Limits...
Determinants of clinical improvement after surgical replacement or transcatheter aortic valve implantation for isolated aortic stenosis.

Gavina C, Gonçalves A, Almeria C, Hernandez R, Leite-Moreira A, Rocha-Gonçalves F, Zamorano J - Cardiovasc Ultrasound (2014)

Bottom Line: At 6 months, TAVI patients had greater clinical improvement and higher effective orifice area index (EAOI), but only SAVR patients already had a significant decrease in 3D indexed LV mass and diastolic volume.At 6 months, functional class improvement was greater after TAVI.Higher initial NYHA class and an increase in EAOI ≥ 105% were independently associated with functional enhancement.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Faculty of Medicine, University of Porto, Rua Dr, Plácido da Costa 4200-450, Porto, Portugal. cristina.gavina@gmail.com.

ABSTRACT

Background: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) and high surgical risk. Hemodynamic performance after TAVI is superior, but the impact of reverse remodeling on clinical improvement is controversial. We aim to address the differences in hemodynamic changes between SAVR and TAVI, and its correlation with LV remodeling and clinical improvement at 6 months follow-up.

Methods: Forty-two patients treated by TAVI were compared with 45 SAVR patients with a stented bioprosthesis. Clinical, 2D and 3D echocardiographic data were prospectively obtained before and six months after intervention.

Results: Patients had similar distribution for sex, body surface area and AS severity. TAVI patients were older, more symptomatic and had more comorbidities. They also had higher LV filling pressures, larger 3D indexed left atrium volume, but similar 3D indexed LV mass. At 6 months, TAVI patients had greater clinical improvement and higher effective orifice area index (EAOI), but only SAVR patients already had a significant decrease in 3D indexed LV mass and diastolic volume. In univariate analysis older age, NYHA class ≥ III, increase in EAOI and TAVI were related with functional class improvement. After multivariate analysis only NYHA class ≥ III (OR 8.81, CI:2.13-36.52; p=0.003) and an increase in EAOI ≥ 105% (OR 3.87, CI:1.02-14.70; p=0.04) were predictors of clinical improvement.

Conclusions: At 6 months, functional class improvement was greater after TAVI. Higher initial NYHA class and an increase in EAOI ≥ 105% were independently associated with functional enhancement. It is debatable if left ventricular remodeling is determinant for functional class improvement.

Show MeSH

Related in: MedlinePlus

Six months changes in parameters of remodeling in TAVI and SAVR groups.A- change in left ventricular mass index (LVMI); B- change in ratio LVMI/left ventricular end-diastolic volume index (LVDVI); C- change in ejection fraction (EF); D- change in left atrial volume index (LAVI); E- change in LVDVI; F- change in left ventricular end-systolic volume index (LVSVI).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4197280&req=5

Fig1: Six months changes in parameters of remodeling in TAVI and SAVR groups.A- change in left ventricular mass index (LVMI); B- change in ratio LVMI/left ventricular end-diastolic volume index (LVDVI); C- change in ejection fraction (EF); D- change in left atrial volume index (LAVI); E- change in LVDVI; F- change in left ventricular end-systolic volume index (LVSVI).

Mentions: At 6 months (Table 2), TAVI patients had a higher effective orifice area index (EAOI) and lower transprosthetic maximal velocity and mean gradient, as well as a greater absolute increase in EAOI. Patient-prosthesis mismatch (PPM) was more frequent in the SAVR patients and there were no severe PPM cases in the TAVI group. There was a significant increase in ejection fraction (EF) in both groups and, when considering LV remodeling (Table 3), although there was a decrease in LV mass index (LVMI) and LV diastolic volume index (LVDVI) in both groups, only in SAVR patients this decrease was significant when compared with baseline values (Figure 1).Figure 1


Determinants of clinical improvement after surgical replacement or transcatheter aortic valve implantation for isolated aortic stenosis.

Gavina C, Gonçalves A, Almeria C, Hernandez R, Leite-Moreira A, Rocha-Gonçalves F, Zamorano J - Cardiovasc Ultrasound (2014)

Six months changes in parameters of remodeling in TAVI and SAVR groups.A- change in left ventricular mass index (LVMI); B- change in ratio LVMI/left ventricular end-diastolic volume index (LVDVI); C- change in ejection fraction (EF); D- change in left atrial volume index (LAVI); E- change in LVDVI; F- change in left ventricular end-systolic volume index (LVSVI).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4197280&req=5

Fig1: Six months changes in parameters of remodeling in TAVI and SAVR groups.A- change in left ventricular mass index (LVMI); B- change in ratio LVMI/left ventricular end-diastolic volume index (LVDVI); C- change in ejection fraction (EF); D- change in left atrial volume index (LAVI); E- change in LVDVI; F- change in left ventricular end-systolic volume index (LVSVI).
Mentions: At 6 months (Table 2), TAVI patients had a higher effective orifice area index (EAOI) and lower transprosthetic maximal velocity and mean gradient, as well as a greater absolute increase in EAOI. Patient-prosthesis mismatch (PPM) was more frequent in the SAVR patients and there were no severe PPM cases in the TAVI group. There was a significant increase in ejection fraction (EF) in both groups and, when considering LV remodeling (Table 3), although there was a decrease in LV mass index (LVMI) and LV diastolic volume index (LVDVI) in both groups, only in SAVR patients this decrease was significant when compared with baseline values (Figure 1).Figure 1

Bottom Line: At 6 months, TAVI patients had greater clinical improvement and higher effective orifice area index (EAOI), but only SAVR patients already had a significant decrease in 3D indexed LV mass and diastolic volume.At 6 months, functional class improvement was greater after TAVI.Higher initial NYHA class and an increase in EAOI ≥ 105% were independently associated with functional enhancement.

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Faculty of Medicine, University of Porto, Rua Dr, Plácido da Costa 4200-450, Porto, Portugal. cristina.gavina@gmail.com.

ABSTRACT

Background: Transcatheter aortic valve implantation (TAVI) is an alternative to surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) and high surgical risk. Hemodynamic performance after TAVI is superior, but the impact of reverse remodeling on clinical improvement is controversial. We aim to address the differences in hemodynamic changes between SAVR and TAVI, and its correlation with LV remodeling and clinical improvement at 6 months follow-up.

Methods: Forty-two patients treated by TAVI were compared with 45 SAVR patients with a stented bioprosthesis. Clinical, 2D and 3D echocardiographic data were prospectively obtained before and six months after intervention.

Results: Patients had similar distribution for sex, body surface area and AS severity. TAVI patients were older, more symptomatic and had more comorbidities. They also had higher LV filling pressures, larger 3D indexed left atrium volume, but similar 3D indexed LV mass. At 6 months, TAVI patients had greater clinical improvement and higher effective orifice area index (EAOI), but only SAVR patients already had a significant decrease in 3D indexed LV mass and diastolic volume. In univariate analysis older age, NYHA class ≥ III, increase in EAOI and TAVI were related with functional class improvement. After multivariate analysis only NYHA class ≥ III (OR 8.81, CI:2.13-36.52; p=0.003) and an increase in EAOI ≥ 105% (OR 3.87, CI:1.02-14.70; p=0.04) were predictors of clinical improvement.

Conclusions: At 6 months, functional class improvement was greater after TAVI. Higher initial NYHA class and an increase in EAOI ≥ 105% were independently associated with functional enhancement. It is debatable if left ventricular remodeling is determinant for functional class improvement.

Show MeSH
Related in: MedlinePlus