Reverse remodelling after aortic valve replacement for chronic aortic regurgitation

Abstract OBJECTIVES This study aimed to assess the long-term outcomes and investigate the factors related to left ventricular (LV) reverse remodelling after aortic valve replacement (AVR) in patients with chronic aortic regurgitation (AR). METHODS A total of 246 patients who underwent AVR for chronic AR at our institution were included in this retrospective study. Primary end-points included all-cause mortality, cardiac mortality and major adverse cerebral and cardiovascular events. Secondary end-points included cardiac function on echocardiography 1 year after surgery. We explored the predictive factors for reverse remodelling 1 year after surgery. RESULTS The 10-year survival rate was 86.0%, with no cardiac deaths in 93.8% and no major adverse cerebral and cardiovascular events in 79.9% of patients. Postoperative LV function and symptoms were significantly improved 1 year after surgery, but 34 patients (13.8%) did not recover normal function and structure. A significant negative correlation was found between the incidence of cardiac death and major adverse cerebral and cardiovascular events and reverse remodelling. Multivariate logistic regression identified preoperative LV ejection fraction (P = 0.001, odds ratio = 1.057) and LV end-systolic dimension index (P = 0.038, odds ratio = 0.912) as significant predictive factors of reverse remodelling 1 year after surgery. CONCLUSIONS Preoperative LV ejection fraction and LV end-systolic dimension index were predictive factors for reverse remodelling after surgery, which was associated with late outcomes. Earlier surgery may thus help to restore normal LV function and achieve better late outcomes after AVR for AR.

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Reverse left ventricular remodelling after aortic valve replacement for severe aortic insufficiency

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivab020 ◽

2021 ◽

Author(s):

Teppei Toya ◽

Satsuki Fukushima ◽

Yusuke Shimahara ◽

Shingo Kasahara ◽

Junjiro Kobayashi ◽

...

Keyword(s):

Aortic Valve ◽

Predictive Factors ◽

Cardiovascular Events ◽

Aortic Insufficiency ◽

Left Ventricular ◽

Lv Function ◽

Term Outcome ◽

Long Term Outcome ◽

Lv Mass

Abstract OBJECTIVES The goal of this study was to investigate the long-term outcome of aortic valve replacement (AVR) for severe aortic insufficiency with a focus on pre- and postoperative left ventricular (LV) function to explore predictive factors that influence the recovery of LV function and clinical outcome. METHODS A total of 478 patients who underwent AVR for pure severe aortic insufficiency were grouped according to the preoperative echocardiographical LV ejection fraction (EF): low (LO) EF <35% (n = 43), moderate EF 35–50% (n = 150) or normal EF >50% (n = 285). RESULTS Actuarial survival at 10 years post-AVR was 64% with a LO EF, 92% with a moderate EF and 93% with a normal EF (P = 0.016), whereas 10-year rates of freedom from major adverse cerebral and cardiovascular events were 47%, 79% and 84%, respectively (P < 0.0001). Echocardiography at 1 year post-AVR demonstrated that EF substantially improved in all groups. We noted a significant difference in survival (P = 0.0086) and in freedom from major adverse cerebral and cardiovascular events (P = 0.024) between patients with an EF ≥35% and those with an EF <35% in the LO EF group. The multivariable logistic regression model showed that predictive factors for lack of improvement in EF 1 year post-AVR in the LO EF group included plasma brain natriuretic peptide >365 pg/mL (P = 0.0022) and echocardiographic LV mass index) >193 g/m2 (P = 0.0018). CONCLUSIONS Long-term outcome post-AVR for severe aortic insufficiency was largely influenced by preoperative LV function. Predictive factors of failure to recover ventricular function post-AVR included EF <25%, pre-brain natriuretic peptide >365 pg/mL or LV mass index >193 g/m2.

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Sex-differences in left ventricular remodeling and mechanics after aortic valve surgery in patients with severe aortic valve disease

European Heart Journal ◽

10.1093/eurheartj/ehab724.1605 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

G K Singh ◽

E M Vollema ◽

E A Prihadi ◽

M V Regeer ◽

S H Ewe ◽

...

Keyword(s):

Sex Differences ◽

Aortic Valve ◽

Ejection Fraction ◽

Aortic Valve Disease ◽

Valve Disease ◽

Men And Women ◽

Lv Mass ◽

Lv Remodeling ◽

Lv Ejection Fraction

Abstract Background Sex-differences in left ventricular (LV) remodeling in patients with aortic valve disease have been reported. However, sex-differences in LV remodeling and mechanics in response to aortic valve replacement (AVR) remained largely unexplored. Purpose The present study aimed to evaluate the sex-differences during the time course of LV remodeling and LV mechanics (by LV global longitudinal strain (GLS)) after aortic valve replacement. Methods Patients with severe aortic valve disease (aortic stenosis (AS) or aortic regurgitation (AR)) undergoing AVR with echocardiographic follow-up at 1,2, and/or 5 years were evaluated. LV mass index, LV ejection fraction, LV GLS and stroke volume (SV) were measured. Linear mixed models analyses were used to assess changes in LV mass index, LVEF, LV GLS and SV between time points. The models were corrected for age, LV end-diastolic diameter at baseline and time between echocardiograms. Results A total of 211 patients (61±14 years, 61% male) with severe aortic valve disease (AS 63% or AR 39%) were included. Before AVR, men had larger LV mass index and higher SV compared to women. Both men and women had a preserved LV ejection fraction (54±12 and 56±9, P=0.102, respectively), but moderately impaired LV GLS (14.6±4.1 and 16.1±4.1, P=0.009, respectively). After AVR, both groups showed LV mass regression, improvement in LV ejection fraction and LV GLS. LV mass index and SV remained higher in men. During follow-up women showed significantly better LV GLS compared to men (P=0.030, figure 1). Conclusion In men and women with severe aortic valve disease undergoing AVR, the time course of changes in LV mass regression, LV ejection fraction, LV GLS and SV are similar. During follow-up LV mass index remained larger in men and women showed significantly better LV GLS. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The department of Cardiology received unrestricted research grants from Abbott Vascular, Bayer, Bioventrix, Biotronik, Boston Scientific, Edwards Lifesciences, GE Healthcare and Medtronic. Victoria Delgado received speaker fees from Abbott Vascular, Edwards Lifesciences, GE Healthcare, MSD and Medtronic. Nina Ajmone Marsan received speakers fees from Abbott Vascular and GE healthcare. Jeroen J Bax received speaker fees from Abbott Vascular. The remaining authors have nothing to disclose.

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Abstract 2066: Does Mitral Regurgitation Regress After Aortic Valve Replacement For Aortic Stenosis ? A Prospective Multicenter Study

Circulation ◽

10.1161/circ.116.suppl_16.ii_447-c ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Philippe Unger ◽

Danièle Plein ◽

Bernard Cosyns ◽

Guy Van Camp ◽

Olivier Xhaët ◽

...

Keyword(s):

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Stenosis ◽

Ejection Fraction ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular ◽

Aortic Valve Area ◽

Regurgitant Volume ◽

Lv Ejection Fraction

Background: Mitral regurgitation (MR) is common in patients undergoing aortic valve replacement (AVR) for aortic stenosis (AS). Whether its severity may decrease after AVR remains controversial. Previous studies were mainly retrospective and the degree of MR was assessed at best semi-quantitatively. This study sought to prospectively and quantitatively assess how AVR may affect MR severity. Methods: Patients with AS scheduled for isolated AVR and presenting holosystolic MR which was not considered for replacement or repair were included. Previous mitral valve surgery; severe aortic regurgitation and poor acoustic windows were excluded. Thirty-five patients (mean age 77±7 years) were studied before (median 1, range 1– 41 days) and after AVR (median 7, range 4 –19 days). All patients underwent a comprehensive echocardiographic examination; MR was assessed by Doppler echocardiography using color flow mapping of the regurgitant jet and the PISA method. No patient had prolapsed or flail mitral leaflet as mechanism of MR. Results: Preoperative maximal and mean transaortic pressure gradients and aortic valve area were 74±26 mmHg, 44±16 mmHg, and 0.57±0.18 cm 2 , respectively. Left ventricular (LV) ejection fraction increased from 49±16 % to 55±15 % after AVR (p<0.001). LV end-diastolic volume decreased from 91±32 ml to 77±30 ml (p<0.001).The ratio of MR jet to left atrial area decreased from 30±16% to 20±14% (p<0.001). MR effective regurgitant orifice (ERO) and regurgitant volume decreased from 10±5 mm 2 to 8±6 mm 2 (p=0.015) and from 19±10 ml to 11±9 ml (p<0.0001). The decrease in ERO and in regurgitant volume was similar in patients with preserved or depressed LV ejection fraction (≤45 %) (2±3 vs 3±6 mm 2 and 7±9 vs 8±7 ml; p=NS, respectively). Conclusions: AVR is associated with an early postoperative reduction of the quantified degree of MR. This mainly results from a decrease in regurgitant volume and only modestly from a reduction in ERO, emphasizing the contributing role of the decrease in driving pressure accross the mitral regurgitant orifice.

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Bone marrow mesenchymal stem cells transfer in patients with ST-segment elevation myocardial infarction: single-blind, randomized controlled muticentre trial

10.21203/rs.3.rs-54127/v1 ◽

2020 ◽

Author(s):

Runfeng Zhang ◽

Jiang Yu ◽

Ningkun Zhang ◽

Wensong Li ◽

Jisheng Wang ◽

...

Keyword(s):

Myocardial Infarction ◽

Ejection Fraction ◽

General Hospital ◽

Myocardial Viability ◽

Left Ventricular ◽

Control Group ◽

Lv Function ◽

St Segment Elevation ◽

Lv Ejection Fraction

Abstract Objective: Our aimed to evaluate efficacy and safety of intracoronary autologous bone morrow mesenchymal stem cells (BM-MSCs) transplantation in patients with ST-segment elevation myocardial infarction（STEMI）. Methods: In this randomised, single-blind, controlled trial, patients with STEMI (aged 39-76 years) were enrolled at 6 centers in Beijing (the People's Liberation Army Navy General Hospital, Beijing Armed Police General Hospital, Chinese People's Liberation Army General Hospital, Beijing Huaxin Hospital, Beijing Tongren Hospital, Beijing Chaoyang Hospital West Hospital). Patients underwent optimum medical treatment and percutaneous coronary intervention,and were randomly assigned in a 1:1 ratio to BM-MSCs group or control group. The primary endpoint was change of myocardial viability at 6 months' follow-up and left-ventricular (LV) function at 12 months' follow-up.The secondary endpoints were incidence of cardiovascular event, total mortality and adverse event at 12 months' follow-up. The myocardial viability assessed by single- photon emission tomography (SPECT). The left ventricular ejection fraction was used to assess LV function. All patients underwent dynamic ECG and laboratory evaluations. This trial is registered with ClinicalTrails.gov, number NCT04421274. Results: Between March , 2008, and July , 2010, 43 patients were randomly assigned to BM-MSCs group (n=21)or control group(n=22) and followed up for 12 months. LV ejection fraction increased from baseline to 12 months in the BM-MSCs group and control group ( mean baseline-adjusted BM-MSCs treatment differences in LV ejection fraction 4.8% (SD 9.0) and mean baseline-adjusted control group treatment differences in LV ejection fraction 5.8% (SD 6.04) ). After 6 months of follow-up, there was no significant improvement in myocardial metabolic activity in the BM-MSCs group before and after transplantation. however,there was no statistically significant difference between the two groups in the change of LV ejection fraction (p=0.30) and myocardial metabolic activity(p>0.05). We noticed that ,after 12 months of follow-up, except for 1 death and 1 coronary microvascular embolism in the BM-MSCs group, no other events occurred and Alanine transaminase(ALT) and C-reactive protein(CRP) in BM-MSCs group were significantly lower than that in control group. Conclusions: It is unreasonable to speculate that intracoronary transfer of autologous bone marrow MSCs could augment recovery of LV function and myocardial viability after acute myocardial infarction.Trial registration: clinicaltrials,NCT04421274. Registered 06,08,2020- Retrospectively registered, https://register.clinicaltrials.gov/NCT04421274.

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Personalised reprogramming to prevent progressive pacemaker-related left ventricular dysfunction: A phase II randomised, controlled clinical trial

PLoS ONE ◽

10.1371/journal.pone.0259450 ◽

2021 ◽

Vol 16 (12) ◽

pp. e0259450

Author(s):

Maria F. Paton ◽

John Gierula ◽

Judith E. Lowry ◽

David A. Cairns ◽

Kieran Bose Rosling ◽

...

Keyword(s):

Quality Of Life ◽

Ejection Fraction ◽

Usual Care ◽

Phase Ii ◽

Left Ventricular ◽

Lv Function ◽

Controlled Clinical Trial ◽

Rv Pacing ◽

Lv Ejection Fraction

Background Pacemakers are widely utilised to treat bradycardia, but right ventricular (RV) pacing is associated with heightened risk of left ventricular (LV) systolic dysfunction and heart failure. We aimed to compare personalised pacemaker reprogramming to avoid RV pacing with usual care on echocardiographic and patient-orientated outcomes. Methods A prospective phase II randomised, double-blind, parallel-group trial in 100 patients with a pacemaker implanted for indications other than third degree heart block for ≥2 years. Personalised pacemaker reprogramming was guided by a published protocol. Primary outcome was change in LV ejection fraction on echocardiography after 6 months. Secondary outcomes included LV remodeling, quality of life, and battery longevity. Results Clinical and pacemaker variables were similar between groups. The mean age (SD) of participants was 76 (+/-9) years and 71% were male. Nine patients withdrew due to concurrent illness, leaving 91 patients in the intention-to-treat analysis. At 6 months, personalised programming compared to usual care, reduced RV pacing (-6.5±1.8% versus -0.21±1.7%; p<0.01), improved LV function (LV ejection fraction +3.09% [95% confidence interval (CI) 0.48 to 5.70%; p = 0.02]) and LV dimensions (LV end systolic volume indexed to body surface area -2.99mL/m2 [95% CI -5.69 to -0.29; p = 0.03]). Intervention also preserved battery longevity by approximately 5 months (+0.38 years [95% CI 0.14 to 0.62; p<0.01)) with no evidence of an effect on quality of life (+0.19, [95% CI -0.25 to 0.62; p = 0.402]). Conclusions Personalised programming in patients with pacemakers for bradycardia can improve LV function and size, extend battery longevity, and is safe and acceptable to patients. Trial registration ClinicalTrials.gov identifier: NCT03627585.

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The Acute Effects of Esmolol in Intact and Infarcted Myocardium–Experimental Study

Journal of Integrative Cardiology Open Access ◽

10.31487/j.jicoa.2020.04.09 ◽

2020 ◽

pp. 1-7

Author(s):

Savvas Toumanidis ◽

John Agrios ◽

Anna Kaladaridou ◽

Dimitrios Bramos ◽

Elias Skaltsiotes ◽

...

Keyword(s):

Ejection Fraction ◽

Speckle Tracking ◽

Systolic Pressure ◽

Left Ventricular ◽

Lv Function ◽

Short Axis ◽

Acute Effects ◽

Anterior Myocardial Infarction ◽

Infarcted Myocardium ◽

Lv Ejection Fraction

Aim: Early intravenous use of b-blockers within the first hours of STEMI is less firmly established. The aim of this study was to evaluate the effect of esmolol on left ventricular (LV) haemodynamic, rotational and strain parameters in intact myocardium and early post an experimental acute anterior myocardial infarction (MI). Methods: In 20 healthy pigs LV torsional and strain parameters were calculated from basal and apical short axis epicardial planes with speckle tracking technique using EchoPAC platform. LV measurements at baseline and during esmolol infusion (0.5 mg/kg for 1 min, then 0.05 mg/kg/min for 5 min) were compared in intact myocardium and repeated without b-blocker and during esmolol infusion 2 hours post LAD ligation. Results: LV function was highly dependent on the esmolol infusion, in the intact and even more in the infarcted myocardium. LV ejection fraction, LV dP/dtmax and LV end-systolic pressure decreased significantly, a deterioration produced by the administration of esmolol. Torsion-twist and untwisting rate also presented significant reduction in correlation with ejection fraction and cardiac output, appearing to affect especially the apex torsional and strain parameters. Conclusion: Esmolol infusion significantly reduces LV haemodynamic, torsional and strain parameters in intact myocardium and early post MI. These results suggest that early intravenous use of esmolol in patients with STEMI is risky and it is prudent to wait for the patient to stabilize before starting esmolol.

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Abstract 14182: Myocardial Fibrosis and Reverse Remodelling in Nonischaemic Dilated Cardiomyopathy

Circulation ◽

10.1161/circ.132.suppl_3.14182 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Andrea Barison ◽

Alessandro Ortalda ◽

Giancarlo Todiere ◽

Giuseppe Vergaro ◽

Gianluca Mirizzi ◽

...

Keyword(s):

Ejection Fraction ◽

Dilated Cardiomyopathy ◽

Myocardial Fibrosis ◽

Left Ventricular ◽

Idiopathic Dilated Cardiomyopathy ◽

Post Contrast ◽

Reverse Remodelling ◽

Lv Volumes ◽

Lv Ejection Fraction

Introduction: In nonischaemic dilated cardiomyopathy (NICM), myocardial fibrosis can be detected by cardiovascular magnetic resonance (CMR) as late gadolinium enhancement (LGE) and is associated with worse prognosis. Hypothesis: Absence of myocardial fibrosis is associated with left ventricular reverse remodelling (LV-RR). Methods: One-hundred-and-twenty-five NICM patients (age 51±16 years, 82 male) were enrolled and underwent baseline CMR; patients with ischaemic, valvular, congenital heart disease, other cardiomyopathies or contraindications to CMR were excluded. After a 24-month follow-up on optimal medical therapy, all patients underwent a second CMR; patients who died, underwent device implantation or declined a second CMR, were also excluded from the study. LGE was quantified on post-contrast CMR images. LV-RR was defined as an increase in LV ejection fraction ≥10 U or decrease in LV end-diastolic volume ≥10% at follow-up. Results: Mean LV ejection fraction was 41±11% at baseline, 47±12% at follow-up: LV-RR was observed in 59 patients (47%), with no age or gender difference (p=NS) . LGE was present in 69 (54%) patients at baseline (mean extent 12±6 g), without significant differences at follow-up (mean extent 13±7 g). Patients experiencing LV-RR during follow-up presented a baseline worse LV ejection fraction (36±12%) than no-LV-RR patients ( 45±9%, p<0.01), greater LV volumes (123±38 vs. 110±22 ml/m2, p=0.02) and worse right ventricular ejection fraction (54±12% vs. 59±10%, p=0.02) . Nevertheless, only 17 (29%) LV-RR patients presented LGE compared to 31 (47%, p=0.04) no-LV-RR patients. Moreover, among LGE-positive patients (n=48), only 17 (35%) developed LV-RR, while among LGE-negative patients (n=77), 42 (55%) developed LV-RR (p=0.04). Multivariate regression analysis showed that the absence of LGE at baseline CMR was a strong predictor of LV-RR (p=0.02), even after correction for age, New York Heart Association class, LV volumes and systolic function. Conclusions: In patients with idiopathic dilated cardiomyopathy, absence of LGE was a strong independent predictor of LV-RR at 2-year follow-up, irrespective of the initial clinical status and the severity of ventricular dilatation and dysfunction.

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Impact of Flow on Prosthesis-Patient Mismatch Following Transcatheter and Surgical Aortic Valve Replacement

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.120.012364 ◽

2021 ◽

Author(s):

Amr E. Abbas ◽

Julien Ternacle ◽

Philippe Pibarot ◽

Ke Xu ◽

Maria Alu ◽

...

Keyword(s):

Aortic Valve ◽

Ejection Fraction ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Odds Ratio ◽

Cardiac Death ◽

Stroke Volume Index ◽

Volume Index ◽

Normal Flow ◽

Surgical Aortic Valve Replacement

Background: Severe prosthesis-patient mismatch (PPM) is diagnosed by an indexed effective orifice area <0.65 cm 2 /m 2 , which is derived from stroke volume index. We examined the impact of flow, determined by stroke volume index, on severe PPM following transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Methods: We included SAVR patients from the PARTNER 2A trial (Placement of Aortic Transcatheter Valve 2A) and TAVR patients from the PARTNER 2 S3i (Placement of Aortic Transcatheter Valve 2 S3i) registry. The primary end point was the separate analysis of all-cause death, cardiac death, and rehospitalization at 5 years. Following TAVR and SAVR, we compared the primary end points between severe versus no-severe PPM in all patients, in low flow (LF), and in normal flow. Multivariable analysis was performed to determine variables associated with the end points. Results: Nine hundred fifty-four TAVR and 726 SAVR patients with PPM and flow data were included. Severe PPM following TAVR was significantly lower compared with SAVR in all patients (9% versus 28%, P <0.0001), in normal flow (5% versus 8%, P =0.04), and in LF (20% versus 42%, P <0.0001). Severe PPM was associated with rehospitalization following TAVR (odds ratio, 1.52 [95% CI, 1.01–2.29], P =0.0456) and SAVR (odds ratio, 1.51 [95% CI, 1.06–2.16], P =0.0237). Severe PPM in LF was independently associated with cardiac death following TAVR (odds ratio, 1.85 [95% CI, 1.06–3.23], P =0.0308). Following SAVR, severe PPM in LF and low ejection fraction was associated with increased cardiac death (35.26% versus 12.51%, P =0.01) and rehospitalization (37.59% versus 15.46%, P =0.006) compared with severe PPM in LF and preserved ejection fraction, respectively. Severe PPM in normal flow was not associated with clinical outcomes despite higher gradients and smaller valves compared with severe PPM in LF. Conclusions: Severe PPM is more common following SAVR compared with TAVR. Regardless of the implanted valve size or gradient, severe PPM impacts mortality only in patients with LF following TAVR and LF and low ejection fraction following SAVR. Severe PPM in normal flow is not associated with poor outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifiers: NCT01314313 and NCT02687035.

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Abstract 18343: B-type Natriuretic Peptide (BNP) Levels Correlate With Indices of Left Ventricular Function and Predict Outcomes Following Transcatheter Aortic Valve Implantation (TAVI): A Cardiovascular Magnetic Resonance Imaging Study

Circulation ◽

10.1161/circ.132.suppl_3.18343 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Alistair C Lindsay ◽

Ritesh Kanyal ◽

Paramvir Sawhney ◽

Helen Broadhurst ◽

Katie Harron ◽

...

Keyword(s):

Aortic Valve ◽

Ejection Fraction ◽

Severe Aortic Stenosis ◽

Left Ventricular ◽

Resonance Imaging ◽

Transcatheter Aortic Valve ◽

All Cause Mortality ◽

The Mean ◽

Lv Ejection Fraction ◽

Valve Implantation

Background: High levels of B-type natriuretic peptide (BNP) have been shown to predict outcomes following transcatheter aortic valve implantation (TAVI). However, the relationship between pre-procedural BNP levels and magnetic resonance imaging (MRI) parameters of cardiac function has not previously been described in patients with severe aortic stenosis undergoing TAVI. Methods: 108 patients underwent cardiac MRI and had measurements of BNP taken prior to TAVI. MRI was performed using a 1.5T scanner; steady-state free precession sequences were used for aortic valve planimetry and to assess ventricular volumes and mass. Gadolinium enhancement was assessed after injection of 0.1 mmol/kg of gadolinium contrast agent. Semi-automated image analysis was performed by two specialist reviewers blinded to patient treatment. Results: The mean age of the population studied was 79 years (IQR 74-85); mean follow-up was 805 days (IQR 368-1025). The mean BNP level was 698 ng/l (range 14-6048); univariate linear regression showed significant relationships between BNP and left ventricular (LV) ejection fraction (p<0.0001), end diastolic volume (p=0.001), end systolic volume (p<0.0001), and indexed mass (p=0.012). Median BNP levels were lower in patients who survived than in those who died (287ng/l vs. 560ng/l; p=0.099); ROC curve analysis found a BNP level of >170ng/l to be the optimal cutoff for the prediction of all-cause mortality. Survival curve analysis showed a significantly increased risk of all-cause mortality in patients with BNP>170ng/l and MRI LV ejection fraction <50% (Hazard ratio 5.72, p=0.015; Figure). Conclusions: In patients with severe aortic stenosis undergoing TAVI, BNP levels are closely correlated with LV function, indexed LV mass, and both end-systolic and end-diastolic volumes, as measured by MRI. Patients with BNP>170ng/l and MRI LV ejection fraction<50% are at significantly higher risk of death following TAVI.

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Measurement of Left Ventricular Function During Arm Ergometry Using the VESTTM Nuclear Probe

Canadian Journal of Applied Physiology ◽

10.1139/h94-038 ◽

1994 ◽

Vol 19 (4) ◽

pp. 462-471

Author(s):

Len S. Goodman ◽

Jack M. Goodman ◽

Linda Yang ◽

Joanna Sloninko ◽

Terry Hsia ◽

...

Keyword(s):

Ejection Fraction ◽

Left Ventricular ◽

Peak Exercise ◽

Lv Function ◽

Trained Subjects ◽

Arm Exercise ◽

Systolic Volume ◽

End Systolic Volume ◽

Lv Ejection Fraction ◽

Rest And Exercise

A chest-mounted left ventricular (LV) nuclear probe (VEST™) for use during arm and leg ergometry is presented, with a discussion of the validity and reproducibility of LV function measures at rest and exercise. During both arm and leg ergometry in trained subjects, transient changes in LV function/volumes were observed. LV ejection fraction and relative end-systolic and end-diastolic volumes were 25 to 30% less with the arms versus the legs, agreeing with data from other studies using conventional techniques. At peak exercise with both limbs, LV ejection fraction and relative LV end-systolic volume increased, followed by immediate postexercise normalization. The effect was greatest with the arms and reflects the effect of high intramuscular and arterial pressures generated during arm cranking, leading to increased LV afterloading. The VESTTM permits rapid and noninvasive assessment of LV function during arm exercise, avoiding the limitations of other techniques. Key words: arm exercise, radionuclide, chest-mounted probe

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