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Shan B, Li J, Shi Z, Han C, Zhang J, Zhao J, Hu R, Liu L, Ta S. Predictive value of estimated plasma volume for postoperative hypotension in percutaneous intramyocardial septal radiofrequency ablation treating for hypertrophic obstructive cardiomyopathy. BMC Cardiovasc Disord 2024; 24:177. [PMID: 38519968 PMCID: PMC10958927 DOI: 10.1186/s12872-024-03844-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/13/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Estimated plasma volume status (ePVS) estimated by the Duarte formula is associated with clinical outcomes in patients with heart failure. It remains unclear the predictive value of the ePVS to the postoperative hypotension (POH) in percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) treating hypertrophic obstructive cardiomyopathy (HOCM). METHODS Data of HOCM patients who underwent PIMSRA were retrospectively collected. Preoperative ePVS was calculated using the Duarte formulas which derived from hemoglobin and hematocrit ratios. Clinical variables including physical assessment, biological and echocardiographic parameters were recorded. Patients were labeled with or without POH according to the medical record in the hospital. Univariable and multivariable logistic regression were performed to evaluate the association between ePVS and POH. Using different thresholds derived from quartiles and the best cutoff value of the receiver operating characteristic curve, the diagnostic performance of ePVS was quantified. RESULTS Among the 405 patients included in this study, 53 (13.1%) patients were observed with symptomatic POH. Median (IQR) of ePVS in overall patients was 3.77 (3.27~4.40) mL/g and in patients with POH were higher than those without POH. The ePVS was associated with POH, with the odds ratio of 1.669 (95% CI 1.299 ~ 2.144) per mL/g. After adjusted by potential confounders, ePVS remained independently associated with POH, with the approximate odds ratio in different models. CONCLUSION The preoperative ePVS derived from the Duarte formulas was independently associated with postoperative hypotension in HOCM patients who underwent PIMSRA and showed prognostic value to the risk stratification of postoperative management. TRIAL REGISTRATION NCT06003478 (22/08/2023).
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Affiliation(s)
- Bo Shan
- Department of Ultrasound, Hypertrophic Cardiomyopathy Center, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Jing Li
- Department of Ultrasound, Hypertrophic Cardiomyopathy Center, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Zhangwei Shi
- Department of Cardiology, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Chao Han
- Department of Ultrasound, Hypertrophic Cardiomyopathy Center, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Juan Zhang
- Department of Ultrasound, Hypertrophic Cardiomyopathy Center, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Jia Zhao
- Department of Ultrasound, Hypertrophic Cardiomyopathy Center, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Rui Hu
- Department of Ultrasound, Hypertrophic Cardiomyopathy Center, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Liwen Liu
- Department of Ultrasound, Hypertrophic Cardiomyopathy Center, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
| | - Shengjun Ta
- Department of Ultrasound, Hypertrophic Cardiomyopathy Center, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China.
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Barzallo D, Torrado J, Benites-Moya CJ, Sturla M, Echarte-Morales J, Scotti A, Kharawala A, Terre JA, Sugiura T, Wiley J, Goldberg Y, Latib A. Acute Hemodynamic Compromise After Transcatheter Aortic Valve Replacement Due to Dynamic Left Ventricle Obstruction: A Systematic Review. Am J Cardiol 2024; 214:125-135. [PMID: 38103763 DOI: 10.1016/j.amjcard.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/08/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
Acute hemodynamic compromise after transcatheter aortic valve replacement (TAVR) because of dynamic left ventricle (LV) obstruction (LVO), also known as suicide LV, is an infrequent but severe complication of TAVR that is poorly defined in previous studies. Understanding this complication is essential for its prompt diagnosis and optimal treatment. We conducted a systematic literature review using PubMed, Embase, Web of Science, and Medline databases for studies describing acute hemodynamic compromise after TAVR because of dynamic LVO or suicide LV. Each study was reviewed by 2 authors individually for eligibility, and a third author resolved disagreements. From a total of 506 studies, 25 publications were considered for the final analysis. The majority of patients with this condition were women demonstrating a hypertrophic septum, a small ventricle, and hyperdynamic contractility on pre-TAVR echocardiographic assessment. An intraventricular gradient before TAVR was found in half of the cases. Acute hemodynamic compromise after TAVR because of dynamic LVO manifested mainly as significant hypotension and occurred most often immediately after valve deployment. The LV outflow tract was the most common site of obstruction. Advanced therapies were required in nearly 65% of the cases. In conclusion, acute hemodynamic compromise after TAVR because of dynamic LVO occurred almost invariably in women. Echocardiography before TAVR may offer essential information to anticipate this complication. LV outflow tract obstruction appears to carry the highest risk of developing this phenomenon. Advanced therapies should be promptly considered as a bailout strategy in patients with hemodynamic collapse refractory to medical therapy.
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Affiliation(s)
- Diego Barzallo
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York.
| | - Juan Torrado
- Department of Cardiology, Montefiore Medical Center, Bronx, New York
| | - Cesar Joel Benites-Moya
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Matteo Sturla
- Department of Cardiology, Montefiore Medical Center, Bronx, New York
| | | | - Andrea Scotti
- Department of Cardiology, Montefiore Medical Center, Bronx, New York
| | - Amrin Kharawala
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Juan A Terre
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Tadahisa Sugiura
- Department of Cardiothoracic Surgery, Montefiore Medical Center, Bronx, New York
| | - Jose Wiley
- Section of Cardiology, Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ythan Goldberg
- Section of Structural Echocardiography, Department of Cardiology, Lenox Hill Hospital and Western Region, Northwell Health, New York, New York
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Bronx, New York
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Torrado J, Barzallo D, Terré JA, Benites-Moya CJ, Ríos S, García M, Chau M, Wiley J, Latib A. Impact of VA-ECMO on Dynamic LV Outflow Obstruction After Transcatheter Aortic Valve Replacement. JACC Case Rep 2024; 29:102157. [PMID: 38264301 PMCID: PMC10801796 DOI: 10.1016/j.jaccas.2023.102157] [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: 04/11/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 01/25/2024]
Abstract
Dynamic left ventricular outflow obstruction is a rare but severe complication of transcatheter aortic valve replacement. It presents as a paradoxical hemodynamic collapse after relieving the left ventricular afterload. Considering its unique pathophysiology, this entity dictates counterintuitive treatments. We describe a case of left ventricular outflow obstruction treated with venoarterial extracorporeal membrane oxygenation and discuss its management principles.
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Affiliation(s)
- Juan Torrado
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Diego Barzallo
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan A. Terré
- Department of Medicine, Section of Cardiology, Tulane University, New Orleans, Louisiana, USA
| | - César Joel Benites-Moya
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Saúl Ríos
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mario García
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mei Chau
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - José Wiley
- Department of Medicine, Section of Cardiology, Tulane University, New Orleans, Louisiana, USA
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Grinberg T, Aviv Y, Vaturi M, Perl L, Wiessman M, Vaknin-Assa H, Codner P, Shapira Y, Kornowski R, Orvin K. Noninvasive Hemodynamic Evaluation Following TAVI for Severe Aortic Stenosis. J Am Heart Assoc 2023; 12:e028479. [PMID: 36942754 PMCID: PMC10122892 DOI: 10.1161/jaha.122.028479] [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] [Indexed: 03/23/2023]
Abstract
Background Various hemodynamic changes occur following transcatheter aortic valve implantation (TAVI) that may impact therapeutic decisions. NICaS is a noninvasive bioimpedance monitoring system aimed at hemodynamic assessment. We used the NICaS system in patients with severe aortic stenosis (AS) to evaluate short-term hemodynamic changes after TAVI. Methods and Results We performed hemodynamic analysis using NICaS on 97 patients with severe AS who underwent TAVI using either self-expandable (68%) or balloon-expandable (32%) valves. Patients were more often women (54%) and had multiple comorbidities including hypertension (83%), coronary artery disease (46%), and diabetes (37%). NICaS was performed at several time points-before TAVI, soon after TAVI, at hospital discharge, and during follow-up. Compared with baseline NICaS measurements, we observed a significant increase in systolic blood pressure and total peripheral resistance (systolic blood pressure 132±21 mm Hg at baseline versus 147±23 mm Hg after TAVI, P<0.001; total peripheral resistance 1751±512 versus 2084±762 dynes*s/cm5, respectively, P<0.001) concurrent with a decrease in cardiac output and stroke volume (cardiac output 4.2±1.5 versus 3.9±1.3 L/min, P=0.037; stroke volume 61.4±14.8 versus 56.2±15.9 mL, P=0.001) in the immediate post-TAVI period. At follow-up (median 59 days [interquartile range, 40.5-91]) these measurements returned to values that were not different from the baseline. A significant improvement in echocardiography-based left ventricular ejection fraction was observed from baseline to follow-up (55.6%±11.6% to 59.4%±9.4%, P<0.001). Conclusions Unique short-term adaptive hemodynamic changes were observed using NICaS in patients with AS soon after TAVI. Noninvasive hemodynamic evaluation immediately following TAVI may contribute to the understanding of complex hemodynamic changes and merits favorable consideration.
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Affiliation(s)
- Tzlil Grinberg
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yaron Aviv
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Mordehay Vaturi
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Leor Perl
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Maya Wiessman
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Hanna Vaknin-Assa
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Pablo Codner
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yaron Shapira
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ran Kornowski
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Katia Orvin
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Zhu Q, Yuan Z, Xu Y, Chen J, Ng S, Yidilisi A, Ren K, Chen Y, Hu W, Zhu G, Liu F, Dang M, He Y, Guo Y, Fan J, Liu X, Wang J. Validation of a novel staging classification system based on the extent of cardiac damage among Chinese patients after transcatheter aortic valve replacement: A single-center retrospective study. Catheter Cardiovasc Interv 2022; 99 Suppl 1:1482-1489. [PMID: 35324060 DOI: 10.1002/ccd.30147] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/21/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES We aimed to validate a novel staging system for aortic stenosis (AS) in a Chinese patient cohort undergoing transcatheter aortic valve replacement (TAVR), and to compare this classification system to the traditional Society of Thoracic Surgeons (STS) score for TAVR risk stratification. BACKGROUND A novel staging system for AS based on the extent of cardiac damage upon echocardiography was recently proposed. METHODS Patients were prospectively enrolled into the Transcatheter Aortic Valve Replacement Single Center Registry in Chinese Population and analyzed retrospectively following additional exclusion criteria. On the basis of echocardiographic findings of cardiac damage, patients were classified into five stages (0-4). RESULTS A total of 427 patients were included in the current analysis. Forty-eight deaths occurred during a median follow-up of 730 days following TAVR. The staging system showed a statistically significant association between cardiac damage and all-cause mortality; advanced stages were associated with higher mortality. In a multivariate-adjusted Cox proportional hazards regression model, stage and STS scores served as risk factors for 2-year mortality. Each increment in the staging class was associated with an increased risk of mortality (hazard ratio, 1.275; 95% confidence interval [CI], 1.052-1.545). Receiver operating characteristic (ROC) curves were plotted for stage (area under the curve, 0.644; 95% CI, 0.562-0.725) and STS score (0.661; 0.573-0.749), and with no statistically significant differences between ROC curves (p = 0.920). CONCLUSIONS We validated a novel staging system as a key risk factor for 2-year mortality in a Chinese TAVR patient cohort. Efficacy for risk stratification was comparable to the STS score.
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Affiliation(s)
- Qifeng Zhu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhengdu Yuan
- Department of Cardiology, Taizhou Municipal Hospital, Taizhou, China
| | - Yeming Xu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Jun Chen
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Stella Ng
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Abuduwufuer Yidilisi
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Kaida Ren
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuwen Chen
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wangxing Hu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Gangjie Zhu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Feng Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengqiu Dang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuxin He
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yuchao Guo
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaqi Fan
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianbao Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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