Subclinical Right Ventricular Dysfunction in Patients with Severe Aortic Stenosis: A Retrospective Case Series

Hernández-Suárez, Dagmar F.; López‐Candales, Angel

doi:10.1007/s40119-017-0084-8

Cited by 5 publications

(4 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The clinical importance of subclinical RV dysfunction and its association with adverse clinical outcomes has been investigated in different clinical scenarios [ 26 , 27 , 28 , 29 , 30 , 31 ]. In ESLD, RV afterload and preload are affected due to several hemodynamical consequences of advanced liver disease including hyperdynamic circulation, increased pulmonary vascular resistance and increased LV diastolic pressure with a subsequent increase in pulmonary wedge pressure [ 3 , 4 , 5 , 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

Isolated Subclinical Right Ventricle Systolic Dysfunction in Patients after Liver Transplantation

Güler

Omaygenç

Naki

et al. 2023

JCM

View full text Add to dashboard Cite

Although hemodynamic alterations in end-stage liver disease (ESLD) and its association with porto-pulmonary hypertension have been well-established, the long-term effects of ESLD on RV systolic function in patients without porto-pulmonary hypertension remain disregarded. Here we aimed to assess the long-term effect of ESLD on RV function and its relationship with the use of NSBBs and clinical, laboratory and imaging parameters in end-stage liver disease. The use of NSBBs is still controversial due to concerns about reduced cardiac contractility and the possibility of increased mortality. Thirty-four liver transplant recipients were included. Demographic characteristics, laboratory and baseline echocardiography measures were obtained. Patients were recalled for transthoracic echocardiographic evaluation after transplantation. Right ventricle dysfunction was identified by having at least one value below the reference levels of RV S’, or TAPSE. Isolated subclinical RV dysfunction was observed at 20.6% of the sample population. The present study demonstrates hemodynamic circulation in cirrhosis and increased preload and afterload might have long-term effects on RV function, even the lack of porto-pulmonary hypertension. These findings underline the significance of cardiac function follow-up in cirrhotic patients after transplantation. In this study, patients treated with propranolol seemed to have better RV function and less gastrointestinal bleeding. We speculated that preoperative propranolol treatment might help preserve RV function by providing RAS suppression, improving endothelial function and hyperdynamic circulation seen in ESLD. This potential protective relationship between the use of propranolol and RV function might improve mortality or graft-failure during OLT and after liver transplantation in patients with cirrhosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Isolated Subclinical Right Ventricle Systolic Dysfunction in Patients after Liver Transplantation

Güler

Omaygenç

Naki

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…In this regard, sPAP predominantly serves in clinical practice, factoring in the patient's current volume status. Various sPAP cut-off values have been applied in comparative studies to define PH [ 21 , 22 ]. This study, too, adopts the commonly used thresholds of 40 and 50 mmHg.…”

Section: Discussionmentioning

confidence: 99%

Elevated systolic pulmonary artery pressure is a substantial predictor of increased mortality after transcatheter aortic valve replacement in males, not in females

Boxhammer,

Dienhart,

Kletzer

et al. 2023

Clin Res Cardiol

View full text Add to dashboard Cite

Background While pulmonary hypertension (PH) in patients with severe aortic valve stenosis (AS) is associated with increased mortality after transcatheter aortic valve replacement (TAVR), there is limited data on gender differences in the effects on long-term survival. Objective The aim of this retrospective, multicenter study was to investigate the prognostic impact of pre-interventional PH on survival of TAVR patients with respect to gender. Methods 303 patients undergoing TAVR underwent echocardiography to detect PH prior to TAVR via measurement of systolic pulmonary artery pressure (sPAP). Different cut-off values were set for the presence of PH. The primary endpoint was all-cause mortality at 1, 3 and 5 years. Results Kaplan–Meier analysis by gender showed that only males exhibited significant increased mortality at elevated sPAP values during the entire follow-up period of 5 years (sPAP ≥ 40 mmHg: p ≤ 0.001 and sPAP ≥ 50 mmHg: p ≤ 0.001 in 1- to 5-year survival), whereas high sPAP values had no effect on survival in females. In Cox regression analysis based on the selected sPAP thresholds, male gender was an independent risk factor for long-term mortality after TAVR in all time courses. Conclusion Male gender was an isolated risk factor for premature death after TAVR in patients with echocardiographic evidence of PH and severe AS. This could mean that, the indication for TAVR should be discussed more critically in men with severe AS and an elevated sPAP, while in females, PH should not be an exclusion criterion for TAVR. Graphical abstract Graphical abstract of the study (Created with BioRender.com) Image material of CoreValve™ Evolut™ was kindly provided by © Medtronic Inc.

show abstract

“…Echocardiography not only plays a crucial role in the detection of severe AS, but is also currently the method of choice in clinical practice to determine the presence or absence of PH in patients with severe AS. Some authors set the cut-off for PH at an sPAP ≥ 40 mmHg [23][24][25][26] and one study at an sPAP ≥ 42 mmHg [27], whereas other authors estimate the cut-off value slightly higher at ≥45 mmHg [28][29][30] or even ≥50 mmHg [31][32][33][34][35]. For example, Schewel et al compared the echocardiographically obtained sPAP with invasively obtained sPAP using RHC in their study.…”

Section: Echocardiographymentioning

confidence: 99%

Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic Review of Non-Invasive Ways of Risk Stratification, Especially in Patients Undergoing Transcatheter Aortic Valve Replacement

Boxhammer

Berezin

Paar

et al. 2022

JPM

View full text Add to dashboard Cite

Patients with severe aortic valve stenosis and concomitant pulmonary hypertension show a significantly reduced survival prognosis. Right heart catheterization as a preoperative diagnostic tool to determine pulmonary hypertension has been largely abandoned in recent years in favor of echocardiographic criteria. Clinically, determination of echocardiographically estimated systolic pulmonary artery pressure falls far short of invasive right heart catheterization data in terms of accuracy. The aim of the present systematic review was to highlight noninvasive possibilities for the detection of pulmonary hypertension in patients with severe aortic valve stenosis, with a special focus on cardiovascular biomarkers. A total of 525 publications regarding echocardiography, cardiovascular imaging and biomarkers related to severe aortic valve stenosis and pulmonary hypertension were analyzed in a systematic database analysis using PubMed Central®. Finally, 39 publications were included in the following review. It was shown that the current scientific data situation, especially regarding cardiovascular biomarkers as non-invasive diagnostic tools for the determination of pulmonary hypertension in severe aortic valve stenosis patients, is poor. Thus, there is a great scientific potential to combine different biomarkers (biomarker scores) in a non-invasive way to determine the presence or absence of PH.

show abstract

Subclinical Right Ventricular Dysfunction in Patients with Severe Aortic Stenosis: A Retrospective Case Series

Cited by 5 publications

References 13 publications

Isolated Subclinical Right Ventricle Systolic Dysfunction in Patients after Liver Transplantation

Isolated Subclinical Right Ventricle Systolic Dysfunction in Patients after Liver Transplantation

Elevated systolic pulmonary artery pressure is a substantial predictor of increased mortality after transcatheter aortic valve replacement in males, not in females

Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic Review of Non-Invasive Ways of Risk Stratification, Especially in Patients Undergoing Transcatheter Aortic Valve Replacement

Contact Info

Product

Resources

About