Abstract 13432: Left Ventricular External Work as a Marker of Cardiac Functional Recovery and Outcome After Transcatheter Aortic Valve Replacement in Patients With Aortic Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Shingo Tsujinaga ◽  
Hiroyuki Iwano ◽  
Ko Motoi ◽  
Yasuyuki Chiba ◽  
Suguru Ishizaka ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Functional Recovery ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Volume Index ◽  
External Work ◽  
Transcatheter Aortic Valve ◽  
Reduced Group

Background: Prediction of cardiac functional recovery and outcome after transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS) is still challenging. We hypothesized that left ventricular (LV) external work estimated by echocardiography before TAVR would reflect potential myocardial damage and thus could be associated with changes in cardiac function and prognosis after TAVR. Methods: Echocardiography was performed in 70 AS patients (83 ± 5 years old) before and after TAVR (1 month and 6 months). LV stroke work index (SWI) was calculated as stroke volume index (SVI) х [mean systemic blood pressure + mean pressure gradient across aortic valve (mPG)] before TAVR as a parameter of LV external work. Patients were divided into reduced and preserved SWI group based on the median value (6106 mmHg · mL/m 2 ). Cardiac events were defined as cardiac death or worsening heart failure within 12 months after TAVR. Results: Reduced group had lower SVI (40 ± 7 vs 57 ± 8 mL/m 2 ), mPG (44 ± 14 vs 57 ± 16 mmHg), and smaller aortic valve area index (0.4 ± 0.1 vs 0.5 ± 0.1 cm 2 /m 2 ) than preserved group at baseline (p < 0.05 for all), although LV mass index (LVMI) (116 ± 35 vs 128 ± 30 g/m 2 ) and left atrial volume index (LAVI) (56 ± 20 vs 52 ± 17 mL/m 2 ) were comparable. LV ejection fraction (EF) (57 ± 13 vs 66 ± 7%) and global longitudinal strain (GLS) (–14.2 ± 4.6 vs –16.6 ± 4.8%) at baseline were significantly lower in reduced group than in preserved one. After TAVR, LVMI and LAVI did not change in reduced group ( Table 1 ). In contrast, preserved group showed significant decrease in these parameters. Although LV EF did not change in both groups, GLS was significantly improved only in preserved group but not in reduced group ( Table 1 ). Seven patients (10%) experienced cardiovascular events after TAVR and all these belonged reduced group. Conclusions: Reduced SWI before TAVR was associated with poor response in cardiac function after TAVR and might be a prognostic marker in AS patients undergoing TAVR.

scholarly journals The discongruence index, a simple predictor of cardiac remodeling after transcatheter aortic valve replacement

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F Islas ◽  
A De Agustin ◽  
P Jimenez ◽  
L Nombela ◽  
P Marcos Alberca ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Cardiac Remodeling ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Transcatheter Aortic Valve

Abstract Background Aortic stenosis causes several changes in left ventricular (LV) geometry and function; cardiac remodeling after transcatheter aortic valve replacement (TAVR) is variable among patients and it is not clearly defined. The aim of this study is to identify factors associated with LV functional and structural recovery. Methods 428 patients were retrospectively studied; all patients underwent transthoracic echocardiography prior to TAVR; specific measurements such as maximum internal diameter of the prosthetic valve, nominal loss and percentage of nominal loss regarding to valve size, as well as the discongruence index (Prosthesis size/BSA) were evaluated at discharge and 1-year follow up. Positive cardiac remodeling (PCR) was considered if patients had a reduction of ≥20% of left ventricle mass index (LVMi) and ≥10% of end-diastolic volume index (LVEDVi). Results Mean age of the cohort was 83±5.6 years, 55% were female (n=236), mean aortic valve area was 0.7±0.2cm2; mean LVMi and LVEDVi were 129.4±35.4gr/m2 and 54.5±22ml/m2 respectively. LVMi reduction ≥20% was observed in 30% (n=128) of patients; LVEDVi reduction ≥10% was observed in 44% (n=188) of patients. A total of 107 patients (25%) showed PCR. Female patients showed more PCR (p=0.04). Discongruence index was significantly higher in patients with PCR (15.5±1.9 vs 14.5±1.8, p=0.01) and was significantly associated to LVMi (121.5±28.9 vs 150.8±41.1g/m2) and LVEDVi individually (55.1±17.2 vs 42.7±16.7ml/m2; p&lt;0.01). Left ventricular ejection fraction (LVEF) had a statistically significant increase among patients with PCR (53.2±14.9 vs 56.7±11.5, p=0.04) global longitudinal strain showed improvement at 1-year follow-up as well, although not statistically significant (−17.3±3.7 vs −18.3±3.4 p=0.53). Conclusions The discongruence index is a simple and feasible parameter that can predict positive cardiac remodeling after TAVR which can have a significant impact in clinical outcome of patients. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 11154: Predictors of Improvement of Left Ventricular Diastolic Function After Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis With Preserved Left Ventricular Systolic Function: A Serial Echocardiographic Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hiroto Utsunomiya ◽  
Hirotsugu Mihara ◽  
Yuji Itabashi ◽  
Javier Berdejo ◽  
Ken Matsuoka ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Diastolic Function ◽  
Transcatheter Aortic Valve Replacement ◽  
Systolic Function ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Valve Area

Background: Improvement of left ventricular (LV) diastolic function (DF) after transcatheter aortic valve replacement (TAVR) is not fully elucidated. The present serial transthoracic echocardiography study aimed to investigate the long-term clinical and hemodynamic impact of DF improvement after TAVR and to identify its predictors. Methods: We retrospectively reviewed echocardiographic and clinical data before and after TAVR in 98 patients with severe aortic stenosis (AS) and preserved LV systolic function. Mitral annular displacement was measured as the maximal distance of lateral annular motion during systole in apical 4-chamber view. DF was classified as grade 0 to 3 based on the recommendations of the American Society of Echocardiography. DF improvement was defined as ≥1 grade improvement at the 1-year follow-up. Results: Fifty-nine patients (60%) showed DF improvement. At baseline, patients with the improvement had a less severity of AS (valve area index, 0.37 ± 0.09 vs. 0.32 ± 0.08 cm2/m2) than those with no improvement. Despite similar baseline and changes in LV ejection fraction and mass index, the improvement group shows better recovery of functional status, stroke volume index, and E/e’ (Fig.1-3), as well as plasma brain natriuretic peptide level (median, 264 to 110 vs. 267 to 252 pg/ml, p = 0.017). When adjusting for age, demographic variables, valve area and change in mass index, absence of coronary artery disease (p = 0.03), mitral annular displacement (p < 0.001), and right ventricular end-diastolic diameter (p = 0.02) were independently associated with DF improvement. A mitral annular displacement >11.9 mm had a sensitivity of 83% and a specificity of 72% for prediction of DF improvement (Fig.4). Conclusion: DF improvement is often observed after TAVR and when present may be accompanied by more favorable clinical and hemodynamic changes. Mitral annular displacement, but not AS severity or degree of mass regression, predicts DF improvement after TAVR.

scholarly journals Metabolomic profiling of patients with high gradient aortic stenosis undergoing transcatheter aortic valve replacement

2020 ◽  
Author(s):  
Daniela Haase ◽  
Laura Bäz ◽  
Tarek Bekfani ◽  
Sophie Neugebauer ◽  
Michael Kiehntopf ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Plasma Metabolites ◽  
Clinical Parameters ◽  
High Gradient ◽  
Transcatheter Aortic Valve

Abstract Aim Aim of our study was to evaluate metabolic changes in patients with aortic stenosis (AS) before and after transcatheter aortic valve replacement (TAVR) and to assess whether this procedure reverses metabolomic alterations. Methods 188 plasma metabolites of 30 patients with severe high-gradient aortic valve stenosis (pre-TAVR and 6 weeks post-TAVR) as well as 20 healthy controls (HC) were quantified by liquid chromatography tandem mass spectrometry. Significantly altered metabolites were then correlated to an extensive patient database of clinical parameters at the time of measurement. Results Out of the determined metabolites, 26.6% (n = 50) were significantly altered in patients with AS pre-TAVR compared to HC. In detail, 5/40 acylcarnitines as well as 10/42 amino acids and biogenic amines were mainly increased in AS, whereas 29/90 glycerophospholipids and 6/15 sphingomyelins were mainly reduced. In the post-TAVR group, 10.1% (n = 19) of metabolites showed significant differences when compared to pre-TAVR. Moreover, we found nine metabolites revealing reversible concentration levels. Correlation with clinically important parameters revealed strong correlations between sphingomyelins and cholesterol (r = 0.847), acylcarnitines and brain natriuretic peptide (r = 0.664) and showed correlation of acylcarnitine with an improvement of left ventricular (LV) ejection fraction (r = − 0.513) and phosphatidylcholines with an improvement of LV mass (r = − 0.637). Conclusion Metabolic profiling identified significant and reversible changes in circulating metabolites of patients with AS. The correlation of circulating metabolites with clinical parameters supports the use of these data to identify novel diagnostic as well as prognostic markers for disease screening, pathophysiological studies as well as patient surveillance.

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