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Grinberg T, Aviv Y, Vaturi M, Perl L, Wiessman M, Vaknin-Assa H, Codner P, Shapira Y, Kornowski R, Orvin K. Noninvasive Hemodynamic Evaluation Following TAVI for Severe Aortic Stenosis. J Am Heart Assoc 2023; 12:e028479. [PMID: 36942754 PMCID: PMC10122892 DOI: 10.1161/jaha.122.028479] [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] [Indexed: 03/23/2023]
Abstract
Background Various hemodynamic changes occur following transcatheter aortic valve implantation (TAVI) that may impact therapeutic decisions. NICaS is a noninvasive bioimpedance monitoring system aimed at hemodynamic assessment. We used the NICaS system in patients with severe aortic stenosis (AS) to evaluate short-term hemodynamic changes after TAVI. Methods and Results We performed hemodynamic analysis using NICaS on 97 patients with severe AS who underwent TAVI using either self-expandable (68%) or balloon-expandable (32%) valves. Patients were more often women (54%) and had multiple comorbidities including hypertension (83%), coronary artery disease (46%), and diabetes (37%). NICaS was performed at several time points-before TAVI, soon after TAVI, at hospital discharge, and during follow-up. Compared with baseline NICaS measurements, we observed a significant increase in systolic blood pressure and total peripheral resistance (systolic blood pressure 132±21 mm Hg at baseline versus 147±23 mm Hg after TAVI, P<0.001; total peripheral resistance 1751±512 versus 2084±762 dynes*s/cm5, respectively, P<0.001) concurrent with a decrease in cardiac output and stroke volume (cardiac output 4.2±1.5 versus 3.9±1.3 L/min, P=0.037; stroke volume 61.4±14.8 versus 56.2±15.9 mL, P=0.001) in the immediate post-TAVI period. At follow-up (median 59 days [interquartile range, 40.5-91]) these measurements returned to values that were not different from the baseline. A significant improvement in echocardiography-based left ventricular ejection fraction was observed from baseline to follow-up (55.6%±11.6% to 59.4%±9.4%, P<0.001). Conclusions Unique short-term adaptive hemodynamic changes were observed using NICaS in patients with AS soon after TAVI. Noninvasive hemodynamic evaluation immediately following TAVI may contribute to the understanding of complex hemodynamic changes and merits favorable consideration.
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Affiliation(s)
- Tzlil Grinberg
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yaron Aviv
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Mordehay Vaturi
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Leor Perl
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Maya Wiessman
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Hanna Vaknin-Assa
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Pablo Codner
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Yaron Shapira
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Ran Kornowski
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Katia Orvin
- Department of Cardiology Rabin Medical Center Petah Tikva Israel
- The Faculty of Medicine Tel Aviv University Tel Aviv Israel
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Albu A, Para I, Bidian C. Arterial stiffness in aortic stenosis - complex clinical and prognostic implications. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:369-379. [PMID: 36128849 DOI: 10.5507/bp.2022.040] [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: 05/07/2022] [Accepted: 08/31/2022] [Indexed: 12/15/2022] Open
Abstract
Arterial stiffness and degenerative aortic stenosis (AoS) are frequently associated leading to a combined valvular and vascular load imposed on the left ventricle (LV). Vascular load consists of a pulsatile load represented by arterial stiffness and a steady load corresponding to vascular resistance. Increased vascular load in AoS has been associated with LV dysfunction and poor prognosis in pre-intervention state, as well as after aortic valve replacement (AVR), suggesting that the evaluation of arterial load in AoS may have clinical benefits. Nevertheless, studies that investigated arterial stiffness in AoS either before or after AVR used various methods of measurement and their results are conflicting. The aim of the present review was to summarize the main pathophysiological mechanisms which may explain the complex valvulo-arterial interplay in AoS and their consequences on LV structure and function on the patients' outcome. Future larger studies are needed to clarify the complex hemodynamic modifications produced by increased vascular load in AoS and its changes after AVR. Prospective evaluation is needed to confirm the prognostic value of arterial stiffness in patients with AoS. Simple, non-invasive, reliable methods which must be validated in AoS still remain to be established before implementing arterial stiffness measurement in patients with AoS in clinical practice.
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Affiliation(s)
- Adriana Albu
- 2nd Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 8 Babes Street, Cluj-Napoca, 400012, Romania
| | - Ioana Para
- 4th Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy, 8 Babes Street, Cluj-Napoca, 400012, Romania
| | - Cristina Bidian
- Department of Physiology, "Iuliu Hatieganu" University of Medicine and Pharmacy, 8 Babes Street, Cluj-Napoca, 400012, Romania
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3
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Arterial biomarkers in the evaluation, management and prognosis of aortic stenosis. Atherosclerosis 2021; 332:1-15. [PMID: 34358732 DOI: 10.1016/j.atherosclerosis.2021.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/03/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022]
Abstract
Degenerative aortic valve stenosis is the most common primary valve disease and a significant cause of cardiovascular morbidity and mortality. In an era when new techniques for the management of aortic stenosis are gaining ground, the understanding of this disease is more important than ever to optimize treatment. So far, the focus has been placed on the assessment of the valve itself. However, the role that the arterial system plays in the pathogenesis and natural history of the disease needs to be further elucidated. Arteriosclerosis, when it coexists with a stenotic valve, augments the load posed on the left ventricle contributing to greater impairment of cardiovascular function. Arterial stiffness, a well-established predictor for cardiovascular disease and all-cause mortality, could play a role in the prognosis and quality of life of this population. Several studies using a variety of indices to assess arterial stiffness have tried to address the potential utility of arterial function assessment in the case of aortic stenosis. Importantly, reliable data identify a prognostic role of arterial biomarkers in aortic stenosis and stress their possible use to optimize timing and method of treatment. This review aims at summarizing the existing knowledge on the interplay between the heart and the vessels in the presence of degenerative aortic stenosis, prior, upon and after interventional management. Further, it discusses the evidence supporting the potential clinical application of arterial biomarkers for the assessment of progression, severity, management and prognosis of aortic stenosis.
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4
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Einarsen E, Hjertaas JJ, Gu H, Matre K, Chowienczyk PJ, Gerdts E, Chambers JB, Saeed S. Impact of arterio-ventricular interaction on first-phase ejection fraction in aortic stenosis. Eur Heart J Cardiovasc Imaging 2021; 22:650-657. [PMID: 32793965 PMCID: PMC8110316 DOI: 10.1093/ehjci/jeaa154] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/30/2020] [Accepted: 05/14/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS First-phase ejection fraction (EF1), the EF at the time to peak aortic jet velocity, has been proposed as a novel marker of peak systolic function in aortic stenosis (AS). This study aimed to explore the association of myocardial contractility and arterial load with EF1 in AS patients. METHODS AND RESULTS Data from a prospective, cross-sectional study of 114 patients with mild, moderate, and severe AS with preserved left ventricular EF (>50%) were analysed. EF1 was measured as the volume change from end-diastole to the time that corresponded to peak aortic jet velocity. Myocardial contractility was assessed by strain rate measured by speckle tracking echocardiography. Arterial stiffness was assessed by central pulse pressure/stroke volume index ratio (PP/SVi). The total study population included 48% women, median age was 73 years, and mean peak aortic jet velocity was 3.47 m/s. In univariable linear regression analyses, lower EF1 was associated with higher age, higher peak aortic jet velocity, lower global EF, lower global longitudinal strain, lower strain rate, and higher PP/SVi. There was no significant association between EF1 and heart rate or sex. In multivariable linear regression analysis, EF1 was associated with lower strain rate and higher PP/SVi, independent of AS severity. Replacing PP/SVi by valvular impedance did not change the results. CONCLUSION In patients with AS, reduced myocardial contractility and increased arterial load were associated with lower EF1 independent of the severity of valve stenosis.
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Affiliation(s)
- Eigir Einarsen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Corresponding author. Tel: +47 98096917. E-mail:
| | | | - Haotian Gu
- British Heart Foundation Centre, King’s College London, London, UK
| | - Knut Matre
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - John B Chambers
- Cardiothoracic Centre, Guy’s and St Thomas’ Hospital, London, UK
| | - Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Augmentation index predicts mortality in patients with aortic stenosis: an echo-tracking study. Int J Cardiovasc Imaging 2021; 37:1659-1668. [PMID: 33713217 DOI: 10.1007/s10554-020-02151-6] [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: 10/26/2020] [Accepted: 12/25/2020] [Indexed: 01/19/2023]
Abstract
Aortic valve stenosis (AS) shares similarities with the atherosclerotic process but little is known about the effect of the mechanical properties of large arteries on outcome in patients with AS. The aims of this study were (1) to determine the relationship between indexes of carotid stiffness/compliance and the severity of AS and (2) to identify whether local arterial stiffness is independently associated with mortality. 133 patients with moderate to severe isolated AS and preserved LV ejection fraction (LVEF) were included. All underwent transthoracic echocardiography and local carotid stiffness evaluation by means of high-definition echo-tracking ultrasound with the calculation of stiffness/compliance parameters included augmentation index (AIx). None of the carotid stiffness parameters were significantly associated with AS severity parameters. During a mean follow-up of 51.6 ± 39.4 months, 70 patients received aortic valve replacement, 45 died and 18 were alive with no surgery. Who died were older (79.2 ± 6.9 vs. 73 ± 8.8 years, p < 0.0001), had higher carotid AIx (21.3 ± 14 vs. 16 ± 12%, p = 0.028). In multivariate Cox regression analysis AIx was independently associated with mortality (HR 1.048, 95% CI 1.01-1.07, p = 0.001), also after inclusion of age and creatinine. There was a significant association between the level of AIx and mortality in those patients who did not have surgery (p = 0.016). In severe AS and a normal LVEF, carotid AIx measured by echo-tracking system was independently associated with death. No relationship between AS severity and local carotid stiffness was found. These data emphasize the importance of arterial stiffness has a hallmark of long-term atherosclerotic burden and impaired prognosis.
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The Progress of Advanced Ultrasonography in Assessing Aortic Stiffness and the Application Discrepancy between Humans and Rodents. Diagnostics (Basel) 2021; 11:diagnostics11030454. [PMID: 33800855 PMCID: PMC8001300 DOI: 10.3390/diagnostics11030454] [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: 02/12/2021] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/26/2022] Open
Abstract
Aortic stiffening is a fundamental pathological alteration of atherosclerosis and other various aging-associated vascular diseases, and it is also an independent risk factor of cardiovascular morbidity and mortality. Ultrasonography is a critical non-invasive method widely used in assessing aortic structure, function, and hemodynamics in humans, playing a crucial role in predicting the pathogenesis and adverse outcomes of vascular diseases. However, its applications in rodent models remain relatively limited, hindering the progress of the research. Here, we summarized the progress of the advanced ultrasonographic techniques applied in evaluating aortic stiffness. With multiple illustrative images, we mainly characterized various ultrasound techniques in assessing aortic stiffness based on the alterations of aortic structure, hemodynamics, and tissue motion. We also discussed the discrepancy of their applications in humans and rodents and explored the potential optimized strategies in the experimental research with animal models. This updated information would help to better understand the nature of ultrasound techniques and provide a valuable prospect for their applications in assessing aortic stiffness in basic science research, particularly with small animals.
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Early hemodynamic changes after transcatheter aortic valve implantation in patients with severe aortic stenosis measured by invasive pressure volume loop analysis. Cardiovasc Interv Ther 2020; 37:191-201. [PMID: 33313960 PMCID: PMC8789710 DOI: 10.1007/s12928-020-00737-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/22/2020] [Indexed: 11/20/2022]
Abstract
Replacement of a stenotic aortic valve reduces immediately the ventricular to aortic gradient and is expected to improve diastolic and systolic left ventricular function over the long term. However, the hemodynamic changes immediately after valve implantation are so far poorly understood. Within this pilot study, we performed an invasive pressure volume loop analysis to describe the early hemodynamic changes after transcatheter aortic valve implantation (TAVI) with self-expandable prostheses. Invasive left ventricular pressure volume loop analysis was performed in 8 patients with aortic stenosis (mean 81.3 years) prior and immediately after transfemoral TAVI with a self-expandable valve system (St. Jude Medical Portico Valve). Parameters for global hemodynamics, afterload, contractility and the interaction of the cardiovascular system were analyzed. Left ventricular ejection fraction, (53.9% vs. 44.8%, p = 0.018), preload recruitable stroke work (68.5 vs. 44.8 mmHg, p = 0.012) and end-systolic elastance (3.55 vs. 2.17, p = 0.036) both marker for myocardial contractility declined significantly compared to baseline. As sign of impaired diastolic function, TAU, a preload-independent measure of isovolumic relaxation (37.3 vs. 41.8 ms, p = 0.018) and end-diastolic pressure (13.1 vs. 16.4 mmHg, p = 0.015) raised after valve implantation. Contrarily, a smaller ratio of end-systolic to arterial elastance (ventricular-arterial coupling) indicates an improvement of global cardiovascular energy efficiency (1.40 vs. 0.97 p = 0.036). Arterial elastance had a strong correlation with the number of conducted rapid ventricular pacings (Pearson correlation coefficient, r = 0.772, p = 0.025). Invasive left ventricular pressure volume loop analysis revealed impaired systolic and diastolic function in the early phase after TAVI with self-expandable valve for the treatment of severe aortic stenosis. Contrarily, we found indications for early improvement of global cardiovascular energy efficiency.
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Roşca M, Mandeş L, Ciupercă D, Călin A, Beladan CC, Enache R, Jurcuţ R, Coman IM, Ginghină C, Popescu BA. Carotid arterial stiffness is increased and related to left ventricular function in patients with hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2020; 21:923-931. [DOI: 10.1093/ehjci/jez243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
To assess the carotid mechanical properties in patients with hypertrophic cardiomyopathy and the relation between arterial stiffness and left ventricular function in this setting.
Methods and results
We have prospectively enrolled 71 patients (52 ± 16 years, 34 men) with hypertrophic cardiomyopathy, divided into two groups depending on the presence (46 patients) or absence (25 patients) of cardiovascular risk factors associated with increased arterial stiffness. Twenty-five normal subjects similar by age and gender with hypertrophic cardiomyopathy patients without risk factors formed the control group. A comprehensive echocardiography was performed in all subjects. Carotid arterial stiffness index (β index), pressure–strain elastic modulus, arterial compliance, and pulse wave velocity were also obtained using an echo-tracking system. β index, pulse wave velocity, and pressure–strain elastic modulus were significantly higher in hypertrophic cardiomyopathy patients without risk factors compared to controls. After linear regression analysis, the increase in carotid β index was independently correlated with the presence of hypertrophic cardiomyopathy [beta = 0.49, 95% confidence interval (CI) = 1.04–3.02; P < 0.001]. In the entire hypertrophic cardiomyopathy population arterial stiffness parameters correlated with age, gender, hypertension degree, presence of hypercholesterolaemia, and the E/e′ ratio. In multivariable analysis, β index (beta = 0.36, 95% CI = 0.32–1.25; P = 0.001), global left ventricular longitudinal strain, and the presence of left ventricular outflow tract obstruction were independently correlated with the E/e′ ratio.
Conclusion
In patients with hypertrophic cardiomyopathy arterial stiffness is increased independently of age or presence of cardiovascular risk factors. Carotid artery stiffness is independently related to left ventricular filling pressure, increased arterial stiffness representing a possible marker of a more severe phenotype.
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Affiliation(s)
- Monica Roşca
- University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Şos. Fundeni 258, Sector 2, 022328 Bucharest, Romania
| | - Leonard Mandeş
- University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Şos. Fundeni 258, Sector 2, 022328 Bucharest, Romania
| | - Daniela Ciupercă
- University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Şos. Fundeni 258, Sector 2, 022328 Bucharest, Romania
| | - Andreea Călin
- University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Şos. Fundeni 258, Sector 2, 022328 Bucharest, Romania
| | - Carmen C Beladan
- University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Şos. Fundeni 258, Sector 2, 022328 Bucharest, Romania
| | - Roxana Enache
- University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Şos. Fundeni 258, Sector 2, 022328 Bucharest, Romania
| | - Ruxandra Jurcuţ
- University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Şos. Fundeni 258, Sector 2, 022328 Bucharest, Romania
| | - Ioan M Coman
- University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Şos. Fundeni 258, Sector 2, 022328 Bucharest, Romania
| | - Carmen Ginghină
- University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Şos. Fundeni 258, Sector 2, 022328 Bucharest, Romania
| | - Bogdan A Popescu
- University of Medicine and Pharmacy “Carol Davila”, Euroecolab, Emergency Institute of Cardiovascular Diseases “Prof. Dr. C. C. Iliescu”, Şos. Fundeni 258, Sector 2, 022328 Bucharest, Romania
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Haghiashtiani G, Qiu K, Zhingre Sanchez JD, Fuenning ZJ, Nair P, Ahlberg SE, Iaizzo PA, McAlpine MC. 3D printed patient-specific aortic root models with internal sensors for minimally invasive applications. SCIENCE ADVANCES 2020; 6:eabb4641. [PMID: 32923641 PMCID: PMC7455187 DOI: 10.1126/sciadv.abb4641] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/06/2020] [Indexed: 06/11/2023]
Abstract
Minimally invasive surgeries have numerous advantages, yet complications may arise from limited knowledge about the anatomical site targeted for the delivery of therapy. Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure for treating aortic stenosis. Here, we demonstrate multimaterial three-dimensional printing of patient-specific soft aortic root models with internally integrated electronic sensor arrays that can augment testing for TAVR preprocedural planning. We evaluated the efficacies of the models by comparing their geometric fidelities with postoperative data from patients, as well as their in vitro hemodynamic performances in cases with and without leaflet calcifications. Furthermore, we demonstrated that internal sensor arrays can facilitate the optimization of bioprosthetic valve selections and in vitro placements via mapping of the pressures applied on the critical regions of the aortic anatomies. These models may pave exciting avenues for mitigating the risks of postoperative complications and facilitating the development of next-generation medical devices.
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Affiliation(s)
- Ghazaleh Haghiashtiani
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kaiyan Qiu
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jorge D. Zhingre Sanchez
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Zachary J. Fuenning
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | | | | | - Paul A. Iaizzo
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA
- Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Michael C. McAlpine
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
- Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN 55455, USA
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Nuis RJ, Goudzwaard JA, de Ronde-Tillmans MJAG, Kroon H, Ooms JF, van Wiechen MP, Geleijnse ML, Zijlstra F, Daemen J, Van Mieghem NM, Mattace-Raso FUS, Lenzen MJ, de Jaegere PPT. Impact of Valvulo-Arterial Impedance on Long-Term Quality of Life and Exercise Performance After Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008372. [PMID: 31937136 DOI: 10.1161/circinterventions.119.008372] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In aortic stenosis, valvulo-arterial impedance (Zva) estimates the overall left ventricular afterload (valve and arterial component). We investigated the association of Zva (≥5 versus <5 mm Hg mL-1 m-2) on quality of life (QOL) and exercise performance (EP) ≥1 year after transcatheter aortic valve replacement (TAVR). METHODS The study population consists of 250 TAVR patients in whom baseline Zva and follow-up QOL was prospectively assessed using EuroQOL-5-dimensions instruments; EP was assessed in 192 patients who survived ≥1 year after TAVR using questionnaires related to daily activities. In 124 patients, Zva at 1-year was also available and was used to study the change in Zva (baseline to 1 year) on QOL/EP. RESULTS Elevated baseline Zva was present in 125 patients (50%). At a median of 28 (IQR, 17-40) months, patients with elevated baseline Zva were more limited in mobility (88% versus 71%; P=0.004), self-care (40% versus 25%; P=0.019), and independent daily activities (taking a shower: 53% versus 38%, P=0.030; walking 100 meter: 76% versus 54%, P=0.001; and walking stairs: 74% versus 54%, P=0.011). By multivariable analysis, elevated Zva predicted unfavorable QOL (lower EuroQOL-5-dimensions-Utility Index, odds ratio, 1.98; CI, 1.15-3.41) and unfavorable EP (any limitation in ≥3 daily activities, odds ratio, 2.55; CI, 1.41-4.62). After TAVR, the proportion of patients with elevated Zva fell from 50% to 21% and remained 21% at 1 year and was found to be associated with more limitations in mobility, self-care, and daily activities compared with patients with Zva <5 mm Hg mL-1 m-2. CONCLUSIONS Elevated Zva was seen in half of patients and predicted unfavorable long-term QOL and EP. At 1 year after TAVR, the prevalence of elevated Zva was 21% but remained associated with poor QOL/EP.
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Affiliation(s)
- Rutger-Jan Nuis
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Jeannette A Goudzwaard
- Section of Geriatrics, Department of Internal Medicine (J.A.G., F.U.S.M.-R.), Erasmus MC, Rotterdam, the Netherlands
| | - Marjo J A G de Ronde-Tillmans
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Herbert Kroon
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Joris F Ooms
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Maarten P van Wiechen
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Felix Zijlstra
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Francesco U S Mattace-Raso
- Section of Geriatrics, Department of Internal Medicine (J.A.G., F.U.S.M.-R.), Erasmus MC, Rotterdam, the Netherlands
| | - Mattie J Lenzen
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
| | - Peter P T de Jaegere
- Department of Cardiology (R.-J.N., M.J.A.G.d.R.T., H.K., J.F.O., M.P.v.W., M.L.G., F.Z., J.D., N.M.V.M., M.J.L., P.P.T.d.J.), Erasmus MC, Rotterdam, the Netherlands
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11
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Satriano A, Guenther Z, White JA, Merchant N, Di Martino ES, Al-Qoofi F, Lydell CP, Fine NM. Three-dimensional thoracic aorta principal strain analysis from routine ECG-gated computerized tomography: feasibility in patients undergoing transcatheter aortic valve replacement. BMC Cardiovasc Disord 2018; 18:76. [PMID: 29720088 PMCID: PMC5932860 DOI: 10.1186/s12872-018-0818-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 04/24/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Functional impairment of the aorta is a recognized complication of aortic and aortic valve disease. Aortic strain measurement provides effective quantification of mechanical aortic function, and 3-dimenional (3D) approaches may be desirable for serial evaluation. Computerized tomographic angiography (CTA) is routinely performed for various clinical indications, and offers the unique potential to study 3D aortic deformation. We sought to investigate the feasibility of performing 3D aortic strain analysis in a candidate population of patients undergoing transcatheter aortic valve replacement (TAVR). METHODS Twenty-one patients with severe aortic valve stenosis (AS) referred for TAVR underwent ECG-gated CTA and echocardiography. CTA images were analyzed using a 3D feature-tracking based technique to construct a dynamic aortic mesh model to perform peak principal strain amplitude (PPSA) analysis. Segmental strain values were correlated against clinical, hemodynamic and echocardiographic variables. Reproducibility analysis was performed. RESULTS The mean patient age was 81±6 years. Mean left ventricular ejection fraction was 52±14%, aortic valve area (AVA) 0.6±0.3 cm2 and mean AS pressure gradient (MG) 44±11 mmHg. CTA-based 3D PPSA analysis was feasible in all subjects. Mean PPSA values for the global thoracic aorta, ascending aorta, aortic arch and descending aorta segments were 6.5±3.0, 10.2±6.0, 6.1±2.9 and 3.3±1.7%, respectively. 3D PSSA values demonstrated significantly more impairment with measures of worsening AS severity, including AVA and MG for the global thoracic aorta and ascending segment (p<0.001 for all). 3D PSSA was independently associated with AVA by multivariable modelling. Coefficients of variation for intra- and inter-observer variability were 5.8 and 7.2%, respectively. CONCLUSIONS Three-dimensional aortic PPSA analysis is clinically feasible from routine ECG-gated CTA. Appropriate reductions in PSSA were identified with increasing AS hemodynamic severity. Expanded study of 3D aortic PSSA for patients with various forms of aortic disease is warranted.
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Affiliation(s)
- Alessandro Satriano
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada.,Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, South Health Campus, 4448 Front Street SE, Calgary, Alberta, T3M 1M4, Canada
| | - Zachary Guenther
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada.,Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James A White
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada.,Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, South Health Campus, 4448 Front Street SE, Calgary, Alberta, T3M 1M4, Canada
| | - Naeem Merchant
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada.,Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Elena S Di Martino
- Department of Civil Engineering and Centre for Bioengineering Research and Education, University of Calgary, Calgary, Alberta, Canada
| | - Faisal Al-Qoofi
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, South Health Campus, 4448 Front Street SE, Calgary, Alberta, T3M 1M4, Canada
| | - Carmen P Lydell
- Stephenson Cardiac Imaging Centre, University of Calgary, Calgary, Alberta, Canada.,Department of Diagnostic Imaging, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nowell M Fine
- Division of Cardiology, Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary, South Health Campus, 4448 Front Street SE, Calgary, Alberta, T3M 1M4, Canada.
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12
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Cantürk E, Çakal B, Karaca O, Omaygenç O, Salihi S, Özyüksel A, Akçevin A. Changes in Aortic Pulse Wave Velocity and the Predictors of Improvement in Arterial Stiffness Following Aortic Valve Replacement. Ann Thorac Cardiovasc Surg 2017; 23:248-255. [PMID: 28890466 DOI: 10.5761/atcs.oa.17-00062] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The interaction between valvular aortic stenosis (AS) and arterial stiffness, as well as the impact of aortic valve replacement (AVR) on arterial stiffness, remains unclear. In this study, we aimed to evaluate the degree of AS severity on non-invasive pulse wave velocity (PWV) measurements. We also searched whether the AVR procedure favorably affects PWV. METHODS In all, 38 patients undergoing AVR for chronic AS were included. The degree of aortic stiffness was measured with PWV at both baseline and 6 months after AVR. Improvement in aortic stiffness was defined as the absolute decrease in PWV at 6 months compared to the baseline value. RESULTS The study population had a mean age of 59 ± 16 years, mean aortic gradient of 47.1 ± 6.4 mmHg, and mean aortic valve area (AVA) index of 0.45 ± 0.11 cm² /m² . Baseline PWV values correlated positively with the mean aortic gradient (r = 0.350, p = 0.031) and negatively with the AVA index (r = -0.512, p = 0.001). The mean PWV improved in 20 patients (53%) and worsened in 18 patients (47%). The baseline New York Heart Association (NYHA) class (odds ratio [OR] = 1.023, 95% confidence interval [CI] = 1.005-1.041, p = 0.041) and AVA index (OR = 1.040, 96% CI = 1.023-1.057, p = 0.028) emerged as the independent predictors of improvement in PWV following AVR. CONCLUSION The severity of AS was significantly associated with baseline PWV. In general, the mean PWV did not change with AVR. Baseline NYHA class and the AVA index independently predicted PWV improvement following AVR. Since the change in PWV after AVR was polarized based on the patients' characteristics, such as preoperative NYHA functional class or AVA index, further studies are needed to confirm clinical significance of PWV change following AVR in severe AS patients.
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Affiliation(s)
- Emir Cantürk
- Department of Cardiovascular Surgery, Dragos Hospital, Bezm-i Alem University, Istanbul, Turkey
| | - Beytullah Çakal
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
| | - Oğuz Karaca
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
| | - Onur Omaygenç
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey
| | - Salih Salihi
- Department of Cardiovascular Surgery, Okan University, Istanbul, Turkey
| | - Arda Özyüksel
- Department of Cardiovascular Surgery, Istanbul Medipol University, Istanbul, Turkey
| | - Atıf Akçevin
- Department of Cardiovascular Surgery, Istanbul Medipol University, Istanbul, Turkey
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13
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Cho IJ, Chang HJ, Heo R, Kim IC, Sung JM, Chang BC, Shim CY, Hong GR, Chung N. Association of Thoracic Aorta Calcium Score With Left Ventricular Hypertrophy and Clinical Outcomes in Patients With Severe Aortic Stenosis After Aortic Valve Replacement. Ann Thorac Surg 2017; 103:74-81. [DOI: 10.1016/j.athoracsur.2016.05.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 04/04/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
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14
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Călin A, Roşca M, Beladan CC, Enache R, Mateescu AD, Ginghină C, Popescu BA. The left ventricle in aortic stenosis--imaging assessment and clinical implications. Cardiovasc Ultrasound 2015; 13:22. [PMID: 25928763 PMCID: PMC4425891 DOI: 10.1186/s12947-015-0017-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/21/2015] [Indexed: 01/07/2023] Open
Abstract
Aortic stenosis has an increasing prevalence in the context of aging population. In these patients non-invasive imaging allows not only the grading of valve stenosis severity, but also the assessment of left ventricular function. These two goals play a key role in clinical decision-making. Although left ventricular ejection fraction is currently the only left ventricular function parameter that guides intervention, current imaging techniques are able to detect early changes in LV structure and function even in asymptomatic patients with significant aortic stenosis and preserved ejection fraction. Moreover, new imaging parameters emerged as predictors of disease progression in patients with aortic stenosis. Although proper standardization and confirmatory data from large prospective studies are needed, these novel parameters have the potential of becoming useful tools in guiding intervention in asymptomatic patients with aortic stenosis and stratify risk in symptomatic patients undergoing aortic valve replacement. This review focuses on the mechanisms of transition from compensatory left ventricular hypertrophy to left ventricular dysfunction and heart failure in aortic stenosis and the role of non-invasive imaging assessment of the left ventricular geometry and function in these patients.
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Affiliation(s)
- Andreea Călin
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.
| | - Monica Roşca
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.
| | - Carmen Cristiana Beladan
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania. .,Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos Fundeni 258 sector 2, 022328, Bucharest, Romania.
| | - Roxana Enache
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania. .,Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos Fundeni 258 sector 2, 022328, Bucharest, Romania.
| | - Anca Doina Mateescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania.
| | - Carmen Ginghină
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania. .,Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos Fundeni 258 sector 2, 022328, Bucharest, Romania.
| | - Bogdan Alexandru Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Bucharest, Romania. .,Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos Fundeni 258 sector 2, 022328, Bucharest, Romania.
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15
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Parikh V, Kim C, Siegel RJ, Arsanjani R, Rader F. Natriuretic Peptides for Risk Stratification of Patients With Valvular Aortic Stenosis. Circ Heart Fail 2015; 8:373-80. [DOI: 10.1161/circheartfailure.114.001649] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vishal Parikh
- From the Department of Medicine (V.P., C.K.) and Heart Institute (R.J.S., R.A., F.R.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Candice Kim
- From the Department of Medicine (V.P., C.K.) and Heart Institute (R.J.S., R.A., F.R.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Robert J. Siegel
- From the Department of Medicine (V.P., C.K.) and Heart Institute (R.J.S., R.A., F.R.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Reza Arsanjani
- From the Department of Medicine (V.P., C.K.) and Heart Institute (R.J.S., R.A., F.R.), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Florian Rader
- From the Department of Medicine (V.P., C.K.) and Heart Institute (R.J.S., R.A., F.R.), Cedars-Sinai Medical Center, Los Angeles, CA
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16
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Kruszelnicka O, Chmiela M, Bobrowska B, Świerszcz J, Bhagavatula S, Bednarek J, Surdacki A, Nessler J, Hryniewiecki T. Depressed Systemic Arterial Compliance is Associated with the Severity of Heart Failure Symptoms in Moderate-to-Severe Aortic Stenosis: a Cross-Sectional Retrospective Study. Int J Med Sci 2015; 12:552-8. [PMID: 26180511 PMCID: PMC4502059 DOI: 10.7150/ijms.12262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 05/25/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patients with aortic stenosis (AS) may develop heart failure even in the absence of severe valve stenosis. Our aim was to assess the contribution of systemic arterial properties and the global left ventricular afterload to graded heart failure symptoms in AS. METHODS We retrospectively reviewed medical records of 157 consecutive subjects (mean age, 71±10 years; 79 women and 78 men) hospitalized owing to moderate-to-severe degenerative AS. Exclusion criteria included more than mild aortic insufficiency or disease of another valve, atrial fibrillation, coronary artery disease, severe respiratory disease or anemia. Heart failure symptoms were graded by NYHA class at admission. Systemic arterial compliance (SAC) and valvulo-arterial impedance (Zva) were derived from routine echocardiography and blood pressure. RESULTS Sixty-one patients were asymptomatic, 49 presented mild (NYHA II) and 47 moderate-to-severe (NYHA III-IV) heart failure symptoms. Mild symptoms were associated with lower SAC and transvalvular gradients, while more severe exercise intolerance coincided with older age, lower systolic blood pressure, smaller aortic valve area and depressed ejection fraction. By multiple ordinal logistic regression, the severity of heart failure symptoms was related to older age, depressed ejection fraction and lower SAC. Each decrease in SAC by 0.1 ml/m² per mmHg was associated with an increased adjusted odds ratio (OR) of a patient being in one higher category of heart failure symptoms graded as no symptoms, mild exercise intolerance and advanced exercise intolerance (OR: 1.16 [95% CI, 1.01-1.35], P=0.045). CONCLUSIONS Depressed SAC may enhance exercise intolerance irrespective of stenosis severity or left ventricular systolic function in moderate-to-severe AS. This finding supports the importance of non-valvular factors for symptomatic status in AS.
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Affiliation(s)
- Olga Kruszelnicka
- 1. Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College and John Paul II Hospital, Cracow, Poland
| | - Mark Chmiela
- 2. School of Medicine in English, Jagiellonian University Medical College, Cracow, Poland
| | - Beata Bobrowska
- 3. Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College and University Hospital, Cracow, Poland
| | - Jolanta Świerszcz
- 3. Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College and University Hospital, Cracow, Poland
| | - Seetha Bhagavatula
- 2. School of Medicine in English, Jagiellonian University Medical College, Cracow, Poland
| | - Jacek Bednarek
- 4. Department of Electrocardiology, Jagiellonian University Medical College and John Paul II Hospital, Cracow, Poland
| | - Andrzej Surdacki
- 3. Second Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Medical College and University Hospital, Cracow, Poland
| | - Jadwiga Nessler
- 1. Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College and John Paul II Hospital, Cracow, Poland
| | - Tomasz Hryniewiecki
- 5. Department of Valvular Heart Defects, Institute of Cardiology, Warsaw, Poland
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17
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Vascular Ehlers-Danlos Syndrome in siblings with biallelic COL3A1 sequence variants and marked clinical variability in the extended family. Eur J Hum Genet 2014; 23:796-802. [PMID: 25205403 PMCID: PMC4795069 DOI: 10.1038/ejhg.2014.181] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 08/06/2014] [Accepted: 08/07/2014] [Indexed: 11/08/2022] Open
Abstract
Vascular Ehlers-Danlos Syndrome (vEDS), also known as EDS type IV, is considered to be an autosomal dominant disorder caused by sequence variants in COL3A1, which encodes the chains of type III procollagen. We identified a family in which there was marked clinical variation with the earliest death due to extensive aortic dissection at age 15 years and other family members in their eighties with no complications. The proband was born with right-sided clubfoot but was otherwise healthy until he died unexpectedly at 15 years. His sister, in addition to signs consistent with vascular EDS, had bilateral frontal and parietal polymicrogyria. The proband and his sister each had two COL3A1 sequence variants, c.1786C>T, p.(Arg596*) in exon 26 and c.3851G>A, p.(Gly1284Glu) in exon 50 on different alleles. Cells from the compound heterozygote produced a reduced amount of type III procollagen, all the chains of which had abnormal electrophoretic mobility. Biallelic sequence variants have a significantly worse outcome than heterozygous variants for either null mutations or missense mutations, and frontoparietal polymicrogyria may be an added phenotype feature. This genetic constellation provides a very rare explanation for marked intrafamilial clinical variation due to sequence variants in COL3A1.
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Weisz SH, Magne J, Dulgheru R, Caso P, Piérard LA, Lancellotti P. Carotid Artery and Aortic Stiffness Evaluation in Aortic Stenosis. J Am Soc Echocardiogr 2014; 27:385-92. [DOI: 10.1016/j.echo.2013.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Indexed: 10/25/2022]
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19
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Petrini J, Jenner J, Rickenlund A, Eriksson P, Franco-Cereceda A, Caidahl K, Eriksson MJ. Elastic Properties of the Descending Aorta in Patients with a Bicuspid or Tricuspid Aortic Valve and Aortic Valvular Disease. J Am Soc Echocardiogr 2014; 27:393-404. [DOI: 10.1016/j.echo.2013.12.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Indexed: 11/29/2022]
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Takata M, Amiya E, Watanabe M, Ozeki A, Watanabe A, Kawarasaki S, Nakao T, Hosoya Y, Uno K, Saito A, Murasawa T, Ono M, Nagai R, Komuro I. Brachial artery diameter has a predictive value in the improvement of flow-mediated dilation after aortic valve replacement for aortic stenosis. Heart Vessels 2014; 30:218-26. [DOI: 10.1007/s00380-014-0475-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/17/2014] [Indexed: 11/24/2022]
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22
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Teixeira R, Moreira N, Baptista R, Barbosa A, Martins R, Castro G, Providencia L. Circumferential ascending aortic strain and aortic stenosis. Eur Heart J Cardiovasc Imaging 2012; 14:631-41. [DOI: 10.1093/ehjci/jes221] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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