Physical Performance and Non-Esterified Fatty Acids in Men and Women after Transcatheter Aortic Valve Implantation (TAVI)

Background: Men and women with valvular heart disease have different risk profiles for clinical endpoints. Non-esterified fatty acids (NEFA) are possibly involved in cardio-metabolic disease. However, it is unclear whether NEFA concentrations are associated with physical performance in patients undergoing transcatheter aortic valve implantation (TAVI) and whether there are sex-specific effects. Methods: To test the hypothesis that NEFA concentration is associated with sex-specific physical performance, we prospectively analysed data from one hundred adult patients undergoing TAVI. NEFA concentrations, physical performance and anthropometric parameters were measured before and 6 and 12 months after TAVI. Physical performance was determined by a six-minute walking test (6-MWT) and self-reported weekly bicycle riding time. Results: Before TAVI, NEFA concentrations were higher in patients (44 women, 56 men) compared to the normal population. Median NEFA concentrations at 6 and 12 months after TAVI were within the reference range reported in the normal population in men but not women. Men but not women presented with an increased performance in the 6-MWT over time (p = 0.026, p = 0.142, respectively). Additionally, men showed an increased ability to ride a bicycle after TAVI compared to before TAVI (p = 0.034). NEFA concentrations before TAVI correlated with the 6-MWT before TAVI in women (Spearman’s rho −0.552; p = 0.001) but not in men (Spearman’s rho −0.007; p = 0.964). No association was found between NEFA concentrations and physical performance 6 and 12 months after TAVI. Conclusions: NEFA concentrations improved into the reference range in men but not women after TAVI. Men but not women have an increased physical performance after TAVI. No association between NEFA and physical performance was observed in men and women after TAVI.

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P1575 Preserved myocardial work efficiency after transcatheter aortic valve implantation-induced left bundle branch block

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.995 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

L G Klaeboe ◽

P H Brekke ◽

K H Haugaa ◽

T Edvardsen

Keyword(s):

Aortic Valve ◽

Reference Range ◽

Work Efficiency ◽

Bundle Branch Block ◽

Transcatheter Aortic Valve ◽

Constructive Work ◽

Aortic Valve Implantation ◽

Ecg Criteria ◽

Valve Implantation ◽

Ventricular Conduction

Abstract Background Left bundle branch block (LBBB) frequently complicates transcatheter aortic valve implantation (TAVI), but may not induce classical mechanical dyssynchrony typically observed in heart failure patients with LBBB. Non-invasive estimated myocardial work by pressure strain-loops is a novel method for evaluation of left ventricular (LV) performance including loading conditions and identifies responders to cardiac resynchronization therapy. Assessment of myocardial work in TAVI-induced LBBB has, however, not been performed earlier. Purpose We aimed to evaluate myocardial performance in TAVI-induced LBBB by myocardial work. Methods Patients with severe aortic stenosis (AS) and normal ventricular conduction undergoing transfemoral TAVI were included. TAVI-induced LBBB was defined according to strict ECG criteria. In addition to standard echocardiographic parameters, we performed speckle tracking echocardiography (STE) within 2 days post procedure. Post-procedural myocardial work was estimated by commercially available software, combining LV strain by STE and a non-invasively estimated LV pressure curve. Peak systolic LV pressure was assumed to be equal to the sum of peak arterial cuff pressure and mean aortic valve pressure gradient. The proportion of constructive work relative to the sum of wasted and constructive work was expressed as myocardial work efficiency (Figure). A global work efficiency < 90 % was considered abnormal according to the recently published EACVI NORRE study. Results We included 109 consecutive patients undergoing TAVI (83 ± 7 years old, 54 % women, logistic Euroscore 16 ± 10) with severe AS (valve area 0.7 ± 0.2 cm2, mean transvalvular gradient 54 ± 18 mmHg), QRS duration 94 ± 10 ms, and a relatively preserved LV ejection fraction (54 ± 9%). New-onset LBBB was observed in 28 patients (26 %) after TAVI. Although post-procedural myocardial work efficiency was slightly better in patients who retained normal ventricular conduction than those with TAVI-induced LBBB (93.6 ± 2.5% vs 91.2 ± 3.4%, p = 0.004), both groups of patients had global myocardial work efficiency within the normal reference range. Conclusions Patients with TAVI-induced LBBB have preserved work efficiency despite gross electrical block satisfying strict ECG criteria. The reduced myocardial work efficiency in TAVI-induced LBBB was within the reference range of normal in the recently published EACVI NORRE study. The preservation of myocardial work in TAVI-induced LBBB may explain why LBBB as a complication to TAVI does not necessarily imply poor prognosis. Abstract P1575 Figure.

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