scholarly journals A novel cardiovascular magnetic resonance risk score for predicting mortality following surgical aortic valve replacement

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Vassilios S. Vassiliou ◽  
Menelaos Pavlou ◽  
Tamir Malley ◽  
Brian P. Halliday ◽  
Vasiliki Tsampasian ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Risk Score ◽  
Left Ventricular ◽  
Surgical Aortic Valve Replacement ◽  
Overall Mortality

AbstractThe increasing prevalence of patients with aortic stenosis worldwide highlights a clinical need for improved and accurate prediction of clinical outcomes following surgery. We investigated patient demographic and cardiovascular magnetic resonance (CMR) characteristics to formulate a dedicated risk score estimating long-term survival following surgery. We recruited consecutive patients undergoing CMR with gadolinium administration prior to surgical aortic valve replacement from 2003 to 2016 in two UK centres. The outcome was overall mortality. A total of 250 patients were included (68 ± 12 years, male 185 (60%), with pre-operative mean aortic valve area 0.93 ± 0.32cm2, LVEF 62 ± 17%) and followed for 6.0 ± 3.3 years. Sixty-one deaths occurred, with 10-year mortality of 23.6%. Multivariable analysis showed that increasing age (HR 1.04, P = 0.005), use of antiplatelet therapy (HR 0.54, P = 0.027), presence of infarction or midwall late gadolinium enhancement (HR 1.52 and HR 2.14 respectively, combined P = 0.12), higher indexed left ventricular stroke volume (HR 0.98, P = 0.043) and higher left atrial ejection fraction (HR 0.98, P = 0.083) associated with mortality and developed a risk score with good discrimination. This is the first dedicated risk prediction score for patients with aortic stenosis undergoing surgical aortic valve replacement providing an individualised estimate for overall mortality. This model can help clinicians individualising medical and surgical care.Trial Registration ClinicalTrials.gov Identifier: NCT00930735 and ClinicalTrials.gov Identifier: NCT01755936.

P909Echocardiographic Assessment of Left Ventricular Function in Patients with Aortic Stenosis and the short-term effects after intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Alfarih ◽  
C Leu ◽  
J Moon ◽  
A Hughes ◽  
P Nihoyannopoulos ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Ventricular ◽  
Myocardial Deformation ◽  
P Value ◽  
Compensatory Mechanisms ◽  
Surgical Aortic Valve Replacement ◽  
The Impact

Abstract Introduction Aortic stenosis (AS) is the most prevalent form of acquired valvular heart disease, it affects ∼2% of people aged over 75. Series of compensatory mechanisms occur, in order for LV to adapt to high pressure overload. Aortic valve replacement has been the mainstay AS treatment either surgically or percutaneously. The evaluation of myocardial strains after Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR) is still underexplored and there is no single study to date scouting the difference between TAVI and SAVR. Aim To assess the impact of unloading LV after TAVI and SAVR on LV remodelling. Methods In this prospective study, we have recruited 111 patients (75±11 years, 63% were females) with varying degrees of aortic stenosis. Of the 111 patients, 43 patients and 11 patients underwent TAVI and SAVR respectively between November 2017 and May 2018. Demographics, clinical and echocardiographic measurements along with speckle tracking parameters were recorded for all participants and again 4±2 weeks after intervention. Results Pre-TAVI LV-GLS mean was −10.8±3.5% and after implantation of aortic prosthesis immediate improvement of the myocardial deformation to −13.98±2.9% was observed after one month of the intervention, mean difference of −3.16% following procedure. There was an evidence of significant improvement in LV-GRS after TAVI (44.86±12.9% to 49.77±10.8%, P value= 0.047). Per contra, when comparing pre and post TAVI LV-GCS, no statistical evidence was noted. However, a difference of −2.4% in GCS following the intervention might be clinically important, but no previous evidence can support this. This is attributed to the poor reproducibility and yet not available standardisation. Table 1 Variables TAVI (n=43) SAVR (n=11) P value† Pre Post P* value Pre Post P* value GLS (%) −10.82±3.5 −13.98±2.9 <0.001 −12.75±4.3 −16.1±2 0.021 0.152 GCS (%) −30.1±8.1 −32.49±9.2 0.134 −27±9.8 −33.9±4.69 0.063 0.062 GRS (%) 44.86±12.9 49.77±10.8 0.047 36.6±13.3 44.97±4.9 0.074 0.058 Data are expressed as mean ± SD. Comparisons were performed using paired Student's t tests. *Pre and post intervention. †Post TAVI vs. post SAVR. Comparison done using unpaired t test of the differences. Conclusion Significant improvement was evident in myocardial deformation parameters – in particular GLS – after weeks of the intervention demonstrating a strong evidence of reversed remodelling following SAVR and TAVI.

scholarly journals Echocardiographic assessment of diastolic dysfunction in elderly patients with severe aortic stenosis before and after aortic valve replacement

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Hatice Akay Caglayan ◽  
Didrik Kjønås ◽  
Siri Malm ◽  
Henrik Schirmer ◽  
Assami Rösner
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Diastolic Dysfunction ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Surgical Aortic Valve Replacement ◽  
Echocardiographic Parameters

Abstract Background The 2016 guidelines of the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) for evaluation of left ventricular (LV) diastolic dysfunction by Doppler flow and tissue Doppler- echocardiography do not adjust assessment of high filling pressures for patients with aortic stenosis (AS). However, most of the studies on this patient group indicate age independent specific diastolic features in AS. The aim of this study is to identify disease-specific range and distribution of diastolic functional parameters and their ability to identify high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels as a marker for high filling pressures. Methods In this study, 169 patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Resting echocardiography was performed including Doppler of the mitral inflow, pulmonary venous flow, tricuspid regurgitant flow and tissue Doppler in the mitral ring and indexed volume-estimates of the left atrium (LAVI). Echocardiography, and NT-proBNP levels were assessed before TAVR/SAVR and at two postoperative visits at 6 and 12 months. Results Pre- and postoperative values were septal e′; 5.1 ± 3.9, 5.2 ± 1.6 cm/s; lateral e′ 6.3 ± 2.1; 7.7 ± 2.7 cm/s; E/e′19 ± 8; 16 ± 7 cm/s; E velocity 96 ± 32; 95 ± 32 cm/s; LAVI 39 ± 8; 36 ± 8 ml/m2, pulmonary artery pressure (PAP) 39 ± 8; 36 ± 8 mmHg, respectively. The scoring recommended by ASE/EACVI detected elevated NT pro-BNP with a specificity of 25%. Adjusting thresholds towards PAP ≥ 40 mmHg, E velocity ≥ 100 cm/s, E deceleration time < 220 ms, and E/septal e′ ≥ 20 or septal e′ < 5.0 cm/s increased prediction of NT-proBNP levels ≥500 ng/L with substantially improved specificity (> 85%). Conclusion Diastolic echocardiographic parameters in AS indicate persistent impaired relaxation and NT-proBNP indicate elevated filling pressures in most of the patients, improving only modestly 6–12 months after TAVR and SAVR. Applying the 2016 ASE/EACVI recommendations for detection of elevated filling pressures to patients with AS, elevated NT pro-BNP levels could not be reliably detected. However, adjusting thresholds of the echocardiographic parameters increased specificities to useful diagnostic levels. Trial registration The study was prospectively approved by the regional ethical committee, REK North with the registration number: REK 2010/397-10.

scholarly journals Echocardiographic Assessment of Diastolic Dysfunction in Elderly Patients with Severe Aortic Stenosis Before and After Aortic Valve Replacement

2021 ◽  
Author(s):  
Hatice Akay Caglayan ◽  
Didrik Kjønås ◽  
Siri Malm ◽  
Henrik Schirmer ◽  
Assami Rösner
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Diastolic Dysfunction ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Surgical Aortic Valve Replacement ◽  
Echocardiographic Parameters

Abstract Background: The 2016 guidelines of the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) for evaluation of left ventricular (LV) diastolic dysfunction by Doppler flow and tissue Doppler- echocardiography do not adjust assessment of high filling pressures for patients with aortic stenosis (AS). However, most of the studies on this patient group indicate age independent specific diastolic features in AS. The aim of this study is to identify disease-specific range and distribution of diastolic functional parameters and their ability to identify high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels as a marker for high filling pressures.Methods: In this study, 169 patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Resting echocardiography was performed including Doppler of the mitral inflow, pulmonary venous flow, tricuspid regurgitant flow and tissue Doppler in the mitral ring and indexed volume-estimates of the left atrium (LAVI). Echocardiography, and NT-proBNP levels were assessed before TAVR/SAVR and at two postoperative visits at 6 and 12 months. Results: Pre- and postoperative values were septal e´; 5.1±3.9, 5.2±1.6 cm/s; lateral e´ 6.3±2.1; 7.7±2.7 cm/s; E/e´19±8; 16±7 cm/s; E velocity 96±32; 95±32 cm/s; LAVI 39±8; 36±8 ml/m2, pulmonary artery pressure (PAP) 39±8; 36±8 mmHg, respectively. The scoring recommended by ASE/EACVI detected elevated NT pro-BNP with a specificity of 25%. Adjusting thresholds towards PAP ≥ 40 mmHg, E velocity ≥ 100 cm/s, E deceleration time < 220 ms, and E/septal e´ ≥ 20 or septal e´< 5.0 cm/s increased prediction of NT-proBNP levels ≥ 500 ng/L with substantially increased specificity (>85%).Conclusion: Diastolic echocardiographic parameters in AS indicate persistent impaired relaxation and NT-proBNP indicate elevated filling pressures in most of the patients, improving only modestly 6-12 months after TAVR and SAVR. Applying the 2016 ASE/EACVI recommendations for detection of elevated filling pressures to patients with AS, elevated NT pro-BNP levels could not be reliably detected. However, adjusting thresholds of the echocardiographic parameters increased specificities to useful diagnostic levels. Trial registration: The study was prospectively approved by the regional ethical committee, REK North with the registration number: REK 2010/397-10

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