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Thellier N, Altes A, Rietz M, Menet A, Layec J, Outteryck F, Appert L, Tribouilloy C, Maréchaux S. Additive Prognostic Value of Left Ventricular Dispersion and Deformation in Patients With Severe Aortic Stenosis. JACC Cardiovasc Imaging 2024; 17:235-245. [PMID: 37943232 DOI: 10.1016/j.jcmg.2023.09.010] [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: 04/14/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Speckle tracking strain echocardiography allows one to visualize the timing of maximum regional strain and quantifies left ventricular-mechanical dispersion (LV-MD). Whether LV-MD and LV-global longitudinal strain (LV-GLS) provide similar or complementary information in mortality risk stratification in patients with severe aortic stenosis (SAS) remains unknown. OBJECTIVES The authors hypothesized that LV mechanical dyssynchrony assessed by LV-MD is associated with an increased risk of mortality and provides additional prognostic information on top of LV-GLS in patients with SAS. METHODS A total of 364 patients with SAS (aortic valve area indexed ≤0.6 cm2/m2 and/or aortic valve area ≤1 cm2), LV ejection fraction ≥50% and no or mild symptoms were enrolled. The endpoint was overall mortality. RESULTS During a median follow-up period of 41 months, 149 patients died. After adjustment, LV-MD ≥68 ms was significantly associated with an increased risk of mortality (adjusted HR: 1.41; 95% CI: 1.01-1.96; P = 0.044). Adding LV-MD ≥68 ms to a multivariable Cox regression model including LV-GLS ≥-15% improved predictive performance in terms of overall mortality, with improved global model fit, reclassification, and better discrimination. Patients with both criteria had an important increase in mortality compared to patients with none or one criterion (adjusted HR: 2.02; 95% CI: 1.34-3.03; P = 0.001). Interobserver reproducibility of LV-MD was good with an intraclass correlation coefficient of 0.90 (95% CI: 0.72-0.97). CONCLUSIONS LV-MD is a reproducible parameter independently associated with an increased risk of mortality in SAS. Increased LV-MD associated with depressed LV-GLS identifies a subgroup of patients with an increased mortality risk. Whether early aortic valve replacement improves the outcome of these patients deserves further studies.
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Affiliation(s)
- Nicolas Thellier
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Alexandre Altes
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Michael Rietz
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Aymeric Menet
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Jeremy Layec
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - François Outteryck
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Ludovic Appert
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Christophe Tribouilloy
- Amiens University Hospital Center, Amiens, France; EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France
| | - Sylvestre Maréchaux
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France.
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Thellier N, Altes A, Layec J, Castel AL, Delelis F, Hubert T, Outerryck F, Appert L, Tribouilloy C, Maréchaux S. Impact of left atrial and diastolic ventricular dysfunction on mortality in patients with aortic stenosis. Arch Cardiovasc Dis 2023; 116:126-135. [PMID: 36739188 DOI: 10.1016/j.acvd.2022.12.006] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Diastolic dysfunction (DD) is common in severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF≥50%). AIM To determine the impact of American Society of Echocardiography/European Association of Cardiovascular Imaging-recommended DD grading and left atrial strain on mortality in a cohort of patients with severe AS and preserved LVEF. METHODS We studied patients with severe AS (aortic valve area indexed<0.6 cm2/m2 and/or aortic valve area<1cm2), LVEF≥50% and no or mild AS-related symptoms. The endpoint was all-cause mortality. RESULTS A total of 387 patients (median age 76years; 53% women) were studied. During a median follow-up of 57 (interquartile range 37; 83) months, 158 patients died. After adjustment for prognostic factors, patients with grade II or III DD had an increased mortality risk versus patients with grade I DD (adjusted hazard ratio (aHR) 1.62, 95% confidence interval (CI) 1.11-2.38; P=0.013; aHR 4.73, 95% CI 2.49-8.99; P<0.001; respectively). Adding peak atrial longitudinal strain (PALS)≤14% to a multivariable model including DD grade improved predictive performance, with better global model fit, reclassification and discrimination. Patients with grade III DD or grade II DD+PALS≤14% displayed an increased mortality risk versus patients with grade I DD+PALS>14% (aHR 4.17, 95% CI 2.46-7.06; P<0.0001). Those with grade I DD+PALS≤14% or grade II DD+PALS>14% were at intermediate risk (aHR 1.63, 95% CI 1.07-2.49; P=0.024). CONCLUSIONS Our results demonstrate the strong relationship between DD and mortality in patients with severe AS and preserved LVEF. Patients with grade III or grade II DD and impaired PALS are at very high risk. These data demonstrate the importance of a comprehensive assessment of diastolic function in patients with severe AS.
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Affiliation(s)
- Nicolas Thellier
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Alexandre Altes
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Jeremy Layec
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Anne Laure Castel
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - François Delelis
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Tiffany Hubert
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - François Outerryck
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Ludovic Appert
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France
| | - Christophe Tribouilloy
- Centre Hospitalier Universitaire d'Amiens, 80054 Amiens, France; EA 7517 MP3CV, Jules Verne University of Picardie, 80054 Amiens, France
| | - Sylvestre Maréchaux
- Cardiology Department, Heart Valve Centre, Lille Catholic Hospitals, ETHICS EA 7446, Lille Catholic University, 59462 Lomme Cedex, France; EA 7517 MP3CV, Jules Verne University of Picardie, 80054 Amiens, France.
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Layec J, Decroocq M, Delelis F, Appert L, Guyomar Y, Riolet C, Dumortier H, Mailliet A, Tribouilloy C, Maréchaux S, Menet A. Dyssynchrony and Response to Cardiac Resynchronization Therapy in Heart Failure Patients With Unfavorable Electrical Characteristics. JACC Cardiovasc Imaging 2023:S1936-878X(23)00027-X. [PMID: 37038875 DOI: 10.1016/j.jcmg.2022.12.023] [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: 06/19/2022] [Revised: 11/23/2022] [Accepted: 12/23/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND Among heart failure (HF) patients undergoing cardiac resynchronization therapy (CRT), those with unfavorable electrical characteristics (UEC) are less frequently CRT responders. OBJECTIVES In this study, the authors sought to evaluate the relationship between preprocedural echocardiographic parameters of electromechanical dyssynchrony (EMD) and outcome following CRT. METHODS Among 551 patients receiving CRT, 121 with UEC, defined as atypical left bundle branch, presence of right bundle branch block, or unspecified intraventricular conduction disturbance, were enrolled. Indices of EMD were presence of septal flash, apical rocking, septal deformation patterns, and global wasted work (GWW), determined with the use of speckle-tracking strain echocardiography. Endpoints were response to CRT, defined as a relative decrease in left ventricular end-systolic volume ≥15% at 9-month postoperative follow-up, and all-cause death or HF hospitalization during follow-up. RESULTS Among the 121 patients, 68 (56%) were CRT responders. In multivariate analysis, GWW ≥200 mm Hg% (adjusted odds ratio [aOR]: 4.17 [95% CI: 1.33-14.56]; P = 0.0182) and longitudinal strain septal contraction patterns 1 and 2 (aOR: 10.05 [95% CI: 2.82-43.97]; P < 0.001) were associated with CRT response. During a 46-month follow-up (IQR: 42-55 months), survival free from death or HF hospitalization increased with the number of positive criteria (87% for 2, 59% for 1, and 27% for 0). After adjustment for established predictors of outcome in patients receiving CRT, absence of either of the 2 criteria remained associated with a considerable increased risk of death and/or HF hospitalization (adjusted HR: 4.83 [95% CI: 1.84-12.68]; P = 0.001). CONCLUSIONS In patients with UEC, echocardiographic assessment of EMD may help to select patients who will derive benefit from CRT.
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Affiliation(s)
- Jeremy Layec
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Marie Decroocq
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Francois Delelis
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Ludovic Appert
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Yves Guyomar
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Clémence Riolet
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Hélène Dumortier
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Amandine Mailliet
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
| | - Christophe Tribouilloy
- Departement de Cardiologie, CHU Amiens, Amiens, France; UR UPJV 7517, Université Jules Verne de Picardie, Amiens, France
| | - Sylvestre Maréchaux
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France.
| | - Aymeric Menet
- Laboratoire ETHICS, Groupement des Hôpitaux de l'Institut Catholique de Lille, Service de Cardiologie, USIC, Université Catholique de Lille, Lille, France
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Ninni S, Layec J, Brigadeau F, Behal H, Labreuche J, Klein C, Schurtz G, Potelle C, Coisne A, Lemesle G, Lamblin N, Klug D, Lacroix D. Incidence and predictors of mortality after an electrical storm in the ICU. Eur Heart J Acute Cardiovasc Care 2022; 11:431-439. [PMID: 35512138 DOI: 10.1093/ehjacc/zuac044] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
AIMS For assessing predictors of early mortality following hospitalization for electrical storm (ES), only limited data are available. The purpose of this study was to assess the incidence and predictors of early mortality following hospitalization in the intensive care unit (ICU) for ES in a large retrospective study. METHODS AND RESULTS In this retrospective study, we included all patients who were hospitalized for ES from July 2015 to May 2020 in our tertiary centre. A total of 253 patients were included. The median age was 66 [56; 73], and 64% had ischemic cardiomyopathy. A total of 37% of patients presented hemodynamic instability requiring catecholamine at admission. A total of 17% of patients presented an acute reversible cause for ES. The one-year mortality was 34% (95% CI, 30-43%), mostly driven by heart failure (HF). The multivariable Cox's regression model identified age, left ventricular ejection fraction, right ventricle dysfunction, haemoglobin level as independent predictors of one-year mortality. The use of catecholamine at admission was identified as the only variable related to the initial management of ES associated with an increased 30-day mortality risk (HR: 7.95 (95%CI, 3.18-19.85). CONCLUSION In patients admitted for ES in ICU, the one-year mortality remains high and mostly driven by HF. The use of catecholamine at admission is associated with a seven-fold risk for mortality within 30 days. In such patients, the potential use of VT ablation can be questioned and a careful action plan regarding invasive HF-related therapy could be considered.
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Affiliation(s)
- Sandro Ninni
- CHU Lille, Institut Coeur-Poumon, service de cardiologie, F-59000 Lille, France
| | - Jeremy Layec
- CHU Lille, Institut Coeur-Poumon, service de cardiologie, F-59000 Lille, France
| | - François Brigadeau
- CHU Lille, Institut Coeur-Poumon, service de cardiologie, F-59000 Lille, France
| | - Hélène Behal
- Univ. Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, F59000 Lille, France
| | - Julien Labreuche
- Univ. Lille, CHU Lille, ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, F59000 Lille, France
| | - Cédric Klein
- CHU Lille, Institut Coeur-Poumon, service de cardiologie, F-59000 Lille, France
| | - Guillaume Schurtz
- CHU Lille, Institut Coeur-Poumon, service de cardiologie, F-59000 Lille, France
| | - Charlotte Potelle
- CHU Lille, Institut Coeur-Poumon, service de cardiologie, F-59000 Lille, France
| | - Augustin Coisne
- CHU Lille, Institut Coeur-Poumon, service de cardiologie, F-59000 Lille, France
| | - Gilles Lemesle
- CHU Lille, Institut Coeur-Poumon, service de cardiologie, F-59000 Lille, France
| | - Nicolas Lamblin
- CHU Lille, Institut Coeur-Poumon, service de cardiologie, F-59000 Lille, France
| | - Didier Klug
- CHU Lille, Institut Coeur-Poumon, service de cardiologie, F-59000 Lille, France
| | - Dominique Lacroix
- CHU Lille, Institut Coeur-Poumon, service de cardiologie, F-59000 Lille, France
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