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Peters AC, Gong FF, Ramesh A, Andrei A, Jankowski M, Cantey E, Chen V, Thomas JD, Flaherty JD, Malaisrie SC, Maganti K. Echocardiographic parameters associated with less reverse left ventricular remodeling after transcatheter aortic valve implant in subjects with prosthesis patient mismatch. Echocardiography 2024; 41:e15698. [PMID: 38284664 DOI: 10.1111/echo.15698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/15/2023] [Accepted: 09/16/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Transaortic valve implant (TAVI) is the treatment of choice for severe aortic stenosis (AS). Some patients develop prosthesis patient mismatch (PPM) after TAVI. It is challenging to determine which patients are at risk for clinical deterioration. METHODS We retrospectively measured echocardiographic parameters of left ventricular (LV) morphology and function, prosthetic aortic valve effective orifice area (iEOA) and hemodynamics in 313 patients before and 1 year after TAVI. Our objective was to compare the change in echocardiographic parameters associated with left ventricular reverse modeling in subjects with and without PPM. Our secondary objective was to evaluate echo parameters associated with PPM and the relationship to patient functional status and survival post-TAVI. RESULTS We found that 82 (26.2%) of subjects had moderate and 37 (11.8%) had severe PPM post-TAVI. There was less relative improvement in LVEF with PPM (1.9 ± 21.3% vs. 8.2 + 30.1%, p = .045). LV GLS also exhibited less relative improvement in those with PPM (13.4 + 34.1% vs. 30.9 + 73.3%, p = .012). NYHA functional class improved in 84.3% of subjects by one grade or more. Echocardiographic markers of PPM were worse in those without improvement in NYHA class (mean AT/ET was .29 vs. .27, p = .05; DVI was .46 vs. .51, p = .021; and iEOA was .8 cm/m2 vs. .9 cm/m2 , p = .025). There was no association with PPM and survival. CONCLUSIONS There was no improvement in LVEF and less improvement in LV GLS in those with PPM post-TAVI. Echocardiographic markers of PPM were present in those with lack of improvement in NYHA functional class.
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Affiliation(s)
- Andrew C Peters
- Northwestern University Feinberg School of Medicine, Chicago, USA
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Fei Fei Gong
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Ashvita Ramesh
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Adin Andrei
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | | | - Eric Cantey
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Vincent Chen
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - James D Thomas
- Northwestern University Feinberg School of Medicine, Chicago, USA
| | - James D Flaherty
- Northwestern University Feinberg School of Medicine, Chicago, USA
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Shi J, Li W, Zhang T, Han C, Wang Z, Pei X, Li X, Zhao Z, Wang P, Han J, Chen S. Quantity and location of aortic valve calcification predicts paravalvular leakage after transcatheter aortic valve replacement: a systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1170979. [PMID: 37293280 PMCID: PMC10244734 DOI: 10.3389/fcvm.2023.1170979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Introduction Transcatheter aortic valve replacement (TAVR) is the first-line treatment for patients with moderate-to-high surgical risk of severe aortic stenosis. Paravalvular leakage (PVL) is a serious complication of TAVR, and aortic valve calcification contributes to the occurrence of PVL. This study aimed to investigate the effect of location and quantity of calcification in the aortic valve complex (AVC) and left ventricular outflow tract (LVOT) on PVL after TAVR. Method We performed a systematic review and meta-analysis to evaluate the effect of quantity and location of aortic valve calcification on PVL after TAVR using observational studies from PubMed and EMBASE databases from inception to February 16, 2022. Results Twenty-four observational studies with 6,846 patients were included in the analysis. A high quantity of calcium was observed in 29.6% of the patients; they showed a higher risk of significant PVL. There was heterogeneity between studies (I2 = 15%). In the subgroup analysis, PVL after TAVR was associated with the quantity of aortic valve calcification, especially those located in the LVOT, valve leaflets, and the device landing zone. A high quantity of calcium was associated with PVL, regardless of expandable types or MDCT thresholds used. However, for valves with sealing skirt, the amount of calcium has no significant effect on the incidence of PVL. Conclusion Our study elucidated the effect of aortic valve calcification on PVL and showed that the quantity and location of aortic valve calcification can help predict PVL. Furthermore, our results provide a reference for the selection of MDCT thresholds before TAVR. We also showed that balloon-expandable valves may not be effective in patients with high calcification, and valves with sealing skirts instead of those without sealing skirts should be applied more to prevent PVL from happening. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=354630, identifier: CRD42022354630.
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Affiliation(s)
- Jiale Shi
- Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Wei Li
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tangshan Zhang
- Department of Vascular Surgery, Jiyang District People's Hospital, Jinan, China
| | - Chengwen Han
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhengjun Wang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xinhao Pei
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xuetao Li
- Department of Second Clinical Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zidong Zhao
- Department of Public Health School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Pengbo Wang
- Department of Public Health School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jingying Han
- Department of Basic Medical School, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shiqiao Chen
- Department of Interventional Diagnosis and Treatment, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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