Circulatory efficiency in patients with severe aortic valve stenosis before and after aortic valve replacement

Nordmeyer, Sarah; Lee, C. B.; Goubergrits, Leonid; Knosalla, Christoph; Berger, Felix; Falk, Volkmar; Ghorbani, Niky; Hireche-Chikaoui, Hanane; Zhu, Miry; Kelle, Sebastian; Küehne, Titus; Kelm, Marcus

doi:10.1186/s12968-020-00686-0

Cited by 7 publications

(8 citation statements)

References 42 publications

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“…Another approach to evaluate global afterload in AS has been to explore the myocardial energy expenditure [ 36 ], which had been done using positron emission tomography to measure the myocardial oxygen consumption [ 37 , 38 ]. More recently, a CMR-based method had also demonstrated the calculation of myocardial energy consumption in AS [ 39 , 40 ]. However, both methods again fail to account for the pulsatile nature of the circulation, and each study found that TAVR failed to improve the myocardial efficiency of a proportion of patients in the medium term, which was defined as the ratio between steady-state circulatory energy consumption and the apparent myocardial energy consumption [ 38 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Pulsatile energy consumption as a surrogate marker for vascular afterload improves with time post transcatheter aortic valve replacement in patients with aortic stenosis

et al. 2022

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The effect of arterial stiffening on elevated pulsatile left ventricular afterload patients with aortic stenosis (AS) is pronounced beyond systemic hypertension. Circulatory afterload pulsatile efficiency (CAPE) is a marker of vascular function, defined as the ratio of steady state energy consumption (SEC) to maintain systemic circulation and pulsatile energy consumption (PEC). Twenty patients aged 80 ± 7 years were assessed at baseline and a median of 60 days post transcatheter aortic valve replacement (TAVR), with pulsatile vascular load calculated using simultaneous radial applanation tonometry derived aortic pressure and cardiac magnetic resonance phase-contrast imaging derived ascending aortic flow. Eight out of 20 patients had a reduction in PEC post TAVR, and the reduction of PEC correlated strongly with the number of days post TAVR ( R = 0.62, P < 0.01). Patients assessed within the 100 days of TAVR had a rise in their PEC when compared to baseline (0.19 ± 0.09 vs 0.14 ± 0.08 W, P = 0.04). Baseline PEC correlated moderately with baseline SEC ( R = 0.49, P = 0.03), and a high baseline PEC was predictive of post TAVR PEC reduction ( R = 0.54, P =0.01). Overall, no significant differences were found between baseline and post TAVR for systolic aortic pressure (131 ± 20 vs 131 ± 20 mmHg), systemic vascular resistance (1894 ± 493 vs 2015 ± 519 dynes.s/cm 5 ), aortic valve ejection time (337 ± 22 vs 324 ± 34 ms) or aortic characteristic impedance (120 ± 48 vs 107 ± 41 dynes.s/cm 5 ). Improved flow profiles after TAVR likely unmask the true vascular properties by altering ventriculo-valvulo-arterial coupling, leading to downstream vascular remodelling secondary to flow conditioning, and results in eventual improvement of pulsatile afterload as reflected by our proposed index of CAPE.

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Section: Discussionmentioning

confidence: 99%

Pulsatile energy consumption as a surrogate marker for vascular afterload improves with time post transcatheter aortic valve replacement in patients with aortic stenosis

et al. 2022

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“…It could decrease significantly when the LV afterload was obviously elevated (27,28). Nowadays, non-invasive approaches independent of afterload were developed to identify myocardial dysfunction by investigating myocardial energetics and metabolism (29)(30)(31)(32). Unlike the myocardial power and power efficiency derived from cardiac magnetic resonance, which was partly based on wall stress analysis according to the Laplace law, non-invasive myocardial work indices measured with echocardiography come from the LV pressure-volume loop in principle.…”

Section: Discussionmentioning

confidence: 99%

Non-invasive Global and Regional Myocardial Work Predicts High-Risk Stable Coronary Artery Disease Patients With Normal Segmental Wall Motion and Left Ventricular Function

Zhang

Liu

Deng

et al. 2021

Front. Cardiovasc. Med.

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Background: Previous studies suggested that myocardial work (MW) may identify abnormalities in the left ventricular (LV) function and establish a more sensitive index for LV dysfunction at the early stage. This study aimed to explore the value of global and regional MW parameters in predicting high-risk stable coronary artery disease (SCAD) patients with normal wall motion and preserved LV function.Patients and Methods: A total of 131 patients, who were clinically diagnosed as SCAD with normal wall motion and LV function, were finally included in this study. Global MW parameters, including global work index (GWI), global constructive work (GCW), global waste work (GWW), and global work efficiency (GWE) were measured with non-invasive LV pressure-strain loops constructed from speckle-tracking echocardiography. Regional myocardial work index (RWI) and work efficiency (RWE) were also calculated according to the perfusion territory of each major coronary artery. All patients underwent coronary angiography and were divided into the high-risk SCAD group, the non-high-risk SCAD group, and the No SCAD group according to the range and degrees of coronary arteries stenosis.Results: The global longitudinal strain (GLS), GWI and GCW were statistically different (P < 0.001) among the three groups. In the high-risk SCAD group, GLS, GWI, and GCW were significantly lower than the other two groups (P < 0.05). Receiver operating characteristic analysis demonstrated GWI and GCW could predict high-risk SCAD at a cutoff value of 1,808 mm Hg% (sensitivity, 52.6%; specificity, 87.8%; predictive positive value, 76.3%; predictive negative value, 69.9%) and 2,308 mm Hg% (sensitivity, 80.7%; specificity, 64.9%; predictive positive value, 63.3%; predictive negative value, 80.0%), respectively. Multivariate analyses showed that carotid plaque, decreased GWI, and GCW was independently related to high-risk SCAD. The cutoff values of RWILAD, RWILCX, and RWIRCA were 2,156, 1,929, and 1,983 mm Hg% in predicting high-risk SCAD, respectively (P < 0.001). When we combined RWI in two or three perfusion regions, the diagnostic performance of SCAD was improved (P < 0.001).Conclusions: Both global and regional MW parameters have great potential in non-invasively predicting high-risk SCAD patients with normal wall motion and preserved LV function, contributing to the early identification of high-risk patients who may benefit from revascularization therapy.

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“…All parameters were computed from cardiac magnetic resonance imaging-derived volumetric data and echocardiographic and clinical data. More details are described in former studies ( 14 ).…”

Section: Methodsmentioning

confidence: 99%

Serum dihydrotestosterone levels are associated with adverse myocardial remodeling in patients with severe aortic valve stenosis before and after aortic valve replacement

Schafstedde

Nordmeyer

Berger

et al. 2022

American Journal of Physiology-Heart and Circulatory Physiology

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Aims Animal studies show a pivotal role of dihydrotestosterone (DHT) in pressure overload induced myocardial hypertrophy and dysfunction. The aim of our study was to evaluate the role of DHT levels and myocardial hypertrophy and myocardial protein expression in patients with severe aortic valve stenosis (AS). Methods and Results 43 patients (median age 68 (41-80) years) with severe AS and indication for surgical aortic valve replacement (SAVR) were prospectively enrolled. Cardiac magnetic resonance imaging including analysis of left ventricular muscle mass (LVM), fibrosis and function and laboratory tests including serum DHT levels were performed before and after SAVR. During SAVR left ventricular (LV) biopsies were performed for proteomic profiling. Serum DHT levels correlated positively with indexed LVM (LVMi, R=0.64, p<0.0001) and fibrosis (R=0.49, p=0.0065) and inversely with LV function (R=-0.42, p=0.005) in patients with severe AS. DHT levels were associated with higher abundance of the hypertrophy (moesin (R=0.52, p=0.0083)) and fibrosis (vimentin (R=0.41, p=0.039)) associated proteins from LV myocardial biopsies. Higher serum DHT levels preoperatively were associated with reduced LV function (ejection fraction: R=-0.34, p=0.035, circulatory efficiency: R=-0.46, p=0.012, global longitudinal strain: R=0.49, p=0.01) and increased fibrosis (R=0.55, p=0.0022) after SAVR. Conclusions Serum DHT levels were associated with adverse myocardial remodeling and higher abundance in hypertrophy and fibrosis associated proteins in patients with severe AS. DHT may be a target to prevent or attenuate adverse myocardial remodeling in patients with pressure overload due to AS.

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Circulatory efficiency in patients with severe aortic valve stenosis before and after aortic valve replacement

Cited by 7 publications

References 42 publications

Pulsatile energy consumption as a surrogate marker for vascular afterload improves with time post transcatheter aortic valve replacement in patients with aortic stenosis

Pulsatile energy consumption as a surrogate marker for vascular afterload improves with time post transcatheter aortic valve replacement in patients with aortic stenosis

Non-invasive Global and Regional Myocardial Work Predicts High-Risk Stable Coronary Artery Disease Patients With Normal Segmental Wall Motion and Left Ventricular Function

Serum dihydrotestosterone levels are associated with adverse myocardial remodeling in patients with severe aortic valve stenosis before and after aortic valve replacement

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