Functional and structural reverse myocardial remodeling following transcatheter aortic valve replacement: a prospective cardiovascular magnetic resonance study View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2022-07-28

AUTHORS

Torben Lange, Sören J. Backhaus, Bo Eric Beuthner, Rodi Topci, Karl-Rudolf Rigorth, Johannes T. Kowallick, Ruben Evertz, Moritz Schnelle, Susana Ravassa, Javier Díez, Karl Toischer, Tim Seidler, Miriam Puls, Gerd Hasenfuß, Andreas Schuster

ABSTRACT

BackgroundSince cardiovascular magnetic resonance (CMR) imaging allows comprehensive quantification of both myocardial function and structure we aimed to assess myocardial remodeling processes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).MethodsCMR imaging was performed in 40 patients with severe AS before and 1 year after TAVR. Image analyses comprised assessments of myocardial volumes, CMR-feature-tracking based atrial and ventricular strain, myocardial T1 mapping, extracellular volume fraction-based calculation of left ventricular (LV) cellular and matrix volumes, as well as ischemic and non-ischemic late gadolinium enhancement analyses. Moreover, biomarkers including NT-proBNP as well as functional and clinical status were documented.ResultsMyocardial function improved 1 year after TAVR: LV ejection fraction (57.9 ± 16.9% to 65.4 ± 14.5%, p = 0.002); LV global longitudinal (− 21.4 ± 8.0% to -25.0 ± 6.4%, p < 0.001) and circumferential strain (− 36.9 ± 14.3% to − 42.6 ± 11.8%, p = 0.001); left atrial reservoir (13.3 ± 6.3% to 17.8 ± 6.7%, p = 0.001), conduit (5.5 ± 3.2% to 8.4 ± 4.6%, p = 0.001) and boosterpump strain (8.2 ± 4.6% to 9.9 ± 4.2%, p = 0.027). This was paralleled by regression of total myocardial volume (90.3 ± 21.0 ml/m2 to 73.5 ± 17.0 ml/m2, p < 0.001) including cellular (55.2 ± 13.2 ml/m2 to 45.3 ± 11.1 ml/m2, p < 0.001) and matrix volumes (20.7 ± 6.1 ml/m2 to 18.8 ± 5.3 ml/m2, p = 0.036). These changes were paralleled by recovery from heart failure (decrease of NYHA class: p < 0.001; declining NT-proBNP levels: 2456 ± 3002 ng/L to 988 ± 1222 ng/L, p = 0.001).ConclusionCMR imaging enables comprehensive detection of myocardial remodeling in patients undergoing TAVR. Regression of LV matrix volume as a surrogate for reversible diffuse myocardial fibrosis is accompanied by increase of myocardial function and recovery from heart failure. Further data are required to define the value of these parameters as therapeutic targets for optimized management of TAVR patients.Trial registration DRKS, DRKS00024479. Registered 10 December 2021—Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024479 More... »

PAGES

45

References to SciGraph publications

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12968-022-00874-0

DOI

http://dx.doi.org/10.1186/s12968-022-00874-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1149799248

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/35897100


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    "description": "BackgroundSince cardiovascular magnetic resonance (CMR) imaging allows comprehensive quantification of both myocardial function and structure we aimed to assess myocardial remodeling processes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).MethodsCMR imaging was performed in 40 patients with severe AS before and 1\u00a0year after TAVR. Image analyses comprised assessments of myocardial volumes, CMR-feature-tracking based atrial and ventricular strain, myocardial T1 mapping, extracellular volume fraction-based calculation of left ventricular (LV) cellular and matrix volumes, as well as ischemic and non-ischemic late gadolinium enhancement analyses. Moreover, biomarkers including NT-proBNP as well as functional and clinical status were documented.ResultsMyocardial function improved  1\u00a0year after TAVR: LV ejection fraction (57.9 \u00b1\u200916.9% to 65.4 \u00b1\u200914.5%, p\u2009=\u20090.002); LV global longitudinal (\u2212\u200921.4 \u00b1\u20098.0% to -25.0 \u00b1\u20096.4%, p\u2009<\u20090.001) and circumferential strain (\u2212\u200936.9 \u00b1\u200914.3% to \u2212\u200942.6 \u00b1\u200911.8%, p\u2009=\u20090.001); left atrial reservoir (13.3 \u00b1\u20096.3% to 17.8 \u00b1\u20096.7%, p\u2009=\u20090.001), conduit (5.5 \u00b1\u20093.2% to 8.4 \u00b1\u20094.6%, p\u2009=\u20090.001) and boosterpump strain (8.2\u2009\u00b1\u20094.6% to 9.9\u2009\u00b1\u20094.2%, p\u2009=\u20090.027). This was paralleled by regression of total myocardial volume (90.3\u2009\u00b1\u200921.0\u2009ml/m2 to 73.5\u2009\u00b1\u200917.0\u2009ml/m2, p\u2009<\u20090.001) including cellular (55.2\u2009\u00b1\u200913.2\u2009ml/m2 to 45.3\u2009\u00b1\u200911.1\u2009ml/m2, p\u2009<\u20090.001) and matrix volumes (20.7 \u00b1\u20096.1 ml/m2 to 18.8\u2009\u00b1\u20095.3 ml/m2, p\u2009=\u20090.036). These changes were paralleled by recovery from heart failure (decrease of NYHA class: p\u2009<\u20090.001; declining NT-proBNP levels: 2456\u2009\u00b1\u20093002\u2009ng/L to 988\u2009\u00b1\u20091222\u2009ng/L, p\u2009=\u20090.001).ConclusionCMR imaging enables comprehensive detection of myocardial remodeling in patients undergoing TAVR. Regression of LV matrix volume as a surrogate for reversible diffuse myocardial fibrosis is accompanied by increase of myocardial function and recovery from heart failure. Further data are required to define the value of these parameters as therapeutic targets for optimized management of TAVR patients.Trial registration DRKS, DRKS00024479. Registered 10 December 2021\u2014Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024479", 
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27 schema:description BackgroundSince cardiovascular magnetic resonance (CMR) imaging allows comprehensive quantification of both myocardial function and structure we aimed to assess myocardial remodeling processes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR).MethodsCMR imaging was performed in 40 patients with severe AS before and 1 year after TAVR. Image analyses comprised assessments of myocardial volumes, CMR-feature-tracking based atrial and ventricular strain, myocardial T1 mapping, extracellular volume fraction-based calculation of left ventricular (LV) cellular and matrix volumes, as well as ischemic and non-ischemic late gadolinium enhancement analyses. Moreover, biomarkers including NT-proBNP as well as functional and clinical status were documented.ResultsMyocardial function improved 1 year after TAVR: LV ejection fraction (57.9 ± 16.9% to 65.4 ± 14.5%, p = 0.002); LV global longitudinal (− 21.4 ± 8.0% to -25.0 ± 6.4%, p < 0.001) and circumferential strain (− 36.9 ± 14.3% to − 42.6 ± 11.8%, p = 0.001); left atrial reservoir (13.3 ± 6.3% to 17.8 ± 6.7%, p = 0.001), conduit (5.5 ± 3.2% to 8.4 ± 4.6%, p = 0.001) and boosterpump strain (8.2 ± 4.6% to 9.9 ± 4.2%, p = 0.027). This was paralleled by regression of total myocardial volume (90.3 ± 21.0 ml/m2 to 73.5 ± 17.0 ml/m2, p < 0.001) including cellular (55.2 ± 13.2 ml/m2 to 45.3 ± 11.1 ml/m2, p < 0.001) and matrix volumes (20.7 ± 6.1 ml/m2 to 18.8 ± 5.3 ml/m2, p = 0.036). These changes were paralleled by recovery from heart failure (decrease of NYHA class: p < 0.001; declining NT-proBNP levels: 2456 ± 3002 ng/L to 988 ± 1222 ng/L, p = 0.001).ConclusionCMR imaging enables comprehensive detection of myocardial remodeling in patients undergoing TAVR. Regression of LV matrix volume as a surrogate for reversible diffuse myocardial fibrosis is accompanied by increase of myocardial function and recovery from heart failure. Further data are required to define the value of these parameters as therapeutic targets for optimized management of TAVR patients.Trial registration DRKS, DRKS00024479. Registered 10 December 2021—Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024479
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