1
|
Bohbot Y, Hucleux E, Rusinaru D, Diouf M, Levy F, Altes A, Maréchaux S, Tribouilloy C. Right Ventricle to Pulmonary Artery Coupling in Severe Aortic Stenosis With Preserved Ejection Fraction. JACC Cardiovasc Imaging 2024; 17:220-222. [PMID: 37855799 DOI: 10.1016/j.jcmg.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 10/20/2023]
|
2
|
Candellier A, Bohbot Y, Pasquet A, Diouf M, Vermes E, Goffin E, Gun M, Peugnet F, Hénaut L, Rusinaru D, Mentaverri R, Kamel S, Choukroun G, Vanoverschelde JL, Tribouilloy C. Chronic kidney disease is a key risk factor for aortic stenosis progression. Nephrol Dial Transplant 2023; 38:2776-2785. [PMID: 37248048 PMCID: PMC10689189 DOI: 10.1093/ndt/gfad116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Rapid progression of aortic stenosis (AS) has been observed in patients undergoing dialysis, but existing cross-sectional evidence is contradictory in non-dialysis-dependent chronic kidney disease (CKD). The present study sought to evaluate whether CKD is associated with the progression of AS over time in a large cohort of patients with AS. METHODS We retrospectively studied all consecutive patients diagnosed with AS [peak aortic jet velocity (Vmax) ≥2.5 m/s] and left ventricular ejection fraction ≥50% in the echocardiography laboratories of two tertiary centers between 2000 and 2018. The estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2) was calculated from serum creatinine values. Patients were divided into five CKD stages according to the baseline eGFR. Annual rates of change in the aortic valve area (AVA) were determined by a linear mixed-effects model. RESULTS Among the 647 patients included, 261 (40%) had CKD. After a median follow-up of 2.9 (interquartile range 1.8-4.8) years, the mean overall rate of change in AVA was -0.077 (95% confidence interval -0.082; -0.073) cm2/year. There was an inverse relationship between the progression rate and kidney function. The more severe the CKD stage, the greater the AVA narrowing (P < .001). By multivariable linear regression analysis, the eGFR was also negatively associated (P < .001) with AS progression. An eGFR strata below 45 mL/min/1.73 m2 was associated with higher odds of rapid progression of AS than normal kidney function. During the clinical follow-up, event-free survival (patients free of aortic valve replacement or death) decreased as CKD progressed. Rapid progression of AS in patients with kidney dysfunction was associated with worse outcomes. CONCLUSIONS Patients with CKD exhibit more rapid progression of AS over time and require close monitoring. The link between kidney dysfunction and rapid progression of AS is still unknown and requires further research.
Collapse
Affiliation(s)
- Alexandre Candellier
- Department of Nephrology Dialysis and Transplantation, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Yohann Bohbot
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Agnes Pasquet
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Department of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Momar Diouf
- Department of Clinical Research, Amiens University Hospital, Amiens, France
| | - Emmanuelle Vermes
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Eric Goffin
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Mesut Gun
- Department of Cardiology, Amiens University Hospital, Amiens, France
- Department of Clinical Research, Amiens University Hospital, Amiens, France
| | - Fanny Peugnet
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Lucie Hénaut
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Dan Rusinaru
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Romuald Mentaverri
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Department of Biochemistry, Amiens-Picardie University Hospital, Amiens, France
| | - Saïd Kamel
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Department of Biochemistry, Amiens-Picardie University Hospital, Amiens, France
| | - Gabriel Choukroun
- Department of Nephrology Dialysis and Transplantation, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Jean-Louis Vanoverschelde
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
- Department of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Christophe Tribouilloy
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
- Department of Cardiology, Amiens University Hospital, Amiens, France
| |
Collapse
|
3
|
Essayagh B, Benfari G, Antoine C, Grigioni F, Le Tourneau T, Roussel JC, Bax JJ, Marsan NA, van Wijngaarden A, Tribouilloy C, Rusinaru D, Hochstadt A, Topilsky Y, Thapa P, Michelena HI, Enriquez-Sarano M. Response by Essayagh et al to Letter Regarding Article, "The MIDA-Q Mortality Risk Score: A Quantitative Prognostic Tool for the Mitral Valve Prolapse Spectrum". Circulation 2023; 148:980-981. [PMID: 37721975 DOI: 10.1161/circulationaha.123.065630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Affiliation(s)
- Benjamin Essayagh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
- Division of Echocardiography, Cardio X Clinic, Cannes, France (B.E.)
| | - Giovanni Benfari
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
| | - Clemence Antoine
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
| | - Francesco Grigioni
- Department of Cardiology, University Campus Bio-Medico, Rome, Italy (F.G.)
| | | | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, he Netherlands (J.J.B., N.A.M., A.v.W.)
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, he Netherlands (J.J.B., N.A.M., A.v.W.)
| | - Aniek van Wijngaarden
- Department of Cardiology, Leiden University Medical Center, he Netherlands (J.J.B., N.A.M., A.v.W.)
| | | | - Dan Rusinaru
- Department of Cardiology, University of Amiens, France (C.T., D.R.)
| | - Aviram Hochstadt
- Heart Institute, Wolfson Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Israel (A.H.)
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Israel (Y.T.)
| | - Prabin Thapa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
| | - Hector I Michelena
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
| |
Collapse
|
4
|
Kubala M, Bohbot Y, Rusinaru D, Maréchaux S, Diouf M, Tribouilloy C. Atrial fibrillation in severe aortic stenosis: Prognostic value and results of aortic valve replacement. J Thorac Cardiovasc Surg 2023; 166:771-779. [PMID: 34937660 DOI: 10.1016/j.jtcvs.2021.11.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although atrial fibrillation (AF) is common, its impact on long-term mortality has not been reliably determined in patients with aortic stenosis (AS). We aimed to assess whether AF is associated with survival in patients with severe AS and to determine the impact of AF on the results of aortic valve replacement (AVR). METHODS The study included 1838 consecutive patients with severe AS (77 ± 11 years, male 47%). Upon AS diagnosis, patients were screened for AF using a 12-lead electrocardiogram. The treatment strategy (conservative management or AVR) was selected by the heart team in accordance with current guidelines. The effect of AVR on survival was analyzed as a time-dependent covariate using the entire follow-up period. RESULTS AF, diagnosed in 593 (32%) patients was associated with poor survival at 5 years (55 ± 2% vs 74 ± 1% for patients in sinus rhythm, P < .001), even after adjustment for established outcome predictors (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.33-1.84; P < .001). In patients with AF, AVR was associated with lower mortality (HR, 0.16; 95% CI, 0.12-0.22; P < .001) even in those with no or minimal symptoms (HR, 0.12; 95% CI, 0.08-0.20; P < .001). However, among patients who underwent AVR, those in AF had an excess mortality (HR, 1.59; 95% CI, 1.22-2.08; P < .001). CONCLUSIONS In severe AS, AF is a strong predictor of mortality even in asymptomatic or minimally symptomatic patients. After AVR, AF remains associated with poorer survival than sinus rhythm. In patients in AF, AVR is associated with lower mortality compared with conservative treatment. Further studies are needed to confirm the benefits of AVR in asymptomatic patients in AF with severe AS.
Collapse
Affiliation(s)
- Maciej Kubala
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Dan Rusinaru
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Sylvestre Maréchaux
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France; Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine, Université Lille Nord de France, Lille, France
| | - Momar Diouf
- Department of Clinical Research, Amiens University Hospital, Amiens, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France.
| |
Collapse
|
5
|
Bohbot Y, Coisne A, Altes A, Levy F, Di Lena C, Aghezzaf S, Maréchaux S, Rusinaru D, Tribouilloy C. Is "moderate" aortic stenosis still the right name? A review of the literature. Arch Cardiovasc Dis 2023; 116:411-418. [PMID: 37230916 DOI: 10.1016/j.acvd.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023]
Abstract
Current guidelines recommend aortic valve replacement for symptomatic or selected asymptomatic high-risk patients with severe aortic stenosis. Conversely, a watchful waiting attitude applies to patients with moderate aortic stenosis, regardless of their risk profile and symptoms, until the echocardiographic thresholds of severe aortic stenosis are reached. This strategy is based on data reporting high mortality in untreated severe symptomatic aortic stenosis, whereas moderate aortic stenosis has always been perceived as a non-threatening condition, with a benefit-risk balance against surgery. Meanwhile, numerous studies have reported a worrying event rate in these patients, surgical techniques and outcomes have improved significantly and the use of transcatheter aortic valve replacement has become more widespread and extended to lower-risk patients, leaving this strategy open to question, especially for patients with moderate aortic stenosis and left ventricular dysfunction. In this review, we summarize the current state of knowledge about moderate aortic stenosis progression and prognosis. We also discuss the particular case of moderate aortic stenosis associated with left ventricular dysfunction, and the ongoing trials that that might change our paradigm for the management of this "moderate" valvular heart disease.
Collapse
Affiliation(s)
- Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, 80054 Amiens, France; UR UPJV 7517, Jules-Verne University of Picardie, 80054 Amiens, France.
| | - Augustin Coisne
- Lille catholic hospitals, Heart valve center, cardiology deparment, ETHICS EA, 7446, Lille Catholic University, France; Cardiovascular Research Foundation, New York, NY 10019, USA
| | - Alexandre Altes
- Department of Cardiology, Heart Valve Centre, Lille Catholic University Hospital, 59400 Lille, France
| | - Franck Levy
- Department of Cardiology, Centre Cardiothoracique de Monaco, 98000 Monaco, Monaco
| | - Chloé Di Lena
- Department of Cardiology, Amiens University Hospital, 80054 Amiens, France
| | - Samy Aghezzaf
- Lille catholic hospitals, Heart valve center, cardiology deparment, ETHICS EA, 7446, Lille Catholic University, France
| | - Sylvestre Maréchaux
- UR UPJV 7517, Jules-Verne University of Picardie, 80054 Amiens, France; Department of Cardiology, Heart Valve Centre, Lille Catholic University Hospital, 59400 Lille, France
| | - Dan Rusinaru
- Department of Cardiology, Amiens University Hospital, 80054 Amiens, France; UR UPJV 7517, Jules-Verne University of Picardie, 80054 Amiens, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, 80054 Amiens, France; UR UPJV 7517, Jules-Verne University of Picardie, 80054 Amiens, France
| |
Collapse
|
6
|
Essayagh B, Benfari G, Antoine C, Grigioni F, Le Tourneau T, Roussel JC, Bax JJ, Delgado V, Ajmone Marsan N, van Wijngaarden A, Tribouilloy C, Rusinaru D, Hochstadt A, Topilsky Y, Thapa P, Michelena HI, Enriquez-Sarano M. The MIDA-Q Mortality Risk Score: A Quantitative Prognostic Tool for the Mitral Valve Prolapse Spectrum. Circulation 2023; 147:798-811. [PMID: 36573420 DOI: 10.1161/circulationaha.122.062612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/06/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Mitral valve prolapse (MVP) is responsible for a considerable disease burden but is widely heterogeneous. The lack of a comprehensive prognostic instrument covering the entire MVP spectrum, encompassing the quantified consequent degenerative mitral regurgitation (DMR), hinders clinical management and therapeutic trials. METHODS The new Mitral Regurgitation International Database Quantitative (MIDA-Q) registry enrolled 8187 consecutive patients (ages 63±16 years, 47% women, follow-up 5.5±3.3 years) first diagnosed with isolated MVP, without or with DMR quantified prospectively (measuring effective regurgitant orifice [ERO] and regurgitant volume) in routine practice of 5 tertiary care centers from North America, Europe, and the Middle East. The MIDA-Q score ranges from 0 to 15 by accumulating guideline-based risk factors and DMR severity. Long-term survival under medical management was the primary outcome end point. RESULTS MVP was associated with DMR absent/mild (ERO <20 mm2) in 50%, moderate (ERO 20-40 mm2) in 25%, and severe or higher (ERO ≥40 mm2) in 25%, with mean ERO 24±24 mm2, regurgitant volume 37±35 mL. Median MIDA-Q score was 4 with a wide distribution (10%-90% range, 0-9). MIDA-Q score was higher in patients with EuroScore II ≥1% versus <1% (median, 7 versus 3; P < 0.0001) but with wide overlap (10%-90% range, 4-11 versus 0-7) and mediocre correlation (R2 0.18). Five-year survival under medical management was strongly associated with MIDA-Q score, 97±1% with score 0, 95±1% with score 1 to 2, 82±1% with score 3 to 4, 67±1% with score 5 to 6, 60±1% with score 7 to 8, 44±1% with score 9 to 10, 35±1% with score 11 to 12, and 5±4% with MIDA-Q score ≥13, with hazard ratio 1.31 [1.29-1.33] per 1-point increment. Excess mortality with higher MIDA-Q scores persisted after adjustment for age, sex, and EuroScore II (adjusted hazard ratio, 1.13 [1.11-1.15] per 1-point increment). Subgroup analysis showed persistent association of MIDA-Q score with mortality in all possible subsets, in particular, with EuroScore II<1% (hazard ratio, 1.08 [1.02-1.14]) or ≥1% (hazard ratio, 1.11 [1.08-1.13]) and with no/mild DMR (hazard ratio, 1.14 [1.10-1.19]) or moderate/severe DMR (hazard ratio, 1.13 [1.10-1.16], all per 1-point increment with P<0.0001). Nested-model and bootstrapping analyses demonstrated incremental prognostic power of MIDA-Q score (all P<0.0001). CONCLUSIONS This large, international cohort of isolated MVP, with prospective DMR quantification in routine practice, demonstrates the wide range of risk factor accumulation and considerable heterogeneity of outcomes after MVP diagnosis. The MIDA-Q score is strongly, independently, and incrementally associated with long-term survival after MVP diagnosis, irrespective of presentation, and is therefore a crucial prognostic instrument for risk stratification, clinical trials, and management of patients diagnosed with all forms of MVP.
Collapse
Affiliation(s)
- Benjamin Essayagh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
- Division of Cardiovascular Diseases, Simone Veil Hospital, Cannes, France (B.E.)
| | - Giovanni Benfari
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
| | - Clemence Antoine
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
| | - Francesco Grigioni
- Department of Cardiology, University Campus Bio-Medico, Rome, Italy (F.G.)
| | | | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.J.B., V.D., N.A.M., A.v.W.)
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.J.B., V.D., N.A.M., A.v.W.)
- Heart Institute, Hospital University Germans Trias i Pujol, Badalona, Spain (V.D.)
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.J.B., V.D., N.A.M., A.v.W.)
| | - Aniek van Wijngaarden
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.J.B., V.D., N.A.M., A.v.W.)
| | | | - Dan Rusinaru
- Department of Cardiology, University of Amiens, France (C.T., D.R.)
| | - Aviram Hochstadt
- Heart Institute, Wolfson Medical Center and the Sackler Faculty of Medicine, Tel-Aviv University, Israel (A.H.)
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Israel (Y.T.)
| | - Prabin Thapa
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
| | - Hector I Michelena
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (B.E., G.B., C.A., P.T., H.I.M., M.E.-S.)
- Minneapolis Heart Institute, MN (M.E.-S.)
| |
Collapse
|
7
|
Butcher SC, Essayagh B, Steyerberg EW, Benfari G, Antoine C, Grigioni F, Le Tourneau T, Roussel JC, van Wijngaarden A, Marsan NA, Tribouilloy C, Rusinaru D, Hochstadt A, Topilsky Y, Michelena HI, Delgado V, Bax JJ, Enriquez-Sarano M. Factors influencing post-surgical survival in degenerative mitral regurgitation. Eur Heart J 2023; 44:871-881. [PMID: 36702625 DOI: 10.1093/eurheartj/ehad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 11/23/2022] [Accepted: 01/04/2023] [Indexed: 01/28/2023] Open
Abstract
AIMS Indications for surgery in patients with degenerative mitral regurgitation (DMR) are increasingly liberal in all clinical guidelines but the role of secondary outcome determinants (left atrial volume index ≥60 mL/m2, atrial fibrillation, pulmonary artery systolic pressure ≥50 mmHg and moderate to severe tricuspid regurgitation) and their impact on post-operative outcome remain disputed. Whether these secondary outcome markers are just reflective of the DMR severity or intrinsically affect survival after DMR surgery is uncertain and may have critical importance in the management of patients with DMR. To address these gaps of knowledge the present study gathered a large cohort of patients with quantified DMR, accounted for the number of secondary outcome markers and examined their independent impact on survival after surgical correction of the DMR. METHODS AND RESULTS The Mitral Regurgitation International DAtabase-Quantitative registry includes patients with isolated DMR from centres across North America, Europe, and the Middle East. Patient enrolment extended from January 2003 to January 2020. All patients undergoing mitral valve surgery within 1 year of registry enrolment were selected. A total of 2276 patients [65 (55-73) years, 32% male] across five centres met study eligibility criteria. Over a median follow-up of 5.6 (3.6 to 8.7) years, 278 patients (12.2%) died. In a comprehensive multivariable Cox regression model adjusted for age, EuroSCORE II, symptoms, left ventricular ejection fraction (LVEF), left ventricular end-systolic diameter (LV ESD) and DMR severity, the number of secondary outcome determinants was independently associated with post-operative all-cause mortality, with adjusted hazard ratios of 1.56 [95% confidence interval (CI): 1.11-2.20, P = 0.011], 1.78 (95% CI: 1.23-2.58, P = 0.002) and 2.58 (95% CI: 1.73-3.83, P < 0.0001) for patients with one, two, and three or four secondary outcome determinants, respectively. A model incorporating the number of secondary outcome determinants demonstrated a higher C-index and was significantly more concordant with post-operative mortality than models incorporating traditional Class I indications alone [the presence of symptoms (P = 0.0003), or LVEF ≤60% (P = 0.006), or LV ESD ≥40 mm (P = 0.014)], while there was no significant difference in concordance observed compared with a model that incorporated the number of Class I indications for surgery combined (P = 0.71). CONCLUSION In this large cohort of patients treated surgically for DMR, the presence and number of secondary outcome determinants was independently associated with post-surgical survival and demonstrated better outcome discrimination than traditional Class I indications for surgery. Randomised controlled trials are needed to determine if patients with severe DMR who demonstrate a cardiac phenotype with an increasing number of secondary outcome determinants would benefit from earlier surgery.
Collapse
Affiliation(s)
- Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.,Department of Cardiology, Royal Perth Hospital, Victoria Square, Perth WA 6000, Australia
| | - Benjamin Essayagh
- Mayo Clinic Cardiovascular Medicine, 200 First St. SW Rochester, MN 55905, USA.,Department of Cardiovascular Medicine, Simone Veil Hospital, 15 Avenue des Broussailles, Cannes 06400, France
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Giovanni Benfari
- Mayo Clinic Cardiovascular Medicine, 200 First St. SW Rochester, MN 55905, USA
| | - Clemence Antoine
- Mayo Clinic Cardiovascular Medicine, 200 First St. SW Rochester, MN 55905, USA
| | - Francesco Grigioni
- University Campus Bio-Medico, Department of Cardiology, Via Álvaro del Portillo, 200, 00128 Roma RM, Italy
| | - Thierry Le Tourneau
- University of Nantes, Department of Cardiology, CHU de Nantes, 44093 Nantes, France
| | | | - Aniek van Wijngaarden
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands
| | - Christophe Tribouilloy
- University of Amiens, Department of Cardiology, Centre Hospitalier Universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Dan Rusinaru
- University of Amiens, Department of Cardiology, Centre Hospitalier Universitaire d'Amiens-Picardie, 80000 Amiens, France
| | - Aviram Hochstadt
- The Tel-Aviv Medical Center and Sackler Faculty of Medicine, Department of Cardiology, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Yan Topilsky
- The Tel-Aviv Medical Center and Sackler Faculty of Medicine, Department of Cardiology, 6 Weizmann Street, Tel Aviv 6423906, Israel
| | - Hector I Michelena
- Mayo Clinic Cardiovascular Medicine, 200 First St. SW Rochester, MN 55905, USA
| | - Victoria Delgado
- Department of Cardiology, Universtiy Hospital Germans Trias i Pujol, Carretera de Canyet, 08916 Badalona, Spain
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, Netherlands.,Turku Heart Center, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Maurice Enriquez-Sarano
- Mayo Clinic Cardiovascular Medicine, 200 First St. SW Rochester, MN 55905, USA.,Department of Cardiovascular Diseases, Minneapolis Heart Institute, Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA
| |
Collapse
|
8
|
CANDELLIER A, Bohbot Y, Pasquet A, Diouf M, Vermes E, Goffin E, Gun M, Peugnet F, Hénaut L, Rusinaru D, Mentaverri R, Kamel S, Choukroun G, Vanoverschelde J, Tribouilloy C. WCN23-0900 CHRONIC KIDNEY DISEASE IS A KEY RISK FACTOR FOR AORTIC STENOSIS PROGRESSION. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
|
9
|
Kubala M, Bohbot Y, Dromzee PH, Hermida A, Rusinaru D, Tribouilloy C. Effect of frailty on survival after cardiac resynchronization therapy. Arch Cardiovasc Dis 2022; 115:610-611. [DOI: 10.1016/j.acvd.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022]
|
10
|
Kardos A, Rusinaru D, Maréchaux S, Alskaf E, Prendergast B, Tribouilloy C. Implementation of a CT-derived correction factor to refine the measurement of aortic valve area and stroke volume using Doppler echocardiography improves grading of severity and prediction of prognosis in patients with severe aortic stenosis. Int J Cardiol 2022; 363:129-137. [PMID: 35716947 DOI: 10.1016/j.ijcard.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022]
Abstract
AIMS To assess rates of reclassification of severity and associated 5-year survival in patients with severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF) after application of a CT-derived correction factor (CF) to refine the measurement of aortic valve area (AVA) and stroke volume index (SVi) using Doppler echocardiography. METHODS AND RESULTS We enrolled 1450 patients with severe AS and preserved LVEF from a French registry. Multiplication of echocardiographic LV outflow tract diameter by a CT-derived CF of 1.13 to calculate the AVA and SVi using the continuity equation resulted in reclassification of 39% of patients from severe to moderate AS (AVA > 1 cm2) and 77% from low flow (LF, SVi < 35 ml/m2) to normal flow (NF, SVi ≥ 35 ml/m2). After application of the CF, 5-year survival with conservative management was 50 ± 4% for severe AS compared to 62 ± 4% for moderate AS (p < 0.001). A strategy of medical management followed by intervention for severe AS was associated with higher risk of mortality over 5-year follow-up after adjustment for covariates and application of the CF (HR 1.35 [1.10-1.55], p = 0.015). Five-year survival was also poorer in patients remaining in the LF group after application of the CF, even after valve intervention (72%, 66% and 47% for NF to NF, LF to NF and LF to LF, respectively). After adjustment for covariates (including intervention), risk of mortality was higher in LF to LF patients compared to NF to NF (HR 1.78 [1.25-2.56]), but similar for NF to NF and LF to NF (HR 1.20 [0.90-1.60]). CONCLUSION Refined accuracy of echocardiographic LV outflow tract diameter measurement using a CF of 1.13 before derivation of AVA and SVi in patients with severe AS and preserved LVEF allows improved grading of severity, and prediction of prognosis. We recommend implementation of the CF during routine echocardiography when using the continuity equation for Doppler haemodynamic measurements.
Collapse
Affiliation(s)
- Attila Kardos
- Translational Cardiovascular Research Group, Department of Cardiology, Milton Keynes University Hospital, United Kingdom; Faculty of Medicine and Health Sciences, University of Buckingham, Buckingham, United Kingdom,.
| | - Dan Rusinaru
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France; Translational Cardiovascular Research Group, Department of Cardiology, Milton Keynes University Hospital, United Kingdom
| | - Sylvestre Maréchaux
- Centre Universitaire de Recherche en Santé, Laboratoire MP3CV -, EA 7517, Université de Picardie, Amiens, France
| | - Ebraham Alskaf
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital and Cleveland Clinic London, United Kingdom
| | - Christophe Tribouilloy
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| |
Collapse
|
11
|
Kubala M, Bohbot Y, Rusinaru D, Levy F, Maréchaux S, Tribouilloy C. Refining Risk Stratification in Severe Aortic Stenosis With Left Atrial Volume and Atrial Fibrillation. JACC Cardiovasc Imaging 2022; 15:945-947. [PMID: 35257679 DOI: 10.1016/j.jcmg.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
|
12
|
Albenque G, Rusinaru D, Bellaiche M, Di Lena C, Gabrion P, Delpierre Q, Malaquin D, Tribouilloy C, Bohbot Y. Resting Left Ventricular Global Longitudinal Strain to Identify Silent Myocardial Ischemia in Asymptomatic Patients with Diabetes Mellitus. J Am Soc Echocardiogr 2021; 35:258-266. [PMID: 34752929 DOI: 10.1016/j.echo.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/22/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Screening for silent coronary artery disease in asymptomatic patients with diabetes mellitus (DM) is challenging and controversial. In this context, it seems crucial to identify early markers of coronary artery disease. METHODS The aim of this study was to investigate the incremental value of resting left ventricular (LV) global longitudinal strain (GLS) for the prediction of positive results on stress (exercise or dobutamine) transthoracic echocardiography in 273 consecutive asymptomatic high-risk patients with DM. Positive results on stress transthoracic echocardiography were defined as stress-induced LV wall motion abnormalities (new or worsening preexisting abnormalities). RESULTS Compared with patients with negative stress results, those with positive stress results (n = 28 [10%]) more frequently had cardiovascular risk factors, complications of DM, vascular disease, moderate and severe calcification of the aortic valve and mitral annulus, and worse resting LV GLS (-16.7 ± 2.9% vs -19.0 ± 1.9%, P < .001). On multivariable logistic regression analysis, DM duration > 10 years, diabetic retinopathy, LV hypertrophy, and impaired LV GLS (odds ratio, 1.39 [95% CI, 1.14-1.70] per percentage increase; odds ratio, 5.16 [95% CI, 1.96-13.59] for LV GLS worse than -18%) were independently associated with positive results on stress transthoracic echocardiography. The area under the curve to predict positive results was 0.74 for LV GLS with a cutoff of -18.0% (sensitivity 68%, specificity 78%). The area under the curve of the multivariable model to predict test results was improved by the addition of LV GLS (P < .001), with a bias-corrected area under the curve after bootstrapping of 0.842 [95% CI, 0.753-0.893]. CONCLUSIONS The present findings show that resting LV GLS is associated with the presence of silent ischemia and could be useful to better identify asymptomatic patients with DM who might benefit from coronary artery disease screening.
Collapse
Affiliation(s)
- Grégoire Albenque
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Dan Rusinaru
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Manon Bellaiche
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Chloé Di Lena
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Paul Gabrion
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Quentin Delpierre
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Dorothée Malaquin
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France.
| |
Collapse
|
13
|
Rusinaru D, Bohbot Y, Maréchaux S, Enriquez-Sarano M, Tribouilloy C. Low-flow low-gradient severe aortic stenosis: Clinical significance depends on definition. Arch Cardiovasc Dis 2021; 114:606-608. [PMID: 34593341 DOI: 10.1016/j.acvd.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Dan Rusinaru
- Department of Cardiology, Pôle Coeur-Thorax-Vaisseaux, University Hospital Amiens, avenue René Laënnec, 80054 Amiens, France; EA 7517 MP3CV, Jules-Verne University of Picardie, 80054 Amiens, France
| | - Yohann Bohbot
- Department of Cardiology, Pôle Coeur-Thorax-Vaisseaux, University Hospital Amiens, avenue René Laënnec, 80054 Amiens, France
| | - Sylvestre Maréchaux
- EA 7517 MP3CV, Jules-Verne University of Picardie, 80054 Amiens, France; Faculté Libre de Médecine, Groupement des Hôpitaux de l'Institut Catholique de Lille, Université Lille Nord de France, 59000 Lille, France
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, 55905 MN, USA
| | - Christophe Tribouilloy
- Department of Cardiology, Pôle Coeur-Thorax-Vaisseaux, University Hospital Amiens, avenue René Laënnec, 80054 Amiens, France; EA 7517 MP3CV, Jules-Verne University of Picardie, 80054 Amiens, France.
| |
Collapse
|
14
|
Rusinaru D, Bohbot Y, Kubala M, Diouf M, Altes A, Pasquet A, Maréchaux S, Vanoverschelde JL, Tribouilloy C. Myocardial Contraction Fraction for Risk Stratification in Low-Gradient Aortic Stenosis With Preserved Ejection Fraction. Circ Cardiovasc Imaging 2021; 14:e012257. [PMID: 34403263 DOI: 10.1161/circimaging.120.012257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial contraction fraction (MCF) is a volumetric measure of myocardial shortening independent of left ventricular size and geometry. This multicenter study investigates the usefulness of MCF for risk stratification in low-gradient severe aortic stenosis with preserved ejection fraction. METHODS We included 643 consecutive patients with low-gradient severe aortic stenosis with preserved ejection fraction in whom MCF was computed at baseline and analyzed mortality during follow-up. RESULTS Throughout follow-up with medical and surgical management (34.9 [16.1-65.3] months), lower MCF tertiles had higher mortality than the highest tertile. Eighty-month survival was 56±4% for MCF>41%, 41±4% for MCF 30% to 41%, and 40±4% for MCF<30% (P<0.001). After comprehensive adjustment, mortality risk remained high for MCF 30% to 41% (adjusted hazard ratio, 1.53 [1.08-2.18]) and for MCF<30% (adjusted hazard ratio, 1.82 [1.24-2.66]) versus MCF>41%. The optimal MCF cutoff point for mortality prediction was 41%. Age, body mass index, Charlson index, peak aortic velocity, and ejection fraction were independently associated with mortality. MCF (χ2 to improve 10.39; P=0.001), provided greater additional prognostic value over the baseline parameters than stroke volume (SV) index (χ2 to improve 5.41; P=0.042), left ventricular mass index (χ2 to improve 2.15; P=0.137), or global longitudinal strain (χ2 to improve 3.67; P=0.061). MCF outperformed ejection fraction for mortality prediction. When patients were classified by SV index and MCF, mortality risk was low when SV index was ≥30 mL/m2 and MCF>41%, higher for patients with SV index ≥30 mL/m2 and MCF≤41% (adjusted hazard ratio, 1.47 [1.05-2.07]) and extremely high for patients with SV index <30 mL/m2 (adjusted hazard ratio, 2.29 [1.45-3.62]). CONCLUSIONS MCF is a valuable marker of risk in low-gradient severe aortic stenosis with preserved ejection fraction and could improve decision-making, especially in normal-flow low-gradient severe aortic stenosis with preserved ejection fraction.
Collapse
Affiliation(s)
- Dan Rusinaru
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology (D.R., Y.B., M.K., C.T.), University Hospital Amiens, France
- Centre Universitaire de Recherche en Santé, Laboratoire MP3CV - EA 7517, Université de Picardie, Amiens, France (D.R., Y.B., S.M., C.T.)
| | - Yohann Bohbot
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology (D.R., Y.B., M.K., C.T.), University Hospital Amiens, France
- Centre Universitaire de Recherche en Santé, Laboratoire MP3CV - EA 7517, Université de Picardie, Amiens, France (D.R., Y.B., S.M., C.T.)
| | - Maciej Kubala
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology (D.R., Y.B., M.K., C.T.), University Hospital Amiens, France
| | - Momar Diouf
- Division of Clinical Research and Innovation (M.D.), University Hospital Amiens, France
| | - Alexandre Altes
- Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France (A.A., S.M.)
| | - Agnès Pasquet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., J.-L.V.)
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium (A.P., J.-L.V.)
| | - Sylvestre Maréchaux
- Centre Universitaire de Recherche en Santé, Laboratoire MP3CV - EA 7517, Université de Picardie, Amiens, France (D.R., Y.B., S.M., C.T.)
- Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France (A.A., S.M.)
| | - Jean-Louis Vanoverschelde
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., J.-L.V.)
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium (A.P., J.-L.V.)
| | - Christophe Tribouilloy
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology (D.R., Y.B., M.K., C.T.), University Hospital Amiens, France
- Centre Universitaire de Recherche en Santé, Laboratoire MP3CV - EA 7517, Université de Picardie, Amiens, France (D.R., Y.B., S.M., C.T.)
| |
Collapse
|
15
|
Bohbot Y, Rusinaru D, Kubala M, Diouf M, Altes A, Pasquet A, Marechaux S, Vanoverschelde J, Tribouilloy C. Myocardial Contraction fraction for risk stratification in low-gradient aortic stenosis with preserved ejection fraction. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2021.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
16
|
Bohbot Y, Kubala M, Rusinaru D, Maréchaux S, Vanoverschelde JL, Tribouilloy C. Survival and Management of Patients With Discordant High-Gradient Aortic Stenosis: A Propensity-Matched Study. JACC Cardiovasc Imaging 2021; 14:1672-1674. [PMID: 33865787 DOI: 10.1016/j.jcmg.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
|
17
|
Cheng C, Bohbot Y, Michelena HI, Rusinaru D, Fay F, Elmkies F, Sarano ME, Tribouilloy C. Clinical Outcomes of Adults With Bicuspid Aortic Valve: A European Perspective. Mayo Clin Proc 2021; 96:648-657. [PMID: 33673916 DOI: 10.1016/j.mayocp.2020.04.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 04/14/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe the clinical history of patients with a wide age range diagnosed with bicuspid aortic valve (BAV) and no surgical indication and to evaluate the long-term outcome of patients with BAV referred for elective surgery. PATIENTS AND METHODS Between 2005 and 2017, 350 consecutive patients with no surgical indication (surveillance group, mean age 53±16, 71% men) and 191 with a surgical indication (surgical group, mean age 59±13, 71% men) were prospectively included. Median follow-up was 80 (32 to 115) months. RESULTS In the surveillance group, the 5-year and 10-year survival rates were 93±1% and 89±2%, respectively, with a relative survival of patients with BAV compared with an age- and sex-matched control population of 98.7%. During follow-up, the cumulative 10-year incidence of aortic valve and aorta surgery was high; of 35±4%, the incidence of native valve infective endocarditis (IE) of 0.2% per patient-year, and no cases of aortic dissection were observed. In the surgical group, the 5-year and 10-year survival rates were 97±1% and 89±3%, respectively, with a relative survival of 99.4% compared with the general population. The incidence of IE was 0.4% per patient-year, and no cases of aortic dissection were observed. CONCLUSION This regional cohort shows that the 10-year survival rates of patients with BAV and a wide age range, but mostly middle-aged adults, were similar to those of the general population with a very low rate of complications. Adherence to prophylactic surgical indications and younger age might have contributed to this lack of difference.
Collapse
Affiliation(s)
- Charles Cheng
- Department of Cardiology, Amiens University Hospital, France
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, France; EA 7517 MP3CV Université de Picardie Jules Verne, Amiens, France
| | | | - Dan Rusinaru
- Department of Cardiology, Amiens University Hospital, France; EA 7517 MP3CV Université de Picardie Jules Verne, Amiens, France
| | - Floriane Fay
- Department of Cardiology, Amiens University Hospital, France
| | | | | | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, France; EA 7517 MP3CV Université de Picardie Jules Verne, Amiens, France.
| |
Collapse
|
18
|
Altes A, Thellier N, Rusinaru D, Marsou W, Bohbot Y, Chadha G, Leman B, Paquet P, Ennezat P, Tribouilloy C, Maréchaux S. Clinical significance of dimensionless index in patients with low-gradient severe aortic stenosis and preserved ejection fraction. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Bohbot Y, Rusinaru D, Belkhir K, Altes A, Levy F, Marechaux S, Sarano M, Tribouilloy C. Impact of sex on management and survival in aortic stenosis. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
20
|
Bohbot Y, Candellier A, Rusinaru D, Altes A, Pasquet A, Marechaux S, Vanoverschelde J, Tribouilloy C. Severe aortic stenosis and chronic kidney disease: Outcomes and impact of aortic valve replacement. Archives of Cardiovascular Diseases Supplements 2021. [DOI: 10.1016/j.acvdsp.2020.10.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
21
|
Tribouilloy C, Bohbot Y, Rusinaru D, Belkhir K, Diouf M, Altes A, Delpierre Q, Serbout S, Kubala M, Levy F, Maréchaux S, Enriquez Sarano M. Excess Mortality and Undertreatment of Women With Severe Aortic Stenosis. J Am Heart Assoc 2020; 10:e018816. [PMID: 33372529 PMCID: PMC7955469 DOI: 10.1161/jaha.120.018816] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Although women represent half of the population burden of aortic stenosis (AS), little is known whether sex affects the presentation, management, and outcome of patients with AS. Methods and Results In a cohort of 2429 patients with severe AS (49.5% women) we aimed to evaluate 5‐year excess mortality and performance of aortic valve replacement (AVR) stratified by sex. At presentation, women were older (P<0.001), with less comorbidities (P=0.030) and more often symptomatic (P=0.007) than men. Women had smaller aortic valve area (P<0.001) than men but similar mean transaortic pressure gradient (P=0.18). The 5‐year survival was lower compared with expected survival, especially for women (62±2% versus 71% for women and 69±1% versus 71% for men). Despite longer life expectancy in women than men, women had lower 5‐year survival than men (66±2% [expected‐75%] versus 68±2% [expected‐70%], P<0.001) after matching for age. Overall, 5‐year AVR incidence was 79±2% for men versus 70±2% for women (P<0.001) with male sex being independently associated with more frequent early AVR performance (odds ratio, 1.49; 1.18–1.97). After age matching, women remained more often symptomatic (P=0.004) but also displayed lower AVR use (64.4% versus 69.1%; P=0.018). Conclusions Women with severe AS are diagnosed at later ages and have more symptoms than men. Despite prevalent symptoms, AVR is less often performed in women and 5‐year excess mortality is noted in women versus men, even after age matching. These imbalances should be addressed to ensure that both sexes receive equivalent care for severe AS.
Collapse
Affiliation(s)
- Christophe Tribouilloy
- Department of Cardiology Amiens University Hospital Amiens France.,UR UPJV 7517 Jules Verne University of Picardie Amiens France
| | - Yohann Bohbot
- Department of Cardiology Amiens University Hospital Amiens France.,UR UPJV 7517 Jules Verne University of Picardie Amiens France
| | - Dan Rusinaru
- Department of Cardiology Amiens University Hospital Amiens France.,UR UPJV 7517 Jules Verne University of Picardie Amiens France
| | - Khadija Belkhir
- Department of Cardiology Amiens University Hospital Amiens France
| | - Momar Diouf
- Department of Clinical Research Amiens Picardy University Hospital Amiens France
| | - Alexandre Altes
- Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine Université Lille Nord de France Lille France
| | | | - Saousan Serbout
- Department of Cardiology Amiens University Hospital Amiens France
| | - Maciej Kubala
- Department of Cardiology Amiens University Hospital Amiens France.,UR UPJV 7517 Jules Verne University of Picardie Amiens France
| | - Franck Levy
- Department of Cardiology Centre Cardio-Thoracique de Monaco Monaco
| | - Sylvestre Maréchaux
- UR UPJV 7517 Jules Verne University of Picardie Amiens France.,Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine Université Lille Nord de France Lille France
| | | |
Collapse
|
22
|
Bohbot Y, Rusinaru D, Belkhir K, Altes A, Delpierre Q, Serbout S, Levy F, Marechaux S, Sarano M, Tribouilloy C. Impact of sex on management and survival in aortic stenosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Increasing attention has been paid to differences between the sexes in recent studies, but only a few have focused on such differences in aortic stenosis (AS).
Purpose
We sought to evaluate the differences between genders in AS outcomes and management.
Methods
We included 2429 patients (51.5% men; 49.5% women) with severe AS. Median follow-up was 42.0 (21–78) months.
Results
Women were older (p<0.001), more often symptomatic (p=0.007), and presented with smaller aortic valve area (p<0.001), and greater ejection fraction (p<0.001) than men. Despite that women have a longer life expectancy than men in the general population, estimated five-year survival of patients with severe AS was lower for women compared to men (62±2% versus 69±1% respectively, p<0.001). The 5-year survival was lower compared to expected survival, especially for women (62±2% vs. 71% for women and 69±1% vs. 71% for men). The cumulative 5-years incidence of AVR was 79±2% for men, and only 70±2% for women (p<0.001) and, being male was independently predictive of AVR (OR: 1.49 [1.18–1.97]; p=0.011). After propensity matching, when both genders were comparable in terms of characteristics and management (AVR), women, as expected due to their higher life expectancy than men, had better 5-year survival than men (69±2% vs. 62±2%; p=0.023).
Conclusion
Women with severe AS present at a more advance stage of the disease, at older ages with more symptoms, and incur higher mortality than men. This excess mortality is related to a combination of late diagnosis and a less frequent and later referral for AVR than in men. This justifies appropriate measures to improve the situation and to ensure that both sexes receive equivalent care.
Figure 1. (A) Survival curves. (B) Surgery incidence.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- Y Bohbot
- University Hospital of Amiens, Amiens, France
| | - D Rusinaru
- University Hospital of Amiens, Amiens, France
| | - K Belkhir
- University Hospital of Amiens, Amiens, France
| | - A Altes
- Lille Catholic University, Lille, France
| | - Q Delpierre
- University Hospital of Amiens, Amiens, France
| | - S Serbout
- University Hospital of Amiens, Amiens, France
| | - F Levy
- Cardio-Thoracic Center of Monaco, Monaco, Monaco
| | - S Marechaux
- University Hospital of Amiens, Amiens, France
| | - M Sarano
- Mayo Clinic, Rochester, United States of America
| | | |
Collapse
|
23
|
Altes A, Thellier N, Rusinaru D, Marsou W, Bohbot Y, Chadha G, Leman B, Paquet P, Ennezat PV, Tribouilloy C, Maréchaux S. Dimensionless Index in Patients With Low-Gradient Severe Aortic Stenosis and Preserved Ejection Fraction. Circ Cardiovasc Imaging 2020; 13:e010925. [DOI: 10.1161/circimaging.120.010925] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Risk stratification of patients with low-gradient (LG) severe aortic stenosis (AS) despite preserved left ventricular ejection fraction remains challenging. We sought to evaluate the relationship between the dimensionless index (DI)—the ratio of the left ventricular outflow tract time-velocity integral to that of the aortic valve jet—and mortality in these patients.
Methods
Seven hundred fifty-five patients with LG severe AS (defined by aortic valve area ≤1 cm
2
or aortic valve area indexed to body surface area ≤0.6 cm
2
/m
2
and mean aortic pressure gradient <40 mm Hg) and preserved left ventricular ejection fraction ≥50% were studied. Flow status was defined according to stroke volume index <35 mL/m
2
(low flow, LF) or ≥35 mL/m
2
(normal flow, NF).
Results
After adjustment for age, sex, body mass index, Charlson comorbidity index, history of hypertension, history of atrial fibrillation, AS-related symptoms, left ventricular ejection fraction, indexed left ventricular ventricular mass, aortic valve area, and aortic valve replacement as a time-dependent covariate, patients with LG-LF and DI<0.25 exhibited a considerable increased risk of death compared with patients with LG-NF and DI≥0.25 (adjusted hazard ratio, 2.41 [95% CI, 1.61–3.62];
P
<0.001), LG-NF and DI<0.25 (adjusted hazard ratio, 1.84 [95% CI, 1.24–2.73];
P
=0.003), and LG-LF and D≥0.25 (adjusted hazard ratio, 2.27 [95% CI, 1.42–3.63];
P
<0.001). In contrast, patients with LG-LF and DI≥0.25, LG-NF and DI<0.25, and LG-NF and DI≥0.25 had similar outcome. DI<0.25 showed incremental prognostic value in patients with LG-LF severe AS but not in patients with LG-NF severe AS.
Conclusions
Among patients with LG severe AS and preserved left ventricular ejection fraction, decreased DI<0.25 is a reliable parameter in patients with LF to identify a subgroup of patients at higher risk of death who may derive benefit from aortic valve replacement.
Collapse
Affiliation(s)
- Alexandre Altes
- Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, France (A.A., N.T., W.M., B.L., P.P., S.M.)
| | - Nicolas Thellier
- Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, France (A.A., N.T., W.M., B.L., P.P., S.M.)
- EA 7517 MP3CV Jules Verne University of Picardie Amiens, France (N.T., D.R., Y.B., G.C., C.T., S.M.)
| | - Dan Rusinaru
- EA 7517 MP3CV Jules Verne University of Picardie Amiens, France (N.T., D.R., Y.B., G.C., C.T., S.M.)
- Centre Hospitalier Universitaire d'Amiens, France (D.R., Y.B., G.C., C.T.)
| | - Wassima Marsou
- Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, France (A.A., N.T., W.M., B.L., P.P., S.M.)
| | - Yohann Bohbot
- EA 7517 MP3CV Jules Verne University of Picardie Amiens, France (N.T., D.R., Y.B., G.C., C.T., S.M.)
- Centre Hospitalier Universitaire d'Amiens, France (D.R., Y.B., G.C., C.T.)
| | - Gagandeep Chadha
- EA 7517 MP3CV Jules Verne University of Picardie Amiens, France (N.T., D.R., Y.B., G.C., C.T., S.M.)
- Centre Hospitalier Universitaire d'Amiens, France (D.R., Y.B., G.C., C.T.)
| | - Blandine Leman
- Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, France (A.A., N.T., W.M., B.L., P.P., S.M.)
| | - Pierre Paquet
- Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, France (A.A., N.T., W.M., B.L., P.P., S.M.)
| | | | - Christophe Tribouilloy
- EA 7517 MP3CV Jules Verne University of Picardie Amiens, France (N.T., D.R., Y.B., G.C., C.T., S.M.)
- Centre Hospitalier Universitaire d'Amiens, France (D.R., Y.B., G.C., C.T.)
| | - Sylvestre Maréchaux
- Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, France (A.A., N.T., W.M., B.L., P.P., S.M.)
- EA 7517 MP3CV Jules Verne University of Picardie Amiens, France (N.T., D.R., Y.B., G.C., C.T., S.M.)
| |
Collapse
|
24
|
Bohbot Y, Candellier A, Diouf M, Rusinaru D, Altes A, Pasquet A, Maréchaux S, Vanoverschelde JL, Tribouilloy C. Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement. J Am Heart Assoc 2020; 9:e017190. [PMID: 32964785 PMCID: PMC7792421 DOI: 10.1161/jaha.120.017190] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The prognostic significance of chronic kidney disease (CKD) in severe aortic stenosis is poorly understood and no studies have yet evaluated the effect of aortic‐valve replacement (AVR) versus conservative management on long‐term mortality by stage of CKD. Methods and Results We included 4119 patients with severe aortic stenosis. The population was divided into 4 groups according to the baseline estimated glomerular filtration rate: no CKD, mild CKD, moderate CKD, and severe CKD. The 5‐year survival rate was 71±1% for patients without CKD, 62±2% for those with mild CKD, 54±3% for those with moderate CKD, and 34±4% for those with severe CKD (P<0.001). By multivariable analysis, patients with moderate or severe CKD had a significantly higher risk of all‐cause (hazard ratio [HR] [95% CI]=1.36 [1.08–1.71]; P=0.009 and HR [95% CI]=2.16 [1.67–2.79]; P<0.001, respectively) and cardiovascular mortality (HR [95% CI]=1.39 [1.03–1.88]; P=0.031 and HR [95% CI]=1.69 [1.18–2.41]; P=0.004, respectively) than patients without CKD. Despite more symptoms, AVR was less frequent in moderate (P=0.002) and severe CKD (P<0.001). AVR was associated with a marked reduction in all‐cause and cardiovascular mortality versus conservative management for each CKD group (all P<0.001). The joint‐test showed no interaction between AVR and CKD stages (P=0.676) indicating a nondifferentialeffect of AVR across stages of CKD. After propensity matching, AVR was still associated with substantially better survival for each CKD stage relative to conservative management (all P<0.0017). Conclusions In severe aortic stenosis, moderate and severe CKD are associated with increased mortality and decreased referral to AVR. AVR markedly reduces all‐cause and cardiovascular mortality, regardless of the CKD stage. Therefore, CKD should not discourage physicians from considering AVR.
Collapse
Affiliation(s)
- Yohann Bohbot
- Department of Cardiology Amiens University Hospital Amiens France.,UR UPJV 7517 Jules Verne University of Picardie Amiens France
| | - Alexandre Candellier
- UR UPJV 7517 Jules Verne University of Picardie Amiens France.,Department of Nephrology Amiens University Hospital Amiens France
| | - Momar Diouf
- Department of Clinical Research Amiens University Hospital Amiens France
| | - Dan Rusinaru
- Department of Cardiology Amiens University Hospital Amiens France.,UR UPJV 7517 Jules Verne University of Picardie Amiens France
| | - Alexandre Altes
- Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine Université Lille Nord de France Lille France
| | - Agnes Pasquet
- Pôle de Recherche Cardiovasculaire Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium.,Division of Cardiology Cliniques Universitaires Saint-Luc Brussels Belgium
| | - Sylvestre Maréchaux
- UR UPJV 7517 Jules Verne University of Picardie Amiens France.,Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté Libre de Médecine Université Lille Nord de France Lille France
| | - Jean-Louis Vanoverschelde
- Pôle de Recherche Cardiovasculaire Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium.,Division of Cardiology Cliniques Universitaires Saint-Luc Brussels Belgium
| | - Christophe Tribouilloy
- Department of Cardiology Amiens University Hospital Amiens France.,UR UPJV 7517 Jules Verne University of Picardie Amiens France
| |
Collapse
|
25
|
Chadha G, Bohbot Y, Lachambre P, Rusinaru D, Serbout S, Altes A, Pasquet A, Maréchaux S, Vanoverschelde JL, Tribouilloy C. Progression of Normal Flow Low Gradient "Severe" Aortic Stenosis With Preserved Left Ventricular Ejection Fraction. Am J Cardiol 2020; 128:151-158. [PMID: 32650909 DOI: 10.1016/j.amjcard.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
Abstract
Normal-flow low-gradient severe aortic stenosis (NF-LG-SAS), defined by an aortic valve area (AVA) <1 cm², mean pressure gradient (MPG) <40 mm Hg and indexed stroke volume ≥35 ml/m², is the most prevalent form of low-gradient aortic stenosis (AS) with preserved ejection fraction (PEF). However, the true severity of AS in these patients is controversial. The aim of this Doppler echocardiographic study was to investigate changes over time in the hemodynamic severity of patients with NF-LG-SAS with PEF. We retrospectively identified 96 patients who had 2 Doppler echocardiographic examinations without an intervening event. After a median follow-up of 25 (interquartile range 15 to 52) months, progression was observed, with increased transaortic MPG (from 28 [25 to 33] to 39 [34 to 50] mm Hg; p<0.001), peak aortic jet velocity (from 3.46 [3.20 to 3.64] to 4.01 [3.70 to 4.39] m/s; p<0.001), and decreased AVA (from 0.87 [0.82 to 0.94] to 0.72 [0.62 to 0.81] cm²; p<0.001). Median annual rates of progression were 4.3 (1.7 to 8.1) mm Hg/year, 0.25 (0.08 to 0.44) m/s/year, and -0.05 (-0.10 to -0.02) cm²/year, respectively. There was no significant change in left ventricular ejection fraction over time (p = 0.74). At follow-up, 46 patients (48%) acquired the features of classical high-gradient severe AS (MPG ≥40 mm Hg). This study shows that most patients with NF-LG-SAS with PEF exhibit significant hemodynamic progression of AS severity without EF impairment. These findings suggest that NF-LG-SAS with PEF is an "intermediate" stage between moderate AS and classical high-gradient severe AS requiring close monitoring.
Collapse
|
26
|
Delesalle G, Bohbot Y, Rusinaru D, Delpierre Q, Maréchaux S, Tribouilloy C. Characteristics and Prognosis of Patients With Moderate Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. J Am Heart Assoc 2020; 8:e011036. [PMID: 30841771 PMCID: PMC6475062 DOI: 10.1161/jaha.118.011036] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Moderate aortic stenosis (MAS) has not been extensively studied and characterized, as no published study has been specifically devoted to this condition. Methods and Results We aimed to describe the characteristics of patients with MAS and to evaluate their long‐term survival compared with that of the general population. This study included 508 patients (mean±SD age, 75±11 years) with MAS (aortic valve area between 1 and 1.5 cm2; mean±SD aortic valve area, 1.2±0.15 cm2) and preserved left ventricular ejection fraction. Patients were mostly (86.4%) asymptomatic or minimally symptomatic, 78.3% had hypertension, 36.2% were diabetics, and 48.3% had dyslipidemia. Each patient with MAS was matched for the average survival (per year) of all patients of the same age and same sex from our region (Somme department, north of France). During follow‐up (median 47 months), 113 patients (22.2%) underwent aortic valve replacement for severe AS. The mean±SD time between inclusion and surgery was 37±22 months. During follow‐up, 255 patients (50.2%) died. The 6‐year survival of patients with MAS was lower than the expected survival (53±2% versus 65%). In multivariate analysis, age (hazard ratio, 1.04 [95% CI, 1.02–1.05]; P<0.001), prior atrial fibrillation (hazard ratio, 1.35 [95% CI, 1.05–1.73]; P=0.019), and Charlson comorbidity index (hazard ratio, 1.11 [95% CI, 1.05–1.18]; P=0.002) were associated with increased mortality. Aortic valve replacement was associated with better survival (hazard ratio, 0.38 [95% CI, 0.27–0.54]; P<0.001). Conclusions The results of this study show that patients with MAS present many cardiovascular risk factors, a high rate of surgery during follow‐up, and increased mortality compared with the general population mainly related to associated comorbidities. Patients with MAS should, therefore, be managed for their cardiovascular risk factors and comorbidities. They require close follow‐up, especially when the aortic valve area is close to 1 cm2, as aortic valve replacement performed when patients transition to severe AS and develop indications for surgery during follow‐up is associated with better survival.
Collapse
Affiliation(s)
- Geraud Delesalle
- 1 Department of Cardiology Amiens University Hospital Amiens France
| | - Yohann Bohbot
- 1 Department of Cardiology Amiens University Hospital Amiens France.,2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| | - Dan Rusinaru
- 1 Department of Cardiology Amiens University Hospital Amiens France.,2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| | | | - Sylvestre Maréchaux
- 2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France.,3 Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de Médecine Université Lille Nord de France Lille France
| | - Christophe Tribouilloy
- 1 Department of Cardiology Amiens University Hospital Amiens France.,2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| |
Collapse
|
27
|
Bohbot Y, Guignant P, Rusinaru D, Kubala M, Maréchaux S, Tribouilloy C. Impact of Right Ventricular Systolic Dysfunction on Outcome in Aortic Stenosis. Circ Cardiovasc Imaging 2020; 13:e009802. [DOI: 10.1161/circimaging.119.009802] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Pulmonary hypertension is an established outcome predictor in patients with aortic stenosis (AS), but the prognostic impact of right ventricular dysfunction has not been well studied.
Methods:
We included 2181 patients (50.4% men; mean age, 77 years) with aortic valve area <1.3 cm
2
and analyzed the occurrence of all-cause death during follow-up according to tricuspid annular plane systolic excursion (TAPSE) quartiles.
Results:
Patients in the lowest quartile (TAPSE <17 mm) were at a high risk of death, whereas survival was comparable for the 3 other quartiles. Five-year survival was 55±2% for TAPSE <17 mm, 72±2% for TAPSE of 17 to 20 mm, 71±2% for TAPSE of 20 to 24 mm, and 73±2% for TAPSE >24 mm (overall
P
<0.001). TAPSE <17 mm was associated with increased mortality after adjustment for established prognostic factors (adjusted hazard ratio [HR], 1.55 [95% CI, 1.21–1.97]) and after further adjustment for aortic valve replacement (AVR; adjusted HR, 1.47 [95% CI, 1.15–1.87]). The excess mortality risk associated with TAPSE <17 mm was noticed in both patients managed initially conservatively (adjusted HR, 1.46 [95% CI, 1.20–1.76]) and patients who underwent early (within 3 months after diagnosis) AVR (adjusted HR, 1.61 [95% CI, 1.03–2.52]). In asymptomatic patients with severe AS and preserved ejection fraction, TAPSE <17 mm was independently predictive of mortality (adjusted HR, 2.14 [95% CI, 1.31–3.51]). Early AVR was associated with similar survival benefit in TAPSE <17 and ≥17 mm (adjusted HR, 0.23 [95% CI, 0.16–0.34] for TAPSE <17 mm, adjusted HR, 0.26 [95% CI, 0.19–0.35] for TAPSE ≥17 mm;
P
for interaction, 0.97).
Conclusions:
Right ventricular dysfunction is an important and independent predictor of mortality in AS. TAPSE <17 mm at the time of AS diagnosis is a marker of poor survival under conservative management and after AVR even in asymptomatic patients with severe AS. AVR was associated with a pronounced reduction in mortality independent of TAPSE suggesting that AVR should be discussed before right ventricular dysfunction occurs in severe AS.
Collapse
Affiliation(s)
- Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, France (Y.B., P.G., D.R., M.K., C.T.)
- EA 7517 MP3CV, Jules Verne University of Picardie, Amiens, France (Y.B., D.R., M.K., S.M., C.T.)
| | - Pierre Guignant
- Department of Cardiology, Amiens University Hospital, France (Y.B., P.G., D.R., M.K., C.T.)
| | - Dan Rusinaru
- Department of Cardiology, Amiens University Hospital, France (Y.B., P.G., D.R., M.K., C.T.)
- EA 7517 MP3CV, Jules Verne University of Picardie, Amiens, France (Y.B., D.R., M.K., S.M., C.T.)
| | - Maciej Kubala
- Department of Cardiology, Amiens University Hospital, France (Y.B., P.G., D.R., M.K., C.T.)
- EA 7517 MP3CV, Jules Verne University of Picardie, Amiens, France (Y.B., D.R., M.K., S.M., C.T.)
| | - Sylvestre Maréchaux
- EA 7517 MP3CV, Jules Verne University of Picardie, Amiens, France (Y.B., D.R., M.K., S.M., C.T.)
- Groupement des Hôpitaux de l’Institut Catholique de Lille, Faculté libre de médecine, Université Lille Nord de France (S.M.)
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, France (Y.B., P.G., D.R., M.K., C.T.)
- EA 7517 MP3CV, Jules Verne University of Picardie, Amiens, France (Y.B., D.R., M.K., S.M., C.T.)
| |
Collapse
|
28
|
Bohbot Y, Rusinaru D, Rietzschel E, De Buyzere M, Buicuic O, Marechaux S, Gilebert T, Tribouilloy T. 620 Normalized stroke volume in severe aortic stenosis with preserved ejection fraction: reference values and outcome implications. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
none
Background
Appropriate normalization methods to scale Doppler-derived stroke volume (SV) in patients with aortic stenosis (AS) are poorly defined and reference values are lacking.
Purpose
We aim to establish reference values for normalized SV, to compare the prognostic value of SV normalized by different methods in AS and to examine the outcome of low-flow(LF) low-gradient(LG) AS with preserved ejection fraction(LVEF) based on newly defined reference values.
Methods
In 2781 normotensive adults without cardiovascular disease we defined normal relationships between SV and body size by nonlinear regression. We analyzed the prognostic performance of ratiometric and allometric normalized SV in 1450 patients with severe AS and preserved LVEF.
Results
The allometric exponents that described the SV-height (H) and SV-body surface area (BSA) relationships were 1.32 and 0.88, respectively. In males, LF reference values were: <28ml/m²,<30ml/m,<30ml/(m²)^0.88, and, respectively,<26 ml/m^1.32, and in females <27ml/m²,<28ml/m,<29ml/(m²)^0.88, and, respectively,<24 ml/m^1.32. In patients with severe AS, SV/H^1.32 was most consistently associated with mortality and showed better prognostic performance than other normalized SV parameters. Compared to H-normalization, BSA-normalization markedly overestimated the frequency of LF (2% vs. 11%). In 1354 AS patients managed initially medically, LF/LG AS defined based on the 35ml/m² cut-off showed better outcome than high gradient(HG) AS (adjusted HR 0.85[0.62-0.96]). When new reference values were used, the mortality risk of LF/LG AS was higher than that of HGAS (adjusted HR 1.37[1.06-1.89] for SV/BSA and adjusted HR 1.42[1.10-2.15] for SV/H^1.32).
Conclusion
We provide reference values and appropriate normalization methods for SV by Doppler-echocardiography. Patients with LG severe AS, preserved LVEF and "true" LF are at high risk of death during follow-up.
Abstract 620 Figure. Frequency of flow-gradient patterns
Collapse
Affiliation(s)
- Y Bohbot
- University Hospital of Amiens, Amiens, France
| | - D Rusinaru
- University Hospital of Amiens, Amiens, France
| | - E Rietzschel
- Ghent university hospital, Cardiology, Ghent, Belgium
| | - M De Buyzere
- Ghent university hospital, Cardiology, Ghent, Belgium
| | - O Buicuic
- University Hospital of Amiens, Amiens, France
| | | | - T Gilebert
- Ghent university hospital, Cardiology, Ghent, Belgium
| | | |
Collapse
|
29
|
Chadha G, Bohbot Y, Rusinaru D, Marechaux S, Tribouilloy C. Outcome of normal-flow low-gradient “severe” aortic stenosis with preserved left ventricular ejection fraction: A propensity matched study. Archives of Cardiovascular Diseases Supplements 2020. [DOI: 10.1016/j.acvdsp.2019.09.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
30
|
Grigioni F, Clavel MA, Vanoverschelde JL, Tribouilloy C, Pizarro R, Huebner M, Avierinos JF, Barbieri A, Suri R, Pasquet A, Rusinaru D, Gargiulo GD, Oberti P, Théron A, Bursi F, Michelena H, Lazam S, Szymanski C, Nkomo VT, Schumacher M, Bacchi-Reggiani L, Enriquez-Sarano M. The MIDA Mortality Risk Score: development and external validation of a prognostic model for early and late death in degenerative mitral regurgitation. Eur Heart J 2019; 39:1281-1291. [PMID: 29020352 DOI: 10.1093/eurheartj/ehx465] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 07/24/2017] [Indexed: 12/13/2022] Open
Abstract
Aims In degenerative mitral regurgitation (DMR), lack of mortality scores predicting death favours misperception of individual patients' risk and inappropriate decision-making. Methods and results The Mitral Regurgitation International Database (MIDA) registries include 3666 patients (age 66 ± 14 years; 70% males; follow-up 7.8 ± 5.0 years) with pure, isolated, DMR consecutively diagnosed by echocardiography at tertiary (European/North/South-American) centres. The MIDA Score was derived from the MIDA-Flail-Registry (2472 patients with DMR and flail leaflet-Derivation Cohort) by weighting all guideline-provided prognostic markers, and externally validated in the MIDA-BNP-Registry (1194 patients with DMR and flail leaflet/prolapse-Validation Cohort). The MIDA Score ranged from 0 to 12 depending on accumulating risk factors. In predicting total mortality post-diagnosis, the MIDA Score showed excellent concordance both in Derivation Cohort (c = 0.78) and Validation Cohort (c = 0.81). In the whole MIDA population (n = 3666 patients), 1-year mortality with Scores 0, 7-8, and 11-12 was 0.4, 17, and 48% under medical management and 1, 7, and 14% after surgery, respectively (P < 0.001). Five-year survival with Scores 0, 7-8, and 11-12 was 98 ± 1, 57 ± 4, and 21 ± 10% under medical management and 99 ± 1, 82 ± 2, and 57 ± 9% after surgery (P < 0.001). In models including all guideline-provided prognostic markers and the EuroScoreII, the MIDA Score provided incremental prognostic information (P ≤ 0.002). Conclusion The MIDA Score may represent an innovative tool for DMR management, being able to position a given patient within a continuous spectrum of short- and long-term mortality risk, either under medical or surgical management. This innovative prognostic indicator may provide a specific framework for future clinical trials aiming to compare new technologies for DMR treatment in homogeneous risk categories of patients.
Collapse
Affiliation(s)
- Francesco Grigioni
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti n. 9, Bologna 40100, Italy
| | - Marie-Annick Clavel
- Mayo Clinic, Division of Cardiovascular Disease, Mayo Medical School, 200 First St. SW. Rochester, MN 55905, USA
| | - Jean-Louis Vanoverschelde
- Cardiovascular Department, University Catholic of Louvain, Avenue Hippocrates 10, 1200 Bruxelles, Belgium
| | - Christophe Tribouilloy
- University of Amiens, Cardiology, CHU Amiens-Picardie - SITE SUD, 80054 Amiens Cedex 1, France
| | - Rodolfo Pizarro
- Department of Cardiology, Hospital Italiano de Buenos Aires, Juan D. Péron 4190, Buenos Aires, Argentina
| | - Marianne Huebner
- Michigan State University, Department of Statistics and Probability, 619 Red Cedar Rd C413, East Lansing, MI 48824, USA
| | - Jean-Francois Avierinos
- University of Marseille, La Timone Hospital, Service de Cardiologie B, Boulevard Jean Moulin, 13005 Marseille, France
| | - Andrea Barbieri
- Department of Diagnostic Medicine, Clinical and Health Public, University of Modena, Via del Pozzo 71, 41124 Modena, Italy
| | - Rakesh Suri
- Cleveland Clinic, Department of Executive Administration, Al Maryah Island, Abu Dhabi, United Arab Emirates
| | - Agnés Pasquet
- Cardiovascular Department, University Catholic of Louvain, Avenue Hippocrates 10, 1200 Bruxelles, Belgium
| | - Dan Rusinaru
- University of Amiens, Cardiology, CHU Amiens-Picardie - SITE SUD, 80054 Amiens Cedex 1, France
| | - Gaetano D Gargiulo
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti n. 9, Bologna 40100, Italy
| | - Pablo Oberti
- Department of Cardiology, Hospital Italiano de Buenos Aires, Juan D. Péron 4190, Buenos Aires, Argentina
| | - Alexis Théron
- University of Marseille, La Timone Hospital, Service de Cardiologie B, Boulevard Jean Moulin, 13005 Marseille, France
| | - Francesca Bursi
- Department of Diagnostic Medicine, Clinical and Health Public, University of Modena, Via del Pozzo 71, 41124 Modena, Italy
| | - Hector Michelena
- Mayo Clinic, Division of Cardiovascular Disease, Mayo Medical School, 200 First St. SW. Rochester, MN 55905, USA
| | - Siham Lazam
- Cardiovascular Department, University Catholic of Louvain, Avenue Hippocrates 10, 1200 Bruxelles, Belgium
| | - Catherine Szymanski
- University of Amiens, Cardiology, CHU Amiens-Picardie - SITE SUD, 80054 Amiens Cedex 1, France
| | - Vuyisile T Nkomo
- Mayo Clinic, Division of Cardiovascular Disease, Mayo Medical School, 200 First St. SW. Rochester, MN 55905, USA
| | - Martin Schumacher
- Institute for Medical Biometry and Statistics, Medical Center-University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany
| | - Letizia Bacchi-Reggiani
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Via Massarenti n. 9, Bologna 40100, Italy
| | - Maurice Enriquez-Sarano
- Mayo Clinic, Division of Cardiovascular Disease, Mayo Medical School, 200 First St. SW. Rochester, MN 55905, USA
| | | |
Collapse
|
31
|
Abstract
See Article by Kanamori et al.
Collapse
Affiliation(s)
- Christophe Tribouilloy
- 1 Pôle Coeur-Thorax-Vaisseaux Department of Cardiology University Hospital Amiens Amiens France.,2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| | - Dan Rusinaru
- 1 Pôle Coeur-Thorax-Vaisseaux Department of Cardiology University Hospital Amiens Amiens France.,2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| | - Yohann Bohbot
- 1 Pôle Coeur-Thorax-Vaisseaux Department of Cardiology University Hospital Amiens Amiens France.,2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| | - Sylvestre Maréchaux
- 2 EA 7517 MP3CV Jules Verne University of Picardie Amiens France.,3 Groupement des Hôpitaux de l'Institut Catholique de Lille Hopital Saint Philibert Lomme France
| | - Jean-Louis Vanoverschelde
- 4 Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique Université Catholique de Louvain Brussels Belgium
| | - Maurice Enriquez-Sarano
- 5 Division of Cardiovascular Diseases and Internal Medicine Mayo Medical School Rochester MN
| |
Collapse
|
32
|
Maréchaux S, Rusinaru D, Altes A, Pasquet A, Vanoverschelde JL, Tribouilloy C. Prognostic Value of Low Flow in Patients With High Transvalvular Gradient Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction: A Multicenter Study. Circ Cardiovasc Imaging 2019; 12:e009299. [PMID: 31597467 DOI: 10.1161/circimaging.119.009299] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Grading of severe (aortic valve area ≤1 cm2) aortic stenosis with preserved left ventricular ejection fraction is based on a classification depending on flow (normal flow versus low flow) and pressure gradient (low gradient versus high gradient). The aim of the present study was to compare the outcome of patients with normal flow high gradient and low flow high gradient severe aortic stenosis (SAS) with no or minimal symptoms. METHODS This multicenter study enrolled 983 consecutive patients (mean age 75±11 years, 459 women) with asymptomatic or minimally symptomatic HG (mean pressure gradient ≥40 mm Hg) SAS with preserved left ventricular ejection fraction. Low flow was defined by Doppler echocardiography as a stroke volume index <30 mL/m2 (n=131) or a stroke volume <55 mL (n=136). The end point was all-cause mortality. RESULTS During a median follow-up period of 48 (45-52) months, 225 patients (23%) died. The 60-month mortality was higher in low flow high gradient SAS compared with normal flow high gradient SAS (36±5% versus 22±2% and 38±5% versus 21±2% for stroke volume index and stroke volume, respectively, both P<0.0001). After adjustment for outcome predictors including aortic valve replacement as time-dependent covariate, low flow high gradient SAS displayed considerable mortality risk during follow up compared with normal flow high gradient SAS (adjusted HR 2.17 [1.51-3.13]; P<0.0001 for stroke volume index <30 mL/m2 and adjusted HR 1.86 [1.29-2.68]; P=0.001, for stroke volume <55 mL). The prognostic impact of low flow was consistent in subgroups of patients. CONCLUSIONS Asymptomatic or minimally symptomatic patients with low flow high gradient SAS and preserved left ventricular ejection fraction have a considerable increased risk of mortality during follow-up. These patients should be promptly considered for aortic valve replacement.
Collapse
Affiliation(s)
- Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Cardiology department and Heart Valve Center, Faculté libre de médecine/Université Catholique de Lille, France (S.M., A.A.).,Centre Universitaire de Recherche en Santé, Laboratoire MP3CV - EA 7517, Université de Picardie, Amiens, France (S.M., D.R., C.T.)
| | - Dan Rusinaru
- Centre Universitaire de Recherche en Santé, Laboratoire MP3CV - EA 7517, Université de Picardie, Amiens, France (S.M., D.R., C.T.).,Department of Cardiology, Amiens University Hospital, France (D.R., C.T.)
| | - Alexandre Altes
- GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Cardiology department and Heart Valve Center, Faculté libre de médecine/Université Catholique de Lille, France (S.M., A.A.)
| | - Agnès Pasquet
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., J.L.V.).,Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium (A.P., J.L.V.)
| | - Jean Louis Vanoverschelde
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium (A.P., J.L.V.).,Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium (A.P., J.L.V.)
| | - Christophe Tribouilloy
- Centre Universitaire de Recherche en Santé, Laboratoire MP3CV - EA 7517, Université de Picardie, Amiens, France (S.M., D.R., C.T.).,Department of Cardiology, Amiens University Hospital, France (D.R., C.T.)
| |
Collapse
|
33
|
Chadha G, Bohbot Y, Rusinaru D, Maréchaux S, Tribouilloy C. Outcome of Normal-Flow Low-Gradient Severe Aortic Stenosis With Preserved Left Ventricular Ejection Fraction: A Propensity-Matched Study. J Am Heart Assoc 2019; 8:e012301. [PMID: 31550970 PMCID: PMC6806034 DOI: 10.1161/jaha.119.012301] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Normal‐flow, low‐gradient severe aortic stenosis (NF‐LG‐SAS), defined by aortic valve area <1 cm2, mean gradient <40 mm Hg, and indexed stroke volume >35 mL/m2, is the most prevalent form of low‐gradient aortic stenosis (AS). However, the true severity of AS and the management of NF‐LG‐SAS are controversial. The aim of this study was to evaluate the outcome of patients with NF‐LG‐SAS compared with moderate AS (MAS) and with high‐gradient severe‐AS (HG‐SAS). Methods and Results A total of 154 patients with NF‐LG‐SAS, 366 with MAS (aortic valve area between 1.0 and 1.3 cm2), and 1055 with HG‐SAS were included. On multivariate analysis, after adjustment for covariates of prognostic importance, NF‐LG‐SAS patients did not exhibit an excess risk of mortality compared with MAS patients under medical management (hazard ratio=1.13 [95% CI, 0.82‐1.56]; P=0.45) and under medical and surgical management (hazard ratio 1.06 [95% CI, 0.79‐1.43]; P=0.70), even after further adjustment for aortic valve replacement (hazard ratio=1.09 [95% CI, 0.81‐1.48]; P=0.56). The 6‐year cumulative incidence of aortic valve replacement (performed in accordance with guidelines) was comparable between the 2 groups (39±4% for NF‐LG‐SAS and 35±3% for MAS, P=0.10). After propensity score matching (n=226), NF‐LG‐SAS and MAS patients also had comparable outcomes under medical (P=0.41) and under medical and surgical management (P=0.52). NF‐LG‐SAS had better outcomes than HG‐SAS patients (adjusted hazard ratio 1.84 [95% CI, 1.18‐2.88]; P<0.001). Conclusions This study shows that patients with NF‐LG‐SAS have a comparable outcome to those with MAS when aortic valve replacement is performed during follow‐up according to guidelines, mostly at the stage of HG‐SAS. Rigorous echocardiographic assessment to rule out measurement errors and close follow‐up are essential to detect progression to true severe AS in NF‐LG‐SAS.
Collapse
Affiliation(s)
- Gagandeep Chadha
- Department of Cardiology Amiens University Hospital Amiens France
| | - Yohann Bohbot
- Department of Cardiology Amiens University Hospital Amiens France.,EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| | - Dan Rusinaru
- Department of Cardiology Amiens University Hospital Amiens France.,EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| | - Sylvestre Maréchaux
- EA 7517 MP3CV Jules Verne University of Picardie Amiens France.,Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de Médecine Université Lille Nord de France Lille France
| | - Christophe Tribouilloy
- Department of Cardiology Amiens University Hospital Amiens France.,EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| |
Collapse
|
34
|
Szymanski C, Bohbot Y, Rusinaru D, Touati G, Tribouilloy C. Impact of Preoperative Left Atrial Dimension on Outcome in Patients in Sinus Rhythm Undergoing Surgical Valve Repair for Severe Mitral Regurgitation due to Mitral Valve Prolapse. Cardiology 2019; 142:189-193. [PMID: 31230053 DOI: 10.1159/000499577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/13/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Left atrial (LA) enlargement has been previously identified as a predictor of mortality in patients with medically managed mitral regurgitation (MR) due to mitral valve prolapse (MVP). No study has specifically assessed the prognostic value of LA size in patients undergoing mitral valve repair (MVRp). OBJECTIVE We aimed to investigate the relationship between LA area and mortality in patients in sinus rhythm (SR) undergoing MVRp for MVP. METHODS We included 305 patients in SR who underwent MVRp for MVP. Median follow-up time was 7.9 years. Patients were divided into 3 groups: LA area ≤25 cm2 (reference group), LA 26-30 cm2, and LA >30 cm2. RESULTS Compared with patients with an LA area ≤25 cm2, those with an LA area >30 cm2 had a lower 10-year survival (98 ± 2 vs. 86 ± 4%; p = 0.037). In multivariate analysis, after adjustment for established outcome predictors including age, symptoms, EuroSCORE, and left ventricular size and function, LA enlargement >30 cm2 was associated with increased mortality (adjusted HR = 2.20, 95% CI 1.03-4.90; p = 0.042), whereas LA enlargement between 26 and 30 cm2 was not (adjusted HR = 1.37, 95% CI 0.56-3.56; p = 0.52). CONCLUSION LA enlargement is independently predictive of long-term mortality after MVRp in patients in SR with severe MR due to MVP. Our findings suggest that MVRp should be considered before the LA area exceeds 30 cm2.
Collapse
Affiliation(s)
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France.,EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France
| | - Dan Rusinaru
- Department of Cardiology, Amiens University Hospital, Amiens, France.,EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France
| | - Gilles Touati
- Department of Cardiac Surgery, Amiens University Hospital, Amiens, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France, .,EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France,
| |
Collapse
|
35
|
Rusinaru D, Bohbot Y, Rietzschel E, De Buyzere M, Buiciuc O, Maréchaux S, Gilebert T, Tribouilloy C. Normalized stroke volume in severe aortic stenosis with preserved ejection fraction: Reference values and outcome implications. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
36
|
Chadha G, Bohbot Y, Rusinaru D, Maréchaux S, Tribouilloy C. Outcome of normal flow low gradient “severe” aortic stenosis with preserved left ventricular ejection fraction: A propensity matched study. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
37
|
Bohbot Y, de Meester de Ravenstein C, Chadha G, Rusinaru D, Belkhir K, Trouillet C, Pasquet A, Marechaux S, Vanoverschelde JL, Tribouilloy C. Relationship Between Left Ventricular Ejection Fraction and Mortality in Asymptomatic and Minimally Symptomatic Patients With Severe Aortic Stenosis. JACC Cardiovasc Imaging 2019; 12:38-48. [DOI: 10.1016/j.jcmg.2018.07.029] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/10/2018] [Accepted: 07/27/2018] [Indexed: 10/27/2022]
|
38
|
Grigioni F, Benfari G, Vanoverschelde JL, Tribouilloy C, Avierinos JF, Bursi F, Suri RM, Guerra F, Pasquet A, Rusinaru D, Marcelli E, Théron A, Barbieri A, Michelena H, Lazam S, Szymanski C, Nkomo VT, Capucci A, Thapa P, Enriquez-Sarano M, Suri R, Clavel M, Maalouf J, Michelena H, Nkomo VT, Enriquez-Sarano M, Tribouilloy C, Trojette F, Szymanski C, Rusinaru D, Touati G, Remadi J, Guerra F, Capucci A, Grigioni F, Russo A, Biagini E, Pasquale F, Ferlito M, Rapezzi C, Savini C, Marinelli G, Pacini D, Gargiulo G, Di Bartolomeo R, Boulif J, de Meester C, El Khoury G, Gerber B, Lazam S, Pasquet A, Noirhomme P, Vancraeynest D, Vanoverschelde JL, Avierinos J, Collard F, Théron A, Habib G, Barbieri A, Bursi F, Mantovani F, Lugli R, Modena M, Boriani G, Bacchi-Reggiani L. Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation. J Am Coll Cardiol 2019; 73:264-274. [DOI: 10.1016/j.jacc.2018.10.067] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/11/2018] [Accepted: 10/16/2018] [Indexed: 11/15/2022]
|
39
|
Bohbot Y, De Meester C, Chadha G, Rusinaru D, Belkhir K, Pasquet A, Maréchaux S, Vanoverschelde JL, Tribouilloy C. Relationship between left ventricular ejection fraction and mortality in asymptomatic and minimally symptomatic patients with severe aortic stenosis. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2018.10.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
40
|
Bohbot Y, Pasquet A, Rusinaru D, Delabre J, Delpierre Q, Altes A, Maréchaux S, Vanoverschelde JL, Tribouilloy C. Asymptomatic Severe Aortic Stenosis With Preserved Ejection Fraction. J Am Coll Cardiol 2018; 72:2938-2939. [DOI: 10.1016/j.jacc.2018.09.049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/10/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
|
41
|
Rusinaru D, Bohbot Y, Ringle A, Maréchaux S, Diouf M, Tribouilloy C. Impact of low stroke volume on mortality in patients with severe aortic stenosis and preserved left ventricular ejection fraction. Eur Heart J 2018; 39:1992-1999. [DOI: 10.1093/eurheartj/ehy123] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 02/23/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Dan Rusinaru
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, D 408, 80054 Amiens Cedex 1, France
- INSERM U-1088, Jules Verne University of Picardie, D 408, 80054 Amiens Cedex 1, France
| | - Yohann Bohbot
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, D 408, 80054 Amiens Cedex 1, France
| | - Anne Ringle
- Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France, F-59045 Lille Cedex, France
| | - Sylvestre Maréchaux
- INSERM U-1088, Jules Verne University of Picardie, D 408, 80054 Amiens Cedex 1, France
- Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France, F-59045 Lille Cedex, France
| | - Momar Diouf
- Division of Clinical Research and Innovation, University Hospital Amiens, D 408, 80054 Amiens Cedex 1, France
| | - Christophe Tribouilloy
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, D 408, 80054 Amiens Cedex 1, France
- INSERM U-1088, Jules Verne University of Picardie, D 408, 80054 Amiens Cedex 1, France
| |
Collapse
|
42
|
Bohbot Y, Rusinaru D, Delpierre Q, Marechaux S, Tribouilloy C. Impact of Preoperative Left Ventricular Remodelling Patterns on Long-Term Outcome after Aortic Valve Replacement for Severe Aortic Stenosis. Cardiology 2018; 139:105-109. [PMID: 29301127 DOI: 10.1159/000484659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/26/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Four patterns of left ventricular (LV) geometry have been described in aortic stenosis (AS): normal geometry, concentric remodelling (LVCR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). LVCR and CH are independently associated with an increased risk of mortality in patients with medically managed AS. No data are available on the impact of aortic valve replacement (AVR) on the negative prognostic implications of LV remodelling patterns. METHODS This study evaluated the long-term postoperative prognostic value of preoperative LV patterns in a cohort of 779 patients (mean age 73 years) with severe AS and ejection fraction >50% undergoing AVR. RESULTS Long-term postoperative all-cause and cardiovascular mortality in patients with LVCR (adjusted HR = 0.50 [0.17-1.45], p = 0.202, and 0.45 [0.10-2.15], p = 0.373, respectively), CH (adjusted HR = 0.98 [0.68-1.40], p = 0.915, and 1.25 [0.60-2.40], p = 0.556, respectively), or EH (adjusted HR = 1.02 [0.79-1.32], p = 0.870, and 1.18 [0.70-1.99], p = 0.537, respectively) were comparable to those of patients with normal LV geometry. CONCLUSIONS Despite the negative prognostic impact of LVCR and CH observed in patients with medically managed AS, these LV remodelling patterns are not associated with excess mortality after AVR. Surgery should therefore be discussed in patients with LVCR or CH and severe AS to avoid the risk of increased mortality observed under conservative management.
Collapse
Affiliation(s)
- Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
| | | | | | | | | |
Collapse
|
43
|
Ringlé A, Tribouilloy C, Truffier A, Bohbot Y, Menet A, Castel A, Delelis F, Ennezat P, Levy F, Vincentelli A, Rusinaru D, Maréchaux S. Impact of ejection dynamics parameters on outcome in patients with aortic stenosis. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Bohbot Y, Belkhir K, Rusinaru D, Maréchaux S, Tribouilloy C. Impact of gender on outcome in aortic stenosis. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Abstract
Background Left atrium (LA) enlargement is common in patients with aortic stenosis (AS), yet its prognostic implications are unclear. This study investigates the value of left atrial volume (LAV) and LAV normalized to body size for predicting mortality in AS. Methods and Results We included 1351 patients with AS in sinus rhythm at diagnosis and analyzed the occurrence of all‐cause death during follow‐up with medical and surgical management. Five parameters of LA enlargement were tested: nonindexed LAV and normalized LAV by ratiometric (LAV/body surface area [BSA] and LAV/height) and allometric (LAV/BSA1.7 and LAV/height2.0) scaling. For each parameter, patients in the highest quartile were at high risk of death, whereas outcome was better and similar for the other quartiles. Five‐year survival was lower for patients with LAV >95 mL and LAV/BSA >50 mL/m2 compared with those with no or mild LA enlargement (both P<0.001). After adjustment for established outcome predictors, including surgery, high risk of death was observed with LAV >95 mL (adjusted hazard ratio, 1.40 [95% confidence interval, 1.06–1.88]) and LAV/BSA >50 mL/m2 (adjusted hazard ratio, 1.42 [95% confidence interval, 1.08–1.91]). LAV/BSA and LAV showed good and similar predictive performance, whereas other scaling methods did not show better outcome prediction. In patients with severe AS at baseline, preserved (≥50%) ejection fraction, and no or minimal symptoms, LA enlargement was significantly associated with mortality (adjusted hazard ratio, 1.87 [95% confidence interval, 1.02–3.44] for LAV >95 mL, and adjusted hazard ratio, 1.90 [95% confidence interval, 1.03–3.56] for LAV/BSA >50 mL/m2). Conclusions LA enlargement is an important predictor of mortality in AS, incrementally to known predictors of outcome. LAV and LAV/BSA have comparable predictive performance and should be assessed in clinical practice for risk stratification.
Collapse
Affiliation(s)
- Dan Rusinaru
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France.,INSERM U-1088, Jules Verne University of Picardie, Amiens, France
| | - Yohann Bohbot
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France
| | - Cédric Kowalski
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France
| | - Anne Ringle
- Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de Médecine, Université Lille Nord de France, Lille, France
| | - Sylvestre Maréchaux
- INSERM U-1088, Jules Verne University of Picardie, Amiens, France.,Groupement des Hôpitaux de l'Institut Catholique de Lille/Faculté libre de Médecine, Université Lille Nord de France, Lille, France
| | - Christophe Tribouilloy
- Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France .,INSERM U-1088, Jules Verne University of Picardie, Amiens, France
| |
Collapse
|
46
|
Bohbot Y, Rusinaru D, Delpierre Q, Marechaux S, Tribouilloy C. Risk Stratification of Severe Aortic Stenosis With Preserved Left Ventricular Ejection Fraction Using Peak Aortic Jet Velocity. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006760. [DOI: 10.1161/circimaging.117.006760] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 08/25/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Yohann Bohbot
- From the Department of Cardiology, Amiens University Hospital, France (Y.B., D.R., Q.D., C.T.); INSERM U-1088, Jules Verne University of Picardie, Amiens, France (D.R., S.M., C.T.); and Groupement des Hôpitaux de l’Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France (S.M.)
| | - Dan Rusinaru
- From the Department of Cardiology, Amiens University Hospital, France (Y.B., D.R., Q.D., C.T.); INSERM U-1088, Jules Verne University of Picardie, Amiens, France (D.R., S.M., C.T.); and Groupement des Hôpitaux de l’Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France (S.M.)
| | - Quentin Delpierre
- From the Department of Cardiology, Amiens University Hospital, France (Y.B., D.R., Q.D., C.T.); INSERM U-1088, Jules Verne University of Picardie, Amiens, France (D.R., S.M., C.T.); and Groupement des Hôpitaux de l’Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France (S.M.)
| | - Sylvestre Marechaux
- From the Department of Cardiology, Amiens University Hospital, France (Y.B., D.R., Q.D., C.T.); INSERM U-1088, Jules Verne University of Picardie, Amiens, France (D.R., S.M., C.T.); and Groupement des Hôpitaux de l’Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France (S.M.)
| | - Christophe Tribouilloy
- From the Department of Cardiology, Amiens University Hospital, France (Y.B., D.R., Q.D., C.T.); INSERM U-1088, Jules Verne University of Picardie, Amiens, France (D.R., S.M., C.T.); and Groupement des Hôpitaux de l’Institut Catholique de Lille/Faculté libre de médecine, Université Lille Nord de France (S.M.)
| |
Collapse
|
47
|
Levy F, Bohbot Y, Sanhadji K, Rusinaru D, Ringle A, Delpierre Q, Smaali S, Gun M, Marechaux S, Tribouilloy C. Impact of pulmonary hypertension on long-term outcome in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2017; 19:553-561. [DOI: 10.1093/ehjci/jex166] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/06/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Franck Levy
- Department of Cardiology, Centre Cardiothoracique de Monaco, 11 bis Avenue d'Ostende, Monaco 98000, Monaco
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Yohann Bohbot
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Khalil Sanhadji
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Dan Rusinaru
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
- INSERM U-1088, Jules Verne University of Picardie, 1 Chemin du Thil, Amiens 80000, France
| | - Anne Ringle
- Groupement des Hôpitaux de l'Institut Catholique de Lille / Faculté libre de médecine, Université Lille Nord de France, 115 Rue du Grand But, Lille 59160, France
| | - Quentin Delpierre
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Sondes Smaali
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Mesut Gun
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
| | - Sylvestre Marechaux
- INSERM U-1088, Jules Verne University of Picardie, 1 Chemin du Thil, Amiens 80000, France
- Groupement des Hôpitaux de l'Institut Catholique de Lille / Faculté libre de médecine, Université Lille Nord de France, 115 Rue du Grand But, Lille 59160, France
| | - Christophe Tribouilloy
- Department of Cardiology, University Hospital Amiens, Avenue Rene Laennec, Salouel, Amiens 80054, France
- INSERM U-1088, Jules Verne University of Picardie, 1 Chemin du Thil, Amiens 80000, France
| |
Collapse
|
48
|
Roux V, Salaun E, Tribouilloy C, Hubert S, Bohbot Y, Casalta JP, Barral PA, Rusinaru D, Gouriet F, Lavoute C, Haentjens J, Di Biscegli M, Dehaene A, Renard S, Casalta AC, Pradier J, Avierinos JF, Riberi A, Lambert M, Collart F, Jacquier A, Thuny F, Camoin-Jau L, Lepidi H, Raoult D, Habib G. Coronary events complicating infective endocarditis. Heart 2017. [DOI: 10.1136/heartjnl-2017-311624] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
49
|
Bohbot Y, Kowalski C, Rusinaru D, Maréchaux S, Ringle A, Tribouilloy C. Impact of Mean Transaortic Pressure Gradient on Long-Term Outcome in Patients with Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
50
|
Bohbot Y, Levy F, Sanhadji K, Rusinaru D, Ringle A, Delpierre Q, Marechaux S, Tribouilloy C. Impact of Pulmonary Hypertension on Long-Term Outcome in Patients with Severe Aortic Stenosis. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|