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Sousa Nunes F, Amaral Marques C, Isabel Pinho A, Sousa-Pinto B, Beco A, Ricardo Silva J, Saraiva F, Macedo F, Leite-Moreira A, Sousa C. Reverse left ventricular remodeling after aortic valve replacement for aortic stenosis: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1407566. [PMID: 39027003 PMCID: PMC11254856 DOI: 10.3389/fcvm.2024.1407566] [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: 03/26/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
Reverse left ventricular (LV) remodeling after aortic valve replacement (AVR), in patients with aortic stenosis, is well-documented as an important prognostic factor. With this systematic review and meta-analysis, we aimed to characterize the response of the unloaded LV after AVR. We searched on MEDLINE/PubMed and Web of Science for studies reporting echocardiographic findings before and at least 1 month after AVR for the treatment of aortic stenosis. In total, 1,836 studies were identified and 1,098 were screened for inclusion. The main factors of interest were structural and dynamic measures of the LV and aortic valve. We performed a random-effects meta-analysis to compute standardized mean differences (SMD) between follow-up and baseline values for each outcome. Twenty-seven studies met the eligibility criteria, yielding 11,751 patients. AVR resulted in reduced mean aortic gradient (SMD: - 38.23 mmHg, 95% CI: - 39.88 to - 36.58 , I 2 = 92 % ), LV mass (SMD: - 37.24 g, 95% CI: - 49.31 to - 25.18 , I 2 = 96 % ), end-diastolic LV diameter (SMD: - 1.78 mm, 95% CI: - 2.80 to - 0.76 , I 2 = 96 % ), end-diastolic LV volume (SMD: - 1.6 ml, 95% CI: - 6.68 to 3.51, I 2 = 91 % ), increased effective aortic valve area (SMD: 1.10 cm2, 95% CI: 1.01 to 1.20, I 2 = 98 % ), and LV ejection fraction (SMD: 2.35%, 95% CI: 1.31 to 3.40%, I 2 = 94.1 % ). Our results characterize the extent to which reverse remodeling is expected to occur after AVR. Notably, in our study, reverse remodeling was documented as soon as 1 month after AVR.
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Affiliation(s)
- F. Sousa Nunes
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiology, Local Health Unit of Gaia and Espinho, Vila Nova de Gaia, Portugal
| | - C. Amaral Marques
- Department of Cardiology, Local Health Unit of Sao Joao, Porto, Portugal
| | - A. Isabel Pinho
- Department of Cardiology, Local Health Unit of Sao Joao, Porto, Portugal
| | - B. Sousa-Pinto
- MEDCIDS—Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS@RISE—Health Research Network, MEDCIDS, Faculty of Medicine, University of Porto, Porto, Portugal
| | - A. Beco
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - J. Ricardo Silva
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - F. Saraiva
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - F. Macedo
- Department of Cardiology, Local Health Unit of Sao Joao, Porto, Portugal
| | - A. Leite-Moreira
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiology, Local Health Unit of Sao Joao, Porto, Portugal
| | - C. Sousa
- Cardiovascular R&D Centre—UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Cardiology, Local Health Unit of Sao Joao, Porto, Portugal
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Falcão-Pires I, Ferreira AF, Trindade F, Bertrand L, Ciccarelli M, Visco V, Dawson D, Hamdani N, Van Laake LW, Lezoualc'h F, Linke WA, Lunde IG, Rainer PP, Abdellatif M, Van der Velden J, Cosentino N, Paldino A, Pompilio G, Zacchigna S, Heymans S, Thum T, Tocchetti CG. Mechanisms of myocardial reverse remodelling and its clinical significance: A scientific statement of the ESC Working Group on Myocardial Function. Eur J Heart Fail 2024; 26:1454-1479. [PMID: 38837573 DOI: 10.1002/ejhf.3264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/22/2024] [Accepted: 04/18/2024] [Indexed: 06/07/2024] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of morbimortality in Europe and worldwide. CVD imposes a heterogeneous spectrum of cardiac remodelling, depending on the insult nature, that is, pressure or volume overload, ischaemia, arrhythmias, infection, pathogenic gene variant, or cardiotoxicity. Moreover, the progression of CVD-induced remodelling is influenced by sex, age, genetic background and comorbidities, impacting patients' outcomes and prognosis. Cardiac reverse remodelling (RR) is defined as any normative improvement in cardiac geometry and function, driven by therapeutic interventions and rarely occurring spontaneously. While RR is the outcome desired for most CVD treatments, they often only slow/halt its progression or modify risk factors, calling for novel and more timely RR approaches. Interventions triggering RR depend on the myocardial insult and include drugs (renin-angiotensin-aldosterone system inhibitors, beta-blockers, diuretics and sodium-glucose cotransporter 2 inhibitors), devices (cardiac resynchronization therapy, ventricular assist devices), surgeries (valve replacement, coronary artery bypass graft), or physiological responses (deconditioning, postpartum). Subsequently, cardiac RR is inferred from the degree of normalization of left ventricular mass, ejection fraction and end-diastolic/end-systolic volumes, whose extent often correlates with patients' prognosis. However, strategies aimed at achieving sustained cardiac improvement, predictive models assessing the extent of RR, or even clinical endpoints that allow for distinguishing complete from incomplete RR or adverse remodelling objectively, remain limited and controversial. This scientific statement aims to define RR, clarify its underlying (patho)physiologic mechanisms and address (non)pharmacological options and promising strategies to promote RR, focusing on the left heart. We highlight the predictors of the extent of RR and review the prognostic significance/impact of incomplete RR/adverse remodelling. Lastly, we present an overview of RR animal models and potential future strategies under pre-clinical evaluation.
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Affiliation(s)
- Inês Falcão-Pires
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Ana Filipa Ferreira
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Fábio Trindade
- UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Luc Bertrand
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Pôle of Cardiovascular Research, Brussels, Belgium
- WELBIO, Department, WEL Research Institute, Wavre, Belgium
| | - Michele Ciccarelli
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Valeria Visco
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | - Nazha Hamdani
- Department of Cellular and Translational Physiology, Institute of Physiology, Ruhr University Bochum, Bochum, Germany
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, Bochum, Germany
- HCEMM-SU Cardiovascular Comorbidities Research Group, Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Department of Physiology, Cardiovascular Research Institute Maastricht University Maastricht, Maastricht, the Netherlands
| | - Linda W Van Laake
- Division Heart and Lungs, Department of Cardiology and Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank Lezoualc'h
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm, Université Paul Sabatier, UMR 1297-I2MC, Toulouse, France
| | - Wolfgang A Linke
- Institute of Physiology II, University Hospital Münster, Münster, Germany
| | - Ida G Lunde
- Oslo Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway
- KG Jebsen Center for Cardiac Biomarkers, Campus Ahus, University of Oslo, Oslo, Norway
| | - Peter P Rainer
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
- St. Johann in Tirol General Hospital, St. Johann in Tirol, Austria
| | - Mahmoud Abdellatif
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- BioTechMed Graz, Graz, Austria
| | | | - Nicola Cosentino
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Alessia Paldino
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Giulio Pompilio
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Serena Zacchigna
- Cardiovascular Biology Laboratory, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Stephane Heymans
- Department of Cardiology, CARIM Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
- Centre of Cardiovascular Research, University of Leuven, Leuven, Belgium
| | - Thomas Thum
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy
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Reis Santos R, Abecasis J, Maltês S, Lopes P, Oliveira L, Freitas P, Ferreira A, Ribeiras R, Andrade MJ, Sousa Uva M, Neves JP, Gil V, Cardim N. Cardiac magnetic resonance patterns of left ventricular remodeling in patients with severe aortic stenosis referred to surgical aortic valve replacement. Sci Rep 2024; 14:7085. [PMID: 38528043 DOI: 10.1038/s41598-024-56838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
Left ventricular (LV) hypertrophy is a common finding in patients with severe aortic stenosis (AS). Cardiac magnetic resonance (CMR) is the gold-standard technique to evaluate LV remodeling. Our aim was to assess the prevalence and describe the patterns of LV adaptation in AS patients before and after surgical aortic valve replacement (AVR). Prospective study of 130 consecutive patients (71y [IQR 68-77y], 48% men) with severe AS, referred for surgical AVR. Patterns of LV remodeling were assessed by CMR. Besides normal LV ventricular structure, four other patterns were considered: concentric remodeling, concentric hypertrophy, eccentric hypertrophy, and adverse remodeling. At baseline CMR study: mean LV indexed mass: 81.8 ± 26.7 g/m2; mean end-diastolic LV indexed volume: 85.7 ± 23.1 mL/m2 and median geometric remodeling ratio: 0.96 g/mL [IQR 0.82-1.08 g/mL]. LV hypertrophy occurred in 49% of subjects (concentric 44%; eccentric 5%). Both normal LV structure and concentric remodeling had a prevalence of 25% among the cohort; one patient had an adverse remodeling pattern. Asymmetric LV wall thickening was present in 55% of the patients, with predominant septal involvement. AVR was performed in 119 patients. At 3-6 months after AVR, LV remodeling changed to: normal ventricular geometry in 60%, concentric remodeling in 27%, concentric hypertrophy in 10%, eccentric hypertrophy in 3% and adverse remodeling (one patient). Indexes of AS severity, LV systolic and diastolic function and NT-proBNP were significantly different among the distinct patterns of remodeling. Several distinct patterns of LV remodelling beyond concentric hypertrophy occur in patients with classical severe AS. Asymmetric hypertrophy is a common finding and LV response after AVR is diverse.
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Affiliation(s)
- Rita Reis Santos
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal.
| | - João Abecasis
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
- NOVA Medical School, Faculdade de Ciências da Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sérgio Maltês
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - Pedro Lopes
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - Luís Oliveira
- Cardiology Department, Hospital Divino Espírito Santo, Açores, Portugal
| | - Pedro Freitas
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - António Ferreira
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - Regina Ribeiras
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - Maria João Andrade
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Av. Prof. Dr. Reinaldo Dos Santos, 2790-134, Lisbon, Portugal
| | - Miguel Sousa Uva
- Cardiac Surgery Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - José Pedro Neves
- Cardiac Surgery Department, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal
| | - Victor Gil
- Cardiology Department, Hospital da Luz, Lisbon, Portugal
| | - Nuno Cardim
- NOVA Medical School, Faculdade de Ciências da Universidade Nova de Lisboa, Lisbon, Portugal
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Balčiūnaitė G, Rudinskaitė I, Palionis D, Besusparis J, Žurauskas E, Janušauskas V, Zorinas A, Valevičienė N, Ručinskas K, Sogaard P, Glaveckaitė S. Electrocardiographic Markers of Adverse Left Ventricular Remodeling and Myocardial Fibrosis in Severe Aortic Stenosis. J Clin Med 2023; 12:5588. [PMID: 37685655 PMCID: PMC10488170 DOI: 10.3390/jcm12175588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/22/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
The optimal timing for aortic valve replacement (AVR) in aortic stenosis (AS) is still controversial and may be guided by markers of adverse left ventricular (LV) remodeling. We aim to assess electrocardiographic (ECG) strain in relation to LV remodeling and myocardial fibrosis. 83 severe AS patients underwent surgical AVR, with preoperative 12-lead ECG, cardiovascular magnetic resonance with T1 mapping and echocardiography with global longitudinal strain analysis. Collagen volume fraction (CVF) was measured in myocardial biopsies sampled during AVR. Patients with ECG strain had more severe AS, more advanced LV remodeling and evidence of heart failure. Patients with ECG strain had more diffuse fibrosis, as evident by higher mean native T1 values (974.8 ± 34 ms vs. 946.5 ± 28 ms, p < 0.001). ECG strain was the only predictor of increased LV mass index on multivariate regression analysis (OR = 7.10, 95% CI 1.46-34.48, p = 0.02). Patients with persistent ECG strain at 1 year following AVR had more advanced LV remodeling and more histological fibrosis (CVF 12.5% vs. 7.3%, p = 0.009) at baseline assessment. Therefore, ECG strain is a marker of adverse LV remodeling and interstitial myocardial fibrosis. Lack of improvement in ECG strain following AVR indicates more advanced baseline LV injury and higher levels of myocardial fibrosis.
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Affiliation(s)
- Giedrė Balčiūnaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
| | - Ieva Rudinskaitė
- Faculty of Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | - Darius Palionis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (D.P.); (N.V.)
| | - Justinas Besusparis
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-08406 Vilnius, Lithuania; (J.B.)
| | - Edvardas Žurauskas
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-08406 Vilnius, Lithuania; (J.B.)
| | - Vilius Janušauskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
| | - Aleksejus Zorinas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
| | - Nomeda Valevičienė
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (D.P.); (N.V.)
| | - Kęstutis Ručinskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
| | - Peter Sogaard
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
- Clinical Institute of Aalborg University, Aalborg University Hospital, Hobrovej 18-22, 9100 Aalborg, Denmark
| | - Sigita Glaveckaitė
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-08661 Vilnius, Lithuania; (V.J.); (A.Z.); (K.R.); (S.G.)
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Yousef S, Amabile A, Ram C, Singh S, Agarwal R, Milewski R, Assi R, Patel PA, Krane M, Geirsson A, Vallabhajosyula P. Direct relationship between transvalvular velocity and cardiac dysfunction, morbidity, and mortality in patients with aortic stenosis. J Card Surg 2022; 37:5052-5062. [PMID: 36378856 DOI: 10.1111/jocs.17199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Current guidelines recommend intervention in subjects with severe symptomatic aortic stenosis (AS), even though any degree of AS is associated with a higher risk of mortality. We investigated the association between the degree of AS, delineated by transvalvular flow velocity, and patient morbidity and mortality. METHODS Medically managed patients aged 40-95 years with maximum flow velocity (Vmax ) by echocardiography between 2013 and 2018 were stratified into five groups (A-E) based on the 75th, 90th, 97.5th, and the 99th percentiles of Vmax distribution. Patient characteristics, cardiac structural changes, and end-organ disease were compared using Kruskal-Wallis and Cochran-Armitage tests. Mortality over a median of 2.8 (1.52-4.8) years was compared using Kaplan-Meier curves and risk estimates were derived from the Cox model. RESULTS The Vmax was reported in 37,131 patients. There was a steady increase (from Group A towards E) in age, Caucasian race, structural cardiac changes, end-organ morbidities, and all-cause mortality. In reference to Group A, there as an increased risk of mortality in Groups B (hazard ratio [HR] = 1.3; confidence interval [CI]: 1.2-1.35; p < .0001), C (HR = 1.5; CI: 1.4-1.6; p < .0001), and D (HR = 1.8; CI: 1.6-2; p < .0001), with an exponential increase in Group E (HR = 2.5; CI: 2.2-2.8; p < .0001). CONCLUSIONS A direct, strong correlation exists between the degree of AS and cardiac structural changes and mortality. Patients with Vmax ≥ 97.5th percentile (≥3.2 m/s) might benefit from early intervention.
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Affiliation(s)
- Sameh Yousef
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrea Amabile
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Chirag Ram
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Saket Singh
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ritu Agarwal
- Joint Data Analytics Team, Information Technology Service, Yale University, New Haven, Connecticut, USA
| | - Rita Milewski
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Roland Assi
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Prakash A Patel
- Division of Cardiac Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Markus Krane
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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Pankayatselvan V, Raber I, Playford D, Stewart S, Strange G, Strom JB. Moderate aortic stenosis: culprit or bystander? Open Heart 2022; 9:openhrt-2021-001743. [PMID: 35074936 PMCID: PMC8788328 DOI: 10.1136/openhrt-2021-001743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Non-rheumatic aortic stenosis (AS) is among the most common valvular diseases in the developed world. Current guidelines support aortic valve replacement (AVR) for severe symptomatic AS, which carries high morbidity and mortality when left untreated. In contrast, moderate AS has historically been thought to be a benign diagnosis for which the potential benefits of AVR are outweighed by the procedural risks. However, emerging data demonstrating the substantial mortality risk in untreated moderate AS and substantial improvements in periprocedural and perioperative mortality with AVR have challenged the traditional risk/benefit paradigm. As such, an appraisal of the contemporary data on morbidity and mortality associated with moderate AS and appropriate timing of valvular intervention in AS is warranted. In this review, we discuss the current understanding of moderate AS, including the epidemiology, current surveillance and management guidelines, clinical outcomes, and future studies.
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Affiliation(s)
- Varayini Pankayatselvan
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Inbar Raber
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Playford
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Simon Stewart
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia.,Torrens University Australia, Adelaide, South Australia, Australia
| | - Geoff Strange
- Torrens University Australia, Adelaide, South Australia, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Heart Research Institute, Sydney, New South Wales, Australia
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA .,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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7
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Left ventricular reverse remodeling and function by strain analysis in aortic stenosis: A CMR analysis of the EPICHEART study. Rev Port Cardiol 2021; 40:153-164. [PMID: 33676777 DOI: 10.1016/j.repc.2020.06.020] [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: 01/17/2020] [Revised: 04/16/2020] [Accepted: 06/11/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES In severe aortic stenosis (AS), the impact of aortic valve replacement (AVR) on left ventricular (LV) systolic function assessed by strain and measured by echocardiography or cardiac magnetic resonance (CMR) has been controversial. We aimed to investigate LV systolic myocardial function changes six months after AVR using global longitudinal (GLS), circumferential (GCS) and radial (GRS) strain derived from CMR imaging. METHODS We included 39 severe AS patients (69.3±7.8 years; 61.5% male) with preserved LV ejection fraction (LVEF) who were recruited as part of the EPICHEART study and underwent successful AVR (aortic valvular area: 0.8 cm2 (IQR: 0.2) pre- to 1.8 cm2 (IQR:0.5) post-AVR). Structural and functional parameters were assessed at baseline and six months after AVR, including LV GRS, GCS and GLS analysis by CMR, using cine short-axial and two-, three-, and four-chamber long-axial view. Comparison between baseline and postoperative LV remodeling was performed using Student t-test and Wilcoxon test. RESULTS At six-month follow-up, LV mass, end-diastolic and end-systolic volumes, stroke volume, cardiac output, lateral E/e', tricuspid annular plane systolic excursion, right ventricular (RV) S wave velocity, GLS [-15.6% (IQR: 4.39) to -13.7% (IQR: 4.62)] and GCS [-17.8±3.58% to -16.1±2.94%] reduced significantly, while LVEF and GRS remained unchanged and lateral e' velocity increased. CONCLUSIONS Despite favorable reverse LV structural and diastolic functional remodeling six months following AVR, GLS and GCS assessed by CMR reduced compared to baseline, LVEF remained unchanged. The clinical utility and timing of assessment of postoperative strain changes as a marker of systolic function progression needs further research.
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8
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Azevedo D, Mancio J, Pessoa-Amorim G, Monteiro D, Almeida N, Ladeiras-Lopes R, Faria R, Ferreira N, Vouga L, Gama Ribeiro V, Leite-Moreira A, Bettencourt N. Left ventricular reverse remodeling and function by strain analysis in aortic stenosis: A CMR analysis of the EPICHEART study. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.repce.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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Haji K, Marwick TH. Clinical Utility of Echocardiographic Strain and Strain Rate Measurements. Curr Cardiol Rep 2021; 23:18. [PMID: 33594493 DOI: 10.1007/s11886-021-01444-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW Assessment of left ventricular function is pivotal in many decisions, but ejection fraction has fundamental limitations for assessment of mild dysfunction, and especially for repeated assessments. Myocardial deformation imaging using speckle-tracking is widely available on modern echocardiography systems, and is now feasible as a clinical, rather than purely a research tool. Strain can be measured in all cardiac chambers, most commonly as a systolic parameter, although it can be measured in diastole. Generally, speckle tracking is more effective at measuring strain than strain-rate, which requires a higher temporal resolution. The purpose of this review is to help clinicians understand the main situations where strain provides incremental value to standard echocardiographic measurements. RECENT FINDINGS The normal range of LV global longitudinal strain (GLS) has now been defined as -18% and lower (ie more negative), abnormal as -16% or higher (ie less negative), with -16 to -18% being borderline. The variation between different vendors is now small for global parameters, but regional strain measurement remains unreliable - and therefore its use for stress echocardiography remains problematic. The most valuable indications for measuring strain are subclinical LV dysfunction (eg., GLS in HFpEF, stage B heart failure, aortic stenosis, mitral regurgitation), RV dysfunction (RV strain in pulmonary hypertension), atrial fibrillation (LA strain) and sequential follow-up (cardiotoxicity). Strain measurements have clinical utility in a number of settings and should be considered as part of the standard echocardiogram.
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Affiliation(s)
- Kawa Haji
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, Victoria, 3004, Australia.,Cardiology Department, Western Health, Melbourne, Australia.,Departments of Cardiometabolic Health and Medicine, University of Melbourne, Melbourne, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, PO Box 6492, Melbourne, Victoria, 3004, Australia. .,Cardiology Department, Western Health, Melbourne, Australia. .,Departments of Cardiometabolic Health and Medicine, University of Melbourne, Melbourne, Australia.
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10
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Bhuva AN, Treibel TA, De Marvao A, Biffi C, Dawes TJW, Doumou G, Bai W, Patel K, Boubertakh R, Rueckert D, O'Regan DP, Hughes AD, Moon JC, Manisty CH. Sex and regional differences in myocardial plasticity in aortic stenosis are revealed by 3D model machine learning. Eur Heart J Cardiovasc Imaging 2020; 21:417-427. [PMID: 31280289 PMCID: PMC7100908 DOI: 10.1093/ehjci/jez166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/22/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS Left ventricular hypertrophy (LVH) in aortic stenosis (AS) varies widely before and after aortic valve replacement (AVR), and deeper phenotyping beyond traditional global measures may improve risk stratification. We hypothesized that machine learning derived 3D LV models may provide a more sensitive assessment of remodelling and sex-related differences in AS than conventional measurements. METHODS AND RESULTS One hundred and sixteen patients with severe, symptomatic AS (54% male, 70 ± 10 years) underwent cardiovascular magnetic resonance pre-AVR and 1 year post-AVR. Computational analysis produced co-registered 3D models of wall thickness, which were compared with 40 propensity-matched healthy controls. Preoperative regional wall thickness and post-operative percentage wall thickness regression were analysed, stratified by sex. AS hypertrophy and regression post-AVR was non-uniform-greatest in the septum with more pronounced changes in males than females (wall thickness regression: -13 ± 3.6 vs. -6 ± 1.9%, respectively, P < 0.05). Even patients without LVH (16% with normal indexed LV mass, 79% female) had greater septal and inferior wall thickness compared with controls (8.8 ± 1.6 vs. 6.6 ± 1.2 mm, P < 0.05), which regressed post-AVR. These differences were not detectable by global measures of remodelling. Changes to clinical parameters post-AVR were also greater in males: N-terminal pro-brain natriuretic peptide (NT-proBNP) [-37 (interquartile range -88 to -2) vs. -1 (-24 to 11) ng/L, P = 0.008], and systolic blood pressure (12.9 ± 23 vs. 2.1 ± 17 mmHg, P = 0.009), with changes in NT-proBNP correlating with percentage LV mass regression in males only (ß 0.32, P = 0.02). CONCLUSION In patients with severe AS, including those without overt LVH, LV remodelling is most plastic in the septum, and greater in males, both pre-AVR and post-AVR. Three-dimensional machine learning is more sensitive than conventional analysis to these changes, potentially enhancing risk stratification. CLINICAL TRIAL REGISTRATION Regression of myocardial fibrosis after aortic valve replacement (RELIEF-AS); NCT02174471. https://clinicaltrials.gov/ct2/show/NCT02174471.
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Affiliation(s)
- Anish N Bhuva
- Institute for Cardiovascular Science, University College London, Chenies Mews, London WC1E6HX, UK
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Thomas A Treibel
- Institute for Cardiovascular Science, University College London, Chenies Mews, London WC1E6HX, UK
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Antonio De Marvao
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W120NN, UK
| | - Carlo Biffi
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W120NN, UK
- Department of Computing, Imperial College London, South Kensington Campus, 180 Queen's Gate, London SW72RH, UK
| | - Timothy J W Dawes
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W120NN, UK
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W120NN, UK
| | - Georgia Doumou
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W120NN, UK
| | - Wenjia Bai
- Department of Computing, Imperial College London, South Kensington Campus, 180 Queen's Gate, London SW72RH, UK
| | - Kush Patel
- Institute for Cardiovascular Science, University College London, Chenies Mews, London WC1E6HX, UK
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Redha Boubertakh
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Daniel Rueckert
- Department of Computing, Imperial College London, South Kensington Campus, 180 Queen's Gate, London SW72RH, UK
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London W120NN, UK
| | - Alun D Hughes
- Institute for Cardiovascular Science, University College London, Chenies Mews, London WC1E6HX, UK
| | - James C Moon
- Institute for Cardiovascular Science, University College London, Chenies Mews, London WC1E6HX, UK
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, King George V Building, West Smithfield, London EC1A 7BE, UK
| | - Charlotte H Manisty
- Institute for Cardiovascular Science, University College London, Chenies Mews, London WC1E6HX, UK
- Department of Cardiovascular Imaging, Barts Heart Centre, Barts Health NHS Trust, King George V Building, West Smithfield, London EC1A 7BE, UK
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11
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Sex-Specific Regulation of miR-29b in the Myocardium Under Pressure Overload is Associated with Differential Molecular, Structural and Functional Remodeling Patterns in Mice and Patients with Aortic Stenosis. Cells 2020; 9:cells9040833. [PMID: 32235655 PMCID: PMC7226763 DOI: 10.3390/cells9040833] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/17/2022] Open
Abstract
Pressure overload in patients with aortic stenosis (AS) induces an adverse remodeling of the left ventricle (LV) in a sex-specific manner. We assessed whether a sex-specific miR-29b dysregulation underlies this sex-biased remodeling pattern, as has been described in liver fibrosis. We studied mice with transverse aortic constriction (TAC) and patients with AS. miR-29b was determined in the LV (mice, patients) and plasma (patients). Expression of remodeling-related markers and histological fibrosis were determined in mouse LV. Echocardiographic morpho-functional parameters were evaluated at baseline and post-TAC in mice, and preoperatively and 1 year after aortic valve replacement (AVR) in patients with AS. In mice, miR-29b LV regulation was opposite in TAC-males (down-regulation) and TAC-females (up-regulation). The subsequent changes in miR-29b targets (collagens and GSK-3β) revealed a remodeling pattern that was more fibrotic in males but more hypertrophic in females. Both systolic and diastolic cardiac functions deteriorated more in TAC-females, thus suggesting a detrimental role of miR-29b in females, but was protective in the LV under pressure overload in males. Clinically, miR-29b in controls and patients with AS reproduced most of the sexually dimorphic features observed in mice. In women with AS, the preoperative plasma expression of miR-29b paralleled the severity of hypertrophy and was a significant negative predictor of reverse remodeling after AVR; therefore, it may have potential value as a prognostic biomarker.
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12
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Xu H, Duan Y, Yuan X, Wu H, Song Y, Xu J, Sun H. Residual left ventricular hypertrophy with adverse clinical outcomes in patients with severe aortic stenosis and asymmetric septal hypertrophy after aortic valve replacement. Eur J Cardiothorac Surg 2019; 56:5303701. [PMID: 30698739 DOI: 10.1093/ejcts/ezy486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/21/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The aim of this study is to describe the temporal pattern of left atrial (LA) and left ventricular (LV) reverse remodelling and to evaluate the impact of residual LV hypertrophy on the prognosis of patients with severe aortic stenosis and asymmetric septal hypertrophy undergoing aortic valve replacement (AVR). METHODS We retrospectively reviewed 59 consecutive patients who underwent AVR for severe aortic stenosis and asymmetric septal hypertrophy. They were divided into the normal LV mass group and the residual LV hypertrophy group according to the LV mass index (LVMI) 2 years after AVR. Thirty patients were eligible for analysis of the time-dependent changes in LA and LV reverse remodelling. RESULTS The interventricular septal thickness and LVMI gradually decreased and reached their lowest points 2 years after operation, whereas the LA dimension rapidly decreased in the early postoperative period and plateaued at 3 months. The multivariable analysis revealed a higher preoperative LVMI [odds ratio 6.36 (1.678-24.11); P = 0.007] as an independent predictor of residual hypertrophy 2 years after operation. The Cox proportional hazards model showed that a higher postoperative peak velocity [hazard ratio 6.715 (1.405-32.104); P = 0.017] was an independent predictor of long-term non-fatal cardiovascular hospitalization. Patients with residual hypertrophy 2 years after AVR had a higher rate of non-fatal cardiovascular hospitalization (P = 0.014). CONCLUSIONS For patients with severe aortic stenosis and asymmetric septal hypertrophy, maximum LA recovery occurred 3 months after AVR, whereas maximum LV recovery occurred 2 years thereafter. A higher preoperative LVMI may lead to postoperative residual hypertrophy, which is associated with adverse clinical outcomes.
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Affiliation(s)
- Haitao Xu
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Yabing Duan
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Xin Yuan
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Hengchao Wu
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Yunhu Song
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Jianping Xu
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Hansong Sun
- Department of Adult Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
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13
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Assessment of Subclinical Left Ventricular Dysfunction in Aortic Stenosis. JACC Cardiovasc Imaging 2019; 12:163-171. [DOI: 10.1016/j.jcmg.2018.08.040] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/19/2018] [Accepted: 08/21/2018] [Indexed: 12/23/2022]
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Is left ventricular hypertrophy a friend or foe of patients with aortic stenosis? ADVANCES IN INTERVENTIONAL CARDIOLOGY 2018; 14:328-337. [PMID: 30603022 PMCID: PMC6309834 DOI: 10.5114/aic.2018.78734] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 08/15/2018] [Indexed: 11/29/2022] Open
Abstract
Left ventricular hypertrophy (LVH) is traditionally considered a physiological compensatory response to LV pressure overload, such as hypertension and aortic stenosis (AS), in an effort to maintain LV systolic function in the face of an increased afterload. According to the Laplace law, LV wall thickening lowers LV wall stress, which in turn would be helpful to preserve LV systolic performance. However, numerous studies have challenged the notion of LVH as a putative beneficial adaptive mechanism. In fact, the magnitude of LVH is associated with higher cardiovascular morbidity and mortality, especially when LVH is disproportionate to LV afterload. We have briefly reviewed: first, the importance of non-valvular factors, beyond AS severity, for total LV afterload and symptomatic status in AS patients; second, associations of excessive LVH with LV dysfunction and adverse outcome in AS; third, prognostic relevance of the presence or absence of pre-operative LVH in patients referred for aortic valve surgery; fourth, time course, determinants and prognostic implications of LVH regression and LV function recovery after surgical valve replacement and transcatheter aortic valve implantation (TAVI) with a focus on TAVI-specific effects; fifth, the potential of medical therapy to modulate LVH before and after surgical or interventional treatment for severe AS, a condition perceived as a relative contraindication to renin-angiotensin system blockade.
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15
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Capoulade R, Clavel MA, Le Ven F, Dahou A, Thébault C, Tastet L, Shen M, Arsenault M, Bédard É, Beaudoin J, O'Connor K, Bernier M, Dumesnil JG, Pibarot P. Impact of left ventricular remodelling patterns on outcomes in patients with aortic stenosis. Eur Heart J Cardiovasc Imaging 2018; 18:1378-1387. [PMID: 28064154 DOI: 10.1093/ehjci/jew288] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/04/2016] [Indexed: 11/12/2022] Open
Abstract
Aims The objective of this study was to examine the association between the different patterns of left ventricular (LV) remodelling/hypertrophy on all-cause and cardiovascular mortality in patients with aortic stenosis (AS). Methods and results In total, 747 consecutive patients (69 ± 14 years, 57% men) with AS and preserved LV ejection fraction were included in this study. According to LV mass index and relative wall thickness, patients were classified into four LV patterns: normal, concentric remodelling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). One hundred and sixteen patients (15%) had normal pattern, 66 (9%) had EH, 169 (23%) had CR, and 396 (53%) had CH. During a median follow-up of 6.4 years, 339 patients died (242 from cardiovascular causes). CH was associated with higher risk of all-cause mortality compared with the three other LV patterns (all P < 0.05). After multivariable adjustment, CH remained associated with higher risk of mortality (HR = 1.27, 95% CI 1.01-1.61, P = 0.046). There was a significant interaction (P < 0.05) between sex and CH with regards to the impact on mortality: CH was associated with worse outcome in women (P = 0.0001) but not in men (P = 0.22). In multivariable analysis, CH remained associated with higher risk of worse outcome in women (HR = 1.56, 95% CI 1.08-2.24, P = 0.018). Conclusions This study shows that CH was independently associated with increased risk of mortality in AS patients with preserved ejection fraction. This association was observed in women but not in men. The pattern of LV remodelling/hypertrophy should be integrated in the risk stratification process in patients with AS.
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Affiliation(s)
- Romain Capoulade
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Florent Le Ven
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Abdellaziz Dahou
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Christophe Thébault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Lionel Tastet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Mylène Shen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Marie Arsenault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Élisabeth Bédard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Kim O'Connor
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Mathieu Bernier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Jean G Dumesnil
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Laval University, 2725 Chemin Sainte-Foy, Québec City, QC, Canada G1V-4G5
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Prevalence, predictors, and prognostic implications of residual impairment of functional capacity after transcatheter aortic valve implantation. Clin Res Cardiol 2017; 106:752-759. [PMID: 28444455 PMCID: PMC5565654 DOI: 10.1007/s00392-017-1119-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/20/2017] [Indexed: 12/21/2022]
Abstract
Background Patients with degenerative aortic stenosis (AS) referred for transcatheter aortic valve implantation (TAVI) typically have advanced cardiac and vascular adverse remodeling and multiple comorbidities and, therefore, might not recover a normal functional capacity after valve replacement. We sought to investigate the prevalence, the predictors, and the prognostic impact of residual impairment of functional capacity after TAVI. Methods and results Out of 790 patients undergoing TAVI with impaired functional capacity (NYHA II–IV) at baseline, NYHA functional class improved in 592 (86.5%) and remained unchanged/worsened in 92 (13.5%) at follow-up [median (IQR): 419 (208–807) days] after TAVI. Normal functional capacity (NYHA I) was recovered in 65.5% (n = 448) of patients, while the rest had variable degrees of residual impairment. On multivariable regression analysis, atrial fibrillation [odds ratio-OR, 2.08 (1.21–3.58), p = 0.008], low-flow–low-gradient AS [OR, 1.97 (1.09–3.57), p = 0.026], chronic obstructive pulmonary disease [OR, 1.92 (1.19–3.12), p = 0.008], and lower hemoglobin at baseline [OR, 1.11 (1.01–1.21) for each g% decrement, p = 0.036] were independently associated with residual impairment of functional capacity. All-cause and cardiac mortality were significantly higher in those with residual impairment of functional capacity than in those in NYHA I class [hazard ratio-HR: 2.37 (95% CI: 1.51–3.72), p < 0.001 and 2.16 (95% CI: 1.08–4.35), p = 0.030, respectively]. Even mild residual functional impairment (NYHA II) was associated with a higher all-cause [HR: 2.02 (95% CI: 1.10–3.72), p = 0.023] and cardiac [HR: 2.08 (95% CI: 1.42–3.07), p < 0.001] mortality. Conclusion Residual impairment of functional capacity is common after TAVI and is independently associated with increased mortality. Predictors of residual impairment of functional status are predominantly patient-rather than procedure-related. Electronic supplementary material The online version of this article (doi:10.1007/s00392-017-1119-9) contains supplementary material, which is available to authorized users.
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Guerra M, Mendes-Ferreira P, Adão R, Pereira E, Vieira M, Lourenço AP, Brás-Silva C, Bastos P, Vouga L, Leite-Moreira AF. Improvement in left intraventricular pressure gradients after aortic valve replacement in aortic stenosis patients. Exp Physiol 2017; 102:411-421. [DOI: 10.1113/ep086191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/10/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Miguel Guerra
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
- Department of Cardiothoracic Surgery; Centro Hospitalar de Vila Nova de Gaia/Espinho; Rua Conceição Fernandes Vila Nova de Gaia Portugal
| | - Pedro Mendes-Ferreira
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
| | - Rui Adão
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
| | - Eulália Pereira
- Department of Cardiothoracic Surgery; Centro Hospitalar de Vila Nova de Gaia/Espinho; Rua Conceição Fernandes Vila Nova de Gaia Portugal
- Department of Cardiology; Centro Hospitalar de Vila Nova de Gaia/Espinho; Rua Conceição Fernandes Vila Nova de Gaia Portugal
| | - Manuela Vieira
- Department of Anesthesiology; Centro Hospitalar de Vila Nova de Gaia/Espinho; Rua Conceição Fernandes Vila Nova de Gaia Portugal
| | - André P. Lourenço
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
| | - Carmen Brás-Silva
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
- Faculty of Nutrition and Food Sciences; University of Porto; Porto Portugal
| | - Pedro Bastos
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
- Department of Cardiothoracic Surgery; Centro Hospitalar São João; Alameda Professor Hernâni Monteiro Porto Portugal
| | - Luís Vouga
- Department of Cardiothoracic Surgery; Centro Hospitalar de Vila Nova de Gaia/Espinho; Rua Conceição Fernandes Vila Nova de Gaia Portugal
| | - Adelino F. Leite-Moreira
- Department of Physiology and Cardiothoracic Surgery, Cardiovascular R&D Unit, Faculty of Medicine; University of Porto; Alameda Professor Hernâni Monteiro Porto Portugal
- Department of Cardiothoracic Surgery; Centro Hospitalar São João; Alameda Professor Hernâni Monteiro Porto Portugal
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The impact of age on the postoperative response of the diastolic function and left ventricular mass regression after surgical or transcatheter aortic valve replacement for severe aortic stenosis. Surg Today 2016; 47:770-776. [DOI: 10.1007/s00595-016-1458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/29/2016] [Indexed: 11/30/2022]
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Connelly KA, Wijeysundera HC, Roifman I. Cardiac Magnetic Resonance Imaging, Transcatheter Aortic Valve Replacement, and Early Left Ventricular Mass Regression-A Virtual Microscope Into Ventricular Remodelling? Can J Cardiol 2016; 32:1369-1371. [PMID: 27717525 DOI: 10.1016/j.cjca.2016.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/24/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Kim A Connelly
- Keenan Biomedical Research Centre, Li Ka Shing Knowledge Institute St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
| | - Harindra C Wijeysundera
- Sunnybrook Research Institute, Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Idan Roifman
- Sunnybrook Research Institute, Schulich Heart Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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