Early Reverse Remodeling of the Left Ventricle after Transcatheter Aortic Valve Placement—The Role of Pulmonary Hypertension

2021 ◽  
Vol 11 (07) ◽  
pp. 3018-3026
Author(s):  
甲易 张
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Valve ◽  
Left Ventricle ◽  
Reverse Remodeling ◽  
Transcatheter Aortic Valve ◽  
Valve Placement

scholarly journals Left ventricle geometry, atrial strain, ventricle strain and hemodynamics across aortic valve before and after transcatheter aortic valve replacements

2022 ◽  
Author(s):  
Aslannif Roslan ◽  
YEE SIN TEY ◽  
Faten Aris A ◽  
Afif Ashari ◽  
Abdul Shaparudin A ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Linear Relationship ◽  
Flow Rate ◽  
Volume Index ◽  
Reverse Remodeling ◽  
Aortic Valve Area ◽  
Area Index ◽  
Transcatheter Aortic Valve ◽  
Valve Area

Background: Transcatheter Aortic Valve Replacements (TAVR) has become widespread throughout the world. To date there are no echocardiographic study of TAVR patients from Southeast Asia (SEA). We sought to evaluate 1) changes in echocardiographic and strain values pre and post TAVR 2) relationship between aortic stenosis (AS) severity and strain values, 3) left ventricle geometry in severe AS 4) relationship of flow rate to dimensionless index (DVI) and acceleration time (AT) and 5) effect of strains on outcome. Methods: Retrospective study of 112 TAVR patients in our center from 2009 to 2020. The echocardiographic and strain images pre (within 1 months), post (day after) and 6 months post TAVR were analyzed by expert echocardiographer. Results: The ejection fraction (EF) increased at 6 months (53.02 ± 12.12% to 56.35 ± 9.00%) (p=0.044). Interventricular septal thickness in diastole (IVSd) decreased (1.27 ± 0.21cm to 1.21 ± 0.23cm) (p=0.038) and left ventricle internal dimension in diastole (LVIDd) decreased from 4.77 ± 0.64cm to 4.49 ± 0.65cm (p = 0.001). No changes in stroke volume index (SVI pre vs 6 months p =0.187), but the flow rate increases (217.80 ± 57.61mls/s to 251.94 ± 69.59mls/s, p<0.001). Global Longitudinal Strain (GLS) improved from -11.44 ± 4.23% to -13.94 ± 3.72% (p <0.001), Left Atrial Reservoir strain (Lar-S) increased from 17.44 ± 9.16% to 19.60 ± 8.77% (p=0.033). 8 patients (7.5%) had IVSd < 1.0cm, and 4 patients (3.7%) had normal left ventricle (LV) geometry. There was linear relationship between IVSd and mean PG (r=0.208, p=0.031), between GLS to aortic valve area (AVA) and aortic valve area index (AVAi) (r = – 0.305, p=0.001 and r= – 0.316, p = 0.001). There was also relationship between AT (r=-0.20, p=0.04) and DVI (r=0.35, p< 0.001) with flow rate. Patients who died late (after 6 months) had lower GLS at 6 months. (Alive; -13.94 ± 3.72% vs Died; -12.43 ± 4.19%, p= 0.001) Conclusion: At 6 months TAVR cause reverse remodeling of the LV with reduction in IVSd, LVIDd and improvement in GLS and LAr-S. There is linear relationship between GLS and AVA and between IVSd and AVA.

scholarly journals How to deal with low-flow low-gradient aortic stenosis and reduced left ventricle ejection fraction: from literature review to tips for clinical practice

2021 ◽  
Author(s):  
F. Contorni ◽  
M. Fineschi ◽  
A. Iadanza ◽  
A. Santoro ◽  
G. E. Mandoli ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricle ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Left Ventricle Ejection Fraction ◽  
Low Flow ◽  
Diagnostic Tools ◽  
Transcatheter Aortic Valve ◽  
Valve Implantation

AbstractLow-flow low-gradient aortic stenosis (LFLG AS) with reduced left ventricle ejection fraction (LVEF) is still a diagnostic and therapeutic challenge. The aim of this paper is to review the latest evidences about the assessment of the valvular disease, usually difficult because of the low-flow status, and the therapeutic options. Special emphasis is given to the available diagnostic tools for the characterization of LFLG AS without functional reserve at stress echocardiography and to the factors that clinicians should evaluate to choose between surgical aortic valve repair, transcatheter aortic valve implantation, or medical therapy.

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