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Superior Haemodynamic Performance Of Mechanical Over Tissue Mitral Prostheses in 179 Transoesophageal Echocardiography Proven Normal Prostheses
S226
Abstracts CSANZ 2012 Abstracts
Heart, Lung and Circulation 2012;21:S143–S316
ABSTRACTS
Methods: A retrospective evaluation of 81 consecutive patients referred for ESE was performed. LV wall motion was interpreted in the conventional manner. Resting and stress RV dimensions were measured in the apical four chamber view. Abnormal RV response was defined by dilation or wall motion abnormalities. Results: Thirteen of 81 (16%) ESE were reported as positive for inducible LV ischaemia. Thirty-four of 81 (42%) ESE had normal RV size at rest and stress, 7/81 (9%) had normal resting RV dimensions but dilation at stress, 6/81 (7%) had RV dilation at rest worsening with stress and 4/81 (5%) had resting RV dilation that normalized with stress. 30/81 (37%) had limited analysis of the resting and/or stress images due to poor endocardial definition of the RV. Invasive coronary angiography was performed in 8/13 positive ESE, revealing significant coronary disease in three patients (38%). Of the 13 patients with stressinduced RV dilation, there was a 69% association with having significant coronary artery disease on cardiac catheterisation. Conclusions: In patients referred for ESE, RV assessment may provide additional diagnostic value to that of LV ischaemia. Dedicated RV views +/− intravenous contrast may improve accuracy as 37% cases had uninterpretable RV imaging. RV analysis could be considered as an addition to the LV in ESE. http://dx.doi.org/10.1016/j.hlc.2012.05.557 547 Superior Haemodynamic Performance Of Mechanical Over Tissue Mitral Prostheses in 179 Transoesophageal Echocardiography Proven Normal Prostheses H. Samardhi ∗ , C. West, J. Chan, O. Raffel, G. Scalia, D. Burstow The Prince Charles Hospital, Australia Introduction: Transthoracic Echocardiography (TTE) is the primary mode of assessment of prosthetic valve function. We aim to describe and compare the haemodynamic performance of the common subtypes of mitral valve prostheses (MVR) assessed as normal by both TTE and gold standard transoesophageal echocardiography (TOE). Methods: Doppler mean gradient, pressure half time, effective orifice area, peak early diastolic velocity, velocity time integral (VTI) and MVR Index (ratio MVR VTI to the left ventricular outflow tract VTI) were obtained by TTE in a cohort of 179 patients with MVR; 112 mechanical (ATS 73, St Jude 36, other 3), 67 bio-prostheses (Mosaic 39, Perimount 23, other 5). All patients had a recently performed TOE with normal MVR findings. Prosthesis–patient mismatch (PPM) was defined as EOA < 0.9 cm2 /m2 . Results: The results are depicted as medians (interquartile range). Valve
BSA (m2 )
Mech (n = 112) Bio (n = 67) P value
1.9 (0.4) 1.8 (0.4) 0.23
Evel (cm/s) 167 (54) 176 (45) 0.07
MVR VTI (cm) 33.6 (11) 40 (14) <0.001
Conclusion: Normal range TTE data for MVR function using comprehensive haemodynamic descriptors demonstrates significant variation between MVR subtypes. Significantly larger EOA and lower MVR index indicates superior haemodynamic performance of mechanical over tissue prostheses. http://dx.doi.org/10.1016/j.hlc.2012.05.558 548 TAVI Results in a Change in Cardiac Structure but not Function at 12 Months S. Lockwood ∗ , P. Mottram, I. Meredith, P. Antonis, S. Ciavarella, J. Harley, S. Moir MonashHeart and Monash Cardiovascular Research Centre, Southern Clinical School, Monash University, Melbourne, Australia Background: Transcatheter Aortic Valve Implantation (TAVI) is an established alternative to surgery for selected patients with severe symptomatic aortic stenosis. Successful TAVI improves aortic valve (AV) haemodynamics and patient symptoms but the effect on cardiac structure and function is less well understood. Methods: All patients undergoing TAVI with Corevalve at MonashHeart, from November 2008 to December 2010 were included in this prospective study. Detailed quantitative echocardiography was performed according to ASE guidelines immediately prior to and 12 months post procedure. Results: Forty consecutive patients (12 females (30%), 83 ± 4 years, mean Euroscore 17.7 ± 10.5%) undergoing TAVI with CoreValve were studied. Complete 12 month follow up data was obtained in 32 patients (80%). As expected, there was a significant reduction in AV gradient and improvement in functional class at 12 months. There was a significant reduction in LV relative wall thickness, regression of LV mass index and reduction in left atrial volume. Left ventricular ejection fraction and mitral annular velocities were unchanged (see table). Conclusion: At 12 months post TAVI there is regression of LV hypertrophy with no change in the standard markers of left ventricular function. Left atrial volume is also reduced which likely reflects a sustained reduction in left atrial pressure.
Mean Gradient (mmHg) 4.25 (2.4) 6.0 (3.9) <0.001
PPM incidence was similar in both subgroups (22.3% mech vs 20.9% bio, P = 0.85).
PHT (ms) 69 (27.5) 80 (34.7) 0.04
LVOT diameter (cm) 2.2 (0.2) 2.2 (0.25) 0.549
EOA (cm2 )
MVR index
2.2 (0.85) 2.0 (0.65) 0.003
1.78 (0.45) 2.03 (0.67) <0.001
Abstracts CSANZ 2012 Abstracts
Heart, Lung and Circulation 2012;21:S143–S316
ABSTRACTS
Methods: A retrospective evaluation of 81 consecutive patients referred for ESE was performed. LV wall motion was interpreted in the conventional manner. Resting and stress RV dimensions were measured in the apical four chamber view. Abnormal RV response was defined by dilation or wall motion abnormalities. Results: Thirteen of 81 (16%) ESE were reported as positive for inducible LV ischaemia. Thirty-four of 81 (42%) ESE had normal RV size at rest and stress, 7/81 (9%) had normal resting RV dimensions but dilation at stress, 6/81 (7%) had RV dilation at rest worsening with stress and 4/81 (5%) had resting RV dilation that normalized with stress. 30/81 (37%) had limited analysis of the resting and/or stress images due to poor endocardial definition of the RV. Invasive coronary angiography was performed in 8/13 positive ESE, revealing significant coronary disease in three patients (38%). Of the 13 patients with stressinduced RV dilation, there was a 69% association with having significant coronary artery disease on cardiac catheterisation. Conclusions: In patients referred for ESE, RV assessment may provide additional diagnostic value to that of LV ischaemia. Dedicated RV views +/− intravenous contrast may improve accuracy as 37% cases had uninterpretable RV imaging. RV analysis could be considered as an addition to the LV in ESE. http://dx.doi.org/10.1016/j.hlc.2012.05.557 547 Superior Haemodynamic Performance Of Mechanical Over Tissue Mitral Prostheses in 179 Transoesophageal Echocardiography Proven Normal Prostheses H. Samardhi ∗ , C. West, J. Chan, O. Raffel, G. Scalia, D. Burstow The Prince Charles Hospital, Australia Introduction: Transthoracic Echocardiography (TTE) is the primary mode of assessment of prosthetic valve function. We aim to describe and compare the haemodynamic performance of the common subtypes of mitral valve prostheses (MVR) assessed as normal by both TTE and gold standard transoesophageal echocardiography (TOE). Methods: Doppler mean gradient, pressure half time, effective orifice area, peak early diastolic velocity, velocity time integral (VTI) and MVR Index (ratio MVR VTI to the left ventricular outflow tract VTI) were obtained by TTE in a cohort of 179 patients with MVR; 112 mechanical (ATS 73, St Jude 36, other 3), 67 bio-prostheses (Mosaic 39, Perimount 23, other 5). All patients had a recently performed TOE with normal MVR findings. Prosthesis–patient mismatch (PPM) was defined as EOA < 0.9 cm2 /m2 . Results: The results are depicted as medians (interquartile range). Valve
BSA (m2 )
Mech (n = 112) Bio (n = 67) P value
1.9 (0.4) 1.8 (0.4) 0.23
Evel (cm/s) 167 (54) 176 (45) 0.07
MVR VTI (cm) 33.6 (11) 40 (14) <0.001
Conclusion: Normal range TTE data for MVR function using comprehensive haemodynamic descriptors demonstrates significant variation between MVR subtypes. Significantly larger EOA and lower MVR index indicates superior haemodynamic performance of mechanical over tissue prostheses. http://dx.doi.org/10.1016/j.hlc.2012.05.558 548 TAVI Results in a Change in Cardiac Structure but not Function at 12 Months S. Lockwood ∗ , P. Mottram, I. Meredith, P. Antonis, S. Ciavarella, J. Harley, S. Moir MonashHeart and Monash Cardiovascular Research Centre, Southern Clinical School, Monash University, Melbourne, Australia Background: Transcatheter Aortic Valve Implantation (TAVI) is an established alternative to surgery for selected patients with severe symptomatic aortic stenosis. Successful TAVI improves aortic valve (AV) haemodynamics and patient symptoms but the effect on cardiac structure and function is less well understood. Methods: All patients undergoing TAVI with Corevalve at MonashHeart, from November 2008 to December 2010 were included in this prospective study. Detailed quantitative echocardiography was performed according to ASE guidelines immediately prior to and 12 months post procedure. Results: Forty consecutive patients (12 females (30%), 83 ± 4 years, mean Euroscore 17.7 ± 10.5%) undergoing TAVI with CoreValve were studied. Complete 12 month follow up data was obtained in 32 patients (80%). As expected, there was a significant reduction in AV gradient and improvement in functional class at 12 months. There was a significant reduction in LV relative wall thickness, regression of LV mass index and reduction in left atrial volume. Left ventricular ejection fraction and mitral annular velocities were unchanged (see table). Conclusion: At 12 months post TAVI there is regression of LV hypertrophy with no change in the standard markers of left ventricular function. Left atrial volume is also reduced which likely reflects a sustained reduction in left atrial pressure.
Mean Gradient (mmHg) 4.25 (2.4) 6.0 (3.9) <0.001
PPM incidence was similar in both subgroups (22.3% mech vs 20.9% bio, P = 0.85).
PHT (ms) 69 (27.5) 80 (34.7) 0.04
LVOT diameter (cm) 2.2 (0.2) 2.2 (0.25) 0.549
EOA (cm2 )
MVR index
2.2 (0.85) 2.0 (0.65) 0.003
1.78 (0.45) 2.03 (0.67) <0.001