Right ventricle to pulmonary artery coupling improves early after transcatheter aortic valve implantation and this is related to improved left atrial function

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Calin ◽  
D Cadil ◽  
C.A Parasca ◽  
A.D Mateescu ◽  
M Rosca ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Atrial ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Before And After ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Transcatheter aortic valve implantation (TAVI) improves not only left heart remodeling but also has an upstream effect on the right ventricle and pulmonary vasculature. Right ventricle (RV) to pulmonary artery (PA) coupling, a parameter which integrates RV systolic performance at a given degree of afterload, was associated with all-cause mortality in these patients (pts). Our aim was to evaluate the short-term effect of TAVI on RV-PA coupling and the main determinants of RV-PA coupling in pts with aortic stenosis (AS) undergoing transfemoral TAVI. Methods We have prospectively enrolled 102 consecutive pts (76±8 years, 57 men) with severe AS undergoing TAVI. All pts underwent a comprehensive echocardiogram both before and 30 days after TAVI, including speckle tracking echocardiography (STE) for myocardial deformation analysis. Peak values of global longitudinal left ventricular strain (GLS), left atrial strain (LAε, reservoir function), and late diastolic LA strain rate (ASr, contractile function) were measured. The ratio of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) was used as an estimate of RV-PA coupling. Results Compared with baseline, there was a significant increase in LV ejection fraction after TAVI (54±12% vs 50±13%, p=0.04), a significant reduction in LV mass (147±35 vs 171±44 g/m2, p<0.001) and increase in absolute GLS values (14±3% vs 12±5%, p=0.007). Indexed LA volumes decreased (49±19 vs 55±19 ml/m2, p=0.03) while both global LAε and ASr improved significantly after TAVI (16±8% vs 13±7%, p=0.01 and −1.2±0.6 vs −0.9±0.6%, p=0.01). A significant improvement of TAPSE/PASP values (0.069±0.026 vs 0.057±0.025 cm/mm Hg, p<0.001) was found after TAVI, indicating an enhanced RV-PA coupling. In multivariable regression analysis global LAε was independently related to RV-PA coupling, both before and after TAVI (R=0.54, p=0.003 and R= 0.39, p<0.001). The increase in RV-PA coupling was significantly related to the increase in LAε (p=0.005). Conclusions Our results confirm that relief of aortic valve obstruction by TAVI has beneficial effects on the RV-PA coupling, that occur early after intervention. This is accompanied by a significant improvement in LV and LA deformation. Moreover, there is a significant correlation between LA function and RV-PA coupling both before and after TAVI. Enhanced RV-PA coupling after TAVI is related to improved LA strain, suggesting the contribution of LA function in modulating right heart function in this setting. Funding Acknowledgement Type of funding source: None

scholarly journals Impact of left atrial strain assessed with feature-tracking computed tomography on long-term mortality after transcatheter aortic valve implantation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Hirasawa ◽  
G K Singh ◽  
J H Kuneman ◽  
N Ajmone Marsan ◽  
V Delgado ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Atrial ◽  
Feature Tracking ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Aortic stenosis (AS) induces left atrial (LA) remodeling through the increase of left ventricular (LV) filling pressure. Peak left atrial longitudinal strain (PALS) has been proposed as a prognostic marker in patients with AS. Novel feature-tracking (FT) software allows to assess LA strain from multidetector computed tomography (MDCT) dataset. Purpose To investigate the association between PALS using FT MDCT and moratlity in patients who underwent transcatheter aortic valve implantation (TAVI). Methods A total of 369 Patients (mean 80±7 years, 51% male) who underwent preprocedual MDCT before TAVI and had suitable data for measureing PALS using dedicated FT software were included. Patients were classified into 4 groups according to PALS quartiles; PALS more than 19.3% (Q1), 19.3% or less to more than 15.0% (Q2), 15.0% or less to more than 9.1% (Q3), and 9.1% or less (Q4). The primary outcome was all-caurse mortality. Results During median follow-up of 45 [22 - 68] months, 124 patients (34%) were died. On multivariable Cox regression analysis, PALS is an independently associated with all-cause mortality (HR: 0.958 [95% CI: 0.925–0.993], P=0.006). Kaplan-Meier analysis showed the worse outcome of the quatile with more impaired PALS (Logrank P<0.001). Compared to Q1, Q3 and Q4 had higher risk of mortality after TAVI (HR: 2.475 [95% CI: 1.411–4.340] for Q3, HR: 3.253 [95% CI: 1.878–5.633] for Q4). Conclusion In this retrospective study, PALS measured with FT MDCT was strongly associated with all-cause mortality after TAVI. LA functial assessment using MDCT may have a importan role for risk stratification in patients referred to TAVI. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): ESC research grant 2018 K-M curve according to PALS quartiles

Effects of Transcatheter Aortic Valve Implantation on Left Ventricular and Left Atrial Morphology and Function

2014 ◽  
Vol 32 (6) ◽  
pp. 928-936 ◽  
Author(s):  
Antonello D'Andrea ◽  
Roberto Padalino ◽  
Rosangela Cocchia ◽  
Enza Di Palma ◽  
Lucia Riegler ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Atrial ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
And Function ◽  
Valve Implantation

New onset left bundle branch block after transcatheter aortic valve implantation and the effect on long-term survival – a UK wide experience

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.S Arri ◽  
A Myat ◽  
I Malik ◽  
N Curzen ◽  
A Baumbach ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Transcatheter Aortic Valve ◽  
All Cause Mortality ◽  
Aortic Valve Implantation ◽  
Valve Implantation ◽  
New Onset

Abstract Introduction New onset left bundle branch block (LBBB) is the most common conduction disturbance associated with transcatheter aortic valve implantation (TAVI). It has been shown to adversely affect cardiac function and increase re-hospitalisation, although its impact on mortality remains contentious. Methods We conducted an observational cohort analysis of all TAVI procedures performed by 13 heart teams in the United Kingdom from inception of their structural programmes until 31st July 2013. The primary outcome was 1-year all-cause mortality. Secondary outcomes included left ventricular ejection fraction (LVEF) at 30 days and need for a post-TAVI permanent pacemaker (PPM). Results 1785 patients were eligible for inclusion to the study. The primary analysis cohort was composed of 1409 patients with complete electrocardiographic (ECG) data pre- and post-TAVI. Pre-existing LBBB was present in 200 (14.2%) patients. New LBBB occurred in 323 (22.9%) patients post TAVI, which resolved in 99 (7%) patients prior to discharge. A balloon-expandable device was implanted in 968 (69%) patients, whilst 421 (30%) patients received a self-expandable valve. New LBBB was observed in 120 (12.4%) and 192 (45.6%) patients receiving a balloon- or self-expandable prosthesis respectively. Overall 1-year all-cause mortality post TAVI was 18.7%. New onset LBBB was not associated with an increase in 1-year all-cause mortality (p=0.416). Factors that were associated with mortality included an increasing logistic EuroScore (p=0.05), history of previous balloon aortic valvuloplasty (p=0.001), renal impairment (p=0.003), previous myocardial infarction with pre-existing LBBB (p=0.028) and atrial fibrillation (p=0.039). Lower baseline peak and mean AV gradients were also associated with greater mortality at 1 year (p=0.001), likely reflecting underlying left ventricular dysfunction. In the majority of patients, LVEF remained unchanged following TAVI. Interestingly, the presence or absence of new onset LBBB did not affect LVEF improvement at 30 days. 10% of patients required a PPM post TAVI. Predictors of PPM included new LBBB (OR 2.6, p<0.001), pre-TAVI left ventricular systolic impairment (OR 1.2, p=0.037), a self-expandable device (p<0.001), and pre-existing RBBB (OR 4.0, p<0.001). Conclusions These findings suggest that new onset LBBB post TAVI does not increase mortality at 1 year or adversely affect LVEF at 30 days. Funding Acknowledgement Type of funding source: None

Guidewire-driven Left Ventricular Pacing During Transcatheter Aortic Valve Implantation

2018 ◽  
Vol 71 (10) ◽  
pp. 869-871
Author(s):  
Luis-Salvador Díaz de la Llera ◽  
José María Cubero Gómez ◽  
Sara Casquero Domínguez ◽  
Mónica Fernández Quero ◽  
Manuel Villa Gil-Ortega ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Ventricular Pacing ◽  
Transcatheter Aortic Valve ◽  
Left Ventricular Pacing ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals Assessment of Retinal Capillary Dropout after Transcatheter Aortic Valve Implantation by Optical Coherence Tomography Angiography

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2399
Author(s):  
Jeanne Martine Gunzinger ◽  
Burbuqe Ibrahimi ◽  
Joel Baur ◽  
Maximilian Robert Justus Wiest ◽  
Marco Picirelli ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Aortic Valve ◽  
Transcatheter Aortic Valve Implantation ◽  
Optical Coherence Tomography Angiography ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Optical Coherence ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Transcatheter aortic valve implantation (TAVI) is an alternative to open heart surgery in the treatment of symptomatic aortic valve stenosis, which is often the treatment of choice in elderly and frail patients. It carries a risk of embolic complications in the whole cerebral vascular bed, which includes the retinal vasculature. The main objective was the evaluation of retinal emboli visible on optical coherence tomography angiography (OCTA) following TAVI. This is a prospective, single center, observational study enrolling consecutive patients over two years. Patients were assessed pre- and post-TAVI. Twenty-eight patients were included in the final analysis, 82.1% were male, median age was 79.5 (range 52–88), median BCVA was 82.5 letters (range 75–93). Eight patients (28.6%) presented new capillary dropout lesions in their post-TAVI OCTA scans. There was no statistically significant change in BCVA. Quantitative analysis of macular or peripapillary OCTA parameters did not show any statistically significant difference in pre- and post-intervention. In conclusion, capillary dropout lesions could frequently be found in patients after TAVI. Quantitative measurements of macular and peripapillary flow remained stable, possibly indicating effective ocular blood flow regulation within the range of left ventricular ejection fraction in our cohort.

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