Acute Improvement in Global and Regional Left Ventricular Systolic Function After Percutaneous Heart Valve Implantation in Patients With Symptomatic Aortic Stenosis

Centre Hospitalier Universitaire Rouen, Rouen, Haute-Normandie, France
Circulation (Impact Factor: 14.43). 09/2004; 110(11):1473-6. DOI: 10.1161/01.CIR.0000134961.36773.D6
Source: PubMed

ABSTRACT The newly developed percutaneous heart valve (PHV) implantation technique decreases transaortic pressure gradient in patients with aortic stenosis. PHV replacement effects on left ventricular (LV) global and regional systolic function are currently unknown.
Eight patients with severe aortic stenosis had 2D echocardiography at baseline and 24 hours after PHV implantation to evaluate changes in LV volume and LV ejection fraction. Regional function, ie, both peak systolic anterior and posterior wall tissue velocity, as well as strain and strain rate imaging, were measured by tissue Doppler imaging from a short-axis view. At 24 hours, a significant reduction in transaortic mean pressure gradient (from 46+/-15 to 8+/-3 mm Hg; P<0.0001) was accompanied by an increase in aortic valve area (from 0.59+/-0.11 to 1.69+/-0.11 cm2; P<0.0001). LV end-diastolic volume remained unchanged (102+/-36 to 101+/-12 mL; P=NS), whereas LV ejection fraction increased (48+/-18% to 57+/-12%; P<0.01). Improvement in posterior wall displacement (posterior wall tissue velocity increased from 2.2+/-0.5 to 4.4+/-1.0 cm/s(-1); P=0.0003) and deformation (strain rate imaging increased from 1.0+/-0.3 to 1.9+/-0.7 s(-1), P=0.009, and strain increased from 11+/-5% to 17+/-9%; P=0.02) were observed.
Immediately after PHV replacement, improvement of LV global and regional systolic function was evidenced by tissue Doppler imaging.

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Available from: Carla Agatiello, Feb 03, 2014
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    • "Bauer et al. [25] 2004 3 b30 Bauer et al. [26] 2013 31 30–40 Clavel et al. [27] 2009 15 30–40 Clavel et al. [3] 2010 41 30–40 Cribier et al. [28] 2004 5 b30 Cribier et al. [29] 2006 15 30–40 D'Ascenzi et al. [30] 2013 18 40–50 Elmariah et al. [5] 2013 108 30–40 Ewe et al. [11] 2010 50 30–40 Fraccaro et al. [12] 2012 50 b30 Gotzmann et al. [14] 2011 15 30–40 Gotzmann et al. [13] 2012 89 40–50 Lauten et al. [33] 2012 149 30–40 Le Ven et al. [34] 2013 90 30–40 Logstrup et al. [35] 2013 74 30–40 Moat et al. [36] 2011 74 b30 Munoz-Garcia et al. [15] 2012 33 30–40 O'Sullivan et al. [8] 2013 95 b30 Pilgrim et al. [7] 2011 37 b30 Rodes-Cabau et al. [37] 2010 54 30–40 Sherif et al. [38] 2010 16 30–40 Stohr et al. [17] 2011 69 40–50 Tzikas et al. [39] 2011 4 b30 Van Linden et al. [18] 2011 39 30–40 van der Boon et al. [6] 2012 33 b30 Zahn et al. [40] 2013 154 b30 Fig. 2. All-cause mortality in low EF aortic stenosis patients after TAVI—A. Forrest plot representing the pooled estimate analysis for overall incidence of 30-day-all-cause mortality. "
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    ABSTRACT: Background: There is conflicting evidence regarding the safety and efficacy of transcatheter aortic valve implantation (TAVI) procedures in patients with severe aortic stenosis and low left ventricular ejection fraction (EF). The primary aim of this study was to determine the impact of TAVI on short- and long-term mortality in patients with low EF (EF <50%); the secondary aim was to analyze the impact of TAVI procedure on EF recovery in the same setting of patients. Methods and results: Twenty-six studies enrolling 6898 patients with severe aortic stenosis undergoing TAVI procedure were included in the meta-analysis and analyzed for 30-day, 6-month and 1-year all-cause and cardiovascular mortality; a further meta-analysis was also performed in patients with low EF to assess EF changes post TAVI. In low EF patients, both all-cause and cardiovascular short- and long-term mortality were significantly higher when compared to patients with normal EF (30-day-all-cause mortality: 0.13; 95% confidence interval [CI]: 0.01 to 0.25, I(2)=49.65, Q=21.85; 1-year-all-cause mortality: 0.25; 95% [CI]: 0.16 to 0.34, I(2)=25.57, Q=16.12; 30-day-cardiovascular mortality: 0.03; 95% [CI]: -0.31 to 0.36, I(2)=66.84, Q=6.03; 1-year-cardiovascular mortality: 0.29; 95% [CI]: 0.12 to 0.45, I(2)=0.00, Q=1.88). Nevertheless, in low EF patients TAVI was associated with a significant recovery of EF, which started at discharge and proceeded up to 1-year-follow-up. Conclusions: Patients with low EF severe aortic stenosis have higher mortality following TAVI compared to normal EF patients, despite a significant and sustained improvement in EF.
    International Journal of Cardiology 06/2014; 176(1). DOI:10.1016/j.ijcard.2014.06.017 · 4.04 Impact Factor
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    • "Following TAVI, an immediate and sustained improvement in aortic valve area, trans-valvular gradient, and left ventricular ejection fraction were reported.[9]–[11] These changes were associated with an enhancement in patients' physical and mental functioning, as well as their quality of life.[12],[13] "
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    ABSTRACT: Aortic valve stenosis (AS) is common in the elderly. Although surgical replacement of the valve has been the gold standard of management, many patients have been excluded from surgery because they were very old, frail, or had co-morbidities that increased operative risks. In the last decade, transcatheter aortic valve implantation (TAVI) has emerged as a new treatment option suitable for these patients. This article reviews the available literature on the role of TAVI in elderly patients with severe aortic stenosis. Published studies showed that elderly individuals who underwent TAVI experienced better in-hospital recovery, and similar short and mid-term mortality compared to those underwent surgical treatment of AS. However, long-term outcomes of TAVI in elderly patients are still unknown. The available data in the literature on the effect of advanced age on clinical outcomes of TAVI are limited, but the data that are available suggest that TAVI is a beneficial and tolerable procedure in very old patients. Some of the expected complications after TAVI are reported more in the oldest patients such as vascular injures. Other complications were comparable in TAVI patients regardless of their age group. However, very old patients may need closer monitoring to avoid further morbidities and mortality.
    Journal of Geriatric Cardiology 06/2014; 11(2):163-70. DOI:10.3969/j.issn.1671-5411.2014.02.004 · 1.40 Impact Factor
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    • "The actual possibility to analyze by 2D strain ventricular function in all three deformation components [36] (longitudinal, radial and circumferential) allows to discover the complex physiopathology modification induced by TAVI, with an acute afterload reduction [3]. "
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    ABSTRACT: The recent development of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) treatment offers a viable option for high-risk patient categories. Our aim is to evaluate whether 2D strain and strain rate can detect subtle improvement in global and regional LV systolic function immediately after TAVI. 2D conventional and 2D strain (speckle analysis) echocardiography was performed before, at discharge and after three months in thirty three patients with severe AS. After TAVI, we assessed by conventional echocardiography an immediate reduction of transaortic peak pressure gradient (p<0.0001), of mean pressure gradient (p<0.0001) and a concomitant increase in aortic valve area (AVA: 1.08±0.31 cm(2)/m(2); p<0.0001). 2D longitudinal systolic strain showed a significant improvement in all patients, both at septal and lateral level, as early as 72 h after procedure (septal: -14.2±5.1 vs -16.7±3.7%, p<0.001; lateral: -9.4±3.9 vs -13.1±4.5%, p<0.001; respectively) and continued at 3 months follow-up (septal: -18.1±4.6%, p<0.0001; lateral: -14.8±4.4%, p<0.0001; respectively). Conventional echocardiography after TAVI proved a significant reduction of LV end-systolic volume and of LV mass with a mild improvement of LV ejection fraction (EF) (51.2±11.8 vs 52.9±6.4%; p<0.02) only after three months. 2D strain seems to be able to detect subtle changes in LV systolic function occurring early and late after TAVI in severe AS, while all conventional echo parameters seem to be less effective for this purpose. Further investigations are needed to prove the real prognostic impact of these echocardiographic findings.
    American Journal of Cardiovascular Disease 01/2011; 1(3):264-73.
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