Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis
Abstract 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...
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| Format: | Article |
| Language: | English |
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Wiley
2022-06-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.13846 |
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| author | Francesca Graziani Pio Cialdella Rosa Lillo Gabriella Locorotondo Lorenzo Genuardi Gessica Ingrasciotta Stefano Cangemi Marialisa Nesta Piergiorgio Bruno Cristina Aurigemma Enrico Romagnoli Michele Calabrese Nicole Giambusso Antonella Lombardo Francesco Burzotta Carlo Trani |
| author_facet | Francesca Graziani Pio Cialdella Rosa Lillo Gabriella Locorotondo Lorenzo Genuardi Gessica Ingrasciotta Stefano Cangemi Marialisa Nesta Piergiorgio Bruno Cristina Aurigemma Enrico Romagnoli Michele Calabrese Nicole Giambusso Antonella Lombardo Francesco Burzotta Carlo Trani |
| author_sort | Francesca Graziani |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-cb77d47cfe954374a4fd7c297b932492 |
| institution | Kabale University |
| issn | 2055-5822 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj-art-cb77d47cfe954374a4fd7c297b9324922025-02-05T05:22:10ZengWileyESC Heart Failure2055-58222022-06-01931721173010.1002/ehf2.13846Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosisFrancesca Graziani0Pio Cialdella1Rosa Lillo2Gabriella Locorotondo3Lorenzo Genuardi4Gessica Ingrasciotta5Stefano Cangemi6Marialisa Nesta7Piergiorgio Bruno8Cristina Aurigemma9Enrico Romagnoli10Michele Calabrese11Nicole Giambusso12Antonella Lombardo13Francesco Burzotta14Carlo Trani15Department of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyUniversità Cattolica del Sacro Cuore Rome ItalyDepartment of Emergency Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyDepartment of Cardiovascular Medicine Fondazione Policlinico Universitario A. Gemelli IRCCS Rome ItalyAbstract 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.https://doi.org/10.1002/ehf2.13846TAVIAortic stenosisHaemodynamicCardiac catheterizationPersonalized medicine |
| spellingShingle | Francesca Graziani Pio Cialdella Rosa Lillo Gabriella Locorotondo Lorenzo Genuardi Gessica Ingrasciotta Stefano Cangemi Marialisa Nesta Piergiorgio Bruno Cristina Aurigemma Enrico Romagnoli Michele Calabrese Nicole Giambusso Antonella Lombardo Francesco Burzotta Carlo Trani Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis ESC Heart Failure TAVI Aortic stenosis Haemodynamic Cardiac catheterization Personalized medicine |
| title | Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis |
| title_full | Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis |
| title_fullStr | Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis |
| title_full_unstemmed | Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis |
| title_short | Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis |
| title_sort | acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis |
| topic | TAVI Aortic stenosis Haemodynamic Cardiac catheterization Personalized medicine |
| url | https://doi.org/10.1002/ehf2.13846 |
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