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Antoine C, Mantovani F, Benfari G, Mankad SV, Maalouf JF, Michelena HI, Enriquez-Sarano M. Pathophysiology of Degenerative Mitral Regurgitation. Circ Cardiovasc Imaging 2018; 11:e005971. [DOI: 10.1161/circimaging.116.005971] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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177
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Enriquez-Sarano M. Mitral Annular Disjunction. JACC Cardiovasc Imaging 2017; 10:1434-1436. [DOI: 10.1016/j.jcmg.2017.03.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 02/16/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
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178
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Pislaru C, Alashry MM, Thaden JJ, Pellikka PA, Enriquez-Sarano M, Pislaru SV. Intrinsic Wave Propagation of Myocardial Stretch, A New Tool to Evaluate Myocardial Stiffness: A Pilot Study in Patients with Aortic Stenosis and Mitral Regurgitation. J Am Soc Echocardiogr 2017; 30:1070-1080. [DOI: 10.1016/j.echo.2017.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 12/13/2022]
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179
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Gerber Y, Weston SA, Enriquez-Sarano M, Jaffe AS, Manemann SM, Jiang R, Roger VL. Contemporary Risk Stratification After Myocardial Infarction in the Community: Performance of Scores and Incremental Value of Soluble Suppression of Tumorigenicity-2. J Am Heart Assoc 2017; 6:JAHA.117.005958. [PMID: 29054840 PMCID: PMC5721833 DOI: 10.1161/jaha.117.005958] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Current American Heart Association/American College of Cardiology guidelines recommend the GRACE (Global Registry of Acute Coronary Events) and TIMI (Thrombolysis in Myocardial Infarction) scores to assess myocardial infarction (MI) prognosis. Changes in the epidemiological characteristics of MI and the availability of new biomarkers warrant an assessment of the performance of these scores in contemporary practice. We assessed the following: (1) the performance of GRACE and TIMI to predict 1-year mortality in a cohort of patients stratified by ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI) and (2) the incremental discriminatory power of soluble suppression of tumorigenicity-2, a myocardial fibrosis biomarker. METHODS AND RESULTS Olmsted County, Minnesota, residents with incident MI (N=1401) were recruited prospectively from November 1, 2002 to December 31, 2012 (mean age, 67 years; 61% men; 79% with NSTEMI). Baseline data were used to calculate risk scores; soluble suppression of tumorigenicity-2 was measured in stored plasma samples obtained at index MI. C-statistics adapted to survival data were used to assess the discriminatory power of the risk scores and the improvement gained by adding other markers. During the first year of follow-up, 190 patients (14%) died. The discriminatory performance to predict death was reasonable for GRACE and poor for TIMI, and was generally worse in those with NSTEMI versus those with STEMI. In people with NSTEMI, sequential addition of comorbidities and soluble suppression of tumorigenicity-2 substantially improved the c-statistic over GRACE (from 0.78 to 0.80 to 0.84) and TIMI (from 0.61 to 0.73 to 0.81), respectively (all P≤0.05). CONCLUSIONS Guideline-recommended scores for risk assessment after MI underperform in contemporary community patients, particularly those with NSTEMI, which now represents most infarcts. Incorporating comorbidities and soluble suppression of tumorigenicity-2 substantially improves risk prediction, thereby delineating opportunities to improve clinical care.
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Huntley GD, Thaden JJ, Alsidawi S, Michelena HI, Maleszewski JJ, Edwards WD, Scott CG, Pislaru SV, Pellikka PA, Greason KL, Ammash NM, Malouf JF, Enriquez-Sarano M, Nkomo VT. Comparative study of bicuspid vs. tricuspid aortic valve stenosis. Eur Heart J Cardiovasc Imaging 2017; 19:3-8. [DOI: 10.1093/ehjci/jex211] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/14/2017] [Indexed: 11/12/2022] Open
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181
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Pradier J, Theron A, Resseguier N, Grigioni F, Tribouilloy C, Habib G, Vanoverschelde JL, Bursi F, Enriquez-Sarano M, Avierinos J. 4106Outcomes penalty linked to female gender in severe primary mitral regurgitation due to flail leaflet. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.4106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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182
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Benfari G, Antoine C, Miller W, Michelena H, Nkomo V, Rossi A, Enriquez-Sarano M. P5823Atrial fibrillation or rapid ventricular response in patients with left ventricular dysfunction: which is relevant to the long-term clinical outcome? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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183
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Pappalardo O, Benfari G, Jenkins W, Araoz P, Votta E, Redaelli A, Onorati F, Faggian G, Enriquez-Sarano M. P1640Anatomic aortic valve area by multi-detector computed tomography: pilot study of semi-automatic custom software assessment compared to doppler-echocardiography. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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184
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Pradier J, Theron A, Resseguier N, Grigioni F, Tribouilloy C, Habib G, Vanoverschelde JL, Bursi F, Enriquez-Sarano M, Avierinos JF. Outcomes penalty linked to female gender in severe primary mitral regurgitation due to flail leaflet treated medically. ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2017. [DOI: 10.1016/s1878-6480(17)30031-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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185
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Antoine C, Benfari G, Pislaru S, Messika-Zeitoun D, Le Tourneau T, Maalouf J, Enriquez-Sarano M. Left atrium volume index measurement in routine practice: does it independently impact survival of degenerative mitral valve disease? ARCHIVES OF CARDIOVASCULAR DISEASES SUPPLEMENTS 2017. [DOI: 10.1016/s1878-6480(17)30035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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186
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Huebner M, Wolkewitz M, Enriquez-Sarano M, Schumacher M. Competing risks need to be considered in survival analysis models for cardiovascular outcomes. J Thorac Cardiovasc Surg 2017; 153:1427-1431. [DOI: 10.1016/j.jtcvs.2016.12.039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
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187
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Sritharen Y, Enriquez-Sarano M, Schaff HV, Casaclang-Verzosa G, Miller JD. Pathophysiology of Aortic Valve Stenosis: Is It Both Fibrocalcific and Sex Specific? Physiology (Bethesda) 2017; 32:182-196. [PMID: 28404735 PMCID: PMC6148342 DOI: 10.1152/physiol.00025.2016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 12/24/2022] Open
Abstract
Our understanding of the fundamental biology and identification of efficacious therapeutic targets in aortic valve stenosis has lagged far behind the fields of atherosclerosis and heart failure. In this review, we highlight the most clinically relevant problems facing men and women with fibrocalcific aortic valve stenosis, discuss the fundamental biology underlying valve calcification and fibrosis, and identify key molecular points of intersection with sex hormone signaling.
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Ancona F, Stella S, Taramasso M, Marini C, Latib A, Denti P, Grigioni F, Enriquez-Sarano M, Alfieri O, Colombo A, Maisano F, Agricola E. Multimodality imaging of the tricuspid valve with implication for percutaneous repair approaches. Heart 2017; 103:1073-1081. [DOI: 10.1136/heartjnl-2016-310939] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 12/20/2022] Open
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189
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Tastet L, Enriquez-Sarano M, Capoulade R, Malouf J, Araoz PA, Shen M, Michelena HI, Larose É, Arsenault M, Bédard É, Pibarot P, Clavel MA. Impact of Aortic Valve Calcification and Sex on Hemodynamic Progression and Clinical Outcomes in AS. J Am Coll Cardiol 2017; 69:2096-2098. [DOI: 10.1016/j.jacc.2017.02.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 01/08/2023]
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190
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Zhang HJ, Thaden J, Pislaru S, Scott C, Krittanawong C, Melduni R, McCully R, Enriquez-Sarano M, Oh JK, Pellikka P, Nkomo V. SINUS RHYTHM VERSUS ATRIAL FIBRILLATION & IT CLINICAL PROFILE AND NATURAL HISTORY OF PATIENTS WITH SEVERE AORTIC STENOSIS MANAGED MEDICALLY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35374-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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191
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Tastet LL, Enriquez-Sarano M, Capoulade R, Maalouf Y, Araoz P, Simard L, Shen M, Michelena H, Larose E, Arsenault M, Bédard É, Miller J, Pibarot P, Clavel MA. IMPACT OF AORTIC VALVE CALCIFICATION AND SEX ON HEMODYNAMIC PROGRESSION AND CLINICAL OUTCOMES IN AORTIC STENOSIS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35318-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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192
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Kimura T, Watanabe N, Barros-Gomes S, Roger V, Enriquez-Sarano M. DYNAMIC CHANGES OF MITRAL APPARATUS IN ACUTE MYOCARDIAL INFARCTION WITH ISCHEMIC MITRAL REGURGITATION: PROSPECTIVE 3D QUANTITATIVE ECHOCARDIOGRAPHIC STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34970-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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193
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Huntley G, Thaden J, Alsidawi S, Michelena H, Maleszewski J, Edwards W, Pislaru S, Pellikka P, Ammash N, Greason K, Maalouf Y, Enriquez-Sarano M, Nkomo V. BICUSPID VERSUS TRICUSPID AORTIC VALVE STENOSIS: COMPARATIVE STUDY OF CLINICAL CHARACTERISTICS AND OUTCOMES FOLLOWING AORTIC VALVE REPLACEMENT IN AN AGE-MATCHED COHORT. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35373-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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194
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Benfari CAG, Michelena H, Maalouf JF, Nkomo V, Enriquez-Sarano M. QUANTITATION OF DEGENERATIVE MITRAL REGURGITATION: RESERVED TO THE SPECIALIZED FEW OR APPLICABLE TO ROUTINE CLINICAL PRACTICE? J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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195
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Casaclang-Verzosa G, Enriquez-Sarano M, Villaraga HR, Miller JD. Echocardiographic Approaches and Protocols for Comprehensive Phenotypic Characterization of Valvular Heart Disease in Mice. J Vis Exp 2017. [PMID: 28287525 DOI: 10.3791/54110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The aim of this manuscript and accompanying video is to provide an overview of the methods and approaches used for imaging heart valve function in rodents, with detailed descriptions of the appropriate methods for anesthesia, the echocardiographic windows used, the imaging planes and probe orientations for image acquisition, the methods for data analysis, and the limitations of emerging technologies for the evaluation of cardiac and valvular function. Importantly, we also highlight several future areas of research in cardiac and heart valve imaging that may be leveraged to gain insights into the pathogenesis of valve disease in preclinical animal models. We propose that using a systematic approach to evaluating cardiac and heart valve function in mice can result in more robust and reproducible data, as well as facilitate the discovery of previously underappreciated phenotypes in genetically-altered and/or physiologically-stressed mice.
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Lazam S, Vanoverschelde JL, Tribouilloy C, Grigioni F, Suri RM, Avierinos JF, de Meester C, Barbieri A, Rusinaru D, Russo A, Pasquet A, Michelena HI, Huebner M, Maalouf J, Clavel MA, Szymanski C, Enriquez-Sarano M, Michelina H, Poulain H, Remadi JP, Touati G, Trojette F, Biagini E, Di Bartolomeo R, Ferlito F, Marinelli G, Pacini D, Pasquale F, Rapezzi C, Savini C, Boulif J, El Khoury G, Gerber B, Noirhomme P, Vancraeynest D, Collard F, Habib G, Metras D, Riberi A, Tafanelli L, Bursi F, Lugli R, Mantovani F, Manicardi C, Grazia M, Bacchi-Reggiani L. Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation. Circulation 2017; 135:410-422. [DOI: 10.1161/circulationaha.116.023340] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/15/2016] [Indexed: 11/16/2022]
Abstract
Background:
Mitral valve (MV) repair is preferred over replacement in clinical guidelines and is an important determinant of the indication for surgery in degenerative mitral regurgitation. However, the level of evidence supporting current recommendations is low, and recent data cast doubts on its validity in the current era. Accordingly, the aim of the present study was to analyze very long-term outcome after MV repair and replacement for degenerative mitral regurgitation with a flail leaflet.
Methods:
MIDA (Mitral Regurgitation International Database) is a multicenter registry enrolling patients with degenerative mitral regurgitation with a flail leaflet in 6 tertiary European and US centers. We analyzed the outcome after MV repair (n=1709) and replacement (n=213) overall, by propensity score matching, and by inverse probability-of-treatment weighting.
Results:
At baseline, patients undergoing MV repair were younger, had more comorbidities, and were more likely to present with a posterior leaflet prolapse than those undergoing MV replacement. After propensity score matching and inverse probability-of-treatment weighting, the 2 treatments groups were balanced, and absolute standardized differences were usually <10%, indicating adequate match. Operative mortality (defined as a death occurring within 30 days from surgery or during the same hospitalization) was lower after MV repair than after replacement in both the entire population (1.3% versus 4.7%;
P
<0.001) and the propensity-matched population (0.2% versus 4.4%;
P
<0.001). During a mean follow-up of 9.2 years, 552 deaths were observed, of which 207 were of cardiovascular origin. Twenty-year survival was better after MV repair than after MV replacement in both the entire population (46% versus 23%;
P
<0.001) and the matched population (41% versus 24%;
P
<0.001). Similar superiority of MV repair was obtained in patient subsets on the basis of age, sex, or any stratification criteria (all
P
<0.001). MV repair was also associated with reduced incidence of reoperations and valve-related complications.
Conclusions:
Among patients with degenerative mitral regurgitation with a flail leaflet referred to mitral surgery, MV repair was associated with lower operative mortality, better long-term survival, and fewer valve-related complications compared with MV replacement.
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Rossi A, Zoppini G, Benfari G, Geremia G, Bonapace S, Bonora E, Vassanelli C, Enriquez-Sarano M, Targher G. Mitral Regurgitation and Increased Risk of All-Cause and Cardiovascular Mortality in Patients with Type 2 Diabetes. Am J Med 2017; 130:70-76.e1. [PMID: 27555095 DOI: 10.1016/j.amjmed.2016.07.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 06/22/2016] [Accepted: 07/18/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mitral regurgitation is the most common heart valve disease in the general population, but little is known about the prevalence and prognostic implications of mitral regurgitation in patients with type 2 diabetes. METHODS We retrospectively analyzed the data from 814 outpatients with type 2 diabetes who had undergone a conventional echocardiography for clinical reasons during the years 1992-2007. Mitral regurgitation was evaluated by using an integrated multiparametric echocardiographic approach. The study outcomes were all-cause and cardiovascular mortality. RESULTS At baseline, 261 (32%) patients had mitral regurgitation (25% mild, 5% moderate, and 2% severe). Over a mean follow-up of 9 years, 120 (14%) patients died, 50 of them from cardiovascular causes. Compared with those without valve disease, patients with mild mitral regurgitation had a 3.3-fold increased risk of all-cause mortality, whereas those with moderate-to-severe mitral regurgitation had a 5.1-fold increased risk of all-cause mortality. Results remained statistically significant after adjustment for multiple potential confounders. Similar results were found for cardiovascular mortality. CONCLUSIONS Mitral regurgitation is a common pathologic condition in patients with type 2 diabetes and is independently associated with an increased risk of both all-cause and cardiovascular mortality, even if the severity of mitral regurgitation is mild.
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Bayer-Topilsky T, Suri RM, Topilsky Y, Marmor YN, Trenerry MR, Antiel RM, Mahoney DW, Schaff HV, Enriquez-Sarano M. Mitral Valve Prolapse, Psychoemotional Status, and Quality of Life: Prospective Investigation in the Current Era. Am J Med 2016; 129:1100-9. [PMID: 27235006 DOI: 10.1016/j.amjmed.2016.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The purpose of this study is to investigate whether mitral valve prolapse is associated with the patient's psychoemotional status and health-related quality of life. METHODS Mitral valve prolapse and mitral regurgitation were prospectively and comprehensively assessed in 281 patients (age 61 ± 13 years; 63% men); 216 patients with mitral valve prolapse were compared with 65 without mitral valve prolapse (of similar age and sex). Simultaneously, we assessed the patient's psychoemotional status (anxiety, depression, posttraumatic stress symptoms), health-related quality of life, and perceived severity of illness using validated questionnaires. RESULTS Twenty-nine percent of the patients had either no or mild mitral regurgitation (area of effective regurgitant orifice ≤0.2), and 71% had clinically significant mitral regurgitation (moderate/severe). Stratifying patients into no/mild vs moderate/severe mitral regurgitation revealed no differences in psychoemotional status or mental health-related quality of life between patients with mitral valve prolapse vs those without mitral valve prolapse within each subgroup; no/mild mitral regurgitation and moderate/severe mitral regurgitation (all P ≥ .5). In multivariate analysis, mitral valve prolapse was not independently associated with psychoemotional status or health-related quality of life (all P ≥ .4). In addition, while objective severity of the illness was not related to psychoemotional status or health-related quality of life (all P ≥ .2), the patient's perceived severity of illness predicted in and of itself all psychoemotional (all P < .03) and quality-of-life outcomes (all P < .003). CONCLUSION Mitral valve prolapse is not a determinant of the patient's psychoemotional status or quality of life. Psychoemotional status and health-related quality of life are determined by the patient's perception of the severity of the mitral valve disease, rather than by the presence of mitral valve prolapse.
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199
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Michelena HI, Suri RM, Katan O, Eleid MF, Clavel MA, Maurer MJ, Pellikka PA, Mahoney D, Enriquez-Sarano M. Sex Differences and Survival in Adults With Bicuspid Aortic Valves: Verification in 3 Contemporary Echocardiographic Cohorts. J Am Heart Assoc 2016; 5:e004211. [PMID: 27688238 PMCID: PMC5121517 DOI: 10.1161/jaha.116.004211] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/01/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sex-related differences in morbidity and survival in bicuspid aortic valve (BAV) adults are fundamentally unknown. Contemporary studies portend excellent survival for BAV patients identified at early echocardiographic-clinical stages. Whether BAV adults incur a survival disadvantage throughout subsequent echocardiographic-clinical stages remains undetermined. METHODS AND RESULTS Analysis was done of 3 different cohorts of consecutive patients with echocardiographic diagnosis of BAV identified retrospectively: (1) a community cohort of 416 patients with first BAV diagnosis (age 35±21 years, follow-up 16±7 years), (2) a tertiary clinical referral cohort of 2824 BAV adults (age 51±16 years, follow-up 9±6 years), and (3) a surgical referral cohort of 2242 BAV adults referred for aortic valve replacement (AVR) (age 62±14 years, follow-up 6±5 years). For the community cohort, 20-year risks of aortic regurgitation (AR), AVR, and infective endocarditis were higher in men (all P≤0.04); for a total BAV-related morbidity risk of 52±4% vs 35±6% in women (P=0.01). The cohort's 25-year survival was identical to that in the general population (P=0.98). AR independently predicted mortality in women (P=0.001). Baseline AR was more common in men (P≤0.02) in the tertiary cohort, with 20-year survival lower than that in the general population (P<0.0001); age-adjusted relative death risk was 1.16 (95% confidence interval [CI] 1.05-1.29) for men versus 1.67 (95% CI 1.38-2.03) for women (P=0.001). AR independently predicted mortality in women (P=0.01). Baseline AR and infective endocarditis were higher in men (both ≤0.001) for the surgical referral cohort, with 15-year survival lower than that in the general population (P<0.0001); age-adjusted relative death risk was 1.34 (95% CI 1.22-1.47) for men versus 1.63 (95% CI 1.40-1.89) for women (P=0.026). AR and NYHA class independently predicted mortality in women (both P≤0.04). CONCLUSIONS Within evolving echocardiographic-clinical stages, the long-term survival of adults with BAV is not benign, as both men and women incur excess mortality. Although BAV-related morbidity is higher in men in the community, and AR and infective endocarditis are more prevalent in men, women exhibit a significantly higher relative risk of death in tertiary and surgical referral cohorts, which is independently associated with AR.
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Sims JR, Enriquez-Sarano M, Michelena HI. Postoperative dyspnoea. Heart 2016; 103:367. [PMID: 27634410 DOI: 10.1136/heartjnl-2016-310204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/08/2016] [Accepted: 08/22/2016] [Indexed: 11/04/2022] Open
Abstract
CLINICAL INTRODUCTION A man in his 50s presented with abscessed aortic valve methicillin-sensitive Staphylococcus aureus endocarditis, received intravenous antibiotics and underwent bioprosthetic aortic valve replacement with removal of all infected tissues. He returned 18 days later with severe dyspnoea, subjective fever and bilateral lower extremity oedema. Physical examination revealed tachypnoea and tachycardia without fever, prominent neck CV waves visible at 90°, left parasternal heave, 3/6 holosystolic murmur across the precordium, lung rales and severe peripheral oedema. C reactive protein was 211 mg/L (normal <8 mg/L). Blood cultures were obtained. ECG showed sinus tachycardia and right axis deviation. Transthoracic echocardiogram (TTE) parasternal zoomed short-axis systolic frame (figure 1A, B), apical four-chamber systolic frame (figure 1C) and subcostal continuous wave (CW) Doppler (figure 1D), are shown. QUESTION Given the clinical presentation and TTE findings, what is the diagnosis?Severe tricuspid regurgitation due to extension of endocarditisAortic valve obstruction resulting in severe pulmonary hypertensionAcquired Gerbode defectAortic valve dehiscence with severe paraprosthetic regurgitation.
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