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Javadikasgari H, McGurk S, Newell PC, Awtry JA, Sabe AA, Kaneko T. Evolving Concept of Aortic Valve Replacement in Asymptomatic Patients With Severe Aortic Stenosis. Ann Thorac Surg 2024; 117:796-803. [PMID: 37660965 DOI: 10.1016/j.athoracsur.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/06/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Surgical treatment of asymptomatic severe aortic stenosis (AS) has been gaining attention ever since the results of the Early Surgery Versus Conventional Treatment in Very Severe Aortic Stenosis (RECOVERY) and Aortic Valve replacement versus conservative treatment in Asymptomatic seveRe aortic stenosis (AVATAR) trials showed survival benefits with early surgical aortic valve replacement (SAVR). This study analyzed the long-term clinical and echocardiographic outcomes of SAVR in asymptomatic severe AS. METHODS Between 2002 and 2020, 272 patients with asymptomatic severe AS and a left ventricular ejection fraction ≥50% underwent SAVR with or without concomitant aortic surgery and met the study criteria. The median follow-up was 8.5 years (interquartile range, 6-12.8 years), for a total of 2584 patient-years. The time course of the left ventricular mass index (LVMI) and the average E/E' (ratio of the Doppler-derived E wave to the tissue Doppler-derived E' wave) were assessed using 594 postoperative echocardiograms. The association of preoperative LVMI and average E/E' with survival was assessed using Cox proportional hazards. RESULTS There was no operative mortality. On longitudinal analyses, LVMI improved in patients who presented with moderate or severe preoperative left ventricular hypertrophy (LVH). However, after the early decline in average E/E', there was a late increase to greater than upper limit normal, particularly in patients with a preoperative average E/E'≥14. Postoperative survival was 100%, 94%, 84%, and 76% at 1, 5, 10, and 15 years, respectively, comparable to age- and sex-matched expected survival on the basis of the US general population. On adjusted Cox survival analysis, only moderate to severe LVH was associated with a survival penalty (hazard ratio], 2.32; 95% CI, 1.02-5.27; P = .045). CONCLUSIONS In asymptomatic patients with AS, SAVR restores survival and improves LVH, but patients with diastolic dysfunction are left with persistent dysfunction. Presentation with moderate or severe LVH at the time of surgery translated to a survival penalty. This observational study supports early SAVR in this population before development of LVH, although further investigation is needed.
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Affiliation(s)
- Hoda Javadikasgari
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Paige C Newell
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jake A Awtry
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ashraf A Sabe
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Tsuyoshi Kaneko
- Mary Culver Department of Surgery, Washington University School of Medicine, St Louis, Missouri
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Dolmaci OB, Hilhorst TL, Malekzadeh A, Mertens BJ, Klautz RJ, Poelmann RE, Grewal N. The Prevalence of Coronary Artery Disease in Bicuspid Aortic Valve Patients: An Overview of the Literature. AORTA (STAMFORD, CONN.) 2023; 11:191-197. [PMID: 38698623 PMCID: PMC11219131 DOI: 10.1055/s-0044-1785190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/07/2024] [Indexed: 05/05/2024]
Abstract
The prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) patients is a debatable topic. Several studies have indicated that BAV patients have a lower prevalence of CAD compared with patients with a tricuspid aortic valve (TAV), but the effects of age and gender have not always been considered. This systematic review provides an overview of articles which report on CAD in BAV and TAV patients. Searches were executed in April 2021 and January 2022 according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines in three online databases: Medline, Embase, and Scopus. Screening and data extraction was done by two investigators separately. Primary and secondary outcomes were compared between BAV and TAV patients; a fixed effects model was used for correcting on confounders. Literature search yielded 1,529 articles with 44 being eligible for inclusion. BAV patients were younger (56.4 ± 8.3 years) than TAV patients (64 ± 10.3 years, p < 0.001). All CAD risk factors and CAD were more prevalent in TAV patients. No significant difference remained after correcting for age and gender as confounders. BAV patients have a lower prevalence of CAD and CAD risk factors compared with TAV patients. However, when the age differences between both groups are considered in the analyses, a similar prevalence of both CAD and CAD risk factors is found.
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Affiliation(s)
- Onur B. Dolmaci
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Tijmen L. Hilhorst
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Arjan Malekzadeh
- Medical Library, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Bart J.A. Mertens
- Department of Statistics, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J.M. Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert E. Poelmann
- Institute of Biology, Leiden University, Sylvius Laboratory, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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3
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Pan Y, Lin J, Wang Y, Li J, Xu P, Zeng M, Shan Y. Association of aortic distensibility and left ventricular function in patients with stenotic bicuspid aortic valve and preserved ejection fraction: a CMR study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2025-2033. [PMID: 35279784 DOI: 10.1007/s10554-022-02581-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/23/2022] [Indexed: 12/30/2022]
Abstract
To determine the relationship between aortic distensibility and left ventricular (LV) remodeling, myocardial strain and blood biomarkers in patients with stenotic bicuspid aortic valve (BAV) and preserved ejection fraction (EF) by cardiovascular magnetic resonance (CMR). 43 stenotic BAV patients were prospectively selected for 3.0 T CMR. Patients were divided into LV remodeling group (LV mass/volume ≥ 1.15, n = 21) and non-remodeling group (LV mass/volume < 1.15, n = 22). Clinical characteristics, biochemical data including cardiac troponin T(cTNT), N-terminal pro-B type natriuretic peptide (NT-proBNP) and creatine kinase isoenzyme (CK-MB) were noted. Distensibility of middle ascending aorta (mid-AA) and proximal descending aorta, LV structural and functional parameters, global and regional myocardial strain were measured. Compared to non-remodeling group, LV remodeling group had significantly decreased LV global strain (radial: 26.04 ± 8.70% vs. 32.92 ± 7.81%, P = 0.009; circumferential: - 17.20 ± 3.38% vs. - 19.65 ± 2.34%, P = 0.008; longitudinal: - 9.13 ± 2.34% vs. - 11.63 ± 1.99%, P < 0.001) and decreased mid-AA distensibility (1.22 ± 0.24 10-3 mm/Hg vs 1.60 ± 0.41 10-3 mm/Hg, P = 0.001). In addition, mid-AA distensibility was independently associated with LV remodeling (β = - 0.282, P = 0.003), and it was also significantly correlated with LV global strain (radial: r = 0.392, P = 0.009; circumferential: r = - 0.348, P = 0.022; longitudinal: r = - 0.333, P = 0.029), cTNT (r = - 0.333, P = 0.029) and NT-proBNP (r = - 0.440, P = 0.003). In this cohort with stenotic BAV and preserved EF, mid-AA distensibility is found significantly associated with LV remolding, which encouraging to better understand mechanism of ventricular vascular coupling.
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Affiliation(s)
- Yijun Pan
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jiang Lin
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yongshi Wang
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jun Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Pengju Xu
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Mengsu Zeng
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yan Shan
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Phua K, Chew NWS, Kong WKF, Tan RS, Ye L, Poh KK. The mechanistic pathways of oxidative stress in aortic stenosis and clinical implications. Theranostics 2022; 12:5189-5203. [PMID: 35836811 PMCID: PMC9274751 DOI: 10.7150/thno.71813] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
Despite the elucidation of the pathways behind the development of aortic stenosis (AS), there remains no effective medical treatment to slow or reverse its progress. Instead, the gold standard of care in severe or symptomatic AS is replacement of the aortic valve. Oxidative stress is implicated, both directly as well as indirectly, in lipid infiltration, inflammation and fibro-calcification, all of which are key processes underlying the pathophysiology of degenerative AS. This culminates in the breakdown of the extracellular matrix, differentiation of the valvular interstitial cells into an osteogenic phenotype, and finally, calcium deposition as well as thickening of the aortic valve. Oxidative stress is thus a promising and potential therapeutic target for the treatment of AS. Several studies focusing on the mitigation of oxidative stress in the context of AS have shown some success in animal and in vitro models, however similar benefits have yet to be seen in clinical trials. Statin therapy, once thought to be the key to the treatment of AS, has yielded disappointing results, however newer lipid lowering therapies may hold some promise. Other potential therapies, such as manipulation of microRNAs, blockade of the renin-angiotensin-aldosterone system and the use of dipeptidylpeptidase-4 inhibitors will also be reviewed.
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Affiliation(s)
- Kailun Phua
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Nicholas WS Chew
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore,✉ Corresponding authors: A/Prof Kian-Keong Poh, . Dr Nicholas Chew, MBChB, MMED (Singapore), MRCP (UK) . Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore. 1E Kent Ridge Rd, NUHS Tower Block, Level 9, Singapore 119228. Fax: (65) 68722998 Telephone: (65) 67722476
| | - William KF Kong
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore
| | - Ru-San Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, 169609, Singapore
| | - Lei Ye
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, 169609, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Singapore,Yong Loo Lin School of Medicine, National University of Singapore, Singapore,✉ Corresponding authors: A/Prof Kian-Keong Poh, . Dr Nicholas Chew, MBChB, MMED (Singapore), MRCP (UK) . Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore. 1E Kent Ridge Rd, NUHS Tower Block, Level 9, Singapore 119228. Fax: (65) 68722998 Telephone: (65) 67722476
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5
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Prognostically Distinct Phenotypes of Metabolic Health Beyond Obesity in Aortic Stenosis. Am J Cardiol 2022; 178:112-118. [DOI: 10.1016/j.amjcard.2022.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
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Butcher SC, Pio SM, Kong WKF, Singh GK, Ng ACT, Perry R, Sia CH, Poh KK, Almeida AG, González A, Shen M, Yeo TC, Shanks M, Popescu BA, Galian Gay L, Fijałkowski M, Liang M, Tay E, Ajmone Marsan N, Selvanayagam J, Pinto F, Zamorano JL, Pibarot P, Evangelista A, Bax JJ, Delgado V. Left ventricular remodelling in bicuspid aortic valve disease. Eur Heart J Cardiovasc Imaging 2021; 23:1669-1679. [PMID: 34966913 DOI: 10.1093/ehjci/jeab284] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/13/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Characterization of left ventricular (LV) geometric pattern and LV mass could provide an important insight into the pathophysiological adaptations of the LV to pressure and/or volume overload in patients with bicuspid aortic valve (BAV) and significant (≥moderate) aortic valve (AV) disease. This study aimed to characterize LV remodelling and its prognostic impact in patients with BAV according to the predominant type of valvular dysfunction. METHODS AND RESULTS In this international, multicentre BAV registry, 1345 patients [51.0 (37.0-63.0) years, 71% male] with significant AV disease were identified. Patients were classified as having isolated aortic stenosis (AS) (n = 669), isolated aortic regurgitation (AR) (n = 499) or mixed aortic valve disease (MAVD) (n = 177). LV hypertrophy was defined as a LV mass index >115 g/m2 in males and >95 g/m2 in females. LV geometric pattern was classified as (i) normal geometry: no LV hypertrophy, relative wall thickness (RWT) ≤0.42, (ii) concentric remodelling: no LV hypertrophy, RWT >0.42, (iii) concentric hypertrophy: LV hypertrophy, RWT >0.42, and (iv) eccentric hypertrophy: LV hypertrophy, RWT ≤0.42. Patients were followed-up for the endpoints of event-free survival (defined as a composite of AV repair/replacement and all-cause mortality) and all-cause mortality. Type of AV dysfunction was related to significant variations in LV remodelling. Higher LV mass index, i.e. LV hypertrophy, was independently associated with the composite endpoint for patients with isolated AS [hazard ratio (HR) 1.08 per 25 g/m2, 95% confidence interval (CI) 1.00-1.17, P = 0.046] and AR (HR 1.19 per 25 g/m2, 95% CI 1.11-1.29, P < 0.001), but not for those with MAVD. The presence of concentric remodelling, concentric hypertrophy and eccentric hypertrophy were independently related to the composite endpoint in patients with isolated AS (HR 1.54, 95% CI 1.06-2.23, P = 0.024; HR 1.68, 95% CI 1.17-2.42, P = 0.005; HR 1.59, 95% CI 1.03-2.45, P = 0.038, respectively), while concentric hypertrophy and eccentric hypertrophy were independently associated with the combined endpoint for those with isolated AR (HR 2.49, 95% CI 1.35-4.60, P = 0.004 and HR 3.05, 95% CI 1.71-5.45, P < 0.001, respectively). There was no independent association observed between LV remodelling and the combined endpoint for patients with MAVD. CONCLUSIONS LV hypertrophy or remodelling were independently associated with the composite endpoint of AV repair/replacement and all-cause mortality for patients with isolated AS and isolated AR, although not for patients with MAVD.
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Affiliation(s)
- Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, 197 Wellington St, Perth WA 6000, Australia
| | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - William K F Kong
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia
| | - Rebecca Perry
- Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Dr, Bedford Park SA 5042, Adelaide, Australia
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Kian Keong Poh
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Ana G Almeida
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal
| | - Ariana González
- Department of Cardiology, Hospital Universitario Ramón y Cajal, M-607, 9, 100, 28034 Madrid, Spain
| | - Mylène Shen
- Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Miriam Shanks
- Division of Cardiology, University of Alberta, Mazankowski Alberta Heart Institute, 11220 83 Ave NW, Edmonton, AB T6G 2B7, Canada
| | - Bogdan A Popescu
- University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bulevardul Eroii Sanitari 8, București 050474, Romania
| | - Laura Galian Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebrón, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Marcin Fijałkowski
- First Department of Cardiology, Medical University of Gdansk, Marii Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland
| | - Michael Liang
- Department of Cardiology, National University Heart Centre, National University Health System, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore.,Department of Cardiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore
| | - Edgar Tay
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, 199 Ipswich Rd, Woolloongabba QLD 4102, Australia
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
| | - Joseph Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, Flinders Dr, Bedford Park SA 5042, Adelaide, Australia
| | - Fausto Pinto
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr, Singapore 117597, Singapore
| | - Jose L Zamorano
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Av. Prof. Egas Moniz MB, 1649-028 Lisboa, Portugal
| | - Philippe Pibarot
- Department of Cardiology, Hospital Universitario Ramón y Cajal, M-607, 9, 100, 28034 Madrid, Spain
| | - Arturo Evangelista
- University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bulevardul Eroii Sanitari 8, București 050474, Romania
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.,Heart Center, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Heart Lung Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands
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Prognostic Implications of Bicuspid and Tricuspid Aortic Valve Phenotype on Progression of Moderate Aortic Stenosis and Ascending Aorta Dilatation. Am J Cardiol 2021; 161:76-83. [PMID: 34627597 DOI: 10.1016/j.amjcard.2021.08.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/10/2021] [Accepted: 08/16/2021] [Indexed: 11/20/2022]
Abstract
Studies on the impact of aortic valve anatomy (bicuspid aortic valve [BAV] or tricuspid aortic valve [TAV]) on the progression of moderate aortic stenosis (AS) and ascending aorta (AA) dilatation and its prognostic implications are limited. From 1991 to 2016, 288 asymptomatic patients with moderate AS detected during index echocardiography with at least 1 year of echocardiographic follow-up were retrospectively studied. Baseline clinical and echocardiographic characteristics were compared between patients with BAV (n = 80) and patients with TAV (n = 208). Co-primary outcomes were 1-year hemodynamic and anatomic progression of AS and AA dilatation. Secondary end points were the incidence of AA rapid progressors, all-cause mortality, aortic valve replacement, and congestive heart failure. Determinants of AS progression, AA diameters, AA dilatation, and prognostic outcomes were evaluated. Similar 1-year progression of the aortic valve peak velocity, Vmax (9 ± 18 vs 9 ± 23 cm/s), mean gradient (1.5 ± 2.3 vs 1.3 ± 3.2 mm Hg), and aortic valve area (AVA) (-0.04 ± 0.09 vs -0.05 ± 0.10 cm2) were noted for BAV and TAV groups, respectively. One-year progressions of AA were similar at Valsalva (0.11 ± 0.88 vs 0.14 ± 1.10 mm) and tubular levels (0.12 ± 0.68 vs 0.30 ± 1.51 mm) in BAV and TAV groups, respectively. A trend toward increased rapid AA progression in patients with BAV (31.3%) was observed compared with patients with TAV (14.8%, p = 0.099). BAV was associated with progression of Vmax (β = 0.17, p = 0.036), the dimensionless index (β = -0.17, p = 0.008), and AVA (β = -0.14, p = 0.048), but not mean gradient after adjusting for age, baseline severity indexes, gender, hypertension, diabetes, and body surface area. Although BAV was a determinant of larger baseline AA diameter, there was no significant association between BAV and AA rapid progressors. Adjusted Kaplan-Meier curves demonstrated no differences in congestive heart failure, aortic valve replacement, or mortality between valve morphology. In conclusion, there was a similar 1-year disease progression in terms of AVA, Vmax, mean gradient, and AA diameters between patients with BAV and patients with TAV. BAV was associated with a significant increase in Vmax, dimensionless index, and AVA after adjusting for important confounders. Close and prolonged follow-up is warranted in both groups of patients.
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8
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Biological knowledge-slanted random forest approach for the classification of calcified aortic valve stenosis. BioData Min 2021; 14:35. [PMID: 34301292 PMCID: PMC8305490 DOI: 10.1186/s13040-021-00269-4] [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: 05/02/2021] [Accepted: 07/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background Calcific aortic valve stenosis (CAVS) is a fatal disease and there is no pharmacological treatment to prevent the progression of CAVS. This study aims to identify genes potentially implicated with CAVS in patients with congenital bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) in comparison with patients having normal valves, using a knowledge-slanted random forest (RF). Results This study implemented a knowledge-slanted random forest (RF) using information extracted from a protein-protein interactions network to rank genes in order to modify their selection probability to draw the candidate split-variables. A total of 15,191 genes were assessed in 19 valves with CAVS (BAV, n = 10; TAV, n = 9) and 8 normal valves. The performance of the model was evaluated using accuracy, sensitivity, and specificity to discriminate cases with CAVS. A comparison with conventional RF was also performed. The performance of this proposed approach reported improved accuracy in comparison with conventional RF to classify cases separately with BAV and TAV (Slanted RF: 59.3% versus 40.7%). When patients with BAV and TAV were grouped against patients with normal valves, the addition of prior biological information was not relevant with an accuracy of 92.6%. Conclusion The knowledge-slanted RF approach reflected prior biological knowledge, leading to better precision in distinguishing between cases with BAV, TAV, and normal valves. The results of this study suggest that the integration of biological knowledge can be useful during difficult classification tasks. Supplementary Information The online version contains supplementary material available at 10.1186/s13040-021-00269-4.
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