Left Ventricular Blood Flow Dynamics In Aortic Stenosis Before And After Aortic Valve Replacement

Minagawa, Tadanori; Oktamuliani, Sri; Kurokawa, Toshiko; Nakajima, Hiroyuki; Hasegawa, Kaoru; Matsuoka, Takahiro; Shimizu, Takuya; Miura, Makoto; Ohara, Takahiro; Kawamoto, Shunsuke

doi:10.1109/embc.2018.8512954

Cited by 2 publications

(2 citation statements)

References 5 publications

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“…Although medical imaging has made remarkable advancements and possess several benefits, however, none of these tools can quantify valve dynamics and (local and global) hemodynamics 38 , 184 . (1) Doppler echocardiography (DE): DE provides functional, real-time information regarding cardiac geometry, instantaneous flow and pressure gradient 185 . DE cannot evaluate local hemodynamics precisely and can not measure global hemodynamics and valve dynamics 186 ; (2) Phase-contrast magnetic resonance imaging (MRI): MRI can provide local hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

A Doppler-exclusive non-invasive computational diagnostic framework for personalized transcatheter aortic valve replacement

Bahadormanesh

Tomka

Abdelkhalek

et al. 2023

Sci Rep

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Given the associated risks with transcatheter aortic valve replacement (TAVR), it is crucial to determine how the implant will affect the valve dynamics and cardiac function, and if TAVR will improve or worsen the outcome of the patient. Effective treatment strategies, indeed, rely heavily on the complete understanding of the valve dynamics. We developed an innovative Doppler-exclusive non-invasive computational framework that can function as a diagnostic tool to assess valve dynamics in patients with aortic stenosis in both pre- and post-TAVR status. Clinical Doppler pressure was reduced by TAVR (52.2 ± 20.4 vs. 17.3 ± 13.8 [mmHg], p < 0.001), but it was not always accompanied by improvements in valve dynamics and left ventricle (LV) hemodynamics metrics. TAVR had no effect on LV workload in 4 patients, and LV workload post-TAVR significantly rose in 4 other patients. Despite the group level improvements in maximum LV pressure (166.4 ± 32.2 vs 131.4 ± 16.9 [mmHg], p < 0.05), only 5 of the 12 patients (41%) had a decrease in LV pressure. Moreover, TAVR did not always improve valve dynamics. TAVR did not necessarily result in a decrease (in 9 out of 12 patients investigated in this study) in major principal stress on the aortic valve leaflets which is one of the main contributors in valve degeneration and, consequently, failure of heart valves. Diastolic stresses increased significantly post-TAVR (34%, 109% and 81%, p < 0.001) for each left, right and non-coronary leaflets respectively. Moreover, we quantified the stiffness and material properties of aortic valve leaflets which correspond with the reduced calcified region average stiffness among leaflets (66%, 74% and 62%; p < 0.001; N = 12). Valve dynamics post-intervention should be quantified and monitored to ensure the improvement of patient conditions and prevent any further complications. Improper evaluation of biomechanical valve features pre-intervention as well as post-intervention may result in harmful effects post-TAVR in patients including paravalvular leaks, valve degeneration, failure of TAVR and heart failure.

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Section: Discussionmentioning

confidence: 99%

A Doppler-exclusive non-invasive computational diagnostic framework for personalized transcatheter aortic valve replacement

Bahadormanesh

Tomka

Abdelkhalek

et al. 2023

Sci Rep

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“…However, it is difficult to observe the posterior wall side by echocardiography due to acoustic shadow of the inflow cannula, and so the duct-sep distance to LVDd ratio provides a potential alternative method of evaluation. Echo-Dynamography and vector-flow mapping 19 could provide more information on LV flow dynamics, 20 and four-dimensional flow magnetic resonance imaging (MRI) analysis 21 may have clinical utility for evaluation of the posterior wall in the future, although MRI is currently contraindicated for LVAD patients. Contrast CT has a low sensitivity but high specificity for detecting LVAD thrombus, 22 and can be another option for this assessment, although contrast CT has limitation in clinical application because of possibly affecting clinical status of the patients with LVAD including renal function.…”

Section: Discussionmentioning

confidence: 99%

Impact of anatomical position of the inflow cannula on stroke in patients with left ventricular assist devices

et al. 2021

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Objectives: Stroke is a substantial complication of left ventricular assist device (LVAD) implantation. The relationship between stroke and the anatomical position of the inflow cannula of patients who underwent LVAD implantation was investigated. Methods: We enrolled 15 patients with advanced-stage heart failure who underwent implantation of continuous-flow-LVAD. Data of patients who suffered a stroke within 6 months after LVAD implantation were retrospectively compared to those who remained free of stroke. The distance between the inflow duct and left ventricular (LV) septum (duct-sep distance) and its ratio to LV diastolic diameter (LVDd) were measured from echocardiography at 1 month after LVAD implantation. Receiver operating characteristic curves for the endpoint of stroke using the duct-sep distance to LVDd ratio was created and the cut-off value was calculated. The incidence of stroke during the 6 months after LVAD implantation according to this ratio was estimated using the Kaplan-Meier method. Results: At 1 month after LVAD implantation, there were no significant differences in baseline characteristics and echocardiography parameters between the stroke and stroke-free groups. Receiver operating characteristic curve analysis for the endpoint of stroke using the duct-sep distance to LVDd ratio revealed 0.217 as a cut-off value (sensitivity: 80%, specificity: 80%, area under the curve: 0.72). Stroke was more frequent in patients with a duct-sep distance to LVDd ratio ⩾0.217 at 1 month than in those with a lower ratio. Conclusion: The duct-sep distance to LVDd ratio was associated with the occurrence of stroke, suggesting that inflow cannula position influences the incidence of stroke.

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Left Ventricular Blood Flow Dynamics In Aortic Stenosis Before And After Aortic Valve Replacement

Cited by 2 publications

References 5 publications

A Doppler-exclusive non-invasive computational diagnostic framework for personalized transcatheter aortic valve replacement

A Doppler-exclusive non-invasive computational diagnostic framework for personalized transcatheter aortic valve replacement

Impact of anatomical position of the inflow cannula on stroke in patients with left ventricular assist devices

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