Left ventricle myocardial deformation pattern in severe aortic valve stenosis without cardiac amyloidosis. The AMY-TAVI trial

Aortic valve stenosis impairs subendocardial perfusion with a risk of irreversible subendocardial tissue damage. A likely precursor of damage is subendocardial contractile dysfunction, expressed by the parameter TransDif, which is defined as epicardial minus endocardial myofiber shortening, normalized to the mean value. With the use of magnetic resonance tagging in two short-axis slices of the left ventricle (LV), TransDif was derived from LV torsion and contraction during ejection. TransDif was determined in healthy volunteers (control, n = 9) and in patients with aortic valve stenosis before (AVSten, n = 9) and 3 mo after valve replacement (AVRepl, n = 7). In the control group, TransDif was 0.00 ± 0.14 (mean ± SD). In the AVSten group, TransDif increased to 0.96 ± 0.62, suggesting impairment of subendocardial myofiber shortening. In the AVRepl group, TransDif decreased to 0.37 ± 0.20 but was still elevated. In eight of nine AVSten patients, the TransDif value was elevated individually ( P < 0.001), suggesting that the noninvasively determined parameter TransDif may provide important information in planning of treatment of aortic valve stenosis.

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P5993Comprehensive characterization of experimental aortic valve stenosis by multiparametric MRI

European Heart Journal ◽

10.1093/eurheartj/ehz746.0714 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Quast ◽

S Zimmer ◽

F Boenner ◽

C Jacoby ◽

I Gyamfi-Poku ◽

...

Keyword(s):

High Resolution ◽

Aortic Valve ◽

Left Ventricle ◽

Disease Progression ◽

Experimental Model ◽

Aortic Valve Stenosis ◽

Three Dimensional ◽

Left Ventricular ◽

Ascending Aorta ◽

Aortic Flow

Abstract Background Recently, we established an experimental model of moderate aortic valve stenosis (AS) aiming to mimic human disease progression closely. Functional and structural MRI of a mouse model in experimental aortic valve stenosis has not been accomplished so far. Purpose Here, we aimed at developing comprehensive MRI approach for simultaneous assessment of changes in valvular, left ventricular and aortic morphology and function. Methods Male 12-week-old wildtype mice (C57Bl/6) were subjected to wire injury of the aortic valve to induce aortic valve stenosis. High resolution MRI at 9.4T was used to monitor subsequent functional and structural changes in the aortic valve, the ascending aorta, the left ventricle and aortic flow patterns. Results MRI permits accurate planimetry of the orifice and the thickness of the aortic valve, allows a reliable three-dimensional mapping of transvalvular aortic flow, simultaneously depicts aortic regurgitation in 3D fashion and permits assessment of left ventricular changes due to AS. In our model we observed a reduced valve orifice and an increase in valve thickness. Homogenous flow pattern under control converted to heterogenous and turbulent flow with progression of AS associated with increased aortic strain, aortic wall and left ventricular wall thickness. Conclusions In a murine model of aortic valve stenosis MRI is capable to reliably display a three-dimensional transvalvular aortic flow profile with concomitant quantification of structural and functional changes in aortic valve, left ventricle, and ascending aorta. This comprehensive functional imaging at high resolution and distinct reproducibility offers for the first time serial assessment of disease progression in an experimental model of aortic valve stenosis.

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Fetoscopy-assisted enables valvuloplasty in a human fetus with disadvantageous intrauterine position — A case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab293 ◽

2021 ◽

Author(s):

Thomas Kohl ◽

Ibrahim Akin ◽

Juliane Frommberger ◽

Nadja Riehle ◽

Dietmar Schranz

Keyword(s):

Case Report ◽

Aortic Valve ◽

Left Ventricle ◽

Minimally Invasive ◽

Aortic Valve Stenosis ◽

Human Fetus ◽

Balloon Valvuloplasty ◽

Ultrasound Guided ◽

Less Invasive ◽

Preterm Rupture Of Membranes

Abstract Background Some fetuses scheduled for balloon valvuloplasty present with unfavorable lies that render a successful procedure unlikely or impossible. In these situations, Foetal posturing previously has been achieved by maternal laparotomy. As a less invasive means, we demonstrate the feasibility of a minimally-invasive fetoscopic approach. Case Percutaneous ultrasound-guided Foetal balloon valvuloplasty for severe aortic valve stenosis was attempted in a human fetus at 29 + 4 weeks of gestation under general maternofetal anesthesia. Unfortunately, prior to the procedure, the fetus had been observed on several occasions remaining in a dorso-anterior cephalic position. Therefore, the left ventricle could not be accessed by the conventional percutaneous ultrasound-guided approach. In order to achieve the desired Foetal lie, fetoscopic assistance was employed: using a standardized fetoscopic setup, a fetoscope and two graspers, the fetus was rotated in dorsoposterior position. After this maneuver, successful balloon valvuloplasty was achieved. Mother and fetus tolerated the procedure well and complications were not observed. Discussion Fetoscopy-assisted Foetal posturing offers itself as an alternative to maternal laparotomy in fetuses presenting with a persisting disadvantageous position at the time of ballon valvuloplasty. Due to the increased risks of preterm rupture of membranes and earlier delivery posed by the fetoscopic approach, this technique may preferably be used in more mature fetuses when Foetal posturing cannot be achieved by other means.

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Retrograde transfemoral catheterization of the left ventricle in children with aortic valve stenosis

Pediatric Cardiology ◽

10.1007/bf02328955 ◽

1986 ◽

Vol 7 (2) ◽

pp. 79-82 ◽

Cited By ~ 1

Author(s):

Kai-Chiu Lau ◽

Maurice Ping Leung ◽

Roxy N. S. Lo

Keyword(s):

Aortic Valve ◽

Left Ventricle ◽

Aortic Valve Stenosis

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P5987Novel model of intensity graded murine wire-induced aortic valve stenosis mimics distinct stages of human aortic valve pathology

European Heart Journal ◽

10.1093/eurheartj/ehz746.0708 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S T Niepmann ◽

E Steffen ◽

A Zietzer ◽

M Adam ◽

J Nordsiek ◽

...

Keyword(s):

Aortic Valve ◽

Left Ventricle ◽

Ejection Fraction ◽

Flow Velocity ◽

Disease Progression ◽

Aortic Regurgitation ◽

Aortic Valve Stenosis ◽

Left Ventricular ◽

Valve Disease ◽

Severe Injury

Abstract Background Aortic valve stenosis (AS) is the most common valve disease requiring therapeutic intervention. Even though the incidence of AS has been continuously rising and AS is associated with significant morbidity and mortality, to date, no medical treatments have been identified that can modify disease progression. In fact, only invasive interventional or surgical replacement of severely diseased valves is recommended. This unmet medical need is likely attributed to the lack of a clear understanding of the molecular mechanism driving disease development. To investigate the pathophysiology leading to AS, reliable and reproducible animal models that mimic human pathophysiology are needed. Hypothesis Induction of a graded wire-induced aortic valve stenosis model in mice is feasible to reflect and study pathophysiological mechanisms underlying the progression of aortic valve stenosis. Methods We have tested and expanded the protocols of a novel wire-injury induced aortic valve stenosis mouse model. A spring coronary guide wire or a bare metal wire was used to apply shear stress to the aortic valve cusps with increasing intensity with ultrasound-guided monitoring in male 10 to 12-week-old C57Bl/6j mice. These protocols allowed the induction of distinct models with soft, moderate and intense wire injury. Functional analysis including maximum flow velocity (Vmax), ejection fraction, fractional shortening, left ventricular volumes, diameters and wall thickness were assessed by echocardiography before, one and four weeks after induction of aortic valve stenosis. Immunohistological analysis were performed after eight weeks (hematoxylin and eosin, von-Kossa staining, anti-CD68-staining). Results Upon moderate or severe injury, AS developed with a significant increase in aortic valve peak blood flow velocity. While moderate injury promoted solitary AS, severe-injury induced mixed aortic valve disease with concomitant mild to moderate aortic regurgitation. Only 5% of the mice who received a moderate injury displayed a mild aortic regurgitation. In the group of mice with intense injury 50% of the mice had a mild and 18,75% had a moderate aortic insufficiency. The changes in aortic valve function were reflected by dilation and hypertrophy of the left ventricle, as well as a decreased left ventricular ejection fraction after intense injury, while moderate injury did not show significant dilation of the left ventricle. Histological analysis revealed the three classic hallmarks of human disease with aortic valve thickening, increased macrophage infiltration and calcification eight weeks after injury. Conclusion Hereby, we demonstrate that the induction of a graded wire induced aortic valve stenosis model in mice mimicking relevant pathophysiological mechanisms is feasible to study disease progression. We extended existing protocols to induce moderate stenosis allowing to solely study aortic valve stenosis without relevant aortic valve regurgitation. Acknowledgement/Funding S.N. was funded by Else-Kröner-Fresenius-Foundation of the Medical Faculty of the University of Bonn

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On Left Ventricle Stroke Work Efficiency in Children with Moderate Aortic Valve Regurgitation or Moderate Aortic Valve Stenosis

Pediatric Cardiology ◽

10.1007/s00246-021-02690-2 ◽

2021 ◽

Author(s):

M. Asaadi ◽

W. Mawad ◽

A. Djebbari ◽

Z. Keshavardz-Motamed ◽

N. Dahdah ◽

...

Keyword(s):

Aortic Valve ◽

Left Ventricle ◽

Aortic Valve Stenosis ◽

Stroke Work ◽

Valve Regurgitation ◽

Aortic Valve Regurgitation ◽

Work Efficiency

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Coexistence of aortic valve stenosis and cardiac amyloidosis: echocardiographic and clinical significance

Cardiovascular Ultrasound ◽

10.1186/s12947-019-0182-y ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 2

Author(s):

Gergely Peskó ◽

Zsigmond Jenei ◽

Gergely Varga ◽

Astrid Apor ◽

Hajnalka Vágó ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Stenosis ◽

Cardiac Amyloidosis ◽

Dobutamine Stress ◽

Left Ventricular ◽

Low Flow ◽

Diagnostic Process ◽

Al Amyloidosis ◽

Low Grade ◽

Work Up

Abstract Background Left ventricular hypertrophy and diastolic dysfunction are common echocardiographic features of both aortic valve stenosis (AS) and cardiac amyloidosis (CA). These two different entities therefore may mask each other. From recent years, there is a growing body of evidence about the relatively high incidence of wild-type transthyretin (wtTTR) amyloidosis in AS, but there are scarce data on the prevalence of AS in CA, particularly in AL-type amyloidosis. The echocardiographic approach to these patients is not obvious, and not evidence based. We aimed to study the prevalence, severity, and type of AS in patients with CA and also to evaluate the potential of echocardiography in the diagnostic process. Methods Between January 2009 and January 2019, we retrospectively analyzed the clinical and echocardiographic data, and the echocardiographic work up of 55 consecutive CA patients. Results 80% of our CA patients had AL amyloidosis. We identified 5 patients (9%) with moderate to severe AS: two with moderate AS and three with low-flow, low-grade AS (LFLG AS). Further analysis of the latter three patients with dobutamine stress echocardiography revealed pseudo-severe LFLG AS in two, and true-severe AS in one patient. Conclusion The prevalence of moderate to severe AS is 9% in our population of CA patients, the majority of whom have AL amyloidosis. Dobutamine echocardiography seems to be appropriate for the further characterization of patients with LFLG AS, even with normal ejection fraction.

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Left ventricle myocardial deformation pattern in severe aortic valve stenosis without cardiac amyloidosis. AMY-TAVI study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0083 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Bastos Fernandez ◽

D Lopez Otero ◽

J Lopez Pais ◽

V Pubul Nunez ◽

C Neiro Rey ◽

...

Keyword(s):

Aortic Valve ◽

Wall Thickness ◽

Cardiac Amyloidosis ◽

Strain Analysis ◽

Maximum Velocity ◽

Strain Ratio ◽

Left Ventricular ◽

Deformation Pattern ◽

Aortic Valve Area ◽

The Mean

Abstract Background The Longitudinal Strain (LS) pattern in cardiac amyloidosis (CA) typically spares the apex of the heart, and this is a sensitive and specific finding that can be used to distinguish AC from other causes of left ventricular (LV) hypertrophy. Purpose To assess the clinical profitability of the LV deformation echocardiographic criteria derived from LS described as suggestive of CA, in patients with severe symptomatic aortic stenosis (AS) without amyloidosis referred for TAVI. Methods Within AMY-TAVI study (NCT03984877). Prior to TAVI implantation, conventional echocardiographic parameters were analyzed, along with LV deformation parameters and strain phenotype using Speckle-Tracking Echocardiography. Strain derived Indices accepted for CA screening were calculated: RELAPS: relative apical LS (average apical LS/sum of the average basal and mid LS); SAB: septal apical to base ratio (apical septal LS/basal septal LS); EFSR: ejection fraction strain ratio (LVEF/GLS). After implant, technetium pyrophosphate99 scintigraphy and proteinogram were performed to diagnose or exclude CA, and those patients in which CA was excluded were selected. Results 109 patients were consecutively included. The mean age was 81±6 yo, 58% were women. The mean aortic valve area (AVA) was 0.7±0.1 cm2 and the mean LVEF was 57.8±15%. Strain analysis could only be performed in 92 patients. Of these, 39 (42%) presented a LV strain pattern with relative apical sparing of LS respect to basal and middle segments (RELAPS>1 pattern); 82 patients (89%) SAB was >2.1; and 39 (42%) showed EFSR >4.1. The RELAPS>1 pattern was significantly associated with greater severity of AS based on AVA (0.7 cm2 in RELAPS <1 vs 0,6 cm2 in RELAPS >1, p=0.041), maximum velocity (4,4 vs 4,7 m/s, p=0.018), maximum aortic valve gradient (81 vs 91 mmHg, p=0.021) and medium gradient (49 vs 56 mmHg, p=0.020); higher degree of LV hypertrophic remodeling (Maximum wall thickness 14,3 vs 16,1 mm, p=0,003; Relative wall thickness 0,5 vs 0,6 mm, p=0,008); LV mass index: 168 vs 192 gr/m2, p=0,005; LV end-diastolic volume 112 vs 91 ml, p=0,005), and significantly lower myocardial contraction fraction (0,22 vs. 0,18, p=0,001). Conclusions In our series, patients with severe symtomatic AS without CA referred for TAVI frequently present a strain phenotype with relative apical preservation and a LVEF/GLS ratio similar to those described in CA. Our results suggest that the classic patterns of CA are common in patients with severe AS, in absence of said pathology, which limits its use for CA screening in these patients. Polar map patterns according to RELAPS Funding Acknowledgement Type of funding source: None

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