Correlation between Left Atrial Volume Index and Pulmonary Hypertension in Patient with Moderate to Severe Aortic Stenosis

2020 ◽  
Vol 103 (8) ◽  
pp. 824-828
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Left Atrium ◽  
Left Atrial ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Left Atrium Volume

Background: Left atrial dilatation is a response to pressure overload in aortic stenosis (AS). Objective: To study the correlation between left atrium volume index (LAVI) and the pulmonary hypertension in patients with moderate to severe AS. Materials and Methods: The authors retrospectively studied patients with moderate to severe AS (either one or all echocardiographic criteria of aortic valve area [AVA]) smaller than 1.5 cm², AV Vmax of more than 3 m/s, AV mean PG of more than 30 mmHg who underwent transthoracic echocardiography at Pranangklao Hospital between January 2015 and December 2019. Results: One hundred thirty-four patients (age 72.31±12.32 years, 46.3% male) were enrolled. In pulmonary hypertension group, proportion of atrial fibrillation (75%) were significantly higher Sinus Rhythm (26.3%). Right ventricular systolic pressure (RVSP) tended to increase when LAVI increased (r=0.695, p<0.001). The mean RVSP in four groups of LAVI (less than 35 ml/m², 35 to 41 ml/m², 42 to 48 ml/m², and more than 48 ml/m²) were 35.11±8.97, 38.22±11.71, 39.0±8.57, and 60.05±31 mmHg, respectively. RVSP in patients with LAVI of more than 48 ml/m² was significantly higher than those of the other group (p<0.001). LAVI in patients with RVSP of less than 50 and more than 50 mmHg were 35.13±6.86 and 65.22±11.55 ml/m², respectively (p<0.001). Conclusion: Moderate to severe AS, RVSP increase when LAVI increases. Keywords: Echocardiography, Left atrium volume index, Aortic stenosis, Pulmonary hypertension

Left atrial dynamics in the hemodynamic response during exercise in patients with asymptomatic severe aortic stenosis: a cardiopulmonary imaging study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Sugimoto ◽  
F Bandera ◽  
M Barletta ◽  
E Alfonzetti ◽  
M Guazzi
Keyword(s):  
Aortic Stenosis ◽  
Left Atrial ◽  
Cardiopulmonary Exercise Testing ◽  
Systolic Pressure ◽  
Stroke Volume Index ◽  
Left Ventricular ◽  
Low Flow ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Significant Difference

Abstract Background The hemodynamic impact of left atrial (LA) dynamics in aortic stenosis (AS) in relation to cardiopulmonary response to exercise has never been studied. We aimed at investigating the link between LA function vs valvulo-arterial impedance (Zva) and right ventricular (RV)-to-pulmonary circulation (PC) coupling in asymptomatic severe AS patients. Methods A total of 94 patients: 64 asymptomatic severe AS patients (aortic valve area (AVA) &lt;1.0 cm2 or AVA index &lt;0.6 cm2/m2) with ejection fraction &gt;50% and 30 gender-matched control subjects underwent cardiopulmonary exercise testing combined with Echo-Doppler with assessment of LA strain and RV-to-PC coupling (tricuspid annular peak systolic excursion (TAPSE)/ pulmonary arterial systolic pressure (PASP) ratio). AS patients were divided into 3 groups according to peak aortic jet velocity (PV), mean pressure gradient (MPG) and stroke volume index (SVI). Zva was assessed using (MPG + systolic blood pressure)/ SVI ratio. Results Paradoxical low-flow low-gradient AS (PLFLG: PV &lt;4 m/s and MPG &lt;40 mmHg, SVI ≤35ml/m2, N=18, AVA 0.77±0.16 cm2), Normal-flow low-gradient AS (NFLG: PV &lt;4 m/s and MPG &lt;40 mmHg, SVI &gt;35ml/m2, N=23, AVA 0.85±0.16 cm2) and High-gradient AS (HG: PV ≥4 m/s or MPG ≥40 mmHg, N=20, AVA 0.62±0.17 cm2) had a higher LA volume index than Control (Control 22±6, PLFLG 33±11*, NFLG 38±12* and HG 33±9* ml/m2, *P&lt;0.05 vs Control). There was no significant difference in peak VO2 (17±5 ml/min/kg) and VE/VCO2 slope (28±3) among 3 AS groups although PLFLG had lower peak cardiac output (7.0±2.4 L/min) compared to NFLG (9.0±2.3 L/min) and HG (9.2±3.3 L/min). In PLFLG and NFLG AS, LA strain at rest (21±9 and 26±13%) and during exercise (26±12 and 31±14%) were decreased compared to Control (37±8% at rest, 43±11% during exercise) but maintained some reserve during exercise (P&lt;0.001). HG AS had no increase in LA strain (31±15% at rest, 28±15% during exercise) (Figure A). In AS groups, no significant correlation at rest was observed between LA strain and Zva, whereas a negative correlation was observed during exercise (R=−0.4, P=0.003, Figure B). LA strain was also correlated with TAPSE/PASP at rest and exercise (R=0.44 and 0.47, P&lt;0.01, respectively, Figure C). Conclusions In asymptomatic severe AS, the study of LA functional adaptation to exercise plays a key role in the hemodynamic unfavorable cascade from AS-related left ventricular afterload to RV-to-PC uncoupling. Funding Acknowledgement Type of funding source: None

scholarly journals 619 Left ventricle remodelling in severe aortic stenosis: analysis of a large cohort of patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Ramos Jimenez ◽  
S Hernandez ◽  
M Plaza Martin ◽  
J L Zamorano Gomez
Keyword(s):  
Left Ventricle ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Systolic Arterial Pressure ◽  
Large Cohort ◽  
P Value ◽  
Aortic Valve Area ◽  
Lv Mass

Abstract Introduction Aortic stenosis (AS) is the most prevalent valve disease. It involves increased left ventricle (LV) postcharge leading to LV hypertrophy. The aim of the study was to assess the burden of LV hypertrophy and its different patterns among a large cohort of patients with severe AS. Methods Observational, multicentre and prospective study of consecutive cases. Patients with severe AS defined as aortic valve area (AVA) &lt;1.0 cm2, and preserved LV ejection fraction (LVEF≥50%) were included. LV hypertrophy was diagnosed in case of LV indexed mass &gt;95 g/m2 in females or &gt;115 g/m2 in males. LV geometry was assessed by relative wall thickness ratio, considering a cut-off value of 0.42. A p value &lt;0.05 was considered statistically significant. Results A total of 805 patients with severe AS were included, 49.7% (n = 400) of them females and 50.3% (n = 405) males. LV indexed mass was available in 665 subjects, most of them (74.9%, n = 498) presenting LV hypertrophy. Females showed higher prevalence of LV hypertrophy than males (82.7% vs. 60.5%; p &lt; 0.01). Concentric hypertrophy was the most frequently encountered phenotype (63.9%; n = 420), being significantly more prevalent among women (74.3% vs 53.4%; p &lt; 0.01). Despite that increased hypertrophy, females showed less severe AS when comparing mean transaortic gradient (39 mmHg vs 42 mmHg; p = 0.04) and indexed AVA (0.42 cm/m2 vs 0.40 cm/m2; p = 0.02). LV hypertrophy was associated with enlarged atria and higher pulmonary systolic pressure. Conclusions LV hypertrophy affects most of patients with severe AS. LV remodelling is different between gender, with women developing higher grade of hypertrophy despite lesser AS severity. LV hypertrophy is associated with poor prognosis echocardiographic signs (increased PSAP and indexed LAV). Differences related to LV mass Normal LV mass LV hypertrophy P value Indexed AVA (cm/m2) 0.42 ± 0.01 0.41 ± 0.01 0.52 Mean gradient (mmHg) 42 ± 0.7 36 ± 1.1 &lt;0.01 Indexed stroke volumen (mL/m2) 41 ± 1 37 ± 1 &lt;0.01 Indexed LAV (mL/m2) 46 ± 1 38 ± 1 &lt;0.01 PSAP (mmHg) 30 ± 2 41 ± 1 0.01 LAV left atrial volume PSAP: pulmonary systolic arterial pressure Abstract 619 Figure. Sex related LV geometry patterns

scholarly journals Impact of the Trifecta bioprosthetic valve in patients with low-flow severe aortic stenosis

2021 ◽  
Author(s):  
Tohru Takaseya ◽  
Atsunobu Oryoji ◽  
Kazuyoshi Takagi ◽  
Tomofumi Fukuda ◽  
Koichi Arinaga ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Stroke Volume Index ◽  
Low Flow ◽  
Volume Index ◽  
Effective Orifice Area ◽  
Aortic Valve Area ◽  
Hemodynamic Performance ◽  
Mid Term Results

AbstractAortic stenosis (AS) is the most common valve disorder in advanced age. Previous reports have shown that low-flow status of the left ventricle is an independent predictor of cardiovascular mortality after surgery. The Trifecta bioprosthesis has recently shown favorable hemodynamic performance. This study aimed to evaluate the effect of the Trifecta bioprosthesis, which has a large effective orifice area, in patients with low-flow severe AS who have a poor prognosis. We retrospectively evaluated 94 consecutive patients with severe AS who underwent aortic valve replacement (AVR). Patients were divided into two groups according to the stroke volume index (SVI): low-flow (LF) group (SVI < 35 ml/m2, n = 22) and normal-flow (NF) group (SVI ≥ 35 ml/m2, n = 72). Patients’ characteristics and early and mid-term results were compared between the two groups. There were no differences in patients’ characteristics, except for systolic blood pressure (LF:NF = 120:138 mmHg, p < 0.01) and the rate of atrial fibrillation between the groups. A preoperative echocardiogram showed that the pressure gradient was higher in the NF group than in the LF group, but aortic valve area was similar. The Trifecta bioprosthesis size was similar in both groups. The operative outcomes were not different between the groups. Severe patient–prosthesis mismatch (PPM) (< 0.65 cm2/m2) was not observed in either of the groups. There were no significant differences in mid-term results between the two groups. The favorable hemodynamic performance of the Trifecta bioprosthesis appears to have the similar outcomes in the LF and NF groups. AVR with the Trifecta bioprosthesis should be considered for avoidance of PPM, particularly in AS patients with LV dysfunction.

Abstract 15388: Persistent Pulmonary Hypertension After Transcatheter Aortic Valve Implantation: Impact on Mortality

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Maria Drakopoulou ◽  
Konstantinos Stathogiannis ◽  
Konstantinos Toutouzas ◽  
George Latsios ◽  
Andreas Synetos ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Aortic Stenosis ◽  
Pulmonary Artery ◽  
Severe Aortic Stenosis ◽  
Systolic Pressure ◽  
Right Atrial ◽  
Pulmonary Artery Systolic Pressure ◽  
End Point ◽  
The Right ◽  
The Impact

Objective: Severe aortic stenosis leads to increased pulmonary arterial systolic pressure. A controversy still remains regarding the impact of persistent pulmonary hypertension (PHT) on prognosis of patients undergoing transcatheter aortic valve implantation (TAVI). We sought to investigate the impact of persistent PHT on 2-year all-cause mortality of patients with severe aortic stenosis following TAVI. Methods: Patients with severe and symptomatic aortic stenosis (effective orifice area [EOA]≤1 cm 2 ) who were scheduled for TAVI with a self-expanding valve at our institution were prospectively enrolled. Prospectively collected echocardiographic data before and after TAVI were retrospectively analyzed in all patients. Pulmonary artery systolic pressure was estimated as the sum of the right ventricular to the right atrial gradient during systole and the right atrial pressure. PHT following TAVI was classified as absent if <35 mmHg and persistent if ≥35 mmHg. Primary clinical end-point was 2-year all-cause mortality defined according to the criteria proposed by the Valve Academic Research Consortium-2. Results: Hundred and forty patients (mean age: 82±9 years) were included in the study. The primary clinical end point occurred in 17 patients (12%) during a median follow-up period of 2 years. Mean pulmonary artery systolic pressure was reduced in all patients following TAVI (45±9 versus 41±6 mmHg, p<0.01). Mortality rate was higher in patients with persistent PHT compared to patients with normal pulmonary artery systolic pressure following TAVI (26% versus 14 %, p<0.01). Patients that reached the primary clinical end point had a higher post procedural mean systolic pulmonary pressure (43±9 versus 39±6 mmHg, p=0.02). In multivariate regression analysis, persistence of PHT (OR: 2.51, 95% CI: 1.109-7.224, p=0.01) was an independent predictor of long-term mortality. Conclusions: The persistence of pulmonary hypertension after TAVI is associated with long term mortality. Identifying the population that will clearly benefit from TAVI is still need to be validated by larger trials.

scholarly journals Right atrial to left atrial volume index ratio is associated with increased mortality in patients with pulmonary hypertension

2018 ◽  
Vol 35 (11) ◽  
pp. 1729-1735 ◽  
Author(s):  
Manu M. Mysore ◽  
Kenneth C. Bilchick ◽  
Priscilla Ababio ◽  
Benjamin K. Ruth ◽  
William C. Harding ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Right Atrial ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Index Ratio

Demographic characteristics, aortic valve intervention rates and all-cause mortality in 4 flow-gradient sub-types of severe aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Saeed ◽  
A Vamvakidou ◽  
H.Y Yakupoglu ◽  
R Senior ◽  
R.S Khattar
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Stroke Volume Index ◽  
Low Flow ◽  
Volume Index ◽  
Mortality Data ◽  
Aortic Valve Area ◽  
Flow Gradient ◽  
All Cause Mortality

Abstract Introduction Severe aortic stenosis (AS), defined as aortic valve area (AVA) &lt;1.0 cm2, can be divided into 4 categories based on flow status and mean gradient. Stroke volume index &lt;35 ml/m2 has classically been used to define low flow, but recent data suggest that flow rate (FR) &lt;200ml/sec may be a more accurate and robust marker of low flow. Methods We prospectively collected demographic, echocardiographic, aortic valve intervention (AVI) and all-cause mortality data on 1562 patients with symptomatic severe AS from 2010 to 2017 with a mean follow up period of 35±22 months. Patients were divided into 4 flow-gradient sub-groups based on a FR threshold of 200ml/s and mean pressure gradient of 40mmHg. Comparative analyses were performed among the 4 groups using analysis of variance. Results The prevalence of normal flow high gradient (NFHG) severe AS was 30%, NF low gradient (NFLG) 21%, low flow HG (LFHG) 18% and LFLG 31% (Table). Across these 4 sub-groups, there was a graded reduction in LVEF and FR, and an increase in age and all–cause mortality. Conclusions Classification of aortic stenosis based on flow-gradient patterns, shows important differences in the demographic profile and clinical outcome among the 4 groups. Classical NFHG AS was associated with the highest rate of AVI and lowest all-cause mortality compared to the 3 discordant flow-gradient subtypes. The LFLG group had the lowest AVI rates and worst outcome. Funding Acknowledgement Type of funding source: None

scholarly journals P1518 Relationship between post-operative asymptomatic status and reverse remodeling of large left atrium in patients with aortic stenosis who underwent aortic valve replacement

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Hozumi ◽  
J Morimoto ◽  
T Nishi ◽  
K Takemoto ◽  
S Fujita ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Reverse Remodeling ◽  
Atrial Volume

Abstract Introduction Recently, we have reported that large left atrial volume (minimum left atrial volume index : LAVImin ≥30ml/m²) at end-diastole determined by direct exposure of left ventricular (LV) end-diastolic pressure can predict post-operative symptomatic status after aortic valve replacement (AVR) in aortic stenosis (AS) patients with high sensitivity and modest specificity. Reverse remodeling of large LAVImin after AVR may contribute to false positive for the prediction of post-operative symptomatic status in patients with AS. Purpose The purpose of this study was to evaluate relationship between post-operative symptomatic status and reverse remodeling of large LAVImin in patients with AS who underwent AVR. Methods The study population consisted of 75 patients with AS who underwent AVR and were followed up for 600 days after AVR, after the exclusion of the followings; atrial fibrillation, significant coronary artery disease, significant mitral valve disease, pacemaker rhythm, and inadequate echocardiographic images. We measured LAVImin by biplane Simpson"s method before and after AVR. Preoperative large LAVImin (≥30ml/m²) according to the previous study was observed in 32 (43%) of 75 patients. We divided these 32 patients into two groups according to the post-operative symptomatic status during the follow-up period. Results There was no significant difference in pre-operative LAVImin between patients with and without post-operative symptom (46.5 ± 13.4 vs 40.4 ± 8.6 ml/m²). On the other hand, post-operative LAVImin in patients without post-operative symptom was significantly smaller than that in patients with post-operative symptom (31.5 ± 8.6 vs 54.8 ± 14.0 ml/m², p &lt; 0.01). While significant regression in LAVImin after AVR was observed in patients without post-operative symptom (40.4 ± 8.6 to 31.5 ± 8.6 ml/m², p &lt; 0.05), no regression in LAVImin after AVR was observed in patients with post-operative symptom (46.5 ± 13.4 to 54.8 ± 14.0 ml/m²). Conclusions Reverse remodeling of large LAVmin in patients with AS who underwent AVR was observed in post-operative asymptomatic group, but not in symptomatic group. These results suggest that reverse remodeling of large LAVImin after AVR could contribute to the post-operative asymptomatic status in patients with AS who underwent AVR.

Sign in / Sign up

Export Citation Format

Share Document