Left Ventricular Functional Recovery and Remodeling in Low-Flow Low-Gradient Severe Aortic Stenosis after Transcatheter Aortic Valve Implantation

2014 ◽  
Vol 27 (8) ◽  
pp. 817-825 ◽  
Author(s):  
Vasileios Kamperidis ◽  
Emer Joyce ◽  
Philippe Debonnaire ◽  
Spyridon Katsanos ◽  
Philippe J. van Rosendael ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Functional Recovery ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Low Flow ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

scholarly journals 725 Assessment of myocardial work for the evaluation of patients undergoing transcatheter aortic valve implantation (TAVI)

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Isabella Leo ◽  
Jolanda Sabatino ◽  
Antonio Strangio ◽  
Sabrina La Bella ◽  
Sabato Sorrentino ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Non Invasive ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Aims A growing number of patients is undergoing transcatheter treatment of severe Aortic Stenosis. Changes in cardiac mechanics after removal of afterload in these patients are under-investigated. Myocardial Work (MW) is emerging as a useful non-invasive correlate of invasively measured myocardial performance and oxygen consumption. Aim of this study was to assess the usefulness of non-invasive MW indices in the clinical assessment of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Methods and results Consecutive patients with severe aortic stenosis referred for TAVI in a single tertiary centre were included. Echocardiography recordings (GE-Healthcare) with systolic and diastolic non-invasive pressures, were obtained immediately before TAVI and after TAVI to measure myocardial work index (MWI), myocardial constructive work (MCW), myocardial wasted work (MWW), and myocardial work efficiency (MWE). Consecutive patients with severe AS (n = 73) undergoing TAVI and matched controls (n = 50) were included. Mean transaortic gradient, AV area, and peak transvalvular velocity were significantly improved (all P < 0.05). No changes in left ventricular ejection fraction nor in global longitudinal strain (GLS) were observed. GWI (P < 0.001) and GCW (P < 0.001) were significantly reduced after TAVI. On the contrary, we observed no significant change in GWW (P = 0.241) nor GWE (P = 0.854). Women had higher GWI (P = 0.007) and GCW (P = 0.014) compared to men, with a larger delta change of GCW. Patients with a low flow low gradient (LF-LG) AS had lower LVEF (P < 0.001), worse GLS (P < 0.001) and lower baseline GWI (P < 0.001), GCW (P < 0.001), and GWE (P = 0.003). The improvement in GWI and GCW observed after TAVI in the general study population were abolished among LF-LG patients. Conclusions The use of non-invasive myocardial work might be useful to further classify patients with AS and could be useful to predict non responders.

Aortic Valve Gradient and Clinical Outcome in Patients Undergoing Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

Cardiology ◽  
2016 ◽  
Vol 134 (2) ◽  
pp. 128-135 ◽  
Author(s):  
Guy Witberg ◽  
Alon Barsheshet ◽  
Abid Assali ◽  
Hana Vaknin-Assa ◽  
Aviv A. Shaul ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Left Ventricular ◽  
Low Flow ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Objectives: To explore the relation between the baseline aortic valve gradient (AVG) as a continuous variable and clinical outcomes following transcatheter aortic valve implantation (TAVI) in general and specifically in patients with high-gradient aortic stenosis (AS). Methods: We reviewed 317 consecutive patients who underwent TAVI at our institution. We investigated the relation between AVG as a continuous/categorical variable and outcome among all patients and in patients without low-flow low-gradient AS, using the Cox proportional hazard model adjusting for multiple prognostic variables. Results: Patients had a peak AVG of 79.9 ± 22.8 mm Hg (mean 50.5 ±15.7). During a mean follow-up of 2.7 years, AVG was inversely associated with mortality and mortality or cardiac hospitalization. Every 10-mm-Hg increase in peak AVG was associated with 18% reduction in mortality (p = 0.003) and 19% reduction in mortality/cardiac hospitalization (p < 0.001). Every 10-mm-Hg increase in mean AVG was associated with a 24% reduction in both outcomes (p = 0.005 and p < 0.001). Subgroup analysis of patients with left-ventricular ejection fraction >40% or peak AVG >64 mm Hg yielded similar results. Conclusions: Mean and peak baseline AVGs are directly associated with improved outcomes after TAVI; AVG can be used to select the patients most likely to benefit from TAVI.

scholarly journals Clinical usefulness of relative apical sparing pattern for predicting functional recovery after transcatheter aortic valve implantation in patients with severe aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Matsuda ◽  
H Okayama ◽  
T Kazatani ◽  
H Okabe ◽  
S Kido ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Transcatheter Aortic Valve Implantation ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Significant Difference ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Relative apical sparing pattern (RASP) is thought to be associated with prognosis in patients with cardiac amyloidosis or left ventricular hypertrophy (LVH). Although almost all patients with severe aortic stenosis (AS) have LVH, little is known about the effect of transcatheter aortic valve implantation (TAVI) in patients with severe AS exhibiting a RASP. Purpose This study aimed to elucidate the effect of TAVI on left ventricular global longitudinal strain (LS; LVGLS) in patients with severe AS exhibiting a RASP. Methods Eighty-four patients who underwent transfemoral or subclavian TAVI were evaluated. They were divided into the RASP and non-RASP groups. The average apical LS divided by the sum of the average mid and basal LS values of &gt;1.0 was defined as the RASP. We analyzed the difference between pre- and post-TAVI LVGLS (ΔGLS = post-TAVI LVGLS − pre-TAVI LVGLS). Results Of the 84 patients (mean age, 84.5±3.9 years; 24 men), 15 (17.9%) exhibited a RASP. No significant difference in mean pre-TAVI LVGLS was found between the RASP and non-RASP groups (−16.6% ± 3.8% vs. −15.8% ± 3.9%). The ΔGLS in the RASP group was significantly higher than that in the non-RASP group (−0.97% ± 2.5% vs. −2.6% ± 3.0%; P&lt;0.05). Multivariate analysis revealed that relative apical longitudinal strain was an independent predictor of ΔGLS (β = 0.35, p=0.002). Conclusion Relative apical longitudinal strain was associated with LVGLS recovery. The effect of TAVI on LVGLS in patients with a RASP is inferior to that in patients without a RASP. Funding Acknowledgement Type of funding source: None

scholarly journals Rapidly progressive aortic stenosis treated with transcatheter aortic valve implantation in a patient with Fabry disease: a case report

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
María C Saccheri ◽  
Tomás F Cianciulli ◽  
Federico L Blanco ◽  
Rodrigo I Blanco
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Fabry Disease ◽  
Transcatheter Aortic Valve Implantation ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Functional Class ◽  
Transcatheter Aortic Valve ◽  
Aortic Valve Implantation ◽  
Valve Implantation

Abstract Background Fabry disease (FD) is a rare lysosomal storage disease, caused by mutations in the gene encoding the enzyme α-galactosidase A (α-Gal A). Cardiac involvement is one of the main causes of death and it is characterized by progressive concentric left ventricular hypertrophy (LVH), which in most cases is symmetric. Mild thickening of the left-sided valves is seen in as many as a quarter of patients. Severe aortic stenosis is an extremely rare disorder in FD. Case summary In this report, we describe the case of a 57-year-old male, who was diagnosed with a cardiac variant of FD 10 years ago. Since the patient had severe LVH, he was started on enzyme replacement therapy when he was 47 years old with an intravenous infusion of 0.2 mg/kg of agalsidase alpha every 14 days. The patient remained stable and asymptomatic for 9 years, until he presented with dyspnoea in New York Heart Association functional class II–III and severe aortic stenosis (aortic valve area: 0.97 cm2) together with severe systolic dysfunction [ejection fraction (EF): 29%]. Because of the patient’s comorbidities and high surgical risk, he underwent successful transfemoral transcatheter aortic valve implantation (TAVI). At 2 months following TAVI, the patient was asymptomatic and, in spite of his Fabry cardiomyopathy, the EF had increased to 45%. Discussion To our knowledge, this is the first case in the literature to demonstrate a rapid progression of aortic stenosis with severe impairment of left ventricular function and worsening in functional class in a patient with FD, who following TAVI improved his EF, with disappearance of symptoms and ventricular arrhythmias.

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