Early hemodynamic changes after transcatheter aortic valve implantation in patients with severe aortic stenosis measured by invasive pressure volume loop analysis.
Aortic stenosis
Hemodynamics
PV loop
TAVI
Journal
Cardiovascular intervention and therapeutics
ISSN: 1868-4297
Titre abrégé: Cardiovasc Interv Ther
Pays: Japan
ID NLM: 101522043
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
received:
14
04
2020
accepted:
22
11
2020
pubmed:
15
12
2020
medline:
28
1
2022
entrez:
14
12
2020
Statut:
ppublish
Résumé
Replacement of a stenotic aortic valve reduces immediately the ventricular to aortic gradient and is expected to improve diastolic and systolic left ventricular function over the long term. However, the hemodynamic changes immediately after valve implantation are so far poorly understood. Within this pilot study, we performed an invasive pressure volume loop analysis to describe the early hemodynamic changes after transcatheter aortic valve implantation (TAVI) with self-expandable prostheses. Invasive left ventricular pressure volume loop analysis was performed in 8 patients with aortic stenosis (mean 81.3 years) prior and immediately after transfemoral TAVI with a self-expandable valve system (St. Jude Medical Portico Valve). Parameters for global hemodynamics, afterload, contractility and the interaction of the cardiovascular system were analyzed. Left ventricular ejection fraction, (53.9% vs. 44.8%, p = 0.018), preload recruitable stroke work (68.5 vs. 44.8 mmHg, p = 0.012) and end-systolic elastance (3.55 vs. 2.17, p = 0.036) both marker for myocardial contractility declined significantly compared to baseline. As sign of impaired diastolic function, TAU, a preload-independent measure of isovolumic relaxation (37.3 vs. 41.8 ms, p = 0.018) and end-diastolic pressure (13.1 vs. 16.4 mmHg, p = 0.015) raised after valve implantation. Contrarily, a smaller ratio of end-systolic to arterial elastance (ventricular-arterial coupling) indicates an improvement of global cardiovascular energy efficiency (1.40 vs. 0.97 p = 0.036). Arterial elastance had a strong correlation with the number of conducted rapid ventricular pacings (Pearson correlation coefficient, r = 0.772, p = 0.025). Invasive left ventricular pressure volume loop analysis revealed impaired systolic and diastolic function in the early phase after TAVI with self-expandable valve for the treatment of severe aortic stenosis. Contrarily, we found indications for early improvement of global cardiovascular energy efficiency.
Identifiants
pubmed: 33313960
doi: 10.1007/s12928-020-00737-4
pii: 10.1007/s12928-020-00737-4
pmc: PMC8789710
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
191-201Informations de copyright
© 2020. The Author(s).
Références
Circ Cardiovasc Interv. 2012 Jun;5(3):415-23
pubmed: 22668556
Circulation. 1985 May;71(5):994-1009
pubmed: 3986986
J Anesth. 2016 Dec;30(6):1051-1055
pubmed: 27514383
Am Heart J. 1993 Jun;125(6):1659-66
pubmed: 8498308
Heart Vessels. 2017 Sep;32(9):1117-1122
pubmed: 28321573
J Am Soc Echocardiogr. 2015 Jul;28(7):727-54
pubmed: 26140936
J Am Soc Echocardiogr. 2014 Nov;27(11):1133-42
pubmed: 25125314
PLoS One. 2014 Dec 05;9(12):e114153
pubmed: 25479594
J Am Heart Assoc. 2018 Jul 9;7(14):
pubmed: 29987119
Eur J Echocardiogr. 2011 Nov;12(11):850-6
pubmed: 21890471
J Am Coll Cardiol. 2011 Jun 14;57(24):2398-405
pubmed: 21658559
J Am Coll Cardiol. 1985 May;5(5):1116-24
pubmed: 3989123
Am J Cardiovasc Dis. 2011;1(3):264-73
pubmed: 22254204
Clin Exp Hypertens. 2004 Oct-Nov;26(7-8):689-99
pubmed: 15702623
Circulation. 2017 Jun 20;135(25):e1159-e1195
pubmed: 28298458
Eur Heart J. 2013 Mar;34(9):676-83
pubmed: 22963833
Circulation. 1991 Feb;83(2):681-8
pubmed: 1991384
J Cardiovasc Echogr. 2013 Oct-Dec;23(4):91-95
pubmed: 28465893
Eur Heart J Cardiovasc Imaging. 2016 Nov;17(11):1269-1278
pubmed: 26588980
Am J Physiol. 1983 Nov;245(5 Pt 1):H773-80
pubmed: 6638199
J Am Soc Echocardiogr. 2009 Jan;22(1):1-23; quiz 101-2
pubmed: 19130998
J Clin Invest. 1990 Oct;86(4):1278-84
pubmed: 2212012
J Am Coll Cardiol. 2012 Oct 9;60(15):1438-54
pubmed: 23036636
J Am Coll Cardiol. 2001 Dec;38(7):2028-34
pubmed: 11738311
Rev Esp Cardiol (Engl Ed). 2018 Feb;71(2):110
pubmed: 29425605
Circulation. 1992 Aug;86(2):513-21
pubmed: 1638719
J Am Soc Echocardiogr. 2009 Nov;22(11):1246-8
pubmed: 19883874
Biomed Res Int. 2018 Apr 30;2018:1080597
pubmed: 29854723
Adv Physiol Educ. 2018 Mar 1;42(1):130-139
pubmed: 29446315
J Am Coll Cardiol. 1993 Mar 15;21(4):997-1001
pubmed: 8450171
Circ Cardiovasc Interv. 2013 Dec;6(6):604-14
pubmed: 24221391
Catheter Cardiovasc Interv. 2010 Feb 15;75(3):444-52
pubmed: 19937778
Am J Cardiol. 2013 May 1;111(9):1337-43
pubmed: 23415511
Circ Res. 1985 Apr;56(4):586-95
pubmed: 3978773
Circ J. 2010 Sep;74(9):1900-5
pubmed: 20625213
Eur Heart J. 2005 Sep;26(17):1790-6
pubmed: 15860517
Am J Physiol. 1993 Jun;264(6 Pt 2):H1817-24
pubmed: 8322910
J Thorac Cardiovasc Surg. 2005 Apr;129(4):890-6
pubmed: 15821660
Catheter Cardiovasc Interv. 2006 Aug;68(2):199-204
pubmed: 16810701
Circulation. 1993 May;87(5 Suppl):IV73-6
pubmed: 8485837
Cardiovasc Ultrasound. 2013 Jun 03;11:18
pubmed: 23731705