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ObjectiveLeft ventricular (LV) twist is a major component of ventricular mechanics reflecting the helical orientation of cardiac fibres and compensating for afterload mismatch. However, it is not known whether it determines outcome after transcatheter aortic valve implantation (TAVI). This study sought to investigate TAVI-induced short-term changes of LV twist and to define its role in outcome prediction.MethodsA total of 146 patients (median age 81.78 years, 50.7% male) undergoing TAVI for severe aortic stenosis were included. LV rotation and twist were determined by speckle tracking echocardiography within 3 months before and 2 weeks after TAVI. All-cause mortality at 2 years was defined as primary end point.ResultsPatients who survived exhibited a higher apical peak systolic rotation (APSR) (pConclusionAPSR, twist and torsion pre-TAVI as well as their change within 2 weeks after TAVI predict 2-year all-cause mortality after TAVI, adding incremental prognostic value to LVEF and GLS.

Bei erhöhter Nachfrage von Herztransplantationen bei terminaler Herzinsuffizienz gewinnen künstliche Herzunterstützungssysteme immer mehr an Gewicht. Die Weiterentwicklung dieser Geräte spielt daher eine wichtige Rolle für künftige Therapie. Mit Hilfe eines Kreislaufsimulators haben wir verschieden sensitive LVAD Pumpdesigns mit einer kontinuierlichen, zentrifugalen Pumpcharakteristik verglichen. Es wurde in verschiedenen Kreislaufszenarien die Auswirkung der Nachlast auf den Kreislauf bei verschieden drucksensitiven Pumpsystemen untersucht. Es stellte sich heraus, dass je größer die Nachlast war (als Gefäßwiderstand definiert), ein drucksensitivere Pumpcharakteristik den linken Ventrikel voluminös besser entlasten kann. Gleichzeitig steigt das Schlagvolumen. Dies kann helfen, in Zukunft LVAD Systeme drucksensitiver zu gestalten, um unter erhöhter Kreislaufbelastung eine geringere Belastung für den linken Ventrikel zu kreieren.

In 53 patients scheduled for aortic valve replacement (22 with aortic stenosis (AS), 18 with aortic insufficiency (AI), 13 with aortic stenosis and insufficiency serial echocardiographic studies were performed pre- and postoperatively (within 7 days and at 6 months). Basal, mid and apical parasternal short-axis views were acquired (GE Vivid 7, Horton, Norway). Using a novel computer software (GE Ultrasound, Horton, Norway) which allows automatic frame-by-frame tracking of accoustic markers during the heart cycle radial and circumferential strain and strain rate were defined as parameters of myocardial deformation for each segment in a 16 segment model of the left ventricle.Results: Preoperatively segmental strain and strain rate data were not significantly different between the three aortic pathologies. Immediately postoperatively radial strain increased in the AS group (P