TY - JOUR
T1 - Difference in cardiac response after transcatheter aortic valve implantation according to flow and gradient pattern
AU - Yokoyama, Hiroaki
AU - Yamanaka, Futoshi
AU - Shishido, Koki
AU - Moriyama, Noriaki
AU - Ochiai, Tomoki
AU - Miyashita, Hirokazu
AU - Sugiyama, Yoichi
AU - Yashima, Fumiaki
AU - Ohno, Yohei
AU - Nishina, Hidetaka
AU - Izumo, Masaki
AU - Asami, Masahiko
AU - Naganuma, Toru
AU - Mizutani, Kazuki
AU - Yamawaki, Masahiro
AU - Tada, Norio
AU - Shirai, Shinichi
AU - Noguchi, Masahiko
AU - Ueno, Hiroshi
AU - Takagi, Kensuke
AU - Watanabe, Yusuke
AU - Yamamoto, Masanori
AU - Saito, Shigeru
AU - Hayashida, Kentaro
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2025/1/1
Y1 - 2025/1/1
N2 - Aims In patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS), data on the differences in subsequent cardiac structure and function among stratified groups with flow gradient patterns through the aortic valve are insufficient Methods In this large multicenter study, 4523 patients undergoing TAVI for severe AS between 2013 and 2019 were divided into three and results groups according to the following criteria: (i) high-gradient AS (HG-AS) [mean pressure gradient (MPG) ≥ 40 mmHg], (ii) classical low-flow low-gradient AS (cLFLG-AS) [MPG < 40 mmHg, left ventricular (LV) ejection fraction (LVEF) <50%], and (iii) paradoxical low-flow low-gradient AS (pLFLG-AS) [MPG < 40 mmHg, LVEF ≥ 50% but stroke volume index (SVi) <35 mL/m2]. Echocardiography was performed at baseline, post-procedure, and 1 year post-TAVI. 3697, 507, and 319 patients had HG-AS, cLFLG-AS, and pLFLG-AS, respectively. After adjusting for clinical factors, cLFLG-AS and pLFLG-AS had an ∼1.5-fold higher 2-year all-cause mortality compared with HG-AS. During 1 year following TAVI, compared with HG-AS, cLFLG-AS showed greater reduction of LV systolic diameter (LVDs) and LV diastolic diameter (LVDd) and greater increase of LVEF (P < 0.001 for all), and changes in LV mass index (LVMi) and SVi were comparable (P = 0.915 and P = 0.821, respectively). However, pLFLG-AS demonstrated less reduction of LVDs and LVDd (P = 0.039 and P = 0.001, respectively), less improvement of LVEF and LVMi (P = 0.045 and P < 0.001, respectively), and comparable change in SVi (P = 0.364) Conclusion During 1 year post-TAVI, compared with HG-AS, cLFLG-AS achieves smaller LV diameters, greater increase in LVEF, and comparable regression of LVMi, whereas pLFLG-AS does not.
AB - Aims In patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS), data on the differences in subsequent cardiac structure and function among stratified groups with flow gradient patterns through the aortic valve are insufficient Methods In this large multicenter study, 4523 patients undergoing TAVI for severe AS between 2013 and 2019 were divided into three and results groups according to the following criteria: (i) high-gradient AS (HG-AS) [mean pressure gradient (MPG) ≥ 40 mmHg], (ii) classical low-flow low-gradient AS (cLFLG-AS) [MPG < 40 mmHg, left ventricular (LV) ejection fraction (LVEF) <50%], and (iii) paradoxical low-flow low-gradient AS (pLFLG-AS) [MPG < 40 mmHg, LVEF ≥ 50% but stroke volume index (SVi) <35 mL/m2]. Echocardiography was performed at baseline, post-procedure, and 1 year post-TAVI. 3697, 507, and 319 patients had HG-AS, cLFLG-AS, and pLFLG-AS, respectively. After adjusting for clinical factors, cLFLG-AS and pLFLG-AS had an ∼1.5-fold higher 2-year all-cause mortality compared with HG-AS. During 1 year following TAVI, compared with HG-AS, cLFLG-AS showed greater reduction of LV systolic diameter (LVDs) and LV diastolic diameter (LVDd) and greater increase of LVEF (P < 0.001 for all), and changes in LV mass index (LVMi) and SVi were comparable (P = 0.915 and P = 0.821, respectively). However, pLFLG-AS demonstrated less reduction of LVDs and LVDd (P = 0.039 and P = 0.001, respectively), less improvement of LVEF and LVMi (P = 0.045 and P < 0.001, respectively), and comparable change in SVi (P = 0.364) Conclusion During 1 year post-TAVI, compared with HG-AS, cLFLG-AS achieves smaller LV diameters, greater increase in LVEF, and comparable regression of LVMi, whereas pLFLG-AS does not.
KW - aortic stenosis
KW - echocardiography
KW - low-flow low-gradient aortic stenosis
KW - transcatheter aortic valve implantation
UR - http://www.scopus.com/inward/record.url?scp=85214318691&partnerID=8YFLogxK
U2 - 10.1093/ehjci/jeae235
DO - 10.1093/ehjci/jeae235
M3 - 学術論文
C2 - 39255370
AN - SCOPUS:85214318691
SN - 2047-2404
VL - 26
SP - 107
EP - 117
JO - European Heart Journal Cardiovascular Imaging
JF - European Heart Journal Cardiovascular Imaging
IS - 1
ER -