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De Colle C, Paolisso P, Gallinoro E, Bertolone DT, Mileva N, Fabbricatore D, Valeriano C, Herman R, Beles M, De Oliveira EK, Mancusi C, Heggermont W, Collet C, Vanderheyden M, De Luca N, Van Camp G, Barbato E, Bartunek J, Penicka M. Association of Mild-to-Moderate Aortic Regurgitation With Outcomes in Heart Failure With Preserved Ejection Fraction. Mayo Clin Proc 2023; 98:1469-1481. [PMID: 37793725 DOI: 10.1016/j.mayocp.2023.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE To assess aortic regurgitation (AR) prevalence, its hemodynamic effect, and long-term prognostic implications in patients admitted with de novo or worsened heart failure with preserved ejection fraction (HFpEF). METHODS Consecutive patients hospitalized with de novo or worsened HFpEF between 2014 and 2020 were enrolled. Patients with more than moderate aortic and/or mitral valve disease were excluded. Based on the presence and degree of AR, patients were divided into those without AR, those with mild, and those with moderate AR. Data on cardiovascular death, heart failure (HF) rehospitalization, and their composite (major adverse cardiovascular events) were collected. RESULTS The final study population consisted of 458 HFpEF patients: 156 (34.1%) with mild-AR, 153 (33.4%) with moderate-AR, and the remaining 149 (32.5%) with no AR. Mild-to-moderate AR patients were older, with larger left atrium-left ventricle (LV) volumes, greater LV mass index, higher filling pressure, and prevalence of diastolic dysfunction compared with the no-AR group (all P<.05). During 5-year follow-up, 113 patients died of cardiovascular causes, 124 patients were rehospitalized for HF, whereas 196 experienced the composite endpoint. Mild-to-moderate AR was identified as an independent predictor of all-cause death (HR, 1.62; 95% CI, 1.14 to 1.58; P=.04) and major adverse cardiovascular event occurrence (HR, 1.48; 95% CI, 1.05 to 2.09; P=.02). A total of 126 (35.5%) of 355 patients showed progression of AR at follow-up echocardiography. CONCLUSION Mild-to-moderate AR is common among patients hospitalized for HFpEF. It is associated with adverse LV remodeling and worse long-term outcomes. These findings warrant further prospective studies addressing the importance of AR in prognostic stratification and exploring therapeutic strategies to mitigate its hemodynamic effect on HF.
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Affiliation(s)
- Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Dario Tino Bertolone
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Cardiology Clinic, Alexandrovska University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Robert Herman
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Monika Beles
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | | | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
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Hwang JW, Kim DG, Kim H, Kwak JJ, Cho SW, Bae DM, Shin YC, Doh JH, Kwon SU, Namgung J, Lee SY. Impact of chronic kidney disease on clinical outcomes in patients with Stage B progressive aortic regurgitation (mild to moderate and moderate grades). Clin Cardiol 2022; 45:391-400. [PMID: 35170778 PMCID: PMC9019887 DOI: 10.1002/clc.23792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/24/2022] [Accepted: 01/27/2022] [Indexed: 11/18/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a significant comorbidity in patients with heart failure and valvular heart disease. Renal impairment is not well evaluated in the patients with Stage B progressive aortic regurgitation (AR) (mild to moderate and moderate grades in this study), for estimating outcome. Hypothesis We sought to investigate the prognostic factor, especially CKD, in the patients with progressive AR. Methods We enrolled 262 patients with Stage B progressive AR and preserved left ventricular systolic function (ejection fraction ≥ 50%). Based on the presence of CKD, the patients were divided into CKD (n = 70) and non‐CKD (n = 192) groups, which CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2. The primary outcome was major adverse cardiac events (MACEs), including cardiac death, myocardial infarction, hospitalization for heart failure, and aortic valve replacement. Results The median follow‐up duration was 41.5 (interquartile range: 16.2–71.7) months. Between groups, the CKD patients were older; they had a higher pulse pressure and higher incidence of hypertension, diabetes mellitus, dyslipidemia, cerebrovascular accident, and atrial fibrillation. Compared to the non‐CKD group, the CKD group had lower eʹ velocity (4.36 ± 2.21 vs. 5.20 ± 2.30 cm/s, p = .009), higher right ventricular systolic pressure (38.02 ± 15.79 vs. 33.86 ± 11.77 mmHg, p = .047). The CKD group was associated with increased risk of MACEs (41.4% vs. 22.4%; unadjusted hazard ratio [HR]: 1.78, 95% confidence interval [CI]: 1.11–2.85, p = .017). In multivariate Cox regression analyses, the risk of MACEs was significantly different between groups (adjusted HR: 1.71, 95% CI: 1.11–2.62, p = .015); furthermore, the risk of hospitalization for heart failure (10.0% vs. 2.6%; adjusted HR: 2.30, 95% CI: 1.16–4.55, p = .017) was significantly higher in the CKD group than in the non‐CKD group. Conclusions In patients with Stage B progressive AR, CKD is an independent prognostic factor for clinical outcomes (composite clinical outcome, hospitalization for heart failure). Chronic kidney disease is a known comorbidity for valvular heart disease. We investigated that chronic kidney disease was an independent prognostic factor for clinical outcomes (composite clinical outcome and hospitalization for heart failure) in patients with Stage B progressive aortic regurgitation. Although Stage B progressive aortic regurgitation should be carefully monitored in all patients by guideline, special attention should be paid to patients with pre‐existing chronic kidney disease.
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Affiliation(s)
- Ji-Won Hwang
- Department of Internal Medicine, Division of Cardiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Dong-Gil Kim
- Department of Internal Medicine, Division of Cardiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Hakju Kim
- Department of Thoracic and Cardiovascular Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Jae-Jin Kwak
- Department of Internal Medicine, Division of Cardiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Sung Woo Cho
- Department of Internal Medicine, Division of Cardiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Da Mi Bae
- Department of Internal Medicine, Division of Cardiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Yoon Cheol Shin
- Department of Thoracic and Cardiovascular Surgery, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Joon Hyung Doh
- Department of Internal Medicine, Division of Cardiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Sung Uk Kwon
- Department of Internal Medicine, Division of Cardiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - June Namgung
- Department of Internal Medicine, Division of Cardiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Sung Yun Lee
- Department of Internal Medicine, Division of Cardiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
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The Evolving Epidemiology of Elderly with Degenerative Valvular Heart Disease: The Guangzhou (China) Heart Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9982569. [PMID: 33981773 PMCID: PMC8088353 DOI: 10.1155/2021/9982569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/13/2021] [Indexed: 12/01/2022]
Abstract
Aim The present study was aimed at investigating the prevalence, incidence, progression, and prognosis of degenerative valvular heart disease (DVHD) in permanent residents aged ≥65 years from Guangzhou, China. Methods This was a prospective study based on community population. Over a 3-year span, we conducted repeated questionnaires, blood tests, and echocardiographic and electrocardiogram examinations (2018) of a random sample of initially 3538 subjects. Results The prevalence of DVHD increased with age, average values being 30.6%, 49.2%, and 62.9% in 65-74, 75-84, and ≥85 years of age, respectively. The incidence rate was 1.7%/year. Aortic stenosis was the result of DVHD, and the mean transvalvular pressure gradient increased by 5.6 mmHg/year. The increase of mild aortic stenosis was lower than that of more severe disease, showing a nonlinear development of gradient, but with great individual variations. Mortality was significantly increased in the DVHD group (HR = 2.49). Risk factors for higher mortality included age (χ2 = 1.9, P < 0.05), renal insufficiency (χ2 = 12.5, P < 0.01), atrial fibrillation (χ2 = 12.2, P < 0.01), mitral regurgitation (χ2 = 1.8, P < 0.05), and tricuspid regurgitation (χ2 = 6.7, P < 0.05) in a DVHD population. Conclusions DVHD was highly prevalent among residents in southern China. With the progression of the disease, the mean transvalvular pressure gradient accelerated. DVHD was an independent predictor of death, and the mortality was higher in those with older age, renal insufficiency, atrial fibrillation, mitral regurgitation, and tricuspid regurgitation.
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Abdurashidova T, Monney P, Tzimas G, Soborun N, Regamey J, Daux A, Barras N, Kirsch M, Müller M, Hullin R. Non-severe aortic regurgitation increases short-term mortality in acute heart failure with preserved ejection fraction. ESC Heart Fail 2020; 7:3901-3909. [PMID: 33026164 PMCID: PMC7754983 DOI: 10.1002/ehf2.12983] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/15/2020] [Accepted: 08/13/2020] [Indexed: 12/26/2022] Open
Abstract
AIMS Mild or moderate aortic regurgitation (AR) has only little effect on cardiovascular outcome in people with normal left ventricular ejection fraction (EF); therefore, it is not perceived as a major clinical problem. This study investigates whether mild or moderate AR is associated with increased short-term mortality in patients hospitalized for treatment of acute heart failure (AHF) and whether mild or moderate AR impacts differently on short-term mortality in AHF patients with reduced EF (AHFrEF), mid-range EF (AHFmrEF), or preserved EF (AHFpEF). METHODS AND RESULTS This mono-centric study included 505 consecutive adult patients hospitalized for de novo or worsening chronic HF not related to acute ischaemia or severe valvular pathology in the echocardiogram at index hospitalization. Cox regression analysis studied the impact of AR on all-cause mortality (ACM) over the 150 days' study period. Mild or moderate AR was associated with increased ACM (HR 1.75 [95% CI: 1.1-2.7]; P = 0.009). The prevalence of mild or moderate AR in the study population was 42% and not significantly different between AHFpEF (n = 227), AHFmrEF (n = 86), and AHFrEF (n = 192) study participants (37.9% vs. 50.0% vs. 42.7%; P = 0.144). In AHFpEF patients, the age-adjusted hazard for ACM was increased in patients with AR compared with patients without AR (HR 2.17 [95% CI: 1.1-4.2]; P = 0.002). The age-adjusted hazard for ACM was increased by a trend in AHFmrEF with AR (HR 7.11, [95% CI: 0.9-57.8]; P = 0.067) and not different between the AHFrEF groups (HR 0.95 [95% CI: 0.5-1.8]; P = 0.875). CONCLUSIONS Mild or moderate AR increased ACM only in AHFpEF patients, highlighting a distinct clinical relevance.
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Affiliation(s)
- Tamila Abdurashidova
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Pierre Monney
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Georgios Tzimas
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Nisha Soborun
- Cardiac Surgery, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Julien Regamey
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Aurelien Daux
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Nicolas Barras
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Matthias Kirsch
- Cardiac Surgery, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
| | - Martin Müller
- Department of Emergency Medicine, InselspitalUniversity Hospital Bern and University of BernBernSwitzerland
| | - Roger Hullin
- Cardiology, Cardiovascular DepartmentLausanne University HospitalRue du Bugnon 46LausanneSwitzerland
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Ghamrawy A, Ibrahim NN, Abd El-Wahab EW. How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018). PLoS Negl Trop Dis 2020; 14:e0008558. [PMID: 32804953 PMCID: PMC7451991 DOI: 10.1371/journal.pntd.0008558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/27/2020] [Accepted: 07/02/2020] [Indexed: 01/10/2023] Open
Abstract
Rheumatic heart disease (RHD) as a chronic sequela of repeated episodes of acute rheumatic fever (ARF), remains a cause of cardiac morbidity in Egypt although it is given full attention through a national RHD prevention and control program. The present report reviews our experience with subjects presenting with ARF or its sequelae in a single RHD centre and describes the disease pattern over the last decade. A cross-sectional study was conducted in El-Mahalla RHD centre between 2006 and 2018. A total of 17014 individual were enrolled and evaluated. Diagnosis ARF was based on the 2015 revised Jones criteria and RHD was ruled in by echocardiography. The majority of the screened subjects were female (63.2%), in the age group 5-15 years (64.6%), rural residents (61.2%), had primary education (43.0%), and of low socioeconomic standard (50.2%). The total percentage of cases presenting with ARF sequelae was 29.3% [carditis/RHD (10.8%), rheumatic arthritis (Rh.A) (14.9%), and Sydenham's chorea (0.05%)]. Noticeably, 72% were free of any cardiac insult, of which 37.7% were victims of misdiagnoses made elsewhere by untrained practitioners who prescribed for them long term injectable long-acting penicillin [Benzathine Penicillin G (BPG)] without need. About 54% of the study cohort reported the occurrence of recurrent attacks of tonsillitis of which 65.2% underwent tonsillectomy. Among those who experienced tonsillectomy and/or received BPG in the past, 14.5% and 22.3% respectively had eventually developed RHD. Screening of family members of some RHD cases who needed cardiac surgery revealed 20.7% with undiagnosed ARF sequalae [RHD (56.0%) and Rh.A (52.2%)]. Upon the follow-up of RHD cases, 1.2% had improved, 98.4% were stable and 0.4% had their heart condition deteriorated. Misdiagnosis of ARF or its sequelae and poor compliance with BPG use may affect efforts being exerted to curtail the disease. Updating national guidelines, capacity building, and reliance on appropriate investigations should be emphasized. Since the genetic basis of RHD is literally confirmed, a family history of RHD warrants screening of all family members for early detection of the disease.
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Affiliation(s)
- Alaa Ghamrawy
- Department of Non-Communicable Diseases, Ministry of Health and Population, Cairo, Egypt
| | - Nermeen N. Ibrahim
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ekram W. Abd El-Wahab
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
- * E-mail:
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Vanoverschelde JL, Vancraeynest D. Progression of Aortic Regurgitation: The Missing Link Between Disease Severity and Clinical Complications. J Am Coll Cardiol 2019; 74:2493-2495. [PMID: 31727287 DOI: 10.1016/j.jacc.2019.08.1059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Jean-Louis Vanoverschelde
- Pôle de Recherche Cardiovasculaire, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - David Vancraeynest
- Pôle de Recherche Cardiovasculaire, Université Catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Gomes B, Hees K, Hund H, Mereles D, Meder B, Katus HA, Bekeredjian R. Prevalence and relevance of impaired left ventricular function in chronic moderate regurgitation of native aortic valves. Acta Cardiol 2019; 75:613-620. [PMID: 31311434 DOI: 10.1080/00015385.2019.1639964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Reduced ejection fraction (EF) in chronic moderate aortic regurgitation (AR) could be either due to a late remodelling response after longstanding moderate AR, or could represent a specific phenotype of cardiomyopathy (CMP) with concomitant AR. The aim of this study was to analyse progression of left ventricular (LV) impairment in moderate AR. Methods: All patients in our echocardiography database between 2005 and 2016 were screened to identify pure chronic moderate AR, excluding significant coronary artery disease (CAD) or concomitant valve disease. Remaining 152 patients were divided into three groups: (a) preserved systolic LV function; (b) reduced LV EF and prediagnosed concomitant cardiomyopathy (CMP); (c) reduced LV EF without prediagnosed CMP. Results: The majority patients (group A = 66%) had preserved systolic LV function, remaining oligosymptomatic with stable LVEDD at follow-up. Non-CMP patients with reduced EF at baseline (group C = 18%) were significantly older (group C: 74 vs. group A: 61 years, p < .001) whereas left ventricular end-diastolic diameter (LVEDD) significantly increased over time (p = .046). Development of renal insufficiency, atrial fibrillation and NYHA > II were significant risk factors linked to the worsening of LV function in patients with moderate AR. Conclusion: Preserved LV EF and LVEDD remain stable over a long lasting period in the majority of patients. However, these data suggest that some patients develop reduced LV EF, even without progression of AR to severe, especially if renal insufficiency or atrial fibrillation are present.
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Affiliation(s)
- Bruna Gomes
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Katharina Hees
- b Institute of Medical Biometry and Informatics , University of Heidelberg , Heidelberg , Germany
| | - Hauke Hund
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Derliz Mereles
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Benjamin Meder
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Hugo A Katus
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany
| | - Raffi Bekeredjian
- a Department of Internal Medicine III , University of Heidelberg , Heidelberg , Germany.,c Department of Cardiology , Robert-Bosch Hospital , Stuttgart , Germany
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