Hemodynamics during transcatheter aortic valve implantation in patients with severe aortic stenosis measured by invasive pressure volume loop analysis

Abstract Introduction Transcatheter aortic valve implantation (TAVI) for a stenotic aortic valve reduces the ventricular to aortic gradient and is expected to improve diastolic and systolic left ventricular function over the long-term. However, information about the early hemodynamic changes are lacking. To address this open question, we performed invasive pressure volume loop analysis prior and immediately after TAVI. Methods Invasive left ventricular pressure volume loop analysis was performed in 8 patients with aortic stenosis (mean 81.3 years) prior and immediately after transfemoral TAVI (conductance catheter). Parameters for global hemodynamics, afterload, contractility and the interaction of the cardiovascular system were analyzed. Results After TAVI, left ventricular ejection fraction (53.9% vs. 44.8%, p=0.018) as well as parameters for myocardial contractility such as preload recruitable stroke work (68.5 vs. 44.8mmHg, p=0.012) and endsystolic elastance (3.55 vs. 2.17, p=0.036) declined significantly compared to baseline. As sign of impaired diastolic function, TAU, a preload-independent measure of isovolumic relaxation (37.3 vs. 41.8ms, p=0.018) and enddiastolic pressure (13.1 vs. 16.4mmHg, p=0.015) increased after valve implantation. Contrarily, decreased ventricular-arterial coupling indicated early improvements in global cardiovascular energy efficiency (1.40 vs. 0.97 p=0.036). Arterial elastance had a strong correlation with the number of conducted rapid ventricular pacings (Pearson correlation coefficient, 0.772, p=0.025). Conclusion Invasive left ventricular pressure volume loop analysis revealed impaired systolic and diastolic function in the early phase after TAVI in patients with severe aortic stenosis. Contrarily, decreased ventricular-arterial indicated early improvement of global cardiovascular energy efficiency. PV Loop pre and post TAVI Funding Acknowledgement Type of funding source: None

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Early hemodynamic changes after transcatheter aortic valve implantation in patients with severe aortic stenosis measured by invasive pressure volume loop analysis

Cardiovascular Intervention and Therapeutics ◽

10.1007/s12928-020-00737-4 ◽

2020 ◽

Author(s):

Philipp Christian Seppelt ◽

Roberta De Rosa ◽

Silvia Mas-Peiro ◽

Andreas Michael Zeiher ◽

Mariuca Vasa-Nicotera

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Severe Aortic Stenosis ◽

Left Ventricular Pressure ◽

Left Ventricular ◽

Loop Analysis ◽

Hemodynamic Changes ◽

Arterial Elastance ◽

Transcatheter Aortic Valve ◽

Valve Implantation

AbstractReplacement of a stenotic aortic valve reduces immediately the ventricular to aortic gradient and is expected to improve diastolic and systolic left ventricular function over the long term. However, the hemodynamic changes immediately after valve implantation are so far poorly understood. Within this pilot study, we performed an invasive pressure volume loop analysis to describe the early hemodynamic changes after transcatheter aortic valve implantation (TAVI) with self-expandable prostheses. Invasive left ventricular pressure volume loop analysis was performed in 8 patients with aortic stenosis (mean 81.3 years) prior and immediately after transfemoral TAVI with a self-expandable valve system (St. Jude Medical Portico Valve). Parameters for global hemodynamics, afterload, contractility and the interaction of the cardiovascular system were analyzed. Left ventricular ejection fraction, (53.9% vs. 44.8%, p = 0.018), preload recruitable stroke work (68.5 vs. 44.8 mmHg, p = 0.012) and end-systolic elastance (3.55 vs. 2.17, p = 0.036) both marker for myocardial contractility declined significantly compared to baseline. As sign of impaired diastolic function, TAU, a preload-independent measure of isovolumic relaxation (37.3 vs. 41.8 ms, p = 0.018) and end-diastolic pressure (13.1 vs. 16.4 mmHg, p = 0.015) raised after valve implantation. Contrarily, a smaller ratio of end-systolic to arterial elastance (ventricular-arterial coupling) indicates an improvement of global cardiovascular energy efficiency (1.40 vs. 0.97 p = 0.036). Arterial elastance had a strong correlation with the number of conducted rapid ventricular pacings (Pearson correlation coefficient, r = 0.772, p = 0.025). Invasive left ventricular pressure volume loop analysis revealed impaired systolic and diastolic function in the early phase after TAVI with self-expandable valve for the treatment of severe aortic stenosis. Contrarily, we found indications for early improvement of global cardiovascular energy efficiency.

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Impact of left ventricular systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation for severe aortic stenosis

Yearbook of Anesthesiology and Pain Management ◽

10.1016/j.yane.2011.01.040 ◽

2011 ◽

Vol 2011 ◽

pp. 78-79

Author(s):

G.P. Gravlee

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Systolic Function ◽

Severe Aortic Stenosis ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

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725 Assessment of myocardial work for the evaluation of patients undergoing transcatheter aortic valve implantation (TAVI)

European Heart Journal Supplements ◽

10.1093/eurheartj/suab132.048 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Isabella Leo ◽

Jolanda Sabatino ◽

Antonio Strangio ◽

Sabrina La Bella ◽

Sabato Sorrentino ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Transcatheter Aortic Valve Implantation ◽

Severe Aortic Stenosis ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Non Invasive ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Aims A growing number of patients is undergoing transcatheter treatment of severe Aortic Stenosis. Changes in cardiac mechanics after removal of afterload in these patients are under-investigated. Myocardial Work (MW) is emerging as a useful non-invasive correlate of invasively measured myocardial performance and oxygen consumption. Aim of this study was to assess the usefulness of non-invasive MW indices in the clinical assessment of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Methods and results Consecutive patients with severe aortic stenosis referred for TAVI in a single tertiary centre were included. Echocardiography recordings (GE-Healthcare) with systolic and diastolic non-invasive pressures, were obtained immediately before TAVI and after TAVI to measure myocardial work index (MWI), myocardial constructive work (MCW), myocardial wasted work (MWW), and myocardial work efficiency (MWE). Consecutive patients with severe AS (n = 73) undergoing TAVI and matched controls (n = 50) were included. Mean transaortic gradient, AV area, and peak transvalvular velocity were significantly improved (all P < 0.05). No changes in left ventricular ejection fraction nor in global longitudinal strain (GLS) were observed. GWI (P < 0.001) and GCW (P < 0.001) were significantly reduced after TAVI. On the contrary, we observed no significant change in GWW (P = 0.241) nor GWE (P = 0.854). Women had higher GWI (P = 0.007) and GCW (P = 0.014) compared to men, with a larger delta change of GCW. Patients with a low flow low gradient (LF-LG) AS had lower LVEF (P < 0.001), worse GLS (P < 0.001) and lower baseline GWI (P < 0.001), GCW (P < 0.001), and GWE (P = 0.003). The improvement in GWI and GCW observed after TAVI in the general study population were abolished among LF-LG patients. Conclusions The use of non-invasive myocardial work might be useful to further classify patients with AS and could be useful to predict non responders.

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