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Takahashi M, Takaoka H, Yashima S, Suzuki-Eguchi N, Ota J, Kitahara H, Matsuura K, Matsumiya G, Kobayashi Y. Extracellular Volume Fraction by Computed Tomography Predicts Prognosis After Transcatheter Aortic Valve Replacement. Circ J 2024; 88:492-500. [PMID: 37558458 DOI: 10.1253/circj.cj-23-0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Extracellular volume fraction (ECV) on magnetic resonance imaging can predict prognosis after aortic valve replacement in patients with aortic stenosis (AS). However, the usefulness of ECV on computed tomography (CT) for patients who have undergone transcatheter aortic valve replacement (TAVR) is unclear, so we investigated whether ECV analysis on CT is associated with clinical outcomes in TAVR candidates.Methods and Results: We analyzed 127 patients with severe AS who underwent preoperative CT for TAVR. We evaluated the utility of ECV analysis on single-energy CT for predicting patient prognosis after TAVR. The primary outcome was a composite of all-cause death and hospitalization due to heart failure (HF) after TAVR. 15 patients (12%) had composite outcomes: 4 deaths and 11 hospitalizations due to HF. In multivariate survival analysis using the Cox proportional hazard model, atrial fibrillation (AF) (hazard ratio (HR), 7.86; 95% confidence interval (CI), 2.57-24.03; P<0.001), history of congestive HF (HR, 4.91; 95% CI, 1.49-16.2; P=0.009) and ECV ≥32.6% on CT (HR, 6.96; 95% CI, 1.92-25.12; P=0.003) were independent predictors of composite outcomes. On Kaplan-Meier analysis, the higher ECV group (≥32.6%) had a significantly greater number of composite outcomes than the lower ECV group (P<0.001). CONCLUSIONS ECV on CT is an independent predictor of prognosis after TAVR.
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Affiliation(s)
- Manami Takahashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Satomi Yashima
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Noriko Suzuki-Eguchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Joji Ota
- Department of Radiology, Chiba University Hospital
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Kaoru Matsuura
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
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Nagai T, Horinouchi H, Hashimoto K, Ijichi T, Kamioka N, Murakami T, Ohno Y, Yoshioka K, Ikari Y. Incremental Value of Global Longitudinal Strain for Confirming Heart Failure-Related Symptoms in Severe Aortic Stenosis. Am J Cardiol 2023; 209:1-7. [PMID: 37839463 DOI: 10.1016/j.amjcard.2023.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/17/2023]
Abstract
The indications or timing of aortic valve replacement for symptomatic aortic stenosis (AS) are based on a patient's life expectancy and symptoms. However, clinical decision-making may be difficult because symptoms are subjective and cannot be quantitatively assessed and confirmed. This study aimed to evaluate the association between heart failure (HF)-related symptoms and cardiac hemodynamic left ventricular deformations in patients with severe AS using transthoracic echocardiographic assessments of left ventricular global longitudinal strain (LV-GLS). The medical records of patients hospitalized for AS between February 2017 and September 2019 were retrospectively screened. Independent cardiologists analyzed the transthoracic echocardiographic images of a digital echocardiography database. The cohort comprised 177 hospitalized patients with severe AS and no history of HF. The subgroup with HF-related symptoms included 87 patients, whereas that without HF-related symptoms included 90 patients. In 145 patients without atrial fibrillation, the left atrial volume index (LAVI) and LV-GLS were significantly associated with HF-related symptoms (odds ratio 1.033, 95% confidence interval 1.008 to 1.059, p = 0.011 and odds ratio 1.224, 95% confidence interval 1.118 to 1.340, p <0.0001, respectively). Moreover, the combination of brain natriuretic peptide level, LAVI, and LV-GLS showed better diagnostic accuracy than the combination of brain natriuretic peptide level and LAVI (p = 0.005). However, there were no such tendencies in 32 patients with atrial fibrillation. The HF-related symptoms in patients with severe AS were strongly linked to LV-GLS. LV-GLS showed incremental value for confirming HF-related symptoms.
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Affiliation(s)
- Tomoo Nagai
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan.
| | - Hitomi Horinouchi
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Kaho Hashimoto
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Takeshi Ijichi
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Norihiko Kamioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Tsutomu Murakami
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Yohei Ohno
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
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Novotny S, Kort S, Tannous H, Pyo R, Gracia E, Wang TY, Callahan S, Skopicki H, Bilfinger T, Parikh PB. Predictors of 1-Year Mortality in Men Versus Women Undergoing Transfemoral Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 186:1-4. [PMID: 36332499 DOI: 10.1016/j.amjcard.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/30/2022] [Accepted: 10/08/2022] [Indexed: 11/08/2022]
Abstract
Although gender-related disparities in intermediate-term outcomes have been reported after transcatheter aortic valve implantation (TAVI), disparate predictors of mortality in men and women who underwent TAVI have not been well studied. This prospective institutional registry study included 297 consecutive patients (153 men, 144 women) who underwent transfemoral TAVI from December 2015 to June 2018 at an academic tertiary medical center. Baseline and clinical characteristics, procedural data, and clinical outcomes at 1 year were recorded. Mortality rates at 1 year were 11.1% and 20.3% in women and men, respectively (p = 0.033). Risk-adjusted mortality was significantly higher in men who underwent TAVI than in women (odds ratio [OR] 2.45, 95% confidence interval [CI] 1.24 to 4.87, p = 0.010). Gender-specific risk-adjusted predictors of 1-year mortality post-TAVI included the presence of atrial fibrillation (OR 4.20, 95% CI 1.31 to 13.46, p = 0.016) and peripheral artery disease (OR 4.64, 95% CI 1.04 to 20.71, p = 0.044) in women and presence of chronic obstructive pulmonary disease (OR 3.14, 95% CI 1.13 to 8.72, p = 0.029), higher serum creatinine (OR 1.57, 95% CI 1.15 to 2.15, p = 0.004), and lower body mass index (OR 0.88, 95% CI 0.80 to 0.97, p = 0.008) in men. In this prospective institutional registry of adults who underwent TAVI, risk-adjusted 1-year mortality is significantly lower in women, and disparate predictors of risk-adjusted 1-year mortality exist in men and women.
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Affiliation(s)
- Samantha Novotny
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Smadar Kort
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Henry Tannous
- Department of Surgery, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Robert Pyo
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Ely Gracia
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Ting-Yu Wang
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Susan Callahan
- Department of Surgery, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Hal Skopicki
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Thomas Bilfinger
- Department of Surgery, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York
| | - Puja B Parikh
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, New York.
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Hecht S, Butcher SC, Pio SM, Kong WKF, Singh GK, Ng ACT, Perry R, Poh KK, Almeida AG, González A, Shen M, Yeo TC, Shanks M, Popescu BA, Gay LG, Fijałkowski M, Liang M, Tay E, Marsan NA, Selvanayagam J, Pinto F, Zamorano JL, Evangelista A, Delgado V, Bax JJ, Pibarot P. Impact of Left Ventricular Ejection Fraction on Clinical Outcomes in Bicuspid Aortic Valve Disease. J Am Coll Cardiol 2022; 80:1071-1084. [PMID: 36075677 DOI: 10.1016/j.jacc.2022.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The prognostic impact of left ventricular ejection fraction (LVEF) in patients with bicuspid aortic valve (BAV) disease has not been previously studied. OBJECTIVES The purpose of this study was to determine the prognostic impact of LVEF in BAV patients according to the type of aortic valve dysfunction. METHODS We retrospectively analyzed the data collected in 2,672 patients included in an international registry of patients with BAV. Patients were classified according to the type of aortic valve dysfunction: isolated aortic stenosis (AS) (n = 749), isolated aortic regurgitation (AR) (n = 554), mixed aortic valve disease (MAVD) (n = 190), or no significant aortic valve dysfunction (n = 1,179; excluded from this analysis). The study population was divided according to LVEF strata to investigate its impact on clinical outcomes. RESULTS The risk of all-cause mortality and the composite endpoint of aortic valve replacement or repair (AVR) and all-cause mortality increased when LVEF was <60% in the whole cohort as well as in the AS and AR groups, and when LVEF was <55% in MAVD group. In multivariable analysis, LVEF strata were significantly associated with increased rate of mortality (LVEF 50%-59%: HR: 1.83 [95% CI: 1.09-3.07]; P = 0.022; LVEF 30%-49%: HR: 1.97 [95% CI: 1.13-3.41]; P = 0.016; LVEF <30%: HR: 4.20 [95% CI: 2.01-8.75]; P < 0.001; vs LVEF 60%-70%, reference group). CONCLUSIONS In BAV patients, the risk of adverse clinical outcomes increases significantly when the LVEF is <60%. These findings suggest that LVEF cutoff values proposed in the guidelines to indicate intervention should be raised from 50% to 60% in AS or AR and 55% in MAVD.
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Affiliation(s)
- Sébastien Hecht
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - William K F Kong
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca Perry
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Ana G Almeida
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Ariana González
- Department of Cardiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Mylène Shen
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Miriam Shanks
- Division of Cardiology, University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr C. C. Iliescu," Bucharest, Romania
| | - Laura Galian Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marcin Fijałkowski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michael Liang
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joseph Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Fausto Pinto
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Jose L Zamorano
- Department of Cardiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada.
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Stassen J, Ewe SH, Butcher SC, Amanullah MR, Hirasawa K, Singh GK, Sin KYK, Ding ZP, Pio SM, Sia CH, Chew NWS, Kong WKF, Poh KK, Cohen DJ, Généreux P, Leon MB, Marsan NA, Delgado V, Bax JJ. Moderate aortic stenosis: importance of symptoms and left ventricular ejection fraction. Eur Heart J Cardiovasc Imaging 2021; 23:790-799. [PMID: 34864942 DOI: 10.1093/ehjci/jeab242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/02/2021] [Indexed: 01/29/2023] Open
Abstract
AIMS The aim of this study is to investigate the independent determinants of survival in patients with moderate aortic stenosis (AS), stratified by severity of symptoms and left ventricular ejection fraction (LVEF). METHODS AND RESULTS Patients with a first diagnosis of moderate AS (aortic valve area >1.0 and ≤1.5 cm2) were identified. Patients were stratified by New York Heart Association (NYHA) functional class (NYHA I, NYHA II, or NYHA III-IV) and LVEF (LVEF ≥60%, LVEF 50-59%, or LVEF <50%) at the time of moderate AS diagnosis. The primary endpoint was all-cause mortality, while the secondary endpoint included all-cause mortality and aortic valve replacement. Of 1961 patients with moderate AS (mean age 73 ± 10 years, 51% men), 1108 (57%) patients were in NYHA class I, while 527 (27%) and 326 (17%) patients had symptoms of NYHA class II and III-IV, respectively. Regarding LVEF, 1032 (53%) had LVEF ≥60%, 544 (28%) LVEF 50-59%, and 385 (20%) LVEF <50%. During a median follow-up of 50 (23-82) months, 868 (44%) patients died. On multivariable analysis, NYHA class II [hazard ratio (HR): 1.633; 95% confidence interval (CI): 1.431-1.864; P < 0.001], NYHA class III-IV (HR: 2.084; 95% CI: 1.797-2.417; P < 0.001), LVEF 50-59% (HR: 1.194; 95% CI: 1.013-1.406; P = 0.034), and LVEF <50% (HR: 1.694; 95% CI: 1.417-2.026; P < 0.001) were independently associated with increased mortality. CONCLUSION Moderate AS is associated with poor long-term survival. Baseline symptom severity and LVEF are associated with worse outcomes in these patients. Patients with low-normal LVEF (<60%) and mild symptoms (NYHA II) already have an increased risk of adverse events.
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Affiliation(s)
- Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA 6000, Australia
| | - Mohammed R Amanullah
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Kenny Y K Sin
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Zee P Ding
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - William K F Kong
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - David J Cohen
- Department of Cardiology, Saint Francis Hospital, 100 Port Washington Blvd, Roslyn, NY 11576, USA.,Cardiovascular Research Foundation, New York, NY, USA
| | - Philippe Généreux
- Department of Cardiology, Gagnon Cardiovascular Institute, Morristown Medical Center, 100 Madison Ave, Morristown, NJ 07960, USA
| | - Martin B Leon
- Department of Cardiology, Columbia University Irving Medical Center/New York-Presbyterian Hospital and Cardiovascular Research Foundation, 622 W 168th St, New York, NY 10032, USA
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Department of Cardiology, Turku Heart Center, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
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6
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Jeong YJ, Ahn JM, Kang DY, Park H, Ko E, Kim HJ, Kim JB, Choo SJ, Lee SA, Park SJ, Kim DH, Park DW. Incidence, Predictors, and Prognostic Impact of Immediate Improvement in Left Ventricular Systolic Function After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 152:99-105. [PMID: 34127247 DOI: 10.1016/j.amjcard.2021.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Immediate improvement in left ventricular ejection fraction (LVEF) following transcatheter aortic valve implantation (TAVI) is common; however, data on the pattern and prognostic value of this improvement are limited. To evaluate the incidence, predictors, and clinical impact of immediate improvement in LVEF, we studied 694 consecutive patient who had underwent successful TAVI for severe aortic stenosis (AS) between March 2010 and December 2019. We defined immediate improvement of LVEF as an absolute increase of ≥5% in LVEF at post-procedure echocardiogram. The primary outcome was major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of death from cardiovascular cause, myocardial infarction, stroke, or rehospitalization from cardiovascular cause. Among them, 160 patients showed immediate improvement in LVEF. The independent predictors of immediate LVEF improvement were absence of hypertension and baseline significant aortic regurgitation, and greater baseline LV mass index. Immediate improvement in LVEF was significantly associated with a lower risk of MACCE (adjusted hazard ratio, 0.48; 95% confidence interval, 0.28-0.81; p = 0.01). In conclusion, approximately one-fourth of patients with severe AS who underwent TAVI showed immediate improvement in LVEF during index hospitalization. Immediate LVEF recovery was associated with a lower risk of MACCE during follow-up.
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7
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Hohri Y, Itatani K, Numata S, Yamazaki S, Miyazaki S, Nishino T, Yaku H. Blood flow energy loss: a predictor for the recovery of left ventricular function after bioprosthetic aortic valve replacement. Interact Cardiovasc Thorac Surg 2021; 33:339-347. [PMID: 33963389 DOI: 10.1093/icvts/ivab094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/12/2021] [Accepted: 03/07/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES It is difficult to estimate the improvement in left ventricular (LV) function after aortic valve replacement (AVR). The present study aimed to evaluate whether energy loss (EL) can predict the postoperative LV function after AVR. METHODS Nine patients who underwent AVR with a bioprosthetic valve were enrolled in the present study. Porcine prostheses were used in 5 patients and bovine pericardial prostheses were used in 4 patients. The aortic flow pattern was visualized and EL and cardiac output (CO) were measured using 4-dimensional flow magnetic resonance imaging from the LV to the descending aorta; the EL/CO ratio in the extracted area was calculated as total EL/CO ratio. RESULTS With a porcine valve, a severe helical flow was observed in the ascending aorta during the holosystolic phase. In contrast, with a bovine pericardial valve, straight transvalvular aortic flow was observed in the early systolic phase and 2 large vortical flows occurred on both sides of the greater and lesser curvature of the ascending aorta after the mid-systolic period. The total EL/CO ratio was strongly correlated with LV ejection fraction improvement after AVR (r = 0.74, P = 0.02). CONCLUSIONS The aortic flow pattern is different between the porcine valve and bovine pericardial valve. The total EL/CO ratio is a valuable tool for evaluating the postoperative LV ejection fraction improvement after AVR. Optimization of total EL/CO ratio would have potential to improve haemodynamic performances after AVR.
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Affiliation(s)
- Yu Hohri
- Department of Cardiovascular Surgery, Cardiovascular Blood Flow Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Cardiovascular Blood Flow Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Cardiovascular Blood Flow Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Sachiko Yamazaki
- Department of Cardiovascular Surgery, Cardiovascular Blood Flow Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Cardiovascular Blood Flow Imaging Research Laboratory, Kyoto Prefectural University of Medicine, Kyoto, Japan
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8
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Mehta S, Sharma D, Pathania R. Early myocardial remodeling after aortic valve replacement. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2021. [DOI: 10.4103/ijca.ijca_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Merdler I, Loewenstein I, Hochstadt A, Morgan S, Schwarzbard S, Sadeh B, Peri Y, Shacham Y, Finkelstein A, Steinvil A. Effectiveness and Safety of Transcatheter Aortic Valve Implantation in Patients With Aortic Stenosis and Variable Ejection Fractions (<40%, 40%-49%, and >50%). Am J Cardiol 2020; 125:583-588. [PMID: 31843234 DOI: 10.1016/j.amjcard.2019.10.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 11/18/2022]
Abstract
We evaluated the safety and efficacy of transcatheter aortic valve implantation (TAVI) in aortic stenosis patients with mid-range ejection fraction (ASmrEF) and compared it to aortic stenosis patients with reduced ejection fraction (ASrEF) and preserved ejection fraction (ASpEF). TAVI cases were stratified by baseline ejection fraction (ASrEF, ASmrEF, ASpEF) and compared for characteristics, procedural outcomes, and change in echocardiographic parameters at 1 year and mortality over a 5-year follow-up. The final study population included 708 patients who underwent TAVI. ASmrEF patients presented with improved EF at 1-year after procedure (49.0 ± 9.8 at 1 year vs 43.0 ± 2.5 at baseline, p <0.001) and showed improvements in left ventricular (LV) diameters (LV end-diastolic diameter: 50.4 ± 6.0 at 1 year vs 53.0 ± 5.5 at baseline and LV end-systolic diameter 34.7 ± 7.8 at 1 year vs 39.5 ± 5.9 at baseline, p <0.001 for both). LVEF improved for patients with ASrEF but not in ASpEF patients. LV diameters did not improve for patients in either group. Procedural safety and success rates were similar between all heart failure groups. Survival rates over a 5-year follow-up post-TAVI were not different between patients with ASmrEF, ASrEF, and ASpEF (ASrEF 78.4%, ASmrEF 81.9%, ASpEF 78.3%, p = 0.327). TAVI for patients with ASmrEF is safe and effective and results in marked improvement of LV function and structure.
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Affiliation(s)
- Ilan Merdler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Itamar Loewenstein
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Samuel Morgan
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sivan Schwarzbard
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ben Sadeh
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yogev Peri
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ariel Finkelstein
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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10
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Côté N, Clavel MA. Sex Differences in the Pathophysiology, Diagnosis, and Management of Aortic Stenosis. Cardiol Clin 2020; 38:129-138. [DOI: 10.1016/j.ccl.2019.09.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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11
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Concistrè G, Bianchi G, Chiaramonti F, Margaryan R, Marchi F, Kallushi E, Solinas M. Minimally Invasive Sutureless Aortic Valve Replacement is Associated With Improved Outcomes in Patients With Left Ventricular Dysfunction. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:445-452. [DOI: 10.1177/1556984519872990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Objective Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of sutureless Perceval (LivaNova, Italy) aortic bioprosthesis on LVEF and clinical outcomes in patients with baseline left ventricular (LV) dysfunction who underwent isolated aortic valve replacement (AVR). Methods Between March 2011 and August 2017, 803 patients underwent AVR with Perceval bioprosthesis implantation. Fifty-two isolated AVR had preoperative LVEF ≤45%. Mean age of these patients was 77 ± 6 years, 24 patients were female (46%), and mean EuroSCORE II was 9.4% ± 4.8%. Perceval bioprosthesis was implanted in 9 REDO operations. In 43 patients (83%), AVR was performed in minimally invasive surgery with an upper ministernotomy ( n = 13) or right anterior minithoracotomy ( n = 30). Results One patient died in hospital. Cardiopulmonary bypass and aortic cross-clamp times were 85.5 ± 26 minutes and 55.5 ± 19 minutes, respectively. At mean follow-up of 33 ± 20 months (range: 1 to 75 months), survival was 90%, freedom from reoperation was 100%, and mean transvalvular pressure gradient was 11 ± 5 mmHg. LVEF improved from 37% ± 7% preoperatively to 43% ± 8% at discharge ( P < 0.01) and further increased to 47% ± 9% at follow-up ( P = 0.06), LV mass decreased from 149.8 ± 16.9 g/m2 preoperatively to 115.3 ± 11.6 g/m2 at follow-up ( P < 0.001), and moderate paravalvular leakage occurred in 1 patient without hemolysis not requiring any treatment. Conclusions AVR with sutureless aortic bioprosthesis implantation in patients with preoperative LV dysfunction demonstrated a significant immediate and early improvement in LVEF.
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Affiliation(s)
- Giovanni Concistrè
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Giacomo Bianchi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Francesca Chiaramonti
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Rafik Margaryan
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Federica Marchi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Enkel Kallushi
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
| | - Marco Solinas
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Fondazione CNR-G. Monasterio, Massa, Italy
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12
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Lin YS, Lin WH, Tsai HY, Huang HY, Kuo LY, Chen BY. Predicting exercise capacity recovery immediately after mitral valve surgery. J Card Surg 2019; 34:889-894. [PMID: 31376195 DOI: 10.1111/jocs.14131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/25/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study presents the exercise capacity of postmitral valve surgery patients and determines predictors capable of affecting recovery. METHODS A total of 302 patients with mitral regurgitation who had undergone mitral surgery at the Heart Center in Taiwan from 1 August 2013 to 31 December 2015 were included in the present study. Data related to specific predictors of operative outcome were collected, including demographic data, intraoperative factors, exercise tolerance, echocardiogram data, concurrent cardiovascular disease history, comorbidities, lifestyle risk factors, and surgery types. Postoperative exercise capacity was presented as peak oxygen consumption (VO2 ; mL of O 2 /kg/min) determined by exercise tests 3 weeks after surgery. Subjects were separated into two groups: a preserved recovery (peak VO 2 ≥ 65% of predicted VO 2max ) group and a poor recovery group (peak VO 2 < 65% of predicted VO 2max ). Preliminary univariate analysis was performed to test for possible relationships between predictive variables and exercise capacity. An analysis of all items shown to be significantly different between the two groups was then subjected to multivariate logistic regression analysis. Detected differences with P < .05 were considered significant. RESULTS Among the 302 patients sampled, female sex (odds ratio [OR], 2.65; 95% confidence interval [95% CI], 1.58-4.47), obesity (OR, 0.26; 95% CI, 0.10-0.64), sedentary lifestyle (OR, 0.47; 95% CI, 0.28-0.79), and high preoperative New York Heart Association Functional Classification level (OR, 0.52; 95% CI, 0.31-0.87) were significant predictors of poor exercise capacity. CONCLUSIONS Without complicated clinical procedures, physicians and medical teams could easily use these items of information to screen the exercise capacity of mitral valve surgery patients and prepare a suitable after surgery plan if needed or request a consultation as early as possible.
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Affiliation(s)
- Yu-Shan Lin
- Division of Cardiac Rehabilitation, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Wei-Hsuan Lin
- Division of Cardiac Rehabilitation, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Hui-Yu Tsai
- Division of Cardiac Rehabilitation, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Hsin-Yi Huang
- Division of Cardiac Rehabilitation, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Li-Ying Kuo
- Division of Cardiac Rehabilitation, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
| | - Bo-Yan Chen
- Division of Cardiac Rehabilitation, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
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13
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Kamada H, Ota H, Nakamura M, Imai Y, Ishida S, Sun W, Sakatsume K, Yoshioka I, Saiki Y, Takase K. Perioperative Hemodynamic Changes in the Thoracic Aorta in Patients With Aortic Valve Stenosis: A Prospective Serial 4D-Flow MRI Study. Semin Thorac Cardiovasc Surg 2019; 32:25-34. [PMID: 31323320 DOI: 10.1053/j.semtcvs.2019.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/11/2019] [Indexed: 01/25/2023]
Abstract
This study investigated hemodynamic changes in the thoracic aorta and aortic arch branches before and after aortic valve replacement (AVR) by 4D-flow MRI in patients with aortic valve stenosis (AS). Thoracic 4D-flow MRI was performed in 10 AS patients before and after AVR (mean 27 ± 1.9 days). Fifteen aortic planes and 3 aortic arch branches planes were set to evaluate the mean volume flow rate in each plane during a cardiac cycle and the angle between the main flow direction in a specified plane and the axial direction of the aorta. We also focused on the distribution and magnitude of helicity density to evaluate the flow complexity. A significant increase in the volume flow rate after AVR was found in the ascending aorta (before 59.2 ± 8.7 mL/s vs after 77.3 ± 6.2 mL/s, P < 0.05) and the aortic arch branches (before 26.5 ± 2.8 mL/s vs after 35.8 ± 3.3 mL/s, P < 0.001). The flow angle significantly decreased in the ascending aorta (before 39.2 ± 2.7 degree vs after 25.2 ± 1.7°, P < 0.0001) and the arch aorta (before 19.3 ± 2.0 degree vs after 13.4 ± 0.9°, P < 0.001). The volume flow rate in the ascending aorta and the arch branches increased within 1 month after AVR, showing an increased blood supply to the upper body, including to the brain. The postoperative change was accompanied with an increased blood flow in the ascending aorta and a decreased flow complexity proximal to the arch branches.
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Affiliation(s)
- Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan.
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Masanori Nakamura
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Yohsuke Imai
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Shunichi Ishida
- Graduate School of Engineering Science, Osaka University, Osaka, Japan
| | - Wenyu Sun
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Ko Sakatsume
- Division of Cardiovascular Surgery, Tohoku University Hospital, Sendai, Japan
| | - Ichiro Yoshioka
- Division of Cardiovascular Surgery, Tohoku University Hospital, Sendai, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
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14
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Ito S, Miranda WR, Nkomo VT, Connolly HM, Pislaru SV, Greason KL, Pellikka PA, Lewis BR, Oh JK. Reduced Left Ventricular Ejection Fraction in Patients With Aortic Stenosis. J Am Coll Cardiol 2018; 71:1313-1321. [DOI: 10.1016/j.jacc.2018.01.045] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/13/2018] [Accepted: 01/15/2018] [Indexed: 01/22/2023]
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Bakkali A, Jaabari I, Dadji CK, Sayah R, Laaroussi M. [Results of aortic valve replacement in patients with aortic stenosis associated with severe left ventricular dysfunction]. Pan Afr Med J 2018; 29:79. [PMID: 29875960 PMCID: PMC5987142 DOI: 10.11604/pamj.2018.29.79.10991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 09/04/2017] [Indexed: 11/30/2022] Open
Abstract
The operative risk of aortic valve replacement (AVR) due to tight aortic stenosis (AS) associated with severe left ventricular dysfunction is high. Several risk factors for postoperative mortality have been described, but most of the reported case series are heterogeneous. This study aimed to analyze the postoperative results of AVR in patients with isolated tight AS associated with severe left ventricular dysfunction and to identify predictive factors of in-hospital mortality. We conducted a retrospective study of 46 patients with tight AS associated with severe left ventricular dysfunction who had undergone AVR. The average age was 59±12.70 years. 69.6% of patients were in NYHA Class III or IV. Mean EF was 32.3 ± 5.3%, and mean EuroScore was 12.20 ± 8.70. In-hospital mortality accounted for 15.20%. Morbidity was mainly marked by low cardiac output in 35% of cases. Multivariate logistic regression analysis showed that renal insufficiency (OR= 11.94, CI [2.65-72.22], p= 0.03) and congestive cardiac failure (OR= 25.33, CI [3.43-194.74], p= 0.009) were related to the risk of in-hospital mortality. Thirty-nine surviving patients were followed up for an average of 59.6± 21 months. Late mortality accounted for 5%. The functional status had significantly improved. EF increased, on average, by 5.5 units in early postoperative period and by 18 units in late postoperative period. In the long term, end-diastolic and end-systolic diameters were reduced by an average of 8 and 9 mm, respectively. The results of AVR due to tight AS associated with severe left ventricular dysfunction are satisfactory. Congestive heart failure and preoperative renal failure are the main risk factors for in-hospital mortality. Patient's outcome is marked by reduction in end-diastolic and end-systolic diameters of the left ventricle with improvement of the EF and of their functional status.
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Affiliation(s)
- Abderrahmane Bakkali
- Service de Chirurgie Cardiovasculaire « A », Hôpital Ibn Sina, Faculté de Médecine et de Pharmacie d'Agadir, Université Ibn Zohr, Agadir, Maroc
| | - Imad Jaabari
- Service de Chirurgie Cardiovasculaire « A », Hôpital Ibn Sina, Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V Souissi, Rabat, Maroc
| | - Claude Koulekey Dadji
- Service de Chirurgie Cardiovasculaire « A », Hôpital Ibn Sina, Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V Souissi, Rabat, Maroc
| | - Rochde Sayah
- Service de Chirurgie Cardiovasculaire « A », Hôpital Ibn Sina, Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V Souissi, Rabat, Maroc
| | - Mohamed Laaroussi
- Service de Chirurgie Cardiovasculaire « A », Hôpital Ibn Sina, Faculté de Médecine et de Pharmacie de Rabat, Université Mohamed V Souissi, Rabat, Maroc
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16
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Taniguchi T, Morimoto T, Shiomi H, Ando K, Kanamori N, Murata K, Kitai T, Kadota K, Izumi C, Nakatsuma K, Sasa T, Watanabe H, Kuwabara Y, Makiyama T, Ono K, Shizuta S, Kato T, Saito N, Minatoya K, Kimura T, Kimura T, Taniguchi T, Shiomi H, Saito N, Imai M, Tazaki J, Toyota T, Higami H, Kawaji T, Ando K, Shirai S, Kourai K, Arita T, Miura S, Yamaji K, Aoyama T, Kanamori N, Onodera T, Murata K, Furukawa Y, Kitai T, Kim K, Kadota K, Kawase Y, Iwasaki K, Miyawaki H, Misao A, Kuwayama A, Ohya M, Shimada T, Amano H, Nakagawa Y, Izumi C, Miyake M, Amano M, Takahashi Y, Yoshikawa Y, Nishimura S, Kuroda M, Shirotani M, Mitsuoka H, Miki S, Mizoguchi T, Kato M, Yokomatsu T, Kushiyama A, Yaku H, Watanabe T, Miyazaki S, Hirano Y, Matsuda M, Matsuda S, Sugioka S, Inada T, Nagao K, Takahashi N, Fukuchi K, Murakami T, Mabuchi H, Takeda T, Sakaguchi T, Maeda K, Yamaji M, Maenaka M, Tadano Y, Sakamoto H, Takeuchi Y, Motooka M, Nishikawa R, Eizawa H, Yamane K, Kawato M, Kinoshita M, Aida K, Tamura T, Toyofuku M, Takahashi K, Ko E, Akao M, Ishii M, Masunaga N, Ogawa H, Iguchi M, Unoki T, Takabayashi K, Hamatani Y, Yamashita Y, Inoko M, Minamino-Muta E, Kato T, Himura Y, Ikeda T, Ishii K, Komasa A, Sato Y, Hotta K, Tsuji S, Hiraoka Y, Higashitani N, Kouchi I, Kato Y, Ikeguchi S, Inuzuka Y, Nishio S, Seki J, Shinoda E, Yamada M, Kawamoto A, Maeda C, Konishi T, Jinnai T, Sogabe K, Tachiiri M, Matsumura Y, Ota C, Kitaguchi S, Morikami Y, Sakata R, Minakata K, Minatoya K, Hanyu M, Yamazaki F, Koyama T, Komiya T, Yamanaka K, Nishiwaki N, Nakajima H, Ohnaka M, Osada H, Meshii K, Saga T, Onoe M, Nakayama S, Sakaguchi G, Iwakura A, Shiraga K, Ueyama K, Fujiwara K, Fukumoto A, Park M, Nishizawa J, Kitano M. Prognostic Impact of Left Ventricular Ejection Fraction in Patients With Severe Aortic Stenosis. JACC Cardiovasc Interv 2018; 11:145-157. [DOI: 10.1016/j.jcin.2017.08.036] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 11/25/2022]
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17
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Dauerman HL, Reardon MJ, Popma JJ, Little SH, Cavalcante JL, Adams DH, Kleiman NS, Oh JK. Early Recovery of Left Ventricular Systolic Function After CoreValve Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003425. [PMID: 27296201 DOI: 10.1161/circinterventions.115.003425] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 04/29/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Approximately one third of patients with symptomatic aortic stenosis have reduced left ventricular ejection fraction (LVEF) before transcatheter aortic valve replacement. The incidence, predictors, and significance of early LVEF recovery after CoreValve transcatheter aortic valve replacement have not been described. METHODS AND RESULTS We studied 156 patients from the CoreValve Extreme and High-Risk trials with LVEF ≤40% at baseline who had 30-day LVEF data. All patients underwent core laboratory echocardiographic assessment of LVEF at baseline, post procedure, discharge, 30 days, 6 months, and 1 year. Early LVEF recovery was defined as an absolute increase of ≥10% in EF at 30 days. One-year outcomes were compared between patients with and without early recovery. Multivariable analysis was performed to determine independent predictors of early recovery. Early LVEF recovery occurred in 62% of patients, generally before discharge. By 30 days LVEF increased >17% compared with baseline in the early recovery group with minimal increase in the no-early recovery group (48.9±8.8% versus 31.5±6.9%; P<0.001). One-year all-cause mortality was numerically (but not statistically) higher in the no-early recovery group (24% versus 12%; P=0.07). Absence of previous myocardial infarction (odds ratio, 0.44; 95% confidence interval, 0.19-1.03) and baseline mean gradient ≥40 mm Hg (odds ratio, 4.59; 95% confidence interval, 1.76-11.96) were identified as predictors of early LVEF recovery. CONCLUSIONS Nearly two thirds of patients with reduced LVEF will have a marked early improvement after transcatheter aortic valve replacement. Early LVEF recovery is associated with improved clinical outcomes and is most likely among patients with higher baseline aortic valve gradients and no previous myocardial infarction. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01240902.
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Affiliation(s)
- Harold L Dauerman
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.).
| | - Michael J Reardon
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - Jeffrey J Popma
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - Stephen H Little
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - João L Cavalcante
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - David H Adams
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - Neil S Kleiman
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
| | - Jae K Oh
- From the University of Vermont College of Medicine, Burlington (H.L.D); Houston DeBakey Heart and Vascular Center, The Houston Methodist Hospital, TX (M.J.R., S.H.L., N.S.K.); Beth Israel Deaconess Medical Center, Boston, MA (J.J.P.); University of Pittsburgh Medical Center, PA (J.L.C.); Mount Sinai School of Medicine, New York, NY (D.H.A.); and Mayo Clinic, Rochester, MN (J.K.O.)
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Angelillis M, Giannini C, De Carlo M, Adamo M, Nardi M, Colombo A, Chieffo A, Bedogni F, Brambilla N, Tamburino C, Barbanti M, Bruschi G, Colombo P, Poli A, Martina P, Violini R, Presbitero P, Petronio AS. Prognostic Significance of Change in the Left Ventricular Ejection Fraction After Transcatheter Aortic Valve Implantation in Patients With Severe Aortic Stenosis and Left Ventricular Dysfunction. Am J Cardiol 2017; 120:1639-1647. [PMID: 28844511 DOI: 10.1016/j.amjcard.2017.07.064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/08/2017] [Accepted: 07/21/2017] [Indexed: 11/30/2022]
Abstract
Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of early LVEF recovery in patients with baseline dysfunction on clinical outcomes after transcatheter aortic valve implantation (TAVI), we included all consecutive patients who underwent TAVI from the Italian ClinicalService registry with an LVEF of ≤45% at baseline who had 1-month LVEF data. Patients who experienced a previous coronary artery bypass graft, a previous valve replacement, or a previous myocardial infarction were excluded from the analysis. Therefore, 131 patients with an improvement in LVEF of <10% (no-R group) were compared with 121 patients with an improvement in LVEF of ≥10% (R group). The primary end point was the rate of death of any cause. Multivariable analysis was performed to determine independent predictors of lack in LVEF recovery. Early LVEF recovery occurred in 48% of the patients, generally before discharge. One-year all-cause mortality and major adverse cardiac and cerebrovascular events were significantly higher in the no-early recovery group (log rank test p = 0.005 and p = 0.003, respectively). Baseline severe left ventricular dysfunction and previous percutaneous coronary intervention were identified as independent predictors to warn the lack of improvement in LVEF. In conclusion, nearly 50% of patients with preoperative left ventricular dysfunction demonstrated a significant early improvement in LVEF after TAVI. Lack of early LVEF recovery is associated with a worse clinical outcome and is most likely among patients with a severely abnormal baseline LVEF and a previous percutaneous coronary intervention.
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Affiliation(s)
- Marco Angelillis
- Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
| | - Cristina Giannini
- Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marco De Carlo
- Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Marianna Adamo
- Medical and Surgery Department, Ospedali Civili, Brescia, Italy
| | - Matilde Nardi
- Medical and Surgery Department, Ospedali Civili, Brescia, Italy
| | - Antonio Colombo
- Cardiovascular Department, Scientific Institute S. Raffaele, Milan, Italy
| | - Alaide Chieffo
- Cardiovascular Department, Scientific Institute S. Raffaele, Milan, Italy
| | - Francesco Bedogni
- Cardiovascular Department, Policlinico San Donato, San Donato Milanese, Italy
| | - Nedy Brambilla
- Cardiovascular Department, Policlinico San Donato, San Donato Milanese, Italy
| | - Corrado Tamburino
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Marco Barbanti
- Cardiovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giuseppe Bruschi
- Cardio-vascular Department, De Gasperis Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - Paola Colombo
- Cardio-vascular Department, De Gasperis Cardio Center ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - Arnaldo Poli
- Cardio-Thoraco Vascular Department, Ospedale Civile, Legnano, Italy
| | - Paola Martina
- Cardio-Thoraco Vascular Department, Ospedale Civile, Legnano, Italy
| | - Roberto Violini
- Cardio-vascular Department, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Anna Sonia Petronio
- Cardio-Thoracic Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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19
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A meta-analysis of effects of transcatheter versus surgical aortic valve replacement on left ventricular ejection fraction and mass. Int J Cardiol 2017; 238:31-36. [DOI: 10.1016/j.ijcard.2017.03.156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 03/21/2017] [Accepted: 03/24/2017] [Indexed: 11/19/2022]
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Sritharen Y, Enriquez-Sarano M, Schaff HV, Casaclang-Verzosa G, Miller JD. Pathophysiology of Aortic Valve Stenosis: Is It Both Fibrocalcific and Sex Specific? Physiology (Bethesda) 2017; 32:182-196. [PMID: 28404735 PMCID: PMC6148342 DOI: 10.1152/physiol.00025.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 12/24/2022] Open
Abstract
Our understanding of the fundamental biology and identification of efficacious therapeutic targets in aortic valve stenosis has lagged far behind the fields of atherosclerosis and heart failure. In this review, we highlight the most clinically relevant problems facing men and women with fibrocalcific aortic valve stenosis, discuss the fundamental biology underlying valve calcification and fibrosis, and identify key molecular points of intersection with sex hormone signaling.
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Affiliation(s)
- Yoginee Sritharen
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Grace Casaclang-Verzosa
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Jordan D Miller
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota;
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
- Department of Surgery, Mayo Clinic, Rochester, Minnesota; and the
- Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota
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21
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Galian L, Tornos P. Resultados esperanzadores para una patología de alto riesgo: la estenosis aórtica severa con disfunción ventricular izquierda. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Jamieson WRE, Germann E, Fradet GJ, Lichtenstein SV, Miyagishima RT. Bioprostheses and Mechanical Prostheses Predictors of Performance. Asian Cardiovasc Thorac Ann 2016. [DOI: 10.1177/021849230000800207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
From 1975 to 1995, 4200 patients had bioprosthetic valve replacements (2240 aortic, 1607 mitral, 353 multiple) and 2038 had mechanical valve replacements (747 aortic, 928 mitral, 363 multiple). Freedom from major thromboembolism or both major thromboembolism and hemorrhage for aortic and mitral valve replacement at 15 years was significantly greater for bioprostheses than mechanical prostheses. Freedom from valve-related mortality and reoperation for both aortic and mitral valve replacements was the same for bioprostheses and mechanical prostheses. Advancing age increased overall mortality (all positions), valve-related mortality (aortic, mitral), major thromboembolism (aortic), thromboembolism and hemorrhage (aortic, mitral) but decreased reoperation (all positions). Coronary artery bypass grafting increased overall mortality (aortic, mitral) but not valve-related mortality, and it decreased reoperation rate (aortic, mitral). Overall mortality was not influenced by valve type in aortic or multiple valve replacement but it was decreased by bioprostheses in mitral valve replacement. Valve type did not influence valve-related mortality (all positions). Mechanical valves decreased reoperation only for aortic valve replacement but they increased major thromboembolism with and without hemorrhage for both aortic and mitral replacements. There is support for bioprostheses in aortic valve replacement and mechanical prostheses in mitral valve replacement but for neither in multiple valve replacements.
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Affiliation(s)
- WR Eric Jamieson
- Department of Surgery Faculty of Medicine University of British Columbia Vancouver, British Columbia, Canada
| | - Eva Germann
- Department of Surgery Faculty of Medicine University of British Columbia Vancouver, British Columbia, Canada
| | - Guy J Fradet
- Department of Surgery Faculty of Medicine University of British Columbia Vancouver, British Columbia, Canada
| | - Samuel V Lichtenstein
- Department of Surgery Faculty of Medicine University of British Columbia Vancouver, British Columbia, Canada
| | - Robert T Miyagishima
- Department of Surgery Faculty of Medicine University of British Columbia Vancouver, British Columbia, Canada
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Une D, Mesana L, Chan V, Maklin M, Chan R, Masters RG, Mesana TG, Ruel M. Clinical Impact of Changes in Left Ventricular Function After Aortic Valve Replacement: Analysis From 3112 Patients. Circulation 2015; 132:741-7. [PMID: 26304665 DOI: 10.1161/circulationaha.115.015371] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Our objectives were to identify correlates of mortality and congestive heart failure after aortic valve replacement (AVR) according to preoperative left ventricular (LV) function and to describe the incidence, time course, and correlates of LV recovery and mass regression postoperatively. METHODS AND RESULTS A total of 3112 patients with AVR were assessed in a follow-up clinic with echocardiography (median follow-up, 6.0 years). At operation, their mean age was 67.8±13.4 years, one third were female, and 29% had LV dysfunction (ejection fraction <50%). In severe patients with severe aortic stenosis and LV dysfunction, transaortic valve mean pressure gradient <40 mm Hg, longer cardiopulmonary bypass duration, and prosthesis-patient mismatch (indexed effective orifice area ≤0.85 cm(2)/m(2)) were independent correlates of the composite outcome of death or congestive heart failure after AVR. In patients with severe aortic regurgitation and LV dysfunction, older age and higher preoperative LV mass were identified. LV recovery correlated with better survival and freedom from heart failure in patients with aortic stenosis. Maximum LV mass regression took 24 months in patients with aortic stenosis and nearly 5 years with aortic regurgitation; independent correlates included smaller LV end-systolic diameter in patients with aortic stenosis and low New York Heart Association class with aortic regurgitation. CONCLUSIONS Incomplete LV recovery, prosthesis-patient mismatch, low transaortic valve pressure gradient, and higher LV mass are associated with increased mortality or heart failure after AVR in patients with LV dysfunction. Higher LV end-systolic diameter and symptoms correlate with less LV mass regression, which takes at least 2 years. These findings help surgeons and cardiologists refine the indications, timing, prognostication, and follow-up of patients before and after AVR.
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Affiliation(s)
- Dai Une
- From Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Laura Mesana
- From Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Vincent Chan
- From Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Michelle Maklin
- From Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Ryan Chan
- From Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Roy G Masters
- From Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Thierry G Mesana
- From Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Marc Ruel
- From Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON, Canada.
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Elmariah S. Patterns of Left Ventricular Remodeling in Aortic Stenosis: Therapeutic Implications. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:391. [DOI: 10.1007/s11936-015-0391-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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25
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Clavel MA, Berthelot-Richer M, Le Ven F, Capoulade R, Dahou A, Dumesnil JG, Mathieu P, Pibarot P. Impact of classic and paradoxical low flow on survival after aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol 2015; 65:645-53. [PMID: 25677424 DOI: 10.1016/j.jacc.2014.11.047] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 11/11/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Low flow (LF) can occur with reduced (classic) or preserved (paradoxical) left ventricular ejection fraction (LVEF). OBJECTIVES The objective of this study was to compare outcomes of patients with low ejection fraction (LEF), paradoxical low flow (PLF), and normal flow (NF) after aortic valve replacement (AVR). METHODS We examined 1,154 patients with severe aortic stenosis (AS) who underwent AVR with or without coronary artery bypass grafting. RESULTS Among these patients, 206 (18%) had LEF as defined by LVEF of <50%; 319 (28%) had PLF as defined by LVEF of ≥50% but stroke volume indexed to body surface area (SVi) of ≤35 ml ∙ m(-2); and 629 (54%) had NF, as defined by LVEF of ≥50% and SVi of >35 ml ∙ m(2). Aortic valve area was lower in low flow/LVEF groups (LEF: 0.71 ± 0.20 cm(2) and PLF: 0.65 ± 0.23 cm(2) vs. NF: 0.77 ± 0.18 cm(2); p < 0.001). The 30-day mortality was higher (p < 0.001) in LEF and PLF groups than in the NF group (6.3% and 6.3% vs. 1.8%, respectively). SVi and PLF group were independent predictors of operative mortality (odds ratio [OR]: 1.18, p < 0.05; and OR: 2.97, p = 0.004; respectively). At 5 years after AVR, overall survival was 72 ± 4% in LEF group, 81 ± 2% in PLF group, and 85 ± 2% in NF group (p < 0.0001). CONCLUSIONS Patients with LEF or PLF AS have a higher operative risk, but pre-operative risk score accounted only for LEF and lower LVEF. Patients with LEF had the worst survival outcome, whereas patients with PLF and normal flow had similar survival rates after AVR. As a major predictor of perioperative mortality, SVi should be integrated in AS patients' pre-operative evaluation.
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Affiliation(s)
- Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
| | - Maxime Berthelot-Richer
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Florent Le Ven
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Romain Capoulade
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Abdellaziz Dahou
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Jean G Dumesnil
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Patrick Mathieu
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
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Luo X, Zhao Z, Chai H, Zhang C, Liao Y, Li Q, Peng Y, Liu W, Ren X, Meng Q, Chen C, Chen M, Feng Y, Huang D. Efficacy of transcatheter aortic valve implantation in patients with aortic stenosis and reduced LVEF. A systematic review. Herz 2015; 40 Suppl 2:168-80. [PMID: 25712464 DOI: 10.1007/s00059-014-4193-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 10/20/2014] [Accepted: 11/29/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is safe and effective for patients with aortic stenosis (AS) who have a high operative risk. However, there is still debate on the effect of TAVI in AS patients with reduced left ventricular ejection fraction (REF). The objective of the review is to clarify the efficacy of TAVI and the impact of REF on the 30-day and midterm mortality in these patients. METHODS Studies on TAVI were searched in PubMed, Embase, and the Cochrane Library databases and were included in this review following predefined criteria. Data were extracted and pooled risk ratios (RR) were synthesized to explore the relationship between REF and 30-day plus midterm mortality. RESULTS Twenty-eight studies comprising 14,099 patients were included in the analysis of the association of REF with the prognosis of patients after TAVI. An average increase in left ventricular ejection fraction of 8-10 % was observed among these patients after TAVI. REF was not related to the 30-day mortality [RR = 1.90, 95 % confidence interval (CI) = 0.80-4.47]; however, it was related to the midterm mortality (RR = 1.49, 95 %CI = 1.14-1.93) of patients undergoing TAVI. Patients with low-flow and low-gradient AS had a higher 30-day mortality (RR = 1.54, 95 %CI = 1.11-2.13) and midterm mortality rate (RR = 1.69, 95 %CI = 1.33-2.14) compared with AS patients without these characteristics. The mortality of TAVI patients was significantly lower than that of those undergoing conservative therapy, and was similar to that of patients undergoing surgical aortic valve replacement. CONCLUSION REF was not associated with 30-day mortality, but it was associated with the midterm mortality of TAVI patients. Patients with REF could benefit from TAVI compared with conservative therapy.
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Affiliation(s)
- X Luo
- Department of Cardiology, West China Hospital of Sichuan University, No.37 Guo Xue Xiang of Wuhou District, 610041, Chengdu, Sichuan, P.R. China
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Elhmidi Y, Piazza N, Mazzitelli D, Wottke M, Lange R, Bleiziffer S. Sex‐Related Differences in 2197 Patients Undergoing Isolated Surgical Aortic Valve Replacement. J Card Surg 2014; 29:772-8. [DOI: 10.1111/jocs.12442] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yacine Elhmidi
- Clinic for Cardiovascular SurgeryGerman Heart CentreMunichGermany
| | - Nicolo Piazza
- Clinic for Cardiovascular SurgeryGerman Heart CentreMunichGermany
| | | | - Michael Wottke
- Clinic for Cardiovascular SurgeryGerman Heart CentreMunichGermany
| | - Rüdiger Lange
- DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart AllianceMunichGermany
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Park J, Chang HJ, Choi JH, Yang PS, Lee SE, Heo R, Shin S, Cho IJ, Kim YJ, Shim CY, Hong GR, Chung N. Late gadolinium enhancement in cardiac MRI in patients with severe aortic stenosis and preserved left ventricular systolic function is related to attenuated improvement of left ventricular geometry and filling pressure after aortic valve replacement. Korean Circ J 2014; 44:312-9. [PMID: 25278984 PMCID: PMC4180608 DOI: 10.4070/kcj.2014.44.5.312] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/27/2014] [Accepted: 07/08/2014] [Indexed: 11/23/2022] Open
Abstract
Background and Objectives We investigated echocardiographic predictors: left ventricular (LV) geometric changes following aortic valve replacement (AVR) according to the late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) in patients with severe aortic stenosis (AS) and preserved LV systolic function. Subjects and Methods We analyzed 41 patients (24 males, 63.1±8.7 years) with preserved LV systolic function who were scheduled to undergo AVR for severe AS. All patients were examined with transthoracic echocardiography (TTE), CMR before and after AVR (in the hospital) and serial TTEs (at 6 and 12 months) were repeated. Results The group with LGE (LGE+) showed greater wall thickness (septum, 14.3±2.6 mm vs. 11.5±2.0 mm, p=0.001, posterior; 14.3±2.5 mm vs. 11.4±1.6 mm, p<0.001), lower tissue Doppler image (TDIS', 4.4±1.4 cm/s vs. 5.5±1.2 cm/s, p=0.021; TDI E', 3.2±0.9 cm/s vs. 4.8±1.4 cm/s, p=0.002), and greater E/e' (21.8±10.3 vs. 15.4±6.3, p=0.066) than those without LGE (LGE-). Multivariate analysis show that TDI e' (odds ratio=0.078, 95% confidence interval=0.007-0.888, p=0.040) was an independent determinant of LGE+. In an analysis of the 6- and 12-month follow-up compared with pre-AVR, LGE- showed decreased LV end-diastolic diameter (48.3±5.0 mm vs. 45.8±3.6 mm, p=0.027; 48.3±5.0 mm vs. 46.5±3.4 mm, p=0.019). Moreover, E/e' (at 12 months) showed further improved LV filling pressure (16.0±6.6 vs. 12.3±4.3, p=0.001) compared with pre-AVR. However, LGE+ showed no significant improvement. Conclusion The absence of LGE is associated with favorable improvements in LV geometry and filling pressure. TDI E' is an independent determinant of LGE in patients with severe AS and preserved LV systolic function.
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Affiliation(s)
- Junbeom Park
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea. ; Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Jung-Ho Choi
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Pil-Sung Yang
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Sang-Eun Lee
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Ran Heo
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Sanghoon Shin
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - In-Jeong Cho
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Young-Jin Kim
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
| | - Namsik Chung
- Division of Cardiology and Radiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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Freixa X, Chan J, Bonan R, Ibrahim R, Lamarche Y, Demers P, Basmadjian A, Ibrahim R, Cartier R, Asgar AW. Impact of coronary artery disease on left ventricular ejection fraction recovery following transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2014; 85:450-8. [PMID: 25115215 DOI: 10.1002/ccd.25632] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 08/10/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The objective of the present study was to assess if the presence and severity of CAD is associated with decreased LVEF recovery after TAVI. BACKGROUND Coronary artery disease (CAD) and low left ventricular ejection fraction (LVEF) are common findings in patients undergoing transcatheter aortic valve implantation (TAVI). The impact of CAD on LVEF recovery after TAVI has not been specifically evaluated. METHODS All patients with LVEF≤50% who underwent TAVI between March 2006 and May 2012 were included in the study. The presence and severity of coronary artery disease was measured using the Duke Myocardial Jeopardy Score (DMJS). A DMJS = 0 corresponds to patients without CAD or complete revascularization and a DMJS > 0 to those with incomplete revascularization. LVEF recovery was assessed by transthoracic echocardiography, measuring the change in LVEF from baseline to 3-months post-TAVI. Myocardial viability was evaluated in a subgroup of patients using cardiac magnetic resonance (CMR) imaging pre-TAVI. RESULTS Fifty-six patients were included in the study. Twenty-eight patients (50%) had a DMJS > 0. At 3 months, patients with incomplete revascularization (DMJS > 0) demonstrated less LVEF recovery post-TAVI (2.0 ± 9.2% versus 11.7 ± 8.9% if DMJS = 0; P = 0.001). On multivariate analysis, DMJS and presence of significant delayed-enhancement were found to be independent predictors of LVEF recovery. Patients with incomplete revascularization exhibited a worse prognosis with higher mortality at 30-days (22.2% versus 0% if DMJS = 0; P = 0.010) and 1-year (25.9% versus 3.5% if DMJS = 0; P = 0.019). CONCLUSIONS The present study demonstrates an independent association between incomplete revascularization and decreased LVEF recovery in patients with left ventricular dysfunction undergoing TAVI for severe aortic stenosis.
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Affiliation(s)
- Xavier Freixa
- Division of Cardiology and Cardiovascular Surgery, Montreal Heart Institute, University of Montreal, Montreal, Quebec, Canada
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Chan PH, Tse HF. Adoption of cardiac resynchronization therapy in heart failure patients with postcardiac valve surgery or interventions? J Cardiovasc Electrophysiol 2014; 25:1214-5. [PMID: 25065469 DOI: 10.1111/jce.12486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Pak-Hei Chan
- Cardiology Division, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, SAR, China; Department of Medicine, Hong Kong University-Shenzhen Hospital, China
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Yadlapati A, Diep J, Barnes M, Grogan T, Bethencourt DM, Vorobiof G. Comprehensive Hemodynamic Comparison and Frequency of Patient-Prosthesis Mismatch between the St. Jude Medical Trifecta and Epic Bioprosthetic Aortic Valves. J Am Soc Echocardiogr 2014; 27:581-9. [DOI: 10.1016/j.echo.2014.01.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Indexed: 11/28/2022]
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Rassi AN, Pibarot P, Elmariah S. Left ventricular remodelling in aortic stenosis. Can J Cardiol 2014; 30:1004-11. [PMID: 25151283 DOI: 10.1016/j.cjca.2014.04.026] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 04/21/2014] [Accepted: 04/27/2014] [Indexed: 02/07/2023] Open
Abstract
Aortic stenosis (AS) is a progressive condition associated with high mortality if not treated. The hemodynamic effects of AS have serious implications for the left ventricle. In this review, we describe the responses of the left ventricle to AS by highlighting the process of adaptive remodelling, which begins as a beneficial compensatory mechanism but ultimately transitions to a maladaptive process with potentially irreversible consequences. We discuss the impact of left ventricular (LV) remodelling on diastolic and systolic function and on the development of symptoms. In addition, we review the adverse consequences of maladaptive LV remodelling on clinical outcomes before and after aortic valve replacement. The relative irreversibility of maladaptive remodelling and the clear relationship between its progression and clinical outcomes suggest a need to incorporate measures of LV performance beyond simply systolic function when deciding on the timing of valve replacement.
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Affiliation(s)
- Andrew N Rassi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Sammy Elmariah
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Abstract
Degenerative, calcific valvular aortic stenosis (AS), caused by an active process of atherosclerosis, calcification and ossification, is the most common cause of AS in industrialized nations. The prevalence of calcific AS is age-dependent, and thus is expected to increase due to demographic aging of the global population. It is well recognized that severe AS carries a poor prognosis if left untreated. Despite this recognition, many patients are inappropriately denied surgery because of perceived risk. This article will examine the etiology, prevalence, and current trends in the treatment of degenerative AS focusing on indications for surgical aortic valve replacement.
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Affiliation(s)
- Jeremy J Thaden
- Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, Rochester, MN
| | - Vuyisile T Nkomo
- Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, Rochester, MN.
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Sintek M, Zajarias A. Patient evaluation and selection for transcatheter aortic valve replacement: the heart team approach. Prog Cardiovasc Dis 2014; 56:572-82. [PMID: 24838133 DOI: 10.1016/j.pcad.2014.02.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has been shown to significantly impact mortality and quality of life in patients with severe aortic stenosis (AS) who are deemed high risk for surgical aortic valve replacement (SAVR). Essential to these outcomes is proper patient selection. The multidisciplinary TAVR heart team was created to provide comprehensive patient evaluation and aid in proper selection. This review with outline the history and components of the heart team, and delineate the team's role in risk and frailty assessment, evaluation of common co-morbidities that impact outcomes, and the complex multi-modality imaging necessary for procedural planning and patient selection. The heart team is critical in determining patient eligibility and benefit and the optimal operative approach for TAVR. The future of structural heart disease will certainly require a team approach, and the TAVR heart team will serve as the successful model.
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Affiliation(s)
- Marc Sintek
- Division of Cardiology, Barnes Jewish Hospital, Washington University School of Medicine, St Louis, MO
| | - Alan Zajarias
- Division of Cardiology, Barnes Jewish Hospital, Washington University School of Medicine, St Louis, MO.
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35
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Long Term Follow-Up After Aortic Valve Replacement (Ross Procedure): Echocardiographic Determinants of Ventricular Recovery. Heart Lung Circ 2014; 23:132-43. [DOI: 10.1016/j.hlc.2013.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 06/28/2013] [Accepted: 07/10/2013] [Indexed: 11/21/2022]
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Elmariah S, Palacios IF, McAndrew T, Hueter I, Inglessis I, Baker JN, Kodali S, Leon MB, Svensson L, Pibarot P, Douglas PS, Fearon WF, Kirtane AJ, Maniar HS, Passeri JJ. Outcomes of transcatheter and surgical aortic valve replacement in high-risk patients with aortic stenosis and left ventricular dysfunction: results from the Placement of Aortic Transcatheter Valves (PARTNER) trial (cohort A). Circ Cardiovasc Interv 2013; 6:604-14. [PMID: 24221391 DOI: 10.1161/circinterventions.113.000650] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The Placement of Aortic Transcatheter Valves (PARTNER) trial demonstrated similar survival after transcatheter and surgical aortic valve replacement (TAVR and SAVR, respectively) in high-risk patients with symptomatic, severe aortic stenosis. The aim of this study was to evaluate the effect of left ventricular (LV) dysfunction on clinical outcomes after TAVR and SAVR and the impact of aortic valve replacement technique on LV function. METHODS AND RESULTS The PARTNER trial randomized high-risk patients with severe aortic stenosis to TAVR or SAVR. Patients were stratified by the presence of LV ejection fraction (LVEF) <50%. All-cause mortality was similar for TAVR and SAVR at 30-days and 1 year regardless of baseline LV function and valve replacement technique. In patients with LV dysfunction, mean LVEF increased from 35.7±8.5% to 48.6±11.3% (P<0.0001) 1 year after TAVR and from 38.0±8.0% to 50.1±10.8% after SAVR (P<0.0001). Higher baseline LVEF (odds ratio, 0.90 [95% confidence interval, 0.86, 0.95]; P<0.0001) and previous permanent pacemaker (odds ratio, 0.34 [95% confidence interval, 0.15, 0.81]) were independently associated with reduced likelihood of ≥10% absolute LVEF improvement by 30 days; higher mean aortic valve gradient was associated with increased odds of LVEF improvement (odds ratio, 1.04 per 1 mm Hg [95% confidence interval, 1.01, 1.08]). Failure to improve LVEF by 30 days was associated with adverse 1-year outcomes after TAVR but not SAVR. CONCLUSIONS In high-risk patients with severe aortic stenosis and LV dysfunction, mortality rates and LV functional recovery were comparable between valve replacement techniques. TAVR is a feasible alternative for patients with symptomatic severe aortic stenosis and LV dysfunction who are at high risk for SAVR. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
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Affiliation(s)
- Sammy Elmariah
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (S.E., I.F.P., I.I., J.N.B., J.J.P.); Harvard Clinical Research Institute, Boston, MA (S.E.); Columbia University Medical Center/New York-Presbyterian Hospital and The Cardiovascular Research Foundation (T.M., I.H., S.K., M.B.L., A.J.K.); Department of Cardiovascular Medicine, Cleveland Clinic, OH (L.S.); Québec Heart and Lung Institute, Laval University, Québec, Canada (P.P.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (W.F.F.); and Division of Cardiothoracic Surgery, Washington University, St. Louis, MO (H.S.M.)
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Bauer F, Coutant V, Bernard M, Stepowski D, Tron C, Cribier A, Bessou JP, Eltchaninoff H. Patients With Severe Aortic Stenosis and Reduced Ejection Fraction: Earlier Recovery of Left Ventricular Systolic Function After Transcatheter Aortic Valve Implantation Compared With Surgical Valve Replacement. Echocardiography 2013; 30:865-70. [DOI: 10.1111/echo.12171] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Aithoussa M, Moutakiallah Y, Abdou A, Bamous M, Nya F, Atmani N, Seghrouchni A, Selkane C, Amahzoune B, Wahid FA, Elbekkali Y, Drissi M, Berrada N, Azendour H, Boulahya A. [Surgery of aortic regurgitation with reduced left ventricular function]. Ann Cardiol Angeiol (Paris) 2013; 62:101-7. [PMID: 23312336 DOI: 10.1016/j.ancard.2012.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 04/08/2012] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aortic valve replacement improves clinical symptoms and left ventricular systolic function in patients with chronic aortic regurgitation despite a higher surgical risk. The objective of this study is to determine if left ventricular function will be normalized after surgery. PATIENTS AND METHOD This retrospective study included 40 patients (nine females and 31 males) with chronic aortic regurgitation and left ventricular systolic dysfunction who were evaluated by echocardiography Doppler. Were included patients with left ventricular ejection fraction less or equal to 45%. Ages ranged from 18 to 77 years (mean = 46.4 ± 12.6 years). Preoperatively, six patients (15%) were asymptomatic, ten (25%) were in NYHA II, half (50%) in NYHA III and four (10%) in NYHA IV. The mean preoperative ejection fraction (EF) was 36.2 ± 2%. The mean end systolic and diastolic dimensions were 61.7 ± 8.5 mm and 78.9 ± 9.7 mm respectively. Aortic regurgitation was quantified grade III in sixteen patients (40%) and grade IV in twenty-four (60%). RESULTS Thirty-seven patients underwent aortic valve replacement and three Bentall operations. Hospital mortality was 7.5% (3/40). The mean follow-up period was 69.7 months. All survivor patients were investigated. Out of these, five were lost and 32 were controlled. Symptomatic improvement was noted in most of the survivors. Sixty percent (24/40) were severely symptomatic before and only 6.25% (2/32) during follow-up. The ejection fraction increased significantly after surgery (36.2 ± 2% in preoperative period vs. 55.2 ± 10% in postoperative period, P < 0.02). Left ventricular diameters decreased significantly also. Survival rates were 3-year 94%, 5-year 91% and 7-year 89%. CONCLUSION Despite reduced left ventricular systolic function, aortic valve replacement in chronic aortic regurgitation was associated with acceptable operative risk. Surgery improves functional status, symptoms and ejection fraction in most patients.
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Affiliation(s)
- M Aithoussa
- Service de chirurgie cardiaque, hôpital militaire d'instruction Mohammed V, Hay Riyad, BB 10100 Rabat, Maroc.
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Abstract
OPINION STATEMENT Advanced heart failure (HF) is a condition that is rarely thought of in terms of cure. Left ventricular assist devices (LVADs), like no therapy before them, provide complete decongestion of the left ventricle, with resulting favorable changes at all levels, from reversal of hypertrophy of cardiomyocytes to recovery of normal geometry and function of the ventricles. Although not a frequent phenomenon at most institutions, LV recovery is achieved in 20-25 % of LVAD recipients in some programs. Patients with good chances for recovery are usually young, with nonischemic cardiomyopathy and short duration of HF symptoms. After LVAD removal, patients with recovered function remain asymptomatic for years. To reach this level of sustainable restoration of cardiac function, several steps need to be taken: 1) myocardial recovery has to be recognized as a therapeutic goal, especially in patients with nonischemic cardiomyopathy; 2) HF medications have to be restarted and aggressively uptitrated after LVAD implantation; 3) regular monitoring for signs of myocardial recovery (eg, echocardiography or hemodynamics) should become a standard practice in LVAD centers; and 4) weaning protocols should be discussed and accepted at each LVAD program. While some protocols involve extensive several-day testing both at rest and with exercise, others are mostly guided by echocardiographic evaluation.
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Vizzardi E, D’Aloia A, Fiorina C, Bugatti S, Parrinello G, De Carlo M, Giannini C, Di Bello V, Petronio AS, Curello S, Ettori F, Dei Cas L. Early Regression of Left Ventricular Mass Associated with Diastolic Improvement after Transcatheter Aortic Valve Implantation. J Am Soc Echocardiogr 2012; 25:1091-8. [DOI: 10.1016/j.echo.2012.06.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Indexed: 01/29/2023]
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Kempny A, Diller GP, Kaleschke G, Orwat S, Funke A, Radke R, Schmidt R, Kerckhoff G, Ghezelbash F, Rukosujew A, Reinecke H, Scheld HH, Baumgartner H. Longitudinal left ventricular 2D strain is superior to ejection fraction in predicting myocardial recovery and symptomatic improvement after aortic valve implantation. Int J Cardiol 2012; 167:2239-43. [PMID: 22766243 DOI: 10.1016/j.ijcard.2012.06.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 06/07/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Predicting improvement of myocardial function after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS) remains a challenge. As ejection fraction (EF) may be of limited value in detecting early myocardial dysfunction and predicting outcome, we assessed the potential of echocardiographic longitudinal function in this setting. MATERIALS AND METHODS Left ventricular (LV) function was assessed using EF, mitral annular plane systolic excursion (MAPSE), peak longitudinal 2D strain (LS) and strain rate (SR) in101consecutive patients with severe symptomatic AS (age 81 ± 11 years) undergoing TAVI. Echocardiography and assessment of clinical status including NYHA functional class were performed prior and after intervention (median 70 days). RESULTS Pre-interventional EF was 57 ± 17% and 32 patients (32%) had an EF<50% while 58 patients (57%) were found to have an impaired LS. After TAVI there was no significant change in EF. In contrast, LS, SR and MAPSE improved significantly (-14.0 ± 4.4 vs. -15.5 ± 4.0%; p=0.007, 0.68 ± 0.24 vs. 0.78 ± 0.23/s, p=0.002; and 9.1 ± 3.2 vs. 10.2 ± 3.3mm, p=0.006, respectively). Receiver Operating Curve characteristic analysis identified a pre-TAVI LS>-13.3% as the optimal cut-off value for predicting lack of LS recovery post TAVI. There was a marked improvement in NYHA FC after intervention (p=0.0002). Among the studied echocardiographic parameters LS change correlated closest with NYHA class improvement (r=0.42, p=0.0008). CONCLUSION Overall, LS appears to be more sensitive for detecting early myocardial damage in patients with AS compared to conventional echocardiographic parameters. More importantly, pre-interventional LS may identify irreversible myocardial dysfunction and LS improvement correlates with symptomatic improvement after intervention.
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Affiliation(s)
- Aleksander Kempny
- Adult Congenital and Valvular Heart Disease Center, Department of Cardiology and Angiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
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van der Boon RM, Nuis RJ, Van Mieghem NM, Benitez LM, van Geuns RJ, Galema TW, van Domburg RT, Geleijnse ML, Dager A, de Jaegere PP. Clinical outcome following transcatheter aortic valve implantation in patients with impaired left ventricular systolic function. Catheter Cardiovasc Interv 2012; 79:702-10. [DOI: 10.1002/ccd.23423] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 10/09/2011] [Indexed: 11/08/2022]
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Neema PK, Singha SK, Manikandan S, Muralikrishna T, Rathod RC, Dhawan R, Stafford-Smith M. Case 6-2011: Aortic valve replacement in a patient with aortic stenosis, dilated cardiomyopathy, and renal dysfunction. J Cardiothorac Vasc Anesth 2011; 25:1193-9. [PMID: 21924640 DOI: 10.1053/j.jvca.2011.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Indexed: 11/11/2022]
Affiliation(s)
- Praveen Kumar Neema
- Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
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Morimoto K, Kimura A, Nishimura K, Miyasaka S, Maeta H, Taniguchi I. Aortic valve replacement combined with the endoventricular patch technique for aortic valve stenosis complicated by ischemic heart disease. Ann Thorac Cardiovasc Surg 2011; 17:607-10. [PMID: 21881366 DOI: 10.5761/atcs.cr.10.01618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The indication for aortic valve replacement (AVR) combined left ventricular (LV) plasty in the patient with aortic valve stenosis (AS) complicated by ischemic heart disease is controversial. We describe a case of AS with ischemic heart disease of a patient who underwent a successful surgical treatment, AVR combined with the endoventricular patch technique. The patient was an 82-year-old woman who suffered from heart failure, New York Heart Association (NYHA) class III. The heart failure derived from AS and ischemic heart disease with severely compromised LV function. She underwent AVR combined with the endoventricular patch technique and the postoperative course was uneventful. She has been well with NYHA class I for about 5 years after the operation without heart failure.
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Affiliation(s)
- Keisuke Morimoto
- Department of Thoracic and Cardiovascular Surgery, Tottori Prefectural Central Hospital, 730 Ezu, Tottori, Japan.
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Impact of concomitant aortic regurgitation on long-term outcome after surgical aortic valve replacement in patients with severe aortic stenosis. J Cardiothorac Surg 2011; 6:51. [PMID: 21489286 PMCID: PMC3084170 DOI: 10.1186/1749-8090-6-51] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Accepted: 04/13/2011] [Indexed: 11/29/2022] Open
Abstract
Background Prognostic value of concomitant aprtic regurgitation (AR) in patients operated for severe aortic stenosis (AS) is not clarified. The aim of this study was to prospectively examine the impact of presence and severity of concomitant AR in patients operated for severe AS on long-term functional capacity, left ventricular (LV) function and mortality. Methods Study group consisted of 110 consecutive patients operated due to severe AS. The patients were divided into AS group (56 patients with AS without AR or with mild AR) and AS+AR group (54 patients with AS and moderate, severe or very severe AR). Follow-up included clinical examination, six minutes walk test (6MWT) and echocardiography 12 and 104 months after AVR. Results Patients in AS group had lower LV volume indices throughout the study than patients in AS+AR group. Patients in AS group did not have postoperative decrease in LV volume indices, whereas patients in AS+AR group experienced decrease in LV volume indices at 12 and 104 months. Unlike LV volume indices, LV mass index was significantly lower in both groups after 12 and 104 months as compared to preoperative values. Mean LVEF remained unchanged in both groups throughout the study. NYHA class was improved in both groups at 12 months, but at 104 months remained improved only in patients with AS. On the other hand, distance covered during 6MWT was longer at 104 months as compared to 12 months only in AS+AR group (p = 0,013), but patients in AS group walked longer at 12 months than patients in AS+AR group (p = 0,002). There were 30 deaths during study period, of which 13 (10 due to cardiovascular causes) in AS group and 17 (12 due to cardiovascular causes) in AS+AR group. Kaplan-Meier analysis showed that the survival probability was similar between the groups. Multivariate analysis identified diabetes mellitus (beta 1.78, p = 0.038) and LVEF < 45% (beta 1.92, p = 0.049) as the only independent predictor of long-term mortality. Conclusion Our data indicate that the preoperative presence and severity of concomitant AR has no influence on long-term postoperative outcome, LV function and functional capacity in patients undergoing AVR for severe AS.
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Ewe SH, Ajmone Marsan N, Pepi M, Delgado V, Tamborini G, Muratori M, Ng AC, van der Kley F, de Weger A, Schalij MJ, Fusari M, Biglioli P, Bax JJ. Impact of left ventricular systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation for severe aortic stenosis. Am Heart J 2010; 160:1113-20. [PMID: 21146666 DOI: 10.1016/j.ahj.2010.09.003] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 09/03/2010] [Indexed: 02/08/2023]
Abstract
BACKGROUND This study aimed to evaluate the impact of baseline left ventricular (LV) systolic function on clinical and echocardiographic outcomes following transcatheter aortic valve implantation (TAVI). Survival of patients undergoing TAVI was also compared with that of a population undergoing surgical aortic valve replacement. METHODS One hundred forty-seven consecutive patients (mean age=80±7 years) undergoing TAVI in 2 centers were included. Mean follow-up period was 9.1±5.1 months. RESULTS At baseline, 34% of patients had impaired LV ejection fraction (LVEF) (<50%) and 66% had normal LVEF (≥50%). Procedural success was similar in these 2 groups (94% vs 97%, P=.41). All patients achieved improvement in transvalvular hemodynamics. At follow-up, patients with a baseline LVEF<50% showed marked LV reverse remodeling, with improvement of LVEF (from 37%±8% to 51%±11%). Early and late mortality rates were not different between the 2 groups, despite a higher rate of combined major adverse cardiovascular events (MACEs) in patients with a baseline LVEF<50%. The predictors of cumulative MACEs were baseline LVEF (HR=0.97, 95% CI=0.94-0.99) and preoperative frailty (HR=4.20, 95% CI=2.00-8.84). In addition, long-term survival of patients with impaired or normal LVEF was comparable with that of a matched population who underwent surgical aortic valve replacement. CONCLUSIONS TAVI resulted in significant improvement in LV function and survival benefit in high-risk patients with severe aortic stenosis, regardless of baseline LVEF. Patients with a baseline LVEF<50% were at higher risk of combined MACEs.
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Long-term predictors of mortality and functional recovery after aortic valve replacement for severe aortic stenosis with left ventricular dysfunction. Rev Esp Cardiol 2010; 63:36-45. [PMID: 20089224 DOI: 10.1016/s1885-5857(10)70007-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES At present, surgery is the only recommended effective treatment for severe aortic stenosis. However, the surgical risk is increased when left ventricular dysfunction is present. The aim of this study was to identify predictors of postoperative and long-term mortality and functional improvement after valve replacement in patients with severe aortic stenosis and left ventricular dysfunction. METHODS Between 1996 and 2008, 635 consecutive patients with severe aortic stenosis underwent surgery. Early postoperative mortality in the 82 with an ejection fraction <40% was 19.5%. The following independent predictors of early postoperative mortality were identified: female sex (odds ratio [OR]=2.60; 95% confidence interval [CI], 2.20-89.0; P=.004), mild mitral regurgitation (OR=2.38; 95% CI, 1.40-80.0; P=.020) and coronary artery disease (OR=2.09; 95% CI, 1.26-51.0; P=.027). RESULTS During the mean follow-up period of 42.59+/-40.83 months, overall mortality was 18.8% and cardiovascular mortality was 11.3%. The only factor associated with increased mortality during follow-up was a low postoperative cardiac output (OR=4.40; 95% CI, 1.20-15.5; P=.02). In total, 70.5% showed early improvement in ventricular function, the predictors of which were: no improvement following a previous myocardial infarction (P=.04), no revascularized coronary lesions (P=.04), and a low aortic valve pressure gradient (P=.02). Functional class improved significantly during follow-up in 93.4% of patients. CONCLUSIONS Despite considerable early postoperative mortality in patients with aortic stenosis and left ventricular dysfunction, over the long term there was evidence of better survival coupled to improved ventricular function and functional class.
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Predictores de mortalidad y recuperación funcional a largo plazo en el reemplazo valvular por estenosis aórtica severa con disfunción ventricular. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70007-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hannan EL, Samadashvili Z, Lahey SJ, Smith CR, Culliford AT, Higgins RS, Gold JP, Jones RH. Aortic Valve Replacement for Patients With Severe Aortic Stenosis: Risk Factors and Their Impact on 30-Month Mortality. Ann Thorac Surg 2009; 87:1741-9. [DOI: 10.1016/j.athoracsur.2009.02.058] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2008] [Revised: 02/18/2009] [Accepted: 02/20/2009] [Indexed: 10/20/2022]
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Survival after valve replacement for aortic stenosis: Implications for decision making. J Thorac Cardiovasc Surg 2008; 135:1270-8; discussion 1278-9. [DOI: 10.1016/j.jtcvs.2007.12.042] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 11/29/2007] [Accepted: 12/18/2007] [Indexed: 11/17/2022]
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