Key result
TAVR is linked to improved cardiac sympathetic function and a ~5% higher late heart-mediastinum ratio.
Why the study?
Although TAVR rapidly improves cardiac sympathetic nervous function within 2 weeks in aortic stenosis, it remained unclear whether such short-term improvements are sustained over the mid-term.
Does transcatheter aortic valve replacement (TAVR) improve cardiac sympathetic nervous function in patients with severe aortic stenosis?
Observational (n=75)
No
Does transcatheter aortic valve replacement (TAVR) improve cardiac sympathetic nervous function in patients with severe aortic stenosis?
TAVR provides sustained mid-term improvement in cardiac sympathetic nervous function in patients with severe aortic stenosis, particularly those with higher baseline mean pressure gradients.
Answers are grounded in this paper and cite their sources.
May support sympathetic benefits of TAVR in severe AS; hypothesis-generating and requires randomized confirmation before practice change.
Abstract Purpose:Transcatheter aortic valve replacement (TAVR) can rapidly improve cardiac sympathetic nervous function (CSNF) within 2 weeks in patients with aortic stenosis (AS). However, it remains unclear whether such short-term improvements will be sustained thereafter. The present study aimed to investigate the mid-term (i.e., 6–12 months) effects of TAVR on CSNF in patients with severe AS using ¹²³I-meta-iodobenzylguanidine (MIBG) imaging.Methods:Patients with severe AS who were scheduled to undergo TAVR between October 2017 and June 2019 were enrolled in this single-centre, prospective, observational study. MIBG imaging was performed at baseline, within 2 weeks after TAVR, and at 6–12 months post-TAVR to evaluate the heart–mediastinum ratio (H/M) and washout rate (WR). Differences between each MIBG parameter at three time points were analysed, and factors involved in the long-term improvement in the late H/M were investigated. Results:Of 183 consecutive patients, 75 (19 men; median age: 86 years) were evaluated. The late H/M significantly improved within 2 weeks after TAVR (P=0.041) and further improved over 6–12 months after TAVR (P=0.041). The WR rapidly improved immediately after TAVR (P=0.003) but remained unchanged at 6–12 months (P=0.827). Multivariate analysis revealed that the baseline mean aortic valve pressure gradient (mPG) was an independent predictor of mid-term improvement in the late H/M (>0.1) (adjusted odds ratio: 0.035; 95% confidence interval: 0.004–0.070; P=0.037). Patients with a high baseline mPG (≥58 mmHg) exhibited a significantly greater increase in the late H/M than those with a low baseline mPG (<42 mmHg) (0.24 vs. 0.01; P=0.029).Conclusions:CSNF, as denoted by the late H/M, demonstrated sustained improvement from within 2 weeks after TAVR until 6–12 months later. Such improvement was related to baseline hemodynamic AS severity.
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Kadoya et al. (2021) conducted an observational in Severe aortic stenosis (n=75). Transcatheter aortic valve replacement (TAVR) vs. Baseline was evaluated on Late heart-mediastinum ratio (H/M) (p=<0.001). Transcatheter aortic valve replacement significantly improved cardiac sympathetic nervous function, increasing the late heart-mediastinum ratio from 2.57 at baseline to 2.71 at 6-12 months.
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