Recovery of Left Ventricular Mechanics after Transcatheter Aortic Valve Implantation: Effects of Baseline Ventricular Function and Postprocedural Aortic Regurgitation

Poulin, Frédéric; Carasso, Shemy; Horlick, Eric; Rakowski, Harry; Lim, Ki-Dong; Finn, Heather; Feindel, Christopher M.; Greutmann, Matthias; Osten, Mark; Cusimano, Robert J.; Woo, Anna

doi:10.1016/j.echo.2014.07.001

Cited by 68 publications

(65 citation statements)

References 51 publications

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“…16 Impaired LVEF in severe AS with CAD may result from both conditions. [21][22][23][24] Our study showed the improvement of LVEF in the group of patients with LVEF <40% after 1 month from the procedure (BAV/PCI/coronary angiography). We did not manage to prove this phenomenon in the group of patients who underwent BAV and PCI which was probably due to a small sample size.…”

Section: Discussionmentioning

confidence: 52%

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In‐hospital and long‐term outcomes of percutaneous balloon aortic valvuloplasty with concomitant percutaneous coronary intervention in patients with severe aortic stenosis

Daniec

Sorysz

Dziewierz

et al. 2017

J Interven Cardiology

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Section: Discussionmentioning

confidence: 52%

“…Impaired LVEF in severe AS with CAD may result from both conditions . Our study showed the improvement of LVEF in the group of patients with LVEF <40% after 1 month from the procedure (BAV/PCI/coronary angiography).…”

Section: Discussionmentioning

confidence: 53%

In‐hospital and long‐term outcomes of percutaneous balloon aortic valvuloplasty with concomitant percutaneous coronary intervention in patients with severe aortic stenosis

Daniec

Sorysz

Dziewierz

et al. 2017

J Interven Cardiology

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“…However, untwist decreases and is associated with diastolic dysfunction and elevated LV enddiastolic filling pressures. 44 Aortic valve replacement either by surgery or by transcatheter (TAVI) in these patients normalizes the LVT, 43,45 although the development of significant aortic regurgitation post-TAVI abolishes this normalization. However, aortic stenosis patients with reduced EF have reduced LVT, signifying exhaustion of LVT compensatory mechanisms and LVT in these patients does not change post-TAVI.…”

Section: Valvular Heart Diseasementioning

confidence: 99%

“…In patients with significant valvular disease, changes in twist mechanics depend on the degree of systolic dysfunction 43 ( Table 4). In patients with aortic stenosis and preserved EF, subendocardial ischemia causes LVT to increase, contributing to the preservation of EF.…”

Section: Valvular Heart Diseasementioning

confidence: 99%

Left Ventricular Twist and Torsion

Omar

Vallabhajosyula

Sengupta

2015

Circ: Cardiovascular Imaging

100

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A 52-year-old white man visited his physician because he started experiencing shortness of breath on walking short distances at ground level. He had smoked half a packet of cigarettes daily for 40 years. Physical examination revealed a blood pressure of 147/95 mm Hg. Chest examination and chest x-ray were unremarkable, and ECG showed left atrial abnormality. The patient had normal serum electrolytes, blood sugar, and kidney function tests. A stress echocardiogram was ordered to exclude potential coronary artery disease. His resting echocardiography showed an ejection fraction (EF) of 60%, normal septal and posterior wall thickness, and mild diastolic dysfunction (septal early diastolic mitral annular velocity [e′] of 7 cm/s, early diastolic [E wave] to late diastolic [A wave] transmitral Doppler flow velocity ratio [E/A] of 1.4, E-wave deceleration time of 210 ms, E/e′ ratio of 9, and left atrial volume index of 44 mL/m 2 ; Figure 1A). There were no resting segmental wall motion abnormalities suggestive of ischemia. The patient exercised on a treadmill using Bruce protocol for 4 minutes and 43 s, and achieved 6.6 metabolic equivalent of task and maximum heart rate of 148 bpm (88% of his maximum age predicted heart rate). At peak exercise, the patient developed severe dyspnea and his blood pressure was 213/90 mm Hg. Post exercise echocardiography was acquired within 1 minute of exercise termination and showed EF of 69% and no segmental wall motion abnormalities, with Doppler recordings obtained at recovering heart rate of 125 bpm; showing a septal e′ velocity of 7.3 cm/s, E/A of 1.9, E-wave deceleration time of 110 ms, and E/e′ of 13.7, left atrial volume index of 35 mL/m 2 ( Figure 1B). Ten minutes into the recovery period, the blood pressure returned to basal level (145/80 mm Hg). Compared with resting levels, the increased E/A ratio, shortened E-wave deceleration time and relatively increased E/e′ ratio suggested post exercise worsening of diastolic function with elevation of left ventricular (LV) filling pressures. To investigate the mechanistic basis of diastolic dysfunction in this patient, LV deformation was assessed offline using speckletracking echocardiography (STE). Besides characterizing the longitudinal and circumferential shortening, and radial thickening, the LV rotational deformation, that resembles the wringing of a towel, was also measured (Figures 2 and 3). This wringing deformation, also referred to as LV twist (LVT) and the subsequent recoil that occurs in diastole, referred to as untwist, were abnormal in this patient (Figure 4). At rest, the patient had mild diastolic dysfunction, which was associated with a higher than normal LVT and untwist values, compared with the published age-related normal values, 1,2 and low global longitudinal strain. At peak exercise, there was a significant worsening of the patient's diastolic parameters, which was associated with worsening untwist values and further reduction of global longitudinal strain, whereas LVT remained same in magnitude. The following ...

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“…42 Transcatheter AVR has been shown to normalize ventricular-arterial coupling, decrease LV hypertrophy, and restore LV function in patients with systolic dysfunction. 43,44 Elevated left-sided filling pressures in severe AS can lead to severe pulmonary hypertension in nearly one third of cases. Patients undergoing TAVR were noted to have a sustained reduction in pulmonary hypertension.…”

mentioning

confidence: 99%