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Yedidya I, Stassen J, Butcher SC, Milhorini Pio S, Lustosa RP, van der Bijl P, Vo NM, Namazi F, Ajmone Marsan N, Delgado V, Bax JJ. Relation of Myocardial Work Indexes and Forward Flow Reserve in Patients With Significant Secondary Mitral Regurgitation Undergoing Transcatheter Mitral Valve Repair. Am J Cardiol 2022; 178:106-111. [PMID: 35835599 DOI: 10.1016/j.amjcard.2022.05.013] [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] [Received: 03/17/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/01/2022]
Abstract
Left ventricular (LV) myocardial work (LVMW) indexes have shown incremental value over LV ejection fraction and were found to have prognostic significance in patients with secondary mitral regurgitation. We therefore aimed to investigate the association between LVMW indexes and forward flow reserve in patients with secondary mitral regurgitation, treated with transcatheter edge-to-edge repair (TEER). LVMW indexes were evaluated at baseline and forward stroke volume index (FSVI) was evaluated at baseline and 6-month follow-up after TEER. Patients were divided in 2 groups: improvers (improvement in FSVI ≥20%) and nonimprovers (improvement in FSVI <20%). A total of 70 patients (median age 76 years, 59% men) were included. FSVI was the only echocardiographic parameter that improved after TEER. There was a significant decrease in LV global longitudinal strain in the nonimprovers (p = 0.002) but not in the improvers (p = 0.177). Global work index and global constructive work worsened in nonimprovers (p = 0.005 and p = 0.004, respectively), whereas no difference was seen in these indexes in improvers (p = 0.093 and p = 0.112, respectively). Global work efficiency remained independently associated with forward flow reserve after adjusting for a variety of potential confounders. In conclusion, FSVI nonimprovers demonstrated worsening of LV systolic function after TEER compared with improvers, in whom LV systolic function remained stable. Global work efficiency was associated with FSVI improvement after TEER, independent of LV systolic function.
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Affiliation(s)
- Idit Yedidya
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel (affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Rodolfo P Lustosa
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ngoc Mai Vo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Farnaz Namazi
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Turku PET Center, University of Turku and Turku University Hospital, Turku, Finland.
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Stassen J, Ewe SH, Butcher SC, Ammanullah MR, Hirasawa K, Singh GK, Ding ZP, Pio SM, Chew NWS, Sia CH, Kong WKF, Poh KK, Marsan NA, Delgado V, Bax JJ. Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.211] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
Background
Moderate aortic stenosis (MAS) is associated with an increased risk of adverse events. Although left ventricular (LV) diastolic dysfunction (DDF) has shown to carry an unfavorable prognosis in severe AS, the prognostic value of LV DDF in MAS has not been investigated.
Purpose
To investigate the prognostic impact of LV DDF in patients with MAS and preserved LV ejection fraction (EF).
Methods
LV diastolic function was evaluated in patients with MAS (aortic valve area >1.0 and ≤1.5cm2) and preserved LVEF (≥50%) using echocardiography according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement (AVR).
Results
Of 1247 patients (age 74 ± 10 years, 47% men) with MAS and preserved LVEF, 396 (32%) had normal diastolic function, 316 (25%) had indeterminate diastolic function and 535 (43%) had DDF. Patients with DDF were more likely to be female, had more comorbidities (hypertension, atrial fibrillation, chronic kidney disease) and were more symptomatic (NYHA ≥2) than patients with normal diastolic function. Patients with DDF also had smaller aortic valve area and higher peak aortic velocities than patients with normal/indeterminate diastolic function. During a median follow-up of 53 (26 – 81) months, 484 (39%) patients died. For the composite endpoint, 770 patients (62%) underwent AVR (n = 376) or died (n = 394) during a median follow-up of 37 (IQR 15 – 62) months. Patients with DDF had significantly lower survival rates (p <0.001) and event-free survival rates (p = 0.015) compared to patients with normal/indeterminate diastolic function (Figure 1). On multivariable analysis, DDF was independently associated with all-cause mortality (HR: 1.368; 95% CI: 1.085 – 1.725; p = 0.008) and the composite endpoint of all-cause mortality and AVR (HR: 1.241; 95% CI: 1.035 – 1.488; p = 0.020) (Figure 2).
Conclusion
LV DDF is associated with worse outcomes in patients with MAS. Assessment of LV diastolic function may contribute significantly to risk stratification of patients with MAS. Abstract Figure. Abstract Figure.
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Affiliation(s)
- J Stassen
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SH Ewe
- National Heart Centre Singapore, Singapore, Singapore
| | - SC Butcher
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - MR Ammanullah
- National Heart Centre Singapore, Singapore, Singapore
| | - K Hirasawa
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - GK Singh
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - ZP Ding
- National Heart Centre Singapore, Singapore, Singapore
| | - SM Pio
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - NWS Chew
- National University Heart Centre, Singapore, Singapore
| | - CH Sia
- National University Heart Centre, Singapore, Singapore
| | - WKF Kong
- National University Heart Centre, Singapore, Singapore
| | - KK Poh
- National University Heart Centre, Singapore, Singapore
| | - NA Marsan
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - JJ Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
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Stassen J, Pio SM, Ewe SH, Singh GK, Hirasawa K, Butcher SC, Marsan NA, Delgado V, Bax JJ. Prognostic value of left ventricular global longitudinal strain in patients with moderate aortic stenosis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.212] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
Background
Impaired left ventricular (LV) global longitudinal strain (GLS) is associated with worse outcomes in patients with severe aortic stenosis, but its prognostic value in patients with moderate aortic stenosis (MAS) is largely unknown.
Purpose
To investigate the prognostic implications of LV GLS in patients with MAS and preserved LV ejection fraction (EF).
Methods
LV GLS was evaluated by speckle tracking echocardiography in 621 patients (age 71 ± 12 years, 59% men) with MAS (aortic valve area 1.0 – 1.5cm2) and preserved LVEF (≥50%). Impaired LV GLS was defined as an LV GLS value <16%, based on spline curve analysis (i.e. where the hazard ratio for all-cause mortality was ≥1). Clinical outcomes were defined as all-cause mortality and a composite endpoint of all-cause mortality and aortic valve replacement.
Results
Patients with LV GLS <16% (n = 282) were significantly older, more likely to be male and had more comorbidities (diabetes mellitus, atrial fibrillation, more impaired renal function) compared to patients with LV GLS ≥16% (n = 339). In terms of echocardiographic data, patients with LV GLS <16% had larger LV volumes, lower LVEF and higher E/e’. During a median follow-up of 53 (27 – 102) months, 199 (32%) patients died. For the composite endpoint, 409 patients (66%) underwent AVR (n = 290) or died (n = 119) during a median follow-up of 29 (IQR 14 – 54) months. Patients with LV GLS <16% experienced significantly lower survival rates (p < 0.001) and event-free survival rates (p = 0.001) compared to patients with LV GLS ≥16% (Figure 1). On multivariable analysis, LV GLS was independently associated with all-cause mortality (HR 2.442; 95% CI: 1.762 – 3.384; p < 0.001) and the composite endpoint of all-cause mortality and aortic valve replacement (HR 1.862; 95% CI: 1.498 – 2.315; p = 0.040) (Figure 2).
Conclusions
In patients with MAS and preserved LVEF, reduced LV GLS is associated with an increased risk of all-cause mortality and the composite endpoint of all-cause mortality and AVR. Assessment of LV GLS may be useful in the risk stratification of these patients. Abstract Figure. Kaplan-Meier curves Abstract Figure. Cox regression analysis
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Affiliation(s)
- J Stassen
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SM Pio
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SH Ewe
- National Heart Centre Singapore, Singapore, Singapore
| | - GK Singh
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - K Hirasawa
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SC Butcher
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - NA Marsan
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - JJ Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
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Stassen J, Ewe SH, Hirasawa K, Butcher SC, Singh GK, Ammanullah RA, Ding ZP, Pio SM, Chew NWS, Sia CH, Kong WKF, Poh KK, Marsan NA, Delgado V, Bax JJ. Left ventricular remodeling patterns in patients with moderate aortic stenosis. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.213] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): ESC Training Grant App000064741
Background
Moderate aortic stenosis (MAS) is associated with an increased risk of adverse events. Although left ventricular (LV) adverse remodeling is associated with worse outcomes in patients with severe AS, the prognostic significance of different patterns of LV remodeling in MAS has not been investigated.
Purpose
To investigate the association between different patterns of LV remodeling on outcomes in patients with MAS.
Methods
Patients with MAS (aortic valve area >1.0 and ≤1.5cm2) were stratified into 4 groups according to the pattern of LV remodeling: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH) or eccentric hypertrophy (EH). Clinical outcomes were defined as all-cause mortality and a composite of all-cause mortality and aortic valve replacement (AVR).
Results
Of 1931 patients (age 73 ± 10 years, 52% men) with MAS, 344 (18%) had NG, 469 (24%) CR, 698 (36%) CH and 420 (22%) EH. Patients with CH were more likely to be female, had more hypertension, were more symptomatic (NYHA ≥III) and had more pronounced LV diastolic dysfunction, whereas patients with EH had more coronary artery disease, were more symptomatic (NYHA ≥III) and had lower LV ejection fraction than patients with NG. Patients with CH had higher aortic mean pressure gradients and peak aortic jet velocities than patients with NG. During a median follow-up of 51 (IQR 25 - 83) months, 833 (43%) patients died. For the composite endpoint, 1286 (67%) patients underwent AVR (n = 613) or died (n = 673) during a median follow-up of 35 (IQR 14 - 60) months. Patients with CH and EH had significantly lower survival rates (p < 0.001; Figure 1) and event-free survival rates (p = 0.004) compared to patients with NG/CR. On multivariable analysis, CH was independently associated with all-cause mortality (HR:1.267; 95% CI:1.024 – 1.568; p = 0.029), whereas both CH (HR:1.293; 95% CI:1.090 – 1.533; p = 0.003) and EH (HR:1.222; 95% CI:1.013 – 1.474; p = 0.036) were associated with the composite endpoint of AVR and all-cause mortality (Figure 2).
Conclusions
In patients with MAS, different patterns of LV remodeling are observed with CH being independently associated with an increased risk of all-cause mortality. Risk stratification according to the different patterns of LV remodeling may help to identify patients with MAS who are at increased risk of adverse events and may benefit from closer follow-up. Abstract Figure. Kaplan-Meier curves Abstract Figure. Cox regression analysis
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Affiliation(s)
- J Stassen
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SH Ewe
- National Heart Centre Singapore, Singapore, Singapore
| | - K Hirasawa
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - SC Butcher
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - GK Singh
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - RA Ammanullah
- National Heart Centre Singapore, Singapore, Singapore
| | - ZP Ding
- National Heart Centre Singapore, Singapore, Singapore
| | - SM Pio
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - NWS Chew
- National University Heart Centre, Singapore, Singapore
| | - CH Sia
- National University Heart Centre, Singapore, Singapore
| | - WKF Kong
- National University Heart Centre, Singapore, Singapore
| | - KK Poh
- National University Heart Centre, Singapore, Singapore
| | - NA Marsan
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - JJ Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
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5
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Pio SM, Medvedofsky D, Delgado V, Namazi F, Weissman N, Grayburn P, Kar S, Lim S, Zhou Z, Liu M, Alu M, Redfors B, Kapadia S, Lindenfeld J, Abraham W, Mack M, Asch F, Stone G, Bax J. TCT-2 Changes in Left Ventricular Global Longitudinal Strain in Patients With Heart Failure and Secondary Mitral Regurgitation: The COAPT trial. J Am Coll Cardiol 2021. [DOI: 10.1016/j.jacc.2021.09.029] [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: 10/19/2022]
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Kuneman JH, Singh GK, Milhorini Pio S, Hirasawa K, Hautemann D, van der Kley F, Ajmone Marsan N, Knuuti J, Delgado V, Bax JJ. Sex differences in left ventricular remodelling in patients with severe aortic valve stenosis. Eur Heart J Cardiovasc Imaging 2021; 23:781-789. [PMID: 34468719 DOI: 10.1093/ehjci/jeab174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/24/2021] [Accepted: 08/13/2021] [Indexed: 01/19/2023] Open
Abstract
AIMS Women with severe aortic stenosis (AS) have better long-term outcome after transcatheter aortic valve implantation (TAVI) but worse survival after surgical aortic valve replacement compared with men. Whether this is related to sex differences in left ventricular (LV) remodelling is unknown. The aim of this study was to examine the sex differences in LV remodelling with multidetector row computed tomography (MDCT) and outcome in patients with severe AS undergoing TAVI between 2007 and 2018. METHODS AND RESULTS A total of 289 patients (age 80 ± 6 years, 54% male) were included. LV volumes, mass, and function were analysed on pre-procedural MDCT scans. Women showed smaller LV volumes and mass compared with men. Patients were classified into four LV remodelling patterns: concentric hypertrophy (50%) was the most frequent pattern of LV remodelling followed by eccentric hypertrophy (33%), normal geometry (13%), and concentric remodelling (4%). Men showed more concentric remodelling compared with women (91% vs. 9%, respectively, P = 0.011). However, no differences were observed in the remaining LV remodelling patterns. During a median follow-up of 3.8 (IQR 2.2-5.1) years after TAVI, 87 (30%) patients died. Women demonstrated better outcome after TAVI compared with men (log-rank χ2 = 4.29, P = 0.038). No association was observed between the interaction of the LV remodelling patterns and sex with outcome. CONCLUSION LV concentric hypertrophy and eccentric hypertrophy are similarly observed in men and women with severe AS but concentric remodelling was more common in men. Women demonstrated better outcome after TAVI when compared with men. The interaction between the LV remodelling patterns and sex was not associated with survival.
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Affiliation(s)
- Jurrien H Kuneman
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Stephan Milhorini Pio
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | | | - Frank van der Kley
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Juhani Knuuti
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Turku PET Center, University of Turku and Turku University Hospital, Turku, Finland.,Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland
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Amanullah MR, Pio SM, Ng ACT, Sin KYK, Marsan NA, Ding ZP, Leon MB, Généreux P, Delgado V, Ewe SH, Bax JJ. Prognostic Implications of Associated Cardiac Abnormalities Detected on Echocardiography in Patients With Moderate Aortic Stenosis. JACC Cardiovasc Imaging 2021; 14:1724-1737. [PMID: 34023268 DOI: 10.1016/j.jcmg.2021.04.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 11/16/2020] [Revised: 03/03/2021] [Accepted: 04/01/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study aimed to evaluate the prevalence and prognostic value of the extent of extra-aortic valvular cardiac abnormalities in a large multicenter registry of patients with moderate AS. BACKGROUND The prognostic significance of a new classification system that incorporates the extent of cardiac injury (beyond the aortic valve) has been proposed in patients with severe aortic stenosis (AS). Whether this can be applied to patients with moderate AS is unclear. METHODS Based on the echocardiographic findings at the time of diagnosis of moderate AS (aortic valve area between 1.0 and 1.5 cm2 and dimensionless velocity index ratio of ≥0.25), a total of 1,245 patients were included and analyzed retrospectively. They were recategorized into 5 groups according to the extent of extra-aortic valvular cardiac abnormalities: none (Group 0), involving the left ventricle (Group 1), the left atrial or mitral valve (Group 2), the pulmonary artery vasculature or tricuspid valve (Group 3), or the right ventricle (Group 4). Patients were followed for all-cause mortality and combined endpoint (all-cause mortality, stroke, heart failure, or myocardial infarction). RESULTS The distribution of patients according to the proposed classification was 13.1%, 26.8%, 42.6%, 10.6%, and 6.9% in Groups 0, 1, 2, 3, and 4, respectively. During a median follow-up of 4.3 (2.4 to 6.9) years, 564 (45.3%) patients died. There was a significant higher mortality rates with increasing extent of extra-aortic valvular cardiac abnormalities (log-rank p < 0.001). On multivariate analysis, the presence of extra-aortic valvular cardiac abnormalities remained independently associated with all-cause mortality and combined outcome, adjusted for aortic valve replacement as a time-dependent covariable. In particular, Group 2 and above were independently associated with all-cause mortality. CONCLUSIONS In patients with moderate AS, the presence of extra-aortic valvular cardiac abnormalities is associated with poor outcome.
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Affiliation(s)
| | | | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia
| | - Kenny Y K Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Zee Pin Ding
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Martin B Leon
- Department of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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Medvedofsky D, Milhorini Pio S, Weissman NJ, Namazi F, Delgado V, Grayburn PA, Kar S, Lim DS, Lerakis S, Zhou Z, Liu M, Alu MC, Kapadia SR, Lindenfeld J, Abraham WT, Mack MJ, Bax JJ, Stone GW, Asch FM. Left Ventricular Global Longitudinal Strain as a Predictor of Outcomes in Patients with Heart Failure with Secondary Mitral Regurgitation: The COAPT Trial. J Am Soc Echocardiogr 2021; 34:955-965. [PMID: 33845158 DOI: 10.1016/j.echo.2021.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/04/2020] [Revised: 02/01/2021] [Accepted: 04/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left ventricular (LV) global longitudinal strain (GLS) is a sensitive marker of LV function and may help identify patients with heart failure (HF) and secondary mitral regurgitation who would have a better prognosis and are more likely to benefit from edge-to-edge transcatheter mitral valve repair with the MitraClip. The aim of this study was to assess the prognostic utility of baseline LV GLS during 2-year follow-up of patients with HF with secondary mitral regurgitation enrolled in the Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation trial. METHODS Patients with symptomatic HF with moderate to severe or severe secondary mitral regurgitation who remained symptomatic despite maximally tolerated guideline-directed medical therapy (GDMT) were randomized to transcatheter mitral valve repair plus GDMT or GDMT alone. Speckle-tracking-derived LV GLS from baseline echocardiograms was obtained in 565 patients and categorized in tertiles. Death and HF hospitalization at 2-year follow-up were the principal outcomes of interest. RESULTS Patients with better baseline LV GLS had higher blood pressure, greater LV ejection fraction and stroke volume, lower levels of B-type natriuretic peptide, and smaller LV size. No significant difference in outcomes at 2-year follow-up were noted according to LV GLS. However, the rate of death or HF hospitalization between 10 and 24 months was lower in patients with better LV GLS (P = .03), with no differences before 10 months. There was no interaction between GLS tertile and treatment group with respect to 2-year clinical outcomes. CONCLUSIONS Baseline LV GLS did not predict death or HF hospitalization throughout 2-year follow-up, but it did predict outcomes after 10 months. The benefit of transcatheter mitral valve repair over GDMT alone was consistent in all subgroups irrespective of baseline LV GLS.
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Affiliation(s)
| | | | - Neil J Weissman
- MedStar Health Research Institute, Washington, District of Columbia; Georgetown University, Washington, District of Columbia
| | - Farnaz Namazi
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paul A Grayburn
- Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, Texas
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California; Bakersfield Heart Hospital, Bakersfield, California
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Zhipeng Zhou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Mengdan Liu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Maria C Alu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | | | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University Medical Center, Columbus, Ohio
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia; Georgetown University, Washington, District of Columbia.
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9
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Hirasawa K, Namazi F, Milhorini Pio S, Vo NM, Ajmone Marsan N, Bax JJ, Delgado V. Insufficient Mitral Leaflet Remodeling in Relation to Annular Dilation and Risk of Residual Mitral Regurgitation After MitraClip Implantation. JACC Cardiovasc Imaging 2020; 14:756-765. [PMID: 33129743 DOI: 10.1016/j.jcmg.2020.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/17/2020] [Accepted: 08/19/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The purpose of this study was to determine whether the mitral valve (MV) total leaflet area (TLA)-to-mitral annular area (MAA) (TLA/MAA) ratio measured using 3-dimensional (3D) transesophageal echocardiography (TEE) was associated with residual mitral regurgitation (MR) after MitraClip implantation in patients with secondary MR. BACKGROUND The factors influencing the results of MitraClip implantation for secondary MR are controversial. This study hypothesized that insufficient remodeling of the mitral leaflets relative to the annular dilation may be associated with significant MR after MitraClip implantation. METHODS This study included patients with secondary MR treated with MitraClips. Using 3D TEE dataset, the TLA in diastole and MAA in systole were measured with dedicated software. RESULTS In a total cohort of 119 patients (mean age 74 ± 9 years; 61% male), significant residual MR (≥2+) was present in 43 patients (36%). In patients with significant residual MR, MAA was greater than in patients without residual MR (10.7 ± 2.4 cm2 vs. 9.0 ± 2.1 cm2; p < 0.001) whereas no significant difference was observed in TLA (12.2 ± 2.6 cm2 vs. 12.0 ± 2.9 cm2; p = 0.836). TLA/MAA ratio was lower in patients with significant residual MR as compared to their counterparts (1.14 ± 0.15 vs. 1.34 ± 0.16; p < 0.001), suggesting insufficient leaflet remodeling relative to annular dilation. On receiver-operating characteristic curve analysis, the TLA/MAA ratio had better discriminative power to identify patients who will have significant residual MR compared to MAA alone (area under the curve [AUC]: 0.830 vs. 0.723; p = 0.049). CONCLUSIONS In patients with secondary MR, insufficient mitral leaflet remodeling relative to the annulus dilation, as reflected by a lower TLA/MAA ratio, is associated with significant residual MR after MitraClip implantation.
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Affiliation(s)
- Kensuke Hirasawa
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands
| | - Farnaz Namazi
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands
| | - Stephan Milhorini Pio
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands
| | - N Mai Vo
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands.
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Center, Leiden, the Netherlands
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10
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Yoon SH, Kim WK, Dhoble A, Milhorini Pio S, Babaliaros V, Jilaihawi H, Pilgrim T, De Backer O, Bleiziffer S, Vincent F, Shmidt T, Butter C, Kamioka N, Eschenbach L, Renker M, Asami M, Lazkani M, Fujita B, Birs A, Barbanti M, Pershad A, Landes U, Oldemeyer B, Kitamura M, Oakley L, Ochiai T, Chakravarty T, Nakamura M, Ruile P, Deuschl F, Berman D, Modine T, Ensminger S, Kornowski R, Lange R, McCabe JM, Williams MR, Whisenant B, Delgado V, Windecker S, Van Belle E, Sondergaard L, Chevalier B, Mack M, Bax JJ, Leon MB, Makkar RR. Bicuspid Aortic Valve Morphology and Outcomes After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 76:1018-1030. [DOI: 10.1016/j.jacc.2020.07.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022]
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11
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Abstract
Introduction In transcatheter aortic valve implantation (TAVI), assessment of aortic valve calcification is not as standardized as aortic annulus measurement. Aortic valve calcification is important for stable anchoring of the prosthesis to the aortic annulus. However, excessive aortic valve calcification is related to procedural complications. Areas covered This review covers the methods to assess aortic valve calcification and the implications of aortic valve calcium burden for TAVI outcomes. We performed a systematic review of the literature in Pubmed and secondary sources. Furthermore, future perspectives on how to integrate aortic valve calcification assessment in the management of patients with aortic stenosis is discussed. Expert opinion Thorough assessment of the aortic valve and aortic root components including aortic valve calcification is key in the planning of TAVI. Aortic valve calcification load, location and extension are important contributors to paravalvular regurgitation. Asymmetric calcification burden with greater calcification of the left-coronary cusp related to higher need of permanent pacemaker implantation. Patients with moderate and severe left ventricular outflow tract/subannular calcification are more susceptible to aortic annular rupture. Periprocedural dislodgement of calcium form cusps and commissures is one of the main reasons of coronary artery ostial occlusion during transcatheter aortic valve implantation. Abbreviations Ao, aorta; LA, left atrium; LAA, left atrial appendage; LV, left ventricle; LVOT, left ventricular outflow tract; THV, transcatheter heart valve.
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Affiliation(s)
- Stephan Milhorini Pio
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center , Leiden, The Netherlands
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12
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Pio SM, Amanullah M, Sin KYK, Marsan N, Ding ZP, Ewe S, Bax J, Delgado V. SEX-RELATED DIFFERENCES IN MODERATE AORTIC STENOSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32201-4] [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: 10/24/2022]
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13
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Amanullah MR, Pio SM, Sin KY, Ajmone Marsan N, Ding ZP, Delgado V, Ewe SH, Bax JJ. P5582Predicting the clinical outcomes in moderate aortic stenosis: implementation of the newly proposed staging classification. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0526] [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
While symptomatic severe aortic stenosis (AS) carries a worse prognosis and early intervention is favoured, it is always assumed that patients with moderate AS are more stable and their disease progression can be monitored yearly. However, it is known that patients with moderate AS have a higher risk of cardiovascular events but is unclear if other factors may also affect the overall prognosis.
Purpose
In this multicentre registry of patients with moderate AS, the prognostic value of a new staging classification on the extent of cardiac damage was examined.
Methods
Based on the echocardiographic findings at the time of diagnosis of moderate AS (valve area >1.0 and ≤1.5 cm2), they were re-classified into five stages depending on the extra-aortic valvular cardiac damage: no signs of cardiac damage (Stage 0), left ventricular (LV) damage [LV ejection fraction <50%, LV mass index >95 g/m2 for women or >115 g/m2 for men or E/e' >14] (Stage 1), mitral valve or left atrial (LA) damage [LA volume index >34 ml/m2 or mitral regurgitation ≥grade 3 or presence of atrial fibrillation] (Stage 2), tricuspid valve or pulmonary artery vasculature damage [systolic pulmonary arterial pressure ≥60 mmHg or tricuspid regurgitation ≥grade 3] (Stage 3), or right ventricular damage [tricuspid annular plane systolic excursion <17 mm] (Stage 4). The clinical endpoint was all-cause mortality. The association between the extent of cardiac damage and all-cause mortality was assessed by the Kaplan Meier method using log-rank test.
Results
Of the included 522 patients with moderate AS (age 71±11 years, 54% males), 12% (63) of patients were re-classified as Stage 0, 30% (157) in Stage 1, 47% (245) in Stage 2, 6% (31) in Stage 3 and 5% (26) in Stage 4. During follow-up, 43% (226) of patients underwent surgical or transcatheter aortic valve replacement. Over a median follow-up of 6.2 [interquartile range 3.2–9.0] years, 254 (49%) patients died. The cumulative event rates for all-cause mortality increased with increasing stage, particularly for Stages ≥2: 39% for Stage 0, 55% for Stage 1, 67% for Stage 2, 68% for Stage 3 and 57% for Stage 4, respectively (Figure, log-rank test p=0.001).
Cumulative death rates after re-staging
Conclusion
In a real-world registry of patients with moderate AS patients, worsening extra-aortic valvular cardiac damage portends a worse long-term prognosis.
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Affiliation(s)
- M R Amanullah
- National Heart Centre Singapore, Cardiology, Singapore, Singapore
| | - S M Pio
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - K Y Sin
- National Heart Centre Singapore, Cardiothoracic surgery, Singapore, Singapore
| | - N Ajmone Marsan
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - Z P Ding
- National Heart Centre Singapore, Cardiology, Singapore, Singapore
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - S H Ewe
- National Heart Centre Singapore, Cardiology, Singapore, Singapore
| | - J J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
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14
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Tjahjadi C, Hiemstra YL, Van Der Bijl P, Pio SM, Marsan NA, Delgado V, Bax JJ. P2465Assessment of left atrial electro-mechanical delay to predict atrial fibrillation in hypertrophic cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0797] [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
Left atrial remodelling in hypertrophic cardiomyopathy (HCM) is recognized as the main contributor to the development of atrial fibrillation (AF). It is well reported that the occurrence of AF in HCM increases both morbidity and mortality. Therefore, early recognition of AF is essential. Due to its often silent and paroxysmal nature, the diagnosis can be missed.
Purpose
PA-TDI, representing total atrial conduction time, reflects the left atrial structural and electrical remodelling. We sought to evaluate the association between this novel non-invasive echocardiographic parameter and AF in patients with HCM.
Methods
The electronic charts of patients with HCM and no previous history of AF from 1993 to 2018 were retrospectively analysed. PA-TDI was measured offline using pulsed wave tissue Doppler imaging with the sample volume placed on the lateral wall of the left atrium just above the mitral annulus in an apical 4-chamber view. The time interval was determined from the onset of P wave on surface ECG to the peak of the a' wave of the left atrial tissue Doppler tracing.
Results
There were 208 patients (64% male) with a mean age of 53±14 years in this study. The incidence of AF was 20% over a median follow-up of 56.3 (IQR 18.4–84.5) months. Patients who developed AF, had higher baseline PA-TDI intervals when in sinus rhythm (134±23 ms vs 111±30 ms, P<0.001) than those who remained free from AF. The cut-off value of PA-TDI duration was the median at 115 ms. A PA-TDI ≥115 ms was independently associated with new onset AF (HR: 2.5, 95% CI: 1.1–5.5, P=0.02) after correcting for age, left atrial diameter and E/e'.
Conclusion
A prolonged PA-TDI was strongly associated with the development of AF in patients with HCM. This parameter may be useful to risk-stratify patients with HCM who are at risk of having AF.
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Affiliation(s)
- C Tjahjadi
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - Y L Hiemstra
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - P Van Der Bijl
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - S M Pio
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - N A Marsan
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - J J Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
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15
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Pio SM, Amanullah MR, Sin KY, Ajmone Marsan N, Ding ZP, Ewe SH, Delgado V, Bax JJ. P3694Discordant criteria in moderate aortic stenosis patients: prognostic implications. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0548] [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
The frequency of discordant mean valve gradient (MG) and aortic valve area (AVA) in patients with moderate aortic stenosis (AS) has not been investigated.
Objectives
Determine the occurrence of discordant gradient in patients with moderate AS (defined by MG <20 mmHg), and how these patients compare with concordant gradient moderate AS (MG >20 mmHg) in terms of patients' characteristics and the impact on long term prognosis.
Methods
Based on the echocardiographic findings at the time of diagnosis of moderate AS (valve area >1.0 and ≤1.5 cm2), they were re-classified into discordant or concordant gradients, MG <20 mmHg or >20 mmHg, respectively. The clinical endpoint was all-cause mortality.
Results
Of 522 patients with moderate AS, 95 (18.2%) had discordant gradient moderate AS (MG <20 mmHg). Patients with discordant mean gradient were older, had higher prevalence of previous myocardial infarct, larger left ventricular (LV) end-diastolic volume index, lower LV ejection fraction (EF), stroke volume index and higher LV filling pressure. Compared to patients with concordant gradients, these patients had higher mortality rates (57.9% vs 46.6%, p=0.05) and lower aortic valve replacement rates (33.7% vs 54.9%, p<0.001) during a median follow-up of 6.2 [IQR 3.2–9.0] years. The results of Cox regression analysis are shown on the table.
Cox proportional hazard analysis All-cause mortality Univariate analysis Multivariate analysis Hazard ratio (95% CI) P value Hazard ratio (95% CI) P value Age (per 1 year increase) 1.05 (1.03–1.06) <0.001 1.04 (1.02–1.06) <0.001 Diabetes (yes/no) 1.34 (1.03–1.74) 0.031 1.33 (0.97–1.82) 0.072 Previous myocardial infarction (yes/no) 1.73 (1.29–2.34) <0.001 1.01 (0.70–1.46) 0.980 eGFR <60 ml/min/1.73m2 (yes/no) 2.15 (1.68–2.76) <0.001 1.71 (1.25–2.33) 0.001 Left ventricular hypertrophy (yes/no) 1.74 (1.31–2.30) <0.001 1.50 (1.07–2.09) 0.018 Indexed LA volume (per 1 mL/m2 increase) 1.005 (1.001–1.009) 0.008 1.006 (1.001–1.012) 0.040 Tricuspid regurgitation >moderate (yes/no) 2.02 (1.29–3.16) 0.002 1.36 (0.73–2.54) 0.337 Discordant moderate AS (yes/no) 1.81 (1.34–2.45) <0.001 1.42 (1.01–2.01) 0.049 AS, aortic stenosis; CI, confidence interval; eGFR, estimated glomerular filtration rate; HR, hazard ratio; LA, Left atrial.
Conclusion
Discrepant aortic mean gradient in moderate AS is not uncommon and occurs more often in older patients, with higher LV filling pressure and lower EF and stroke volume index. The lower gradient values lead to underestimation of AS severity, and is associated with greater cardiac extra-valvular damage and higher mortality.
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Affiliation(s)
- S M Pio
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - M R Amanullah
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - K Y Sin
- National Heart Centre Singapore, Department of Cardiothoracic Surgery, Singapore, Singapore
| | | | - Z P Ding
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - S H Ewe
- National Heart Centre Singapore, Department of Cardiology, Singapore, Singapore
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - J J Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
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16
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Azevedo PS, Gumieiro DN, Polegato BF, Pereira GJC, Silva IA, Pio SM, Junior CPC, Junior ELF, de Paiva SAR, Minicucci MF, Zornoff LAM. Goldman score, but not Detsky or Lee indices, predicts mortality 6 months after hip fracture. BMC Musculoskelet Disord 2017; 18:134. [PMID: 28372593 PMCID: PMC5379496 DOI: 10.1186/s12891-017-1480-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/08/2017] [Indexed: 12/21/2022] Open
Abstract
Background Over the past years, several cardiac risk indices were evaluated and modified, including Goldman, Detsky, and Lee scores. The predictive capacity of these scores in hip fracture patients is lacking. Thus, our objective was to compare the Goldman, Detsky, and Lee scores as predictors of mortality in 6 months after hip fracture. Methods We prospectively evaluated 80 consecutive patients with hip fractures, over the age of 65 admitted to an orthopedic ward at Botucatu Medical School. Patient demographic information, Goldman, Detsky and Lee scores were recorded. All patients were followed for 6 months after hip fracture, and mortality was recorded. Multiple logistic regression analyses were performed for mortality prediction. Results The mortality rate was 23% after a 6-month follow-up period. Patients who died had advanced age and the majority of them were male. They also had lower values of handgrip strength, and higher values of creatinine and urea. In the multiple logistic regression models when adjusted by age, gender, handgrip strength and creatinine, Goldman’s score (OR:3.025; 95%CI:1.022-8.953; p:0.046), but not Detsky (OR:2.328; 95%CI:0.422-12.835; p:0.332) and Lee (OR:1.262; 95%CI:0.649-2.454; p:0.494), was associated with mortality 6 months after hip fracture. Each 1 category increase in Goldman score increased the mortality to more than 3-fold. Conclusions In conclusion, our data suggest that Goldman score, but not Detsky or Lee indices, predicts mortality associated with hip fracture at up to 6 months post-injury.
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Affiliation(s)
- Paula Schmidt Azevedo
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, ZipCode: 18618-970, Botucatu, SP, Brazil.
| | - David Nicoletti Gumieiro
- Surgery and Orthopedic Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - Bertha Furlan Polegato
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, ZipCode: 18618-970, Botucatu, SP, Brazil
| | - Gilberto José Cação Pereira
- Surgery and Orthopedic Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, Brazil
| | - Igor Almonfrey Silva
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, ZipCode: 18618-970, Botucatu, SP, Brazil
| | - Stephan Milhorini Pio
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, ZipCode: 18618-970, Botucatu, SP, Brazil
| | - Cacionor Pereira Cunha Junior
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, ZipCode: 18618-970, Botucatu, SP, Brazil
| | - Edson Luiz Favero Junior
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, ZipCode: 18618-970, Botucatu, SP, Brazil
| | - Sergio Alberto Rupp de Paiva
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, ZipCode: 18618-970, Botucatu, SP, Brazil
| | - Marcos Ferreira Minicucci
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, ZipCode: 18618-970, Botucatu, SP, Brazil
| | - Leonardo Antonio Mamede Zornoff
- Internal Medicine Department, Botucatu Medical School, UNESP - Univ Estadual Paulista, Rubião Júnior s/n, ZipCode: 18618-970, Botucatu, SP, Brazil
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