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Kasa G, Teis A, Juncà G, Aimo A, Lupón J, Cediel G, Santiago-Vacas E, Codina P, Ferrer-Sistach E, Vallejo-Camazón N, López-Ayerbe J, Bayés-Genis A, Delgado V. Clinical and prognostic implications of left ventricular dilatation in heart failure. Eur Heart J Cardiovasc Imaging 2024; 25:849-856. [PMID: 38246859 DOI: 10.1093/ehjci/jeae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/23/2024] Open
Abstract
AIMS To assess the agreement between left ventricular end-diastolic diameter index (LVEDDi) and volume index (LVEDVi) to define LV dilatation and to investigate the respective prognostic implications in patients with heart failure (HF). METHODS AND RESULTS Patients with HF symptoms and LV ejection fraction (LVEF) < 50% undergoing cardiac magnetic resonance were evaluated retrospectively. LV dilatation was defined as LVEDDi or LVEDVi above the upper normal limit according to published reference values. Patients were followed up for the combined endpoint of cardiovascular death or HF hospitalization during 5 years. A total of 564 patients (median age 64 years; 79% men) were included. LVEDDi had a modest correlation with LVEDVi (r = 0.682, P < 0.001). LV dilatation was noted in 84% of patients using LVEDVi-based definition and in 73% using LVEDDi-based definition, whereas 20% of patients displayed discordant definitions of LV dilatation. During a median follow-up of 2.8 years, patients with both dilated LVEDDi and LVEDVi had the highest cumulative event rate (HR 3.00, 95% CI 1.15-7.81, P = 0.024). Both LVEDDi and LVEDVi were independently associated with the primary outcome (hazard ratio 3.29, 95%, P < 0.001 and 2.8, P = 0.009; respectively). CONCLUSION The majority of patients with HF and LVEF < 50% present both increased LVEDDi and LVEDVi whereas 20% show discordant linear and volumetric definitions of LV dilatation. Patients with increased LVEDDi and LVEDVi have the worst clinical outcomes suggesting that the assessment of these two metrics is needed for better risk stratification.
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Affiliation(s)
- Gizem Kasa
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
| | - Albert Teis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
| | - Gladys Juncà
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
| | - Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Josep Lupón
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - German Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Evelyn Santiago-Vacas
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
| | - Pau Codina
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
| | - Elena Ferrer-Sistach
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
| | - Nuria Vallejo-Camazón
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
| | - Jorge López-Ayerbe
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
| | - Antoni Bayés-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Victoria Delgado
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Carretera del Canyet s/n, Barcelona 08916, Spain
- Centre for Comparative Medicine and Bioimage (CMCiB), Germans Trias i Pujol Research Institute (IGTP), Camí del Tanatori, Badalona 08916, Spain
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2
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Santens B, Van De Bruaene A, De Meester P, Claessen G, Moons P, Claus P, Goetschalckx K, Bogaert J, Budts W. Decreased cardiac reserve in asymptomatic patients after arterial switch operation for transposition of the great arteries. Int J Cardiol 2023; 388:131153. [PMID: 37433406 DOI: 10.1016/j.ijcard.2023.131153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/13/2023] [Accepted: 07/05/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Exercise capacity is impaired in patients after arterial switch operation (ASO) for complete transposition of the great arteries. Maximal oxygen consumption is related with outcome. OBJECTIVES This study assessed ventricular function by advanced echocardiography and cardiac magnetic resonance (CMR) imaging at rest and during exercise, to determine exercise capacity in ASO patients, and to correlate exercise capacity with ventricular function as potential early marker of subclinical impairment. METHODS Forty-four patients (71% male, mean age 25 ± 4 years - range 18-40 years) were included during routine clinical follow-up. Assessment involved physical examination, 12‑lead ECG, echocardiography, and cardiopulmonary exercise test (CPET) (day 1). On day 2 CMR imaging at rest and during exercise was performed. Blood was sampled for biomarkers. RESULTS All patients reported New York Heart Association class I, the overall cohort had an impaired exercise capacity (80 ± 14% of predicted peak oxygen consumption). Fragmented QRS was present in 27%. Exercise CMR showed that 20% of patients had abnormal contractile reserve (CR) of the left ventricle (LV) and 25% had reduced CR of the right ventricle (RV). CR LV and CR RV were significantly associated with impaired exercise capacity. Pathological patterns on myocardial delayed enhancement and hinge point fibrosis were detected. Biomarkers were normal. CONCLUSION This study found that in some asymptomatic ASO patients electrical, LV and RV changes at rest, and signs of fibrosis are present. Maximal exercise capacity is impaired and seems to be linearly related to the CR of the LV and the RV. Therefore, exercise CMR might play a role in detecting subclinical deterioration of ASO patients.
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Affiliation(s)
- Béatrice Santens
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Alexander Van De Bruaene
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Pieter De Meester
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium; Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Belgium
| | | | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Werner Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Belgium.
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3
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Hashimoto G, Enriquez-Sarano M, Stanberry LI, Oh F, Wang M, Acosta K, Sato H, Lopes BBC, Fukui M, Garcia S, Goessl M, Sorajja P, Bapat VN, Lesser J, Cavalcante JL. Association of Left Ventricular Remodeling Assessment by Cardiac Magnetic Resonance With Outcomes in Patients With Chronic Aortic Regurgitation. JAMA Cardiol 2022; 7:924-933. [PMID: 35857306 DOI: 10.1001/jamacardio.2022.2108] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Importance Chronic aortic regurgitation (AR) causes left ventricular (LV) volume overload, which results in progressive LV remodeling negatively affecting outcomes. Whether cardiac magnetic resonance (CMR) volumetric quantification can provide incremental risk stratification over standard clinical and echocardiographic evaluation in patients with chronic moderate or severe AR is unknown. Objective To compare LV remodeling measurements by CMR and echocardiography between patients with and without heart failure symptoms and to verify the association of remodeling measurements of patients with chronic moderate or severe AR but no or minimal symptoms with clinical outcomes receiving medical management. Design, Setting, and Participants This multicenter retrospective cohort study included consecutive patients with at least moderate chronic native AR evaluated by 2-dimensional transthoracic echocardiography and CMR examination within 90 days from each other between January 2012 and February 2020 at Allina Health System. Data were analyzed from June 2021 to January 2022. Exposures Clinical evaluation and risk stratification by CMR. Main Outcomes and Measures The end point was a composite of death, heart failure hospitalization, or progression of New York Heart Association functional class while receiving medical management, censoring patients at the time of aortic valve replacement (when performed) or at the end of follow-up. Results Of the 178 included patients, 119 (66.9%) were male, 158 (88.8%) presented with no or minimal symptoms (New York Heart Association class I or II), and the median (IQR) age was 58 (44-69) years. Compared with patients with no or minimal symptoms, symptomatic patients had greater LV end-systolic volume index (LVESVi) by CMR (median [IQR], 66 [46-85] mL/m2 vs 42 [30-58] mL/m2; P < .001), while there were no significant differences by echocardiography (LVESVi: median [IQR], 38 [30-58] mL/m2 vs 27 [20-42] mL/m2; P = .07; LV end-systolic diameter index: median [IQR], 21 [17-25] mm/m2 vs 18 [15-22] mm/m2; P = .17). During the median (IQR) follow-up of 3.3 (1.6-5.8) years, 50 patients with no or minimal symptoms receiving medical management developed the composite end point, which, in multivariate analysis adjusted for age and EuroSCORE II, was independently associated with LVESVi of 45 mL/m2 or greater and aortic regurgitant fraction of 32% or greater, the latter adding incremental prognostic value to CMR volumetric assessment. Conclusions and Relevance In patients with chronic moderate or severe AR, patients presenting with heart failure symptoms have greater LVESVi by CMR than those with no or minimal symptoms. In patients with no or minimal symptoms, CMR quantification of LVESVi and AR severity may identify those at risk of death or incident heart failure and therefore should be considered in the clinical evaluation and decision-making of these patients.
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Affiliation(s)
- Go Hashimoto
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Larissa I Stanberry
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Felix Oh
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Matthew Wang
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Keith Acosta
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Hirotomo Sato
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Bernardo B C Lopes
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota
| | - Santiago Garcia
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mario Goessl
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - John Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota.,Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
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4
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Vermes E, Iacuzio L, Levy F, Bohbot Y, Renard C, Gerber B, Maréchaux S, Tribouilloy C. Role of Cardiovascular Magnetic Resonance in Native Valvular Regurgitation: A Comprehensive Review of Protocols, Grading of Severity, and Prediction of Valve Surgery. Front Cardiovasc Med 2022; 9:881141. [PMID: 35872899 PMCID: PMC9300884 DOI: 10.3389/fcvm.2022.881141] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/07/2022] [Indexed: 11/15/2022] Open
Abstract
Valvular regurgitation is common in developed countries with an increasing prevalence due to the aging of the population and more accurate diagnostic imaging methods. Echocardiography is the gold standard method for the assessment of the severity of valvular heart regurgitation. Nonetheless, cardiovascular magnetic resonance (CMR) has emerged as an additional tool for assessing mainly the severity of aortic and mitral valve regurgitation in the setting of indeterminate findings by echocardiography. Moreover, CMR is a valuable imaging modality to assess ventricular volume and flow, which are useful in the calculation of regurgitant volume and regurgitant fraction of mitral valve regurgitation, aortic valve regurgitation, tricuspid valve regurgitation, and pulmonary valve regurgitation. Notwithstanding this, reference values and optimal thresholds to determine the severity and prognosis of valvular heart regurgitation have been studied lesser by CMR than by echocardiography. Hence, further larger studies are warranted to validate the potential prognostic relevance of the severity of valvular heart regurgitation determined by CMR. The present review describes, analyzes, and discusses the use of CMR to determine the severity of valvular heart regurgitation in clinical practice.
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Affiliation(s)
- Emmanuelle Vermes
- Department of Cardiology, Amiens University Hospital, Amiens, France
- *Correspondence: Emmanuelle Vermes,
| | - Laura Iacuzio
- Department of Cardiology, Center Cardio-Thoracique de Monaco, Monaco, Monaco
| | - Franck Levy
- Department of Cardiology, Center Cardio-Thoracique de Monaco, Monaco, Monaco
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Cédric Renard
- Department of Radiology, Amiens University Hospital, Amiens, France
| | - Bernhard Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Sylvestre Maréchaux
- Department of Cardiology, Heart Valve Center, Lille Catholic University Hospital, Lille, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Christophe Tribouilloy,
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5
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Optimization of the method of measuring left ventricular end-diastolic diameter in cardiac magnetic resonance as a predictor of left ventricular enlargement. Sci Rep 2022; 12:8425. [PMID: 35589833 PMCID: PMC9120015 DOI: 10.1038/s41598-022-12359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 05/09/2022] [Indexed: 11/21/2022] Open
Abstract
The objective of the study was to optimize the method of measuring left ventricular end-diastolic diameter (LVEDD) in cardiac magnetic resonance (CMR) as a predictor of left ventricular end-diastolic volume (LVEDV). The study group consisted of 78 patients (age 55.28 ± 17.18) who underwent 1.5 T CMR examination. LVEDD measurements in the short axis, in the long axis in the 2-chamber, 3-chamber and 4-chamber views were made by 2 radiologists. The repeatability of LVEDD measurements was assessed. The sensitivity and specificity of various methods of measuring LVEDD as a predictor of left ventricular enlargement (diagnosed based on LVEDV) were assessed. The correlation coefficients between LVEDD measurements made by researcher A and B were 0.98 for the long axis measurements in the 2-chamber and 3-chamber view, and 0.99 for measurements made in the short axis and in the long axis in the 4-chamber view. The lowest LVEDD measurements variability was recorded for the short axis measurements (RD 0.02, CV 1.38%), and the highest for the long axis measurements in the 3-chamber view (RD 0.04, CV 2.53%). In the male subgroup, the highest accuracy in predicting left ventricular enlargement was characterized by the criterion “LVEDD measured in the long axis in the 2-chamber view > 68.0 mm” (accuracy 94.1%). In the female subgroup, the highest accuracy in predicting left ventricular enlargement was achieved by the criterion “LVEDD measured in the short axis > 63.5 mm” (96.3%). In summary, the measurement made in the short axis should be considered the optimal method to LVEDD measure in CMR, considering the repeatability of measurements and the accuracy of left ventricular enlargement prediction.
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6
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Tower-Rader A, Mathias IS, Obuchowski NA, Kocyigit D, Kumar Y, Donnellan E, Bolen M, Phelan D, Flamm S, Griffin B, Cho L, Svensson LG, Pettersson G, Popovic Z, Kwon D. Sex-based differences in left ventricular remodeling in patients with chronic aortic regurgitation: a multi-modality study. J Cardiovasc Magn Reson 2022; 24:12. [PMID: 35193584 PMCID: PMC8862390 DOI: 10.1186/s12968-022-00845-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/16/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Significant aortic regurgitation (AR) leads to left ventricular (LV) remodeling; however, little data exist regarding sex-based differences in LV remodeling in this setting. We sought to compare LV remodeling and AR severity, assessed by echocardiography and cardiovascular magnetic resonance (CMR), to discern sex-based differences. METHODS Patients with ≥ moderate chronic AR by echocardiography who underwent CMR within 90 days between December 2005 and October 2015 were included. Nonlinear regression models were built to assess the effect of AR regurgitant fraction (RF) on LV remodeling. A generalized linear model and Bland Altman analyses were constructed to evaluate differences between CMR and echocardiography. Referral for surgical intervention based on symptoms and LV remodeling was evaluated. RESULTS Of the 243 patients (48.3 ± 16.6 years, 58 (24%) female), 119 (49%) underwent surgical intervention with a primary indication of severe AR, 97 (82%) men, 22 (18%) women. Significant sex differences in LV remodeling emerged on CMR. Women demonstrated significantly smaller LV end-diastolic volume index (LVEDVI) (96.8 ml/m2 vs 125.6 ml/m2, p < 0.001), LV end-systolic volume index (LVESVI) (41.1 vs 54.5 ml/m2, p < 0.001), blunted LV dilation in the setting of increasing AR severity (LVEDVI p value < 0.001, LVESVI p value 0.011), and LV length indexed (8.32 vs 9.69 cm, p < 0.001). On Bland Altman analysis, a significant interaction with sex and LV diameters was evident, demonstrating a significant increase in the difference between CMR and echocardiography measurements as the LV enlarged in women: LVEDVI (p = 0.006), LVESVI (p < 0.001), such that echocardiographic measurements increasingly underestimated LV diameters in women as the LV enlarged. LV length was higher for males with a linear effect from RF (p < 0.001), with LV length increasing at a higher rate with increasing RF for males compared to females (two-way interaction with sex p = 0.005). Sphericity volume index was higher for men after adjusting for a relative wall thickness (p = 0.033). CONCLUSIONS CMR assessment of chronic AR revealed significant sex differences in LV remodeling and significant echocardiographic underestimation of LV dilation, particularly in women. Defining optimal sex-based CMR thresholds for surgical referral should be further developed. TRIAL REGISTRATION NA.
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Affiliation(s)
- Albree Tower-Rader
- Department of Cardiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Yawkey 5B, Boston, MA, 02114, USA
| | - Isadora Sande Mathias
- Department of Cardiology, Houston Methodist Hospital, Weill Cornell Medical College, 6565 Fannin St., Houston, TX, 77030, USA
| | - Nancy A Obuchowski
- Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA
| | - Duygu Kocyigit
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA
| | - Yash Kumar
- Case Western University, 10900 Euclid Ave, Cleveland, OH, 44106-7017, USA
| | - Eoin Donnellan
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA
| | - Michael Bolen
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA
| | - Dermot Phelan
- Sanger Heart & Vascular Institute, Atrium Health, 1237 Harding Place, MOB1 Suite 5000, Charlotte, NC, 28204, USA
| | - Scott Flamm
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA
| | - Brian Griffin
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA
| | - Leslie Cho
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA
| | - Lars G Svensson
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA
| | - Gosta Pettersson
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA
| | - Zoran Popovic
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA
- Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA
| | - Deborah Kwon
- Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave, J1-5, Cleveland, OH, 44195, USA.
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7
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Faber M, Sonne C, Rosner S, Persch H, Reinhard W, Hendrich E, Will A, Martinoff S, Hadamitzky M. Predicting the need of aortic valve surgery in patients with chronic aortic regurgitation: a comparison between cardiovascular magnetic resonance imaging and transthoracic echocardiography. Int J Cardiovasc Imaging 2021; 37:2993-3001. [PMID: 34008075 PMCID: PMC8494718 DOI: 10.1007/s10554-021-02255-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 04/24/2021] [Indexed: 11/26/2022]
Abstract
To compare the ability of cardiac magnetic resonance tomography (CMR) and transthoracic echocardiography (TTE) to predict the need for valve surgery in patients with chronic aortic regurgitation on a mid-term basis. 66 individuals underwent assessment of aortic regurgitation (AR) both in CMR and TTE between August 2012 and April 2017. The follow-up rate was 76% with a median of 5.1 years. Cox proportional hazards method was used to assess the association of the time-to-aortic-valve-surgery, including valve replacement and reconstruction, and imaging parameters. A direct comparison of most predictive CMR and echocardiographic parameters was performed by using nested-factor-models. Sixteen patients (32%) were treated with aortic valve surgery during follow-up. Aortic valve insufficiency parameters, both of echocardiography and CMR, showed good discriminative and predictive power regarding the need of valve surgery. Within all examined parameters AR gradation derived by CMR correlated best with outcome [χ2 = 27.1; HR 12.2 (95% CI: 4.56, 36.8); (p < 0.0001)]. In direct comparison of both modalities, CMR assessment provided additive prognostic power beyond echocardiographic assessment of AR but not vice versa (improvement of χ2 from 21.4 to 28.4; p = 0.008). Nested model analysis demonstrated an overall better correlation with outcome by using both modalities compared with using echo alone with the best improvement in the moderate to severe AR range with an echo grade II out of III and a regurgitation fraction of 32% in CMR. This study corroborates the capability of CMR in direct quantification of AR and its role for guiding further treatment decisions particularly in patients with moderate AR in echocardiography.
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Affiliation(s)
- M Faber
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Hospital at Technical University Munich, Lazarettstr. 36, 80636, Munich, Germany
| | - C Sonne
- Department of Cardiovascular Diseases, German Heart Center Munich, Hospital at Technical University Munich, Lazarettstr. 36, 80636, Munich, Germany
| | - S Rosner
- Department of Cardiovascular Diseases, German Heart Center Munich, Hospital at Technical University Munich, Lazarettstr. 36, 80636, Munich, Germany
| | - H Persch
- Division of Sports and Rehabilitation Medicine, Center of Internal Medicine, University of Ulm, Leimgrubenweg 14, 89073, Ulm, Germany
| | - W Reinhard
- Department of Cardiovascular Diseases, German Heart Center Munich, Hospital at Technical University Munich, Lazarettstr. 36, 80636, Munich, Germany
| | - E Hendrich
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Hospital at Technical University Munich, Lazarettstr. 36, 80636, Munich, Germany
| | - A Will
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Hospital at Technical University Munich, Lazarettstr. 36, 80636, Munich, Germany
| | - S Martinoff
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Hospital at Technical University Munich, Lazarettstr. 36, 80636, Munich, Germany
| | - M Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Hospital at Technical University Munich, Lazarettstr. 36, 80636, Munich, Germany.
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8
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Postigo A, Pérez-David E, Revilla A, Raquel LA, González-Mansilla A, Prieto-Arévalo R, Espinosa MÁ, López-Jimenez RA, Sevilla T, Urueña N, Martínez-Legazpi P, Oliver JM, Fernández-Avilés F, J Alberto SR, Bermejo J. A comparison of the clinical efficacy of echocardiography and magnetic resonance for chronic aortic regurgitation. Eur Heart J Cardiovasc Imaging 2020; 23:392-401. [PMID: 33332549 DOI: 10.1093/ehjci/jeaa338] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/25/2020] [Indexed: 12/25/2022] Open
Abstract
AIMS Timing surgery in chronic aortic regurgitation (AR) relies mostly on echocardiography. However, cardiac magnetic resonance (CMR) may be more accurate for quantifying regurgitation and left ventricular (LV) remodelling. We aimed to compare the technical and clinical efficacies of echocardiography and CMR to account for the severity of the disease, the degree of LV remodelling, and predict AR-related outcomes. METHODS AND RESULTS We studied 263 consecutive patients with isolated AR undergoing echocardiography and CMR. After a median follow-up of 33 months, 76 out of 197 initially asymptomatic patients reached the primary endpoint of AR-related events: 6 patients (3%) were admitted for heart failure, and 70 (36%) underwent surgery. Adjusted survival models based on CMR improved the predictions of the primary endpoint based on echocardiography: R2 = 0.37 vs. 0.22, χ2 = 97 vs. 49 (P < 0.0001), and C-index = 0.80 vs. 0.70 (P < 0.001). This resulted in a net classification index of 0.23 (0.00-0.46, P = 0.046) and an integrated discrimination improvement of 0.12 (95% confidence interval 0.08-0.58, P = 0.02). CMR-derived regurgitant fraction (<28, 28-37, or >37%) and LV end-diastolic volume (<83, 183-236, or >236 mL) adequately stratified patients with normal EF. The agreement between techniques for grading AR severity and assessing LV dilatation was poor, and CMR showed better reproducibility. CONCLUSIONS CMR improves the clinical efficacy of ultrasound for predicting outcomes of patients with AR. This is due to its better reproducibility and accuracy for grading the severity of the disease and its impact on the LV. Regurgitant fraction, LV ejection fraction, and end-diastolic volume obtained by CMR most adequately predict AR-related events.
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Affiliation(s)
- Andrea Postigo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Esther Pérez-David
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Ana Revilla
- Instituto de Ciencias del Corazón. Hospital Clínico Universitario de Valladolid, and CIBERCV, Valladolid, Spain
| | - Ladrón Abia Raquel
- Instituto de Ciencias del Corazón. Hospital Clínico Universitario de Valladolid, and CIBERCV, Valladolid, Spain
| | - Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Raquel Prieto-Arévalo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - M Ángeles Espinosa
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Rosa Ana López-Jimenez
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Teresa Sevilla
- Instituto de Ciencias del Corazón. Hospital Clínico Universitario de Valladolid, and CIBERCV, Valladolid, Spain
| | - Noelia Urueña
- Instituto de Ciencias del Corazón. Hospital Clínico Universitario de Valladolid, and CIBERCV, Valladolid, Spain
| | - Pablo Martínez-Legazpi
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - José M Oliver
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
| | - San Román J Alberto
- Instituto de Ciencias del Corazón. Hospital Clínico Universitario de Valladolid, and CIBERCV, Valladolid, Spain
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón; Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, and CIBERCV, Madrid, Spain
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