1
|
Falcão-Pires I, Ferreira AF, Trindade F, Bertrand L, Ciccarelli M, Visco V, Dawson D, Hamdani N, Van Laake LW, Lezoualc'h F, Linke WA, Lunde IG, Rainer PP, Abdellatif M, Van der Velden J, Cosentino N, Paldino A, Pompilio G, Zacchigna S, Heymans S, Thum T, Tocchetti CG. Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function. Eur J Heart Fail 2024. [PMID: 38837573 DOI: 10.1002/ejhf.3264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/22/2024] [Accepted: 04/18/2024] [Indexed: 06/07/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbimortality in Europe and worldwide. CVD imposes a heterogeneous spectrum of cardiac remodelling, depending on the insult nature, that is, pressure or volume overload, ischaemia, arrhythmias, infection, pathogenic gene variant, or cardiotoxicity. Moreover, the progression of CVD-induced remodelling is influenced by sex, age, genetic background and comorbidities, impacting patients' outcomes and prognosis. Cardiac reverse remodelling (RR) is defined as any normative improvement in cardiac geometry and function, driven by therapeutic interventions and rarely occurring spontaneously. While RR is the outcome desired for most CVD treatments, they often only slow/halt its progression or modify risk factors, calling for novel and more timely RR approaches. Interventions triggering RR depend on the myocardial insult and include drugs (renin-angiotensin-aldosterone system inhibitors, beta-blockers, diuretics and sodium-glucose cotransporter 2 inhibitors), devices (cardiac resynchronization therapy, ventricular assist devices), surgeries (valve replacement, coronary artery bypass graft), or physiological responses (deconditioning, postpartum). Subsequently, cardiac RR is inferred from the degree of normalization of left ventricular mass, ejection fraction and end-diastolic/end-systolic volumes, whose extent often correlates with patients' prognosis. However, strategies aimed at achieving sustained cardiac improvement, predictive models assessing the extent of RR, or even clinical endpoints that allow for distinguishing complete from incomplete RR or adverse remodelling objectively, remain limited and controversial. This scientific statement aims to define RR, clarify its underlying (patho)physiologic mechanisms and address (non)pharmacological options and promising strategies to promote RR, focusing on the left heart. We highlight the predictors of the extent of RR and review the prognostic significance/impact of incomplete RR/adverse remodelling. Lastly, we present an overview of RR animal models and potential future strategies under pre-clinical evaluation.
Collapse
Affiliation(s)
- Inês Falcão-Pires
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ana Filipa Ferreira
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fábio Trindade
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Luc Bertrand
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Pôle of Cardiovascular Research, Brussels, Belgium
- WELBIO, Department, WEL Research Institute, Wavre, Belgium
| | - Michele Ciccarelli
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Valeria Visco
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Nazha Hamdani
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- HCEMM-SU Cardiovascular Comorbidities Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht, Maastricht, the Netherlands
| | - Linda W Van Laake
- Division Heart and Lungs, Department of Cardiology and Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Lezoualc'h
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm, Université Paul Sabatier, UMR 1297-I2MC, Toulouse, France
| | - Wolfgang A Linke
- Institute of Physiology II, University Hospital Münster, Münster, Germany
| | - Ida G Lunde
- Oslo Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway
- KG Jebsen Center for Cardiac Biomarkers, Campus Ahus, University of Oslo, Oslo, Norway
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
- St. Johann in Tirol General Hospital, St. Johann in Tirol, Austria
| | - Mahmoud Abdellatif
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
| | | | - Nicola Cosentino
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessia Paldino
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giulio Pompilio
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Serena Zacchigna
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Stephane Heymans
- Department of Cardiology, CARIM Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
- Centre of Cardiovascular Research, University of Leuven, Leuven, Belgium
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
| |
Collapse
|
2
|
Wakami T, Fukunaga N, Shimoji A, Maeda T, Mori O, Yoshizawa K, Tamura N. Mid-term outcomes and hemodynamic performance of the St Jude Medical Epic aortic bioprosthesis for severe aortic stenosis. J Artif Organs 2024; 27:125-130. [PMID: 37291209 DOI: 10.1007/s10047-023-01405-z] [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: 12/02/2022] [Accepted: 05/10/2023] [Indexed: 06/10/2023]
Abstract
The St. Jude Medical Epic Supra valve is a porcine bioprosthesis designed for complete supraannular implantation. No report has shown the hemodynamic performance and clinical outcomes of aortic valve replacement with the Epic Supra valve for severe aortic stenosis in a Japanese cohort. We retrospectively evaluated 65 patients who underwent aortic valve replacement using the Epic Supra valve for aortic stenosis at our department between May, 2011 and October, 2016. The mean follow-up period was 68.7 ± 32.7 months, and the follow-up rate was 89.2%. The mean age was 76.8 ± 5.3 years. The 1-, 5-, and 8-year survival rates were 96.9%, 79.4%, and 60.3%, respectively. The rates of freedom from valve-related events were 96.6% and 81.9% at 5 and 8 years, respectively. Four patients were diagnosed with structural valve deterioration (SVD), and reintervention was performed in two patients. The rates of freedom from SVD were 98.2% and 83.3% at 5 and 8 years, respectively, and the mean time to diagnosis of SVD was 72.5 ± 25.3 months. The mean pressure gradient (MPG) was 16.8 ± 6.0 mmHg postoperatively, 17.5 ± 9.4 mmHg at 5 years, and 21.2 ± 12.4 mmHg at 8 years (p = 0.08). The effective orifice area index (EOAI) was 0.95 ± 0.2 cm2/m2 immediately after surgery, 0.96 ± 0.27 cm2/m2 at 5 years, and 0.84 ± 0.2 cm2/m2 at 8 years (p = 0.10). An increase in MPG and decrease in EOAI were also observed, which may be associated with SVD. Follow-up after 5 years is important to determine if there is an increase.
Collapse
Affiliation(s)
- Tatsuto Wakami
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Naoto Fukunaga
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan.
| | - Akio Shimoji
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Toshi Maeda
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Otohime Mori
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Kosuke Yoshizawa
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| | - Nobushige Tamura
- Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77, Higashinaniwa-Cho, Amagasaki, Hyogo, 660-8550, Japan
| |
Collapse
|
3
|
Bernhard B, Schütze J, Leib ZL, Spano G, Boscolo Berto M, Bakula A, Tomii D, Shiri I, Brugger N, De Marchi S, Reineke D, Dobner S, Heg D, Praz F, Lanz J, Stortecky S, Pilgrim T, Windecker S, Gräni C. Myocardial analysis from routine 4D cardiac-CT to predict reverse remodeling and clinical outcomes after transcatheter aortic valve implantation. Eur J Radiol 2024; 175:111425. [PMID: 38490128 DOI: 10.1016/j.ejrad.2024.111425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/07/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Our study aimed to determine whether 4D cardiac computed tomography (4DCCT) based quantitative myocardial analysis may improve risk stratification and can predict reverse remodeling (RRM) and mortality after transcatheter aortic valve implantation (TAVI). METHODS Consecutive patients undergoing clinically indicated 4DCCT prior to TAVI were prospectively enrolled. 4DCCT-derived left- (LV) and right ventricular (RV), and left atrial (LA) dimensions, mass, ejection fraction (EF) and myocardial strain were evaluated to predict RRM and survival. RRM was defined by either relative increase in LVEF by 5% or relative decline in LV end diastolic diameter (LVEDD) by 5% assessed by transthoracic echocardiography prior TAVI, at discharge, and at 12-month follow-up compared to baseline prior to TAVI. RESULTS Among 608 patients included in this study (55 % males, age 81 ± 6.6 years), RRM was observed in 279 (54 %) of 519 patients at discharge and in 218 (48 %) of 453 patients at 12-month echocardiography. While no CCT based measurements predicted RRM at discharge, CCT based LV mass index and LVEF independently predicted RRM at 12-month (ORadj = 1.012; 95 %CI:1.001-1.024; p = 0.046 and ORadj = 0.969; 95 %CI:0.943-0.996; p = 0.024, respectively). The most pronounced changes in LVEF and LVEDD were observed in patients with impaired LV function at baseline. In multivariable analysis age (HRadj = 1.037; 95 %CI:1.005-1.070; p = 0.022) and CCT-based LVEF (HRadj = 0.972; 95 %CI:0.945-0.999; p = 0.048) and LAEF (HRadj = 0.982; 95 %CI:0.968-0.996; p = 0.011) independently predicted survival. CONCLUSION Comprehensive myocardial functional information derived from routine 4DCCT in patients with severe aortic stenosis undergoing TAVI could predict reverse remodeling and clinical outcomes at 12-month following TAVI.
Collapse
Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jonathan Schütze
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Zoe L Leib
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Giancarlo Spano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martina Boscolo Berto
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Adam Bakula
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Daijiro Tomii
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Isaac Shiri
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Stefano De Marchi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Cardiovascular Center, Bern University Hospital, Inselspital, University of Bern, Switzerland
| | - Stephan Dobner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
| |
Collapse
|
4
|
Salama A, Ibrahim G, Fikry M, Elsannan MH, Eltahlawi M. Prognostic value of high-sensitive troponin T in patients with severe aortic stenosis undergoing valve replacement surgery. Indian J Thorac Cardiovasc Surg 2024; 40:142-150. [PMID: 38389769 PMCID: PMC10879475 DOI: 10.1007/s12055-023-01594-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 02/24/2024] Open
Abstract
Background Aortic stenosis (AS) is a well-known cause of mortality. We aimed to assess the prognostic value of high-sensitive troponin T (hs-TnT) in symptomatic patients with severe AS and preserved left ventricular ejection fraction (LVEF) after surgical aortic valve replacement (AVR). Patients and methods The study recruited patients with severe symptomatic AS fulfilling the inclusion criteria in the period between April 2020 and February 2022. Comprehensive echocardiography was done. The following parameters were assessed: AS severity, LV mass index (LVMI), left atrium volume index (LAVI), and LVEF. E/e' and LVEF were calculated using the biplane method of Simpsons. Global longitudinal strain (GLS) was assessed by speckle tracking echocardiography. Peripheral blood samples were collected for hs-TnT measurement. All patients underwent surgical AVR. The patients were followed for the following 6 months for major adverse cardiovascular events (MACE). MACE was defined as cardiac death, re-admission for congestive heart failure (CHF) and fatal arrhythmia. Results One hundred and eight patients (mean age = 58.7 ± 7.68 years) with severe AS were recruited. Seventeen patients presented with MACE including 8 cardiac deaths. We divided the patients into two groups based on the normal hs-TnT values. The Kaplan-Meier curve revealed a statistically significant difference in MACE rate among troponin groups (log-rank test = 5.06, p = 0.025). There was significant difference between both groups regarding GLS with smaller GLS in negative hs-TnT group. In multivariate analysis, GLS and hs-TnT were significantly associated with MACE (p = 0.022 and < 0.01 respectively). The cutoff value of hs-TnT of 238.25 had a sensitivity of 70% and a specificity of 81% for predicting future MACE. There was a significant correlation between GLS and troponin (p < 0.001). Conclusions hs-TnT is associated with bad short-term prognosis after AVR. hs-TnT and GLS could be significant predictors for future MACE in patients with severe symptomatic AS and preserved LVEF who underwent AVR. Elevated hs-TnT and impaired GLS could set an indication of early intervention in asymptomatic severe AS.
Collapse
Affiliation(s)
- Alaa Salama
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | - Ghada Ibrahim
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | - Mohammad Fikry
- Cardiology Department, Zagazig University, Zagazig, Egypt
| | | | | |
Collapse
|
5
|
Waller AH, Gardin JM. Does Left Ventricular Mass Have Additional Diagnostic Value in Severe Aortic Stenosis? Am J Cardiol 2023; 207:302-304. [PMID: 37782968 DOI: 10.1016/j.amjcard.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Alfonso H Waller
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
| |
Collapse
|
6
|
Pedersen ALD, Povlsen JA, Rasmussen VG, Frederiksen CA, Christiansen EH, Terkelsen CJ, Vase H, Poulsen SH. Prognostic implications of residual left ventricular hypertrophy and systolic dysfunction in aortic stenosis following transcatheter aortic valve replacement. Int J Cardiovasc Imaging 2023; 39:13-22. [PMID: 36598683 DOI: 10.1007/s10554-022-02688-8] [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: 05/25/2022] [Accepted: 07/01/2022] [Indexed: 01/07/2023]
Abstract
The impact of left ventricle (LV) hypertrophy (LVH) regression on contractility-associated measures, the extent of residual cardiac dysfunction and prognostic implications after the initial remodeling process after transcatheter aortic valve replacement (TAVR) has not been investigated. We aimed to assess whether greater LV mass regression from pre-TAVR to 12-months after TAVR was associated with increased systolic function; and assess the prognostic value of residual LVH, systolic function and contractility-associated measures 12-months after TAVR. A total of 439 symptomatic patients were included and examined by echocardiography. LVH regression was assessed as percentage change in LV mass index (LVMi) from baseline to 12-months after TAVR. Midwall fractional shortening (mFS) and stress-corrected (SC-mFS) were used as contractility-associated measures. Primary outcome was all-cause mortality. SC-mFS increased from 0.94 (0.7) at baseline (BS) to 1.22 (0.7) (p < 0.05) 12-months after TAVR for patients with the most LVH regression, compared to patients with no LV regression (BS 1.06 (0.7) to 1.04 (0.5), NS). At 12-months after TAVR, multivariate analysis showed independent prognostic value of LVEF < 50% or GLS < 15% (HR 1.59, p = 0.049) and mFS < 14% (HR 1.99, p = 0.002) for future all cause death. LVH regression in AS after TAVR is associated with significant improvements of LV systolic function in contrast to patients without LV regression. Residual LVH and subsequent LV systolic dysfunction is substantial 12 months after TAVR and are associated with reduced survival. Impaired mFS and the combination of abnormal LVEF or GLS independently predicted all-cause mortality beyond 12 months after TAVR.
Collapse
Affiliation(s)
| | - Jonas Agerlund Povlsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Vibeke Guldbrand Rasmussen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | | | - Evald Høj Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Christian Juhl Terkelsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Henrik Vase
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| |
Collapse
|
7
|
Hemodynamic performance of INSPIRIS RESILIA aortic bioprosthesis for severe aortic stenosis: 2-year follow-up in Japanese cohort. J Artif Organs 2022; 25:323-328. [DOI: 10.1007/s10047-022-01316-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 01/24/2022] [Indexed: 10/19/2022]
|
8
|
Jin XY, Petrou M, Hu JT, Nicol ED, Pepper JR. Challenges and opportunities in improving left ventricular remodelling and clinical outcome following surgical and trans-catheter aortic valve replacement. Front Med 2021; 15:416-437. [PMID: 34047933 DOI: 10.1007/s11684-021-0852-7] [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: 10/17/2020] [Accepted: 02/20/2021] [Indexed: 11/26/2022]
Abstract
Over the last half century, surgical aortic valve replacement (SAVR) has evolved to offer a durable and efficient valve haemodynamically, with low procedural complications that allows favourable remodelling of left ventricular (LV) structure and function. The latter has become more challenging among elderly patients, particularly following trans-catheter aortic valve implantation (TAVI). Precise understanding of myocardial adaptation to pressure and volume overloading and its responses to valve surgery requires comprehensive assessments from aortic valve energy loss, valvular-vascular impedance to myocardial activation, force-velocity relationship, and myocardial strain. LV hypertrophy and myocardial fibrosis remains as the structural and morphological focus in this endeavour. Early intervention in asymptomatic aortic stenosis or regurgitation along with individualised management of hypertension and atrial fibrillation is likely to improve patient outcome. Physiological pacing via the His-Purkinje system for conduction abnormalities, further reduction in para-valvular aortic regurgitation along with therapy of angiotensin receptor blockade will improve patient outcome by facilitating hypertrophy regression, LV coordinate contraction, and global vascular function. TAVI leaflet thromboses require anticoagulation while impaired access to coronary ostia risks future TAVI-in-TAVI or coronary interventions. Until comparable long-term durability and the resolution of TAVI related complications become available, SAVR remains the first choice for lower risk younger patients.
Collapse
Affiliation(s)
- Xu Yu Jin
- Surgical Echo-Cardiology Services, Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 9DU, UK.
- Cardiac Surgical Physiology and Genomics Group, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK.
| | - Mario Petrou
- Department of Cardiac Surgery, Royal Brompton Hospital, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
| | - Jiang Ting Hu
- Cardiac Surgical Physiology and Genomics Group, Nuffield Division of Clinical Laboratory Sciences, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU, UK
| | - Ed D Nicol
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
- Department of Cardiology, Royal Brompton Hospital, London, SW3 6NP, UK
| | - John R Pepper
- Department of Cardiac Surgery, Royal Brompton Hospital, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College London, London, SW3 6LY, UK
- NIHR Imperial Biomedical Research Centre, London, W2 1NY, UK
| |
Collapse
|
9
|
Barletta G, Del Bene MR, Venditti F, Pilato G, Stefàno P. Surgical aortic valve replacement and left ventricular remodeling: Survival and sex-related differences. Echocardiography 2021; 38:1095-1103. [PMID: 34028878 DOI: 10.1111/echo.15122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/02/2021] [Accepted: 05/07/2021] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To analyze how left ventricular (LV) remodeling and hypertrophy geometry evolve after surgical aortic valve replacement (SAVR) in octogenarian patients, and identify potential sex-related differences and implications for long-term outcomes. METHODS In 170 patients with aortic stenosis ([AS], age 80 ± 4 years, 59% women), hypertrophy geometry and remodeling (LV index) were reanalyzed one year post-SAVR. The six-year outcomes were evaluated. RESULTS Pre-SAVR, 65% of the women and 38.6% of the men (P < .001) showed adaptive remodeling. Concentric hypertrophy was prevalent in adaptive remodeling, and mixed and dilated hypertrophy were more prevalent in maladaptive remodeling. At one year, the remodeling patterns and sex distribution were similar to those observed pre-SAVR, but the LV index decreased in women and increased in men (P < .0001). Women with adaptive remodeling had a higher incidence of persistent concentric hypertrophy with higher LV filling pressures. Long-term survival was better in women and worse in men with adaptive remodeling (P = .039). Men with adaptive remodeling and men with concentric hypertrophy had the highest risk of cardiac death. This risk was similar between sexes for patients with maladaptive remodeling and dilated hypertrophy. Women with LV ejection fraction >55% had a lower risk of cardiac death than men. CONCLUSIONS The long-term outcomes of SAVR differ between sexes in older patients with AS and adaptive LV remodeling. The LV index facilitates studying the pathways of adaptation to AS. The follow-up shifts help explain the sex differences in long-term outcomes post-SAVR. Concentric hypertrophy is associated with the highest risk of cardiac death in men.
Collapse
Affiliation(s)
| | | | | | - Giuseppe Pilato
- Diagnostic Cardiology, Careggi University Hospital, Florence, Italy
| | | |
Collapse
|
10
|
Shishido K, Yamanaka F, Ochiai T, Moriyama N, Yokoyama H, Yokota S, Noguchi K, Yashima F, Tada N, Naganuma T, Araki M, Shirai S, Ueno H, Mizutani K, Tabata M, Takagi K, Watanabe Y, Yamamoto M, Saito S, Hayashida K. Effect of Sex on Mortality and Left Ventricular Remodeling After Transcatheter Aortic Valve Implantation. Circ J 2021; 85:979-988. [PMID: 33907051 DOI: 10.1253/circj.cj-20-1095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of sex on mortality is controversial; furthermore, sex differences in left ventricular (LV) remodeling after transcatheter aortic valve implantation (TAVI) remain unknown.Methods and Results:This study included 2,588 patients (1,793 [69.3%] female) enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI Japanese multicenter registry between October 2013 and May 2017. We retrospectively analyzed the effect of sex on mortality, and evaluated changes in the LV mass index (LVMI) after TAVI. Female sex was significantly associated with lower all-cause and cardiovascular mortality (log-rank P<0.001 for both). Multivariate analysis showed that female sex was independently associated with lower cumulative long-term mortality (hazard ratio 0.615; 95% confidence interval 0.512-0.738; P<0.001). Regression in the LVMI was observed in both sexes, and there was no significant difference in the percentage LVMI regression from baseline to 1 year after TAVI between women and men. Women had a survival advantage compared with men among patients with LVMI regression at 1 year, but not among patients with no LVMI regression. CONCLUSIONS We found that female sex is associated with better survival outcomes after TAVI in a large Japanese registry. Although LVMI regression was observed in women and men after TAVI, post-procedural LV mass regression may be related to the sex differences in mortality.
Collapse
Affiliation(s)
- Koki Shishido
- Department of Cardiology, Shonan Kamakura General Hospital
| | | | - Tomoki Ochiai
- Department of Cardiology, Shonan Kamakura General Hospital
| | | | | | - Shohei Yokota
- Department of Cardiology, Shonan Kamakura General Hospital
| | - Kenichiro Noguchi
- Department of Cardiovascular Surgery, Shonan Kamakura General Hospital
| | | | - Norio Tada
- Department of Cardiology, Sendai Kousei Hospital
| | | | - Motoharu Araki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital
| | | | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University School of Medicine
| | - Kazuki Mizutani
- Department of Cardiovascular Medicine, Osaka City University School of Medicine
| | - Minoru Tabata
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center
| | | | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Canter.,Department of Cardiology, Nagoya Heart Canter
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital
| | | |
Collapse
|
11
|
Trindade F, Saraiva F, Keane S, Leite-Moreira A, Vitorino R, Tajsharghi H, Falcão-Pires I. Preoperative myocardial expression of E3 ubiquitin ligases in aortic stenosis patients undergoing valve replacement and their association to postoperative hypertrophy. PLoS One 2020; 15:e0237000. [PMID: 32946439 PMCID: PMC7500680 DOI: 10.1371/journal.pone.0237000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 07/17/2020] [Indexed: 12/31/2022] Open
Abstract
Currently, aortic valve replacement is the only treatment capable of relieving left ventricle pressure overload in patients with severe aortic stenosis. It aims to improve cardiac function and revert hypertrophy, by triggering myocardial reverse remodeling. Despite immediately relieving afterload, reverse remodeling turns out to be extremely variable. Among other factors, the extent of reverse remodeling may depend on how well ubiquitin-proteasome system tackle hypertrophy. Therefore, we assessed tagged ubiquitin and ubiquitin ligases in the left ventricle collected from patients undergoing valve replacement and tested their association to the degree of reverse remodeling. Patients were classified according to the regression of left ventricle mass (ΔLVM) and assigned to complete (ΔLVM≥15%) or incomplete (ΔLVM≤5%) reverse remodeling groups. No direct inter-group differences were observed. Nevertheless, correlation analysis supports a fundamental role of the ubiquitin-proteasome system during reverse remodeling. Indeed, total protein ubiquitination was associated to hypertrophic indexes such as interventricular septal thickness (r = 0.55, p = 0.03) and posterior wall thickness (r = 0.65, p = 0.009). No significant correlations were observed for Muscle Ring Finger 3. Surprisingly, though, higher levels of atrogin-1 were associated to postoperative interventricular septal thickness (r = 0.71, p = 0.005). In turn, Muscle Ring Finger 1 correlated negatively with this postoperative hypertrophy marker (r = -0.68, p = 0.005), suggesting a cardioprotective role during reverse remodeling. No significant correlations were found with left ventricle mass regression, although a trend for a negative association between the ligase Murine Double Minute 2 and mass regression (r = -0.44, p = 0.10) was found. Animal studies will be necessary to understand whether this ligase is protective or detrimental. Herein, we show, for the first time, an association between the preoperative myocardial levels of ubiquitin ligases and postoperative hypertrophy, highlighting the therapeutic potential of targeting ubiquitin ligases in incomplete reverse remodeling.
Collapse
Affiliation(s)
- Fábio Trindade
- Department of Medical Sciences, iBiMED–Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
- Department of Surgery and Physiology, UnIC—Cardiovascular Research and Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisca Saraiva
- Department of Surgery and Physiology, UnIC—Cardiovascular Research and Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Simon Keane
- Division Biomedicine, School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, UnIC—Cardiovascular Research and Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui Vitorino
- Department of Medical Sciences, iBiMED–Institute of Biomedicine, University of Aveiro, Aveiro, Portugal
- Department of Surgery and Physiology, UnIC—Cardiovascular Research and Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Homa Tajsharghi
- Division Biomedicine, School of Health Sciences, University of Skövde, Skövde, Sweden
| | - Inês Falcão-Pires
- Department of Surgery and Physiology, UnIC—Cardiovascular Research and Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
- * E-mail:
| |
Collapse
|
12
|
Weber A, L Büttner A, Rellecke P, Petrov G, Albert A, Sixt SU, Lichtenberg A, Akhyari P. Osteopontin as novel biomarker for reversibility of pressure overload induced left ventricular hypertrophy. Biomark Med 2020; 14:513-523. [PMID: 32462909 DOI: 10.2217/bmm-2019-0410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The aim of this study was to evaluate the prognostic value of osteopontin (OPN) as a marker for left ventricular (LV) hypertrophy and its reversibility after surgical aortic valve replacement (SAVR). Patients & methods: Echocardiographic data and OPN plasma levels of 149 consecutive patients undergoing SAVR were obtained preoperatively and 3 months postoperatively. OPN was measured by Quantikine Human OPN immunoassay. Results: There was a significant correlation between higher OPN plasma levels and lower LV-mass regression. In patients receiving SAVR combined with coronary artery bypass grafting, high OPN plasma levels were also an indicator for eccentric hypertrophy phenotype. Conclusion: OPN may be a useful indicator for LV hypertrophy phenotype and could have a prognostic value to estimate LV-mass regression after SAVR.
Collapse
Affiliation(s)
- Andreas Weber
- Department of Cardiac Surgery, Heinrich-Heine-University, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Annalena L Büttner
- Department of Cardiac Surgery, Heinrich-Heine-University, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Philipp Rellecke
- Department of Cardiac Surgery, Heinrich-Heine-University, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Georgi Petrov
- Department of Cardiac Surgery, Heinrich-Heine-University, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Alexander Albert
- Department of Cardiac Surgery, Heinrich-Heine-University, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany.,Department of Cardiac Surgery, Dortmund 44137, Germany
| | - Stephan U Sixt
- Department of Anaesthesiology, Heinrich-Heine-University, Medical Faculty, Moorenstraße 5, Düsseldorf 40225, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Heinrich-Heine-University, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Heinrich-Heine-University, Medical Faculty, Moorenstraße 5, 40225 Düsseldorf, Germany
| |
Collapse
|
13
|
Katsi V, Georgiopoulos G, Oikonomou D, Aggeli C, Grassos C, Papadopoulos DP, Thomopoulos C, Marketou M, Dimitriadis K, Toutouzas K, Nihoyannopoulos P, Tsioufis C, Tousoulis D. Aortic Stenosis, Aortic Regurgitation and Arterial Hypertension. Curr Vasc Pharmacol 2020; 17:180-190. [PMID: 29295699 DOI: 10.2174/1570161116666180101165306] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 12/19/2017] [Accepted: 12/21/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Hypertension (HT) is an important risk factor for cardiovascular disease and might precipitate pathology of the aortic valve. OBJECTIVE To investigate the association of HT with aortic dysfunction (including both aortic regurgitation and stenosis) and the impact of antihypertensive treatment on the natural course of underlying aortic disease. METHODS We performed a systematic review of the literature for all relevant articles assessing the correlation between HT and phenotype of aortic disease. RESULTS Co-existence of HT with aortic stenosis and aortic regurgitation is highly prevalent in hypertensive patients and predicts a worse prognosis. Certain antihypertensive agents may improve haemodynamic parameters (aortic jet velocity, aortic regurgitation volume) and remodeling of the left ventricle, but there is no strong evidence of benefit regarding clinical outcomes. Renin-angiotensin system inhibitors, among other vasodilators, are well-tolerated in aortic stenosis. CONCLUSION Several lines of evidence support a detrimental association between HT and aortic valve disease. Therefore, HT should be promptly treated in aortic valvulopathy. Despite conventional wisdom, specific vasodilators can be used with caution in aortic stenosis.
Collapse
Affiliation(s)
- V Katsi
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - G Georgiopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - D Oikonomou
- Department of Cardiology, 'Evaggelismos' General Hospital, Athens, Greece
| | - C Aggeli
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - C Grassos
- Department of Cardiology, 'KAT' General Hospital, Athens, Greece
| | - D P Papadopoulos
- Department of Cardiology, 'Laiko' General Hospital, Athens, Greece
| | - C Thomopoulos
- Department of Cardiology, Helena Venizelou Hospital, Athens, Greece
| | - M Marketou
- Department of Cardiology, Heraklion University Hospital, Crete, Greece
| | - K Dimitriadis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - K Toutouzas
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - P Nihoyannopoulos
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - C Tsioufis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| | - D Tousoulis
- First Department of Cardiology, 'Hippokration' Hospital, University of Athens, Medical School, Athens, Greece
| |
Collapse
|
14
|
Chau KH, Douglas PS, Pibarot P, Hahn RT, Khalique OK, Jaber WA, Cremer P, Weissman NJ, Asch FM, Zhang Y, Gertz ZM, Elmariah S, Clavel MA, Thourani VH, Daubert M, Alu MC, Leon MB, Lindman BR. Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 75:2446-2458. [DOI: 10.1016/j.jacc.2020.03.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/15/2020] [Indexed: 12/20/2022]
|
15
|
Rozenbaum Z, Finkelstein A, Zhitomirsky S, Topilsky Y, Halkin A, Banai S, Bazan S, Barbash I, Segev A, Guetta V, Danenberg H, Planner D, Orvin K, Assa HV, Assali A, Kornowski R, Steinvil A. Impact of preprocedural left ventricle hypertrophy and geometrical patterns on mortality following TAVR. Am Heart J 2020; 220:184-191. [PMID: 31862472 DOI: 10.1016/j.ahj.2019.11.013] [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: 04/26/2019] [Accepted: 11/24/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND In contrast to surgical aortic valve replacement, left ventricle (LV) hypertrophy (LVH) had not been clearly associated with mortality following transcatheter aortic valve replacement (TAVR). METHODS We performed a retrospective analysis of patients enrolled in the Israeli multicenter TAVR registry for whom preprocedural LV mass index (LVMI) data were available. Patients were divided into categories according to LVMI: normal LVMI and mild, moderate, and severe LVH. Mild LVH was regarded as the reference group. Additionally, LV geometry patterns were examined (concentric and eccentric LVH, and concentric remodeling). RESULTS The cohort consisted of 1,559 patients, 46.5% male, with a mean age of 82.2 (±6.8) years and mean LVMI of 121 (±29) g/m2. Rates of normal LVMI and mild, moderate, and severe LVH were 31% (n = 485), 21% (n = 322), 18% (n = 279), and 30% (n = 475), respectively. Three-year mortality rates for normal LVMI and mild, moderate, and severe LVH were 19.8%, 18.3%, 23.7%, and 24.4%, respectively. Compared to mild LVH, moderate LVH and severe LVH were independently associated with an increased risk for all-cause mortality (hazard ratio [HR] 1.58, 95% CI 1.15-2.18, P = .005; HR 1.46, 95% CI 1.1-1.95, P = .009; respectively). Concentric LVH was independently associated with a decreased risk for mortality compared to normal LV geometry (HR 0.75, 95% CI 0.63-0.89, P = .001). Compared to concentric LVH, eccentric LVH was independently associated with a 33% increased risk for mortality (HR 1.33, 95% CI 1.11-1.60, P = .002). CONCLUSIONS Mild concentric LVH confers a protective effect among patients with severe aortic stenosis undergoing TAVR. However, hypertrophy becomes maladaptive, and an increased baseline LVMI, eccentric pattern particularly, may be associated with all-cause mortality in this population.
Collapse
Affiliation(s)
- Zach Rozenbaum
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ariel Finkelstein
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sophia Zhitomirsky
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Halkin
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Samuel Bazan
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Israel Barbash
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victor Guetta
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haim Danenberg
- Cardiology department, Hadassah Medical Center, Jerusalem; Affiliated to the Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Planner
- Cardiology department, Hadassah Medical Center, Jerusalem; Affiliated to the Hebrew University of Jerusalem, Jerusalem, Israel
| | - Katia Orvin
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin Assa
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Abid Assali
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Cardiology department, Rabin Medical Center, Petach Tikva, Israel; Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arie Steinvil
- Cardiology department, Tel Aviv Sourasky Medical Center, Israel; Affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
16
|
Treibel TA, Badiani S, Lloyd G, Moon JC. Multimodality Imaging Markers of Adverse Myocardial Remodeling in Aortic Stenosis. JACC Cardiovasc Imaging 2019; 12:1532-1548. [DOI: 10.1016/j.jcmg.2019.02.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 12/11/2022]
|
17
|
Takagi H, Hari Y, Kawai N, Kuno T, Ando T. Meta-Analysis of Impact of Baseline N-TerminalPro-Brain Natriuretic Peptide Levels on SurvivalAfter Transcatheter Aortic Valve Implantation for Aortic Stenosis. Am J Cardiol 2019; 123:820-826. [PMID: 30587374 DOI: 10.1016/j.amjcard.2018.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/18/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022]
Abstract
We performed a meta-analysis of currently available studies investigating impact of baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) on mortality after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). MEDLINE and EMBASE were searched through August 2018 using PubMed and OVID. Studies considered for inclusion met the following criteria: the design was a study researching impact of baseline NT-proBNP levels on survival; the study population was patients underwent TAVI for AS; outcomes included all-cause mortality. For each study, we directly extracted odds ratio (ORs) or hazard ratios (HRs) of mortality (for high vs low baseline NT-proBNP); and generated ORs using mortality rates in both patients with high and low levels of baseline NT-proBNP. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model. We identified 16 eligible studies including a total of 3,679 patients who underwent TAVI for AS. Pooled analyses demonstrated that high levels of baseline NT-proBNP were associated with a statistically nonsignificant increase in early (30-day or 2-month) mortality (pooled OR, 1.60; 95% confidence interval, 0.84 to 3.04; p = 0.15) and a statistically significant increase in midterm (6-month to 4-year) mortality (pooled OR/HR, 1.88; 95% confidence interval, 1.54 to 2.28; p < 0.00001). Although funnel-plot asymmetry suggesting publication bias was detected, adjusting for funnel-plot asymmetry indicated an association of high levels of baseline NT-proBNP with a still significant increase in midterm mortality. In conclusion, high levels of baseline NT-proBNP predict increased midterm, not early, mortality after TAVI for AS.
Collapse
|
18
|
Alenezi F, Fudim M, Rymer J, Dunning A, Chiswell K, Swaminathan M, Bottiger B, Velagapudi P, Nicoara A, Kisslo J, Velazquez E, Vemulapalli S, Bloomfield GS, Samad Z. Predictors and Changes in Cardiac Hemodynamics and Geometry With Transcatheter Aortic Valve Implantation. Am J Cardiol 2019; 123:813-819. [PMID: 30598241 DOI: 10.1016/j.amjcard.2018.11.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/16/2018] [Accepted: 11/21/2018] [Indexed: 11/26/2022]
Abstract
The introduction of transcatheter aortic valve implantation (TAVI) has revolutionized the treatment of patients with severe aortic stenosis (AS). However, despite the great clinical success of TAVI, less is known about the cardiac hemodynamics and structural changes to post-TAVI. We analyzed patients with AS who had a transthoracic echocardiography at most 6 months before index TAVI and follow-up transthoracic echocardiography 9 to 18 months later, performed at Duke University Medical Center from 2012 to 2014. A total of 152 TAVI patients with a median age of 81 years (median interquartile range 74 to 86) were included. TAVI resulted in the reduction of left ventricle (LV) mass index (g/m2), median (interquartile range) 130 (115 to 157) pre versus 106 (85 to 135) post, p <0.001; LV end-diastolic volume (ml) 127 (105 to 143) pre versus 120 (100 to 143) post, p = 0.013; and LV end-systolic volume (ml) 55 (38 to 77) pre versus 45 (40 to 65) post, p = 0.027. TAVI also significantly improved LV global longitudinal strain (%) -14.4 (-11.3, -15.5) pre versus -14.8 (-12.2, -16.6) post (p <0.001, respectively). Post-TAVI LV mass regression was predicted by baseline LV mass and LV global longitudinal strain whereas post-TAVI LV ejection fraction was predicted by baseline LV ejection fraction, LV mass, and post-TAVI paravalvular leak. In conclusion, TAVI results in significant cardiac hemodynamic, geometrical, and functional changes at approximately 1-year postprocedure for patients with AS. Better baseline myocardial structure and function leads to more reverse remodeling.
Collapse
|
19
|
Del Bene MR, Barletta G, Venditti F, Di Mario C, Blanzola C, Stefàno P. Left ventricular mass regression after aortic valve replacement: Sex differences or effect of different methods of indexation? Echocardiography 2018; 36:219-228. [DOI: 10.1111/echo.14221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
| | | | | | - Carlo Di Mario
- Structural Interventional CardiologyCareggi University Hospital Florence Italy
| | | | | |
Collapse
|
20
|
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]
|
21
|
Kadkhodayan A, Lin G, Popma JJ, Reardon MJ, Little SH, Adams DH, Marcus R, Henry S, Baker MT, Kleiman NS, Deeb GM, Huang J, Oh JK. A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1322734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | - Grace Lin
- Mayo Clinic, Rochester, Minnesota, MN, USA
| | | | | | - Stephen H. Little
- Houston-Methodist-DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | | | - Sonia Henry
- North Shore University Hospital, Manhasset, NY, USA
| | | | - Neal S. Kleiman
- Houston-Methodist-DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | | | - Jae K. Oh
- Mayo Clinic, Rochester, Minnesota, MN, USA
| |
Collapse
|
22
|
Dimitriadis Z, Scholtz S, Ensminger S, Wiemer M, Fischbach T, Scholtz W, Piper C, Börgermann J, Bitter T, Horstkotte D, Faber L. Left ventricular adaptation after TAVI evaluated by conventional and speckle-tracking echocardiography. Int J Cardiol 2017; 228:633-637. [DOI: 10.1016/j.ijcard.2016.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/16/2016] [Accepted: 11/05/2016] [Indexed: 11/28/2022]
|
23
|
An Early Canadian Experience With the Correx Automated Coring and Apical Connector Device for Aortic Valve Bypass. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016; 11:434-438. [PMID: 27930602 DOI: 10.1097/imi.0000000000000322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Aortic valve replacement is the standard of care for severe, symptomatic aortic valve stenosis (AS); however, anatomy or pre-existing comorbidities may preclude conventional or alternative transcatheter approaches. Aortic valve bypass (AVB) may be performed as a salvage procedure for the relief of symptomatic aortic stenosis in patients who are not suitable candidates for aortic valve replacement. METHODS At our institution, seven patients underwent AVB using the Correx automated coring and apical connector system. All patients had severe AS with New York Heart Association functional class 3 symptoms and were not candidates for conventional or transcatheter approaches. Via a left anterolateral thoracotomy to access the descending aorta and left ventricular apex, we used the Correx system (Correx, Waltham, MA USA) to anastomose a valve conduit to the left ventricular apex proximally and the descending aorta distally. Three patients required cardiopulmonary bypass. RESULTS In all seven patients, the automated coring and apical connector was successfully deployed. There were two in-hospital deaths in this series. Immediately postoperatively and at 3 months, there was a significant reduction in mean and peak valve gradients, and all surviving patients performed at New York Heart Association functional class 1. CONCLUSIONS Aortic valve bypass seems to be an acceptable alternative for the treatment of severe AS in high-risk patients who are not candidates for aortic valve replacement. The Correx automated system may improve the clinical applicability and surgical reproducibility of AVB in appropriately selected patients in which conventional or transcatheter aortic valve replacement is not a feasible options.
Collapse
|
24
|
An Early Canadian Experience with the Correx Automated Coring and Apical Connector Device for Aortic Valve Bypass. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2016. [DOI: 10.1177/155698451601100612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
25
|
Jang JY, Seo JS, Sun BJ, Kim DH, Song JM, Kang DH, Song JK. Impact of Valvuloarterial Impedance on Concentric Remodeling in Aortic Stenosis and Its Regression after Valve Replacement. J Cardiovasc Ultrasound 2016; 24:201-207. [PMID: 27721950 PMCID: PMC5050308 DOI: 10.4250/jcu.2016.24.3.201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/17/2016] [Accepted: 08/17/2016] [Indexed: 11/28/2022] Open
Abstract
Background Left ventricle (LV) in patients with aortic stenosis (AS) faces a double hemodynamic load incorporating both valvular stenosis and reduced systemic arterial compliance (SAC). This study aimed to evaluate the impact of global LV afterload on LV hypertrophy (LVH) before and after aortic valve replacement (AVR). Methods The study cohort included 453 patients (247 males; mean age, 64 ± 11 years) who underwent AVR. Pre- and post-AVR echocardiographic examinations were retrospectively analyzed including an index of valvuloarterial impedance (ZVA) and LV mass index/LV end-diastolic volume index (LVMI/LVEDVI) as a parameter of LVH. Results Pre-AVR LVMI/LVEDVI was 2.7 ± 0.9 g/mL with an aortic valve area (AVA) of 0.6 ± 0.2 cm2. ZVA was 5.9 ± 1.9 mm Hg/mL/m2 and showed a stronger correlation (β = 0.601, p < 0.001) with pre-AVR LVMI/LVEDVI than indexed AVA (β = 0.061, p = 0.19), transvalvular peak velocity (β = 0.211, p < 0.001). During a median follow-up of 3.5 years, patients had a 18.8 ± 10.4% decrease in the LV geometry index with a decrease in SAC from 1.20 ± 0.48 to 1.00 ± 0.38 mL/m2/mm Hg (p < 0.001). Pre-AVR LV ejection fraction (r = 0.284, p < 0.001) and ZVA (r = 0.523, p < 0.001) were independent factors associated with LVH regression in 322 patients with follow-up duration >1 year after AVR. Conclusion ZVA is a major determinant of concentric remodeling in AS before AVR and LVH regression after AVR, which should be incorporated in routine evaluation of AS.
Collapse
Affiliation(s)
- Jeong Yoon Jang
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea.; Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicinen, Busan, Korea
| | - Byung Joo Sun
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Dae-Hee Kim
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Min Song
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Hyun Kang
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Kockova R, Kacer P, Pirk J, Maly J, Sukupova L, Sikula V, Kotrc M, Barciakova L, Honsova E, Maly M, Kautzner J, Sedmera D, Penicka M. Native T1 Relaxation Time and Extracellular Volume Fraction as Accurate Markers of Diffuse Myocardial Fibrosis in Heart Valve Disease – Comparison With Targeted Left Ventricular Myocardial Biopsy –. Circ J 2016; 80:1202-9. [DOI: 10.1253/circj.cj-15-1309] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Radka Kockova
- Department of Cardiology, Institute for Clinical and Experimental Medicine
- Institute of Physiology, Academy of Sciences of the Czech Republic
| | - Petr Kacer
- Department of Cardiothoracic Surgery, Institute for Clinical and Experimental Medicine
| | - Jan Pirk
- Department of Cardiothoracic Surgery, Institute for Clinical and Experimental Medicine
| | - Jiri Maly
- Department of Cardiothoracic Surgery, Institute for Clinical and Experimental Medicine
| | - Lucie Sukupova
- Department of Cardiology, Institute for Clinical and Experimental Medicine
| | - Viktor Sikula
- Department of Cardiology, Institute for Clinical and Experimental Medicine
| | - Martin Kotrc
- Department of Cardiology, Institute for Clinical and Experimental Medicine
| | - Lucia Barciakova
- Department of Cardiothoracic Surgery, Institute for Clinical and Experimental Medicine
| | - Eva Honsova
- Clinical and Transplant Pathology Department, Institute for Clinical and Experimental Medicine
| | | | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine
| | - David Sedmera
- First Faculty of Medicine, Institute of Anatomy, Charles University in Prague
- Institute of Physiology, Academy of Sciences of the Czech Republic
| | | |
Collapse
|
27
|
Sehovic S, Talic A, Kacila M, Tahirovic E. The Influence of Aortic Valve Replacement on Functional Moderate - To-Severe Mitral Regurgitation in Patients with Aortic Valve Stenosis. Acta Inform Med 2015; 23:147-50. [PMID: 26236080 PMCID: PMC4499301 DOI: 10.5455/aim.2015.23.147-150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 05/16/2015] [Indexed: 11/06/2022] Open
Abstract
Goal: The aim of this study was to show whether the concomitant functional mitral regurgitation in patients undergoing aortic valve replacement improves after this surgical procedure and to identify preoperative echocardiographic parameters that may influence the lack of improvement in mitral regurgitation (MR) after aortic valve replacement (AVR). Material and methods: The study included 45 patients with severe aortic stenosis and concomitant moderate to severe (+2/+3)mitral regurgitation. Results: The results of our study indicated an improvement in the degree of mitral regurgitation in 24 patients. The most prominent parameters responsible for the lack of improvement of mitral regurgitation in our study were LVIDd, ERO, RVol, pulmonary artery systolic pressure and left atrial diameter. Identification of echocardiographic predictors may assist in selection of patients for whom more aggressive surgical treatment is advised. Conclusion: Concomitant moderate to severe functional MR indicates that MV should be repaired or replaced at the time of aortic valve surgery where at least two of indicated predicted preoperative echocardiographic parameters are present.
Collapse
Affiliation(s)
- Sejla Sehovic
- Institute for Heart Disease, Cardiothoracic Clinic, Clinical Center University of Sarajevo
| | - Adnana Talic
- Institute for Heart Disease, Cardiothoracic Clinic, Clinical Center University of Sarajevo
| | - Mirsad Kacila
- Institute for Heart Disease, Cardiothoracic Clinic, Clinical Center University of Sarajevo
| | - Elnur Tahirovic
- Institute for Heart Disease, Cardiothoracic Clinic, Clinical Center University of Sarajevo
| |
Collapse
|
28
|
van der Straaten EP, Rademakers LM, van Straten AH, Houterman S, Tan MES, Soliman Hamad MA. Mid-term haemodynamic and clinical results after aortic valve replacement using the Freedom Solo stentless bioprosthesis versus the Carpentier Edwards Perimount stented bioprosthesis. Eur J Cardiothorac Surg 2015. [DOI: 10.1093/ejcts/ezv255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
29
|
Gavina C, Falcão-Pires I, Pinho P, Manso MC, Gonçalves A, Rocha-Gonçalves F, Leite-Moreira A. Relevance of residual left ventricular hypertrophy after surgery for isolated aortic stenosis. Eur J Cardiothorac Surg 2015; 49:952-9. [DOI: 10.1093/ejcts/ezv240] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/12/2015] [Indexed: 11/13/2022] Open
|
30
|
Lindman BR, Stewart WJ, Pibarot P, Hahn RT, Otto CM, Xu K, Devereux RB, Weissman NJ, Enriquez-Sarano M, Szeto WY, Makkar R, Miller DC, Lerakis S, Kapadia S, Bowers B, Greason KL, McAndrew TC, Lei Y, Leon MB, Douglas PS. Early regression of severe left ventricular hypertrophy after transcatheter aortic valve replacement is associated with decreased hospitalizations. JACC Cardiovasc Interv 2015; 7:662-73. [PMID: 24947722 DOI: 10.1016/j.jcin.2014.02.011] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 02/13/2014] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This study sought to examine the relationship between left ventricular mass (LVM) regression and clinical outcomes after transcatheter aortic valve replacement (TAVR). BACKGROUND LVM regression after valve replacement for aortic stenosis is assumed to be a favorable effect of LV unloading, but its relationship to improved clinical outcomes is unclear. METHODS Of 2,115 patients with symptomatic aortic stenosis at high surgical risk receiving TAVR in the PARTNER (Placement of Aortic Transcatheter Valves) randomized trial or continued access registry, 690 had both severe LV hypertrophy (left ventricular mass index [LVMi] ≥ 149 g/m(2) men, ≥ 122 g/m(2) women) at baseline and an LVMi measurement at 30-day post-TAVR follow-up. Clinical outcomes were compared for patients with greater than versus lesser than median percentage change in LVMi between baseline and 30 days using Cox proportional hazard models to evaluate event rates from 30 to 365 days. RESULTS Compared with patients with lesser regression, patients with greater LVMi regression had a similar rate of all-cause mortality (14.1% vs. 14.3%, p = 0.99), but a lower rate of rehospitalization (9.5% vs. 18.5%, hazard ratio [HR]: 0.50, 95% confidence interval [CI]: 0.32 to 0.78; p = 0.002) and a lower rate of rehospitalization specifically for heart failure (7.3% vs. 13.6%, p = 0.01). The association with a lower rate of rehospitalization was consistent across subgroups and remained significant after multivariable adjustment (HR: 0.53, 95% CI: 0.34 to 0.84; p = 0.007). Patients with greater LVMi regression had lower B-type natriuretic peptide (p = 0.002) and a trend toward better quality of life (p = 0.06) at 1-year follow-up than did those with lesser regression. CONCLUSIONS In high-risk patients with severe aortic stenosis and severe LV hypertrophy undergoing TAVR, those with greater early LVM regression had one-half the rate of rehospitalization over the subsequent year compared to those with lesser regression.
Collapse
Affiliation(s)
- Brian R Lindman
- Washington University School of Medicine, St. Louis, Missouri.
| | | | - Philippe Pibarot
- Québec Heart and Lung Institute, Laval University, Québec, Québec, Canada
| | - Rebecca T Hahn
- Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
| | - Catherine M Otto
- University of Washington School of Medicine, Seattle, Washington
| | - Ke Xu
- Cardiovascular Research Foundation, New York, New York
| | | | | | | | - Wilson Y Szeto
- University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California
| | - D Craig Miller
- Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | | - Yang Lei
- Saint Luke's Mid-America Heart Institute, Kansas City, Missouri
| | - Martin B Leon
- Columbia University Medical Center/New York Presbyterian Hospital, New York, New York; Cardiovascular Research Foundation, New York, New York
| | - Pamela S Douglas
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina
| |
Collapse
|
31
|
Helder MR, Ugur M, Bavaria JE, Kshettry VR, Groh MA, Petracek MR, Jones KW, Suri RM, Schaff HV. The effect of postoperative medical treatment on left ventricular mass regression after aortic valve replacement. J Thorac Cardiovasc Surg 2015; 149:781-6. [DOI: 10.1016/j.jtcvs.2014.10.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/25/2014] [Accepted: 10/04/2014] [Indexed: 10/24/2022]
|
32
|
Tavakoli R, Auf der Maur C, Mueller X, Schläpfer R, Jamshidi P, Daubeuf F, Frossard N. Full-root aortic valve replacement with stentless xenograft achieves superior regression of left ventricular hypertrophy compared to pericardial stented aortic valves. J Cardiothorac Surg 2015; 10:15. [PMID: 25643748 PMCID: PMC4322600 DOI: 10.1186/s13019-015-0219-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 01/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Full-root aortic valve replacement with stentless xenografts has potentially superior hemodynamic performance compared to stented valves. However, a number of cardiac surgeons are reluctant to transform a classical stented aortic valve replacement into a technically more demanding full-root stentless aortic valve replacement. Here we describe our technique of full-root stentless aortic xenograft implantation and compare the early clinical and midterm hemodynamic outcomes to those after aortic valve replacement with stented valves. METHODS We retrospectively compared the pre-operative characteristics of 180 consecutive patients who underwent full-root replacement with stentless aortic xenografts with those of 80 patients undergoing aortic valve replacement with stented valves. In subgroups presenting with aortic stenosis, we further analyzed the intra-operative data, early postoperative outcomes and mid-term regression of left ventricular mass index. RESULTS Patients in the stentless group were younger (62.6 ± 13 vs. 70.3 ± 11.8 years, p < 0.0001) but had a higher Euroscore (9.14 ± 3.39 vs.6.83 ± 2.54, p < 0.0001) than those in the stented group. In the subgroups operated for aortic stenosis, the ischemic (84.3 ± 9.8 vs. 62.3 ± 9.4 min, p < 0.0001) and operative times (246.3 ± 53.6 vs. 191.7 ± 53.2 min, p < 0.0001) were longer for stentless versus stented valve implantation. Nevertheless, early mortality (0% vs. 3%, p < 0.25), re-exploration for bleeding (0% vs. 3%, p < 0.25) and stroke (1.8% vs. 3%, p < 0.77) did not differ between stentless and stented groups. One year after the operation, the mean transvalvular gradient was lower in the stentless versus stented group (5.8 ± 2.9 vs. 13.9 ± 5.3 mmHg, p < 0.0001), associated with a significant regression of the left ventricular mass index in the stentless (p < 0.0001) but not in the stented group (p = 0.2). CONCLUSION Our data support that full-root stentless aortic valve replacement can be performed without adversely affecting the early morbidity or mortality in patients operated on for aortic valve stenosis provided that the coronary ostia are not heavily calcified. The additional time necessary for the full-root stentless compared to the classical stented aortic valve replacement is therefore not detrimental to the early clinical outcomes and is largely rewarded in patients with aortic stenosis by lower transvalvular gradients at mid-term and a better regression of their left ventricular mass index.
Collapse
Affiliation(s)
- Reza Tavakoli
- Department of Cardiac Surgery, Canton Hospital Lucerne, Lucerne, Switzerland. .,Institute of Veterinary Pysiology Vetsuisse Faculty and Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
| | | | - Xavier Mueller
- Department of Cardiac Surgery, Canton Hospital Lucerne, Lucerne, Switzerland.
| | - Reinhard Schläpfer
- Department of Cardiac Surgery, Canton Hospital Lucerne, Lucerne, Switzerland.
| | - Peiman Jamshidi
- Department of Cardiology, Canton Hospital Lucerne, Lucerne, Switzerland.
| | - François Daubeuf
- Laboratoire d'Innovation Thérapeutique, Unité Mixte de Recherche 7200, Centre National de la Recherche Scientifique-Université de Strasbourg, Faculté de Pharmacie, Illkirch, Strasbourg, F-67400, France.
| | - Nelly Frossard
- Laboratoire d'Innovation Thérapeutique, Unité Mixte de Recherche 7200, Centre National de la Recherche Scientifique-Université de Strasbourg, Faculté de Pharmacie, Illkirch, Strasbourg, F-67400, France.
| |
Collapse
|
33
|
Kim SJ, Samad Z, Bloomfield GS, Douglas PS. A critical review of hemodynamic changes and left ventricular remodeling after surgical aortic valve replacement and percutaneous aortic valve replacement. Am Heart J 2014; 168:150-9.e1-7. [PMID: 25066553 DOI: 10.1016/j.ahj.2014.04.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED The introduction of transcatheter aortic valve replacement (TAVR) in clinical practice has widened options for symptomatic patients at high surgical risk; however, it is not known whether TAVR has equivalent or prolonged benefits in terms of left ventricular (LV) remodeling. METHODS To explore the relative hemodynamic benefits and postoperative LV remodeling associated with TAVR and surgical aortic valve replacement (SAVR), we performed a critical review of the available literature. A total of 67 studies were included in this systematic review. RESULTS There is at least equivalent if not slightly superior hemodynamic performance of TAVR over SAVR, and TAVR showed lower prosthesis-patient mismatch compared with SAVR. However, LV mass appears to regress to a greater degree after SAVR compared with TAVR. Aortic regurgitation, paravalvular in particular, is more common after TAVR than SAVR, although it is rarely more than moderate in severity. Improvements in diastolic function and mitral regurgitation are reported in only a handful of studies each and could not be compared across prosthesis types. CONCLUSIONS The published data support the hemodynamic comparability of SAVR and TAVR, with the higher incidence of prosthesis-patient mismatch in SAVR offset by higher incidence of paravalvular leak in TAVR. These results highlight the need for further studies focusing on hemodynamic changes after valve therapy.
Collapse
|
34
|
Poulsen RH, Rasmussen JT, Bøtker HE, Waehrens LS, Falborg L, Heegaard CW, Rehling M. Imaging the myocardium at risk with ⁹⁹mTc-lactadherin administered after reperfusion in a porcine model. Nucl Med Biol 2013; 41:114-9. [PMID: 24267057 DOI: 10.1016/j.nucmedbio.2013.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 09/23/2013] [Accepted: 09/28/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Phosphatidylserine is translocated from the inner to the outer leaflet of the plasma membrane in the early stages of apoptosis and necrosis and in reversibly injured cells. In rabbit hearts, ischemia followed by reperfusion results in exposure of phosphatidylserine on myocytes unaffected by apoptosis or necrosis. Lactadherin was recently introduced as a highly sensitive phosphatidylserine ligand. We hypothesized that ischemic myocardial cell damage can be identified by radio-labeled lactadherin and that the ischemic area at risk (AAR) can be visualized retrospectively after reperfusion. METHODS Left anterior descending coronary artery in pigs was occluded for 20 minutes, 45 minutes or 45 minutes preceded by ischemic preconditioning. In all three groups, (99m)Tc-lactadherin was injected intravenously 30 minutes after reperfusion. The AAR was demarcated by Evans blue and the infarct size by 2,3,5,-triphenyltetrazodium chloride staining. RESULTS The regional myocardial uptake of (99m)Tc-lactadherin closely correlated with the AAR (r=.83, P = .001). The area of (99m)Tc-lactadherin uptake was unaltered by a shorter duration of ischemia and ischemic preconditioning (P=.23) despite significantly different infarct development (P=.001). CONCLUSION The results suggest that (99m)Tc-lactadherin can be used as a sensitive marker for AAR imaging when injected 30 minutes after reperfusion following acute ischemia.
Collapse
Affiliation(s)
- Runa H Poulsen
- Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | | | | | | | | | | | | |
Collapse
|
35
|
Gavina C, Falcão-Pires I, Rodrigues J, Marinho B, Gonçalves N, Lopes R, Amorim MJ, Almeida J, Pinho P, Gonçalves A, Rocha-Gonçalves F, Leite-Moreira A. Load independent impairment of reverse remodeling after valve replacement in hypertensive aortic stenosis patients. Int J Cardiol 2013; 170:324-30. [PMID: 24268509 DOI: 10.1016/j.ijcard.2013.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 08/16/2013] [Accepted: 11/02/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND We evaluated the impact of hypertension on the left ventricular mass regression in aortic stenosis after aortic valve replacement. METHODS We prospectively studied 135 patients with severe aortic stenosis at baseline and 1 year after surgery. In 32 patients we analyzed myocardial gene expression of collagen types I and III, connective tissue growth factor, transforming growth factor-β1, metalloproteinase-2 and its tissue inhibitor and compared its levels vs controls. RESULTS Seventy-six patients (56.3%) had a history of hypertension. Hypertensive patients were older, had higher Euroscore-II and NYHA class, with no differences in stenosis severity. At 1 year follow-up there was a median decrease of mass index of 14.2% (P25-75: -4.3%-30.4%; p<0.001). Mass regression was significantly higher in patients without hypertension, with a median decrease of 25.9% (P25-75: 12.0%-38.7%) vs 5.4% (P25-75: -12.5%-20.1%; p=0.001), despite similar increase in effective orifice area and no differences in valvuloarterial impedance. After 1 year, higher baseline left ventricular mass index (p=0.005) and the absence of hypertension (p=0.002) or diabetes (p=0.041) were the only independent predictors of mass regression higher than the median. Comparing with controls, aortic stenosis patients had an increased expression of collagen types I and III, but only hypertensive patients had higher relative expression of collagen type I vs III. In hypertensive patients TIMP2 expression was up-regulated and correlated with higher baseline left ventricular mass index (r=0.61; p=0.020). CONCLUSIONS In aortic stenosis, hypertension impairs mass regression one year after valve replacement, independently of total afterload. Differences in the expression of extracellular matrix remodeling genes might contribute to this finding.
Collapse
Affiliation(s)
- Cristina Gavina
- Department of Medicine, Faculty of Medicine, University of Porto, Portugal.
| | - Inês Falcão-Pires
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal
| | | | - Benjamim Marinho
- Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Nadia Gonçalves
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal
| | - Ricardo Lopes
- Cardiology, Centro Hospitalar São João, Porto, Portugal
| | - Mário Jorge Amorim
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Jorge Almeida
- Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | - Paulo Pinho
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| | | | | | - Adelino Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar São João, Porto, Portugal
| |
Collapse
|
36
|
Katsi V, Marketou M, Kallistratos MS, Makris T, Manolis AJ, Tousoulis D, Stefanadis C, Vardas P, Kallikazaros I. Aortic valve stenosis and arterial hypertension: a synopsis in 2013. Curr Hypertens Rep 2013; 15:298-303. [PMID: 23843194 DOI: 10.1007/s11906-013-0357-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Systemic hypertension and aortic valve stenosis (AVS) are both age-related diseases. The pathophysiology of AVS shares some similarities with essential hypertension, which might be the link between the two diseases. Although AS is usually related with low blood pressure levels, approximately one third of patients with severe AS suffer from arterial hypertension, a percentage that can increase up to 50 % according some studies. This review will summarize various aspects regarding the prevalence the pathophysiology and the natural history of those two diseases that seems to be linked, as well as the effect of blood pressure and antihypertensive treatment on various echocardiographic parameters in patients with AVS.
Collapse
Affiliation(s)
- Vasiliki Katsi
- Cardiology Department, Hippokration Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Fairbairn TA, Steadman CD, Mather AN, Motwani M, Blackman DJ, Plein S, McCann GP, Greenwood JP. Assessment of valve haemodynamics, reverse ventricular remodelling and myocardial fibrosis following transcatheter aortic valve implantation compared to surgical aortic valve replacement: a cardiovascular magnetic resonance study. Heart 2013; 99:1185-91. [PMID: 23749779 PMCID: PMC3747520 DOI: 10.1136/heartjnl-2013-303927] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objective To compare the effects of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) on aortic valve haemodynamics, ventricular reverse remodelling and myocardial fibrosis (MF) by cardiovascular magnetic resonance (CMR) imaging. Design A 1.5 T CMR scan was performed preoperatively and 6 months postoperatively. Setting University hospitals of Leeds and Leicester, UK. Patients 50 (25 TAVI, 25 SAVR; age 77±8 years) high-risk severe symptomatic aortic stenosis (AS) patients. Main outcome measures Valve haemodynamics, ventricular volumes, ejection fraction (EF), mass and MF. Results Patients were matched for gender and AS severity but not for age (80±6 vs 73±7 years, p=0.001) or EuroSCORE (22±14 vs 7±3, p<0.001). Aortic valve mean pressure gradient decreased to a greater degree post-TAVI compared to SAVR (21±8 mm Hg vs 35±13 mm Hg, p=0.017). Aortic regurgitation reduced by 8% in both groups, only reaching statistical significance for TAVI (p=0.003). TAVI and SAVR improved (p<0.05) left ventricular (LV) end-systolic volumes (46±18 ml/m2 vs 41±17 ml/m2; 44±22 ml/m2 vs32±6 ml/m2) and mass (83±20 g/m2 vs 65±15 g/m2; 74±11 g/m2 vs 59±8 g/m2). SAVR reduced end-diastolic volumes (92±19 ml/m2 vs 74±12 ml/m2, p<0.001) and TAVI increased EF (52±12% vs 56±10%, p=0.01). MF reduced post-TAVI (10.9±6% vs 8.5±5%, p=0.03) but not post-SAVR (4.2±2% vs 4.1±2%, p=0.98). Myocardial scar (p≤0.01) and baseline ventricular volumes (p<0.001) were the major predictors of reverse remodelling. Conclusions TAVI was comparable to SAVR at LV reverse remodelling and superior at reducing the valvular pressure gradient and MF. Future work should assess the prognostic importance of reverse remodelling and fibrosis post-TAVI to aid patient selection.
Collapse
Affiliation(s)
- Timothy A Fairbairn
- Multidisciplinary Cardiovascular Research Centre, Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds LS1 3EX, UK
| | | | | | | | | | | | | | | |
Collapse
|
38
|
van Straten AHM, Soliman Hamad MA, Peels KCH, van den Broek KC, ter Woorst JFJ, Elenbaas TW, van Dantzig JM. Increased septum wall thickness in patients undergoing aortic valve replacement predicts worse late survival. Ann Thorac Surg 2012; 94:66-71. [PMID: 22607789 DOI: 10.1016/j.athoracsur.2012.03.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/05/2012] [Accepted: 03/09/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Following guidelines, aortic valve replacement (AVR) in asymptomatic patients with severe aortic valve stenosis is often postponed until symptoms do occur. Delaying AVR will inevitably lead to progression of left ventricular hypertrophy. We studied the relationship between septum wall thickness indexed for body surface area (SWTI) as a measure for LV hypertrophy and 30-day and late all-cause mortality after AVR. METHODS This study included the data of adult patients who underwent isolated AVR between January 2006 and December 2010 and in whom a reliable measurement of the septum wall thickness could be made. The patients were stratified into three groups according to their SWTI. The SWTI was less than 6 mm/m(2) in 136 patients, between 6 and 8 mm/m(2) in 307 patients, and more than 8 mm/m(2) in 126 patients. RESULTS Death occurred in 10 patients within 30 days (1.8%), and 41 patients died during follow-up (7.2%). Univariate logistic regression analysis revealed only endocarditis as predictor of early mortality. Multivariate Cox regression analyses revealed SWTI as a continuous variable as well as a categorical (group) variable to be a predictor of late mortality. Compared with the group SWTI less than 6 mm/m(2), odds ratio for the group with SWTI 6 to 8 mm/m(2) was 3.4 (p = 0.046), and for the group with SWTI more than 8 mm/m(2), it was 6.0 (p = 0.005). CONCLUSIONS In patients undergoing AVR, the SWTI was a strong predictor of late mortality. Whether avoidance of progression of left ventricular hypertrophy by early AVR leads to better outcome remains to be investigated.
Collapse
|
39
|
Enhanced left ventricular mass regression after aortic valve replacement in patients with aortic stenosis is associated with improved long-term survival. J Thorac Cardiovasc Surg 2011; 142:285-91. [PMID: 21272899 DOI: 10.1016/j.jtcvs.2010.08.084] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2009] [Revised: 07/29/2010] [Accepted: 08/31/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Aortic valve replacement in patients with aortic stenosis is usually followed by regression of left ventricular hypertrophy. More complete resolution of left ventricular hypertrophy is suggested to be associated with superior clinical outcomes; however, its translational impact on long-term survival after aortic valve replacement has not been investigated. METHODS Demographic, operative, and clinical data were obtained retrospectively through case note review. Transthoracic echocardiography was used to measure left ventricular mass preoperatively and at annual follow-up visits. Patients were classified according to their reduction in left ventricular mass at 1 year after the operation: group 1, less than 25 g; group 2, 25 to 150 g; and group 3, more than 150 g. Kaplan-Meier and multivariable Cox regression were used. RESULTS A total of 147 patients were discharged from the hospital after aortic valve replacement for aortic stenosis between 1991 and 2001. Preoperative left ventricular mass was 279 ± 98 g in group 1 (n = 47), 347 ± 104 g in group 2 (n = 62), and 491 ± 183 g in group 3 (n = 38) (P < .001). Mean time to last echocardiogram was 6.2 ± 3.2 years. Left ventricular mass at late follow-up was 310 ± 119 g in group 1, 267 ± 107 g in group 2, and 259 ± 96 g in group 3 (P = .05). Transvalvular gradients at follow-up were not significantly different among the groups (group 1, 24.8 ± 23 mm Hg; group 2, 21.4 ± 16 mm Hg; group 3, 14.7 ± 9 mm Hg) (P = .31). There was no difference in the prevalence of other factors influencing left ventricular mass regression such as ischemic heart disease or hypertension, valve type, or valve size used. Ten-year actuarial survival was not statistically different in patients with enhanced left ventricular mass regression when compared with the log-rank test (group 1, 51% ± 9%; group 2, 54% ± 8%; and group 3, 72% ± 10%) (P = .26). After adjustment, left ventricular mass reduction of more than 150 g was demonstrated as an independent predictor of improved long-term survival on multivariate analysis (P = .02). CONCLUSIONS Our study is the first to suggest that enhanced postoperative left ventricular mass regression, specifically in patients undergoing aortic valve replacement for aortic stenosis, may be associated with improved long-term survival. In view of these findings, strategies purported to be associated with superior left ventricular mass regression should be considered when undertaking aortic valve replacement.
Collapse
|
40
|
Chan V, Kulik A, Tran A, Hendry P, Masters R, Mesana TG, Ruel M. Long-Term Clinical and Hemodynamic Performance of the Hancock II Versus the Perimount Aortic Bioprostheses. Circulation 2010; 122:S10-6. [DOI: 10.1161/circulationaha.109.928085] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
The Medtronic Hancock II and the Carpentier-Edwards Perimount are among the world’s most commonly used aortic bioprostheses. However, a direct comparison of their clinical performance is lacking. To minimize biases inherent to between-center comparisons, we examined these prostheses within a large, contemporary, single-center cohort.
Methods and Results—
Between 1990 and 2007, 1659 patients (mean age, 73.1±9.3 years) underwent aortic valve replacement with either the Hancock II (N=1021) or the Perimount (N=638). Patients were prospectively followed-up with serial clinic visits and echocardiograms for up to 16 years (mean, 5.0±3.3 years). There was no significant difference in aortic root size preoperatively (
P
=0.7). Aortic root enlargement was more commonly performed with the Perimount (
P
<0.001), and the manufacturer valve size of the implanted prosthesis was larger with the Hancock II (
P
<0.001). Postoperatively, peak and mean transprosthesis gradients were higher for the Hancock II (32.7±0.7 and 16.0±0.3 mm Hg, respectively) than for the Perimount (24.9±0.7 and 13.4±0.4 mm Hg, respectively;
P
<0.001). However, no difference in left ventricular mass regression was observed at late follow-up (
P
=0.9). Unadjusted 10-year survival was 59.4%±2.4% for the Hancock II and 70.2%±3.8% for the Perimount (
P
=0.07). Multivariable predictors of survival did not include prosthesis type (
P
=0.2).
Conclusions—
For the same manufacturer valve size, the Perimount is larger, which may warrant enlarging the aortic root more often, and it is associated with better hemodynamics than the Hancock II. These differences do not impact survival or left ventricular mass regression, and the long-term clinical performances of the Hancock II and Perimount bioprostheses are equivalent.
Collapse
Affiliation(s)
- Vincent Chan
- From Division of Cardiac Surgery (V.C., A.K., A.T., P.H., R.M., T.G.M., M.R.) and Department of Epidemiology and Community Medicine (M.R.), University of Ottawa, Ottawa, Ontario, Canada
| | - Alexander Kulik
- From Division of Cardiac Surgery (V.C., A.K., A.T., P.H., R.M., T.G.M., M.R.) and Department of Epidemiology and Community Medicine (M.R.), University of Ottawa, Ottawa, Ontario, Canada
| | - Anthony Tran
- From Division of Cardiac Surgery (V.C., A.K., A.T., P.H., R.M., T.G.M., M.R.) and Department of Epidemiology and Community Medicine (M.R.), University of Ottawa, Ottawa, Ontario, Canada
| | - Paul Hendry
- From Division of Cardiac Surgery (V.C., A.K., A.T., P.H., R.M., T.G.M., M.R.) and Department of Epidemiology and Community Medicine (M.R.), University of Ottawa, Ottawa, Ontario, Canada
| | - Roy Masters
- From Division of Cardiac Surgery (V.C., A.K., A.T., P.H., R.M., T.G.M., M.R.) and Department of Epidemiology and Community Medicine (M.R.), University of Ottawa, Ottawa, Ontario, Canada
| | - Thierry G. Mesana
- From Division of Cardiac Surgery (V.C., A.K., A.T., P.H., R.M., T.G.M., M.R.) and Department of Epidemiology and Community Medicine (M.R.), University of Ottawa, Ottawa, Ontario, Canada
| | - Marc Ruel
- From Division of Cardiac Surgery (V.C., A.K., A.T., P.H., R.M., T.G.M., M.R.) and Department of Epidemiology and Community Medicine (M.R.), University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
41
|
Effect of candesartan treatment on left ventricular remodeling after aortic valve replacement for aortic stenosis. Am J Cardiol 2010; 106:713-9. [PMID: 20723651 DOI: 10.1016/j.amjcard.2010.04.028] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 04/18/2010] [Accepted: 04/18/2010] [Indexed: 11/23/2022]
Abstract
In hypertension, angiotensin receptor blockers can augment regression of left ventricular (LV) hypertrophy. It is not known whether this also is the case after aortic valve replacement (AVR) for severe aortic stenosis (AS). To test the hypothesis that treatment with candesartan in addition to conventional treatment is able to augment LV and left atrial (LA) reverse remodeling in patients with AS undergoing AVR, we studied 114 patients scheduled for AVR. Patients were randomized to treatment with candesartan 32 mg 1 time/day or conventional therapy immediately after AVR. Patients were followed with echocardiographic evaluations 3, 6, and 12 months after surgery. Primary end point was change in LV mass index. At baseline and during follow-up no differences in systolic, diastolic, and pulse pressures were seen between groups. Baseline LV mass index was 134 +/- 41 g/m(2) with no difference between groups. Mean decrease in LV mass index in the control group was 12 +/- 28 g/m(2) compared to 30 +/- 40 g/m(2) in the candesartan group (p = 0.015) during follow-up. After 12 months LV mass index was significantly lower in the candesartan group (103 +/- 29 vs 119 +/- 31 g/m(2), p = 0.01). In addition, the candesartan group had greater improvement in longitudinal LV systolic function assessed by tissue Doppler S' wave (0.6 +/- 0.1-cm/s increase in control group vs 1.4 +/- 0.1 cm/s in candesartan group, p = 0.01, p for trend = 0.02) and a decrease in LA volume (p for trend = 0.01). Treatment had no effect on diastolic E/e' ratio or B-type natriuretic peptide. In conclusion, angiotensin receptor blockade with candesartan after AVR in patients with AS is associated with augmented reverse LV and LA remodeling compared to conventional management.
Collapse
|
42
|
Wayangankar SA, Dasari TW, Lozano PM, Beckman KJ. A case of critical aortic stenosis masquerading as acute coronary syndrome. Cardiol Res Pract 2010; 2010. [PMID: 20721272 PMCID: PMC2913510 DOI: 10.4061/2010/423465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 05/27/2010] [Accepted: 06/22/2010] [Indexed: 11/26/2022] Open
Abstract
Serum cardiac troponins I and T are reliable and highly specific markers of myocardial injury. Studies have shown that at least 20% of patients with severe aortic stenosis have detectable serum troponins. This case report describes a patient who presented as suspected acute coronary syndrome with markedly elevated troponin levels, who was later found to have normal coronaries and critical aortic stenosis. This case highlights the need for comprehensive and accurate physical examination in patients who present with angina. Critical aortic stenosis may cause such severe subendocardial ischemia as to cause marked elevation in cardiac markers and mimic an acute coronary syndrome. Careful physical examination will lead to an earlier use of non invasive techniques, such as echocardiography to confirm the correct diagnosis and the avoidance of inappropriate treatments such as intravenous nitroglycerin and glycoprotein IIb/IIIa inhibitors.
Collapse
Affiliation(s)
- Siddharth A Wayangankar
- Department Internal Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd., WP 1130, Oklahoma City, OK 73104-5020, USA
| | | | | | | |
Collapse
|
43
|
Moderate chronic kidney disease and left ventricular hypertrophy after aortic valve replacement for aortic valve stenosis. J Thorac Cardiovasc Surg 2010; 139:881-6. [DOI: 10.1016/j.jtcvs.2009.05.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 04/14/2009] [Accepted: 05/22/2009] [Indexed: 11/24/2022]
|
44
|
Cramariuc D, Gerdts E, Segadal L. Impact of hypertension on left ventricular hypertrophy regression and exercise capacity in patients operated for aortic valve stenosis. SCAND CARDIOVASC J 2009; 40:167-74. [PMID: 16798664 DOI: 10.1080/14017430500468161] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the influence of concomitant hypertension on left ventricular hypertrophy regression and exercise capacity in patients operated for aortic stenosis. DESIGN We performed echocardiography 1 week, 6- and 18-month postoperatively in 78 patients, aged 70 (28-86) years, who received Medtronic Hall (33), Biocor (8), Carpentier-Edwards S.A.V. (14) and Freestyle (23) prosthetic valves for severe aortic stenosis. Forty nine patients participated in treadmill tests with ergospirometry at the 6- and 18-month visits. RESULTS Left ventricular mass index was comparably reduced in normotensive and hypertensive patients (34 vs. 40 g/m2 after 6 months, and 43 vs. 46 g/m2 after 18 months, ns). In multiple regression analysis, adjusting for baseline left ventricular mass index, larger reduction in left ventricular mass index was associated with younger age and having a Freestyle prosthesis, but not with gender or history of hypertension (multiple R2=0.68, p < 0.05). Exercise capacity assessed as peak oxygen uptake increased from early to late evaluation in normotensive patients (VO2max 24.27 vs. 27.08 ml/kg/min, p < 0.05) while remained unchanged in hypertensive patients (VO2max 22.2 vs. 21.1 ml/kg/min). In multiple regression analysis, higher improvement in exercise capacity was predicted by male gender, younger age and absence of hypertension, while no independent association was found with Freestyle prosthesis (multiple R2 = 0.37, p < 0.05). CONCLUSIONS In patients operated for aortic stenosis, concomitant hypertension is associated with lack of improvement in exercise capacity in spite of early left ventricular hypertrophy reduction comparable to what is found in normotensive patients.
Collapse
Affiliation(s)
- Dana Cramariuc
- Institute of Medicine, University of Bergen, Bergen, Norway.
| | | | | |
Collapse
|
45
|
Jolobe OM. Systolic hypertension is also the neglected stepsister of aortic stenosis. Am J Med 2008; 121:e21, author reply e23. [PMID: 18724948 DOI: 10.1016/j.amjmed.2008.03.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 03/14/2008] [Indexed: 11/17/2022]
|
46
|
Casali G, Luzi G, Vicchio M, Lilla della Monica P, Minardi G, Musumeci F. Echocardiographic Follow-Up after Implanting 17-mm Regent Mechanical Prostheses. Asian Cardiovasc Thorac Ann 2008; 16:208-11. [DOI: 10.1177/021849230801600306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to evaluate midterm echocardiographic results and changes in quality of life after aortic valve replacement with 17-mm St. Jude Medical Regent mechanical prostheses in patients with aortic valve stenosis. The study population was 34 women and 2 men, aged 31–83 years. Echocardiographic follow-up was 100% complete at 4.1 ± 1.8 years. Hospital mortality was 5.6%. Actuarial 5-year survival was 88.5% ± 0.067%. Postoperative echocardiography showed significant regression of left ventricular mass index and significant reductions of peak gradient, mean gradient and mean effective orifice area index. All survivors were interviewed using the 36-item Short Form Health Survey questionnaire. Scores obtained in 7 of the 8 domains of the test were significantly higher than preoperative values. In our experience, implantation of this prosthesis allowed regression of left ventricular mass index and improved the perceived quality of life.
Collapse
Affiliation(s)
- Giovanni Casali
- Department of Cardiology and Cardiovascular Surgery, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Giampaolo Luzi
- Department of Cardiology and Cardiovascular Surgery, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Mariano Vicchio
- Department of Cardiology and Cardiovascular Surgery, S. Camillo-Forlanini Hospital, Rome, Italy
| | | | - Giovanni Minardi
- Department of Cardiology and Cardiovascular Surgery, S. Camillo-Forlanini Hospital, Rome, Italy
| | - Francesco Musumeci
- Department of Cardiology and Cardiovascular Surgery, S. Camillo-Forlanini Hospital, Rome, Italy
| |
Collapse
|
47
|
Iyem H, Sekuri C, Tavli M, Büket S. Left ventricular hypertrophy and remodeling after aortic valve replacement. Asian Cardiovasc Thorac Ann 2008; 15:459-62. [PMID: 18042767 DOI: 10.1177/021849230701500602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Left ventricular geometric remodeling and regression of hypertrophy were assessed after aortic valve replacement with a mechanical prosthesis in 37 patients with aortic stenosis and 39 with aortic insufficiency, aged 54.2 +/- 14.3 and 52.6 +/- 16.6 years, respectively. The follow-up period was 2 years. In patients with aortic insufficiency, ejection fraction increased from 54.4 +/- 3.5 preoperatively to 59.6 +/- 3.4 after 6 months and 61.7 +/- 2.7 after 2 years. In patients with aortic stenosis, ejection fraction increased from 56.6 +/- 5.1 preoperatively to 63.9 +/- 4.4 after 6 months and 71.7 +/- 4.1 after 2 years. Geometric remodeling, regression of hypertrophy, and increased ejection fraction of the left ventricle were similar in both groups at 6 months after surgery, but after 2 years of follow-up, greater improvement was found in patients who had undergone valve replacement for aortic stenosis.
Collapse
Affiliation(s)
- Hikmet Iyem
- Cardiovascular Surgery Department, Kent Hospital, Izmir, Turkey.
| | | | | | | |
Collapse
|
48
|
Anselmi A, Gaudino M, Baldi A, Vetrovec GW, Bussani R, Possati G, Abbate A. Role of apoptosis in pressure-overload cardiomyopathy. J Cardiovasc Med (Hagerstown) 2008; 9:227-32. [DOI: 10.2459/jcm.0b013e328277f1d7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
49
|
Elahi M, Asopa S, Khan J. The right choice of prosthesis for patients undergoing aortic valve surgery: searching the truth. ACTA ACUST UNITED AC 2007; 9:77-81. [PMID: 17573580 DOI: 10.1080/17482940601173121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Aortic valve surgery is suggested when native aortic valve is diseased and complications outweigh the risks. Choice of prosthesis for aortic valve surgery is vastly undetermined, in part due to the varied options (bioprosthetic, mechanical prosthesis, homografts and allografts) available. The technical issues during valve surgery and the anticoagulation concerns along with the patient type with respect to age, ethnicity, sex and quality of life do contribute to the challenge for deciding the type of valve prosthesis best substituted to the diseased native valve. Here we attempt to unravel the controversies and present a holistic approach towards settling on the best possible prosthesis for a diseased aortic valve.
Collapse
Affiliation(s)
- Maqsood Elahi
- Wessex Cardiothoracic Centre, General/BUPA Hospital, Southampton, Hampshire, UK.
| | | | | |
Collapse
|
50
|
Vánky FB, Håkanson E, Svedjeholm R. Long-Term Consequences of Postoperative Heart Failure After Surgery for Aortic Stenosis Compared With Coronary Surgery. Ann Thorac Surg 2007; 83:2036-43. [PMID: 17532392 DOI: 10.1016/j.athoracsur.2007.01.031] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 01/18/2007] [Accepted: 01/22/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although postoperative heart failure is a major determinant of operative mortality in cardiac surgery it has received little attention in the literature, and long-term consequences remain to be addressed. Therefore, the impact of postoperative heart failure on long-term survival in relation to other risk factors was studied. METHODS All patients undergoing aortic valve replacement (AVR) for aortic stenosis from 1995 through 2000 in the southeast region of Sweden (n = 398) were compared with a cohort, matched for age and sex, undergoing coronary artery bypass grafting (CABG [n = 398]). Risk factors for 5-year mortality were analyzed. RESULTS Forty-five AVR and 47 CABG patients required treatment for postoperative heart failure. Thirty-day, 1-year, and 5-year mortality in patients with and without postoperative heart failure after AVR were 6.7% versus 1.4% (p = 0.05), 8.9% versus 4.0% (p = 0.13), and 42.2% versus 14.2% (p < 0.0001) respectively. Corresponding results in the CABG group were 21.3% versus 1.1% (p < 0.0001), 25.5% versus 3.1% (p < 0.0001), and 36.2% versus 11.1% (p = 0.0015). Postoperative heart failure, preoperative renal dysfunction, procedure-associated stroke, body mass index less than 19 kg/m2, older age, preoperative atrial fibrillation, and preoperative anemia turned out as independent risk factors for 5-year mortality after AVR. In the CABG group, postoperative heart failure, diabetes mellitus, older age, and procedure-associated stroke emerged as independent risk factor for 5-year mortality. CONCLUSIONS Postoperative heart failure was associated with high early mortality after CABG whereas the grave consequences of postoperative heart failure after AVR for aortic stenosis became evident only with time.
Collapse
Affiliation(s)
- Farkas B Vánky
- Department of Cardiothoracic Surgery, University Hospital, Linköping, Sweden
| | | | | |
Collapse
|