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Cardiac Function and Aortic Valve Intervention: Echocardiographic Studies of Myocardial Recovery in Patients with Severe Aortic Valve Disease
Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Center for Medical Image Science and Visualization, CMIV. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In patients with severe aortic valve disease, aortic valve intervention is performed when the risk for mortality or morbidity with conservative management is significantly increased. Left ventricular (LV) longitudinal motion decreases before conventional echocardiographic measures such as ejection fraction, are influenced in patients with severe aortic valve disease. This thesis is devoted to the assessment of cardiac function, including ventricular longitudinal motion, by echocardiography before and after aortic valve intervention in patients with chronic severe aortic regurgitation (AR) or severe aortic stenosis (AS).

Patients with chronic AR (n=29) were studied preoperatively, and 6 months and 4 years postoperatively by echocardiography, including tissue Doppler imaging, at rest and during exercise. LV longitudinal function (atrioventricular plane displacement, AVPD, and peak systolic velocity, PSV) decreased postoperatively, and patients with low PSV continued to show reduced longitudinal function 6 months after surgery. Preoperative exercise echocardiographic variables showed a strong correlation to late LV function variables, while preoperative variables obtained at rest were not useful for prediction. Exercise echocardiography and longitudinal LV function could therefore be useful complements in the timing of aortic valve surgery for AR.

Patients with chronic AR (n=29) were studied preoperatively, and 6 months and 4 years postoperatively by echocardiography, including tissue Doppler imaging, at rest and during exercise. LV longitudinal function (atrioventricular plane displacement, AVPD, and peak systolic velocity, PSV) decreased postoperatively, and patients with low PSV continued to show reduced longitudinal function 6 months after surgery. Preoperative exercise echocardiographic variables showed a strong correlation to late LV function variables, while preoperative variables obtained at rest were not useful for prediction. Exercise echocardiography and longitudinal LV function could therefore be useful complements in the timing of aortic valve surgery for AR.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. , 78 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1319
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-81051ISBN: 978-91-7519-844-6 (print)OAI: oai:DiVA.org:liu-81051DiVA: diva2:550026
Public defence
2012-09-28, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings Universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2012-09-06 Created: 2012-09-06 Last updated: 2012-09-06Bibliographically approved
List of papers
1. Preoperative Longitudinal Left Ventricular Function by Tissue Doppler Echocardiography at Rest and During Exercise Is Valuable in Timing of Aortic Valve Surgery in Male Aortic Regurgitation Patients
Open this publication in new window or tab >>Preoperative Longitudinal Left Ventricular Function by Tissue Doppler Echocardiography at Rest and During Exercise Is Valuable in Timing of Aortic Valve Surgery in Male Aortic Regurgitation Patients
2010 (English)In: Journal of the American Society of Echocardiography, ISSN 0894-7317, E-ISSN 1097-6795, Vol. 23, no 4, 387-395 p.Article in journal (Refereed) Published
Abstract [en]

Background: The aim of this study was to evaluate if left ventricular (LV) systolic function by tissue Doppler echocardiography at rest and during exercise preoperatively could predict postoperative LV function and thereby be useful in the timing of aortic valve surgery in patients with severe aortic regurgitation. Methods: In 29 patients (median age, 59 years; interquartile range, 39-64 years), echocardiography, tissue Doppler echocardiography, and radionuclide ventriculography were performed preoperatively and postoperatively at rest and during supine bicycle exercise. Results: Preoperative ejection fraction (EF) was 62%. Patients formed two groups, with basal LV peak systolic velocity (PSV) 5.9 cm/s preoperatively as the cutoff value between low and high PSV. Preoperatively, patients with low PSV had lower PSV during exercise (Pandlt;.005), EF during exercise (Pandlt;.05), and atrioventricular plane displacement (AVPD) at rest (Pandlt;.005) and during exercise (P andlt;.05) than those with high PSV. Postoperatively, patients with low PSV had smaller AVPD at rest (P andlt;.05), AVPD during exercise (Pandlt;.01), and PSV during exercise (Pandlt;.01). Conclusion: In patients with chronic aortic regurgitation with EFs and LV dimensions not fulfilling criteria for surgery according to guidelines, preoperative PSV and AVPD at rest and during exercise detected postoperative LV dysfunction.

Place, publisher, year, edition, pages
Elsevier Science B.V. Amsterdam, 2010
Keyword
Aortic valve insufficiency, Left ventricular function, Cardiac surgery, Tissue Doppler echocardiography, Exercise echocardiography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54856 (URN)10.1016/j.echo.2010.01.013 (DOI)000276248600009 ()
Note

Original Publication: Lena Helin, Eva Tamas and Eva Nylander, Preoperative Longitudinal Left Ventricular Function by Tissue Doppler Echocardiography at Rest and During Exercise Is Valuable in Timing of Aortic Valve Surgery in Male Aortic Regurgitation Patients, 2010, JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, (23), 4, 387-395. http://dx.doi.org/10.1016/j.echo.2010.01.013 Copyright: Elsevier Science B.V. Amsterdam http://www.elsevier.com/

Available from: 2010-04-16 Created: 2010-04-16 Last updated: 2017-12-12Bibliographically approved
2. Exercise echocardiography predicts postoperative left ventricular remodeling in aortic regurgitation
Open this publication in new window or tab >>Exercise echocardiography predicts postoperative left ventricular remodeling in aortic regurgitation
2014 (English)In: SCANDINAVIAN CARDIOVASCULAR JOURNAL, ISSN 1401-7431, Vol. 48, no 1, 4-12 p.Article in journal (Refereed) Published
Abstract [en]

Objective. We aimed to investigate if preoperative left ventricular (LV) function assessed by exercise echocardiography could predict late postoperative LV function in aortic regurgitation (AR) patients and to evaluate how LV long-axis function is affected late after aortic valve surgery. Design. A total of 21 male chronic AR patients, aged 49 (12) years, accepted for surgery were examined preoperatively, 6 months-, and 4 years postoperatively, at rest and during exercise. Besides conventional echocardiographic parameters, the atrioventricular plane displacement (AVPD) by M-mode and peak systolic velocity (s) in the basal LV by color tissue Doppler were measured. Results. Preoperatively EFrest and EFexercise, were 55(7)% and 54(9)%, respectively, and Delta EF 0(8)%. LV dimensions and volumes indexed to BSA had decreased at the 6-month follow-up and were stable at late follow-up. s(rest), s(exercise), AVPD(rest), and AVPD(exercise) were unchanged at both the postoperative examinations (all P >= 0.05). Preoperative EFexercise and AVPD(exercise) showed inverse correlation to late postoperative indexed LV enddiastolic volume (r = -0.68, p < 0.004 and r = -0.86, P < 0.001) and indexed LV endsystolic volume (r = -0.68, P = 0.004 and r = -0.81, P < 0.001), while there was no correlation to preoperative EFrest and AVPD(rest) (all r < 0.2). Conclusions. Preoperative exercise echocardiography can detect AR patients with suboptimal LV remodeling late postoperatively.

Place, publisher, year, edition, pages
Informa Healthcare, 2014
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-81049 (URN)10.3109/14017431.2013.861077 (DOI)000330849500002 ()
Available from: 2012-09-06 Created: 2012-09-06 Last updated: 2015-03-31Bibliographically approved
3. Left and right ventricular function in aortic stenosis patients 8 weeks post-transcatheter aortic valve implantation or surgical aortic valve replacement
Open this publication in new window or tab >>Left and right ventricular function in aortic stenosis patients 8 weeks post-transcatheter aortic valve implantation or surgical aortic valve replacement
Show others...
2011 (English)In: European Journal of Echocardiography, ISSN 1525-2167, E-ISSN 1532-2114, Vol. 12, no 8, 603-611 p.Article in journal (Refereed) Published
Abstract [en]

Aims Knowledge of longitudinal left and right ventricular (LV and RV) function after transcatheter aortic valve implantation (TAVI) is scarce. We hypothesized that the longitudinal systolic biventricular function in aortic stenosis (AS) patients is affected differently by TAVI and surgical aortic valve replacement (SAVR). less thanbrgreater than less thanbrgreater thanMethods and results Thirty-three AS patients (all-TAVI group, age 81 +/- 9 years, 18 female), with EuroSCORE 18 +/- 9%, were accepted for TAVI. Seventeen of these patients were matched (by gender, age, and LV function) to 17 patients undergoing SAVR. Conventional echocardiographic parameters, systolic atrioventricular plane displacement (AVPD) at standard sites and peak systolic velocity (PSV) by pulsed tissue Doppler at basal RV free wall, LV lateral wall, and septum were studied before and 8 weeks after the procedure. Procedural success was 100%, and 30-day mortality 9%. In all TAVI patients, AVPD(lateral), PSV(lateral), AVPD(septal), and PSV(septal) increased (P andlt; 0.001, 0.003, 0.006 and 0.002). When studying the matched patients postoperatively, both the SAVR and TAVI patients had increased PSV(lateral) and AVPD(lateral) (SAVR: P = 0.03 and P = 0.04, TAVI: P = 0.04 and P = 0.01). The PSV(RV) increased in the all-TAVI group (P = 0.007), while the AVPD(RV) was unchanged. SAVR patients had decreased AVPD(RV) (P = 0.001) and PSV(RV) (P = 0.004), while the matched TAVI patients had unchanged RV function parameters. less thanbrgreater than less thanbrgreater thanConclusion An improvement in regional longitudinal LV function in the septal and lateral wall could be seen after TAVI. Among the matched patients, both the TAVI and SAVR patients seemed to improve LV function in the lateral wall. RV systolic function increased in TAVI patients, but was impaired in the matched SAVR group at the 8-week follow-up.

Place, publisher, year, edition, pages
Oxford University Press (OUP), 2011
Keyword
Transcatheter aortic valve implantation, Aortic stenosis, Left ventricular function, Right ventricular function, Echocardiography
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-71089 (URN)10.1093/ejechocard/jer085 (DOI)000294861700006 ()
Note

Funding Agencies|Swedish Heart Lung Foundation||Medical Research Council of Southeast Sweden||County Council of Ostergotland, Sweden||

Available from: 2011-09-30 Created: 2011-09-30 Last updated: 2017-12-08
4. Differences in recovery of left and right ventricular function following aortic valve interventions: a longitudinal echocardiographic study in patients undergoing surgical, transapical or transfemoral aortic valve implantation
Open this publication in new window or tab >>Differences in recovery of left and right ventricular function following aortic valve interventions: a longitudinal echocardiographic study in patients undergoing surgical, transapical or transfemoral aortic valve implantation
Show others...
2013 (English)In: Catheterization and cardiovascular interventions, ISSN 1522-1946, E-ISSN 1522-726X, Vol. 82, no 6, 1004-1014 p.Article in journal (Refereed) Published
Abstract [en]

Objectives

To evaluate longitudinal left and right ventricular function (LVF and RVF) after transcatheter aortic valve implantation (TAVI) as compared to surgical aortic valve replacement (SAVR) and LVF and RVF after TAVI by the transfemoral (TF) or transapical (TA) approach.

Background

Knowledge about differences in recovery of LVF and RVF after TAVI and SAVR is scarce.

Methods

Sixty patients (age 81 ± 7 years, logistic EuroSCORE 16 ± 10%), undergoing TAVI (TF: n = 35 and TA: n  = 25), were examined by echocardiography including atrioventricular plane displacement (AVPD) and peak systolic velocities (PSV) by tissue Doppler at basal RV free wall, LV lateral wall and septum preprocedurally, 7 weeks and 6 months postprocedurally. Twenty-seven SAVR patients were matched to 27 TAVI patients by age, gender and LVF.

Results

Early postintervention, TAVI patients had improved longitudinal LVF. However, when analyzed separately, only TF, but not TA patients, had improved LV lateral and septal AVPD and PSV (all P ≤ 0.01). All TAVI patients, as well as the TF and TA group had unchanged longitudinal LVF between the early and late follow-ups (all P > 0.05). The SAVR group had higher septal LVF than the matched TAVI group preprocedurally, while postoperatively this difference was diminished. Longitudinal RVF was better in the TF group than in the TA group pre- and postprocedurally. Although the SAVR group had superior longitudinal RVF preoperatively, this was inferior to TAVI postoperatively.

Conclusions

Postprocedural longitudinal LVF and RVF in patients undergoing TF-TAVI, TA-TAVI, or SAVR differ considerably. Preservation of longitudinal RVF after TAVI might influence the selection of aortic valve intervention in the future.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-81050 (URN)10.1002/ccd.24812 (DOI)000326532300036 ()
Available from: 2012-09-06 Created: 2012-09-06 Last updated: 2017-12-07Bibliographically approved

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