Evolution and Prognostic Impact of Left Ventricular Myocardial Work Indices After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis

IF 1.6 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques Pub Date : 2024-10-20 DOI:10.1111/echo.70006

Hoi W. Wu, Federico Fortuni, Tamilla Muzafarova, Camille Sarrazyn, Pilar Lopez Santi, Aileen P. A. Chua, Steele C. Butcher, Frank van der Kley, Arend de Weger, J. Wouter Jukema, Jeroen J. Bax, Nina Ajmone Marsan

{"title":"Evolution and Prognostic Impact of Left Ventricular Myocardial Work Indices After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis","authors":"Hoi W. Wu, Federico Fortuni, Tamilla Muzafarova, Camille Sarrazyn, Pilar Lopez Santi, Aileen P. A. Chua, Steele C. Butcher, Frank van der Kley, Arend de Weger, J. Wouter Jukema, Jeroen J. Bax, Nina Ajmone Marsan","doi":"10.1111/echo.70006","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>Left ventricular myocardial work (LVMW) has been shown to better characterize LV function in patients with severe aortic stenosis by correcting LV afterload. The aim of this study was to evaluate the evolution in LVMW indices after transcatheter aortic valve replacement (TAVR) and their prognostic value.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>The following LVMW indices were calculated before and immediately after TAVR in 255 patients (median age 82 years, 51% male): global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). The study endpoint was all-cause mortality.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>After TAVR, LV ejection fraction and LV global longitudinal strain (GLS) did not change significantly (from 56% to 55%, <i>p</i> = 0.470 and from 13.6% to 13.2%, <i>p</i> = 0.068). Concerning LVMW indices, while LV GWW remained unchanged after TAVR (from 247 to 258 mmHg%, <i>p</i> = 0.080), LV GWI, LV GCW, and LV GWE significantly decreased (from 1882 to 1291 mmHg%, <i>p</i> < 0.001, from 2248 to 1671 mmHg%, <i>p</i> < 0.001, and from 89% to 85%, <i>p</i> < 0.001, respectively). During a median follow-up of 59 [40–72] months, 129 patients died. After correcting for potential confounders (sex, diabetes, renal function, atrial fibrillation, Charlson comorbidity index, and pacemaker implantation post-TAVR), post-TAVR LV GLS, GWI, and GCW remained independently associated with all-cause mortality. However, post-TAVR LV GWI demonstrated the highest increase in model predictivity.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>In patients undergoing TAVR, LVMW parameters significantly change after intervention. LV GWI after TAVR showed the strongest association with all-cause mortality among both conventional and advanced parameters of LV systolic function both pre- and post-TAVR and might enable better risk stratification of these patients after intervention.</p>\n </section>\n </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/echo.70006","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

Left ventricular myocardial work (LVMW) has been shown to better characterize LV function in patients with severe aortic stenosis by correcting LV afterload. The aim of this study was to evaluate the evolution in LVMW indices after transcatheter aortic valve replacement (TAVR) and their prognostic value.

Methods

The following LVMW indices were calculated before and immediately after TAVR in 255 patients (median age 82 years, 51% male): global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). The study endpoint was all-cause mortality.

Results

After TAVR, LV ejection fraction and LV global longitudinal strain (GLS) did not change significantly (from 56% to 55%, p = 0.470 and from 13.6% to 13.2%, p = 0.068). Concerning LVMW indices, while LV GWW remained unchanged after TAVR (from 247 to 258 mmHg%, p = 0.080), LV GWI, LV GCW, and LV GWE significantly decreased (from 1882 to 1291 mmHg%, p < 0.001, from 2248 to 1671 mmHg%, p < 0.001, and from 89% to 85%, p < 0.001, respectively). During a median follow-up of 59 [40–72] months, 129 patients died. After correcting for potential confounders (sex, diabetes, renal function, atrial fibrillation, Charlson comorbidity index, and pacemaker implantation post-TAVR), post-TAVR LV GLS, GWI, and GCW remained independently associated with all-cause mortality. However, post-TAVR LV GWI demonstrated the highest increase in model predictivity.

Conclusion

In patients undergoing TAVR, LVMW parameters significantly change after intervention. LV GWI after TAVR showed the strongest association with all-cause mortality among both conventional and advanced parameters of LV systolic function both pre- and post-TAVR and might enable better risk stratification of these patients after intervention.

查看原文本刊更多论文

重度主动脉瓣狭窄患者经导管主动脉瓣置换术后左心室心肌工作指数的变化和预后影响

目的左心室心肌功（LVMW）通过纠正左心室后负荷，已被证明能更好地描述重度主动脉瓣狭窄患者的左心室功能。本研究旨在评估经导管主动脉瓣置换术（TAVR）后 LVMW 指数的变化及其预后价值。方法计算了 255 名患者（中位年龄 82 岁，51% 为男性）在经导管主动脉瓣置换术前和术后的 LVMW 指数：全局工作指数 (GWI)、全局建设性工作 (GCW)、全局浪费工作 (GWW) 和全局工作效率 (GWE)。研究终点为全因死亡率。结果 TAVR术后，左心室射血分数和左心室整体纵向应变（GLS）无明显变化（从56%降至55%，P = 0.470；从13.6%降至13.2%，P = 0.068）。关于 LVMW 指数，虽然 TAVR 后 LV GWW 保持不变（从 247 mmHg% 到 258 mmHg%，p = 0.080），但 LV GWI、LV GCW 和 LV GWE 显著下降（分别从 1882 mmHg% 到 1291 mmHg%，p <0.001；从 2248 mmHg% 到 1671 mmHg%，p <0.001；从 89% 到 85%，p <0.001）。中位随访时间为 59 [40-72] 个月，129 名患者死亡。在校正了潜在的混杂因素（性别、糖尿病、肾功能、心房颤动、Charlson合并症指数和TAVR后植入起搏器）后，TAVR后左心室GLS、GWI和GCW仍与全因死亡率独立相关。但是，TAVR 后左心室 GWI 在模型预测中的增幅最大。结论在接受 TAVR 的患者中，介入治疗后 LVMW 参数会发生显著变化。在TAVR前后左心室收缩功能的常规参数和高级参数中，TAVR后左心室GWI与全因死亡率的相关性最强，可能有助于在介入治疗后对这些患者进行更好的风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques 医学-心血管系统

CiteScore

2.40

自引率

6.70%

发文量

211

审稿时长

3-6 weeks

期刊介绍： Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.