Right coronary artery spectral Doppler coronary flow velocity signal in baseline (A) and hyperemic (B) conditions

<p><b>Copyright information:</b></p><p>Taken from "Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy"</p><p>http://www.cardiovascularultrasound.com/content/5/1/31</p><p>Cardiovascular Ultrasound 2007;5():31-31.</p><p>Published online 26 Sep 2007</p><p>PMCID:PMC2137923.</p><p></p> S = systolic, D = diastolic, portions of phasic coronary flow. APV = time-averaged peak coronary flow velocity. DSVR = diastolic/systolic flow velocity ratio

Baseline spectral Doppler coronary flow velocity signal in right coronary artery (A) and left anterior descending coronary artery (B)

<p><b>Copyright information:</b></p><p>Taken from "Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy"</p><p>http://www.cardiovascularultrasound.com/content/5/1/31</p><p>Cardiovascular Ultrasound 2007;5():31-31.</p><p>Published online 26 Sep 2007</p><p>PMCID:PMC2137923.</p><p></p> S = systolic, D = diastolic, portions of phasic coronary flow. APV = time-averaged peak coronary flow velocity. DSVR = diastolic/systolic flow velocity ratio

Box-plot representing the RCA phasic coronary flow pattern (D/S) according the RV ejection fraction, showing no difference between RV non-dysfunctional vs

<p><b>Copyright information:</b></p><p>Taken from "Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy"</p><p>http://www.cardiovascularultrasound.com/content/5/1/31</p><p>Cardiovascular Ultrasound 2007;5():31-31.</p><p>Published online 26 Sep 2007</p><p>PMCID:PMC2137923.</p><p></p> dysfunctional subgroups. APV – time-averaged peak coronary flow velocity; D/S – diastolic/systolic APV ratio; N – number of patients; RCA – right coronary artery; RV EF – right ventricular ejection fraction

Box-plot representing the RCA vs LAD comparison respecting the coronary flow reserve, showing no significant difference

<p><b>Copyright information:</b></p><p>Taken from "Echocardiographic and hemodynamic determinants of right coronary artery flow reserve and phasic flow pattern in advanced non-ischemic cardiomyopathy"</p><p>http://www.cardiovascularultrasound.com/content/5/1/31</p><p>Cardiovascular Ultrasound 2007;5():31-31.</p><p>Published online 26 Sep 2007</p><p>PMCID:PMC2137923.</p><p></p> LAD – left anterior descending coronary artery; N – number of patients; RCA – right coronary artery

Permanent Pacing After Transcatheter Aortic Valve Implantation: Incidence, Predictors and Evolution of Left Ventricular Function

<div><p>Abstract Background: Transcatheter aortic valve implantation (TAVI) is a well-established procedure; however, atrioventricular block requiring permanent pacemaker implantation (PPI) is a common complication. Objectives: To determine the incidence, predictors and clinical outcomes of PPI after TAVI, focusing on how PPI affects left ventricular ejection fraction (LVEF) after TAVI. Methods: The Brazilian Multicenter TAVI Registry included 819 patients submitted to TAVI due to severe aortic stenosis from 22 centers from January/2008 to January/2015. After exclusions, the predictors of PPI were assessed in 670 patients by use of multivariate regression. Analysis of the ROC curve was used to measure the ability of the predictors; p < 0.05 was the significance level adopted. Results: Within 30 days from TAVI, 135 patients (20.1%) required PPI. Those patients were older (82.5 vs. 81.1 years; p = 0.047) and mainly of the male sex (59.3% vs 45%; p = 0.003). Hospital length of stay was longer in patients submitted to PPI (mean = 15.7 ± 25.7 vs. 11.8 ± 22.9 days; p < 0.001), but PPI affected neither all-cause death (26.7% vs. 25.6%; p = 0.80) nor cardiovascular death (14.1% vs. 14.8%; p = 0.84). By use of multivariate analysis, the previous presence of right bundle-branch block (RBBB) (OR, 6.19; 3.56-10.75; p ≤ 0.001), the use of CoreValve® prosthesis (OR, 3.16; 1.74-5.72; p ≤ 0.001) and baseline transaortic gradient > 50 mm Hg (OR, 1.86; 1.08-3.2; p = 0.025) were predictors of PPI. The estimated risk of PPI ranged from 4%, when none of those predictors was present, to 63%, in the presence of all of them. The model showed good ability to predict the need for PPI: 0.69 (95%CI: 0.64 - 0.74) in the ROC curve. The substudy of 287 echocardiograms during the 1-year follow-up showed worse LVEF course in patients submitted to PPI (p = 0.01). Conclusion: BRD prévio, gradiente aórtico médio > 50 mmHg e CoreValve® são preditores independentes de implante de MPD pós-TAVI. Ocorreu implante de MPD em aproximadamente 20% dos casos de TAVI, o que prolongou a internação hospitalar, mas não afetou a mortalidade. O implante de MPD afetou negativamente a FEVE pós-TAVI.</p></div