Echocardiographic assessment of diastolic dysfunction in elderly patients with severe aortic stenosis before and after aortic valve replacement

Abstract Background The 2016 guidelines of the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) for evaluation of left ventricular (LV) diastolic dysfunction by Doppler flow and tissue Doppler- echocardiography do not adjust assessment of high filling pressures for patients with aortic stenosis (AS). However, most of the studies on this patient group indicate age independent specific diastolic features in AS. The aim of this study is to identify disease-specific range and distribution of diastolic functional parameters and their ability to identify high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels as a marker for high filling pressures. Methods In this study, 169 patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Resting echocardiography was performed including Doppler of the mitral inflow, pulmonary venous flow, tricuspid regurgitant flow and tissue Doppler in the mitral ring and indexed volume-estimates of the left atrium (LAVI). Echocardiography, and NT-proBNP levels were assessed before TAVR/SAVR and at two postoperative visits at 6 and 12 months. Results Pre- and postoperative values were septal e′; 5.1 ± 3.9, 5.2 ± 1.6 cm/s; lateral e′ 6.3 ± 2.1; 7.7 ± 2.7 cm/s; E/e′19 ± 8; 16 ± 7 cm/s; E velocity 96 ± 32; 95 ± 32 cm/s; LAVI 39 ± 8; 36 ± 8 ml/m2, pulmonary artery pressure (PAP) 39 ± 8; 36 ± 8 mmHg, respectively. The scoring recommended by ASE/EACVI detected elevated NT pro-BNP with a specificity of 25%. Adjusting thresholds towards PAP ≥ 40 mmHg, E velocity ≥ 100 cm/s, E deceleration time < 220 ms, and E/septal e′ ≥ 20 or septal e′ < 5.0 cm/s increased prediction of NT-proBNP levels ≥500 ng/L with substantially improved specificity (> 85%). Conclusion Diastolic echocardiographic parameters in AS indicate persistent impaired relaxation and NT-proBNP indicate elevated filling pressures in most of the patients, improving only modestly 6–12 months after TAVR and SAVR. Applying the 2016 ASE/EACVI recommendations for detection of elevated filling pressures to patients with AS, elevated NT pro-BNP levels could not be reliably detected. However, adjusting thresholds of the echocardiographic parameters increased specificities to useful diagnostic levels. Trial registration The study was prospectively approved by the regional ethical committee, REK North with the registration number: REK 2010/397-10.

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Echocardiographic Assessment of Diastolic Dysfunction in Elderly Patients with Severe Aortic Stenosis Before and After Aortic Valve Replacement

10.21203/rs.3.rs-764226/v1 ◽

2021 ◽

Author(s):

Hatice Akay Caglayan ◽

Didrik Kjønås ◽

Siri Malm ◽

Henrik Schirmer ◽

Assami Rösner

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Diastolic Dysfunction ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Tissue Doppler ◽

Left Ventricular ◽

Surgical Aortic Valve Replacement ◽

Echocardiographic Parameters

Abstract Background: The 2016 guidelines of the American Society of Echocardiography (ASE) and European Association of Cardiovascular Imaging (EACVI) for evaluation of left ventricular (LV) diastolic dysfunction by Doppler flow and tissue Doppler- echocardiography do not adjust assessment of high filling pressures for patients with aortic stenosis (AS). However, most of the studies on this patient group indicate age independent specific diastolic features in AS. The aim of this study is to identify disease-specific range and distribution of diastolic functional parameters and their ability to identify high N-terminal prohormone of brain natriuretic peptide (NT-proBNP) levels as a marker for high filling pressures.Methods: In this study, 169 patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) were prospectively enrolled. Resting echocardiography was performed including Doppler of the mitral inflow, pulmonary venous flow, tricuspid regurgitant flow and tissue Doppler in the mitral ring and indexed volume-estimates of the left atrium (LAVI). Echocardiography, and NT-proBNP levels were assessed before TAVR/SAVR and at two postoperative visits at 6 and 12 months. Results: Pre- and postoperative values were septal e´; 5.1±3.9, 5.2±1.6 cm/s; lateral e´ 6.3±2.1; 7.7±2.7 cm/s; E/e´19±8; 16±7 cm/s; E velocity 96±32; 95±32 cm/s; LAVI 39±8; 36±8 ml/m2, pulmonary artery pressure (PAP) 39±8; 36±8 mmHg, respectively. The scoring recommended by ASE/EACVI detected elevated NT pro-BNP with a specificity of 25%. Adjusting thresholds towards PAP ≥ 40 mmHg, E velocity ≥ 100 cm/s, E deceleration time < 220 ms, and E/septal e´ ≥ 20 or septal e´< 5.0 cm/s increased prediction of NT-proBNP levels ≥ 500 ng/L with substantially increased specificity (>85%).Conclusion: Diastolic echocardiographic parameters in AS indicate persistent impaired relaxation and NT-proBNP indicate elevated filling pressures in most of the patients, improving only modestly 6-12 months after TAVR and SAVR. Applying the 2016 ASE/EACVI recommendations for detection of elevated filling pressures to patients with AS, elevated NT pro-BNP levels could not be reliably detected. However, adjusting thresholds of the echocardiographic parameters increased specificities to useful diagnostic levels. Trial registration: The study was prospectively approved by the regional ethical committee, REK North with the registration number: REK 2010/397-10

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Perioperative changes in global myocardial work indices in a patient with severe aortic stenosis with severe left ventricular dysfunction undergoing surgical aortic valve replacement

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2021.07.034 ◽

2021 ◽

Author(s):

Deepak Borde ◽

Pooja Joshi ◽

Balaji Asegaonkar ◽

Ashish Agrawal

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Left Ventricular Dysfunction ◽

Ventricular Dysfunction ◽

Severe Aortic Stenosis ◽

Left Ventricular ◽

Surgical Aortic Valve Replacement ◽

Severe Left Ventricular Dysfunction

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Improvement in left ventricular function assessed by tissue Doppler imaging after aortic valve replacement for severe aortic stenosis

Singapore Medical Journal ◽

10.11622/smedj.2015187 ◽

2015 ◽

Vol 56 (12) ◽

pp. 672-676 ◽

Cited By ~ 3

Author(s):

CC Nieh ◽

AY Teo ◽

WM Soo ◽

GK Lee ◽

D Singh ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Left Ventricular Function ◽

Ventricular Function ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Tissue Doppler ◽

Left Ventricular ◽

Doppler Imaging

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Novel Echocardiographic Parameters in Patients With Aortic Stenosis and Preserved Left Ventricular Systolic Function Undergoing Surgical Aortic Valve Replacement

The American Journal of Cardiology ◽

10.1016/j.amjcard.2018.03.359 ◽

2018 ◽

Vol 122 (2) ◽

pp. 284-293 ◽

Cited By ~ 4

Author(s):

Chetan P. Huded ◽

Kenya Kusunose ◽

Fatima Shahid ◽

Andrew L. Goodman ◽

Alaa Alashi ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Systolic Function ◽

Left Ventricular Systolic Function ◽

Left Ventricular ◽

Ventricular Systolic Function ◽

Surgical Aortic Valve Replacement ◽

Echocardiographic Parameters

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Sex-related differences in patients undergoing isolated surgical aortic valve replacement for severe aortic stenosis

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332619 ◽

2013 ◽

Vol 61 (S 01) ◽

Author(s):

Y Elhmidi ◽

S Bleiziffer ◽

N Piazza ◽

B Voss ◽

C Schreiber ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Severe Aortic Stenosis ◽

Surgical Aortic Valve Replacement

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Aortic valve function post-replacement of severe aortic stenosis by transcatheter procedure versus surgery: a systematic review and metanalysis

Scientific Reports ◽

10.1038/s41598-021-91548-x ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Charbel Abi Khalil ◽

Barbara Ignatiuk ◽

Guliz Erdem ◽

Hiam Chemaitelly ◽

Fabio Barilli ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Randomized Clinical Trials ◽

Severe Aortic Stenosis ◽

Paravalvular Leak ◽

Effective Orifice Area ◽

Surgical Aortic Valve Replacement ◽

Transcatheter Heart Valve

AbstractTranscatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51–0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73–0.38]) in gradient and an increase of 0.47 (95% CI [0.38–0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12–0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53–16.46]). All results were sustainable at 2 years.

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