Echocardiographic L-wave as a prognostic indicator in transcatheter aortic valve replacement.

Szczegóły
Abstrakt

Tytuł:: Echocardiographic L-wave as a prognostic indicator in transcatheter aortic valve replacement.
Autorzy:: Merdler I; Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel.
Richert E; Tel Aviv University Medical School, Tel-Aviv, Israel.
Hochstadt A; Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel.
Loewenstein I; Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel.
Morgan S; Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel.
Itach T; Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel.
Topilsky Y; Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel.
Finkelstein A; Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel.
Laufer-Perl M; Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel.
Banai S; Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel.
Sadeh B; Department of Cardiology, Tel-Aviv Sourasky Medical Center, Affiliated to the Tel-Aviv University, 6 Weizzman St, 64239, Tel-Aviv, Israel. .
Źródło:: The international journal of cardiovascular imaging [Int J Cardiovasc Imaging] 2020 Oct; Vol. 36 (10), pp. 1897-1905. Date of Electronic Publication: 2020 Jun 17.
Typ publikacji:: Journal Article; Observational Study
Język:: English
Imprint Name(s):: Publication: [New York] : Springer
Original Publication: Boston : Kluwer Academic Publishers, c2001-
MeSH Terms:: Echocardiography, Doppler, Pulsed*
Hemodynamics*
Transcatheter Aortic Valve Replacement*/adverse effects
Transcatheter Aortic Valve Replacement*/mortality
Ventricular Function, Left*
Aortic Valve/*surgery
Aortic Valve Stenosis/*surgery
Aged ; Aged, 80 and over ; Aortic Valve/diagnostic imaging ; Aortic Valve/physiopathology ; Aortic Valve Stenosis/diagnostic imaging ; Aortic Valve Stenosis/mortality ; Aortic Valve Stenosis/physiopathology ; Diastole ; Female ; Humans ; Male ; Predictive Value of Tests ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome
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Contributed Indexing:: Keywords: Aortic stenosis; Diastolic dysfunction; L-wave; TAVR
Entry Date(s):: Date Created: 20200620 Date Completed: 20200928 Latest Revision: 20211222
Update Code:: 20240105
DOI:: 10.1007/s10554-020-01903-8
PMID:: 32556718
: Czasopismo naukowe

This study applies L-wave measurements of mid-diastolic trans-mitral flow. Although considered to be a marker of elevated filling pressure or delayed myocardial relaxation, its clinical and prognostic value is yet to be completely elucidated. It has been shown that transcatheter aortic valve replacement (TAVR) induces reverse remodeling and improves diastolic function and prognosis in patients with severe aortic stenosis (AS). Our purpose was to evaluate the prognostic value of L-wave following TAVR. We examined clinical and echocardiographic data of patients undergoing TAVR. L-Wave presence and velocity were recorded at baseline and at 1 month and 6 months following TAVR. The effect of the procedure on L-wave measurements and its impact on mortality and other clinical outcomes were analyzed. A total of 502 patients (mean age 82.58 ± 5.9) undergoing TAVR were included. Patients with baseline L-wave (n = 68, 12%) had a smaller stroke volume index by 5.7 ± 2.3 ml/m 2 (p = 0.01) as compared to patients without L-wave at baseline. L-waves disappeared In 35% and 70% of patients at 1 month and at 6 months respectively. Baseline L-wave velocity was 34.8 ± 11.5 (cm/s) and decreased significantly at follow-up examinations. Patients with persistent L-wave following TAVR had higher 3-year adjusted mortality rates (HR 5.7, 95% CI 3.7-8.9, p < 0.001). Multivariate analysis of survival was also statistically significant (p < 0.001). TAVR induces L-wave disappearance and a decrease in L-wave velocity in patients with severe AS. L-wave persistence following TAVR is an independent risk factor for mortality.

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