Role of advanced left ventricular imaging in adults with aortic stenosis

Călin, Andreea; Mateescu, A.; Popescu, Andreea C.; Bing, Rong; Dweck, Marc R; Popescu, Bogdan A.

doi:10.1136/heartjnl-2019-315211

Cited by 18 publications

(11 citation statements)

References 51 publications

(66 reference statements)

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“…Long-term mortality in patients with recovered average S' was similar to those of patients with pre-TAVI preserved average S', while prognosis remained poorer for patients with persistently reduced S'. This finding suggests once again that several mechanisms may underlie reduced contractile function in severe AS, entailing differential prognostic implications [1,19,20,26,27]. More importantly, it adds up to current literature that demonstrated LV reverse remodeling following TAVI to be a positive marker of favorable long-term outcome [27][28][29] and it points at post-TAVI average S' as a reliable echocardiographic feature able to define the patient's trajectory also within the preserved EF population and at an early assessment, thus providing an over post-TAVI LV mass and EF which recover throughout a longer time course [27].…”

Section: Discussionmentioning

confidence: 92%

Prognostic implications of impaired longitudinal left ventricular systolic function assessed by tissue Doppler imaging prior to transcatheter aortic valve implantation for severe aortic stenosis

Gallone

Bruno

Trenkwalder

et al. 2022

Int J Cardiovasc Imaging

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Change in longitudinal left ventricular (LV) systolic function serves as an early marker of the deleterious effect of aortic stenosis (AS) and other cardiac comorbidities on cardiac function. We explored the prognostic value of tissue Doppler imaging (TDI)-derived longitudinal LV systolic function, defined by the peak systolic average of lateral and septal mitral annular velocities (average S’) among symptomatic patients with severe AS undergoing transcatheter aortic valve implantation (TAVI). 297 consecutive patients with severe AS undergoing TAVI at three european centers with available average S’ at preprocedural echocardiography were retrospectively included. The primary endpoint was the Kaplan Meier estimate of all-cause mortality. After a median 18 months (IQR 12–18) follow-up, 36 (12.1%) patients had died. Average S’ was associated with all-cause mortality (per 1 cm/sec decrease: HR 1.29, 95%CI 1.03–1.60, p = 0.025), the cut-off of 6.5 cm/sec being the most accurate. Patients with average S’ < 6.5 cm/sec (55.2%) presented characteristics of more advanced LV remodeling and functional impairment along with higher burden of cardiac comorbidities, and experienced higher all-cause mortality (17.6% vs. 7.5%, p = 0.007), also when adjusted for in-study outcome predictors (adj-HR: 2.69, 95%CI 1.22–5.93, p = 0.014). Results were consistent among patients with preserved ejection fraction, normal-flow AS, high-gradient AS and in those without LV hypertrophy. Longitudinal LV systolic function assessed by average S’ is independently associated with long-term all-cause mortality among TAVI patients. An average S’ below 6.5 cm/sec best defines clinically meaningful reduced longitudinal systolic function and may aid clinical risk stratification in these patients.

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Section: Discussionmentioning

confidence: 92%

Prognostic implications of impaired longitudinal left ventricular systolic function assessed by tissue Doppler imaging prior to transcatheter aortic valve implantation for severe aortic stenosis

Gallone

Bruno

Trenkwalder

et al. 2022

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

show abstract

“…Long-term mortality in patients with recovered average S' was similar to those of patients with pre-TAVI preserved average S', while prognosis remained poorer for patients with persistently reduced S'. This nding suggests once again that several mechanisms may underlie reduced contractile function in severe AS, entailing differential prognostic implications 1,19,20,26,27 . More importantly, it adds up to current literature that demonstrated LV reverse remodeling following TAVI to be a positive marker of favorable long-term outcome [27][28][29] and it points at post-TAVI average S' as a reliable echocardiographic feature able to de ne the patient's trajectory also within the preserved EF population and at an early assessment, thus providing an advantage over post-TAVI LV mass and EF which recover throughout a longer time course 27 .…”

Section: Discussionmentioning

confidence: 95%

Prognostic Implications of Impaired Longitudinal Left Ventricular Systolic Function Assessed by Tissue Doppler Imaging Prior to Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

Gallone

Bruno²,

Trenkwalder

et al. 2021

Preprint

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BackgroundChange in longitudinal left ventricular (LV) systolic function serves as an early marker of the deleterious effect of aortic stenosis (AS) and other cardiac comorbidities on cardiac function. We explored the prognostic value of tissue doppler imaging (TDI)-derived longitudinal LV systolic function, defined by the peak systolic average of lateral and septal mitral annular velocities (average S’) among symptomatic patients with severe AS undergoing transcatheter aortic valve implantation (TAVI).Methods and results297 unselected patients with severe AS undergoing TAVI at three european centers with available average S’ at preprocedural echocardiography were retrospectively included. The primary endpoint was the Kaplan Meier estimate of all-cause mortality. After a median 18 months (IQR 12-18) follow-up, 36 (12.1%) patients died. Average S’ was associated with all-cause mortality (per 1 cm/sec decrease: HR 1.29, 95%CI 1.03-1.60, p=0.025), being the cut-off of 6.5 cm/sec the most accurate. Patients with average S’ <6.5 cm/sec (55.2%) presented characteristics of more advanced LV remodeling and functional impairment along with higher burden of cardiac comorbidities, and experienced higher all-cause mortality (17.6% vs. 7.5%, p=0.007), also when adjusted for in-study outcome predictors (adj-HR: 2.69, 95%CI 1.22-5.93, p=0.014). Results were consistent among patients with preserved ejection fraction, normal-flow AS, high-gradient AS and in those without LV hypertrophy.Conclusions Longitudinal LV systolic function assessed by average S’ is independently associated with long-term all-cause mortality among TAVI patients. An average S’ below 6.5 cm/sec best defines clinically meaningful reduced longitudinal systolic function and may aid clinical risk stratification in these patients.

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“…Magnetic resonance imaging is the medical imaging modality that provides the best tissue characterization. CMR studies using late gadolinium enhancement imaging, native T1 mapping and determination of extracellular volume (ECV), by native and postgadolinium T1 mapping, have demonstrated the ability of CMR to detect scarring and oedema in patients with AS [42][43][44]. It sounds reasonable that patients with evidence of intracardiac scars and/or oedema…”

Section: Relevant Aspects Of Assessment Of Aortic Valve By Cardiac Computed Tomography and Cardiac Magnetic Resonance Imagingmentioning

confidence: 99%

Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. Part I: Aortic stenosis of the native valve

Walpot¹,

Vermeiren²,

Mafragi³

et al. 2021

ait

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Aortic stenosis (AS) causes obstruction of left ventricle outflow. Severe AS is a condition with major haemodynamic implications in patients, scheduled for major surgery or hospitalized in the intensive care unit (ICU). Basically, AS causes left ventricular outflow obstruction. Especially in critically ill patients, in whom increased cardiac output and oxygen delivery are required (e.g. sepsis, postoperative anaemia), the consequences of unrecognized severe AS may be devasting.A prevalence of 7.6 million cases among adults above 75 years of age in North America and Europe has been reported [1]. With an aging population,

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Role of advanced left ventricular imaging in adults with aortic stenosis

Cited by 18 publications

References 51 publications

Prognostic implications of impaired longitudinal left ventricular systolic function assessed by tissue Doppler imaging prior to transcatheter aortic valve implantation for severe aortic stenosis

Prognostic implications of impaired longitudinal left ventricular systolic function assessed by tissue Doppler imaging prior to transcatheter aortic valve implantation for severe aortic stenosis

Prognostic Implications of Impaired Longitudinal Left Ventricular Systolic Function Assessed by Tissue Doppler Imaging Prior to Transcatheter Aortic Valve Implantation for Severe Aortic Stenosis

Comprehensive assessment of the aortic valve in critically ill patients for the non-cardiologist. Part I: Aortic stenosis of the native valve

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