scholarly journals 227 Myocardial work evaluation in severe aortic stenosis undergoing transcatheter aortic valve implantation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Simona Sperlongano ◽  
Francesca Renon ◽  
Carmen Del Giudice ◽  
Angela Iannuzzi ◽  
Marco Bocchetti ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Atrial Volume ◽  
Transcatheter Aortic Valve ◽  
Before And After ◽  
Global Work ◽  
Valve Implantation

Abstract Aims Myocardial work (MW) is a novel echocardiographic technique which assesses left ventricular (LV) performance through LV pressure-strain loops. MW corrects speckle tracking echocardiography (STE)-derived parameters for afterload using non-invasive systolic blood pressure (SBP) as a surrogate for LV systolic pressure. In patients with severe aortic stenosis (AS), the corrected MW (cMW) has been proposed, consisting in adding the mean aortic gradient in SBP. This method revealed to be feasible and reliable, demonstrating good correlation with invasively measured LV systolic pressure. To evaluate myocardial performance of patients with severe AS, before and after transcatheter aortic valve implantation (TAVI), by MW indices. Methods patients with severe AS undergoing TAVI were included. Transthoracic, standard echocardiography and STE were performed the day before the procedure and within 2 days after. MW was calculated by combining STE-derived indices with non-invasively estimated LV systolic pressure. Results 30 patients (79±5 years old, 56% females) with severe AS (mean gradient 47±14 mmHg, aortic valve area 0.6±0.1 cm2), and eligible for TAVI were enrolled. Baseline global longitudinal strain was impaired (GLS −15±4%), in presence of normal LV ejection fraction (LVEF 57±10%). Corrected global work index and global constructive work were preserved at baseline and markedly decreased after TAVI (cGWI 2322±791 vs. 1710±505 mmHg%, P=0.001; cGCW 2774±803 vs. 2083±536 mmHg%, P=0.0007). Corrected global wasted work and global work efficiency were respectively higher and lower than reference values existing in literature, and no significant changes were observed after TAVI (cGWW 276±174 vs. 277±165 mmHg%, P=0.974; cGWE 89±5 vs. 87±5%, P=0.177). A significant inverse correlation was found between baseline cGWI and left atrial volume index (r = −0.5, P=0.03). Conclusions Patients with severe aortic stenosis and preserved LVEF show a good LV performance before and after TAVI, with a significant decrease in MW indices after TAVI, because of the reduced afterload due to AS treatment. The negative correlation between left atrial volume and cGWI may reflect the extent of myocardial damage in AS. However, further studies with larger sample size and appropriate follow-up are needed to evaluate the role of MW in prognosis and risk stratification of this subset of patients.

scholarly journals 676 Impact of transcatheter aortic valve implantation in patients with severe aortic stenosis and concomitant mitral regurgitation

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Lina Manzi ◽  
Federica Ilardi ◽  
Fiorenzo Simonetti ◽  
Nicola Verde ◽  
Anna Franzone ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Valve Surgery ◽  
Transcatheter Aortic Valve ◽  
Before And After ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Aims Severe aortic stenosis (AS) and functional mitral regurgitation (MR) frequently coexist. There is no consensus about the optimal therapeutic strategy for patients with combined valve disease. Evidence has shown that double valve surgery is associated with high complication rates and mortality, whereas MR severity may improve after transcatheter aortic valve implantation (TAVI). To date, little is known on prognostic parameters associated with MR improvement after TAVI. Recently, a new echocardiographic parameter based on the ratio between peak E velocity and peak atrial longitudinal strain (E/PALS) has demonstrated to be accurate and sensitive in the prediction of elevated filling pressure. Its role in the setting of AS patients undergoing TAVI has never been investigated. Our study aims to evaluate haemodynamic conditions and left ventricular (LV) systolic and diastolic function in patients with severe AS and concomitant MR undergoing TAVI and to identify new echocardiographic parameters associated with MR improvement 1 month after the aortic valve replacement. Methods We prospectively enrolled 87 consecutive patients (mean age 80 ± 6 years) with severe symptomatic AS and concomitant MR undergoing TAVI between 2016 and 2021, for whom a complete echocardiographic assessment was available at baseline and 1 month after the procedure, selected from the EffecTAVI registry. Exclusion criteria were prior valve surgery, severe mitral stenosis, permanent atrial fibrillation, and poor ultrasound acoustic window. Echo-Doppler assessment, including global longitudinal strain (GLS) and peak atrial longitudinal strain (PALS), was performed before and after 1 month to TAVI procedure. Changes (Δ) of the main echo parameters before and after intervention were computed. Results A month after the procedure, 20 (23%) patients had a reduction of at least one degree of MR (P <0.001). Dividing study population in two groups, based on whether or not MR was reduced after TAVI, we found that patients with MR improvement had higher LV end-diastolic volume (P = 0.036) and left atrial volume (P = 0.015) at baseline compared with those without MR reduction. After TAVI no significant differences were found in heart chambers size between the two groups, but a significant increase in PALS (23.2 ± 7.3 vs. 22.3 ± 7, P=0.028), together with a reduction in E/A ratio (0.69 ± 0.14 vs. 0.90 ± 0.46, P = 0.046) were detected in patients with MR reduction. Furthermore, Δ E/PALS (−17.3±34.4% vs. 3.9±35.0% P=0.027), Δ E/A (−12.6±33.9% vs. 24.7±64.3%, P=0.018) and Δ systolic pulmonary artery pressure (sPAP) (−13.0±20.2% vs. −2.0±18.3, P=0.031) were significantly higher in patients with MR improvement to compared those without MR reduction. By the multivariate logistic regression analysis performed in the pooled population, Δ E/PALS (OR 0.968, 95% CI: 0.947–0.990, P=0.005), together with LV mass at baseline (OR 1.056, 95% CI: 1.007–1.107, P = 0.024) appeared to be independently associated with MR reduction post-TAVI. Conclusions Our study demonstrated that: after TAVI in a significant percentage of patients a relevant improvement in concomitant MR was detected; in the group of patients with improved MR a parallel improvement of sPAP, E/A and E/PALS ratio post TAVI was found; Δ E/PALS appears to be the main parameter independently associated with the reduction of MR severity.

scholarly journals Real-time observation of a high-echoic mass in the left ventricle during transcatheter aortic valve implantation: a case report

2020 ◽  
Author(s):  
Akiko Masumoto ◽  
Takeshi Kitai ◽  
Mitsuhiko Ota ◽  
Kitae Kim ◽  
Natsuhiko Ehara ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Cerebral Arteries ◽  
Transoesophageal Echocardiography ◽  
Transcatheter Aortic Valve ◽  
Transcatheter Heart Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Increasing number of symptomatic patients with severe aortic stenosis is treated with transcatheter aortic valve implantation (TAVI). Stroke is one of the most serious complications of TAVI, and the majority of cerebral events in patients undergoing TAVI have an embolic origin. Case summary A 90-year-old female underwent trans-femoral TAVI for symptomatic severe aortic stenosis. Just before the implantation of the transcatheter heart valve (THV), transoesophageal echocardiography (TOE) showed a mobile, high-echoic mass attached to the THV, which gradually enlarged to 26 mm, then spontaneously detached from the THV and flowed up the ascending aorta, disappearing from the TOE field of. After the procedure, the patient presented with ischaemic stroke. The patient’s stroke was thought to have resulted from the embolism migrating to the distal cerebral arteries. Discussion The detailed images acquired with TOE during TAVI enabled the prompt identification of the unusual intracardiac mass.

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