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Hakgor A, Dursun A, Kahraman BC, Yazar A, Savur U, Akhundova A, Olgun FE, Arman ME, Boztosun B. Prognostic impact of main pulmonary artery to ascending aorta diameter ratio in patients with severe aortic stenosis underwent transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2024; 103:782-791. [PMID: 38415894 DOI: 10.1002/ccd.31000] [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: 08/24/2023] [Revised: 01/09/2024] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Pulmonary hypertension (PH) and right ventricular dysfunction are poor prognostic predictors in patients underwent transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). AIMS The prognostic impact of the main pulmonary artery/ascending aorta diameter ratio (MPA/AOr), measured simply by computed-tomographic angiography (CTA), was investigated in this patient group. METHODS A total of 374 retrospectively evaluated patients (mean age 78.1 ± 8.4 years, 192 [51.3%] females) who underwent TAVI for severe AS were included. MPA/AOr was measured on preprocedural CTA in all patients and the effect of this measurement on the presence of PH, in-hospital and 2-year-overall long-term mortality was investigated. RESULTS The presence of PH was defined as a systolic pulmonary artery pressure (sPAP) >42 mmHg measured by echocardiography. According to multivariate-logistic-regression analysis, MPA/AOr (adjusted [Adj] odds ratio [OR]: 1.188, confidence interval [CI] 95% [1.002-1.410], p = 0.048), tricuspid annular plane systolic excursion (TAPSE) (adj OR:0.736, CI 95% [0.663-0.816], p < 0.001) and left atrial diameter (adj OR:1.051, CI 95% [1.007-1.098], p = 0.024) were identified as independent predictors of PH. In addition, a statistically significant correlation was found between MPA/AOr and TAPSE (r: -0.283, p < 0.001). Furthermore, MPA/AOr was found to be an independent predictor of both in-hospital (adj OR:1.434, CI 95% [1.093-1.881], p = 0.009) and 2-year long-term (adj OR:1.518, CI 95% [1.243-1.853], p < 0.001) mortality in multivariate analysis including TAPSE, STS score and sPAP. In the 2-year Kaplan-Meier survival probability analysis, an MPA/AOr >0.86 was found to have a hazard ratio of 3.697 (95% CI: 2.341-5.840), with a log-rank p < 0.001. CONCLUSION MPA/AOr, which can be measured simply by CTA, may be useful as an indicator of the presence of PH and poor prognosis in patients planned for TAVI for severe AS.
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Affiliation(s)
- Aykun Hakgor
- Depatment of Cardiology, Medipol Mega University Hospital, Istanbul, Turkey
| | - Atakan Dursun
- Depatment of Cardiology, Medipol Mega University Hospital, Istanbul, Turkey
| | | | - Arzu Yazar
- Depatment of Cardiology, Medipol Mega University Hospital, Istanbul, Turkey
| | - Umeyir Savur
- Depatment of Cardiology, Medipol Mega University Hospital, Istanbul, Turkey
| | - Aysel Akhundova
- Depatment of Cardiology, Medipol Mega University Hospital, Istanbul, Turkey
| | - Fatih Erkam Olgun
- Depatment of Cardiology, Medipol Mega University Hospital, Istanbul, Turkey
| | - Mehmet Emir Arman
- Depatment of Cardiology, Medipol Mega University Hospital, Istanbul, Turkey
- Depatment of Internal Medicine, Ascension St. Vincent Hospital, Indianapolis, Indiana, USA
| | - Bilal Boztosun
- Depatment of Cardiology, Medipol Mega University Hospital, Istanbul, Turkey
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van de Veerdonk MC, Roosma L, Trip P, Gopalan D, Vonk Noordegraaf A, Dorfmüller P, Nossent EJ. Clinical-imaging-pathological correlation in pulmonary hypertension associated with left heart disease. Eur Respir Rev 2024; 33:230144. [PMID: 38417969 PMCID: PMC10900069 DOI: 10.1183/16000617.0144-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/25/2023] [Indexed: 03/01/2024] Open
Abstract
Pulmonary hypertension (PH) is highly prevalent in patients with left heart disease (LHD) and negatively impacts prognosis. The most common causes of PH associated with LHD (PH-LHD) are left heart failure and valvular heart disease. In LHD, passive backward transmission of increased left-sided filling pressures leads to isolated post-capillary PH. Additional pulmonary vasoconstriction and remodelling lead to a higher vascular load and combined pre- and post-capillary PH. The increased afterload leads to right ventricular dysfunction and failure. Multimodality imaging of the heart plays a central role in the diagnostic work-up and follow-up of patients with PH-LHD. Echocardiography provides information about the estimated pulmonary artery pressure, morphology and function of the left and right side of the heart, and valvular abnormalities. Cardiac magnetic resonance imaging is the gold standard for volumetric measurements and provides myocardial tissue characterisation. Computed tomography of the thorax may show general features of PH and/or LHD and is helpful in excluding other PH causes. Histopathology reveals a spectrum of pre- and post-capillary vasculopathy, including intimal fibrosis, media smooth muscle cell hyperplasia, adventitial fibrosis and capillary congestion. In this paper, we provide an overview of clinical, imaging and histopathological findings in PH-LHD based on three clinical cases.
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Affiliation(s)
- Marielle C van de Veerdonk
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Lize Roosma
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Pia Trip
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Deepa Gopalan
- Department of Radiology, Imperial College Hospital NHS Trust, London, UK
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Peter Dorfmüller
- Department of Pathology, University Hospital Giessen and Marburg (UKGM), German Centre for Lung Research (DZL) and Institute for Lung Health (ILH), Giessen, Germany
| | - Esther J Nossent
- Department of Pulmonary Diseases, Amsterdam University Medical Centers, Free University, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
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Ivanov B, Krasivskyi I, Förster F, Gaisendrees C, Elderia A, Großmann C, Mihaylova M, Djordjevic I, Eghbalzadeh K, Sabashnikov A, Kuhn E, Deppe AC, Rahmanian PB, Mader N, Gerfer S, Wahlers T. Impact of pulmonary hypertension on short-term outcomes in patients undergoing surgical aortic valve replacement for severe aortic valve stenosis. Perfusion 2024:2676591241227883. [PMID: 38213127 DOI: 10.1177/02676591241227883] [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: 01/13/2024]
Abstract
OBJECTIVES In patients with left heart disease and severe aortic stenosis (AS), pulmonary hypertension (PH) is a common comorbidity and predictor of poor prognosis. Untreated AS aggravates PH leading to an increased right ventricular afterload and, in line to right ventricular dysfunction. The surgical benefit of aortic valve replacement (AVR) in elderly patients with severe AS and PH could be limited due to the multiple comorbidities and poor outcomes. Therefore, we purposed to investigate the impact of PH on short-term outcomes in patients with moderate to severe AS who underwent surgical AVR in our heart center. METHODS In this study we retrospectively analyzed a cohort of 99 patients with severe secondary post-capillary PH who underwent surgical AVR (AVR + PH group) at our heart center between 2010 and 2021 with a regard to perioperative outcomes. In order to investigate the impact of PH on short-term outcomes, the control group of 99 patients without pulmonary hypertension who underwent surgical AVR (AVR group) at our heart center with similar risk profile was accordingly analyzed regarding pre-, intra- and postoperative data. RESULTS Atrial fibrillation occurred significantly more often (p = .013) in patients who suffered from PH undergoing AVR. In addition, the risk for cardiac surgery (EUROSCORE II) was significantly higher (p < .001) in the above-mentioned group. Likewise, cardiopulmonary bypass time (p = .018), aortic cross-clamp time (p = .008) and average operation time (p = .009) were significantly longer in the AVR + PH group. Furthermore, the in-hospital survival rate was significantly higher (p = .044) in the AVR group compared to the AVR + PH group. Moreover, the dialysis rate was significantly higher (p < .001) postoperatively in patients who suffered PH compared to the patients without PH undergoing AVR. CONCLUSION In our study, patients with severe PH and severe symptomatic AS who underwent surgical aortic valve replacement showed adverse short-term outcomes compared to patients without PH.
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Affiliation(s)
- Borko Ivanov
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
- Department of Cardiothoracic Surgery, Helios Hospital Siegburg, Siegburg, Germany
| | - Ihor Krasivskyi
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Friedrich Förster
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Ahmed Elderia
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Clara Großmann
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Mariya Mihaylova
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Ilija Djordjevic
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Kaveh Eghbalzadeh
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Antje-Christin Deppe
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | | | - Navid Mader
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Stephen Gerfer
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
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Patel B, D'Souza S, Sahni T, Yehya A. Pulmonary hypertension secondary to valvular heart disease: a state-of-the-art review. Heart Fail Rev 2024; 29:277-286. [PMID: 38017225 DOI: 10.1007/s10741-023-10372-9] [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] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
Pulmonary hypertension (PH) is a common disease affecting up to 1% of the population and at least 50% of patients diagnosed with heart failure (HF) (Hoeper et al. in Lancet Respir Med 4(4):306-322, 2016). It is estimated that PH is present in 15% to 60% of patients with valvular heart disease (VHD) which can result from an increase in pulmonary blood flow and subsequently in pulmonary venous congestion and pulmonary vascular resistance (PVR). It is important to identify the severity of PH in patients with VHD to appropriately risk stratify and manage these patients (Magne et al. in JACC Cardiovasc Imaging 8(1):83-99, 2015). In this review, we examine the diagnostic criteria for PH and its pathophysiology. We also focus on the growing evidence supporting the presence of PH secondary to VHD and describe the contemporary surgical and medical therapeutic interventions in this patient population (Fig. 1).
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Affiliation(s)
- Bansi Patel
- Virginia Hospital Center, Arlington, VA, USA
| | | | - Tamanna Sahni
- Kaiser Permanente Internal Medicine Residency, Gaithersburg, MD, USA
| | - Amin Yehya
- Sentara Advanced Heart Failure Center, Norfolk, VA, USA.
- Eastern Virginia Medical School, Norfolk, VA, USA.
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Viva T, Postolache A, Nguyen Trung ML, Danthine P, Petitjean H, Bruno VD, Martinez C, Lempereur M, Guazzi M, Aghezzaf S, Coisne A, Oury C, Dulgheru R, Lancellotti P. A new integrative approach combining right heart catheterization and echocardiography to stage aortic stenosis-related cardiac damage. Front Cardiovasc Med 2023; 10:1184308. [PMID: 37600042 PMCID: PMC10436206 DOI: 10.3389/fcvm.2023.1184308] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Although staging of the extent of aortic stenosis (AS)-related cardiac damages is usually performed via echocardiography, this technique has considerable limitations in assessing pulmonary artery and right chamber pressures. The present hypothesis-generating study sought to explore the efficacy of a staging system of cardiac damage based on echocardiographic and invasive [right heart catheterization (RHC)] hemodynamic parameters in patients undergoing transcatheter aortic valve implantation (TAVI). Methods We studied 90 symptomatic patients with severe AS in whom echocardiographic and invasive evaluation by RHC was obtained prior to TAVI. Cardiac damage stages were defined as follows: no cardiac damage (stage 0), left ventricular (LV) damage (stage 1), left atrial or mitral valve damage (stage 2), pulmonary vasculature or tricuspid valve damage (stage 3), and right ventricular (RV) dysfunction or low-flow state (stage 4). With the integrative approach using RHC, pulmonary hypertension (PH) was defined as an mPAP ≥25 mmHg and the low-flow state corresponded to a cardiac index of <1.8 L/min/m2 and a right atrial pressure of >10 mmHg. Results During follow-up (median: 2.9 years), 43 patients (47.8%) died. The integrative cardiac damage staging was associated with a significant increase in all-cause and cardiovascular mortality per each increase of cardiac damage stage, whereas the outcome was similar according to the echocardiographic staging. Conclusions A staging system of cardiac lesion based on echocardiographic and invasive hemodynamic parameters in patients with severe AS undergoing TAVI predicts mortality. Patients with pre-existing PH, ≥ moderate tricuspid regurgitation and/or RV dysfunction, and a low-flow state had a markedly increased risk of death. Further larger studies are needed to validate our findings.
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Affiliation(s)
- Tommaso Viva
- GIGA Cardiovascular Sciences, CHU Sart Tilman, Cardiology Department, University of Liège Hospital, Liège, Belgium
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
- Department of Minimally Invasive Cardiac Surgery, IRCCS Galeazzi—Sant’Ambrogio Hospital, Milan, Italy
| | - Adriana Postolache
- GIGA Cardiovascular Sciences, CHU Sart Tilman, Cardiology Department, University of Liège Hospital, Liège, Belgium
| | - Mai-Linh Nguyen Trung
- GIGA Cardiovascular Sciences, CHU Sart Tilman, Cardiology Department, University of Liège Hospital, Liège, Belgium
| | - Pauline Danthine
- GIGA Cardiovascular Sciences, CHU Sart Tilman, Cardiology Department, University of Liège Hospital, Liège, Belgium
| | - Hélène Petitjean
- GIGA Cardiovascular Sciences, CHU Sart Tilman, Cardiology Department, University of Liège Hospital, Liège, Belgium
| | - Vito Domenico Bruno
- Department of Minimally Invasive Cardiac Surgery, IRCCS Galeazzi—Sant’Ambrogio Hospital, Milan, Italy
| | - Christophe Martinez
- GIGA Cardiovascular Sciences, CHU Sart Tilman, Cardiology Department, University of Liège Hospital, Liège, Belgium
| | - Mathieu Lempereur
- GIGA Cardiovascular Sciences, CHU Sart Tilman, Cardiology Department, University of Liège Hospital, Liège, Belgium
| | - Marco Guazzi
- School of Medicine, Department of Biological Sciences, University of Milano, Milan, Italy
- CardiologyDivision, San Paolo Hospital, Milan, Italy
| | - Samy Aghezzaf
- CHU Lille, Institut Pasteur de Lille, University Lille, Inserm, Lille, France
| | - Augustin Coisne
- CHU Lille, Institut Pasteur de Lille, University Lille, Inserm, Lille, France
- Cardiovascular Research Foundation, New York, NY, United States
| | - Cécile Oury
- GIGA Cardiovascular Sciences, CHU Sart Tilman, Cardiology Department, University of Liège Hospital, Liège, Belgium
| | - Raluca Dulgheru
- GIGA Cardiovascular Sciences, CHU Sart Tilman, Cardiology Department, University of Liège Hospital, Liège, Belgium
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, CHU Sart Tilman, Cardiology Department, University of Liège Hospital, Liège, Belgium
- Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
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6
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Liu TX, Tanenbaum MT, Seo CH, Park D, Lystash JC, Joseph M, Arnold WS. Left Ventricular Diastolic Dysfunction and Pulmonary Hypertension: Outcomes in SAVR. Thorac Cardiovasc Surg 2023; 71:398-406. [PMID: 33862634 DOI: 10.1055/s-0041-1727138] [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: 10/21/2022]
Abstract
BACKGROUND Severe pulmonary hypertension (PH) and left ventricular diastolic dysfunction (LVDD) are independently associated with poor outcomes in cardiac surgery. We evaluated the relationship of several measures of LVDD, PH, and hemodynamic subtypes of PH including precapillary pulmonary hypertension(pcPH) and isolated post-capillary pulmonary hypertension(ipcPH) and combined pre and post capillary pulmonary hypertension(cpcPH) capillary PH to postoperative outcomes in a cohort of patients who underwent elective isolated-AVR. METHODS We evaluated (n = 206) patients in our local STS database who underwent elective isolated-AVR between 2014 and 2018, with transthoracic echocardiogram (n = 177) or right heart catheterization (n = 183) within 1 year of operation (or both, n = 161). The primary outcome was a composite end point of death, prolonged ventilation, ICU readmission, and hospital stay >14 days. RESULTS Severe PH was associated with worse outcomes (moderate: OR, 1.1, p = 0.09; severe: OR, 1.28, p = 0.01), but degree of LVDD was not associated with worse outcomes. Across hemodynamic subtypes of PH, odds of composite outcome were similar (p = 0.89), however, patients with cpcPH had more postoperative complications (67 vs. 36%, p = 0.06) and patients with ipcPH had greater all-cause mortality at 1 (8 vs. 1%, p = 0.03) and 3 years (27 vs. 4%, p = 0.008). CONCLUSION Severe PH conferred modestly greater risk of adverse events, and both LVDD grade and the combination of severe PH and LVDD were not associated with worse outcomes. However, hemodynamic stratification of PH revealed higher postoperative complications and worse long-term outcomes for those with cpcPH and ipcPH. Preoperative stratification of PH by hemodynamic subtype in valve replacement surgery may improve our risk stratification in this heterogenous condition. Further evaluation of the significance of LVDD and PH in other cardiac operations is warranted.
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Affiliation(s)
- Tom X Liu
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Mira T Tanenbaum
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
| | - Claire H Seo
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
| | - Dan Park
- School of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
| | - John C Lystash
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Mark Joseph
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - William S Arnold
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
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7
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Ahmad M, Del Cid Fratti J, Henien M, Pant K, Wattelet MP, Whorf D, Austin BC, Kim M, Barzallo M, Mungee S. Association Between Pulmonary Hypertension and Its Effect on 30-Day Mortality, Readmission, and Cost After Transcatheter Aortic Valve Replacement: A Multicenter Study. Cureus 2023; 15:e40976. [PMID: 37388720 PMCID: PMC10300306 DOI: 10.7759/cureus.40976] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 07/01/2023] Open
Abstract
Background Pulmonary hypertension (PH) is commonly seen in patients with severe aortic stenosis. Transcatheter aortic valve replacement (TAVR) has been shown to improve PH, however, its impact on clinical outcomes and cost remains unclear. Methods We did a multicenter, retrospective analysis of patients undergoing TAVR in our system between December 2012 to November 2020. The initial sample size was 1356. We excluded patients with prior history of heart failure, with a left ventricular ejection fraction of 40% or less, and patients who had active symptoms of heart failure within two weeks of the procedure. Patients were divided into four groups based on their pulmonary pressures, using right ventricular systolic pressure (RVSP) as a surrogate for PH. Groups included patients with normal pulmonary pressures (<35mmHg), mild (35-45mmHg) moderate (46-60mmHg), and severe PH (>60mmHg). Primary outcomes included 30-day mortality and readmission. Secondary outcomes included length of ICU stay and cost of admission. We used Chi-square and T-tests for demographic analysis of categorical continuous variables respectively. Adjusted regression was used for the reliability of correlation between variables. Multivariate analysis was used for final outcomes. Results Final sample size was 474. Average age was 78.9 years (SD: 8.2, 53% Male). Thirty-one percent (n=150) had normal pulmonary pressures, 33% (n=156) had mild PH, 25% (n=122) had moderate and 10% (n=46) had severe PH. Patients with history of hypertension (p-value<0.001), diabetes (p-value<0.001), chronic lung disease (p-value=0.006) and those on supplemental oxygen (p-value=0.046), had significantly higher proportion of patients with moderate and severe PH. We found significantly higher odds of 30-day mortality in patients with severe PH (OR: 6.77, CI: 1.09-41.98: p-value 0.04) compared with normal or mild PH. There was no significant difference in 30-day readmission (p-value=0.859) between the four groups. Cost did not change with severity of PH (Avg: $261,075: p-value=0.810). Patients with severe PH spent a significantly higher number of hours in ICU, compared with the other three groups (Mean: 18.2, p=value <0.001). Conclusions Severe pulmonary hypertension significantly increased the odds of 30-day mortality and ICU stay in TAVR patients. We did not see any significant difference in 30-day readmission and cost of admission, based on PH severity.
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Affiliation(s)
- Mansoor Ahmad
- Cardiology, University of Illinois College at Chicago Peoria, Peoria, USA
| | | | - Mena Henien
- Cardiology, University of Illinois College at Chicago Peoria, Peoria, USA
| | - Kailash Pant
- Cardiology, University of Illinois College at Chicago Peoria, Peoria, USA
| | - Matthew P Wattelet
- Cardiology, University of Illinois College at Chicago Peoria, Peoria, USA
| | - Daniel Whorf
- Cardiology, University of Illinois College at Chicago Peoria, Peoria, USA
| | - Brett C Austin
- Cardiology, University of Illinois College at Chicago Peoria, Peoria, USA
| | - Minchul Kim
- Cardiology, University of Illinois College at Chicago Peoria, Peoria, USA
| | - Marco Barzallo
- Cardiology, University of Illinois College at Chicago Peoria, Peoria, USA
| | - Sudhir Mungee
- Cardiology, University of Illinois College at Chicago Peoria, Peoria, USA
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Nguyen AQN, Denault AY, Théoret Y, Varin F. Inhaled milrinone in cardiac surgical patients: pharmacokinetic and pharmacodynamic exploration. Sci Rep 2023; 13:3557. [PMID: 36864229 PMCID: PMC9981759 DOI: 10.1038/s41598-023-29945-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 02/13/2023] [Indexed: 03/04/2023] Open
Abstract
Mean arterial pressure to mean pulmonary arterial pressure ratio (mAP/mPAP) has been identified as a strong predictor of perioperative complications in cardiac surgery. We therefore investigated the pharmacokinetic/pharmacodynamic (PK/PD) relationship of inhaled milrinone in these patients using this ratio (R) as a PD marker. Following approval by the ethics and research committee and informed consent, we performed the following experiment. Before initiation of cardiopulmonary bypass in 28 pulmonary hypertensive patients scheduled for cardiac surgery, milrinone (5 mg) was nebulized, plasma concentrations measured (up to 10 h) and compartmental PK analysis carried out. Baseline (R0) and peak (Rmax) ratios as well as magnitude of peak response (∆Rmax-R0) were measured. During inhalation, individual area under effect-time (AUEC) and plasma concentration-time (AUC) curves were correlated. Potential relationships between PD markers and difficult separation from bypass (DSB) were explored. In this study, we observed that milrinone peak concentrations (41-189 ng ml-1) and ΔRmax-R0 (- 0.12-1.5) were obtained at the end of inhalation (10-30 min). Mean PK parameters agreed with intravenous milrinone published data after correction for the estimated inhaled dose. Paired comparisons yielded a statistically significant increase between R0 and Rmax (mean difference, 0.58: 95% CI 0.43-0.73; P < 0.001). Individual AUEC correlated with AUC (r = 0.3890, r2 = 0.1513; P = 0.045); significance increased after exclusion of non-responders (r = 4787, r2 = 0.2292; P = 0.024). Individual AUEC correlated with ∆Rmax-R0 (r = 5973, r2 = 0.3568; P = 0.001). Both ∆Rmax-R0 (P = 0.009) and CPB duration (P < 0.001) were identified as predictors of DSB. In conclusion, both magnitude of peak response of the mAP/mPAP ratio and CPB duration were associated with DSB.
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Affiliation(s)
- Anne Quynh-Nhu Nguyen
- Faculty of Pharmacy, Université de Montréal, 2940 Chemin de la Polytechnique, Montreal, QC, H3T 1J4, Canada
| | - André Y Denault
- Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
| | - Yves Théoret
- Clinical Pharmacology Unit, CHU Sainte-Justine, Montreal, Canada
| | - France Varin
- Faculty of Pharmacy, Université de Montréal, 2940 Chemin de la Polytechnique, Montreal, QC, H3T 1J4, Canada.
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Bahadormanesh N, Tomka B, Kadem M, Khodaei S, Keshavarz-Motamed Z. An ultrasound-exclusive non-invasive computational diagnostic framework for personalized cardiology of aortic valve stenosis. Med Image Anal 2023; 87:102795. [PMID: 37060702 DOI: 10.1016/j.media.2023.102795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
Aortic stenosis (AS) is an acute and chronic cardiovascular disease and If left untreated, 50% of these patients will die within two years of developing symptoms. AS is characterized as the stiffening of the aortic valve leaflets which restricts their motion and prevents the proper opening under transvalvular pressure. Assessments of the valve dynamics, if available, would provide valuable information about the patient's state of cardiac deterioration as well as heart recovery and can have incredible impacts on patient care, planning interventions and making critical clinical decisions with life-threatening risks. Despite remarkable advancements in medical imaging, there are no clinical tools available to quantify valve dynamics invasively or noninvasively. In this study, we developed a highly innovative ultrasound-based non-invasive computational framework that can function as a diagnostic tool to assess valve dynamics (e.g. transient 3-D distribution of stress and displacement, 3-D deformed shape of leaflets, geometric orifice area and angular positions of leaflets) for patients with AS at no risk to the patients. Such a diagnostic tool considers the local valve dynamics and the global circulatory system to provide a platform for testing the intervention scenarios and evaluating their effects. We used clinical data of 12 patients with AS not only to validate the proposed framework but also to demonstrate its diagnostic abilities by providing novel analyses and interpretations of clinical data in both pre and post intervention states. We used transthoracic echocardiogram (TTE) data for the developments and transesophageal echocardiography (TEE) data for validation.
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Affiliation(s)
| | - Benjamin Tomka
- Department of Mechanical Engineering, McMaster University Hamilton, ON, Canada
| | - Mason Kadem
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University Hamilton, ON, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University Hamilton, ON, Canada; School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada; School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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10
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Koike T, Iwata H, Chikata Y, Doi S, Naito R, Yasuda H, Funamizu T, Endo H, Miyazaki S, Okazaki S, Higuchi R, Takamisawa I, Sato K, Tamura H, Yokoyama H, Tobaru T, Takanashi S, Tabata M, Minamino T. Favorable Prognosis in Patients with Recovered Pulmonary Hypertension after TAVI: An Analysis of the LAPLACE-TAVI Registry. J Clin Med 2023; 12:jcm12020729. [PMID: 36675658 PMCID: PMC9866150 DOI: 10.3390/jcm12020729] [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: 12/06/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Pulmonary hypertension (PH) is a common complication of aortic stenosis (AS). Despite the established association between PH and poor outcomes in patients with AS, the prognostic implication of a change in PH after transcatheter aortic valve implantation (TAVI) has been rarely evaluated. This study analyzed a prospective multi-center TAVI registry database involving six Japanese centers and used the transtricuspid pressure gradient (TRPG) obtained by echocardiography to estimate pulmonary artery systolic pressure. The participants (n = 2056) were first divided into two groups by TRPG before TAVI, a PH (−) group (TRPG < 30 mmHg) (n = 1407, 61.9%) and a PH (+) group (TRPG ≥ 30 mmHg) (n = 649, 28.6%). Next, by TRPG after (4.1 ± 5.3 days) TAVI, the PH (+) group was further subdivided into two groups, Recovered PH (TRPG < 30 mmHg, n = 253) and Persistent PH (TRPG after TAVI ≥ 30 mmHg, n = 396). The median follow-up duration was 1.8 years. The primary and secondary endpoints were the composite and each of cardiovascular (CV) death and heart failure hospitalization, respectively. Unadjusted Kaplan-Meier estimates with log-rank comparisons showed significantly higher cumulative incidences of primary and secondary endpoints in the Persistent PH group compared to other groups. Moreover, adjusted multivariate Cox-proportional hazard analyses showed that a decreased (−10 mmHg) TRPG after TAVI was linearly associated with a reduced risk of the primary endpoint (hazard ratio (HR): 0.76, 95% confidence interval (CI): 0.64−0.90, p = 0.0020). The findings in the present study indicate that the recovery of PH may partly contributes to the prognostic benefit of TAVI procedure in patients with AS and elevated pulmonary artery systolic pressure.
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Affiliation(s)
- Takuma Koike
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
- Correspondence: ; Tel.: +81-3-3813-3111
| | - Yuichi Chikata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Ryo Naito
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Hidetoshi Yasuda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Takehiro Funamizu
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Sakiko Miyazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Ryosuke Higuchi
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan
| | - Itaru Takamisawa
- Department of Cardiology, Sakakibara Heart Institute, Tokyo 183-0003, Japan
| | - Kei Sato
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie 514-8507, Japan
| | - Harutoshi Tamura
- Department of Cardiology, Pulmonology and Nephrology, Yamagata University School of Medicine, Yamagata 990-9585, Japan
| | - Hiroaki Yokoyama
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine, Aomori 036-8652, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Kawasaki Saiwai Hospital, Kanagawa 212-0014, Japan
| | - Shuichiro Takanashi
- Department of Cardiovascular Surgery, Kawasaki Saiwai Hospital, Kanagawa 212-0014, Japan
- Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo 183-0003, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo 113-8421, Japan
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Muacevic A, Adler JR, Jamil A, Csendes D, Gutlapalli SD, Prakash K, Swarnakari KM, Bai M, Manoharan MP, Raja R, Khan S. Outcomes of Preprocedural Pulmonary Hypertension on All-Cause and Cardiac Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review. Cureus 2023; 15:e34300. [PMID: 36860229 PMCID: PMC9969809 DOI: 10.7759/cureus.34300] [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: 11/27/2022] [Accepted: 01/27/2023] [Indexed: 01/30/2023] Open
Abstract
Patients with symptomatic aortic stenosis (AS) commonly have an associated finding of pulmonary hypertension (PH), and it has been previously shown to have increased morbidity and mortality following surgical aortic valve repair (SAVR) as well as transcatheter aortic valve implantation (TAVI). There are no guidelines stating the cut-off point for PH at which the patient can safely undergo TAVI with benefits outweighing the risks. This is partly due to the lack of uniformity in the PH definition used in various studies. This systematic review sought to study the effect of preprocedural pulmonary hypertension on early and late all-cause and cardiac mortality in patients undergoing TAVI. We performed a systematic review of studies comparing patients with AS undergoing TAVI having PH. The review was undertaken as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were identified from PubMed, Pubmed Central (PMC), Cochrane, and Medline on January 10, 2022, for literature published until January 10, 2022. MeSH strategy was used on PubMed to search the literature, and filters were applied to search only Observational Studies, randomized controlled trials (RCT), and meta-analysis. A total of 170 unique articles were identified and screened. Of the 33 full-text articles that were reviewed, 18 articles, including duplicates, were excluded. Fifteen articles fulfilled the selection criteria and were included in this review. The study design included two meta-analyses, one randomized control trial, one prospective cohort study, and 11 retrospective cohort studies. The studies involved a total of approximately 30,000 patients. The observational studies in our review were of good to fair quality, the RCT had a low to moderate bias, and the meta-analysis was of moderate quality. Baseline PH and persistence of PH post-TAVI are strongly associated with all-cause and cardiac mortality. Few studies have shown that a decrease in post-TAVI PH carries mortality benefits. Therefore, efforts should be made to identify mechanisms of persistent PH post-TAVI and whether interventions to reduce PH pre-TAVI will have any clinical implications or not by conducting RCT.
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12
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Jaiswal V, Khan N, Jaiswal A, Dagar M, Joshi A, Huang H, Naz H, Attia AM, Ghanim M, Baburaj A, Song D. Early surgery vs conservative management among asymptomatic aortic stenosis: A systematic review and meta-analysis. IJC HEART & VASCULATURE 2022; 43:101125. [PMID: 36176308 PMCID: PMC9513172 DOI: 10.1016/j.ijcha.2022.101125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/31/2022] [Accepted: 09/17/2022] [Indexed: 11/20/2022]
Abstract
Aortic valve replacement remains the definitive choice of treatment for AS. All-cause mortality and adverse events are lower with early surgical valve repair. In high-risk AS patients, early surgery is safer than conservative management. Early intervention is crucial to prevent irreversible damage of AS.
Introduction Although aortic valve replacement in severe symptomatic Aortic Stenosis (AS) are clearly outlined, the role of surgical intervention in asymptomatic severe AS remains unclear with limited evidence. The aim of our meta-analysis is to evaluate the efficacy and safety of early surgical aortic valve repair compared to conservative management. Methods A systematic literature search was performed in PubMed, Scopus, Embase and Cochrane databases for studies comparing the early surgery versus conservative management among asymptomatic aortic stenosis patients. Unadjusted odds ratios (OR) were pooled using a random-effect model, and a p-value of < 0.05 was considered statistically significant. Results A total of 5 articles (3 observational studies and 2 randomized controlled trials) were included. At a median followup of 4.1 years, here were significantly lower odds of all-cause mortality [OR = 0.30 (95 %CI:0.17–0.53), p < 0.0001], cardiovascular mortality [OR = 0.35 (95 %CI:(0.17–0.72), p = 0.005], and sudden cardiac death (OR = 0.36 (95 %CI: 0.15–0.89), p = 0.03) among early surgery group compared with conservative care. There was no significant difference between incidence of major bleeding, clinical thromboembolic events, hospitalization due to heart failure, stroke and myocardial infarction between the conservative care groups and early surgery. Conclusion Among asymptomatic patients with AS, early surgery shows better outcomes in reducing all-cause mortality and cardiovascular mortality compared with conservative management approaches.
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Affiliation(s)
- Vikash Jaiswal
- Department of Cardiovascular Research, Larkin Community Hospital, FL, USA
| | - Nida Khan
- Jinnah Sindh Medical University, Karachi, Pakistan
| | - Akash Jaiswal
- Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi, India
| | - Mehak Dagar
- Himalayan Institute of Medical Science, Dehradun, India
| | - Amey Joshi
- Department of Cardiovascular Research, Larkin Community Hospital, FL, USA
| | - Helen Huang
- University of Medicine and Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
- Corresponding author: University of Medicine and Health Science, Royal College of Surgeons in Ireland, 123 St, Stephen Green, Dublin D02 YN77, Ireland.
| | - Hira Naz
- Fatima Jinnah Medical University, Pakistan
| | | | | | - Abiram Baburaj
- Center for Public Health, Queen’s University Belfast, UK
| | - David Song
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai – Elmhurst Hospital Center, NY, USA
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Miyamoto J, Ohno Y, Kamioka N, Ikari Y, Otsuka T, Tada N, Naganuma T, Yamawaki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Impact of Periprocedural Pulmonary Hypertension on Outcomes After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2022; 80:1601-1613. [DOI: 10.1016/j.jacc.2022.08.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/02/2022] [Accepted: 08/10/2022] [Indexed: 11/05/2022]
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Iliuta L, Rac-Albu M, Rac-Albu ME, Andronesi A. Impact of Pulmonary Hypertension on Mortality after Surgery for Aortic Stenosis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:1231. [PMID: 36143909 PMCID: PMC9502966 DOI: 10.3390/medicina58091231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/26/2022] [Accepted: 08/31/2022] [Indexed: 11/23/2022]
Abstract
Background and Objectives: The prognosis of patients with aortic stenosis (AS) adding pulmonary hypertension (PHT) is worse than in those with normal pulmonary artery pressure (PAP), and there are few results reported for the association between PHT and adverse outcomes of AS. We aimed to determine the predictive factors for the development of PHT in patients with surgical AS and to identify those factors that may predict the surgical prognosis. We aimed to identify the independent predictors for PHT regression at 2 years after surgery. Additionally, we tried to evaluate the involvement of PHT as an additional perioperative risk factor in patients with AS undergoing surgical aortic valve replacement (AVR). Materials and Methods: We carried out a two-year prospective study on 340 patients with AS undergoing surgical AVR. Results: The independent predictors for the occurrence of PHT in patients with surgical AS were: age > 75 years (RR = 6, p = 0.001), a restrictive left ventricle diastolic filling pattern (LVDFP) (RR = 9, p = 0.001) and associated moderate mitral regurgitation (MR) (RR = 9, p = 0.0001). The presence of severe PHT increased by 7.6 times the early postoperative risk of death, regardless of the presence of other parameters. The independent predictors for early postoperative mortality were: severe PHT, restrictive left ventricle diastolic pattern, age > 75 years, interventricular septum (IVS) thickness >18 mm and the presence of comorbidities. Conclusions: The presence of a severe PHT in patients with AS undergoing surgical AVR is associated with an early postoperative increased mortality rate. The mean PAP is a more reliable parameter for prognosis appreciation than the LV systolic function.
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Affiliation(s)
- Luminita Iliuta
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
| | - Marius Rac-Albu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Cardioclass Clinic for Cardiovascular Disease, 031125 Bucharest, Romania
| | - Madalina-Elena Rac-Albu
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
| | - Andreea Andronesi
- Nephrology Department, University of Medicine and Pharmacy “Carol Davila”, 050474 Bucharest, Romania
- Nephrology Department, Fundeni Clinical Institute, 022328 Bucharest, Romania
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15
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Boxhammer E, Berezin AE, Paar V, Bacher N, Topf A, Pavlov S, Hoppe UC, Lichtenauer M. Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic Review of Non-Invasive Ways of Risk Stratification, Especially in Patients Undergoing Transcatheter Aortic Valve Replacement. J Pers Med 2022; 12:jpm12040603. [PMID: 35455719 PMCID: PMC9026430 DOI: 10.3390/jpm12040603] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 02/01/2023] Open
Abstract
Patients with severe aortic valve stenosis and concomitant pulmonary hypertension show a significantly reduced survival prognosis. Right heart catheterization as a preoperative diagnostic tool to determine pulmonary hypertension has been largely abandoned in recent years in favor of echocardiographic criteria. Clinically, determination of echocardiographically estimated systolic pulmonary artery pressure falls far short of invasive right heart catheterization data in terms of accuracy. The aim of the present systematic review was to highlight noninvasive possibilities for the detection of pulmonary hypertension in patients with severe aortic valve stenosis, with a special focus on cardiovascular biomarkers. A total of 525 publications regarding echocardiography, cardiovascular imaging and biomarkers related to severe aortic valve stenosis and pulmonary hypertension were analyzed in a systematic database analysis using PubMed Central®. Finally, 39 publications were included in the following review. It was shown that the current scientific data situation, especially regarding cardiovascular biomarkers as non-invasive diagnostic tools for the determination of pulmonary hypertension in severe aortic valve stenosis patients, is poor. Thus, there is a great scientific potential to combine different biomarkers (biomarker scores) in a non-invasive way to determine the presence or absence of PH.
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Affiliation(s)
- Elke Boxhammer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Alexander E. Berezin
- Internal Medicine Department, State Medical University of Zaporozhye, 69035 Zaporozhye, Ukraine;
| | - Vera Paar
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Nina Bacher
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Albert Topf
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Sergii Pavlov
- Department of Clinical Laboratory Diagnostics, State Medical University of Zaporozhye, 69035 Zaporozhye, Ukraine;
| | - Uta C. Hoppe
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
| | - Michael Lichtenauer
- Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria; (E.B.); (V.P.); (N.B.); (A.T.); (U.C.H.)
- Correspondence:
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Diaz-Rodriguez N, Nyhan SM, Kolb TM, Steppan J. How We Would Treat Our Own Pulmonary Hypertension if We Needed to Undergo Cardiac Surgery. J Cardiothorac Vasc Anesth 2021; 36:1540-1548. [PMID: 34649806 DOI: 10.1053/j.jvca.2021.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/13/2021] [Accepted: 09/19/2021] [Indexed: 01/08/2023]
Abstract
Pulmonary hypertension (PH) is a disease that has many etiologies and is particularly prevalent in patients presenting for cardiac surgery, with which it is linked to poor outcomes. This manuscript is intended to provide a comprehensive review of the impact of PH on the perioperative management of patients who are undergoing cardiac surgery. The diagnosis of PH often involves a combination of noninvasive and invasive testing, whereas preoperative optimization frequently necessitates the use of specific medications that affect anesthetic management of these patients. The authors postulate that a thoughtful, multidisciplinary approach is required to deliver excellent perioperative care. Furthermore, they use an index case to illustrate the implications of managing a patient with pulmonary hypertension who presents for cardiac surgery with cardiopulmonary bypass.
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Affiliation(s)
- Natalia Diaz-Rodriguez
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Sinead M Nyhan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Todd M Kolb
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Jochen Steppan
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
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17
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Zou T, Chen Q, Zhang L, Chen C, Ling Y, Liu G, Wang S, Pang Y, Xu Y, Cheng K, Zhou D, Zhu W, Ge J. Pulmonary artery pressure is associated with mid-term major adverse cardiovascular events and postprocedure pericardial effusion in atrial fibrillation patients undergoing left atrial appendage occlusion. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1324. [PMID: 34532461 PMCID: PMC8422141 DOI: 10.21037/atm-21-3561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/01/2021] [Indexed: 11/06/2022]
Abstract
Background Patients with nonvalvular atrial fibrillation (NVAF) undergoing left atrial appendage occlusion (LAAO) are at high risk of stroke or bleeding. However, risk factors for their adverse cardiovascular events remain largely unknown. Pulmonary hypertension has been shown to be related to poor prognosis in many heart diseases. In this study, we determined whether elevated pulmonary artery systolic pressure (PASP) is associated with postprocedure adverse events and major adverse cardiovascular events (MACE) in these patients. Methods From June 2017 and December 2019, 530 consecutive patients with NAVF at high risk of stroke or bleeding who undergone LAAO were retrospectively enrolled in our study. The preprocecure PASP was obtained by transthoracic echocardiography using the simplified Bernoulli's equation. Patients were followed-up through clinic visits or over the phone at discharge at 1-3 months, 6 months, and annually thereafter. The median follow-up time was 12 months, and clinical data were analyzed. MACE was defined as myocardial infarction, definite heart failure, stroke, or all-cause death. The outcome of postprocedure pericardial effusion included in-hospital pericardial effusion and pericardial effusion detected after discharge. Results Univariate analyses indicated that patients who had MACE tended to have elevated PASP (P=0.005). After dividing the cohort according to the cut-off value of PASP, Kaplan-Meier curves indicated that patients with PASP ≥39.5 mmHg had a higher risk of MACE (P=0.007) and heart failure hospitalization (P=0.005) compared to patients whose PASP <39.5 mmHg. Cox regression analysis showed that PASP was a predominant risk factor of MACE (HR =2.337, 95% CI, 1.207-4.526, P=0.012) and heart failure hospitalization (HR =3.701, 95% CI, 1.118-12.251, P=0.032). Furthermore, the PASP cut-off added incremental discriminatory capacity to the MACE risk model of this cohort. In addition, logistic regression showed that PASP had as a significant association with postprocedure pericardial effusion (OR =1.061, P=0.032). Conclusions Elevated PASP was associated with postprocedure pericardial effusion and mid-term MACEs in patients with atrial fibrillation (AF) undergoing LAAO.
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Affiliation(s)
- Tian Zou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Qingxing Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Lei Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Chaofeng Chen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Yunlong Ling
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Guijian Liu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Sunying Wang
- Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Yang Pang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Ye Xu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Kuan Cheng
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Wenqing Zhu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, China
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18
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Karacop HB, Karacop E. Improvement of Pulmonary Function in Heart Failure Patients with Restrictive Patterns Undergoing Transcatheter Aortic Valve Replacement. Int J Gen Med 2021; 14:5159-5165. [PMID: 34511998 PMCID: PMC8421250 DOI: 10.2147/ijgm.s309175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to investigate the improvement of pulmonary function in heart failure patients with restrictive patterns undergoing transcatheter aortic valve replacement (TAVR). Methods A total of 80 patients with heart failure and restrictive patterns undergoing TAVR due to severe aortic stenosis were included in this study. Spirometry and gas diffusion were assessed before and 4–6 months after TAVR. Pre- and post-TAVR measures were compared using paired t-tests. Results Spirometry demonstrated increased absolute and percentage predicted total lung capacity (TLC), forced vital capacity (FVC), residual volume (RV), forced expiratory volume in the first second (FEV1), and forced vital capacity (FVC). FEV1/FVC decreased due to a pronounced increase in FVC. Additionally, the diffusing capacity for carbon monoxide (DLCO) increased significantly. Conclusion Pulmonary function improves in heart failure patients with restrictive patterns undergoing TAVR.
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Affiliation(s)
- Handan Basel Karacop
- Bezmialem Foundation University, Faculty of Medicine, Department of Pulmonary Medicine, Istanbul, Turkey
| | - Erdem Karacop
- Bezmialem Foundation University, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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19
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Maffeis C, Benfari G, Nistri S, Ribichini FL, Rossi A. Clinical impact of mitral regurgitation in aortic valve stenosis: Insight from effective regurgitant orifice area. Echocardiography 2021; 38:1604-1611. [PMID: 34505313 DOI: 10.1111/echo.15184] [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: 03/21/2021] [Revised: 06/27/2021] [Accepted: 08/09/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Mechanisms leading to heart failure (HF) symptoms in aortic valve stenosis (AS) are contentious. We examined the impact of secondary mitral regurgitation (MR) on the symptomatic status in patients with AS. METHODS Outpatients performing echocardiography with any degree of AS, without organic mitral valve disease, mitral valve intervention, or aortic insufficiency were enrolled. MR was quantitatively defined through mitral effective regurgitant orifice area (EROA) using the proximal isovelocity surface area method. Patients were divided into two groups (New York Heart Association [NYHA] class I-II vs. NYHA class III-IV). RESULTS Five hundred and eighty-four patients were enrolled (484 NYHA I-II, 100 NYHA III-IV). More symptomatic patients had smaller aortic valve area (AVA), lower left ventricular ejection fraction (LVEF) and stroke volume, higher E/E', and LV global afterload. MR was present in 178 (30%) patients and EROA was <.20 cm2 in 158 (89%). NYHA III-IV patients showed higher prevalence of MR (78% vs 21%, P < 0.0001) and larger EROA (.13±.08 cm2 vs .09±.07 cm2 , P < 0.0001). An association between EROA and symptoms was present in the total cohort and in subgroups with preserved LVEF, AVA ≥ 1 and <1 cm2 , EE' 8-14 and ≥14 (P < 0.05 for all). EROA was associated with severe symptoms after adjustment for LVEF, E/E', and AVA in the overall population (OR 1.10 [1.06-1.15]; P < 0.0001) and in the 516 patients with preserved LVEF (OR 1.13 [1.08-1.19]; P < 0.0001). CONCLUSION In patients with AS, greater EROA values are associated with HF symptoms, even though MR degree is far from the threshold of MR severity. Therefore, even a mild MR represents a supportive marker of HF symptoms presence.
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Affiliation(s)
- Caterina Maffeis
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | - Stefano Nistri
- Cardiology Service, Centro Medico Strumentale Riabilitativo Veneto Medica, Altavilla Vicentina, Italy
| | - Flavio L Ribichini
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
| | - Andrea Rossi
- Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy
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Chaturvedi A, Baran TM, Ambrosini R, Krishnamoorthy V. Improving CT assessment for pulmonary hypertension in patients with severe aortic stenosis, correlation with right heart catheterization. Clin Imaging 2021; 77:122-129. [PMID: 33676129 DOI: 10.1016/j.clinimag.2021.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/27/2020] [Accepted: 01/28/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE To identify CT parameters useful for assessment of pulmonary hypertension (PH) in patients with severe aortic stenosis (AS). MATERIALS AND METHODS Retrospective study of 165 patients who had undergone right heart catheterization (RHC), and CTA of the thorax for preoperative aortic valve replacement (TAVR) planning. These were divided into groups based on mean pulmonary artery (PA) pressure (mPAP) of 25 mm Hg on RHC (85 cases and 80 controls). Diameters of main pulmonary artery diameter (MPAD), left pulmonary artery (LPA), right pulmonary artery (RPA), and maximal long axis and short axis diameters of the right atrium (RA) and ventricle (RV) were measured on the axial plane. Univariate and multivariate statistical analysis was utilized to identify metrics predictive of PH. RESULTS MPAD, LPA, and RPA were higher in subjects with mPAP >25 mm Hg (p < 0.0001 for all). Thresholds of 30.5 mm for MPAD (68.4% sensitivity, 82.7% specificity), and 27.5 mm for LPA and RPA (LPA: 51.9% sensitivity, 78.8% specificity; RPA: 62.0% sensitivity, 78.8% specificity) provided the best discrimination of elevated mPAP. Compared to literature values for MPAD (28.9 mm in men and 26.9 mm in women), these thresholds provide lower sensitivity but greatly increased specificity. Inclusion of RA enlargement to MPAD increased specificity to 98.5%, while inclusion of RV enlargement increased specificity to 100%. CONCLUSION Threshold to identify PH in patients with AS using PA enlargement is higher than previously reported range for normal. Inclusion of RA and RV enlargement improves the ability of CT to more accurately identify PH in patients with AS.
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Affiliation(s)
- Abhishek Chaturvedi
- Imaging Science, University of Rochester Medical Center, Rochester, NY, USA.
| | - Timothy M Baran
- Imaging Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Robert Ambrosini
- Imaging Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Vijay Krishnamoorthy
- Department of Medicine: Cardiology, University of Rochester Medical Center, Rochester, NY, USA
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21
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Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, Takanashi S, Tanaka H, Nakatani S, Ninami H, Nishi H, Hayashida K, Yaku H, Yamaguchi J, Yamamoto K, Watanabe H, Abe Y, Amaki M, Amano M, Obase K, Tabata M, Miura T, Miyake M, Murata M, Watanabe N, Akasaka T, Okita Y, Kimura T, Sawa Y, Yoshida K. JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease. Circ J 2020; 84:2037-2119. [DOI: 10.1253/circj.cj-20-0135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University Hospital
| | - Takeshi Arita
- Division of Cardiovascular Medicine Heart & Neuro-Vascular Center, Fukuoka Wajiro
| | - Yutaka Otsuji
- Department of Cardiology, Hospital of University of Occupational and Environmental Health
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, The University of Tokyo Hospital
| | | | | | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroshi Ninami
- Department of Cardiac Surgery, Tokyo Women’s Medical University
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kikuko Obase
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, Sakakibara Heart Institute of Okayama
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22
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Cid-Menéndez A, López-Otero D, González-Ferreiro R, Iglesias-Álvarez D, Álvarez-Rodríguez L, Antúnez-Muiños PJ, Cid-Álvarez B, Sanmartin-Pena X, Trillo-Nouche R, González-Juanatey JR. Predictores e impacto pronóstico de la insuficiencia cardiaca tras el implante percutáneo de válvula aórtica con una prótesis autoexpandible. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Cladellas M, Garcia-Ribas C, Ble M, Gómez M, Farré N, Mas-Stachurska A, Ivern C, Vila J, Martí-Almor J. Impact of Preoperative Measurement of Right Heart Chambers in the Evaluation of Pulmonary Hypertension Following Aortic Valve Replacement. Chest 2020; 157:1597-1605. [PMID: 31958443 DOI: 10.1016/j.chest.2019.12.017] [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: 05/17/2019] [Revised: 11/15/2019] [Accepted: 12/04/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Severe pulmonary hypertension (PH) in patients with aortic stenosis is related to poor prognosis following aortic valve replacement (AVR). Current European PH guidelines recommend adding two different echocardiographic signs to tricuspid regurgitation velocity (TRV) in PH estimation, classifying its probability as low (TRV ≤ 2.8 m/s), intermediate (TRV 2.9-3.4 m/s), and high (TRV > 3.4 m/s). The right ventricle is an important determinant of prognosis in PH. The goal of this study was to analyze the value of right atrial area > 18 cm2 and right ventricular/left ventricular ratio > 1 in the long-term prognosis following AVR, mainly in the intermediate probability group. METHODS This study included 429 consecutive patients (mean age, 73 ± 8 years; 55% male) with a median follow-up of 4.25 years (completed in 98%). Patients were divided into low (n = 247), intermediate (n = 117), and high probability groups (n = 65). The intermediate probability group was divided into two subgroups: subgroup 2a (n = 27; TRV nonmeasurable or ≤ 2.8 m/s and two signs present) and subgroup 2b (n = 90; TRV 2.9-3.4 m/s, and none or only one sign present). RESULTS Overall mortality rates during follow-up of the low, intermediate, and high probability groups were 24%, 32%, and 42%, respectively. High PH probability was an independent predictor of all-cause mortality (hazard ratio [HR], 1.82; 95% CI, 1.11-3.00), but the intermediate probability group did not reach significance following multivariate analysis (HR, 1.40; 95% CI, 0.91-2.16). When the intermediate probability group was divided into subgroups, the subgroup 2a mortality rate (56%) was higher than that of both subgroup 2b (24%; P = .002) and the low probability group (24%; P < .001). Following multivariate analysis, subgroup 2a showed a significantly higher mortality (HR, 2.13; 95% CI, 1.11-4.10) in contrast to subgroup 2b (HR, 1.24; 95% CI, 0.75-2.05), both compared with the low probability group. CONCLUSIONS Incorporating measurement of the right cavities into the PH probability model in the assessment of long-term prognosis following AVR allowed better risk discrimination, especially in the intermediate probability group.
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Affiliation(s)
- Mercè Cladellas
- Department of Cardiology, Hospital del Mar. Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona.
| | - Cora Garcia-Ribas
- Department of Cardiology, Hospital del Mar. Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona
| | - Mirea Ble
- Department of Cardiology, Hospital del Mar. Barcelona, Spain
| | - Miquel Gómez
- Department of Cardiology, Hospital del Mar. Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona
| | - Núria Farré
- Department of Cardiology, Hospital del Mar. Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona
| | | | - Consol Ivern
- Department of Cardiology, Hospital del Mar. Barcelona, Spain
| | - Joan Vila
- IMIM Hospital del Mar Medical Research Institute, Inflammatory and Cardiovascular Disorders, Barcelona; CIBER Epidemiology and Public Health
| | - Julio Martí-Almor
- Department of Cardiology, Hospital del Mar. Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona
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Subramanian H, Parida S, Thangaswamy CR, Badhe AS, Sai Chandran BV, Mishra SK. Relationship between transesophageal echocardiography-derived pulmonary artery systolic pressure measurements and early morbidity in patients undergoing coronary artery bypass grafting. Ann Card Anaesth 2020; 23:453-459. [PMID: 33109803 PMCID: PMC7879900 DOI: 10.4103/aca.aca_161_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Context: We studied the relationship between intraoperative transesophageal echocardiography-derived (TEE-derived) pulmonary artery systolic pressure (PASP) measurements with early morbidity in on-pump coronary artery bypass grafting (CABG) surgery. Aims: The objective of the study was to assess whether TEE-derived elevated PASP is independently predictive of significant morbidity. Settings and Design: Prospective observational study in a university hospital. Materials and Methods: Around 54 patients who underwent CABG under cardiopulmonary bypass (CPB) were divided into two groups; with PASP ≥35 mmHg and PASP <35 mmHg, assessed by intraoperative TEE. Outcomes studied were poor coronary revascularization, postoperative arrhythmias, myocardial infarction, respiratory failure, intra-aortic balloon pump use, pacemaker dependence, significant inotrope use, prolonged intensive care unit stay, and the total length of stay in the hospital. Mortality analysis was not a part of this study since expected sample sizes were low. Results: Patients with PASP ≥35 mmHg had a higher risk of respiratory failure, increased inotrope use and prolonged hospital stay, although multivariate analysis failed to demonstrate an independent association of PASP with these outcomes. Diabetes mellitus (DM), peripheral vascular disease, low cardiac output and elevated mitral annular E/e’ ratio were significantly associated with higher pulmonary arterial pressures. Multivariate analysis showed that PASP was independently associated with higher mitral annular E/e’ ratio. Conclusions: Our study, therefore, suggests that higher PASP may predict higher left ventricular filling pressures, and although elevated PASP ≥35 mmHg may be associated with DM; peripheral vascular disease, lower intraoperative cardiac output, postoperative respiratory failure, higher inotrope use, and delayed hospital discharge, it is not an independent predictor of any of these variables.
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Affiliation(s)
| | - Satyen Parida
- Department of Anesthesiology and Critical Care, JIPMER, Puducherry, India
| | | | | | - B V Sai Chandran
- Department of Cardiothoracic and Vascular Surgery, JIPMER, Puducherry, India
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25
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Omote K, Nagai T, Kamiya K, Aikawa T, Tsujinaga S, Kato Y, Komoriyama H, Iwano H, Yamamoto K, Yoshikawa T, Saito Y, Anzai T. Long-term Prognostic Significance of Admission Tricuspid Regurgitation Pressure Gradient in Hospitalized Patients With Heart Failure With Preserved Ejection Fraction: A Report From the Japanese Real-World Multicenter Registry. J Card Fail 2019; 25:978-985. [DOI: 10.1016/j.cardfail.2019.07.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/11/2019] [Accepted: 07/17/2019] [Indexed: 12/20/2022]
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Villanueva DLE, Agustin RD, Llanes EJ. Pre-Operative Sildenafil for Patients With Pulmonary Hypertension Undergoing Mitral Valve Surgery: A Systematic Review and Meta-Analysis. Cardiol Res 2019; 10:369-377. [PMID: 31803335 PMCID: PMC6879044 DOI: 10.14740/cr962] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
Background Pulmonary hypertension is a usual complication of long-standing mitral valve disease. Perioperative pulmonary hypertension is a risk factor for right ventricular failure and is an important cause of morbidity and mortality in patients with pulmonary hypertension undergoing mitral valve surgery. Phosphodiesterase-5 inhibitors particularly sildenafil citrate have proven clinical benefit for pulmonary arterial hypertension but have shown discordant results in group 2 pulmonary hypertension patients. We sought to determine the effect of pre-operative sildenafil on the intra-operative hemodynamic parameters of these patients. Methods Studies were included if they satisfied the following criteria: 1) Randomized controlled trials; 2) Adult patients with pulmonary hypertension scheduled for elective mitral valve surgery; and 3) Reported data on changes in pre-, intra-, and post-operative hemodynamic parameters. Using PUBMED, Clinical Key, Science Direct, and Cochrane databases, a search for eligible studies was conducted from September 1 to December 31, 2018. The quality of each study was evaluated using the Cochrane Risk of Bias Tool. The primary outcome of interest is on the effect of pre-operative sildenafil on the improvement of intra-operative hemodynamic parameters such as systolic pulmonary artery pressure (sPAP), mean pulmonary arterial pressure, mean arterial pressure, pulmonary and systemic vascular resistances. We also investigated its effect on the post-operative mortality, length of cardiopulmonary bypass time, ventilation time, and inotrope support requirement. Review Manager 5.3 was utilized to perform analysis of random effects for continuous outcomes. Results We identified three studies involving 153 patients with pulmonary hypertension undergoing mitral valve surgery, showing that among those who received pre-operative sildenafil there is a significant decrease in intra-operative systolic pulmonary arterial pressure (mean difference -11.19 (95% confidence interval (CI), -20.23 to -2.15), P < 0.05) and post-operative sPAP (mean difference -13.67 (95% CI, - 19.56 to - 7.78), P < 0.05) without significantly affecting the mean arterial pressure (mean difference 1.94 (95% CI, -5.49 to 9.37), P < 0.05). The systemic and pulmonary vascular resistances were not affected as well. Conclusions Administration of pre-operative sildenafil to patients with pulmonary hypertension undergoing mitral valve surgery decreases intra-operative and post-operative systolic pulmonary arterial pressure without significantly affecting other systemic hemodynamic parameters.
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Affiliation(s)
- Danielle Louis E Villanueva
- Division of Cardiovascular Medicine, University of the Philippines, Philippine General Hospital, Manila 1000, Philippines
| | - Ruth Divine Agustin
- Division of Cardiovascular Medicine, University of the Philippines, Philippine General Hospital, Manila 1000, Philippines
| | - Elmer Jasper Llanes
- Division of Cardiovascular Medicine, University of the Philippines, Philippine General Hospital, Manila 1000, Philippines
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27
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Rocha RV, Friedrich JO, Hong K, Lee J, Cheema A, Bagai A, Verma S, Yanagawa B. Aortic valve replacement with pulmonary hypertension: Meta-analysis of 70 676 patients. J Card Surg 2019; 34:1617-1625. [PMID: 31794128 DOI: 10.1111/jocs.14309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY We compared early and late outcomes of surgical aortic valve replacement (SAVR) in patients with aortic stenosis (AS) and pulmonary hypertension (PHT). METHODS We searched MEDLINE and EMBASE databases until July 2018 for studies comparing patients with AS and none, mild-moderate, or severe PHT undergoing SAVR. Random-effects meta-analysis was performed. RESULTS There were 12 observational studies with 70 676 patients with median follow-up 4.0 years (interquartile range, 2.6-4 years). Compared to patients with no PHT, patients with any PHT undergoing SAVR were older (mean difference [MD], 2.31 years; 95% confidence interval [CI], 1.38-3.23 years; P < .01), with greater comorbidities and reduced ejection fraction (MD, -4.36; 95%CI, -5.94 to -2.78; P < .01). Patients with any PHT had higher unadjusted (5.2% vs 2.4%; risk ratio [RR], 2.27; 95%CI, 2.04-2.53; P < .01) and adjusted (RR, 1.65; 95%CI, 1.28-2.14; P < .01) in-hospital mortality compared with no PHT. Severe (RR, 3.53; 95%CI, 1.46-8.54; P < .01) and mild-moderate PHT (RR, 2.13; 95%CI, 1.28-3.55; P < .01) were associated with higher unadjusted in-hospital mortality compared with no PHT. Any PHT was associated with a higher unadjusted risk of stroke (RR, 1.64; 95%CI, 1.42-1.90; P < .01), acute kidney injury (RR, 2.02; 95%CI, 1.50-2.72; P < .01), prolonged ventilation (RR, 1.62; 95%CI, 1.04-2.52; P = .03), and longer hospital stay (MD, 1.76 days; 95%CI, 0.57-2.95; P < .01). Severe (HR, 2.44; 95%CI, 1.60-3.72; P < .01) but not mild-moderate PHT (HR, 2.25; 95%CI, 0.91-5.59; P = .08) was associated with higher adjusted long-term mortality compared with no PHT. CONCLUSIONS Patients with severe AS and severe PHT had a significant increase in operative mortality and more than double the risk of long-term mortality following SAVR compared with patients with no PHT. Such patients may benefit from a less invasive transcatheter aortic valve intervention.
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Affiliation(s)
- Rodolfo V Rocha
- Divisions of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jan O Friedrich
- Critical Care and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Hong
- Divisions of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Lee
- Divisions of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Asim Cheema
- Cardiology St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Akshay Bagai
- Cardiology St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Divisions of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Bobby Yanagawa
- Divisions of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
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Pibarot P, Iung B, Cavalcante JL. Risk Stratification in Patients With Aortic Stenosis. JACC Cardiovasc Interv 2019; 12:2169-2172. [DOI: 10.1016/j.jcin.2019.08.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/20/2019] [Indexed: 01/06/2023]
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29
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Cid-Menéndez A, López-Otero D, González-Ferreiro R, Iglesias-Álvarez D, Álvarez-Rodríguez L, Antúnez-Muiños PJ, Cid-Álvarez B, Sanmartin-Pena X, Trillo-Nouche R, González-Juanatey JR. Predictors and outcomes of heart failure after transcatheter aortic valve implantation using a self-expanding prosthesis. ACTA ACUST UNITED AC 2019; 73:383-392. [PMID: 31501029 DOI: 10.1016/j.rec.2019.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES The purpose of this analysis was to assess the incidence, predictors and prognostic impact of acute heart failure (AHF) after transcatheter aortic valve implantation (TAVI) using a self-expanding prosthesis. METHODS From November 2008 to June 2017, all consecutive patients undergoing TAVI in our center were prospectively included in our TAVI registry. The predictive effect of AHF on all-cause mortality following the TAVI procedure was analyzed using Cox regression models. RESULTS A total of 399 patients underwent TAVI with a mean age of 82.4 ± 5.8 years, of which 213 (53.4%) were women. During follow-up (27.0 ± 24.1 months), 29.8% (n = 119) were admitted due to AHF, which represents a cumulative incidence function of 13.2% (95%CI, 11.1%-15.8%). At the end of follow-up, 150 patients (37.59%) had died. Those who developed AHF showed a significantly higher mortality rate (52.1% vs 31.4%; HR, 1.84; 95%; CI, 1.14-2.97; P = .012). Independent predictors of AHF after TAVI were a past history of heart failure (P = .019) and high Society of Thoracic Surgeons score (P = .004). We found that nutritional risk index and chronic obstructive pulmonary disease were strongly correlated with outcomes in the AHF group. CONCLUSIONS TAVI was associated with a high incidence of clinical AHF. Those who developed AHF had higher mortality. Pre-TAVI AHF and high Society of Thoracic Surgeons score were the only independent predictors of AHF in our cohort. A low nutritional risk index and chronic obstructive pulmonary disease were independent markers of mortality in the AHF group.
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Affiliation(s)
- Adrián Cid-Menéndez
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Diego López-Otero
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | | | - Diego Iglesias-Álvarez
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Leyre Álvarez-Rodríguez
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Pablo J Antúnez-Muiños
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Belén Cid-Álvarez
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Xoan Sanmartin-Pena
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain
| | - Ramiro Trillo-Nouche
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José R González-Juanatey
- Departamento de Cardiología, Complexo Hospitalario Universitario de Santiago, Instituto para el Desarrollo e Integración de la Salud (IDIS), Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Shirakawa K, Murata M. Significance of echocardiographic evaluation for transcatheter aortic valve implantation. Cardiovasc Interv Ther 2019; 35:85-95. [PMID: 31502235 DOI: 10.1007/s12928-019-00617-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is widely accepted as an alternative to surgical aortic valve replacement (SAVR) for the treatment of severe aortic stenosis (AS). Existing scientific evidence demonstrates that TAVI is superior to SAVR, and it is expected that indications for the clinical applications of TAVI will be expanded in the future. Echocardiography plays a key role in perioperative assessment of patients undergoing TAVI. Preprocedural echocardiographic evaluation is important to determine the severity of AS in addition to patients' anatomical suitability for TAVI. Furthermore, echocardiography is essential for intraoperative guidance, assessment of complications, postoperative evaluation, and prognostic prediction. Inaccurate echocardiographic measurements and evaluation can lead to less-than-optimal/inappropriate treatment strategies in patients with AS. Therefore, a thorough understanding of the limitations of echocardiographic evaluation is important. This review summarizes the role of echocardiographic evaluation in patients undergoing TAVI.
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Affiliation(s)
- Kohsuke Shirakawa
- Japan Society for the Promotion of Science, Tokyo, Japan.,Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mitsushige Murata
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan. .,School of Medicine, Center for Preventive Medicine, Keio University, Tokyo, Japan.
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Ranchoux B, Nadeau V, Bourgeois A, Provencher S, Tremblay É, Omura J, Coté N, Abu-Alhayja'a R, Dumais V, Nachbar RT, Tastet L, Dahou A, Breuils-Bonnet S, Marette A, Pibarot P, Dupuis J, Paulin R, Boucherat O, Archer SL, Bonnet S, Potus F. Metabolic Syndrome Exacerbates Pulmonary Hypertension due to Left Heart Disease. Circ Res 2019; 125:449-466. [PMID: 31154939 DOI: 10.1161/circresaha.118.314555] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
RATIONALE Pulmonary hypertension (PH) due to left heart disease (LHD), or group 2 PH, is the most prevalent form of PH worldwide. PH due to LHD is often associated with metabolic syndrome (MetS). In 12% to 13% of cases, patients with PH due to LHD display vascular remodeling of pulmonary arteries (PAs) associated with poor prognosis. Unfortunately, the underlying mechanisms remain unknown; PH-targeted therapies for this group are nonexistent, and the development of a new preclinical model is crucial. Among the numerous pathways dysregulated in MetS, inflammation plays also a critical role in both PH and vascular remodeling. OBJECTIVE We hypothesized that MetS and inflammation may trigger the development of vascular remodeling in group 2 PH. METHODS AND RESULTS Using supracoronary aortic banding, we induced diastolic dysfunction in rats. Then we induced MetS by a combination of high-fat diet and olanzapine treatment. We used metformin treatment and anti-IL-6 (interleukin-6) antibodies to inhibit the IL-6 pathway. Compared with sham conditions, only supracoronary aortic banding+MetS rats developed precapillary PH, as measured by both echocardiography and right/left heart catheterization. PH in supracoronary aortic banding+MetS was associated with macrophage accumulation and increased IL-6 production in lung. PH was also associated with STAT3 (signal transducer and activator of transcription 3) activation and increased proliferation of PA smooth muscle cells, which contributes to remodeling of distal PA. We reported macrophage accumulation, increased IL-6 levels, and STAT3 activation in the lung of group 2 PH patients. In vitro, IL-6 activates STAT3 and induces human PA smooth muscle cell proliferation. Metformin treatment decreased inflammation, IL-6 levels, STAT3 activation, and human PA smooth muscle cell proliferation. In vivo, in the supracoronary aortic banding+MetS animals, reducing IL-6, either by anti-IL-6 antibody or metformin treatment, reversed pulmonary vascular remodeling and improve PH due to LHD. CONCLUSIONS We developed a new preclinical model of group 2 PH by combining MetS with LHD. We showed that MetS exacerbates group 2 PH. We provided evidence for the importance of the IL-6-STAT3 pathway in our experimental model of group 2 PH and human patients.
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Affiliation(s)
- Benoît Ranchoux
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Valérie Nadeau
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Alice Bourgeois
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Steeve Provencher
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Éve Tremblay
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Junichi Omura
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Nancy Coté
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Rami Abu-Alhayja'a
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Valérie Dumais
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Québec City, Canada (V.D., R.T.N., A.M.)
| | - Renato T Nachbar
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Québec City, Canada (V.D., R.T.N., A.M.)
| | - Lionel Tastet
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Abdellaziz Dahou
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Sandra Breuils-Bonnet
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - André Marette
- Institut universitaire de cardiologie et de pneumologie de Québec Research Center, Laval University, Québec City, Canada (V.D., R.T.N., A.M.)
| | - Philippe Pibarot
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Jocelyn Dupuis
- Institut de cardiologie de Montréal, Québec, Canada (J.D.)
| | - Roxane Paulin
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Olivier Boucherat
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - Stephen L Archer
- Department of Medicine, Queen's University, Kingston, Ontario, Canada (S.L.A., F.P.)
| | - Sébastien Bonnet
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.)
| | - François Potus
- From the Pulmonary Hypertension Research Group of the Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec City, Canada (B.R., V.N., A.B., S.P., E.T., J.O., N.C., R.A-A., L.T., A.D., S.B.-B., P.P., R.P., O.B., S.B., F.P.).,Department of Medicine, Queen's University, Kingston, Ontario, Canada (S.L.A., F.P.)
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Averina II, Bockeria OL, Mironenko MY, Aleksandrova SA. [A. N. Bakoulev Scientific Center for Cardiovascular Surgery]. KARDIOLOGIYA 2019; 59:26-35. [PMID: 31131765 DOI: 10.18087/cardio.2019.5.10256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 05/25/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to assess dynamics of diastolic function for detection of development of diastolic dysfunction (DD) and it's causes, to evaluate the effect of DD on prognosis in the postoperative period in patients with acquired heart diseases. MATERIALS AND METHODS We included in this study 112 patients with aortic and mitral valve diseases (90 men, 22 women, median age 51 [35; 57] years). All patients underwent echocardiography (echo), tissue Doppler, speckle tracking echo prior to surgery, in the early postoperative period (8-14 days) and in 12-36 months after surgery. In 28 patients dynamic contrast-enhanced magnetic resonance imaging was also performed. Patients were divided into groups according to prognosis: group 0 - without complications; group 1 - with postoperative heart failure (HF) and preserved left ventricular ejection fraction (EF); group 2 - with HF and EF <45 %. The following parameters were used for identifying left ventricular (LV) DD: septal velocity es <7 cm / sec, lateral el <10 cm / sec, average E / e ratio >14, left atrial (LA) volume index >34 ml / m2, peak tricuspid regurgitation velocity >2.8 m / sec. RESULTS Initially diastolicLV function was normal in 34 of 112 patients (30.4 %), in early postoperative period DD emerged in 9 (26.5 %) of these patients. The appearance of LV DD was associated with decrease of septal es immediately after surgery and its subsequent progressive decline in the long-term postoperative period from 8.5±0.71 to 4.6 ±0.53 cm / sec (p=0.005). Worsening of diastolic function and lowering of septal velocity was detected namely in patients with presence of fibrosis. In the group of other patients in whom fibrosis was not studied and the degree of DD increased there was a transient decrease of lateral el (from 10.2±3.1 to 7.5±2.43 cm / sec, p=0.035) and an increase of the E / el (from 10.53±4.07 to 14.5±5.23, p=0.05) in the early period after the operation. There were no correlations between DD and LV EF,LV volumes, and development of arrhythmias. The prognostic model for DD included average longitudinal deformation of LA (global LA longitudinal strain) and E / e ratio on the tricuspid lateral annular velocity. CONCLUSIONS Appearance of DD in postoperative period after correction of acquired heart defects was due to damage of the septal diastolic function which correlated with fibrosis and was indicative of inadequate myocardial protection. The model of development of heart failure with normal EF after operation was designed.
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Affiliation(s)
- I I Averina
- A. N. Bakoulev Scientific Center for Cardiovascular Surgery
| | - O L Bockeria
- A. N. Bakoulev Scientific Center for Cardiovascular Surgery
| | - M Yu Mironenko
- A. N. Bakoulev Scientific Center for Cardiovascular Surgery
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Patel KK, Shah SY, Arrigain S, Jolly S, Schold JD, Navaneethan SD, Griffin BP, Nally JV, Desai MY. Characteristics and Outcomes of Patients With Aortic Stenosis and Chronic Kidney Disease. J Am Heart Assoc 2019; 8:e009980. [PMID: 30686093 PMCID: PMC6405577 DOI: 10.1161/jaha.118.009980] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 12/12/2018] [Indexed: 01/09/2023]
Abstract
Background We sought to study longer term survival in patients with aortic stenosis ( AS ) and nondialysis chronic kidney disease ( CKD ). Methods and Results We studied 839 patients (aged 78±9 years and 51% male) with CKD and AS on echocardiogram from 2005 to 2012. Longer term all-cause and cardiovascular mortality was compared with a CKD group without AS , propensity matched for age, sex, race, left ventricular ejection fraction and CKD stage. Cox models were used to evaluate all-cause mortality and competing-risks regression models censored at time of aortic valve replacement to evaluate cardiac mortality in patients with AS and CKD . Overall, 511 (61%), 252 (30%), and 76 (9%) patients had CKD stages 3a, 3b, and 4, respectively; 93% had hypertension, 28% had diabetes mellitus, and 37% had coronary artery disease. In total, 185 (22%) had mild AS, 355 (42%) had moderate AS, and 299 (36%) had severe AS (66 symptomatic). Patients with CKD and AS had higher cardiac and all-cause mortality compared with controls with CKD and no AS ( P<0.001). Among patients with AS and CKD , there were 156 (19%) aortic valve replacements and 454 (54%) deaths (203 cardiac deaths) at 4.0±2.3 years of follow-up. Lower estimated glomerular filtration rate (hazard ratio per 10 mL/min per 1.73 m2: 1.18; 95% CI, 1.08-1.29) was associated with increased risk of all-cause mortality but not cardiac mortality (hazard ratio: 1.12; 95% CI, 0.97-1.30; P=0.13). Of patients undergoing aortic valve replacement, 61% had improvement in estimated glomerular filtration rate within 1 year (median percentage change=+2.8% per month). Conclusions Among patients with nondialysis CKD , AS is associated with significantly higher cardiac and all-cause mortality; lower estimated glomerular filtration rate is associated with increased mortality, and aortic valve replacement was associated with improved survival.
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Affiliation(s)
- Krishna K. Patel
- Department of Internal MedicineCleveland ClinicClevelandOH
- Department of CardiologySaint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityKansas CityMO
| | | | - Susana Arrigain
- Department of Quantitative Health SciencesCleveland ClinicClevelandOH
| | - Stacey Jolly
- Department of Internal MedicineCleveland ClinicClevelandOH
| | - Jesse D. Schold
- Department of Quantitative Health SciencesCleveland ClinicClevelandOH
- Glickman Urology and Kidney InstituteCleveland ClinicClevelandOH
| | - Sankar D. Navaneethan
- Section of NephrologyDepartment of MedicineSelzman Institute for Kidney HealthBaylor College of MedicineHoustonTX
- Section of NephrologyMichael E. DeBakey Veterans Affairs Medical CenterHoustonTX
| | - Brian P. Griffin
- Department of Cardiovascular Medicine, Heart and Vascular InstituteCleveland ClinicClevelandOH
| | - Joseph V. Nally
- Glickman Urology and Kidney InstituteCleveland ClinicClevelandOH
| | - Milind Y. Desai
- Department of Cardiovascular Medicine, Heart and Vascular InstituteCleveland ClinicClevelandOH
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Mehra P, Mehta V, Sukhija R, Sinha AK, Gupta M, Girish M, Aronow WS. Pulmonary hypertension in left heart disease. Arch Med Sci 2019; 15:262-273. [PMID: 30697278 PMCID: PMC6348356 DOI: 10.5114/aoms.2017.68938] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/14/2016] [Indexed: 12/20/2022] Open
Affiliation(s)
- Pratishtha Mehra
- Department of Cardiology, Maulana Azad Medical College and G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Vimal Mehta
- Department of Cardiology, Maulana Azad Medical College and G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Rishi Sukhija
- Division of Cardiology, Indiana University La Porte Hospital, La Porte, Indiana, USA
| | - Anjan K. Sinha
- Division of Cardiology, Indiana University Health, Indianapolis, Indiana, USA
| | - Mohit Gupta
- Department of Cardiology, Maulana Azad Medical College and G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - M.P. Girish
- Department of Cardiology, Maulana Azad Medical College and G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Kokkinidis DG, Papanastasiou CA, Jonnalagadda AK, Oikonomou EK, Theochari CA, Palaiodimos L, Karvounis HI, Armstrong EJ, Faillace RT, Giannakoulas G. The predictive value of baseline pulmonary hypertension in early and long term cardiac and all-cause mortality after transcatheter aortic valve implantation for patients with severe aortic valve stenosis: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:859-867. [DOI: 10.1016/j.carrev.2018.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/17/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
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Hsu PC, Lee WH, Chu CY, Tsai WC, Lee HH, Lee CS, Yen HW, Lin TH, Voon WC, Lai WT, Sheu SH, Su HM. Tricuspid Regurgitation Pressure Gradient as a Useful Predictor of Adverse Cardiovascular Events and All-Cause Mortality in Patients With Atrial Fibrillation. Am J Med Sci 2018; 356:147-151. [PMID: 30219157 DOI: 10.1016/j.amjms.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tricuspid regurgitation pressure gradient (TRPG) is reportedly a predictor of cardiovascular (CV) mortality in patients without atrial fibrillation (AF); its relationship with cardiac outcomes in patients with AF has never been evaluated. This study aimed to examine the ability of TRPG to predict CV events and all-cause mortality in patients with AF. MATERIALS AND METHODS Comprehensive echocardiography was performed in 155 patients with persistent AF. Combined CV events were defined as CV mortality, stroke and hospitalization for heart failure. RESULTS During an average follow-up period of 27 months, 57 CV events and 31 all-cause deaths occurred. According to multivariate analysis, predictors of CV events included diuretic use, decreased left ventricular ejection fraction (LVEF), increased ratio of transmitral E velocity (E) to early diastolic mitral annular velocity (E') and TRPG. Predictors of all-cause mortality included old age, decreased LVEF, increased E/E' and TRPG. Notably, the addition of TRPG to a model containing clinical significant parameters, LVEF and E/E' significantly improved the values in predicting adverse CV events and all-cause mortality. CONCLUSIONS The TRPG is not only a useful predictor of adverse CV events and all-cause mortality in patients with AF, it may also provide additional prognostic values for CV outcome and all-cause mortality over conventional parameters in such patients.
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Affiliation(s)
- Po-Chao Hsu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Wen-Hsien Lee
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Chun-Yuan Chu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Wei-Chung Tsai
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Hung-Hao Lee
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Chee-Siong Lee
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Hsueh-Wei Yen
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Tsung-Hsien Lin
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Wen-Chol Voon
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Wen-Ter Lai
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Sheng-Hsiung Sheu
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China
| | - Ho-Ming Su
- Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, Republic of China.
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Filippetti L, Voilliot D, Bellino M, Citro R, Go YY, Lancellotti P. The Right Heart-Pulmonary Circulation Unit and Left Heart Valve Disease. Heart Fail Clin 2018; 14:431-442. [PMID: 29966640 DOI: 10.1016/j.hfc.2018.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Valvular heart disease (VHD) is frequently accompanied by pulmonary hypertension (PH). In asymptomatic patients, PH is rare, although the exact prevalence is unknown and mainly stems from the severity of the VHD and the presence of diastolic dysfunction. PH can also be depicted during exercise echocardiography. PH either at rest or during exercise is also a powerful determinant of outcome and is independently associated with reduced survival, regardless of the severity of the underlying valvular pathology. Therefore, because PH is a marker of poor prognosis, assessment of PH in VHD is crucial for risk stratification and management of patients with VHD.
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Affiliation(s)
- Laura Filippetti
- Department of Cardiology, University Hospital of Nancy, Lorrain Institute for Heart and Vessels, F-54500 Vandoeuvre-lès-Nancy, France
| | - Damien Voilliot
- Department of Cardiology, University Hospital of Nancy, Lorrain Institute for Heart and Vessels, F-54500 Vandoeuvre-lès-Nancy, France; IADI Laboratory (DIAGNOSIS AND INTERVENTIONAL ADAPTIVE IMAGING), INSERM U947, University of Lorraine, F-54500 Nancy, France
| | - Michele Bellino
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Largo Città di Ippocrate, 84131 Salerno, Italy
| | - Rodolfo Citro
- Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Largo Città di Ippocrate, 84131 Salerno, Italy
| | - Yun Yun Go
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, 16960 Singapore, Singapore; GIGA Cardiovascular Sciences, University Hospital Sart Tilman, 4000 Liège, Belgium
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, University Hospital Sart Tilman, 4000 Liège, Belgium; Heart Valve Clinic, Department of Cardiology, University Hospital Sart Tilman, 4000 Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, VIA C. ROSALBA, 35/37 70124 Bari, Italy.
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Mitral Effective Regurgitant Orifice Area Predicts Pulmonary Artery Pressure Level in Patients with Aortic Valve Stenosis. J Am Soc Echocardiogr 2018; 31:570-577.e1. [DOI: 10.1016/j.echo.2017.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Indexed: 11/22/2022]
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Testa L, Latib A, De Marco F, De Carlo M, Fiorina C, Montone R, Agnifili M, Barbanti M, Petronio AS, Biondi Zoccai G, Ettori F, Klugmann S, Tamburino C, Brambilla N, Colombo A, Bedogni F. Persistence of Severe Pulmonary Hypertension After Transcatheter Aortic Valve Replacement: Incidence and Prognostic Impact. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.115.003563. [PMID: 27301395 DOI: 10.1161/circinterventions.115.003563] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/29/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Severe pulmonary hypertension (PH) is considered to negatively affect the outcome after transcatheter aortic valve replacement. However, a clear understanding of the pattern, evolution, and clinical impact of different grades of PH in this setting is lacking. METHODS AND RESULTS A total of 990 consecutive patients were enrolled in 6 high-volume centers and analyzed as follows: group 1, systolic pulmonary artery pressure (sPAP) <40 mm Hg (346 patients; 35%); group 2, sPAP 40 to 60 mm Hg (426 patients; 43%); and group 3, sPAP >60 mm Hg (218 patients; 22%). At 1 month, mortality rate did not differ across the groups. When compared with groups 1 and 2, patients in group 3 had a higher-rate of New York Heart Association 3 to 4 (26% versus 12% and 10%), and a higher-rate of hospitalization for heart failure (7% versus 3% and 3%). At 1 year, when compared with patients in group 1, patients in group 2 and 3 had both a higher overall mortality (hazard ratio [HR], 1.5 [1.3-3.2]; P=0.01 and HR, 2.3 [1.8-2.8]; P=0.001) and a higher cardiac mortality (HR, 1.3 [1.1-2.1]; P=0.01 and HR, 1.7 [1.3-2.5]; P=0.002). After 1 month, the sPAP decreased ≥15 mm Hg in 32% and 35% of the patients in groups 2 and 3. Baseline sPAP >60 mm Hg (HR, 1.6 [1.1-2.3]; P=0.03) and, in a larger extent, a persistent severe PH after 1 month (HR, 2.4 [1.5-2.8]; P=0.004), independently predicted 1-year mortality, whereas the 1-month reduction of the sPAP did not. CONCLUSIONS The persistence of severe PH after transcatheter aortic valve replacement is a stronger predictor of 1-year mortality than baseline severe PH. The early reduction of sPAP is not associated with a reduced mortality. The benefit of transcatheter aortic valve replacement in terms of quality of life is substantial in patients with and without a reduction of sPAP at early follow-up.
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Affiliation(s)
- Luca Testa
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.).
| | - Azeem Latib
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Federico De Marco
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Marco De Carlo
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Claudia Fiorina
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Rocco Montone
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Mauro Agnifili
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Marco Barbanti
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Anna Sonia Petronio
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Giuseppe Biondi Zoccai
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Federica Ettori
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Silvio Klugmann
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Corrado Tamburino
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Nedy Brambilla
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Antonio Colombo
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
| | - Francesco Bedogni
- From the Department of Cardiology, IRCCS Pol San Donato, San Donato Milanese, Milan, Italy (L.T., R.M., M.A., N.B., F.B.); Interventional Cardiology Unit, Department of Cardiology, San Raffaele Hospital and EMO-GVM Centro Cuore Columbus, Milan, Italy (A.L., A.C.); Department of Cardiology, Niguarda Ca Granda Hospital, Milan, Italy (F.D.M., S.K.); Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.D.C., A.S.P.); Cardiothoracic Department, Spedali Civili, Brescia, Italy (C.F., F.E.); Department of Cardiology, Ferrarotto Hospital, Catania, Italy (M.B., C.T.); Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy (G.B.Z.); and Department of AngioCardioNeurology, IRCCS Neurome, Pozzilli, Italy (G.B.Z.)
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Gavra P, Laflamme M, Denault AY, Théoret Y, Perrault LP, Varin F. Use of nebulized milrinone in cardiac surgery; Comparison of vibrating mesh and simple jet nebulizers. Pulm Pharmacol Ther 2017; 46:20-29. [DOI: 10.1016/j.pupt.2017.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 06/30/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
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Hargrave J. Con: Preinduction Pulmonary Artery Catheter Placement Is Advisable in Patients With Right Ventricular Dysfunction Secondary to Severe Pulmonary Hypertension. J Cardiothorac Vasc Anesth 2017; 31:1514-1518. [DOI: 10.1053/j.jvca.2017.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Indexed: 12/26/2022]
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Left atrial dysfunction as a determinant of pulmonary hypertension in patients with severe aortic stenosis and preserved left ventricular ejection fraction. Int J Cardiovasc Imaging 2017; 33:1939-1947. [PMID: 28712069 DOI: 10.1007/s10554-017-1211-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 06/30/2017] [Indexed: 01/20/2023]
Abstract
In patients with severe aortic stenosis (AS), the presence of pulmonary hypertension (PH) has been linked to a poor prognosis. We aimed to assess the main determinants of PH in patients with severe AS and preserved left ventricular ejection fraction (LVEF). We prospectively enrolled 108 consecutive patients with isolated severe AS (indexed aortic valve area <0.6 cm2/m2) and LVEF >50%, in sinus rhythm. Left atrial (LA) function was assessed using longitudinal deformation parameters (by speckle tracking echocardiography). PH (defined as systolic pulmonary artery pressure >40 mmHg) was present in 20 patients. Patients with severe AS and PH were older (p = 0.05), had higher BNP values (p = 0.05) and a greater degree of LV diastolic dysfunction: higher E/e' and E/A ratios and lower EDT values (p < 0.03 for all) compared to patients without PH. There were no differences between groups regarding AS severity and LV systolic function parameters. Patients with PH had a more impaired LA function: lower septal and lateral late diastolic peak velocity a' (p < 0.001 and p = 0.04 respectively) and lower LA peak longitudinal strain and strain rate parameters (p ≤ 0.005 for all). In multivariable analysis, LA late diastolic longitudinal strain rate was the only independent correlate of PH in our patients (p = 0.04). Patients with isolated severe AS, preserved LVEF and PH had larger LA volumes, a more impaired LA function, and higher LV filling pressures compared to those without PH. LA booster pump function, reflected by late diastolic longitudinal strain rate, emerged as an independent correlate of PH in these patients.
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Levy F, Bohbot Y, Sanhadji K, Rusinaru D, Ringle A, Delpierre Q, Smaali S, Gun M, Marechaux S, Tribouilloy C. Impact of pulmonary hypertension on long-term outcome in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2017; 19:553-561. [DOI: 10.1093/ehjci/jex166] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Franck Levy
- Department of Cardiology, Centre Cardiothoracique de Monaco, 11 bis Avenue d'Ostende, Monaco 98000, Monaco
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Yohann Bohbot
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Khalil Sanhadji
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Dan Rusinaru
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
- INSERM U-1088, Jules Verne University of Picardie, 1 Chemin du Thil, Amiens 80000, France
| | - Anne Ringle
- Groupement des Hôpitaux de l'Institut Catholique de Lille / Faculté libre de médecine, Université Lille Nord de France, 115 Rue du Grand But, Lille 59160, France
| | - Quentin Delpierre
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Sondes Smaali
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Mesut Gun
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Sylvestre Marechaux
- INSERM U-1088, Jules Verne University of Picardie, 1 Chemin du Thil, Amiens 80000, France
- Groupement des Hôpitaux de l'Institut Catholique de Lille / Faculté libre de médecine, Université Lille Nord de France, 115 Rue du Grand But, Lille 59160, France
| | - Christophe Tribouilloy
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
- INSERM U-1088, Jules Verne University of Picardie, 1 Chemin du Thil, Amiens 80000, France
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Impact of Pulmonary Hypertension on Outcome in Patients with Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. Clin Res Cardiol 2017; 106:542-550. [DOI: 10.1007/s00392-017-1085-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/19/2017] [Indexed: 10/20/2022]
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Treatment of advanced group 2 PH. Prog Cardiovasc Dis 2016; 59:78-86. [PMID: 27417251 DOI: 10.1016/j.pcad.2016.07.002] [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: 07/07/2016] [Accepted: 07/07/2016] [Indexed: 11/22/2022]
Abstract
Pulmonary hypertension (PH) frequently occurs in patients with left heart disease (LHD), including heart failure with reduced and preserved ejection fraction and valvular heart disease. PH in patients with LHD is associated with worse outcomes making it an attractive target of therapy. Despite the strong rational for treatment, no clear benefits from treating with pulmonary arterial hypertension specific therapies in patients with PH from LHD have been found in clinical trials and some studies have demonstrated harm. Therefore, PH in the setting of LHD should be managed with optimal medical and surgical treatment of LHD and identification and treatment of comorbidities that could contribute to PH. Additionally, significant PH is a contraindication to heart transplantation and, in select patients with left heart failure, left ventricular unloading with prolonged inotrope infusion or left ventricular assist device implantation may successfully reduce pulmonary artery pressures and facilitate transplantation.
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Martinez C, Bernard A, Dulgheru R, Incarnato P, Oury C, Lancellotti P. Pulmonary Hypertension in Aortic Stenosis and Mitral Regurgitation: Rest and Exercise Echocardiography Significance. Prog Cardiovasc Dis 2016; 59:59-70. [PMID: 27389810 DOI: 10.1016/j.pcad.2016.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 01/21/2023]
Abstract
Valvular heart disease is a common cause of increased mean pulmonary artery pressure (PAP). Aortic stenosis and mitral regurgitation are frequently accompanied by pulmonary hypertension (PH), especially when they are severe and symptomatic. In asymptomatic patients, PH is rare, though the exact prevalence is unknown and mainly stems from the severity of the valvular heart disease and the presence of diastolic dysfunction. Exercise echocardiography has recently gained interest in depicting PH. In these asymptomatic patients, exercise PH is observed in about >40%. Either PH at rest (systolic PAP >50 mmHg) or during exercise (systolic PAP >60 mmHg) is a powerful determinant of outcome and is independently associated with reduced survival, regardless of the severity of the underlying valvular pathology.
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Affiliation(s)
- Christophe Martinez
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium
| | - Anne Bernard
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; University of Tours Hospital, Cardiology Department, Tours, France and University François Rabelais, Tours, France
| | - Raluca Dulgheru
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium
| | - Pierluigi Incarnato
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium
| | - Cécile Oury
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy.
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Fryearson J, Edwards NC, Doshi SN, Steeds RP. The role of TTE in assessment of the patient before and following TAVI for AS. Echo Res Pract 2016; 3:R19-34. [PMID: 27249549 PMCID: PMC4989100 DOI: 10.1530/erp-16-0004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/13/2016] [Indexed: 12/12/2022] Open
Abstract
Transcatheter aortic valve implantation is now accepted as a standard mode of treatment for an increasingly large population of patients with severe aortic stenosis. With the availability of this technique, echocardiographers need to be familiar with the imaging characteristics that can help to identify which patients are best suited to conventional surgery or transcatheter aortic valve implantation, and what parameters need to be measured. This review highlights the major features that should be assessed during transthoracic echocardiography before presentation of the patient to the 'Heart Team'. In addition, this review summarises the aspects to be considered on echocardiography during follow-up assessment after successful implantation of a transcatheter aortic valve.
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Affiliation(s)
- John Fryearson
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
| | - Nicola C Edwards
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
| | - Sagar N Doshi
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
| | - Richard P Steeds
- University Hospital Birmingham NHS Foundation Trust & Institute of Cardiovascular Science, University of Birmingham, Edgbaston, Birmingham
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O'Sullivan CJ, Wenaweser P, Ceylan O, Rat-Wirtzler J, Stortecky S, Heg D, Spitzer E, Zanchin T, Praz F, Tüller D, Huber C, Pilgrim T, Nietlispach F, Khattab AA, Carrel T, Meier B, Windecker S, Buellesfeld L. Effect of Pulmonary Hypertension Hemodynamic Presentation on Clinical Outcomes in Patients With Severe Symptomatic Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation: Insights From the New Proposed Pulmonary Hypertension Classification. Circ Cardiovasc Interv 2016; 8:e002358. [PMID: 26156149 DOI: 10.1161/circinterventions.114.002358] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary hypertension (PH) frequently coexists with severe aortic stenosis, and PH severity has been shown to predict outcomes after transcatheter aortic valve implantation (TAVI). The effect of PH hemodynamic presentation on clinical outcomes after TAVI is unknown. METHODS AND RESULTS Of 606 consecutive patients undergoing TAVI, 433 (71.4%) patients with severe aortic stenosis and a preprocedural right heart catheterization were assessed. Patients were dichotomized according to whether PH was present (mean pulmonary artery pressure, ≥25 mm Hg; n=325) or not (n=108). Patients with PH were further dichotomized by left ventricular end-diastolic pressure into postcapillary (left ventricular end-diastolic pressure, >15 mm Hg; n=269) and precapillary groups (left ventricular end-diastolic pressure, ≤15 mm Hg; n=56). Finally, patients with postcapillary PH were divided into isolated (n=220) and combined (n=49) subgroups according to whether the diastolic pressure difference (diastolic pulmonary artery pressure-left ventricular end-diastolic pressure) was normal (<7 mm Hg) or elevated (≥7 mm Hg). Primary end point was mortality at 1 year. PH was present in 325 of 433 (75%) patients and was predominantly postcapillary (n=269/325; 82%). Compared with baseline, systolic pulmonary artery pressure immediately improved after TAVI in patients with postcapillary combined (57.8±14.1 versus 50.4±17.3 mm Hg; P=0.015) but not in those with precapillary (49.0±12.6 versus 51.6±14.3; P=0.36). When compared with no PH, a higher 1-year mortality rate was observed in both precapillary (hazard ratio, 2.30; 95% confidence interval, 1.02-5.22; P=0.046) and combined (hazard ratio, 3.15; 95% confidence interval, 1.43-6.93; P=0.004) but not isolated PH patients (P=0.11). After adjustment, combined PH remained a strong predictor of 1-year mortality after TAVI (hazard ratio, 3.28; P=0.005). CONCLUSIONS Invasive stratification of PH according to hemodynamic presentation predicts acute response to treatment and 1-year mortality after TAVI.
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Affiliation(s)
- Crochan J O'Sullivan
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Peter Wenaweser
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Osman Ceylan
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Julie Rat-Wirtzler
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Stefan Stortecky
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Dik Heg
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Ernest Spitzer
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Thomas Zanchin
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Fabien Praz
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - David Tüller
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Christoph Huber
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Thomas Pilgrim
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Fabian Nietlispach
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Ahmed A Khattab
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Thierry Carrel
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Bernhard Meier
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Stephan Windecker
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.)
| | - Lutz Buellesfeld
- From the Department of Cardiology (C.J.O., P.W., O.C., S.S., E.S., T.Z., F.P., T.P., A.A.K., B.M., S.W., L.B.), Clinical Trials Unit (J.R.-W., D.H., S.W.), Institute of Social and Preventive Medicine (J.R.-W., D.H., S.W.), Department of Cardiovascular Surgery (C.H., T.C.), Bern University Hospital, Bern, Switzerland; Department of Cardiology, Stadtspital Triemli, Zürich, Switzerland (C.J.O., D.T.); and Department of Cardiology, University Heart Center, Zürich, Switzerland (F.N.).
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Cho IJ, Hong GR, Lee SH, Lee S, Chang BC, Shim CY, Chang HJ, Ha JW, Chung N. Prosthesis-Patient Mismatch after Mitral Valve Replacement: Comparison of Different Methods of Effective Orifice Area Calculation. Yonsei Med J 2016; 57:328-36. [PMID: 26847283 PMCID: PMC4740523 DOI: 10.3349/ymj.2016.57.2.328] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 05/13/2015] [Accepted: 06/19/2015] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The incidence of prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) has been reported to vary. The purpose of the current study was to investigate incidence of PPM according to the different methods of calculating effective orifice area (EOA), including the continuity equation (CE), pressure half time (PHT) method and use of reference EOA, and to compare these with various echocardiographic variables. MATERIALS AND METHODS We retrospectively reviewed 166 individuals who received isolated MVR due to rheumatic mitral stenosis and had postoperative echocardiography performed between 12 and 60 months after MVR. EOA was determined by CE (EOA(CE)) and PHT using Doppler echocardiography. Reference EOA was determined from the literature or values offered by the manufacturer. Indexed EOA was used to define PPM as present if ≤1.2 cm²/m². RESULTS Prevalence of PPM was different depending on the methods used to calculate EOA, ranging from 7% in PHT method to 49% in referred EOA method to 62% in CE methods. The intraclass correlation coefficient was low between the methods. PPM was associated with raised trans-prosthetic pressure, only when calculated by CE (p=0.021). Indexed EOA(CE) was the only predictor of postoperative systolic pulmonary artery (PA) pressure, even after adjusting for age, preoperative systolic PA pressure and postoperative left atrial volume index (p<0.001). CONCLUSION Prevalence of mitral PPM varied according to the methods used to calculate EOA in patients with mitral stenosis after MVR. Among the various methods used to define PPM, EOA(CE) was the only predictor of postoperative hemodynamic parameters.
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Affiliation(s)
- In Jeong Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geu Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Seung Hyun Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sak Lee
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Chul Chang
- Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Namsik Chung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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50
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Ong KC, Geske JB, Hebl VB, Nishimura RA, Schaff HV, Ackerman MJ, Klarich KW, Siontis KC, Coutinho T, Dearani JA, Ommen SR, Gersh BJ. Pulmonary hypertension is associated with worse survival in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2016; 17:604-10. [DOI: 10.1093/ehjci/jew024] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Accepted: 01/18/2016] [Indexed: 01/09/2023] Open
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