scholarly journals EARLY IMPROVEMENT IN FLOW (LEFT VENTRICULAR STROKE VOLUME INDEX) AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT IS ASSOCIATED WITH IMPROVED SURVIVAL IN LOW-FLOW AORTIC STENOSIS

2015 ◽  
Vol 65 (10) ◽  
pp. A1709
Author(s):  
Venkatesh Y. Anjan ◽  
Howard Herrmann ◽  
Philippe Pibarot ◽  
William Stewart ◽  
Samir Kapadia ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Replacement ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Low Flow ◽  
Volume Index ◽  
Left Ventricular Stroke Volume ◽  
Early Improvement ◽  
Transcatheter Aortic Valve

scholarly journals P1370 Correlation of aortic stenosis by integrated transthoracic and transesophageal echocardiography with calcium score

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Schwartzenberg ◽  
Y Shapira ◽  
M Vaturi ◽  
M Nassar ◽  
A Hamdan ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Low Flow ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Coronary Ct

Abstract Funding Acknowledgements None BACKGROUND Aortic stenosis (AS) classification depends on left-ventricular ejection-fraction (LVEF <≥50%), aortic valve area (AVA<≥1cm2), mean pressure gradient (MG<≥40mmHg), peak velocity<≥400 cm/sec, and stroke-volume index (SVI<≥35ml/m2). Aortic Valve Agatston CT score (AVC) correlates with AS severity by trans-thoracic echo (TTE), but its association with AS severity determined by integrated TTE and TEE is unknown. PURPOSE We investigated correlation of AVC with dichotomous AS grouping by Integrated TTE + TEE vs TTE only. METHODS 64 TAVI candidates underwent sequential TTE and TEE, of which 24 underwent coronary CT within 4 months. Based on recommended conservative vs invasive treatment implication (A/B respectively), AS types were aggregated separately by TTE or Integrated TTE-TEE into two groups: Group-A (Moderate AS and Normal-Flow Low-Gradient), and Group-B (High-Gradient, Low-EF Low-Flow Low-Gradient, and Paradoxical Low-Flow Low-Gradient). Continuous and dichotomous AVC correlation (cutoffs based on guidelines) with echo binary classification was then determined. RESULTS Patients were 81.1(77.3-84.6) years old, 18(48.6%) were women, and had LVEF of 60% (49-65). AVC-score distribution in the two AS A/B Groups by two echo modalities is presented in the boxplot Figure. Only classification by TTE held discriminative accuracy in A/B grouping, with Area-Under-Curve of 0.736 (CI 0.57-0.9), and optimal threshold value of 1946 AU having 77% sensitivity and 74% specificity. Compared with AVC dichotomous classification, integrated TTE + TEE upgraded AS class (from A to B) in 5/6 (83.3%) patients vs 12/18 (66.7%) in which it downgraded AS class from B to A. CONCLUSIONS Aortic valve calcification correlates well with AS class dichotomized by operative implication through conventional TTE but not through integrated TTE + TEE. Our preliminary results appear to be caused by initial selection bias of patients in whom coronary CT performance was deemed to be justified by the treating physician rather than reflect a true better correlation between CT score and AS assessment by TTE vs by integrated TTE + TEE. Abstract P1370 Figure.

scholarly journals Use of passive leg rise as an add-on to dobutamine in patients with paradoxical low-flow, low-gradient aortic stenosis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Buffle ◽  
A Papadis ◽  
C Seiler ◽  
S F De Marchi
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Low Flow ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Low Ejection Fraction ◽  
Valve Area

Abstract Background Dobutamine has been proposed for the assessment of low-flow, low-gradient aortic stenosis (LFLGAS). However, in 1/3 of patients, no increase in stroke volume index can be achieved by Dobutamine, thus hampering its diagnostic value. This study evaluated the manoeuvre of cardiac preload augmentation by passive leg rise (PLR) alone or on top of Dobutamine to increase stroke volume index (SVI) in patients with LFLGAS, particularly in paradoxical LFLGAS. Methods We examined 50 patients with LFLGAS. Patients were assigned to the paradoxical LFLGAS (Paradox) group if left ventricular ejection fraction (LVEF) was ≥50% (n=29) and to the LFLGAS with low ejection fraction (LEF) group if LVEF was <50% (n=21). A modified Dobutamine stress echocardiography was performed in all patients with the following 4 steps: Rest, PLR alone, maximal Dobutamine infusion rate alone (Dmax) and Dobutamine plus PLR (Dmax + PLR). Three SVI measurement methods were used: first the left ventricular outflow tract velocity time integral (LVOT VTI) method, second the 2D Simpson's method, and third the 3D method. The corresponding aortic valve area (AVA) was obtained by the continuity equation. The increase of those values compared to measurements at rest was calculated and compared between the 3 stress steps. Results In the paradoxical LFLGAS group, delta SVI with Dmax assessed by both Simpson's (depicted in the figures) and 3D method was lowest compared to PLR and Dmax + PLR. PLR alone yielded an equally high delta SVI as Dmax + PLR in Simpson's and 3D, and was at least as high as Dmax across all methods. Dobutamine alone yielded the lowest delta transaortic aortic valve VTI. The highest delta aortic valve area resulted for Dmax + PLR. In the LEF group, the three stress steps yielded an equally high delta SVI with Simpson's method. Dmax never yielded a higher delta SVI than PLR alone. The yielded delta SVI was the highest for Dmax + PLR for both LVOT VTI and 3d method, although the difference was overall not as strong as in the Paradox group. Conclusions In patients with paradoxical LFLGAS, Dobutamine alone is inadequate for testing the potential of aortic valve opening augmentation. Instead, PLR alone or the addition of PLR plus Dobutamine should be used for that purpose. In low LVEF, adding PLR to Dobutamine also seems useful although its diagnostic added value is less evident than in the Paradox group. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): Gottfried und Julia Bangerter-Rhyner-Foundation Paradox group Low ejection fraction group

Abstract 13432: Left Ventricular External Work as a Marker of Cardiac Functional Recovery and Outcome After Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shingo Tsujinaga ◽  
Hiroyuki Iwano ◽  
Ko Motoi ◽  
Yasuyuki Chiba ◽  
Suguru Ishizaka ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Functional Recovery ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Volume Index ◽  
External Work ◽  
Transcatheter Aortic Valve ◽  
Reduced Group

Background: Prediction of cardiac functional recovery and outcome after transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) is still challenging. We hypothesized that left ventricular (LV) external work estimated by echocardiography before TAVR would reflect potential myocardial damage and thus could be associated with changes in cardiac function and prognosis after TAVR. Methods: Echocardiography was performed in 70 AS patients (83 ± 5 years old) before and after TAVR (1 month and 6 months). LV stroke work index (SWI) was calculated as stroke volume index (SVI) х [mean systemic blood pressure + mean pressure gradient across aortic valve (mPG)] before TAVR as a parameter of LV external work. Patients were divided into reduced and preserved SWI group based on the median value (6106 mmHg · mL/m 2 ). Cardiac events were defined as cardiac death or worsening heart failure within 12 months after TAVR. Results: Reduced group had lower SVI (40 ± 7 vs 57 ± 8 mL/m 2 ), mPG (44 ± 14 vs 57 ± 16 mmHg), and smaller aortic valve area index (0.4 ± 0.1 vs 0.5 ± 0.1 cm 2 /m 2 ) than preserved group at baseline (p < 0.05 for all), although LV mass index (LVMI) (116 ± 35 vs 128 ± 30 g/m 2 ) and left atrial volume index (LAVI) (56 ± 20 vs 52 ± 17 mL/m 2 ) were comparable. LV ejection fraction (EF) (57 ± 13 vs 66 ± 7%) and global longitudinal strain (GLS) (–14.2 ± 4.6 vs –16.6 ± 4.8%) at baseline were significantly lower in reduced group than in preserved one. After TAVR, LVMI and LAVI did not change in reduced group ( Table 1 ). In contrast, preserved group showed significant decrease in these parameters. Although LV EF did not change in both groups, GLS was significantly improved only in preserved group but not in reduced group ( Table 1 ). Seven patients (10%) experienced cardiovascular events after TAVR and all these belonged reduced group. Conclusions: Reduced SWI before TAVR was associated with poor response in cardiac function after TAVR and might be a prognostic marker in AS patients undergoing TAVR.

Abstract 14646: Left Ventricular Global Longitudinal Strain and CT Derived Extracellular Volume Predicts Outcomes in Patients With Low-flow, Low-gradient Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Maulin B Shah ◽  
Suzanne Oskouie ◽  
Nir Flint ◽  
James Mirocha ◽  
Donghee Han ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Replacement ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Low Flow ◽  
Transcatheter Aortic Valve ◽  
Lv Remodeling

Introduction: Low-flow, low-gradient aortic stenosis (LFLG-AS) is associated with impaired left ventricular (LV) function and afterload mismatch. Indications and timing for transcatheter aortic valve replacement (TAVR) in LFLG-AS do not account for the presence of subclinical LV remodeling. We evaluated whether combining LV global longitudinal strain (GLS) and CT-derived extracellular volume (ECV), both markers of LV remodeling, provides incremental prediction of adverse outcomes in patients with LFLG-AS undergoing TAVR. Methods: We retrospectively evaluated patients with LFLG-AS undergoing TAVR in whom pre-TAVR CT-based ECV measurements were available. GLS was measured in pre-TAVR echocardiograms using speckle tracking. Cox regression analysis was performed with a primary outcome of heart failure hospitalization (HFH) or death. Four sub-groups were identified for analysis based on optimal cutoff points: Group 1 (n=64): ECV< 33 + GLS≥

scholarly journals Left Ventricular Mechanics Differ in Subtypes of Aortic Stenosis Following Transcatheter Aortic Valve Replacement

2022 ◽  
Vol 8 ◽  
Author(s):  
Adil Wani ◽  
Daniel R. Harland ◽  
Tanvir K. Bajwa ◽  
Stacie Kroboth ◽  
Khawaja Afzal Ammar ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Survival Benefit ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Low Flow ◽  
Normal Flow ◽  
Transcatheter Aortic Valve

BackgroundLeft 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.MethodsWe 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.ResultsBoth GLS (−13.9 ± 4.3 to −14.8 ± 4.3, P &lt; 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 &lt; 0.0001).ConclusionsLV 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.

scholarly journals Transcatheter Aortic Valve Replacement (TAVR) in Low Flow-Low Gradient Severe Aortic Stenosis without Cardiac Reserve

2017 ◽  
Vol 2 ◽  
Author(s):  
Anuraj Sudhakaran ◽  
Mahek Shah ◽  
Aparna Baburaj ◽  
Brijesh Patel ◽  
Matthew Martinez ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Low Flow ◽  
Left Ventricular Ejection ◽  
Contractile Reserve ◽  
Transcatheter Aortic Valve

<p>With accumulating positive evidence in favour of <em>transcatheter aortic valve replacement</em> (TAVR) over a surgical <em>approach</em>, it has replaced surgical AVR to become the mainstay of treatment for severe symptomatic aortic stenosis in patients with prohibitive and high surgical risk. There is significant surgical mortality and morbidity associated with surgical aortic valve replacement in patients with low flow-low gradient (LFLG) true severe aortic valve stenosis (AS) and severely reduced left ventricular ejection fraction (rEF) without contractile reserve (CR). CR is measured following use of dobutamine in an attempt to increase cardiac output by more than 20% while differentiating severe from pseudostenosis in some cases. The value of <em>transcatheter aortic valve replacement</em> (TAVR) over a surgical <em>approach</em> for these patients with rEF LFLG true severe AS and no CR is uncertain. We present a patient with LFLG severe AS and low left ventricular EF without contractile reserve who underwent TAVR and experienced significant improvement in their clinical status without complications.</p>

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