Clinical Study On Patients With Sever Aortic Stenosis And Heart Failure In TAVI Era

Objectives:Transcatheter aortic valve replacement(TAVR)is well established in the treatment of high-risk or inoperable patients with severe aortic stenosis(AS).To explore the characteristics and outcomes of the cardiac function,transvalvular gradient and transvalvular velocity in patients after TAVR.Methods:From December 2013 to December 2015,a total of 49 consecutive patients who had successful undergone TAVR were selected.Echocardiography and plasma levels of N-terminal pro-form B-type natriuretic peptide(NT-proBNP)were performed before and after TAVR.An ejection fraction of left ventricular(LVEF),aortic valve mean gradient(MG),Peak gradient(PG),peak velocity(PV),an aortic valve area(AVA)and N-terminal pro-form B-type natriuretic peptide(NT-proBNP)were measured.An ejection fraction of left ventricular<50%was defined as cardiac dysfunction.Results:Cardiac dysfunction group was detected in 30.6%(15/49).LVEF、MG、PG、PV、NT-proBNP were significantly improved in cardiac dysfunction group[(40.4±15.1)%vs(34.6±7.8)%],[(10.9±5.3)mmHg vs(46.8±15.2)mmHg],[(20.1±9.6)mmHg vs(77.2±21.3)mmHg],[(2.2±0.5)m/s vs(4.4±0.7)m/s],[1874(1446-3120)pg/ml vs 8580(3425-9132)pg/ml],and normal cardiac function group[(62.9±7.3)%vs(60.4±6.5)%],[(11.9±4.7)mmHg vs(63.2±17.6)mmHg],[(22.4±9.5)mmHg vs(100.4±28.7)mmHg],[(2.3±0.5)m/s vs(4.9±0.7)m/s],[1688(723-3435)pg/ml vs 3071(1169-6721)pg/ml],(P<0.05,respectively).LVEF[(56.0±14.6)%vs(52.5±13.8)%],MG[(11±5)mmHg vs(58±18)mmHg],PG[(21.7±9.5)mmHg vs(93.0±28.6)mmHg],PV[(2.3±0.5)m/s vs(4.8±0.7)m/s].NT-proBNP[1831(1098-3363)pg/ml vs 3842(1763-8664)pg/ml],AVA[(1.57±0.43)cm2 vs(0.58±0.23)cm2]were significantly improved in all patients in seven days after TAVR(P<0.05,respectively).The left ventricular function continued to improve in six months after TAVR,especially in patients with cardiac dysfunction.MG,PV,and NT-proBNP had gradual decline from one month to six months after TAVR(P<0.05,respectivelyConclusions:TAVR was an effective treatment in inoperable and high-risk patient with aortic stenosis.The left ventricular functions were successfully improved after TAVR and continued to be improved in six months.Objectives:Levosimendan characterized by a dual mechanism of action has positive inotropic,vasodilatory and cardioprotective properties.To explore the safety and effectiveness of levosimendan on patients with severe aortic stenosis and left ventricular dysfunction.Methods:From January 2014 to December 2015,a total of 20 consecutive patients with severe aortic stenosis and NYHA Ⅲ～Ⅳ level were selected.Intravenous levosimendan infusion(0.1ug/kg/min without a loading dose)was maintained for 24h.Echocardiography,degree of dyspnea,blood pressure,heart rate and plasma levels of N-terminal pro-form B-type natriuretic peptide(NT-proBNP)were performed before and after administration of levosimendan.Then,improvement of ventricular function and degree of dyspnea before and after intravenous levosimendan was evaluated.Results:NYHA level was improved(P =0.025),and degree of dyspnea was improved in 90%(18/20)after administration of levosimendan.NT-proBNP level was significantly improved[(9101.6±7368)pg/mL vs(13776.5±9503.7)pg/mL,P=0.018].There were no significant difference in ejection fraction of left ventricular[(33.1±8.5)%vs(31.1±7.5)%,P =0.071],heart rate[(82.8±9.5)bmp vs(79.6±13.8)bmp,P =0.200]and systolic blood pressure[(97.2± 12.1)mmHg vs(99.6± 11.7)mmHg,P=0.071]before and after administration of levosimendan.No levosimendan specific adverse events were observed.Conclusions:Levosimendan has safety and was an effective treatment in patients with severe aortic stenosis and left ventricular dysfunction.