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Ribeyrolles S, Monin JL, Rohnean A, Diakov C, Caussin C, Monnot S, Berrebi A, Paul JF. Grading mitral regurgitation using 4D flow CMR: Comparison to transthoracic echocardiography. Echocardiography 2022; 39:783-793. [PMID: 35536700 DOI: 10.1111/echo.15364] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/22/2022] [Accepted: 04/25/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To determine the 4D Flow Cardiac Magnetic Resonance (CMR) thresholds that achieve the best agreement with transthoracic echocardiography (TTE) for grading mitral regurgitation (MR). METHODS We conducted a single-center prospective study of patients evaluated for chronic primary MR in 2016-2020. MR was evaluated blindly by TTE and 4D Flow CMR, respectively by two cardiologists and two radiologists with decades of experience. MR was graded with both methods as mild, moderate, or severe. 4D Flow CMR measurements included MR regurgitant volume per beat (RV) and mitral anterograde flow per beat (MF). RF was obtained as the ratio RV/MF. Additionally, MF was compared to left ventricular stroke volume (LVSV) by cine-CMR. RESULTS We included 33 patients in the initial cohort and 33 in the validation cohort. Inter-observer agreement was excellent for 4D Flow CMR ICC = .94 (95% CI, .86-.97, p < 0.0001). Using recommended TTE thresholds (30 ml, 60 ml, 30%, 50%), agreement was moderate for RV and RF. The best agreement between 4D Flow CMR and TTE was obtained with CMR thresholds of 20 and 40 ml for RV (κ = .93; 95% CI, .8-1) and 20% and 37% for RF (κ = .90; 95% CI, .7-.9). In the validation cohort, agreement between TTE and 4D Flow CMR was good with the optimal thresholds (κ = .78; 95% CI, .61-.94). CONCLUSION We propose CMR thresholds that provide a good agreement between TTE and CMR for grading MR. Further studies are needed to fully validate 4D-Flow CMR accuracy for primary MR quantification.
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Affiliation(s)
- Sophie Ribeyrolles
- Department of Cardiovascular Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Luc Monin
- Department of Cardiovascular Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Adela Rohnean
- Department of Cardiovascular Imaging, Institut Mutualiste Montsouris, Paris, France
| | - Christelle Diakov
- Department of Cardiovascular Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Christophe Caussin
- Department of Cardiovascular Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Sebastien Monnot
- Department of Cardiovascular Imaging, Institut Mutualiste Montsouris, Paris, France
| | - Alain Berrebi
- Department of Cardiovascular Medicine, Institut Mutualiste Montsouris, Paris, France
| | - Jean-François Paul
- Department of Cardiovascular Imaging, Institut Mutualiste Montsouris, Paris, France
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Eugène M, Duchnowski P, Prendergast B, Wendler O, Laroche C, Monin JL, Jobic Y, Popescu BA, Bax JJ, Vahanian A, Iung B. Contemporary Management of Severe Symptomatic Aortic Stenosis. J Am Coll Cardiol 2021; 78:2131-2143. [PMID: 34823655 DOI: 10.1016/j.jacc.2021.09.864] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 05/12/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND There were gaps between guidelines and practice when surgery was the only treatment for aortic stenosis (AS). OBJECTIVES This study analyzed the decision to intervene in patients with severe AS in the EORP VHD (EURObservational Research Programme Valvular Heart Disease) II survey. METHODS Among 2,152 patients with severe AS, 1,271 patients with high-gradient AS who were symptomatic fulfilled a Class I recommendation for intervention according to the 2012 European Society of Cardiology guidelines; the primary end point was the decision for intervention. RESULTS A decision not to intervene was taken in 262 patients (20.6%). In multivariate analysis, the decision not to intervene was associated with older age (odds ratio [OR]: 1.34 per 10-year increase; 95% CI: 1.11 to 1.61; P = 0.002), New York Heart Association functional classes I and II versus III (OR: 1.63; 95% CI: 1.16 to 2.30; P = 0.005), higher age-adjusted Charlson comorbidity index (OR: 1.09 per 1-point increase; 95% CI: 1.01 to 1.17; P = 0.03), and a lower transaortic mean gradient (OR: 0.81 per 10-mm Hg decrease; 95% CI: 0.71 to 0.92; P < 0.001). During the study period, 346 patients (40.2%, median age 84 years, median EuroSCORE II [European System for Cardiac Operative Risk Evaluation II] 3.1%) underwent transcatheter intervention and 515 (59.8%, median age 69 years, median EuroSCORE II 1.5%) underwent surgery. A decision not to intervene versus intervention was associated with lower 6-month survival (87.4%; 95% CI: 82.0 to 91.3 vs 94.6%; 95% CI: 92.8 to 95.9; P < 0.001). CONCLUSIONS A decision not to intervene was taken in 1 in 5 patients with severe symptomatic AS despite a Class I recommendation for intervention and the decision was particularly associated with older age and combined comorbidities. Transcatheter intervention was extensively used in octogenarians.
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Affiliation(s)
- Marc Eugène
- Cardiology Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France
| | - Piotr Duchnowski
- Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | | | - Olaf Wendler
- Department of Cardiothoracic Surgery, King's College Hospital, London, United Kingdom
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia-Antipolis, France
| | - Jean-Luc Monin
- Cardiology Department, Institut Mutualiste Montsouris, Paris, France
| | - Yannick Jobic
- Cardiology Department, Hôpital Cavale Blanche, Brest, France
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila-Euroecolab, Emergency Institute for Cardiovascular Diseases Prof Dr C. C. Iliescu, Bucharest, Romania
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Bernard Iung
- Cardiology Department, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France; Université de Paris, Paris, France.
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Ribeyrolles S, Monin JL, Rohnean A, Diakov C, Caussin C, Monnot S, Paul JF. Grading mitral regurgitation using 4D flow CMR: comparison to transthoracic echocardiography. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0174] [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
Mitral Regurgitation (MR) is currently primarily assessed using multiple transthoracic echocardiography (TTE) parameters. Two-dimensional Cardiac Magnetic Resonance (CMR) can be used in difficult cases but has limited agreement with TTE for quantifying MR. We hypothesized that 4D Flow CMR may help to quantify MR.
Purpose
To determine the 4D Flow CMR thresholds that achieve the best agreement with TTE for grading MR.
Methods
We conducted a single-center prospective study of patients evaluated for chronic primary MR in 2016–2020. MR was evaluated blindly by TTE and 4D Flow CMR respectively by two cardiologists and two radiologists with decades of experience. MR was graded with both methods as mild, moderate or severe. 4D Flow CMR measurements included MR regurgitant volume per beat (RV) and mitral anterograde flow per beat (MF). RF was obtained as the ratio RV/MF. Additionally, MF was compared to left ventricular stroke volume (LVSV) by cine-CMR.
Results
We included 33 patients in the initial cohort and 33 in the validation cohort. Inter-observer agreement was good for TTE and excellent for 4D Flow CMR. Agreement between MF and LVSV was excellent. Using recommended TTE thresholds (30 mL, 60 mL, 30%, 50%), agreement was moderate for RV and RF. The best agreement between 4D Flow CMR and TTE was obtained with CMR thresholds of 20 mL and 40 mL for RV (κ=0.93; 95% CI, 0.8–1) and 20% and 37% for RF (κ=0.90; 95% CI, 0.7–0.9). In the validation cohort, agreement between TTE and 4D Flow CMR was good with the optimal thresholds (κ= 0.78; 95% CI, 0.61–0.94).
Conclusion
We propose CMR thresholds that provide a good agreement between TTE and CMR for grading MR. Further studies are needed to fully validate 4D-Flow CMR accuracy for primary MR quantification.
Funding Acknowledgement
Type of funding sources: None. Quantification of MR using 4D Flow CMR
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Affiliation(s)
- S Ribeyrolles
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - J L Monin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - A Rohnean
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - C Diakov
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - C Caussin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - S Monnot
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - J F Paul
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
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Ribeyrolles S, Monin JL, Rohnean A, Diakov C, Caussin C, Monnot S, Paul JF. Grading mitral regurgitation using 4D flow CMR: comparison to transthoracic echocardiography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.049] [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
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND
Mitral Regurgitation (MR) is currently primarily assessed using multiple transthoracic echocardiography (TTE) parameters. Two-dimensional Cardiac Magnetic Resonance (CMR) can be used in difficult cases but has limited agreement with TTE for quantifying MR. We hypothesized that 4D Flow CMR may help to quantify MR.
OBJECTIVES
To determine the 4D Flow CMR thresholds that achieve the best agreement with TTE for grading MR.
METHODS
We conducted a single-center prospective study of patients evaluated for chronic primary MR in 2016-2020. MR was evaluated blindly by TTE and 4D Flow CMR respectively by two cardiologists and two radiologists with decades of experience. MR was graded with both methods as mild, moderate or severe. 4D Flow CMR measurements included MR regurgitant volume per beat (RV) and mitral anterograde flow per beat (MF). RF was obtained as the ratio RV/MF. Additionally, MF was compared to left ventricular stroke volume (LVSV) by cine-CMR.
RESULTS
We included 33 patients in the initial cohort and 33 in the validation cohort. Inter-observer agreement was good for TTE and excellent for 4D Flow CMR. Agreement between MF and LVSV was excellent. Using recommended TTE thresholds (30 mL, 60 mL, 30%, 50%), agreement was moderate for RV and RF. The best agreement between 4D Flow CMR and TTE was obtained with CMR thresholds of 20 mL and 40 mL for RV (κ=0.93; 95%CI, 0.8-1) and 20% and 37% for RF (κ=0.90; 95%CI, 0.7-0.9). In the validation cohort, agreement between TTE and 4D Flow CMR was good with the optimal thresholds (κ= 0.78; 95%CI, 0.61-0.94).
CONCLUSION
We propose CMR thresholds that provide a good agreement between TTE and CMR for grading MR. Further studies are needed to fully validate 4D-Flow CMR accuracy for primary MR quantification.
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Affiliation(s)
- S Ribeyrolles
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - JL Monin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - A Rohnean
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - C Diakov
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - C Caussin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - S Monnot
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - JF Paul
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
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Ribeyrolles S, Monin JL, Rohnean A, Diakov C, Caussin C, Sarran A, Paul JF. P5874D Flow cardiac magnetic resonance quantification of mitral regurgitation, comparison with transthoracic echocardiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0196] [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
Mitral valve regurgitation (MR) is currently primarily assessed by a multiparametric approach with transthoracic echocardiography (TTE) that can be further completed by 2D Cardiac Magnetic Resonance (2D CMR) in case of doubt or poor acoustic window. TTE and 2D CMR have nevertheless imperfect agreement in terms of MR quantification. Time-resolved phase-contrast cardiac magnetic resonance imaging with flow-encoding in three spatial directions (4D Flow CMR) could help in MR quantification.
Purpose
Compare 4D Flow CMR quantification of MR with TTE using a multiparametric approach.
Methods
We conducted a monocentric, prospective study at the Institut Mutualiste Montsouris in Paris between November 2016 and 2017 including patients with chronic primitive MR. MR was evaluated with a multiparametric approach by two cardiologists with TTE and quantitatively by two radiologists with 4D Flow CMR. MR was classified as mild, moderate or severe and evaluated blindly with consensus in case of disagreement. 4D Flow CMR measurements consisted in quantifying MR regurgitant volume (RV) and MR regurgitant fraction (RF). 4D anterograde mitral flow was compared to left ventricular stroke volume using 2D-cine CMR.
Results
33 patients were included. Inter-observer agreement was good in TTE (kappa= 0.75 95% CI [0.57- 0.92]) and excellent in 4D Flow CMR (ICC= 0.94 95% CI [0.79–0.95]). Agreement with TTE was excellent using optimized thresholds (Mild: RV≤20mL RF≤20%, Moderate: RV=21–39mL RF=21–36%, Severe: RV≥40mL RF≥37%): kappa= 0.93 95% CI [0.8–1] for RV and kappa= 0.90 95% CI [0.7–0.9] for RF. A validation cohort confirmed that the 4D flow thresholds as determined were accurate for MR grading. Agreement between 4D anterograde mitral flow and 2D-cine CMR left ventricular stroke volume was also excellent (ICC= 0.92 95% CI [0.85–0.96]).
Conclusion
4D Flow CMR is a reliable tool for MR quantification. It provides direct quantitative evaluation of MR with low inter-observer variability. It may therefore be used as a gatekeeper before therapeutic decisions such as surgery.
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Affiliation(s)
- S Ribeyrolles
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - J L Monin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - A Rohnean
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - C Diakov
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - C Caussin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine, Paris, France
| | - A Sarran
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - J F Paul
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
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Besnard A, Raoux F, Khelil N, Monin JL, Saal JP, Veugeois A, Zannis K, Debauchez M, Caussin C, Amabile N. Current Management of Symptomatic Pericardial Effusions in Cancer Patients. JACC CardioOncol 2019; 1:137-140. [PMID: 34396173 PMCID: PMC8352300 DOI: 10.1016/j.jaccao.2019.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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7
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de Heer F, Kluin J, Elkhoury G, Jondeau G, Enriquez-Sarano M, Schäfers HJ, Takkenberg JJ, Lansac E, Dinges C, Steindl J, Ziller R, De Kerchove L, Benkacem T, Coulon C, Elkhoury G, Kaddouri F, Vanoverschelde JL, de Meester C, Pasquet A, Nijs J, Van Mosselvelde V, Loeys B, Meuris B, Schepmans E, Van den Bossche K, Verbrugghe P, Goossens W, Gutermann H, Pettinari M, El-Hamamsy I, Lenoir M, Noly PE, Tousch M, Shah P, Boodhwani M, Rudez I, Baric D, Unic D, Varvodic J, Gjorgijevska S, Vojacek J, Zacek P, Karalko M, Hlubocky J, Novotny R, Slautin A, Soliman S, Arnaud-Crozat E, Boignard A, Fayad G, Bouchot O, Albat B, Leguerrier A, Doguet F, Fuzellier JF, Glock Y, Jondeau G, Fernandez G, Chatel D, Zeitoun DM, Jouan J, Di Centa I, Obadia JF, Leprince P, Houel R, Bergoend E, Lopez S, Berrebi A, Tubach F, Lansac E, Lejeune S, Monin JL, Pousset S, Mankoubi L, Noghin M, Diakov C, Czytrom D, Schäfers HJ, Borger M, Aicher D, Theisohn F, Ferrero P, Stoica S, Matuszewski M, Yiu P, Bashir M, Ceresa F, Patane F, De Paulis R, Chirichilli I, Masat M, Antona C, Contino M, Mangini A, Romagnoni C, Grigioni F, Rosa R, Okita Y, Miyairi T, Kunihara T, de Heer F, Koolbergen D, Marsman M, Gökalp A, Kluin J, Bekkers J, Duininck L, Takkenberg JJ, Klautz R, Van Brakel T, Arabkhani B, Mecozzi G, Accord R, Jasinski M, Aminov V, Svetkin M, Kolesar A, Sabol F, Toporcer T, Bibiloni I, Rábago G, Alvarez-Asiain V, Melero A, Sadaba R, Aramendi J, Crespo A, Porras C, Evangelista Masip A, Kelley S, Bavaria J, Milewski R, Moeller P, Wenger I, Enriquez-Sarano M, Alger S, Alger A, Leavitt K. AVIATOR: An open international registry to evaluate medical and surgical outcomes of aortic valve insufficiency and ascending aorta aneurysm. J Thorac Cardiovasc Surg 2019; 157:2202-2211.e7. [DOI: 10.1016/j.jtcvs.2018.10.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/02/2018] [Accepted: 10/16/2018] [Indexed: 01/08/2023]
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8
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Ribeyrolles S, Monin JL, Rohnean A, Diakov C, Caussin C, Sarran A, Paul JF. 518Comparative assessment of chronic primitive mitral regurgitation severity by transthoracic echocardiography and 4D flow MRI. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez124.003] [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: 11/12/2022] Open
Affiliation(s)
- S Ribeyrolles
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - J L Monin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - A Rohnean
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - C Diakov
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - C Caussin
- Institut Mutualiste Montsouris, Department of Cardiovascular Medicine , Paris, France
| | - A Sarran
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
| | - J F Paul
- Institut Mutualiste Montsouris, Department of Cardiovascular Imaging, Paris, France
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9
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Galat A, Guellich A, Bodez D, Lipskaia L, Moutereau S, Bergoend E, Hüe S, Ternacle J, Mohty D, Monin JL, Derumeaux G, Radu C, Damy T. Causes and consequences of cardiac fibrosis in patients referred for surgical aortic valve replacement. ESC Heart Fail 2019; 6:649-657. [PMID: 31115164 PMCID: PMC6676299 DOI: 10.1002/ehf2.12451] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/02/2019] [Accepted: 04/21/2019] [Indexed: 12/25/2022] Open
Abstract
Aims Cardiac fibrosis is associated with left ventricular (LV) remodelling and contractile dysfunction in aortic stenosis (AS). The fibrotic process in this condition is still unclear. The aim of this study was to determine the role of both local and systemic inflammation as underlying mechanisms of LV fibrosis and contractile dysfunction. The diagnostic values of 2D‐strain echocardiography and serum biomarkers in the evaluation of cardiac fibrosis in this condition were assessed through correlation analyses. Methods and results Patients with AS referred for surgical valve replacement were prospectively and consecutively included. They all had a comprehensive echocardiography including 2D strain. Blood samples were collected to measure cytokines and inflammatory biomarkers using Luminex bead‐based assays. A per‐surgical myocardial biopsy of the basal antero‐septal segment (S1) was performed. Serial sections of each biopsy were stained with Sirius red. Digital image analysis was used to quantify fibrosis. Immunostainings using specific antibodies against macrophage, glycoprotein (gp) 130, and interleukin 6 (IL‐6) were also performed. Patients were divided into tertiles reflecting the severity of fibrosis: mild, moderate, and severe load (TF1 to TF3). The mean age of the 58 included patients was 73 ± 11 years. Twenty‐four (43%) were in New York Heart Association III–IV. Mean aortic valve area was 0.8 ± 0.2 cm2. Mean aortic stenosis peak velocity and mean gradient were respectively 4.5 ± 0.8 m/s and 54 ± 15 mmHg. The mean LV ejection fraction was 54 ± 12%, and the global LV longitudinal strain was −15 ± 4%. The mean S1 strain, corresponding to the biopsied region, was −10 ± 6% and was strongly correlated to fibrosis load (R = 0.83, P < 0.0001). TF3 was associated with higher mortality (P = 0.009), higher serum C‐reactive protein and IL‐6, and lower gp130 compared with the other tertiles (P < 0.05). IL‐6 and gp130 were expressed in the heart and respectively in the plasma membrane of macrophages and in the cytoplasm of both macrophages and cardiomyocytes. During follow‐up, three patients died and were all in the third fibrosis tertile. Conclusions We found a positive correlation between elevated inflammatory markers and degree of fibrosis load. These two parameters were associated with worse outcomes in patients with severe AS. Our results may be of interest especially in patients for whom a transcatheter aortic valve implantation is indicated and myocardial biopsy is not possible. Strategies aiming at preventing inflammation might be considered to decrease or limit the progression of cardiac fibrosis in patients followed for AS.
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Affiliation(s)
- Arnault Galat
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood (DHU ATVB), Créteil, France.,GRC Amyloid Research Institute, IMRB/INSERM U955, Créteil, France
| | - Aziz Guellich
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood (DHU ATVB), Créteil, France.,GRC Amyloid Research Institute, IMRB/INSERM U955, Créteil, France
| | - Diane Bodez
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood (DHU ATVB), Créteil, France.,GRC Amyloid Research Institute, IMRB/INSERM U955, Créteil, France
| | - Larissa Lipskaia
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood (DHU ATVB), Créteil, France.,GRC Amyloid Research Institute, IMRB/INSERM U955, Créteil, France
| | - Stéphane Moutereau
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Department of Biochemistry, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France
| | - Eric Bergoend
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood (DHU ATVB), Créteil, France.,Department of Cardiovascular Surgery, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France
| | - Sophie Hüe
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Department of Immunology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France
| | - Julien Ternacle
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood (DHU ATVB), Créteil, France.,GRC Amyloid Research Institute, IMRB/INSERM U955, Créteil, France
| | - Dania Mohty
- Department of Cardiology, Dupuytren Hospital, CHU Limoges, Pôle Cœur-Poumon-Rein, Limoges, France
| | - Jean-Luc Monin
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood (DHU ATVB), Créteil, France.,GRC Amyloid Research Institute, IMRB/INSERM U955, Créteil, France
| | - Geneviève Derumeaux
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood (DHU ATVB), Créteil, France.,GRC Amyloid Research Institute, IMRB/INSERM U955, Créteil, France
| | - Costin Radu
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood (DHU ATVB), Créteil, France.,Department of Cardiovascular Surgery, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France
| | - Thibaud Damy
- UPEC, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Department of Cardiology, AP-HP, Henri-Mondor Teaching Hospital, Créteil, France.,Département Hospitalo-Universitaire Ageing Thorax-Vessels-Blood (DHU ATVB), Créteil, France.,GRC Amyloid Research Institute, IMRB/INSERM U955, Créteil, France.,Inserm, Clinical Investigation Centre 1430, AP-HP, Henri Mondor Teaching Hospital, Créteil, France
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Berrebi A, Monin JL, Lansac E. Systematic echocardiographic assessment of aortic regurgitation-what should the surgeon know for aortic valve repair? Ann Cardiothorac Surg 2019; 8:331-341. [PMID: 31240177 DOI: 10.21037/acs.2019.05.15] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aortic valve (AV) repair is the preferred surgical treatment in young patients with aortic regurgitation (AR) and/or proximal aorta aneurysm, as noted in the recent European Society of Cardiology (ESC) guidelines. However, this surgical option is still underused in clinical practice. This emphasizes the need to build a heart team dedicated to AV repair with expert surgeons and echocardiographers. Surgical techniques are now standardized in their approaches to enhance the reproducibility and expansion of AV repair. The objective of this keynote is to also demonstrate the need for a standardized pre-pump intra-operative echocardiography protocol to fulfill surgeon's needs in providing a road map and predicting techniques to be used for an effective and durable repair.
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Affiliation(s)
- Alain Berrebi
- Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France
| | - Jean-Luc Monin
- Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France
| | - Emmanuel Lansac
- Department of Cardiac Pathology, Institut Mutualiste Montsouris, Paris, France
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Zannis K, Diplaris K, Monin JL, Khelil N, Debauchez M, Dervanian P, Lansac E, Czirom D, Noghin M, Mankoubi L, Amabile N. Mitroflow LXA structural deterioration following aortic valve replacement: a single-center experience. J Cardiovasc Surg (Torino) 2018; 59:746-752. [PMID: 29786406 DOI: 10.23736/s0021-9509.18.10204-7] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Concerns have been previously raised regarding the potential early degeneration of the Mitroflow (Sorin Group Italia, Saluggia, Vercelli, Italy) bioprostheses. We aimed to evaluate our clinical experience with the Mitroflow LXA prosthesis for aortic valve replacement. METHODS We prospectively analyzed data from 227 consecutive patients (133 males, mean age 73.9±9.2 years) implanted with the Mitroflow LXA between February 2007 and October 2011. Follow-up data were obtained by contacting the referring cardiologists. Kaplan-Meier curves were constructed for all-cause mortality, valve related mortality and structural valve degeneration (SVD). Multivariable analysis was conducted to identify SVD predictors. RESULTS Median follow-up time was 54.2±37.9 months and completeness of follow-up was 95%. Overall mortality in the entire series was at 31% (N.=71) and mortality from cardiac or unknown causes at 20% (N.=46). SVD occurred in 24 patients (10%) (median delay between implantation and diagnosis: 62.6 (36.5) months). Reintervention was required in 20 cases (13 redo surgery, 7 percutaneous transcatheter valve intervention). The 8 years actuarial global survival was 54.7±4.9%, freedom from valve related mortality 67.5±4.9% and freedom from SVD 72±8%. The estimated freedom from SVD was significantly (P=0.007) longer in larger prosthesis (diameter >21 mm, 77±11%) compared to the smaller devices (≤21 mm, 59±13%.). Multivariate analysis identified smaller prostheses and age at implantation as independent predictors of SVD. CONCLUSIONS The Mitroflow LXA showed evidence of early SVD in this cohort. A close follow-up of these patients is strongly advised.
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Galat A, Guellich A, Bodez D, Slama M, Dijos M, Zeitoun DM, Milleron O, Attias D, Dubois-Randé JL, Mohty D, Audureau E, Teiger E, Rosso J, Monin JL, Damy T. Aortic stenosis and transthyretin cardiac amyloidosis: the chicken or the egg? Eur Heart J 2016; 37:3525-3531. [DOI: 10.1093/eurheartj/ehw033] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/18/2015] [Accepted: 01/21/2016] [Indexed: 12/21/2022] Open
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Faivre L, Lim P, Bergoend E, Couetil JP, Antoine C, Monin JL, Dubois-Randé JL, Teiger E, Ternacle J. 0314: Biomakers are better than right ventricular function for assessing postoperative mortality in patients referred for tricuspid regurgitation correction. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30311-1] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Winter R, Fazlinezhad A, Martins Fernandes S, Pellegrino M, Iriart X, Moustafa S, Stolfo D, Bieseviciene M, Patel S, Vriz O, Sarvari SI, Santos M, Berezin A, Stoebe S, Benyounes Iglesias N, De Chiara B, Soliman A, Oni O, Ricci F, Tumasyan LR, Kim KH, Popa BA, Yiangou K, Olsen RH, Cacicedo A, Monti L, Holte E, Orlic D, Trifunovic D, Nucifora G, Casalta AC, Cavalcante JL, Keramida K, Calin A, Almeida Morais L, Bandera F, Galli E, Kamal HM, Leite L, Polte CL, Martinez Santos P, Jin CN, Generati G, Reali M, Kalcik M, Cacicedo A, Nascimento H, Ferreiro Quero C, Kazum S, Madeira S, Villagra JM, Muraru D, Gobbo M, Generati G, D'andrea A, Azevedo O, Nucifora G, Cruz I, Lozano Granero VC, Stampfli SF, Marketou M, Bento D, Mohty D, Hernandez Jimenez V, Gascuena R, Ingvarsson A, Cameli M, Werther Evaldsson A, Greiner S, Michelsen MM, El Eraky AZZA, Kamal HM, D'ascenzi F, Spinelli L, Stojanovic S, Mincu RI, Vindis D, Mantovani F, Yi JE, Styczynski G, Battah AHMED, O'driscoll J, Generati G, Velasco Del Castillo S, Voilliot D, Scali MC, Garcia Campos A, Opitz B, Herold IHF, Veiga CESAR, Santos Furtado M, Khan UM, Leite L, Leite L, Leite L, Keramida K, Molnar AA, Rio P, Huang MS, Papadopoulos C, Venneri L, Onut R, Casas Rojo E, Bayat F, Aggeli C, Ben Kahla S, Abid L, Choi JH, Barreiro Perez M, Lindqvist P, Sheehan F, Vojdanparast M, Nezafati P, Teixeira R, Generati G, Bandera F, Labate V, Alfonzetti E, Guazzi M, Dinet ML, Jalal Z, Cochet H, Thambo JB, Ho TH, Shah P, Murphy K, Nelluri BK, Lee H, Wilansky S, Mookadam F, Tonet E, Merlo M, Barbati G, Gigli M, Pinamonti B, Ramani F, Zecchin M, Sinagra G, Vaskelyte JJ, Mizariene V, Lesauskaite V, Verseckaite R, Karaliute R, Jonkaitiene R, Li L, Craft M, Danford D, Kutty S, Pellegrinet M, Zito C, Carerj S, Di Bello V, Cittadini A, Bossone E, Antonini-Canterin F, Rodriguez M, Sitges M, Sepulveda-Martinez A, Gratacos E, Bijnens B, Crispi F, Leite L, Martins R, Baptista R, Barbosa A, Ribeiro N, Oliveira A, Castro G, Pego M, Samura T, Kremzer A, Tarr A, Pfeiffer D, Hagendorff A, Van Der Vynckt C, Gout O, Devys JM, Cohen A, Musca F, D'angelo L, Cipriani MG, Parolini M, Rossi A, Santambrogio GM, Russo C, Giannattasio C, Moreo A, Moharram M, Gamal A, Reda A, Adebiyi A, Aje A, Aquilani R, Dipace G, Bucciarelli V, Bianco F, Miniero E, Scipioni G, De Caterina R, Gallina S, Adamyan KG, Chilingaryan AL, Tunyan LG, Cho JY, Yoon HJ, Ahn Y, Jeong MH, Cho JG, Park JC, Popa A, Cerin G, Azina CH, Yiangou A, Georgiou C, Zitti M, Ioannides M, Chimonides S, Pedersen LR, Snoer M, Christensen TE, Ghotbi AA, Hasbak P, Kjaer A, Haugaard SB, Prescott E, Velasco Del Castillo S, Gomez Sanchez V, Anton Ladislao A, Onaindia Gandarias J, Rodriguez Sanchez I, Jimenez Melo O, Garcia Cuenca E, Zugazabeitia Irazabal G, Romero Pereiro A, Nardi B, Di Giovine G, Malanchini G, Scardino C, Balzarini L, Presbitero P, Gasparini GL, Tesic M, Zamaklar-Trifunovic D, Vujisic-Tesic B, Borovic M, Milasinovic D, Zivkovic M, Kostic J, Belelsin B, Ostojic M, Krljanac G, Savic L, Asanin M, Aleksandric S, Petrovic M, Zlatic N, Lasica R, Mrdovic I, Muser D, Zanuttini D, Tioni C, Bernardi G, Spedicato L, Proclemer A, Galli E, Szymanski C, Salaun E, Lavoute C, Haentjens J, Tribouilloy C, Mancini J, Donal E, Habib G, Delgado-Montero A, Dahou A, Caballero L, Rijal S, Gorcsan J, Monin JL, Pibarot P, Lancellotti P, Kouris N, Kostopoulos V, Giannaris V, Trifou E, Markos L, Mihalopoulos A, Mprempos G, Olympios CD, Mateescu AD, Rosca M, Beladan CC, Enache R, Gurzun MM, Varga P, Calin C, Ginghina C, Popescu BA, Galrinho A, Branco L, Gomes V, Timoteo AT, Daniel P, Rodrigues I, Rosa S, Fragata J, Ferreira R, Generati G, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Leclercq C, Samset E, Donal E, Oraby MA, Eleraky AZ, Yossuef MA, Baptista R, Teixeira R, Ribeiro N, Oliveira AP, Barbosa A, Castro G, Martins R, Elvas L, Pego M, Gao SA, Lagerstrand KM, Johnsson ÅA, Bech-Hanssen O, Vilacosta I, Batlle Lopez E, Sanchez Sauce B, Jimenez Valtierra J, Espana Barrio E, Campuzano Ruiz R, De La Rosa Riestra A, Alonso Bello J, Perez Gonzalez F, Wan S, Sun JP, Lee AP, Bandera F, Pellegrino M, Carbone F, Labate V, Alfonzetti E, Guazzi M, Cimino S, Salatino T, Silvetti E, Mancone M, Pennacchi M, Giordano A, Sardella G, Agati L, Yesin M, Gunduz S, Gursoy MO, Astarcioglu MA, Karakoyun S, Bayam E, Cersit S, Ozkan M, Velasco Del Castillo S, Gomez Sanchez V, Anton Ladislao A, Onaindia Gandarias J, Rodriguez Sanchez I, Jimenez Melo O, Quintana Razcka O, Romero Pereiro A, Zugazabeitia Irazabal G, Braga M, Flores L, Ribeiro V, Melao F, Dias P, Maciel MJ, Bettencourt P, Mesa Rubio MD, Ruiz Ortiz M, Delgado Ortega M, Sanchez Fernandez J, Duran Jimenez E, Morenate Navio C, Romero M, Pan M, Suarez De Lezo J, Vaturi M, Weisenberg D, Monakier D, Valdman A, Vaknin- Assa H, Assali A, Kornowski R, Sagie A, Shapira Y, Ribeiras R, Abecasis J, Teles R, Castro M, Tralhao A, Horta E, Brito J, Andrade M, Mendes M, Avegliano G, Ronderos R, Matta MG, Camporrotondo M, Castro F, Albina G, Aranda A, Navia D, Siciliano M, Migliore F, Cavedon S, Folino F, Pedrizzetti G, Bertaglia M, Corrado D, Iliceto S, Badano LP, Merlo M, Stolfo D, Losurdo P, Ramani F, Barbati G, Pivetta A, Pinamonti B, Sinagra GF, Di Lenarda A, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Di Palma E, Baldini L, Verrengia M, Vastarella R, Limongelli G, Bossone E, Calabro' R, Russo MG, Pacileo G, Cruz I, Correia E, Bento D, Teles L, Lourenco C, Faria R, Domingues K, Picarra B, Marques N, Muser D, Gianfagna P, Morocutti G, Proclemer A, Gomes AC, Lopes LR, Stuart B, Caldeira D, Morgado G, Almeida AR, Canedo P, Bagulho C, Pereira H, Pardo Sanz A, Marco Del Castillo A, Monteagudo Ruiz JM, Rincon Diaz LM, Ruiz Rejon F, Casas E, Hinojar R, Fernandez-Golfin C, Zamorano Gomez JL, Erhart L, Staehli BE, Kaufmann BA, Tanner FC, Kontaraki J, Parthenakis F, Maragkoudakis S, Zacharis E, Patrianakos A, Vardas P, Domingues K, Correia E, Lopes L, Teles L, Picarra B, Magalhaes P, Faria R, Lourenco C, Azevedo O, Boulogne C, Magne J, Damy T, Martin S, Boncoeur MP, Aboyans V, Jaccard A, Saavedra Falero J, Alberca Vela MT, Molina Blazquez L, Mata Caballero R, Serrano Rosado JA, Elviro R, Di Gioia C, Fernandez Rozas I, Manzano MC, Martinez Sanchez JI, Molina M, Palma J, Werther Evaldsson A, Radegran G, Stagmo M, Waktare J, Roijer A, Meurling CJ, Righini FM, Sparla S, Di Tommaso C, Focardi M, D'ascenzi F, Tacchini D, Maccherini M, Henein M, Mondillo S, Ingvarsson A, Waktare J, Thilen U, Stagmo M, Roijer A, Radegran G, Meurling C, Jud A, Aurich M, Katus HA, Mereles D, Faber R, Pena A, Mygind ND, Suhrs HE, Zander M, Prescott E, Handoka NESRIN, Ghali MONA, Eldahshan NAHED, Ibrahim AHMED, Al-Eraky AZ, El Attar MA, Omar AS, Pelliccia A, Alvino F, Solari M, Cameli M, Focardi M, Bonifazi M, Mondillo S, Giudice CA, Assante Di Panzillo E, Castaldo D, Riccio E, Pisani A, Trimarco B, Deljanin Ilic M, Ilic S, Magda LS, Florescu M, Velcea A, Mihalcea D, Chiru A, Popescu BO, Tiu C, Vinereanu D, Hutyra M, Cechakova E, Littnerova S, Taborsky M, Lugli R, Bursi F, Fabbri M, Modena MG, Stefanelli G, Mussini C, Barbieri A, Youn HJ, O JH, Yoon HJ, Jung HO, Shin GJ, Rdzanek A, Pietrasik A, Kochman J, Huczek Z, Milewska A, Marczewska M, Szmigielski CA, Abd Eldayem SOHA, El Magd El Bohy ABO, Slee A, Peresso V, Nazir S, Sharma R, Bandera F, Pellegrino M, Labate V, Carbone F, Alfonzetti E, Guazzi M, Anton Ladislao A, Gomez Sanchez V, Cacidedo Fernandez Bobadilla A, Onaindia Gandarias JJ, Rodriguez Sanchez I, Romero Pereira A, Quintana Rackza O, Jimenez Melo O, Zugazabeitia Irazabal G, Huttin O, Venner C, Deballon R, Manenti V, Villemin T, Olivier A, Sadoul N, Juilliere Y, Selton-Suty C, Simioniuc A, Mandoli GE, Dini FL, Marzilli M, Picano E, Martin-Fernandez M, De La Hera Galarza JM, Corros-Vicente C, Leon-Aguero V, Velasco-Alonso E, Colunga-Blanco S, Fidalgo-Arguelles A, Rozado-Castano J, Moris De La Tassa C, Stelzmueller ME, Wisser W, Reichenfelser W, Mohl W, Saporito S, Mischi M, Bouwman RA, Van Assen HC, Van Den Bosch HCM, De Lepper A, Korsten HHM, Houthuizen P, Rodrigues A, Leal G, Silvestre O, Andrade J, Hjertaas JJ, Greve G, Matre K, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Ribeiro N, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Teixeira R, Baptista R, Barbosa A, Oliveira AP, Castro G, Martins R, Cardim N, Goncalves L, Pego M, Kouris N, Kostopoulos V, Markos L, Olympios CD, Kovacs A, Tarnoki AD, Tarnoki DL, Kolossvary M, Apor A, Maurovich-Horvat P, Jermendy G, Sengupta P, Merkely B, Viveiros Monteiro A, Galrinho A, Pereira-Da-Silva T, Moura Branco L, Timoteo A, Abreu J, Leal A, Varela F, Cruz Ferreira R, Yang LT, Tsai WC, Mpaltoumas K, Fotoglidis A, Triantafyllou K, Pagourelias E, Kassimatis E, Tzikas S, Kotsiouros G, Mantzogeorgou E, Vassilikos V, Calicchio F, Manivarmane R, Pareek N, Baksi J, Rosen S, Senior R, Lyon AR, Khattar RS, Marinescu C, Onciul S, Zamfir D, Tautu O, Dorobantu M, Carbonell San Roman A, Rincon Diez LM, Gonzalez Gomez A, Fernandez Santos S, Lazaro Rivera C, Moreno Vinues C, Sanmartin Fernandez M, Fernandez-Golfin C, Zamorano Gomez JL, Alirezaei T, Karimi AS, Kakiouzi V, Felekos I, Panagopoulou V, Latsios G, Karabela M, Petras D, Tousoulis D, Abid L, Abid D, Kammoun S, Ben Kahla S, Lee JW, Martin Fernandez M, Costilla Garcia SM, Diaz Pelaez E, Moris De La Tassa C. Poster session 3The imaging examinationP646Simulator-based testing of skill in transthoracic echoP647Clinical and echocardiographic characteristics of isolated left ventricular non-compactionP648Appropriate use criteria of transthoracic echocardiography and its clinical impact in an aged populationAnatomy and physiology of the heart and great vesselsP649Prevalence and determinants of exercise oscillatory ventilation in the EUROEX trial populationAssessment of diameters, volumes and massP650Left atrial remodeling after percutaneous left atrial appendage closureP651Global atrial performance with tyrosine kinase inhibitors in metastatic renal cell carcinomaP652Early right ventricular response to cardiac resynchronization therapy: impact on clinical outcomesP653Parameters of speckle-tracking echocardiography and biomechanical values of a dilative ascending aortaAssessments of haemodynamicsP654Right atrial hemodynamics in infants and children: observations from 3-dimensional echocardiography derived right atrial volumesAssessment of systolic functionP655One-point carotid wave intensity predicts cardiac mortality in patients with congestive heart failure and reduced ejection fractionP656Persistence of cardiac remodeling in adolescents with previous fetal growth restrictionP6572D speckle tracking-derived left ventricle global longitudinal strain and left ventricular dysfunction stages: a useful discriminator in moderate-to-severe aortic regurgitationP658Global longitudinal strain and strain rate in type two diabetes patients with chronic heart failure: relevance to circulating osteoprotegerinP659Analysis of left ventricular function in patients before and after surgical and interventional mitral valve therapyP660Left ventricular end-diastolic volume is complementary with global longitudinal strain for the prediction of left ventricular ejection fraction in echocardiographic daily practiceP661Left ventricular assist device, right ventricle function, and selection bias: the light side of the moonP662Assessment of right ventricular function in patients with anterior ST elevation myocardial infarction; a 2-d speckle tracking studyP663Right ventricular systolic function assessment in sickle cell anaemia using echocardiographyAssessment of diastolic functionP664Prognostic value of transthoracic cardiopulmonary ultrasound in cardiac surgery intensive care unitP665Comparative efficacy of renin-angiotensin system modulators on prognosis, right heart and left atrial parameters in patients with chronic heart failure and preserved left ventricular systolic functionP666Left atrial volume index is the most significant diastolic functional parameter of hemodynamic burden as measured by NT-proBNP in acute myocardial infarctionP667Preventive echocardiographic screening. preliminary dataP668Assessment of the atrial electromechanical delay and the mechanical functions of the left atrium in patients with diabetes mellitus type IIschemic heart diseaseP669Coronary flow velocity reserve by echocardiography as a measure of microvascular function: feasibility, reproducibility and agreement with PET in overweight patients with coronary artery diseaseP670Influence of cardiovascular risk in the occurrence of events in patients with negative stress echocardiographyP671Prevalence of transmural myocardial infarction and viable myocardium in chronic total occlusion (CTO) patientsP672The impact of the interleukin 6 receptor antagonist tocilizumab on mircovascular dysfunction after non st elevation myocardial infarction assessed by coronary flow reserve from a randomized studyP673Impact of manual thrombus aspiration on left ventricular remodeling: the echocardiographic substudy of the randomized Physiologic Assessment of Thrombus Aspirtion in patients with ST-segment ElevatioP674Acute heart failure in STEMI patients treated with primary percutaneous coronary intervention is related to transmural circumferential myocardial strainP675Long-term prognostic value of infarct size as assessed by cardiac magnetic resonance imaging after a first st-segment elevation myocardial infarctionHeart valve DiseasesP676Prognostic value of LV global longitudinal strain in aortic stenosis with preserved LV ejection fractionP677Importance of longitudinal dyssynchrony in low flow low gradient severe aortic stenosis patients undergoing dobutamine stress echocardiography. a multicenter study (on behalf of the HAVEC group)P678Predictive value of left ventricular longitudinal strain by 2D Speckle Tracking echocardiography, in asymptomatic patients with severe aortic stenosis and preserved ejection fractionP679Clinical and echocardiographic characteristics of the flow-gradient patterns in patients with severe aortic stenosis and preserved left ventricular ejection fractionP6802D and 3D speckle tracking assessment of left ventricular function in severe aortic stenosis, a step further from biplane ejection fractionP681Functional evaluation in aortic stenosis: determinant of exercise capacityP682Left ventricular mechanics: novel tools to evaluate left ventricular function in patients with primary mitral regurgitationP683Plasma B-type natriuretic peptide level in patients with isolated rheumatic mitral stenosisP684Quantitative assessment of severity in aortic regurgitation and the influence of elastic proprieties of thoracic aortaP685Characterization of chronic aortic and mitral regurgitation using cardiovascular magnetic resonanceP686Functional mitral regurgitation: a warning sign of underlying left ventricular systolic dysfunction in heart failure with preserved ejection fraction.P687Secondary mitral valve tenting in primary degenerative prolapse quantified by three-dimensional echocardiography predicts regurgitation recurrence after mitral valve repairP688Advanced heart failure with reduced ejection fraction and severe mitral insufficiency compensate with a higher oxygen peripheral extraction to a reduced cardiac output vs oxygen uptake response to maxP689Predictors of acute procedural success after percutaneous mitraclip implantation in patients with moderate-to-severe or severe mitral regurgitation and reduced ejection fractionP690The value of transvalvular gradients obtained by transthoracic echocardiography in estimation of severe paravalvular leakage in patients with mitral prosthetic valvesP691Characteristics of infective endocarditis in a non tertiary hospitalP692Infective endocarditis: predictors of severity in a 3-year retrospective analysisP693New echocardiographic predictors of early recurrent mitral functional regurgitation after mitraclip implantationP694Transesophageal echocardiography can be reliably used for the allocation of patients with severe aortic stenosis for tras-catheter aortic valve implantationP695Annular sizing for transcatheter aortic valve selection. A comparison between computed tomography and 3D echocardiographyP696Association between aortic dilatation, mitral valve prolapse and atrial septal aneurysm: first descriptive study.CardiomyopathiesP698Cardiac resynchronization therapy by multipoint pacing improves the acute response of left ventricular mechanics and fluid dynamics: a three-dimensional and particle image velocimetry echo studyP699Long-term natural history of right ventricular function in dilated cardiomyopathy: innocent bystander or leading actor?P700Right to left ventricular interdependence at rest and during exercise assessed by the ratio between pulmonary systolic to diastolic time in heart failure reduced ejection fractionP701Exercise strain imaging demonstrates impaired right ventricular contractile reserve in patients with hypertrophic cardiomyopathyP702Prevalence of overt left ventricular dysfunction (burn-out phase) in a portuguese population of hypertrophic cardiomyopathy, a multicentre studyP703Systolic and diastolic myocardial mechanics in hypertrophic cardiomyopathy and their link to the extent of hypertrophy, replacement fibrosis and interstitial fibrosisP704Multimodality imaging and genotype-phenotype associations in a cohort of patients with hypertrophic cardiomyopathy studied by next generation sequencing and cardiac magnetic resonanceP705Sudden cardiac death risk assessment in apical hypertrophic cardiomyopathy: do we need to add MRI to the equation?P706Prognostic value of left ventricular ejection fraction, proBNP, exercise capacity, and NYHA functional class in patients with left ventricular non-compaction cardiomyopathyP707The anti-hypertrophic microRNAs miR-1, miR-133a and miR-26b and their relationship to left ventricular hypertrophy in patients with essential hypertensionP708Prevalence of left ventricular systolic dysfunction in a portuguese population of left ventricular non-compaction cardiomyopathy, a multicentre studyP709Assessment of systolic and diastolic features in light chain amyloidosis: an echocardiographic and cardiac magnetic resonance studyP710Morbid obesity-associated hypertension identifies bariatric surgery best responders: Clinical and echocardiographic follow up studyP711Echocardiographic markera for overhydration in patients under haemodialysisP712Gender aspects of right ventricular size and function in clinically stable heart transplant patientsP713Evidence of cardiac stem cells from the left ventricular apical tip in patients undergone LVAD implant: a comparative strain-ultrastructural studySystemic diseases and other conditionsP714Speckle tracking assessment of right ventricular function is superior for differentiation of pressure versus volume overloaded right ventricleP715Prognostic value of pulmonary arterial pressure: analysis in a large dataset of timely matched non-invasive and invasive assessmentsP716Effect of the glucagon-like peptide-1 analogue liraglutide on left ventricular diastolic and systolic function in patients with type 2 diabetes: a randomised, single-blinded, crossover pilot studyP717Tissue doppler evaluation of left ventricular functions, left atrial mechanical functions and atrial electromechanical delay in juvenile idiopathic arthritisP718Echocardiographic detection of subclinical left ventricular dysfunction in patients with rheumatoid arthritisP719Left ventricular strain values are unaffected by intense training: a longitudinal, speckle-tracking studyP720Diastolic left ventricular function in autosomal dominant polycystic kidney disease: a matched-cohort, speckle-tracking echocardiographic studyP721Relationship between adiponectin level and left ventricular mass and functionP722Left atrial function is impaired in patients with multiple sclerosisMasses, tumors and sources of embolismP723Paradoxical embolization to the brain in patients with acute pulmonary embolism and confirmed patent foramen ovale with bidirectional shunt, results of prospective monitoringP724Following the European Society of Cardiology proposed echocardiographic algorithm in elective patients with clinical suspicion of infective endocarditis: diagnostic yield and prognostic implicationsP725Metastatic cardiac18F-FDG uptake in patients with malignancy: comparison with echocardiographic findingsDiseases of the aortaP726Echocardiographic measurements of aortic pulse wave velocity correlate well with invasive methodP727Assessment of increase in aortic and carotid intimal medial thickness in adolescent type 1 diabetic patientsStress echocardiographyP728Determinants and prognostic significance of heart rate variability in renal transplant candidates undergoing dobutamine stress echocardiographyP729Pattern of cardiac output vs O2 uptake ratio during maximal exercise in heart failure with reduced ejection fraction: pathophysiological insightsP730Prognostic value and predictive factors of cardiac events in patients with normal exercise echocardiographyP731Right ventricular mechanics during exercise echocardiography: normal values, feasibility and reproducibility of conventional and new right ventricular function parametersP732The added value of exercise-echo in heart failure patients: assessing dynamic changes in extravascular lung waterP733Applicability of appropriate use criteria of exercise stress echocardiography in real-life practice: what have we improved with new documents?Transesophageal echocardiographyP7343D-TEE guidance in percutaneous mitral valve interventions correcting mitral regurgitationContrast echocardiographyP735Pulmonary transit time by contrast enhanced ultrasound as parameter for cardiac performance: a comparison with magnetic resonance imaging and NT-ProBNPReal-time three-dimensional TEEP736Optimal parameter selection for anisotropic diffusion denoising filters applied to aortic valve 4d echocardiographsP737Left ventricle systolic function in non-alcoholic cirrhotic candidates for liver transplantation: a three-dimensional speckle-tracking echocardiography studyTissue Doppler and speckle trackingP738Optimizing speckle tracking echocardiography strain measurements in infants: an in-vitro phantom studyP739Usefulness of vascular mechanics in aortic degenerative valve disease to estimate prognosis: a two dimensional speckle tracking studyP740Vascular mechanics in aortic degenerative valve disease: a two dimensional speckle-tracking echocardiography studyP741Statins and vascular load in aortic valve disease patients, a speckle tracking echocardiography studyP742Is Left Bundle Branch Block only an electrocardiographic abnormality? Study of LV function by 2D speckle tracking in patients with normal ejection fractionP743Dominant inheritance of global longitudinal strain in a population of healthy and hypertensive twinsP744Mechanical differences of left atria in paroxysmal atrial fibrillation: A speckle-tracking study.P745Different distribution of myocardial deformation between hypertrophic cardiomyopathy and aortic stenosisP746Left atrial mechanics in patients with chronic renal failure. Incremental value for atrial fibrillation predictionP747Subclinical myocardial dysfunction in cancer patients: is there a direct effect of tumour growth?P748The abnormal global longitudinal strain predicts significant circumflex artery disease in low risk acute coronary syndromeP7493D-Speckle tracking echocardiography for assessing ventricular funcion and infarct size in young patients after acute coronary syndromeP750Evaluation of left ventricular dyssynchrony by echocardiograhy in patients with type 2 diabetes mellitus without clinically evident cardiac diseaseP751Differences in myocardial function between peritoneal dialysis and hemodialysis patients: insights from speckle tracking echoP752Appraisal of left atrium changes in hypertensive heart disease: insights from a speckle tracking studyP753Left ventricular rotational behavior in hypertensive patients: Two dimensional speckle tracking imaging studyComputed Tomography & Nuclear CardiologyP754Effectiveness of adaptive statistical iterative reconstruction of 64-slice dual-energy ct pulmonary angiography in the patients with reduced iodine load: comparison with standard ct pulmonary angiograP755Clinical prediction model to inconclusive result assessed by coronary computed tomography angiography. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Ternacle J, Kanellopoulos G, Monin JL, Antoine C, Couetil JP, Dubois-Randé JL, Gueret P, Lim P. 26 Structural myocardial dysfunction in bicuspid aortic valve disease? A speckle tracking study. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)30264-0] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kanellopoulos G, Monin JL, Ternacle J, Dubois-Randé JL, Lim P. 0347: Structural myocardial dysfunction in bicuspid aortic valve disease - a speckle tracking study. Archives of Cardiovascular Diseases Supplements 2015. [DOI: 10.1016/s1878-6480(15)71608-3] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Ternacle J, Berry M, Cognet T, Kloeckner M, Damy T, Monin JL, Couetil JP, Dubois-Rande JL, Gueret P, Lim P. Prognostic Value of Right Ventricular Two-Dimensional Global Strain in Patients Referred for Cardiac Surgery. J Am Soc Echocardiogr 2013; 26:721-6. [DOI: 10.1016/j.echo.2013.03.021] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Indexed: 11/17/2022]
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18
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Meguro K, Lellouche N, Yamamoto M, Fougeres E, Monin JL, Lim P, Mouillet G, Dubois-Rande JL, Teiger E. Prognostic value of QRS duration after transcatheter aortic valve implantation for aortic stenosis using the CoreValve. Am J Cardiol 2013; 111:1778-83. [PMID: 23528030 DOI: 10.1016/j.amjcard.2013.02.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [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: 09/10/2012] [Revised: 02/17/2013] [Accepted: 02/17/2013] [Indexed: 01/10/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is effective in treating severe aortic stenosis in high-risk surgical patients. We evaluated the value of the QRS duration (QRSd) in predicting the mid-term morbidity and mortality after TAVI. We conducted a prospective cohort study of 91 consecutive patients who underwent TAVI using the CoreValve at our teaching hospital cardiology unit in 2008 to 2010 who survived to hospital discharge; 57% were women, and their mean age was 84 ± 7 years. The QRSd at discharge was used to classify the patients into 3 groups: QRSd ≤120 ms, n = 18 (20%); QRSd >120 ms but ≤150 ms, n = 30 (33%); and QRSd >150 ms, n = 43 (47%). We used 2 end points: (1) all-cause mortality and (2) all-cause mortality or admission for heart failure. After a median of 12 months, the normal-QRSd patients showed a trend toward, or had, significantly better overall survival and survival free of admission for heart failure compared with the intermediate-QRSd group (p = 0.084 and p = 0.002, respectively) and the long-QRSd group (p = 0.015 and p = 0.001, respectively). The factors significantly associated with all-cause mortality were the Society of Thoracic Surgeons score, aortic valve area, post-TAVI dilation, acute kidney injury, hospital days after TAVI, and QRSd at discharge. On multivariate analysis, QRSd was the strongest independent predictor of all-cause mortality (hazard ratio 1.036, 95% confidence interval 1.016 to 1.056; p <0.001) and all-cause mortality or heart failure admission (hazard ratio 1.025, 95% confidence interval 1.011 to 1.039; p <0.001). The other independent predictors were the Society of Thoracic Surgeons score, acute kidney injury, and post-TAVI hospital days. In conclusion, a longer QRSd after TAVI was associated with greater morbidity and mortality after 12 months. The QRSd at discharge independently predicted mortality and morbidity after TAVI.
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Affiliation(s)
- Kentaro Meguro
- Interventional Cardiology Unit, Henri Mondor University Hospital, Val-de-Marne University, Creteil, France.
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Gallet R, Seemann A, Yamamoto M, Hayat D, Mouillet G, Monin JL, Gueret P, Couetil JP, Dubois-Randé JL, Teiger E, Lim P. Effect of transcatheter (via femoral artery) aortic valve implantation on the platelet count and its consequences. Am J Cardiol 2013; 111:1619-24. [PMID: 23523059 DOI: 10.1016/j.amjcard.2013.01.332] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/22/2013] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
Abstract
Decrease in blood platelet count has been described after percutaneous coronary intervention and surgical valve replacement, although no study has been performed in the setting of transcatheter aortic valve implantation (TAVI). The aim of this study was to address the incidence, mechanism, and impact of blood platelet count decrease after TAVI. One hundred forty-four consecutive patients (mean age 84 ± 7 years, 64 men) with severe symptomatic aortic stenosis who underwent TAVI from December 2007 to July 2011 were enrolled. Blood platelet count was recorded before and after aortic valve implantation. Decrease in blood platelet count was compared with in-hospital major adverse cardiovascular events (death, stroke, and major or life-threatening bleeding). Blood platelet count decreases occurred in all but 1 patient. The percentage of platelet count decrease averaged 34 ± 15% and was 24% greater than blood protein decrease. Decrease in platelet count was associated with a higher rate of prosthesis migration, longer x-ray and procedural times, and larger contrast amounts (230 ± 128 ml for the third tertile vs 170 ± 77 ml for the second and first tertiles, p = 0.0006), but no association was observed with regard to changes in bilirubin. In-hospital major adverse cardiovascular events (n = 50 [35%]) were observed more frequently in patients with severe platelet count decreases (21% for the first tertile, 35% for the second tertile, and 48% for the third tertile, p = 0.02). Finally, the percentage of blood platelet count decrease was the only predictor of in-hospital major adverse cardiovascular events (odds ratio 1.67, 95% confidence interval 1.05 to 2.67, p = 0.03). In conclusion, a decrease in platelet count is a common phenomenon after TAVI, and its severity is associated with poor outcomes.
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Ternacle J, Berry M, Alonso E, Couetil JP, Dubois Randé JL, Gueret P, Monin JL, Lim P. 100: Incremental Value of Global Longitudinal Strain for Predicting Outcome after Cardiac Surgery. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71030-9] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Yamamoto M, Meguro K, Mouillet G, Bergoend E, Monin JL, Lim P, Dubois-Rande JL, Teiger E. Effect of local anesthetic management with conscious sedation in patients undergoing transcatheter aortic valve implantation. Am J Cardiol 2013; 111:94-9. [PMID: 23068861 DOI: 10.1016/j.amjcard.2012.08.053] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [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: 06/18/2012] [Revised: 08/20/2012] [Accepted: 08/20/2012] [Indexed: 11/18/2022]
Abstract
The present study sought to assess the effectiveness of local anesthesia with conscious sedation (LACS) during transcatheter aortic valve implantation (TAVI). On its introduction, TAVI was mostly performed with the patient under general anesthesia (GA); however, evidence supporting the use of less-invasive LACS has been increasing. The data from 174 consecutive patients who underwent TAVI by way of the femoral artery from December 2007 to December 2011 were analyzed. GA was mainly used in early phase of the study (n = 44); this was gradually shifted to LACS in the late phase (n = 130). The clinical outcomes were compared for those patients who received GA versus LACS. The incidence and causes of "LACS failure," defined as conversion to GA from LACS during TAVI, were also assessed. The rates of procedural success and 30-day mortality were not different between the 2 groups (93.3% vs 95.3%, p = 0.60; 6.7% vs 7.8%, p = 0.55, respectively). Although the clinical backgrounds of the patients showed differences, these results were not significant after adjusting for other influential confounders. The intensive care unit stay and hospital stay were longer in the GA group than in the LACS group (3.9 ± 2.2 vs 3.3 ± 1.5 days, p = 0.044; and 12.2 ± 8.3 vs 8.1 ± 6.5 days, p = 0.001, respectively). LACS failure occurred in 6 patients (4.6%), and the causes were multifactorial, as follows: cardiac tamponade in 2, cardiac arrest in 2, myocardial infarction in 1, and stroke in 1. In conclusion, transfemoral TAVI with the patient under LACS could be successfully performed in most patients, with the advantage of early recovery, although the perioperative risks involved in the TAVI procedure should be considered.
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Affiliation(s)
- Masanori Yamamoto
- Department of Interventional Cardiology, AP-HP Henri Mondor University Hospital, Creteil, France.
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Ternacle J, Berry M, Jurzak P, Alonso E, Couetil JP, Dubois Randé JL, Gueret P, Monin JL, Lim P. 113: Prognostic value of right ventricular two-dimensional global strain after cardiac surgery. Archives of Cardiovascular Diseases Supplements 2013. [DOI: 10.1016/s1878-6480(13)71043-7] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mouillet G, Lellouche N, Lim P, Meguro K, Yamamoto M, Deux JF, Monin JL, Bergoënd E, Dubois-Randé JL, Teiger E. Patients without prolonged QRS after TAVI with CoreValve device do not experience high-degree atrio-ventricular block. Catheter Cardiovasc Interv 2012; 81:882-7. [DOI: 10.1002/ccd.24657] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [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: 05/29/2012] [Accepted: 09/09/2012] [Indexed: 11/12/2022]
Affiliation(s)
- Gauthier Mouillet
- Department of Cardiology; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U 955; 51 Avenue du Maréchal de Lattre de Tassigny; Creteil; France
| | - Nicolas Lellouche
- Department of Cardiology; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U 955; 51 Avenue du Maréchal de Lattre de Tassigny; Creteil; France
| | - Pascal Lim
- Department of Cardiology; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U 955; 51 Avenue du Maréchal de Lattre de Tassigny; Creteil; France
| | - Kentaro Meguro
- Department of Cardiology; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U 955; 51 Avenue du Maréchal de Lattre de Tassigny; Creteil; France
| | - Masanori Yamamoto
- Department of Cardiology; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U 955; 51 Avenue du Maréchal de Lattre de Tassigny; Creteil; France
| | - Jean-François Deux
- Department of Cardiovascular Imaging; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U 955; 51 Avenue du Maréchal de Lattre de Tassigny; Creteil; France
| | - Jean-Luc Monin
- Department of Cardiology; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U 955; 51 Avenue du Maréchal de Lattre de Tassigny; Creteil; France
| | - Eric Bergoënd
- Cardiac Surgery Unit; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris; 51 Avenue du Maréchal de Lattre de Tassigny; Creteil; France
| | - Jean-Luc Dubois-Randé
- Department of Cardiology; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U 955; 51 Avenue du Maréchal de Lattre de Tassigny; Creteil; France
| | - Emmanuel Teiger
- Department of Cardiology; Hôpital Henri Mondor; Assistance Publique Hôpitaux de Paris and INSERM U 955; 51 Avenue du Maréchal de Lattre de Tassigny; Creteil; France
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Yamamoto M, Meguro K, Mouillet G, Bergoend E, Monin JL, Lim P, Dubois-Rande JL, Teiger E. Comparison of effectiveness and safety of transcatheter aortic valve implantation in patients aged ≥90 years versus <90 years. Am J Cardiol 2012; 110:1156-63. [PMID: 23021601 DOI: 10.1016/j.amjcard.2012.05.058] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/24/2012] [Accepted: 05/24/2012] [Indexed: 11/24/2022]
Abstract
In a fraction of patients aged ≥90 years, less-invasive transcatheter aortic valve implantation (TAVI) has been considered a therapeutic option for aortic stenosis under careful clinical screening. However, the safety and effectiveness using TAVI in such a population has not been fully elucidated. The aim of the present study was to investigate the feasibility of TAVI in nonagenarians. We prospectively enrolled 136 consecutive patients with severe aortic stenosis who were referred for TAVI. The procedural, early, and midterm clinical outcomes were compared between patients aged <90 years (n = 110, average age 82.3 ± 8.3 years) and ≥90 years (n = 26; average age 91.6 ± 1.9 years). A comparison of the baseline characteristics revealed that among patients aged ≥90 years, the prevalence of women (50% vs 81%, p <0.001) and the mean aortic valve gradient (45.5 ± 15.4 vs 56.3 ± 23.4 mm Hg, p = 0.005) were greater than those in patients aged <90 years. Major vascular complications occurred more frequently in patients ≥90 years (5% vs 19%, p = 0.022), although the rate of procedural success and 30-day and 6-month mortality were not different between the 2 age groups (96% vs 100%, p = 0.58; 6% vs 15%, p = 0.22; and 14% vs 27%, p = 0.14, respectively). The mortality rates were greater among patients aged ≥90 years. At 6 months, both groups of survivors were similar in symptom status, with a New York Heart Association classification less than class II (89% vs 84%, p = 0.68). The cumulative survival (median 13.4 ± 8.0 months of follow-up) was not significantly different between the 2 age groups (p = 0.22, log-rank test). In conclusion, even very elderly nonagenarians can experience acceptable clinical results and benefits after TAVI.
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Ternacle J, Berry M, Alonso E, Kloeckner M, Couetil JP, Randé JLD, Gueret P, Monin JL, Lim P. Incremental value of global longitudinal strain for predicting early outcome after cardiac surgery. Eur Heart J Cardiovasc Imaging 2012; 14:77-84. [PMID: 22893712 DOI: 10.1093/ehjci/jes156] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Global longitudinal strain (GLS) seems accurate for detecting subclinical myocardial dysfunction, and may therefore be used to improve risk stratification for cardiac surgery. METHODS AND RESULTS Longitudinal strain (by two-dimensional speckle tracking) was computed in 425 patients [mean age 67 ± 13 years, 69% male, left ventricular ejection fraction (LVEF) 51 ± 13%] referred for cardiac surgery [isolated coronary artery bypass graft (CABG) (n = 155), aortic valve surgery (n = 174), mitral surgery (n = 96)]. GLS (global-ε) was assessed for predicting early postoperative death. Despite a fair correlation between LVEF and global strain (r = -0.73, P < 0.0001), 40% of patients with preserved LVEF (defined as LVEF ≥50%) had abnormal global-ε (defined as global-ε >-16%): -12.8 ± 1.7%, range -15% to -8%. In patients with preserved LVEF, NT-proBNP level (983 vs. 541 pg/mL, P = 0.03), heart failure symptoms (NYHA class, 2.2 ± 0.9 vs. 1.9 ± 0.9, P = 0.02), and the need for prolonged (>48 h) inotropic support after surgery (33.3 vs. 21.2%, P = 0.03) were greater when global-ε was impaired. Importantly, despite similar EuroSCORE (9.7 ± 12 vs. 7.7 ± 9%, P = 0.2 for EuroSCORE I and 4.2 ± 6.2 vs. 3.4 ± 4.9%, P = 0.4 for EuroSCORE II), the rate of postoperative death was 2.4-fold (11.8 vs. 4.9%, P = 0.04) in patients with preserved LVEF when global-ε was impaired. Multivariate analysis showed that global-ε is an independent predictor for early postoperative mortality [odds ratio = 1.10 (1.01-1.21)] after adjustment to EuroSCORE. CONCLUSION GLS has an incremental value over LVEF for risk stratification in patients referred for cardiac surgery.
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Affiliation(s)
- Julien Ternacle
- APHP, Cardiovascular Department and INSERM U955 Team 3, Henri Mondor University Hospital, 51 Av de Lattre de Tassigny, 94100 Creteil, France
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Guendouz S, Rappeneau S, Nahum J, Dubois-Randé JL, Gueret P, Monin JL, Lim P, Adnot S, Hittinger L, Damy T. Prognostic Significance and Normal Values of 2D Strain to Assess Right Ventricular Systolic Function in Chronic Heart Failure. Circ J 2012; 76:127-36. [DOI: 10.1253/circj.cj-11-0778] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [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: 11/09/2022]
Affiliation(s)
- Soulef Guendouz
- Federation de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier
| | | | - Julien Nahum
- Federation de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier
| | - Jean-Luc Dubois-Randé
- Federation de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier
- INSERM, Unité U955
- Faculté de Médecine and Université Paris-Est Val de Marne
| | - Pascal Gueret
- Federation de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier
- Faculté de Médecine and Université Paris-Est Val de Marne
| | - Jean-Luc Monin
- Federation de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier
| | - Pascal Lim
- Federation de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier
| | - Serge Adnot
- Service de Physiologie-Explorations Fonctionnelles, AP-HP, Groupe Henri-Mondor Albert-Chenevier
- INSERM, Unité U955
- Faculté de Médecine and Université Paris-Est Val de Marne
| | - Luc Hittinger
- Federation de Cardiologie, AP-HP, Groupe Henri-Mondor Albert-Chenevier
- INSERM, Unité U955
- Faculté de Médecine and Université Paris-Est Val de Marne
| | - Thibaud Damy
- INSERM, Unité U955
- Faculté de Médecine and Université Paris-Est Val de Marne
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Berry M, Nahum J, Zaghden O, Monin JL, Couetil JP, Macron L, Lairez O, Dubois-Randé JL, Gueret P, Lim P. 143 Logistic EuroSCORE by longitudinal global strain in predicting outcome after cardiac surgery. Archives of Cardiovascular Diseases Supplements 2012. [DOI: 10.1016/s1878-6480(12)70539-6] [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] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Bensaid A, Gallet R, Fougeres E, Lim P, Nahum J, Macron L, Troussier X, Deux JF, Teiger E, Guéret P, Dubois-Randé JL, Monin JL. 120 Superiority of CT scan over transthoracic echocardiography in predicting aortic regurgitation after TAVI. Archives of Cardiovascular Diseases Supplements 2011. [DOI: 10.1016/s1878-6480(11)70122-7] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lancellotti P, Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C, Hagendorff A, Monin JL, Badano L, Zamorano JL. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 2: mitral and tricuspid regurgitation (native valve disease). Eur J Echocardiogr 2010; 11:307-32. [PMID: 20435783 DOI: 10.1093/ejechocard/jeq031] [Citation(s) in RCA: 928] [Impact Index Per Article: 66.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Mitral and tricuspid are increasingly prevalent. Doppler echocardiography not only detects the presence of regurgitation but also permits to understand mechanisms of regurgitation, quantification of its severity and repercussions. The present document aims to provide standards for the assessment of mitral and tricuspid regurgitation.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, Valvular Disease Clinic, University Hospital, Université de Liège, CHU du Sart Tilman, 4000 Liège, Belgium.
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Nahum J, Bensaid A, Dussault C, Macron L, Clémence D, Bouhemad B, Monin JL, Rande JLD, Gueret P, Lim P. Impact of Longitudinal Myocardial Deformation on the Prognosis of Chronic Heart Failure Patients. Circ Cardiovasc Imaging 2010; 3:249-56. [DOI: 10.1161/circimaging.109.910893] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [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: 11/16/2022]
Affiliation(s)
- Julien Nahum
- From the APHP, Henri Mondor University Hospital, Cardiovascular Department and INSERM U841, Creteil, France
| | - Alexandre Bensaid
- From the APHP, Henri Mondor University Hospital, Cardiovascular Department and INSERM U841, Creteil, France
| | - Caroline Dussault
- From the APHP, Henri Mondor University Hospital, Cardiovascular Department and INSERM U841, Creteil, France
| | - Laurent Macron
- From the APHP, Henri Mondor University Hospital, Cardiovascular Department and INSERM U841, Creteil, France
| | - Darrort Clémence
- From the APHP, Henri Mondor University Hospital, Cardiovascular Department and INSERM U841, Creteil, France
| | - Belaid Bouhemad
- From the APHP, Henri Mondor University Hospital, Cardiovascular Department and INSERM U841, Creteil, France
| | - Jean-Luc Monin
- From the APHP, Henri Mondor University Hospital, Cardiovascular Department and INSERM U841, Creteil, France
| | - Jean-Luc Dubois Rande
- From the APHP, Henri Mondor University Hospital, Cardiovascular Department and INSERM U841, Creteil, France
| | - Pascal Gueret
- From the APHP, Henri Mondor University Hospital, Cardiovascular Department and INSERM U841, Creteil, France
| | - Pascal Lim
- From the APHP, Henri Mondor University Hospital, Cardiovascular Department and INSERM U841, Creteil, France
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Lancellotti P, Tribouilloy C, Hagendorff A, Moura L, Popescu BA, Agricola E, Monin JL, Pierard LA, Badano L, Zamorano JL. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: aortic and pulmonary regurgitation (native valve disease). European Journal of Echocardiography 2010; 11:223-44. [PMID: 20375260 DOI: 10.1093/ejechocard/jeq030] [Citation(s) in RCA: 360] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, Valvular Disease Clinic, University Hospital, Université de Liège, CHU du Sart Tilman, 4000 Liège, Belgium.
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Monin JL, Monchi M, Lancellotti P, Lim P, Weiss E, Piérard L, Guéret P. 166 A risk score for predicting outcome in asymptomatic aortic stenosis. Archives of Cardiovascular Diseases Supplements 2010. [DOI: 10.1016/s1878-6480(10)70168-3] [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] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Background—
The management of patients with asymptomatic severe aortic stenosis remains controversial. We sought to develop a continuous risk score for predicting the midterm development of symptoms or adverse events in this setting.
Methods and Results—
We prospectively followed 107 patients with asymptomatic aortic stenosis (aged 72 years [63 to 77]; 35 women; aortic-jet velocity, 4.1 m/s [3.5 to 4.4]) at a single center in France. Predefined end points for assessing outcome were the occurrence within 24 months of death or aortic valve replacement necessitated by symptoms or by a positive exercise test. Variables independently associated with outcome were used to build a score that was validated in an independent cohort of 107 patients from Belgium. Independent predictors of outcome were female sex, peak aortic-jet velocity, and B-type natriuretic peptide at baseline. Accordingly, the score could be calculated as follows: Score=[peak velocity (m/s)×2]+(natural logarithm of B-type natriuretic peptide×1.5)+1.5 (if female sex). Event-free survival after 20 months was 80% for patients within the first score quartile compared with only 7% for the fourth quartile. Areas under the receiver operating characteristic curve for the score were 0.90 and 0.89 in the development and validation cohorts, respectively.
Conclusions—
If further validation is achieved, this score may be useful to predict outcome in individual patients with asymptomatic aortic stenosis to select those who might benefit from early surgery.
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Affiliation(s)
- Jean-Luc Monin
- From Assistance Publique-Hôpitaux de Paris, Department of Cardiology, Henri Mondor University Hospital, Créteil, France (J.-L.M., P.L., E.W., P.G.); Department of Intensive Care Medicine, Institut Jacques Cartier, Massy, France (M.M.); and Sart Tilman University Hospital, Liège, Belgium, (P.L., L.P.)
| | - Patrizio Lancellotti
- From Assistance Publique-Hôpitaux de Paris, Department of Cardiology, Henri Mondor University Hospital, Créteil, France (J.-L.M., P.L., E.W., P.G.); Department of Intensive Care Medicine, Institut Jacques Cartier, Massy, France (M.M.); and Sart Tilman University Hospital, Liège, Belgium, (P.L., L.P.)
| | - Mehran Monchi
- From Assistance Publique-Hôpitaux de Paris, Department of Cardiology, Henri Mondor University Hospital, Créteil, France (J.-L.M., P.L., E.W., P.G.); Department of Intensive Care Medicine, Institut Jacques Cartier, Massy, France (M.M.); and Sart Tilman University Hospital, Liège, Belgium, (P.L., L.P.)
| | - Pascal Lim
- From Assistance Publique-Hôpitaux de Paris, Department of Cardiology, Henri Mondor University Hospital, Créteil, France (J.-L.M., P.L., E.W., P.G.); Department of Intensive Care Medicine, Institut Jacques Cartier, Massy, France (M.M.); and Sart Tilman University Hospital, Liège, Belgium, (P.L., L.P.)
| | - Emmanuel Weiss
- From Assistance Publique-Hôpitaux de Paris, Department of Cardiology, Henri Mondor University Hospital, Créteil, France (J.-L.M., P.L., E.W., P.G.); Department of Intensive Care Medicine, Institut Jacques Cartier, Massy, France (M.M.); and Sart Tilman University Hospital, Liège, Belgium, (P.L., L.P.)
| | - Luc Piérard
- From Assistance Publique-Hôpitaux de Paris, Department of Cardiology, Henri Mondor University Hospital, Créteil, France (J.-L.M., P.L., E.W., P.G.); Department of Intensive Care Medicine, Institut Jacques Cartier, Massy, France (M.M.); and Sart Tilman University Hospital, Liège, Belgium, (P.L., L.P.)
| | - Pascal Guéret
- From Assistance Publique-Hôpitaux de Paris, Department of Cardiology, Henri Mondor University Hospital, Créteil, France (J.-L.M., P.L., E.W., P.G.); Department of Intensive Care Medicine, Institut Jacques Cartier, Massy, France (M.M.); and Sart Tilman University Hospital, Liège, Belgium, (P.L., L.P.)
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36
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Tribouilloy C, Lévy F, Rusinaru D, Guéret P, Petit-Eisenmann H, Baleynaud S, Jobic Y, Adams C, Lelong B, Pasquet A, Chauvel C, Metz D, Quéré JP, Monin JL. Outcome after aortic valve replacement for low-flow/low-gradient aortic stenosis without contractile reserve on dobutamine stress echocardiography. J Am Coll Cardiol 2009; 53:1865-73. [PMID: 19442886 DOI: 10.1016/j.jacc.2009.02.026] [Citation(s) in RCA: 251] [Impact Index Per Article: 16.7] [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: 11/18/2008] [Revised: 02/23/2009] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES This study investigated whether aortic valve replacement (AVR) is associated with improved survival in patients with severe low-flow/low-gradient aortic stenosis (LF/LGAS) without contractile reserve (CR) on dobutamine stress echocardiography (DSE). BACKGROUND Patients with LF/LGAS without CR have a high mortality rate with conservative therapy. The benefit of AVR in this subset of patients remains controversial. METHODS Eighty-one consecutive patients with symptomatic calcified LF/LGAS (valve area <or=1 cm(2), left ventricular ejection fraction <or=40%, mean pressure gradient [MPG] <or=40 mm Hg) without CR on DSE were enrolled. Absence of CR was defined as the absence of increase in stroke volume of >or=20% compared with the baseline value. Multivariable analysis and propensity scores were used to compare survival according to whether or not AVR was performed (n = 55). RESULTS Five-year survival was higher in AVR patients compared with medically managed patients (54 +/- 7% vs. 13 +/- 7%, p = 0.001) despite a high operative mortality of 22% (n = 12). An AVR was independently associated with lower 5-year mortality (adjusted hazard ratio from 0.16 to 5.21 varying with time [95% confidence interval: 0.12-3.16 to 0.21-8.50], p = 0.00026). In 42 propensity-matched patients, 5-year survival was markedly improved by AVR (65 +/- 11% vs. 11 +/- 7%, p = 0.019). Associated bypass surgery (p = 0.007) and MPG <or=20 mm Hg (p = 0.035) were independently predictive of operative mortality. Late survival after AVR (excluding operative death) was 69 +/- 8% at 5 years. CONCLUSIONS In patients with LF/LGAS without CR on DSE, AVR is associated with better outcome compared with medical management. Surgery should not be withheld from this subset of patients solely on the basis of lack of CR on DSE.
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Affiliation(s)
- Christophe Tribouilloy
- Department of Cardiology, INSERM, ERI-12, Amiens and University Hospital Amiens, Amiens, France.
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37
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Monin JL, Monchi M, Kirsch MEW, Petit-Eisenmann H, Baleynaud S, Chauvel C, Metz D, Adams C, Quere JP, Gueret P, Tribouilloy C. Low-gradient aortic stenosis: impact of prosthesis-patient mismatch on survival. Eur Heart J 2007; 28:2620-6. [PMID: 17901082 DOI: 10.1093/eurheartj/ehm393] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [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] [Indexed: 11/14/2022] Open
Abstract
AIMS To assess the prognostic impact of prosthesis-patient mismatch (PPM) in a large consecutive series of patients operated for low-gradient aortic stenosis (AS). METHODS AND RESULTS Outcomes after surgery for low-gradient AS were prospectively assessed in 152 consecutive patients from seven institutions. There were 113 men (74%); mean age was 72 years (64-76); valve area, 0.7 cm(2) (0.6-0.8); left ventricular (LV) ejection fraction 0.31 (0.25-0.37) and baseline mean transaortic pressure gradient (MPG), 30 mmHg (25-35) Among 139 patients with available prosthetic valve effective orifice area (EOA), PPM (defined by an indexed EOA < or = 0.85 cm(2)/m(2)) was present in 79 patients (57%) and had no significant impact on post-operative mortality. Independent predictors of overall mortality were LV contractile reserve [hazard ratio (HR) 0.52; 95% confidence interval (CI) 0.35-0.78; P = 0.002], associated coronary artery bypass grafting (HR 1.87; 95% CI 1.24-2.82; P =0.003), baseline MPG (per 1 mmHg decrease to 10 mmHg; HR 1.03; 95% CI 1.01-1.06; P = 0.021), previous cancer (HR 2.13; 95% CI 1.05-4.29; P = 0.037), and logistic EuroSCORE (per 1% increase; HR 1.02; 95% CI 1.01-1.04; P = 0.040). CONCLUSION In this large multicentre series of patients with low-gradient AS, we found that PPM (moderate in most cases) had no influence on post-operative mortality. Therefore, the performance of more complex interventions in order to avoid moderate PPM may not be justified in the setting of low-gradient AS, because their higher risk probably outweighs the expected benefit.
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Affiliation(s)
- Jean-Luc Monin
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Henri Mondor Hospital, 51 avenue De Lattre de Tassigny, 94010 Créteil, France.
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38
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Lancellotti P, Donal E, Cosyns B, Van Camp G, Monin JL, Brochet E, Berrebi A, Pibarot P, Chauvel C, Hassager C, Tumminello G, Tribouilloy C, Lafitte S, Fraser AG, Derumeaux G, Athanassopoulos G, Bax J, Piérard LA. Effects of surgery on ischaemic mitral regurgitation: A prospective multicenter registry (SIMRAM registry). European Journal of Echocardiography 2007; 9:26-30. [PMID: 17336589 DOI: 10.1016/j.euje.2006.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIMS Functional ischaemic mitral regurgitation (IMR) is common in patients with ischaemic left ventricular dysfunction undergoing coronary artery bypass surgery. Although the presence of IMR negatively affects prognosis, the additional benefit of valve repair is debated, particularly with mild IMR at rest. Exercise echocardiography may help identify a subset of patients at higher risk of cardiovascular events by revealing the dynamic component of IMR. METHODS A large prospective, multicentre, non-randomized registry is designed to evaluate the effects of surgery on IMR at rest and on its dynamic component at exercise (z). SIMRAM will enrol approximately 550 patients with IMR in up to 17 centres with clinical and exercise follow-up for 1 year. Three sets of outcomes will be prospectively assessed and several hypotheses will be tested including determinants of adverse outcome and progressive left ventricular remodeling, efficacy of treatment and role of ischaemia on the dynamic consequences of IMR. Enrolment began in November 2006 and is expected to end by early 2008.
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Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, University Hospital, CHU Sart Tilman, B-4000 Liège, Belgium.
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39
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Badoual T, Monin JL. [Aortic stenosis]. Rev Prat 2006; 56:2173-8. [PMID: 17416057] [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] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
- Thierry Badoual
- Pôle cardiovasculaire, groupe hospitalier Chenevier-Mondor, 94010 Créteil.
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40
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Quere JP, Monin JL, Levy F, Petit H, Baleynaud S, Chauvel C, Pop C, Ohlmann P, Lelguen C, Dehant P, Gueret P, Tribouilloy C. Influence of Preoperative Left Ventricular Contractile Reserve on Postoperative Ejection Fraction in Low-Gradient Aortic Stenosis. Circulation 2006; 113:1738-44. [PMID: 16585393 DOI: 10.1161/circulationaha.105.568824] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.6] [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] [Indexed: 11/16/2022]
Abstract
Background—
Dobutamine stress hemodynamics (DSH) has the potential to stratify operative risk in low-gradient aortic stenosis (AS), but little is known about the relation between left ventricle contractile reserve and postoperative left ventricular ejection fraction (LVEF). We sought to assess the value of DSH to predict postoperative improvement in LVEF.
Methods and Results—
Sixty-six consecutive patients with symptomatic severe AS (aortic valve area ≤1 cm
2
), LVEF ≤40%, and mean pressure gradient ≤40 mm Hg prospectively enrolled in the French multicenter study on low-gradient AS and who survived to aortic valvular replacement (AVR) were included. Preoperative contractile reserve was present in 46 patients (group I; 70%) and absent in 20 patients (group II; 30%). In the overall sample, 58% of patients improved by 2 New York Heart Association (NYHA) classes after AVR. Mean LVEF improved from 29±6% to 47±11% (
P
<0.0001). LVEF improved by ≥10 EF units in 38 patients (83%) in group I and in 13 patients (65%) in group II. Mean LVEF improvement was similar in the 2 groups (19±10% versus 17±11%;
P
=0.54). On multivariable analysis, multivessel coronary artery disease (
P
=0.05) and baseline mean transaortic pressure gradient (
P
=0.01) were related to LVEF improvement, whereas contractile reserve was not.
Conclusions—
LVEF increases in the majority of patients with low-gradient AS who survive after AVR. Although the absence of contractile reserve on DSH is related to high operative mortality, it does not predict the absence of LVEF recovery in patients surviving to AVR. These data further support the concept that surgery should not be contraindicated on the basis of absence of contractile reserve alone.
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Affiliation(s)
- Jean-Paul Quere
- Department of Cardiology, INSERM, ERI-12, University Hospital, Amiens, France
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41
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Delclaux C, Zerah-Lancner F, Bachir D, Habibi A, Monin JL, Godeau B, Galacteros F. Factors associated with dyspnea in adult patients with sickle cell disease. Chest 2005; 128:3336-44. [PMID: 16304281 DOI: 10.1378/chest.128.5.3336] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE The aim of this prospective study was to determine the cardiorespiratory factors associated with dyspnea in patients with sickle cell SS-hemoglobin disease, with a specific interest in lung vascular involvement. MEASUREMENTS Forty-nine patients (29 women and 20 men; mean [+/- SD] age: women, 29 +/- 6 years; men, 31 +/- 11 years) underwent direct evaluations (Borg scale evaluation during a 6-min walk test) and indirect evaluations (modified Medical Research Council [MRC]score) of their dyspnea, pulmonary function tests (PFTs) [spirometry, volumes, diffusing capacity of the lung for carbon monoxide (Dlco), diffusing capacity of the alveolar-capillary membrane, and pulmonary capillary blood volume measurements], echocardiography, and biological evaluation. RESULTS Thirty-four patients complained of significant breathlessness (MRC score, > 1). Indirect and direct evaluations of dyspnea were correlated. PFT results depicted a very mild restrictive pattern (mean total pulmonary capacity, 86 +/- 11% predicted) and an impairment of Dlco (mean Dlco corrected for the degree of anemia, 69 +/- 13% predicted). The statistical analysis demonstrated that dyspnea and exercise performance were closely linked to indexes of Dlco but not with any echocardiographic or biological measure including anemia. Nevertheless, only approximately 25% of the variability was explained by these associations. Despite having a similar history of vasoocclusive crisis events, women had more severe anemia, dyspnea, decreases in Dlco (corrected for the degree of anemia), and a higher capillary blood volume (corrected for alveolar volume) than men. CONCLUSION Lung vascular disease contributes to dyspnea and the exercise limitation of patients with sickle cell disease. A sequential assessment of Dlco would therefore constitute one of the objective functional end points for follow-up studies of these patients.
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Affiliation(s)
- Christophe Delclaux
- Service de Physiologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
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42
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Guéret P, Lim P, Abitbol E, Monin JL. [Echocardiography and mechanical complications of recent myocardial infarction]. Arch Mal Coeur Vaiss 2005; 98:1101-10. [PMID: 16379106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The constantly advancing technology of echocardiography and its widespread usage in the intensive care unit has made it a routine examination in patients with acute myocardial infarction. It has become the reference method for diagnosis and monitoring of certain complications such as pericardial effusion, intra-ventricular thrombosis, ventricular aneurysm and mitral regurgitation. The echocardiographic description of these complications dates back to the 1980s during which prospective studies accurately described the principal abnormalities. These descriptions have not been much improved upon with the advent of new technology. On the other hand, the frequency of these complications assessed in an era when reperfusion by thrombolysis or primary angioplasty was much less common than today, has considerably decreased.
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Affiliation(s)
- P Guéret
- Fédération de cardiologie, hôpital Henri Mondor, Tassigny, Créteil
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43
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Abstract
Patients with aortic stenosis (AS) and left ventricular (LV) systolic dysfunction have a poor short-term prognosis. In this setting, the decrease in transaortic gradients has an independent prognostic value for operative risk and long-term outcome. The 2 main issues for these patients are: (1) The real severity of AS; (2) How to stratify operative risk and evaluate long-term prognosis. Dobutamine Hemodynamics has the potential to address these issues. In case of relative AS, valve area is increased by dobutamine (final valve area > 1.2 cm2 with a mean pressure gradient <30 mmHg); on the basis of published data, medical treatment is justified in this case. Left ventricular contractile reserve is defined an increase in stroke volume, by 20% or more, under dobutamine. Operative risk is between 5 and 11% in case of LV contractile reserve and long-term outcome is improved by surgery in this case. In contrast, operative risk varies from 30 to 60% in case of exhausted reserve; this risk is also determined by other factors such as the presence of coronary artery disease and associated comorbidities. All these parameters are factored into risk-benefit analysis in order to determine the best therapeutic approach for each patient.
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Affiliation(s)
- J L Monin
- Fédération de cardiologie, CHU Henri-Mondor, AP-HP, 51, avenue De-Lattre-de-Tassigny 94010 Créteil, France.
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44
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Monin JL, Dehant P, Roiron C, Monchi M, Tabet JY, Clerc P, Fernandez G, Houel R, Garot J, Chauvel C, Gueret P. Functional Assessment of Mitral Regurgitation by Transthoracic Echocardiography Using Standardized Imaging Planes. J Am Coll Cardiol 2005; 46:302-9. [PMID: 16022959 DOI: 10.1016/j.jacc.2005.03.064] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [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: 02/04/2005] [Revised: 03/12/2005] [Accepted: 03/15/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We sought to assess the value of transthoracic echocardiography (TTE) using standardized imaging planes for the functional analysis of mitral regurgitation (MR) as well as for postoperative outcome implications. BACKGROUND The feasibility of mitral valve repair is based on functional assessment of MR, mainly by transesophageal echocardiography (TEE). Considering the recent advances in TTE imaging, the incremental value of TEE in this setting needs to be re-examined. METHODS Consecutive patients (n = 279; 181 men; median age 68 years [quartiles, 61 to 74]) who underwent surgery for MR were enrolled prospectively in two tertiary care centers. The accuracy of TTE (harmonic imaging) versus TEE for functional assessment of MR was evaluated against surgical findings. RESULTS Valve repair (n = 237 patients, 85%) or replacement (n = 42) was predicted accurately by TTE in 97% of cases; TEE added significant information for only two patients. In the subgroup of degenerative MR (n = 190), agreement with surgical findings for the localization of prolapsed segments was 91% for TTE (kappa, 0.81) and 93% for TEE (kappa, 0.85) without incremental value of TEE (p = 0.40). Patients with single prolapse of the middle posterior scallop (P2) had a better postoperative outcome as compared with patients who had non-P2 lesions (p = 0.008). Furthermore, mitral replacement predicted by TTE was an independent predictor for postoperative long-term mortality (odds ratio 5.7, 95% confidence interval 1.97 to 16.4, p = 0.001). CONCLUSIONS In experienced hands, functional assessment of MR by TTE can predict accurately valve repairability and has a strong influence on postoperative outcome. Thus, in most cases preoperative TEE is not mandatory, provided intraoperative TEE is performed.
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Affiliation(s)
- Jean-Luc Monin
- Department of Cardiology, Henri Mondor Hospital, Créteil, France (Assistance Publique Hôpitaux de Paris).
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45
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Monin JL. [Stress echo and valvular heart disease]. Arch Mal Coeur Vaiss 2005; 98 Spec No 3:15-20. [PMID: 16007827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Stress echo has already been validated in some forms of valvular heart disease, especially in calcific aortic stenosis with low cardiac output and dynamic mitral regurgitation (MR) of valvular heart disease. Stress Doppler haemodynamics is a term used to differentiate these new indications from that of segmental wall analysis of the left atrium in ischaemic heart disease. In calcific aortic stenosis with low output, the haemodynamics with low dose dobutamine allows assessment of the real severity of the aortic stenosis and identification of the rare cases with mild stenosis: the principal indication remains the assessment of operative risk and long-term prognosis by the study of left ventricular contractile reserve. In cases of ischaemic left ventricular systolic dysfunction, the presence of mild mitral regurgitation (regurgitant surface area >20 mm2 at rest) is a poor prognostic factor. The dynamic character of mitral regurgitation is related to left ventricular remodelling which leads to deformation of the valvular apparatus (mitral tenting). Dynamic mitral regurgitation (regurgitant orifice area >13 mm2 on exercise) is a powerful prognostic factor, the role of which has recently been demonstrated in the genesis of acute pulmonary oedema. the other indications of stress haemodynamics are under validation, mainly the assessment of exercise capacity and valvular compliance in mitral stenosis or asymptomatic aortic stenosis.
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Affiliation(s)
- J L Monin
- CHU de Henri Mondor, Cardiologie, Créteil
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46
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Lellouche N, Berthier R, Mekontso-Dessap A, Braconnier F, Monin JL, Duval AM, Dubois-Randé JL, Guéret P, Garot J. Usefulness of plasma B-type natriuretic peptide in predicting recurrence of atrial fibrillation one year after external cardioversion. Am J Cardiol 2005; 95:1380-2. [PMID: 15904651 DOI: 10.1016/j.amjcard.2005.01.090] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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: 11/29/2004] [Revised: 01/27/2005] [Accepted: 01/26/2005] [Indexed: 11/19/2022]
Abstract
After successful external cardioversion, the rate of recurrence of atrial fibrillation remains high. The hypothesis that plasma B-type natriuretic peptide could predict the recurrence of atrial fibrillation at 1 year was tested. Plasma B-type natriuretic peptide was measured in 66 consecutive asymptomatic patients who underwent external cardioversion for atrial fibrillation. Twelve-lead electrocardiograms were obtained at 1 year. Sinus rhythm was maintained in 55% of patients. The independent predictors of the recurrence of atrial fibrillation at 1 year were a history of atrial fibrillation, plasma B-type natriuretic peptide, and the energy delivered for conversion. In patients without symptoms of heart failure, plasma B-type natriuretic peptide is an independent predictor of the recurrence of atrial fibrillation.
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Affiliation(s)
- Nicolas Lellouche
- Fédération de Cardiologie, Hôpital de Jour, Henri Mondor University Hospital, Créteil, France
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47
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Itti E, Klein G, Rosso J, Evangelista E, Monin JL, Gueret P, Meignan M, Thirion JP. Assessment of myocardial reperfusion after myocardial infarction using automatic 3-dimensional quantification and template matching. J Nucl Med 2004; 45:1981-8. [PMID: 15585471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
UNLABELLED Assessment of perfusion defect extent is essential for determining prognosis after a myocardial infarction (MI), but quantification methods usually rely on segmental analysis, which may lack accuracy. We present an automated voxel-based and template-based approach for precise quantification of perfusion defect extent and reperfusion evolution. METHODS Coronary angiography and stress/reinjection (201)Tl tomography were performed prospectively on 49 patients with recent MI (45 men; mean age +/- SD, 54 +/- 10 y), before and 3 mo after revascularization (40 angioplasties and 9 bypasses). Perfusion defect extent was quantified using expert 16-segment visual scoring of the slices and a 3-dimensional (3D) method with spatial normalization between times 1 and 2. Briefly, the latter automatically extracted myocardial edges, matched them to a reference template, and compared the perfusion intensity in each voxel with the intensity of the corresponding voxel in a control population of 100 healthy subjects. RESULTS Reocclusion occurred in 12 patients within 3 mo of surgery (all had undergone angioplasty). The perfusion gain between times 1 and 2, assessed by visual analysis, was significantly higher in permeable patients than in reoccluded patients: 12.4% +/- 13.3% and 2.3% +/- 8.2% of the initial stress defect, respectively (P = 0.02). Proportional gains, measured with the quantitative 3D method, were 4.5% +/- 3.6% and 1.9% +/- 2.7%, respectively (P = 0.02). Furthermore, the 3D method allowed measurement within the initial ischemic defect (reversible part of the stress defect at time 1), the extent of myocardium whose perfusion improved at time 2 (reperfusion), and the extent of myocardium whose perfusion remained unchanged (residual ischemia). A voxel-by-voxel analysis of these regions revealed that the proportion of reperfusion was significantly higher in permeable patients than in reoccluded patients: 60.0% +/- 21.3% versus 40.0% +/- 22.5%, respectively (P = 0.008). This was cumbersome to quantify using visual analysis and did not reach statistical significance, likely because of segmental division (partial-volume effect) and absence of spatial normalization. CONCLUSION The 3D voxel-based quantification allows satisfying assessment of reperfusion 3 mo after MI. Moreover, the automated analysis using spatial normalization should facilitate a reproducible assessment of large populations over time.
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Affiliation(s)
- Emmanuel Itti
- Nuclear Medicine, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Paris XII University, Créteil, France.
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48
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Affiliation(s)
- Jean-Luc Monin
- Department of Cardiology, Henri Mondor Hospital, 51 avenue De Lattre de Tassigny, 94010 Créteil, France.
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49
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Puel J, Valensi P, Vanzetto G, Lassmann-Vague V, Monin JL, Moulin P, Ziccarelli C, Mayaudon H, Ovize M, Bernard S, Van Belle E, Halimi S. [Identifying myocardial ischaemia in diabetics. SFC/ALFEDIAM joint recommendations]. Arch Mal Coeur Vaiss 2004; 97:338-57. [PMID: 15182078] [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] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- J Puel
- Société française de cardiologie
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50
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Russel S, Monin JL, Garot J, Tabet JY, Gueret P. [Localization of mitral valve prolapse zones with multiplane transesophageal echocardiography]. Arch Mal Coeur Vaiss 2004; 97:101-7. [PMID: 15032408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
CONTEXT There are few literature data on the localization and extent of mitral valve prolapse zones with transesophageal echocardiography (TEE). AIM OF THE STUDY To assess a standardized imaging technique for the localization and extent determination of prolapse zones, based on 3 easily reproducible views with multiplane TEE. METHODS Seventy patients with severe mitral regurgitation due to valve prolapse requiring a multiplane TEE prior to surgery (valve repair or replacement) have been retrospectively assessed. Data of TEE on the localization and extent of prolapse zones have been confronted to per-operative anatomical observations (gold standard). RESULTS The sensitivity of TEE for the identification of isolated P2 prolapse, prolapse with commisural extension, isolated rupture of the posterior commisure and bi-valvular prolapses were respectively at 96%, 88%, 86% and 80%. The corresponding specificities were from 98% to 100%. CONCLUSIONS The use of a standardized technique with the use of 3 easily reproducible incidences with multiplane TEE allows a precise definition of the localization and extent of mitral valve prolapse zones, in order to potentially indicate valve repair.
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Affiliation(s)
- S Russel
- Service de cardiologie, CHU Henri Mondor, Créteil
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