The Role of Invasive Hemodynamics in Guiding Contemporary Transcatheter Valvular Interventions

Alkhouli, Mohamad; Eleid, Mackram F.; Nishimura, Rick A.; Rihal, Charanjit S.

doi:10.1016/j.jcin.2021.08.072

Cited by 14 publications

(9 citation statements)

References 40 publications

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“…Patients with paradoxical low-flow, low-gradient AS tend to have Z va ≥ 5.5 mmHg/ml/m 2 , and these values are associated with a worse prognosis ( 26 ). In this setting, a nitroprusside challenge may be further helpful to assess the fixed component of total left ventricular afterload, unmask true aortic stenosis ( 27 ), and ideally predict symptomatic response to hemodynamic relief of aortic stenosis.…”

Section: Role Of Cardiac Catheterization In Low-flow Statesmentioning

confidence: 99%

Invasive assessment of aortic stenosis in contemporary practice

Brito

Raposo

Teles

2022

Front. Cardiovasc. Med.

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The authors review the current role of cardiac catheterization in the characterization of aortic stenosis, its main clinical applications, its pitfalls, and its additional value to the information provided by echocardiography. Discrepancies that may arise between these two modalities are discussed and further explained. Hemodynamic variables besides transvalvular pressure drop are described, and emphasis is given to an integrative approach to aortic stenosis assessment, that includes invasive and noninvasive evaluation.

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Section: Role Of Cardiac Catheterization In Low-flow Statesmentioning

confidence: 99%

Invasive assessment of aortic stenosis in contemporary practice

Brito

Raposo

Teles

2022

Front. Cardiovasc. Med.

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“…Recently, several studies proposed the incorporation of invasive hemodynamics in the assessment of TEER success. [5][6][7][8][9][10][11] These studies documented an independent association between a reduction in left atrial pressure (LAP) after TEER and improved outcomes suggesting that improving LAP should be considered as a target of the procedure. Nonetheless, predictors of LAP reduction with TEER have not been previously explored.…”

Section: Introductionmentioning

confidence: 98%

“…However, echocardiographic criteria of residual MR after TEER have neither been standardized or validated. Recently, several studies proposed the incorporation of invasive hemodynamics in the assessment of TEER success 5–11 . These studies documented an independent association between a reduction in left atrial pressure (LAP) after TEER and improved outcomes suggesting that improving LAP should be considered as a target of the procedure.…”

Section: Introductionmentioning

confidence: 99%

Predictors of hemodynamic response to mitral transcatheter edge‐to‐edge repair

Samimi

Ponce

Alarouri

et al. 2023

Cathet Cardio Intervent

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Background: Improvement in left atrial pressure (LAP) during transcatheter edge-toedge repair (TEER) is associated with improved outcomes. We sought to investigate the predictors of optimal hemodynamic response to TEER. Methods:We identified patients who underwent TEER at Mayo Clinic between May 2014 and February 2022. Patients with missing LAP data, an aborted procedure, and those undergoing a concomitant tricuspid TEER were excluded. We performed a logistic regression analysis to identify predictors of optimal hemodynamic response to TEER (defined as LAP ≤ 15 mmHg).Results: A total of 473 patients were included (Mean age 78.5 ± 9.4 years, 67.2% males). Overall, 195 (41.2%) achieved an optimal hemodynamic response after TEER.Patients who did not achieve an optimal response had higher baseline LAP (20.0 [17][18][19][20][21][22][23][24][25] vs. 15.0 [12-18] mmHg, p < 0.001), higher prevalence of AF (68.3% vs. 55.9%, p = 0.006), functional MR (47.5% vs. 35.9%, p = 0.009), annular calcification (41% vs. 29.2%, p = 0.02), lower left ventricular EF (55% vs. 58%, p = 0.02), and more frequent postprocedural severe MR (11.9% vs. 5.1%, p = 0.02) and elevated mitral gradient >5 mmHg (30.6% vs. 14.4%, p < 0.001). In the multivariate logistic regression analysis, AF (OR = 0.58; 95% CI = 0.35-0.96; p = 0.03), baseline LAP (OR = 0.80; 95% CI = 0.75-0.84; p < 0.001) and postprocedural mitral gradient <5 mmHg (OR = 0.35; 95% CI = 0.19-0.65; p < 0.001), were independent predictors of achieving an optimal hemodynamic response. In the multivariate model, residual MR was not independently associated with optimal hemodynamic response.Conclusions: Optimal hemodynamic response is achieved in 4 in 10 patients undergoing TEER. AF, higher baseline LAP, and higher postprocedural mitral gradient were negative predictors of optimal hemodynamic response after TEER.

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“…With the popularity of echocardiography, the application of invasive hemodynamic monitors was once limited. However, invasive hemodynamics have been revived with the rise of TTVI recently (11). Exploring hemodynamic changes could not only guide TTVI patient selection and predict patient prognosis, but also deepen the understanding of the pathophysiology of valvular heart disease (12).…”

Section: Introductionmentioning

confidence: 99%

Hemodynamics of transcatheter tricuspid valve replacement with Lux-Valve

Wang

Ning

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveTranscatheter tricuspid valve intervention (TTVI) has emerged as an alternative treatment option for high-risk and inoperable patients with symptomatic tricuspid regurgitation (TR). However, scarce data in hemodynamic profiles were available on TTVI. In this paper, we attempt to report the hemodynamic profiles of LuX-Valve.Methods30 patients from July 2020 to July 2021 were enrolled in this study. The patient was diagnosed with severe symptomatic TR. The clinical, invasive hemodynamic, and echocardiographic data were collected.ResultsThe surgical success rate was 100%. The cardiac index and stroke volume increased sharply from 2.42(2.27, 2.85) and 47.8(43.6, 62.0) to 3.04 ± 0.63 and 57.2 ± 14.7, respectively. With the elimination of TR and the increase of forward blood flow of the tricuspid valve, the extravascular lung water [798.0 (673.0, 1147.0) vs. 850.3 ± 376.1, P < 0.01] increased subsequently. The peak right atrium pressure decreased after Lux-Valve implantation (21.0 ± 6.4 vs. 19.4 ± 6.5, P < 0.05). On the contrary, the nadir right atrium pressure increased [10.0(8.0, 15.0) vs. 12.0(10.0, 17.0), P < 0.01]. Notably, the right atrium pressure difference dropped sharply from 9.0(5.0, 13.0) to 5.0(4.0, 8.0) after Lux-Valve implantation. There was no significant change in the pulmonary artery pressure. The right atrium volume decreased from 128(83, 188) to 91(67, 167) mL at 1 month and 107(66,157) mL at 6 months. With the remolding of the right heart chamber, the tricuspid annulus diameter shrank significantly from 42.5 ± 5.6 to 36.6 ± 6.3 mm at 1 month and 36.0 (33.0, 38.0) at 6 months.ConclusionInvasive right atrium pressure may act as a potential candidate for TR evaluation and procedural guidance. Elimination of TR by LuX-Valve implantation improves the cardiac output and right atrium pressure and has no significant effect on the pulmonary artery pressure even with the increment of forward blood flow, suggesting the hemodynamic superiority of transcatheter tricuspid valve replacement but needs further study.

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The Role of Invasive Hemodynamics in Guiding Contemporary Transcatheter Valvular Interventions

Cited by 14 publications

References 40 publications

Invasive assessment of aortic stenosis in contemporary practice

Invasive assessment of aortic stenosis in contemporary practice

Predictors of hemodynamic response to mitral transcatheter edge‐to‐edge repair

Hemodynamics of transcatheter tricuspid valve replacement with Lux-Valve

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