Tarique Al Musa1, Akhlaque Uddin2, Timothy A Fairbairn3, Laura E Dobson4, Christopher D Steadman5, Ananth Kidambi6, David P Ripley7, Peter P Swoboda8, Adam K McDiarmid9, Bara Erhayiem10, Pankaj Garg11, Daniel J Blackman12, Sven Plein13, Gerald P McCann14, John P Greenwood15. 1. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: t.a.musa@leeds.ac.uk. 2. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: a.uddin@leeds.ac.uk. 3. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: timothy.fairbairn@lhch.nhs.uk. 4. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: l.dobson@leeds.ac.uk. 5. Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, Leicester, UK. Electronic address: chris.steadman@poole.nhs.uk. 6. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: a.kidambi@leeds.ac.uk. 7. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: d.ripley@leeds.ac.uk. 8. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: p.swoboda@leeds.ac.uk. 9. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: a.k.mcdiarmid@leeds.ac.uk. 10. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: b.erhayiem@leeds.ac.uk. 11. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: p.garg@leeds.ac.uk. 12. Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK. Electronic address: daniel.blackman1@nhs.net. 13. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: s.plein@leeds.ac.uk. 14. Department of Cardiovascular Sciences, University of Leicester, Cardiovascular Research Centre and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, Leicester, UK. Electronic address: gerry.mccann@uhl-tr.nhs.uk. 15. Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK. Electronic address: j.greenwood@leeds.ac.uk.
Abstract
OBJECTIVE: The response of the RV following treatment of aortic stenosis is poorly defined, reflecting the challenge of accurate RV assessment. Cardiovascular magnetic resonance (CMR) is the established reference for imaging of RV volumes, mass and function. We sought to define the impact of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) upon RV function in patients treated for severe aortic stenosis using CMR. METHODS: A 1.5T CMR scan was performed preoperatively and 6months postoperatively in 112 (56 TAVI, 56 SAVR; 76±8years) high-risk severe symptomatic aortic stenosis patients across two UK cardiothoracic centres. RESULTS: TAVI patients were older (80.4±6.7 vs. 72.8±7.2years, p<0.05) with a higher STS score (2.13±0.73 vs. 5.54±3.41%, p<0.001). At 6months, SAVR was associated with a significant increase in RV end systolic volume (33±10 vs. 37±10ml/m2, p=0.008), and decrease in RV ejection fraction (58±8 vs. 53±8%, p=0.005) and tricuspid annular plane systolic excursion (22±5 vs. 14±3mm, p<0.001). Only 4 (7%) SAVR patients had new RV late gadolinium hyper-enhancement with no new cases seen in the TAVI patients at 6months. Longer surgical cross-clamp time was the only predictor of increased RV end systolic volume at 6months. Post-TAVI, there was no observed change in RV volumes or function. Over a maximum 6.3year follow-up, 18(32%) of TAVI patients and 1(1.7%) of SAVR patients had died (p=0.001). On multivariable Cox analysis, the RV mass at 6m post-TAVI was independently associated with all-cause mortality (HR 1.359, 95% CI 1.108-1.666, p=0.003). CONCLUSIONS: SAVR results in a deterioration in RV systolic volumes and function associated with longer cross-clamp times and is not fully explained by suboptimal RV protection during cardiopulmonary bypass. TAVI had no adverse impact upon RV volumes or function.
OBJECTIVE: The response of the RV following treatment of aortic stenosis is poorly defined, reflecting the challenge of accurate RV assessment. Cardiovascular magnetic resonance (CMR) is the established reference for imaging of RV volumes, mass and function. We sought to define the impact of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) upon RV function in patients treated for severe aortic stenosis using CMR. METHODS: A 1.5T CMR scan was performed preoperatively and 6months postoperatively in 112 (56 TAVI, 56 SAVR; 76±8years) high-risk severe symptomatic aortic stenosis patients across two UK cardiothoracic centres. RESULTS: TAVI patients were older (80.4±6.7 vs. 72.8±7.2years, p<0.05) with a higher STS score (2.13±0.73 vs. 5.54±3.41%, p<0.001). At 6months, SAVR was associated with a significant increase in RV end systolic volume (33±10 vs. 37±10ml/m2, p=0.008), and decrease in RV ejection fraction (58±8 vs. 53±8%, p=0.005) and tricuspid annular plane systolic excursion (22±5 vs. 14±3mm, p<0.001). Only 4 (7%) SAVR patients had new RV late gadolinium hyper-enhancement with no new cases seen in the TAVI patients at 6months. Longer surgical cross-clamp time was the only predictor of increased RV end systolic volume at 6months. Post-TAVI, there was no observed change in RV volumes or function. Over a maximum 6.3year follow-up, 18(32%) of TAVI patients and 1(1.7%) of SAVR patients had died (p=0.001). On multivariable Cox analysis, the RV mass at 6m post-TAVI was independently associated with all-cause mortality (HR 1.359, 95% CI 1.108-1.666, p=0.003). CONCLUSIONS: SAVR results in a deterioration in RV systolic volumes and function associated with longer cross-clamp times and is not fully explained by suboptimal RV protection during cardiopulmonary bypass. TAVI had no adverse impact upon RV volumes or function.
Authors: Ghazaleh Mehdipoor; Shmuel Chen; Saurav Chatterjee; Pooya Torkian; Ori Ben-Yehuda; Martin B Leon; Gregg W Stone; Martin R Prince Journal: J Cardiovasc Magn Reson Date: 2020-06-01 Impact factor: 5.364
Authors: Salih N Grevious; Marcelo F Fernandes; Ama K Annor; Michel Ibrahim; Garly R Saint Croix; Eduardo de Marchena; Mauricio G Cohen; Carlos E Alfonso Journal: J Am Heart Assoc Date: 2020-06-10 Impact factor: 5.501