Predictors and Changes in Cardiac Hemodynamics and Geometry With Transcatheter Aortic Valve Implantation

Alenezi, Fawaz; Fudim, Marat; Rymer, Jennifer A.; Dunning, Allison; Chiswell, Karen; Swaminathan, Madhav; Bottiger, Brandi; Velagapudi, Poonam; Nicoara, Alina; Kisslo, Joseph; Velázquez, Eric J.; Vemulapalli, Sreekanth; Bloomfield, Gerald S.; Samad, Zainab

doi:10.1016/j.amjcard.2018.11.038

Cited by 13 publications

(12 citation statements)

References 20 publications

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“…However, it has previously been shown that in low-risk and intermediate-risk patients, TAVI carries higher rates of vascular complications when compared with SAVR [8]. Recent studies have also shown that TAVI can reduce the mortality rate by 46% and significantly improve the quality of life in patients with severe aortic stenosis who tolerate SAVR [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

Zhou

Yang³

et al. 2019

Med Sci Monit

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Departmental sources Background: Patients with severe aortic stenosis who have comorbidities that prevent general anesthesia and open cardiothoracic surgery are candidates for transcatheter aortic valve implantation (TAVI). However, TAVI can result in patient mortality following the procedure. This systematic review of the literature and meta-analysis aimed to determine the relationship between preoperative anemia and postoperative mortality in patients following TAVI. Material/Methods: PubMed, EMBASE, the Cochrane Library, and the Web of Science were systematically searched from their inception to February 2019 for relevant published studies that included patients with bicuspid aortic valve stenosis and tricuspid aortic valve stenosis who underwent TAVI and who had preoperative data on hemoglobin levels. The pooled odds ratios (OR) and 95% confidence interval (CI) were calculated using a random-effects generic inverse variance method. Results: Six published studies that involved 6,406 patients with aortic stenosis were included in the meta-analysis. There was no significant difference observed for the final pooled result for patients with and without anemia for the short-term 30-day postoperative mortality (OR, 1.34; 95% CI, 0.77-2.35). However, long-term mortality rates were significantly worse in patients with preoperative anemia compared with those without anemia (OR, 1.77; 95% CI, 1.34-2.35). Conclusions: Systematic review of the literature and meta-analysis showed that pre-procedural anemia reduced long-term mortality following TAVI. This finding supports the need to correct preoperative anemia in patients with aortic stenosis to improve patient outcome following TAVI.

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Section: Introductionmentioning

confidence: 99%

Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

Zhou

Yang³

et al. 2019

Med Sci Monit

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“…In their study, they hypothesized that myocardial deformation was not influenced by pacemaker implantation or the duration of left bundle branch block. Similarly, Alenezi et al [14] found a significant change in global longitudinal strain after transcatheter aortic valve replacement (P value < 0.001).…”

Section: Discussionmentioning

confidence: 78%

“…The conventional method in monitoring viability and performance of the left ventricle during transcatheter aortic valve implantation is the two-dimensional echocardiography method. But recent studies have found that strain analysis-using speckle tracking approach-is superior to the routine two-dimensional echocardiography method [14].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Left Ventricular Function after Transcatheter Aortic Valve Implantation in Sever Aortic Stenosis: A Speckle Tracking Imaging Study

Saad¹,

Montaser²,

Emara³

et al. 2020

WJCD

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Background: Long standing aortic stenosis leads to elevated left ventricular (LV) pressure and as a result LV hypertrophy and myocardial fibrosis shall increase. The left ventricular ejection fraction (EF) usually remains adequately-preserved until advanced and late stages of aortic stenosis. But the preserved muscle of the LV is only limited to a portion of the entire myocardium. Speckle tracking echocardiography has proved its superiority to the standard two-dimensional echocardiography method in the detection of Left Ventricular (LV) function. Global Longitudinal strain (GLS) is considered as the most robust myocardial strain component. Objective: The aim of the study is to assess the early course of left ventricular reverse remodelling after Transcutaneous Aortic Valve Implantation (TAVI) in patients with symptomatic severe aortic valve stenosis. Methods: 50 patients with severe symptomatic valvular aortic stenosis undergoing TAVI as decided by the heart team after comprehensive discussion. Standard transthoracic echocardiography including Doppler analysis was performed. 2D speckle-tracking strain assessment of Global radial, circumferential and longitudinal strain at parasternal mid-ventricular short-axis view (at the level of papillary muscle) and from the apical long-axis, two-chamber and four-chamber views with a frame rate between 40 and 80 frames per second. Tracing of endocardial borders was done. Patients with significant coronary artery disease were fully revascularized by percutaneous coronary intervention prior to the study and the procedure. Results: 23 (46%) patients were males, while 27 (54%) were females. The patients' stratification according to comorbidities/associated risk factors re

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“…At an intermediate follow-up of three months post-TAVR, Giannini et al ( 12 ) and Al-Rashid et al ( 23 ) demonstrated an improvement in longitudinal strain despite any significant change in LVEF. Lozano et al ( 24 ) and Alenezi et al ( 25 ) demonstrated an improvement in GLS at one year post-TAVR with no significant change in LVEF, suggesting strain may be a more sensitive measure for changes in LV recovery.…”

Section: Discussionmentioning

confidence: 98%

Left Ventricular Mechanics Differ in Subtypes of Aortic Stenosis Following Transcatheter Aortic Valve Replacement

Wani

Harland

Bajwa

et al. 2022

Front. Cardiovasc. Med.

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BackgroundLeft ventricular (LV) mechanics are impaired in patients with severe aortic stenosis (AS). We hypothesized that there would be differences in myocardial mechanics, measured by global longitudinal strain (GLS) recovery in patients with four subtypes of severe AS after transcatheter aortic valve replacement (TAVR), stratified based upon flow and gradient.MethodsWe retrospectively evaluated 204 patients with severe AS who underwent TAVR and were followed post-TAVR at our institution for clinical outcomes. Speckle-tracking transthoracic echocardiography was performed pre- and post-TAVR. Patients were classified as: (1) normal-flow and high-gradient, (2) normal-flow and high-gradient with reduced LV ejection fraction (LVEF), (3) classical low-flow and low-gradient, or (4) paradoxical low-flow and low-gradient.ResultsBoth GLS (−13.9 ± 4.3 to −14.8 ± 4.3, P < 0.0001) and LVEF (55 ± 15 to 57 ± 14%, P = 0.0001) improved immediately post-TAVR. Patients with low-flow AS had similar improvements in LVEF (+2.6 ± 9%) and aortic valve mean gradient (−23.95 ± 8.34 mmHg) as patients with normal-flow AS. GLS was significantly improved in patients with normal-flow (−0.93 ± 3.10, P = 0.0004) compared to low-flow AS. Across all types of AS, improvement in GLS was associated with a survival benefit, with GLS recovery in alive patients (mean GLS improvement of −1.07 ± 3.10, P < 0.0001).ConclusionsLV mechanics are abnormal in all patients with subtypes of severe AS and improve immediately post-TAVR. Recovery of GLS was associated with a survival benefit. Patients with both types of low-flow AS showed significantly improved, but still impaired, GLS post-TAVR, suggesting underlying myopathy that does not correct post-TAVR.

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Predictors and Changes in Cardiac Hemodynamics and Geometry With Transcatheter Aortic Valve Implantation

Cited by 13 publications

References 20 publications

Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis

Assessment of Left Ventricular Function after Transcatheter Aortic Valve Implantation in Sever Aortic Stenosis: A Speckle Tracking Imaging Study

Left Ventricular Mechanics Differ in Subtypes of Aortic Stenosis Following Transcatheter Aortic Valve Replacement

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