1. Comparison of Pressure vs Volume Overload Ventricular Wall Stress in Patients With Valvular Heart Disease.
- Author
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Papapostolou S, Kearns J, Costello BT, O'Brien J, Gutman SJ, Nanayakarra S, Kaye D, Walton A, Hare J, Stub D, and Taylor AJ
- Subjects
- Humans, Male, Female, Aged, Aged, 80 and over, Magnetic Resonance Imaging, Cine methods, Echocardiography, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Transcatheter Aortic Valve Replacement methods, Aortic Valve Stenosis surgery, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis diagnostic imaging, Ventricular Remodeling physiology, Mitral Valve Insufficiency surgery, Mitral Valve Insufficiency physiopathology, Mitral Valve Insufficiency diagnostic imaging
- Abstract
Background: Aortic stenosis (AS) and mitral regurgitation (MR) result in different patterns of left ventricular remodeling and hypertrophy., Objectives: We characterized left ventricular wall stress (LVWS) profiles in pressure and volume-overloaded systems, examined the relationship between baseline LVWS and cardiac remodeling, and assessed the acute effects of valve intervention on LVWS using invasive pressures combined with cardiac magnetic resonance (CMR) imaging measures of left ventricular volumes/mass., Methods: A total of 47 patients with severe AS undergoing transcatheter aortic valve replacement (TAVR) and 15 patients with severe MR undergoing MitraClip (MC) underwent a 6-minute walk test (6MWT), transthoracic echocardiogram, and CMR before their procedures. Catheters in the left ventricle were used to record hemodynamic changes before and after valve/clip deployment. This was integrated with CMR data to calculate LVWS before and after intervention., Results: The TAVR group demonstrated significant reductions in systolic LVWS post procedure (median 24.7 Pa [IQR: 14 Pa] pre vs median 17.3 Pa [IQR: 12 Pa] post; P < 0.001). The MC group demonstrated significant reductions in diastolic LVWS (median 6.4 Pa [IQR: 5 Pa] pre vs median 4.3 Pa [IQR: 4.1 Pa] post; P = 0.021) with no significant change in systolic LVWS (30.6 ±1.61 pre vs 33 ±2.47 Pa post; P = 0.16). There was an inverse correlation between baseline systolic LVWS and 6MWT in the TAVR group (r = -0.31; P = 0.04)., Conclusions: TAVR results in significant reductions in systolic LVWS acutely. MC results in significant reductions in diastolic LVWS. Higher baseline systolic LVWS in TAVR is associated with shorter 6MWT suggesting that in AS, LVWS may be a useful marker of early decompensation., Competing Interests: Funding Support and Author Disclosures Prof Taylor is supported by an National Health and Medical Research Council (NHMRC) Leadership Investigator grant and A/Professor Dion Stub is supported by National Heart Foundation and NHMRC Research Fellowships. All authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2024
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