Functional and structural reverse myocardial remodeling following transcatheter aortic valve replacement: a prospective cardiovascular magnetic resonance study

Lange, Torben; Backhaus, Sören J.; Beuthner, Bo Eric; Topci, Rodi; Rigorth, Karl-Rudolf; Kowallick, Johannes T.; Evertz, Ruben; Schnelle, Moritz; Ravassa, Susana; Díez, Javier; Toischer, Karl; Seidler, Tim; Puls, Miriam; Hasenfuß, Gerd; Schuster, Andreas

doi:10.1186/s12968-022-00874-0

Cited by 11 publications

(11 citation statements)

References 46 publications

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“…Consistent with these findings, a multicentre, observational, outcome study with imaging core‐lab analysis of 674 patients with severe AS, LGE on CMR before SAVR or TAVI was independently associated with all‐cause mortality 42 . On the other hand, ECV is associated with myocardial functional recovery from HF following TAVI 41 . Additionally, electrocardiographic strain pattern (ESP) is a relevant marker of myocardial fibrosis that is associated with an increased risk of CV morbidity and mortality in asymptomatic AS and SAVR patients.…”

Section: Clinical Factors Associated With Heart Failure Hospitalizati...mentioning

confidence: 62%

“…It is important to note that the prognosis of patients with AS after valve replacement may not solely depend on improved flow dynamics but rather on the extent of irreversible myocardial fibrosis during the remodelling phase that occurs before the intervention 39 . Myocardial fibrosis can be divided in two categories: diffuse fibrosis occurs in the early phase of the disease, is potentially reversible, and can be quantified as extracellular volume (ECV) with CMR T1 mapping techniques, whereas replacement fibrosis is irreversible and can be identified using late gadolinium enhancement (LGE) on CMR 39–41 . Consistent with these findings, a multicentre, observational, outcome study with imaging core‐lab analysis of 674 patients with severe AS, LGE on CMR before SAVR or TAVI was independently associated with all‐cause mortality 42 .…”

Section: Clinical Factors Associated With Heart Failure Hospitalizati...mentioning

confidence: 74%

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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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Section: Clinical Factors Associated With Heart Failure Hospitalizati...mentioning

confidence: 62%

Section: Clinical Factors Associated With Heart Failure Hospitalizati...mentioning

confidence: 74%

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

et al. 2023

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“…However, cardiac magnetic resonance scans as an alternative also are accompanied by advantages and disadvantages such as software‐specific native T1 times and differing normal values 37 . Furthermore, in the absence of follow‐up examinations, we are unable to report on reverse remodelling in regard to AVC and MF 38 . Finally, our study included Medtronic CoreValve and the Edwards SAPIEN 3™ valves, which were standard devices at the time of data collection.…”

Section: Discussionmentioning

confidence: 99%

“…37 Furthermore, in the absence of follow-up examinations, we are unable to report on reverse remodelling in regard to AVC and MF. 38 Finally, our study included Medtronic CoreValve and the Edwards SAPIEN 3 ™ valves, which were standard devices at the time of data collection.…”

Section: Limitationsmentioning

confidence: 99%

Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement

et al. 2023

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Aims There is evidence to suggest that the subtype of aortic stenosis (AS), the degree of myocardial fibrosis (MF), and level of aortic valve calcification (AVC) are associated with adverse cardiac outcome in AS. Because little is known about their respective contribution, we sought to investigate their relative importance and interplay as well as their association with adverse cardiac events following transcatheter aortic valve replacement (TAVR). Methods and resultsOne hundred consecutive patients with severe AS and indication for TAVR were prospectively enrolled between January 2017 and October 2018. Patients underwent transthoracic echocardiography, multidetector computed tomography, and left ventricular endomyocardial biopsies at the time of TAVR. The final study cohort consisted of 92 patients with a completed study protocol, 39 (42.4%) of whom showed a normal ejection fraction (EF) high-gradient (NEFHG) AS, 13 (14.1%) a low EF high-gradient (LEFHG) AS, 25 (27.2%) a low EF low-gradient (LEFLG) AS, and 15 (16.3%) a paradoxical low-flow, low-gradient (PLFLG) AS. The high-gradient phenotypes (NEFHG and LEFHG) showed the largest amount of AVC (807 ± 421 and 813 ± 281 mm 3 , respectively) as compared with the low-gradient phenotypes (LEFLG and PLFLG; 503 ± 326 and 555 ± 594 mm 3 , respectively, P < 0.05). Conversely, MF was most prevalent in low-output phenotypes (LEFLG > LEFHG > PLFLG > NEFHG, P < 0.05). This was paralleled by a greater cardiovascular (CV) mortality within 600 days after TAVR (LEFLG 28% > PLFLG 26.7% > LEFHG 15.4% > NEFHG 2.5%; P = 0.023). In patients with a high MF burden, a higher AVC was associated with a lower mortality following TAVR (P = 0.045, hazard ratio 0.261, 95% confidence interval 0.07-0.97). Conclusions MF is associated with adverse CV outcome following TAVR, which is most prevalent in low EF situations. In the presence of large MF burden, patients with large AVC have better outcome following TAVR. Conversely, worse outcome in large MF and relatively little AVC may be explained by a relative prominence of an underlying cardiomyopathy. The better survival rates in large AVC patients following TAVR indicate TAVR induced relief of severe AS-associated pressure overload with subsequently improved outcome.

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“…Lange et al reported that not only hypertrophic cardiomyocytes but also some fibrotic tissue associated with LVH due to severe AS recover after TAVR. 26 Such histological reversibility may be associated with recovery of CSN function after TAVR. CSN dysfunction is known to be a poor prognostic factor in patients with heart failure.…”

Section: Left Ventricular Hypertrophy and Cardiac Sympathetic Nerve D...mentioning

confidence: 99%

Left ventricular hypertrophy as a predictor of cardiovascular outcomes after transcatheter aortic valve replacement

et al. 2023

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Aims This study aimed to clarify the relationship between cardiovascular prognosis and left ventricular hypertrophy (LVH) in patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR) and to investigate the relationship between cardiac sympathetic nerve (CSN) function and these factors using 123 I‐metaiodobenzylguanidine scintigraphy. Methods and results In this single‐centre, retrospective observational study, 349 patients who underwent TAVR at our institution between July 2017 and May 2020 were divided into two groups: those with severe LVH pre‐operatively [severe LVH (+) group] and those without LVH pre‐operatively [severe LVH (−) group]. The rates of freedom from cardiovascular events (cardiovascular death and heart failure hospitalization) were compared. The relationship between changes in left ventricular mass index (LVMi) and changes in delay heart–mediastinum ratio (H/M) from before TAVR to 6 months after TAVR was also investigated. The event‐free rate was significantly lower in the severe LVH (+) group (87.1% vs. 96.0%, log‐rank P = 0.021). The severe LVH (+) group exhibited a significantly lower delay H/M value, scored by 123 I‐metaiodobenzylguanidine scintigraphy, than the severe LVH (−) group (2.33 [1.92–2.67] vs. 2.67 [2.17–3.68], respectively, P < 0.001). Moreover, the event‐free rate of post‐operative cardiovascular events was lower among patients with a delay H/M value < 2.50 than that among other patients (87.7% vs. 97.2%, log‐rank P = 0.012). LVMi was significantly higher (115 [99–130] vs. 90 [78–111] g/m 2 , P < 0.001) and delay H/M value was significantly lower (2.53 [1.98–2.83] vs. 2.71 [2.25–3.19], P = 0.025) in the severe LVH (+) group than in the severe LVH (−) group at 6 months after TAVR. Patients with improved LVH at 6 months after TAVR also had increased delay H/M (from 2.51 [2.01–2.81] to 2.67 [2.26–3.02], P < 0.001), whereas those without improved LVH had no significant change in delay H/M (from 2.64 [2.23–3.06] to 2.53 [1.97–3.00], P = 0.829). Conclusions Severe LVH before TAVR is a prognostic factor for poor post‐operative cardiovascular outcomes. LVH associated with aortic stenosis and CSN function are correlated, suggesting their involvement in LVH prognosis.

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Functional and structural reverse myocardial remodeling following transcatheter aortic valve replacement: a prospective cardiovascular magnetic resonance study

Cited by 11 publications

References 46 publications

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

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

Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement

Left ventricular hypertrophy as a predictor of cardiovascular outcomes after transcatheter aortic valve replacement

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