Assessment of 10-Year Left-Ventricular-Remodeling by CMR in Patients Following Aortic Valve Replacement

Rank, Nina; Stoiber, Lukas; Nasser, Mithal; Tanacli, Radu; Stehning, Christian; Knierim, Jan; Schoenrath, Felix; Pieske, Burkert; Falk, Volkmar; Küehne, Titus; Meyer, Alexander; Kelle, Sebastian

doi:10.3389/fcvm.2021.645693

Cited by 5 publications

(8 citation statements)

References 41 publications

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“…The reduction of LV mass within the rst years after the AV surgery has been previously reported [28,43,44], and LV reverse remodeling is an important indicator related to long-term prognosis [45]. Our results are consistent with earlier studies, showing the regression of electrocardiographic markers of LV hypertrophy after the AVR [10,25].…”

Section: Ecg Strain Follow-upsupporting

confidence: 92%

Electrocardiographic markers of adverse left ventricular remodeling and myocardial fibrosis in severe aortic stenosis

Balčiūnaitė

Rudinskaitė

Palionis

et al. 2023

Preprint

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Background. The optimal timing for aortic valve replacement (AVR) in aortic stenosis (AS) is still controversial and may be guided by markers of adverse left ventricular (LV) remodeling. We aim to assess electrocardiographic (ECG) strain patterns in relation to adverse LV remodeling and myocardial fibrosis. Methods. A total of 83 symptomatic severe AS patients (age 66.5 ± 8.6, 42% male) scheduled for surgical AVR underwent preoperative cardiovascular magnetic resonance (CMR) with T1 mapping and echocardiography with global longitudinal strain (GLS) analysis. Collagen volume fraction (CVF) was measured in myocardial biopsies (71) sampled at the time of AVR. The 12-lead ECG was performed preoperatively and 3 and 12 months postoperatively. Results. ECG strain-positive patients (prevalence of 43.4%) had more severe AS, increased LV mass, higher levels of brain natriuretic peptides (BNP) and high-sensitivity troponin I, lower GLS, and lower LV ejection fraction (LVEF). Patients with ECG strain had more diffuse fibrosis, as evident by higher native T1 values (974.8 ± 33.6 ms vs 946.5 ± 28.2 ms, p < 0.001). ECG strain was the only predictor of increased LV mass index on multivariate regression analysis (OR = 7.10, 95% CI 1.46–34.48, p = 0.015). Patients with persistent ECG strain at 1 year following AVR had larger LV volumes and mass, lower GLS, lower LVEF, higher BNP levels, and more histological fibrosis (CVF 12.5% vs. 7.3%, p = 0.009) at baseline assessment. Conclusion. ECG strain is a marker of adverse structural and functional LV remodeling and interstitial myocardial fibrosis. Lack of improvement in ECG strain following AVR indicates more advanced baseline LV injury and higher levels of myocardial fibrosis.

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Section: Ecg Strain Follow-upsupporting

confidence: 92%

Electrocardiographic markers of adverse left ventricular remodeling and myocardial fibrosis in severe aortic stenosis

Balčiūnaitė

Rudinskaitė

Palionis

et al. 2023

Preprint

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“…At this point, valvular cardiomyopathy may persist and even progress despite successful surgical treatment of AV disease [ 5 , 6 , 7 ]. Clinical observations indicate that LV reverse remodeling after AV surgery is less predictable in AR patients suffering from volume overload than in AS patients with a predominant pressure overload [ 6 , 8 , 9 , 10 ]. This phenomenon has also been demonstrated in a rat model of long-lasting pressure vs. volume overload in which animals with chronic volume overload had less beneficial functional outcomes [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Yet, even after successful AV surgery, a substantial subset of patients experiences persistent or even progressive cardiomyopathy, presumably due to irreversible myocardial dysfunction before surgery [ 5 , 6 , 7 ]. Clinical observations indicate that this phenomenon is more common in AR patients [ 6 , 8 , 9 , 10 ]. However, the precise pathophysiological mechanisms underlying different responses to relief from chronic pressure or volume overload in valvular cardiomyopathy are still insufficiently understood.…”

Section: Introductionmentioning

confidence: 99%

“…However, the precise pathophysiological mechanisms underlying different responses to relief from chronic pressure or volume overload in valvular cardiomyopathy are still insufficiently understood. Currently, no functional or imaging biomarkers are available to predict postoperative lack of LV reverse remodeling in AR patients [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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Proteomic Analysis in Valvular Cardiomyopathy: Aortic Regurgitation vs. Aortic Stenosis

Holst

Petersen

Ameling

et al. 2023

Cells

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Left ventricular (LV) reverse remodeling after aortic valve (AV) surgery is less predictable in chronic aortic regurgitation (AR) than in aortic stenosis (AS). We aimed to disclose specific LV myocardial protein signatures possibly contributing to differential disease progression. Global protein profiling of LV myocardial samples excised from the subaortic interventricular septum in patients with isolated AR or AS undergoing AV surgery was performed using liquid chromatography–electrospray ionization–tandem mass spectrometry. Based on label-free quantitation protein intensities, a logistic regression model was calculated and adjusted for age, sex and protein concentration. Web-based functional enrichment analyses of phenotype-associated proteins were performed utilizing g:Profiler and STRING. Data are available via ProteomeXchange with identifier PXD039662. Lysates from 38 patients, including 25 AR and 13 AS samples, were analyzed. AR patients presented with significantly larger LV diameters and volumes (end-diastolic diameter: 61 (12) vs. 48 (13) mm, p < 0.001; end-diastolic volume: 180.0 (74.6) vs. 92.3 (78.4), p = 0.001). A total of 171 proteins were associated with patient phenotype: 117 were positively associated with AR and the enrichment of intracellular compartment proteins (i.e., assigned to carbohydrate and nucleotide metabolism, protein biosynthesis and the proteasome) was detected. Additionally, 54 were positively associated with AS and the enrichment of extracellular compartment proteins (i.e., assigned to the immune and hematopoietic system) was observed. In summary, functional enrichment analysis revealed specific AR- and AS-associated signatures of LV myocardial proteins.

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“…Aortic stenosis is a common valvular heart disease in the ageing population that is characterized by a variable asymptomatic period preceding the development of symptoms. The left ventricular (LV) pressure overload induces hypertrophy and fibrosis, resulting in impaired LV filling and progressive cardiac dysfunction ( Figure ) 9,10 . At an advanced stage, long‐standing persistent LV hypertrophy induces oxygen supply demand mismatch, reduced capillary density, and chronic subendocardial ischaemia.…”

Section: Pathophysiology Of Heart Failure In Patients With Aortic Ste...mentioning

confidence: 99%

Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch

et al. 2023

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Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis in elderly and comorbid population. Significant improvement in heart function has been observed in patients undergoing TAVI, but numerous patients are readmitted to hospital for heart failure (HF). Moreover, repeat HF hospitalization is strongly associated with an adverse prognosis and increases the financial burden of health care. Although studies have identified pre-existing and post-procedural factors that contribute to HF hospitalization after TAVI, there is a paucity of data regarding optimal post-procedural pharmacological treatments. This review aims to provide an overview of the current understanding of mechanisms, determinants, and potential treatments of HF following TAVI. We first review the pathophysiology of left ventricular (LV) remodelling, coronary microcirculation disorder, and endothelial dysfunction in patients with aortic stenosis and then examine the impact of TAVI on these conditions. We then present evidence of various factors and complications that may interplay with LV remodelling and contribute to HF events after TAVI. Next, we describe the triggers and predictors of early and late HF rehospitalizations following TAVI. Lastly, we discuss the potential of conventional pharmacological treatments, including renin-angiotensin blockers, beta-blockers, and diuretics in TAVI patients. The paper explores the potential of newer drugs, including sodium-glucose co-transporter 2 inhibitors, anti-inflammatory drugs, and ion supplementation. Comprehensive knowledge in this field may aid in recognizing successful existing therapies, developing effective new treatments, and establishing dedicated patient care strategies during follow-up after TAVI.

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Assessment of 10-Year Left-Ventricular-Remodeling by CMR in Patients Following Aortic Valve Replacement

Cited by 5 publications

References 41 publications

Electrocardiographic markers of adverse left ventricular remodeling and myocardial fibrosis in severe aortic stenosis

Electrocardiographic markers of adverse left ventricular remodeling and myocardial fibrosis in severe aortic stenosis

Proteomic Analysis in Valvular Cardiomyopathy: Aortic Regurgitation vs. Aortic Stenosis

Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch

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