scholarly journals Electrocardiographic Strain Pattern Is a Major Determinant of Rehospitalization for Heart Failure After Transcatheter Aortic Valve Replacement

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Joé Heger ◽  
Antonin Trimaille ◽  
Marion Kibler ◽  
Benjamin Marchandot ◽  
Marilou Peillex ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Bundle Branch Block ◽  
Strain Pattern ◽  
Transcatheter Aortic Valve

Background Electrocardiographic strain pattern (ESP) has recently been associated with increased adverse outcome in aortic stenosis and after surgical aortic valve replacement. Our study sought to determine the impact and incremental value of ESP pattern in predicting adverse outcome after transcatheter aortic valve replacement. Methods and Results A total of 585 patients with severe aortic stenosis (mean age, 83±7 years; men, 39.8%) were enrolled for transcatheter aortic valve replacement from November 2012 to May 2018. ESP was defined as ≥1‐mm concave down‐sloping ST‐segment depression and asymmetrical T‐wave inversion in the lateral leads. The primary end points of the study were all‐cause mortality, rehospitalization for heart failure, myocardial infarction, and stroke. A total of 178 (30.4%) patients were excluded because of left bundle‐branch block (n=103) or right bundle‐branch block (n=75). Among the 407 remaining patients, 106 had ESP (26.04%). At a median follow‐up of 20.00 months (11.70–29.42 months), no impact of electric strain on overall and cardiac death could be established. By contrast, incidence of rehospitalization for heart failure was significantly higher (33/106 [31.1%] versus 33/301 [11%]; P <0.001) in patients with ESP. By multivariate analyses, ESP remained a strong predictor of rehospitalization for heart failure (hazard ratio, 2.75 [95% CI, 1.61–4.67]; P <0.001). Conclusions In patients with aortic stenosis who were eligible for transcatheter aortic valve replacement, ESP is frequent and associated with an increased risk of postinterventional heart failure regardless of preoperative left ventricular hypertrophy. ESP represents an easy, objective, reliable, and low‐cost tool to identify patients who may benefit from intensified postinterventional follow‐up.

P6485Incremental prognostic value of electrocardiographic strain after transcatheter aortic valve replacement for aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Heger ◽  
B Marchandot ◽  
M Kibler ◽  
M Peillex ◽  
A Trimaille ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Adverse Outcome ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Strain Pattern ◽  
Transcatheter Aortic Valve

Abstract Background Electrocardiographic (ECG) strain pattern has recently been associated with increased adverse outcome in aortic stenosis (AS) and after surgical aortic valve replacement (AVR). However, the relation linking ECG strain and cardiovascular MACE in patients with transcatheter aortic valve replacement (TAVR) has not been yet described. Objectives The aim of our study was to determine the impact and incremental value of ECG Strain pattern in predicting adverse outcome after TAVR. Methods 585 patients with severe AS (mean age: 83±7 male 39.8%) were enrolled from November 2012 to May 2018. ECG strain pattern was defined as ≥1 mm concave down-sloping ST-segment depression and asymmetrical T-wave inversion in the lateral leads. Patients with baseline left bundle branch block (LBBB), right bundle branch block (RBBB) or ventricular paced rhythm were excluded. All patients underwent transthoracic echocardiography (TTE) before TAVR and at 30 days follow up. The primary endpoints of the study were the overall all-cause mortality after TAVR, rehospitalization for Hearth failure (HF), myocardial infarction and stroke. Results 178 (30.4%) patients were excluded from analyses owing to the presence of either LBBB (n=103) or RBBB (n=75). Among the 407 remaining patients, 106 had ECG strain pattern (26.04%). Patients with ECG strain were significantly younger (81.6±8 years vs 83.5±6.8 years; p=0.022), had lower BMI (23±4.5 kg.m2 vs 27.9±6.8 kg.m2; p=0.02) more severe AS (mean gradient 52.3±15.2 mmHg vs 47.9±11.8 mmHg; p=0.003), significant lower LVEF (51.8±15% vs 58.4±10.7%; p<0.001). Left ventricular hypertrophy (LVH) was more frequent in patients with ECG Strain (indexed left ventricular mass (135.9±33.4 g.m2 vs 123.6±31.9 g.m2; p=0.002)). Death from any cause (22 (20.8%) vs 61 (20.3%); p=0.508) did not differ significantly between groups. Major adverse cardiovascular events (MACE) including death, stroke and heart failure at 1 month showed similar incidence (7 (6.6%) vs 17 (5.6%), p=0.439). Rehospitalization for hearth failure (HF) was significantly higher (33 (31.1%) vs 33 (11%); p<0.001) in patients with ECG strain pattern. In univariate model, ECG Strain was a strong predictor of rehospitalization for HF (HR 2.621 95% CI (1.607–4.277), p=0.001), independently of LVH assessed either by ECG criteria (HR 1.181 95% CI (0.698–1.997; p=0.536) or TTE (HR 1.557 95% (CI 0.701–3.458; p=0.277). ECG Strain remained associated with a higher risk of rehospitalization for hearth failure in multivariate analyses (HR 2.747 95% (CI 1.614- 4.674); p<0.001) Conclusion In patients with AS eligible for TAVR, ECG Strain Pattern is frequent and associated with an increased risk of post interventional heart failure regardless of preoperative LVH. ECG Strain pattern represents an easy, objective, reliable and low-cost tool to identify patients who may benefit from an extend and intensified post-interventional follow-up.

P5984Clinical results and predictors of long-term mortality after Transcatheter Aortic Valve Replacement in according to gender

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Munoz-Garcia ◽  
M Munoz-Garcia ◽  
A J Munoz Garcia ◽  
A J Dominguez-Franco ◽  
F Carrasco-Chinchilla ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Cox Regression ◽  
Transcatheter Aortic Valve ◽  
Long Term Mortality

Abstract Although it is well known, the differences between both sexes in cardiovascular disease, however, there is a lack of data in aortic valve, treated with Transcatheter Aortic Valve Replacement (TAVR). The purpose of our study was to analyze the long-term clinical results of patients treated with TAVR in the female and male population. Material Between April 2008 and December 2017, 647 patients with aortic stenosis and 20 patients with aortic prosthesis dysfunction, were treated with TAVR consecutively in our center. The primary objective was to analyze, by Cox regression, the predictors of long-term mortality in both sexes. Results 59.1% were women. Males had a higher number of comorbidities and after a mean follow-up of 2.87±2.2 years (range between 0 and 9 years), mortality was higher for male patients 40.7% vs. 32% (HR = 1.447 [95% CI 1.057–2.009], p=0.022) and there were no differences for the presence of threatening bleeding (HR = 1.654 [IC95% 0.719–3.808], p=0.237), myocardial infarction (HR = 1,768 [IC95% 0.753–4.132], p=0.191), stroke (HR = 0.992 [IC95% 0.564–1.743], p=0.976) and hospitalizations for heart failure (HR = 1.388 [IC95% 0.811–2.376], p=0.231). Among the predictors of long-term mortality, common to both sexes were: threatening bleeding, heart failure, Charlson index, Karnofsky, and STS score. Conclusion In our series, there was clinical differences between both sexes, which has an impact on survival, being worse for men due to comorbidities, however, in the population of patients with aortic stenosis treated with TAVI, we found predictors of late mortality similarities between in female and male.

P5986Clinical outcomes of age in patients with severe aortic stenosis treated with Transcatheter Aortic Valve Replacement

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Munoz-Garcia ◽  
M Munoz-Garcia ◽  
A J Munoz Garcia ◽  
F Carrasco-Chinchilla ◽  
A J Dominguez-Franco ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Vascular Complications ◽  
Surgical Aortic Valve Replacement ◽  
Transcatheter Aortic Valve

Abstract Transcatheter Aortic valve Replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement for patients considered at high or prohibitive operative risk. It is widely known the short and mid-term outcomes, however, is limited about long-term outcomes in according to age. The aim of this study was to determine the survival and the clinical outcomes on based of age. after TAVR with the CoreValve prosthesis. Methods From April 2008 to December 2017, the CoreValve and Sapiens 3 prosthesis were implanted in 667 patients with symptomatic severe aortic stenosis with deemed high risk on base to age, <80 years and ≥80 years old Results The mean age in patients <80 compared with ≥80 years, was 73.6±7 vs. 83.4±2.8 years and the logistic EuroSCORE and STS score were 16.3±11% vs. 18.1±11%. In-hospital mortality was 3.4%, and the combined endpoint of death, vascular complications, myocardial infarction, majopr bleeding or stroke had a rate of 18.3%. The late mortality (beyond 30 days) was 40.5%. When compared both groups, there were no differences for the presence of threatening bleeding 3.5% vs. 3.6% (HR = 1.033 [IC95% 0.452–2.360], p=0.557), myocardial infarction4.2% vs. 2.9% (HR = 0.67 [IC95% 0.290–1,530], p=0.0.226), stroke 8.9% vs. 9.4% (HR = 1.067 [IC95% 0.625–1.821], p=0.814) and mortality 44.5% vs. 41.1% (HR=0.971388 [IC95% 0.639–1.188], p=0.214) and there was difference in between groups in hospitalizations for heart failure 13.8% vs. 7.7% (HR = 1.374 [IC95% 1.037–1.821], p=0.008. Survival at 1, 2, 3, 4, 5 were similar in both groups (86.9% vs. 89.8%, 78.4 vs. 78.3%, 65.5 vs. 72.5%, 57.9% vs. 62.8% and 51.1 vs. 52.8%>; log Rank 0.992, p=0.319), respectively, after a mean follow-up of 43.9±27 months. Conclusions TAVR is associated with significant survival benefit throughout 3.2 years of follow-up. Survival during follow-up was similar in patients with <80 compared with ≥80 years old.

scholarly journals Prognostic Value of Ventricular‐Arterial Coupling After Transcatheter Aortic Valve Replacement on Midterm Clinical Outcomes

2021 ◽  
Author(s):  
Hiroaki Yokoyama ◽  
Futoshi Yamanaka ◽  
Koki Shishido ◽  
Tomoki Ochiai ◽  
Shohei Yokota ◽  
...  
Keyword(s):  
Heart Failure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Cardiovascular Death ◽  
Transcatheter Aortic Valve ◽  
Group 4 ◽  
Group 2

Background Ventricular‐arterial coupling predicts outcomes in patients with heart failure. The arterial elastance to end‐systolic elastance ratio (Ea/Ees) is a noninvasively assessed index that reflects ventricular‐arterial coupling. We aimed to determine the prognostic value of ventricular‐arterial coupling assessed through Ea/Ees after transcatheter aortic valve replacement to predict clinical events. Methods and Results We retrieved data on 1378 patients (70% women) who underwent transcatheter aortic valve replacement between October 2013 and May 2017 from the OCEAN‐TAVI (Optimized transCathEter vAlvular iNtervention) Japanese multicenter registry. We determined the association between Ea/Ees and the composite end point of hospitalization for heart failure and cardiovascular death by classifying the patients into quartiles based on Ea/Ees values (group 1: <0.326; group 2: 0.326–0.453; group 3: 0.453–0.666; and group 4: >0.666) during the midterm follow‐up after transcatheter aortic valve replacement. During a median follow‐up period of 736 days (interquartile range, 414–956), there were 247 (17.9%) all‐cause deaths, 89 (6.5%) cardiovascular deaths, 130 (9.4%) hospitalizations for heart failure, and 199 (14.4%) composite events of hospitalization for heart failure and cardiovascular death. The incidence of the composite end point was significantly higher in group 2 (hazard ratio [HR], 1.76; 95% CI, 1.08–2.87 [ P =0.024]), group 3 (HR, 2.43; 95% CI, 1.53–3.86 [ P <0.001]), and group 4 (HR, 2.89; 95% CI, 1.83–4.57 [ P <0.001]) than that in group 1. On adjusted multivariable Cox analysis, Ea/Ees was significantly associated with composite events (HR, 1.47 per 1‐unit increase; 95% CI, 1.08–2.01 [ P =0.015]). Conclusions These findings suggest that a higher Ea/Ees at discharge after transcatheter aortic valve replacement is associated with adverse clinical outcomes during midterm follow‐up. Registration URL: https://www.upload.umin.ac.jp/ . Unique identifier: UMIN000020423.

Timing and evolution of advanced conduction disturbances in patients with right bundle branch block undergoing transcatheter aortic valve replacement

EP Europace ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. 1537-1546
Author(s):  
Guillem Muntané-Carol ◽  
David del Val ◽  
Lucía Junquera ◽  
Laurent Faroux ◽  
Robert Delarochellière ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Right Bundle Branch Block ◽  
Transcatheter Aortic Valve Replacement ◽  
Ventricular Pacing ◽  
Bundle Branch Block ◽  
Conduction Disturbances ◽  
Transcatheter Aortic Valve

Abstract Aims This study sought to determine the timing and evolution over time of advanced conduction disturbances (CDs) in patients with baseline right bundle branch block (RBBB) undergoing transcatheter aortic valve replacement (TAVR). Methods and results One hundred and ten consecutive patients with pre-existing RBBB were included (out of 1341, 8.2%). All arrhythmias during the hospitalization period were recorded. Follow-up was performed at 30 days, 1 year, and yearly thereafter. Conduction recovery and ventricular pacing percentage (VPP) was evaluated at 30 days in those patients with permanent pacemaker implantation (PPMI). Sixty-one (55.5%) patients suffered advanced CDs [97% complete or high-degree atrioventricular block (CHB/HAVB)], and the vast majority (98%) occurred within the first 3 days post-procedure (intraprocedural: 85%). Fifty-two (47.3%) patients had PPMI (vs. 11.0% in non-RBBB patients, P &lt; 0.001). Ventricular pacing percentage at 1 month was higher in patients with persistent-intraprocedural CHB/HAVB compared to those with transient-intraprocedural or post-procedural CHB/HAVB [99 (interquartile range, IQR 97–100)% vs. 72 (IQR 30–99)%, P = 0.02]. Complete recovery (VPP &lt; 1%) was observed in only one patient (2%) with CHB/HAVB. After hospital discharge, no symptomatic bradyarrhythmias or sudden death occurred within 30 days. Patients with pre-existing RBBB exhibited a higher risk of PPMI at 4-year follow-up (26% vs. 8% in non-RBBB patients, P &lt; 0.001). Conclusion In patients with pre-existing RBBB, the vast majority of advanced CDs occurred within the 3 days following TAVR, and most did not recover at 1-month, particularly those with intra-procedural persistent CHB/HAVB. These results should help to determine the hospitalization length and timing of PPMI in RBBB patients undergoing TAVR.

scholarly journals Transcatheter aortic valve replacement and His bundle pacing in the presence of severe left ventricular dysfunction and left bundle branch block

2021 ◽  
Vol 29 ◽  
pp. 1-4
Author(s):  
Luiz São Thiago ◽  
Luis Luciano ◽  
Aline Tscha ◽  
Artur Guimarães ◽  
Alice Silva ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Bundle Branch Block ◽  
Transcatheter Aortic Valve Replacement ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Transcatheter Aortic Valve

Aortic stenosis is the most prevalent valve disease in developed countries and has high morbidity and mortality after the onset of symptoms. The prevalence of severe aortic stenosis in elderly patients (>75 years) is approximately 3.4%. The transcatheter aortic valve replacement has been employed for approximately 20 years and had robust outcomes published. However, it is a challenging procedure when performed on a patient in cardiogenic shock, caused by severe deterioration of left ventricular function, a condition aggravated in cases of electromechanical dyssynchrony due to left bundle branch block. There is evidence that reestablishing the electrical conduction with a pacemaker implanted directly in the conduction system, in patients with left ventricular dysfunction and dyssynchrony, can significantly improve the systolic function. In this context, the objective of the present study was to present and discuss the particularities and evidence available for treating this complex subgroup of patients.

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