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16-03-2023 | Aortic Valve Replacement | Original Article

Left-atrial volume reduction reflects improvement of cardiac sympathetic nervous function in patients with severe aortic stenosis after transcatheter aortic valve replacement

Authors: Tasuku Higashihara, Yukihiro Fukuda, Takayuki Nakano, Atsushi Takeda, Yuichi Morita, Masafumi Ono, Noriaki Watanabe, Yoshiharu Sada, Hiroki Ikenaga, Hiroto Utsunomiya, Shinya Takahashi, Yukiko Nakano

Published in: Heart and Vessels | Issue 8/2023

Abstract

Trans-catheter aortic valve replacement (TAVR) is an excellent alternative intervention for surgical aortic valve replacement. Cardiac sympathetic nervous (CSN) function and left atrial (LA) volume are both important prognostic factors in patients with aortic stenosis (AS) after TAVR. The relationship between the two clinical factors is unknown, however. This retrospective observational study aimed to assess the correlation between CSN function and LA volume in 48 symptomatic patients with severe AS (median age: 85 years, IQR 82–88 years; 81% female) before and after TAVR. CSN function was assessed by performing ¹²³I-metaiodobenzylguanidine (MIBG) scintigraphy before and 6 months after TAVR, and the delayed heart-to-mediastinum ratio (dHMR) and washout rate (WR) were calculated. We also performed transthoracic echocardiography near the same time. TAVR improved the dHMR, WR, and LA volume index (LAVI) (dHMR: median 2.89 [IQR 2.62–3.23] vs. 2.98 [2.49–3.25], p = 0.0182; WR: 28% [24–38] vs. 23% [16–32], p < 0.0001; LAVI: 47.7 mL/m² [37.8–56.3] vs. 41.2 mL/m² [33.7–56.1], p = 0.0024). In multiple linear regression analysis, the percentage change in LAVI from baseline to post-TAVR (∆LAVI%) was an independent predictor of change in dHMR from baseline to post-TAVR (β = − 0.35, p = 0.0110). In conclusion, LA volume reduction reflected CSN functional improvement after TAVR. In patients with TAVR, ∆LAVI% might be a valuable parameter for evaluating CSN functional recovery.

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Title: Left-atrial volume reduction reflects improvement of cardiac sympathetic nervous function in patients with severe aortic stenosis after transcatheter aortic valve replacement
Authors: Tasuku Higashihara
Yukihiro Fukuda
Takayuki Nakano
Atsushi Takeda
Yuichi Morita
Masafumi Ono
Noriaki Watanabe
Yoshiharu Sada
Hiroki Ikenaga
Hiroto Utsunomiya
Shinya Takahashi
Yukiko Nakano
Publication date: 16-03-2023
Publisher: Springer Japan
Keywords: Aortic Valve Replacement
Transthoracic Echocardiography
Aortic Valve Replacement
Aortic Valve Replacement
Scintigraphy
Published in: Heart and Vessels / Issue 8/2023
Print ISSN: 0910-8327
Electronic ISSN: 1615-2573
DOI: https://doi.org/10.1007/s00380-023-02257-6

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Left-atrial volume reduction reflects improvement of cardiac sympathetic nervous function in patients with severe aortic stenosis after transcatheter aortic valve replacement

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