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Iliuta L, Rac-Albu ME, Panaitescu E, Andronesi AG, Moldovan H, Furtunescu FL, Scafa-Udriște A, Dobra MA, Dinescu CM, Petrescu GD, Rac-Albu M. Challenges Regarding the Value of Routine Perioperative Transesophageal Echocardiography in Mitral Valve Surgery. Diagnostics (Basel) 2024; 14:1095. [PMID: 38893620 PMCID: PMC11172182 DOI: 10.3390/diagnostics14111095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/18/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Transesophageal echocardiography (TEE) is considered an indispensable tool for perioperative evaluation in mitral valve (MV) surgery. TEE is routinely performed by anesthesiologists competent in TEE; however, in certain situations, the expertise of a senior cardiologist specializing in TEE is required, which incurs additional costs. The purpose of this study is to determine the indications for specialized perioperative TEE based on its utility and the correlation between intraoperative TEE diagnoses and surgical findings, compared with routine TEE performed by an anesthesiologist. MATERIALS AND METHODS We conducted a three-year prospective study involving 499 patients with MV disease undergoing cardiac surgery. Patients underwent intraoperative and early postoperative TEE and at least one other perioperative echocardiographic evaluation. A computer application was dedicated to calculating the utility of each type of specialized TEE indication depending on the type of MV disease and surgical intervention. RESULTS The indications for performing specialized perioperative TEE identified in our study can be categorized into three groups: standard, relative, and uncertain. Standard indications for specialized intraoperative TEE included establishing the mechanism and severity of MR (mitral regurgitation), guiding MV valvuloplasty, diagnosing associated valvular lesions post MVR (mitral valve replacement), routine evaluations in triple-valve replacements, and identifying the causes of acute, intraoperative, life-threatening hemodynamic dysfunction. Early postoperative specialized TEE in the intensive care unit (ICU) is indicated for the suspicion of pericardial or pleural effusions, establishing the etiology of acute hemodynamic dysfunction, and assessing the severity of residual MR post valvuloplasty. CONCLUSIONS Perioperative TEE in MV surgery can generally be performed by a trained anesthesiologist for standard measurements and evaluations. In certain cases, however, a specialized TEE examination by a trained senior cardiologist is necessary, as it is indirectly associated with a decrease in postoperative complications and early postoperative mortality rates, as well as an improvement in immediate and long-term prognoses. Also, for standard indications, the correlation between surgical and TEE diagnoses was superior when specialized TEE was used.
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Affiliation(s)
- Luminita Iliuta
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (L.I.); (E.P.); (C.M.D.); (G.D.P.); (M.R.-A.)
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
| | - Madalina-Elena Rac-Albu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (L.I.); (E.P.); (C.M.D.); (G.D.P.); (M.R.-A.)
| | - Eugenia Panaitescu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (L.I.); (E.P.); (C.M.D.); (G.D.P.); (M.R.-A.)
| | - Andreea Gabriella Andronesi
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Nephrology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Horatiu Moldovan
- Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (H.M.); (A.S.-U.)
- Department of Cardiovascular Surgery, Clinical Emergency Hospital, 014461 Bucharest, Romania
- Academy of Romanian Scientist (AOSR), 050711 Bucharest, Romania
| | - Florentina Ligia Furtunescu
- Department of Public Health and Management, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
| | - Alexandru Scafa-Udriște
- Department of Cardio-Thoracic Pathology, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (H.M.); (A.S.-U.)
- Department of Cardiology, Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Mihai Adrian Dobra
- Center of Uronephrology and Renal Transplantation, Fundeni Clinical Institute, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania;
| | - Cristina Mirela Dinescu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (L.I.); (E.P.); (C.M.D.); (G.D.P.); (M.R.-A.)
| | - Gheorghe Dodu Petrescu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (L.I.); (E.P.); (C.M.D.); (G.D.P.); (M.R.-A.)
| | - Marius Rac-Albu
- Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania; (L.I.); (E.P.); (C.M.D.); (G.D.P.); (M.R.-A.)
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
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Mihara K, Kanemoto I, Sato K, Yasuhira Y, Watanabe I, Suzuki Y, Nagura J, Misumi K. Effects of mitral valve repair on valvular geometry and hemodynamics in dogs with myxomatous mitral valve disease. Vet Surg 2024; 53:415-425. [PMID: 38205863 DOI: 10.1111/vsu.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 10/10/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE To investigate the effects of mitral valve repair on the geometry of the mitral valve complex, hemodynamics, and cardiac function of dogs with myxomatous mitral valve disease (MMVD). STUDY DESIGN Retrospective cohort study. SAMPLE POPULATION Dogs (n = 77) with stage C MMVD undergoing mitral valve repair under cardiopulmonary bypass. METHODS Mitral valve geometry and cardiac function were assessed using echocardiography preoperatively, 1 week postoperatively and 3 months postoperatively. RESULTS The coaptation length (0 [0-0] vs. 7 [6-8.5] mm, p < .001) and forward stroke volume index (1.5 ± 0.4 vs. 2.3 ± 0.6 mL/kg, p < .001) were higher at 3-months postoperatively than preoperatively, whereas the vertebral heart score (12.3 ± 1.2 vs. 10.8 ± 0.8 V, p < .001), left atrial-to-aortic ratio (2.2 ± 0.7 vs. 1.2 ± 0.3, p < .001), peak velocity of early diastolic transmitral flow (144 ± 34 vs. 91 ± 18 cm/s, p < .001), and regurgitant volume index (11.3 [8.2-14.0] vs. 1.6 [0.95-2.35] mL/kg, p < .001) were lower. Postoperatively, mitral valve geometry was completely changed within 1 week, whereas changes in vertebral heart score lasted for 3 months. CONCLUSION Mitral valve repair changed valvular geometry and improved hemodynamics as assessed by follow-up echocardiography. CLINICAL SIGNIFICANCE This study acts as reference for surgeons and cardiologists considering or evaluating the effects of mitral valve repair in dogs and provides useful data for the enhancement of relevant surgical techniques and the selection of relevant pre- and postoperative observations.
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Affiliation(s)
- Kippei Mihara
- Joint Graduate School of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
- Chayagasaka Animal Hospital, Nagoya, Japan
| | | | | | | | | | | | | | - Kazuhiro Misumi
- Joint Graduate School of Veterinary Medicine, Kagoshima University, Kagoshima, Japan
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Abadie BQ, Cremer PC, Vakamudi S, Gillinov AM, Svensson LG, Cho L. Sex-Specific Prognosis of Left Ventricular Size and Function Following Repair of Degenerative Mitral Regurgitation. J Am Coll Cardiol 2024; 83:303-312. [PMID: 38199708 DOI: 10.1016/j.jacc.2023.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/29/2023] [Accepted: 10/13/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Prior studies have demonstrated worse long-term outcomes for women after surgery for severe mitral regurgitation (MR). The current Class I indications for surgery for severe degenerative MR use cutoffs of left ventricular end-systolic dimension (LVESD) and left ventricular ejection fraction (EF) that do not account for known sex-related differences. OBJECTIVES The primary objective of this study was to assess long-term mortality following mitral valve repair in women compared with men on the basis of preoperative left ventricular systolic dimensions and EF. METHODS Consecutive patients who underwent isolated mitral valve repair for degenerative MR at a single institution between 1994 and 2016 were screened. Adjusted HRs for all-cause mortality were compared according to baseline LVESD, LVESD indexed to body surface area (LVESDi), and EF for men and women. RESULTS Among 4,589 patients, 1,825 were women (40%), and after a median follow-up period of 7.2 years, 344 patients (7.5%) had died. The risk for mortality for women increased from the baseline hazard at an LVESD of 3.6 cm, whereas an inflection point for increased risk with LVESD was not evident in men. Regarding LVESDi, the risk for women increased at 1.8 cm/m2 compared with 2.1 cm/m2 in men. For EF, women and men had a similar inflection point (58%); however, mortality was higher for women as EF decreased. CONCLUSIONS After mitral valve repair, women have a higher risk for all-cause mortality at lower LVESD and LVESDi and higher EF. These results support consideration of sex-specific thresholds for LVESDi in surgical decision making for patients with severe MR.
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Affiliation(s)
- Bryan Q Abadie
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul C Cremer
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sneha Vakamudi
- Ascension Texas Cardiovascular and the University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - A Marc Gillinov
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Lars G Svensson
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Leslie Cho
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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Sharma H, Liu B, Yuan M, Shakeel I, Morley-Smith A, Hatch A, Bradley J, Chue C, Myerson SG, Steeds RP, Lim S. Predictors and clinical implications of residual mitral regurgitation following left ventricular assist device therapy. Open Heart 2023; 10:e002240. [PMID: 37316326 DOI: 10.1136/openhrt-2022-002240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 05/23/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Correction of mitral regurgitation (MR) at the time of left ventricular assist device (LVAD) implantation remains controversial. There is conflicting evidence regarding the clinical impact of residual MR, and studies have not examined whether MR aetiology or right heart function impacts the likelihood of residual MR. METHODS This is a retrospective single-centre study of 155 consecutive patients with LVAD implantation from January 2011 to March 2020. Exclusion criteria were no MR pre-LVAD (n=8), inaccessible echocardiography (n=9), duplicate records (n=10) and concomitant mitral valve repair (n=1). Statistical analysis was performed using STATA V.16 and SPSS V.24. RESULTS Carpentier IIIb MR aetiology was associated with more severe MR pre-LVAD (severe 18/27 (67%) vs non-severe 32/91 (35%), p=0.004) and a higher likelihood of residual MR (8/11 (72%) vs 30/74 (41%), p=0.045). Of 95 patients with significant MR pre-LVAD, 15 (16%) had persistent significant MR, which was associated with higher mortality (p=0.006), post-LVAD right ventricle (RV) dilatation (10/15 (67%) vs 28/80 (35%), p=0.022) and RV dysfunction (14/15 (93%) vs 35/80 (44%), p<0.001). Aside from ischaemic aetiology, other pre-LVAD parameters that were associated with significant residual MR included left ventricular end-systolic diameter (LVESD) (6.9 cm (5.7-7.2) vs 5.9 cm (5.5-6.5), p=0.043), left atrial volume index (LAVi) (78 mL/m2 (56-88) vs 57 mL/m2 (47-77), p=0.021), posterior leaflet displacement (2.5 cm (2.3-2.9) vs 2.3 cm (1.9-2.7), p=0.042) and basal right ventricular end-diastolic diameter (RVEDD) (5.1±0.8 cm vs 4.5±0.8 cm, p=0.010). CONCLUSION LVAD therapy improves MR and tricuspid regurgitation severity in the majority, but 14% have persistent significant residual MR, associated with right ventricular dysfunction and higher long-term mortality. This may be predicted pre-LVAD by greater LVESD, RVEDD and LAVi and by ischaemic aetiology.
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Affiliation(s)
- Harish Sharma
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Boyang Liu
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mengshi Yuan
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Iqra Shakeel
- Institute of Cardiovascular Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Andrew Morley-Smith
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alice Hatch
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Joseph Bradley
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Colin Chue
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Saul G Myerson
- Department of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Richard Paul Steeds
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cardiovascular Sciences, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Sern Lim
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Zheng J, Wu Q, Li Q, Tang M, He J, Qiu Z, Xie L, Chen L. Benefits of sacubitril/valsartan use in patients with chronic heart failure after cardiac valve surgery: a single-center retrospective study. J Cardiothorac Surg 2023; 18:138. [PMID: 37041595 PMCID: PMC10091567 DOI: 10.1186/s13019-023-02252-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy of sacubitril/valsartan for the treatment of patients with chronic heart failure (CHF) after cardiac valve surgery (CVS). METHODS Data were collected from 259 patients who underwent CVS due to valvular heart disease and were admitted to the hospital with CHF from January 2018 to December 2020. The patients were divided into Group A (treatment with sacubitril/valsartan) and Group B (treatment without sacubitril/valsartan). The duration of treatment and follow-up was 6 months. The two groups' prior and clinical characteristics, post-treatment data, mortality, and follow-up data were analysed. RESULTS The effective rate of Group A was higher than that of Group B (82.56% versus 65.52%, P < 0.05). The left ventricular ejection fraction (LVEF, %) was improved in both groups. The final value minus the initial value was (11.14 ± 10.16 versus 7.15 ± 11.18, P = 0.004). The left ventricular end-diastolic/-systolic diameter (LVEDD/LVESD, mm) in Group A decreased more than in Group B. The final value minus the initial value was (-3.58 ± 9.21 versus - 0.27 ± 14.44, P = 0.026; -4.21 ± 8.15 versus - 1.14 ± 12.12, P = 0.016, respectively). Both groups decreased the N-terminal prohormone of B-type natriuretic peptide (NT-proBNP, pg/ml). The final value minus initial value was [-902.0(-2226.0, -269.5) versus - 535.0(-1738, -7.0), P = 0.029]. The systolic and diastolic blood pressure (SBP/DBP, mmHg) in Group A decreased more than in Group B. The final value minus the initial value was (-13.13 ± 23.98 versus - 1.81 ± 10.89, P < 0.001; -8.28 ± 17.79 versus - 2.37 ± 11.41, P = 0.005, respectively). Liver and renal insufficiency, hyperkalaemia, symptomatic hypotension, angioedema, and acute heart failure had no statistical differences between the two groups. CONCLUSIONS Sacubitril/valsartan can effectively improve the cardiac function of patients with CHF after CVS by increasing LVEF and reducing LVEDD, LVESD, NT-proBNP, and BP, with good safety.
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Affiliation(s)
- Jian Zheng
- Department of Pharmacy, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, P. R. China
| | - Qingsong Wu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29, 350001, Fuzhou, Fujian, P. R. China
- Key Laboratory of Cardio-Thoracic SurgeryFujian Medical University), Fujian Province University, Fujian Medical University), Fuzhou, Fujian, P. R. China
| | - Qianzhen Li
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29, 350001, Fuzhou, Fujian, P. R. China
| | - Mirong Tang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29, 350001, Fuzhou, Fujian, P. R. China
| | - Jian He
- Fujian Medical University, Fuzhou, Fujian, P. R. China
| | - Zhihuang Qiu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29, 350001, Fuzhou, Fujian, P. R. China
- Key Laboratory of Cardio-Thoracic SurgeryFujian Medical University), Fujian Province University, Fujian Medical University), Fuzhou, Fujian, P. R. China
| | - Linfeng Xie
- Fujian Medical University, Fuzhou, Fujian, P. R. China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Xinquan Road 29, 350001, Fuzhou, Fujian, P. R. China.
- Key Laboratory of Cardio-Thoracic SurgeryFujian Medical University), Fujian Province University, Fujian Medical University), Fuzhou, Fujian, P. R. China.
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Petolat E, Theron A, Resseguier N, Fabre C, Norscini G, Badaoui R, Habib G, Collart F, Zaffran S, Porto A, Avierinos JF. Prognostic value of forward flow indices in primary mitral regurgitation due to mitral valve prolapse. Front Cardiovasc Med 2023; 10:1076708. [PMID: 36910534 PMCID: PMC9995829 DOI: 10.3389/fcvm.2023.1076708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
Background Degenerative mitral regurgitation (DMR) due to mitral valve prolapse (MVP) is a common valve disease associated with significant morbidity and mortality. Timing for surgery is debated for asymptomatic patients without Class I indication, prompting the search for novel parameters of early left ventricular (LV) systolic dysfunction. Aims To evaluate the prognostic impact of preoperative forward flow indices on the occurrence of post-operative LV systolic dysfunction. Methods We retrospectively included all consecutive patients with severe DMR due to MVP who underwent mitral valve repair between 2014 and 2019. LVOTTVI, forward stroke volume index, and forward LVEF were assessed as potential risk factors for LVEF <50% at 6 months post-operatively. Results A total of 198 patients were included: 154 patients (78%) were asymptomatic, and 46 patients (23%) had hypertension. The mean preoperative LVEF was 69 ± 9%. 35 patients (18%) had LVEF ≤ 60%, and 61 patients (31%) had LVESD ≥40 mm. The mean post-operative LVEF was 59 ± 9%, and 21 patients (11%) had post-operative LVEF<50%. Based on multivariable analysis, LVOTTVI was the strongest independent predictor of post-operative LV dysfunction after adjustment for age, sex, symptoms, LVEF, LV end systolic diameter, atrial fibrillation and left atrial volume index (0.75 [0.62-0.91], p < 0.01). The best sensitivity (81%) and specificity (63%) was obtained with LVOTTVI ≤15 cm based on ROC curve analysis. Conclusion LVOTTVI represents an independent marker of myocardial performance impairment in the presence of severe DMR. LVOTTVI could be an earlier marker than traditional echo parameters and aids in the optimization of the timing of surgery.
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Affiliation(s)
- Elisabeth Petolat
- Department of Cardiology, La Timone Hospital, Marseille, France.,Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Alexis Theron
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | | | | | - Giulia Norscini
- Department of Cardiology, La Timone Hospital, Marseille, France
| | - Rita Badaoui
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Gilbert Habib
- Department of Cardiology, La Timone Hospital, Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Stéphane Zaffran
- U1251 INSERM, Marseille Medical Genetics, Aix-Marseille University, Marseille, France
| | - Alizée Porto
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
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Ohte N, Ishizu T, Izumi C, Itoh H, Iwanaga S, Okura H, Otsuji Y, Sakata Y, Shibata T, Shinke T, Seo Y, Daimon M, Takeuchi M, Tanabe K, Nakatani S, Nii M, Nishigami K, Hozumi T, Yasukochi S, Yamada H, Yamamoto K, Izumo M, Inoue K, Iwano H, Okada A, Kataoka A, Kaji S, Kusunose K, Goda A, Takeda Y, Tanaka H, Dohi K, Hamaguchi H, Fukuta H, Yamada S, Watanabe N, Akaishi M, Akasaka T, Kimura T, Kosuge M, Masuyama T. JCS 2021 Guideline on the Clinical Application of Echocardiography. Circ J 2022; 86:2045-2119. [DOI: 10.1253/circj.cj-22-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Itoh
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Science
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- The Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health
| | - Kazuaki Tanabe
- The Fourth Department of Internal Medicine, Shimane University Faculty of Medicine
| | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Kazuhiro Nishigami
- Division of Cardiovascular Medicine, Miyuki Hospital LTAC Heart Failure Center
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Heart Center, Nagano Children’s Hospital
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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Stassen J, van Wijngaarden AL, Wu HW, Palmen M, Tomsic A, Delgado V, Bax JJ, Marsan NA. Left Atrial Remodeling after Mitral Valve Repair for Primary Mitral Regurgitation: Evolution over Time and Prognostic Significance. J Cardiovasc Dev Dis 2022; 9:jcdd9070230. [PMID: 35877592 PMCID: PMC9320730 DOI: 10.3390/jcdd9070230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023] Open
Abstract
Left atrial (LA) dilatation is associated with worse outcomes in primary mitral regurgitation (MR). However, the effects of mitral valve repair on LA size and its prognostic implications are not well known. In the current study, LA volume index (LAVi) and LA reservoir strain (LASr) were evaluated immediately before and after surgery, and during long-term follow-up in 226 patients undergoing mitral valve repair for primary MR (age 62 ± 13 years, 66% male). Mean LAVi was reduced significantly after surgery and at long-term follow-up (from 56 ± 28 to 38 ± 21 to 32 ± 17 mL/m2; p < 0.001). LASr reduced significantly after surgery but increased again during the long-term (from 23.6 ± 9.4 to 11.5 ± 5.0 to 17.3 ± 7.5%; p < 0.001). Age, pre-operative LAVi, MR severity, and postoperative transmitral pressure gradient were associated with LA reverse remodeling by the long-term check-up. During a median follow-up of 72 (40−114) months, 43 (19%) patients died. Patients with LAVi ≥ 42 mL/m2 at long-term follow-up showed significant higher mortality rates compared to patients with LAVI < 42 mL/m2 (p < 0.001), even after adjusting for clinical covariates. In conclusion, significant LA reverse remodeling was observed both immediately and at long-term follow-up after mitral valve repair. LA dilatation at long term follow-up after surgery was still associated with all-cause mortality.
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Affiliation(s)
- Jan Stassen
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (J.S.); (A.L.v.W.); (H.W.W.); (V.D.); (J.J.B.)
- Department of Cardiology, Jessa Hospital, 3500 Hasselt, Belgium
| | - Aniek L. van Wijngaarden
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (J.S.); (A.L.v.W.); (H.W.W.); (V.D.); (J.J.B.)
| | - Hoi W. Wu
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (J.S.); (A.L.v.W.); (H.W.W.); (V.D.); (J.J.B.)
| | - Meindert Palmen
- Department of Thoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.P.); (A.T.)
| | - Anton Tomsic
- Department of Thoracic Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (M.P.); (A.T.)
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (J.S.); (A.L.v.W.); (H.W.W.); (V.D.); (J.J.B.)
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (J.S.); (A.L.v.W.); (H.W.W.); (V.D.); (J.J.B.)
- Department of Cardiology, Turku Heart Center, University of Turku and Turku University Hospital, 20521 Turku, Finland
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (J.S.); (A.L.v.W.); (H.W.W.); (V.D.); (J.J.B.)
- Correspondence: ; Tel.: +31-71-526-2020; Fax: +31-71-526-6809
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9
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Hibino M, Dhingra NK, Chan V, Mazer CD, Teoh H, Quan A, Verma R, Leong-Poi H, Bisleri G, Connelly KA, Verma S. Stage-based approach to predict left ventricular reverse remodeling after mitral repair. Clin Cardiol 2022; 45:921-927. [PMID: 35748086 PMCID: PMC9451668 DOI: 10.1002/clc.23879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Although predictors of reverse left ventricular (LV) remodeling postmitral valve repair are critical for guiding perioperative decision‐making, there remains a paucity of randomized, prospective data to support the criteria that potential predictor variables must meet. Methods and Results The CAMRA CardioLink‐2 randomized trial allocated 104 patients to either leaflet resection or preservation strategies for mitral repair. The correlation of indexed left ventricular end‐systolic volume (LVESVI), indexed left ventricular end‐diastolic volume (LVEDVI), and left ventricular ejection fraction (LVEF) were tested with univariate analysis and subsequently with multivariate analysis to determine independent predictors of reverse remodeling at discharge and at 12 months postoperatively. At discharge, both LVESVI and LVEDVI were independently associated with their preoperative values (p < .001 for both) and LVEF by preoperative LVESVI (p < .001). Mitral ring size was favorably associated with the change in LVESVI (p < .05) and LVEF (p < .01) from predischarge to 12 months, while the mean mitral valve gradient after repair was adversely associated with the change in LVESVI (p < .05) and LVEDVI (p < .05). No significant associations were found between reverse remodeling and coaptation height nor mitral repair technique. Conclusions Beyond confirming the lack of impact of mitral repair technique on reverse remodeling, this investigation suggests that recommending surgery before significant LV dilatation or dysfunction, as well as higher postoperative mitral valve hemodynamic performance, may enhance remodeling capacity following mitral repair.
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Affiliation(s)
- Makoto Hibino
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Nitish K Dhingra
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Vincent Chan
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - C David Mazer
- Department of Anesthesia, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Hwee Teoh
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Endocrinology and Metabolism, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Adrian Quan
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Raj Verma
- Royal College of Surgeon Ireland, Dublin, Ireland
| | - Howard Leong-Poi
- Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gianluigi Bisleri
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kim A Connelly
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Division of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
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10
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Liu L, Xiao B, Wu B, Guo Y. Transcatheter Mitral Valve-in-Valve Implantations Using Inverted J-Valve. Front Cardiovasc Med 2022; 9:896639. [PMID: 35811703 PMCID: PMC9260111 DOI: 10.3389/fcvm.2022.896639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAs bioprosthetic valves are being widely used, the incidence of structural valve deterioration increases, as well as the need for reoperation. Transcatheter mitral valve-in-valve implantations are being increasingly adopted as an alternative to redo-surgical mitral replacement for patients with high surgical risks. This study reports a series of transcatheter mitral valve-in-valve implantations using inverted J-valves.MethodsFrom April 2019 to September 2021, 17 symptomatic high-risk patients with mitral bioprosthetic valve dysfunction underwent transapical transcatheter mitral valve-in-valve implantations using inverted J-valves at our institution.ResultsThe median age was 70 years, with 76.5% being female. The median Society of Thoracic Surgeons predicted risk of mortality (STS PROM) was 17.2% (8.7–82.24%). All patients had successful transapical transcatheter mitral valve-in-valve implantations except for one intraoperative death due to left ventricle rupture. Four patients underwent simultaneous transcatheter aortic valve implantation, two of which had valve-in-valve transcatheter aortic valve implantation. There was no major complication except one case of bleeding. Thirty-day mortality was 11.8% (2/17), and 90-days mortality was 23.5% (4/17). Percentages of patients with New York Heart Association class III/IV symptoms decreased from 100 (17/17) to 20% (3/15) at 30-days. Median mitral inflow velocity was 1.95 mm/s at 30 days, compared to 2.7 mm/s at baseline. Median mitral valve effective orifice area increases from 1.5 mm at baseline to 1.85 mm at 30 days.ConclusionTranscatheter transapical valve-in-valve implantations with J-valve can be a plausible solution to failed mitral bioprosthesis with acceptable results for high-risk patients.
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11
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Pype LL, Bertrand PB, Paelinck BP, Heidbuchel H, Van Craenenbroeck EM, Van De Heyning CM. Left Ventricular Remodeling in Non-syndromic Mitral Valve Prolapse: Volume Overload or Concomitant Cardiomyopathy? Front Cardiovasc Med 2022; 9:862044. [PMID: 35498019 PMCID: PMC9039519 DOI: 10.3389/fcvm.2022.862044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/07/2022] [Indexed: 01/11/2023] Open
Abstract
Mitral valve prolapse (MVP) is a common valvular disorder that can be associated with mitral regurgitation (MR), heart failure, ventricular arrhythmias and sudden cardiac death. Given the prognostic impact of these conditions, it is important to evaluate not only mitral valve morphology and regurgitation, but also the presence of left ventricular (LV) function and remodeling. To date, several possible hypotheses have been proposed regarding the underlying mechanisms of LV remodeling in the context of non-syndromic MVP, but the exact pathophysiological explanation remains elusive. Overall, volume overload related to severe MR is considered the main cause of LV dilatation in MVP. However, significant LV remodeling has been observed in patients with MVP and no/mild MR, particularly in patients with bileaflet MVP or Barlow’s disease, generating several new hypotheses. Recently, the concept of “prolapse volume” was introduced, adding a significant volume load to the LV on top of the transvalvular MR volume. Another possible hypothesis is the existence of a concomitant cardiomyopathy, supported by the link between MVP and myocardial fibrosis. The origin of this cardiomyopathy could be either genetic, a second hit (e.g., on top of genetic predisposition) and/or frequent ventricular ectopic beats. This review provides an overview of the different mechanisms and remaining questions regarding LV remodeling in non-syndromic MVP. Since technical specifications of imaging modalities impact the evaluation of MR severity and LV remodeling, and therefore might influence clinical decision making in these patients, this review will also discuss assessment of MVP using different imaging modalities.
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Affiliation(s)
- Lobke L. Pype
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Vasculature and Skeleton (GENCOR) Research Group, University of Antwerp, Antwerp, Belgium
| | - Philippe B. Bertrand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- Cardio and Organ Systems (COST) Resarch Group, Hasselt University, Hasselt, Belgium
| | - Bernard P. Paelinck
- Genetics, Pharmacology and Physiopathology of Heart, Vasculature and Skeleton (GENCOR) Research Group, University of Antwerp, Antwerp, Belgium
- Department of Cardiac Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Vasculature and Skeleton (GENCOR) Research Group, University of Antwerp, Antwerp, Belgium
| | - Emeline M. Van Craenenbroeck
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Vasculature and Skeleton (GENCOR) Research Group, University of Antwerp, Antwerp, Belgium
| | - Caroline M. Van De Heyning
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
- Genetics, Pharmacology and Physiopathology of Heart, Vasculature and Skeleton (GENCOR) Research Group, University of Antwerp, Antwerp, Belgium
- *Correspondence: Caroline M. Van De Heyning,
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12
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Zhou N, Ji Z, Li F, Qiao B, Lin R, Jiang W, Zhu Y, Lin Y, Zhang K, Li S, You B, Gao P, Dong R, Wang Y, Du J. Machine Learning-Based Personalized Risk Prediction Model for Mortality of Patients Undergoing Mitral Valve Surgery: The PRIME Score. Front Cardiovasc Med 2022; 9:866257. [PMID: 35433879 PMCID: PMC9010531 DOI: 10.3389/fcvm.2022.866257] [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: 01/31/2022] [Accepted: 03/01/2022] [Indexed: 11/24/2022] Open
Abstract
Background Mitral valve surgery (MVS) is an effective treatment for mitral valve diseases. There is a lack of reliable personalized risk prediction models for mortality in patients undergoing mitral valve surgery. Our aim was to develop a risk stratification system to predict all-cause mortality in patients after mitral valve surgery. Methods Different machine learning models for the prediction of all-cause mortality were trained on a derivation cohort of 1,883 patients undergoing mitral valve surgery [split into a training cohort (70%) and internal validation cohort (30%)] to predict all-cause mortality. Forty-five clinical variables routinely evaluated at discharge were used to train the models. The best performance model (PRIME score) was tested in an externally validated cohort of 220 patients undergoing mitral valve surgery. The model performance was evaluated according to the area under the curve (AUC). Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were compared with existing risk strategies. Results After a median follow-up of 2 years, there were 133 (7.063%) deaths in the derivation cohort and 17 (7.727%) deaths in the validation cohort. The PRIME score showed an AUC of 0.902 (95% confidence interval [CI], 0.849–0.956) in the internal validation cohort and 0.873 (95% CI: 0.769–0.977) in the external validation cohort. In the external validation cohort, the performance of the PRIME score was significantly improved compared with that of the existing EuroSCORE II (NRI = 0.550, [95% CI 0.001–1.099], P = 0.049, IDI = 0.485, [95% CI 0.230–0.741], P < 0.001). Conclusion Machine learning-based model (the PRIME score) that integrate clinical, demographic, imaging, and laboratory features demonstrated superior performance for the prediction of mortality patients after mitral valve surgery compared with the traditional risk model EuroSCORE II. Clinical Trial Registration [http://www.clinicaltrials.gov], identifier [NCT05141292].
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Affiliation(s)
- Ning Zhou
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhili Ji
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fengjuan Li
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Bokang Qiao
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Rui Lin
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenxi Jiang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuexin Zhu
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yuwei Lin
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Kui Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuanglei Li
- Department of Cardiac Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Bin You
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Pei Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Peking University Health Science Center, Peking University, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Peking University, Beijing, China
| | - Ran Dong
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- *Correspondence: Ran Dong,
| | - Yuan Wang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Yuan Wang,
| | - Jie Du
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Jie Du,
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13
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Li Q, Zhang Y, Huang H, Chen W, Shi S, Chen S, Wang B, Lai W, Huang Z, Luo Z, Chen J, Tan N, Liu J, Liu Y. Are There Any Differences in the Prognostic Value of Left Ventricular Ejection Fraction in Coronary Artery Disease Patients With or Without Moderate and Severe Mitral Regurgitation? Front Cardiovasc Med 2022; 9:799253. [PMID: 35310991 PMCID: PMC8930921 DOI: 10.3389/fcvm.2022.799253] [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: 10/21/2021] [Accepted: 02/01/2022] [Indexed: 11/28/2022] Open
Abstract
Background Left ventricular ejection fraction (LVEF) is a vital variable to describe left ventricle systolic function and contractility of left ventricle. However, the association between LVEF and the prognostic effect in patients with moderate or severe mitral regurgitation (MR) is still controversial. Methods This study comprised 30,775 coronary artery disease (CAD) patients who underwent coronary arteriography (CAG) in the Cardiorenal ImprovemeNt (CIN) registry from January 2007 to December 2018. Patients were divided into none or mild MR group and moderate or severe MR group, and 3 levels of LVEF ≥50, 40–50%, and <40% were further distinguished according to hospital baseline. Univariate and multivariate Cox proportional analyses were used to investigate the association between LVEF levels and long-term all-cause mortality in patients with different MR severities. Results Of 30,775 CAD patients (62.9 ± 10.6 years, females 23.8%), 26,474 (86.0%) patients had none or mild MR. Compared with none or mild MR patients, patients with moderate or severe MR were older and had worse cardio-renal function. In multivariable Cox proportional analysis, LVEF <40% was independently associated with higher mortality compared with LVEF ≥ 50% in all kinds of MR severity {none or mild MR [adjusted hazard ratio (HR): 1.79; 95% CI: 1.56–2.05, p < 0.001], moderate or severe MR [adjusted HR: 1.57; 95% CI: 1.29–1.91, p < 0.001]}. Conclusions LVEF is a reliable prognostic index in CAD patients, even in those with moderate or severe MR. LVEF monitoring would still be clinically useful in CAD patients with moderate or severe MR. Clinical trials are needed to prospectively evaluate the optimal threshold for LVEF in patients with moderate or severe MR.
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Affiliation(s)
- Qiang Li
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yifei Zhang
- Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Haozhang Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Weihua Chen
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
- The Third Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Shanshan Shi
- Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
- The Third Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Shiqun Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bo Wang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenguang Lai
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zhidong Huang
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiling Luo
- Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Jin Liu
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- *Correspondence: Yong Liu
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14
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Sun BJ, Park JH. Current Unmet Needs and Clues to the Solution in the Management of Tricuspid Regurgitation. Korean Circ J 2022; 52:414-428. [PMID: 35656901 PMCID: PMC9160646 DOI: 10.4070/kcj.2022.0117] [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: 04/18/2022] [Accepted: 05/06/2022] [Indexed: 11/11/2022] Open
Abstract
The clinical importance of tricuspid regurgitation (TR) has been recently highlighted. However, there remain several unmet needs with the diagnosis and treatment of TR. The major dilemma is a delayed treatment decision and an intervention at an advanced stage. Other important unmet needs are limitations in diagnostic imaging modalities, ambiguity in the guidelines regarding the interventional criteria, high surgical mortality, uncertainty in the reversibility of the right ventricle, and lack of long-term clinical data after the intervention. We have discussed such overall aspects of TR, the problems frequently experienced by clinical physicians and future strategies to improve the treatment of TR. Although tricuspid regurgitation (TR) is a general medical issue with growing prevalence and socioeconomic burden, most clinicians have not paid much attention to TR in the past. Several problems of TR have been pointed out in clinical practice, which include: ambiguous clinical manifestations and the difficulty in initial detection, limitations in generally used diagnostic tools, the absence of objective criterion for therapeutic intervention, high operative morbidity and mortality, and lack of long-term clinical data after the intervention for TR. Therefore, patients with TR usually visit clinicians at a much-advanced state, and this delay gives a major dilemma in clinical decision-making in a routine clinical practice. To improve the clinical outcome of TR, we need more knowledge about TR for solving the current problems and making strategies for better clinical practice. With this background, we have discussed in the present article about the pathophysiology of TR and the problems frequently experienced by clinical physicians in the diagnosis and treatment of TR. Furthermore, we have discussed the future strategy to improve the treatment of TR.
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Affiliation(s)
- Byung Joo Sun
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
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15
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Shoaib A, Rashid M, Berry C, Curzen N, Kontopantelis E, Timmis A, Ahmad A, Kinnaird T, Mamas MA. Clinical Characteristics, Management Strategies, and Outcomes of Non-ST-Segment-Elevation Myocardial Infarction Patients With and Without Prior Coronary Artery Bypass Grafting. J Am Heart Assoc 2021; 10:e018823. [PMID: 34612049 PMCID: PMC8751868 DOI: 10.1161/jaha.120.018823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background There are limited data on the management strategies, temporal trends and clinical outcomes of patients who present with non–ST‐segment–elevation myocardial infarction and have a prior history of CABG. Methods and Results We identified 287 658 patients with non–ST‐segment–elevation myocardial infarction between 2010 and 2017 in the United Kingdom Myocardial Infarction National Audit Project database. Clinical and outcome data were analyzed by dividing into 2 groups by prior history of coronary artery bypass grafting (CABG): group 1, no prior CABG (n=262 362); and group 2, prior CABG (n=25 296). Patients in group 2 were older, had higher GRACE (Global Registry of Acute Coronary Events) risk scores and burden of comorbid illnesses. More patients underwent coronary angiography (69% versus 63%) and revascularization (53% versus 40%) in group 1 compared with group 2. Adjusted odds of receiving inpatient coronary angiogram (odds ratio [OR], 0.91; 95% CI, 0.88–0.95; P<0.001) and revascularization (OR, 0.73; 95% CI, 0.70–0.76; P<0.001) were lower in group 2 compared with group 1. Following multivariable logistic regression analyses, the OR of in‐hospital major adverse cardiovascular events (composite of inpatient death and reinfarction; OR, 0.97; 95% CI, 0.90–1.04; P=0.44), all‐cause mortality (OR, 0.96; 95% CI, 0.88–1.04; P=0.31), reinfarction (OR, 1.02; 95% CI, 0.89–1.17; P=0.78), and major bleeding (OR, 1.01; 95% CI, 0.90–1.11; P=0.98) were similar across groups. Lower adjusted risk of inpatient mortality (OR, 0.67; 95% CI, 0.46–0.98; P=0.04) but similar risk of bleeding (OR,1.07; CI, 0.79–1.44; P=0.68) and reinfarction (OR, 1.13; 95% CI, 0.81–1.57; P=0.47) were observed in group 2 patients who underwent percutaneous coronary intervention compared with those managed medically. Conclusions In this national cohort, patients with non–ST‐segment–elevation myocardial infarction with prior CABG had a higher risk profile, but similar risk‐adjusted in‐hospital adverse outcomes compared with patients without prior CABG. Patients with prior CABG who received percutaneous coronary intervention had lower in‐hospital mortality compared with those who received medical management.
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Affiliation(s)
- Ahmad Shoaib
- Keele Cardiovascular Research Group Centre for Prognosis Research Institute for Primary Care and Health Sciences Keele University Stoke-on-Trent UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group Centre for Prognosis Research Institute for Primary Care and Health Sciences Keele University Stoke-on-Trent UK
| | - Colin Berry
- Institute of Cardiovascular & Medical Sciences University of Glasgow UK
| | - Nick Curzen
- Cardiothoracic Department University Hospital Southampton & Faculty of MedicineUniversity of Southampton UK
| | | | - Adam Timmis
- Barts & the London School of Medicine and Dentistry Queen Mary University London London UK
| | - Ayesha Ahmad
- Keele Cardiovascular Research Group Centre for Prognosis Research Institute for Primary Care and Health Sciences Keele University Stoke-on-Trent UK
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group Centre for Prognosis Research Institute for Primary Care and Health Sciences Keele University Stoke-on-Trent UK
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16
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Glower D. Commentary: Assessing recovery of ejection fraction after mitral repair: One year after operation, are we there yet? J Thorac Cardiovasc Surg 2021:S0022-5223(21)01368-4. [PMID: 34620504 DOI: 10.1016/j.jtcvs.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022]
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Lavine SJ, Raby K. Adverse Outcomes with Eccentric Hypertrophy in a Community Based University Cohort with Aortic Stenosis. Am J Med Sci 2021; 362:442-452. [PMID: 34400150 DOI: 10.1016/j.amjms.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 05/04/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Aortic stenosis (AS) patients with eccentric hypertrophy (Ecc-LVH) have increased left ventricular (LV) size and possibly reduced ejection fraction (EF). However, previous studies suggest worse outcomes with concentric remodeling and hypertrophy. We hypothesized that Ecc-LVH pattern in AS patients will also be associated with greater heart failure (HF) and all-cause mortality (ACM). METHODS We queried the electronic medical record from a community-based university practice for all AS patients. We included patients with >60 days follow-up and interpretable Doppler echocardiograms. We recorded demographics, Doppler-echo parameters, laboratories, HF readmission and ACM with follow-up to 2083 days. There were 329 patients divided into 4 groups based on the presence of LV hypertrophy (LVH) and relative wall thickness (RWT) by echocardiography. Ecc-LVH had RWT<0.43 and LVH. RESULTS Patients with severe AS were older, had greater coronary disease prevalence, lower hemoglobin, greater LV mass index, more abnormal diastolic function, greater HF and ACM. Multivariate Cox proportional analysis revealed that valvulo-arterial impedance (p=0.017) and Ecc-LVH (p=0.033) were HF predictors. Brain natriuretic peptide>100 pg/ml (p<0.001) and Ecc-LVH (p=0.019) were ACM predictors. ACM was increased in Ecc-LVH patients with both moderate (HR=3.67-8.18 vs other geometries, p=0.007-0.0007) and severe AS (HR=3.94-9.48 vs normal and concentric remodeling, p=0.0002). In patients with HF, Ecc-LVH was associated with greater HF in moderate AS vs normal geometry (HR=3.28, p=0.0135) and concentric remodeling (HR=2.66, p=0.0472). CONCLUSIONS Patients with AS and Ecc-LVH have greater ACM than other LV geometries with both moderate and severe AS and greater HF in moderate AS.
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Affiliation(s)
- Steven J Lavine
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States; Washington University of St. Louis, St. Louis, MO, United States.
| | - Kirsten Raby
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, United States
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18
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An SM, Nam JS, Kim HJ, Bae HJ, Chin JH, Lee EH, Choi IC. Postoperative changes in left ventricular systolic function after combined mitral and aortic valve replacement in patients with rheumatic heart disease. J Card Surg 2021; 36:3654-3661. [PMID: 34252984 DOI: 10.1111/jocs.15814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/05/2021] [Accepted: 04/20/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUNDS We sought to identify short- and long-term changes in postoperative left ventricular systolic function in patients with rheumatic heart disease (RHD) who underwent combined aortic and mitral valve replacement. METHODS We analyzed 146 patients according to their preoperative left ventricular ejection fraction (LVEF) (113 with preoperative LVEF ≥50% and 33 with preoperative LVEF <50%). A restricted cubic spline model was used to assess the effect of time on the postoperative changes in echocardiographic parameters. RESULTS There were no significant difference in preoperative and immediately postoperative LVEF before discharge in either group. During median follow-up of 3.2 years (interquartile range: 1.3-4.7 years) after surgery, postoperative LVEF increased slightly and then plateaued in patients with preoperative LVEF ≥50%, whereas it increased over 3-4 years after surgery and then gradually decreased in patients with preoperative LVEF <50% (p < .001). CONCLUSION Long-term postoperative LVEF showed a downward trend in RHD patients with reduced preoperative LVEF, whereas it reached a plateau in RHD patients with normal preoperative LVEF.
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Affiliation(s)
- Sang-Mee An
- Department of Anesthesiology and Pain Medicine, Ewha Womans University Seoul Hospital, Seoul, South Korea
| | - Jae-Sik Nam
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyeun Joon Bae
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ji-Hyun Chin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Ho Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - In-Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Morningstar JE, Nieman A, Wang C, Beck T, Harvey A, Norris RA. Mitral Valve Prolapse and Its Motley Crew-Syndromic Prevalence, Pathophysiology, and Progression of a Common Heart Condition. J Am Heart Assoc 2021; 10:e020919. [PMID: 34155898 PMCID: PMC8403286 DOI: 10.1161/jaha.121.020919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/21/2021] [Indexed: 01/01/2023]
Abstract
Mitral valve prolapse (MVP) is a commonly occurring heart condition defined by enlargement and superior displacement of the mitral valve leaflet(s) during systole. Although commonly seen as a standalone disorder, MVP has also been described in case reports and small studies of patients with various genetic syndromes. In this review, we analyzed the prevalence of MVP within syndromes where an association to MVP has previously been reported. We further discussed the shared biological pathways that cause MVP in these syndromes, as well as how MVP in turn causes a diverse array of cardiac and noncardiac complications. We found 105 studies that identified patients with mitral valve anomalies within 18 different genetic, developmental, and connective tissue diseases. We show that some disorders previously believed to have an increased prevalence of MVP, including osteogenesis imperfecta, fragile X syndrome, Down syndrome, and Pseudoxanthoma elasticum, have few to no studies that use up-to-date diagnostic criteria for the disease and therefore may be overestimating the prevalence of MVP within the syndrome. Additionally, we highlight that in contrast to early studies describing MVP as a benign entity, the clinical course experienced by patients can be heterogeneous and may cause significant cardiovascular morbidity and mortality. Currently only surgical correction of MVP is curative, but it is reserved for severe cases in which irreversible complications of MVP may already be established; therefore, a review of clinical guidelines to allow for earlier surgical intervention may be warranted to lower cardiovascular risk in patients with MVP.
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Affiliation(s)
- Jordan E. Morningstar
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Annah Nieman
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Christina Wang
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Tyler Beck
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Andrew Harvey
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell BiologyMedical University of South CarolinaCharlestonSC
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20
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Kim J, Nam JS, Kim Y, Chin JH, Choi IC. Forward Left Ventricular Ejection Fraction as a Predictor of Postoperative Left Ventricular Dysfunction in Patients with Degenerative Mitral Regurgitation. J Clin Med 2021; 10:jcm10143013. [PMID: 34300179 PMCID: PMC8306203 DOI: 10.3390/jcm10143013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Left ventricular dysfunction (LVD) can occur immediately after mitral valve repair (MVr) for degenerative mitral regurgitation (DMR) in some patients with normal preoperative left ventricular ejection fraction (LVEF). This study investigated whether forward LVEF, calculated as left ventricular outflow tract stroke volume divided by left ventricular end-diastolic volume, could predict LVD immediately after MVr in patients with DMR and normal LVEF. Methods: Echocardiographic and clinical data were retrospectively evaluated in 234 patients with DMR ≥ moderate and preoperative LVEF ≥ 60%. LVD and non-LVD were defined as LVEF < 50% and ≥50%, respectively, as measured by echocardiography after MVr and before discharge. Results: Of the 234 patients, 52 (22.2%) developed LVD at median three days (interquartile range: 3–4 days). Preoperative forward LVEF in the LVD and non-LVD groups were 24.0% (18.9–29.5%) and 33.2% (26.4–39.4%), respectively (p < 0.001). Receiver operating characteristic (ROC) analyses showed that forward LVEF was predictive of LVD, with an area under the ROC curve of 0.79 (95% confidence interval: 0.73–0.86), and an optimal cut-off was 31.8% (sensitivity: 88.5%, specificity: 58.2%, positive predictive value: 37.7%, and negative predictive value: 94.6%). Preoperative forward LVEF significantly correlated with preoperative mitral regurgitant volume (correlation coefficient [CC] = −0.86, p < 0.001) and regurgitant fraction (CC = −0.98, p < 0.001), but not with preoperative LVEF (CC = 0.112, p = 0.088). Conclusion: Preoperative forward LVEF could be useful in predicting postoperative LVD immediately after MVr in patients with DMR and normal LVEF, with an optimal cut-off of 31.8%.
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Affiliation(s)
| | | | | | - Ji-Hyun Chin
- Correspondence: ; Tel.: +82-2-3010-5632; Fax: +82-2-3010-6790
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21
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Changes in Left Ventricular Ejection Fraction after Mitral Valve Repair for Primary Mitral Regurgitation. J Clin Med 2021; 10:jcm10132830. [PMID: 34206958 PMCID: PMC8267705 DOI: 10.3390/jcm10132830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022] Open
Abstract
This study sought to identify the short- and long-term changes in left ventricular ejection fraction (LVEF) after mitral valve repair (MVr) in patients with chronic primary mitral regurgitation according to preoperative LVEF (pre-LVEF) and preoperative left ventricular end-systolic diameter (pre-LVESD). This study evaluated 461 patients. Restricted cubic spline regression models were constructed to demonstrate the long-term changes in postoperative LVEF (post-LVEF). The patients were divided into four groups according to pre-LVEF (<50%, 50–60%, 60–70%, and ≥70%). The higher the pre-LVEF was, the greater was the decrease in LVEF immediately after MVr. In the same pre-LVEF range, immediate post-LVEF was lower in patients with pre-LVESD ≥ 40 mm than in those with pre-LVESD < 40 mm. The patterns of long-term changes in post-LVEF differed according to pre-LVEF (p for interaction < 0.001). The long-term post-LVEF reached a plateau of approximately 60% when the pre-LVEF was ≥50%, but it seemed to show a downward trend after reaching a peak at approximately 3–4 years after MVr when the pre-LVEF was ≥70%. The patterns of short- and long-term changes in post-LVEF differed according to pre-LVEF and pre-LVESD values in patients with chronic primary mitral regurgitation after MVr.
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22
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Cormican DS, McHugh S, Sypert M, Shoubaki A, Boisen M, Ramakrishna H. Intervention for Asymptomatic Valvular Heart Disease: Analysis of Recent Data and Implications for the Perioperative Echocardiographer. J Cardiothorac Vasc Anesth 2021; 36:2196-2206. [PMID: 34247925 DOI: 10.1053/j.jvca.2021.05.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel S Cormican
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA; Division of Critical Care Medicine, Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | - Stephen McHugh
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Shadyside, Pittsburgh, PA
| | - Michael Sypert
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | - Ahmad Shoubaki
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | - Michael Boisen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Shadyside, Pittsburgh, PA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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23
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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24
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 522] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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25
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 721] [Impact Index Per Article: 240.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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26
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Žvirblytė R, Montvilaitė A, Tamulėnaitė E, Saniukaitė A, Ereminienė E, Vaškelytė JJ. Echocardiographic predictors of exercise induced pulmonary hypertension in patients with asymptomatic moderate to severe mitral regurgitation and preserved left ventricular ejection fraction. Perfusion 2021; 37:188-197. [PMID: 33509060 DOI: 10.1177/0267659120987545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The significant role of mitral regurgitation (MR) in development of pulmonary hypertension (PH) has been proved in previous studies. Experts suggest systolic pulmonary arterial pressure (SPAP) ⩾60 mmHg during exercise as a significant threshold of negative prognostic value in patients with MR. PURPOSE The aim of this study was to evaluate the changes of SPAP and to ascertain the determinants of exercise induced pulmonary hypertension (EIPH) in patients with asymptomatic primary MR. METHODS We performed a prospective study that included 50 patients with asymptomatic primary moderate to severe MR with preserved left ventricular ejection fraction (LV EF ⩾60%) at rest. They were divided into two groups according to the presence (PH group; n = 13) or absence (non-PH group; n = 37) of EIPH. Rest and stress (bicycle ergometry) echocardiography and speckle-tracking offline analysis were performed. RESULTS An increment of SPAP from rest to peak stress was higher in PH group (p < 0.001). Multivariate regression analysis showed that MR effective regurgitation orifice area (EROA; p = 0.008) and regurgitant volume (RVol; p = 0.006) contributed significantly to SPAP at rest. Higher increment of MR EROA during stress and worse parameters of LV diastolic function at rest (E, A, E/e') correlated significantly with higher SPAP during peak stress and they had a major role in predicting EIPH according to univariate logistic regression analysis. In ROC analysis SPAP >33.1 mmHg at rest could predict EIPH with 84.6% sensitivity and 87.1% specificity (95%CI 0.849-1.000; p < 0.001). CONCLUSIONS Parameters of MR severity (EROA and RVol) were significant determinants of SPAP at rest, while the increment of MR EROA during stress and parameters of resting LV diastolic function were the best predictors of significant EIPH.
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Affiliation(s)
- Rūta Žvirblytė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aistė Montvilaitė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Tamulėnaitė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Agnė Saniukaitė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Eglė Ereminienė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jolanta Justina Vaškelytė
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,The Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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27
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Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, Takanashi S, Tanaka H, Nakatani S, Ninami H, Nishi H, Hayashida K, Yaku H, Yamaguchi J, Yamamoto K, Watanabe H, Abe Y, Amaki M, Amano M, Obase K, Tabata M, Miura T, Miyake M, Murata M, Watanabe N, Akasaka T, Okita Y, Kimura T, Sawa Y, Yoshida K. JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease. Circ J 2020; 84:2037-2119. [DOI: 10.1253/circj.cj-20-0135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University Hospital
| | - Takeshi Arita
- Division of Cardiovascular Medicine Heart & Neuro-Vascular Center, Fukuoka Wajiro
| | - Yutaka Otsuji
- Department of Cardiology, Hospital of University of Occupational and Environmental Health
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, The University of Tokyo Hospital
| | | | | | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroshi Ninami
- Department of Cardiac Surgery, Tokyo Women’s Medical University
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kikuko Obase
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, Sakakibara Heart Institute of Okayama
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Harkness A, Ring L, Augustine DX, Oxborough D, Robinson S, Sharma V. Normal reference intervals for cardiac dimensions and function for use in echocardiographic practice: a guideline from the British Society of Echocardiography. Echo Res Pract 2020; 7:X1. [PMID: 32105051 PMCID: PMC7040881 DOI: 10.1530/erp-19-0050] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This guideline presents reference limits for use in echocardiographic practice, updating previous guidance from the British Society of Echocardiography. The rationale for change is discussed, in addition to how the reference intervals were defined and the current limitations to their use. The importance of interpretation of echocardiographic parameters within the clinical context is explored, as is grading of abnormality. Each of the following echo parameters are discussed and updated in turn: left ventricular linear dimensions and LV mass; left ventricular volumes; left ventricular ejection fraction; left atrial size; right heart parameters; aortic dimensions; and tissue Doppler imaging. There are several important conceptual changes to the assessment of the heart’s structure and function within this guideline. New terminology for left ventricular function and left atrial size are introduced. The British Society of Echocardiography has advocated a new approach to the assessment of the aortic root, the right heart, and clarified the optimal methodology for assessment of LA size. The British Society of Echocardiography has emphasized a preference to use, where feasible, indexed measures over absolute values for any chamber size.
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Affiliation(s)
- Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Essex, UK
| | - Liam Ring
- West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, UK
| | | | - David Oxborough
- Liverpool John Moores University, Research Institute for Sports and Exercise Science, Liverpool, UK
| | - Shaun Robinson
- North West Anglia NHS Foundation Trust, Peterborough, UK
| | - Vishal Sharma
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
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29
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Kislitsina ON, Thomas JD, Crawford E, Michel E, Kruse J, Liu M, Andrei AC, Cox JL, McCarthy PM. Predictors of Left Ventricular Dysfunction After Surgery for Degenerative Mitral Regurgitation. Ann Thorac Surg 2019; 109:669-677. [PMID: 31830438 DOI: 10.1016/j.athoracsur.2019.10.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study was performed to determine whether strain can supplement the ability of left ventricular (LV) ejection fraction (LVEF) to predict postoperative ventricular dysfunction in patients undergoing mitral valve surgery for degenerative mitral regurgitation (DMR). METHODS From 2004 to 2017, 520 patients with an LVEF of 60% or more underwent mitral valve surgery (98% repair) for DMR. All patients had preoperative, predischarge, and follow-up (mean, 5.0 ± 3.6 years) echocardiograms. Speckle tracking was performed in 119 of 520 patients (22.9%) to determine LV strain, right ventricular free-wall strain, and left atrial longitudinal strain. Multivariate logistic and Cox regression models were used in this subgroup to evaluate associations with early postoperative LV dysfunction and medium-term overall survival, respectively. RESULTS Median preoperative LVEF of the entire cohort was 65%. Based on predischarge echocardiogram, 449 patients (86.3%) maintained postoperative LVEF of 50% or greater. Seventy-one patients (13.7%) had a predischarge LVEF of less than 50%, 49 (9.4%) had a predischarge LVEF of 40% to 49%, and 22 (4.2% overall) had a predischarge LVEF of less than 40%. Abnormal preoperative LV, right ventricular, and left atrial strain measurements were significantly associated with the development of postoperative LV dysfunction, but preoperative hemodynamic and non-strain echo parameters did not vary enough in absolute values to be clinically useful as predictors of postoperative LV dysfunction. CONCLUSIONS Preoperative strain measurements in DMR patients were significantly associated with superior capabilities of detecting underlying LV dysfunction despite preserved preoperative LVEF. Strain analysis may serve as another marker for optimal timing of surgical intervention in DMR patients.
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Affiliation(s)
- Olga N Kislitsina
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - James D Thomas
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erin Crawford
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eriberto Michel
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jane Kruse
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Menghan Liu
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Adin-Cristian Andrei
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James L Cox
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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30
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Walmsley J, Squara P, Wolfhard U, Cornelussen R, Lumens J. Impact of abrupt versus gradual correction of mitral and tricuspid regurgitation: a modelling study. EUROINTERVENTION 2019; 15:902-911. [PMID: 31746755 DOI: 10.4244/eij-d-19-00598] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Correction of mitral and/or tricuspid regurgitation (MR, TR) frequently leads to poor outcomes in the days following intervention. We sought to understand how abrupt correction of MR and TR affects ventricular load and to investigate if gradual correction is beneficial. METHODS AND RESULTS MR and TR were simulated using the CircAdapt cardiovascular system model with effective regurgitant orifice (ERO) areas of 0.5 cm2 and 0.7 cm2. Ventricular and atrial contractility reductions to 40% of normal and pulmonary hypertension were simulated. Abrupt and gradual ERO closure were simulated with homeostatic regulation of blood pressure and volume. Abrupt correction of MR increased left and right ventricular fibre stress by 40% and 15%, respectively, whereas TR correction increased left and right ventricular fibre stress by 26% and 19%, respectively. This spike was followed by a rapid drop in fibre stress. Myocardial dysfunction prolonged the spike but reduced its amplitude. Right ventricular fibre stress increased more with pulmonary hypertension and TR. Gradual correction demonstrated no spike in tissue load. CONCLUSIONS Simulations demonstrated that abrupt ERO closure creates a transient increase in ventricular load that is prolonged by worsened myocardial condition and exacerbated by pulmonary hypertension. Gradual closure of the ERO abolishes this spike and merits clinical investigation.
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Affiliation(s)
- John Walmsley
- CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands
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Santoro C, Galderisi M, Esposito R, Buonauro A, Monteagudo JM, Sorrentino R, Lembo M, Fernandez-Golfin C, Trimarco B, Zamorano JL. Global longitudinal strain is a hallmark of cardiac damage in mitral regurgitation: the Italian arm of the European Registry of mitral regurgitation (EuMiClip). Cardiovasc Ultrasound 2019; 17:28. [PMID: 31752893 PMCID: PMC6873488 DOI: 10.1186/s12947-019-0178-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 11/08/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The search for reliable cardiac functional parameters is crucial in patients with mitral regurgitation (MR). In the Italian arm of the European Registry of MR, we compared the ability of global longitudinal strain (GLS) and left ventricular (LV) ejection fraction (LVEF) to detect cardiac damage in MR. METHODS Five hundred four consecutive patients with MR underwent a complete echo-Doppler exam. A total of 431, 53 and 20 patients had degenerative, secondary and mixed MR, respectively. The main echocardiographic parameters, including LV and left atrial (LA) size measurements, pulmonary artery systolic pressure (PASP) and GLS were compared between patients with mild MR (n = 392) vs. moderate to severe MR (n = 112). RESULTS LVEF and GLS were related one another in the pooled population, and separately in patients with mild and moderate/severe MR (all p < 0.0001). However, a certain number of patients were above the upper or below the lower limits of the 95% confidence interval (CI) of the normal relation in the pooled population and in patients with mild MR. Only 2 patients were below the 95% CI in moderate to severe MR. After adjusting for confounders by separate multivariate models, LVEF and GLS were independently associated with LV and left atrial size in the pooled population and in mild and moderate/severe MR. GLS, but not LVEF, was also independently associated with PASP in patients with mild and moderate to severe MR. CONCLUSIONS Both LVEF and GLS are independently associated with LV and LA size, but only GLS is related to pulmonary arterial pressure. GLS is a powerful hallmark of cardiac damage in MR.
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Affiliation(s)
- Ciro Santoro
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy.
| | - Roberta Esposito
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | - Agostino Buonauro
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | | | - Regina Sorrentino
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | - Maria Lembo
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | | | - Bruno Trimarco
- Department of Advanced Biomedical Science, Interdepartmental Laboratory of Cardiac Imaging, Federico II University Hospital, V. S. Pansini 5, bld 1, 80131, Naples, Italy
| | - Josè Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
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Le Tourneau T, Topilsky Y, Inamo J, Mahoney DW, Suri R, Schaff HV, Sarano M. Reverse Left Ventricular Remodeling after Surgery in Primary Mitral Regurgitation: A Volume-Related Phased Process. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2019. [DOI: 10.1080/24748706.2019.1639870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Thierry Le Tourneau
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
- Institut du Thorax, Inserm, CNRS, Université de Nantes, Nantes, France
| | - Yan Topilsky
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jocelyn Inamo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas W. Mahoney
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Rakesh Suri
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell V. Schaff
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Maurice Sarano
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
- Section of Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
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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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Affiliation(s)
- Aeshah Althunayyan
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Steffen E Petersen
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Guy Lloyd
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
- Institute of Cardiovascular Sciences, UCL, London, UK
| | - Sanjeev Bhattacharyya
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
- Institute of Cardiovascular Sciences, UCL, London, UK
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Aortic stiffness index and its association with cardiovascular functions in children before and after transcatheter closure of PDA. Egypt Heart J 2018; 70:261-266. [PMID: 30591740 PMCID: PMC6303348 DOI: 10.1016/j.ehj.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 09/19/2018] [Indexed: 11/23/2022] Open
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Wu S, Chai A, Arimie S, Mehra A, Clavijo L, Matthews RV, Shavelle DM. Incidence and treatment of severe primary mitral regurgitation in contemporary clinical practice. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:960-963. [DOI: 10.1016/j.carrev.2018.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
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Guérin P. [Percutaneous treatment of mitral regurgitation by Mitraclip in the elderly]. Ann Cardiol Angeiol (Paris) 2018; 67:474-481. [PMID: 30389097 DOI: 10.1016/j.ancard.2018.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Mitral regurgitation (MR) is the second most common form of valvular heart disease. It is classified as either primary (degenerative) or secondary (functional). Secondary MR is the consequence of myocardium disease. Primary MR from degenerative valve disease is due to a primary disruption of the mitral valve apparatus from either prolapsed or flail leaflets. It covers all aetiologies in which intrinsic lesions affect one or several components of the mitral valve apparatus. Gold-standard therapeutic management of severe primary MR is surgery usually to repair but sometime to replace the mitral valve. However patients considered to be at high-risk due to their age or the presence of comorbidities - accounting for 50% of all patients - are not eligible for surgery. Catheter-based interventions have been developed to correct MR percutaneously. The only such intervention which has been evaluated in organic MR is the edge-to-edge procedure using the MitraClip® (Abbott Vascular, Menlo Park, CA). MitraClip® offers an alternative to open surgical repair or replacement via a minimally invasive route and it was shown in the EVEREST II study that MitraClip® was safer than surgery even though it was less effective in reducing MR. A substantial number of patients are ineligible for mitral valve surgery because of prohibitive surgical risk. For those patients, MitraClip® may offer an alternative treatment option. Percutaneous edge-to-edge repair is the first percutaneous option accepted in the 2012 ESC guidelines: Percutaneous edge-to-edge procedure may be considered in patients with symptomatic severe primary MR who fulfill the echo criteria of eligibility, are judged inoperable or at high surgical risk by a 'heart team', and have a life expectancy greater than 1 year (recommendation class IIb, level of evidence C). Because of its frailty, MitraClip® in the elderly may be a good alternative to mitral surgery when indicated for primary or secondary MD.
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Affiliation(s)
- P Guérin
- Unité de cardiologie interventionnelle, l'institut du thorax, CHU Nantes, 44000 Nantes, France.
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Ring L, Abu-Omar Y, Kaye N, Rana BS, Watson W, Dutka DP, Vassiliou VS. Left Atrial Function Is Associated with Earlier Need for Cardiac Surgery in Moderate to Severe Mitral Regurgitation: Usefulness in Targeting for Early Surgery. J Am Soc Echocardiogr 2018; 31:983-991. [DOI: 10.1016/j.echo.2018.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Indexed: 11/25/2022]
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Kim HM, Cho GY, Hwang IC, Choi HM, Park JB, Yoon YE, Kim HK. Myocardial Strain in Prediction of Outcomes After Surgery for Severe Mitral Regurgitation. JACC Cardiovasc Imaging 2018; 11:1235-1244. [DOI: 10.1016/j.jcmg.2018.03.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/20/2018] [Accepted: 03/20/2018] [Indexed: 12/29/2022]
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Zilberszac R, Heinze G, Binder T, Laufer G, Gabriel H, Rosenhek R. Long-Term Outcome of Active Surveillance in Severe But Asymptomatic Primary Mitral Regurgitation. JACC Cardiovasc Imaging 2018; 11:1213-1221. [DOI: 10.1016/j.jcmg.2018.05.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/26/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
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Cameli M, Mandoli GE, Nistor D, Lisi E, Massoni A, Crudele F, Stricagnoli M, Lunghetti S, Mondillo S. Left heart longitudinal deformation analysis in mitral regurgitation. Int J Cardiovasc Imaging 2018; 34:1741-1751. [DOI: 10.1007/s10554-018-1391-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
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Maeder MT, Weber L, Buser M, Gerhard M, Haager PK, Maisano F, Rickli H. Pulmonary Hypertension in Aortic and Mitral Valve Disease. Front Cardiovasc Med 2018; 5:40. [PMID: 29876357 PMCID: PMC5974123 DOI: 10.3389/fcvm.2018.00040] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/13/2018] [Indexed: 12/30/2022] Open
Abstract
In patients with aortic and/or mitral valve disease the presence of pulmonary hypertension (PH) indicates a decompensated state of the disease with left ventricular and left atrial dysfunction and exhausted compensatory mechanism, i.e., a state of heart failure. Pulmonary hypertension in this context is the consequence of the backwards transmission of elevated left atrial pressure. In this form of PH, pulmonary vascular resistance is initially normal (isolated post-capillary PH). Depending on the extent and chronicity of left atrial pressure elevation additional pulmonary vascular remodeling may occur (combined pre- and post-capillary PH). Mechanical interventions for the correction of valve disease often but not always reduce pulmonary pressures. However, the reduction in pulmonary pressures is often modest, and persistent PH in these patients is common and a marker of poor prognosis. In the present review we discuss the pathophysiology and clinical impact of PH in patients with aortic and mitral valve disease, the comprehensive non-invasive and invasive diagnostic approach required to define treatment of PH, and recent insights from mechanistic studies, registries and randomized studies, and we provide an outlook regarding gaps in evidence, future clinical challenges, and research opportunities in this setting.
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Affiliation(s)
| | - Lukas Weber
- Cardiology Division, Kantonsspital, St. Gallen, Switzerland
- Department of Internal Medicine, Spital Rorschach, Rorschach, Switzerland
| | - Marc Buser
- Cardiology Division, Kantonsspital, St. Gallen, Switzerland
| | - Marc Gerhard
- Cardiology Division, Kantonsspital, St. Gallen, Switzerland
| | | | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Hans Rickli
- Cardiology Division, Kantonsspital, St. Gallen, Switzerland
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Evaluation of left ventricular functions by conventional echocardiography and tissue Doppler imaging in children with rheumatic valve disease. JOURNAL OF CONTEMPORARY MEDICINE 2018. [DOI: 10.16899/gopctd.369657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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El Sabbagh A, Reddy YN, Nishimura RA. Mitral Valve Regurgitation in the Contemporary Era. JACC Cardiovasc Imaging 2018; 11:628-643. [DOI: 10.1016/j.jcmg.2018.01.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 12/05/2017] [Accepted: 01/04/2018] [Indexed: 11/24/2022]
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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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47
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Dupuis M, Mahjoub H, Clavel MA, Côté N, Toubal O, Tastet L, Dumesnil JG, O'Connor K, Dahou A, Thébault C, Bélanger C, Beaudoin J, Arsenault M, Bernier M, Pibarot P. Forward Left Ventricular Ejection Fraction: A Simple Risk Marker in Patients With Primary Mitral Regurgitation. J Am Heart Assoc 2017; 6:JAHA.117.006309. [PMID: 29079561 PMCID: PMC5721745 DOI: 10.1161/jaha.117.006309] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The timing of mitral valve surgery in asymptomatic patients with primary mitral regurgitation (MR) is controversial. We hypothesized that the forward left ventricular (LV) ejection fraction (LVEF; ie, LV outflow tract stroke volume divided by LV end‐diastolic volume) is superior to the total LVEF to predict outcomes in MR. The objective of this study was to examine the association between echocardiographic parameters of MR severity and LV function and outcomes in patients with MR. Methods and Results The clinical and Doppler‐echocardiographic data of 278 patients with ≥mild MR and no class I indication of mitral valve surgery at baseline were retrospectively analyzed. The primary study end point was the composite of mitral valve surgery or death. During a mean follow‐up of 5.4±3.2 years, there were 147 (53%) events: 96 (35%) MV surgeries and 66 (24%) deaths. Total LVEF and global longitudinal strain were not associated with the occurrence of events, whereas forward LVEF (P<0.0001) and LV end‐systolic diameter (P=0.0003) were. After adjustment for age, sex, MR severity, Charlson probability, coronary artery disease, and atrial fibrillation, forward LVEF remained independently associated with the occurrence of events (adjusted hazard ratio: 1.09, [95% confidence interval]: 1.02–1.17 per 5% decrease; P=0.01), whereas LV end‐systolic diameter was not (P=0.48). Conclusions The results of this study suggest that the forward LVEF may be superior to the total LVEF and LV end‐systolic diameter to predict outcomes in patients with primary MR. This simple and easily measurable parameter may be useful to improve risk stratification and select the best timing for intervention in patients with primary MR.
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Affiliation(s)
- Marlène Dupuis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Haïfa Mahjoub
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Nancy Côté
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Oumhani Toubal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Lionel Tastet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Jean G Dumesnil
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Kim O'Connor
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Abdellaziz Dahou
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Christophe Thébault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Catherine Bélanger
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Marie Arsenault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Mathieu Bernier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute Laval University, Québec City, Québec, Canada
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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: 4209] [Impact Index Per Article: 601.3] [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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Jansen R, Kluin J, Ray SG, Cramer MJM, Suyker WJL, Chamuleau SAJ. Identification of the Asymptomatic Patient With Severe Mitral Regurgitation. Cardiol Rev 2017; 25:110-116. [DOI: 10.1097/crd.0000000000000119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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