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Bernhard B, Schütze J, Leib ZL, Spano G, Boscolo Berto M, Bakula A, Tomii D, Shiri I, Brugger N, De Marchi S, Reineke D, Dobner S, Heg D, Praz F, Lanz J, Stortecky S, Pilgrim T, Windecker S, Gräni C. Myocardial analysis from routine 4D cardiac-CT to predict reverse remodeling and clinical outcomes after transcatheter aortic valve implantation. Eur J Radiol 2024; 175:111425. [PMID: 38490128 DOI: 10.1016/j.ejrad.2024.111425] [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: 12/26/2023] [Revised: 02/07/2024] [Accepted: 03/11/2024] [Indexed: 03/17/2024]
Abstract
PURPOSE Our study aimed to determine whether 4D cardiac computed tomography (4DCCT) based quantitative myocardial analysis may improve risk stratification and can predict reverse remodeling (RRM) and mortality after transcatheter aortic valve implantation (TAVI). METHODS Consecutive patients undergoing clinically indicated 4DCCT prior to TAVI were prospectively enrolled. 4DCCT-derived left- (LV) and right ventricular (RV), and left atrial (LA) dimensions, mass, ejection fraction (EF) and myocardial strain were evaluated to predict RRM and survival. RRM was defined by either relative increase in LVEF by 5% or relative decline in LV end diastolic diameter (LVEDD) by 5% assessed by transthoracic echocardiography prior TAVI, at discharge, and at 12-month follow-up compared to baseline prior to TAVI. RESULTS Among 608 patients included in this study (55 % males, age 81 ± 6.6 years), RRM was observed in 279 (54 %) of 519 patients at discharge and in 218 (48 %) of 453 patients at 12-month echocardiography. While no CCT based measurements predicted RRM at discharge, CCT based LV mass index and LVEF independently predicted RRM at 12-month (ORadj = 1.012; 95 %CI:1.001-1.024; p = 0.046 and ORadj = 0.969; 95 %CI:0.943-0.996; p = 0.024, respectively). The most pronounced changes in LVEF and LVEDD were observed in patients with impaired LV function at baseline. In multivariable analysis age (HRadj = 1.037; 95 %CI:1.005-1.070; p = 0.022) and CCT-based LVEF (HRadj = 0.972; 95 %CI:0.945-0.999; p = 0.048) and LAEF (HRadj = 0.982; 95 %CI:0.968-0.996; p = 0.011) independently predicted survival. CONCLUSION Comprehensive myocardial functional information derived from routine 4DCCT in patients with severe aortic stenosis undergoing TAVI could predict reverse remodeling and clinical outcomes at 12-month following TAVI.
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Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jonathan Schütze
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Zoe L Leib
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Giancarlo Spano
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martina Boscolo Berto
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Adam Bakula
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Daijiro Tomii
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Isaac Shiri
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Stefano De Marchi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Cardiovascular Center, Bern University Hospital, Inselspital, University of Bern, Switzerland
| | - Stephan Dobner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland.
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Vermes E, Iacuzio L, Maréchaux S, Levy F, Loardi C, Tribouilloy C. Is there a role for cardiovascular magnetic resonance imaging in the assessment of biological aortic valves? Front Cardiovasc Med 2023; 10:1250576. [PMID: 38124892 PMCID: PMC10730731 DOI: 10.3389/fcvm.2023.1250576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Patients with biological aortic valves (following either surgical aortic valve replacement [SAVR] or trans catheter aortic valve implantation [TAVI]) require lifelong follow-up with an imaging modality to assess prosthetic valve function and dysfunction. Echocardiography is currently the first-line imaging modality to assess biological aortic valves. In this review, we discuss the potential role of cardiac magnetic resonance imaging (CMR) as an additional imaging modality in situations of inconclusive or equivocal echocardiography. Planimetry of the prosthetic orifice can theoretically be measured, as well as the effective orifice area, with potential limitations, such as CMR valve-related artefacts and calcifications in degenerated prostheses. The true benefit of CMR is its ability to accurately quantify aortic regurgitation (paravalvular and intra-valvular) with a direct and reproducible method independent of regurgitant jet morphology to accurately assess reverse remodelling and non-invasively detect focal and interstitial diffuse myocardial fibrosis. Following SAVR or TAVI for aortic stenosis, interstitial diffuse fibrosis can regress, accompanied by structural and functional improvement that CMR can accurately assess.
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Affiliation(s)
- Emmanuelle Vermes
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Laura Iacuzio
- Department of Cardiology, Centre Cardio-Thoracique de Monaco, Monaco City, Monaco
| | - Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Franck Levy
- Department of Cardiology, Centre Cardio-Thoracique de Monaco, Monaco City, Monaco
| | - Claudia Loardi
- Department of Thoracic Surgery, Tours University Hospital, Tours, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
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3
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Waller AH, Gardin JM. Does Left Ventricular Mass Have Additional Diagnostic Value in Severe Aortic Stenosis? Am J Cardiol 2023; 207:302-304. [PMID: 37782968 DOI: 10.1016/j.amjcard.2023.09.026] [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: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 10/04/2023]
Affiliation(s)
- Alfonso H Waller
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
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Prieto-Lobato A, Nuche J, Avvedimento M, Paradis JM, Dumont E, Kalavrouziotis D, Mohammadi S, Rodés-Cabau J. Managing the challenge of a small aortic annulus in patients with severe aortic stenosis. Expert Rev Cardiovasc Ther 2023; 21:747-761. [PMID: 37869793 DOI: 10.1080/14779072.2023.2271395] [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: 07/22/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Small aortic annulus (SAA) poses a challenge in the management of patients with severe aortic stenosis requiring aortic valve replacement - both surgical and transcatheter - since it has been associated with worse clinical outcomes. AREAS COVERED This review aims to comprehensively summarize the available evidence regarding the management of aortic stenosis in patients with SAA and discuss the current controversies as well as future perspectives in this field. EXPERT OPINION It is paramount to agree in a common definition for diagnosing and properly treating SAA patients, and for that purpose, multidetector computer tomography is essential. The results of recent trials led to the expansion of transcatheter aortic valve replacement among patients of all the surgical-risk spectrum, and the choice of treatment (transcatheter, surgical) should be based on patient comorbidities, anatomical characteristics, and patient preferences.
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Affiliation(s)
- Alicia Prieto-Lobato
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
- Hospital del Mar, Barcelona, Spain
| | - Jorge Nuche
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Marisa Avvedimento
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | | | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, QC, Canada
- Clínic Barcelona, Barcelona, Spain
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Aziminia N, Nitsche C, Mravljak R, Bennett J, Thornton GD, Treibel TA. Heart failure and excess mortality after aortic valve replacement in aortic stenosis. Expert Rev Cardiovasc Ther 2023; 21:193-210. [PMID: 36877090 PMCID: PMC10069375 DOI: 10.1080/14779072.2023.2186853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION In aortic stenosis (AS), the heart transitions from adaptive compensation to an AS cardiomyopathy and eventually leads to decompensation with heart failure. Better understanding of the underpinning pathophysiological mechanisms is required in order to inform strategies to prevent decompensation. AREAS COVERED In this review, we therefore aim to appraise the current pathophysiological understanding of adaptive and maladaptive processes in AS, appraise potential avenues of adjunctive therapy before or after AVR and highlight areas of further research in the management of heart failure post AVR. EXPERT OPINION Tailored strategies for the timing of intervention accounting for individual patient's response to the afterload insult are underway, and promise to guide better management in the future. Further clinical trials of adjunctive pharmacological and device therapy to either cardioprotect prior to intervention or promote reverse remodeling and recovery after intervention are needed to mitigate the risk of heart failure and excess mortality.
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Affiliation(s)
- Nikoo Aziminia
- Institute of Cardiovascular Science, University College London, London, England
- Barts Heart Centre, London, England
| | - Christian Nitsche
- Institute of Cardiovascular Science, University College London, London, England
- Barts Heart Centre, London, England
| | | | - Jonathan Bennett
- Institute of Cardiovascular Science, University College London, London, England
- Barts Heart Centre, London, England
| | - George D Thornton
- Institute of Cardiovascular Science, University College London, London, England
- Barts Heart Centre, London, England
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, England
- Barts Heart Centre, London, England
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Wedin JO, Vedin O, Rodin S, Simonson OE, Hörsne Malmborg J, Pallin J, James SK, Flachskampf FA, Ståhle E, Grinnemo KH. Patients With Bicuspid Aortic Stenosis Demonstrate Adverse Left Ventricular Remodeling and Impaired Cardiac Function Before Surgery With Increased Risk of Postoperative Heart Failure. Circulation 2022; 146:1310-1322. [PMID: 35971843 PMCID: PMC9586833 DOI: 10.1161/circulationaha.122.060125] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Differences in adverse cardiac remodeling between patients who have bicuspid (BAV) and tricuspid aortic valve (TAV) with severe isolated aortic stenosis (AS) and its prognostic impact after surgical aortic valve replacement remains unclear. We sought to investigate differences in preoperative diastolic and systolic function in patients with BAV and TAV who have severe isolated AS and the incidence of postoperative heart failure hospitalization and mortality. METHODS Two hundred seventy-one patients with BAV (n=152) or TAV (n=119) and severe isolated AS without coronary artery disease or other valvular heart disease, scheduled for surgical aortic valve replacement, were prospectively included. Comprehensive preoperative echocardiographic assessment of left ventricular (LV) diastolic and systolic function was performed. The heart failure events were registered during a mean prospective follow-up of 1260 days versus 1441 days for patients with BAV or TAV, respectively. RESULTS Patients with BAV had a more pronounced LV hypertrophy with significantly higher indexed LV mass ([LVMi] 134 g/m2 versus 104 g/m2, P<0.001), higher prevalence of LV diastolic dysfunction (72% versus 44%, P<0.001), reduced LV ejection fraction (55% versus 60%, P<0.001), significantly impaired global longitudinal strain (P<0.001), significantly higher NT-proBNP (N-terminal pro-brain natriuretic peptide) levels (P=0.007), and a higher prevalence of preoperative levosimendan treatment (P<0.001) than patients with TAV. LVMi was associated with diastolic dysfunction in both patients with BAV and TAV. There was a significant interaction between aortic valve morphology and LVMi on LV ejection fraction, which indicated a pronounced association between LVMi and LV ejection fraction for patients with BAV and lack of association between LVMi and LV ejection fraction for patients with TAV. Postoperatively, the patients with BAV required significantly more inotropic support (P<0.001). The patients with BAV had a higher cumulative incidence of postoperative heart failure admissions compared with patients with TAV (28.2% versus 10.6% at 6 years after aortic valve replacement, log-rank P=0.004). Survival was not different between patients with BAV and TAV (log-rank P=0.165). CONCLUSIONS Although they were significantly younger, patients with BAV who had isolated severe AS had worse preoperative LV function and an increased risk of postoperative heart failure hospitalization compared with patients who had TAV. Our findings suggest that patients who have BAV with AS might benefit from closer surveillance and possibly earlier intervention.
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Affiliation(s)
- Johan O. Wedin
- Department of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K.-H.G.), Uppsala University, Sweden.,Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
| | - Ola Vedin
- Department of Medical Sciences (O.V., S.K.J., F.A.F.), Uppsala University, Sweden.,Boehringer Ingelheim AB, Stockholm, Sweden (O.V.)
| | - Sergey Rodin
- Department of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K.-H.G.), Uppsala University, Sweden
| | - Oscar E. Simonson
- Department of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K.-H.G.), Uppsala University, Sweden.,Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
| | - Jonathan Hörsne Malmborg
- Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
| | - Johan Pallin
- Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
| | - Stefan K. James
- Department of Medical Sciences (O.V., S.K.J., F.A.F.), Uppsala University, Sweden.,Department of Clinical Physiology and Cardiology (S.K.J., F.A.F.), Uppsala University Hospital, Sweden
| | - Frank A. Flachskampf
- Department of Medical Sciences (O.V., S.K.J., F.A.F.), Uppsala University, Sweden.,Department of Clinical Physiology and Cardiology (S.K.J., F.A.F.), Uppsala University Hospital, Sweden
| | - Elisabeth Ståhle
- Department of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K.-H.G.), Uppsala University, Sweden.,Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
| | - Karl-Henrik Grinnemo
- Department of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K.-H.G.), Uppsala University, Sweden.,Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
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Stadiotti I, Santoro R, Scopece A, Pirola S, Guarino A, Polvani G, Maione AS, Ascione F, Li Q, Delia D, Foiani M, Pompilio G, Sommariva E. Pressure Overload Activates DNA-Damage Response in Cardiac Stromal Cells: A Novel Mechanism Behind Heart Failure With Preserved Ejection Fraction? Front Cardiovasc Med 2022; 9:878268. [PMID: 35811699 PMCID: PMC9259931 DOI: 10.3389/fcvm.2022.878268] [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: 02/17/2022] [Accepted: 05/17/2022] [Indexed: 11/22/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous syndrome characterized by impaired left ventricular (LV) diastolic function, with normal LV ejection fraction. Aortic valve stenosis can cause an HFpEF-like syndrome by inducing sustained pressure overload (PO) and cardiac remodeling, as cardiomyocyte (CM) hypertrophy and fibrotic matrix deposition. Recently, in vivo studies linked PO maladaptive myocardial changes and DNA damage response (DDR) activation: DDR-persistent activation contributes to mouse CM hypertrophy and inflammation, promoting tissue remodeling, and HF. Despite the wide acknowledgment of the pivotal role of the stromal compartment in the fibrotic response to PO, the possible effects of DDR-persistent activation in cardiac stromal cell (C-MSC) are still unknown. Finally, this novel mechanism was not verified in human samples. This study aims to unravel the effects of PO-induced DDR on human C-MSC phenotypes. Human LV septum samples collected from severe aortic stenosis with HFpEF-like syndrome patients undergoing aortic valve surgery and healthy controls (HCs) were used both for histological tissue analyses and C-MSC isolation. PO-induced mechanical stimuli were simulated in vitro by cyclic unidirectional stretch. Interestingly, HFpEF tissue samples revealed DNA damage both in CM and C-MSC. DDR-activation markers γH2AX, pCHK1, and pCHK2 were expressed at higher levels in HFpEF total tissue than in HC. Primary C-MSC isolated from HFpEF and HC subjects and expanded in vitro confirmed the increased γH2AX and phosphorylated checkpoint protein expression, suggesting a persistent DDR response, in parallel with a higher expression of pro-fibrotic and pro-inflammatory factors respect to HC cells, hinting to a DDR-driven remodeling of HFpEF C-MSC. Pressure overload was simulated in vitro, and persistent activation of the CHK1 axis was induced in response to in vitro mechanical stretching, which also increased C-MSC secreted pro-inflammatory and pro-fibrotic molecules. Finally, fibrosis markers were reverted by the treatment with a CHK1/ATR pathway inhibitor, confirming a cause-effect relationship. In conclusion we demonstrated that, in severe aortic stenosis with HFpEF-like syndrome patients, PO induces DDR-persistent activation not only in CM but also in C-MSC. In C-MSC, DDR activation leads to inflammation and fibrosis, which can be prevented by specific DDR targeting.
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Affiliation(s)
- Ilaria Stadiotti
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Rosaria Santoro
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
- Department of Electronics, Information and Biomedical Engineering, Politecnico di Milano, Milan, Italy
- *Correspondence: Rosaria Santoro
| | - Alessandro Scopece
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Sergio Pirola
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Anna Guarino
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Gianluca Polvani
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
- Cardiovascular Tissue Bank of Milan, Centro Cardiologico Monzino IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Angela Serena Maione
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
| | - Flora Ascione
- IFOM (Istituto FIRC di Oncologia Molecolare), Milan, Italy
| | - Qingsen Li
- IFOM (Istituto FIRC di Oncologia Molecolare), Milan, Italy
| | - Domenico Delia
- IFOM (Istituto FIRC di Oncologia Molecolare), Milan, Italy
| | - Marco Foiani
- IFOM (Istituto FIRC di Oncologia Molecolare), Milan, Italy
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, Milan, Italy
| | - Giulio Pompilio
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy
| | - Elena Sommariva
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), Milan, Italy
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The Haemodynamic and Pathophysiological Mechanisms of Calcific Aortic Valve Disease. Biomedicines 2022; 10:biomedicines10061317. [PMID: 35740339 PMCID: PMC9220142 DOI: 10.3390/biomedicines10061317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022] Open
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Vattay B, Nagy AI, Apor A, Kolossváry M, Manouras A, Vecsey-Nagy M, Molnár L, Boussoussou M, Bartykowszki A, Jermendy ÁL, Kováts T, Zsarnóczay E, Maurovich-Horvat P, Merkely B, Szilveszter B. The Predictive Value of Left Atrial Strain Following Transcatheter Aortic Valve Implantation on Anatomical and Functional Reverse Remodeling in a Multi-Modality Study. Front Cardiovasc Med 2022; 9:841658. [PMID: 35548439 PMCID: PMC9081648 DOI: 10.3389/fcvm.2022.841658] [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: 12/22/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionTranscatheter aortic valve implantation (TAVI) can improve left ventricular (LV) mechanics and survival. Data on the predictive value of left atrial (LA) strain following TAVI are scarce. We aimed to evaluate the association of LA strain measured shortly post-TAVI with functional and anatomical reverse remodeling of the LA and LV, and its association with mortality.MethodsWe prospectively investigated 90 patients who underwent TAVI. Transthoracic echocardiography including strain analysis was performed shortly after TAVI and repeated 6 months later. CT angiography (CTA) was performed for pre-TAVI planning and 6 months post-TAVI. Speckle tracking echocardiography was used to determine LA peak reservoir strain (LASr) and LV global longitudinal strain (LV-GL), LA volume index (LAVi) was measured by TTE. LV mass index (LVMi) was calculated using CTA images. LA reverse remodeling was based on LASr and LAVi changes, whereas LV reverse remodeling was defined as an improvement in LV-GLS or a reduction of LVMi. The association of severely reduced LASr (<20%) at baseline with changes (Δ) in LASr, LAVi, LV-GLS and LVMi were analyzed using linear regression, and Cox proportional hazard model for mortality.ResultsMean LASr and LV-GLS were 17.7 ± 8.4 and −15.3 ± 3.4% at baseline and 20.2 ± 10.2 and −16.6 ± 4.0% at follow-up (p = 0.024 and p < 0.001, respectively). Severely reduced LASr at baseline was associated with more pronounced ΔLASr (β = 5.24, p = 0.025) and LVMi reduction on follow-up (β = 5.78, p = 0.036), however, the majority of the patients had <20% LASr on follow-up (44.4%). Also, ΔLASr was associated with ΔLV-GLS (adjusted β = 2.10, p < 0.001). No significant difference in survival was found between patients with baseline severely reduced LASr (<20%) and higher LASr (≥20%) (p = 0.054).ConclusionLV reverse remodeling based on LVMi was present even in patients with severely reduced LASr following TAVI, although extensive LA damage based on LA strain was demonstrated by its limited improvement over time.Clinical Trial Registration(ClinicalTrials.gov number: NCT02826200).
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Affiliation(s)
- Borbála Vattay
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Anikó Ilona Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Astrid Apor
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | | | - Levente Molnár
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Ádám L. Jermendy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Tímea Kováts
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Emese Zsarnóczay
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Medical Imaging Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- *Correspondence: Bálint Szilveszter
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10
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Paraggio L, Burzotta F, Graziani F, Aurigemma C, Romagnoli E, Pedicino D, Locorotondo G, Mencarelli E, Lillo R, Bruno P, Laezza D, Giambusso N, Lombardo A, Trani C. Transcatheter aortic valve implantation in pure aortic regurgitation: Hemodynamic and echocardiographic findings in bioprosthesis vs. native valve. Catheter Cardiovasc Interv 2022; 99:1599-1608. [DOI: 10.1002/ccd.30082] [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: 10/04/2021] [Revised: 12/11/2021] [Accepted: 01/02/2022] [Indexed: 01/06/2023]
Affiliation(s)
- Lazzaro Paraggio
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
- Università Cattolica del Sacro Cuore Roma Italia
| | - Francesco Burzotta
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
- Università Cattolica del Sacro Cuore Roma Italia
| | - Francesca Graziani
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | - Cristina Aurigemma
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | - Enrico Romagnoli
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | - Daniela Pedicino
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | - Gabriella Locorotondo
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | - Erica Mencarelli
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
- Università Cattolica del Sacro Cuore Roma Italia
| | - Rosa Lillo
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
- Università Cattolica del Sacro Cuore Roma Italia
| | - Piergiorgio Bruno
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
- Università Cattolica del Sacro Cuore Roma Italia
| | - Domenico Laezza
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | - Nicole Giambusso
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | - Antonella Lombardo
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
- Università Cattolica del Sacro Cuore Roma Italia
| | - Carlo Trani
- Institute of Cardiology Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
- Università Cattolica del Sacro Cuore Roma Italia
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11
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Kuneman JH, Singh GK, Hansson NC, Fusini L, Poulsen SH, Fortuni F, Vollema EM, Pedersen ALD, Annoni AD, Nørgaard BL, Pontone G, Ajmone Marsan N, Delgado V, Bax JJ, Knuuti J. Subclinical leaflet thrombosis after transcatheter aortic valve implantation: no association with left ventricular reverse remodeling at 1-year follow-up. Int J Cardiovasc Imaging 2021; 38:695-705. [PMID: 34655348 PMCID: PMC8926967 DOI: 10.1007/s10554-021-02438-2] [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: 07/27/2021] [Accepted: 10/05/2021] [Indexed: 11/28/2022]
Abstract
Hypo-attenuated leaflet thickening (HALT) of transcatheter aortic valves is detected on multidetector computed tomography (MDCT) and reflects leaflet thrombosis. Whether HALT affects left ventricular (LV) reverse remodeling, a favorable effect of LV afterload reduction after transcatheter aortic valve implantation (TAVI) is unknown. The aim of this study was to examine the association of HALT after TAVI with LV reverse remodeling. In this multicenter case–control study, patients with HALT on MDCT were identified, and patients without HALT were propensity matched for valve type and size, LV ejection fraction (LVEF), sex, age and time of scan. LV dimensions and function were assessed by transthoracic echocardiography before and 12 months after TAVI. Clinical outcomes (stroke or transient ischemic attack, heart failure hospitalization, new-onset atrial fibrillation, all-cause mortality) were recorded. 106 patients (age 81 ± 7 years, 55% male) with MDCT performed 37 days [IQR 32–52] after TAVI were analyzed (53 patients with HALT and 53 matched controls). Before TAVI, all echocardiographic parameters were similar between the groups. At 12 months follow-up, patients with and without HALT showed a significant reduction in LV end-diastolic volume, LV end-systolic volume and LV mass index (from 125 ± 37 to 105 ± 46 g/m2, p = 0.001 and from 127 ± 35 to 101 ± 27 g/m2, p < 0.001, respectively, p for interaction = 0.48). Moreover, LVEF improved significantly in both groups. In addition, clinical outcomes were not statistically different. Improvement in LVEF and LV reverse remodeling at 12 months after TAVI were not limited by HALT.
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Affiliation(s)
- Jurrien H Kuneman
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Gurpreet K Singh
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Nicolaj C Hansson
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Laura Fusini
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Steen H Poulsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Federico Fortuni
- Department of Cardiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - E Mara Vollema
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | | | - Andrea D Annoni
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Bjarne L Nørgaard
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Gianluca Pontone
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - Juhani Knuuti
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.,Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
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12
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Patel V, Jneid H, Cornwell L, Kherallah R, Preventza O, Rosengart TK, Amin A, Khalid M, Paniagua D, Denktas A, Patel A, McClafferty A, Jimenez E. Left Ventricle Mass Regression After Surgical or Transcatheter Aortic Valve Replacement in Veterans. Ann Thorac Surg 2021; 114:77-83. [PMID: 34416227 DOI: 10.1016/j.athoracsur.2021.07.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/11/2021] [Accepted: 07/08/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Differences in left ventricular mass regression (LVMR) between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) have not been studied. We present clinical and echocardiographic data from veterans who underwent TAVR and SAVR, evaluating the degree of LVMR and its association with survival. METHODS We retrospectively reviewed TAVR (n = 194) and SAVR (n = 365) procedures performed in veterans from 2011 to 2019. After 1:1 propensity matching, we evaluated mortality and secondary outcomes. Echocardiographic data (median follow-up 957 days, interquartile range 483-1652 days) were used to evaluate LVMR, its association with survival, and predictors of LVMR. RESULTS There was no difference between SAVR and TAVR patients in mortality (for up to 8 years), stroke at 30 days, myocardial infarction, renal failure, prolonged ventilation, reoperation, or structural valve deterioration. SAVR patients (67.3% [101 of 150]) were more likely to have LVMR than TAVR patients (55.7% [44 of 79], P = .11). The magnitude of LVMR was greater for the SAVR patients (median, -23.3%) than for the TAVR patients (median, -17.8%, P = .062). SAVR patients with LVMR had a survival advantage over SAVR patients without LVMR (P = .016). However, LVMR was not associated with greater survival in TAVR patients (P = .248). CONCLUSIONS SAVR patients were more likely to have LVMR and had a greater magnitude of LVMR than TAVR patients. LVMR was associated with better survival in SAVR patients, but not in TAVR patients.
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Affiliation(s)
- Vivek Patel
- Department of Cardiothoracic Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Hani Jneid
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Lorraine Cornwell
- Department of Cardiothoracic Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Riyad Kherallah
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ourania Preventza
- Department of Cardiothoracic Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Todd K Rosengart
- Department of Cardiothoracic Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Arsalan Amin
- Department of Cardiothoracic Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Mirza Khalid
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - David Paniagua
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ali Denktas
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ashley Patel
- Department of Cardiothoracic Surgery, Texas Heart Institute, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Anthony McClafferty
- Department of Cardiothoracic Surgery, Texas Heart Institute, Houston, Texas; Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Ernesto Jimenez
- Department of Cardiothoracic Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
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13
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Taboada-Martín R, Arribas-Leal JM, Esteve-Pastor MA, Abellán Alemán J, Marín F, Rivera-Caravaca JM, Cánovas-Lopez SJ. Comparison of Aortic Gradient and Ventricular Mass after Valve Replacement for Aortic Stenosis with Rapid Deployment, Sutureless, and Conventional Bioprostheses. Cardiology 2021; 146:656-666. [PMID: 34120109 DOI: 10.1159/000516465] [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: 10/05/2020] [Accepted: 04/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The use of rapid deployment and sutureless aortic prostheses is increasing. Previous reports have shown promising results on haemodynamic performance and mortality rates. However, the impact of these bioprostheses on left ventricular mass (LVM) regression remains unknown. We decided to study the changes in remodelling and LVM regression in isolated severe aortic stenosis treated with conventional or Perceval® or Intuity® valves. METHOD AND RESULTS From January 2011 to January 2016, 324 bioprostheses were implanted in our centre. The collected characteristics were divided into 3 groups: conventional valves, Perceval®, and Intuity®, and they were analysed after 12 months. There were 183 conventional valves (56%), 72 Perceval® (22%), and 69 Intuity® (21.2%). The statistical analysis showed significant differences in transprosthetic postoperative peak gradient (23 [18-29] mm Hg vs. 21 [16-29] mm Hg and 18 [14-24] mm Hg, p < 0.001), ventricular mass electrical criteria regression (Sokolow and Cornell products), and 1-year survival (90 vs. 93% and 97%, log rank p value = 0.04) in conventional, Perceval®, and Intuity® groups. CONCLUSIONS We observed differences in haemodynamic, electrocardiographic, and echocardiographic parameters related to the different types of prosthesis. Patients with the Intuity® prosthesis had the highest reduction in peak aortic gradient and the higher ventricular mass regression. Besides, patients with the Intuity® prosthesis had less risk of mortality during follow-up than the other two groups. Further studies are needed to confirm these findings.
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Affiliation(s)
- Rubén Taboada-Martín
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - José María Arribas-Leal
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
| | - María Asunción Esteve-Pastor
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, CIBERCV, Murcia, Spain
| | | | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, CIBERCV, Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, IMIB-Arrixaca, CIBERCV, Murcia, Spain
| | - Sergio Juan Cánovas-Lopez
- Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain
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14
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Impacto de los inhibidores del sistema renina-angiotensina en el pronóstico tras recambio valvular aórtico quirúrgico o percutáneo. Metanálisis. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2020.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Takagi H, Kuno T, Hari Y, Nakashima K, Yokoyama Y, Ueyama H, Ando T. Meta-analysis of impact of renin-angiotensin system inhibitors on survival after transcatheter aortic valve implantation. Minerva Cardiol Angiol 2021; 69:299-309. [PMID: 33703852 DOI: 10.23736/s2724-5683.20.05289-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION To determine whether renin-angiotensin system inhibitor (RASI) prescription is associated with better survival after transcatheter aortic valve implantation (TAVI), we performed the first meta-analysis of currently available studies. EVIDENCE ACQUISITION To identify all studies reporting impact of RASI prescription on survival after TAVI, we searched PubMed, Web of Science, Google Scholar, etc. through October 2019. We extracted adjusted (if unavailable, unadjusted) hazard ratios (HRs) with their confidence intervals (CIs) of midterm (up to ≥6-month) all-cause mortality for RASI prescription from each study and combined study-specific estimates using inverse variance-weighted averages of logarithmic HRs in the random-effects model. EVIDENCE SYNTHESIS We identified 13 eligible studies with a total of 26,132 TAVI patients and included them in the present meta-analysis. None was a randomized controlled trial, 5 were observational studies comparing patients with versus without RASI prescription (including 3 propensity score matched studies), and 8 were observational studies investigating RASI prescription as one of covariates. The primary meta-analysis of all studies demonstrated that RASI prescription was associated with significantly lower midterm mortality (HR=0.83; 95% CI: 0.76 to 0.92; P=0.0002). Although we identified significant funnel plot asymmetry (P=0.036 by the rank correlation test) suggesting publication bias, correcting for it using the trim-and-fill method did not substantially alter the result favoring RASI prescription (corrected HR=0.85; 95% CI: 0.76 to 0.95; P=0.004). CONCLUSIONS RASI prescription may be associated with better midterm survival after TAVI.
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Affiliation(s)
- Hisato Takagi
- Shizuoka Medical Center, Department of Cardiovascular Surgery, Shizuoka, Japan - .,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan -
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Yosuke Hari
- Shizuoka Medical Center, Department of Cardiovascular Surgery, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouki Nakashima
- Shizuoka Medical Center, Department of Cardiovascular Surgery, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | | | - Hiroki Ueyama
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, NY, USA
| | - Tomo Ando
- Division of Interventional Cardiology, Department of Cardiology, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
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16
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Vollema EM, Singh GK, Prihadi EA, Regeer MV, Ewe SH, Ng ACT, Mertens BJA, Klautz RJM, Ajmone Marsan N, Bax JJ, Delgado V. Time course of left ventricular remodelling and mechanics after aortic valve surgery: aortic stenosis vs. aortic regurgitation. Eur Heart J Cardiovasc Imaging 2020; 20:1105-1111. [PMID: 30932153 PMCID: PMC6753383 DOI: 10.1093/ehjci/jez049] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 03/19/2019] [Indexed: 11/13/2022] Open
Abstract
Aims Pressure overload in aortic stenosis (AS) and both pressure and volume overload in aortic regurgitation (AR) induce concentric and eccentric hypertrophy, respectively. These structural changes influence left ventricular (LV) mechanics, but little is known about the time course of LV remodelling and mechanics after aortic valve surgery (AVR) and its differences in AS vs. AR. The present study aimed to characterize the time course of LV mass index (LVMI) and LV mechanics [by LV global longitudinal strain (LV GLS)] after AVR in AS vs. AR. Methods and results Two hundred and eleven (61 ± 14 years, 61% male) patients with severe AS (63%) or AR (37%) undergoing surgical AVR with routine echocardiographic follow-up at 1, 2, and/or 5 years were evaluated. Before AVR, LVMI was larger in AR patients compared with AS. Both groups showed moderately impaired LV GLS, but preserved LV ejection fraction. After surgery, both groups showed LV mass regression, although a more pronounced decline was seen in AR patients. Improvement in LV GLS was observed in both groups, but characterized by an initial decline in AR patients while LV GLS in AS patients remained initially stable. Conclusion In severe AS and AR patients undergoing AVR, LV mass regression and changes in LV GLS are similar despite different LV remodelling before AVR. In AR, relief of volume overload led to reduction in LVMI and an initial decline in LV GLS. In contrast, relief of pressure overload in AS was characterized by a stable LV GLS and more sustained LV mass regression.
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Affiliation(s)
- E Mara Vollema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands.,Department of Cardiology, Antwerp Cardiovascular Center, ZNA Middelheim, Lindendreef 1, Antwerp, Belgium
| | - Madelien V Regeer
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Drive, Singapore, Singapore
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, University of Queensland, 199 Ipswich Rd, Woolloongabba QLD, Australia
| | - Bart J A Mertens
- Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
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17
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Miranda-Silva D, G Rodrigues P, Alves E, Rizo D, Fonseca ACRG, Lima T, Baganha F, Conceição G, Sousa C, Gonçalves A, Miranda I, Vasques-Nóvoa F, Magalhães J, Leite-Moreira A, Falcão-Pires I. Mitochondrial Reversible Changes Determine Diastolic Function Adaptations During Myocardial (Reverse) Remodeling. Circ Heart Fail 2020; 13:e006170. [PMID: 33176457 DOI: 10.1161/circheartfailure.119.006170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Often, pressure overload-induced myocardial remodeling does not undergo complete reverse remodeling after decreasing afterload. Recently, mitochondrial abnormalities and oxidative stress have been successively implicated in the pathogenesis of several chronic pressure overload cardiac diseases. Therefore, we aim to clarify the myocardial energetic dysregulation in (reverse) remodeling, mainly focusing on the mitochondria. METHODS Thirty-five Wistar Han male rats randomly underwent sham or ascending (supravalvular) aortic banding procedure. Echocardiography revealed that banding induced concentric hypertrophy and diastolic dysfunction (early diastolic transmitral flow velocity to peak early-diastolic annular velocity ratio, E/E': sham, 13.6±2.1, banding, 18.5±4.1, P=0.014) accompanied by increased oxidative stress (dihydroethidium fluorescence: sham, 1.6×108±6.1×107, banding, 2.6×108±4.5×107, P<0.001) and augmented mitochondrial function. After 8 to 9 weeks, half of the banding animals underwent overload relief by an aortic debanding surgery (n=10). RESULTS Two weeks later, hypertrophy decreased with the decline of oxidative stress (dihydroethidium fluorescence: banding, 2.6×108±4.5×107, debanding, 1.96×108±6.8×107, P<0.001) and diastolic dysfunction improved simultaneously (E/E': banding, 18.5±4.1, debanding, 15.1±1.8, P=0.029). The reduction of energetic demands imposed by overload relief allowed the mitochondria to reduce its activity and myocardial levels of phosphocreatine, phosphocreatine/ATP, and ATP/ADP to normalize in debanding towards sham values (phosphocreatine: sham, 38.4±7.4, debanding, 35.6±8.7, P=0.71; phosphocreatine/ATP: sham, 1.22±0.23 debanding, 1.11±0.24, P=0.59; ATP/ADP: sham, 6.2±0.9, debanding, 5.6±1.6, P=0.66). Despite the decreased mitochondrial area, complex III and V expression increased in debanding compared with sham or banding. Autophagy and mitophagy-related markers increased in banding and remained higher in debanding rats. CONCLUSIONS During compensatory and maladaptive hypertrophy, mitochondria become more active. However, as the disease progresses, the myocardial energetic demands increase and the myocardium becomes energy deficient. During reverse remodeling, the concomitant attenuation of cardiac hypertrophy and oxidative stress allowed myocardial energetics, left ventricle hypertrophy, and diastolic dysfunction to recover. Autophagy and mitophagy are probably involved in the myocardial adaptation to overload and to unload. We conclude that these mitochondrial reversible changes underlie diastolic function adaptations during myocardial (reverse) remodeling.
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Affiliation(s)
- Daniela Miranda-Silva
- Department of Surgery and Physiology, Porto, Portugal (D.M.S., P.G.R., T.L., F.B., G.C., C.S., A.G., I.M., F.V.-N., A.L.-M., I.F.-P.)
| | - Patrícia G Rodrigues
- Department of Surgery and Physiology, Porto, Portugal (D.M.S., P.G.R., T.L., F.B., G.C., C.S., A.G., I.M., F.V.-N., A.L.-M., I.F.-P.)
| | - Estela Alves
- LaMetEX, Laboratory of Metabolism and Exercise (E.A., D.R., J.M.).,CIAFEL, Research Centre in Physical Activity, Health and Leisure, Faculty of Sports, Portugal (E.A., D.R., J.M.)
| | - David Rizo
- LaMetEX, Laboratory of Metabolism and Exercise (E.A., D.R., J.M.).,CIAFEL, Research Centre in Physical Activity, Health and Leisure, Faculty of Sports, Portugal (E.A., D.R., J.M.)
| | - Ana Catarina R G Fonseca
- Instituto de Investigação e Inovação em Saúde (i3S), Universidade do Porto, Portugal (A.C.R.G.F.)
| | - Tânia Lima
- Department of Surgery and Physiology, Porto, Portugal (D.M.S., P.G.R., T.L., F.B., G.C., C.S., A.G., I.M., F.V.-N., A.L.-M., I.F.-P.)
| | - Fabiana Baganha
- Department of Surgery and Physiology, Porto, Portugal (D.M.S., P.G.R., T.L., F.B., G.C., C.S., A.G., I.M., F.V.-N., A.L.-M., I.F.-P.)
| | - Gloria Conceição
- Department of Surgery and Physiology, Porto, Portugal (D.M.S., P.G.R., T.L., F.B., G.C., C.S., A.G., I.M., F.V.-N., A.L.-M., I.F.-P.)
| | - Cláudia Sousa
- Department of Surgery and Physiology, Porto, Portugal (D.M.S., P.G.R., T.L., F.B., G.C., C.S., A.G., I.M., F.V.-N., A.L.-M., I.F.-P.)
| | - Alexandre Gonçalves
- Department of Surgery and Physiology, Porto, Portugal (D.M.S., P.G.R., T.L., F.B., G.C., C.S., A.G., I.M., F.V.-N., A.L.-M., I.F.-P.)
| | - Isabel Miranda
- Department of Surgery and Physiology, Porto, Portugal (D.M.S., P.G.R., T.L., F.B., G.C., C.S., A.G., I.M., F.V.-N., A.L.-M., I.F.-P.)
| | - Francisco Vasques-Nóvoa
- Department of Surgery and Physiology, Porto, Portugal (D.M.S., P.G.R., T.L., F.B., G.C., C.S., A.G., I.M., F.V.-N., A.L.-M., I.F.-P.)
| | - José Magalhães
- LaMetEX, Laboratory of Metabolism and Exercise (E.A., D.R., J.M.).,CIAFEL, Research Centre in Physical Activity, Health and Leisure, Faculty of Sports, Portugal (E.A., D.R., J.M.)
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Porto, Portugal (D.M.S., P.G.R., T.L., F.B., G.C., C.S., A.G., I.M., F.V.-N., A.L.-M., I.F.-P.)
| | - Inês Falcão-Pires
- Department of Surgery and Physiology, Porto, Portugal (D.M.S., P.G.R., T.L., F.B., G.C., C.S., A.G., I.M., F.V.-N., A.L.-M., I.F.-P.)
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Bhardwaj B, Cohen DJ, Vemulapalli S, Kosinski AS, Xiang Q, Li Z, Allen KB, Kapadia S, Aggarwal K, Sorajja P, Chhatriwalla AK. Outcomes of transcatheter aortic valve replacement for patients with severe aortic stenosis and concomitant aortic insufficiency: Insights from the TVT Registry. Am Heart J 2020; 228:57-64. [PMID: 32828047 DOI: 10.1016/j.ahj.2020.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/14/2020] [Indexed: 11/25/2022]
Abstract
AIMS Data regarding outcomes for patients with severe aortic stenosis (AS) with concomitant aortic insufficiency (AI), undergoing transcatheter aortic valve replacement (TAVR) are limited. This study aimed to analyze the prevalence of severe AS with concomitant AI among patients undergoing TAVR and outcomes of TAVR in this patient group. METHODS AND RESULTS Using data from the STS/ACC-TVT Registry, we identified patients with severe AS with or without concomitant AI who underwent TAVR between 2011 and 2016. Patients were categorized based on the severity of pre-procedural AI. Multivariable proportional hazards regression models were used to examine all-cause mortality and heart failure (HF) hospitalization at 1-year. Among 54,535 patients undergoing TAVR, 42,568 (78.1%) had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001). CONCLUSIONS Severe AS with concomitant AI is common among patients undergoing TAVR, and is associated with lower 1 year mortality and HF hospitalization. Future studies are warranted to better understand the mechanisms underlying this benefit. SHORT ABSTRACT In this nationally representative analysis from the United States, 78.1% of patients undergoing TAVR had severe AS with concomitant AI. Device success was lower in patients with severe AS with concomitant AI as compared with isolated AS. The presence of baseline AI was associated with lower 1 year mortality (HR 0.94 per 1 grade increase in AI severity; 95% CI, 0.91-0.98, P < .001) and HF hospitalization (HR 0.87 per 1 grade increase in AI severity; 95% CI, 0.84-0.91, P < .001).
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19
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Szilveszter B, Oren D, Molnár L, Apor A, Nagy AI, Molnár A, Vattay B, Kolossváry M, Karády J, Bartykowszki A, Jermendy ÁL, Suhai FI, Panajotu A, Maurovich-Horvat P, Merkely B. Subclinical leaflet thrombosis is associated with impaired reverse remodelling after transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2020; 21:1144-1151. [PMID: 31665257 DOI: 10.1093/ehjci/jez256] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/12/2019] [Accepted: 10/24/2019] [Indexed: 01/19/2023] Open
Abstract
AIMS Cardiac CT is increasingly applied for planning and follow-up of transcatheter aortic valve implantation (TAVI). However, there are no data available on reverse remodelling after TAVI assessed by CT. Therefore, we aimed to evaluate the predictors and the prognostic value of left ventricular (LV) reverse remodelling following TAVI using CT angiography. METHODS AND RESULTS We investigated 117 patients with severe, symptomatic aortic stenosis (AS) who underwent CT scanning before and after TAVI procedure with a mean follow-up time of 2.6 years after TAVI. We found a significant reduction in LV mass (LVM) and LVM indexed to body surface area comparing pre- vs. post-TAVI images: 180.5 ± 53.0 vs. 137.1 ± 44.8 g and 99.7 ± 25.4 vs. 75.4 ± 19.9 g/m2, respectively, both P < 0.001. Subclinical leaflet thrombosis (SLT) was detected in 25.6% (30/117) patients. More than 20% reduction in LVM was defined as reverse remodelling and was detected in 62.4% (73/117) of the patients. SLT, change in mean pressure gradient on echocardiography and prior myocardial infarction was independently associated with LV reverse remodelling after adjusting for age, gender, and traditional risk factors (hypertension, body mass index, diabetes mellitus, and hyperlipidaemia): OR = 0.27, P = 0.022 for SLT and OR = 0.22, P = 0.006 for prior myocardial infarction, OR = 1.51, P = 0.004 for 10 mmHg change in mean pressure gradient. Reverse remodelling was independently associated with favourable outcomes (HR = 0.23; P = 0.019). CONCLUSION TAVI resulted in a significant LVM regression on CT. The presence of SLT showed an inverse association with LV reverse remodelling and thus it may hinder the beneficial LV structural changes. Reverse remodelling was associated with improved long-term prognosis.
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Affiliation(s)
- Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Daniel Oren
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Levente Molnár
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Astrid Apor
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Anikó I Nagy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Andrea Molnár
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Borbála Vattay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Andrea Bartykowszki
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Ádám L Jermendy
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Ferenc I Suhai
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Alexisz Panajotu
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary.,Medical Imaging Center, Semmelweis University, Üllői Street, 1082 Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Városmajor Street, 1122 Budapest, Hungary
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20
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Hernandez-Vaquero D, Vigil-Escalera C, Persia Y, Morales C, Pascual I, Domínguez-Rodríguez A, Rodríguez-Caulo E, Carnero M, Díaz R, Avanzas P, Moris C, Silva J. Perceval or Trifecta to Prevent Patient-Prosthesis Mismatch. J Clin Med 2020; 9:jcm9092964. [PMID: 32937912 PMCID: PMC7563879 DOI: 10.3390/jcm9092964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/16/2022] Open
Abstract
The Trifecta aortic valve has excellent hemodynamics characteristics. Moreover, the Perceval prosthesis may achieve better hemodynamics than the conventional valves; therefore, it has been proposed to reduce the incidence of patient-prosthesis mismatch. Our aim was to compare the prevalence of this complication between both prostheses. All patients who underwent valve replacement with a Perceval or a Trifecta from 2016 to 2020 at our institution were included. We calculated the prevalence of patient-prosthesis mismatch for each prosthesis and size and performed a multinomial logistic regression model to investigate the impact of choosing one prosthesis over the other. A total of 516 patients were analyzed. Moderate mismatch was present in 33 (8.6%) in the Trifecta group and 28 (21.4%) in the Perceval group, p < 0.001. Severe mismatch was present in 8 (2.1%) patients with Trifecta and 5 (3.8%) patients with Perceval, p = 0.33. Compared with the Perceval, the Trifecta prosthesis was shown to reduce moderate patient-prosthesis mismatch: OR = 0.5 (95% CI 0.3-0.9, p = 0.02). Both prostheses led to a similar risk of severe patient-prosthesis mismatch: OR = 0.9 (95% CI 0.3-2.8, p = 0.79). Both prostheses provide a very low risk of severe patient-prosthesis mismatch. Compared with the Perceval prothesis, the Trifecta prosthesis is able to reduce by 50% the risk of moderate mismatch.
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Affiliation(s)
- Daniel Hernandez-Vaquero
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
- Correspondence: ; Tel.: +34-985274688
| | - Carlota Vigil-Escalera
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
| | - Yvan Persia
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | - Carlos Morales
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
| | - Isaac Pascual
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | | | | | - Manuel Carnero
- Cardiac Surgery Department, Hospital Universitario Clinico San Carlos, 28040 Madrid, Spain;
| | - Rocío Díaz
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
| | - Pablo Avanzas
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | - Cesar Moris
- Department of Cardiology, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (Y.P.); (I.P.); (P.A.); (C.M.)
| | - Jacobo Silva
- Cardiac Surgery Department, Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.V.-E.); (C.M.); (R.D.); (J.S.)
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21
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Dahiya G, Kyvernitakis A, Joshi AA, Lasorda DM, Bailey SH, Raina A, Biederman RWW, Kanwar MK. Impact of transcatheter aortic valve replacement on left ventricular hypertrophy, diastolic dysfunction and quality of life in patients with preserved left ventricular function. Int J Cardiovasc Imaging 2020; 37:485-492. [DOI: 10.1007/s10554-020-02015-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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22
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Brener MI, Uriel N, Burkhoff D. Left Ventricular Volume Reduction and Reshaping as a Treatment Option for Heart Failure. STRUCTURAL HEART 2020. [DOI: 10.1080/24748706.2020.1777359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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23
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Choi J, Kim E, Kim HY, Lee S, Kim SM. Allometric scaling patterns among the human coronary artery tree, myocardial mass, and coronary artery flow. Physiol Rep 2020; 8:e14514. [PMID: 32725793 PMCID: PMC7387886 DOI: 10.14814/phy2.14514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/09/2023] Open
Abstract
Human coronary artery tree is a physiological transport system for oxygen and vital materials through a hierarchical vascular network to match the energy demands of myocardium, which has the highest oxygen extraction ratio among body organs and heavily depends on the blood flow for its energy supply. Therefore, it would be reasonable to expect that the key design principle of this arterial network is to minimize energy expenditure, which can be described by allometric scaling law. We enrolled patients who underwent coronary computed tomography angiography without obstructive lesion. The cumulative arterial length (L), volume (V), and diameter (D) in relation to the artery-specific myocardial mass (M) were assessed. Flow rate (Q) was computed using quantitative flow ratio (QFR) measurement in patients who underwent invasive angiography. A total of 638 arteries from 43 patients (mean age 61 years, male gender 65%) were analyzed. A significant power-law relationship was found among L-M, V-M, D-M, V-L, D-L, and V-D, and also among Q-M, Q-L, Q-V, and Q-D in 106 arteries interrogated with QFR (p < .001, all). Our results suggest that the fundamental design principle of the human coronary arterial network may follow allometric scaling law.
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Affiliation(s)
- Jin‐Ho Choi
- Department of Emergency MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Eunsoo Kim
- College of Life Science and BiotechnologyKorea UniversitySeoulRepublic of Korea
| | - Hyung Yoon Kim
- Department of Cardiovascular MedicineChonnam National University HospitalGwangjuRepublic of Korea
| | - Seung‐Hwa Lee
- Department of MedicineSamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
| | - Sung Mok Kim
- Depart of RadiologySamsung Medical CenterSungkyunkwan University School of MedicineSeoulRepublic of Korea
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24
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Validation of four-dimensional flow cardiovascular magnetic resonance for aortic stenosis assessment. Sci Rep 2020; 10:10569. [PMID: 32601326 PMCID: PMC7324609 DOI: 10.1038/s41598-020-66659-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
The management of patients with aortic stenosis (AS) crucially depends on accurate diagnosis. The main aim of this study were to validate the four-dimensional flow (4D flow) cardiovascular magnetic resonance (CMR) methods for AS assessment. Eighteen patients with clinically severe AS were recruited. All patients had pre-valve intervention 6MWT, echocardiography and CMR with 4D flow. Of these, ten patients had a surgical valve replacement, and eight patients had successful transcatheter aortic valve implantation (TAVI). TAVI patients had invasive pressure gradient assessments. A repeat assessment was performed at 3–4 months to assess the remodelling response. The peak pressure gradient by 4D flow was comparable to an invasive pressure gradient (54 ± 26 mmHG vs 50 ± 34 mmHg, P = 0.67). However, Doppler yielded significantly higher pressure gradient compared to invasive assessment (61 ± 32 mmHG vs 50 ± 34 mmHg, P = 0.0002). 6MWT was associated with 4D flow CMR derived pressure gradient (r = −0.45, P = 0.01) and EOA (r = 0.54, P < 0.01) but only with Doppler EOA (r = 0.45, P = 0.01). Left ventricular mass regression was better associated with 4D flow derived pressure gradient change (r = 0.64, P = 0.04). 4D flow CMR offers an alternative method for non-invasive assessment of AS. In addition, 4D flow derived valve metrics have a superior association to prognostically relevant 6MWT and LV mass regression than echocardiography.
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25
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Mehdipoor G, Chen S, Chatterjee S, Torkian P, Ben-Yehuda O, Leon MB, Stone GW, Prince MR. Cardiac structural changes after transcatheter aortic valve replacement: systematic review and meta-analysis of cardiovascular magnetic resonance studies. J Cardiovasc Magn Reson 2020; 22:41. [PMID: 32475350 PMCID: PMC7262773 DOI: 10.1186/s12968-020-00629-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is increasingly used to treat patients with severe aortic stenosis (AS). Cardiovascular magnetic resonance imaging (CMR) provides reliable and reproducible estimates for assessment of cardiac structure and function after TAVR. The goal of this study was to conduct a systematic review and meta-analysis of the literature to assess left ventricular (LV) volumes, mass and function by CMR after TAVR. METHODS Using Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, we searched PubMed and Embase for studies reporting CMR findings before and at least 1 month after TAVR. Main factors of interest were LV end-diastolic volume index (LVEDVi), LV end-systolic volume index (LVESVi), LV mass index (LVMi), and left ventricular ejection fraction (LVEF). Standardized mean differences (SMD) were pooled by random effects meta-analytic techniques. RESULTS Of 453 screened publications, 10 studies (published between 2012 and 2018) were included. A total of 305 patients completed pre- and post-TAVR follow-up CMR (mean age range 78.6-85.0 years, follow-up range 6-15 months). Random effects analysis showed TAVR resulted in reduced LVEDVi (SMD: -0.25, 95% CI: - 0.43 to - 0.07, P = 0.006), LVESVi (SMD: -0.24, 95% CI: - 0.44 to - 0.05, P = 0.01), LVMi (SMD: -0.82, 95% CI: - 1.0 to - 0.63, P < 0.001) and increased LVEF (SMD: 22, 95% CI: 6 to 38%, P = 0.006). Heterogeneity across studies was low (I2: 0%, Pheterogeneity > 0.05 for all). The median reduction was 4 ml/m2 (IQR: 3.1 to 8.2) for LVEDVi, 5 ml/m2 (IQR: 3.0 to 6.0) for LVESVi, and 15.1 g/m2 (IQR: 11.8 to 18.3) for LVMi. The median increase for LVEF was 3.4% (IQR 1.0 to 4.6%). CONCLUSIONS CMR demonstrates reverse LV remodeling occurrs within 6-15 months after TAVR, with reductions in LVEDVi, LVESVi and LVMi, and increased LVEF.
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Affiliation(s)
| | - Shmuel Chen
- Cardiovascular Research Foundation, New York, NY USA
- Department of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Saurav Chatterjee
- Hoffman Heart Institute, Saint Francis Hospital of the University of Connecticut, Hartford, CT USA
| | - Pooya Torkian
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, NY USA
- Department of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Martin B. Leon
- Cardiovascular Research Foundation, New York, NY USA
- Department of Cardiology, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Gregg W. Stone
- Cardiovascular Research Foundation, New York, NY USA
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Martin R. Prince
- Department of Radiology, Weill Cornell Medical College& New York Presbyterian Hospital, 416 East 55th Street, New York, NY 10022 USA
- Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY USA
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26
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Amat-Santos IJ, Santos-Martínez S, Julca F, Catalá P, Rodríguez-Gabella T, Redondo-Diéguez A, Hinojosa W, Veras C, Campo A, Serrador Frutos A, Carrasco-Moraleja M, San Román JA. Impact of renin-angiotensin system inhibitors on outcomes after surgical or transcatheter aortic valve replacement. A meta-analysis. ACTA ACUST UNITED AC 2020; 74:421-426. [PMID: 32402685 DOI: 10.1016/j.rec.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/25/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES To determine whether renin-angiotensin system inhibitor (RASi) prescription is associated with better outcomes after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). METHODS All comparative studies of RASi vs no RASi prescription in patients undergoing TAVI/SAVR were gathered from PubMed, Web of Science, and Google Scholar through August, 2019. We extracted hazard ratios (HRs) with their confidence intervals (CIs) for mortality from each study and combined study-specific estimates using inverse variance-weighted averages of logarithmic HRs in the random effects model. RESULTS We identified 6 eligible studies with a total of 21 390 patients (TAVI: 17 846; SAVR: 3544) and included them in the present meta-analysis. The 6 studies were observational comparative studies (including 3 propensity score matched and 3 cohort studies) of RASi vs no RASi prescription. The analysis demonstrated that RASi prescription was associated with significantly lower mortality in the whole group of patients undergoing aortic valve intervention (HR, 0.64; 95%CI, 0.47-0.88; P <.001). However, subgroup analysis suggested differences according to the selected therapy, with TAVI showing better mortality rates in the RASi group (HR, 0.67; 95%CI, 0.49-0.93) but not in the SAVR group (HR, 0.61; 95%CI, 0.29-1.30). No funnel plot asymmetry was identified, suggesting minimum publication bias. Sensitivity analyses sequentially eliminating dissimilar studies did not substantially alter the primary result favoring RASI prescription. CONCLUSIONS These findings suggest a mortality benefit of RASi in patients with AS treated with aortic valve replacement that might be particularly relevant following TAVI. Future randomized studies are warranted to confirm this relevant finding.
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Affiliation(s)
- Ignacio J Amat-Santos
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
| | - Sandra Santos-Martínez
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Fabián Julca
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Pablo Catalá
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Tania Rodríguez-Gabella
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Alfredo Redondo-Diéguez
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Williams Hinojosa
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Carlos Veras
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Alberto Campo
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Ana Serrador Frutos
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | | | - José A San Román
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, CIBERCV, Valladolid, Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Chau KH, Douglas PS, Pibarot P, Hahn RT, Khalique OK, Jaber WA, Cremer P, Weissman NJ, Asch FM, Zhang Y, Gertz ZM, Elmariah S, Clavel MA, Thourani VH, Daubert M, Alu MC, Leon MB, Lindman BR. Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 75:2446-2458. [DOI: 10.1016/j.jacc.2020.03.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/15/2020] [Indexed: 12/20/2022]
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28
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Manabe S, Koinoshita R, Hirayama D, Yuge N, Hirooka K. Hemodynamic performance and incidence of patient-prosthesis mismatch of small-sized Trifecta pericardial aortic valves. Gen Thorac Cardiovasc Surg 2020; 68:938-942. [PMID: 31894504 DOI: 10.1007/s11748-019-01284-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Small-sized bioprosthetic valves are sometimes associated with suboptimal hemodynamic performance, leading to a patient-prosthesis mismatch. Trifecta pericardial valves are designed to improve hemodynamic performance. The purpose of this study was to investigate the hemodynamic properties of small-sized Trifecta valves and their efficacy in preventing a patient-prosthesis mismatch. METHODS This was a retrospective analysis of 108 patients undergoing surgical aortic valve replacement with a Trifecta valve of 23 mm or less in a single Japanese institution. The hemodynamic performance was evaluated with an echocardiography examination in all patients after surgery, and the development of a patient-prosthesis mismatch was judged with the measured in vivo indexed effective orifice area. RESULTS There was one early and seven late mortalities. There were no valve explants due to structural valve deterioration. Postoperative mean pressure gradients of 19-, 21-, and 23-mm valves were 15.1, 11.4, and 9.0 mmHg, respectively. The effective orifice area of 19-, 21-, and 23-mm valves was 1.41, 1.69, and 1.78 cm2, respectively. Patient-prosthesis mismatch occurred in 14 patients (1 severe and 13 moderate) and the incidence was 13.0% (15.4% in 19 mm, 18.0% in 21 mm, and 3.3% in 23 mm). CONCLUSIONS The small-sized Trifecta valves showed excellent hemodynamic performance and were associated with a low incidence rate of patient-prosthesis mismatch.
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Affiliation(s)
- Susumu Manabe
- Department of Cardiac Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ohtsuno, Tsuchiura, Ibaraki, 300-0028, Japan.
| | - Ryoji Koinoshita
- Department of Cardiac Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ohtsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Daiki Hirayama
- Department of Cardiac Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ohtsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Norihisa Yuge
- Department of Cardiac Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ohtsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Kazunobu Hirooka
- Department of Cardiac Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Ohtsuno, Tsuchiura, Ibaraki, 300-0028, Japan
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Hachiro K, Kinoshita T, Asai T, Suzuki T. Left ventricular mass regression in patients without patient–prosthesis mismatch after aortic valve replacement for aortic stenosis. Gen Thorac Cardiovasc Surg 2019; 68:227-232. [DOI: 10.1007/s11748-019-01188-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
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Hulshof HG, van Oorschot F, van Dijk AP, Hopman MTE, George KP, Oxborough DL, Thijssen DHJ. Changes in dynamic left ventricular function, assessed by the strain-volume loop, relate to reverse remodeling after aortic valve replacement. J Appl Physiol (1985) 2019; 127:415-422. [DOI: 10.1152/japplphysiol.00190.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Aortic valve replacement (AVR) leads to remodeling of the left ventricle (LV). Adopting a novel technique to examine dynamic LV function, our study explored whether post-AVR changes in dynamic LV function and/or changes in aortic valve characteristics are associated with LV mass regression during follow-up. We retrospectively analyzed 30 participants with severe aortic stenosis who underwent standard transthoracic echocardiographic assessment before AVR [88 (IQR or interquartile range: 22–143) days], post-AVR [13 (6–22) days], and during follow-up [455 (226–907) days]. We assessed standard measures of LV structure, function, and aortic valve characteristics. Novel insight into dynamic LV function was provided through a four-chamber image by examination of the temporal relation between LV longitudinal strain (ε) and volume (ε-volume loops), representing the contribution of LV mechanics to volume change. AVR resulted in immediate changes in structural valve characteristics, alongside a reduced LV longitudinal peak ε and improved coherence between the diastolic and systolic part of the ε-volume loop (all P < 0.05). Follow-up revealed a decrease in LV mass ( P < 0.05) and improvements in LV ejection fraction and LV longitudinal peak ε ( P < 0.05). A significant relationship was present between decline in LV mass during follow-up and post-AVR improvement in coherence of the ε-volume loops ( r = 0.439, P = 0.03), but not with post-AVR changes in aortic valve characteristics or LV function (all P > 0.05). We found that post-AVR improvements in dynamic LV function are related to long-term remodeling of the LV. This highlights the potential importance of assessing dynamic LV function for cardiac adaptations in vivo. NEW & NOTEWORTHY Combining temporal measures of left ventricular longitudinal strain and volume (strain-volume loop) provides novel insights in dynamic cardiac function. In patients with aortic stenosis who underwent aortic valve replacement, postsurgical changes in the strain-volume loop are associated with regression of left ventricular mass during follow-up. This provides novel insight into the relation between postsurgery changes in cardiac hemodynamics and long-term structural remodeling, but also supports the potential utility of the assessment of dynamic cardiac function.
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Affiliation(s)
- Hugo G. Hulshof
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frederieke van Oorschot
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Arie P. van Dijk
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maria T. E. Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Keith P. George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - David L. Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Dick H. J. Thijssen
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Kalogerakos PD, Kontopodis N, Ioannou CV, Kladou E, Chalkiadakis G, Athanasiou T, Lazopoulos G. Hemodynamics and reverse remodeling associated with Mosaic, Perimount and Trifecta aortic bioprostheses. Expert Rev Med Devices 2019; 16:743-751. [PMID: 31318302 DOI: 10.1080/17434440.2019.1642105] [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: 10/26/2022]
Abstract
Introduction: The implantation rate of aortic bioprostheses is increasing. Their durability has improved to some extent over the years and they allow for future transcatheter valve-in-valve deployment. In the lack of long term follow up, their hemodynamic profile, i.e. transvalvular mean pressure gradient and effective orifice area indexed, and the associated left ventricular reverse remodeling indexed are useful surrogates for clinical outcomes. Areas covered: A systematic review of the literature was conducted by searching Medline, Cochrane, Scielo, Embase databases, and grey literature until July 2018 for articles that perform comparisons among the three most popular aortic bioprostheses. Six randomized and 12 non-randomized studies were included with 565 patients receiving a Mosaic, 1334 a Perimount and 557 a Trifecta valve. These articles are heterogeneous but they allow the meta-analytic comparison of the abovementioned outcomes. Expert opinion: Compared to the Perimount valve, the Mosaic is hemodynamically inferior, while the Trifecta is superior. Despite these statistically significant differences, the left ventricular mass regression indexed, that is indicative of reverse remodeling, was comparable in all groups. All patients were similarly benefited. The predilection among these valves is fueled by their hemodynamic profile but not supported by the comparable reverse remodeling.
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Affiliation(s)
- Paris D Kalogerakos
- a Cardiothoracic Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Nikolaos Kontopodis
- b Vascular Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Christos V Ioannou
- b Vascular Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Eleni Kladou
- c Internal Medicine Department, University Hospital of Heraklion , Crete , Greece
| | - George Chalkiadakis
- a Cardiothoracic Surgery Division, University Hospital of Heraklion , Crete , Greece
| | - Thanos Athanasiou
- d Faculty of Medicine, Department of Surgery and Cancer, Imperial College London , London , UK
| | - George Lazopoulos
- a Cardiothoracic Surgery Division, University Hospital of Heraklion , Crete , Greece
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Bilkhu R, Jahangiri M, Otto CM. Patient-prosthesis mismatch following aortic valve replacement. Heart 2019; 105:s28-s33. [DOI: 10.1136/heartjnl-2018-313515] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/01/2018] [Accepted: 10/14/2018] [Indexed: 01/12/2023] Open
Abstract
Patient-prosthesis mismatch (PPM) occurs when an implanted prosthetic valve is too small for the patient; severe PPM is defined as an indexed effective orifice area (iEOA) <0.65 cm2/m2 following aortic valve replacement (AVR). This review examines articles from the past 10 years addressing the prevalence, outcomes and options for prevention and treatment of PPM after AVR. Prevalence of PPM ranges from 8% to almost 80% in individual studies. PPM is thought to have an impact on mortality, mainly in patients with severe PPM, although severe PPM accounts for only 10–15% of cases. Outcomes of patients with moderate PPM are not significantly different to those without PPM. PPM is associated with higher rates of perioperative stroke and renal failure and lack of left ventricular mass regression. Predictors include female sex, older age, hypertension, diabetes, renal failure and higher surgical risk score. PPM may be a marker of comorbidity rather than a risk factor for adverse outcomes. PPM should be suspected in patients with persistent cardiac symptoms after AVR when there is high prosthetic valve velocity or gradient and a small calculated effective orifice area. After exclusion of other causes of increased transvalvular gradient, re-intervention may be considered if symptoms persist and are unresponsive to medical therapy. However, this decision needs to consider the available options to relieve PPM and whether expected benefits justify the risk of intervention. The only effective intervention is redo surgery with implantation of a larger valve and/or annular enlargement. Therefore, focus needs to be on prevention.
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Miranda-Silva D, Gonçalves-Rodrigues P, Almeida-Coelho J, Hamdani N, Lima T, Conceição G, Sousa-Mendes C, Cláudia-Moura, González A, Díez J, Linke WA, Leite-Moreira A, Falcão-Pires I. Characterization of biventricular alterations in myocardial (reverse) remodelling in aortic banding-induced chronic pressure overload. Sci Rep 2019; 9:2956. [PMID: 30814653 PMCID: PMC6393473 DOI: 10.1038/s41598-019-39581-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/18/2019] [Indexed: 01/03/2023] Open
Abstract
Aortic Stenosis (AS) is the most frequent valvulopathy in the western world. Traditionally aortic valve replacement (AVR) has been recommended immediately after the onset of heart failure (HF) symptoms. However, recent evidence suggests that AVR outcome can be improved if performed earlier. After AVR, the process of left ventricle (LV) reverse remodelling (RR) is variable and frequently incomplete. In this study, we aimed at detecting mechanism underlying the process of LV RR regarding myocardial structural, functional and molecular changes before the onset of HF symptoms. Wistar-Han rats were subjected to 7-weeks of ascending aortic-banding followed by a 2-week period of debanding to resemble AS-induced LV remodelling and the early events of AVR-induced RR, respectively. This resulted in 3 groups: Sham (n = 10), Banding (Ba, n = 15) and Debanding (Deb, n = 10). Concentric hypertrophy and diastolic dysfunction (DD) were patent in the Ba group. Aortic-debanding induced RR, which promoted LV functional recovery, while cardiac structure did not normalise. Cardiac parameters of RV dysfunction, assessed by echocardiography and at the cardiomyocyte level prevailed altered after debanding. After debanding, these alterations were accompanied by persistent changes in pathways associated to myocardial hypertrophy, fibrosis and LV inflammation. Aortic banding induced pulmonary arterial wall thickness to increase and correlates negatively with effort intolerance and positively with E/e′ and left atrial area. We described dysregulated pathways in LV and RV remodelling and RR after AVR. Importantly we showed important RV-side effects of aortic constriction, highlighting the impact that LV-reverse remodelling has on both ventricles.
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Affiliation(s)
| | | | | | - Nazha Hamdani
- Department of Systems Physiology, Ruhr University, Bochum, Germany
| | - Tânia Lima
- Department of Surgery and Physiology, University of Porto, Porto, Portugal
| | - Glória Conceição
- Department of Surgery and Physiology, University of Porto, Porto, Portugal
| | | | - Cláudia-Moura
- Department of Surgery and Physiology, University of Porto, Porto, Portugal
| | - Arantxa González
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra and CIBERCV, Pamplona, Spain.,Department of Cardiology and Cardiac Surgery and Department of Nephrology, University of Navarra Clinic, Pamplona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra and CIBERCV, Pamplona, Spain.,Department of Cardiology and Cardiac Surgery and Department of Nephrology, University of Navarra Clinic, Pamplona, Spain
| | - Wolfgang A Linke
- Institute of Physiology II, University of Muenster, Muenster, Germany
| | | | - Inês Falcão-Pires
- Department of Surgery and Physiology, University of Porto, Porto, Portugal.
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Is left ventricular hypertrophy a friend or foe of patients with aortic stenosis? ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:328-337. [PMID: 30603022 PMCID: PMC6309834 DOI: 10.5114/aic.2018.78734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/15/2018] [Indexed: 11/29/2022] Open
Abstract
Left ventricular hypertrophy (LVH) is traditionally considered a physiological compensatory response to LV pressure overload, such as hypertension and aortic stenosis (AS), in an effort to maintain LV systolic function in the face of an increased afterload. According to the Laplace law, LV wall thickening lowers LV wall stress, which in turn would be helpful to preserve LV systolic performance. However, numerous studies have challenged the notion of LVH as a putative beneficial adaptive mechanism. In fact, the magnitude of LVH is associated with higher cardiovascular morbidity and mortality, especially when LVH is disproportionate to LV afterload. We have briefly reviewed: first, the importance of non-valvular factors, beyond AS severity, for total LV afterload and symptomatic status in AS patients; second, associations of excessive LVH with LV dysfunction and adverse outcome in AS; third, prognostic relevance of the presence or absence of pre-operative LVH in patients referred for aortic valve surgery; fourth, time course, determinants and prognostic implications of LVH regression and LV function recovery after surgical valve replacement and transcatheter aortic valve implantation (TAVI) with a focus on TAVI-specific effects; fifth, the potential of medical therapy to modulate LVH before and after surgical or interventional treatment for severe AS, a condition perceived as a relative contraindication to renin-angiotensin system blockade.
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Philip JL, Zens T, Lozonschi L, De Oliveira NC, Osaki S, Kohmoto T, Akhter SA, Tang PC. Outcomes of surgical aortic valve replacement for mixed aortic valve disease. J Thorac Dis 2018; 10:4042-4051. [PMID: 30174847 DOI: 10.21037/jtd.2018.06.128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Mixed aortic valve disease (MAVD) is associated with a poorer natural history compared with isolated lesions. However, clinical and echocardiographic outcomes for aortic valve replacement (AVR) in mixed disease are less well understood. Methods Retrospective review of AVRs (n=1,011) from 2000-2016. Isolated AVR, AVR + coronary bypass, and AVR + limited ascending aortic replacement were included. Predominant aortic stenosis (AS) group was stratified into group 1 (n=660) with concomitant mild or less aortic insufficiency (AI), and group 2 (n=197) with accompanying moderate or greater AI. Predominant AI group was stratified using the same schema for concomitant AS into groups 3 (n=143) and 4 (n=53). Median follow-up was 3.1 and 4.4 years respectively for AS and AI groups. Results For the predominant AS group (n=857) preoperatively, group 2 had a larger preoperative left ventricular end diastolic diameter (LVESD) (51.0±8.4 vs. 48.6±7.2, P=0.02) and lower preoperative left ventricular ejection fraction (LVEF) (57.6% vs. 60.2%, P=0.043). No differences in left ventricular (LV) dimensions, LV or right ventricular (RV) function was evident at follow up (P>0.05). After propensity matching for age, operation, and comorbidities, there was no difference in survival (P=0.19). After propensity matching for the predominant AI group (n=196), survival was lower for group 4 compared to 3 (P=0.02). There were no differences in LV dimensions, LV or RV function preoperatively or on follow-up (P>0.05). Conclusions Predominant AS associated with higher AI grades had larger LV dimensions and worse LV function preoperatively. These differences resolve after AVR with equivalent survival. However, predominant AI with more severe AS had reduced survival despite AVR.
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Affiliation(s)
- Jennifer L Philip
- Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Tiffany Zens
- Department of Surgery, Division of General Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lucian Lozonschi
- Department of Surgery, Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nilto C De Oliveira
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Satoru Osaki
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Takushi Kohmoto
- Department of Surgery, Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Shahab A Akhter
- Department of Cardiovascular Sciences, Division of Cardiac Surgery, East Carolina Heart Institute at East Carolina University, Greenville, North Carolina, USA
| | - Paul C Tang
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, Michigan, USA
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36
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Musa TA, Uddin A, Dobson LE, Swoboda PP, Garg P, Foley JRJ, Malkin C, Plein S, Blackman DJ, Greenwood JP. Cardiovascular magnetic resonance assessment of 1st generation CoreValve and 2nd generation Lotus valves. J Interv Cardiol 2018; 31:391-399. [PMID: 29696693 DOI: 10.1111/joic.12512] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/01/2018] [Accepted: 03/20/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES We sought to compare using serial CMR, the quantity of AR and associated valve hemodynamics, following the first-generation CoreValve (Medtronic, Minneapolis, MN) and the second-generation Lotus valve (Boston Scientific, Natick, MA). BACKGROUND Aortic regurgitation (AR) following Transcatheter Aortic Valve Replacement (TAVR) confers a worse prognosis and can be accurately quantified using cardiovascular magnetic resonance (CMR). Second generation valves have been specifically designed to reduce paravalvular AR and improve clinical outcomes. METHODS Fifty-one patients (79.0 ± 7.7 years, 57% male) were recruited and imaged at three time points: immediately pre- and post-TAVR, and at 6 months. RESULTS CMR-derived AR fraction immediately post-TAVR was greater in the CoreValve compared to Lotus group (11.7 ± 8.4 vs. 4.3 ± 3.4%, P = 0.001), as was the frequency of ≥moderate AR (9/24 (37.5%) versus 0/27, P < 0.001). However, at 6 months AR fraction had improved significantly in the CoreValve group such that the two valve designs were comparable (6.4 ± 5.0 vs 5.6 ± 5.3%, P = 0.623), with no patient in either group having ≥moderate AR. The residual peak pressure gradient immediately following TAVR was significantly lower with CoreValve compared to Lotus (14.1 ± 5.6 vs 25.4 ± 11.6 mmHg, P = 0.001), but again by 6 months the two valve designs were comparable (16.5 ± 9.4 vs 19.7 ± 10.5 mmHg, P = 0.332). There was no difference in the degree of LV reverse remodeling between the two valves at 6 months. CONCLUSION Immediately post-TAVR, there was significantly less AR but a higher residual peak pressure gradient with the Lotus valve compared to CoreValve. However, at 6 months both devices had comparable valve hemodynamics and LV reverse remodeling.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Laura E Dobson
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter P Swoboda
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - James R J Foley
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Daniel J Blackman
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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Treibel TA, Kozor R, Schofield R, Benedetti G, Fontana M, Bhuva AN, Sheikh A, López B, González A, Manisty C, Lloyd G, Kellman P, Díez J, Moon JC. Reverse Myocardial Remodeling Following Valve Replacement in Patients With Aortic Stenosis. J Am Coll Cardiol 2018; 71:860-871. [PMID: 29471937 PMCID: PMC5821681 DOI: 10.1016/j.jacc.2017.12.035] [Citation(s) in RCA: 240] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/12/2017] [Accepted: 12/12/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Left ventricular (LV) hypertrophy, a key process in human cardiac disease, results from cellular (hypertrophy) and extracellular matrix expansion (interstitial fibrosis). OBJECTIVES This study sought to investigate whether human myocardial interstitial fibrosis in aortic stenosis (AS) is plastic and can regress. METHODS Patients with symptomatic, severe AS (n = 181; aortic valve area index 0.4 ± 0.1 cm2/m2) were assessed pre-aortic valve replacement (AVR) by echocardiography (AS severity, diastology), cardiovascular magnetic resonance (CMR) (for volumes, function, and focal or diffuse fibrosis), biomarkers (N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T), and the 6-min walk test. CMR was used to measure the extracellular volume fraction (ECV), thereby deriving matrix volume (LV mass × ECV) and cell volume (LV mass × [1 - ECV]). Biopsy excluded occult bystander disease. Assessment was repeated at 1 year post-AVR. RESULTS At 1 year post-AVR in 116 pacemaker-free survivors (age 70 ± 10 years; 54% male), mean valve gradient had improved (48 ± 16 mm Hg to 12 ± 6 mm Hg; p < 0.001), and indexed LV mass had regressed by 19% (88 ± 26 g/m2 to 71 ± 19 g/m2; p < 0.001). Focal fibrosis by CMR late gadolinium enhancement did not change, but ECV increased (28.2 ± 2.9% to 29.9 ± 4.0%; p < 0.001): this was the result of a 16% reduction in matrix volume (25 ± 9 ml/m2 to 21 ± 7 ml/m2; p < 0.001) but a proportionally greater 22% reduction in cell volume (64 ± 18 ml/m2 to 50 ± 13 ml/m2; p < 0.001). These changes were accompanied by improvement in diastolic function, N-terminal pro-B-type natriuretic peptide, 6-min walk test results, and New York Heart Association functional class. CONCLUSIONS Post-AVR, focal fibrosis does not resolve, but diffuse fibrosis and myocardial cellular hypertrophy regress. Regression is accompanied by structural and functional improvements suggesting that human diffuse fibrosis is plastic, measurable by CMR and a potential therapeutic target. (Regression of Myocardial Fibrosis After Aortic Valve Replacement; NCT02174471).
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Affiliation(s)
- Thomas A Treibel
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute for Cardiovascular Sciences, University College London, London, United Kingdom
| | - Rebecca Kozor
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Rebecca Schofield
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Giulia Benedetti
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Marianna Fontana
- Institute for Cardiovascular Sciences, University College London, London, United Kingdom
| | - Anish N Bhuva
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute for Cardiovascular Sciences, University College London, London, United Kingdom
| | - Amir Sheikh
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Begoña López
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Cardiovascular Biomedical Research Center Network (CIBERCV), Carlos III National Institute of Health, Madrid, Spain
| | - Arantxa González
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Cardiovascular Biomedical Research Center Network (CIBERCV), Carlos III National Institute of Health, Madrid, Spain
| | - Charlotte Manisty
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute for Cardiovascular Sciences, University College London, London, United Kingdom
| | - Guy Lloyd
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute for Cardiovascular Sciences, University College London, London, United Kingdom
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland
| | - Javier Díez
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain; Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; Cardiovascular Biomedical Research Center Network (CIBERCV), Carlos III National Institute of Health, Madrid, Spain; Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, Pamplona, Spain
| | - James C Moon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Institute for Cardiovascular Sciences, University College London, London, United Kingdom.
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Ochiai T, Saito S, Yamanaka F, Shishido K, Tanaka Y, Yamabe T, Shirai S, Tada N, Araki M, Naganuma T, Watanabe Y, Yamamoto M, Hayashida K. Renin–angiotensin system blockade therapy after transcatheter aortic valve implantation. Heart 2017; 104:644-651. [DOI: 10.1136/heartjnl-2017-311738] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 01/29/2023] Open
Abstract
ObjectiveThe persistence of left ventricular (LV) hypertrophy is associated with poor clinical outcomes after transcatheter aortic valve implantation (TAVI) for aortic stenosis. However, the optimal medical therapy after TAVI remains unknown. We investigated the effect of renin−angiotensin system (RAS) blockade therapy on LV hypertrophy and mortality in patients undergoing TAVI.MethodsBetween October 2013 and April 2016, 1215 patients undergoing TAVI were prospectively enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry. This cohort was stratified according to the postoperative usage of RAS blockade therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). Patients with at least two prescriptions dispensed 180 days apart after TAVI and at least a 6-month follow-up constituted the RAS blockade group (n=371), while those not prescribed any ACE inhibitors or ARBs after TAVI were included in the no RAS blockade group (n=189).ResultsAt 6 months postoperatively, the RAS blockade group had significantly greater LV mass index regression than the no RAS blockade group (−9±24% vs −2±25%, p=0.024). Kaplan-Meier analysis revealed a significantly lower cumulative 2-year mortality in the RAS blockade than that in the no RAS blockade group (7.5% vs 12.5%; log-rank test, p=0.031). After adjusting for confounding factors, RAS blockade therapy was associated with significantly lower all-cause mortality (HR, 0.45; 95% CI 0.22 to 0.91; p=0.025).ConclusionsPostoperative RAS blockade therapy is associated with greater LV mass index regression and reduced all-cause mortality. These data need to be confirmed by a prospective randomised controlled outcome trial.
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Kadkhodayan A, Lin G, Popma JJ, Reardon MJ, Little SH, Adams DH, Marcus R, Henry S, Baker MT, Kleiman NS, Deeb GM, Huang J, Oh JK. A Paradox between LV Mass Regression and Hemodynamic Improvement after Surgical and Transcatheter Aortic Valve Replacement. STRUCTURAL HEART-THE JOURNAL OF THE HEART TEAM 2017. [DOI: 10.1080/24748706.2017.1322734] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
| | - Grace Lin
- Mayo Clinic, Rochester, Minnesota, MN, USA
| | | | | | - Stephen H. Little
- Houston-Methodist-DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | | | - Sonia Henry
- North Shore University Hospital, Manhasset, NY, USA
| | | | - Neal S. Kleiman
- Houston-Methodist-DeBakey Heart and Vascular Center, Houston, TX, USA
| | | | | | - Jae K. Oh
- Mayo Clinic, Rochester, Minnesota, MN, USA
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Dobson LE, Musa TA, Uddin A, Fairbairn TA, Swoboda PP, Erhayiem B, Foley J, Garg P, Haaf P, Fent GJ, Malkin CJ, Blackman DJ, Plein S, Greenwood JP. Acute Reverse Remodelling After Transcatheter Aortic Valve Implantation: A Link Between Myocardial Fibrosis and Left Ventricular Mass Regression. Can J Cardiol 2016; 32:1411-1418. [DOI: 10.1016/j.cjca.2016.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/18/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022] Open
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Connelly KA, Wijeysundera HC, Roifman I. Cardiac Magnetic Resonance Imaging, Transcatheter Aortic Valve Replacement, and Early Left Ventricular Mass Regression-A Virtual Microscope Into Ventricular Remodelling? Can J Cardiol 2016; 32:1369-1371. [PMID: 27717525 DOI: 10.1016/j.cjca.2016.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/24/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Kim A Connelly
- Keenan Biomedical Research Centre, Li Ka Shing Knowledge Institute St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Harindra C Wijeysundera
- Sunnybrook Research Institute, Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Idan Roifman
- Sunnybrook Research Institute, Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Foroutan F, Guyatt GH, O'Brien K, Bain E, Stein M, Bhagra S, Sit D, Kamran R, Chang Y, Devji T, Mir H, Manja V, Schofield T, Siemieniuk RA, Agoritsas T, Bagur R, Otto CM, Vandvik PO. Prognosis after surgical replacement with a bioprosthetic aortic valve in patients with severe symptomatic aortic stenosis: systematic review of observational studies. BMJ 2016; 354:i5065. [PMID: 27683072 PMCID: PMC5040922 DOI: 10.1136/bmj.i5065] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine the frequency of survival, stroke, atrial fibrillation, structural valve deterioration, and length of hospital stay after surgical replacement of an aortic valve (SAVR) with a bioprosthetic valve in patients with severe symptomatic aortic stenosis. DESIGN Systematic review and meta-analysis of observational studies. DATA SOURCES Medline, Embase, PubMed (non-Medline records only), Cochrane Database of Systematic Reviews, and Cochrane CENTRAL from 2002 to June 2016. STUDY SELECTION Eligible observational studies followed patients after SAVR with a bioprosthetic valve for at least two years. METHODS Reviewers, independently and in duplicate, evaluated study eligibility, extracted data, and assessed risk of bias for patient important outcomes. We used the GRADE system to quantify absolute effects and quality of evidence. Published survival curves provided data for survival and freedom from structural valve deterioration, and random effect models provided the framework for estimates of pooled incidence rates of stroke, atrial fibrillation, and length of hospital stay. RESULTS In patients undergoing SAVR with a bioprosthetic valve, median survival was 16 years in those aged 65 or less, 12 years in those aged 65 to 75, seven years in those aged 75 to 85, and six years in those aged more than 85. The incidence rate of stroke was 0.25 per 100 patient years (95% confidence interval 0.06 to 0.54) and atrial fibrillation 2.90 per 100 patient years (1.78 to 4.79). Post-SAVR, freedom from structural valve deterioration was 94.0% at 10 years, 81.7% at 15 years, and 52% at 20 years, and mean length of hospital stay was 12 days (95% confidence interval 9 to 15). CONCLUSION Patients with severe symptomatic aortic stenosis undergoing SAVR with a bioprosthetic valve can expect only slightly lower survival than those without aortic stenosis, and a low incidence of stroke and, up to 10 years, of structural valve deterioration. The rate of deterioration increases rapidly after 10 years, and particularly after 15 years.
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Affiliation(s)
- Farid Foroutan
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Gordon H Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Kathleen O'Brien
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Eva Bain
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Madeleine Stein
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Sai Bhagra
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Daegan Sit
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Rakhshan Kamran
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Yaping Chang
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Tahira Devji
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Hassan Mir
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8
| | - Veena Manja
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Department of Internal Medicine, State University of New York at Buffalo, Buffalo, USA VA WNY Health Care System at Buffalo, Department of Veterans Affairs, USA
| | - Toni Schofield
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Reed A Siemieniuk
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Agoritsas
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St West, Hamilton, Ontario, Canada L8S 4L8 Division of General Internal Medicine, and Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Rodrigo Bagur
- Division of Cardiology, London Health Sciences Centre and Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada N6A 5W9
| | - Catherine M Otto
- Division of Cardiology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Per O Vandvik
- Department of Internal Medicine, Innlandet Hospital Trust-division Gjøvik, Norway Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
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Candela-Navarro G, Esteban-Molina M, Aguilar-Jiménez JM, Nuila-Durán L, Gomera-Martínez F, Abdallah A, Lara-Torrano J, López-Checa S, Calleja-Hernández M. Seguimiento a largo plazo de pacientes con disfunción ventricular izquierda intervenidos de sustitución valvular aórtica. Experiencia en nuestra institución. CIRUGIA CARDIOVASCULAR 2016. [DOI: 10.1016/j.circv.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Effect of aortic pericardial valve choice on outcomes and left ventricular mass regression in patients with left ventricular hypertrophy. J Thorac Cardiovasc Surg 2016; 152:1291-1298.e2. [PMID: 27423336 DOI: 10.1016/j.jtcvs.2016.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 05/22/2016] [Accepted: 06/09/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We sought to assess the effect of 2 contemporary pericardial valves on left ventricular mass regression and clinical outcomes after aortic valve replacement (AVR) in patients with aortic stenosis (AS). METHODS Patients were followed postoperatively in a dedicated valve clinic. A propensity score was derived for each patient and used to adjust all analyses. Longitudinal analysis was performed using a repeated measures growth curve model. Survival analysis was assessed with a Cox proportional hazards model. RESULTS Since February 2011, 258 patients with AS and left ventricular hypertrophy underwent AVR with the Trifecta (TR) (St Jude Medical, St Paul, Minn) or Perimount Magna Ease (ME) (Edwards LifeSciences, Irvine, Calif) bioprosthesis. There were longer bypass and crossclamp times and the indexed left ventricular outflow tract was smaller in the TR group. For the TR and ME, respectively, peak (14.4 ± 5.1 mm Hg vs 20.9 ± 7.2 mm Hg; P < .001) and mean (7.3 ± 2.7 mm Hg vs 10.9 ± 4.3 mm Hg; P < .001) gradients were significantly smaller postoperatively in the TR group. There was greater total mass regression (44.3 g/m2; 95% confidence interval [CI], 36.3-52.3 vs 29.5; 95% CI, 20.4-38.5 g/m2; P = .020) and mass regression over time in the TR group compared with the ME group (P = .016). Freedom from readmission, congestive heart failure, and the composite outcome of all-cause mortality, readmission, and congestive heart failure at 2.5 years was significantly improved in the TR group (composite outcome in TR and ME groups, respectively, 90.2; 95% CI, 81.9-94.9 and 78.2; 95% CI, 67.1-86.0; P = .013) CONCLUSIONS: TR use was associated with significantly increased left ventricular mass regression and improved intermediate-term clinical outcome in patients with left ventricular hypertrophy undergoing AVR for AS, compared with use of the ME.
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Merino D, Villar AV, García R, Tramullas M, Ruiz L, Ribas C, Cabezudo S, Nistal JF, Hurlé MA. BMP-7 attenuates left ventricular remodelling under pressure overload and facilitates reverse remodelling and functional recovery. Cardiovasc Res 2016; 110:331-45. [DOI: 10.1093/cvr/cvw076] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/18/2016] [Indexed: 12/28/2022] Open
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Astapov DA, Demidov DP, Semenova EI. [Aortic valve replacement with stentless bioprosthesis]. Khirurgiia (Mosk) 2016:4-12. [PMID: 27271713 DOI: 10.17116/hirurgia201654-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM To evaluate prospectively the hemodynamic performance of «BioLAB Mono» stentless bioprosthesis implanted into aortic position. MATERIAL AND METHODS Twenty seven patients (mean age 71 (67; 73); 17 women) with severe aortic stenosis underwent aortic valve replacement with «BioLAB Mono» stentless bioprosthesis from 2012 to 2014. The valves were implanted into supra-annular position using continuous polypropylene suture. RESULTS In the early postoperative period 1 patient (3.7%) died for acute heart failure. The mean aortic cross-clamping time was 81 (75; 90) min. Echocardiographic peak pressure gradient were 18 (16; 23) mmHg (postoperative). There were no cases of valve dysfunction in early postoperative period. Level of thrombocytes recovered after 10 days postoperatively. CONCLUSION «BioLAB Mono» aortic bioprosthesis implantation is easy and reproducible. The valve has excellent hemodynamic performance in early postoperative period.
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Affiliation(s)
- D A Astapov
- Academician E.N. Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - D P Demidov
- Academician E.N. Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia
| | - E I Semenova
- Academician E.N. Meshalkin Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia
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Yamabe S, Dohi Y, Higashi A, Kinoshita H, Sada Y, Hidaka T, Kurisu S, Shiode N, Kihara Y. Clinical value of regression of electrocardiographic left ventricular hypertrophy after aortic valve replacement. Heart Vessels 2015; 31:1497-503. [DOI: 10.1007/s00380-015-0761-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/09/2015] [Indexed: 01/20/2023]
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Outcome of Left-Sided Cardiac Remodeling in Severe Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Implantation. Am J Cardiol 2015; 116:595-603. [PMID: 26089011 DOI: 10.1016/j.amjcard.2015.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 05/14/2015] [Accepted: 05/14/2015] [Indexed: 01/01/2023]
Abstract
Left-sided cardiac remodeling in patients with severe aortic stenosis (AS) was associated with improved outcome; however, there are scarce data on remodeling process after transcatheter aortic valve implantation (TAVI). We sought to describe the remodeling process in patients with severe AS who underwent TAVI. Echocardiographic data were systematically collected at baseline, 30 days, 6 months, and 1 year, from a cohort of 333 patients who underwent TAVI. Patients were categorized according to left ventricular mass index (LVMi) and relative wall thickness (RWT) to the following geometries: (1) normal; (2) concentric remodeling; (3) concentric hypertrophy; and (4) eccentric hypertrophy. Reverse remodeling (partial or complete) was defined as normalization of LVMi and/or RWT and adverse remodeling as an increase in LVMi and/or RWT. The longitudinal change in LVMi and left atrial diameter index (LADi) was assessed using mixed models. Reverse LV remodeling at 1-year was observed in 24% of patients with available echo at follow-up, whereas 17% of patients had adverse remodeling at 1-year follow-up. This was especially noted in patients with normal geometry at baseline. Interestingly, LV reverse remodeling was not accompanied by a reduction in left atrial diameter. In conclusion, TAVI reverse ventricular remodeling and LV hypertrophy induced by aortic stenosis; however, this reversal is incomplete in most patients at 1-year and not followed by change in left atrial dimensions. Whether this favorable remodeling may impact clinical outcome needs to be further elucidated.
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van der Straaten EP, Rademakers LM, van Straten AH, Houterman S, Tan MES, Soliman Hamad MA. Mid-term haemodynamic and clinical results after aortic valve replacement using the Freedom Solo stentless bioprosthesis versus the Carpentier Edwards Perimount stented bioprosthesis. Eur J Cardiothorac Surg 2015. [DOI: 10.1093/ejcts/ezv255] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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50
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Gavina C, Falcão-Pires I, Pinho P, Manso MC, Gonçalves A, Rocha-Gonçalves F, Leite-Moreira A. Relevance of residual left ventricular hypertrophy after surgery for isolated aortic stenosis. Eur J Cardiothorac Surg 2015; 49:952-9. [DOI: 10.1093/ejcts/ezv240] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/12/2015] [Indexed: 11/13/2022] Open
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