scholarly journals NON-INVASIVE EVALUATION OF AORTIC PRESSURE, FLOW AND VALVULO-ARTERIAL LOAD IN PATIENTS WITH AORTIC STENOSIS BEFORE AND AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT

2021 ◽  
Vol 77 (18) ◽  
pp. 1140
Author(s):  
Ning Song ◽  
Audrey Adji ◽  
Sara Hungerford ◽  
Mayooran Namasivayam ◽  
Christopher Hayward ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Aortic Pressure ◽  
Non Invasive ◽  
Transcatheter Aortic Valve ◽  
Arterial Load ◽  
Before And After ◽  
Invasive Evaluation

scholarly journals Personalized intervention cardiology with transcatheter aortic valve replacement made possible with a non-invasive monitoring and diagnostic framework

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seyedvahid Khodaei ◽  
Alison Henstock ◽  
Reza Sadeghi ◽  
Stephanie Sellers ◽  
Philipp Blanke ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Blood Flow ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Diagnostic Methods ◽  
Patient Specific ◽  
Non Invasive ◽  
Transcatheter Aortic Valve

AbstractOne of the most common acute and chronic cardiovascular disease conditions is aortic stenosis, a disease in which the aortic valve is damaged and can no longer function properly. Moreover, aortic stenosis commonly exists in combination with other conditions causing so many patients suffer from the most general and fundamentally challenging condition: complex valvular, ventricular and vascular disease (C3VD). Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. Although blood flow quantification is critical for accurate and early diagnosis of C3VD in both pre and post-TAVR, proper diagnostic methods are still lacking because the fluid-dynamics methods that can be used as engines of new diagnostic tools are not well developed yet. Despite remarkable advances in medical imaging, imaging on its own is not enough to quantify the blood flow effectively. Moreover, understanding of C3VD in both pre and post-TAVR and its progression has been hindered by the absence of a proper non-invasive tool for the assessment of the cardiovascular function. To enable the development of new non-invasive diagnostic methods, we developed an innovative image-based patient-specific computational fluid dynamics framework for patients with C3VD who undergo TAVR to quantify metrics of: (1) global circulatory function; (2) global cardiac function as well as (3) local cardiac fluid dynamics. This framework is based on an innovative non-invasive Doppler-based patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-solid interaction. We validated the framework against clinical cardiac catheterization and Doppler echocardiographic measurements and demonstrated its diagnostic utility by providing novel analyses and interpretations of clinical data in eleven C3VD patients in pre and post-TAVR status. Our findings position this framework as a promising new non-invasive diagnostic tool that can provide blood flow metrics while posing no risk to the patient. The diagnostic information, that the framework can provide, is vitally needed to improve clinical outcomes, to assess patient risk and to plan treatment.

Myocardial work assessment in severe aortic stenosis undergoing transcatheter aortic valve replacement

2020 ◽  
Author(s):  
Renuka Jain ◽  
Tanvir Bajwa ◽  
Sarah Roemer ◽  
Hillary Huisheree ◽  
Suhail Q Allaqaband ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Systolic Blood Pressure ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Non Invasive ◽  
Transcatheter Aortic Valve

Abstract Aims Myocardial work is a novel echocardiographic algorithm that corrects speckle-tracking-derived global longitudinal strain (GLS) for afterload using non-invasive systolic blood pressure as a surrogate for left ventricular systolic pressure (LVSP). Yet, in patients with severe aortic stenosis, non-invasive systolic blood pressure does not equal LVSP. Methods and results We evaluated 35 patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR). Transthoracic echocardiography, including myocardial mechanics, was performed pre- and post-TAVR. We performed simultaneous echocardiographic and cardiac catheterization measurements in 23 of the 35 patients at the time of TAVR. Peak and mean aortic gradients were calculated from echocardiographic and cardiac catheterization data. Peak-to-peak LV-aortic gradient correlated highly with mean LV-aortic gradient (r = 0.96); measured LVSP correlated highly with our novel method of non-invasively estimated LVSP (non-invasive systolic blood pressure cuff + Doppler-derived mean aortic gradient, r = 0.92). GLS improved from pre- to post-TAVR (−14.2% ± 4.3 vs. −15.1% ± 3.2), and myocardial work reduced from corrected pre-TAVR to post-TAVR (global work index: 1856.2 mmHg% ± 704.6 vs. 1534.8 ± 385.0). Conclusion We propose that non-invasive assessment of myocardial work can be reliably performed in aortic stenosis by the addition of mean aortic gradient to non-invasive systolic blood pressure. From this analysis, we note the novel and unique finding that GLS can improve as myocardial work reduces post-TAVR in patients with severe aortic stenosis. Both GLS and myocardial work post-TAVR remain below normal values, requiring further studies.

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