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Molenaar MA, Bouma BJ, Coerkamp CF, Man JP, Išgum I, Verouden NJ, Selder JL, Chamuleau SAJ, Schuuring MJ. The impact of valvular heart disease in patients with chronic coronary syndrome. Front Cardiovasc Med 2023; 10:1211322. [PMID: 37547247 PMCID: PMC10401435 DOI: 10.3389/fcvm.2023.1211322] [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: 04/24/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Background The European Society of Cardiology 2019 Guidelines on chronic coronary syndrome (CCS) recommend echocardiographic measurement of the left ventricular function for risk stratification in all patients with CCS. Whereas CCS and valvular heart disease (VHD) share common pathophysiological pathways and risk factors, data on the impact of VHD in CCS patients are scarce. Methods Clinical data including treatment and mortality of patients diagnosed with CCS who underwent comprehensive transthoracic echocardiography (TTE) in two tertiary centers were collected. The outcome was all-cause mortality. Data were analyzed with Kaplan-Meier curves and Cox proportional hazard analysis adjusting for significant covariables and time-dependent treatment. Results Between 2014 and 2021 a total of 1,984 patients with CCS (59% men) with a median age of 65 years (interquartile range [IQR] 57-73) underwent comprehensive TTE. Severe VHD was present in 44 patients and moderate VHD in 325 patients. A total of 654 patients (33%) were treated with revascularization, 39 patients (2%) received valve repair or replacement and 299 patients (15%) died during the median follow-up time of 3.5 years (IQR 1.7-5.6). Moderate or severe VHD (hazard ratio = 1.33; 95% CI 1.02-1.72) was significantly associated with mortality risk, independent of LV function and other covariables, as compared to no/mild VHD. Conclusions VHD has a significant impact on mortality in patients with CCS additional to LV dysfunction, which emphasizes the need for a comprehensive echocardiographic assessment in these patients.
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Affiliation(s)
- Mitchel A. Molenaar
- Department of Cardiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Berto J. Bouma
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Casper F. Coerkamp
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Jelle P. Man
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Ivana Išgum
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
| | - Niels J. Verouden
- Department of Cardiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Jasper L. Selder
- Department of Cardiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Steven A. J. Chamuleau
- Department of Cardiology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
| | - Mark J. Schuuring
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
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Blanken CPS, Westenberg JJM, Aben JP, Bijvoet GP, Chamuleau SAJ, Boekholdt SM, Nederveen AJ, Leiner T, van Ooij P, Planken RN. Quantification of Mitral Valve Regurgitation from 4D Flow MRI Using Semiautomated Flow Tracking. Radiol Cardiothorac Imaging 2020; 2:e200004. [PMID: 33778618 DOI: 10.1148/ryct.2020200004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 11/11/2022]
Abstract
Purpose To compare the accuracy of semiautomated flow tracking with that of semiautomated valve tracking in the quantification of mitral valve (MV) regurgitation from clinical four-dimensional (4D) flow MRI data obtained in patients with mild, moderate, or severe MV regurgitation. Materials and Methods The 4D flow MRI data were retrospectively collected from 30 patients (21 men; mean age, 61 years ± 10 [standard deviation]) who underwent 4D flow MRI from 2006 to 2016. Ten patients had mild MV regurgitation, nine had moderate MV regurgitation, and 11 had severe MV regurgitation, as diagnosed by using semiquantitative echocardiography. The regurgitant volume (Rvol) across the MV was obtained using three methods: indirect quantification of Rvol (RvolINDIRECT), semiautomated quantification of Rvol using valve tracking (RvolVALVE), and semiautomated quantification of Rvol using flow tracking (RvolFLOW). A second observer repeated the measurements. Aortic valve flow was quantified as well to test for intervalve consistency. The Wilcoxon signed rank test, orthogonal regression, Bland-Altman analysis, and coefficients of variation were used to assess agreement among measurements and between observers. Results RvolFLOW was higher (median, 24.8 mL; interquartile range [IQR], 14.3-45.7 mL) than RvolVALVE (median, 9.9 mL; IQR, 6.0-16.9 mL; P < .001). Both RvolFLOW and RvolVALVE differed significantly from RvolINDIRECT (median, 19.1 mL; IQR, 4.1-47.5 mL; P = .03). RvolFLOW agreed more with RvolINDIRECT (ŷ = 0.78x + 12, r = 0.88) than with RvolVALVE (ŷ = 0.16x + 8.1, r = 0.53). Bland-Altman analysis revealed underestimation of RvolVALVE in severe MV regurgitation. Interobserver agreement was excellent for RvolFLOW (r = 0.95, coefficient of variation = 27%) and moderate for RvolVALVE (r = 0.72, coefficient of variation = 57%). Orthogonal regression demonstrated better intervalve consistency for flow tracking (ŷ = 1.2x - 13.4, r = 0.82) than for valve tracking (ŷ = 2.7x - 92.4, r = 0.67). Conclusion Flow tracking enables more accurate 4D flow MRI-derived MV regurgitation quantification than valve tracking in terms of agreement with indirect quantification and intervalve consistency, particularly in severe MV regurgitation.Supplemental material is available for this article.© RSNA, 2020.
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Affiliation(s)
- Carmen P S Blanken
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jos J M Westenberg
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jean-Paul Aben
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geertruida P Bijvoet
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Steven A J Chamuleau
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - S Matthijs Boekholdt
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Aart J Nederveen
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tim Leiner
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pim van Ooij
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - R Nils Planken
- Departments of Radiology and Nuclear Medicine (C.P.S.B., A.J.N., P.v.O., R.N.P.) and Cardiology (S.M.B.), Amsterdam University Medical Centers, Location Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (J.J.M.W.); Department of Research and Development, Pie Medical Imaging BV, Maastricht, the Netherlands (J.P.A.); and Departments of Cardiology (G.P.B., S.A.J.C.) and Radiology (T.L.), University Medical Center Utrecht, Utrecht, the Netherlands
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Jansen R, Wind AM, Cramer MJ, Nijhoff F, Agostoni P, Ramjankhan FZ, Suyker WJ, Stella PR, Chamuleau SAJ. Evaluation of mitral regurgitation by an integrated 2D echocardiographic approach in patients undergoing transcatheter aortic valve replacement. Int J Cardiovasc Imaging 2018. [PMID: 29524077 DOI: 10.1007/s10554-018-1328-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to evaluate mitral regurgitation (MR) severity in patients undergoing transcatheter aortic valve replacement (TAVR) by standardized assessment of two-dimensional (2D) transthoracic echocardiography (TTE) and 1-year echocardiographic and clinical outcomes. Pre- and post-procedural TTE's of patients undergoing TAVR between 2008 and 2014 were analyzed. MR was graded according to current guidelines with a systematic and integrated approach. Longitudinal echocardiographic and clinical results were analyzed. Regression analysis was performed for change in MR grade at follow-up, using pre-determined variables and confounders. Pre- and post-procedural TTE were available in 213 subjects. Significant MR was seen in 22% at baseline and 15% at follow-up; MR grade ≥ 3 in < 10%. Severity did not change in 61%, and decreased in 20% of the patients. Overall, the prevalence of MR grades pre- and post TAVR was not significantly different, nor influenced by MR etiology or TAVR prosthesis type. However, higher MR grades and pacemaker absence at baseline, were independently correlated to more improvement of MR after TAVR. Regarding clinical outcomes, NYHA class improved in two-thirds of the patients, irrespective of the baseline MR grade. Overall survival was not significantly different amongst MR grades post-TAVR. MR grading using an systematic 2D echocardiographic approach in patients undergoing TAVR is feasible in clinical practice. Our data revealed a relatively frequent prevalence of significant MR (although grade ≥ 3 was scarce), overall no change in the MR grade at 1 year follow-up, improvement of functional NYHA class, and no significant differences in long-term survival amongst the post-TAVR MR grades.
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Affiliation(s)
- R Jansen
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - A M Wind
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - M J Cramer
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - F Nijhoff
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P Agostoni
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W J Suyker
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - S A J Chamuleau
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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