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Guala A, Gil-Sala D, Garcia Reyes ME, Azancot MA, Dux-Santoy L, Allegue Allegue N, Teixido-Turà G, Goncalves Martins G, Galian-Gay L, Garrido-Oliver J, Constenla García I, Evangelista A, Tello Díaz C, Carrasco-Poves A, Morales-Galán A, Ferreira-González I, Rodríguez-Palomares J, Bellmunt Montoya S. Impact of thoracic endovascular aortic repair following blunt traumatic thoracic aortic injury on blood pressure. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00623-2. [PMID: 37490995 DOI: 10.1016/j.jtcvs.2023.07.018] [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: 03/20/2023] [Revised: 06/16/2023] [Accepted: 07/02/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Blunt traumatic thoracic aortic injuries (BTAIs) are associated with a high mortality rate. Thoracic endovascular aortic repair (TEVAR) is the most frequently used surgical strategy in patients with BTAI, as it offers good short- and middle-term results. Previous studies have reported an abnormally high prevalence of hypertension (HT) in these patients. This work aimed to describe the long-term prevalence of HT and provide a comprehensive evaluation of the biomechanical, clinical, and functional factors involved in HT development. METHODS Twenty-six patients treated with TEVAR following BTAI with no history of HT at the time of trauma were enrolled. They were matched with 37 healthy volunteers based on age, sex, and body surface area and underwent a comprehensive follow-up study, including cardiovascular magnetic resonance, 24-hour ambulatory blood pressure monitoring, and assessment of carotid-femoral pulse wave velocity (cfPWV, a measure of aortic stiffness) and flow-mediated vasodilation. RESULTS The mean patient age was 43.5 ± 12.9 years, and the majority were male (23 of 26; 88.5%). At a mean of 120.2 ± 69.7 months after intervention, 17 patients (65%) presented with HT, 14 (54%) had abnormal nighttime blood pressure dipping, and 6 (23%) high cfPWV. New-onset HT was related to a more proximal TEVAR landing zone and greater distal oversizing. Abnormal nighttime blood pressure was related to high cfPWV, which in turn was associated with TEVAR length and premature arterial aging. CONCLUSIONS HT frequently occurs otherwise healthy subjects undergoing TEVAR implantation after BTAI. TEVAR stiffness and length, the proximal landing zone, and distal oversizing are potentially modifiable surgical characteristics related to abnormal blood pressure.
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Affiliation(s)
- Andrea Guala
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain.
| | - Daniel Gil-Sala
- Vascular and Endovascular Surgery, Institut Clínic Cardiovascular, Hospital Clínic, Barcelona, Spain; Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Marvin E Garcia Reyes
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Maria A Azancot
- Department of Nephrology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Gisela Teixido-Turà
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Laura Galian-Gay
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Ivan Constenla García
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Arturo Evangelista
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Heart Institute, Quirónsalud-Teknon, Barcelona, Spain
| | - Cristina Tello Díaz
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | | | - Ignacio Ferreira-González
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Center for Biomedical Research in Epidemiology and Public Health Network (CIBER-ESP), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Jose Rodríguez-Palomares
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; CIBER-CV, Instituto de Salud Carlos III, Madrid, Spain; Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - Sergi Bellmunt Montoya
- Vall d'Hebron Institut de Recerca, Barcelona, Spain; Department of Surgery, Universitat Autònoma de Barcelona, Bellaterra, Spain; Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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Evangelista A, Sitges M, Jondeau G, Nijveldt R, Pepi M, Cuellar H, Pontone G, Bossone E, Groenink M, Dweck MR, Roos-Hesselink JW, Mazzolai L, van Kimmenade R, Aboyans V, Rodríguez-Palomares J. Multimodality imaging in thoracic aortic diseases: a clinical consensus statement from the European Association of Cardiovascular Imaging and the European Society of Cardiology working group on aorta and peripheral vascular diseases. Eur Heart J Cardiovasc Imaging 2023; 24:e65-e85. [PMID: 36881779 DOI: 10.1093/ehjci/jead024] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 03/09/2023] Open
Abstract
Imaging techniques play a pivotal role in the diagnosis, follow-up, and management of aortic diseases. Multimodality imaging provides complementary and essential information for this evaluation. Echocardiography, computed tomography, cardiovascular magnetic resonance, and nuclear imaging each have strengths and limitations in the assessment of the aorta. This consensus document aims to review the contribution, methodology, and indications of each technique for an adequate management of patients with thoracic aortic diseases. The abdominal aorta will be addressed elsewhere. While this document is exclusively focused on imaging, it is of most importance to highlight that regular imaging follow-up in patients with a diseased aorta is also an opportunity to check the patient's cardiovascular risk factors and particularly blood pressure control.
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Affiliation(s)
- Artur Evangelista
- Servei de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Vall d´Hebron Research Institute, VHIR, Barcelona, Spain
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.,CIBERCV, Institut Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, Spain
| | - Guillaume Jondeau
- Reference Center for Marfan Syndrome and related diseases, Cardiology Department, VASCERN HTAD European Reference Centre, Hopital Bichat, APHP, INSERM U1148, Université de Paris, France
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Mauro Pepi
- Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, Milano, Italy
| | - Hug Cuellar
- Radiology Department, Institut de Diagnòstic per la Imatge, Hospital Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Vall d´Hebron Research Institute (VHIR), Barcelona, Spain
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Eduardo Bossone
- Cardiology Division, Antonio Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Naples, Italy
| | - Maarten Groenink
- Department of Cardiology and Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Marc R Dweck
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Little France Crescent, Edinburgh EH16 4SB, UK
| | - Jolien W Roos-Hesselink
- Cardiology Department, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,VASCERN HTAD European Reference Centre
| | - L Mazzolai
- Division of Angiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Roland van Kimmenade
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Inserm U1094, Limoges, France
| | - Jose Rodríguez-Palomares
- Servei de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Vall d´Hebron Research Institute, VHIR, Barcelona, Spain
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Evangelista A, Rodríguez-Palomares J. Special Issue: State of the Art of Cardiac Multimodality Imaging. J Clin Med 2022; 11:jcm11133793. [PMID: 35807079 PMCID: PMC9267328 DOI: 10.3390/jcm11133793] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Imaging has progressed significantly in recent years and plays a pivotal role in the diagnosis, prognosis, and management of cardiac diseases [...]
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Evangelista A, Pineda V, Guala A, Bijnens B, Cuellar H, Rudenick P, Sao-Aviles A, Ruiz A, Teixido-Tura G, Rodriguez-Lecoq R, Bellmunt S, Ferreira I, Rodríguez-Palomares J. False Lumen Flow Assessment by Magnetic Resonance Imaging and Long-Term Outcomes in Uncomplicated Aortic Dissection. J Am Coll Cardiol 2022; 79:2415-2427. [PMID: 35710193 DOI: 10.1016/j.jacc.2022.04.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 07/19/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Despite the absence of clinical complications after an acute aortic dissection (AD) with persistent patent false lumen (FL), a high risk for clinical events may persist. OBJECTIVES The aim of this study was to assess the natural evolution of noncomplicated AD and ascertain whether different FL flow patterns by magnetic resonance imaging (MRI) have independent prognostic value for AD-related events beyond established morphologic parameters. METHODS One hundred thirty-one consecutive patients, 78 with surgically treated type A dissections and 53 with medically treated type B dissections, were followed up prospectively after acute AD with persistent patent FL in the descending aorta. Maximum aortic diameter, true lumen compression, entry tear, and partial FL thrombosis by computed tomography were assessed. Systolic antegrade true lumen and FL flow volumes and diastolic antegrade and retrograde flows were analyzed by MRI during the first year after AD. RESULTS After a median follow-up period of 8.0 years (IQR: 4.6-10.9 years), 43 patients presented aorta-related events (25 died and 18 required endovascular treatment). FL systolic antegrade flow ≥30% with respect to total systolic antegrade flow and retrograde diastolic flow ≥80% with respect to total diastolic FL flow were predictors of aortic events. In multivariate analysis, aortic diameter >45 mm (HR: 2.91), type B dissection (HR: 2.44), and MRI flow pattern (HR: 16.87) were independent predictors of AD-related events. CONCLUSIONS High systolic antegrade flow volume in the FL with significant diastolic retrograde flow assessed by MRI and aortic diameter >45 mm identify patients with higher risk for complications in whom more aggressive management would be indicated.
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Affiliation(s)
- Arturo Evangelista
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Victor Pineda
- Institut de Diagnòstic per la Imatge, Hospital Vall d'Hebron, Barcelona, Spain
| | - Andrea Guala
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Hug Cuellar
- Institut de Diagnòstic per la Imatge, Hospital Vall d'Hebron, Barcelona, Spain
| | - Paula Rudenick
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Augusto Sao-Aviles
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Aroa Ruiz
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Gisela Teixido-Tura
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Rafael Rodriguez-Lecoq
- Department de Cirurgia Cardiaca, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Sergi Bellmunt
- Department de Cirurgia Vascular, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Ignacio Ferreira
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Jose Rodríguez-Palomares
- Departament de Cardiologia, Hospital Vall d'Hebron, CIBERCV, Universitat Autonoma de Barcelona, Barcelona, Spain
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González-Del-Hoyo M, Servato L, Ródenas E, Bañeras J, Ferreira-González I, Rodríguez-Palomares J. Echocardiography in the acute phase of COVID-19 infection: impact on management and prognosis. Revista Española de Cardiología (English Edition) 2022; 75:532-535. [PMID: 34972647 PMCID: PMC8668385 DOI: 10.1016/j.rec.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/29/2021] [Indexed: 10/25/2022]
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González-Del-Hoyo M, Servato L, Ródenas E, Bañeras J, Ferreira-González I, Rodríguez-Palomares J. Ecocardiografía en la fase aguda de la infección por COVID-19: impacto en el tratamiento clínico y el pronóstico. Rev Esp Cardiol 2022; 75:532-535. [PMID: 35068655 PMCID: PMC8761554 DOI: 10.1016/j.recesp.2021.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maribel González-Del-Hoyo
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, España
| | - Luz Servato
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, España
| | - Eduardo Ródenas
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Jordi Bañeras
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Ignacio Ferreira-González
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, España
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España
| | - Jose Rodríguez-Palomares
- Departamento de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
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7
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Servato ML, Teixidó-Turá G, Sabate-Rotes A, Galian-Gay L, Gutiérrez L, Valente F, Fernandez-Galera R, Casas G, López-Sainz A, González-Alujas MT, Sao-Aviles A, Ferreira I, Rodríguez-Palomares J, Evangelista A. Are Aortic Root and Ascending Aorta Diameters Measured by the Pediatric versus the Adult American Society of Echocardiography Guidelines Interchangeable? J Clin Med 2021; 10:jcm10225290. [PMID: 34830571 PMCID: PMC8617792 DOI: 10.3390/jcm10225290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/06/2021] [Accepted: 11/08/2021] [Indexed: 11/16/2022] Open
Abstract
Ascending aorta diameters have important clinical value in the diagnosis, follow-up, and surgical indication of many aortic diseases. However, there is no uniformity among experts regarding ascending aorta diameter quantification by echocardiography. The aim of this study was to compare maximum aortic root and ascending aorta diameters determined by the diastolic leading edge (DLE) and the systolic inner edge (SIE) conventions in adult and pediatric patients with inherited cardiovascular diseases. Transthoracic echocardiograms were performed in 328 consecutive patients (260 adults and 68 children). Aorta diameters were measured twice at the root and ascending aorta by the DLE convention following the 2015 American Society of Echocardiography (ASE) adult guidelines and the SIE convention following the 2010 ASE pediatric guidelines. Comparison of the diameters measured by the two conventions in the overall population showed a non-significant underestimation of the diameter measured by the SIE convention at root level of 0.28 mm (CI -1.36; 1.93) and at tubular ascending aorta level of 0.17 mm (CI -1.69; 2.03). Intraobserver and interobserver variability were excellent. Maximum aorta diameter measured by the leading edge convention in end-diastole and the inner edge convention in mid-systole had similar values to a mild non-significant underestimation of the inner-to-inner method that permits them to be interchangeable when used in clinical practice.
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Affiliation(s)
- Maria Luz Servato
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Gisela Teixidó-Turá
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Anna Sabate-Rotes
- Department of Pediatric Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain;
| | - Laura Galian-Gay
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Laura Gutiérrez
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Filipa Valente
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Ruben Fernandez-Galera
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Guillem Casas
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Angela López-Sainz
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - M. Teresa González-Alujas
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Augusto Sao-Aviles
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Ignacio Ferreira
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Jose Rodríguez-Palomares
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
| | - Arturo Evangelista
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (M.L.S.); (G.T.-T.); (L.G.-G.); (L.G.); (F.V.); (R.F.-G.); (G.C.); (A.L.-S.); (M.T.G.-A.); (A.S.-A.); (I.F.); (J.R.-P.)
- Teknon Medical Center-Quirón Salud, Heart Institute, 08022 Barcelona, Spain
- Correspondence:
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Lopez A, Dentamaro I, Galian L, Calvo F, Alegret JM, Sanchez V, Citro R, Moreo A, Chirillo F, Colonna P, Carrero MC, Bossone E, Moral S, Sao-Aviles A, Gutiérrez L, Teixido-Tura G, Rodríguez-Palomares J, Evangelista A. Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve. J Clin Med 2021; 10:jcm10225264. [PMID: 34830546 PMCID: PMC8621265 DOI: 10.3390/jcm10225264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/05/2021] [Accepted: 11/09/2021] [Indexed: 12/01/2022] Open
Abstract
Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysfunction and ascending aorta dilation. However, the progression of the disease is not well defined. We aimed to assess mid-long-term aorta dilation and valve dysfunction progression and their predictors. Patients were referred from cardiac outpatient clinics to the echocardiographic laboratories of 10 tertiary hospitals and followed clinically and by echocardiography for >5 years. Seven hundred and eighteen patients with BAV (median age 47.8 years [IQR 33–62], 69.2% male) were recruited. BAV without raphe was observed in 11.3%. After a median follow-up of 7.2 years [IQR5–8], mean aortic root growth rate was 0.23 ± 0.15 mm/year. On multivariate analysis, rapid aortic root dilation (>0.35 mm/year) was associated with male sex, hypertension, presence of raphe and aortic regurgitation. Annual ascending aorta growth rate was 0.43 ± 0.32 mm/year. Rapid ascending aorta dilation was related only to hypertension. Variables associated with aortic stenosis and regurgitation progression, adjusted by follow-up time, were presence of raphe, hypertension and dyslipidemia and basal valvular dysfunction, respectively. Intrinsic BAV characteristics and cardiovascular risk factors were associated with aorta dilation and valvular dysfunction progression, taking into account the inherent limitations of our study-design. Strict and early control of cardiovascular risk factors is mandatory in BAV patients.
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Affiliation(s)
- Angela Lopez
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Ilaria Dentamaro
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Laura Galian
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Francisco Calvo
- Cardiology Department, Hospital Alvaro Cunqueiro, 36213 Vigo, Spain;
| | - Josep M. Alegret
- Cardiology Department, Hospital Universitari Sant Joan de Reus, IISPV, Universitat Rovira i Virgili, 43204 Reus, Spain;
| | - Violeta Sanchez
- Cardiology Department, University Hospital 12 de Octubre, 28041 Madrid, Spain;
| | - Rodolfo Citro
- Cardiology Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84125 Salerno, Italy;
| | - Antonella Moreo
- Cardiology Department, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy;
| | - Fabio Chirillo
- Cardiology Department, Bassano del Grappa General Hospital, 36061 Bassano Del Grappa, Italy;
| | - Paolo Colonna
- Cardiology Department, Polyclinic Hospital of Bari, 70124 Bari, Italy;
| | - María Celeste Carrero
- Instituto Cardiovascular San Isidro, Sanatorio Las Lomas, Buenos Aires 3031, Argentina;
| | - Eduardo Bossone
- Cardiology Department, Azienda Ospedaliera di Rilievo Nazionale Antonio Cardarelli, 80131 Napoli, Italy;
| | - Sergio Moral
- Servei de Cardiologia, Hospital Josep Trueta, 17007 Girona, Spain;
| | - Augusto Sao-Aviles
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Laura Gutiérrez
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Gisela Teixido-Tura
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Jose Rodríguez-Palomares
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
| | - Arturo Evangelista
- Department of Cardiology, University Hospital Vall d’Hebron, CIBERCV, 08035 Barcelona, Spain; (A.L.); (I.D.); (L.G.); (A.S.-A.); (L.G.); (G.T.-T.); (J.R.-P.)
- Heart Institute, Teknon Medical Center-Quirón Salud, 08022 Barcelona, Spain
- Correspondence:
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9
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Rivas-Gándara N, Dos-Subirá L, Francisco-Pascual J, Rodríguez-García J, Pijuan-Domenech A, Benito B, Valente F, Pascual-González G, Santos-Ortega A, Miranda B, Pérez-Rodon J, Ribera-Solé A, Burcet-Rodriguez G, Roses-Noguer F, Gordon B, Rodríguez-Palomares J, Ferreira-González I. Substrate characterization of the right ventricle in repaired tetralogy of Fallot using late enhancement cardiac magnetic resonance. Heart Rhythm 2021; 18:1868-1875. [PMID: 34098087 DOI: 10.1016/j.hrthm.2021.05.032] [Citation(s) in RCA: 1] [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: 03/09/2021] [Revised: 05/20/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Three-dimensional (3D) substrate characterization by high-resolution late gadolinium enhancement cardiac magnetic resonance (LE-CMR) is useful for guiding ventricular tachycardia ablation of the left ventricle in ischemic heart disease. OBJECTIVE The purpose of this study was to validate the substrate characterization and 3D reconstruction of LE-CMR images of the right ventricle (RV) in patients with repaired tetralogy of Fallot (rTOF) and to identify the algorithm that best fits with electroanatomic mapping (EAM). METHODS RV LE-CMR images were compared with RV EAM in 10 patients with rTOF. RV LE-CMR images were postprocessed and analyzed to identify fibrotic tissue on 3D color maps. The 3D RV substrate reconstructions were created using an adjustable percentage of the maximum voxel signal intensity (MSI) of the scar region to define the threshold between core, transitional zone (TZ), and healthy tissue. Extensions of the core and TZ areas were compared with the scar (<0.5 mV) and low-voltage (0.5-1.5 mV) areas obtained by RV EAM. Agreement on anatomic isthmi identification was quantified. RESULTS The best match between core and scar was obtained at 65% MSI cutoff (mean areas 17.4 ± 9.9 cm2 vs 16.9 ± 10.0 cm2, respectively; r = 0.954; P <.001). Agreement on anatomic isthmi identification was best at 60% MSI cutoff, which identified 95% of isthmi and achieved a total fit in 90% of patients. CONCLUSION This study demonstrates that characterization of the RV substrate by postprocessing LE-CMR images in rTOF patients is feasible and validates the technique against RV EAM, which could help in planning target ablation.
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Affiliation(s)
- Nuria Rivas-Gándara
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Laura Dos-Subirá
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Jaume Francisco-Pascual
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Julián Rodríguez-García
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Antonia Pijuan-Domenech
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Begoña Benito
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Filipa Valente
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiac Imaging Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Alba Santos-Ortega
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Berta Miranda
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Jordi Pérez-Rodon
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Aida Ribera-Solé
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Epidemiology Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - Ferran Roses-Noguer
- Arrhythmia Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Department of Cardiology and Pediatric Cardiac Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Blanca Gordon
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Integrated Congenital Heart Disease Unit, Vall d'Hebron University Hospital-Sant Pau Hospital, Barcelona, Spain
| | - Jose Rodríguez-Palomares
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiac Imaging Unit, Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Ignacio Ferreira-González
- Faculty of Medicine and Surgery, Universitat Autonoma Barcelona (UAB), Barcelona, Spain; Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
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10
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Guala A, Teixidó-Tura G, Rodríguez-Palomares J, Ruiz-Muñoz A, Dux-Santoy L, Villalva N, Granato C, Galian L, Gutiérrez L, González-Alujas T, Sanchez V, Forteza A, García-Dorado D, Evangelista A. Proximal aorta longitudinal strain predicts aortic root dilation rate and aortic events in Marfan syndrome. Eur Heart J 2020; 40:2047-2055. [PMID: 30977783 DOI: 10.1093/eurheartj/ehz191] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [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: 07/19/2018] [Revised: 10/15/2018] [Accepted: 03/22/2019] [Indexed: 12/31/2022] Open
Abstract
AIMS Life expectancy in Marfan syndrome patients has improved thanks to the early detection of aortic dilation and prophylactic aortic root surgery. Current international clinical guidelines support the use of aortic root diameter as a predictor of complications. However, other imaging markers are needed to improve risk stratification. This study aim to ascertain whether proximal aorta longitudinal and circumferential strain and distensibility assessed by cardiac magnetic resonance (CMR) predict the aortic root dilation rate and aortic events in Marfan syndrome. METHODS AND RESULTS One hundred and seventeen Marfan patients with no previous aortic dissection, cardiac/aortic surgery, or moderate/severe aortic regurgitation were prospectively included in a multicentre protocol of clinical and imaging follow-up. At baseline, CMR was performed and proximal aorta longitudinal strain and ascending aorta circumferential strain and distensibility were obtained. During follow-up (85.7 [75.0-93.2] months), the annual growth rate of aortic root diameter was 0.62 ± 0.65 mm/year. Fifteen patients underwent elective surgical aortic root replacement and four presented aortic dissection. Once corrected for baseline clinical and demographic characteristics and aortic root diameter, proximal aorta longitudinal strain, but not circumferential strain and distensibility, was an independent predictor of the aortic root diameter growth rate (P = 0.001, P = 0.823, and P = 0.997, respectively), z-score growth rate (P = 0.013, P = 0.672, and P = 0.680, respectively), and aortic events (P = 0.023, P = 0.096, and P = 0.237, respectively). CONCLUSION Proximal aorta longitudinal strain is independently related to the aortic root dilation rate and aortic events in addition to aortic root diameter, clinical risk factors, and demographic characteristics in Marfan syndrome patients.
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Affiliation(s)
- Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Gisela Teixidó-Tura
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Jose Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Aroa Ruiz-Muñoz
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Lydia Dux-Santoy
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Nicolas Villalva
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Chiara Granato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Laura Galian
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Teresa González-Alujas
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Violeta Sanchez
- Department of Cardiology, Hospital doce de Octubre, Avenida Cordoba, Madrid, Spain
| | - Alberto Forteza
- Department of Cardiac Surgery, Hospital Puerta de Hierro. Calle Manuel de Falla, 1, Majadahonda, Spain
| | - David García-Dorado
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Artur Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
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11
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Guala A, Teixidó-Tura G, Rodríguez-Palomares J, Ruiz-Muñoz A, Dux-Santoy L, Villalva N, Granato C, Galian L, Gutiérrez L, González-Alujas T, Sanchez V, Forteza A, García-Dorado D, Evangelista A. Proximal aorta longitudinal strain predicts aortic root dilation rate and aortic events in Marfan syndrome. Eur Heart J 2019. [PMID: 30977783 DOI: 10.1093/eurheart/ehz191] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
AIMS Life expectancy in Marfan syndrome patients has improved thanks to the early detection of aortic dilation and prophylactic aortic root surgery. Current international clinical guidelines support the use of aortic root diameter as a predictor of complications. However, other imaging markers are needed to improve risk stratification. This study aim to ascertain whether proximal aorta longitudinal and circumferential strain and distensibility assessed by cardiac magnetic resonance (CMR) predict the aortic root dilation rate and aortic events in Marfan syndrome. METHODS AND RESULTS One hundred and seventeen Marfan patients with no previous aortic dissection, cardiac/aortic surgery, or moderate/severe aortic regurgitation were prospectively included in a multicentre protocol of clinical and imaging follow-up. At baseline, CMR was performed and proximal aorta longitudinal strain and ascending aorta circumferential strain and distensibility were obtained. During follow-up (85.7 [75.0-93.2] months), the annual growth rate of aortic root diameter was 0.62 ± 0.65 mm/year. Fifteen patients underwent elective surgical aortic root replacement and four presented aortic dissection. Once corrected for baseline clinical and demographic characteristics and aortic root diameter, proximal aorta longitudinal strain, but not circumferential strain and distensibility, was an independent predictor of the aortic root diameter growth rate (P = 0.001, P = 0.823, and P = 0.997, respectively), z-score growth rate (P = 0.013, P = 0.672, and P = 0.680, respectively), and aortic events (P = 0.023, P = 0.096, and P = 0.237, respectively). CONCLUSION Proximal aorta longitudinal strain is independently related to the aortic root dilation rate and aortic events in addition to aortic root diameter, clinical risk factors, and demographic characteristics in Marfan syndrome patients.
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Affiliation(s)
- Andrea Guala
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Gisela Teixidó-Tura
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Jose Rodríguez-Palomares
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Aroa Ruiz-Muñoz
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Lydia Dux-Santoy
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Nicolas Villalva
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Chiara Granato
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Laura Galian
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Laura Gutiérrez
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Teresa González-Alujas
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Violeta Sanchez
- Department of Cardiology, Hospital doce de Octubre, Avenida Cordoba, Madrid, Spain
| | - Alberto Forteza
- Department of Cardiac Surgery, Hospital Puerta de Hierro. Calle Manuel de Falla, 1, Majadahonda, Spain
| | - David García-Dorado
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
| | - Artur Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, CIBER-CV, Vall d'Hebron institut de Recerca, Universitat Autònoma de Barcelona, Paseo Vall d'Hebron 119-129, Barcelona, Spain
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12
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Evangelista A, Maldonado G, Gruosso D, Gutiérrez L, Granato C, Villalva N, Galian L, González-Alujas T, Teixido G, Rodríguez-Palomares J. The current role of echocardiography in acute aortic syndrome. Echo Res Pract 2019; 6:R53-R63. [PMID: 30921764 PMCID: PMC6454227 DOI: 10.1530/erp-18-0058] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 01/16/2023] Open
Abstract
Acute aortic syndrome (AAS) comprises a range of interrelated conditions caused by disruption of the medial layer of the aortic wall, including aortic dissection, intramural haematoma and penetrating aortic ulcer. Since mortality from AAS is high, a prompt and accurate diagnosis using imaging techniques is paramount. Both transthoracic (TTE) and transoesophageal echocardiography (TEE) are useful in the diagnosis of AAS. TTE should be the first imaging technique to evaluate patients with thoracic pain in the emergency room. Should AAS be suspected, contrast administration is recommended when images are not definitive. TEE allows high-quality images in thoracic aorta. The main drawback of this technique is that it is semi-invasive and the presence of a blind area that limits visualisation of the distal ascending aorta near. TEE identifies the location and size of the entry tear, secondary communications, true lumen compression and the dynamic flow pattern of false lumen. Although computed tomography (CT) is the most used imaging technique in the diagnosis of AAS, echocardiography offers complementary information relevant for its management. The best imaging strategy for appropriately diagnosing and assessing AAS is to combine CT, mainly ECG-gated contrast-enhanced CT, and TTE. Currently, TEE tends to be carried out in the operating theatre immediately before surgical or endovascular therapy and in monitoring their results. The aims of this review are to establish the current role of echocardiography in the diagnosis and management of AAS based on its advantages and limitations.
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Affiliation(s)
- Arturo Evangelista
- Cardiovascular Imaging Department, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Giuliana Maldonado
- Cardiovascular Imaging Department, Instituto del Corazon, Quironsalud Teknon, Barcelona, Spain
| | - Domenico Gruosso
- Cardiovascular Imaging Department, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Laura Gutiérrez
- Cardiovascular Imaging Department, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Chiara Granato
- Cardiovascular Imaging Department, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Nicolas Villalva
- Cardiovascular Imaging Department, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Laura Galian
- Cardiovascular Imaging Department, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Teresa González-Alujas
- Cardiovascular Imaging Department, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Gisela Teixido
- Cardiovascular Imaging Department, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
| | - Jose Rodríguez-Palomares
- Cardiovascular Imaging Department, University Hospital Vall d'Hebron, CIBER-CV, Barcelona, Spain
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13
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Teixido-Tura G, Forteza A, Rodríguez-Palomares J, González Mirelis J, Gutiérrez L, Sánchez V, Ibáñez B, García-Dorado D, Evangelista A. Losartan Versus Atenolol for Prevention of Aortic Dilation in Patients With Marfan Syndrome. J Am Coll Cardiol 2018; 72:1613-1618. [DOI: 10.1016/j.jacc.2018.07.052] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 07/29/2018] [Indexed: 01/16/2023]
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Evangelista A, Rabasa JM, Mosquera VX, Barros A, Fernández-Tarrio R, Calvo-Iglesias F, Ferrera C, Rozado J, López-Ayerbe J, Garrote C, San román JA, Nistal F, Sanchez V, García Robles JA, Valera F, Ballester C, Gil-Albarova O, Domínguez F, Vivancos R, Mateo-Martinez A, Gallego P, González-Molina M, Fernández-Golfin C, Josa M, Hurlé A, Rodríguez-Sanchez I, Rodríguez-Palomares J. Diagnosis, management and mortality in acute aortic syndrome: results of the Spanish Registry of Acute Aortic Syndrome (RESA-II). European Heart Journal: Acute Cardiovascular Care 2016; 7:602-608. [DOI: 10.1177/2048872616682343] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background: Recent advances in the diagnosis and treatment of acute aortic syndrome should improve the outcome of this disease. The Spanish Registry of Acute Aortic Syndrome aimed to assess current results in acute aortic syndrome management in a wide cohort of hospitals in the same geographical area. Methods: From January 2012 to January 2014, 26 tertiary hospitals included 629 consecutive patients with acute aortic syndrome: 73% men, mean age 64.7±14 years (range 22–92), 443 type A (70.4%) and 186 type B (29.6%). Results: Time elapsed between symptom onset and diagnosis was <12 hours in 70.7% of cases and <24 hours in 84.0% (median 5 hours; 25th–75th percentiles, 2.7–15.5 hours). Computed tomography was the first diagnostic technique in 78% of patients and transthoracic echocardiography in 15%. Surgical treatment was indicated in 78.3% of type A acute aortic syndrome. The interval between diagnosis and surgery was 4.8 hours (quartile 1–3, 2.5–11.4 hours). Among the patients with type B acute aortic syndrome, treatment was medical in 116 cases (62.4%), endovascular in 61 (32.8%) and surgical in nine (4.8%). Type A mortality during hospitalisation was 25.1% in patients treated surgically and 68% in those treated medically. Mortality in type B was 13.8% in those with medical treatment, 18.0% with endovascular therapy and 33.0% with surgical treatment. Conclusion: Improvements in the diagnosis and treatment of acute aortic syndrome have not resulted in a significant reduction in hospital mortality. The results of this study reflect more overall and less selected information on acute aortic syndrome management and the need for sustained advances in the therapeutic strategy of acute aortic syndrome.
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Affiliation(s)
| | | | | | | | | | | | | | - Jose Rozado
- Hospital Universitario de Asturias, Oviedo, Spain
| | | | | | | | - Francisco Nistal
- Hospital de Valdecilla, Universidad de Cantabria, Santander, Spain
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Evangelista A, Maldonado G, Gruosso D, Teixido G, Rodríguez-Palomares J, Eagle K. Insights from the International Registry of Acute Aortic Dissection. Glob Cardiol Sci Pract 2016; 2016:e201608. [PMID: 29043258 PMCID: PMC5642834 DOI: 10.21542/gcsp.2016.8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The International Registry of Acute Aortic Dissection (IRAD) was established in 1996 for the purpose of enrolling patients at large referral centres to assess the presentation, management and outcomes of acute aortic dissection (AAD). Data on presentation, diagnostic, management and outcomes were initially collected by 12 centres and then extended to 28 referral centres. All data of more than 5,000 cases were reviewed and analysed by the IRAD Coordinating Center at the University of Michigan. Since the first publication in 2000, IRAD investigators have reported a number of clinical observations, in more than 70 publications. This article will cover most of these points highlighting the findings of IRAD in patients with type A (with ascending aorta involvement) and type B (without ascending aorta involvement) AAD.
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Affiliation(s)
| | | | - Doménico Gruosso
- Servei de Cardiología. Hospital Universitari Vall d'Hebron. Barcelona
| | - Gisela Teixido
- Servei de Cardiología. Hospital Universitari Vall d'Hebron. Barcelona
| | | | - Kim Eagle
- Cardiovascular Center. University of Michigan. Ann Arbor
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