201
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Antoine C, Michelena HI, Enriquez-Sarano M. Mitral valve prolapse: where is the missing link? J Thorac Dis 2016; 8:2394-2396. [DOI: 10.21037/jtd.2016.09.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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202
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Nishino S, Watanabe N, Kimura T, Enriquez-Sarano M, Nakama T, Furugen M, Koiwaya H, Ashikaga K, Kuriyama N, Shibata Y. The Course of Ischemic Mitral Regurgitation in Acute Myocardial Infarction After Primary Percutaneous Coronary Intervention. Circ Cardiovasc Imaging 2016; 9:e004841. [DOI: 10.1161/circimaging.116.004841] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 06/24/2016] [Indexed: 11/16/2022]
Abstract
Background—
Previously published evidence on ischemic mitral regurgitation (IMR) and its adverse prognosis after myocardial infarction has been based on the severity of IMR in the subacute or chronic period of myocardial infarction. However, the state of IMR can vary from the early stage to the chronic stage as a result of various responses of myocardium after primary percutaneous coronary intervention (PCI).
Methods and Results—
Standard echocardiography was serially performed in 546 consecutive patients with first-onset acute myocardial infarction (1) immediately after their arrival (pre-PCI), (2) before discharge (early post-PCI), and (3) 6 to 8 months after PCI (late post-PCI). The course of IMR after primary PCI and the prognostic impact of the IMR in each phase were investigated. IMR was found in 193/546 (35%) patients at the emergency room. In the acute phase after PCI, IMR improved in 63 patients. IMR worsened in 78 patients despite successful PCI. Shorter onset-to-reperfusion time and nontotal occlusion before PCI were the independent predictors of early improvement of IMR. In the chronic phase, IMR improved in 79 patients and worsened in 36 patients. Lower peak creatine kinase–myocardial band was an independent predictor of late improvement of IMR. IMR before PCI worsened 30-day prognosis (
P
=0.02), and persistent IMR in the chronic phase worsened long-term prognosis (
P
=0.04) after primary PCI.
Conclusions—
Degrees of IMR changed in the early and chronic phase after primary PCI for acute myocardial infarction. IMR on arrival and persistent IMR in the chronic phase worsened short-term and long-term prognosis after acute myocardial infarction, respectively.
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203
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Suri RM, Clavel MA, Schaff HV, Michelena HI, Huebner M, Nishimura RA, Enriquez-Sarano M. Effect of Recurrent Mitral Regurgitation Following Degenerative Mitral Valve Repair: Long-Term Analysis of Competing Outcomes. J Am Coll Cardiol 2016; 67:488-98. [PMID: 26846946 DOI: 10.1016/j.jacc.2015.10.098] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/16/2015] [Accepted: 10/27/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The risk for and consequences of recurrent mitral regurgitation (MR) following degenerative mitral valve repair are poorly understood. OBJECTIVES This study sought to examine recurrent MR risk along with reoperation and survival rates. METHODS We evaluated patients undergoing primary mitral repair for isolated degenerative MR over 1 decade. Median follow-up was 11.5 years (interquartile range: 9.2 to 13.6 years) and was 99% complete. Multivariate analysis of post-repair MR recurrence employed Cox proportional hazards and multistate modeling. RESULTS A total of 1,218 patients met the study criteria; the mean age was 64 ± 13 years, mean ejection fraction was 63 ± 9%, and 864 (71%) patients were men. Prolapse was posterior in 62%, bileaflet in 26%, and anterior in 12%. The 15-year incidence of recurrent MR (i.e., MR ≥2) was 13.3%, incidence of mitral reoperation was 6.9%, and overall mortality was 44.0%. Repair before 1996 independently predicted MR recurrence (hazard ratio: 1.52). Additional determinants were: age, mild intraoperative residual MR, anterior leaflet prolapse, bileaflet prolapse, perfusion time >90 min, and lack of annuloplasty. Recurrence of moderate or greater MR was associated with adverse left ventricular remodeling and increased likelihood of death (hazard ratio: 1.72). Among those undergoing repair after 1996, MR recurrence rate was 1.5 per 100 patient-years during the first year post-repair, decreasing markedly to 0.9 thereafter. CONCLUSIONS Our study demonstrated that recurrent MR following degenerative mitral valve repair is associated with adverse left ventricular remodeling and late death. The incidence of MR recurrence decreases markedly following the first year after intervention. A transparent discussion of recurrent MR risk has pressing relevance when referring patients with complex mitral valve prolapse.
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204
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Jenkins W, Simard L, Clavel MA, Enriquez-Sarano M. THE NOVEL IMAGING OF AORTIC STENOSIS USING 4-DIMENSIONAL COMPUTED TOMOGRAPHY; NEW PHYSIOLOGICAL INSIGHTS USING EN-FACE QUANTITATIVE ANALYSIS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32209-4] [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: 10/22/2022]
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205
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206
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Mantovani F, Clavel MA, Michelena HI, Suri RM, Schaff HV, Enriquez-Sarano M. Comprehensive Imaging in Women With Organic Mitral Regurgitation. JACC Cardiovasc Imaging 2016; 9:388-96. [DOI: 10.1016/j.jcmg.2016.02.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 02/19/2016] [Accepted: 02/25/2016] [Indexed: 11/25/2022]
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207
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Katan O, Michelena HI, Avierinos JF, Mahoney DW, DeSimone DC, Baddour LM, Suri RM, Enriquez-Sarano M. Incidence and Predictors of Infective Endocarditis in Mitral Valve Prolapse: A Population-Based Study. Mayo Clin Proc 2016; 91:336-42. [PMID: 26856780 PMCID: PMC4998970 DOI: 10.1016/j.mayocp.2015.12.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/30/2015] [Accepted: 12/11/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the incidence and predictors of infective endocarditis (IE) in a population-based cohort of patients with mitral valve prolapse (MVP). PATIENTS AND METHODS We identified all adult Olmsted County residents with MVP diagnosed by echocardiography from January 1989 to December 1998 and cross-matched them with the Rochester Epidemiology Project-identified Olmsted County cases of IE from January 1, 1986, through December 31, 2006. We retrospectively analyzed and de novo confirmed each IE case using the modified Duke criteria. RESULTS There were 896 Olmsted County residents with echocardiographically diagnosed MVP (mean age, 53±21 years; 565 women [63%]). The mean follow-up period was 11±5 years. The 15-year cohort risk of IE after MVP diagnosis was 1.1%±0.4% (incidence, 86.6 cases per 100,000 person-years; 95% CI, 43.3-173.2 cases per 100,000 person-years); thus, the age- and sex-adjusted relative risk of IE in patients with MVP was 8.1 (95% CI, 3.6-18.0) in comparison to the general population of Olmsted County (P<.001). There were no IE cases in patients without previously diagnosed mitral regurgitation (MR). Conversely, IE incidence was higher in patients with MVP with moderate, moderate-severe, or severe MR (289.5 cases per 100,000 person-years; 95% CI, 108.7-771.2 cases per 100,000 person-years; P=.02 compared with trivial, mild, or mild-moderate MR) and in patients with a flail mitral leaflet (715.5 cases per 100,000 person-years; 95% CI, 178.9-2861.0 cases per 100,000 person-years; P=.02 compared with no flail mitral leaflet). CONCLUSION The population-based incidence of IE in adults with MVP is higher than those previously reported in case-control, tertiary care center studies. Patients with MVP and moderate, moderate-severe, or severe MR or a flail mitral leaflet are at a notable risk of developing IE in comparison with those without MR.
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208
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Michelena HI, Katan O, Suri RM, Baddour LM, Enriquez-Sarano M. Incidence of Infective Endocarditis in Patients With Bicuspid Aortic Valves in the Community. Mayo Clin Proc 2016; 91:122-3. [PMID: 26763517 DOI: 10.1016/j.mayocp.2015.10.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/19/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
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209
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Gerber Y, Weston SA, Enriquez-Sarano M, Berardi C, Chamberlain AM, Manemann SM, Jiang R, Dunlay SM, Roger VL. Mortality Associated With Heart Failure After Myocardial Infarction: A Contemporary Community Perspective. Circ Heart Fail 2015; 9:e002460. [PMID: 26699392 DOI: 10.1161/circheartfailure.115.002460] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 11/06/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contemporary data are lacking on the prognostic importance of heart failure (HF) after myocardial infarction (MI). We evaluated the prognostic impact of HF post MI according to preserved/reduced ejection fraction and the timing of its occurrence. METHODS AND RESULTS All Olmsted County, Minnesota, residents (n=2596) with incident MI diagnosed in 1990 to 2010 and no prior HF were followed through March 2013. Cox models were used to examine (1) the hazard ratios for death associated with HF type and timing and (2) secular trends in survival by HF status. During a mean follow-up of 7.6 years, there were 1116 deaths, 634 in the 902 patients who developed HF (70%) and 482 in the 1694 patients who did not develop HF (28%). After adjustment for age and sex, HF as a time-dependent variable was strongly associated with mortality (hazard ratio =3.31, 95% confidence interval: 2.93-3.75), particularly from cardiovascular causes (hazard ratio =4.20, 95% confidence interval: 3.50-5.03). Further adjustment for MI severity and comorbidity, acute treatment, and recurrent MI moderately attenuated these associations (hazard ratio =2.49 and 2.94 for all-cause and cardiovascular mortality, respectively). Mortality did not differ by ejection fraction, but was higher for delayed- versus early-onset HF (P for heterogeneity =0.002). The age- and sex-adjusted 5-year survival estimates in 2001 to 2010 versus 1990 to 2000 were 82% and 81% among HF-free and 61% and 54% among HF patients, respectively (P for heterogeneity of trends =0.05). CONCLUSIONS HF markedly increases the risk of death after MI. This excess risk is similar regardless of ejection fraction but greater for delayed- versus early-onset HF. Mortality after MI declined over time, primarily as a result of improved HF survival.
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210
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Clavel MA, Malouf J, Messika-Zeitoun D, Araoz PA, Michelena HI, Enriquez-Sarano M. Aortic valve area calculation in aortic stenosis by CT and Doppler echocardiography. JACC Cardiovasc Imaging 2015; 8:248-257. [PMID: 25772832 DOI: 10.1016/j.jcmg.2015.01.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to verify the hypothesis that multidetector computed tomography (MDCT) is superior to echocardiography for measuring the left ventricular outflow tract (LVOT) and calculating the aortic valve area (AVA) with regard to hemodynamic correlations and survival outcome prediction after a diagnosis of aortic stenosis (AS). BACKGROUND MDCT demonstrated that the LVOT is noncircular, casting doubt on the AVA measurement by 2-dimensional (2D) echocardiography. METHODS A total of 269 patients (76 ± 11 years of age, 61% men) with isolated calcific AS (mean gradient 44 ± 18 mm Hg; ejection fraction 58 ± 15%) underwent Doppler echocardiography and MDCT within the same episode of care. AVA was calculated by echocardiography (AVAEcho) and by MDCT (AVACT) using each technique measurement of LVOT area. In the subset of patients undergoing dynamic 4-dimensional MDCT (n = 135), AVA was calculated with the LVOT measured at 70% and 20% of the R-R interval and measured by planimetry (AVAPlani). RESULTS Phasic measurements of the LVOT by MDCT yielded slight differences in eccentricity and size (all p < 0.001) but with excellent AVA correlation (r = 0.92, p < 0.0001) and minimal bias (0.05 cm(2)), whereas the AVAPlani showed poor correlations with all other methods (all r values <0.58). AVACT was larger than AVAEcho (difference 0.12 ± 0.16 cm(2); p < 0.0001) but did not improve outcome prediction. Correlation gradient-AVA was slightly better with AVAEcho than AVACT (r = -0.65 with AVAEcho vs. -0.61 with AVACT; p = 0.01), and discordant gradient-AVA was not reduced. For long-term survival, after multivariable adjustment, AVAEcho or AVACT were independently predictive (hazard ratio [HR]: 1.26, 95% confidence interval [CI]: 1.13 to 1.42; p < 0.0001 or HR: 1.18, 95% CI: 1.09 to 1.29 per 0.10 cm(2) decrease; p < 0.0001) with a similar prognostic value (p ≥ 0.80). Thresholds for excess mortality differed between methods: AVAEcho ≤1.0 cm(2) (HR: 4.67, 95% CI: 2.22 to 10.50; p < 0.0001) versus AVACT ≤1.2 cm(2) (HR: 3.16, 95% CI: 1.64 to 6.43; p = 0.005), with simple translation of spline-curve analysis. CONCLUSIONS Head-to-head comparison of MDCT and Doppler echocardiography refutes the hypothesis of MDCT superiority for AVA calculation. AVACT is larger than AVAEcho but does not improve the correlation with transvalvular gradient, the concordance gradient-AVA, or mortality prediction compared with AVAEcho. Larger cut-point values should be used for severe AS if AVACT (<1.2 cm(2)) is measured versus AVAEcho (<1.0 cm(2)).
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211
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Latib A, Agricola E, Pozzoli A, Denti P, Taramasso M, Spagnolo P, Juliard JM, Brochet E, Ou P, Enriquez-Sarano M, Grigioni F, Alfieri O, Vahanian A, Colombo A, Maisano F. First-in-Man Implantation of a Tricuspid Annular Remodeling Device for Functional Tricuspid Regurgitation. JACC Cardiovasc Interv 2015; 8:e211-4. [DOI: 10.1016/j.jcin.2015.06.028] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/06/2015] [Accepted: 06/05/2015] [Indexed: 11/15/2022]
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212
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Thaden JJ, Nkomo VT, Suri RM, Maleszewski JJ, Soderberg DJ, Clavel MA, Pislaru SV, Malouf JF, Foley TA, Oh JK, Miller JD, Edwards WD, Enriquez-Sarano M. Sex-related differences in calcific aortic stenosis: correlating clinical and echocardiographic characteristics and computed tomography aortic valve calcium score to excised aortic valve weight. Eur Heart J 2015; 37:693-9. [PMID: 26508159 DOI: 10.1093/eurheartj/ehv560] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 08/27/2015] [Indexed: 12/25/2022] Open
Abstract
AIMS Calcific aortic valve stenosis (AS) is purportedly associated with less calcium burden in women than in men. We sought to examine sex-related differences and correlates of surgically excised aortic valve weight (AVW) in pure AS. METHODS AND RESULTS Clinical and echocardiographic characteristics of 888 consecutive patients who underwent aortic valve replacement for severe AS were correlated to AVW, and in 126 patients, AVW was also correlated to computed tomography aortic valve calcium (AVC) score. Women and men had similar indexed valve area (0.42 ± 0.09 vs. 0.42 ± 0.07 cm (2)/m(2), P = 0.95) and mean systolic gradient (53 ± 15 vs. 52 ± 13 mmHg, P = 0.11), but women had higher New York Heart Association class (2.63 ± 0.70 vs. 2.50 ± 0.70, P = 0.01) and less prevalent coronary artery disease (38 vs. 52%, P < 0.0001). Aortic valve weight was lower in women (1.94 ± 0.88 vs. 3.08 ± 1.32 g, P < 0.0001) even when indexed to body surface area (1.09 ± 0.48 vs. 1.48 ± 0.62 g/m(2), P < 0.0001) or left ventricular outflow tract (LVOT) area (0.54 ± 0.23 vs. 0.71 ± 0.29 g/cm(2), P < 0.0001). Using multivariate analysis, male sex (P < 0.0001), bicuspid valve (P < 0.0001), and larger LVOT area (P < 0.0001) were the major determinants of increased AVW, along with current cigarette smoking (P = 0.007). Diabetes (P = 0.004) and hypertension (P = 0.03) were independently associated with lower AVW. Aortic valve calcium correlated well with AVW (r = 0.81, P < 0.0001) and was lower in women than in men (2520 ± 1199 vs. 3606 ± 1632 arbitrary units, P < 0.0001). CONCLUSIONS Despite the same degree of AS severity, women have less AVC and lower AVW compared with men, irrespective of valve morphology. Aortic valve calcium is correlated to excised AVW. Hypertension, diabetes, and current cigarette smoking were independently associated with AVW.
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213
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Suri RM, Taggarse A, Burkhart HM, Daly RC, Mauermann W, Nishimura RA, Li Z, Dearani JA, Michelena HI, Enriquez-Sarano M. Robotic Mitral Valve Repair for Simple and Complex Degenerative Disease: Midterm Clinical and Echocardiographic Quality Outcomes. Circulation 2015; 132:1961-8. [PMID: 26481775 DOI: 10.1161/circulationaha.115.017792] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/02/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe primary (degenerative) mitral regurgitation (MR) is repaired with durable results when simple single-scallop disease is addressed. The midterm quality outcomes of minimally invasive repair for complex disease are unknown, however. METHODS AND RESULTS From January 2008 to January 2015, 487 patients (56±11 years, 360 men, ejection fraction 65±6%, 98.8% complete follow-up) underwent robotic mitral valve repair for severe nonischemic degenerative MR. Simple pathology was addressed in 289 of 487 (59%) patients, and complex repair (all others) was performed in 198 of 487 (41%). Four patients died during follow-up with a 5-year survival rate 99.5% (99.4% simple; 99.5% complex; hazard ratio, 0.48; 95% confidence interval, 0.05-4.59); and New York Heart Association functional class I/II was documented in 97.9% (477/487). Eight patients had recurrence of moderate-to-severe MR (4 simple, 4 complex), with a 5-year freedom from MR of 94.6% (96.2% simple; 92.7%, complex; P=0.67; hazard ratio, 1.36; 95% confidence interval, 0.34-5.43). Seven patients (2 simple, 5 complex), underwent mitral reoperation, with a 5-year freedom from reoperation of 97.7% (99.1% simple; 95.7% complex; P=0.13; hazard ratio, 3.35; 95% confidence interval, 0.65-17.32). CONCLUSIONS At a large tertiary care referral center, midterm quality outcomes after robotic correction of degenerative MR are excellent, with very high survival, infrequent complications, and a low likelihood of MR recurrence, regardless of mitral valve repair complexity. Awareness of these improvements in outcome is important to inform contemporary decisions regarding high-quality alternatives to conventional and percutaneous mitral repair.
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214
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Pressman GS, Movva R, Topilsky Y, Clavel MA, Saldanha JA, Watanabe N, Enriquez-Sarano M. Three-Dimensional Echocardiography: A Powerful New Tool in the Evaluation of Mitral Annular Structure and Dynamics. J Am Soc Echocardiogr 2015; 28:1256-7. [DOI: 10.1016/j.echo.2015.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Indexed: 10/23/2022]
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215
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Clavel M, Hourdain J, Deharo J, Asirvatham S, Avierinos J, Ackerman M, Enriquez-Sarano M. MITRAL VALVE PROLAPSE PHENOTYPES ASSOCIATED WITH SUDDEN CARDIAC DEATH. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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216
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Clavel MA, Malouf J, Messika-Zeitoun D, Araoz PA, Michelena HI, Enriquez-Sarano M. Reply. JACC Cardiovasc Imaging 2015; 8:1116. [DOI: 10.1016/j.jcmg.2015.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
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217
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Michelena HI, Della Corte A, Prakash SK, Milewicz DM, Evangelista A, Enriquez-Sarano M. Bicuspid aortic valve aortopathy in adults: Incidence, etiology, and clinical significance. Int J Cardiol 2015; 201:400-7. [PMID: 26310986 DOI: 10.1016/j.ijcard.2015.08.106] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/11/2015] [Accepted: 08/10/2015] [Indexed: 12/21/2022]
Abstract
Bicuspid aortic valve is the most common congenital heart defect and is associated with an aortopathy manifested by dilatation of the ascending thoracic aorta. The clinical consequences of this aortopathy are the need for periodic monitoring of aortic diameters, elective prophylactic surgical aortic repair, and the occurrence of aortic dissection or rupture. This review describes the current knowledge of BAV aortopathy in adults, including incidence, pathophysiologic insights into its etiology, contemporary hypothesis-generating observations into its complications, and recommendations for monitoring and intervention.
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218
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Suri RM, Enriquez-Sarano M, Schaff HV. Preservation of left ventricular function after degenerative mitral valve repair: Refocusing on timing, techniques, and teaching. J Thorac Cardiovasc Surg 2015; 150:448-9. [PMID: 26319458 DOI: 10.1016/j.jtcvs.2015.07.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 07/14/2015] [Indexed: 10/23/2022]
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219
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Stone GW, Vahanian AS, Adams DH, Abraham WT, Borer JS, Bax JJ, Schofer J, Cutlip DE, Krucoff MW, Blackstone EH, Généreux P, Mack MJ, Siegel RJ, Grayburn PA, Enriquez-Sarano M, Lancellotti P, Filippatos G, Kappetein AP. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 1: clinical trial design principles. Eur Heart J 2015; 36:1851-77. [DOI: 10.1093/eurheartj/ehv281] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 05/21/2015] [Indexed: 12/28/2022] Open
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220
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Stone GW, Vahanian AS, Adams DH, Abraham WT, Borer JS, Bax JJ, Schofer J, Cutlip DE, Krucoff MW, Blackstone EH, Généreux P, Mack MJ, Siegel RJ, Grayburn PA, Enriquez-Sarano M, Lancellotti P, Filippatos G, Kappetein AP. Clinical Trial Design Principles and Endpoint Definitions for Transcatheter Mitral Valve Repair and Replacement: Part 1: Clinical Trial Design Principles. J Am Coll Cardiol 2015; 66:278-307. [DOI: 10.1016/j.jacc.2015.05.046] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 05/05/2015] [Accepted: 05/21/2015] [Indexed: 01/22/2023]
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221
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Enriquez-Sarano M, Suri RM, Clavel MA, Mantovani F, Michelena HI, Pislaru S, Mahoney DW, Schaff HV. Is there an outcome penalty linked to guideline-based indications for valvular surgery? Early and long-term analysis of patients with organic mitral regurgitation. J Thorac Cardiovasc Surg 2015; 150:50-8. [DOI: 10.1016/j.jtcvs.2015.04.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/24/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
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222
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Le RJ, Nishimura RA, Mankad R, Enriquez-Sarano M, Michelena HI. Transthoracic echocardiogram-guided agitated-saline aortography for post-TAVR peri-prosthetic leak evaluation. Eur Heart J 2015; 36:1305. [PMID: 25802393 DOI: 10.1093/eurheartj/ehv078] [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: 11/13/2022] Open
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223
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Mantovani F, Clavel MA, Vatury O, Suri RM, Mankad SV, Malouf J, Michelena HI, Jain S, Badano LP, Enriquez-Sarano M. Cleft-like indentations in myxomatous mitral valves by three-dimensional echocardiographic imaging. Heart 2015; 101:1111-7. [DOI: 10.1136/heartjnl-2014-307016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/27/2015] [Indexed: 11/03/2022] Open
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224
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Clavel MA, Mantovani F, Malouf J, Michelena HI, Vatury O, Jain MS, Mankad SV, Suri RM, Enriquez-Sarano M. Dynamic Phenotypes of Degenerative Myxomatous Mitral Valve Disease. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002989. [DOI: 10.1161/circimaging.114.002989] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background—
Fibro-elastic deficiency (FED) and diffuse myxomatous degeneration (DMD) are phenotypes of degenerative mitral valve disease defined morphologically. Whether physiological differences in annular and valvular dynamics exist between these phenotypes remains unknown.
Methods and Results—
We performed triple quantitation of cardiac remodeling and of mitral regurgitation severity and of annular and valvular dimensions by real-time 3-dimensional-transesophageal-echocardiography. Forty-nine patients with degenerative mitral valve disease classified as FED (n=31) and DMD (n=18) by surgical observation showed no difference in age (65±10 versus 59±13;
P
=0.5), body surface area (2.0±0.2 versus 2.0±0.2 m
2
;
P
=0.5), left ventricular and atrial dimensions (all
P
>0.55), and mitral regurgitation regurgitant orifice (
P
=0.62). On average, annular dimensions were larger in DMD versus FED, but height was similar resulting in lower saddle shape. Dynamically, annular DMD versus FED display poorer contraction and saddle-shape accentuation in early systole and abnormal enlargement, particularly intercommissural, in late-systole (all
P
<0.05). Valvular dynamics showed stable valvular area in systole in FED versus considerable systolic increased area in DMD (
P
<0.001). Prolapse height and volume increased little throughout systole in FED versus marked increase in DMD (
P
<0.001).
Conclusions—
Our novel observations show that FED and DMD, although both labeled myxomatous, display considerable physiological phenotypic differences. In DMD, the annular increased size and profoundly abnormal dynamics demonstrate DMD-specific annular degeneration compared with the enlarged but relatively normal FED annulus. DMD does not incur more severe mitral regurgitation, despite larger prolapse and valve redundancy, underscoring potential compensatory role of tissue redundancy of DMD (or aggravating role of tissue paucity of FED) on mitral regurgitation severity.
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Thalji NM, Suri RM, Enriquez-Sarano M, Gersh BJ, Huebner M, Dearani JA, Burkhart HM, Li Z, Greason KL, Michelena HI, Schaff HV. Untreated aortic valve stenosis identified at the time of coronary artery bypass grafting: thresholds associated with adverse prognosis. Eur J Cardiothorac Surg 2015; 47:712-719. [DOI: 10.1093/ejcts/ezu231] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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