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Annabi M, Carter‐Storch R, Zaroui A, Galat A, Oghina S, Kharoubi M, Bezard M, Derumeaux G, Fanen P, Lemonnier F, Poullot E, Itti E, Gallet R, Teiger E, Pibarot P, Damy T, Clavel M. Prevalence, Characteristics, and Impact on Prognosis of Aortic Stenosis in Patients With Cardiac Amyloidosis. J Am Heart Assoc 2024; 13:e034723. [PMID: 38904242 PMCID: PMC11255711 DOI: 10.1161/jaha.124.034723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/23/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Cardiac amyloidosis (CA) is frequently found in older patients with aortic stenosis (AS). However, the prevalence of AS among patients with CA is unknown. The objective was to study the prevalence and prognostic impact of AS among patients with CA. METHODS AND RESULTS We conducted a retrospective analysis of a prospective registry comprising 976 patients with native aortic valves who were confirmed with wild type transthyretin amyloid (ATTRwt), hereditary variant transthyretin amyloid (ATTRv), or immunoglobulin light-chain (AL) CA. CA patients' echocardiograms were re-analyzed focusing on the aortic valve. Multivariable Cox regression analysis was performed to assess the mortality risk associated with moderate or greater AS in ATTRwt CA. The crude prevalence of AS among patients with CA was 26% in ATTRwt, 8% in ATTRv, and 5% in AL. Compared with population-based controls, all types of CA had higher age- and sex-standardized rate ratios (SRRs) of having any degree of AS (AL: SRR, 2.62; 95% Confidence Interval (CI) [1.09-3.64]; ATTRv: SRR, 3.41; 95%CI [1.64-4.60]; ATTRwt: SRR, 10.8; 95%CI [5.25-14.53]). Compared with hospital controls, only ATTRwt had a higher SRR of having any degree of AS (AL: SRR, 0.97, 95%CI [0.56-1.14]; ATTRv: SRR, 1.27; 95%CI [0.85-1.44]; ATTRwt: SRR, 4.01; 95%CI [2.71-4.54]). Among patients with ATTRwt, moderate or greater AS was not associated with increased all-cause death after multivariable adjustment (hazard ratio, 0.71; 95%CI [0.42-1.19]; P=0.19). CONCLUSIONS Among patients with CA, ATTRwt but not ATTRv or AL is associated with a higher prevalence of patients with AS compared with hospital controls without CA, even after adjusting for age and sex. In our population, having moderate or greater AS was not associated with a worse outcome in patients with ATTRwt.
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Affiliation(s)
- Mohamed‐Salah Annabi
- Institut Universitaire de Cardiologie et de PneumologieUniversité LavalQuébecCanada
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
- INSERM U955, Team «Senescence, Metabolism and Cardiovascular Diseases»Paris‐Est Créteil University (UPEC)CréteilFrance
| | - Rasmus Carter‐Storch
- Institut Universitaire de Cardiologie et de PneumologieUniversité LavalQuébecCanada
- Department of CardiologyOdense University HospitalOdenseDenmark
| | - Amira Zaroui
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
- INSERM Unit U955Clinical Epidemiology and Ageing (CEpiA, Paris‐Est Créteil University, Val‐de‐Marne)CréteilFrance
| | - Arnault Galat
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
- INSERM Unit U955Clinical Epidemiology and Ageing (CEpiA, Paris‐Est Créteil University, Val‐de‐Marne)CréteilFrance
| | - Silvia Oghina
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
| | - Mounira Kharoubi
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
- INSERM Unit U955Clinical Epidemiology and Ageing (CEpiA, Paris‐Est Créteil University, Val‐de‐Marne)CréteilFrance
| | - Mélanie Bezard
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
- INSERM Unit U955Clinical Epidemiology and Ageing (CEpiA, Paris‐Est Créteil University, Val‐de‐Marne)CréteilFrance
| | - Geneviève Derumeaux
- INSERM U955, Team «Senescence, Metabolism and Cardiovascular Diseases»Paris‐Est Créteil University (UPEC)CréteilFrance
- AP‐HP, Department of PhysiologyHenri Mondor Hospital, FHU‐SENECCréteilFrance
| | - Pascale Fanen
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
- INSERM Unit U955Clinical Epidemiology and Ageing (CEpiA, Paris‐Est Créteil University, Val‐de‐Marne)CréteilFrance
| | - François Lemonnier
- AP‐HP, Henri Mondor HospitalLymphoid Malignancies UnitCréteilFrance
- Univ Paris Est Créteil, INSERM, IMRBCréteilFrance
| | - Elsa Poullot
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
- Univ Paris Est Créteil, INSERM, IMRBCréteilFrance
- Department of PathologyAP‐HP Henri Mondor HospitalCréteilFrance
| | - Emmanuel Itti
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
- INSERM Unit U955Clinical Epidemiology and Ageing (CEpiA, Paris‐Est Créteil University, Val‐de‐Marne)CréteilFrance
| | - Romain Gallet
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
- INSERM Unit U955Clinical Epidemiology and Ageing (CEpiA, Paris‐Est Créteil University, Val‐de‐Marne)CréteilFrance
| | - Emmanuel Teiger
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
- INSERM Unit U955Clinical Epidemiology and Ageing (CEpiA, Paris‐Est Créteil University, Val‐de‐Marne)CréteilFrance
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de PneumologieUniversité LavalQuébecCanada
| | - Thibaud Damy
- Referral Center for Cardiac Amyloidosis, Mondor Amyloidosis Network, GRC Amyloid Research Institute and Cardiology DepartmentAPHP Henri Mondor HospitalCréteilFrance
- INSERM Unit U955Clinical Epidemiology and Ageing (CEpiA, Paris‐Est Créteil University, Val‐de‐Marne)CréteilFrance
| | - Marie‐Annick Clavel
- Institut Universitaire de Cardiologie et de PneumologieUniversité LavalQuébecCanada
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Laenens D, Stassen J, Galloo X, Myagmardorj R, Marsan NA, Bax JJ. Association Between Left Ventricular Apical-to-Basal Strain Ratio and Conduction Disorders after Aortic Valve Replacement. J Am Soc Echocardiogr 2024; 37:77-86. [PMID: 37730096 DOI: 10.1016/j.echo.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The aim of the study was to evaluate whether left ventricular apical-to-basal longitudinal strain differences, representing advanced basal interstitial fibrosis, are associated with conduction disorders after aortic valve replacement (AVR) in patients with severe aortic stenosis. METHODS Patients with aortic stenosis undergoing AVR were included. The apical-to-basal strain ratio was calculated by dividing the average strain of the apical segments by the average strain of the basal segments. Values >1.9 were considered abnormal, as previously described. All patients were followed up for the occurrence of complete left or right bundle branch block or permanent pacemaker implantation within 2 years after AVR. Subgroup analysis was performed in patients undergoing transcatheter AVR. RESULTS Two hundred seventy-four patients were included (median age of 74 years [interquartile range, 65, 80], 46.4% male). During a median follow-up of 12.2 months (interquartile range, 0.2, 24.3), 74 patients (27%) developed complete bundle branch block or were implanted with a permanent pacemaker. These patients more often had an abnormal apical-to-basal strain ratio. Cumulative event-free survival analysis showed worse outcome in patients with an abnormal apical-to-basal strain ratio (log rank χ2 = 7.258, P = .007). In multivariable Cox regression analysis, an abnormal apical-to-basal strain ratio was the only independent factor associated with the occurrence of complete bundle branch block or permanent pacemaker implantation after adjusting for other factors previously shown to be associated with conduction disorders after AVR. Subgroup analysis confirmed the independent association of an abnormal apical-to-basal strain ratio with conduction disorders after transcatheter AVR. CONCLUSION The apical-to-basal strain ratio is independently associated with conduction disorders after AVR and could guide risk stratification in patients potentially at risk for pacemaker implantation.
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Affiliation(s)
- Dorien Laenens
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, University Hospital Brussels, Jette, Belgium
| | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
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Coisne A, Donal E. Before Aortic Valve Replacement: Think Globally, Look Regionally. J Am Soc Echocardiogr 2024; 37:87-88. [PMID: 37966416 DOI: 10.1016/j.echo.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023]
Affiliation(s)
- Augustin Coisne
- University of Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France; Cardiovascular Research Foundation, New York City, New York.
| | - Erwan Donal
- Cardiologie, CHU de Rennes, LTSI, Inserm, Rennes, France
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Meredith T, Roy D, Hayward C, Feneley M, Kovacic J, Muller D, Namasivayam M. Strain Assessment in Aortic Stenosis: Pathophysiology and Clinical Utility. J Am Soc Echocardiogr 2024; 37:64-76. [PMID: 37805144 DOI: 10.1016/j.echo.2023.10.001] [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: 10/19/2022] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/09/2023]
Abstract
Contemporary echocardiographic criteria for grading aortic stenosis severity have remained relatively unchanged, despite significant advances in noninvasive imaging techniques over the last 2 decades. More recently, attention has shifted to the ventricular response to aortic stenosis and how this might be quantified. Global longitudinal strain, semiautomatically calculated from standard two-dimensional echocardiographic images, has been the focus of extensive research. Global longitudinal strain is a sensitive marker of subtle hypertrophy-related impairment in left ventricular function and has shown promise as a relatively robust prognostic marker, both independently and when added to severity classification systems. Herein we review the pathophysiological basis underpinning the potential utility of global longitudinal strain in the assessment of aortic stenosis, as well as its potential role in quantifying myocardial recovery and prognostic discrimination following aortic valve replacement.
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Affiliation(s)
- Thomas Meredith
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Roy
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Hayward
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Feneley
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jason Kovacic
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - David Muller
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mayooran Namasivayam
- Department of Cardiology, St. Vincent's Hospital, Sydney, New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia; Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.
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Ajmone Marsan N, Graziani F, Meucci MC, Wu HW, Lillo R, Bax JJ, Burzotta F, Massetti M, Jukema JW, Crea F. Valvular heart disease and cardiomyopathy: reappraisal of their interplay. Nat Rev Cardiol 2024; 21:37-50. [PMID: 37563454 DOI: 10.1038/s41569-023-00911-0] [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] [Accepted: 07/03/2023] [Indexed: 08/12/2023]
Abstract
Cardiomyopathies and valvular heart diseases are typically considered distinct diagnostic categories with dedicated guidelines for their management. However, the interplay between these conditions is increasingly being recognized and they frequently coexist, as in the paradigmatic examples of dilated cardiomyopathy and hypertrophic cardiomyopathy, which are often complicated by the occurrence of mitral regurgitation. Moreover, cardiomyopathies and valvular heart diseases can have a shared aetiology because several genetic or acquired diseases can affect both the cardiac valves and the myocardium. In addition, the association between cardiomyopathies and valvular heart diseases has important prognostic and therapeutic implications. Therefore, a better understanding of their shared pathophysiological mechanisms, as well as of the prevalence and predisposing factors to their association, might lead to a different approach in the risk stratification and management of these diseases. In this Review, we discuss the different scenarios in which valvular heart diseases and cardiomyopathies coexist, highlighting the need for an improved classification and clustering of these diseases with potential repercussions in the clinical management and, particularly, personalized therapeutic approaches.
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Affiliation(s)
- Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Francesca Graziani
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Hoi W Wu
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosa Lillo
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Francesco Burzotta
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Filippo Crea
- Department of Cardiovascular Science, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Hjertaas JJ, Einarsen E, Gerdts E, Kokorina M, Moen CA, Urheim S, Saeed S, Matre K. Impact of aortic valve stenosis on myocardial deformation in different left ventricular levels: A three-dimensional speckle tracking echocardiography study. Echocardiography 2023; 40:1028-1039. [PMID: 37543718 DOI: 10.1111/echo.15668] [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: 12/29/2022] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Global systolic left ventricular (LV) myocardial function progressively declines as degenerative aortic valve stenosis (AS) progresses. Whether this results in uniformly distributed deformation changes from base to apex has not been investigated. METHODS Eighty-five AS patients underwent three-dimensional (3D) echocardiography in this cross-sectional study. Patients were grouped by peak jet velocity into mild (n = 32), moderate (n = 31), and severe (n = 22) AS. 3D speckle tracking derived strain, rotation, twist, and torsion were obtained to assess global LV function and myocardial function at the apical, mid, and basal levels. RESULTS Global longitudinal strain (GLS) was lower in patients with severe AS (-16.1 ± 2.4% in mild, -15.5 ± 2.5% in moderate, and -13.5 ± 3.0% in severe AS [all p < .01]). Peak basal and mid longitudinal strain (LS), basal rotation and twist from apical to basal level followed the same pattern, while peak apical LS was higher in moderate AS compared to severe AS (all p < .05). In multivariate analyses, lower GLS was particularly associated with male sex, higher body mass index and peak aortic jet velocity, lower basal LS with higher filling pressure (E/e') and LV mass, lower mid LS with higher RWT and presence of AS symptoms, and lower apical LS with male sex and higher systolic blood pressure, respectively (all p < .05). CONCLUSION Using 3D speckle tracking echocardiography reveals regional and global changes in LV mechanics in AS related to the severity of AS, LV remodeling and presence of cardiovascular risk factors.
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Affiliation(s)
| | - Eigir Einarsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Marina Kokorina
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Stig Urheim
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Knut Matre
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Prognostic Value of Preprocedural LV Global Longitudinal Strain for Post-TAVR-Related Morbidity and Mortality: A Meta-Analysis. JACC Cardiovasc Imaging 2023; 16:332-341. [PMID: 36889849 DOI: 10.1016/j.jcmg.2023.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/26/2022] [Accepted: 01/03/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) demonstrates limited prognostic value for post-transcatheter aortic valve replacement (TAVR) outcomes. Evidence regarding the potential role of left ventricular global longitudinal strain (LV-GLS) in this setting is inconsistent. OBJECTIVES The aim of this systematic review and meta-analysis of aggregated data was to evaluate the prognostic value of preprocedural LV-GLS for post-TAVR-related morbidity and mortality. METHODS The authors searched PubMed, Embase, and Web of Science for studies investigating the association between preprocedural 2-dimensional speckle-tracking-derived LV-GLS and post-TAVR clinical outcomes. An inversely weighted random effects meta-analysis was adopted to investigate the association between LV-GLS vs primary (ie, all-cause mortality) and secondary (ie, major cardiovascular events [MACE]) post-TAVR outcomes. RESULTS Of the 1,130 identified records, 12 were eligible, all of which had a low-to-moderate risk of bias (Newcastle-Ottawa scale). On average, 2,049 patients demonstrated preserved LVEF (52.6% ± 1.7%), but impaired LV-GLS (-13.6% ± 0.6%). Patients with a lower LV-GLS had a higher all-cause mortality (pooled HR: 2.01; 95% CI: 1.59-2.55) and MACE (pooled odds ratio [OR]: 1.26; 95% CI: 1.08-1.47) risk compared with patients with higher LV-GLS. In addition, each percentage point decrease of LV-GLS (ie, toward 0%) was associated with an increased mortality (HR: 1.06; 95% CI: 1.04-1.08) and MACE risk (OR: 1.08; 95% CI: 1.01-1.15). CONCLUSIONS Preprocedural LV-GLS was significantly associated with post-TAVR morbidity and mortality. This suggests a potential clinically important role of pre-TAVR evaluation of LV-GLS for risk stratification of patients with severe aortic stenosis. (Prognostic value of left ventricular global longitudinal strain in patients with aortic stenosis undergoing Transcatheter Aortic Valve Implantation: a meta-analysis; CRD42021289626).
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Strange G, Stewart S, Playford D, Strom JB. Risk for Mortality with Increasingly Severe Aortic Stenosis: An International Cohort Study. J Am Soc Echocardiogr 2023; 36:60-68.e2. [PMID: 36208655 PMCID: PMC9822866 DOI: 10.1016/j.echo.2022.09.020] [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: 04/05/2022] [Revised: 08/10/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aortic stenosis (AS) is the most common valvular heart disease in high-income countries. Adjusted for clinical confounders, the risk associated with increasing AS severity across the spectrum of AS severity remains uncertain. METHODS The authors conducted an international, multicenter, parallel-cohort study of 217,599 Australian (mean age, 76.0 ± 7.3 years; 49.3% women) and 30,865 US (mean age, 77.4 ± 7.3 years; 52.2% women) patients aged ≥65 years who underwent echocardiography. Patients with previous aortic valve replacement were excluded. The risk of increasing AS severity, quantified by peak aortic velocity (Vmax), was assessed through linkage to 97,576 and 14,481 all-cause deaths in Australia and the United States, respectively. RESULTS The distribution of AS severity (mean Vmax, 1.7 ± 0.7 m/sec) was similar in both cohorts. Compared with those with Vmax of 1.0 to 1.49 m/sec, those with Vmax of 2.50 to 2.99 m/sec (US cohort) or Vmax of 3.0 to 3.49 m/sec (Australian cohort) had a 1.5-fold increase in mortality risk within 10 years, adjusting for age, sex, presence of left heart disease, and left ventricular ejection fraction. Overall, the adjusted risk for mortality plateaued (1.75- to 2.25-fold increased risk) above a Vmax of 3.5 m/sec. This pattern of mortality persisted despite adjustment for a comprehensive list of comorbidities and treatments within the US cohort. CONCLUSIONS Within large, parallel patient cohorts managed in different health systems, similar patterns of mortality linked to increasingly severe AS were observed. These findings support ongoing clinical trials of aortic valve replacement in patients with nonsevere AS and suggest the need to develop and apply more proactive surveillance strategies in this high-risk population.
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Affiliation(s)
- Geoff Strange
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Institute of Health Research, University of Notre Dame, Fremantle, Australia; Heart Research Institute, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Simon Stewart
- Institute of Health Research, University of Notre Dame, Fremantle, Australia; School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - David Playford
- Institute of Health Research, University of Notre Dame, Fremantle, Australia
| | - Jordan B Strom
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Xiao Y, Bi W, Qiao W, Wang X, Li Y, Ren W. Prognostic value of ventricular longitudinal strain in patients undergoing transcatheter aortic valve replacement: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:965440. [PMID: 36093137 PMCID: PMC9448921 DOI: 10.3389/fcvm.2022.965440] [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: 06/09/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Strain obtained by speckle tracking echocardiography (STE) can detect subclinical myocardial impairment due to myocardial fibrosis (MF) and is considered a prognostic marker. Aortic stenosis (AS) is not only a valve disease, but also a cardiomyopathy characterized by MF. The purpose of this study was to systematically review and analyze ventricular strain as a predictor of adverse outcomes in patients with AS undergoing transcatheter aortic valve replacement (TAVR). Methods PubMed, Embase, and the Cochrane library were searched for studies that investigated the prognostic value of impaired ventricular strain on patients with AS undergoing TAVR with all-cause mortality (ACM) and major adverse cardiovascular events (MACE). Pooled odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated to assess the role of left (LVLS) and right (RVLS) ventricular longitudinal strain in the prognostic prediction of patients with AS undergoing TAVR. Sensitivity and subgroup analysis was performed to assess heterogeneity. Results Twelve studies were retrieved from 571 citations for analysis. In total, 1,489 patients with a mean age of 82 years and follow-up periods varying between 1 year and 8.5 years were included. Meta-analysis showed the impaired LVLS from eight studies was associated with an increased risk for combined ACM and MACE (OR: 1.08, 95% CI: 1–1.16; p = 0.037), and ACM alone (HR: 1.08, 95% CI: 1.01–1.16; p = 0.032). Impaired RVLS from four studies was associated with an increased risk of combined ACM and MACE (OR: 1.08, 95% CI: 1.02–1.14; p < 0.01), and ACM alone (HR: 1.07, 95% CI: 1.02–1.12; p < 0.01). Conclusions This meta-analysis demonstrated that ventricular strain, including LVLS and RVLS, had a substantial prognostic value in ACM or combined ACM and MACE, which could be used as a valid marker for risk stratification in patients with AS undergoing TAVR.
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Ye Z, Yang LT, Medina-Inojosa JR, Scott CG, Padang R, Luis SA, Nkomo VT, Enriquez-Sarano M, Michelena HI. Multi-chamber Strain Characterization is a Robust Prognosticator for both Bicuspid and Tricuspid Aortic Stenosis. J Am Soc Echocardiogr 2022; 35:956-965. [DOI: 10.1016/j.echo.2022.05.010] [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: 11/26/2021] [Revised: 05/08/2022] [Accepted: 05/10/2022] [Indexed: 11/25/2022]
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Incremental Prognostic Value of Left Ventricular Global Longitudinal Strain in Patients with Preserved Ejection Fraction Undergoing Transcatheter Aortic Valve Implantation. J Am Soc Echocardiogr 2022; 35:947-955.e7. [DOI: 10.1016/j.echo.2022.04.013] [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: 09/03/2021] [Revised: 04/19/2022] [Accepted: 04/24/2022] [Indexed: 11/18/2022]
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Sin-Ying Ho J, Kor Q, Kong WK, Lim YC, Yan-Yee Chan M, Syn NL, Ngiam JN, Chew NW, Yeo TC, Chai P, Poh KK, Wong RC, Lin W, Sia CH. Prevalence and outcomes of concomitant cardiac amyloidosis and aortic stenosis: A systematic review and meta-analysis. Hellenic J Cardiol 2021; 64:67-76. [PMID: 34856378 DOI: 10.1016/j.hjc.2021.11.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cardiac amyloidosis (CA) is an increasingly recognised condition in patients with aortic stenosis (AS). However, there is large variation in the reported prevalence figures, due to differences in populations and diagnostic methods. We aimed to investigate the prevalence, risk factors and outcomes of concomitant CA and AS. METHODS We performed a systematic review and meta-analysis of the literature searched on Medline, EMBASE, Scopus and CENTRAL. We analysed the prevalence of CA in AS grouped according to diagnostic techniques, and the risk factors and outcomes of concomitant CA and AS was analysed in AS patients referred for surgical or transcatheter aortic valve replacement (AVR). RESULTS A total of 21 studies were included, involving 4,243 patients. The pooled prevalence of CA in patients with AS was 14.4%, with substantial heterogeneity. The pooled prevalence of AS in CA was 8.7%, with substantial heterogeneity. Patients with both AS and CA had higher all-cause mortality than those with AS or CA alone. In AS patients requiring AVR, CA was associated with increasing age, male sex, higher NT-proBNP levels, increased interventricular septal end diastole thickness and lower left ventricular ejection fraction. Concomitant AS and CA was associated with increased all-cause mortality and pacemaker implantation post-procedure. Study limitations included the heterogeneity of results and the fair to good quality of studies published. CONCLUSION Overall, a substantial proportion of patients with AS may have CA, and they have poorer prognosis. A high degree of clinical suspicion is needed to identify "red flags" and perform appropriate diagnostic imaging.
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Affiliation(s)
- Jamie Sin-Ying Ho
- Academic Foundation Programme, North Middlesex University Hospital NHS Trust, United Kingdom
| | - Qianyi Kor
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William Kf Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Yoke Ching Lim
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Nicholas Lx Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jinghao Nicholas Ngiam
- Internal Medicine Residency, University Medicine Cluster, National University Health System, Singapore
| | - Nicholas Ws Chew
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Kian-Keong Poh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Raymond Cc Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Weiqin Lin
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore.
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