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Hoedemakers S, Verwerft J, Reddy YNV, Delvaux R, Stroobants S, Jogani S, Claessen G, Droogmans S, Cosyns B, Borlaug BA, Herbots L, Verbrugge FH. Cardiac dysfunction rather than aortic valve stenosis severity drives exercise intolerance and adverse haemodynamics. Eur Heart J Cardiovasc Imaging 2024; 25:302-312. [PMID: 37875135 DOI: 10.1093/ehjci/jead276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 08/16/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023] Open
Abstract
AIMS To study the impact of heart failure with preserved ejection fraction (HFpEF) vs. aortic stenosis (AS) lesion severity on left ventricular (LV) hypertrophy, diastolic dysfunction, left atrial (LA) dysfunction, haemodynamics, and exercise capacity. METHODS AND RESULTS Patients (n = 206) with at least moderate AS (aortic valve area ≤0.85 cm/m2) and discordant symptoms underwent cardiopulmonary exercise testing with simultaneous echocardiography. The population was stratified according to the probability of underlying HFpEF by the heavy, hypertension, atrial fibrillation, pulmonary hypertension, elder, filling pressure (H2FPEF) score [0-5 (AS/HFpEF-) vs. 6-9 points (AS/HFpEF+)] and AS severity (Moderate vs. Severe). Mean age was 73 ± 10 years with 40% women. Twenty-eight patients had Severe AS/HFpEF+ (14%), 111 Severe AS/HFpEF- (54%), 13 Moderate AS/HFpEF+ (6%), and 54 Moderate AS/HFpEF- (26%). AS/HFpEF+ vs. AS/HFpEF- patients, irrespective of AS severity, had a lower LV global longitudinal strain, impaired diastolic function, reduced LV compliance, and more pronounced LA dysfunction. The pulmonary arterial pressure-cardiac output slope was significantly higher in AS/HFpEF+ vs. AS/HFpEF- (5.4 ± 3.1 vs. 3.9 ± 2.2 mmHg/L/min, respectively; P = 0.003), mainly driven by impaired cardiac output and chronotropic reserve, with signs of right ventricular pulmonary arterial uncoupling. AS/HFpEF+ vs. AS/HFpEF- was associated with a lower peak aerobic capacity (11.5 ± 3.7 vs. 15.9 ± 5.9 mL/min/kg, respectively; P < 0.0001) but did not differ between Moderate and Severe AS (14.7 ± 5.5 vs. 15.2 ± 5.9 mL/min/kg, respectively; P = 0.6). CONCLUSION A high H2FPEF score is associated with a reduced exercise capacity and adverse haemodynamics in patients with moderate to severe AS. Both exercise performance and haemodynamics correspond better with intrinsic cardiac dysfunction than AS severity.
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Affiliation(s)
- Sarah Hoedemakers
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, University Hasselt (UHasselt), Hasselt, Belgium
- Centre for Cardiovascular Diseases, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Jan Verwerft
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, University Hasselt (UHasselt), Hasselt, Belgium
| | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Robin Delvaux
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, University Hasselt (UHasselt), Hasselt, Belgium
| | | | | | - Guido Claessen
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
- Department of Cardiology, University Hospital Leuven, Leuven, Belgium
| | - Steven Droogmans
- Centre for Cardiovascular Diseases, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Bernard Cosyns
- Centre for Cardiovascular Diseases, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Belgium
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, 1216 2nd St SW, Rochester, MN 55902, USA
| | - Lieven Herbots
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
- Biomedical Research Institute, Faculty of Medicine and Life Sciences, University Hasselt (UHasselt), Hasselt, Belgium
| | - Frederik H Verbrugge
- Centre for Cardiovascular Diseases, University Hospital Brussels, Laarbeeklaan 101, 1090 Jette, Belgium
- Department of Cardiovascular Medicine, Mayo Clinic, 1216 2nd St SW, Rochester, MN 55902, USA
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Jette, Belgium
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Panç C, Güler A, Doğan AC, Gülmez R, Güner A, Çelik Ö. Fragmented QRS complex may predict long-term mortality after isolated surgical aortic valve replacement in patients with severe aortic stenosis. Interact Cardiovasc Thorac Surg 2022; 34:26-32. [PMID: 34999796 PMCID: PMC8923387 DOI: 10.1093/icvts/ivab214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Fragmented QRS (fQRS), related to myocardial fibrosis, is an important prognostic marker of cardiovascular events and mortality. Aortic stenosis (AS), the most frequent valvular heart disease in developed countries, causes myocardial fibrosis due to ventricular pressure overload. The current study aimed to investigate whether fQRS is associated with long-term mortality after isolated surgical aortic valve replacement (SAVR) in patients with severe AS. METHODS A total of 289 patients who underwent SAVR for severe AS between May 2009 and January 2020 with interpretable electrocardiogram were included. Patients were divided into 2 groups according to the presence of fQRS. Kaplan-Meier survival analyses were used to detect cumulative survival rates. Univariable and multivariable Cox proportional hazards models were used to determine the predictors of all-cause mortality. RESULTS fQRS occurred in 126 (43.5%) patients. A total of 59 (20.4%) patients died over a follow-up period of 54 ± 32 months. All-cause mortality was higher in the fQRS group (23 [14.1%] vs 36 [28.6], log-rank test P = 0.002) in the long term. The presence of fQRS [hazard ratio (HR): 1.802, confidence interval (CI): 1.035-3.135, P = 0.037], electrocardiographic left ventricular strain (HR: 1.836, CI: 1.036-3.254, P = 0.038) and history of stroke or transient ischaemic attack (HR: 3.130, CI: 1.528-6.412, P = 0.002) were independent predictors of all-cause mortality in the multivariable Cox regression model. CONCLUSIONS fQRS is associated with a 1.8-fold increase in long-term mortality in patients undergoing isolated SAVR for severe AS. Detecting fQRS in electrocardiograms may provide prognostic information about the long-term outcomes.
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Affiliation(s)
- Cafer Panç
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Arda Güler
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Arda Can Doğan
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Recep Gülmez
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ömer Çelik
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Haider A, Khwaja IA, Khan AH, Yousaf MS, Zaneb H, Qureshi AB, Rehman H. Efficacy of Whole-Blood Del Nido Cardioplegia Compared with Diluted Del Nido Cardioplegia in Coronary Artery Bypass Grafting: A Retrospective Monocentric Analysis of Pakistan. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:918. [PMID: 34577841 PMCID: PMC8470719 DOI: 10.3390/medicina57090918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 01/02/2023]
Abstract
Background and Objectives: Cardioplegia is one of the most significant components used to protect the myocardium during cardiac surgery. There is a paucity of evidence regarding the utilization of whole-blood Del Nido cardioplegia (WB-DNC) on clinical outcomes in coronary artery bypass grafting (CABG). The purpose of this retrospective cross-sectional study is to compare the effectiveness of diluted (blood to crystalloid; 1:4) Del Nido cardioplegia (DNC) with WB-DNC in patients who underwent elective CABG in a tertiary care hospital in Lahore-Pakistan. Materials and Methods: This was a retrospective descriptive study conducted at the Department of Cardiovascular Surgery, King Edward Medical University, Lahore. The medical database of all consecutive patients admitted from January 2018 to March 2020 and who fulfilled the inclusion criteria were reviewed. Results: Out of 471 patients admitted during the study period, 450 underwent various elective cardiac surgeries. Out of 450, 321 patients (71.33%) were operated on for CABG. Only 234/321 (72.89%) CABG patients fulfilled our inclusion criteria; 120 (51.28%) patients received WB-DNC, while 114 (48.71%) patients were administered with DNC. The former group presented with better clinical outcomes compared with the latter in terms of lesser requirements of inotropic support, low degree of hemodilution, shorter in-hospital stay, improved renal function, and cost-effectiveness. Peak values of serum Troponin-T (Trop-T), creatine kinase-myocardial band (CK-MB) release, and activated clotting time (ACT) were also lower in the WB-DNC group compared with the DNC group. Conclusions: The WB-DNC conferred better myocardial protection, improved early clinical outcomes, and also proved to be economical for patients undergoing elective CABG compared with classical crystalloid cardioplegia solution.
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Affiliation(s)
- Adnan Haider
- Department of Physiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan; (A.H.); (M.S.Y.)
- Department of Cardiovascular Surgery, King Edward Medical University, Lahore 54000, Pakistan;
| | - Irfan Azmatullah Khwaja
- Department of Cardiovascular Surgery, King Edward Medical University, Lahore 54000, Pakistan;
| | - Ammar Hameed Khan
- Department of Cardiovascular Surgery, Shalamar Medical and Dental College, Lahore 54812, Pakistan;
| | - Muhammad Shahbaz Yousaf
- Department of Physiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan; (A.H.); (M.S.Y.)
| | - Hafsa Zaneb
- Department of Anatomy and Histology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan;
| | - Abdul Basit Qureshi
- Department of Surgery, Services Institute of Medical Sciences, Lahore 54810, Pakistan;
| | - Habib Rehman
- Department of Physiology, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan; (A.H.); (M.S.Y.)
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Bernard J, Tastet L, Capoulade R, Shen M, Clisson M, Guzzetti E, Larose É, Arsenault M, Bédard É, Côté N, Clavel MA, Pibarot P. Left ventricular asymmetric remodeling and subclinical left ventricular dysfunction in patients with calcific aortic valve stenosis - Results from a subanalysis of the PROGRESSA study. Int J Cardiol 2021; 332:148-156. [PMID: 33727121 DOI: 10.1016/j.ijcard.2021.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/09/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND LV asymmetric remodeling (LVAR) is a feature commonly found in AS patients and it is presumed to be mainly related to the severity of valve stenosis. The aim of this study was to determine the associated factors and impact on left ventricular (LV) systolic function of LVAR in patients with mild and moderate aortic valve stenosis (AS). METHODS Clinical, Doppler-echocardiographic and computed-tomographic data of 155 AS patients with preserved LV ejection fraction (≥50%) prospectively recruited in the PROGRESSA study (NCT01679431) were analyzed. LVAR was defined as a septal wall thickness ≥ 13 mm and a ratio of septal/posterior wall thickness > 1.5. LV global longitudinal strain (LV-GLS) was available in 129 patients. Plasma levels of N-terminal natriuretic B-type peptides (Nt-proBNP) were also measured. RESULTS Mean age was 63 ± 15 years (70% men). LVAR was present in 21% (n = 33) of patients. A series of nested multivariate analysis revealed that age was the only factor associated with LVAR (all p ≤ 0.03). Additionally, these patients had higher baseline Nt-proBNP ratio (median [25-75 percentiles]: 1.04 [0.66-2.41] vs. 0.65 [0.33-1.19], p = 0.02), and significantly reduced LV-GLS (17.9[16.6-19.5] vs. 19.3[17.4-20.7] |%|, p = 0.04). A 1:1 matched analysis showed a significant association of LVAR with reduced LV-GLS (17.9[16.6-19.5] vs. 19.8[18.1-20.7] |%|, p = 0.02) and elevated Nt-proBNP (134[86-348] vs. 83[50-179]pg/ml, p = 0.03). Multivariable analysis also revealed that LVAR remains significantly associated with reduced LV-GLS (p = 0.03) and elevated Nt-proBNP (p = 0.001). LVAR was significantly associated with increased risk of major adverse cardiac events and death (Hazard ratio [95% confidence interval]: 2.32[1.28-4.22], p = 0.006). CONCLUSIONS LVAR was found in ~20% of patients with mild or moderate AS and was not related to the degree of AS severity or concomitant comorbidities, but rather to older age. LVAR was significantly associated with reduced LV longitudinal systolic function, increased Nt-proBNP levels, and higher risk of major adverse events and death. These findings provide support for closer clinical and echocardiographic surveillance of patients harboring this adverse LV remodeling feature.
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Affiliation(s)
- Jérémy Bernard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Lionel Tastet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Romain Capoulade
- l'institut du thorax, INSERM, CNRS UNIV Nantes, CHU Nantes, Nantes, France
| | - Mylène Shen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Marine Clisson
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Éric Larose
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Marie Arsenault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Élisabeth Bédard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Nancy Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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