Pulmonary Hypertension in Patients With Severe Aortic Stenosis: Prognostic Impact After Transcatheter Aortic Valve Replacement

Alushi, Brunilda; Beckhoff, Frederik; Leistner, David M.; Franz, Marcus; Reinthaler, Markus; Stähli, Barbara E.; Morguet, Andreas J.; Figulla, Hans R.; Doenst, Torsten; Maisano, Francesco; Falk, Volkmar; Landmesser, Ulf; Lauten, Alexander

doi:10.1016/j.jcmg.2018.02.015

Cited by 89 publications

(84 citation statements)

References 33 publications

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“…First, DD evaluation is dependent on loading conditions, particularly mitral valve disease and is associated with pulmonary hypertension . Pulmonary hypertension in particular is a known predictor of mortality in TAVR and was not reported or adjusted for in the largest study of DD in TAVR by Asami et al Indeed, our analysis on a propensity‐matched cohort based on pertinent echocardiographic covariates did not reveal an association between severe DD and the outcome measure, suggesting that advanced DD is not an independent predictor. Second, patients undergoing TAVR tend to be elderly, often have poor baseline functional status, higher rates of comorbidities including renal failure, diabetes, and more advanced MF, characteristics that are associated with both worse outcomes and more advanced degrees of DD .…”

Section: Discussionmentioning

confidence: 61%

Prognostic role of diastolic dysfunction in patients undergoing transcatheter aortic valve replacement

Kampaktsis

Vavuranakis

Choi

et al. 2019

Cathet Cardio Intervent

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Objectives: Prior studies have shown that left ventricular diastolic dysfunction (DD) is associated with increased mortality after surgical aortic valve replacement but studies on transcatheter aortic valve replacement (TAVR) are limited and have not taken into account mitral annular calcification (MAC), which limits the use of mitral valve annular tissue Doppler imaging. We performed a single-center retrospective analysis to better evaluate the role of baseline DD on outcomes after TAVR.Methods: After excluding patients with atrial fibrillation, mitral valve prostheses and significant mitral stenosis, 359 consecutive TAVR patients were included in the study. Moderate-to-severe MAC was present in 58% of the patients. We classified patients into severe versus nonsevere DD based on the evaluation of elevated left ventricular filling pressure. The outcome measure was all-cause mortality or heart failure hospitalization.

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Section: Discussionmentioning

confidence: 61%

Prognostic role of diastolic dysfunction in patients undergoing transcatheter aortic valve replacement

Kampaktsis

Vavuranakis

Choi

et al. 2019

Cathet Cardio Intervent

View full text Add to dashboard Cite

show abstract

“…Additionally, these control mechanisms could be influenced during the valve replacement procedure by the anaesthetist, to stabilize the patient. Other long-term physiological changes such as the decrease in pulmonary pressure after TAVI 56 were also not taken into account, due to the lack of available data in these time-scales. Although the UKF approach can provide much information during the estimation process, problems such as identifiability and non-uniqueness of solutions should ideally be examined beforehand.…”

Section: Discussionmentioning

confidence: 99%

Uncertainty in model‐based treatment decision support: Applied to aortic valve stenosis

Meiburg

Huberts

Rutten

et al. 2020

Numer Methods Biomed Eng

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Patient outcome in trans-aortic valve implantation (TAVI) therapy partly relies on a patient's haemodynamic properties that cannot be determined from current diagnostic methods alone. In this study, we predict changes in haemodynamic parameters (as a part of patient outcome) after valve replacement treatment in aortic stenosis patients. A framework to incorporate uncertainty in patient-specific model predictions for decision support is presented. A 0D lumped parameter model including the left ventricle, a stenotic valve and systemic circulatory system has been developed, based on models published earlier. The unscented Kalman filter (UKF) is used to optimize model input parameters to fit measured data pre-intervention. After optimization, the valve treatment is simulated by significantly reducing valve resistance. Uncertain model parameters are then propagated using a polynomial chaos expansion approach. To test the proposed framework, three in silico test cases are developed with clinically feasible measurements. Quality and availability of simulated measured patient data are decreased in each case. The UKF approach is compared to a Monte Carlo Markov Chain (MCMC) approach, a well-known approach in modelling predictions with uncertainty. Both methods show increased confidence intervals as measurement quality decreases. By considering three in silico test-cases we were able to show that the proposed framework is able to incorporate optimization uncertainty in model predictions and is faster and the MCMC approach, although it is more sensitive to noise in flow measurements. To conclude, this work shows that the proposed framework is ready to be applied to real patient data. Novelty Statement • We developed a lumped parameter model to predict changes in haemodynamic parameters after valve replacement therapy in aortic stenosis

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“…The study by Obokata and co-workers published in this issue of the European Respiratory Journal significantly contributes to the field of noninvasive prediction of haemodynamics during exercise http://bit.ly/2svY7TP Pulmonary hypertension (PH) describes a heterogeneous set of diseases associated with increased morbidity and mortality, regardless of the aetiology [1][2][3][4]. The gold standard for diagnosing and phenotyping PH remains invasive measurement via right heart catheterisation [5].…”

Section: @Erspublicationsmentioning

confidence: 99%

Floating the invisible swan: noninvasive prediction of haemodynamics

Agrawal

Brittain

2020

Eur Respir J

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Pulmonary Hypertension in Patients With Severe Aortic Stenosis: Prognostic Impact After Transcatheter Aortic Valve Replacement

Cited by 89 publications

References 33 publications

Prognostic role of diastolic dysfunction in patients undergoing transcatheter aortic valve replacement

Prognostic role of diastolic dysfunction in patients undergoing transcatheter aortic valve replacement

Uncertainty in model‐based treatment decision support: Applied to aortic valve stenosis

Floating the invisible swan: noninvasive prediction of haemodynamics

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