Assessment of aortic stiffness by cardiovascular magnetic resonance following the treatment of severe aortic stenosis by TAVI and surgical AVR

Journal of Cardiovascular Magnetic Resonance

Research

Christopher D. Steadman¹  Gerald P. McCann¹  Steven P. Sourbron²  James J. Oliver³  Daniel J. Blackman³  Manish Motwani⁴  Akhlaque Uddin⁴  Bara Erhayiem⁴  Tarique Al Musa⁴  Ananth Kidambi⁴  Peter P. Swoboda⁴  Timothy A. Fairbairn⁴  David P. Ripley⁴  Sven Plein⁴  John P. Greenwood⁴  Laura E. Dobson⁴  Adam K. McDiarmid⁴ 

[1] Department of Cardiovascular Sciences, Cardiovascular Research Centre, Cardiovascular Biomedical Research Unit, University of Leicester, National Institute of Health Research (NIHR), Glenfield General Hospital, Leicester, UK;Division of Medical Physics, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK;Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK;Multidisciplinary Cardiovascular Research Centre and The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT, Leeds, UK;

关键词: Aortic stenosis;    Transcatheter aortic valve implantation;    Aortic valve replacement;    Aortic distensibility;    Pulse wave velocity;    Cardiovascular magnetic resonance;   

DOI  :  10.1186/s12968-016-0256-z

 received in 2016-03-08, accepted in 2016-05-31,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundAortic stiffness is increasingly used as an independent predictor of adverse cardiovascular outcomes. We sought to compare the impact of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) upon aortic vascular function using cardiovascular magnetic resonance (CMR) measurements of aortic distensibility and pulse wave velocity (PWV).Methods and resultsA 1.5 T CMR scan was performed pre-operatively and at 6 m post-intervention in 72 patients (32 TAVI, 40 SAVR; age 76 ± 8 years) with high-risk symptomatic severe aortic stenosis. Distensibility of the ascending and descending thoracic aorta and aortic pulse wave velocity were determined at both time points. TAVI and SAVR patients were comparable for gender, blood pressure and left ventricular ejection fraction. The TAVI group were older (81 ± 6.3 vs. 72.8 ± 7.0 years, p < 0.05) with a higher EuroSCORE II (5.7 ± 5.6 vs. 1.5 ± 1.0 %, p < 0.05). At 6 m, SAVR was associated with a significant decrease in distensibility of the ascending aorta (1.95 ± 1.15 vs. 1.57 ± 0.68 × 10−3mmHg−1, p = 0.044) and of the descending thoracic aorta (3.05 ± 1.12 vs. 2.66 ± 1.00 × 10−3mmHg−1, p = 0.018), with a significant increase in PWV (6.38 ± 4.47 vs. 11.01 ± 5.75 ms−1, p = 0.001). Following TAVI, there was no change in distensibility of the ascending aorta (1.96 ± 1.51 vs. 1.72 ± 0.78 × 10−3mmHg−1, p = 0.380), descending thoracic aorta (2.69 ± 1.79 vs. 2.21 ± 0.79 × 10−3mmHg−1, p = 0.181) nor in PWV (8.69 ± 6.76 vs. 10.23 ± 7.88 ms−1, p = 0.301) at 6 m.ConclusionsTreatment of symptomatic severe aortic stenosis by SAVR but not TAVI was associated with an increase in aortic stiffness at 6 months. Future work should focus on the prognostic implication of these findings to determine whether improved patient selection and outcomes can be achieved.

【 授权许可】

CC BY   
© The Author(s). 2016