurately predicting left ventricular adverse remodeling following TAVR in patients with symptomatic severe aortic stenosis.
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Affiliation(s)
- Wenzhang He
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - He Huang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoyi Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jianqun Yu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongkun Yin
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Kai Zhang
- Infervision Medical Technology Co., Ltd., Beijing, China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Liqing Peng,
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10
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Prognostic Implications of Change in Left Ventricular Ejection Fraction After Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 177:90-99. [PMID: 35691708 DOI: 10.1016/j.amjcard.2022.04.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/15/2022] [Accepted: 04/23/2022] [Indexed: 11/23/2022]
Abstract
Reduced left ventricular (LV) systolic function is associated with worse prognosis in patients with severe aortic stenosis (AS) treated with transcatheter aortic valve implantation (TAVI). We aimed to examine the changes in left ventricular ejection fraction (LVEF) after TAVI among patients with varying baseline LVEF. Moreover, variables associated with lack of LVEF improvement were identified and the association with long-term outcomes was investigated. A total of 560 patients (age 80 ± 7 years, 53% men) with severe AS who underwent transfemoral TAVI between 2007 and 2019 were selected. LVEF was assessed from transthoracic echocardiography at baseline (before TAVI) and at 6 and 12 months after TAVI. Patients were stratified according to baseline LVEF: (1) LVEF ≥50%, (2) LVEF 40% to 49%, and (3) LVEF <40%. The clinical end point was ≥5% LVEF improvement. The primary outcome was all-cause mortality. Patients with baseline LVEF<40% showed greater increase in LVEF than those with baseline LVEF 40% to 49% and LVEF ≥50% (from 33% ± 6% to 43% ± 10%, p <0.001; from 45% ± 3% to 52% ± 8%, p <0.001; and from 58% ± 5% to 59% ± 7%, p = 0.012, respectively, p for interaction <0.001). Coronary artery disease (odds ratio [OR] 1.80 [95% confidence interval (CI) 1.06 to 3.06], p = 0.031), myocardial infarction (OR 2.07 [95% CI 1.19 to 3.61], p = 0.010), and permanent pacemaker (OR: 1.93 [95% CI 1.25 to 3.00], p = 0.003) were independently associated with the lack of ≥5% LVEF improvement. During a median follow-up of 3.8 (interquartile range 2.6 to 5.2) years, 176 patients died (31%). Patients with ≥5% LVEF improvement had similar outcomes compared with those with <5% LVEF improvement (log-rank p = 0.89). In conclusion, patients with severe AS and baseline LVEF <40% had the greatest improvement in LVEF at 1-year follow-up after TAVI. Coronary artery disease, myocardial infarction, and permanent pacemaker were associated with lack of LVEF improvement. However, LVEF improvement at 12 months was not associated with long-term outcomes.
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11
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Aimo A, Vergaro G, González A, Barison A, Lupón J, Delgado V, Richards AM, de Boer RA, Thum T, Arfsten H, Hülsmann M, Falcao-Pires I, Díez J, Foo RSY, Chan MYY, Anene-Nzelu CG, Abdelhamid M, Adamopoulos S, Anker SD, Belenkov Y, Ben Gal T, Cohen-Solal A, Böhm M, Chioncel O, Jankowska EA, Gustafsson F, Hill L, Jaarsma T, Januzzi JL, Jhund P, Lopatin Y, Lund LH, Metra M, Milicic D, Moura B, Mueller C, Mullens W, Núñez J, Piepoli MF, Rakisheva A, Ristić AD, Rossignol P, Savarese G, Tocchetti CG, van Linthout S, Volterrani M, Seferovic P, Rosano G, Coats AJS, Emdin M, Bayes-Genis A. Cardiac remodelling - Part 2: Clinical, imaging and laboratory findings. A review from the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2022; 24:944-958. [PMID: 35488811 DOI: 10.1002/ejhf.2522] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/06/2022] Open
Abstract
In patients with heart failure, the beneficial effects of drug and device therapies counteract to some extent ongoing cardiac damage. According to the net balance between these two factors, cardiac geometry and function may improve (reverse remodelling, RR) and even completely normalize (remission), or vice versa progressively deteriorate (adverse remodelling, AR). RR or remission predict a better prognosis, while AR has been associated with worsening clinical status and outcomes. The remodelling process ultimately involves all cardiac chambers, but has been traditionally evaluated in terms of left ventricular volumes and ejection fraction. This is the second part of a review paper by the Study Group on Biomarkers of the Heart Failure Association of the European Society of Cardiology dedicated to ventricular remodelling. This document examines the proposed criteria to diagnose RR and AR, their prevalence and prognostic value, and the variables predicting remodelling in patients managed according to current guidelines. Much attention will be devoted to RR in patients with heart failure with reduced ejection fraction because most studies on cardiac remodelling focused on this setting.
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Affiliation(s)
- Alberto Aimo
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Arantxa González
- CIMA Universidad de Navarra, and IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Andrea Barison
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Josep Lupón
- Institut del Cor, Hospital Universitari Germans Trias i Pujol Badalona, Barcelona, Spain
| | - Victoria Delgado
- Institut del Cor, Hospital Universitari Germans Trias i Pujol Badalona, Barcelona, Spain
| | | | - Rudolf A de Boer
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Thomas Thum
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Henrike Arfsten
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Martin Hülsmann
- Clinical Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Javier Díez
- Center for Applied Medical Research, Pamplona, Spain
| | - Roger S Y Foo
- Department of Medicine, Yong Loo-Lin School of Medicine, National University Hospital, Singapore, Singapore
| | - Mark Yan Yee Chan
- Department of Medicine, Yong Loo-Lin School of Medicine, National University Hospital, Singapore, Singapore
| | - Chukwuemeka G Anene-Nzelu
- Department of Medicine, Yong Loo-Lin School of Medicine, National University Hospital, Singapore, Singapore
| | | | - Stamatis Adamopoulos
- 2nd Department of Cardiovascular Medicine, Onassis Cardiac Surgery Center, Athens, Greece
| | - Stefan D Anker
- Department of Cardiology (CVK), and Berlin Institute of Health Center for Regenerative Therapy (BCRT), German Center for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Tuvia Ben Gal
- Cardiology Department, Rabin Medical Center, Beilinson, Israel
| | | | - Michael Böhm
- University of the Saarland, Homburg/Saar, Germany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu' Bucharest, University of Medicine Carol Davila, Bucharest, Romania
| | - Ewa A Jankowska
- Institute of Heart Disases, Wroclaw Medical University, Wroclaw, Poland
| | - Finn Gustafsson
- Heart Centre, Department of Cardiology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - James L Januzzi
- Massachusetts General Hospital and Baim Institute for Clinical Research, Boston, MA, USA
| | | | - Yuri Lopatin
- Volgograd State Medical University, Volgograd, Russia
| | - Lars H Lund
- Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Metra
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Davor Milicic
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | | | | | - Julio Núñez
- Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, Spain
| | - Massimo F Piepoli
- Cardiology Division, Castelsangiovanni Hospital, Castelsangiovanni, Italy
| | - Amina Rakisheva
- Scientific Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan
| | - Arsen D Ristić
- Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Patrick Rossignol
- Université de Lorraine, Centre d'Investigations Cliniques-Plurithématique 1433 and Inserm U1116, CHRU Nancy, F-CRIN INI-CRCT, Nancy, France
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Carlo G Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| | - Sophie van Linthout
- Berlin Institute of Health (BIH) at Charité - Universitätmedizin Berlin, BIH Center for Regenerative Therapies (BCRT), Berlin, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | | | - Petar Seferovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Giuseppe Rosano
- St. George's Hospitals, NHS Trust, University of London, London, UK
| | | | - Michele Emdin
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Antoni Bayes-Genis
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
- Institut del Cor, Hospital Universitari Germans Trias i Pujol Badalona, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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12
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Graziani F, Cialdella P, Lillo R, Locorotondo G, Genuardi L, Ingrasciotta G, Cangemi S, Nesta M, Bruno P, Aurigemma C, Romagnoli E, Calabrese M, Giambusso N, Lombardo A, Burzotta F, Trani C. Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis. ESC Heart Fail 2022; 9:1721-1730. [PMID: 35348288 PMCID: PMC9065843 DOI: 10.1002/ehf2.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/26/2021] [Accepted: 02/04/2022] [Indexed: 11/21/2022] Open
Abstract
Aims There are limited data about the intraprocedural haemodynamic study performed immediately before and after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS). We aimed to evaluate the acute haemodynamic impact of TAVI in patients with severe AS and to investigate invasive and non‐invasive parameters predicting all‐cause mortality. Methods and results A total of 245 consecutive AS patients (43% male, mean age 80.3 ± 7.3 years) undergoing TAVI were enrolled. Intraprocedural left heart catheterization (LHC) and echocardiogram before and after TAVI were performed. The clinical endpoint was the death for any cause. LHC after TAVI revealed significant changes in aortic and left ventricular (LV) pressures, including indexes of intrinsic myocardial contractility and diastolic function such as positive dP/dT (1128.9 ± 398.7 vs. 806.3 ± 247.2 mmHg/s, P ˂ 0.001) and negative dP/dT (1310.7 ± 431.1 vs. 1075.1 ± 440.8 mmHg/s, P ˂ 0.001). Post‐TAVI echo showed a significant reduction in LV end‐diastolic (P = 0.036) and end‐systolic (P ˂ 0.001) diameters, improvement in LV ejection fraction (from 55 ± 12% to 57.2 ± 10.5%, P ˂ 0.001), and pulmonary artery systolic pressure (42.1 ± 14.2 vs. 33.1 ± 10.7 mmHg, P < 0.001). After a mean follow‐up time interval of 24 months, 47 patients died. Post‐TAVI significant aortic regurgitation at echocardiography was the only independent predictor of mortality (hazard ratio 5.592, confidence interval 1.932–16.184, P = 0.002). Conclusions Left heart catheterization performed immediately before and after prosthesis release offers a unique insight in the assessment of LV adaptation to severe AS and the impact of TAVI on LV, catching changes in indexes of intrinsic contractility and myocardial relaxation. Aortic regurgitation assessed by echocardiography was the only independent predictor of mortality in patients undergoing TAVI.
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Affiliation(s)
- Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Rosa Lillo
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Locorotondo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Genuardi
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gessica Ingrasciotta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Cangemi
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Calabrese
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicole Giambusso
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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13
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The Effect of TAVR on Left Ventricular and Left Atrial Mechanics in Patients with Aortic Stenosis. J Cardiovasc Dev Dis 2022; 9:jcdd9020035. [PMID: 35200690 PMCID: PMC8877352 DOI: 10.3390/jcdd9020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background. Measures of adverse cardiac remodeling, left ventricular global longitudinal strain (LVGLS) and left atrial (LA) phasic function, are predictive of cardiac events in patients with severe aortic stenosis (AS). How these parameters of cardiac function change following TAVR requires further investigation. Methods. A number of 109 consecutive patients with symptomatic severe AS who were seen in the heart valve clinic between 2014 and 2019 for TAVR were included. All patients underwent echocardiographic assessment prior to and 30 days following TAVR, with LVGLS and LA phasic function evaluation using 2D speckle-tracking echocardiography. Heart failure hospitalization, and death were assessed at 12 months. Results. The mean age of the study cohort was 81 ± 7.3 years. Following TAVR, there was a significant reduction in NYHA class III/IV symptoms [89 (82%) vs. 12 (11%), p < 0.01], and median mean aortic valve gradient [44 mmHg (16) vs. 9 mmHg (7), p < 0.01]. There was no significant change in the median LVEF [62% (13) vs. 62% (6.0), p = 0.2]; however, the LVGLS significantly increased following TAVR [15 ± 3.5% vs. 18 ± 3.3%, p < 0.01]. The median LA reservoir, conduit and contractile function significantly improved following TAVR [22.0% (14.0) vs. 18.0% (14.0) p < 0.01, 8.9% (5.4) vs. 7.8% (4.8) p < 0.01, 12% (11.0) vs. 9.6% (11.0) p < 0.01, respectively]. The incidence of death or heart failure hospitalization at 12 months was low, and occurred in eight patients (7.3%). Conclusions. TAVR results in significant short-term reverse LV and LA remodeling, as shown by improvement in LV GLS and all three components of LA phasic function, despite no change in the LVEF. The findings indicate the possible utility of strain imaging for the assessment of global LV and LA function following TAVR.
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14
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Wani A, Harland DR, Bajwa TK, Kroboth S, Ammar KA, Allaqaband SQ, Duval S, Khandheria BK, Tajik AJ, Jain R. Left Ventricular Mechanics Differ in Subtypes of Aortic Stenosis Following Transcatheter Aortic Valve Replacement. Front Cardiovasc Med 2022; 8:777206. [PMID: 35111823 PMCID: PMC8803205 DOI: 10.3389/fcvm.2021.777206] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/07/2021] [Indexed: 01/25/2023] Open
Abstract
Background Left ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). We hypothesized that there would be differences in myocardial mechanics, measured by global longitudinal strain (GLS) recovery in patients with four subtypes of severe AS after transcatheter aortic valve replacement (TAVR), stratified based upon flow and gradient. Methods We retrospectively evaluated 204 patients with severe AS who underwent TAVR and were followed post-TAVR at our institution for clinical outcomes. Speckle-tracking transthoracic echocardiography was performed pre- and post-TAVR. Patients were classified as: (1) normal-flow and high-gradient, (2) normal-flow and high-gradient with reduced LV ejection fraction (LVEF), (3) classical low-flow and low-gradient, or (4) paradoxical low-flow and low-gradient. Results Both GLS (−13.9 ± 4.3 to −14.8 ± 4.3, P < 0.0001) and LVEF (55 ± 15 to 57 ± 14%, P = 0.0001) improved immediately post-TAVR. Patients with low-flow AS had similar improvements in LVEF (+2.6 ± 9%) and aortic valve mean gradient (−23.95 ± 8.34 mmHg) as patients with normal-flow AS. GLS was significantly improved in patients with normal-flow (−0.93 ± 3.10, P = 0.0004) compared to low-flow AS. Across all types of AS, improvement in GLS was associated with a survival benefit, with GLS recovery in alive patients (mean GLS improvement of −1.07 ± 3.10, P < 0.0001). Conclusions LV mechanics are abnormal in all patients with subtypes of severe AS and improve immediately post-TAVR. Recovery of GLS was associated with a survival benefit. Patients with both types of low-flow AS showed significantly improved, but still impaired, GLS post-TAVR, suggesting underlying myopathy that does not correct post-TAVR.
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Affiliation(s)
- Adil Wani
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Daniel R. Harland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Tanvir K. Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Stacie Kroboth
- Advocate Aurora Research Institute, Advocate Aurora Health, Milwaukee, WI, United States
| | - Khawaja Afzal Ammar
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Suhail Q. Allaqaband
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Sue Duval
- Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Bijoy K. Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - A. Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, United States
- *Correspondence: Renuka Jain
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15
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Gonska B, Buckert D, Mörike J, Scharnbeck D, Kersten J, Cuspidi C, Rottbauer W, Tadic M. Imaging Challenges in Patients with Severe Aortic Stenosis and Heart Failure: Did We Find a Way Out of the Labyrinth? J Clin Med 2022; 11:jcm11020317. [PMID: 35054012 PMCID: PMC8777924 DOI: 10.3390/jcm11020317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 11/16/2022] Open
Abstract
Aortic stenosis (AS) is the most frequent degenerative valvular disease in developed countries. Its incidence has been constantly rising due to population aging. The diagnosis of AS was considered straightforward for a very long time. High gradients and reduced aortic valve area were considered as "sine qua non" in diagnosis of AS until a growing body of evidence showed that patients with low gradients could also have severe AS with the same or even worse outcome. This completely changed the paradigm of AS diagnosis and involved large numbers of parameters that had never been used in the evaluation of AS severity. Low gradient AS patients may present with heart failure (HF) with preserved or reduced left ventricular ejection fraction (LVEF), associated with changes in cardiac output and flow across the aortic valve. These patients with low-flow low-gradient or paradoxical low-flow low-gradient AS are particularly challenging to diagnose, and cardiac output and flow across the aortic valve have become the most relevant parameters in evaluation of AS, besides gradients and aortic valve area. The introduction of other imaging modalities in the diagnosis of AS significantly improved our knowledge about cardiac mechanics, tissue characterization of myocardium, calcium and inflammation burden of the aortic valve, and their impact on severity, progression and prognosis of AS, not only in symptomatic but also in asymptomatic patients. However, a variety of novel parameters also brought uncertainty regarding the clinical relevance of these indices, as well as the necessity for their validation in everyday practice. The aim of this review is to summarize the prevalence of HF in patients with severe AS and elaborate on the diagnostic challenges and advantages of comprehensive multimodality cardiac imaging to identify the patients that may benefit from surgical or transcatheter aortic valve replacement, as well as parameters that may help during follow-up.
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Affiliation(s)
- Birgid Gonska
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Dominik Buckert
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Johannes Mörike
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Dominik Scharnbeck
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Johannes Kersten
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Cesare Cuspidi
- Department for Internal Medicine, University of Milan-Bicocca, 20126 Milan, Italy;
| | - Wolfang Rottbauer
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
| | - Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (B.G.); (D.B.); (J.M.); (D.S.); (J.K.); (W.R.)
- Correspondence: ; Tel.: +49-176-3236-0011
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16
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Kuneman JH, Singh GK, Hansson NC, Fusini L, Poulsen SH, Fortuni F, Vollema EM, Pedersen ALD, Annoni AD, Nørgaard BL, Pontone G, Ajmone Marsan N, Delgado V, Bax JJ, Knuuti J. Subclinical leaflet thrombosis after transcatheter aortic valve implantation: no association with left ventricular reverse remodeling at 1-year follow-up. Int J Cardiovasc Imaging 2021; 38:695-705. [PMID: 34655348 PMCID: PMC8926967 DOI: 10.1007/s10554-021-02438-2] [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: 07/27/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Abstract
Hypo-attenuated leaflet thickening (HALT) of transcatheter aortic valves is detected on multidetector computed tomography (MDCT) and reflects leaflet thrombosis. Whether HALT affects left ventricular (LV) reverse remodeling, a favorable effect of LV afterload reduction after transcatheter aortic valve implantation (TAVI) is unknown. The aim of this study was to examine the association of HALT after TAVI with LV reverse remodeling. In this multicenter case–control study, patients with HALT on MDCT were identified, and patients without HALT were propensity matched for valve type and size, LV ejection fraction (LVEF), sex, age and time of scan. LV dimensions and function were assessed by transthoracic echocardiography before and 12 months after TAVI. Clinical outcomes (stroke or transient ischemic attack, heart failure hospitalization, new-onset atrial fibrillation, all-cause mortality) were recorded. 106 patients (age 81 ± 7 years, 55% male) with MDCT performed 37 days [IQR 32–52] after TAVI were analyzed (53 patients with HALT and 53 matched controls). Before TAVI, all echocardiographic parameters were similar between the groups. At 12 months follow-up, patients with and without HALT showed a significant reduction in LV end-diastolic volume, LV end-systolic volume and LV mass index (from 125 ± 37 to 105 ± 46 g/m2, p = 0.001 and from 127 ± 35 to 101 ± 27 g/m2, p < 0.001, respectively, p for interaction = 0.48). Moreover, LVEF improved significantly in both groups. In addition, clinical outcomes were not statistically different. Improvement in LVEF and LV reverse remodeling at 12 months after TAVI were not limited by HALT.
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Affiliation(s)
- Jurrien H Kuneman
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Gurpreet K Singh
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Nicolaj C Hansson
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Steen H Poulsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Federico Fortuni
- Department of Cardiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - E Mara Vollema
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | | | - Andrea D Annoni
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - Juhani Knuuti
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.,Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
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17
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Strachinaru M, Ren B, van Dalen BM, Van Mieghem N, De Jaegere PPT, van Gils L, Galema TW, Geleijnse ML. Determinants of changes in pulmonary artery pressure in patients with severe aortic stenosis treated by transcatheter aortic valve implantation. Acta Cardiol 2021; 76:185-193. [PMID: 31920151 DOI: 10.1080/00015385.2019.1708599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Elevated pulmonary artery pressure (PAP) in patients with severe aortic stenosis (AS) is a strong predictor of adverse prognosis. This study sought to assess the relation between PAP and clinical and echocardiographic parameters in elderly patients with severe AS, as well as to identify the determinants of the change in PAP after transcatheter aortic valve implantation (TAVI). METHODS The study included 170 subjects (age 81 ± 7 years, 45% men) with symptomatic severe AS who were treated by TAVI. They underwent a clinical evaluation and a transthoracic echocardiography before the TAVI procedure and 6 months after. RESULTS In a multivariable analysis, the independent predictors for baseline PAP were the body mass index (BMI) (β = 0.21, p = .006), COPD GOLD class (β = 0.20; p = .009), the E/e' ratio (β = 0.20; p = .02) and the degree of aortic regurgitation (β = 0.20; p = .01). After TAVI, there was significantly less (51% vs. 29%, p<.0001) pulmonary hypertension, defined as a tricuspid regurgitation velocity ≥2.8 m/s. The baseline variables related to an improvement in PAP were the tricuspid regurgitation velocity (p = .0001) and the E/e' (p = .005). From the parameters potentially modified with TAVI, the only independent predictor of PAP variation was the change in the E/e' ratio (β = 0.23; p = .01). CONCLUSIONS Independent predictors for baseline PAP in elderly patients with symptomatic AS were the BMI, GOLD class, the aortic regurgitation and the E/e' ratio. The baseline predictors for a change in PAP 6 months after TAVI were the baseline PAP and E/e', with only the change in the E/e' ratio being correlated to the change in PAP.
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Affiliation(s)
- Mihai Strachinaru
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Ben Ren
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Bas M. van Dalen
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Nicolas Van Mieghem
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | | | - Lennart van Gils
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Tjebbe W. Galema
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Marcel L. Geleijnse
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
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18
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Kong WKF, Bax JJ, Delgado V. Left ventricular myocardial fibrosis: a marker of bad prognosis in symptomatic severe aortic stenosis. Eur Heart J 2021; 41:1915-1917. [PMID: 32211751 DOI: 10.1093/eurheartj/ehaa151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- William K F Kong
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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19
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Grund FF, Myhr KA, Visby L, Hassager C, Mogelvang R. Impact of surgical aortic valve replacement on global and regional longitudinal strain across four flow gradient patterns of severe aortic stenosis. Int J Cardiovasc Imaging 2021; 37:2175-2187. [PMID: 33604765 DOI: 10.1007/s10554-021-02187-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/05/2021] [Indexed: 11/28/2022]
Abstract
To evaluate the impact of surgical aortic valve replacement (SAVR) on global (GLS) and regional longitudinal strain (RLS) across four flow-gradient patterns of severe aortic stenosis (AS) 3 months after surgery. A total of 103 patients with severe AS (aortic valve area < 1.0 cm2) were examined by speckle tracking echocardiography the day before SAVR and at 3-months follow-up. Patients were stratified into four flow-gradient patterns by stroke volume index (>35 mL/m2 vs. ≤35 mL/m2) and mean transaortic gradients (>40 mmhg vs. ≤40 mmhg): normal-flow, high gradient (NF/HG); low-flow, high gradient (LF/HG); normal-flow, low gradient (NF/LG); low-flow, low gradient (LF/LG). Strain analysis comprised GLS and RLS at a basal (BLS), mid-ventricular (MLS) and apical level (ALS). Patients with high gradients improved GLS (NF/HG: 16.1 ± 3.5 % vs. 17.3 ± 3.4 %, p = 0.03 and LF/HG: 15.4 ± 3.6 % vs. 16.9 ± 3.1 %, p = 0.03), BLS (NF/HG: 12.7 ± 3.1 % vs. 14.2 ± 3.1 %, p = 0.003 and LF/HG: 11.4 ± 3.2 % vs. 13.8 ± 2.7 %, p = 0.005) and MLS (NF/HG: 15.4 ± 3.3 % vs. 16.5 ± 3.3 %, p = 0.04 and LF/HG: 14.5 ± 3.1 % vs. 16.2 ± 2.7 %, p = 0.01) whereas patients with low gradients showed no improvements three months after SAVR. ALS did not change significantly in any group. Patients with high gradients demonstrated a reduction in left ventricular (LV) mass index (p < 0.001) and N-terminal pro-Brain Natriuretic Peptide levels (p < 0.001) following SAVR in contrast to patients with low gradients. Patients with high gradient severe AS improve GLS and RLS three months after SAVR with concomitant reduction of LV mass and neurohormonal activation whereas patients with low gradients do not improve longitudinal strain, LV mass or neurohormonal activation.
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Affiliation(s)
- Frederik Fasth Grund
- Department of Cardiology, The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
| | - Katrine Aagaard Myhr
- Department of Cardiology, The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lasse Visby
- Department of Cardiology, The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Cardiovascular Research Unit, University of Southern Denmark, Odense, Denmark
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20
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Mohamed Ali A, Wasim D, Løland KH, Rotevatn S, Bleie Ø, Saeed S. Impact of transcatheter aortic valve implantation on left ventricular function recovery, mass regression and outcome in patients with aortic stenosis: protocol of the TAVI-NOR prospective study. BMJ Open 2021; 11:e039961. [PMID: 33472776 PMCID: PMC7818832 DOI: 10.1136/bmjopen-2020-039961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is a widely used treatment option as an alternative to surgical aortic valve replacement in patients with severe aortic stenosis (AS) at high or intermediate surgical risk. TAVI improves symptoms, induces reverse left ventricular (LV) remodelling and increases overall survival. However, a careful patient selection is essential to achieve better outcome. Evidence on LV functional recovery and LV mass regression after TAVI based on contemporary registry data is scarce. The impact of TAVI on the arterial vasculature is also less explored. METHOD AND ANALYSES This is a study of 600 consecutive patients with AS who underwent a TAVI at Haukeland University Hospital, Bergen, Norway. Demographics, clinical data, arterial haemodynamics and echocardiographic parameters were prospectively collected. In the present paper, we describe the design, major scientific objectives and echocardiography imaging protocol of the TAVI-NOR (TAVI in western NORway) study. The main objectives are: To explore the impact of TAVI on cardiac structure and function in patients with severe AS, identify the echocardiographic predictors of reverse LV remodelling, assess survival benefits according to baseline risk profile, evaluate long-term therapeutic success as reflected by reduction in valvular-arterial impedance and to investigate the impact of various types of blood pressure response immediately after TAVI on clinical outcome. ETHICS AND DISSEMINATION The study was approved by the Regional Committees for Medical and Health Research Ethics (REK vest, ref. number 33814) and the Institutional Data Protection Services. Patients' consent was waived. The study findings will be disseminated via peer-reviewed publications and presentation in national and international scientific meetings and conferences. TRAIL REGISTRATION NUMBER The study was registered in the international database: ClinicalTrials.gov, Identifier: NCT04417829.
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Affiliation(s)
- Abukar Mohamed Ali
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Daanyaal Wasim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Kjetil Halvorsen Løland
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Norwegian Registry of Invasive Cardiology (NORIC), Bergen, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Norwegian Registry of Invasive Cardiology (NORIC), Bergen, Norway
| | - Øyvind Bleie
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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21
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Vlachou M, Kamperidis V, Vlachaki E, Tziatzios G, Pantelidou D, Boutou A, Apostolou C, Papadopoulou D, Giannakoulas G, Karvounis H. Left Atrial Strain Identifies Increased Atrial Ectopy in Patients with Beta-Thalassemia Major. Diagnostics (Basel) 2020; 11:diagnostics11010001. [PMID: 33375056 PMCID: PMC7822012 DOI: 10.3390/diagnostics11010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/15/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022] Open
Abstract
Patients with beta-thalassemia major (β-ΤΜ) may develop cardiac arrhythmias through a multifactorial mechanism. The current study evaluated the association of cardiac structure and function on echocardiography with atrial ectopic burden on 24-hour tape recording in β-ΤΜ patients. This prospective study included consecutive β-ΤΜ patients. Demographic, laboratory, echocardiographic, cardiac magnetic resonance (CMR) T2* and 24-hour tape recording data were prospectively collected. The patients were classified according to the median value of premature atrial contractions (PACs) on 24-hour tape. In total, 50 β-TM patients (37.6 ± 9.1 years old, 50% male) were divided in 2 groups; PACs ≤ 24/day and > 24/day. Patients with PACs > 24/day were treated with blood transfusion for a longer period of time (39.0 ± 8.6 vs. 32.0 ± 8.9 years, p < 0.007), compared to their counterparts. Older age (OR: 1.121, 95% CI: 1.032–1.217, p = 0.007), longer duration of blood transfusion (OR:1.101, 95% CI:1.019–1.188, p = 0.014), larger LV end-diastolic diameter (OR: 4.522, 95% CI:1.009–20.280, p = 0.049), higher values of LA peak systolic strain (OR: 0.869, 95% CI: 0.783–0.964, p = 0.008), higher MV E/E′ average (OR: 1.407, 95% CI: 1.028–1.926, p = 0.033) and higher right ventricular systolic pressure (OR: 1.147, 95% CI: 1.039–1.266, p = 0.006) were univariably associated with PACs > 24/day. LA peak systolic strain remained significantly associated with PACs > 24/day after adjusting for the duration of blood transfusions or for CMR T2*. The multivariable model including blood transfusion duration and LA peak systolic strain was the most closely associated with PACs > 24/day. Receiver operating characteristic curve analysis identified a left atrial peak systolic strain of 31.5%, as the best cut-off value (83% sensitivity, 68% specificity) for prediction of PACs > 24/day. In β-TM patients, LA peak systolic strain was associated with the atrial arrhythmia burden independently to the duration of blood transfusions and CMR T2*.
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Affiliation(s)
- Maria Vlachou
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Vasileios Kamperidis
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
- Correspondence: ; Tel./Fax: +30-2310-994830
| | - Efthymia Vlachaki
- Thalassaemia Unit, Ippokratio University Hospital, 54642 Thessaloniki, Greece; (E.V.); (C.A.)
| | - Georgios Tziatzios
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Despoina Pantelidou
- Thalassaemia Unit, AHEPA University Hospital, 54621 Thessaloniki, Greece; (D.P.); (D.P.)
| | - Afroditi Boutou
- Pulmonary Department, Papanikolaou Hospital, 57010 Thessaloniki, Greece;
| | - Chrysa Apostolou
- Thalassaemia Unit, Ippokratio University Hospital, 54642 Thessaloniki, Greece; (E.V.); (C.A.)
| | - Despoina Papadopoulou
- Thalassaemia Unit, AHEPA University Hospital, 54621 Thessaloniki, Greece; (D.P.); (D.P.)
| | - George Giannakoulas
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
| | - Haralambos Karvounis
- 1st Cardiology Department, AHEPA Hospital, Aristotle University of Thessaloniki, Stilponos Kyriakidi 1, 54621 Thessaloniki, Greece; (M.V.); (G.T.); (G.G.); (H.K.)
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22
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Szilveszter B, Oren D, Molnár L, Apor A, Nagy AI, Molnár A, Vattay B, Kolossváry M, Karády J, Bartykowszki A, Jermendy ÁL, Suhai FI, Panajotu A, Maurovich-Horvat P, Merkely B. Subclinical leaflet thrombosis is associated with impaired reverse remodelling after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2020; 21:1144-1151. [PMID: 31665257 DOI: 10.1093/ehjci/jez256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/12/2019] [Accepted: 10/24/2019] [Indexed: 01/19/2023] Open
Abstract
AIMS Cardiac CT is increasingly applied for planning and follow-up of transcatheter aortic valve implantation (TAVI). However, there are no data available on reverse remodelling after TAVI assessed by CT. Therefore, we aimed to evaluate the predictors and the prognostic value of left ventricular (LV) reverse remodelling following TAVI using CT angiography. METHODS AND RESULTS We investigated 117 patients with severe, symptomatic aortic stenosis (AS) who underwent CT scanning before and after TAVI procedure with a mean follow-up time of 2.6 years after TAVI. We found a significant reduction in LV mass (LVM) and LVM indexed to body surface area comparing pre- vs. post-TAVI images: 180.5 ± 53.0 vs. 137.1 ± 44.8 g and 99.7 ± 25.4 vs. 75.4 ± 19.9 g/m2, respectively, both P < 0.001. Subclinical leaflet thrombosis (SLT) was detected in 25.6% (30/117) patients. More than 20% reduction in LVM was defined as reverse remodelling and was detected in 62.4% (73/117) of the patients. SLT, change in mean pressure gradient on echocardiography and prior myocardial infarction was independently associated with LV reverse remodelling after adjusting for age, gender, and traditional risk factors (hypertension, body mass index, diabetes mellitus, and hyperlipidaemia): OR = 0.27, P = 0.022 for SLT and OR = 0.22, P = 0.006 for prior myocardial infarction, OR = 1.51, P = 0.004 for 10 mmHg change in mean pressure gradient. Reverse remodelling was independently associated with favourable outcomes (HR = 0.23; P = 0.019). CONCLUSION TAVI resulted in a significant LVM regression on CT. The presence of SLT showed an inverse association with LV reverse remodelling and thus it may hinder the beneficial LV structural changes. Reverse remodelling was associated with improved long-term prognosis.
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Affiliation(s)
- Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Daniel Oren
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Levente Molnár
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Astrid Apor
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Anikó I Nagy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Andrea Molnár
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Andrea Bartykowszki
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Ádám L Jermendy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Ferenc I Suhai
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Alexisz Panajotu
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary.,Medical Imaging Center, Semmelweis University, Üllői Street, 1082 Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
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23
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Saeed S, Dweck MR, Chambers J. Sex differences in aortic stenosis: from pathophysiology to treatment. Expert Rev Cardiovasc Ther 2020; 18:65-76. [PMID: 32066291 DOI: 10.1080/14779072.2020.1732209] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: In aortic stenosis (AS), there are clear sex differences in clinical presentation, left ventricular (LV) response to pressure overload, and pathophysiology of valvular calcification. These differences may affect outcome following valve intervention.Area covered: This review aims to discuss sex differences in clinical presentation, pathophysiology of aortic valve calcification, LV remodeling in view of historic and recent echocardiographic and cardiac magnetic resonance imaging studies, and outcome after valve intervention. In addition, it will also provide some brief insights on the exercise physiology in women and men with AS.Expert commentary: Women at presentation are often older, have higher prevalence of hypertension and diastolic dysfunction, while men are younger, and more often have a bicuspid aortic valve and higher atherosclerotic disease burden. Men have more valve calcification than women for a given severity of AS and develop different patterns of LV remodeling and myocardial fibrosis. Although women tend to walk shorter on treadmill and achieve lower metabolic equivalents, they achieve similar peak heart rates and blood pressure, and the frequency of revealed symptoms during exercise test is comparable in both sexes. Men are more likely to undergo a surgical AVR with better outcome, while women have generally better outcome after TAVI.
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Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Marc R Dweck
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - John Chambers
- Cardiothoracic Centre, Guy's & St Thomas' Hospital, London, UK
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Chau KH, Douglas PS, Pibarot P, Hahn RT, Khalique OK, Jaber WA, Cremer P, Weissman NJ, Asch FM, Zhang Y, Gertz ZM, Elmariah S, Clavel MA, Thourani VH, Daubert M, Alu MC, Leon MB, Lindman BR. Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 75:2446-2458. [DOI: 10.1016/j.jacc.2020.03.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/15/2020] [Indexed: 12/20/2022]
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A new non-invasive index for prognosis evaluation in patients with aortic stenosis. Sci Rep 2020; 10:7333. [PMID: 32355310 PMCID: PMC7193646 DOI: 10.1038/s41598-020-63777-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Accepted: 03/31/2020] [Indexed: 11/09/2022] Open
Abstract
The global left ventricular (LV) contractility index, dσ*/dtmax measures the maximal rate of change in pressure-normalized LV wall stress. We aim to describe the trend of dσ*/dtmax in differing severity of aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) and the association of dσ*/dtmax with clinical outcomes in moderate AS and severe AS. We retrospectively studied a total of 1738 patients with AS (550 mild AS, 738 moderate AS, 450 severe AS) and preserved LVEF ≥ 50% diagnosed from 1st January 2001 to 31st December 2015. dσ*/dtmax worsened with increasing severity of AS despite preserved LVEF (mild AS: 3.69 ± 1.28 s-1, moderate AS: 3.17 ± 1.09 s-1, severe AS: 2.58 ± 0.83 s-1, p < 0.001). Low dσ*/dtmax < 2.8 s-1 was independently associated with a higher composite outcome of aortic valve replacement, congestive cardiac failure admissions and all-cause mortality (adjusted hazard ratio 1.48, 95% CI: 1.25-1.77, p < 0.001). In conclusion, dσ*/dtmax declined with worsening AS despite preserved LVEF. Low dσ*/dtmax < 2.8 s-1 was independently associated with adverse clinical outcomes in moderate AS and severe AS with preserved LVEF.
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Schewel J, Schlüter M, Schmidt T, Kuck KH, Frerker C, Schewel D. Early haemodynamic changes and long-term outcome of patients with severe low-gradient aortic stenosis after transcatheter aortic valve replacement. EUROINTERVENTION 2020; 15:1181-1189. [DOI: 10.4244/eij-d-19-00399] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gegenava T, Vollema EM, van Rosendael A, Abou R, Goedemans L, van der Kley F, de Weger A, Ajmone Marsan N, Bax JJ, Delgado V. Changes in Left Ventricular Global Longitudinal Strain after Transcatheter Aortic Valve Implantation according to Calcification Burden of the Thoracic Aorta. J Am Soc Echocardiogr 2019; 32:1058-1066.e2. [DOI: 10.1016/j.echo.2019.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022]
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Treibel TA, Badiani S, Lloyd G, Moon JC. Multimodality Imaging Markers of Adverse Myocardial Remodeling in Aortic Stenosis. JACC Cardiovasc Imaging 2019; 12:1532-1548. [DOI: 10.1016/j.jcmg.2019.02.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 12/11/2022]
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Impact of stroke volume on severe aortic stenosis in patients with normal left ventricular function. Gen Thorac Cardiovasc Surg 2019; 68:129-135. [PMID: 31286414 DOI: 10.1007/s11748-019-01173-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/01/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Low-flow (LF) aortic stenosis (AS) with a normal ejection fraction reportedly has a worse prognosis than normal-flow (NF) AS. We assessed whether the stroke volume affects early- and long-term survival of patients with AS undergoing aortic valve replacement. METHODS AND RESULTS From 2007 to 2016, 179 patients with AS and a normal ejection fraction (≥ 50%) and without other valve diseases were divided into two groups according to the stroke volume index (SVI): NF group (SVI ≥ 35 ml/m2, n = 167) and LF group (SVI < 35 ml/m2, n = 12). Early- and long-term survival was compared between the two groups. Preoperative echocardiography showed that the end-diastolic diameter and aortic valve area were smaller in the LF than NF group (43 ± 1.9 vs. 48 ± 0.4 mm, p < 0.005 and 0.33 ± 0.14 vs. 0.49 ± 0.14 cm2/m2, p < 0.0005, respectively). Hospital mortality was significantly higher (16.7% vs. 1.8%, p < 0.05) and 5-year overall survival was lower (58 ± 17 vs. 84 ± 4.2 months, p < 0.005) in the LF than NF group. CONCLUSION Patients with LF AS had worse operative and long-term outcomes than those with NF, even though they had preserved LV function.
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Singh A, Voss WB, Lentz RW, Thomas JD, Akhter N. The Diagnostic and Prognostic Value of Echocardiographic Strain. JAMA Cardiol 2019; 4:580-588. [DOI: 10.1001/jamacardio.2019.1152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Arushi Singh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Robert W. Lentz
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - James D. Thomas
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nausheen Akhter
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Predictive Value of Left Ventricular Myocardial Deformation for Left Ventricular Remodeling in Patients With Classical Low-Flow, Low-Gradient Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2019; 32:730-736. [DOI: 10.1016/j.echo.2019.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Indexed: 01/21/2023]
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Nara Y, Kataoka A, Watanabe Y, Makoto N, Hioki H, Kawashima H, Fukuko N, Kozuma K, Shirai S, Tada N, Araki M, Naganuma T, Yamanaka F, Ueno H, Tabata M, Mizutani K, Higashimori A, Takagi K, Yamamoto M, Hayashida K. Prognostic impact of postprocedure stroke volume in patients with low-gradient aortic stenosis. Open Heart 2019; 6:e000988. [PMID: 31218001 PMCID: PMC6546191 DOI: 10.1136/openhrt-2018-000988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/26/2019] [Accepted: 05/06/2019] [Indexed: 12/11/2022] Open
Abstract
Objective The effect of postoperative blood flow status on the prognosis of patients with low-gradient severe aortic stenosis (AS) has not been examined. Severe AS is associated with a higher mortality rate after transcatheter aortic valve implantation (TAVI). We examined the prognostic value of low-flow status by comparing stroke volume indices (SVi) before and after TAVI in patients with symptomatic, low-gradient severe AS. Methods A total of 1613 patients with severe symptomatic AS who underwent TAVI in 14 Japanese institutes for low-gradient severe AS (418 patients, median age 84 years, 32.5% men) were prospectively enrolled. The primary endpoint was cardiovascular mortality during follow-up after TAVI, and independent predictors were evaluated. Receiver operating characteristic curves were generated to determine the optimal cut-off value of post-TAVI SVi for predicting cardiovascular mortality, and the receiver operating characteristic curves of pre-TAVI and post-TAVI SVi were compared. Results The cardiovascular mortality rate was 4.1% (17 patients) during follow-up (median 9.2 months). Multivariate analysis revealed post-TAVI SVi to be an independent predictor of cardiovascular mortality (per 10 mL/m2 decrease; HR, 2.0; 95% CI 1.28 to 3.12). The optimal cut-off value of post-TAVI SVi was 41.4 mL/m2. Post-TAVI SVi showed significantly larger area under the curve than pre-TAVI SVi (0.74 (95% CI 0.69 to 0.79) vs 0.61 (95% CI 0.56 to 0.65), p<0.05). Conclusions Post-TAVI SVi is a better predictor of cardiovascular mortality than pre-TAVI SVi in patients with symptomatic low-gradient severe AS. Low-flow and low-normal-flow status (35≤ SVi <40 mL/m2) require careful management after TAVI.
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Affiliation(s)
- Yugo Nara
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Akihisa Kataoka
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Nakashima Makoto
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hirofumi Hioki
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Hideyuki Kawashima
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Nagura Fukuko
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Ken Kozuma
- Division of Cardiology, Department of Internal Medicine, Teikyo University, Tokyo, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Fukuoka, Japan
| | - Norio Tada
- Department of Cardiovascular Centre, Sendai Kousei Hospital, Miyagi, Japan
| | - Motoharu Araki
- Department of Cardiovascular Medicine, Yokohama City Eastern Hospital, Kanagawa, Japan
| | - Toru Naganuma
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Futoshi Yamanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hiroshi Ueno
- The Second Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Minoru Tabata
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Centre, Chiba, Japan
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Gifu, Japan
| | - Masanori Yamamoto
- Division of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan.,Division of Cardiovascular Medicine, Nagoya Heart Center, Aichi, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Deng MD, Wei X, Zhang XL, Li XD, Liu GY, Zhu D, Guo YQ, Tang H. Changes in left ventricular function in patients with aortic regurgitation 12 months after transapical transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2018; 35:99-105. [PMID: 30264363 DOI: 10.1007/s10554-018-1445-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/17/2018] [Indexed: 02/05/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an established treatment for high surgical risk aortic stenosis patients; in recent years, it has also been used in patients with pure/dominant aortic regurgitation (AR). This study aimed to determine the impact of transapical TAVI on left ventricle myocardial mechanics in AR patients. Thirty AR patients (70% men; mean age, 72.8 ± 4.3 years) were enrolled. Conventional echocardiography was performed on all patients before and 12 months after TAVI. Three-dimensional speckle tracking was accomplished in 20 AR patients for the evaluation of global longitudinal strain, global circumferential strain, twist, torsion, apical rotation and basal rotation. Preoperative left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), twist, torsion and apical rotation were impaired in AR patients compared with controls. Mean left ventricular (LV) end-diastolic diameter (from 62.9 ± 7.3 to 52.0 ± 6.8 mm, p < 0.001), LV end-diastolic volume (from 199.4 ± 55.0 to 130.1 ± 48.9 mL, p < 0.001), and LV mass index (179.8 ± 52.2-134.4 ± 42.5 g/m2, p = 0.001) decreased 12 months after TAVI. Interestingly, GLS (from - 17.2 ± 3.2 to - 18.9 ± 3.7, p = 0.007) and GCS (from - 23.9 ± 4.9 to - 25.7 ± 5.0, p = 0.008) improved significantly, but LVEF did not significantly improve. In terms of the rotational mechanics, twist, rotation and basal rotation remained almost unchanged, whereas apical rotation (from 7.4 ± 4.0 to 5.5 ± 3.9, p = 0.009) was significantly impaired after transapical TAVI. Our results indicate that LV function was improved in terms of myocardial deformation but worsened in terms of apical rotation 12 months after TAVI in AR patients. Three-dimensional speckle tracking echocardiography appears to be a sensitive method for detecting subtle cardiac remodeling after TAVI.
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Affiliation(s)
- Ming-Dan Deng
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Ling Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiao-Dong Li
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Gu-Yue Liu
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Da Zhu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang 37, Chengdu, 610041, Sichuan, People's Republic of China.
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Tiwari N, Patel K. Newer echocardiographic techniques for aortic-valve imaging: Clinical aids today, clinical practice tomorrow. World J Cardiol 2018; 10:62-73. [PMID: 30190799 PMCID: PMC6121002 DOI: 10.4330/wjc.v10.i8.62] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/22/2018] [Accepted: 06/30/2018] [Indexed: 02/06/2023] Open
Abstract
Increasing life expectancy is expected to lead to a corresponding increase in the prevalence of aortic valve disease (AVD). Further, the number of indications for transcatheter aortic valve replacement (TAVR) as a treatment option for AVD is expanding, with a growing role for echocardiography in its management. In this review we summarize the current literature on some newer echocardiographic modalities and the parameters they generate, with a particular focus on their prognostic and clinical value beyond conventional methods in the management of aortic stenosis, TAVR, and aortic regurgitation. Speckle tracking and 3D echocardiography are now increasingly being used in the management of AVD. For instance, global longitudinal strain, the best-studied speckle tracking echocardiographic parameter, can detect subtle subclinical cardiac dysfunction in patients with AVD that is not apparent using traditional echocardiographic techniques. The emerging technique of 3D full volume color Doppler echocardiography provides more accurate measurement of the severity of aortic regurgitation than 2D-proximal isovelocity surface area. These novel techniques are promising for evaluating and risk stratifying patients to optimize surgical interventions, predict recovery, and improve clinical outcomes.
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Affiliation(s)
- Nidhish Tiwari
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States.
| | - Kavisha Patel
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, United States
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Strain Evaluation in TAVR—Current Evidence, Knowledge Gaps, and Future Directions. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9462-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Ribeiro HB, Lerakis S, Gilard M, Cavalcante JL, Makkar R, Herrmann HC, Windecker S, Enriquez-Sarano M, Cheema AN, Nombela-Franco L, Amat-Santos I, Muñoz-García AJ, Garcia del Blanco B, Zajarias A, Lisko JC, Hayek S, Babaliaros V, Le Ven F, Gleason TG, Chakravarty T, Szeto WY, Clavel MA, de Agustin A, Serra V, Schindler JT, Dahou A, Puri R, Pelletier-Beaumont E, Côté M, Pibarot P, Rodés-Cabau J. Transcatheter Aortic Valve Replacement in Patients With Low-Flow, Low-Gradient Aortic Stenosis. J Am Coll Cardiol 2018; 71:1297-1308. [DOI: 10.1016/j.jacc.2018.01.054] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 11/30/2022]
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Deste W, Gulino S, Zappulla P, Iacono F, Sicuso R, Indelicato A, Monte PI, Rapisarda G, Trovato D, Cirasa A, Sgroi C, Barbanti M, Tamburino C. Early Recovery of Left Ventricular Systolic Function after Transcatheter Aortic Valve Implantation. J Cardiovasc Echogr 2018; 28:166-170. [PMID: 30306020 PMCID: PMC6172881 DOI: 10.4103/jcecho.jcecho_13_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background A lot of studies have shown a positive effect of transcatheter aortic valve implantation (TAVI) on left ventricular ejection fraction (LVEF). Objectives We aimed to investigate the effect of TAVI on left ventricular function and correlate this phenomenon with hypertrophy degree in an early follow-up. Materials and Methods Between August 2015 and July 2016, 250 consecutive patients with symptomatic severe aortic stenosis (AS) underwent TAVI in our institution. Given the aim of this analysis, only patients with an LVEF <50%, no more than moderate mitral valve regurgitation, successful valve implantation, and 1-month follow-up available were included in the study (n = 46). Patients were enrolled in a prospective database, with clinical and echocardiographic evaluations at 1 month after TAVI. Results All patients had severe symptomatic AS (mean transaortic pressure gradients: 44.1 ± 13.8 mmHg and mean aortic valve area: 0.66 ± 0.19 cm2). Mean baseline LVEF was 39.3 ± 8.8%. Significant hemodynamic improvement was observed after TAVI. Mean transvalvular aortic gradient decreased significantly from 44.1 ± 13.8 mmHg to 8.9 ± 4.2 mmHg (P < 0.005). A statistically significant improvement in LVEF compared to baseline was observed in the 1st month of follow-up (39.3 ± 8.8% vs. 44.1 ± 10.1%, P < 0.019). Overall, 52.2% of patients showed an increase in LVEF, 32.6% had no change, while only 2.2% had a decrease in LVEF. Interestingly, we found a significant reverse correlation between LVEF improvement and ventricular hypertrophy measured as diastolic interventricular septum thickness (Pearson index r = -0.42). Patients showing greater improvement in LVEF were those with less than moderate hypertrophy. Conclusions Patients with depressed systolic function show a consistent and early LVEF recovery after TAVI. An impaired LVEF recovery is most likely among patients with more than moderate hypertrophy, probably responsible of left ventricular fibrosis that irremediably compromises systolic function.
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Affiliation(s)
- Wanda Deste
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - Simona Gulino
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - Paolo Zappulla
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - Federica Iacono
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - Rita Sicuso
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - Antonino Indelicato
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - P Ines Monte
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - Giulia Rapisarda
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - Danilo Trovato
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - Arianna Cirasa
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - Carmelo Sgroi
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Cardio-Thoracic-Vascular Department, Policlinico-Vittorio Emanuele, Catania, Italy.,ETNA Foundation, Catania, Italy
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Sato K, Kumar A, Jones BM, Mick SL, Krishnaswamy A, Grimm RA, Desai MY, Griffin BP, Rodriguez LL, Kapadia SR, Obuchowski NA, Popović ZB. Reversibility of Cardiac Function Predicts Outcome After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis. J Am Heart Assoc 2017; 6:JAHA.117.005798. [PMID: 28698259 PMCID: PMC5586298 DOI: 10.1161/jaha.117.005798] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Reversibility of left ventricular (LV) dysfunction in high‐risk aortic stenosis patient and its impact on survival after transcatheter aortic valve replacement (TAVR) are unclear. We aimed to evaluate longitudinal changes of LV structure and function after TAVR and their impact on survival. Methods and Results We studied 209 patients with aortic stenosis who underwent TAVR from May 2006 to December 2012. Echocardiograms were used to calculate LV end‐diastolic volume index (LVEDVi), LV ejection fraction, LV mass index (LVMi), and global longitudinal strain before, immediately (<10 days), late (1–3 months), and yearly after TAVR. During a median follow‐up of 1345 days, 118 patients died, with 26 dying within 1 year. Global longitudinal strain, LVEDVi, LV ejection fraction, and LVMi improved during follow‐up. In patients who died during the first year, death was preceded by LVEDVi and LVMi increase. Multivariable longitudinal data analysis showed that aortic regurgitation at baseline, aortic regurgitation at 30 days, and initial LVEDVi were independent predictors of subsequent LVEDVi. In a joint analysis of longitudinal and survival data, baseline Society of Thoracic Surgeons score was predictive of survival, with no additive effect of longitudinal changes in LVEDVi, LVMi, global longitudinal strain, or LV ejection fraction. Presence of aortic regurgitation at 1 month after TAVR was the only predictor of 1‐year survival. Conclusions LV reverse remodeling was observed after TAVR, whereas lack of LVEDVi and LVMi improvement was observed in patients who died during the first year after TAVR. Post‐TAVR, aortic regurgitation blocks reverse remodeling and is associated with poor 1‐year survival after TAVR.
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Affiliation(s)
- Kimi Sato
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Arnav Kumar
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Brandon M Jones
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | | | | | - Richard A Grimm
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Brian P Griffin
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | | | - Samir R Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
| | - Nancy A Obuchowski
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Zoran B Popović
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH
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Poulin F, Yingchoncharoen T, Wilson WM, Horlick EM, Généreux P, Tuzcu EM, Stewart W, Osten MD, Woo A, Thavendiranathan P. Impact of Prosthesis-Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2016; 5:JAHA.115.002866. [PMID: 26857069 PMCID: PMC4802434 DOI: 10.1161/jaha.115.002866] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis‐patient mismatch (PPM). Methods and Results In a retrospective study, speckle‐tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid‐term follow‐up post‐TAVR. Moderate and severe PPM were defined as an effective orifice area ≤0.85 and <0.65 cm2/m2, respectively. A total of 102 patients (median age, 83 years [77–88]) with severe AS were included. At 6±3 months post‐TAVR, moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m2; P=0.001) at follow‐up whereas those with PPM did not. There was a significant improvement in LV GLS (−12.8±4.0 to −14.3±4.3%; P=0.01), GLSR (−0.61±0.20 to −0.73±0.25 second−1; P<0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second−1; P<0.001) in patients without PPM, but not in those with PPM. After adjustment for pre‐TAVR ejection fraction and post‐TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM. After a median follow‐up of 46.1 months (interquartile range, 35.4–60.8), there was no difference in survival between patients with and without PPM. Conclusions TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM. Presence of PPM was not associated with mortality.
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Affiliation(s)
- Frédéric Poulin
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada Research Center, Hôpital du Sacré-Coeur de Montréal, University of Montreal Montreal Quebec, Canada
| | | | - William M Wilson
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
| | - Eric M Horlick
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
| | - Philippe Généreux
- Research Center, Hôpital du Sacré-Coeur de Montréal, University of Montreal Montreal Quebec, Canada
| | | | | | - Mark D Osten
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
| | - Anna Woo
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
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Leong DP, Pizzale S, Haroun MJ, Yazdan-Ashoori P, Ladak K, Sun YY, Dalak F, Al-Maashani S, Elbarasi EA, Masiero S, Ghazal S, Dokainish H. Factors Associated with Low Flow in Aortic Valve Stenosis. J Am Soc Echocardiogr 2016; 29:158-65. [DOI: 10.1016/j.echo.2015.10.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Indexed: 11/16/2022]
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Herrmann S, Fries B, Liu D, Hu K, Stoerk S, Voelker W, Ruppert C, Lorenz K, Ertl G, Weidemann F. Differences in Natural History of Low- and High-Gradient Aortic Stenosis from Nonsevere to Severe Stage of the Disease. J Am Soc Echocardiogr 2015; 28:1270-1282.e4. [DOI: 10.1016/j.echo.2015.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Indexed: 10/23/2022]
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Abstract
Echocardiography is the imaging modality of choice for the assessment of patients with valvular heart disease. Echocardiographic advancements may have particular impact on the assessment and management of patients with valvular heart disease. This review will summarize the current literature on advancements, such as three-dimensional echocardiography, strain imaging, intracardiac echocardiography, and fusion imaging, in this patient population.
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Affiliation(s)
- Rebecca Hahn
- Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA
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Kamperidis V, Hadjimiltiades S, Mouratoglou S, Ziakas A, Sianos G, Sarafidou A, Ventoulis I, Kazinakis G, Giannakoulas G, Efthimiadis G, Parcharidis G, Karvounis H. Aortic balloon valvuloplasty before transcatheter valve replacement in high-risk patients with aortic stenosis. Herz 2015; 41:144-50. [DOI: 10.1007/s00059-015-4353-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/27/2015] [Accepted: 08/10/2015] [Indexed: 10/23/2022]
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Zughaft DJL, Hyllén S, Harnek J, Nozohoor S, Bjursten H, Götberg M. Safety, Feasibility, and Hemodynamic Effects of Mild Hypothermia in Transcatheter Aortic Valve Replacement: The TAVR-CHILL Trial. Ther Hypothermia Temp Manag 2015. [PMID: 26222725 DOI: 10.1089/ther.2015.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The safety, feasibility, and hemodynamic effects of mild hypothermia (MH) induced by transnasal cooling were studied in transcatheter aortic valve replacement (TAVR). MH is a common therapy following cardiac arrest and seems to have favorable effects in myocardial infarction and on hemodynamic stability. In TAVR, hemodynamic instability is common during rapid pacing. Twenty subjects undergoing TAVR were randomized 1:1 to hypothermia or normothermia. Hemodynamic endpoints were mean arterial blood pressure and required dosage of vasoactive and inotropic drugs. Patients were followed up at 6 months. All patients in the MH group (n=10) reached the target temperature of 34°C before first rapid pacing. Tympanic and urinary bladder temperature remained significantly lower in the MH group during the procedure. No adverse effects of cooling were observed. Mean arterial pressure was higher in the MH group (90±20 mm Hg) than in the control group (71±13 mm Hg) at the start of the procedure, at first rapid pacing (94±19 vs. 80±16 mm Hg), and at balloon aortic valvuloplasty (90±17 vs. 73±14 mm Hg). Less norepinephrine was administered to the hypothermia group. Transnasal cooling during TAVR was safe and well tolerated. We observed a more stable hemodynamic profile in the MH group, indicated by higher blood pressure and lower levels of vasoactive drugs required. A larger study of patients with severe ventricular dysfunction is required to more comprehensively investigate the hemodynamic effects of transnasal cooling in TAVR.
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Affiliation(s)
- David J L Zughaft
- 1 Department of Coronary Heart Disease, Skane University Hospital, Lund University , Lund, Sweden .,2 Department of Cardiology, Skane University Hospital , Lund University, Lund, Sweden
| | - Snejana Hyllén
- 3 Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund University , Lund, Sweden
| | - Jan Harnek
- 1 Department of Coronary Heart Disease, Skane University Hospital, Lund University , Lund, Sweden .,2 Department of Cardiology, Skane University Hospital , Lund University, Lund, Sweden
| | - Shahab Nozohoor
- 3 Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund University , Lund, Sweden
| | - Henrik Bjursten
- 3 Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Skane University Hospital, Lund University , Lund, Sweden
| | - Matthias Götberg
- 1 Department of Coronary Heart Disease, Skane University Hospital, Lund University , Lund, Sweden .,2 Department of Cardiology, Skane University Hospital , Lund University, Lund, Sweden
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Clavel MA, Berthelot-Richer M, Le Ven F, Capoulade R, Dahou A, Dumesnil JG, Mathieu P, Pibarot P. Impact of classic and paradoxical low flow on survival after aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol 2015; 65:645-53. [PMID: 25677424 DOI: 10.1016/j.jacc.2014.11.047] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 11/11/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Low flow (LF) can occur with reduced (classic) or preserved (paradoxical) left ventricular ejection fraction (LVEF). OBJECTIVES The objective of this study was to compare outcomes of patients with low ejection fraction (LEF), paradoxical low flow (PLF), and normal flow (NF) after aortic valve replacement (AVR). METHODS We examined 1,154 patients with severe aortic stenosis (AS) who underwent AVR with or without coronary artery bypass grafting. RESULTS Among these patients, 206 (18%) had LEF as defined by LVEF of <50%; 319 (28%) had PLF as defined by LVEF of ≥50% but stroke volume indexed to body surface area (SVi) of ≤35 ml ∙ m(-2); and 629 (54%) had NF, as defined by LVEF of ≥50% and SVi of >35 ml ∙ m(2). Aortic valve area was lower in low flow/LVEF groups (LEF: 0.71 ± 0.20 cm(2) and PLF: 0.65 ± 0.23 cm(2) vs. NF: 0.77 ± 0.18 cm(2); p < 0.001). The 30-day mortality was higher (p < 0.001) in LEF and PLF groups than in the NF group (6.3% and 6.3% vs. 1.8%, respectively). SVi and PLF group were independent predictors of operative mortality (odds ratio [OR]: 1.18, p < 0.05; and OR: 2.97, p = 0.004; respectively). At 5 years after AVR, overall survival was 72 ± 4% in LEF group, 81 ± 2% in PLF group, and 85 ± 2% in NF group (p < 0.0001). CONCLUSIONS Patients with LEF or PLF AS have a higher operative risk, but pre-operative risk score accounted only for LEF and lower LVEF. Patients with LEF had the worst survival outcome, whereas patients with PLF and normal flow had similar survival rates after AVR. As a major predictor of perioperative mortality, SVi should be integrated in AS patients' pre-operative evaluation.
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Affiliation(s)
- Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
| | - Maxime Berthelot-Richer
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Florent Le Ven
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Romain Capoulade
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Abdellaziz Dahou
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Jean G Dumesnil
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Patrick Mathieu
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
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