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Effect of Quinolones Versus Cefixime on International Normalized Ratio Levels After Valve Replacement Surgery with Warfarin Therapy. MEDICINA-LITHUANIA 2019; 55:medicina55100644. [PMID: 31561580 PMCID: PMC6843472 DOI: 10.3390/medicina55100644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/02/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Abstract
Background and Objectives: A dispute over interaction of warfarin with two quinolones—i.e., moxifloxacin and levofloxacin—leading to significant increase in international normalized ratio (INR) levels and coagulopathies is currently in debate. The study objective was to compare the INR values due to addition of quinolones and cefixime in warfarin treated patients after replacement of disease valves with metallic valves. Material and Methods: A prospective evaluation of patients who undergone valve replacement surgeries in the cardiology hospital setup in Pakistan during the period 2018–2019 was done, including all those subjects treated concurrently with levofloxacin, moxifloxacin, cefixime, and warfarin for the study. Data organized included demographic information, concurrent medications, and appropriate analytical parameters, especially INR values taken before and within seven days after prescribing three antibiotics in discharged patients who had undergone valve replacement surgeries. Patients for whom laboratory INR values were not given at the time of discharge and with deranged liver function, renal function, low albumin levels, and febrile patients were removed from study. Furthermore, patients were advised on possible food interactions and evaluated to examine if these factors have any possible influence on the interaction being studied. Results: Differences in INR were analyzed statistically by means of SPSS analysis before and after the possible interaction. Following the administration of levofloxacin and moxifloxacin to warfarin therapy, statistical analysis showed remarkable increase in INR (p < 0.001) and no significant change in INR was observed after cefixime treatment (p > 0.05). Conclusion: Results showed that, after adding levofloxacin and moxifloxacin in patients on warfarin, therapy contributed to remarkable increase in INR. However, addition of cefixime prevented frequent coagulopathies; therefore, close monitoring of INR and switching to a safe antibiotic such as cefixime is recommended.
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De Rubeis G, Galea N, Ceravolo I, Dacquino GM, Carbone I, Catalano C, Francone M. Aortic valvular imaging with cardiovascular magnetic resonance: seeking for comprehensiveness. Br J Radiol 2019; 92:20170868. [PMID: 30277407 PMCID: PMC6732913 DOI: 10.1259/bjr.20170868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 09/05/2018] [Accepted: 09/23/2018] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) has an emerging role in aortic valve disease evaluation, becoming an all-in-one technique. CMR evaluation of the anatomy and flow through the aortic valve has a higher reproducibility than echocardiography. Its unique ability of in vivo myocardial tissue characterization, significantly improves the risk stratification and management of patients. In addition, CMR is equivalent to cardiac CT angiography for trans-aortic valvular implantation and surgical aortic valve replacement planning; on the other hand, its role in the evaluation of ventricular function improving and post-treatment complications is undisputed. This review encompasses the existing literature regarding the role of CMR in aortic valve disease, exploring all the aspects of the disease, from diagnosis to prognosis.
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Affiliation(s)
- Gianluca De Rubeis
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | | | - Isabella Ceravolo
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Gian Marco Dacquino
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Carlo Catalano
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences,"Sapienza” University of Rome, Rome, Italy
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Fava AM, Meredith D, Desai MY. Clinical Applications of Echo Strain Imaging: a Current Appraisal. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:50. [PMID: 31473859 DOI: 10.1007/s11936-019-0761-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW This article reviews recent advances in echocardiographic strain imaging, particularly in its ability to prognosticate in cardiovascular outcomes and impact clinical decision making. RECENT FINDINGS Strain has been proposed as a sensitive tool in detecting early ventricular dysfunction. Left ventricular global longitudinal strain (LV-GLS) detects subtle changes in myocardial function, often not quantifiable by ejection fraction alone. Thus, LV-GLS provides the opportunity for early decision-making, and the implementation of more effective treatments, improving outcomes in a variety of diseases such as valvular heart diseases, cardio-oncology, ischemic heart disease, cardiomyopathies, heart transplantation, and pericardial diseases and cardiomyopathies. Strain is a promising tool for the early detection of myocardial dysfunction in patients with preserved left ventricular ejection fraction and can prognosticate long-term outcomes.
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Affiliation(s)
- Agostina M Fava
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Dane Meredith
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA
| | - Milind Y Desai
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, OH, 44195, USA.
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105
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Nicolosi GL, Antonini-Canterin F, Pavan D, Piazza R. Simplified three-dimensional spatial approach for improving confidence in reliably measuring left ventricular linear internal dimensions. J Cardiovasc Med (Hagerstown) 2019; 20:367-371. [PMID: 31045854 DOI: 10.2459/jcm.0000000000000775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
| | | | - Daniela Pavan
- Cardiologia, ARC, Ospedale Civile, San Vito al Tagliamento
| | - Rita Piazza
- Cardiologia, ARC, Ospedale Civile, Pordenone, Italy
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106
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Yang LT, Michelena HI, Scott CG, Enriquez-Sarano M, Pislaru SV, Schaff HV, Pellikka PA. Outcomes in Chronic Hemodynamically Significant Aortic Regurgitation and Limitations of Current Guidelines. J Am Coll Cardiol 2019; 73:1741-1752. [DOI: 10.1016/j.jacc.2019.01.024] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 12/18/2018] [Accepted: 01/07/2019] [Indexed: 12/19/2022]
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107
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Chetrit M, Roujol S, Picard MH, Timmins L, Manning WJ, Rudski LG, Levine RA, Afilalo J. Optimal Technique for Measurement of Linear Left Ventricular Dimensions. J Am Soc Echocardiogr 2019; 32:476-483.e1. [PMID: 30826223 DOI: 10.1016/j.echo.2018.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Echocardiographic assessment of the left ventricle (LV) begins with the measurement of linear dimensions that approximate its ellipsoid diameter. These linear dimensions have historically been measured at the basal level of the LV, which is not representative of its true diameter. The objective of this study was to determine the optimal level to measure LV cavity dimensions to more accurately estimate its size and mass. METHODS The derivation study included 75 patients who had a clinically indicated cardiac magnetic resonance (CMR) exam for ischemic heart disease (n = 15), nonischemic cardiomyopathy (n = 25), or normal studies (n = 35). The three-chamber bright blood cine sequence was analyzed using a custom MATLAB program to measure the LV cavity diameter and wall thickness at 15 equidistant levels from base to apex. The linear measurements from each of these levels were compared against the CMR volumetric reference standard. The validation study included 100 patients who had a clinically indicated echocardiogram and CMR within 3 days for ischemic heart disease (n = 20), nonischemic cardiomyopathy (n = 44), and normal or near-normal studies (n = 36). The parasternal long-axis cine sequence was analyzed to measure the LV cavity diameter and wall thickness at the traditional basal level and the midventricular level, which were compared against the CMR volumetric reference standard. RESULTS In both the derivation and validation studies, the midventricular linear dimensions, defined as those located at the true (maximal) diameter of the LV ellipsoid cavity, were found to be more closely correlated with the volumetric reference standard for LV mass, LV end-diastolic size, and LV ejection fraction. CONCLUSIONS Measurement of linear dimensions at the midventricular level better reflects the ellipsoid geometry of the LV cavity and provides a more accurate estimate of LV mass, size, and systolic function as compared with the traditionally recommended basal level.
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Affiliation(s)
- Michael Chetrit
- Azrieli Heart Center, Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Sébastien Roujol
- School of Biomedical Engineering and Imaging Sciences, King's College, London, United Kingdom; Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michael H Picard
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Logan Timmins
- Faculty of Sciences, Concordia University, Montreal, Quebec, Canada
| | - Warren J Manning
- Departments of Medicine (Cardiovascular Division) and Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Lawrence G Rudski
- Azrieli Heart Center, Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Robert A Levine
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jonathan Afilalo
- Azrieli Heart Center, Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
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Ghorayeb N, Stein R, Daher DJ, Silveira ADD, Ritt LEF, Santos DFPD, Sierra APR, Herdy AH, Araújo CGSD, Colombo CSSDS, Kopiler DA, Lacerda FFRD, Lazzoli JK, Matos LDNJD, Leitão MB, Francisco RC, Alô ROB, Timerman S, Carvalho TD, Garcia TG. The Brazilian Society of Cardiology and Brazilian Society of Exercise and Sports Medicine Updated Guidelines for Sports and Exercise Cardiology - 2019. Arq Bras Cardiol 2019; 112:326-368. [PMID: 30916199 PMCID: PMC6424031 DOI: 10.5935/abc.20190048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Nabil Ghorayeb
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
- Programa de Pós-Graduação em Medicina do Esporte da Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
- Instituto de Assistência Médica ao Servidor Público Estadual (IAMSPE), São Paulo, SP - Brazil
| | - Ricardo Stein
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, RS - Brazil
- Vitta Centro de Bem Estar Físico, Porto Alegre, RS - Brazil
| | - Daniel Jogaib Daher
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
| | - Anderson Donelli da Silveira
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (HCPA/UFRGS), Porto Alegre, RS - Brazil
- Vitta Centro de Bem Estar Físico, Porto Alegre, RS - Brazil
| | - Luiz Eduardo Fonteles Ritt
- Hospital Cárdio Pulmonar, Salvador, BA - Brazil
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brazil
| | | | | | - Artur Haddad Herdy
- Instituto de Cardiologia de Santa Catarina, Florianópolis, SC - Brazil
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
| | | | - Cléa Simone Sabino de Souza Colombo
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
- Sports Cardiology, Cardiology Clinical Academic Group - St George's University of London,14 London - UK
| | - Daniel Arkader Kopiler
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brazil
| | - Filipe Ferrari Ribeiro de Lacerda
- Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares da Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brazil
| | - José Kawazoe Lazzoli
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
- Federação Internacional de Medicina do Esporte (FIMS), Lausanne - Switzerland
| | | | - Marcelo Bichels Leitão
- Sociedade Brasileira de Medicina do Esporte e do Exercício (SBMEE), São Paulo, SP - Brazil
| | - Ricardo Contesini Francisco
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
| | - Rodrigo Otávio Bougleux Alô
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital Geral de São Mateus, São Paulo, SP - Brazil
| | - Sérgio Timerman
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (InCor-FMUSP), São Paulo, SP - Brazil
- Universidade Anhembi Morumbi, Laureate International Universities, São Paulo, SP - Brazil
| | - Tales de Carvalho
- Clínica Cardiosport de Prevenção e Reabilitação, Florianópolis, SC - Brazil
- Departamento de Ergometria e Reabilitação Cardiovascular da Sociedade Brasileira de Cardiologia (DERC/SBC), Rio de Janeiro, RJ - Brazil
- Universidade do Estado de Santa Catarina (UDESC), Florianópolis, SC - Brazil
| | - Thiago Ghorayeb Garcia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brazil
- Hospital do Coração (HCor), Associação do Sanatório Sírio, São Paulo, SP - Brazil
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109
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Doukky R, Golzar Y. Straining for New Prognostic Predictors in Asymptomatic Severe Aortic Regurgitation. JACC Cardiovasc Imaging 2019; 13:22-24. [PMID: 30772225 DOI: 10.1016/j.jcmg.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 01/03/2019] [Accepted: 01/03/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Rami Doukky
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois; Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
| | - Yasmeen Golzar
- Division of Cardiology, Cook County Health and Hospitals System, Chicago, Illinois
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110
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Isselbacher EM, Meyersohn NM, Sarma AA, Spooner AE, Tomaszewski KJ. Case 38-2018: A 54-Year-Old Man with New Heart Failure. N Engl J Med 2018; 379:2362-2372. [PMID: 30575474 DOI: 10.1056/nejmcpc1810386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Eric M Isselbacher
- From the Departments of Medicine (E.M.I., A.A.S., A.E.S.), Radiology (N.M.M.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Medicine (E.M.I., A.A.S., A.E.S.), Radiology (N.M.M.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
| | - Nandini M Meyersohn
- From the Departments of Medicine (E.M.I., A.A.S., A.E.S.), Radiology (N.M.M.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Medicine (E.M.I., A.A.S., A.E.S.), Radiology (N.M.M.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
| | - Amy A Sarma
- From the Departments of Medicine (E.M.I., A.A.S., A.E.S.), Radiology (N.M.M.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Medicine (E.M.I., A.A.S., A.E.S.), Radiology (N.M.M.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
| | - Amy E Spooner
- From the Departments of Medicine (E.M.I., A.A.S., A.E.S.), Radiology (N.M.M.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Medicine (E.M.I., A.A.S., A.E.S.), Radiology (N.M.M.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
| | - Kristen J Tomaszewski
- From the Departments of Medicine (E.M.I., A.A.S., A.E.S.), Radiology (N.M.M.), and Pathology (K.J.T.), Massachusetts General Hospital, and the Departments of Medicine (E.M.I., A.A.S., A.E.S.), Radiology (N.M.M.), and Pathology (K.J.T.), Harvard Medical School - both in Boston
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Abstract
Valvular heart disease is a common clinical problem. Although echocardiography is the standard technique for the noninvasive evaluation of the valves, cardiac CT has evolved to become a useful tool in the evaluation of the cardiac structures as well. Importantly, CT allows for improved quantification of valvular calcification due to its superior spatial resolution. It may improve the detection of small valvular or perivalvular pathology or the characterization of valvular masses and vegetations. This review describes the assessment of normal and diseased heart valves by cardiac CT and discusses its strengths and weaknesses.
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112
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McConkey H, Zhao Z, Redwood S, Chen M, Prendergast BD. Timing and mode of intervention for patients with left sided valvular heart disease: an individualized approach. PRECISION CLINICAL MEDICINE 2018; 1:118-128. [PMID: 35692702 PMCID: PMC8985789 DOI: 10.1093/pcmedi/pby017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/20/2018] [Accepted: 11/20/2018] [Indexed: 02/05/2023] Open
Abstract
Left sided valvular heart disease poses major impact on life and lifestyle. Medical therapy merely palliates chronic severe valve disease and once symptoms or haemodynamic sequelae appear, life expectancy is markedly truncated. In this article, we review the mechanisms of valve pathology, latest evidence in the quest for pharmacological options, means by which to predict deterioration, and standard and novel treatment options.
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Affiliation(s)
- Hannah McConkey
- King’s College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital Campus, London, United Kingdom, and the Department of Cardiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Zhengang Zhao
- Department of Cardiology, West China Hospital, Sichuan University
| | - S Redwood
- King’s College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital Campus, London, United Kingdom, and the Department of Cardiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - M Chen
- Department of Cardiology, West China Hospital, Sichuan University
| | - B D Prendergast
- King’s College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas’ Hospital Campus, London, United Kingdom, and the Department of Cardiology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
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113
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Barbieri A, Giubertoni E, Bartolacelli Y, Bursi F, Manicardi M, Boriani G. New classification of geometric patterns considering left ventricular volume in patients with chronic aortic valve regurgitation: Prevalence and association with adverse cardiovascular outcomes. Echocardiography 2018; 36:38-46. [PMID: 30407661 DOI: 10.1111/echo.14190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/23/2018] [Accepted: 10/11/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Left ventricular (LV) remodeling due to aortic regurgitation (AR) often leads to maladaptive responses. We assessed the prevalence and clinical implications of LV remodeling considering LV volume, mass, and relative wall thickness at the time of AR diagnosis. METHODS AND RESULTS Between 2008 and 2017, 370 consecutive patients (mean age 67.3 ± 16.1 years, 56.5% males), with moderate or severe AR, were retrospectively analyzed. LV geometric patterns and clinical outcomes (cardiovascular death, hospitalization for heart failure, or aortic valve replacement) were evaluated. LV dilatation (LV end-diastolic volume >75 mL/m2 ) was present in 228 patients (61.6%). Applying the new LV remodeling classification system, 40 (10.8%) patients had normal geometry, 14 (3.8%) concentric remodeling, 43 (11.6%) concentric hypertrophy (LVH), 45 (12.2%) indeterminate LVH, 38 (10.3%) mixed LVH, 93 (25.1%) dilated LVH, 54 (14.6%) eccentric LVH, and 43 (11.6%) eccentric remodeling. During a median follow-up of 3.48 years (25th-75th percentile 0.91-5.57), 97 (26.2%) had the combined endpoint. LV dilation (P < 0.001), LVH (P < 0.001), and LV remodeling patterns were significantly associated with the combined endpoint. After multivariable adjustment for age, EF, aortic stenosis, CAD history, and moderate mitral regurgitation, dilated LVH (HR 7.61, IC 95% 1.82-31.80; P = 0.005) and eccentric LVH (HR 7.91, IC 95% 1.82-34.38; P = 0.006) were associated with adverse outcome compared to eccentric remodeling, that showed the best event-free survival rate. CONCLUSIONS In a contemporary cohort of patients with AR, applying the new LV remodeling classification system, only a minority had normal geometry. Dilated LVH and eccentric LVH showed distinct outcome penalty after adjustment for confounders.
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Affiliation(s)
- Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Giubertoni
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Ylenia Bartolacelli
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Bursi
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy.,Division of Cardiology, San Paolo Hospital, Heart and Lung Department, ASST Santi Paolo and Carlo, University of Milan, Milan, Italy
| | - Marcella Manicardi
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Boriani
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
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114
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Ejection Fraction Pros and Cons. J Am Coll Cardiol 2018; 72:2360-2379. [DOI: 10.1016/j.jacc.2018.08.2162] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/06/2018] [Accepted: 08/09/2018] [Indexed: 12/18/2022]
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115
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Abstract
Valvular heart disease is a major public health issue. The prevalence of valvular heart disease is expected to increase due to an aging population. Valve dysfunction manifests as valve stenosis, regurgitation, or both due to various etiologies. Valve repair and replacement are the main treatment options for severe valve dysfunction. Valve replacement is achieved by using either a mechanical or a bioprosthetic valve. Mechanical valves are more durable but require lifelong anticoagulation with associated complications. Bioprosthetic valves usually require anticoagulation only transiently after implantation but are less durable and degenerate more rapidly. In this article, we discuss antithrombotic regimens in persons after valve operations. We discuss general issues and antithrombotic recommendations for patients undergoing surgical bioprosthetic valve replacement, mechanical valve replacement (including different regimens for different positions and types of mechanical valves), mitral valve repair, and transcatheter aortic valve replacement. In addition, we discuss the antithrombotic management of patients in special circumstances, including patients with mechanical valves who have recurrent bleeding or thrombotic events, patients with mechanical valves undergoing surgery, and pregnant women with mechanical valves.
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116
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Popović ZB, Desai MY, Griffin BP. Decision Making With Imaging in Asymptomatic Aortic Regurgitation. JACC Cardiovasc Imaging 2018; 11:1499-1513. [DOI: 10.1016/j.jcmg.2018.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/07/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
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117
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De Backer O, Pilgrim T, Simonato M, Mackensen GB, Fiorina C, Veulemanns V, Cerillo A, Schofer J, Amabile N, Achkouty G, Schäfer U, Deutsch MA, Sinning JM, Rahman MS, Sawaya FJ, Hildick-Smith D, Hernandez JM, Kim WK, Lefevre T, Seiffert M, Bleiziffer S, Petronio AS, Van Mieghem N, Taramasso M, Søndergaard L, Windecker S, Latib A, Dvir D. Usefulness of Transcatheter Aortic Valve Implantation for Treatment of Pure Native Aortic Valve Regurgitation. Am J Cardiol 2018; 122:1028-1035. [PMID: 30072124 DOI: 10.1016/j.amjcard.2018.05.044] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/17/2018] [Accepted: 05/23/2018] [Indexed: 11/30/2022]
Abstract
Patients with pure native aortic valve regurgitation (NAVR) and increased surgical risk are often denied surgery. This retrospective study aimed to evaluate the "off-label" use of transcatheter heart valves (THV) for the treatment of NAVR. A total of 254 high surgical risk patients with NAVR (age 74 ± 12 years, Society of Thoracic Surgeons risk score 6.6 ± 6.2%) underwent transcatheter aortic valve implantation (TAVI) with early generation (43%) or newer generation (57%) devices at 46 different sites. Device success was significantly higher in patients treated with newer as compared with early generation THV (82% vs 47%, p <0.001). The difference was driven by lower rates of device malpositioning (9% vs 33%) and aortic regurgitation (AR) ≥ moderate (4% vs 31%) and translated into higher clinical efficacy at 30 days in patients treated with newer as compared with early generation THV (72% vs 56%, p = 0.041). Both THV under- and oversizing were associated with an increased risk of THV malpositioning. In conclusion, TAVI is a feasible treatment strategy in selected high-risk patients with NAVR but is associated with a considerable risk of THV malpositioning and residual AR. Although newer-generation THV are associated with better outcomes, novel devices for the treatment of NAVR are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Guy Achkouty
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrich Schäfer
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Mohammed S Rahman
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | | | - David Hildick-Smith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | - Danny Dvir
- University of Washington Medical Center, Seattle, Washington
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Borer JS, Supino PG, Herrold EM, Innasimuthu A, Hochreiter C, Krieger K, Girardi LN, Isom OW. Survival after Aortic Valve Replacement for Aortic Regurgitation: Prediction from Preoperative Contractility Measurement. Cardiology 2018; 140:204-212. [PMID: 30138945 DOI: 10.1159/000490848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Noninvasive measurement of myocardial contractility (end-systolic wall stress-adjusted change in left ventricular ejection fraction from rest to exercise [ΔLVEF - ΔESS]) predicts heart failure, subnormal LVEFrest, and sudden death in asymptomatic patients with chronic severe aortic regurgitation (AR). Here we assess the relation of preoperative ΔLVEF - ΔESS to survival after aortic valve replacement (AVR). METHODS Patients who underwent AVR for chronic, isolated, pure severe AR (n = 66) were followed for 13.0 ± 6.4 event-free years. Preoperative ΔLVEF - ΔESS (from combined echocardiographic and radionuclide cineangiographic data) enabled cohort stratification into 3 terciles (-1 to -11% [normal or mild] contractility deficit, -12 to -16% [moderate], and ≤-17% [severe], identical with segregation in our earlier study) to relate preoperative contractility to postoperative survival and to age- and gender-matched US census data. RESULTS Since AVR, 22 patients died (average annual risk [AAR] for all-cause mortality for the entire co hort = 3.15%). Preoperative ΔLVEF - ΔESS predicted postoperative survival (p = 0.009, log rank test). By contractility terciles, all-cause AARs were 1.44, 2.58, and 6.40%. Survival was lower than among US census comparators (p < 0.02), but the "mild" tercile was indistinguishable from census data (p = ns). By multivariable Cox regression, survival prediction by pre-AVR ΔLVEF - ΔESS was independent of, and superior to, prediction by age at surgery, gender, preoperative functional class, LVEFrest, LVEFexercise, change in LVEFrest to exercise, and LV diastolic or systolic dimensions (p ≤ 0.01, pre-AVR ΔLVEF - ΔESS vs. other covariates). CONCLUSION In severe AR, preoperative contractility predicts post-AVR survival and may be prognostically superior to clinical, geometric and performance descriptors, potentially impacting on patient selection for surgery.
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Affiliation(s)
- Jeffrey S Borer
- Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart Valve Disease, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Phyllis G Supino
- Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart Valve Disease, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Edmund McM Herrold
- Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart Valve Disease, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Antony Innasimuthu
- Division of Cardiovascular Medicine and The Howard Gilman Institute for Heart Valve Disease, State University of New York Downstate Medical Center, Brooklyn, New York, USA
| | - Clare Hochreiter
- Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York, USA
| | - Karl Krieger
- Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York, USA
| | - O Wayne Isom
- Department of Cardiothoracic Surgery, Weill Medical College of Cornell University, New York, New York, USA
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Verseckaite R, Mizariene V, Montvilaite A, Auguste I, Bieseviciene M, Laukaitiene J, Jonkaitiene R, Jurkevicius R. The predictive value of left ventricular myocardium mechanics evaluation in asymptomatic patients with aortic regurgitation and preserved left ventricular ejection fraction. A long-term speckle-tracking echocardiographic study. Echocardiography 2018; 35:1277-1288. [DOI: 10.1111/echo.14030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Raimonda Verseckaite
- Department of Cardiology; Hospital of Lithuanian University of Health Sciences; Kaunas Clinics; Kaunas Lithuania
| | - Vaida Mizariene
- Department of Cardiology; Hospital of Lithuanian University of Health Sciences; Kaunas Clinics; Kaunas Lithuania
| | - Aiste Montvilaite
- Department of Cardiology; Hospital of Lithuanian University of Health Sciences; Kaunas Clinics; Kaunas Lithuania
| | - Indre Auguste
- Department of Cardiology; Hospital of Lithuanian University of Health Sciences; Kaunas Clinics; Kaunas Lithuania
| | - Monika Bieseviciene
- Department of Cardiology; Hospital of Lithuanian University of Health Sciences; Kaunas Clinics; Kaunas Lithuania
| | - Jolanta Laukaitiene
- Department of Cardiology; Hospital of Lithuanian University of Health Sciences; Kaunas Clinics; Kaunas Lithuania
| | - Regina Jonkaitiene
- Department of Cardiology; Hospital of Lithuanian University of Health Sciences; Kaunas Clinics; Kaunas Lithuania
| | - Renaldas Jurkevicius
- Department of Cardiology; Hospital of Lithuanian University of Health Sciences; Kaunas Clinics; Kaunas Lithuania
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Effects of the cardiac myosin activator Omecamtiv-mecarbil on severe chronic aortic regurgitation in Wistar rats. BMC Cardiovasc Disord 2018; 18:99. [PMID: 29783950 PMCID: PMC5963065 DOI: 10.1186/s12872-018-0831-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/07/2018] [Indexed: 01/10/2023] Open
Abstract
Background Aortic regurgitation (AR) is a valvular disease that can lead to systolic heart failure. Treatment options besides cardiac surgery are limited and consequently severe AR is associated with higher mortality and morbidity when not operated. In this investigation, we examined the effects of a novel cardiac myosin activator, Omecamtiv-mecarbil (OM), in rats with chronic severe AR. Methods AR was created by retrograde puncture of the aortic valve leaflets in 20 adults Wistar rats. 12 animals survived the acute AR phase and were randomized 2 months thereafter into OM (n = 7) or placebo groups (n = 5). Two rats underwent a sham operation and served as controls. Equal volumes of OM or placebo (NaCl 0.9%) were perfused in the femoral vein by continuous infusion (1.2 mg/kg/hour) during 30 min. Doppler-echocardiography was performed before and at the end of the infusion periods. Results OM increased indices of global cardiac function (cardiac output, stroke volume), and increased systolic performance (fractional shortening, ejection fraction, left ventricular end systolic diameter) (all p < 0.05). These effects concurred with decreases in indices of LV preload (left atrial size, left ventricular end diastolic diameter) as well in the aortic pre-ejection period / left ventricular ejection time ratio (all p < 0.05). The severity score of the regurgitant AR jet did not change. Placebo infusion did not affect these parameters. Conclusion The cardiac myosin activator OM exerts favorable hemodynamic effects in rats with experimental chronic AR.
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Leitlinie „Management von Herzklappenerkrankungen“ der EACTS und ESC – Version 2017. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2018. [DOI: 10.1007/s00398-017-0192-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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123
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Bob-Manuel T, Kadire S, Heckle MR, Wang J, Ibebuogu UN. Outcomes following transcatheter aortic valve replacement in patients with native aortic valve regurgitation. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:8. [PMID: 29404354 DOI: 10.21037/atm.2017.09.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Due to the absence of annular calcification for device anchoring, it is presumed that transcatheter aortic valve replacement (TAVR) is not suitable for the treatment of native aortic valve regurgitation (NAVR) resulting in very limited data and experience concerning its safety and efficacy. We sought to review published data on the safety and efficacy of TAVR in high-risk patients with NAVR. Studies including case reports, case series and original articles published between 2002 and 2016 on TAVR in patients with NAVR were identified with a systematic electronic search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Only studies reporting data on demographic and procedural characteristics, management and follow up outcomes were analyzed. A total of 30 publications describing 182 patients were identified. Most patients (54%) were men, with a mean age of 70.1±2.6 years, mean logistic European System for Cardiac Operative Risk Evaluation score (EuroSCORE) of 21.8%±4.5% and mean Society of Thoracic Surgeons (STS) score of 8%±1.8% for mortality. The majority (87%) of patients had severe NAVR with no valvular calcification. TAVR was mostly performed through the femoral (58.8%) and apical (33.1%) approach. Device success, defined by VARC-2, was achieved in 86.3% of our study population. A second valve was required in 17 patients (9.3%) during the index procedure for residual aortic regurgitation or malposition. Post-procedure aortic regurgitation of grade 1 or less was present in 80 patients (81%). Pacemaker implantation was required post procedure in 17 patients (9.3%). The 30-day and 1-year mortality was 11.9% and 16.2%, respectively. TAVR is associated with favorable pacemaker implantation and 1-year mortality rates with a high 30-day mortality among selected patients with NAVR.
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Affiliation(s)
- Tamunoinemi Bob-Manuel
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Memphis, TN, USA
| | - Siri Kadire
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Memphis, TN, USA
| | - Mark R Heckle
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Memphis, TN, USA
| | - Jiajing Wang
- Division of Biostatistics & Epidemiology, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center/Methodist University Hospital, Memphis, TN, USA
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McConkey HZ, Rajani R, Prendergast BD. Improving outcomes in chronic aortic regurgitation: timely diagnosis, access to specialist assessment and earlier surgery. Heart 2017; 104:794-795. [PMID: 29122929 DOI: 10.1136/heartjnl-2017-312518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Hannah Zr McConkey
- King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital Campus, London, UK.,Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Ronak Rajani
- King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital Campus, London, UK.,Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Bernard D Prendergast
- King's College London British Heart Foundation Centre of Excellence, The Rayne Institute, St. Thomas' Hospital Campus, London, UK.,Department of Cardiology, Guy's and St. Thomas' NHS Foundation Trust, London, UK
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Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38:2739-2791. [PMID: 28886619 DOI: 10.1093/eurheartj/ehx391] [Citation(s) in RCA: 4260] [Impact Index Per Article: 608.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, Roffi M, Alfieri O, Agewall S, Ahlsson A, Barbato E, Bueno H, Collet JP, Coman IM, Czerny M, Delgado V, Fitzsimons D, Folliguet T, Gaemperli O, Habib G, Harringer W, Haude M, Hindricks G, Katus HA, Knuuti J, Kolh P, Leclercq C, McDonagh TA, Piepoli MF, Pierard LA, Ponikowski P, Rosano GM, Ruschitzka F, Shlyakhto E, Simpson IA, Sousa-Uva M, Stepinska J, Tarantini G, Tchétché D, Aboyans V. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2017; 52:616-664. [DOI: 10.1093/ejcts/ezx324] [Citation(s) in RCA: 429] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Badiani S, van Zalen J, Saheecha S, Hart L, Topham A, Patel N, Sturridge L, Marshall A, Sulke N, Furniss S, Lloyd G. Clinical events and echocardiographic lesion progression rate in subjects with mild or moderate aortic regurgitation. Echo Res Pract 2017; 4:37-44. [PMID: 28611061 PMCID: PMC5516543 DOI: 10.1530/erp-17-0002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/13/2017] [Indexed: 11/08/2022] Open
Abstract
Background: The rate of progression of aortic regurgitation (AR) is not well described. Current guidelines state that asymptomatic patients with mild AR should be followed up every 3–5 years and 1–2 yearly for moderate AR. This study describes the lesion and clinical based progression of mild and moderate AR in a population of patients undergoing systematic follow-up. Methods and results: 341 patients with either mild or moderate AR were included. The rates of clinical events (death, aortic valve replacement and cardiac hospitalization) and progression of AR are reported. 341 patients were included; mean age was 71.1 years (IQR 66–80 years) and the median follow-up period was 4.6 (IQR 2–6.7) years. 292 patients did not have any events during follow-up. 3 patients required aortic valve replacement (2 of these due to severe aortic stenosis and 1 due to severe mitral regurgitation and co-existent moderate AR). 44 patients required cardiac hospitalization. 9 patients died during follow-up and 35 patients (10%) showed a progression of AR during follow-up with an average time of 4.0 ± 2.6 years. 8 patients (2.3% of the total) progressed to severe AR. Patients with mixed valvular pathology showed a greater increase in AR progression (27 (15%) vs 8 (5%); P = 0.004). Conclusions: Over medium term systematic follow-up progression and clinical events in patients with AR is rare, regardless of etiology. Patients who suffered from AR as an isolated valve pathology were less likely to show AR progression over time.
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Affiliation(s)
- Sveeta Badiani
- East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, East Sussex, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Jet van Zalen
- East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, East Sussex, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
| | - Saad Saheecha
- East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, East Sussex, UK
| | - Lesley Hart
- East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, East Sussex, UK
| | - Ann Topham
- East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, East Sussex, UK
| | - Nikhil Patel
- East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, East Sussex, UK
| | | | - Andrew Marshall
- East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, East Sussex, UK
| | - Neil Sulke
- East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, East Sussex, UK
| | - Stephen Furniss
- East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, East Sussex, UK
| | - Guy Lloyd
- East Sussex Healthcare NHS Trust, Eastbourne District General Hospital, East Sussex, UK
- Barts Heart Centre, St Bartholomew’s Hospital, London, UK
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Mǎrgulescu AD. Assessment of aortic valve disease - a clinician oriented review. World J Cardiol 2017; 9:481-495. [PMID: 28706584 PMCID: PMC5491466 DOI: 10.4330/wjc.v9.i6.481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/11/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023] Open
Abstract
Aortic valve disease [aortic stenosis (AS) and aortic regurgitation (AR)] represents an important global health problem; when severe, aortic valve disease carries poor prognosis. For AS, aortic valve replacement, either surgical or interventional, may provide definite treatment in carefully selected patients. For AR, valve surgery (either replacement or - in selected cases - aortic valve repair) remains the gold standard of care. To properly identify those patients who are candidates for surgery, the clinician has to carefully assess the severity of valve disease with an understanding of the potential pitfalls involved in these assessments. This review focuses on the practical issues concerning the evaluation of patients with AS and AR from a general cardiologist’s perspective. The most important issues regarding the documentation of the severity of AS and AR are summarized. More specific issues, such as the role of stress echocardiography, other imaging techniques and details regarding the treatment options (medical, surgical, or interventional), are mentioned briefly.
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Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Chronic Aortic Regurgitation and Preserved Left Ventricular Ejection Fraction. JACC Cardiovasc Imaging 2017. [PMID: 28624411 DOI: 10.1016/j.jcmg.2017.02.016] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study sought to examine the prognostic utility of left ventricular (LV) global longitudinal strain (GLS) in asymptomatic patients with ≥III+ aortic regurgitation (AR), an indexed LV end-systolic dimension of <2.5 cm/m2, and preserved left ventricular ejection fraction (LVEF). BACKGROUND Management of asymptomatic patients with severe chronic AR and preserved LVEF is challenging and is typically based on LV dimensions. METHODS We studied 1,063 such patients (age 53 ± 16 years; 77% men) seen between 2003 and 2010 (excluding those with symptoms, obstructive coronary artery disease, acute AR/dissection, aortic/mitral stenosis, more than moderate mitral regurgitation, and previous cardiac surgery). Society of Thoracic Surgeons (STS) score was calculated. The primary endpoint was mortality. Average resting LV-GLS was measured offline on 2-, 3-, and 4-chamber views using Velocity Vector Imaging (Siemens, Malvern, Pennsylvania). RESULTS Mean STS score, LVEF, LV-GLS, and right ventricular systolic pressure were 4.4 ± 5.0%, 57.0 ± 4.0%, -19.5 ± 0.2%, and 31.0 ± 9.0 mm Hg, respectively. In total, 671 patients (63%) underwent aortic valve surgery at a median of 42 days after the initial evaluation. At 6.8 ± 3.0 years, 146 patients (14%) had died. On multivariable Cox survival analysis, LV-GLS (hazard ratio [HR]: 1.11), STS score (HR: 1.51), indexed LV end-systolic dimension (HR: 0.50), right ventricular systolic pressure (HR: 1.33), and aortic valve surgery (HR: 0.35) were associated with longer term mortality (all p < 0.001). Sequential addition of LV-GLS and aortic valve surgery improved the C-statistic for longer term mortality for the clinical model (STS score + right ventricular systolic pressure + indexed LV end-systolic dimension) from 0.61 (95% confidence interval [CI]: 0.51 to 0.72) to 0.67 (95% CI: 0.54 to 0.87) and to 0.77 (95% CI: 0.63 to 0.90), respectively (p < 0.001 for both). A significantly higher proportion (log-rank p = 0.01) of patients with LV-GLS worse than median (-19.5%) died versus those with an LV-GLS better than median (86 of 513 [17%] vs. 60 of 550 [11%]). The risk of death at 5 years significantly increased with an LV-GLS of worse than -19%. CONCLUSIONS In asymptomatic patients with ≥III+ chronic AR and preserved LVEF, worsening LV-GLS was associated with longer term mortality, providing incremental prognostic value and improved reclassification.
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Egbe AC, Luis SA, Padang R, Warnes CA. Outcomes in Moderate Mixed Aortic Valve Disease: Is it Time for a Paradigm Shift? J Am Coll Cardiol 2017; 67:2321-2329. [PMID: 27199054 DOI: 10.1016/j.jacc.2016.03.509] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND A direct comparison of outcomes between moderate mixed aortic valve disease (MAVD) and isolated aortic stenosis (AS) or aortic regurgitation (AR) has not been performed, making evidence-based recommendations difficult in patients with MAVD. OBJECTIVES This study sought to determine adverse event (AE) occurrence (the primary endpoint), defined as New York Heart Association functional class III/IV symptoms, aortic valve replacement, or cardiac death, and to compare AE rates between MAVD and isolated AS or AR. METHODS Asymptomatic patients were identified with moderate MAVD and an ejection fraction ≥50% and were followed at Mayo Clinic from 1994 to 2013. Moderate MAVD was defined as a combination of moderate AS and moderate AR. Age- and sex-matched control groups were selected with isolated moderate AR (n = 117), moderate AS (n = 117), or severe AS (n = 117). RESULTS At 9.1 ± 4.2 years of follow-up, patients with moderate MAVD (n = 251) had a mean age of 63 ± 11 years, 73% were male, and 38% had bicuspid valve. AE occurred in 193 (77%) patients in this group, including symptom development (69%), aortic valve replacement (67%), and cardiac death (4%). Predictors of AE were older age (hazard ratio [HR]: 1.71 per decade; 95% confidence interval [CI]: 1.38 to 1.97 per decade; p = 0.001), and relative wall thickness >0.42 (HR: 2.01; 95% CI: 1.86 to 2.33; p = 0.002). AE rates were similar in the MAVD and severe AS group (71% vs. 68% at 5 years; p = 0.49), but were significantly higher compared with the moderate AS and AR groups. CONCLUSIONS MAVD patients had outcomes comparable to those with severe AS, and preserved ejection fraction and should be monitored closely for symptoms.
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Affiliation(s)
- Alexander C Egbe
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Sushil A Luis
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Ratnasari Padang
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Carole A Warnes
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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Kaneko H, Hoelschermann F, Schau T, Tambor G, Neuss M, Butter C. Different impact of aortic regurgitation assessed by aortic root angiography after transcatheter aortic valve implantation according to baseline left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide. Cardiovasc Interv Ther 2017; 33:232-238. [DOI: 10.1007/s12928-017-0473-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
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132
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Safety and Efficacy of Transcatheter Aortic Valve Replacement in the Treatment of Pure Aortic Regurgitation in Native Valves and Failing Surgical Bioprostheses. JACC Cardiovasc Interv 2017; 10:1048-1056. [DOI: 10.1016/j.jcin.2017.03.004] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/27/2017] [Accepted: 03/03/2017] [Indexed: 11/19/2022]
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Andell P, Li X, Martinsson A, Andersson C, Stagmo M, Zöller B, Sundquist K, Smith JG. Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study. Heart 2017; 103:1696-1703. [PMID: 28432156 PMCID: PMC5749343 DOI: 10.1136/heartjnl-2016-310894] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 03/14/2017] [Accepted: 03/16/2017] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Transitions in the spectrum of valvular heart diseases (VHDs) in developed countries over the 20th century have been reported from clinical case series, but large, contemporary population-based studies are lacking. METHODS We used nationwide registers to identify all patients with a first diagnosis of VHD at Swedish hospitals between 2003 and 2010. Age-stratified and sex-stratified incidence of each VHD and adjusted comorbidity profiles were assessed. RESULTS In the Swedish population (n=10 164 211), the incidence of VHD was 63.9 per 100 000 person-years, with aortic stenosis (AS; 47.2%), mitral regurgitation (MR; 24.2%) and aortic regurgitation (AR; 18.0%) contributing most of the VHD diagnoses. The majority of VHDs were diagnosed in the elderly (68.9% in subjects aged ≥65 years), but pulmonary valve disease incidence peaked in newborns. Incidences of AR, AS and MR were higher in men who were also more frequently diagnosed at an earlier age. Mitral stenosis (MS) incidence was higher in women. Rheumatic fever was rare. Half of AS cases had concomitant atherosclerotic vascular disease (48.4%), whereas concomitant heart failure and atrial fibrillation were common in mitral valve disease and tricuspid regurgitation. Other common comorbidities were thoracic aortic aneurysms in AR (10.3%), autoimmune disorders in MS (24.5%) and abdominal hernias or prolapse in MR (10.7%) and TR (10.3%). CONCLUSIONS Clinically diagnosed VHD was primarily a disease of the elderly. Rheumatic fever was rare in Sweden, but specific VHDs showed a range of different comorbidity profiles . Pronounced sex-specific patterns were observed for AR and MS, for which the mechanisms remain incompletely understood.
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Affiliation(s)
- Pontus Andell
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Andreas Martinsson
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Charlotte Andersson
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Martin Stagmo
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
| | - Bengt Zöller
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | | | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden.,Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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134
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Harris AW, Krieger EV, Kim M, Cawley PJ, Owens DS, Hamilton-Craig C, Maki J, Otto CM. Cardiac Magnetic Resonance Imaging Versus Transthoracic Echocardiography for Prediction of Outcomes in Chronic Aortic or Mitral Regurgitation. Am J Cardiol 2017; 119:1074-1081. [PMID: 28153348 DOI: 10.1016/j.amjcard.2016.12.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
Abstract
In subjects with aortic regurgitation (AR) or mitral regurgitation (MR), transthoracic echocardiography (TTE) is recommended for surveillance. Few prospective studies have directly compared the ability of TTE and cardiac magnetic resonance (CMR) to predict clinical outcomes in AR and MR. We hypothesized that, given its higher reproducibility, CMR would predict the need for valve surgery or heart failure (HF) hospitalization better than TTE. Quantitative TTE and CMR were performed on the same day for 51 subjects: 29 with chronic AR and 22 with chronic, primary MR for quantification of valve regurgitation. Baseline measurements of valve regurgitation were compared to the combined primary end point of new HF and valve surgery using receiver operating characteristics, simple logistic regression, and Kaplan-Meier survival analyses. The primary end point occurred in 5 AR subjects (all surgery) and 8 MR subjects (7 surgery, 1 HF) after a mean follow-up of 4.4 ± 1.5 years. For AR, CMR-derived regurgitant volume >50 ml identified those at high risk with 50% undergoing valve surgery versus 0% for those with regurgitant volume ≤50 ml and was more strongly associated with outcomes than regurgitant volume by TTE (p <0.05). For MR, 6.8% of those with regurgitant volume by TTE ≤30 ml developed the primary end point versus 70% in those with regurgitant volume >30 ml. Regurgitant volume by CMR showed no significant separation of survival curves for MR. In conclusion, regurgitant volume by CMR was more predictive of outcomes than by TTE in subjects with AR. In MR, the 2 methods performed similarly.
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135
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Hulshof HG, van Dijk AP, George KP, Hopman MTE, Thijssen DHJ, Oxborough DL. Exploratory assessment of left ventricular strain-volume loops in severe aortic valve diseases. J Physiol 2017; 595:3961-3971. [PMID: 28117492 DOI: 10.1113/jp273526] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/18/2017] [Indexed: 12/31/2022] Open
Abstract
KEY POINTS Severe aortic valve diseases are common cardiac abnormalities that are associated with poor long-term survival. Before any reduction in left ventricular (LV) function, the left ventricle undergoes structural remodelling under the influence of changing haemodynamic conditions. In this study, we combined temporal changes in LV structure (volume) with alterations in LV functional characteristics (strain, ԑ) into a ԑ-volume loop, in order to provide novel insight into the haemodynamic cardiac consequences of aortic valve diseases in those with preserved LV ejection fraction. We showed that our novel ԑ-volume loop and the specific loop characteristics provide additional insight into the functional and mechanical haemodynamic consequences of severe aortic valve diseases (with preserved LV ejection fraction). Finally, we showed that the ԑ-volume loop characteristics provide discriminative capacity compared with conventional measures of LV function. ABSTRACT The purpose of this study was to examine left ventricular (LV) strain (ԑ)-volume loops to provide novel insight into the haemodynamic cardiac consequences of aortic valve stenosis (AS) and aortic valve regurgitation (AR). Twenty-seven participants were retrospectively recruited: AR (n = 7), AS (n = 10) and control subjects (n = 10). Standard transthoracic echocardiography was used to obtain apical four-chamber images to construct ԑ-volume relationships, which were assessed using the following parameters: early systolic ԑ (ԑ_ES); slope of ԑ-volume relationship during systole (Sslope); end-systolic peak ԑ (peak ԑ); and diastolic uncoupling (systolic ԑ-diastolic ԑ at same volume) during early diastole (UNCOUP_ED) and late diastole (UNCOUP_LD). Receiver operating characteristic curves were used to determine the ability to detect impaired LV function. Although LV ejection fraction was comparable between groups, longitudinal peak ԑ was reduced compared with control subjects. In contrast, ԑ_ES and Sslope were lower in both pathologies compared with control subejcts (P < 0.01), but also different between AS and AR (P < 0.05). UNCOUP_ED and UNCOUP_LD were significantly higher in both patient groups compared with control subjects (P < 0.05). Receiver operating characteristic curves revealed that loop characteristics (AUC = 0.99, 1.00 and 1.00; all P < 0.01) were better able then peak ԑ (AUC = 0.75, 0.89 and 0.76; P = 0.06, <0.01 and 0.08, respectively) and LV ejection fraction (AUC = 0.56, 0.69 and 0.69; all P > 0.05) to distinguish AS vs control, AR vs control and AS vs AR groups, respectively. Temporal changes in ԑ-volume characteristics provide novel insight into the haemodynamic cardiac impact of AS and AR. Contrary to traditional measures (i.e. ejection fraction, peak ԑ), these novel measures successfully distinguish between the haemodynamic cardiac impact of AS and AR.
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Affiliation(s)
- Hugo G Hulshof
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arie P van Dijk
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Keith P George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Maria T E Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dick H J Thijssen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David L Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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136
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Abstract
OPINION STATEMENT Chronic aortic regurgitation can result from various congenital and acquired anomalies and can be associated with proximal aortic disease. As the number of aortic valve procedures is growing, the incidence of post-procedural regurgitation also increases with associated morbidity. Typical evolution is characterized by a clinically silent phase of variable duration followed by a rather rapid decline with high incidence of adverse events. A challenge remains to find the optimal timing for an intervention: Patients are exposed to unnecessary surgical risks if treated prematurely, but peri- and post-operative prognosis is worse when the intervention is performed too late. Clinical evaluation and serial imaging tests can optimize the timing for intervention. Clinical follow-up should try to elucidate associated symptoms, with quantitative measurement of functional capacity as needed. Serial imaging examinations are required to identify sub-clinical left ventricular dysfunction or severe dilatation that should prompt a surgery. At least in selected cases, newer imaging modalities (MRI, 3D echocardiography) and/or biomarkers can help for the management of these patients, and more research is needed to determine if their systematic use can be beneficial. Medical treatment with vasodilators and anti-remodeling drugs can be helpful in some patients but should not replace or delay aortic valve surgery when indicated. Most patients will eventually be treated with surgical aortic valve replacement. Although possible in selected cases, transcatheter aortic valve replacement is not commonly used for patients with pure aortic regurgitation. For patients with prior aortic valve replacement and aortic regurgitation (paravalvular or intravalvular), emerging percutaneous approaches can be considered when available, especially for those at high surgical risk.
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137
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Bertrand A, Legrand C, Carroll RJ, De Meester C, Van Keilegom I. Inference in a survival cure model with mismeasured covariates using a simulation-extrapolation approach. Biometrika 2017; 104:31-50. [PMID: 29151774 DOI: 10.1093/biomet/asw054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In many situations in survival analysis, it may happen that a fraction of individuals will never experience the event of interest: they are considered to be cured. The promotion time cure model takes this into account. We consider the case where one or more explanatory variables in the model are subject to measurement error, which should be taken into account to avoid biased estimators. A general approach is the simulation-extrapolation algorithm, a method based on simulations which allows one to estimate the effect of measurement error on the bias of the estimators and to reduce this bias. We extend this approach to the promotion time cure model. We explain how the algorithm works, and we show that the proposed estimator is approximately consistent and asymptotically normally distributed, and that it performs well in finite samples. Finally, we analyse a database in cardiology: among the explanatory variables of interest is the ejection fraction, which is known to be measured with error.
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Affiliation(s)
- Aurelie Bertrand
- Institute of Statistics, Biostatistics and Actuarial Sciences, Université catholique de Louvain, Voie du Roman Pays 20, 1348 Louvain-la-Neuve, Belgium
| | - Catherine Legrand
- Institute of Statistics, Biostatistics and Actuarial Sciences, Université catholique de Louvain, Voie du Roman Pays 20, 1348 Louvain-la-Neuve, Belgium
| | - Raymond J Carroll
- Department of Statistics, Texas A&M University, College Station, 447 Blocker Building, Texas 77843-3143, U.S.A
| | - Christophe De Meester
- Cardiovascular Research Group, Institute of Experimental and Clinical Research, Université catholique de Louvain, Avenue Hippocrate 55, 1200 Brussels, Belgium
| | - Ingrid Van Keilegom
- Institute of Statistics, Biostatistics and Actuarial Sciences, Université catholique de Louvain, Voie du Roman Pays 20, 1348 Louvain-la-Neuve, Belgium
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138
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Wang Y, Jiang W, Liu J, Li G, Liu Y, Hu X, Dong N. Early surgery versus conventional treatment for asymptomatic severe aortic regurgitation with normal ejection fraction and left ventricular dilatation. Eur J Cardiothorac Surg 2017; 52:118-124. [DOI: 10.1093/ejcts/ezx018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/20/2016] [Indexed: 11/14/2022] Open
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139
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Egbe AC, Warnes CA. Predictor of left ventricular dysfunction after aortic valve replacement in mixed aortic valve disease. Int J Cardiol 2017; 228:511-517. [DOI: 10.1016/j.ijcard.2016.11.237] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 11/05/2016] [Accepted: 11/10/2016] [Indexed: 12/19/2022]
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140
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Left Ventricular Contraction Pattern in Chronic Aortic Regurgitation and Preserved Ejection Fraction: Simultaneous Stress-Strain Analysis by Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2017; 30:422-430.e2. [PMID: 28065583 DOI: 10.1016/j.echo.2016.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The role of speckle-tracking echocardiography in the assessment of chronic aortic regurgitation (AR) is not established. Load dependency may encumber the interpretation of strain measurements in the chronically overloaded left ventricle. The aim of this study was to investigate the mechanisms of left ventricular (LV) contraction patterns in asymptomatic patients with moderate to severe AR and preserved ejection fractions. METHODS In this prospective, cross-sectional study, 31 patients with moderate to severe AR, 15 elite endurance athletes, and 17 healthy control subjects were examined using three-dimensional speckle-tracking echocardiography. Global circumferential strain (GCS), global longitudinal strain (GLS), end-systolic circumferential wall stress (ESSc), end-systolic meridional wall stress (ESSm), and the wall stress ratio (ESSc/ESSm) were measured. RESULTS LV end-diastolic volumes were similar in athletes and patients with AR and significantly larger than in healthy control subjects. Values of GLS in control subjects, athletes, and patients with AR were -18.8 ± 1.9%, -17.3 ± 2.0%, and -16.4± 2.0%, respectively (control subjects vs athletes and patients, P < .05), whereas values of GCS were -16.9 ± 2.0%, -15.5 ± 1.9%, and -17.9 ± 2.6%, respectively (athletes vs control subjects and patients, P < .01). The ESSc/ESSm ratio was lower in patients with AR (P < .01). When adjusted for ESSm, GLS remained impaired in patients compared with control subjects and athletes (P = .015). On the other hand, GCS was better in patients with AR when adjusted for ESSc (P = .003). CONCLUSIONS In compensated AR, relatively high GCS compensates for reduced GLS in a manner consistent with the preserved ejection fractions observed in these patients.
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141
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Amano M, Izumi C, Imamura S, Onishi N, Tamaki Y, Enomoto S, Miyake M, Tamura T, Kondo H, Kaitani K, Yamanaka K, Nakagawa Y. Late recurrence of left ventricular dysfunction after aortic valve replacement for severe chronic aortic regurgitation. Int J Cardiol 2016; 224:240-244. [DOI: 10.1016/j.ijcard.2016.09.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 09/05/2016] [Accepted: 09/15/2016] [Indexed: 11/30/2022]
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142
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Summers MR, Jaber WA. Recovery of left ventricular function and positive remodeling post aortic valve replacement: Evidence from radionucleotide ventriculography in a patient with severe aortic insufficiency. J Nucl Cardiol 2016; 23:1508-1509. [PMID: 26843201 DOI: 10.1007/s12350-016-0401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 01/07/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Matthew R Summers
- Robert and Suzanne Tomisch Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, J1-5, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
| | - Wael A Jaber
- Robert and Suzanne Tomisch Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, J1-5, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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143
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Hu P, Liu XB, Liang J, Zhu QF, Pu CX, Tang MY, Wang JA. A hospital-based survey of patients with severe valvular heart disease in China. Int J Cardiol 2016; 231:244-247. [PMID: 27908608 DOI: 10.1016/j.ijcard.2016.11.301] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Accepted: 11/21/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Due to increasing aging, the epidemiology of VHD may have changed in China. This study aimed to provide contemporary information on the prevalence, distribution patterns, and etiology of severe VHD in China. METHODS This was a retrospective survey at Second Affiliated Hospital of Zhejiang University, which included all consecutive patients between 2010 and 2015. RESULTS In all, 139,496 patients were enrolled. Among severe valve diseases, MR was the most frequent (n=946, 0.68%) followed by MS (n=524, 0.38%), AS (n=392, 0.28%), and AR (n=371, 0.27%). Severe MR and AS prevalence rates increased strikingly with age. Rheumatic heart disease had an prevalence of 1.56% (n=2179), and remained one of the most common causes of severe VHD in patients younger than 65years old (99.5% of MS with rheumatic; 27.6% of MR with rheumatic; 25.7% of AS with rheumatic; 31.6% of AR with rheumatic). Aortic valve calcification was the predominant AS etiology, and its prevalence greatly increased with age. In severe AR, rheumatic fever was the most common etiology in patients below 65; in those above 65, etiology was mostly degenerative. In severe primary MR, mitral valve prolapse was the most common cause. Prevalence of secondary MR increased with age, from 16.4% in 18-44years old to 51.7% in individuals ≥75. CONCLUSIONS Severe valvular diseases are very common; rheumatic fever and degenerative valvular changes remain predominant causes in patients below 65 and older ones, respectively. Young adults present mainly with primary MR, while secondary MR is more common in elderly ones.
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Affiliation(s)
- Po Hu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Xian-Bao Liu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Jie Liang
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Qi-Feng Zhu
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Chao-Xia Pu
- Department of Echocardiography, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
| | - Meng-Yao Tang
- Harvard T.H. Chan School of Public Health. United States
| | - Jian-An Wang
- Department of Cardiology, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China.
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144
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Prognostic value of exercise left ventricular end-systolic volume index in patients with asymptomatic aortic regurgitation: an exercise echocardiography study. J Echocardiogr 2016; 15:70-78. [DOI: 10.1007/s12574-016-0323-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/25/2016] [Accepted: 11/09/2016] [Indexed: 12/17/2022]
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145
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Exercise capacity and peak oxygen consumption in asymptomatic patients with chronic aortic regurgitation. Int J Cardiol 2016; 223:688-692. [DOI: 10.1016/j.ijcard.2016.08.237] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/22/2016] [Accepted: 08/12/2016] [Indexed: 11/19/2022]
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146
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Long-Term Outcomes in Patients With Aortic Regurgitation and Preserved Left Ventricular Ejection Fraction. J Am Coll Cardiol 2016; 68:2144-2153. [DOI: 10.1016/j.jacc.2016.08.045] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/09/2016] [Indexed: 11/22/2022]
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147
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Abnormal Ventricular and Aortic Wall Properties Can Cause Inconsistencies in Grading Aortic Regurgitation Severity: A Computer Simulation Study. J Am Soc Echocardiogr 2016; 29:1122-1130.e4. [DOI: 10.1016/j.echo.2016.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Indexed: 11/20/2022]
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148
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Schantz DI, Dragulescu A, Memauri B, Grotenhuis HB, Seed M, Grosse-Wortmann L. Effect of hydration status on atrial and ventricular volumes and function in healthy adult volunteers. Pediatr Radiol 2016; 46:1520-7. [PMID: 27492341 DOI: 10.1007/s00247-016-3656-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/11/2016] [Accepted: 06/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Assessment of cardiac chamber volumes is a fundamental part of cardiac magnetic resonance (CMR) imaging. While the effects of inter- and intraobserver variability have been studied and have a recognized effect on the comparability of serial cardiac MR imaging studies, the effect of differences in hydration status has not been evaluated. OBJECTIVE To evaluate the effects of volume administration on cardiac chamber volumes. MATERIALS AND METHODS Thirteen healthy adults underwent a baseline cardiac MR to evaluate cardiac chamber volumes after an overnight fast. They were then given two saline boluses of 10 ml/kg of body weight and the cardiac MR was repeated immediately after each bolus. RESULTS From the baseline scan to the final scan there was a significant increase in all four cardiac chamber end-diastolic volumes. Right atrial volumes increased 8.0%, from 61.1 to 66.0 ml/m2 (P<0.001), and left atrial volumes increased 10.0%, from 50.0 to 55.0 ml/m2 (P<0.001). Right ventricular volumes increased 6.0%, from 91.1 to 96.5 ml/m2 (P<0.001), and left ventricular volumes increased 3.2%, from 87.0 to 89.8 ml/m2 (P<0.001). CONCLUSION Hydration status has a significant effect on the end-diastolic volumes of all cardiac chambers assessed by cardiac MR. Thus, hydration represents a "variable" that should be taken into account when assessing cardiac chamber volumes, especially when performing serial imaging studies in a patient.
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Affiliation(s)
- Daryl I Schantz
- The Labatt Family Heart Centre in the Department of Paediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Variety Children's Heart Centre, University of Manitoba, FE241-685 William Avenue, Winnipeg, MB, Canada.
| | - Andreea Dragulescu
- The Labatt Family Heart Centre in the Department of Paediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
| | - Brett Memauri
- Department of Radiology, St. Boniface General Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Heynric B Grotenhuis
- The Labatt Family Heart Centre in the Department of Paediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Mike Seed
- The Labatt Family Heart Centre in the Department of Paediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lars Grosse-Wortmann
- The Labatt Family Heart Centre in the Department of Paediatrics, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
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149
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Favarato D, Benvenuti LA. Case 4 - A 67 Year-Old Man with Aortic Regurgitation Who Presented Syncope Followed by Shock. Arq Bras Cardiol 2016; 107:176-83. [PMID: 27627642 PMCID: PMC5074071 DOI: 10.5935/abc.20160125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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150
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Hiendlmayr B, Nakda J, Elsaid O, Wang X, Flynn A. Timing of Surgical Intervention for Aortic Regurgitation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:63. [PMID: 27620637 DOI: 10.1007/s11936-016-0485-3] [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] [Indexed: 11/29/2022]
Abstract
OPINION STATEMENT Aortic regurgitation is a frequently encountered condition, in which traditional measurements of severity have proven to be of limited value in identifying those who would be best served by aortic valve replacement. Novel methods of assessing severity are vital, particularly as an entirely new paradigm of aortic regurgitation has surfaced, with the advent of transcatheter aortic valve replacement (TAVR), and the adverse events that are being observed with varying degrees of aortic regurgitation. With that in mind, a comprehensive assessment of aortic regurgitation should now include indexed left ventricular systolic volumes and a comprehensive assessment of right ventricular function, in addition to the quantitative measures that are currently recommended. Cardiac MRI also provides valuable information and should be strongly considered, particularly in challenging cases. The incremental value of additional echocardiographic parameters such as strain imaging, speckle tracking imaging, and tissue Doppler imaging remains unclear, and evidence for their utility is not, as yet, compelling. However, the field of aortic regurgitation assessment has been reinvigorated by the prevalence of paravalvular regurgitation post-TAVR, and many of the abovementioned parameters may need to be re-visited so that we can more accurately determine prognosis and risk stratify patients in a more reliable and evidence-based manner.
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Affiliation(s)
| | - Joseph Nakda
- Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Ossama Elsaid
- Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA
| | - Xuan Wang
- University of Connecticut School of Medicine, Farmington, CT, 06030, USA
| | - Aidan Flynn
- Hartford Hospital, 80 Seymour Street, Hartford, CT, 06102, USA. .,University of Connecticut School of Medicine, Farmington, CT, 06030, USA.
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