Association between aortic stiffness and left ventricular function in inflammatory bowel disease

Background: Recent studies have reported an increased incidence of both aortic stiffness and left ventricular (LV) systolic and diastolic dysfunction in patients with inflammatory bowel disease (IBD). However, the association between aortic stiffness and the LV function has not been fully defined. We aimed to investigate the relationship between aortic stiffness and the LV function in IBD patients. Methods and Results: Seventy-two patients with IBD (56 cases of ulcerative colitis and 16 cases of Crohn’s disease) and 50 healthy controls were consecutively enrolled in this study. The LV systolic and diastolic functions were assessed using conventional echocardiographic techniques, including tissue Doppler echocardiography. The degree of aortic strain and distensibility were calculated based on the aortic diameters measured on M-mode echocardiography at the level of 3 cm above the aortic valve and the blood pressure values obtained on sphygmomanometry. There were significant differences between the IBD and control group in the degree of aortic strain and distensibility. Significant differences were also observed between the patient and control groups in the parameters of the LV systolic and diastolic functions. Moreover, aortic stiffness was found to be associated with the LV function in the patient group. Conclusions: There is a significant relationship between aortic stiffness and LV systolic and diastolic dysfunction in patients with IBD, based on the findings of this study. The parameters of aortic elasticity measured according to 2-dimensional echocardiographic methods can be beneficial for predicting early cardiovascular risk in cases of IBD. (

Impact of transcatheter aortic valve implantation on the left ventricular mass

Background: Aortic stenosis (AS) induces pressure overload of the left ventricle (LV) and results in left ventricular hypertrophy. The remodeling of the LV in patients with AS is a com­plex process including structural and functional disturbances. After aortic valve replacement, reverse remodeling of LV begins. The aim of this study was to evaluate the impact of transcatheter aortic valve ımplantation (TAVI) on LV mass (LVM) in early and mid-term follow-ups after the procedure. Methods and Results: We enrolled consecutive 75 patients who underwent successful TAVI. Transthoracic echocardiography was performed prior to TAVI and at hospital discharge, in the 1st month and 6th month of the follow-ups. The mean LV ejection fraction improved significantly after TAVI (54.2 ± 15.0% to 57.3 ± 11.7%, p < 0.001). There were no significant changes between the baseline and discharge mean LVM and LVM index values (LVMI; p = 0.1). However, LVMI decreased significantly in the 1st month of follow-up compared to baseline (123.3 ± 20.3 to 127.9 ± 21.3 g/m2, respectively, p < 0.001). Also, significant regression of LVM was observed at the 1st month of follow-up compared to baseline (228.3 ± 33.5 g vs. 236.5 ± 34.2 g, respectively, p < 0.001). Furthermore, the significant regression in both of LVM and LVMI continued at 1st and 6th months of the follow-ups (p < 0.001). Conclusions: A significant regression of LVM was observed after TAVI. These changes may have prognostic value in patients with severe AS

Immediate recovery of the left atrial and left ventricular diastolic function after transcatheter aortic valve implantation: A transesophageal echocardiography study

Background: Chronic increased afterload due to severe aortic stenosis (AS) results in com­pensatory concentric left ventricular (LV) hypertrophy and LV dysfunction. These in turn cause remodeling of the left heart. The aim of this study was to investigate the acute effect of transcatheter aortic valve implantation (TAVI) on left atrial (LA) mechanics and LV diastolic function. Methods: The study consisted of a total of 35 consecutive patients (mean age was 77.7 ± 5.0 years, 25 female) undergoing TAVI. All TAVI procedures have been performed under the transesophageal echocardiography (TEE) guidance. Before and 24 h after TAVI, all patients underwent transthoracic echocardiography (TTE) and mitral inflow velocities with pulsed-wave (PW) Doppler including early filling wave (E), late diastolic filling wave (A), and E/A ratio were obtained. LV diastolic function was also explored by pulsed tissue Doppler imaging (TDI). Early (E’) and late (A’) diastolic annular velocities, E’/A’ ratio and E/E’ ratio were obtained. In addition, during the procedure before and minutes after the valve implantation, the left atrial appendage-peak antegrade flow velocity (LAA-PAFV) was measured and recorded with TEE. Results: Compared with baseline, the mean mitral E, septal E’ and E’/A’ ratio increased significantly after TAVI. In addition, the LAA-PAFV increased significantly within minutes of TAVI (32.45 ± 10.7 cm/s vs. 47.6 ± 12.6 cm/s, p < 0.001). Conclusions: TAVI improves LV diastolic function and LA performance immediately

Impact of transcatheter aortic valve implantation in patients with reduced ejection fraction

Background: Aortic stenosis increases with age. According to guidelines, left ventricular systolic dysfunction is an indication for aortic valve replacement, even in asymptomatic patients. There is no clear data on the application of transcatheter aortic valve implantation (TAVI), which is a method showing continuous improvement in recent years, in patients with reduced ejection fraction (REF) having a poor prognosis for surgical aortic valve replacement. We therefore aimed to investigate the effect of TAVI on left ventricular ejection fraction (LVEF) and also its efficacy and safety in patients with REF. Methods and results: The study included 104 patients who underwent transfemoral TAVI in our clinic. The patients were divided into two groups: LVEF ≤ 45% (REF group, n = 28) and LVEF > 45% (preserved ejection fraction [PEF] group, n = 76). Follow-up measure­ments were performed at baseline, discharge, 1st, 6th and 12th months. No statistical difference was found between the groups with respect to complications and mortality rates. A statistically significant difference was detected in LVEF after TAVI, either in all patients (53.9 ± 14.6, 57.0 ± 11.4, 59.4 ± 8.4, 60.4 ± 6.8, 63.2 ± 3.9, respectively, at baseline, discharge, 1st, 6th and 12th months, p < 0.001) or in the groups separately. A statistically significant increase in LVEF (p < 0.001) was determined at discharge, 1st, 6th and 12th months, whereas LVEF increased in all follow-ups of the PEF group, however this elevation reached a statistical significance only at the 1st month (p = 0.04). Conclusions: Our study has shown the positive effect of TAVI on LVEF and its effective and safe applicability in patients with REF.

Role of calcium–albumin ratio in severity of coronary artery disease assessed by angiographic SYNTAX score

Aim: Numerous studies have reported a relationship between serum calcium or albumin levels and acute coronary syndromes and coronary artery disease. The present study investigated the relation between serum albumin, calcium or albumin-corrected calcium levels or calcium/albumin ratio (CAR) and extensiveness and severity of atherosclerosis. Methods: This prospective study included patients with non-ST elevation myocardial infarction (NSTEMI, n=120) and a control group (n=109). We used the SYNTAX score to evaluate the association between CAR and severity and extent of coronary artery disease. Results: There were higher, but statistically nonsignificant, levels of calcium in patients with NSTEMI (p=0.058). However, serum albumin-corrected calcium levels were significantly higher in NSTEMI group (p=0.001). Yet, albumin levels did not differ between the groups (p=0.093). CAR and corrected calcium–albumin ratio (cCAR) were significantly higher in NSTEMI group (p=0.001). A positive correlation existed between CAR (r=0.235, p=0.010), cCAR (r=0.259, p=0.004), and SYNTAX score, whereas albumin and SYNTAX score (r=−0.259, p=0.004) showed a negative correlation. Conclusion: Calcium/albumin ratio has been found to be associated with an increased coronary atherosclerotic burden as calculated by SYNTAX score. Further large-scale studies are warranted to confirm our findings

304 Advances in Interventional Cardiology 2015; 11, 4 (42) Original paper Corresponding author:

Transfemoral aortic valve implantation in severe aortic stenosis patients with prior mitral valve prosthesi

Prosthetic valve endocarditis 7 months after transcatheter aortic valve implantation diagnosed with 3D TEE

Transcatheter aortic valve implantation (TAVI) was introduced as an alternative treatment for patients with severe symptomatic aortic stenosis for whom surgery would be high-risk. Prosthetic aortic valve endocarditis is a serious complication of surgical AVR (SAVR) with high morbidity and mortality. According to recent cases, post-TAVI prosthetic valve endocarditis (PVE) seems to occur very rarely. We present the case of a 75-year-old woman who underwent TAVI (Edwards Saphien XT) with an uneventful postoperative stay. She was diagnosed with endocarditis using three dimensional (3D) echocardiography on the TAVI device 7 months later and she subsequently underwent surgical aortic valve replacement. Little experience of the interpretation of transoesophageal echocardiography (TEE) and the clinical course and effectiveness of treatment strategies in post-TAVI endocarditis exists. We report a case of PVE in a TAVI patient which was diagnosed with three-dimensional transoesophageal echocardiography (3DTEE)