Elena Caporali, Gaetano Paone, Giorgio Moschovitis, Maria Luisa De Perna, Elia Lo Priore, Enos Bernasconi, Giovanni Pedrazzini, Giorgio Treglia
Infective endocarditis and infection of cardiac devices are conditions characterized by high morbidity and mortality, thus requiring a prompt diagnosis. Advanced imaging modalities are often required in the management of infectious endocarditis according to guidelines. The aim of this review is to collect and describe evidence-based knowledge about the diagnostic role and clinical usefulness of [18F]FDG PET/CT in endocarditis and cardiac device infections based on published systematic reviews and meta-analyses on this topic and on recent guidelines. [18F]FDG PET/CT is recommended only in selected cases. This imaging method has good diagnostic accuracy in detecting prosthetic valve endocarditis and cardiac device infection. Furthermore, it can identify extra-cardiac infectious foci changing the clinical management in a significant percentage of cases.
{"title":"Evidence-Based Data on the Diagnostic Role and Clinical Usefulness of [18F]FDG PET/CT in Endocarditis and Cardiac Device Infections","authors":"Elena Caporali, Gaetano Paone, Giorgio Moschovitis, Maria Luisa De Perna, Elia Lo Priore, Enos Bernasconi, Giovanni Pedrazzini, Giorgio Treglia","doi":"10.1111/echo.15934","DOIUrl":"10.1111/echo.15934","url":null,"abstract":"<div>\u0000 \u0000 <p>Infective endocarditis and infection of cardiac devices are conditions characterized by high morbidity and mortality, thus requiring a prompt diagnosis. Advanced imaging modalities are often required in the management of infectious endocarditis according to guidelines. The aim of this review is to collect and describe evidence-based knowledge about the diagnostic role and clinical usefulness of [<sup>18</sup>F]FDG PET/CT in endocarditis and cardiac device infections based on published systematic reviews and meta-analyses on this topic and on recent guidelines. [<sup>18</sup>F]FDG PET/CT is recommended only in selected cases. This imaging method has good diagnostic accuracy in detecting prosthetic valve endocarditis and cardiac device infection. Furthermore, it can identify extra-cardiac infectious foci changing the clinical management in a significant percentage of cases.</p>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Does Left Atrial Appendage Dysfunction Predict Recurrent Atrial Fibrillation Post Radiofrequency Ablation? And, If So, Why?","authors":"Charles Pollick","doi":"10.1111/echo.70014","DOIUrl":"10.1111/echo.70014","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 11","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142512275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Frequent and high-intensity exercise is associated with a range of structural, functional, and electrical cardiac adaptations that enhance cardiac performance. The structural changes primarily involve proportional cardiac four-chamber enlargement and increased left ventricular mass [<span>1</span>]. Functionally, the resting heart rate is usually lower in athletes versus age- and sex-matched non-athlete, although maximal heart rates tend to be similar [<span>2</span>]. Although this allows for a potentially greater heart rate rise with exercise, it is the significantly greater left ventricular size and stroke volume of athletes that is the main determinant of their higher cardiac outputs [<span>1</span>]. Left ventricular wall thickness is either preserved or marginally increased. The most commonly observed electrical changes are identified on a resting 12-lead electrocardiogram. These include relatively longer PR intervals, higher voltage of R, and T waves and more frequently incomplete right bundle branch block (RBBB), left ventricular (LV) hypertrophy, early repolarization, and anterior (typically V1–3) T-wave inversion as compared to non-athletes [<span>3, 4</span>]. The degree of cardiac remodeling is subject to marked individual variation which is heavily influenced by the type of exercise (endurance vs. strength), height, sex, genetics, ethnicity and the exercise dose (= intensity × time) [<span>1</span>].</p><p>Although these adaptations are usually benign and enhance cardiac performance, they can sometimes lead to difficulties in differentiating a genuine athletic heart (AH) from an underlying cardiomyopathy (the so-called “grey zone”) [<span>2</span>]. This is particularly noticeable where phenotypic expression of cardiomyopathy is more covert (e.g., mild concentric hypertrophic cardiomyopathy or mild left ventricular dysfunction with a dilated cardiomyopathy) or where there has been extreme exercise-related remodeling. Consequently, there is a need to accurately define the phenotype of the AH in order to improve the clinical precision of differentiating it from a true cardiomyopathy.</p><p>In a very recent publication in our Journal, Stadter and Keller present the results of an observational study designed to better understand the potential differences in cardiac structure and function among athletes determined to have an AH versus those who did not [<span>5</span>]. They conducted a retrospective analysis of pre-participation screening data collected on 648 adult athletes at University Hospital Heidelberg (Germany) between April 2020 and October 2021. All of the participants underwent standard transthoracic echocardiography, cardiopulmonary exercise testing (adapted to the athlete's sport), basic height and weight assessment, and body fat estimation using calipometry. Their primary aim was to examine the differences in atrial adaptations between those with and without a defined AH and explore the baseline factors influencing potent
{"title":"Atrial Adaptations and Total Cardiac Volume in Athletes","authors":"Christopher J. Boos","doi":"10.1111/echo.70002","DOIUrl":"10.1111/echo.70002","url":null,"abstract":"<p>Frequent and high-intensity exercise is associated with a range of structural, functional, and electrical cardiac adaptations that enhance cardiac performance. The structural changes primarily involve proportional cardiac four-chamber enlargement and increased left ventricular mass [<span>1</span>]. Functionally, the resting heart rate is usually lower in athletes versus age- and sex-matched non-athlete, although maximal heart rates tend to be similar [<span>2</span>]. Although this allows for a potentially greater heart rate rise with exercise, it is the significantly greater left ventricular size and stroke volume of athletes that is the main determinant of their higher cardiac outputs [<span>1</span>]. Left ventricular wall thickness is either preserved or marginally increased. The most commonly observed electrical changes are identified on a resting 12-lead electrocardiogram. These include relatively longer PR intervals, higher voltage of R, and T waves and more frequently incomplete right bundle branch block (RBBB), left ventricular (LV) hypertrophy, early repolarization, and anterior (typically V1–3) T-wave inversion as compared to non-athletes [<span>3, 4</span>]. The degree of cardiac remodeling is subject to marked individual variation which is heavily influenced by the type of exercise (endurance vs. strength), height, sex, genetics, ethnicity and the exercise dose (= intensity × time) [<span>1</span>].</p><p>Although these adaptations are usually benign and enhance cardiac performance, they can sometimes lead to difficulties in differentiating a genuine athletic heart (AH) from an underlying cardiomyopathy (the so-called “grey zone”) [<span>2</span>]. This is particularly noticeable where phenotypic expression of cardiomyopathy is more covert (e.g., mild concentric hypertrophic cardiomyopathy or mild left ventricular dysfunction with a dilated cardiomyopathy) or where there has been extreme exercise-related remodeling. Consequently, there is a need to accurately define the phenotype of the AH in order to improve the clinical precision of differentiating it from a true cardiomyopathy.</p><p>In a very recent publication in our Journal, Stadter and Keller present the results of an observational study designed to better understand the potential differences in cardiac structure and function among athletes determined to have an AH versus those who did not [<span>5</span>]. They conducted a retrospective analysis of pre-participation screening data collected on 648 adult athletes at University Hospital Heidelberg (Germany) between April 2020 and October 2021. All of the participants underwent standard transthoracic echocardiography, cardiopulmonary exercise testing (adapted to the athlete's sport), basic height and weight assessment, and body fat estimation using calipometry. Their primary aim was to examine the differences in atrial adaptations between those with and without a defined AH and explore the baseline factors influencing potent","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christoph Ryffel, Fabien Praz, Martina Boscolo Berto, Stefano de Marchi, Nicolas Brugger, Thomas Pilgrim, Ronny R Buechel, Stephan Windecker, Christoph Gräni
Approximately 5% of elderly patients suffer from moderate or severe tricuspid valve regurgitation, which is an independent predictor of high morbidity and mortality. Surgical treatment of isolated tricuspid valve regurgitation has been associated with elevated fatality rate, leading to a growing interest in minimal invasive, transcatheter-based therapies such as transcatheter edge-to-edge repair and transcatheter valve replacement. Nevertheless, despite high procedural efficacy and safety of transcatheter-based therapies, a number of challenges limit their rapid adoption in routine clinical practice. In particular, the wide range of transcatheter approaches to address the significant variability in tricuspid valve pathology challenges the reproducibility of clinical outcomes. Multimodality imaging is pivotal for grading the regurgitation severity, determining the underlying pathology, assessing RV function and pulmonary pressures, identifying concomitant cardiac disease, and selecting the most beneficial treatment modality and access. This article reviews the role of different imaging modalities in guiding the management of patients with significant tricuspid valve regurgitation.
{"title":"Multimodality Imaging in the Management of Tricuspid Valve Regurgitation","authors":"Christoph Ryffel, Fabien Praz, Martina Boscolo Berto, Stefano de Marchi, Nicolas Brugger, Thomas Pilgrim, Ronny R Buechel, Stephan Windecker, Christoph Gräni","doi":"10.1111/echo.15960","DOIUrl":"10.1111/echo.15960","url":null,"abstract":"<p>Approximately 5% of elderly patients suffer from moderate or severe tricuspid valve regurgitation, which is an independent predictor of high morbidity and mortality. Surgical treatment of isolated tricuspid valve regurgitation has been associated with elevated fatality rate, leading to a growing interest in minimal invasive, transcatheter-based therapies such as transcatheter edge-to-edge repair and transcatheter valve replacement. Nevertheless, despite high procedural efficacy and safety of transcatheter-based therapies, a number of challenges limit their rapid adoption in routine clinical practice. In particular, the wide range of transcatheter approaches to address the significant variability in tricuspid valve pathology challenges the reproducibility of clinical outcomes. Multimodality imaging is pivotal for grading the regurgitation severity, determining the underlying pathology, assessing RV function and pulmonary pressures, identifying concomitant cardiac disease, and selecting the most beneficial treatment modality and access. This article reviews the role of different imaging modalities in guiding the management of patients with significant tricuspid valve regurgitation.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.15960","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Infective endocarditis (IE) continues to have high rates of adverse outcomes, despite recent advances in diagnosis and management. Although the use of computer tomography and nuclear imaging appears to be increasing, echocardiography, widely available in most centers, is the recommended initial modality of choice to diagnose and consequently guide the management of IE in a timely-dependent fashion. Echocardiographic imaging should be performed as soon as the IE diagnosis is suspected. Several factors may delay diagnosis, for example, echocardiography findings may be negative early in the disease course. Thus, repeated echocardiography is recommended in patients with negative initial echocardiography if high suspicion for IE persists in patients at high risk. However, systematic echocardiographic screening should not be utilized as a common tool for fever, but only in the presence of a reasonable clinical suspicion of IE. It may increase the risk of false-positive rates of patients requiring IE therapy or may exacerbate diagnostic uncertainty about subtle findings. Considering the complexity of the disease, the echocardiographic use should be increasingly time-efficient and should focus on the correct identification of IE lesions and associated complications. The path to identify patients who need surgery passes through an echocardiographic skill ensuring the identification of the cardiac anatomical structures and their involvement in the destructive infective extension. We pointed out the role of echocardiography focused on the correct identification of IE distinctive lesions and the associated complications, as part of a diagnostic strategy, within an integrated multimodality imaging, managed by an “endocarditis team”.
{"title":"Echocardiography in Endocarditis","authors":"Cosimo Angelo Greco, Salvatore Zaccaria, Giovanni Casali, Salvatore Nicolardi, Miriam Albanese","doi":"10.1111/echo.15945","DOIUrl":"10.1111/echo.15945","url":null,"abstract":"<div>\u0000 \u0000 <p>Infective endocarditis (IE) continues to have high rates of adverse outcomes, despite recent advances in diagnosis and management. Although the use of computer tomography and nuclear imaging appears to be increasing, echocardiography, widely available in most centers, is the recommended initial modality of choice to diagnose and consequently guide the management of IE in a timely-dependent fashion. Echocardiographic imaging should be performed as soon as the IE diagnosis is suspected. Several factors may delay diagnosis, for example, echocardiography findings may be negative early in the disease course. Thus, repeated echocardiography is recommended in patients with negative initial echocardiography if high suspicion for IE persists in patients at high risk. However, systematic echocardiographic screening should not be utilized as a common tool for fever, but only in the presence of a reasonable clinical suspicion of IE. It may increase the risk of false-positive rates of patients requiring IE therapy or may exacerbate diagnostic uncertainty about subtle findings. Considering the complexity of the disease, the echocardiographic use should be increasingly time-efficient and should focus on the correct identification of IE lesions and associated complications. The path to identify patients who need surgery passes through an echocardiographic skill ensuring the identification of the cardiac anatomical structures and their involvement in the destructive infective extension. We pointed out the role of echocardiography focused on the correct identification of IE distinctive lesions and the associated complications, as part of a diagnostic strategy, within an integrated multimodality imaging, managed by an “endocarditis team”.</p>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preload, Afterload, E and e′","authors":"Roger E. Peverill","doi":"10.1111/echo.70011","DOIUrl":"https://doi.org/10.1111/echo.70011","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Left Atrial Thrombosis in the Setting of Venoarterial Extracorporeal Membrane Oxygenation","authors":"Yehia Saleh, Ola Abdelkarim","doi":"10.1111/echo.70000","DOIUrl":"https://doi.org/10.1111/echo.70000","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This commentary discusses the recently published article, “Speckle-tracking echocardiography as an effective screening tool for cardiac involvement among patients with systemic sarcoidosis in an Indian cohort: A prospective observational study”. Owing to improved imaging modalities and increased awareness of cardiac sarcoidosis (CS), the prevalence of CS has risen. Given that CS is a relatively rare condition with high mortality, it is essential for the initial test to demonstrate high sensitivity. However, several guidelines offer differing opinions on the diagnosis algorithm for CS. This commentary highlighted the importance of speckle-tracking echocardiography as an effective screening tool. Due to its high negative predictive value (NPV), it would be useful to rule out cardiac involvement. Nevertheless, larger prospective multicenter studies are warranted to develop a more cost-effective diagnosis algorithm for CS.
{"title":"Diagnosis Algorithm of Cardiac Sarcoidosis: Where Are We?","authors":"Yi Wang","doi":"10.1111/echo.70009","DOIUrl":"https://doi.org/10.1111/echo.70009","url":null,"abstract":"<p>This commentary discusses the recently published article, “Speckle-tracking echocardiography as an effective screening tool for cardiac involvement among patients with systemic sarcoidosis in an Indian cohort: A prospective observational study”. Owing to improved imaging modalities and increased awareness of cardiac sarcoidosis (CS), the prevalence of CS has risen. Given that CS is a relatively rare condition with high mortality, it is essential for the initial test to demonstrate high sensitivity. However, several guidelines offer differing opinions on the diagnosis algorithm for CS. This commentary highlighted the importance of speckle-tracking echocardiography as an effective screening tool. Due to its high negative predictive value (NPV), it would be useful to rule out cardiac involvement. Nevertheless, larger prospective multicenter studies are warranted to develop a more cost-effective diagnosis algorithm for CS.</p>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What Is the Significance of Greater Global Wasted Work in Patients With Apical Hypertrophic Cardiomyopathy and Apical Aneurysm? Is It the Chicken or the Egg?","authors":"Charles Pollick","doi":"10.1111/echo.70010","DOIUrl":"https://doi.org/10.1111/echo.70010","url":null,"abstract":"","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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
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.
{"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":"https://doi.org/10.1111/echo.70006","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <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>\u0000 </section>\u0000 </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"41 10","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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