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Gutierrez-Ortiz E, Olmos C, Carrión-Sanchez I, Jiménez-Quevedo P, Nombela-Franco L, Párraga R, Gil-Abizanda S, Mahía P, Luaces M, de Agustín JA, Islas F. Redefining cardiac damage staging in aortic stenosis: the value of GLS and RVAc. Eur Heart J Cardiovasc Imaging 2023; 24:1608-1617. [PMID: 37315235 DOI: 10.1093/ehjci/jead140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/30/2023] [Accepted: 06/02/2023] [Indexed: 06/16/2023] Open
Abstract
AIMS Cardiac damage staging has been postulated as a prognostic tool in patients undergoing transcatheter aortic valve replacement (TAVR). The aims of our study are (i) to validate cardiac damage staging systems previously described to stratify patients with aortic stenosis (AS), (ii) to identify independent risk factors for 1-year mortality in patients with severe AS undergoing TAVR, and (iii) to develop a novel staging model and compare its predictive performance to that of the above mentioned. METHODS AND RESULTS Patients undergoing TAVR from 2017 to 2021 were included in a single-centre prospective registry. Transthoracic echocardiography was performed in all patients before TAVR. Logistic and Cox's regression analysis were used to identify predictors of 1-year all-cause mortality. In addition, patients were classified based on previously published cardiac damage staging systems, and the predictive performance of the different scores was measured.Four hundred and ninety-six patients (mean age 82.1 ± 5.9 years, 53% female) were included. Mitral regurgitation (MR), left ventricle global longitudinal strain (LV-GLS) and right ventricular-arterial coupling (RVAc) were independent predictors of all-cause 1-year mortality. A new classification system with four different stages was developed using LV-GLS, MR, and RVAc. The area under the receiver operating characteristic curve was 0.66 (95% confidence interval 0.63-0.76), and its predictive performance was superior compared with the previously published systems (P < 0.001). CONCLUSION Cardiac damage staging might have an important role in patients' selection and better timing for TAVR. A model that includes LV-GLS, MR, and RVAc may help to improve prognostic stratification and contribute to better selection of patients undergoing TAVR.
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Affiliation(s)
- Eva Gutierrez-Ortiz
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Irene Carrión-Sanchez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Pilar Jiménez-Quevedo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Rocío Párraga
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Sandra Gil-Abizanda
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Patricia Mahía
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - María Luaces
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - José Alberto de Agustín
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
| | - Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdSSC), Calle Profesor Martín Lagos S/N, Madrid 28040, Spain
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Atoe-Imagbe OM, Azzu A, Aiwuyo HO, Osarenkhoe JO. Challenging Decision-Making Between Transcatheter Aortic Valve Implantation and Aortic Valve Surgery: A Case of a Jehovah's Witness Patient With Severe Symptomatic Aortic Stenosis Coexisting With Severe Mitral Regurgitation and Bicuspid Aortic Valve. Cureus 2023; 15:e34973. [PMID: 36938227 PMCID: PMC10019555 DOI: 10.7759/cureus.34973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
A 73-year-old Jehovah's witness man with a bicuspid aortic valve and a history of epilepsy presented to the emergency room with chest pain and dyspnea. Echocardiography revealed normal left ventricular systolic function, but also revealed severe aortic stenosis and severe mitral regurgitation. Coronary angiography and computerized tomography angiography ruled out any significant coronary artery disease and aortic dissection, respectively. In view of his religious views, transcatheter aortic valve implantation was considered more suitable than aortic valve surgery and was successful with a stable postoperative state. This case reaffirms that autonomy should be maintained while considering the best interest of patients in decision-making.
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Affiliation(s)
- Osagioduwa Mike Atoe-Imagbe
- Medicine, Delta State University Teaching Hospital, Oghara, NGA
- Medicine, Betsi Cadwaladr University Health Board, Bangor, GBR
| | | | - Henry O Aiwuyo
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - John O Osarenkhoe
- Medicine and Surgery, Igbinedion University Teaching Hospital, Benin City, NGA
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Balloon aortic valvuloplasty in high-risk patients: when the going gets tough, the tough get going. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2022; 18:189-191. [PMID: 36751278 PMCID: PMC9885238 DOI: 10.5114/aic.2022.123298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
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Hahn RT, Pibarot P, Otto CM. Transcatheter interventions spark a paradigm change for management of patients with mixed valve disease. Eur Heart J 2022; 43:2767-2769. [PMID: 35653690 DOI: 10.1093/eurheartj/ehac229] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Rebecca T Hahn
- Department of Cardiology, Columbia University Medical Center/NY Presbyterian Hospital, New York, NY, USA
| | - Philippe Pibarot
- Department of Medicine, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ) - Université Laval, Canada
| | - Catherine M Otto
- Division of Cardiology, University of Washington School of Medicine, Seattle, WA, USA
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