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Sousa Nunes F, Amaral Marques C, Isabel Pinho A, Sousa-Pinto B, Beco A, Ricardo Silva J, Saraiva F, Macedo F, Leite-Moreira A, Sousa C. Reverse left ventricular remodeling after aortic valve replacement for aortic stenosis: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1407566. [PMID: 39027003 PMCID: PMC11254856 DOI: 10.3389/fcvm.2024.1407566] [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: 03/26/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
Reverse left ventricular (LV) remodeling after aortic valve replacement (AVR), in patients with aortic stenosis, is well-documented as an important prognostic factor. With this systematic review and meta-analysis, we aimed to characterize the response of the unloaded LV after AVR. We searched on MEDLINE/PubMed and Web of Science for studies reporting echocardiographic findings before and at least 1 month after AVR for the treatment of aortic stenosis. In total, 1,836 studies were identified and 1,098 were screened for inclusion. The main factors of interest were structural and dynamic measures of the LV and aortic valve. We performed a random-effects meta-analysis to compute standardized mean differences (SMD) between follow-up and baseline values for each outcome. Twenty-seven studies met the eligibility criteria, yielding 11,751 patients. AVR resulted in reduced mean aortic gradient (SMD: - 38.23 mmHg, 95% CI: - 39.88 to - 36.58 , I 2 = 92 % ), LV mass (SMD: - 37.24 g, 95% CI: - 49.31 to - 25.18 , I 2 = 96 % ), end-diastolic LV diameter (SMD: - 1.78 mm, 95% CI: - 2.80 to - 0.76 , I 2 = 96 % ), end-diastolic LV volume (SMD: - 1.6 ml, 95% CI: - 6.68 to 3.51, I 2 = 91 % ), increased effective aortic valve area (SMD: 1.10 cm2, 95% CI: 1.01 to 1.20, I 2 = 98 % ), and LV ejection fraction (SMD: 2.35%, 95% CI: 1.31 to 3.40%, I 2 = 94.1 % ). Our results characterize the extent to which reverse remodeling is expected to occur after AVR. Notably, in our study, reverse remodeling was documented as soon as 1 month after AVR.
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Affiliation(s)
- F. Sousa Nunes
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiology, Local Health Unit of Gaia and Espinho, Vila Nova de Gaia, Portugal
| | - C. Amaral Marques
- Department of Cardiology, Local Health Unit of Sao Joao, Porto, Portugal
| | - A. Isabel Pinho
- Department of Cardiology, Local Health Unit of Sao Joao, Porto, Portugal
| | - B. Sousa-Pinto
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE—Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A. Beco
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - J. Ricardo Silva
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - F. Saraiva
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - F. Macedo
- Department of Cardiology, Local Health Unit of Sao Joao, Porto, Portugal
| | - A. Leite-Moreira
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiology, Local Health Unit of Sao Joao, Porto, Portugal
| | - C. Sousa
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiology, Local Health Unit of Sao Joao, Porto, Portugal
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Wada T, Ota S, Honda K, Tanimoto T, Taruya A, Nishi T, Takeda J, Hikida R, Asae Y, Takahata M, Ozaki Y, Kashiwagi M, Shiono Y, Kuroi A, Yamano T, Takemoto K, Kitabata H, Nishimura Y, Tanaka A. Left ventricular reverse remodeling and reduction of interstitial fibrosis in patients with severe aortic stenosis who underwent transcatheter aortic valve implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00562-1. [PMID: 38965018 DOI: 10.1016/j.carrev.2024.06.022] [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: 04/16/2024] [Revised: 06/09/2024] [Accepted: 06/28/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Left ventricular (LV) structural and functional changes have been reported in patients with aortic stenosis (AS) who have undergone transcatheter aortic valve implantation (TAVI); however, the relationship between change in LV structure and systolic function and tissue characteristics assessed via cardiovascular magnetic resonance imaging (CMRI) post-TAVI has been not fully elucidated. This study aimed to investigate this relationship in patients with severe AS who underwent TAVI and CMRI. METHODS In this retrospective study, 65 patients who underwent TAVI and CMRI at the 6-month follow-up were analyzed. The relationship between percent changes in LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF), and LV mass (LVM) (⊿LVEDV, ⊿LVESV, ⊿LVEF, and ⊿LVM) and those in the native T1 value (⊿native T1) was analyzed using a correlation analysis. Moreover, extracellular volume fraction (ECV) value changes were analyzed. RESULTS The ⊿native T1 significantly decreased from 1292.8 (1269.9-1318.4) ms at pre-TAVI to 1282.3 (1262.6-1310.2) ms at the 6-month follow-up (P = 0.022). A significant positive correlation between ⊿LVEDV, ⊿LVESV, and ⊿LVM and ⊿native T1 (r = 0.351, P = 0.004; r = 0.339, P = 0.006; r = 0.261, P = 0.035, respectively) and a tendency toward a negative correlation between ⊿LVEF and ⊿native T1 (r = -0.237, P = 0.058) were observed. The ECV value increased significantly from 26.7 % (25.3-28.3) to 28.2 % (25.7-30.5) (P = 0.002). CONCLUSIONS The decrease in native T1 might be associated with LV reverse remodeling. Evaluating structural and functional changes using CMRI may be useful for patient management.
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Affiliation(s)
- Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan.
| | - Shingo Ota
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kentaro Honda
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takahiro Nishi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Jumpei Takeda
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ryo Hikida
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshinori Asae
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Takahata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yuichi Ozaki
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kazushi Takemoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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Yan T, Wang L, Chen X, Yin H, He W, Liu J, Liu S, Li X, Wang Y, Peng L. Predicting Left Ventricular Adverse Remodeling After Transcatheter Aortic Valve Replacement: A Radiomics Approach. Acad Radiol 2024:S1076-6332(24)00238-1. [PMID: 38821814 DOI: 10.1016/j.acra.2024.04.029] [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: 01/01/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 06/02/2024]
Abstract
RATIONALE AND OBJECTIVES To develop a radiomics model based on cardiac computed tomography (CT) for predicting left ventricular adverse remodeling (LVAR) in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS Patients with severe AS who underwent TAVR from January 2019 to December 2022 were recruited. The cohort was divided into adverse remodeling group and non-adverse remodeling group based on LVAR occurrence, and further randomly divided into a training set and a validation set at an 8:2 ratio. Left ventricular radiomics features were extracted from cardiac CT. The least absolute shrinkage and selection operator regression was utilized to select the most relevant radiomics features and clinical features. The radiomics features were used to construct the Radscore, which was then combined with the selected clinical features to build a nomogram. The predictive performance of the models was evaluated using the area under the curve (AUC), while the clinical value of the models was assessed using calibration curves and decision curve analysis. RESULTS A total of 273 patients were finally enrolled, including 71 with adverse remodeling and 202 with non-adverse remodeling. 12 radiomics features and five clinical features were extracted to construct the radiomics model, clinical model, and nomogram, respectively. The radiomics model outperformed the clinical model (training AUC: 0.799 vs. 0.760; validation AUC: 0.766 vs. 0.755). The nomogram showed highest accuracy (training AUC: 0.859, validation AUC: 0.837) and was deemed most clinically valuable by decision curve analysis. CONCLUSION The cardiac CT-based radiomics features could predict LVAR after TAVR in patients with severe AS.
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Affiliation(s)
- Tingli Yan
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Department of Radiology, Chengdu Universal Dicom Medical Imaging Diagnostic Center, Chengdu, China
| | - Lujing Wang
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoyi Chen
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Hongkun Yin
- Infervision Medical Technology 9Co., Ltd, Beijing, China
| | - Wenzhang He
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Shengmei Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xue Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yinqiu Wang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Liqing Peng
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
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El-Zein RS, Malik AO, Cohen DJ, Spertus JA, Saxon JT, Pibarot P, Hahn RT, Alu MC, Shang K, Kodali SK, Thourani VH, Leon MB, Mack MJ, Chhatriwalla AK. Diastolic Dysfunction and Health Status Outcomes After Transcatheter Aortic Valve Replacement. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100225. [PMID: 38283566 PMCID: PMC10818150 DOI: 10.1016/j.shj.2023.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 01/30/2024]
Abstract
Background Baseline left ventricular diastolic dysfunction (LVDD) is associated with poor health status in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but health status improvement after TAVR appears similar across all grades of LVDD. Here, we aim to examine the relationship between changes in LVDD severity and health status outcomes following TAVR. Methods Patients who underwent TAVR and had evaluable LVDD at both baseline and 1 year in the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registries and PARTNER 3 trial were analyzed. LVDD grade was evaluated using echocardiography core lab data and an adapted definition of American Society of Echocardiography guidelines. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score. The association between ΔLVDD severity and ΔKCCQ-OS was examined using linear regression models adjusted for baseline KCCQ-OS. Results Of 1100 patients, 724 (65.8%), 283 (25.7%), and 93 (8.5%) had grade 0/1, 2, and 3 LVDD at baseline, respectively. At 1 year, LVDD severity was unchanged in 790 (71.8%) patients, improved in 189 (17.2%), and worsened in 121 (11.0%). Among 376 patients with baseline grade 2 or 3 LVDD, 50.3% had improvement in LVDD. In the overall cohort, KCCQ-OS score improved by 21.9 points at 1 year. There was a statistically significant association between change in LVDD severity (improved, unchanged, and worsened) and ΔKCCQ-OS at 1 year (p = 0.007). Conclusions Change in LVDD grade was associated with change in health status 1 year following TAVR.
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Affiliation(s)
- Rayan S. El-Zein
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | - Ali O. Malik
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | - David J. Cohen
- Division of Cardiology, Saint Francis Hospital, New York, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - John A. Spertus
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | - John T. Saxon
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | | | - Rebecca T. Hahn
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Maria C. Alu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - Kan Shang
- Edwards Lifesciences, California, USA
| | - Susheel K. Kodali
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Vinod H. Thourani
- Division of Cardiothoracic Surgery, Piedmont Heart Institute, Georgia, USA
| | - Martin B. Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Michael J. Mack
- Division of Cardiothoracic Surgery, Baylor Scott & White Health, Texas, USA
| | - Adnan K. Chhatriwalla
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
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Vermes E, Iacuzio L, Maréchaux S, Levy F, Loardi C, Tribouilloy C. Is there a role for cardiovascular magnetic resonance imaging in the assessment of biological aortic valves? Front Cardiovasc Med 2023; 10:1250576. [PMID: 38124892 PMCID: PMC10730731 DOI: 10.3389/fcvm.2023.1250576] [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: 06/30/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Patients with biological aortic valves (following either surgical aortic valve replacement [SAVR] or trans catheter aortic valve implantation [TAVI]) require lifelong follow-up with an imaging modality to assess prosthetic valve function and dysfunction. Echocardiography is currently the first-line imaging modality to assess biological aortic valves. In this review, we discuss the potential role of cardiac magnetic resonance imaging (CMR) as an additional imaging modality in situations of inconclusive or equivocal echocardiography. Planimetry of the prosthetic orifice can theoretically be measured, as well as the effective orifice area, with potential limitations, such as CMR valve-related artefacts and calcifications in degenerated prostheses. The true benefit of CMR is its ability to accurately quantify aortic regurgitation (paravalvular and intra-valvular) with a direct and reproducible method independent of regurgitant jet morphology to accurately assess reverse remodelling and non-invasively detect focal and interstitial diffuse myocardial fibrosis. Following SAVR or TAVI for aortic stenosis, interstitial diffuse fibrosis can regress, accompanied by structural and functional improvement that CMR can accurately assess.
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Affiliation(s)
- Emmanuelle Vermes
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Laura Iacuzio
- Department of Cardiology, Centre Cardio-Thoracique de Monaco, Monaco City, Monaco
| | - Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Franck Levy
- Department of Cardiology, Centre Cardio-Thoracique de Monaco, Monaco City, Monaco
| | - Claudia Loardi
- Department of Thoracic Surgery, Tours University Hospital, Tours, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
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6
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Brener MI, Kapadia SR, Burkhoff D. Reverse Left Ventricular Remodeling With Transcatheter Interventions in Chronic Heart Failure Syndromes: An Updated Appraisal of the Device Landscape. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101196. [PMID: 39131059 PMCID: PMC11307650 DOI: 10.1016/j.jscai.2023.101196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 08/13/2024]
Abstract
Chronic heart failure (HF) is a clinical syndrome of myocardial dysfunction characterized by inadequate cardiac output or preserved output that can only be achieved by sustaining abnormal loading conditions. Morphologically, HF with reduced left ventricular function results in progressive chamber remodeling, meaning the ventricle dilates, operating at larger end-diastolic and end-systolic volumes, and takes on an abnormal, spherical shape that increases wall stress. Reverse remodeling is the goal of HF-directed therapies and can be achieved by biological means, ie, altering the loading conditions that, at a cellular level, promote myocardial dysfunction, or physical means, ie, directly altering myocardial mass or shape. In this review, we highlight the existing and emerging device-based mechanisms for biologically and physically reverse remodeling the left ventricle in chronic HF.
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Affiliation(s)
- Michael I. Brener
- Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Samir R. Kapadia
- Division of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Daniel Burkhoff
- Division of Cardiology, Columbia University Medical Center, New York, New York
- Cardiovascular Research Foundation, New York, New York
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7
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Escárcega RO, Lopez-Mattei J. Editorial: The importance of RV-PA coupling assessment prior to TAVR in patients with RV dysfunction and pulmonary hypertension. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 56:35-36. [PMID: 37391323 DOI: 10.1016/j.carrev.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Affiliation(s)
- Ricardo O Escárcega
- Cardiac Catheterization Laboratory, Heart and Vascular Institute, Lee Health, United States of America.
| | - Juan Lopez-Mattei
- Medical Director of Cardiac Imaging, Heart and Vascular Institute, Lee Health, United States of America
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8
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Küçükseymen S, Ciardetti N, Stolcova M, Mario CD, Meucci F. Platypnea-Orthodeoxia Syndrome Following Transcatheter Aortic Valve Replacement. Anatol J Cardiol 2023; 27:549-551. [PMID: 37551749 PMCID: PMC10510414 DOI: 10.14744/anatoljcardiol.2023.3217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Affiliation(s)
- Selçuk Küçükseymen
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Niccolò Ciardetti
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Miroslava Stolcova
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Carlo di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | - Francesco Meucci
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
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Lange T, Backhaus SJ, Beuthner BE, Topci R, Rigorth KR, Kowallick JT, Evertz R, Schnelle M, Ravassa S, Díez J, Toischer K, Seidler T, Puls M, Hasenfuß G, Schuster A. Functional and structural reverse myocardial remodeling following transcatheter aortic valve replacement: a prospective cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2022; 24:45. [PMID: 35897100 PMCID: PMC9331125 DOI: 10.1186/s12968-022-00874-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since cardiovascular magnetic resonance (CMR) imaging allows comprehensive quantification of both myocardial function and structure we aimed to assess myocardial remodeling processes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). METHODS CMR imaging was performed in 40 patients with severe AS before and 1 year after TAVR. Image analyses comprised assessments of myocardial volumes, CMR-feature-tracking based atrial and ventricular strain, myocardial T1 mapping, extracellular volume fraction-based calculation of left ventricular (LV) cellular and matrix volumes, as well as ischemic and non-ischemic late gadolinium enhancement analyses. Moreover, biomarkers including NT-proBNP as well as functional and clinical status were documented. RESULTS Myocardial function improved 1 year after TAVR: LV ejection fraction (57.9 ± 16.9% to 65.4 ± 14.5%, p = 0.002); LV global longitudinal (- 21.4 ± 8.0% to -25.0 ± 6.4%, p < 0.001) and circumferential strain (- 36.9 ± 14.3% to - 42.6 ± 11.8%, p = 0.001); left atrial reservoir (13.3 ± 6.3% to 17.8 ± 6.7%, p = 0.001), conduit (5.5 ± 3.2% to 8.4 ± 4.6%, p = 0.001) and boosterpump strain (8.2 ± 4.6% to 9.9 ± 4.2%, p = 0.027). This was paralleled by regression of total myocardial volume (90.3 ± 21.0 ml/m2 to 73.5 ± 17.0 ml/m2, p < 0.001) including cellular (55.2 ± 13.2 ml/m2 to 45.3 ± 11.1 ml/m2, p < 0.001) and matrix volumes (20.7 ± 6.1 ml/m2 to 18.8 ± 5.3 ml/m2, p = 0.036). These changes were paralleled by recovery from heart failure (decrease of NYHA class: p < 0.001; declining NT-proBNP levels: 2456 ± 3002 ng/L to 988 ± 1222 ng/L, p = 0.001). CONCLUSION CMR imaging enables comprehensive detection of myocardial remodeling in patients undergoing TAVR. Regression of LV matrix volume as a surrogate for reversible diffuse myocardial fibrosis is accompanied by increase of myocardial function and recovery from heart failure. Further data are required to define the value of these parameters as therapeutic targets for optimized management of TAVR patients. Trial registration DRKS, DRKS00024479. Registered 10 December 2021-Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024479.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Bo Eric Beuthner
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Rodi Topci
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Karl-Rudolf Rigorth
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Moritz Schnelle
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Clinical Chemistry, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Susana Ravassa
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Karl Toischer
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tim Seidler
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Miriam Puls
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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10
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Alotaibi S, Elbasha K, Landt M, Kaur J, Kurniadi A, Abdel-Wahab M, Toelg R, Richardt G, Allali A. Prognostic Value of HFA-PEFF Score in Patients Undergoing Transcatheter Aortic Valve Implantation. Cureus 2022; 14:e27152. [PMID: 36017287 PMCID: PMC9393071 DOI: 10.7759/cureus.27152] [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] [Accepted: 07/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background The HFA-PEFF score may help in predicting long-term outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis and preserved left ventricular ejection fraction (EF). Methods We retrieved data from 1,332 patients undergoing TAVI between 2010 and 2019 from the Prospective Segeberg TAVI Registry (ClinicalTrials.gov Identifier: NCT03192774). We calculated the HFA-PEFF score for 1,022 patients who had preserved EF (≥50%). To assess the prognostic value of the HFA-PEFF score in predicting adverse events, we dichotomised the patients according to a cut-off score of five (score <5 group: n=528 (51.6%), score ≥5 group: n=494 (48.3%)). Results The HFA-PEFF score ≥5 groups were older (81.9±6.3 years vs. 80.3±6.9 years; p<0.001) and had a higher prevalence of atrial fibrillation (35.1% vs 20.8%; p<0.001) and chronic kidney disease (30.1% vs 26.1%; p<0.001). Kaplan-Meier survival analyses over 24 months showed increased cardiovascular (CV) mortality (12.5% vs. 7.7%, log-rank; p=0.028) and first heart failure-related rehospitalisation (7.7% vs. 4.0%, log-rank p=0.014) in the HFA-PEFF score ≥5 groups compared with those of lower scores. No significant difference in all-cause mortality between both groups was observed (22.0% vs. 17.9%, log-rank p=0.127). In multivariate analysis, HFA-PEFF score ≥5 failed to predict CV mortality (aHR 1.37, 95% CI: 0.90-2.08, p=0.140) and time to first heart failure-related rehospitalisation (aHR 1.49, 95% CI: 0.83-2.65, p=0.181). Conclusion The HFA-PEFF score showed limited value in predicting long-term mortality and adverse heart failure-related events in patients with preserved EF undergoing TAVI. Clinical variables specific to this population could complement the HFA-PEFF score for better risk prediction.
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11
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Seoudy H, Eberstein M, Frank J, Thomann M, Puehler T, Lutter G, Lutz M, Bramlage P, Frey N, Saad M, Frank D. HFA‐PEFF score: prognosis in patients with preserved ejection fraction after transcatheter aortic valve implantation. ESC Heart Fail 2022; 9:1071-1079. [PMID: 35092186 PMCID: PMC8934930 DOI: 10.1002/ehf2.13774] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 10/31/2021] [Accepted: 12/02/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
- Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
| | - Mira Eberstein
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
| | - Johanne Frank
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
| | - Maren Thomann
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
| | - Thomas Puehler
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
- Department of Cardiac and Vascular Surgery University Hospital Schleswig‐Holstein, Campus Kiel Kiel Germany
| | - Georg Lutter
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
- Department of Cardiac and Vascular Surgery University Hospital Schleswig‐Holstein, Campus Kiel Kiel Germany
| | - Matthias Lutz
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine Cloppenburg Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology Heidelberg University Hospital Heidelberg Germany
- DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim Heidelberg Germany
| | - Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology University Hospital Schleswig‐Holstein, Campus Kiel Arnold‐Heller‐Str.3, Haus K3 Kiel 24105 Germany
- DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck Kiel Germany
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