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Cobos Gil MA, Diz-Díaz J, Islas F. Electrocardiogram Recording in the Prone Position. JAMA Intern Med 2024; 184:120. [PMID: 38048092 DOI: 10.1001/jamainternmed.2023.6098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
| | - Jesús Diz-Díaz
- Department of Cardiology, H Clinico San Carlos, Madrid, Spain
| | - Fabian Islas
- Department of Cardiology, H Clinico San Carlos, Madrid, Spain
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2
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Gallone G, Islas F, Gorla R, Melillo F, Leone PP, Cimaglia P, Pastore MC, Franzone A, Landra F, Bruno F, Scudeler L, Jimenez-Quevedo P, Viva T, Piroli F, Bragato R, Trichilo M, Degiovanni A, Ilardi F, Andreis A, Nombela-Franco L, Maurizio T, Toselli M, Conrotto F, Montorfano M, Manzo R, Cameli M, Patti G, Stefanini G, Testa L, Giannini F, Agricola E, Escaned J, D'Ascenzo F, De Ferrari GM. Stroke volume index and transvalvular flow rate trajectories in severe aortic stenosis treated with TAVR. Eur Heart J Cardiovasc Imaging 2023:7031091. [PMID: 36752044 DOI: 10.1093/ehjci/jead018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/29/2022] [Accepted: 01/12/2023] [Indexed: 02/09/2023] Open
Abstract
AIMS The prognostic impact of flow trajectories according to stroke volume index (SVi) and transvalvular flow rate (FR) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) remains poorly assessed. We evaluated and compared SVi and FR prior and after TAVR for severe AS. METHODS AND RESULTS Patients were categorized according to SVi (<35 mL/m2) and FR (<200 mL/s). The association of pre- and post-TAVR SVi and FR with all-cause mortality up to 3 years was assessed with multivariable Cox regression models. Among 980 patients with pre-TAVR flow assessment, SVi was reduced in 41.3% and FR in 48.1%. Baseline flow status was not an independent mortality predictor [SVi: hazard ratio (HR) 1.22, 95% confidence interval (CI) 0.85-1.82, FR: HR 0.78, 95% CI 0.48-1.27]. Among 731 patients undergoing early (5 days, interquartile range 2-29) post-TAVR flow assessment, SVi recovered in 40.1% and FR in 49.0% patients with baseline low flow. Reduced FR following TAVR was an independent predictor of mortality (HR 1.67, 95% CI 1.02-2.74), whereas SVi was not (HR 0.97, 95% CI 0.53-1.78). Three-year estimated mortality in patients with recovered FR was lower than that in patients with reduced FR (13.3 vs. 37.7% vs, P = 0.003) and similar to that in patients with normal baseline FR (P = 0.317). CONCLUSION Baseline flow status was not an independent predictor of mid-term mortality among all-comers with severe AS undergoing TAVR. Flow recovery early after TAVR was frequent. Post-TAVR FR, but not SVi, was independently associated with mid-term all-cause mortality. By impacting flow status, AV replacement modifies the association of flow status with outcomes.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Fabian Islas
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Melillo
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Pier Pasquale Leone
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele-Milan, Italy.,Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Paolo Cimaglia
- GVM Care and Research Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola, Ravenna, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita";, L.go Bellini, 28100 Novara, Italy.,Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Federico Landra
- Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 22, 53100 Siena, Italy
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Luca Scudeler
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Pilar Jimenez-Quevedo
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Tommaso Viva
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Piroli
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Renato Bragato
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele-Milan, Italy.,Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Michele Trichilo
- Division of Cardiology, Azienda Ospedaliero Universitaria di Ferrara, Via Aldo Moro 8, Italy
| | - Anna Degiovanni
- Division of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita", L.go Bellini, 28100 Novara, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Luis Nombela-Franco
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Tusa Maurizio
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Marco Toselli
- GVM Care and Research Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola, Ravenna, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Matteo Montorfano
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Policlinico "Le Scotte", Viale Bracci 22, 53100 Siena, Italy
| | - Giuseppe Patti
- Division of Cardiology, Azienda Ospedaliero Universitaria "Maggiore Della Carita", L.go Bellini, 28100 Novara, Italy.,Department of Translational Medicine, University of Eastern Piedmont, Via Solaroli 17, 28100 Novara, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, 20072 Pieve Emanuele-Milan, Italy.,Cardio Center, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano, Milan, Italy
| | - Luca Testa
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesco Giannini
- GVM Care and Research Maria Cecilia Hospital, Via Corriera, 1, 48033 Cotignola, Ravenna, Italy
| | - Eustachio Agricola
- Interventional Cardiology and Echocardiography Units, IRCCS San Raffaele Hospital, Via Olgettina, 60, 20132 Milan, Italy
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Calle del Prof Martín Lagos, S/N, 28040 Madrid, Spain
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10121 Turin, Italy
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Urmeneta Ulloa J, Pozo Osinalde E, Cabrera JA, Recio Rodríguez M, Thuissard-Vasallo IJ, Andreu-Vázquez C, Islas F, Pérez de Isla L, Marcos-Alberca P, Mahía P, Cobos MA, Cabeza B, Rodríguez-Hernández JL, Luaces Méndez M, Gómez de Diego JJ, Bustos A, Pérez-Villacastín J, de Agustín A, Martínez de Vega V. Relevance of subclinical right ventricular dysfunction measured by feature-tracking cardiac magnetic resonance in non-ischemic dilated cardiomyopathy. BMC Cardiovasc Disord 2023; 23:13. [PMID: 36635626 PMCID: PMC9835255 DOI: 10.1186/s12872-023-03044-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/06/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Right ventricular (RV) dysfunction in patients with non-ischemic dilated cardiomyopathy (NICM) is associated with cardiovascular events. To analyze the feasibility of assessing RV myocardial deformation by feature tracking (FT)-cardiac magnetic resonance (CMR), and its usefulness as a prognostic marker. METHODS Retrospective study of NICM patients undergoing CMR. Longitudinal FT-RV free wall (LFT-RVFW) and fractional area change (FAC) were obtained. Correlation with standard RV parameters was studied. An association with combined event (heart failure (HF), ICD implantation or cardiovascular death) was assessed using a logistic regression model. RESULTS 98 patients (64 ± 13 years) were included. Left ventricular (LV) systolic function (LVEF 29.5 ± 9.6%, 47% with LVEF ≥ 30%) and RV (RVEF 52.2 ± 14.6%, 72% with RVEF ≥ 45%). Follow-up of 38 ± 17 months, 26.5% presented at least one admission for HF. An excellent correlation of LFT-RVFW (r = 0.82) and FAC (r = 0.83) with RVEF was evident. No association of RV-FT parameters with prognosis entire study population was found. However, in patients with LVEF ≥ 30%, admissions for HF were associated with lower LFT-RVFW (-21.6 ± 6.6% vs -31.3 ± 10%; p = 0.006) and FAC (36.6 ± 9.6% vs 50.5 ± 13.4%; p < 0.001) values. Similar differences were observed when only patients with RVEF ≥ 45% were considered. An LFT-RVFW cut-off point of -19.5% and FAC of 36.5% showed good prognostic performance. Decreased LFT-RVFW or FAC represented an independent predictor of combined event in patients with LVEF ≥ 30%. CONCLUSIONS In NICM patients without severe LV dysfunction, decreased values of LFT-RVFW and/or FAC were associated with HF admissions, independently of RVEF.
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Affiliation(s)
- J. Urmeneta Ulloa
- grid.488466.00000 0004 0464 1227Radiology Department, Hospital Universitario Quirónsalud Madrid, Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid Spain ,grid.488466.00000 0004 0464 1227Cardiology Department, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - E. Pozo Osinalde
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - J. A. Cabrera
- grid.488466.00000 0004 0464 1227Cardiology Department, Hospital Universitario Quirónsalud Madrid, Madrid, Spain
| | - M. Recio Rodríguez
- grid.488466.00000 0004 0464 1227Radiology Department, Hospital Universitario Quirónsalud Madrid, Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid Spain
| | - I. J. Thuissard-Vasallo
- grid.119375.80000000121738416Faculty of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
| | - C. Andreu-Vázquez
- grid.119375.80000000121738416Faculty of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
| | - F. Islas
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - L. Pérez de Isla
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - P. Marcos-Alberca
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - P. Mahía
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - M. A. Cobos
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - B. Cabeza
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | | | - M. Luaces Méndez
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - J. J. Gómez de Diego
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - A. Bustos
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - J. Pérez-Villacastín
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - A. de Agustín
- grid.411068.a0000 0001 0671 5785Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos of Madrid, Madrid, Spain
| | - V. Martínez de Vega
- grid.488466.00000 0004 0464 1227Radiology Department, Hospital Universitario Quirónsalud Madrid, Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid Spain
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Ferrandez M, Zulet P, Islas F, Travieso A, De Agustin JA, Goirigolzarri J, Vilacosta I, Olmos C. Development of a new score to predict left ventricular reverse remodelling in patients with nonischemic cardiomyopathy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Implantable cardioverter-defibrillator is indicated in patients with dilated non-ischemic cardiomyopathy (DCM) and severely depressed left ventricular ejection fraction (LVEF) after a wait-and-see period of 3–9 months under optimised medical therapy. However, in the first 6 months after the disease debut, around 2% of patients might suffer life-threatening arrhythmias.
The appearance of left ventricular reverse remodelling (LVRR) in patients with DCM is associated with a lower incidence of ventricular tachyarrhythmias. Therefore, it is relevant an early identification of the patients who will experience LVRR during the follow-up.
Our aim was to develop a score to predict the appearance of LVRR in patients with DCM.
Methods
From 2014 to 2021, 201 patients with DCM and LVEF ≤45% were prospectively evaluated in our tertiary care hospital. All patients underwent a transthoracic echocardiogram and 1.5 Tesla scanner cardiac magnetic resonance (MR) as part of the diagnostic workup. LVRR was defined as an increase in LVEF ≥10 points or absolute LVEF ≥50% associated with a reduction in left ventricular end-diastolic diameter ≥10%.
Results
The median age of our cohort (n=201) was 61.6 (14.7) years, and 68% were male. Most patients (>90%) were treated with beta-blockers or RASS blockers, and 72% with mineralocorticoid receptor antagonists.
During a mean follow-up period of 37.6 (33.9) months 45% of patients had LVRR.
Patients with LVRR had a lower cardiovascular mortality (3.33 vs 9.59%; p=0.153), lower mortality due to heart failure (0% vs 8.22%; p=0.023), and a lower incidence of ventricular tachyarrhythmias (1.67% vs 19.18%; p=0.001).
Table 1 shows the echocardiographic, MR and clinical characteristics of patients who experienced LVRR.
Variables significantly associated with LVRR in the univariable analysis and considered clinically relevant were included in a multivariable logistic regression analysis. The final model included the presence of right ventricular end systolic volume index (RVESVi) >50 ml/m2 (2 points), left bundle brach block (LBBB) echo pattern (1 point), female gender (1 point) and tachycardiomyopathy/idiopathic/alcoholic/chemotherapy induced cardiomyopathy as the potencial cause of DCM (1 point).
The score showed a good discrimination, with an area under the ROC curve of 0.82 (95% CI 0.69 to 0.94), 84% sensitivity and 80% specificity. The presence of 3 or more points was associated with a high probability to had LVRR (0 points: 1%; 1 points: 17%; 2 points: 38%; 3 points: 64%; 4 points: 84%%; 5 points: 94% and 6 points: 98%) (Figure 1).
Conclusion
A new score with four variables (RVESV, LBBB echo pattern, female gender and tachycardiomyopathy/idiopatic/alcoholic/chemotheapy induced cardiomyopathy as potential cause) accurately predicts the probability of LVRR. Considering patients who experience LVRR have less cardiovascular events, this score may be a helpful tool for patients' risk stratification.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Ferrandez
- San Carlos Clinical University Hospital , Madrid , Spain
| | - P Zulet
- San Carlos Clinical University Hospital , Madrid , Spain
| | - F Islas
- San Carlos Clinical University Hospital , Madrid , Spain
| | - A Travieso
- San Carlos Clinical University Hospital , Madrid , Spain
| | - J A De Agustin
- San Carlos Clinical University Hospital , Madrid , Spain
| | | | - I Vilacosta
- San Carlos Clinical University Hospital , Madrid , Spain
| | - C Olmos
- San Carlos Clinical University Hospital , Madrid , Spain
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5
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Bastidas Plaza D, Pozo Osinalde E, Islas F, Perez De Isla L, Marcos-Alberca P, Hernandez P, Martin-Lores I, Luaces Mendez M, Gomez De Diego JJ, Bustos A, Perez-Villacastin J, De Agustin JA. Global and regional left ventricular deformation evaluation with feature tracking in transthyretin cardiac amyloidosis. Comparison with echocardiographic findings. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Diagnosis of cardiac amyloidosis (CA) is basically based on imaging techniques. Transthoracic echocardiography (TTE) is crucial to raise suspicion of this disease through detection of the classical features. An specific left ventricular (LV) deformation pattern with apical sparing (“cherry on top”) has been described on speckle tracking (ST) TTE. However, there is no data regarding the role of the LV global and regional analysis with the new tool feature tracking (FT) of cardiac magnetic resonance (CMR) in CA.
Purpose
Our aim is to analyze the concordance of LV deformation between ST-TTE and FT-CMR.
Methods
Consecutive patients with definitive diagnosis of transthyretin (TTR) CA, based on DPD scintigraphy, and imaging evaluation with TTE and CMR were retrospectively included. LV volumes and ejection were calculated from both TTE and CMR following the ongoing recommendations. Global and segmental longitudinal strain values were obtained from apical 2-, 3- and 4-chambers projections on TTE, while the same parameters were calculated on the same cine views of CMR using a dedicated software of FT analysis. Student t-test was used to compared mean measurements derived from both imaging techniques. Apical index was calculated as the ratio between apical and basal-mid longitudinal values. Moreover, agreement was established using Passing-Bablok regression analysis.
Results
27 patients (80 years-old, 88% men) with definitive diagnosis of TTR CA from our tertiary hospital were included. Regarding echocardiographic findings, 80% showed concentric LV hypertrophy with low normal ejection fraction in the majority (52±10%). When longitudinal LV strain parameters were compared (Table 1), no differences were noted in global and apical values whereas basal and mid measurements were higher from CRM resulting in different apical indexes. Although 42% showed a typical “cherry on top” pattern in ST analysis, in only 18% of the FT apical sparing was detected. Consistently, decremental pattern was observed in 60% of TTE and in 20% of CMR. Concordance analysis with Passing-Bablok showed no constant or proportional differences, meaning both techniques were comparable.
Conclusions
Among patients with TTR CA there were no differences in global longitudinal LV strain analysis between ST-TTE and FT-CMR. Nevertheless, discordance in regional parameters resulted in a less frequent detection of apical sparing in CMR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - F Islas
- Hospital Clinic San Carlos , Madrid , Spain
| | | | | | | | | | | | | | - A Bustos
- Hospital Clinic San Carlos , Madrid , Spain
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Zulet Fraile P, Ferrandez Escarabajal M, Islas F, Travieso Gonzalez A, Higueras Nafria J, De Agustin Loeches A, Vilacosta I, Olmos Blanco C. Impact of diabetes mellitus in non-ischemic dilated cardiomyopathy: focus on diastolic dysfunction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
In patients with diabetes mellitus (DM), the presence of myocardial dysfunction in the absence of coronary artery disease, valvular disease and other conventional cardiovascular risk factors has been defined as diabetic cardiomyopathy. Left ventricle concentric hypertrophy and myocardial fibrosis are the structural hallmarks that lead to overt diastolic dysfunction.
The impact of DM in imaging features and clinical outcomes of patients with non-ischaemic dilated cardiomyopathy (DCM) has not been completely elucidated yet.
Purpose
We aim to describe advance imaging and clinical characteristics of DCM's patients with DM, and its potential impact on cardiac morphology and function in comparison to non-diabetic patients.
Methods
From 2014 to 2021, all patients with DCM were prospectively evaluated in our tertiary care hospital.
All patients underwent a transthoracic echocardiogram and 165 patients underwent a 1.5 Tesla scanner cardiac magnetic resonance (CMR) as part of the diagnostic workup. Left ventricle ejection fraction (LVEF), mechanical dyssynchrony, and diastolic function were analyzed according to current guidelines. Late gadolinium enhancement (LGE) was assessed visually and its extent was calculated as the number of affected myocardial segments.
Heart failure (HF) hospitalizations, arrhythmic events and mortality were assessed during follow-up.
Results
The median age of our cohort (n=227) was 61.6 (14.7) years, 66% were male, and DM was present in 57 patients (25.1%). Mean follow-up was 37.6 (33.9) months. Diabetic patients were significantly older, more frequently male, and with more comorbidity. Left bundle branch block was more frequent in patients with DM. The use of SGLT2 inhibitors was higher in diabetic patients (47.4% vs 21.1%; p<0.05). No significant differences were observed regarding other guideline-recommended HF drugs.
With regard to imaging features, no significant differences were found in LVEF and global longitudinal strain between the two groups. There was a trend toward a higher left ventricle mass index measured by CMR in diabetic patients (p=0.364). Parameters of mechanical dyssynchrony and diastolic dysfunction were worse in diabetic patients (Table 1). High-risk LGE pattern (defined as the presence of epicardial, transmural or septal plus free-wall LGE) was more frequently observed in the diabetes group (p<0.05).
Finally, the diabetic group had a higher incidence of HF hospitalization (45.61% vs 22%, p<0.001) and all-cause mortality (24.6% vs 11.8%, p<0.05), as shown in Figure 1. There was also a trend toward a higher cardiovascular mortality (12.3% vs 6.5%, p=0.164) in this group.
Conclusion
DM confers a high-risk profile to DCM patients, explained by extracardiac (more comorbidities) and cardiac (more diastolic dysfunction and high-risk LGE pattern) reasons. These patients may benefit from a close monitoring, and new therapies should be developed to improve their prognosis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - F Islas
- San Carlos Clinical Hospital , Madrid , Spain
| | | | | | | | - I Vilacosta
- San Carlos Clinical Hospital , Madrid , Spain
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7
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Gutierrez E, Carrion I, Olmos C, Jimenez P, Nombela L, Pozo E, Mahia P, Gil S, De Agustin A, Islas F. Cardiac damage staging in patients undergoing TAVR. Incremental value of global longitudinal strain and right ventricular-arterial coupling. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transcatheter aortic valve replacement (TAVR) is nowadays a safe and increasingly frequent option to treat severe aortic stenosis (AS). Cardiac damage staging has been proposed and validated in some studies as a prognostic tool; however, many patients continue to undergo aortic valve replacement only after there is evidence of cardiac damage. The aim of this study is to assess the potential incremental value of global longitudinal strain (GLS) and right ventricular-arterial coupling (RV-VAc) in the prognostic performance of the cardiac damage staging.
Methods
Consecutive patients with AS and undergoing TAVR were included in our hospital registry. Baseline echocardiography was performed before TAVR according to current guidelines. For this study, patients were classified based on the following stage of cardiac damage: Stage 0: no cardiac damage; Stage 1: left ventricular (LV) damage (LV ejection fraction (LVEF) <50%, LV mass index >95 g/m2 for women, >115 g/m2 for men); Stage 2: left atrial (LA) or mitral valve damage (LA volume index >34 ml/m2, mitral regurgitation moderate-severe, or presence of atrial fibrillation); Stage 3: pulmonary vasculature or tricuspid valve damage (systolic pulmonary artery pressure 60 mmHg, or tricuspid regurgitation moderate-severe); Stage 4: RV damage (TAPSE <1.7 cm, S' <9.5 cm/s).
Results
496 patients were studied. Mean age of the cohort was 81.9±6.2 years, mean aortic valve area was 0.86±0.6 cm2, mean LVEF was 57.9±12.3%, mean LV-GLS was −15.6±3.5% and RV-Vac was 0.61±0.34. Table 1 shows clinical and echo characteristics of patients. Only one patient (0.2%) met criteria for stage 0; 38 (7.7%) patients were in stage 1; 159 (32.1%) patients in stage 2, 157 (31.7%) patients in stage 3 and 141 (28.4%) patients in stage 4. 1-year mortality for stage 1 was (10.5%), for stage 2 (13.7%), for stage 3 (32.2%) and for stage 4 (19.5%). The area under the ROC curve (AUC) for 1-year mortality for the cardiac damage staging system was 0.622, CI (0.539–0.705); the best cut-off value for LV-GLS to predict 1-year mortality was −14% with an AUC of 0.634 CI (0.487–0.781) and RV-VAc had an AUC of 0.748 CI (0.638–858). Finally, the model that included the staging system, LV-GLS and RV-VAc had an AUC ROC of 0.875, CI (0.780–0.971) (Figure 1).
Conclusions
Cardiac damage staging is a good prognostic tool and it has been validated in several studies, however, the addition of feasible and widely available echo parameters such as LV-GLS and RV-VAc can significantly increase its prognostic yield.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- E Gutierrez
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - I Carrion
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - C Olmos
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - P Jimenez
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - L Nombela
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - E Pozo
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - P Mahia
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - S Gil
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - A De Agustin
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
| | - F Islas
- Hospital Clinic San Carlos, Cardiovascular Institute , Madrid , Spain
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8
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Witberg G, Landes U, Talmor-Barkan Y, Richter I, Barbanti M, Valvo R, De Backer O, Ooms JF, Islas F, Marroquin L, Sedaghat A, Sugiura A, Masiero G, Armario X, Fiorina C, Arzamendi D, Santos-Martinez S, Fernández-Vázquez F, Baz JA, Steblovnik K, Mauri V, Adam M, Merdler I, Hein M, Ruile P, Codner P, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat-Santos IJ, Mylotte D, Bunc M, Tarantini G, Nombela-Franco L, Søndergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Center Valve Preference and Outcomes of Transcatheter Aortic Valve Replacement: Insights From the AMTRAC Registry. JACC Cardiovasc Interv 2022; 15:1266-1274. [PMID: 35738747 DOI: 10.1016/j.jcin.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/25/2022] [Accepted: 05/03/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Data on outcomes of transcatheter aortic valve replacement (TAVR) using balloon-expandable valves (BEVs) or self-expandable valves (SEVs) as well as the impact of center valve preference on these outcomes are limited. OBJECTIVES The aim of this study was to compare outcomes of TAVR procedures using third-generation BEVs and SEVs stratified by center valve preference. METHODS In a multicenter registry (n = 17), 13 centers exhibited valve preference (66.6%-90% of volume) and were included. Outcomes were compared between BEVs and SEVs stratified by center valve preference. RESULTS In total, 7,528 TAVR procedures (3,854 with SEVs and 3,674 with BEVs) were included. The mean age was 81 years, and the mean Society of Thoracic Surgeons score was 5.2. Baseline characteristics were similar between BEVs and SEVs. Need for pacemaker implantation was higher with SEVs at BEV- and SEV-dominant centers (17.8% vs 9.3% [P < 0.001] and 12.7% vs 10.0% [P = 0.036], respectively; HR: 1.51; P for interaction = 0.021), risk for cerebrovascular accident was higher with SEVs at BEV-dominant but not SEV-dominant centers (3.6% vs 1.1% [P < 0.001] and 2.2% vs 1.4% [P = 0.162]; HR: 2.08; P for interaction < 0.01). Aortic regurgitation greater than mild was more frequent with SEVs at BEV-dominant centers and similar with BEVs regardless of center dominance (5.2% vs 2.8% [P < 0.001] and 3.4% vs 3.7% [P = 0.504], respectively). Two-year mortality was higher with SEVs at BEV-dominant centers but not at SEV-dominant centers (21.9% vs 16.9% [P = 0.021] and 16.8% vs 16.5% [P = 0.642], respectively; HR: 1.20; P for interaction = 0.032). CONCLUSIONS Periprocedural outcomes, aortic regurgitation greater than mild, and 2-year mortality are worse when TAVR is performed using SEVs at BEV-dominant centers. Outcomes are similar regardless of valve type at SEV-dominant centers. The present results stress the need to account for this factor when comparing BEV and SEV outcomes. (The Aortic+Mitral Transcatheter [AMTRAC] Valve Registry; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Uri Landes
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Cardiology, Wolfson Medical Center, Holon, Israel
| | - Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilan Richter
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fabian Islas
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Xavier Armario
- Department of Cardiology, Galway University Hospital, and National University of Ireland Galway, Galway, Ireland
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Center, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Germany
| | - Ilan Merdler
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Carmelo Grasso
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Cardiology, Wolfson Medical Center, Holon, Israel
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | | | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, and National University of Ireland Galway, Galway, Ireland
| | - Matjaz Bunc
- Department of Cardiology, University Medical Center, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach-Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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9
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Souza-Neto FV, Islas F, Jiménez-González S, Luaces M, Ramchandani B, Romero-Miranda A, Delgado-Valero B, Roldan-Molina E, Saiz-Pardo M, Cerón-Nieto MÁ, Ortega-Medina L, Martínez-Martínez E, Cachofeiro V. Mitochondrial Oxidative Stress Promotes Cardiac Remodeling in Myocardial Infarction through the Activation of Endoplasmic Reticulum Stress. Antioxidants (Basel) 2022; 11:antiox11071232. [PMID: 35883722 PMCID: PMC9311874 DOI: 10.3390/antiox11071232] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 12/10/2022] Open
Abstract
We have evaluated cardiac function and fibrosis in infarcted male Wistar rats treated with MitoQ (50 mg/kg/day) or vehicle for 4 weeks. A cohort of patients admitted with a first episode of acute MI were also analyzed with cardiac magnetic resonance and T1 mapping during admission and at a 12-month follow-up. Infarcted animals presented cardiac hypertrophy and a reduction in the left ventricular ejection fraction (LVEF) and E- and A-waves (E/A) ratio when compared to controls. Myocardial infarction (MI) rats also showed cardiac fibrosis and endoplasmic reticulum (ER) stress activation. Binding immunoglobulin protein (BiP) levels, a marker of ER stress, were correlated with collagen I levels. MitoQ reduced oxidative stress and prevented all these changes without affecting the infarct size. The LVEF and E/A ratio in patients with MI were 57.6 ± 7.9% and 0.96 ± 0.34, respectively. No major changes in cardiac function, extracellular volume fraction (ECV), or LV mass were observed at follow-up. Interestingly, the myeloperoxidase (MPO) levels were associated with the ECV in basal conditions. BiP staining and collagen content were also higher in cardiac samples from autopsies of patients who had suffered an MI than in those who had died from other causes. These results show the interactions between mitochondrial oxidative stress and ER stress, which can result in the development of diffuse fibrosis in the context of MI.
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Affiliation(s)
- Francisco V. Souza-Neto
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
| | - Fabian Islas
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (F.I.); (M.L.)
| | - Sara Jiménez-González
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
| | - María Luaces
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, 28040 Madrid, Spain; (F.I.); (M.L.)
| | - Bunty Ramchandani
- Servicio de Cirugía Cardiaca Infantil, Hospital La Paz, 28046 Madrid, Spain;
| | - Ana Romero-Miranda
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
| | - Beatriz Delgado-Valero
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
| | - Elena Roldan-Molina
- Biobanco del Hospital Clínico San Carlos, Instituto de Investigación de Salud del Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.R.-M.); (L.O.-M.)
| | - Melchor Saiz-Pardo
- Departamento de Patología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.S.-P.); (M.Á.C.-N.)
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Mª Ángeles Cerón-Nieto
- Departamento de Patología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.S.-P.); (M.Á.C.-N.)
| | - Luis Ortega-Medina
- Biobanco del Hospital Clínico San Carlos, Instituto de Investigación de Salud del Hospital Clínico San Carlos, 28040 Madrid, Spain; (E.R.-M.); (L.O.-M.)
- Departamento de Patología, Hospital Clínico San Carlos, 28040 Madrid, Spain; (M.S.-P.); (M.Á.C.-N.)
- Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Ernesto Martínez-Martínez
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
- Ciber de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28222 Majadahonda, Spain
- Correspondence: (E.M.-M.); (V.C.); Tel.: +34-91-3941483 (E.M.-M.); +34-91-3941489 (V.C.)
| | - Victoria Cachofeiro
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain; (F.V.S.-N.); (S.J.-G.); (A.R.-M.); (B.D.-V.)
- Ciber de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28222 Majadahonda, Spain
- Correspondence: (E.M.-M.); (V.C.); Tel.: +34-91-3941483 (E.M.-M.); +34-91-3941489 (V.C.)
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10
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Gallone G, Bruno F, Trenkwalder T, D'Ascenzo F, Islas F, Leone PP, Nicol P, Pellegrini C, Incaminato E, Jimenez-Quevedo P, Alvarez-Covarrubias HA, Bragato R, Andreis A, Salizzoni S, Rinaldi M, Kastrati A, Conrotto F, Joner M, Stefanini G, Nombela-Franco L, Xhepa E, Escaned J, De Ferrari GM. Prognostic implications of impaired longitudinal left ventricular systolic function assessed by tissue Doppler imaging prior to transcatheter aortic valve implantation for severe aortic stenosis. Int J Cardiovasc Imaging 2022; 38:10.1007/s10554-021-02519-2. [PMID: 35006473 DOI: 10.1007/s10554-021-02519-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/30/2021] [Indexed: 11/05/2022]
Abstract
Change in longitudinal left ventricular (LV) systolic function serves as an early marker of the deleterious effect of aortic stenosis (AS) and other cardiac comorbidities on cardiac function. We explored the prognostic value of tissue Doppler imaging (TDI)-derived longitudinal LV systolic function, defined by the peak systolic average of lateral and septal mitral annular velocities (average S') among symptomatic patients with severe AS undergoing transcatheter aortic valve implantation (TAVI). 297 consecutive patients with severe AS undergoing TAVI at three european centers with available average S' at preprocedural echocardiography were retrospectively included. The primary endpoint was the Kaplan Meier estimate of all-cause mortality. After a median 18 months (IQR 12-18) follow-up, 36 (12.1%) patients had died. Average S' was associated with all-cause mortality (per 1 cm/sec decrease: HR 1.29, 95%CI 1.03-1.60, p = 0.025), the cut-off of 6.5 cm/sec being the most accurate. Patients with average S' < 6.5 cm/sec (55.2%) presented characteristics of more advanced LV remodeling and functional impairment along with higher burden of cardiac comorbidities, and experienced higher all-cause mortality (17.6% vs. 7.5%, p = 0.007), also when adjusted for in-study outcome predictors (adj-HR: 2.69, 95%CI 1.22-5.93, p = 0.014). Results were consistent among patients with preserved ejection fraction, normal-flow AS, high-gradient AS and in those without LV hypertrophy. Longitudinal LV systolic function assessed by average S' is independently associated with long-term all-cause mortality among TAVI patients. An average S' below 6.5 cm/sec best defines clinically meaningful reduced longitudinal systolic function and may aid clinical risk stratification in these patients.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy.
| | - Francesco Bruno
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | | | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Fabian Islas
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | | | | | | | - Enrico Incaminato
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Pilar Jimenez-Quevedo
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | | | - Renato Bragato
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Alessandro Andreis
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Stefano Salizzoni
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | | | - Federico Conrotto
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
| | | | - Giulio Stefanini
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Luis Nombela-Franco
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Erion Xhepa
- Deutsches Herzzentrum München, Munich, Germany
| | - Javier Escaned
- Hospital Clínico San Carlos, IDISSC, and Universidad Complutense de Madrid, Madrid, Spain
| | - Gaetano M De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy
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11
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Cobos Gil MA, Diz J, Islas F. A new method for ECG recording in the prone position. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Prone ventilation is frequently used in critical patients. ECG is usually recorded transposing the precordial positions to the back (Fig. 1A). The resultant precordial leads are unpredictably different from the supine ECG and difficult to interpret.
According to the dipole theory and the concept of mirror image electrocardiogram, each precordial point has an antipodal area where a mirror precordial lead can be recorded. Fig. 1B shows the location of the antipodal areas for the precordial points
Purpose
Based on this theoretical background we propose to use these antipodal areas to record inverted precordial leads (mirror leads M1 – M6) with diagnostic and monitoring potential.
Patients and methods
We have placed the precordial electrodes in the corresponding antipodal area for each precordial point (Fig. 1B) and we have recorded prone ECG in 20 subjects (10 healthy volunteers, 10 cardiac patients) The resultant ECGs (leads M1-M6) were compared with the standard supine ECGs (v1-V6).
Results
Mirror leads show low amplitude (especially V2-V4) compared to standard precordials, but are qualitatively quite similar (but inverted) to the supine precordial leads (Fig. 2).
Conclusion
We proposed a new method to obtain ECGs in prone patients. The resultant precordial leads are comparable to the standard precordial leads.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- M A Cobos Gil
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - J Diz
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - F Islas
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
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12
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Salinas Gallegos A, Pozo Osinalde E, Gordillo X, Jimenez Quevedo P, Mahia P, Marcos-Alberca P, Tirado G, Islas F, Macaya C, Perez-Villacastin J, Fernandez-Ortiz A, Nombela-Franco L, De Agustin JA. Impact of mitral valve anatomy suitability in echocardiographic and clinical evolution in patients referred for percutaneous edge-to-edge repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Percutaneous edge-to-edge mitral repair has become an effective therapeutic alternative to surgery in high-risk patients with moderate-to-severe mitral regurgitation (MR). A traffic light system has been proposed to evaluate echocardiographic suitability for this therapy. However, few data is available regarding prognostic impact of these criteria.
Purpose
To study the impact of imaging eligibility classification in echocardiographic and clinical evolution.
Methods
We evaluated all the consecutive patients who underwent percutaneous mitral repair with the MitraClip system between 2010 and 2020 in our tertiary university hospital, excluding the redo procedures (n=1). Imaging eligibility classification was blindly made by two experts in structural heart disease. Pre and posprocedural echocardiographic measurements were reassessed and clinical events were collected from medical records.
Results
87 patients (65.5% males) with a mean age of 76±10 years were finally included. Regarding mitral valve disease, 13 (14.9%) was graded as moderate-to-severe whereas 74 (85.1%) was considered severe. MR etiology was: functional 44.8%, organic 34.5% and mixed 20.7%. Prior to the procedure the NYHA class was III or higher in 88.5% and LVEF was 44.4±15.4%. Eligibility criteria was: green (44, 50.6%), yellow (39, 44.8%) and red (4, 4.6%). The later patients, with theorical contraindication for the procedure, were excluded from analysis. Although less number of clips were needed in green morphology (1.14 vs 1.46; p=0.01), pulmonary vein flow improved more markedly (Table) in these patients. This resulted only in a slightly greater reduction in MR grade at 6 months (−2.5 vs −1.9; p=0.008). No differences were noted in follow up absolute MR grade or changes in ventricular volumes, LVEF or pulmonary artery systolic pressure. Moreover, there was no impact in MACE during the evolution.
Conclusion
Excluding contraindicated group, no relevant echocardiographic or clinical impact was noted regarding eligibility criteria for percutaneous edge-to-edge mitral repair. Thus, suboptimal patients may equally benefit from this therapy even in moderate-volume centers.
Funding Acknowledgement
Type of funding sources: None. Table 1. Postprocedural pulmonary vein flow pattern in relation with eligibility criteria
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Affiliation(s)
| | | | - X Gordillo
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - P Mahia
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - G Tirado
- Hospital Clinic San Carlos, Madrid, Spain
| | - F Islas
- Hospital Clinic San Carlos, Madrid, Spain
| | - C Macaya
- Hospital Clinic San Carlos, Madrid, Spain
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13
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Islas F, De Agustin A, Jimenez P, Nombela L, Marcos Alberca P, Seabra D, Olmos C, Lepori A, Mahia P, Perez De Isla L. The discongruence index, a simple predictor of cardiac remodeling after transcatheter aortic valve replacement. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Aortic stenosis causes several changes in left ventricular (LV) geometry and function; cardiac remodeling after transcatheter aortic valve replacement (TAVR) is variable among patients and it is not clearly defined. The aim of this study is to identify factors associated with LV functional and structural recovery.
Methods
428 patients were retrospectively studied; all patients underwent transthoracic echocardiography prior to TAVR; specific measurements such as maximum internal diameter of the prosthetic valve, nominal loss and percentage of nominal loss regarding to valve size, as well as the discongruence index (Prosthesis size/BSA) were evaluated at discharge and 1-year follow up. Positive cardiac remodeling (PCR) was considered if patients had a reduction of ≥20% of left ventricle mass index (LVMi) and ≥10% of end-diastolic volume index (LVEDVi).
Results
Mean age of the cohort was 83±5.6 years, 55% were female (n=236), mean aortic valve area was 0.7±0.2cm2; mean LVMi and LVEDVi were 129.4±35.4gr/m2 and 54.5±22ml/m2 respectively. LVMi reduction ≥20% was observed in 30% (n=128) of patients; LVEDVi reduction ≥10% was observed in 44% (n=188) of patients. A total of 107 patients (25%) showed PCR. Female patients showed more PCR (p=0.04). Discongruence index was significantly higher in patients with PCR (15.5±1.9 vs 14.5±1.8, p=0.01) and was significantly associated to LVMi (121.5±28.9 vs 150.8±41.1g/m2) and LVEDVi individually (55.1±17.2 vs 42.7±16.7ml/m2; p<0.01). Left ventricular ejection fraction (LVEF) had a statistically significant increase among patients with PCR (53.2±14.9 vs 56.7±11.5, p=0.04) global longitudinal strain showed improvement at 1-year follow-up as well, although not statistically significant (−17.3±3.7 vs −18.3±3.4 p=0.53).
Conclusions
The discongruence index is a simple and feasible parameter that can predict positive cardiac remodeling after TAVR which can have a significant impact in clinical outcome of patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Islas
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A De Agustin
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Jimenez
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Nombela
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Marcos Alberca
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - D Seabra
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - C Olmos
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A Lepori
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Mahia
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Perez De Isla
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
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14
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De Agustin Loeches J, Pozo E, Nombela- Franco L, Jimenez-Quevedo P, Tirado G, Mahia P, Marcos-Alberca P, Luaces M, Perez De Isla L, Gomez De Diego J, Cobos M, Islas F, Fernandez-Ortiz A, Villacastin J, Macaya C. Discongruence Index: predictor of prosthesis size loss after transcatheter aortic valve replacement. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Prosthesis under-expansion has been associated with higher rates of complications and worse long term outcome after transcatheter aortic valve replacement (TAVR). The objective of the current study was to assess the value of a new “Discongruence index”, to predict the percentage of prosthesis size loss (compared to its nominal size). The “discongruence index” is obtained from the relation between transcatheter valve size and the patient body surface area.
Methods
A total of 247 consecutive patients with severe aortic stenosis that underwent TAVR with balloon expandable Edwards-Sapiens prosthesis or CoreValve Revalving system at our institution were included. The “Discongruence index” was calculated pre-procedurally as the ratio: selected transcatheter valve size (mm) / body surface area (cm2). Two-dimensional transesophageal echocardiography images were studied in the 120–135° plane after the prosthesis deployment, and the maximum anteroposterior diameter was measured (in millimeters). From this measurement was obtained the percentage of prosthesis size loss (compared to the prosthesis nominal size).
Results
Mean age was 82±6 years and 102 patients (41.3%) were men. Mean aortic valvular area before TAVR was 0,87±3,8 cm2, (indexed 0,36±0,1 cm2) and the mean aortic gradient 49,1±16,9 mmHg. Mean prosthesis maximum deployment was 18,9±2,7 mm; absolute loss of prosthesis size compared to nominal 6,5±2,8 mm and the percentage loss of prosthesis size 25.1±9,5%. The “Discongruence index” was predictor of the percentage of prosthesis size loss (y = 5,7650 + 1,3010x, p<0,001), see figure.
Conclusions
The “Discongruence index” is a useful tool to predict the percentage of prosthesis size loss after TAVR. This new index should be taken into consideration in the selection of transcatheter valve sizes to avoid prosthesis under-expansion.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
| | - E Pozo
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | - G Tirado
- Hospital Clinic San Carlos, Madrid, Spain
| | - P Mahia
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - M Luaces
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | - M.A Cobos
- Hospital Clinic San Carlos, Madrid, Spain
| | - F Islas
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | - C Macaya
- Hospital Clinic San Carlos, Madrid, Spain
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15
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Islas F, Bottino R, Jimenez P, Nombela L, Marcos Alberca P, D'Amato M, Lepori A, Olmos C, Perez De Isla L, De Agustin A. Ventricular-arterial coupling in hypertensive patients after TAVR. It is not all about the valve. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In severe aortic stenosis, the left ventricle faces the challenge of the valvular load and the arterial load caused by abnormalities in systemic arterial compliance and systemic vascular resistance. The aim of this study is to assess the effect of hypertension control on left ventricular performance in patients that underwent TAVR.
Methods
68 consecutive patients who underwent TAVR were analyzed; all patients were evaluated to confirm severe aortic stenosis with transthoracic echo (TTE). Conventional echo parameters were assessed as well as left ventricular mechanics parameters and vascular parameters such as arterial elastance (Ea), ventricular elastance (Ees) and V/Ac; besides all patients underwent TTE prior to TAVR, at discharge and 90 days follow-up visit.
Results
Mean age was 82±5; mean aortic valve area was 0.69±0.19, mean left ventricular ejection fraction was 58.3±12.1 and mean ventricular-arterial coupling was 1.6±0.9. At 90 days follow up we observed a significant worsening in V/Ac in those patients with poor control of blood pressure (>140/90mmHg), (1.8±0.5 vs 2.1±0.3, p=0.03). Aortic impedance was significantly higher (4.4±1.4 vs 3.5±1.2, p=0.05); Ea and Ees were also significantly higher in hypertensive patients (2.3±0.8 vs 1.7±0.6, p=0.05) and (1.4±0.7 vs 0.9±0.6, p=0.01) respectively. Left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) showed a slightly reduction in hypertensive patients, although not statistically significant.
Conclusions
Control of blood pressure seems to be an important factor that contributes to a better or rather worse LV performance and could have a potential role in systolic function and clinical outcome of patients after TAVR.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Islas
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - R Bottino
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Jimenez
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Nombela
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Marcos Alberca
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - M D'Amato
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A Lepori
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - C Olmos
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Perez De Isla
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A De Agustin
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
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16
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Perez Garcia CN, Olmos C, Garcia Arribas D, Lopez J, Ladron R, San Roman JA, Jeronimo A, Islas F, Ferrera C, Saenz-Bejar C, Vilacosta I. Impact of frailty on elderly patients with infective endocarditis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Frailty studies focused on patients with infective endocarditis (IE) are scarce and its potential impact on patient outcomes is not well known.
The aim of this study is to describe the clinical profile and prognosis of elderly patients with IE, comparing patients who met the frailty criteria versus those who did not.
Methods
A total of 121 cases of confirmed IE were consecutively collected in three tertiary hospitals between 2017 and 2019. The patients were classified into two groups: Group I (n=49), patients with IE who met the Frail criteria for frailty, and Group II (n=72), those patients without frailty by this scale.
Results
The median age of our cohort was 77 years (69–82), and 62.8% were men. Frail patients were older than those in Group II, as shown in Table 1.
Regarding comorbidity, chronic anemia (40.8% vs 25%; p<0.060) was more common in Group I, as well as rheumatic manifestations at admission (12.2% vs 1.4%; p=0.014).
The most frequently isolated microorganisms were S. aureus (n=25), coagulase negative staphylococci (n=25), viridans group streptococci (n=14), and enterococci (n=14). Enterococci (16.3% vs 8.3%, p=0.177) and non-viridans streptococci (10.2% vs 2.8%); p=0.086) were more frequent in frail patients.
Vegetation (79.6% vs 80.6%; p=0.896) and periannular complications (24.5% vs 29.2%; p=0.571) were similar in both groups. No significant differences were found regarding the location of the infection.
The incidence of in-hospital complications was similar between both groups. Frail patients underwent surgery less frequently than those in Group II, and had higher predicted mortality on surgical risk scale scores. However, the percentage of patients who met the surgical criteria and were considered inoperable was similar (33.3% vs 26.2%; p=0.415). In-hospital mortality was similar in both groups. When analyzing in-hospital mortality according to the therapeutic strategy in Group I, a mortality of 34.5% was observed in frail patients with conservative medical treatment, compared to 47.1% in those patients who underwent surgery in the same group.
One third of our patients received outpatient antibiotic treatment, being significantly more frequent in Group I (39.6% vs 29.0%; p=0.232).
Conclusions
The elderly patients with IE and frailty criteria were older and more frequently had rheumatic symptoms at admission. Enterococci and non-viridans streptococci were isolated more frequently than in non-frailty patients. Surgery was less performed among frail patients, who had a higher predicted surgical risk. Although complications and in-hospital mortality were similar between both groups, in the group of frail patients, those with conservative management showed lower mortality compared to surgery.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C N Perez Garcia
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - C Olmos
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - D Garcia Arribas
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - J Lopez
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - R Ladron
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - J A San Roman
- Institute of Heart Sciences (ICICOR), Valladolid, Spain
| | - A Jeronimo
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - F Islas
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - C Ferrera
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | | | - I Vilacosta
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
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17
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Pozo Osinalde E, Urmeneta Ulloa J, Rodriguez Hernandez JL, Perez De Isla L, Martinez Fernandez H, Islas F, Marcos-Alberca P, Mahia P, Cobos MA, Hernandez P, Luaces M, Gomez De Diego JJ, Bustos A, Macaya C, De Agustin JA. Correlation between cardiac magnetic resonance feature tracking derived left ventricular strain and morphological characteristics of non-ischemic dilated cardiomyopathy at baseline and follow-up. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) strain from echocardiography is a known useful predictor of LVEF recovery in non-ischemic dilated cardiomyopathy (NIDCM). More recently, feature tracking (FT) has allowed LV myocardial deformation analysis using conventional cardiac magnetic resonance (CMR) cine sequences.
Purpose
Our aim is to establish the correlation between LV strain values from CMR-FT at diagnosis and morphological parameters at baseline and during follow-up.
Methods
Consecutive patients with NIDCM who underwent CMR were retrospectively collected. All the studies were performed in a 1.5 Tesla magnet following a standard acquisition protocol of conventional SSFP cine sequences in long and short axis. Global longitudinal, circumferential and radial strain (GLS, GCS and GRS, respectively) were obtained with a dedicated FT software. Correlation with CMR morphological parameters at baseline were evaluated. Likewise, in the cases with follow-up echocardiogram association between FT LV strain and evolution of morphofunctional variables was explored.
Results
CMR-FT strain analysis was performed in 98 patients (age 68±13 years, 72% males) with NIDCM. They showed severe LV dilatation (LVEDVi= 133.6±33.4 mL/m2) and systolic dysfunction (LVEF= 29.5±9.6%) at baseline. Myocardial fibrosis was detected in 38.8% of the patients with late gadolium enhancement (LGE) sequence. All the basal CMR morphological characteristics were significantly correlated with FT strain analysis (Table), even more markedly for GCS. However, there was no association of baseline morphofunctional parameters with LGE. An echocardiogram was performed in 85.7% of the patients during the follow-up (2.4 [1.8–3.4] years), with an LVEF >50% in the 25.5% of the cases. These patients with preserved LVEF in the evolution showed better GCS (−9 vs −7.1%; p=0.019) at baseline, with no differences in the other FT LV strain parameters. Despite less fibrosis in LGE (16.1% vs 37.7%; p=0.037), none of the baseline morphofunctional CMR parameters (LVEF, LVEDVi...) were associated with systolic function restoration. In multivariate analysis, GCS was the only independent predictor (OR 1.16; p=0.045) of LVEF recovery among imaging variables.
Conclusions
All the FT derived LV strain values were correlated with the degree of basal morphofunctional involvement in NIDCM. Furthermore, GCS emerged as an independent imaging predictor of LV systolic function restoration in our series.
Funding Acknowledgement
Type of funding sources: None. Table 1. Correlation between myocardial deformation values by feature tracking and morphofunctional variables in basal CMR.
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Affiliation(s)
| | - J Urmeneta Ulloa
- University Hospital Quironsalud Madrid, Cardiology, Madrid, Spain
| | | | | | | | - F Islas
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - P Mahia
- Hospital Clinic San Carlos, Madrid, Spain
| | - M A Cobos
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - M Luaces
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - A Bustos
- Hospital Clinic San Carlos, Madrid, Spain
| | - C Macaya
- Hospital Clinic San Carlos, Madrid, Spain
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18
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Pozo Osinalde E, Urmeneta Ulloa J, Rodriguez Hernandez JL, Perez De Isla L, Martinez Fernandez H, Islas F, Marcos-Alberca P, Mahia P, Cobos MA, Martin Lores I, Luaces M, Gomez De Diego JJ, Cabeza B, Macaya C, De Agustin JA. Clinical relevance of cardiac magnetic resonance feature tracking derived left ventricular strain in nonischemic dilated cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) myocardial deformation analysis with echocardiography has shown an additive value for risk stratification in nonischemic dilated cardiomyopathy (NIDCM). However, scarce data is available with the new cardiac magnetic resonance (CMR) technique feature tracking, which allows strain evaluation from conventional cine sequences.
Purpose
Our aim is to analyze prognostic relevance of FT in NIDCM
Methods
Consecutive patients with NIDCM diagnosis and CMR at diagnosis were retrospectively included. LV global longitudinal, circumferential and radial strain (GLS, GCS and GRS, respectively) were obtained from standard CMR cine sequences with a dedicated FT software. Their association with a composite endpoint (heart failure admission, implantable cardioverter defibrillator in secondary prevention, and death) was evaluated.
Results
FT derived strain was obtained in 98 patients (68±13 years, 72% males) with NIDCM, mostly idiopathic (75.5%). The vast majority showed a severely dilated LV (LVEDVi= 133.6±33.4 mL/m2) with severely impaired systolic function (LVEF= 29.5±9.6%), and in 38.8% of the cases fibrosis was demonstrated in late gadolium enhancement (LGE). During a 3.2 [2.2–4] years follow-up 25.5% had an admission due to heart failure, 5.1% received an implantable cardioverter defibrillator in secondary prevention, and 10.2% died. Only a trend towards worse GCS values (−7.1 vs −8.5%; p=0.10) was noted among patients with heart failure hospitalization. Mortality was associated with poorer GCS (−5.9 vs −7.9%; p=0.012) and GLS (−6.9 vs −9.6%; p=0.051) values, whereas GRS was not related with any prognostic variable. Exclusively GCS was associated with the composite endpoint (−6.7 vs −8.2%; p=0.035). Considering other morphological parameters with prognostic relevance (LVEF and LVEDVi), GCS was the only independent predictor (OR 1.15; p=0.038). A cut-off point <−8.2% was able to identify those patients with a worse clinical evolution (Figure, Log Rank 4.6; p=0.032)
Conclusions
In our series LV myocardial deformation analysis with FT has shown prognostic relevance in NIDCM, especially GCS determination.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
| | - J Urmeneta Ulloa
- University Hospital Quironsalud Madrid, Cardiology, Madrid, Spain
| | | | | | | | - F Islas
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - P Mahia
- Hospital Clinic San Carlos, Madrid, Spain
| | - M A Cobos
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - M Luaces
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - B Cabeza
- Hospital Clinic San Carlos, Madrid, Spain
| | - C Macaya
- Hospital Clinic San Carlos, Madrid, Spain
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19
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Ferrandez M, Islas F, Travieso A, Diz-Diaz J, Restrepo A, Goirigolzarri J, Luaces M, De Agustin JA, Bustos A, Olmos C. Cardiac mechanics as predictors of left ventricular reverse remodelling in patients with dilated non-ischemic cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
The appearance of left ventricular reverse remodelling (LVRR) is associated with a better prognosis in patients with dilated non-ischemic cardiomyopathy (DCM).
Our aim was to identify cardiac imaging parameters, including speckle tracking by transthoracic echocardiography (TTE) and feature tracking by CMR, associated with LVRR in a prospective cohort of patients with DCM.
Methods
From 2014 to 2021, 182 patients with DCM and left ventricle ejection fraction (LVEF) <40% were prospectively evaluated in our hospital.
LVRR was defined as an increase in LVEF ≥10 points or absolute LVEF ≥50%, associated with a reduction in left ventricular end- diastolic diameter ≥10%.
Patients underwent multimodality imaging evaluation including CMR with a 1.5 Tesla scanner, and TTE. Cardiac mechanics, including global longitudinal strain (GLS), strain rate (SR) and mechanical dispersion (MD) were measured.
Results
Median age of our cohort was 62.3 (14.4) years, and 67.7% were male.
Most patients (>90%) were treated with beta-blockers or RASS blockers, and 67% with mineralocorticoid receptor antagonists. 30% had cardiac resynchronization therapy (CRT) and 37% had ICD as primary prevention. Mean LVEF was 31.3%. During a mean follow-up period of 35.9 (35.4) months, 38.3% of patients had LVRR.
Age and gender distribution were similar in both groups. Regarding cardiovascular risk factors and pharmacological treatment, no differences were found between patients with and without LVRR. Baseline CRT therapy was not associated with LVRR (22.6% vs 34.7%; p=0.249). However, there was a trend towards higher LVRR in those who received CRT during follow-up 18.8% vs 0%; p=0.069).
Patients who experienced LVRR had lower basal LVEF (23.4% vs 29%; p<0.008), as well as poorer RV function, including lower RVEF (40.5% vs 51%; p=0.006) and lower TAPSE (16 mm vs 19 mm; p=0.021). Regarding cardiac mechanics, those patients with lower GLS (−9% vs −12%; p=0.001), and higher MD (73 mm vs 55 mm; p=0,050) had LVRR more frequently during follow-up. The presence of a left bundle branch block (LBBB) contraction pattern by strain was associated with higher rate of LVRR (83.3% vs 30.4%; p=0.011). The burden of fibrosis measured by LGE with CMR was not associated with LVRR (14% vs 12%; p=NS).
Patients with LVRR had a lower cardiovascular mortality (3.3 vs 14.3%; p=0.117), lower mortality due to heart failure (0% vs 12.2%; p=0.046), less heart failure hospitalizations (20% vs 46.9%; p=0.016), and a lower incidence of ventricular tachyarrhythmias (3.3% vs 18.4%; p=0.051).
Conclusions
LVRR in patients with DCM receiving optimized medical therapy is associated with a better prognosis. Imaging parameters, including a lower basal LVEF, RVEF, GLS and higher MD, as well as LBBB echo pattern, were associated with a higher frequency of LVRR, and might help to identify patients who could benefit from CRT/and may be helpful to stratify patients's risk.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Ferrandez
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - F Islas
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - A Travieso
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - J Diz-Diaz
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - A Restrepo
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - J Goirigolzarri
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - M Luaces
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - J A De Agustin
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - A Bustos
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
| | - C Olmos
- University Hospital Clinico San Carlos - Madrid Health Service, Madrid, Spain
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20
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Tirado-Conte G, McInerney A, Jimenez-Quevedo P, Carnero M, Marroquin Donday LA, De Agustin A, Witberg G, Pozo E, Islas F, Marcos-Alberca P, Cobiella J, Koronowski R, Macaya C, Rodes-Cabau J, Nombela-Franco L. Managing the patient undergoing transcatheter aortic valve replacement with ongoing mitral regurgitation. Expert Rev Cardiovasc Ther 2021; 19:711-723. [PMID: 34275408 DOI: 10.1080/14779072.2021.1955347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Significant mitral regurgitation (MR) frequently coexists in patients with severe symptomatic aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). These patients have worse clinical outcomes than those with non-significant MR, especially if MR persists after treatment of the aortic stenosis. The optimal treatment approach for this challenging high-risk population is not well defined. AREAS COVERED This review aims to present the current literature on concomitant significant MR in the TAVR population, and to provide a comprehensive algorithmic approach for clinical decision-making in this challenging cohort of patients. EXPERT OPINION Concomitant mitral and aortic valve disease is a complex clinical entity. An exhaustive and comprehensive assessment of patient's clinical characteristics and mitral valve anatomy and function is required in order to assess the surgical risk, predict the MR response after AVR and evaluate the feasibility of percutaneous MV treatment if necessary. Further developments in transcatheter techniques will expand the indications for double valve treatment in operable and inoperable patients with concomitant significant MR and aortic stenosis.
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Affiliation(s)
- Gabriela Tirado-Conte
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Angela McInerney
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Pilar Jimenez-Quevedo
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Manuel Carnero
- Department of Cardiac Surgery, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis A Marroquin Donday
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Alberto De Agustin
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Centre, Petach-Tikvav, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Eduardo Pozo
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Fabian Islas
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Pedro Marcos-Alberca
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Cobiella
- Department of Cardiac Surgery, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Ran Koronowski
- Department of Cardiology, Rabin Medical Centre, Petach-Tikvav, Israel.,Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Carlos Macaya
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Luis Nombela-Franco
- Department of Cardiology, Unit of Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
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21
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Witberg G, Codner P, Landes U, Schwartzenberg S, Barbanti M, Valvo R, De Backer O, Ooms JF, Islas F, Marroquin L, Sedaghat A, Sugiura A, Masiero G, Werner P, Armario X, Fiorina C, Arzamendi D, Santos-Martinez S, Fernández-Vázquez F, Baz JA, Steblovnik K, Mauri V, Adam M, Merdler I, Hein M, Ruile P, Grasso C, Branca L, Estévez-Loureiro R, Benito-González T, Amat-Santos IJ, Mylotte D, Andreas M, Bunc M, Tarantini G, Sinning JM, Nombela-Franco L, Søndergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Effect of Transcatheter Aortic Valve Replacement on Concomitant Mitral Regurgitation and Its Impact on Mortality. JACC Cardiovasc Interv 2021; 14:1181-1192. [PMID: 33992550 DOI: 10.1016/j.jcin.2021.02.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the impact of residual mitral regurgitation (MR) on mortality in patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND MR is common in patients undergoing TAVR. Data on optimal management of patients with significant MR after TAVR are limited. METHODS The registry consisted of 16 TAVR centers (n = 7,303). Outcomes of patients with ≥ moderate versus lesser grade MR after TAVR were compared. RESULTS In 1,983 (27.2%) patients, baseline MR grade was ≥ moderate. MR regressed in 874 (44.1%) patients and persisted in 1,109 (55.9%) after TAVR. Four-year mortality was higher for those with MR persistence, but not for those with MR regression after TAVR, compared with nonsignificant baseline MR (43.8% vs. 35.1% vs. 32.4%; hazard ratio [HR]: 1.38; p = 0.008; HR: 1.02; p = 0.383, respectively). New York Heart Association functional class III to IV after TAVR was more common in those with MR persistence vs. regression (14.4% vs. 3.9%; p < 0.001). In a propensity score-matched cohort (91 patients' pairs), with significant residual MR after TAVR who did or did not undergo staged mitral intervention, staged intervention was associated with a better functional class through 1 year of follow-up (82.4% vs. 33.3% New York Heart Association functional class I or II; p < 0.001), and a numerically lower 4-year mortality, which was not statistically significant (64.6% vs. 37.5%; HR: 1.66; p = 0.097). CONCLUSIONS Risk stratification based on improvement in MR and symptoms after TAVR can identify patients at increased mortality risk after TAVR. These patients may benefit from a staged transcatheter mitral intervention, but this requires further proof from future studies. (Transcatheter Treatment for Combined Aortic and Mitral Valve Disease. The Aortic+Mitral TRAnsCatheter [AMTRAC] Valve Registry [AMTRAC]; NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uri Landes
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Schwartzenberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Marco Barbanti
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Joris F Ooms
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Fabian Islas
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Luis Marroquin
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | | | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Paul Werner
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Xavier Armario
- Department of Cardiology, Galway University Hospital, National University of Ireland, Galway, Ireland
| | | | - Dabit Arzamendi
- Hospital de Sant Creu i Sant Pau Barcelona, Barcelona, Spain
| | - Sandra Santos-Martinez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Germany
| | - Ilan Merdler
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili, Brescia, Italy
| | | | | | - Ignacio J Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, National University of Ireland, Galway, Ireland
| | - Martin Andreas
- Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Matjaz Bunc
- Department of Cardiology, University Medical Centre, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | | | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Lars Søndergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Travieso Gonzalez A, Romero Delgado T, Luque Diaz TS, Islas F, Olmos C, Higueras Nafria J, Vivas D, Mahia Casado P, Vilacosta I. Multivariate analysis of right ventricle echocardiographic function parameters for the prediction of outcomes in significant functional tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Functional tricuspid regurgitation is a common disease that significantly impairs survival and quality of life. The role of echocardiographic right ventricular (RV) function parameters to detect patients with worse prognosis that may benefit from invasive treatment is still under debate.
Methods
121 consecutive patients with grade III and IV functional tricuspid regurgitation were evaluated. RV function parameters and clinical variables were assessed at baseline, and then patients were prospectively followed-up. The primary endpoint was the combination of death or heart failure (HF) admissions. Comparison of imaging parameters was done using receiver-operating characteristics (ROC) curves. Multivariate logistic regression analysis was preformed to establish independent predictors of outcomes.
Results
Median follow up was 27.3 months. 73.6% of the patients were female, and mean age was 80.4 years. 63.6% were grade IV tricuspid regurgitation.
In the univariate analysis using the area under the ROC curve (AUC), RV-free wall strain (RVS, AUC = 0.633) and pulmonary artery systolic pressure (PASP, AUC = 0.605) were the best predictors of death and HF admissions, showing better diagnostic performance than tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC) and tricuspid S’ (p < 0.001 for each comparison) (graph 1A).
In the multivariate analysis including either clinical and echocardiographic variables, independent predictors of death and HF admissions were Age (OR 1.07, p = 0.029), RVS>-16 (OR 5.0, p = 0.001), Diabetes mellitus (OR 3.0, p = 0.011), eGFR (ml/min, OR 0.96, p = 0.001) and Hemoglobin (g/dL, OR = 0.74, p = 0.048) (table 1). The model including these variables was superior than RVS and PASP alone (AUC 0.884, p < 0.001) (graph 1B), showing high sensitivity (78.8%) and moderate specificity (67.3%).
Conclusions
In patients with significant functional tricuspid regurgitation, RVS and PASP show the best performance for the detection of death and HF admissions. A multivariate model including age, diabetes, eGFR, hemoglobin and RVS was superior than the individual imaging parameters.
Table 1 Variable OR 95% CI P value Age (years) 1.07 1.01-1.13 0.029 Diabetes Mellitus 3.00 1.29-7.00 0.011 RV free wall strain >-16 5.01 1.87-13.4 0.001 Hemoglobin (d/dL) 0.74 0.55-1.00 0.048 eGFR (ml/min) 0.96 0.94-0.98 0.001 OR odds ratio. CI: confidence interval. eGFR: estimated glomerular filtration rate (CKD-EPI formula). Abstract Figure. Graph 1
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Affiliation(s)
| | | | | | - F Islas
- Hospital Clinico San Carlos, Madrid, Spain
| | - C Olmos
- Hospital Clinico San Carlos, Madrid, Spain
| | | | - D Vivas
- Hospital Clinico San Carlos, Madrid, Spain
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23
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Freitas-Ferraz AB, Nombela-Franco L, Urena M, Maes F, Veiga G, Ribeiro H, Vilalta V, Silva I, Cheema AN, Islas F, Fischer Q, Fradejas-Sastre V, Rosa VEE, Fernandez-Nofrerias E, Moris C, Junquera L, Mohammadi S, Pibarot P, Rodés-Cabau J. Transcatheter aortic valve replacement in patients with paradoxical low-flow, low-gradient aortic stenosis: Incidence and predictors of treatment futility. Int J Cardiol 2020; 316:57-63. [PMID: 32505373 DOI: 10.1016/j.ijcard.2020.04.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 03/30/2020] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Few and controversial data exist on the outcomes of patients with paradoxical low-flow, low-gradient aortic stenosis (PLFLG-AS) following transcatheter aortic valve replacement (TAVR). This study aims to better characterize clinical outcomes and predictors of treatment futility in PLFLG-AS patients undergoing TAVR. METHODS In this multicenter study, 318 patients with PLFLG-AS undergoing TAVR were categorized according to treatment futility, defined as all-cause mortality, poor functional status (NYHA class III-IV) or deterioration in functional class at 1-year follow-up. Clinical outcomes and the factors associated with treatment futility were assessed. RESULTS The mean age of the patients was 81.0 ± 8.3 years and 50.3% were women. At 1-year follow-up, 17.6% died and 12.9% had heart failure hospitalization. Residual impaired functional capacity (NYHA ≥ II) was present in 54.4% of patients who were alive at 1-year, and 9.8% remained in NYHA III/IV. The primary endpoint was observed in 103 (32.4%) patients, of which 54% died and 46% had a poor or worsening functional class. Factors independently associated with treatment futility were the presence of atrial fibrillation (AF) (OR:1.79, 95%CI, 1.04-3.10), chronic obstructive pulmonary disease (COPD) (OR:2.66, 95%CI, 1.50-4.74) and a lower SVi (OR per each decrease in 10 ml/m2:1.89, 95%CI, 1.06-3.45). The risk of treatment futility of patients with AF, COPD and a SVi < 30 ml/m2 was 66.38% (95%CI, 54.29%-78.48%). CONCLUSION Close to one-third of patients with PLFLG-AS failed to derive a benefit from TAVR. The presence of AF, COPD and a low SVi were predictors of treatment futility. Being able to identify patients less likely to improve after the procedure may help to guide management and improve outcomes in patients with PLFLG-AS.
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Affiliation(s)
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Marina Urena
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | - Frederic Maes
- Cliniques Universitaires Saint Luc, Brussels, Belgium
| | | | | | | | - Iria Silva
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Fabian Islas
- Cardiovascular Institute, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Quentin Fischer
- Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
| | | | | | | | - César Moris
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lucia Junquera
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada.
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Mahia P, Salinas P, Gonzalo N, Islas F, Escaned J, Perez De Isla L, Macaya C. P4352Usefulness of speckle tracking echocardiography in the detection of ventricular mechanics changes after percutaneous intervention of coronary chronic total occlusions. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Previous studies show contradictory results of the effect of chronic total occlusions (CTO) revascularization on LVEF. Deformation parameters based on speckle tracking (2D-ST) echo allows the evaluation of the systolic regional function.
Purpose
To examine the usefulness of 2D-ST to detect changes in regional ventricular mechanics in a consecutive cohort of patients with successful CTO percutaneous revascularization.
Methods
Prospective study that included 13 consecutive patients (72±8 y, 85% men). Revascularization was justified based on the evidence of viability of the underlying territory. 2D-ST was performed before, one and three months after of the procedure. Based on 16 segments model (n: 208), these were classified in two groups (dependent/non-dependent) according to their relationship with the treated CTO. Strain rate (Sr) and Strain (S) of the three myocardial layers were measured.
Results
208 segments analyzed. 62 (30%) perfusion dependent, (mean 5 segments/patient), non-dependent: 146 (70%). During follow-up (median: 3.3 m), there were no significant differences with respect to LVEF (56±6 vs. 59±6, p: 0.2). Although non-dependent segments showed no significant changes of deformation parameters after the procedure, dependent segments showed an increase (Δ) of both the S and Sr, being statistically significant the Δ of the three layers S at 3 months vs. non-dependent.
Table 1 PRE POST p Δ Non-Dependent segments (N: 146) S-epicardial −16.6±4.9 −16.0±4.0 0.06 0.6±4.0 S-mesocardiac −17.4±4.8 −16.8±4.2 0.08 0.6±3.9 S-endocardial −18.1±5.1 −17.7±4.9 0.337 0.4±4.5 Sr −1.15±0.4 −1.09±0.4 0.080 0.07±0.47 Dependent segments (N: 62) S-epicardial −13.7±5.8 −16.3±4.5 <0.001 −2.6±5.2* S-mesocardiac −14.7±6.1 −17.0±4.5 <0.05 −2.3±5.2* S-endocardial −15.8±6.7 −17.9±4.9 <0.05 −2.1±5.6* Sr −0.98±0.4 −1.03±0.4 0.353 −0.05±0.42 *p<0.05 ΔNon-dependents vs. ΔDependents.
S (%) improvement post RCA CTO treatment
Conclusions
This study shows that CTO treatment improves regional myocardial function in LV segments dependent on CTO at three months of follow-up, without changes in LVEF. 2D-ST allows to examine the effect of flow restoration, providing new information on the potential short-term benefits of this strategy
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Affiliation(s)
- P Mahia
- Hospital Clinico San Carlos, Madrid, Spain
| | - P Salinas
- Hospital Clinico San Carlos, Madrid, Spain
| | - N Gonzalo
- Hospital Clinico San Carlos, Madrid, Spain
| | - F Islas
- Hospital Clinico San Carlos, Madrid, Spain
| | - J Escaned
- Hospital Clinico San Carlos, Madrid, Spain
| | | | - C Macaya
- Hospital Clinico San Carlos, Madrid, Spain
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Travieso Gonzalez A, Islas F, Ferrandez Escarabajal M, Luque-Diaz TS, Palacios-Rubio J, Luaces M, Perez De Isla L, Olmos C. P6456Role of cardiac imaging in the prediction of ventricular arrythmias, heart failure and death in dilated non-ischemic cardiomyopathy with severe left ventricular systolic disfunction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Dilated non-ischemic cardiomyopathy (DCM) is associated with an increased risk of cardiac events. Implantable Cardioverter Defibrillator (ICD) is recommended in DCM with severe left ventricular ejection fraction impairment, but the evidence of its usefulness is somewhat controversial. We evaluated the predictive value of myocardial fibrosis measured by cardiac magnetic resonance (CMR) and of global longitudinal strain (GLS) in the incidence of adverse cardiac events.
Methods
From 2009 to 2019, sixty-six patients with DCM were evaluated. CMR with a 1.5 Tesla scanner was performed, and the presence and extent of late gadolinium enhancement (LGE) was blindly assessed. GLS was measured using speckle-tracking 2D echocardiography. We examined the incidence of sustained ventricular arrhythmias (SVA, including appropriate anti-tachycardia pacing and shocks), admissions due to heart failure (HF) and all-cause mortality.
Results
62.1% of the patients were male, with a median age of 63.8 years. 50.0% had cardiac resynchronization therapy and 73.9% had ICD as primary prevention therapy. Median LVEF was 25.7%.
Median follow-up was 32 months. In that period, 10.6% of patients died, 25.8% had hospital admissions due to HF, and 9.2% had SVA. A burden of LGE over 14% was independently associated with higher risk of SVA (3.0% vs 19.2%, p=0.041). This cut-off value had a sensitivity of 83.3% and a negative predictive value of 97.0%. LGE was not associated with higher risk of HF admissions (27.3% vs 23.1%, p=0.731) or death (9.1% vs 11.5%, p=0.757).
On the other hand, GLS was not associated with higher risk of SVA (8.7% vs 4.55% for a cut-off value of −10.6%, p=0.577), HF admissions (26.1% vs 30.4%, p=0.743) or death (8.7% vs 8.7%, p=1.00).
Table 1. Main etiologies of DCM Causes N (%) Idiopathic 43 (65.2) Alcoholic 6 (9.1) Chemotherapy 4 (6.1) Non-compaction 4 (6.1) Familiar 3 (4.6) Thoracic radiotherapy 2 (3.0) Chagas disease 2 (3.0)
Conclusions
The burden of myocardial fibrosis measured by LGE is a high sensitive marker for the development of SVA. However, is not a predictive tool for HF admissions or all-cause mortality. GLS was not associated with the incidence of cardiac events in this population.
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Affiliation(s)
| | - F Islas
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | | | - M Luaces
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - C Olmos
- Hospital Clinic San Carlos, Madrid, Spain
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26
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de Agustin JA, Islas F, Jimenez-Quevedo P, Nombela-Franco L, Rueda Liñares A, Mahia P, Marcos-Alberca P, Pozo E, Gomez de Diego JJ, Luaces M, Nuñez-Gil IJ, Garcia-Fernandez MÁ, Fernandez-Ortiz A, Macaya C, Perez de Isla L. Discongruence Index - Simple Indicator to Predict Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement. Circ J 2018; 82:2880-2886. [PMID: 30135324 DOI: 10.1253/circj.cj-18-0298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) remains an important issue. The aim of this study was to assess the value of a new discongruence index, to predict PPM after TAVR.Methods and Results: A total of 185 patients with severe aortic stenosis who underwent TAVR with the Edwards Sapien prosthesis or CoreValve Revalving system were included (Edwards valve, n=119; Core Valve Revalving system, n=66). Discongruence index was calculated pre-procedurally as the ratio of selected transcatheter valve size (mm) to body surface area (cm2). PPM was defined as effective orifice area (EOA) ≤0.85 cm2/m2 on transthoracic echocardiography before hospital discharge. Mean age was 82±5 years and 72 patients (38.9%) were men. The overall incidence of post-TAVR PPM was 35.1% (n=65). Discongruence index correlated with post-TAVR indexed EOA (y=0.18+0.057x; P<0.001). On multivariate logistic regression analysis, discongruence index was the only independent predictor of post-TAVR PPM (OR, 0.15; 95% CI: 0.03-0.66; P=0.012), and the area under the receiver operating characteristic curve was 0.62 (95% CI: 0.54-0.70, P=0.003), with an optimal cut-off point of 15.02 (sensitivity, 86.2%; specificity, 72.5%; positive predictive value, 74.3%; negative predictive value, 83.4%). CONCLUSIONS The new discongruence index may be useful tool to predict PPM after TAVR.
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Affiliation(s)
| | - Fabian Islas
- Cardiovascular Institute, San Carlos University Clinical Hospital
| | | | | | | | - Patricia Mahia
- Cardiovascular Institute, San Carlos University Clinical Hospital
| | | | - Eduardo Pozo
- Cardiovascular Institute, San Carlos University Clinical Hospital
| | | | - Maria Luaces
- Cardiovascular Institute, San Carlos University Clinical Hospital
| | | | | | | | - Carlos Macaya
- Cardiovascular Institute, San Carlos University Clinical Hospital
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Rodriguez-Gabella T, Nombela-Franco L, Auffret V, Asmarats L, Islas F, Maes F, Ferreira-Neto AN, Paradis JM, Dumont E, Côté M, Jiménez-Quevedo P, Macaya C, Pibarot P, Rodés-Cabau J. Transcatheter Aortic Valve Implantation in Patients With Paradoxical Low-Flow, Low-Gradient Aortic Stenosis. Am J Cardiol 2018; 122:625-632. [PMID: 30064863 DOI: 10.1016/j.amjcard.2018.04.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 11/13/2022]
Abstract
Controversial data exist on clinical outcomes of patients with paradoxical low-flow, low-gradient aortic stenosis (PLF-LG-AS) undergoing valve replacement. The objective of this study was to determine the clinical outcomes and treatment futility in patients with paradoxical low-flow (PLF), low-gradient (LG) severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). A total of 493 patients with severe symptomatic AS and preserved ejection fraction (>50%) undergoing TAVI were included. Patients were divided in two groups: high gradient AS group (HG-AS; mean gradient ≥40 mm Hg and stroke volume index >35 ml/m2, n = 396); and PLF, LG AS group (PLF-LG-AS; mean AV gradient <40 mm Hg and indexed stroke volume ≤35 ml/m2, n = 97). The primary endpoint was treatment futility defined as death or poor functional status (New York Heart Association class III and/or IV) at 6-month follow-up. There were no differences in mortality between groups (PLF-LG-AS: 5%, HG: 8%; adjusted odds ratio (OR): 0.85, 95% confidence interval (CI):0.29 to 2.46), but PLF-LG-AS patients remained more frequently in New York Heart Association class III to IV (20% vs 8% in the HG group, adjusted OR: 2.46, 95% CI:1.19 to 5.07). TAVI treatment futility was more frequent in the PLF-LG-AS group (24% vs 14%, adjusted OR: 1.90 [1.01 to 3.57]), and patients with PLF-LG-AS exhibited a higher rate of rehospitalization for cardiovascular causes (9% vs 5%, adjusted OR: 2.95, 95% CI:1.08 to 8.09). Previous myocardial infarction and chronic obstructive pulmonary disease were associated with treatment futility (p< 0.03 for both). In conclusion, TAVI was a futile treatment in one fourth of patients with PLF-LG-AS. These results underscore the complexity and need for improving the clinical decision-making process and management of patients with PLF-LG-AS.
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Affiliation(s)
- Tania Rodriguez-Gabella
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec, Canada
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Vincent Auffret
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec, Canada
| | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec, Canada
| | - Fabian Islas
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Frederic Maes
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec, Canada
| | | | - Jean-Michel Paradis
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec, Canada
| | - Eric Dumont
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec, Canada
| | - Melanie Côté
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec, Canada
| | | | - Carlos Macaya
- Instituto Cardiovascular, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Quebec, Canada.
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Islas F, De Jesus K, De Agustin A, Jimenez P, Nombela L, Olmos C, Marcos-Alberca P, Cristobal A, Vargas J, Werenitzky J, Feliz J, Luaces M, Perez De Isla L. P4215Procedural TAVI results better predict the evolution of mitral regurgitation rather than mitral valve features itself. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F Islas
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - K De Jesus
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A De Agustin
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Jimenez
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Nombela
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - C Olmos
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - P Marcos-Alberca
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - A Cristobal
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - J Vargas
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - J Werenitzky
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - J Feliz
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - M Luaces
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - L Perez De Isla
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
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Olmos C, Perez-Garcia C, Garcia-Arribas D, Sanchez-Enrique C, Islas F, Jimenez-Ballve A, Perez-Castejon MJ, Ortega-Candil A, Vilacosta I. P4194Usefulness of 18F-FDG PET/CT in patients with suspected cardiac implantable electronic device infection: differences between pocket infection and infective endocarditis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- C Olmos
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - C Perez-Garcia
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | - D Garcia-Arribas
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | | | - F Islas
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
| | | | | | | | - I Vilacosta
- Hospital Clinic San Carlos, Cardiovascular Institute, Madrid, Spain
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De Agustin Loeches JA, Mejia H, Mahia P, Islas F, Marcos-Alberca P, Gomez De Diego JJ, Luaces M, Pozo E, Cobos MA, Nunez-Gil IJ, Fernandez-Ortiz A, Macaya C, Perez De Isla L. P1768PISA 3D method avoids the requirement of an angle correction factor for mitral valve area assessment in mitral stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - H Mejia
- Hospital Clinic San Carlos, Madrid, Spain
| | - P Mahia
- Hospital Clinic San Carlos, Madrid, Spain
| | - F Islas
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | - M Luaces
- Hospital Clinic San Carlos, Madrid, Spain
| | - E Pozo
- Hospital Clinic San Carlos, Madrid, Spain
| | - M A Cobos
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | - C Macaya
- Hospital Clinic San Carlos, Madrid, Spain
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De Agustin Loeches JA, Islas F, Nombela-Franco L, Jimenez-Quevedo P, Mahia P, Rueda Linares A, Marcos-Alberca P, Pozo E, Gomez De Diego JJ, Luaces M, Nunez-Gil IJ, Fernandez-Ortiz A, Macaya C, Perez De Isla L. P5632Discongruence Index predict mismatch after transcatheter aortic aalve replacement. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - F Islas
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | - P Mahia
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | - E Pozo
- Hospital Clinic San Carlos, Madrid, Spain
| | | | - M Luaces
- Hospital Clinic San Carlos, Madrid, Spain
| | | | | | - C Macaya
- Hospital Clinic San Carlos, Madrid, Spain
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Marin-Royo G, Jimenz-Gonzalez S, Jurado-Lopez R, Avila-Heredia IE, Lagunas E, Luaces M, Islas F, Nieto ML, Cachofeiro V. P376The administration of a mitochondrial antioxidant protects against the cardiac consequences associated with obesity in rats. Cardiovasc Res 2018. [DOI: 10.1093/cvr/cvy060.285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- G Marin-Royo
- Universidad Complutense de Madrid, Dpt Physiology, Madrid, Spain
| | | | - R Jurado-Lopez
- Universidad Complutense de Madrid, Dpt Physiology, Madrid, Spain
| | - I E Avila-Heredia
- Universidad Autonoma de Sinaloa, Facultad de Medicina, Culiacan, Mexico
| | - E Lagunas
- Universidad Complutense de Madrid, Dpt Physiology, Madrid, Spain
| | - M Luaces
- Hospital Clinico San Carlos, Cardiologia, Madrid, Spain
| | - F Islas
- Hospital Clinico San Carlos, Cardiologia, Madrid, Spain
| | - M L Nieto
- CSIC-Universidad de Valladolid-CIBERCV, Instituto de Biología y Genética Molecular, Valladolid, Spain
| | - V Cachofeiro
- Universidad Complutense-CIBERCV, Physiology Dpt. School of Medicine, Madrid, Spain
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Cortés C, Amat-Santos IJ, Nombela-Franco L, Muñoz-Garcia AJ, Gutiérrez-Ibanes E, De La Torre Hernandez JM, Córdoba-Soriano JG, Jimenez-Quevedo P, Hernández-García JM, Gonzalez-Mansilla A, Ruano J, Jimenez-Mazuecos J, Castrodeza J, Tobar J, Islas F, Revilla A, Puri R, Puerto A, Gómez I, Rodés-Cabau J, San Román JA. Mitral Regurgitation After Transcatheter Aortic Valve Replacement: Prognosis, Imaging Predictors, and Potential Management. JACC Cardiovasc Interv 2017; 9:1603-14. [PMID: 27491611 DOI: 10.1016/j.jcin.2016.05.025] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/09/2016] [Accepted: 05/15/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVES This study sought to analyze the clinical impact of the degree and improvement of mitral regurgitation in TAVR recipients, validate the main imaging determinants of this improvement, and assess the potential candidates for double valve repair with percutaneous techniques. BACKGROUND Many patients with severe aortic stenosis present with concomitant mitral regurgitation (MR). Cardiac imaging plays a key role in identifying prognostic factors of MR persistence after transcatheter aortic valve replacement (TAVR) and for planning its treatment. METHODS A total of 1,110 patients with severe aortic stenosis from 6 centers who underwent TAVR were included. In-hospital to 6-month follow-up clinical outcomes according to the degree of baseline MR were evaluated. Off-line analysis of echocardiographic and multidetector computed tomography images was performed to determine predictors of improvement, clinical outcomes, and potential percutaneous alternatives to treat persistent MR. RESULTS Compared with patients without significant pre-TAVR MR, 177 patients (16%) presented with significant pre-TAVR MR, experiencing a 3-fold increase in 6-month mortality (35.0% vs. 10.2%; p < 0.001). After TAVR, the degree of MR improved in 60% of them. A mitral annular diameter of >35.5 mm (odds ratio: 9.0; 95% confidence interval: 3.2 to 25.3; p < 0.001) and calcification of the mitral apparatus by multidetector computed tomography (odds ratio: 11.2; 95% confidence interval: 4.03 to 31.3; p < 0.001) were independent predictors of persistent MR. At least 14 patients (1.3% of the entire cohort, 13.1% of patients with persistent MR) met criteria for percutaneous mitral repair with either MitraClip (9.3%) or a balloon-expandable valve (3.8%). CONCLUSIONS Significant MR is not uncommon in TAVR recipients and associates with greater mortality. In more than one-half of patients, the degree of MR improves after TAVR, which can be predicted by characterizing the mitral apparatus with multidetector computed tomography. According to standardized imaging criteria, at least 1 in 10 patients whose MR persists after TAVR could benefit from percutaneous mitral procedures, and even more could be treated with MitraClip after dedicated pre-imaging evaluation.
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Affiliation(s)
- Carlos Cortés
- Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain
| | | | | | | | | | | | | | | | | | | | - Javier Ruano
- Hospital Universitario Marques de Valdecilla, Santander, Spain
| | | | - Javier Castrodeza
- Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain
| | - Javier Tobar
- Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain
| | - Fabian Islas
- Hospital Clínico Universitario San Carlos, Madrid, Spain
| | - Ana Revilla
- Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain
| | - Rishi Puri
- Quebec Heart and Lung Institute, Quebec, Canada
| | - Ana Puerto
- Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain
| | - Itziar Gómez
- Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain
| | | | - José A San Román
- Institute of Heart Sciences, Hospital Clínico Universitario, Valladolid, Spain
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Olmos C, Fernandez-Perez C, Elola J, Bernal J, Islas F, Perez-Garcia C, Garcia-Arribas D, Ferrera C, Vilacosta I. 127The increasing incidence and changing profile of infective endocarditis in Spain: a population-based study (2003-2014). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Islas F, Olmos C, De Agustin J, Marcos-Alberca P, Jimenez-Quevedo P, Nombela-Franco L, Luaces M, Cruz-Utrilla A, Garcia-Arribas D, Mahia P, Pozo-Osinalde E, Perez De Isla L. P2410New-onset left bundle branch block and its influence on left ventricular systolic function after 1-year of transcatheter aortic valve implantation (TAVI). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Marcos-Alberca Moreno P, Perez-Isla L, Manganaro R, Nombela L, Islas F, De Agustin J, Fernandez-Ortiz A, Garcia-Fernandez M, Villacastin J, Macaya C. P1352Prediction of TAVR-related severe AV conduction disorders with a bedside and fast scoring system and Real time 3D TEE. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rueda A, Lopez De Isla L, Enriquez L, Espejo C, Jimenez M, Alcantar A, Islas F, Gomez J, Ruiz V, Carballeira D, De Agustin J, Mahia P, Marcos Alberca P, Perez Villacastin J, Macaya C. P6377Influence of the delay in performing electrical cardioversion over atrial fibrillation recurrence: comparision of two strategies. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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El-Dosouky I, Polte CL, Okubo T, Gonzalez Gomez A, Liu B, Generati G, Drakopoulou M, Olmos C, Trifunovic D, Ilhao Moreira R, Ilhao Moreira R, Morgan HP, Bosseau C, Romano G, Argiolas A, Kuperstein R, Koyuncu A, Sahara E, Spinelli L, Yaneva-Sirakova T, Ben Said R, Nowakowska MA, Ruivo C, Neves Pestana G, Wiligorska N, Gao SA, Lagerstrand KM, Johnsson ÅA, Bech-Hanssen O, Mahara K, Yamamoto H, Shitan H, Abe K, Terada M, Saito M, Nagatomo Y, Takanashi S, Del Val D, Monteagudo JM, Fernandez-Golfin C, Hinojar R, Garcia A, Marco A, Casas E, Jimenez-Nacher JJ, Zamorano JL, Baig S, Hayer M, Edwards N, Steeds R, Bandera F, Alfonzetti E, Guazzi M, Toutouzas K, Stathogiannis K, Michelongona A, Latsios G, Synetos A, Lazaros G, Brili S, Tsiamis E, Tousoulis D, Islas F, Ferrera C, Sanchez-Enrique C, Freitas-Ferraz A, Mahia P, Marcos-Alberca P, Tirado G, Perez De Isla L, Vilacosta I, Marinkovic J, Obrenovic- Kircanski B, Ivanovic B, Kalimanovska-Ostric D, Stevanovic G, Petrovic M, Boricic-Kostic M, Petrovic O, Tutos V, Petrovic I, Petrovic J, Draganic G, Stepanovic J, Vujisic-Tesic B, Coutinho Cruz M, Moura Branco L, Galrinho A, Coutinho Miranda L, Almeida Morais L, Modas Daniel P, Rodrigues I, Fragata J, Cruz Ferreira R, Coutinho Cruz M, Moura Branco L, Galrinho A, Timoteo AT, Viveiros Monteiro S, Aguiar Rosa S, Rodrigues I, Fragata J, Cruz Ferreira R, Nana M, Constantin C, Tarando F, Galli E, Rousseau C, Hubert A, Leclercq C, Donal E, Vitale G, Agnese V, Mina' C, Magro S, Falletta C, Di Gesaro G, Bellavia D, Clemenza F, Elena Reffo ER, Ornella Milanesi OM, Klempfner R, Ben-Zekry S, Maor E, Raanani E, Ofek E, Freimark D, Arad M, Oflar E, Ciftci S, Ungan I, Caglar FM, Ocal L, Kilicgedik A, Toprak C, Kahveci G, Atmadikoesoemah C, Kasim M, Pellegrino T, Pisani A, Giudice CA, Riccio E, Imbriaco M, Cuocolo A, Trimarco B, Tarnovska-Kadreva R, Traykov L, Vassilev D, Vladimirova L, Shumkova M, Gruev I, Zairi I, Mzoughi K, Ben Moussa F, Kammoun S, Fennira S, Kraiem S, Chrzanowski L, Frynas-Jonczyk K, Wdowiak-Okrojek K, Wejner-Mik P, Lipiec P, Krakowska M, Potemski P, Plonska-Gosciniak E, Kasprzak JD, Marques N, Domingues K, Lourenco C, Santos R, Gomes C, Abreu L, Reis L, Moz M, Azevedo O, Tavares-Silva M, Sousa C, Pinto R, Ribeiro V, Vasconcelos M, Bernardo-Almeida P, Macedo F, Maciel MJ, Wiligorska D, Talarowska P, Segiet A, Mozenska O, Kosior DA. P1088Match and mismatch between opening area and resistance in mild and moderate rheumatic mitral stenosisP1089When should cardiovascular magnetic resonance imaging be considered in patients with chronic aortic or mitral regurgitation?P1090Echocardiographic characteristics of aortic valve fenestration with aortic regurgitation for aortic valve repairP1091Aortic regurgitation assessment by 3D transesophageal echocardiography vena contracta area: usefulness and comparison with 2D methods.P1092Characterising cardiomyopathy in mitral regurgitation due to barlow disease: role of CMRP1093Compensatory peripheral increase in artero-venous o2 difference to severe functional mitral regurgitation in heart failureP1094Prognostic impact of concomitant atrioventricular valve regurgitation in patients undergoing transcatheter aortic valve implantationP1095Morphological characterization of vegetations by real-time three-dimensional transesophageal echocardiography in infective endocarditis: prognostic impactP1096Relation between causative pathogen and echocardiographic findings in patients with infective endocarditis: is there an association and is it clinically relevant?P1097Aortic and mitral valve infective endocarditis: different clinical and echocardiographic features and peculiar complication ratesP1098Vegetation size relevance and impact on prognosis in patients with infective endocarditisP1099Causes of death on the valvular heart disease surveillance list- a 5 year auditP1100Left ventricular non-compaction and idiopathic dilated cardiomyopathy: the significant diagnostic value of longitudinal strainP1101The role of echocardiography in the management of diuretics withdrawal in patients with chronic heart failure and severely reduced ejection fraction: a prospective cohort studyP1102Outcomes in paediatric new onset left ventricle dysfunction and dilatation: differences between post-myocarditis and DCMP1103De novo mitral regurgitation as a cause of heart failure exacerbation in hypertrophic cardiomyopathyP1104Correlation of conventional and new echocardiograhic parameters with sudden cardiac death risk score in patients with hypertrophic cardiomyopathyP1105Inverse correlation between myocardial fibrosis and left ventricular function in rheumatic mitral stenosis: a preliminary study with cardiac magnetic resonanceP1106Left ventricular diastolic dysfunction and cardiac sympathetic derangement in patients with Anderson-Fabry disease: a 2D speckle tracking echocardiography and cardiac 123I-MIBG studyP1107Left ventricular hypertrophy and mild cognitive impairment as markers for target organ damage in hypertensive patients with multiple risk factorsP1108Subclinical left ventricular dysfunction in asymptomatic type 1 diabetic childrenP1109Minimal differences shown by echocardiography and NT-proBNP level distinguishing cardiotoxic effect related to breast cancer therapy in patients with or without HER2 expression.P1110Speed of recovery of left ventricular function is not related to the prognosis of takotsubo cardiomyopathy - a portuguese multicenter studyP1111Myocardial dysfunction in Takotsubo cardiomyopathy - more than meets the eye?P1112Obstructive sleep apnea and echocardiographic parameters. Eur Heart J Cardiovasc Imaging 2016; 17:ii227-ii234. [DOI: 10.1093/ehjci/jew262.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Alexander B, Rodriguez C, de la Isla LP, Islas F, Quevedo PJ, Nombela-Franco L, Hopman W, Malik P, Baranchuk A. The impact of advanced Interatrial block on new-onset atrial fibrillation following TAVR procedure. Int J Cardiol 2016; 223:672-673. [DOI: 10.1016/j.ijcard.2016.08.083] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
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Ferrera C, Nombela-Franco L, Garcia E, Jimenez-Quevedo P, Biagioni C, Gonzalo N, Nuñez-Gil I, Viana-Tejedor A, Salinas P, Alberto de Agustin J, Almeria C, Islas F, Perez de Isla L, Fernandez-Perez C, Escaned J, Fernández-Ortiz A, Macaya C. Clinical and hemodynamic results after direct transcatheter aortic valve replacement versus pre-implantation balloon aortic valvuloplasty: A case-matched analysis. Catheter Cardiovasc Interv 2016; 90:809-816. [DOI: 10.1002/ccd.26671] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 07/03/2016] [Indexed: 01/26/2023]
Affiliation(s)
- Carlos Ferrera
- Cardiovascular Institute; Hospital Universitario Clínico San Carlos; Madrid Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute; Hospital Universitario Clínico San Carlos; Madrid Spain
| | - Eulogio Garcia
- Interventional Cardiology Department; Hospital Universitario Montepríncipe; Madrid Spain
| | | | - Corina Biagioni
- Cardiovascular Institute; Hospital Universitario Clínico San Carlos; Madrid Spain
| | - Nieves Gonzalo
- Cardiovascular Institute; Hospital Universitario Clínico San Carlos; Madrid Spain
| | - Ivan Nuñez-Gil
- Cardiovascular Institute; Hospital Universitario Clínico San Carlos; Madrid Spain
| | - Ana Viana-Tejedor
- Cardiovascular Institute; Hospital Universitario Clínico San Carlos; Madrid Spain
| | - Pablo Salinas
- Cardiovascular Institute; Hospital Universitario Clínico San Carlos; Madrid Spain
| | | | - Carlos Almeria
- Cardiovascular Institute; Hospital Universitario Clínico San Carlos; Madrid Spain
| | - Fabian Islas
- Cardiovascular Institute; Hospital Universitario Clínico San Carlos; Madrid Spain
| | | | - Cristina Fernandez-Perez
- Epidemiology and Statistical Department, Instituto de investigación Sanitaria; Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid; Madrid Spain
| | - Javier Escaned
- Cardiovascular Institute; Hospital Universitario Clínico San Carlos; Madrid Spain
| | | | - Carlos Macaya
- Cardiovascular Institute; Hospital Universitario Clínico San Carlos; Madrid Spain
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Ren B, Sturmberger T, Ancona R, Schwartz SL, Del Val Martin D, Szymanski P, Islas F, Muratori M, Mcghie J, Van Weenen S, Rodriguez-Olivares R, Van Gils L, Geleijnse ML, De Jaegere PPT, Van Mieghem NMDA, Ebner C, Tkalec W, Eder V, Aichinger J, Comenale Pinto S, Caso P, Monteforte I, Coppola MG, Sellitto V, Macrino M, Ferro A, Calabro R, Rozenbaum RZ, Topilsky Y, Fraile Sanz C, Salido Tahoces L, Hernandez-Antolin R, Fernandez-Golfin C, Mestre Barcelo JL, Casas Rojo E, Zamorano Gomez JL, Hryniewiecki T, Jastrzebski J, Dabrowski M, Sorysz D, Kochman J, Kukulski T, Zembala M, Almeria C, Olmos C, Garcia E, Nombela L, Marcos-Alberca P, De Agustin JA, Mahia P, Macaya C, Perez De Isla L, Fusini L, Ghulam Ali S, Tamborini G, Gripari P, Salvi L, Bartorelli AL, Alamanni F, Pepi M. Rapid Fire Abstract session: new insights in TAVI334Transcatheter heart valve underexpansion patterns335Echocardiography after TAVI with directflow medical prosthesis: small leaks and high gradients336Effects of transcatheter aortic valve implantation on left ventricular and atrial function evaluated by two and three-dimensional speckle tracking at eighteen-month follow-up337Impact of tricuspid regurgitation and right ventricular dysfunction on outcome of patients undergoing trans-catheter aortic valve replacement338Significant mitral regurgitation evolution in patients with severe aortic stenosis after transcatheter aortic valve implantation (TAVI): results and prognostic implications339An impact of pre- and postprocedural mitral regurgitation on mortality following TAVI340Immediate and one-year changes in systolic echocardiographic parameters after TAVI. Are there significant differences between patients with low and normal ejection fraction?341Long term echocardiographic follow-up (5-year) in transcatheter aortic valve implantation: morpho-functional changes of the implanted aortic valve: Table. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pontone G, Demir OM, Celeng C, Llao-Ferrando JI, Kitsiou AN, Portugal G, Becoulet L, Demir OM, Marcos-Alberca Moreno P, Iriart X, Andreini D, Annoni A, Petulla M, Russo E, Innocenti E, Guglielmo M, Mushtaq S, Tondo C, Pepi M, Bashir A, Marshall K, Douglas M, Wasan B, Plein S, Alfakih K, Kolossvary M, Kovacs A, Szilveszter B, Molnar A, Horvath T, Jermendy AL, Tarnoki AD, Merkely B, Maurovich-Horvat P, Castro JC, Vilades-Medel D, Mirabet S, Pons-Llado G, Roig E, Leta R, Papanikolaou S, Griroriou K, Antonopoulos M, Mpouki M, Moustakas G, Giougi A, Giannakopoulos V, Gionakis G, Balomenos A, Abreu A, Rio P, Santos V, Martins Oliveira M, Silva Cunha P, Mota Carmo M, Branco LM, Morais L, Cruz Ferreira R, Guijarro D, Pallardy A, Mathieu C, Valette F, Gueffet JP, Serfaty JM, Kraeber-Bodere F, Trochu JN, Piriou N, Bashir A, Marshall K, Wasan B, Plein S, Alfakih K, Perez-Isla L, Palacios J, Gomez De Diego JJ, Islas F, De Agustin JA, Luaces M, Arrazola J, Garcia-Fernandez MA, Macaya C, Selmi W, Jalal Z, Thambo JB. Moderated Posters session: complementary role of imaging techniquesP184Submillisievert computed tomography with model-based iterative reconstruction before pulmonary veins radiofrequency catheter ablation of atrial fibrillation: impact on radiation exposure and outcomeP185Calcium score and CT coronary angiography can be a low cost strategy for the investigation of patients with chest pain with low and intermediate predicted riskP186Impact of imaging modality on the heritability estimates of aortic root geometry: a classical twin studyP187Diagnosis of cardiac allograft vasculopathy with cardiac CT. Relation between clinical variables and mid-term prognosisP188Stress-only normal SPECT myocardial perfusion imaging: is it enough?P189Global longitudinal strain and its relation to cardiac autonomic denervation as assessed by 123-mIBG scintigraphy: insights from the BETTER-HF trialP190FDG-PET imaging in suspected inflammatory cardiomyopathies : comparison with the classical pattern of cardiac sarcoidosis and impact on diagnosisP191CT coronary angiography can be an effective alternative to imaging stress tests in patients with high pre-test probability of CADP192Outcomes at long term follow up of subclinical and mild coronary artery disease diagnosed with MDCT in Mediterranean EuropeP193Cardiac ct peri-device flow after percutaneous left atrial appendage closure using the amplatzer cardiac plug device:. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Colunga Blanco S, Gonzalez Matos C, Angelis A, Dinis PG, Chinali M, Toth A, Andreassi MG, Rodriguez Munoz D, Reid AB, Park JH, Shetye A, Novo G, De Marchi SF, Cikes M, Smarz K, Illatopa V, Peluso D, Wellnhofer E, De La Rosa Riestra A, Sattarzadeh Badkoubeh R, Mandour Ali M, Azoz A, Pontone G, Krljanac G, Acar R, Nucifora G, Sirtautas A, Roos ST, Qasem MS, Marini C, Fabiani I, Gillis K, Bandera F, Borowiec A, Lim YJ, Chalbia TE, Santos M, Gao SA, Zilberszac R, Farrag AAM, Palmiero G, Aruta P, De Diego Soler O, Fasano D, Tamborini G, Ancona F, Raafat DM, Marchel M, De Gregorio C, Gommans DHF, Godinho AR, Mielczarek M, Bandera F, Kubik M, Cho JY, Tarando F, Lourenco Marmelo BF, Reis L, Domingues K, Krestjyaninov MV, Mesquita J, Ikonomidis I, Ferferieva V, Peluso D, Peluso D, King GJ, D'ascenzi F, Ferrera Duran C, Sormani P, Gonzalez Fernandez O, Tereshina O, Cambronero Cortinas E, Kupczynska K, Carvalho JF, Shivalkar B, Aghamohammadzadeh R, Cifra B, Cifra B, Bandera F, Kuznetsov VA, Van Zalen JJ, Kochanowski J, Goebel B, Ladeiras-Lopes R, Goebel B, Karvandi M, Karvandi M, Alonso Salinas G, Unkun T, Ranjbar S, Hubert A, Enescu OA, Liccardo M, Cameli M, Ako E, Lembo M, Goffredo C, Enache R, Novo G, Wdowiak-Okrojek K, Nemes A, Nemes A, Di Salvo G, Capotosto L, Caravaca P, Maceira Gonzalez AM, Iriart X, Jug B, Garcia Campos A, Capin Sampedro E, Corros Vicente C, Martin Fernandez M, Leon Arguero V, Fidalgo Arguelles A, Velasco Alonso E, Lopez Iglesias F, De La Hera Galarza JM, Chaparro-Munoz M, Recio-Mayoral A, Vlachopoulos C, Ioakeimidis N, Felekos I, Abdelrasoul M, Aznaouridis K, Chrysohoou C, Rousakis G, Aggeli K, Tousoulis D, Faustino AC, Paiva L, Fernandes A, Costa M, Cachulo MC, Goncalves L, Emma F, Rinelli G, Esposito C, Franceschini A, Doyon A, Raimondi F, Schaefer F, Pongiglione G, Mateucci MC, Vago H, Juhasz C, Janosa C, Oprea V, Balint OH, Temesvari A, Simor T, Kadar K, Merkely B, Bruno RM, Borghini A, Stea F, Gargani L, Mercuri A, Sicari R, Picano E, Lozano Granero C, Carbonell San Roman A, Moya Mur JL, Fernandez-Golfin C, Moreno Planas J, Fernandez Santos S, Casas Rojo E, Hernandez-Madrid A, Zamorano Gomez JL, Pearce K, Gamlin W, Miller C, Schmitt M, Seong IW, Kim KH, Kim MJ, Jung HO, Sohn IS, Park SM, Cho GY, Choi JO, Park SW, Nazir SA, Khan JN, Singh A, Kanagala P, Squire I, Mccann GP, Di Lisi D, Meschisi MC, Brunco V, Badalamenti G, Bronte E, Russo A, Novo S, Von Tscharner M, Urheim S, Aakhus S, Seiler C, Schmalholz S, Biering-Sorensen T, Cheng S, Oparil S, Izzo J, Pitt B, Solomon SD, Zaborska B, Jaxa-Chamiec T, Tysarowski M, Budaj A, Cordova F, Aguirre O, Sanabria S, Ortega J, Romeo G, Perazzolo Marra M, Tona F, Famoso G, Pigatto E, Cozzi F, Iliceto S, Badano LP, Kriatselis C, Gerds-Li JH, Kropf M, Pieske B, Graefe M, Martinez Santos P, Batlle Lopez E, Vilacosta I, Sanchez Sauce B, Espana Barrio E, Jimenez Valtierra J, Campuzano Ruiz R, Alonso Bello J, Martin Rios MD, Farrashi M, Abtahi H, Sadeghi H, Sadeghipour P, Tavoosi A, Abdel Rahman TA, Mohamed LA, Maghraby HM, Kora IM, Abdel Hameed FR, Ali MN, Al Shehri A, Youssef A, Gad A, Alsharqi M, Alsaikhan L, Andreini D, Rota C, Guglielmo M, Mushtaq S, Baggiano A, Beltrama V, Solbiati A, Guaricci AI, Pepi M, Trifunovic D, Sobic Saranovic D, Savic L, Grozdic Milojevic I, Asanin M, Srdic M, Petrovic M, Zlaic N, Mrdovic I, Dogan C, Izci S, Gecmen C, Unkun T, Cap M, Erdogan E, Onal C, Yilmaz F, Ozdemir N, Muser D, Tioni C, Zanuttini D, Morocutti G, Spedicato L, Bernardi G, Proclemer A, Pranevicius R, Zapustas N, Briedis K, Valuckiene Z, Jurkevicius R, Juffermans LJM, Enait V, Van Royen N, Van Rossum AC, Kamp O, Khalaf HASSEN, Hitham SAKER, Osama AS, Abazid RAMI, Guall RAHIM, Durdan SHAFAT, Mohammed ZYAD, Stella S, Rosa I, Ancona F, Spartera M, Italia L, Latib A, Colombo A, Margonato A, Agricola E, Scatena C, Mazzanti C, Conte L, Pugliese N, Barletta V, Bortolotti U, Naccarato AG, Di Bello V, Bala G, Roosens B, Hernot S, Remory I, Droogmans S, Cosyns B, Generati G, Labate V, Donghi V, Pellegrino M, Carbone F, Alfonzetti E, Guazzi M, Dabrowski R, Kowalik I, Firek B, Chwyczko T, Szwed H, Kawamura A, Kawano S, Zaroui A, Ben Said R, Ben Halima M, Kheder N, Farhati A, Mourali S, Mechmech R, Leite L, Martins R, Baptista R, Barbosa A, Ribeiro N, Oliveira A, Castro G, Pego M, Polte CL, Lagerstrand K, Johnsson ÅA, Janulewicz M, Bech-Hanssen O, Gabriel H, Wisser W, Maurer G, Rosenhek R, El Aroussy W, Abdel Ghany M, Al Adeeb K, Ascione L, Carlomagno G, Sordelli C, Ferro A, Ascione R, Severino S, Caso P, Muraru D, Janei C, Haertel Miglioranza M, Cavalli G, Romeo G, Peluso D, Cucchini U, Iliceto S, Badano L, Armario Bel X, Garcia-Garcia C, Ferrer Sistach E, Rueda Sobella F, Oliveras Vila T, Labata Salvador C, Serra Flores J, Lopez-Ayerbe J, Bayes-Genis A, Conte E, Gonella A, Morena L, Civelli D, Losardo L, Margaria F, Riva L, Tanga M, Carminati C, Muratori M, Gripari P, Ghulam Ali S, Fusini L, Vignati C, Bartorelli AL, Alamanni F, Pepi M, Rosa I, Stella S, Marini C, Spartera M, Latib A, Montorfano M, Colombo A, Margonato A, Agricola E, Ismaiel A, Ali N, Amry S, Serafin A, Kochanowski J, Filipiak KJ, Opolski G, Speranza G, Ando' G, Magaudda L, Cramer GE, Bakker J, Michels M, Dieker HJ, Fouraux MA, Marcelis CLM, Timmermans J, Brouwer MA, Kofflard MJM, Vasconcelos M, Araujo V, Almeida P, Sousa C, Macedo F, Cardoso JS, Maciel MJ, Voilliot D, Huttin O, Venner C, Olivier A, Villemin T, Deballon R, Manenti V, Juilliere Y, Selton-Suty C, Generati G, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Dabrowska-Kugacka A, Dorniak K, Lewicka E, Szalewska D, Kutniewska-Kubik M, Raczak G, Kim KH, Yoon HJ, Park HJ, Ahn Y, Jeong MH, Cho JG, Park JC, Kim JH, Galli E, Habib G, Schnell F, Lederlin M, Daubert JC, Mabo P, Donal E, Faria R, Magalhaes P, Marques N, Domingues K, Lourenco C, Almeida AR, Teles L, Picarra B, Azevedo O, Lourenco C, Oliveira M, Magalhaes P, Domingues K, Marmelo B, Almeida A, Picarra B, Faria R, Marques N, Bento D, Lourenco C, Magalhaes P, Cruz I, Marmelo B, Reis L, Picarra B, Faria R, Azevedo O, Gimaev RH, Melnikova MA, Olezov NV, Ruzov VI, Goncalves P, Almeida MS, Branco P, Carvalho MS, Dores H, Gaspar MA, Sousa H, Andrade MJ, Mendes M, Makavos G, Varoudi M, Papadavid E, Andreadou I, Gravanis K, Liarakos N, Pavlidis G, Rigopoulos D, Lekakis J, Deluyker D, Bito V, Pigatto E, Romeo G, Muraru D, Cozzi F, Punzi L, Iliceto S, Badano LP, Pigatto E, Romeo G, Muraru D, Cozzi F, Iliceto S, Badano LP, Neilan T, Coen K, Gannon S, Bennet K, Clarke JG, Solari M, Cameli M, Focardi M, Corrado D, Bonifazi M, Henein M, Mondillo S, Gomez-Escalonilla C, De Agustin A, Egido J, Islas F, Simal P, Gomez De Diego JJ, Luaces M, Macaya C, Perez De Isla L, Zancanella M, Rusconi C, Musca F, Santambrogio G, De Chiara B, Vallerio P, Cairoli R, Giannattasio G, Moreo A, Alvarez Ortega C, Mori Junco R, Caro Codon J, Meras Colunga P, Ponz De Antonio I, Lopez Fernandez T, Valbuena Lopez S, Moreno Yanguela M, Lopez-Sendon JL, Surkova E, Bonanad-Lozano C, Lopez-Lereu MP, Monmeneu-Menadas JV, Gavara J, De Dios E, Paya-Chaume A, Escribano-Alarcon D, Chorro-Gasco FJ, Bodi-Peris V, Michalski BW, Miskowiec D, Kasprzak JD, Lipiec P, Morgado G, Caldeira D, Cruz I, Joao I, Almeida AR, Lopes L, Fazendas P, Cotrim C, Pereira H, De Block C, Buys D, Salgado R, Vrints C, Van Gaal L, Mctear C, Irwin RB, Dragulescu A, Friedberg M, Mertens L, Dragulescu A, Friedberg M, Mertens L, Carbone F, Generati G, Pellegrino M, Labate V, Alfonzetti E, Guazzi M, Krinochkin DV, Yaroslavskaya EI, Zaharova EH, Pushkarev GS, Sugihara C, Patel NR, Sulke AN, Lloyd GW, Piatkowski R, Scislo P, Grabowski M, Marchel M, Opolski G, Roland H, Hamadanchi A, Otto S, Jung C, Lauten A, Figulla HC, Poerner TC, Sampaio F, Fonseca P, Fontes-Carvalho R, Pinho M, Campos AS, Castro P, Fonseca C, Ribeiro J, Gama V, Heck R, Hamdanchi A, Otto S, Jung C, Lauten A, Figulla HR, Poerner TC, Ranjbar S, Ghaffaripour Jahromi M, Ranjbar S, Hinojar R, Fernandez Golfin C, Esteban A, Pascual-Izco M, Garcia-Martin A, Casas Rojo E, Jimenez-Nacher JJ, Zamorano JL, Gecmen C, Cap M, Izci S, Erdogan E, Onal C, Acar R, Bakal RB, Kaymaz C, Ozdemir N, Karvandi M, Ghaffaripour Jahromi M, Galand V, Schnell F, Matelot D, Martins R, Leclercq C, Carre F, Suran BC, Margulescu AD, Rimbas RC, Siliste C, Vinereanu D, Nocerino P, Urso AC, Borrino A, Carbone C, Follero P, Ciardiello C, Prato L, Salzano G, Marino F, Ruspetti A, Sparla S, Di Tommaso C, Loiacono F, Focardi M, D'ascenzi F, Henein M, Mondillo S, Porter J, Walker M, Lo Iudice F, Esposito R, Santoro C, Cocozza S, Izzo R, De Luca N, De Simone G, Trimarco B, Galderisi M, Gervasi F, Patti G, Mega S, Bono M, Di Sciascio G, Buture A, Badea R, Platon P, Ghiorghiu I, Jurcut R, Coman IM, Popescu BA, Ginghina C, Lunetta M, Spoto MS, Lo Vi AM, Pensabene G, Meschisi MC, Carita P, Coppola G, Novo S, Assennato P, Shim A, Wejner-Mik P, Kasprzak JD, Lipiec P, Havasi K, Domsik P, Kalapos A, Forster T, Piros GA, Domsik P, Kalapos A, Lengyel C, Orosz A, Forster T, Bulbul Z, Issa Z, Al Sehly A, Pergola V, Oufi S, Conde Y, Cimino E, Rinaldi E, Ashurov R, Ricci S, Pergolini M, Vitarelli A, Lujan Valencia JE, Chaparro M, Garcia-Guerrero A, Cristo Ropero MJ, Izquierdo Bajo A, Madrona L, Recio-Mayoral A, Monmeneu JV, Igual B, Lopez Lereu P, Garcia MP, Selmi W, Jalal Z, Thambo JB, Kosuta D, Fras Z. Poster session 5The imaging examinationP1097Correlation between visual and quantitative assessment of left ventricle: intra- and inter-observer agreementP1099Incremental prognostic value of late gadolinium-enhanced by cardiac magnetic resonance in patients with heart failureAnatomy and physiology of the heart and great vesselsP1100Left ventricular geometry and diastolic performance in erectile dysfunction patients; a topic of differential arterial stiffness influenceAssessment of diameters, volumes and massP1101Impact of the percutaneous closure of atrial septal defect on the right heart "remodeling"P1102Left Ventricular Mass Indexation in Infants, Children and Adolescents: a Simplified Approach for the Identification of Left Ventricular Hypertrophy in Clinical PracticeP1103Impact of trabecules while quantifying cardiac magnetic resonance exams in patients with systemic right ventricleP1104Detection of subclinical atherosclerosis by carotid intima-media thickness: correlation with leukocytes telomere shorteningAssessments of haemodynamicsP1105Flow redirection towards the left ventricular outflow tract: vortex formation is not affected by variations in atrio-ventricular delayAssessment of systolic functionP1106Reproducibility and feasibility of cardiac MRI feature tracking in Fabry diseaseP1107Normal left ventricular strain values by two-dimensional strain echocardiography; result of normal (normal echocardiographic dimensions and functions in korean people) studyP1108Test-retest repeatability of global strain following st-elevation myocardial infarction - a comparison of tagging and feature trackingP1109Cardiotoxicity induced by tyrosine kinase inhibitors in patients with gastrointestinal stromal tumors (GIST)P1110Finite strain ellipses for the analysis of left ventricular principal strain directions using 3d speckle tracking echocardiographyP1111Antihypertensive therapy reduces time to peak longitudinal strainP1112Right ventricular systolic function as a marker of prognosis after inferior myocardial infarction - 5-year follow-upP1113Is artery pulmonary dilatation related with right but also early left ventricle dysfunction in pulmonary artery hypertension?P1114Right ventricular mechanics changes according to pressure overload increasing, a 2D-speckle tracking echocardiographic evaluationAssessment of diastolic functionP1115Paired comparison of left atrial strain from P-wave to P-wave and R-wave to R-waveP1116Diagnostic role of Tissue Doppler Imaging echocardiographic criteria in obese heart failure with preserved ejection fraction patientsP1117Evaluation of diastolic function of right ventricle in idiopathic pulmonary arterial hypertensionP1118Severity and predictors of diastolic dysfunction in a non-hypertensive non-ischemic cohort of Egyptian patients with documented systemic autoimmune disease; pilot reportP1119correlation between ST segment shift and cardiac diastolic function in patients with acute myocardial infarctionIschemic heart diseaseP1120Computed tomography coronary angiography verSus sTRess cArdiac magneTic rEsonance for the manaGement of sYmptomatic revascularized patients: a cost effectiveness study (STRATEGY study)P1121Utility of transmural myocardial mechanic for early infarct size prediction after primary percutaneous coronary intervention in STEMI patientsP1122Progressive Improvements of the echocardiographic deformation parameters in ST Elevation Myocardial Infarction after five years follow-upP1123Long-term prognostic value of left ventricular dyssynchrony as assessed by cardiac magnetic resonance feature-tracking imaging after a first st-segment elevation myocardial infarctionP1124Differences in mitral annulus remodeling in acute anterior ST elevation and acute inferior ST elevation myocardial infarctionP1125Reduction of microvascular injury using a novel theragnostic ultrasound strategy: a first in men feasibility and safety studyP1126Impact of focused echocardiography in clinical decision of patient presented with st elevation myocardial infarction underwent primary angioplastyHeart valve DiseasesP1127Aortic valve area calculation in aortic stenosis: a comparison among conventional and 3D-transesophageal echocardiography and computed tomographyP1128Myocardial fibrosis and microRNA-21 expression in patients with severe aortic valve stenosis and preserved ejection fraction: a 2D speckle tracking echocardiography, tissutal and plasmatic studyP1129Quantification of calcium amount in a new experimental model: a comparison between calibrated integrated backscatter of ultrasound and computed tomographyP1130Altered diffusion capacity in aortic stenosis: role of the right heartP1131Osteoprotegerin predicts all-cause mortality in calcific aortic stenosis patients with preserved left ventricle ejection fraction in long term observationP1132Mitral regurgitation as a risk factor for pulmonary hypertension in patients with aortic stenosisP1133The relationship between the level of plasma B-type natriuretic peptide and mitral stenosisP1134Aortic regurgitation, left ventricle mechanics and vascular load: a single centre 2d derived-speckle tracking studyP1135Feasibility and reproducibility issues limit the usefulness of quantitative colour Doppler parameters in the assessment of chronic aortic and mitral regurgitation severityP1136Predictors of postoperative outcome in degenerative mitral regurgitationP1137Left ventricular mechanical dyssynchrony in patients with severe mitral regurgitation of rheumatic etiology; three dimensional echocardiography studyP1138Functional mitral regurgitation and left atrial dysfunction concur in determining pulmonary hypertension and functional status in subjects with left ventricular systolic dysfunctionP11393D echocardiography allows more effective quantitative assessment of the severity of functional tricuspid regurgitation than conventional 2D/Doppler echocardiographyP1140Prosthetic valve thrombosis: still a severe disease? 10-years experience in a university hospitalP1141Validity of echocardiography in the hospital course of patients with feverP1142Do baseline 3DTEE characteristics of mitral valve apparatus predict long term result in patients undergoing percutaneous valve repair for degenerative regurgitation?P1143Influence of baseline aortic regurgitation on mitral regurgitation change after transcatheter aortic valve replacement for aortic stenosisP1144Prevalence of echocardiography detected significant valvular regurge in subclinical rheumatic carditis in assiut childrenCardiomyopathiesP1145Can we early detect left ventricular systolic dysfunction in patients with Duchenne muscular dystrophy using global longitudinal strain assessment?P1146Prevalence of isolated papillary muscle hypertrophy in young competitive athletesP1147Troponin release after exercise in patients with hypertrophic cardiomyopathy: associations with clinical and mr imaging characteristicsP1148Atrial fibrillation in hypertrophic cardiomyopathy: can we score the risk?P1149Impact of hypertrophy on multiple layer longitudinal deformation in hypertrophy cardiomyopathy and cardiac amyloidosis compared to controlsP1150Functional evaluation in hypertrophic cardiomyopathy combining cardiopulmonary exercise testing combined with exercise-echocardiographyP1151Refinement of the old diagnostic criteria of left ventricular noncompaction cardiomyopathy (LVNC) based on cardiac magnetic resonance (CMR)P1152Differences of clinical characteristics and outcomes between acute myocarditis with preserved and reduced left ventricular systolic functionP1153Value of longitudinal strain for distinguishing left ventricular non-compaction from idiopathic dilated cardiomyopathyP1154Speed of recovery of left ventricular function is not related to the prognosis of Takotsubo cardiomyopathy. A Portuguese multicentre studyP1155Predictors of in-hospital left ventricular systolic function recovery after admission with takotsubo cardiomyopathy. Portuguese multicentre studyP1156Mid-ventricular takotsubo detected by initial echocardiogram associates with recurrence of takotsubo cardiomyopathy - a portuguese multicentre studySystemic diseases and other conditionsP1157Relations between left ventricle remodelling and expression of angiotensin 2 AT2R1 geneP1158Impact of renal denervation on long-term blood pressure variability and surrogate markers of target organ damage in individuals with drug-resistant arterial hypertensionP1159Greater improvement of coronary artery function, left ventricular deformation and twisting by IL12/23 compared to TNF-a inhibition in psoriasisP1160Advanced glycation end products play a role in adverse LV remodeling following MIP1161Incidence of subclinical myocardial dysfunction in patients with systemic sclerosis and normal left ventricular systolic and diastolic functionP1162Left atrial remodeling and dysfunction occur early in patients with systemic sclerosis and normal left ventricular functionP1163Intrinsic vortex formation : a unique performance indicatorP1164P-wave morphology is unaffected by training-induced biatrial dilatation: a prospective, longitudinal study in healthy athletesP1165Usefulness of transthoracic echocardiography in diagnosis of young patients with ischemic strokeP1166Primary cardiac lymphoma: role of echocardiography in the clinical managementP1167Abnormal echocardiographic findings in cancer patients before chemotherapyMasses, tumors and sources of embolismP1168Three-dimensional transesophageal echocardiography of the left atrial appendage reduces rate of postpone electrical cardioversionP1169Detection of ventricular thrombus by cmr after reperfused st-segment elevation myocardial infarction correlated with echocardiographyP1170Clinical and transthoracic echocardiographic predictors of left atrial appendage thrombus in patients with atrial fibrillationStress echocardiographyP1171Pharmacological stress echocardiography complications: a 4-year single center experienceP1172Myocardial functional and perfusion reserve in type I diabetesP1173Feasibility of incorporating 3D Dobutamine stress echocardiography into routine clinical practiceP1174Right ventricular isovolumic acceleration at rest and during exercise in children after heart transplantP1175Right ventricular systolic and diastolic response to exercise in children after heart transplant -a bicycle exercise studyP1176Determinants of functional capacity in heart failure patients with reduced ejection fractionP1177Handgrip stress echocardiography with emotional component compared to conventional isometric exercise in coronary artery disease diagnosisP1178The relationship between resting transthoracic echocardiography and exercise capacity in patients with paroxysmal atrial fibrillationP1179Correlation between NT-proBNP and selected echocardiography parameters at rest and after exercise in patients with functional ischemic mitral regurgitation qualified for cardiosurgical treatmentReal-time three-dimensional TEEP1180Vena contracta area for severity grading in functional and degenerative mitral regurgitation: A study based on transesophageal 3D colour Doppler in 419 patientsP1181Proximal flow convergence by 3D echocardiography in the evaluation of mitral valve area in rheumatic mitral stenosisP1182Quantification of valve dimensions by transesophageal 3D echocardiography in patients with functional and degenerative mitral regurgitationTissue Doppler and speckle trackingP1183Automatic calculation of left ventricular volume changes over a cardiac cycle from echocardiography images by nonlinear dimensionality reductionP1184Effect of the mitral valve repairs on the left ventricular blood flow formationP1185Quantification of left atrial strain using cardiovascular magnetic resonance. a comparison between hypertrophic cardiomyopathy and healthy controlsP1186The role of early systolic lengthening in patients with non-ST elevation acute coronary syndrome and its relation to syntax scoreP1187Different standard two dimensional strain methods to quantity left ventricular mechanicsP1188Atrial function and electrocardiography caracteristics in sportsmen with or without paroxysmal atrial fibrillationP1189Right ventricular outflow premature contractions induce regional left ventricular dysfunctionP1190Ultrasound guided venous access for pacemaker and defibrillators. Randomized TrialP1191Atrial function analysis correlates with symptoms and quality of life of heart failure patientsP1192The use of tissue doppler echocardiography in myocardial iron overload in patients with thalassaemia majorP1193Independent association between pulse pressure and left ventricular global longitudinal strainP1194Global and regional longitudinal strain identifies the presence of coronary artery disease in patients with suspected reduction of coronary flow reserve and absence of wall motion abnormalitiesP1195Prognostic value of invasive and noninvasive parameters of right ventricular function in patients with pulmonary arterial hypertension receiving specific vasodilator therapyP1196Myocardial deformation analysis to improve arrhythmic risk stratificationP1197Quantitative assessment of regional systolic and diastolic function parameters for detecting prior transient ischemia in normokinetic segmentsP1198Left atrial function in patients with corrected tetralogy of Fallot - a three-dimensional speckle-tracking echocardiographic studyP1199Left atrial ejection force correlates with left atrial strain and volume-based functional properties as assessed by three-dimensional speckle tracking echocardiographyP1200Acute angulation of the aortic arch late after the arterial switch operation for transposition of the great arteries: impact on cardiac mechanicsP1201Circumferential deformation of the ascending thoracic aorta in hypertensive patients by three-dimensional speckle tracking echocardiographyCardiac Magnetic ResonanceP1202The incremental value of cardiac magnetic resonance on diagnosis myocardial infarction and non-obstructed coronary arteriesP1204Reference ranges of global and regional myocardial T1 values derived from MOLLI and shMOLLI at 3TComputed Tomography & Nuclear CardiologyP1205Deformation of the left atrial appendage after percutaneous closure with the Amplatzer cardiac plugP1206Prognostic impact of non-obstructive coronary artery disease on coronary computed tomographic angiography: A single-center study. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Martínez-Martínez E, López-Ándres N, Jurado-López R, Rousseau E, Bartolomé MV, Fernández-Celis A, Rossignol P, Islas F, Antequera A, Prieto S, Luaces M, Cachofeiro V. Galectin-3 Participates in Cardiovascular Remodeling Associated With Obesity. Hypertension 2015; 66:961-9. [DOI: 10.1161/hypertensionaha.115.06032] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/10/2015] [Indexed: 02/07/2023]
Abstract
Remodeling, diastolic dysfunction, and arterial stiffness are some of the alterations through which obesity affects the cardiovascular system. Fibrosis and inflammation are important mechanisms underlying cardiovascular remodeling, although the precise promoters involved in these processes are still unclear. Galectin-3 (Gal-3) induces inflammation and fibrosis in the cardiovascular system. We have investigated the potential role of Gal-3 in cardiac damage in morbidly obese patients, and we have evaluated the protective effect of the Gal-3 inhibition in the occurrence of cardiovascular fibrosis and inflammation in an experimental model of obesity. Morbid obesity is associated with alterations in cardiac remodeling, mainly left ventricular hypertrophy and diastolic dysfunction. Obesity and hypertension are the main determinants of left ventricular hypertrophy. Insulin resistance, left ventricular hypertrophy, and circulating levels of C-reactive protein and Gal-3 are associated with a worsening of diastolic function in morbidly obese patients. Obesity upregulates Gal-3 production in the cardiovascular system in a normotensive animal model of diet-induced obesity by feeding for 6 weeks a high-fat diet (33.5% fat). Gal-3 inhibition with modified citrus pectin (100 mg/kg per day) reduced cardiovascular levels of Gal-3, total collagen, collagen I, transforming and connective growth factors, osteopontin, and monocyte chemoattractant protein-1 in the heart and aorta of obese animals without changes in body weight or blood pressure. In morbidly obese patients, Gal-3 levels are associated with diastolic dysfunction. In obese animals, Gal-3 blockade decreases cardiovascular fibrosis and inflammation. These data suggest that Gal-3 could be a novel therapeutic target in cardiac fibrosis and inflammation associated with obesity.
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Affiliation(s)
- Ernesto Martínez-Martínez
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
| | - Natalia López-Ándres
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
| | - Raquel Jurado-López
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
| | - Elodie Rousseau
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
| | - Mará Visitación Bartolomé
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
| | - Amaya Fernández-Celis
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
| | - Patrick Rossignol
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
| | - Fabian Islas
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
| | - Alfonso Antequera
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
| | - Santiago Prieto
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
| | - María Luaces
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
| | - Victoria Cachofeiro
- From the Cardiovascular Translational Research, Navarrabiomed (Fundación Miguel Servet), Pamplona, Spain (E.M.-M., N.L.-A., A.F.-C.); INSERM, Centre d’Investigations Cliniques-Plurithématique 1433, UMR 1116 Université de Lorraine, CHU de Nancy, and INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France (N.L.-A., E.T., P.R.); Department of Physiology, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid,
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Spitzer E, Mercado J, Islas F, Rothenbühler M, Kurmann R, Zürcher F, Krähenmann P, Llerena N, Jüni P, Torres P, Pilgrim T. Screening for Rheumatic Heart Disease among Peruvian Children: A Two-Stage Sampling Observational Study. PLoS One 2015. [PMID: 26208006 PMCID: PMC4514892 DOI: 10.1371/journal.pone.0133004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The objective of the study was to evaluate the implications of different classifications of rheumatic heart disease on estimated prevalence, and to systematically assess the importance of incidental findings from echocardiographic screening among schoolchildren in Peru. METHODS We performed a cluster randomized observational survey using portable echocardiography among schoolchildren aged 5 to 16 years from randomly selected public and private schools in Arequipa, Peru. Rheumatic heart disease was defined according to the modified World Health Organization (WHO) criteria and the World Heart Federation (WHF) criteria. FINDINGS Among 1395 eligible students from 40 classes and 20 schools, 1023 (73%) participated in the present survey. The median age of the children was 11 years (interquartile range [IQR] 8-13 years) and 50% were girls. Prevalence of possible, probable and definite rheumatic heart disease according to the modified WHO criteria amounted to 19.7/1000 children and ranged from 10.2/1000 among children 5 to 8 years of age to 39.8/1000 among children 13 to 16 years of age; the prevalence of borderline/definite rheumatic heart disease according to the WHF criteria was 3.9/1000 children. 21 children (2.1%) were found to have congenital heart disease, 8 of which were referred for percutaneous or surgical intervention. CONCLUSIONS Prevalence of RHD in Peru was considerably lower compared to endemic regions in sub-Saharan Africa, southeast Asia, and Oceania; and paralleled by a comparable number of undetected congenital heart disease. Strategies to address collateral findings from echocardiographic screening are necessary in the setup of active surveillance programs for RHD. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02353663.
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Affiliation(s)
- Ernest Spitzer
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | | | | | - Martina Rothenbühler
- Institute of Social and Preventive Medicine and Clinical Trials Unit, University of Bern, Bern, Switzerland
| | - Reto Kurmann
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Fabian Zürcher
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Peter Krähenmann
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Nassip Llerena
- National Hospital Carlos Alberto Seguín Escobedo, Arequipa, Peru
| | - Peter Jüni
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Pedro Torres
- Institute of Cardiology CardioSalud, Arequipa, Peru
- National Hospital Carlos Alberto Seguín Escobedo, Arequipa, Peru
| | - Thomas Pilgrim
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
- * E-mail:
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Fukuyama A, Takeuchi M, Wu V, Nagata Y, Hayashi A, Otani K, Fukuda S, Yoshitani H, Lin F, Otsuji Y, Islas F, Olmos C, Almeria C, Rodrigo J, De Agustin A, Marcos-Alberca P, Clavero M, Saltijeral A, Perez De Isla L, Atout W, Maceira Gonzalez AM, Igual B, Cosin-Sales J, Diago J, Aguilar J, Ruvira J, Sotillo J, Bertella E, Baggiano A, Loguercio M, Mushtaq S, Petulla' M, Segurini C, Conte E, Andreini D, Pontone G, Tong L, Ramalli A, Tortoli P, Luo J, D'hooge J, Galanti G, Toncelli L, Stefani L, Pedri S, Pedrizzetti G, Kaminska-Kegel A, Jaroch J, Brzezinska B, Kruszynska E, Kusmierz M, Loboz-Grudzien K, Hagendorff A, Stoebe S, Tarr A, Pfeiffer D, Fazlinezhad A, Fazlinezhad A, Azimi S, Vejdan Parast M, Hashemi Doost A. MODERATED POSTER SESSION: New imaging techniques in classical scenarios: Saturday 6 December 2014, 08:30-12:30 * Location: Moderated Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Martinez-Martinez E, Miana M, Jurado-Lopez R, Luaces M, Islas F, Galan M, Lopez-Andres N, Martinez-Gonzalez J, Rodriguez C, Cachofeiro V. P484The inhibition of lysyl oxidase improves the cardiovascular remodeling associated with obesity in rats. Cardiovasc Res 2014. [DOI: 10.1093/cvr/cvu091.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Islas F, Olmos C, Paiva M, Vieira C, De Agustin A, Rodrigo JL, Almeria C, Garcia-Fernandez MA, Macaya C, Perez De Isla L. Thromboembolic risk in atrial fibrillation: association between left atrium mechanics and risk scales. A study based on 3DWMT. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.2026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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de Agustin JA, Viliani D, Vieira C, Islas F, Marcos-Alberca P, Gomez de Diego JJ, Nuñez-Gil IJ, Almeria C, Rodrigo JL, Luaces M, Garcia-Fernandez MA, Macaya C, Perez de Isla L. Proximal isovelocity surface area by single-beat three-dimensional color Doppler echocardiography applied for tricuspid regurgitation quantification. J Am Soc Echocardiogr 2013; 26:1063-72. [PMID: 23860094 DOI: 10.1016/j.echo.2013.06.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The two-dimensional (2D) proximal isovelocity surface area (PISA) method has known technical limitations, mainly the geometric assumptions of PISA shape required to calculate effective regurgitant orifice area (EROA). Recently developed single-beat real-time three-dimensional (3D) color Doppler imaging allows the direct measurement of PISA without geometric assumptions and has already been validated for mitral regurgitation assessment. The aim of this study was to apply this novel method in patients with chronic tricuspid regurgitation (TR). METHODS Ninety patients with chronic TR were enrolled. EROA and regurgitant volume (Rvol) were assessed using transthoracic 2D and 3D PISA methods. Quantitative Doppler and 3D transthoracic planimetry of EROA were used as reference methods. RESULTS Both EROA and Rvol assessed using the 3D PISA method had better correlations with the reference methods than using conventional 2D PISA, particularly in the assessment of eccentric jets. On the basis of 3D planimetry-derived EROA, 35 patients had severe TR (EROA ≥ 0.4 cm(2)). Among these 35 patients, 25.7% (n = 9) were underestimated as having nonsevere TR (EROA ≤ 0.4 cm(2)) using the 2D PISA method. In contrast, the 3D PISA method had 94.3% agreement (33 of 35) with 3D planimetry in classifying severe TR. Good intraobserver and interobserver agreement for 3D PISA measurements was observed, with intraclass correlation coefficients of 0.92 and 0.88 respectively. CONCLUSIONS TR quantification using PISA by single-beat real-time 3D color Doppler echocardiography is feasible in the clinical setting and more accurate than the conventional 2D PISA method.
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Affiliation(s)
- Jose Alberto de Agustin
- Instituto Cardiovascular, Unidad de Imagen Cardiaca, Hospital Universitario San Carlos, Madrid, Spain.
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Islas F, de Agustin JA, Gomez de Diego JJ, Olmos C, Ferrera C, Luaces M, Cabeza B, Macaya C, Pérez de Isla L. Giant pericardial cyst compressing the heart. J Am Coll Cardiol 2013; 62:e19. [PMID: 23850918 DOI: 10.1016/j.jacc.2013.02.102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 02/19/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Fabian Islas
- Cardiovascular Institute, Hospital Universitario San Carlos, Madrid, Spain
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