Transcatheter aortic valve replacement acutely improves left ventricular mechanical efficiency in severe aortic stenosis: effects of different phenotypes

Marino, Paolo; Binda, G; Calzaducca, Elisa; Panizza, Alice; Ferrari, Ilaria; Bellacosa, Ilaria; Ambrosio, Giuseppe

doi:10.1007/s00392-019-01570-3

Cited by 5 publications

(7 citation statements)

References 30 publications

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“…which was contributed to the decrease of PVA after TAVI. The improvement of energy transfer and LV efficiency were consistent with previous studies (Bastos et al, 2019;Marino et al, 2020). Conventional method of PV analysis has major limitations such as the complexity for pressure/flow acquisition and its invasiveness.…”

Section: Tavisupporting

confidence: 90%

Quantification of cardiac pumping mechanics in TAVI patients: A pilot study utilizing minimally invasive method for pressure‐volume analysis

Ko,

Chuang,

Lin

et al. 2023

Physiological Reports

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The ventriculo‐arterial coupling (VAC) and left ventricle (LV) mechanics are crucial and play an important role in the pathophysiology of aortic stenosis (AS). The pressure‐volume (PV) analysis is a powerful tool to study VAC and LV mechanics. We proposed a novel minimally‐invasive method for PV analysis in patients with severe AS receiving transcatheter aortic valve implantation (TAVI). Patients with severe AS were prospectively enrolled in a single center. LV pressure and cardiac output were recorded before and after TAVI. We constructed the PV loop for analysis by analyzing LV pressure and the assumed flow. 26 patients were included for final analysis. The effective arterial elastance (Ea) decreased after TAVI (3.7 ± 1.3 vs. 2.9 ± 1.1 mmHg/mL, p < 0.0001). The LV end‐systolic elastance (Ees) did not change immediately after TAVI (2.4 ± 1.3 vs. 2.6 ± 1.1 mmHg/mL, p = 0.3670). The Ea/Ees improved after TAVI (1.8 ± 0.8 vs. 1.2 ± 0.4, p < 0.0001), demonstrating an immediate improvement of VAC. The stroke work (SW) did not change (7669.6 ± 1913.8 vs. 7626.2 ± 2546.9, p = 0.9330), but the pressure‐volume area (PVA) decreased (14469.0 ± 4974.1 vs. 12177.4 ± 4499.9, p = 0.0374) after TAVI. The SW/PVA increased after TAVI (0.55 ± 0.12 vs. 0.63 ± 0.08, p < 0.0001) representing an improvement of LV efficiency. We proposed a novel minimally invasive method for PV analysis in patients with severe AS receiving TAVI. The VAC and LV efficiency improved immediately after TAVI.

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Section: Tavisupporting

confidence: 90%

Quantification of cardiac pumping mechanics in TAVI patients: A pilot study utilizing minimally invasive method for pressure‐volume analysis

Ko,

Chuang,

Lin

et al. 2023

Physiological Reports

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“…Literature reports on changing cardiac mechanoenergetics during transcatheter valvular interventions are sparse. Marino et al 10 reported a decrease in PVA from 16.424 (standard deviation [SD] AE 6.268) mmHg mL À1 to 12.053 (SD AE 5.260) following TAVR (p < 0.001) using noninvasive PVL-monitoring. Based on these numbers, and assuming normal distribution and moderate to strong negative intrapatient correlation, 65 patients will be needed to detect a significant change in PVA with 0.05 alpha and 90% power for patients undergoing TAVR.…”

Section: Sample Size Calculationmentioning

confidence: 99%

Invasive Real Time Biventricular Pressure-Volume Loops to Monitor Dynamic Changes in Cardiac Mechanoenergetics During Structural Heart Interventions: Design and Rationale of a Prospective Single-Center Study

Enden¹,

Dorpel²,

Bastos³

et al. 2022

Structural Heart

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“…In patients with mild systolic HF and metabolic syndrome, MEEi increased after 12 months in patients randomized to an aldosterone receptor antagonist on the top of optimal therapy, which was associated with improved LV diastolic function and decreased levels of B-type natriuretic peptide compared to placebo [60]. Recently, in a small group of aortic stenosis subjects, a surrogate estimate of MVO 2 dropped and the EW-to-TME ratio increased immediately after transcatheter aortic valve implantation (TAVI), and over-median post-TAVI rises in the ratio (normalized to the individualized estimate of MVO 2 ) were associated with a lower risk of all-cause death over an approximately 3-year follow up [61].…”

Section: Implications For Future Research-treatment Effects On Meementioning

confidence: 99%

Depressed Cardiac Mechanical Energetic Efficiency: A Contributor to Cardiovascular Risk in Common Metabolic Diseases—From Mechanisms to Clinical Applications

Juszczyk

Jankowska

Zawiślak³

et al. 2020

JCM

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Cardiac mechanical energetic efficiency is the ratio of external work (EW) to the total energy consumption. EW performed by the left ventricle (LV) during a single beat is represented by LV stroke work and may be calculated from the pressure–volume loop area (PVLA), while energy consumption corresponds to myocardial oxygen consumption (MVO2) expressed on a per-beat basis. Classical early human studies estimated total mechanical LV efficiency at 20–30%, whereas the remaining energy is dissipated as heat. Total mechanical efficiency is a joint effect of the efficiency of energy transfer at three sequential stages. The first step, from MVO2 to adenosine triphosphate (ATP), reflects the yield of oxidative phosphorylation (i.e., phosphate-to-oxygen ratio). The second step, from ATP split to pressure–volume area, represents the proportion of the energy liberated during ATP hydrolysis which is converted to total mechanical energy. Total mechanical energy generated per beat—represented by pressure–volume area—consists of EW (corresponding to PVLA) and potential energy, which is needed to develop tension during isovolumic contraction. The efficiency of the third step of energy transfer, i.e., from pressure–volume area to EW, decreases with depressed LV contractility, increased afterload, more concentric LV geometry with diastolic dysfunction and lower LV preload reserve. As practical assessment of LV efficiency poses methodological problems, De Simone et al. proposed a simple surrogate measure of myocardial efficiency, i.e., mechano-energetic efficiency index (MEEi) calculated from LV stroke volume, heart rate and LV mass. In two independent cohorts, including a large group of hypertensive subjects and a population-based cohort (both free of prevalent cardiovascular disease and with preserved ejection fraction), low MEEi independently predicted composite adverse cardiovascular events and incident heart failure. It was hypothesized that the prognostic ability of low MEEi can result from its association with both metabolic and hemodynamic alterations, i.e., metabolic syndrome components, the degree of insulin resistance, concentric LV geometry, LV diastolic and discrete systolic dysfunction. On the one part, an increased reliance of cardiomyocytes on the oxidation of free fatty acids, typical for insulin-resistant states, is associated with both a lower yield of ATP per oxygen molecule and lesser availability of ATP for contraction, which might decrease energetic efficiency of the first and second step of energy transfer from MVO2 to EW. On the other part, concentric LV remodeling and LV dysfunction despite preserved ejection fraction can impair the efficiency of the third energy transfer step. In conclusion, the association of low MEEi with adverse cardiovascular outcome might be related to a multi-step impairment of energy transfer from MVO2 to EW in various clinical settings, including metabolic syndrome, diabetes, hypertension and heart failure. Irrespective of theoretical considerations, MEEi appears an attractive simple tool which couldt improve risk stratification in hypertensive and diabetic patients for primary prevention purposes. Further clinical studies are warranted to estimate the predictive ability of MEEi and its post-treatment changes, especially in patients on novel antidiabetic drugs and subjects with common metabolic diseases and concomitant chronic coronary syndromes, in whom the potential relevance of MEE can be potentiated by myocardial ischemia.

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Transcatheter aortic valve replacement acutely improves left ventricular mechanical efficiency in severe aortic stenosis: effects of different phenotypes

Cited by 5 publications

References 30 publications

Quantification of cardiac pumping mechanics in TAVI patients: A pilot study utilizing minimally invasive method for pressure‐volume analysis

Quantification of cardiac pumping mechanics in TAVI patients: A pilot study utilizing minimally invasive method for pressure‐volume analysis

Invasive Real Time Biventricular Pressure-Volume Loops to Monitor Dynamic Changes in Cardiac Mechanoenergetics During Structural Heart Interventions: Design and Rationale of a Prospective Single-Center Study

Depressed Cardiac Mechanical Energetic Efficiency: A Contributor to Cardiovascular Risk in Common Metabolic Diseases—From Mechanisms to Clinical Applications

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