TY - JOUR
T1 - Invasive Real Time Biventricular Pressure-Volume Loops to Monitor Dynamic Changes in Cardiac Mechanoenergetics During Structural Heart Interventions
T2 - Design and Rationale of a Prospective Single-Center Study
AU - van den Enden, Antoon J.M.
AU - van den Dorpel, Mark M.P.
AU - Bastos, Marcelo B.
AU - Nuis, Rutger Jan M.
AU - Schreuder, Jan J.
AU - Kardys, Isabella
AU - Lenzen, Mattie J.
AU - Brugts, Jasper J.
AU - Daemen, Joost
AU - Van Mieghem, Nicolas M.
N1 - Funding Information:
This research does not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The study is investigator-initiated and was sponsored by the Erasmus University Medical Center in Rotterdam, The Netherlands.
Publisher Copyright:
© 2022 The Author(s)
PY - 2022/10/1
Y1 - 2022/10/1
N2 - Background: Transcatheter valvular interventions affect cardiac and hemodynamic physiology by changing ventricular (un-)loading and metabolic demand as reflected by cardiac mechanoenergetics. Real-time quantifications of these changes are scarce. Pressure-volume loop (PVL) monitoring appraises both load-dependent and load-independent compounds of cardiac physiology including myocardial work, ventricular unloading, and ventricular-vascular interactions. The primary objective is to describe changes in physiology induced by transcatheter valvular interventions using periprocedural invasive biventricular PVL monitoring. The study hypothesizes transcatheter valve interventions modify cardiac mechanoenergetics that translate into improved functional status at 1-month and 1-year follow-up. Methods: In this single-center prospective study, invasive PVL analysis is performed in patients undergoing transcatheter aortic valve replacement or tricuspid or mitral transcatheter edge-to-edge repair. Clinical follow-up is per standard of care at 1 and 12 months. This study aims to include 75 transcatheter aortic valve replacement patients and 41 patients in both transcatheter edge-to-edge repair cohorts. Results: The primary outcome is the periprocedural change in stroke work, potential energy, and pressure-volume area (mmHg mL−1). The secondary outcomes comprise changes in a myriad of parameters obtained by PVL measurements, including ventricular volumes and pressures and the end-systolic elastance—effective arterial elastance ratio as a reflection of ventricular—vascular coupling. A secondary endpoint associates these periprocedural changes in cardiac mechanoenergetics with functional status at 1 month and 1 year. Conclusions: This prospective study aims to elucidate the fundamental changes in cardiac and hemodynamic physiology during contemporary transcatheter valvular interventions.
AB - Background: Transcatheter valvular interventions affect cardiac and hemodynamic physiology by changing ventricular (un-)loading and metabolic demand as reflected by cardiac mechanoenergetics. Real-time quantifications of these changes are scarce. Pressure-volume loop (PVL) monitoring appraises both load-dependent and load-independent compounds of cardiac physiology including myocardial work, ventricular unloading, and ventricular-vascular interactions. The primary objective is to describe changes in physiology induced by transcatheter valvular interventions using periprocedural invasive biventricular PVL monitoring. The study hypothesizes transcatheter valve interventions modify cardiac mechanoenergetics that translate into improved functional status at 1-month and 1-year follow-up. Methods: In this single-center prospective study, invasive PVL analysis is performed in patients undergoing transcatheter aortic valve replacement or tricuspid or mitral transcatheter edge-to-edge repair. Clinical follow-up is per standard of care at 1 and 12 months. This study aims to include 75 transcatheter aortic valve replacement patients and 41 patients in both transcatheter edge-to-edge repair cohorts. Results: The primary outcome is the periprocedural change in stroke work, potential energy, and pressure-volume area (mmHg mL−1). The secondary outcomes comprise changes in a myriad of parameters obtained by PVL measurements, including ventricular volumes and pressures and the end-systolic elastance—effective arterial elastance ratio as a reflection of ventricular—vascular coupling. A secondary endpoint associates these periprocedural changes in cardiac mechanoenergetics with functional status at 1 month and 1 year. Conclusions: This prospective study aims to elucidate the fundamental changes in cardiac and hemodynamic physiology during contemporary transcatheter valvular interventions.
UR - http://www.scopus.com/inward/record.url?scp=85139252535&partnerID=8YFLogxK
U2 - 10.1016/j.shj.2022.100084
DO - 10.1016/j.shj.2022.100084
M3 - Article
C2 - 37288055
AN - SCOPUS:85139252535
SN - 2474-8706
VL - 6
JO - Structural Heart
JF - Structural Heart
IS - 5
M1 - 100084
ER -