Acute left ventricle diastolic function improvement after transcatheter aortic valve implantation (original) (raw)
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Journal of the American College of Cardiology, 2011
Katheterunterstützte Aortenklappenimplantation-TAVI: Frühe Ergebnisse nach transapikalen Zugang in einer multimorbiden, hoch betagten, Hochrisiko-Population Zusammenfassung. Grundlagen: Bericht ü ber die Erfahrungen an unserer Abteilung ü ber die transapikale Implantation von Aortenklappenprothesen (TAVI) bei Hochrisiko-Patienten ohne den Einsatz einer extrakorporalen Kreislaufunterstü tzung.
ESC Heart Failure
Aims There are limited data about the intraprocedural haemodynamic study performed immediately before and after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS). We aimed to evaluate the acute haemodynamic impact of TAVI in patients with severe AS and to investigate invasive and non-invasive parameters predicting all-cause mortality. Methods and results A total of 245 consecutive AS patients (43% male, mean age 80.3 ± 7.3 years) undergoing TAVI were enrolled. Intraprocedural left heart catheterization (LHC) and echocardiogram before and after TAVI were performed. The clinical endpoint was the death for any cause. LHC after TAVI revealed significant changes in aortic and left ventricular (LV) pressures, including indexes of intrinsic myocardial contractility and diastolic function such as positive dP/dT (1128.9 ± 398.7 vs. 806.3 ± 247.2 mmHg/s, P ˂ 0.001) and negative dP/dT (1310.7 ± 431.1 vs. 1075.1 ± 440.8 mmHg/s, P ˂ 0.001). Post-TAVI echo showed a significant reduction in LV end-diastolic (P = 0.036) and end-systolic (P ˂ 0.001) diameters, improvement in LV ejection fraction (from 55 ± 12% to 57.2 ± 10.5%, P ˂ 0.001), and pulmonary artery systolic pressure (42.1 ± 14.2 vs. 33.1 ± 10.7 mmHg, P < 0.001). After a mean follow-up time interval of 24 months, 47 patients died. Post-TAVI significant aortic regurgitation at echocardiography was the only independent predictor of mortality (hazard ratio 5.592, confidence interval 1.932-16.184, P = 0.002). Conclusions Left heart catheterization performed immediately before and after prosthesis release offers a unique insight in the assessment of LV adaptation to severe AS and the impact of TAVI on LV, catching changes in indexes of intrinsic contractility and myocardial relaxation. Aortic regurgitation assessed by echocardiography was the only independent predictor of mortality in patients undergoing TAVI.
Echocardiography, 2020
Introduction: Limited data are available regarding the evaluation of right ventricular (RV) performance in patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Objective: To evaluate the prevalence of RV dysfunction in patients with severe AS undergoing TAVI and long-term changes. Methods: Consecutive patients with severe AS undergoing TAVI from January 2016 to July 2017 were included. RV anatomical and functional parameters were analyzed: RV diameters, fractional area change, tricuspid annular plane systolic excursion (TAPSE), S-wave tissue Doppler of the tricuspid annulus (RV-S'TDI), global longitudinal strain (RV-GLS), and free wall strain (RV-FWS). Preprocedure and 1-year echo were analyzed. Results: Final population included 114 patients, mean age 83.63 ± 6.31 years, and 38.2% women. The prevalence of abnormal RV function was high, variable depending on the parameter that we analyzed, and it showed a significant reduction 1 year after TAVI implantation: 13.9% vs 6.8% (TAPSE < 17mm), P = .04; 26.3% vs 20% (fractional area change < 35%), P = .048; 41.2% vs 29.2% (RV-S'TDI < 9.5cm/s), P = .04; 48.7% vs 39.5% (RV-GLS > [20]), P = .049; and 48.7% vs 28.9% (RV-FWS > [20]), P = .03. Significant differences were noted between patients with low-flow (LF) vs normal-flow (NF) AS in RV dysfunction prevalence as well as in RV function recovery which is less evident in LF compared with NF patients. Conclusions: RV dysfunction is high among symptomatic AS patients undergoing TAVI, with variable prevalence depending on the echocardiographic parameter used.
Heart, 2012
Objective To investigate early haemodynamic changes after transfemoral transcatheter aortic valve implantation (TAVI) and the relationship with myocardial injury and neurohormonal activation. Design Single-centre prospective observational study. Setting Tertiary cardiac centre. Patients 42 patients undergoing transfemoral TAVI were included in this study. Main outcome measures Haemodynamic measurements and echocardiography-derived indices characterising myocardial function were recorded at baseline, 6 and 24 h postprocedure. Postprocedural myocardial injury was quantified using serum troponin I and CK-MB levels. In addition, biomarkers of myocardial dysfunction/heart failure and neurohormonal activation were measured. Results 6 h Post-TAVI there was a significant deterioration in both systolic and diastolic function as measured by dP/dt max /EDV, myocardial performance index and mean E/e' index. Recovery of myocardial function was observed at 24 h. These haemodynamic changes were associated with a significant increase in both troponin I (0.0760.01 vs 1.5960.21 mg/l, p<0.005) and CK-MB (1.9960.19 vs 6.8260.7 ng/ml, p<0.005). There was a positive correlation among myocardial injury and NT-BNP (r¼0.34, p<0.0005), aldosterone (r¼0.56, p<0.0001) and ST2 levels (r¼0.21, p<0.05). Conclusions This is the first study to demonstrate that procedurally successful TF-TAVI results in a transient depression of both systolic and diastolic left ventricular function within the first 24 postoperative hours, despite impressive relief of previously severe, chronic pressure overload. The rise in the markers of myocardial damage suggests that this may be due to periprocedural myocardial injury. Complete recovery of contractility is generally observed after 24 h.
European Heart Journal – Cardiovascular Imaging, 2015
Despite expected improvement in left ventricular (LV) systolic and diastolic function after transcatheter aortic valve implantation (TAVI), the complex relationship between pre-existent LV systolic and diastolic function and changes in LV haemodynamics and clinical symptoms have been scarcely investigated. This study investigated the presence of preoperative LV diastolic dysfunction and its improvement over time after TAVI alongside improvement in New York Heart Association (NYHA) class in high-risk patients with severe aortic stenosis. Methods and results The study population (n ¼ 358) was divided into two groups according to baseline LV ejection fraction (LVEF): LVEF , 50% (n ¼ 96) and LVEF ≥ 50% (n ¼ 262). We compared clinical and echocardiographic parameters between groups before TAVI, at 6 and 12 months follow-up. Grade III LV diastolic dysfunction was more frequent in patients with LVEF , 50% compared with patients with LVEF ≥ 50% (50.0 vs. 16.3%, P , 0.001). Systolic and diastolic echocardiographic parameters improved after TAVI together with improvement in NYHA class both in patients with LVEF , 50% (diastolic dysfunction grade ≥2: baseline 100% of patients; 12 months 58.8%, P , 0.001; NYHA III/IV: baseline, 93.8%; 12 months, 9.7%, P , 0.001) and with LVEF ≥ 50% (diastolic dysfunction grade ≥2: baseline, 87.1%; 12 months, 61.2%; NYHA III/IV: baseline, 74.5%; 12 months, 2.6%, P , 0.001). All-cause mortality was comparable between groups. Conclusion TAVI exerts favourable effects on LV systolic and diastolic function with a remarkable improvement in LV diastolic function associated with improvement in NYHA functional class at follow-up. Prognosis at 1 year after TAVI was not influenced by baseline LV diastolic dysfunction both in patients with and without LV systolic dysfunction.
2018
Transcatheter aortic valve implantation (TAVI) has become the treatment of choice in patients with severe symptomatic aortic stenosis (AS) considered inoperable or at high surgical risk. More recently, TAVI has been performed also to lower risk patients based on the Heart Team decision. Few studies have studied interaction between surgical risk categories and outcomes. Aim of the study To analyze safety and efficacy (VARC-2 defined) TAVI treated patients as function of different preoperative risk. To assess independent predictors of death. Methods Four-hundred-eighty-two patients who underwent TAVI in our center between 2007 and 2017 were included in the study. According to Society of Thoracic Surgeons (STS) score and to other parameters, all the patients were retrospectively stratified into 4 groups: prohibitive (contraindications to aortic valve replacement, n = 124), high (STS > 8, n = 131), intermediate (4 ≤ STS ≤ 8, n = 112) and low (STS < 4, n = 115) risk. Early, 1-year ...