P2968Correlation of apical left ventricular wall thickness and 13N-ammonia uptake in myocardial perfusion positron emission tomography

D.A. Steffen, M. Grossmann, A.A. Giannopoulos, M. Messerli, P.A. Kaufmann, R.R. Buechel
2017 European Heart Journal  
A loss of von Willebrand factor (VWF) high-molecular-weight multimers (HMW-multimers) is observed in patients with severe aortic stenosis (AS) or valvular regurgitation. We recently reported the interest of monitoring VWF HMW-multimers defect and closure time-ADP (CT-ADP) to predict the success of transcatheter aortic valve implantation (TAVI). However, the value of VWF and CT-ADP in the subset of patients with lowflow/low-gradient AS (LF/LG-AS) undergoing TAVI procedure has never been
more » ... . Purpose: 1-To assess if VWF and CT-ADP can differentiate LF/LG-AS from normal-flow/high-gradient AS (NF/HG-AS). 2-To investigate if VWF and CT-ADP can be used in LF/LG-AS to assess the success of TAVI procedure. Methods: We identified 19 LF/LG-AS among 181 AS-patients from the WITAVI cohort who underwent successfull TAVI procedure without significant paravalvular regurgitation (PVR). Blood samples were collected before and immediately after TAVI for analysis of VWF antigen, HMW-multimers ratio (obtained after SDSagarose electrophoresis and densitometric integration of mers >15) and CT-ADP. The absence of PVR was evaluated by transesophageal echocardiography. Results: We observed a significant baseline difference between mean transvalvular gradient and left ventricular ejection fraction between the LF/LG-AS group and the NF/HG-AS patients (48±6,4 mmHg vs 25,9±4; p<0,001 and 55,2±4 vs 35,6±8; p<0,001). Before TAVI procedure, LF/LG-AS patients had a higher HMW-multimer ratio (0.80±0.19 vs 0.63±0.19; p<0.01) and a lower CT-ADP (197±76 vs 240±61; p<0.01) compared to NF/HG-AS. The correction of valve stenosis in the both LF/LG-AS group and in the HF/HG-AS group were respectively associated with a significant increase in HMW-multimer ratio (0,99±0,17 vs 1,08±0,25 vs; p=ns) and a significant decrease in CT-ADP (106±24,4 vs 121±56; p=ns) ( fig. 1A&B ).
doi:10.1093/eurheartj/ehx504.p2968 fatcat:xvagu7cgpjehxeivkeh77zj7ke