1
|
Sabbag A, Essayagh B, Antoine C, Benfari G, Malouf J, Asirvatham S, Michelena H, Enriquez-Sarano M. 650The arrhythmic mitral valve prolapse: presentation and outcome. Europace 2020. [DOI: 10.1093/europace/euaa162.351] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The majority of patients with of Mitral-valve-prolapse (MVP) have a excellent prognosis. Until recently most cases of mortality were thought to be related to mitral regurgitation and left ventricular dysfunction. The concept of the arrhythmic MVP emerged to describe cases of sudden cardiac death (SCD) in the presence of isolated MVP yet it’s phonotype remains incompletely and inconsistently defined.
Purpose
To analyze the prevalence, severity and characteristics of ventricular-arrhythmia (VA), to determine it’s phenotypical context and independent impact on outcome in patients with MVP.
Methods
A cohort of 595 (65 ± 16 years, 278 female) consecutive patients with MVP and comprehensive clinical, arrhythmia (24hour-Holter) and Doppler-echocardiographic characterization, was identified and long-term outcome analyzed.
Results
VA was frequent, present in 43% of patients with at least ventricular ectopy≥5%, but was most often moderate (ventricular-tachycardia—VT 120-179bpm) in 27% and rarely severe (VT≥180/min) in 8.6%. Presence of VA was associated with older age, male sex, bileaflet-prolapse, marked leaflet redundancy, mitral-annulus-disjunction (MAD), larger left-atrium and left ventricular end-systolic diameter, and T-wave-inversion/ST-depression (all P ≤ 0.001). Severe VA was independently associated with presence of MAD, leaflet-redundancy and T-wave-inversion/ST-depression (all P < 0.0001) but not with mitral regurgitation severity or ejection-fraction. Outcome primary endpoint of overall survival after arrhythmia diagnosis (8-year 87 ± 2%) was strongly associated with arrhythmia-severity (8-year 90 ± 2% for no/trivial arrhythmia, 85 ± 3% for mild/moderate and 76 ± 7% for severe arrhythmia. P = 0.02, Figure). Excess-mortality was substantial for severe-arrhythmia (univariate-hazard-ratio 2.70[1.27-5.77], P = 0.01 vs. no/trivial arrhythmia), even adjusted comprehensively including for MVP-characteristics (adjusted-hazard-ratio 2.94[1.36-6.36], P = 0.006) ).
Conclusions
This large cohort of isolated consecutive MVP characterized with 24-hour-Holter monitoring, clinical and Echocardiographic assessment, demonstrates that VA are frequent with MVP but rarely severe. The arrhythmic MVP was independently and strongly associated with specific ECG and morphologic patterns, particularly ST-T changes, MAD presence and marked leaflet redundancy, suggestive of a specific arrhythmic MVP phenotype, independently of MR-severity. Arrhythmia, particularly severe, is associated with long-term excess-mortality, independently of any other characteristics, including MR severity and LVEF. These findings lay the foundation for novel risk-stratification of MVP for the conduct of prospective controlled studies evaluating the management of MVP high-risk patients.
Figure – Impact on survival of ventricular arrhythmia
Overall survival of MVP stratified by ventricular arrhythmia (Panel A) or ventricular arrhythmia severity (Panel B) throughout follow-up.
Abstract Figure.
Collapse
Affiliation(s)
- A Sabbag
- Sheba Medical Center, Heart Institute, Ramat Gan, Israel
| | - B Essayagh
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - C Antoine
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - G Benfari
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - J Malouf
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - S Asirvatham
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - H Michelena
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| | - M Enriquez-Sarano
- Mayo Clinic, Department of Cardiovascular Medicine, Rochester, United States of America
| |
Collapse
|
2
|
Magallares López BP, Park H, Cerda D, Betancourt J, Fraga G, Boronat S, Gich I, Marín AM, Herrera S, Malouf J, Casademont J, García-Guillén A, Corominas H. AB0997 IS HEIGHT ADJUSTMENT NECESSARY IN PEDIATRIC DENSITOMETRY IN ALL CHILDREN? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The current guidelines of the International Society for Clinical Densitometry (1) recommend that in children with linear growth or maturational delay, Z score results should be adjusted. Height for age Z score (HAZ) adjustment is valid and can be calculated using the formula the formula proposed by Zemmel et al(2).It is possible that pediatric populations without linear growth or maturational delay, also benefit from HAZ, to prevent bone size from influencing the final Z score.Objectives:To evaluate Z score variability adjusted and without adjusting for height for age.Methods:We analysed data from densitometry performed on patients 2-20 years of age, from 2016 to 2018, assessed in the pediatric rheumatology office of our hospital for presenting risk factors for low bone mass/osteoporosis. The HAZ was calculated according to Zemel’s formula.Results:Data from 103 patients are presented. Its characteristics are summarized in Table 1Table 1.Mean age9,8 yearsFemale52,4%Height Percentil ≤ 36,8%Height Percentil ≥ 974,9%LBM (Z score ≤ -2) spine8,2%LBM HAZ spine6,4%LBM whole body10,5%LBM HAZ whole body7,2%The table shows that the proportion of patients with BMD decreases in both the spine region and the whole body when adjusting for HAZ.When evaluating the relationship between densitometric measurements we found that spine Z score (ZsS) and whole body Z score (ZsWB) had a correlation coefficient of 0,73 (p<0,001). There were no differences between their averages (p=0,170).At the LBM cut-off point (Z score ≤ -2) there were discrepancies in 7%, where 5% presented LBM in ZsWB but not in ZsS. The concordance index at this point was 0,557.When comparing these measures with their HAZ adjusted equivalents, we observe:HAZ adjusted ZsS vs ZsS without adjusting: There were no differences between their averages (p=0,913) with a correlation coefficient of 0,78 (p<0,001). Concordance index at cut-off point for LBM was 0,498, with a discrepancy of7%, where2%had LBM according to HAZ adjusted ZsS, but not to ZsS without adjusting.HAZ adjusted ZsWB vs ZsWB without adjusting: There were no differences between their averages (p=0, 367) with a correlation coefficient of 0,82 (p<0,001). Concordance index at cut-off point for LBM was 0,557, with a discrepancy of7%, where2%had LBM according to HAZ adjusted ZsWB, but not to ZsWB without adjusting.Conclusion:There are discrepancies at the LBM cut-off point depending on the HAZ adjustment.The pediatric population without linear growth or maturational delay, can also benefit from HAZ adjustment, especially those with high height percentiles in which their size can hide a diagnosis of LBM.References:[1]Weber DR, Boyce A, Gordon C, Hogler W, Kecskemethy HH, Misra M, et al. The Utility of DXA Assessment at the Forearm, Proximal Femur, and Lateral Distal Femur, and Vertebral Fracture Assessment in the Pediatric Population: 2019 ISCD Official Position. Journal of clinical densitometry: the official journal of the International Society for Clinical Densitometry. 2019;22(4):567-89.[2]Zemel BS, Leonard MB, Kelly A, Lappe JM, Gilsanz V, Oberfield S, et al. Height adjustment in assessing dual energy x-ray absorptiometry measurements of bone mass and density in children. The Journal of clinical endocrinology and metabolism. 2010;95(3):1265-73.Disclosure of Interests:None declared
Collapse
|
3
|
Magallares López BP, Park H, Cerda D, Betancourt J, Fraga G, Boronat S, Herrera S, Marín AM, Gich I, Malouf J, Casademont J, García-Guillén A, Corominas H. AB0998 TRABECULAR BONE SCORE IN PEDIATRICS, IS IT USEFUL? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Bone fragility depends not only on bone mineral density (BMD), but also on bone microarchitecture. In adults, Trabecular Bone Score (TBS) is being used as an indirect marker of bone microarchitectureIt is a software that applicated to the vertebral image obtained by conventional densitometry, informs about the thickness of the trabeculae, the trabecular connectivity and the space between them. A high score indicates a better bone microstructure. In adults, a TBS equal to or greater than 1,350 is considered to represent a normal microarchitectureObjectives:To evaluate the usefulness of TBS in pediatric population with risk factors for Low Bone Mass (LBM)Methods:TBS was assessed by analyzing vertebral densitometries performed on patients from 4 to 20 years of age, assessed in the pediatric rheumatology office of our hospital for presenting risk factors for LBM, consecutively from 2016 until 2018Data were compared with normal pediatric populationResults:Data from 83 patients are shown, with an average age of 11.2 years, 62% female, 80% CaucasianThe main risk factors for LBM were (%): Insufficient calcium intake (84,5), medications with osteopenizing potential (31), corticosteroids (39), sedentary lifestyle (13,6), fractures of long or vertebral bones (12,6) and hypovitaminosis D (8,1)Table 1.TBS por age groups and in patients with and without LBMAge groupsnMeanSDMinimum-MaximumScholars (4-9a)221,3210,0931,119-1,502Adolescence (10-17a)541,3090,0881,073-1,493Youth (18-20a)61,3590,0851,258-1,460Spine Z scorenMean (SD)pMinimum-Maximum ≤-281,270 (0,075)0,1261,419-1,162 >-2741,321 (0,090)1,502-1,073Whole Body Z score ≤-291,246 (0,060)0,0121,323-1,145 >-2731,324 (0,089)1,502-1,073Table 2.TBS in healthy population and study population for ageHealthy girls (n=2535)Healthy boys (n=1459)Study girls (n=47)Study boys (n=36)Age (y)Spine BMDTBSSpine BMDTBSTBSTBS1-20,401,3250,371,2722-30,511,3630,461,2671,1273-40,521,3460,511,2641,2044-50,601,3460,601,2671,2371,2435-60,601,2880,561,2691,3301,3686-70,651,2800,601,2321,3181,4227-80,671,2680,641,2441,3391,3458-90,711,2660,681,2281,2449-100,751,2780,701,2081,2531,34110-110,81,2850,731,2311,2291,29211-120,841,3370,761,2501,3031,31512-130,991,3550,811,2481,3811,36813-141,061,3860,891,2731,3941,33814-151,101,3980,991,3031,4741,28515-161,141,4051,081,3111,3681,40616-171,171,4051,151,3341,3321,37117-181,171,4041,201,3281,3741,28518-191,171,4041,161,314Conclusion:TBS was lower in the patients with LBM by whole body Z score, but not in those with LBM by spine Z score. We observed a decrease in TBS in adolescence, not corresponding with a decrease in BMD, and that should not be interpreted as a pathological findingSimilar results have been described in other pediatric populations (1, 2), but larger studies are needed to evaluate this phenomenon. We hypothesize that it may be due to a higher rate of growth in adolescence, with a lower rate of calcium apposition into the osteoid materialReferences:[1]Del Rio DS, Winthenrieth R. BONE MICROARCHITECTURE (TBS) AND BONE MASS DEVELOPMENT DURING CHILDHOOD AND ADOLESCENCE IN A SPANISH POPULATION GROUP. . WCO-IOF-ESCEO; Seville2014.[2]Shawwa K, Arabi A, Nabulsi M, et al. Predictors of trabecular bone score in school children. Osteoporosis international: a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2016;27(2):703-10.Disclosure of Interests:None declared
Collapse
|
4
|
Raphael CE, Alkhouli M, Maor E, Panaich SS, Alli O, Coylewright M, Reeder GS, Sandhu G, Holmes DR, Nishimura R, Malouf J, Cabalka A, Eleid MF, Rihal CS. Building Blocks of Structural Intervention. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005686. [DOI: 10.1161/circinterventions.117.005686] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Claire E. Raphael
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Mohamad Alkhouli
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Elad Maor
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Sidakpal S. Panaich
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Oluseun Alli
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Megan Coylewright
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Guy S. Reeder
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Gurpreet Sandhu
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - David R. Holmes
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Rick Nishimura
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Joseph Malouf
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Allison Cabalka
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Mackram F. Eleid
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| | - Charanjit S. Rihal
- From the Departments of Cardiovascular Medicine (C.E.R., E.M., S.S.P., G.S.R., G.S., D.R.H., R.N., J.M., M.F.E., C.S.R.) and Pediatrics (A.C.), Mayo Clinic, Rochester, MN; Division of Cardiology, Department of Medicine, West Virginia University School of Medicine, Morgantown (M.A.); Division of Cardiology, Department of Medicine, Novant Heart and Vascular Institute, Charlotte, NC (O.A.); and Department of Cardiology, Dartmouth-Hitchcock Heart and Vascular Center, Lebanon, NH (M.C.)
| |
Collapse
|
5
|
Tastet L, Enriquez-Sarano M, Capoulade R, Malouf J, Araoz PA, Shen M, Michelena HI, Larose É, Arsenault M, Bédard É, Pibarot P, Clavel MA. Impact of Aortic Valve Calcification and Sex on Hemodynamic Progression and Clinical Outcomes in AS. J Am Coll Cardiol 2017; 69:2096-2098. [DOI: 10.1016/j.jacc.2017.02.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 01/08/2023]
|
6
|
Laiz A, Malouf J, Marin A, Longobardi V, de Caso J, Farrerons J, Casademont J. Impact of 3-Monthly Vitamin D Supplementation Plus Exercise on Survival after Surgery for Osteoporotic Hip Fracture in Adult Patients over 50 Years: A Pragmatic Randomized, Partially Blinded, Controlled Trial. J Nutr Health Aging 2017; 21:413-420. [PMID: 28346568 DOI: 10.1007/s12603-016-0773-3] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine whether 3-monthly supplementation of an oral vitamin D widely used in Spain (calcifediol) plus daily exercise could influence survival at one and four years after surgery for osteoporotic hip fracture. DESIGN A pragmatic, randomized, partially single-blind placebo-controlled study. SETTING Patients admitted to a tertiary university hospital for acute hip fracture. PARTICIPANTS 675 healthy adult patients undergoing surgery for osteoporotic hip fracture were recruited from January 2004 to December 2007. INTERVENTION Patients were randomized to receive either 3-monthly oral doses of 3 mg calcifediol (Hidroferol Choque®) or placebo in the 12 months postsurgery. Patients who received calcifediol were also given an exercise programme. The placebo group received standard health recommendations only. MEASUREMENTS The primary endpoint was survival at 1 year and at 4 year follow-up. We also recorded new fractures, medical complications and anti-osteoporotic treatment compliance. RESULTS We included a total of 88 patients, aged 62 to 99 years. Mean age was 82 years and 88.6% were women. At 12 months, 10 (11.3%) patients had died, 9 of them, from the non-intervention group. At 4 years after surgery, 20 (22.7%) had died, 3 (3.4%) from the intervention group and 17 (19.3%) from the non-intervention group. At this time, survival curve analysis showed 93% survival in the intervention group and 62% in the non-intervention group (p=0.001). At 12-month follow up, there were 18 new fractures, 9 in each group. The non-intervention group had more medical complications, with significant differences at visit 2 (p = 0.04) and 3 (p = 0.02) but not at visit 4 (p = 0.18). No significant differences between groups were found regarding treatment compliance. CONCLUSION 3-monthly, oral supplements of 3 mg calcifediol plus daily exercise improved survival at one-year and four-year follow up after surgery for an osteoporotic hip fracture.
Collapse
Affiliation(s)
- A Laiz
- Ana Laiz MD, PhD. Internal Medicine Department, C/Sant Antoni Mª Claret 167, Hospital de la Santa Creu I Sant Pau, 08025 Barcelona, Spain, e-mail: , +34935565609
| | | | | | | | | | | | | |
Collapse
|
7
|
Miller PD, Pannacciulli N, Brown JP, Czerwinski E, Nedergaard BS, Bolognese MA, Malouf J, Bone HG, Reginster JY, Singer A, Wang C, Wagman RB, Cummings SR. Denosumab or Zoledronic Acid in Postmenopausal Women With Osteoporosis Previously Treated With Oral Bisphosphonates. J Clin Endocrinol Metab 2016; 101:3163-70. [PMID: 27270237 PMCID: PMC4971333 DOI: 10.1210/jc.2016-1801] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
CONTEXT Denosumab and zoledronic acid (ZOL) are parenteral treatments for patients with osteoporosis. OBJECTIVE The objective of the study was to compare the effect of transitioning from oral bisphosphonates to denosumab or ZOL on bone mineral density (BMD) and bone turnover. DESIGN AND SETTING This was an international, multicenter, randomized, double-blind trial. PARTICIPANTS A total of 643 postmenopausal women with osteoporosis previously treated with oral bisphosphonates participated in the study. INTERVENTIONS Subjects were randomized 1:1 to sc denosumab 60 mg every 6 months plus iv placebo once or ZOL 5 mg iv once plus sc placebo every 6 months for 12 months. MAIN OUTCOME MEASURES Changes in BMD and bone turnover markers were measured. RESULTS BMD change from baseline at month 12 was significantly greater with denosumab compared with ZOL at the lumbar spine (primary end point; 3.2% vs 1.1%; P < .0001), total hip (1.9% vs 0.6%; P < .0001), femoral neck (1.2% vs -0.1%; P < .0001), and one-third radius (0.6% vs 0.0%; P < .05). The median decrease from baseline was greater with denosumab than ZOL for serum C-telopeptide of type 1 collagen at all time points after day 10 and for serum procollagen type 1 N-terminal propeptide at month 1 and at all time points after month 3 (all P < .05). Median percentage changes from baseline in serum intact PTH were significantly greater at months 3 and 9 with denosumab compared with ZOL (all P < .05). Adverse events were similar between groups. Three events consistent with the definition of atypical femoral fracture were observed (two denosumab and one ZOL). CONCLUSIONS In postmenopausal women with osteoporosis previously treated with oral bisphosphonates, denosumab was associated with greater BMD increases at all measured skeletal sites and greater inhibition of bone remodeling compared with ZOL.
Collapse
Affiliation(s)
- P D Miller
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - N Pannacciulli
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - J P Brown
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - E Czerwinski
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - B S Nedergaard
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - M A Bolognese
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - J Malouf
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - H G Bone
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - J-Y Reginster
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - A Singer
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - C Wang
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - R B Wagman
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| | - S R Cummings
- Colorado Center for Bone Research (P.D.M.), Lakewood, Colorado 80277; Amgen Inc (N.P., C.W., R.B.W.), Thousand Oaks, California 91320; Laval University and Centre Hospitalier Universitaire de Québec Research Centre (J.P.B.), Québec City, Québec G1V 4G2, Canada; Krakow Medical Center (E.C.), 31-501 Krakow, Poland; Center for Clinical and Basic Research (B.S.N.), Aalborg, DK-9000 Aalborg, Denmark; Bethesda Health Research Center (M.A.B.), Bethesda, Maryland 20817; Hospital de la Santa Creu i Sant Pau (J.M.), 08025 Barcelona, Spain; Michigan Bone and Mineral Clinic (H.G.B.), Detroit, Michigan 48236; University of Liège (J.-Y.R.), 4000 Liège, Belgium; Georgetown University Medical Center (A.S.), Washington, DC 20007; and San Francisco Coordinating Center (S.R.C.), California Pacific Medical Center Research Institute, San Francisco, California 94143
| |
Collapse
|
8
|
Langdahl B, Libanati C, Crittenden D, Bolognese M, Brown J, Daizadeh N, Dokoupilova E, Engelke K, Finkelstein J, Genant H, Goemaere S, Hyldstrup L, Jodar-Gimeno E, Keaveny T, Kendler D, Lakatos P, Maddox J, Malouf J, Massari F, Molina J, Ulla M, Grauer A. OP0100 Superior Gains in Bone Mineral Density and Estimated Strength at The Hip for Romosozumab Compared with Teriparatide in Women with Postmenopausal Osteoporosis Transitioning from Bisphosphonate Therapy: Results of The Phase 3 Open-Label Structure Study. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.1163] [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: 11/03/2022]
|
9
|
Clavel MA, Malouf J, Messika-Zeitoun D, Araoz PA, Michelena HI, Enriquez-Sarano M. Aortic valve area calculation in aortic stenosis by CT and Doppler echocardiography. JACC Cardiovasc Imaging 2015; 8:248-257. [PMID: 25772832 DOI: 10.1016/j.jcmg.2015.01.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [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: 10/26/2014] [Revised: 01/23/2015] [Accepted: 01/26/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to verify the hypothesis that multidetector computed tomography (MDCT) is superior to echocardiography for measuring the left ventricular outflow tract (LVOT) and calculating the aortic valve area (AVA) with regard to hemodynamic correlations and survival outcome prediction after a diagnosis of aortic stenosis (AS). BACKGROUND MDCT demonstrated that the LVOT is noncircular, casting doubt on the AVA measurement by 2-dimensional (2D) echocardiography. METHODS A total of 269 patients (76 ± 11 years of age, 61% men) with isolated calcific AS (mean gradient 44 ± 18 mm Hg; ejection fraction 58 ± 15%) underwent Doppler echocardiography and MDCT within the same episode of care. AVA was calculated by echocardiography (AVAEcho) and by MDCT (AVACT) using each technique measurement of LVOT area. In the subset of patients undergoing dynamic 4-dimensional MDCT (n = 135), AVA was calculated with the LVOT measured at 70% and 20% of the R-R interval and measured by planimetry (AVAPlani). RESULTS Phasic measurements of the LVOT by MDCT yielded slight differences in eccentricity and size (all p < 0.001) but with excellent AVA correlation (r = 0.92, p < 0.0001) and minimal bias (0.05 cm(2)), whereas the AVAPlani showed poor correlations with all other methods (all r values <0.58). AVACT was larger than AVAEcho (difference 0.12 ± 0.16 cm(2); p < 0.0001) but did not improve outcome prediction. Correlation gradient-AVA was slightly better with AVAEcho than AVACT (r = -0.65 with AVAEcho vs. -0.61 with AVACT; p = 0.01), and discordant gradient-AVA was not reduced. For long-term survival, after multivariable adjustment, AVAEcho or AVACT were independently predictive (hazard ratio [HR]: 1.26, 95% confidence interval [CI]: 1.13 to 1.42; p < 0.0001 or HR: 1.18, 95% CI: 1.09 to 1.29 per 0.10 cm(2) decrease; p < 0.0001) with a similar prognostic value (p ≥ 0.80). Thresholds for excess mortality differed between methods: AVAEcho ≤1.0 cm(2) (HR: 4.67, 95% CI: 2.22 to 10.50; p < 0.0001) versus AVACT ≤1.2 cm(2) (HR: 3.16, 95% CI: 1.64 to 6.43; p = 0.005), with simple translation of spline-curve analysis. CONCLUSIONS Head-to-head comparison of MDCT and Doppler echocardiography refutes the hypothesis of MDCT superiority for AVA calculation. AVACT is larger than AVAEcho but does not improve the correlation with transvalvular gradient, the concordance gradient-AVA, or mortality prediction compared with AVAEcho. Larger cut-point values should be used for severe AS if AVACT (<1.2 cm(2)) is measured versus AVAEcho (<1.0 cm(2)).
Collapse
Affiliation(s)
| | - Joseph Malouf
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - David Messika-Zeitoun
- Cardiology Department, AP-HP, Bichat Hospital, Paris, France; INSERM U698, University Paris 7-Diderot, Paris, France
| | - Phillip A Araoz
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | | |
Collapse
|
10
|
Clavel MA, Malouf J, Messika-Zeitoun D, Araoz PA, Michelena HI, Enriquez-Sarano M. Reply. JACC Cardiovasc Imaging 2015; 8:1116. [DOI: 10.1016/j.jcmg.2015.05.005] [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: 04/30/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
|
11
|
Papapoulos S, Roux C, Bone H, Dakin P, Czerwiński E, Frey D, Kendler D, Lewiecki E, Malouf J, Mellström D, Reginster J, Resch H, Daizadeh N, Wang A, Gavin M, Wagman R, Brandi M. FRI0289 Denosumab Treatment in Postmenopausal Women with Osteoporosis for Up to 9 Years: Results Through Year 6 of the Freedom Extension. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1097] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
12
|
Taniguchi Y, Takahashi Y, Toba T, Yamada S, Yokoi K, Kobayashi S, Okajima S, Shimane A, Kawai H, Yasaka Y, Smanio P, Oliveira MA, Machado L, Cestari P, Medeiros E, Fukuzawa S, Okino S, Ikeda A, Maekawa J, Ichikawa S, Kuroiwa N, Yamanaka K, Igarashi A, Inagaki M, Patel K, Mahan M, Ananthasubramaniam K, Mouden M, Yokota S, Ottervanger J, Knollema S, Timmer J, Jager P, Padron K, Peix A, Cabrera L, Pena Bofill V, Valera D, Rodriguez Nande L, Carrillo Hernandez R, Mena Esnard E, Fernandez Columbie Y, Bertella E, Baggiano A, Mushtaq S, Segurini C, Loguercio M, Conte E, Beltrama V, Petulla' M, Andreini D, Pontone G, Guzic Salobir B, Dolenc Novak M, Jug B, Kacjan B, Novak Z, Vrtovec M, Mushtaq S, Pontone G, Bertella E, Conte E, Segurini C, Volpato V, Baggiano A, Formenti A, Pepi M, Andreini D, Ajanovic R, Husic-Selimovic A, Zujovic-Ajanovic A, Mlynarski R, Mlynarska A, Golba K, Sosnowski M, Ameta D, Goyal M, Kumar D, Chandra S, Sethi R, Puri A, Dwivedi SK, Narain VS, Saran RK, Nekolla S, Rischpler C, Nicolosi S, Langwieser N, Dirschinger R, Laugwitz K, Schwaiger M, Goral JL, Napoli J, Forcada P, Zucchiatti N, Damico A, Damico A, Olivieri D, Lavorato M, Dubesarsky E, Montana O, Salgado C, Jimenez-Heffernan A, Ramos-Font C, Lopez-Martin J, Sanchez De Mora E, Lopez-Aguilar R, Manovel A, Martinez A, Rivera F, Soriano E, Maroz-Vadalazhskaya N, Trisvetova E, Vrublevskaya O, Abazid R, Kattea M, Saqqah H, Sayed S, Smettei O, Winther S, Svensson M, Birn H, Jorgensen H, Botker H, Ivarsen P, Bottcher M, Maaniitty T, Stenstrom I, Saraste A, Pikkarainen E, Uusitalo V, Ukkonen H, Kajander S, Bax J, Knuuti J, Choi T, Park H, Lee C, Lee J, Seo Y, Cho Y, Hwang E, Cho D, Sanchez Enrique C, Ferrera C, Olmos C, Jimenez - Ballve A, Perez - Castejon MJ, Fernandez C, Vivas D, Vilacosta I, Nagamachi S, Onizuka H, Nishii R, Mizutani Y, Kitamura K, Lo Presti M, Polizzi V, Pino P, Luzi G, Bellavia D, Fiorilli R, Madeo A, Malouf J, Buffa V, Musumeci F, Rosales S, Puente A, Zafrir N, Shochat T, Mats A, Solodky A, Kornowski R, Lorber A, Boemio A, Pellegrino T, Paolillo S, Piscopo V, Carotenuto R, Russo B, Pellegrino S, De Matteis G, Perrone-Filardi P, Cuocolo A, Piscopo V, Pellegrino T, Boemio A, Carotenuto R, Russo B, Pellegrino S, De Matteis G, Petretta M, Cuocolo A, Amirov N, Ibatullin M, Sadykov A A, Saifullina G, Ruano R, Diego Dominguez M, Rodriguez Gabella T, Diego Nieto A, Diaz Gonzalez L, Garcia-Talavera J, Sanchez Fernandez P, Leen A, Al Younis I, Zandbergen-Harlaar S, Verberne H, Gimelli A, Veltman C, Wolterbeek R, Bax J, Scholte A, Mooney D, Rosenblatt J, Dunn T, Vasaiwala S, Okuda K, Nakajima K, Nystrom K, Edenbrandt L, Matsuo S, Wakabayashi H, Hashimoto M, Kinuya S, Iric-Cupic V, Milanov S, Davidovic G, Zdravkovic V, Ashikaga K, Yoneyama K, Akashi Y, Shugushev Z, Maximkin D, Chepurnoy A, Volkova O, Baranovich V, Faibushevich A, El Tahlawi M, Elmurr A, Alzubaidi S, Sakrana A, Gouda M, El Tahlawi R, Sellem A, Melki S, Elajmi W, Hammami H, Okano M, Kato T, Kimura M, Funasako M, Nakane E, Miyamoto S, Izumi T, Haruna T, Inoko M, Massardo T, Swett E, Fernandez R, Vera V, Zhindon J, Fernandez R, Swett E, Vera V, Zhindon J, Alay R, Massardo T, Ohshima S, Nishio M, Kojima A, Tamai S, Kobayashi T, Murohara T, Burrell S, Van Rosendael A, Van Den Hoogen I, De Graaf M, Roelofs J, Kroft L, Bax J, Scholte A, Rjabceva I, Krumina G, Kalvelis A, Chanakhchyan F, Vakhromeeva M, Kankiya E, Koppes J, Knol R, Wondergem M, Van Der Ploeg T, Van Der Zant F, Lazarenko SV, Bruin VS, Pan XB, Declerck JM, Van Der Zant FM, Knol RJJ, Juarez-Orozco LE, Alexanderson E, Slart R, Tio R, Dierckx R, Zeebregts C, Boersma H, Hillege H, Martinez-Aguilar M, Jordan-Rios A, Christensen TE, Ahtarovski KA, Bang LE, Holmvang L, Soeholm H, Ghotbi AA, Andersson H, Ihlemann N, Kjaer A, Hasbak P, Gulya M, Lishmanov YB, Zavadovskii K, Lebedev D, Stahle M, Hellberg S, Liljenback H, Virta J, Metsala O, Yla-Herttuala S, Saukko P, Knuuti J, Saraste A, Roivainen A, Thackeray J, Wang Y, Bankstahl J, Wollert K, Bengel F, Saushkina Y, Evtushenko V, Minin S, Efimova I, Evtushenko A, Smishlyaev K, Lishmanov Y, Maslov L, Okuda K, Nakajima K, Kirihara Y, Sugino S, Matsuo S, Taki J, Hashimoto M, Kinuya S, Ahmadian A, Berman J, Govender P, Ruberg F, Miller E, Piriou N, Pallardy A, Valette F, Cahouch Z, Mathieu C, Warin-Fresse K, Gueffet J, Serfaty J, Trochu J, Kraeber-Bodere F, Van Dijk J, Mouden M, Ottervanger J, Van Dalen J, Jager P, Zafrir N, Ofrk H, Vaturi M, Shochat T, Hassid Y, Belzer D, Sagie A, Kornowski R, Kaminek M, Metelkova I, Budikova M, Koranda P, Henzlova L, Sovova E, Kincl V, Drozdova A, Jordan M, Shahid F, Teoh Y, Thamen R, Hara N, Onoguchi M, Hojyo O, Kawaguchi Y, Murai M, Udaka F, Matsuzawa Y, Bulugahapitiya DS, Avison M, Martin J, Liu YH, Wu J, Liu C, Sinusas A, Daou D, Sabbah R, Bouladhour H, Coaguila C, Aguade-Bruix S, Pizzi M, Romero-Farina G, Candell-Riera J, Castell-Conesa J, Patchett N, Sverdlov A, Miller E, Daou D, Sabbah R, Bouladhour H, Coaguila C, Smettei O, Abazid R, Boulaamayl El Fatemi S, Sallam L, Snipelisky D, Park J, Ray J, Shapiro B, Kostkiewicz M, Szot W, Holcman K, Lesniak-Sobelga A, Podolec P, Clerc O, Possner M, Liga R, Vontobel J, Mikulicic F, Graeni C, Benz D, Herzog B, Gaemperli O, Kaufmann P. Poster Session 1: Sunday 3 May 2015, 08:30-18:00 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev051] [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] [Indexed: 11/12/2022] Open
|
13
|
Mantovani F, Clavel MA, Vatury O, Suri RM, Mankad SV, Malouf J, Michelena HI, Jain S, Badano LP, Enriquez-Sarano M. Cleft-like indentations in myxomatous mitral valves by three-dimensional echocardiographic imaging. Heart 2015; 101:1111-7. [DOI: 10.1136/heartjnl-2014-307016] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/27/2015] [Indexed: 11/03/2022] Open
|
14
|
Clavel MA, Mantovani F, Malouf J, Michelena HI, Vatury O, Jain MS, Mankad SV, Suri RM, Enriquez-Sarano M. Dynamic Phenotypes of Degenerative Myxomatous Mitral Valve Disease. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002989. [DOI: 10.1161/circimaging.114.002989] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [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: 12/11/2022]
Abstract
Background—
Fibro-elastic deficiency (FED) and diffuse myxomatous degeneration (DMD) are phenotypes of degenerative mitral valve disease defined morphologically. Whether physiological differences in annular and valvular dynamics exist between these phenotypes remains unknown.
Methods and Results—
We performed triple quantitation of cardiac remodeling and of mitral regurgitation severity and of annular and valvular dimensions by real-time 3-dimensional-transesophageal-echocardiography. Forty-nine patients with degenerative mitral valve disease classified as FED (n=31) and DMD (n=18) by surgical observation showed no difference in age (65±10 versus 59±13;
P
=0.5), body surface area (2.0±0.2 versus 2.0±0.2 m
2
;
P
=0.5), left ventricular and atrial dimensions (all
P
>0.55), and mitral regurgitation regurgitant orifice (
P
=0.62). On average, annular dimensions were larger in DMD versus FED, but height was similar resulting in lower saddle shape. Dynamically, annular DMD versus FED display poorer contraction and saddle-shape accentuation in early systole and abnormal enlargement, particularly intercommissural, in late-systole (all
P
<0.05). Valvular dynamics showed stable valvular area in systole in FED versus considerable systolic increased area in DMD (
P
<0.001). Prolapse height and volume increased little throughout systole in FED versus marked increase in DMD (
P
<0.001).
Conclusions—
Our novel observations show that FED and DMD, although both labeled myxomatous, display considerable physiological phenotypic differences. In DMD, the annular increased size and profoundly abnormal dynamics demonstrate DMD-specific annular degeneration compared with the enlarged but relatively normal FED annulus. DMD does not incur more severe mitral regurgitation, despite larger prolapse and valve redundancy, underscoring potential compensatory role of tissue redundancy of DMD (or aggravating role of tissue paucity of FED) on mitral regurgitation severity.
Collapse
Affiliation(s)
- Marie-Annick Clavel
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN
| | - Francesca Mantovani
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN
| | - Joseph Malouf
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN
| | - Hector I. Michelena
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ori Vatury
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN
| | - Mothilal Sonia Jain
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN
| | - Sunil V. Mankad
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN
| | - Rakesh M. Suri
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN
| | - Maurice Enriquez-Sarano
- From the Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
15
|
Polizzi V, Giuseppe PP, Luzi G, Bellavia D, Fiorilli R, Chialastri C, Madeo A, Presti ML, Malouf J, Buffa V, Musumeci F. AORTIC ANNULUS SIZING FOR TRANSAPICAL HEART VALVE IMPLANTATION: AN AGREEMENT ANALISYS OF DIFFERENT THREE-DIMENSIONAL TRANSOESOPHAGEAL ECHOCARDIOGRAPHIC MODALITIES AND CARDIAC COMPUTED TOMOGRAPHY SCAN. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61311-0] [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] [Indexed: 11/25/2022]
|
16
|
Goirigolzarri Artaza J, Gallego Delgado M, Jaimes Castellanos C, Cavero Gibanel M, Pastrana Ledesma M, Alonso Pulpon L, Gonzalez Mirelis J, Al Ansi RZ, Sokolovic S, Cerin G, Szychta W, Popa BA, Botezatu D, Benea D, Manganiello S, Corlan A, Jabour A, Igual Munoz B, Osaca Asensi J, Andres La Huerta A, Maceira Gonzalez A, Estornell Erill J, Cano Perez O, Sancho-Tello M, Alonso Fernandez P, Sepulveda Sanchez P, Montero Argudo A, Palombo C, Morizzo C, Baluci M, Kozakova M, Panajotu A, Karady J, Szeplaki G, Horvath T, Tarnoki D, Jermendy A, Geller L, Merkely B, Maurovich-Horvat P, Moustafa S, Mookadam F, Youssef M, Zuhairy H, Connelly M, Prieur T, Alvarez N, Ashikhmin Y, Drapkina O, Boutsikou M, Demerouti E, Leontiadis E, Petrou E, Karatasakis G, Kozakova M, Morizzo C, Bianchi V, Marchi B, Federico G, Palombo C, Chatzistamatiou E, Moustakas G, Memo G, Konstantinidis D, Mpampatzeva Vagena I, Manakos K, Traxanas K, Vergi N, Feretou A, Kallikazaros I, Goto M, Uejima T, Itatani K, Pedrizzetti G, Mada R, Daraban A, Duchenne J, Voigt J, Chiu DYY, Green D, Johnstone L, Sinha S, Kalra P, Abidin N, Sikora-Frac M, Zaborska B, Maciejewski P, Bednarz B, Budaj A, Nemes A, Sasi V, Gavaller H, Kalapos A, Domsik P, Katona A, Szucsborus T, Ungi T, Forster T, Ungi I, Pluchinotta F, Arcidiacono C, Saracino A, Carminati M, Bussadori C, Dahlslett T, Karlsen S, Grenne B, Sjoli B, Bendz B, Skulstad H, Smiseth O, Edvardsen T, Brunvand H, Vereckei A, Szelenyi Z, Szenasi G, Santoro C, Galderisi M, Niglio T, Santoro M, Stabile E, Rapacciuolo A, Spinelli L, De Simone G, Esposito G, Trimarco B, Hubert S, Jacquier A, Fromonot J, Resseguier C, Tessier A, Guieu R, Renard S, Haentjiens J, Lavoute C, Habib G, Menting ME, Koopman L, Mcghie J, Rebel B, Gnanam D, Helbing W, Van Den Bosch A, Roos-Hesselink J, Shiino K, Yamada A, Sugimoto K, Takada K, Takakuwa Y, Miyagi M, Iwase M, Ozaki Y, Hayashi T, Itatani K, Inuzuka R, Shindo T, Hirata Y, Shimizu N, Miyaji K, Henri C, Dulgheru R, Magne J, Kou S, Davin L, Nchimi A, Oury C, Pierard L, Lancellotti P, Kovalyova O, Honchar O, Tengku W, Ketaren A, Mingo Santos S, Monivas Palomero V, Restrepo Cordoba A, Rodriguez Gonzalez E, Goirigolzarri Artaza J, Sayago Silva I, Garcia Lunar I, Mitroi C, Cavero Gibanel M, Segovia Cubero J, Ryu S, Park J, Kim S, Choi J, Goh C, Byun Y, Choi J, Westholm C, Johnson J, Jernberg T, Winter R, Rio P, Moura Branco L, Galrinho A, Pinto Teixeira P, Viveiros Monteiro A, Portugal G, Pereira-Da-Silva T, Afonso Nogueira M, Abreu J, Cruz Ferreira R, Mazzone A, Botto N, Paradossi U, Chabane A, Francini M, Cerone E, Baroni M, Maffei S, Berti S, Ghattas A, Shantsila E, Griffiths H, Lip G, Galli E, Guirette Y, Daudin M, Auffret V, Mabo P, Donal E, Fabiani I, Conte L, Scatena C, Barletta V, Pratali S, De Martino A, Bortolotti U, Naccarato A, Di Bello V, Falanga G, Alati E, Di Giannuario G, Zito C, Cusma' Piccione M, Carerj S, Oreto G, Dattilo G, Alfieri O, La Canna G, Generati G, Bandera F, Pellegrino M, Alfonzetti E, Labate V, Guazzi M, Cengiz B, Sahin ST, Yurdakul S, Kahraman S, Bozkurt A, Aytekin S, Borges IP, Peixoto E, Peixoto R, Peixoto R, Marcolla V, Venkateshvaran A, Sola S, Dash PK, Thapa P, Manouras A, Winter R, Brodin L, Govind SC, Mizariene V, Verseckaite R, Bieseviciene M, Karaliute R, Jonkaitiene R, Vaskelyte J, Arzanauskiene R, Janenaite J, Jurkevicius R, Rosner S, Orban M, Nadjiri J, Lesevic H, Hadamitzky M, Sonne C, Manganaro R, Carerj S, Cusma-Piccione M, Caprino A, Boretti I, Todaro M, Falanga G, Oreto L, D'angelo M, Zito C, Le Tourneau T, Cueff C, Richardson M, Hossein-Foucher C, Fayad G, Roussel J, Trochu J, Vincentelli A, Cavalli G, Muraru D, Miglioranza M, Addetia K, Veronesi F, Cucchini U, Mihaila S, Tadic M, Lang R, Badano L, Polizzi V, Pino P, Luzi G, Bellavia D, Fiorilli R, Chialastri C, Madeo A, Malouf J, Buffa V, Musumeci F, Gripari P, Tamborini G, Bottari V, Maffessanti F, Carminati C, Muratori M, Vignati C, Bartorelli A, Alamanni F, Pepi M, Polymeros S, Dimopoulos A, Spargias K, Karatasakis G, Athanasopoulos G, Pavlides G, Dagres N, Vavouranakis E, Stefanadis C, Cokkinos D, Pradel S, Mohty D, Magne J, Darodes N, Lavergne D, Damy T, Beaufort C, Aboyans V, Jaccard A, Mzoughi K, Zairi I, Jabeur M, Ben Moussa F, Ben Chaabene A, Kamoun S, Mrabet K, Fennira S, Zargouni A, Kraiem S, Jovanova S, Arnaudova-Dezjulovic F, Correia CE, Cruz I, Marques N, Fernandes M, Bento D, Moreira D, Lopes L, Azevedo O, Keramida K, Kouris N, Kostopoulos V, Psarrou G, Giannaris V, Olympios C, Marketou M, Parthenakis F, Kalyva N, Pontikoglou C, Maragkoudakis S, Zacharis E, Patrianakos A, Roufas K, Papadaki H, Vardas P, Dominguez Rodriguez F, Monivas Palomero V, Mingo Santos S, Arribas Rivero B, Cuenca Parra S, Zegri Reiriz I, Vazquez Lopez-Ibor J, Garcia-Pavia P, Szulik M, Streb W, Wozniak A, Lenarczyk R, Sliwinska A, Kalarus Z, Kukulski T, Nemes A, Domsik P, Kalapos A, Forster T, Serra W, Lumetti F, Mozzani F, Del Sante G, Ariani A, Corros C, Colunga S, Garcia-Campos A, Diaz E, Martin M, Rodriguez-Suarez M, Leon V, Fidalgo A, Moris C, De La Hera J, Kylmala MM, Rosengard-Barlund M, Groop PH, Lommi J, Bruin De- Bon H, Bilt Van Der I, Wilde A, Brink Van Den R, Teske A, Rinkel G, Bouma B, Teixeira R, Monteiro R, Garcia J, Silva A, Graca M, Baptista R, Ribeiro M, Cardim N, Goncalves L, Duszanska A, Skoczylas I, Kukulski T, Polonski L, Kalarus Z, Choi JH, Park J, Ahn J, Lee J, Ryu S, Ahn J, Kim D, Lee H, Przewlocka-Kosmala M, Mlynarczyk J, Rojek A, Mysiak A, Kosmala W, Pellissier A, Larochelle E, Krsticevic L, Baron E, Le V, Roy A, Deragon A, Cote M, Garcia D, Tournoux F, Yiangou K, Azina C, Yiangou A, Zitti M, Ioannides M, Ricci F, Dipace G, Aquilani R, Radico F, Cicchitti V, Bianco F, Miniero E, Petrini F, De Caterina R, Gallina S, Jardim Prista Monteiro R, Teixeira R, Garcia J, Baptista R, Ribeiro M, Cardim N, Goncalves L, Chung H, Kim J, Joung B, Uhm J, Pak H, Lee M, Lee K, Ragab A, Abdelwahab A, Yazeed Y, El Naggar W, Spahiu K, Spahiu E, Doko A, Liesting C, Brugts J, Kofflard M, Kitzen J, Boersma E, Levin MD, Coppola C, Piscopo G, Rea D, Maurea C, Caronna A, Capasso I, Maurea N, Azevedo O, Tadeu I, Lourenco M, Portugues J, Pereira V, Lourenco A, Nesukay E, Kovalenko V, Cherniuk S, Danylenko O, Nemes A, Domsik P, Kalapos A, Lengyel C, Varkonyi T, Orosz A, Forster T, Castro M, Abecasis J, Dores H, Madeira S, Horta E, Ribeiras R, Canada M, Andrade M, Mendes M, Morosin M, Piazza R, Leonelli V, Leiballi E, Pecoraro R, Cinello M, Dell' Angela L, Cassin M, Sinagra G, Nicolosi G, Wierzbowska-Drabik K, Hamala P, Kasprzak J, O'driscoll J, Rossato C, Gargallo-Fernandez P, Araco M, Sharma S, Sharma R, Jakus N, Baricevic Z, Ljubas Macek J, Skoric B, Skorak I, Velagic V, Separovic Hanzevacki J, Milicic D, Cikes M, Deljanin Ilic M, Ilic S, Kocic G, Pavlovic R, Stoickov V, Ilic V, Nikolic L, Generati G, Bandera F, Pellegrino M, Alfonzetti E, Labate V, Guazzi M, Labate V, Bandera F, Generati G, Pellegrino M, Donghi V, Alfonzetti E, Guazzi M, Zakarkaite D, Kramena R, Aidietiene S, Janusauskas V, Rucinskas K, Samalavicius R, Norkiene I, Speciali G, Aidietis A, Kemaloglu Oz T, Ozpamuk Karadeniz F, Akyuz S, Unal Dayi S, Esen Zencirci A, Atasoy I, Osken A, Eren M, Fazendas PR, Caldeira D, Stuart B, Cruz I, Rocha Lopes L, Almeida AR, Sousa P, Joao I, Cotrim C, Pereira H, Fazendas PR, Caldeira D, Stuart B, Cruz I, Rocha Lopes L, Almeida AR, Joao I, Cotrim C, Pereira H, Sinem Cakal S, Elif Eroglu E, Baydar O, Beytullah Cakal B, Mehmet Vefik Yazicioglu M, Mustafa Bulut M, Cihan Dundar C, Kursat Tigen K, Birol Ozkan B, Ali Metin Esen A, Yagasaki H, Kawasaki M, Tanaka R, Minatoguchi S, Houle H, Warita S, Ono K, Noda T, Watanabe S, Minatoguchi S, Cho EJ, Park SJ, Lim HJ, Chang SA, Lee SC, Park SW, Cho EJ, Park SJ, Lim HJ, Chang SA, Lee SC, Park SW, Mornos C, Cozma D, Ionac A, Mornos A, Popescu I, Ionescu G, Pescariu S, Melzer L, Faeh-Gunz A, Seifert B, Attenhofer Jost CH, Storve S, Haugen B, Dalen H, Grue J, Samstad S, Torp H, Ferrarotti L, Maggi E, Piccinino C, Sola D, Pastore F, Marino P, Ranjbar S, Karvandi M, Hassantash S, Karvandi M, Ranjbar S, Tierens S, Remory I, Bala G, Gillis K, Hernot S, Droogmans S, Cosyns B, Lahoutte T, Tran N, Poelaert J, Al-Mallah M, Alsaileek A, Nour K, Celeng C, Horvath T, Kolossvary M, Karolyi M, Panajotu A, Kitslaar P, Merkely B, Maurovich Horvat P, Aguiar Rosa S, Ramos R, Marques H, Portugal G, Pereira Da Silva T, Rio P, Afonso Nogueira M, Viveiros Monteiro A, Figueiredo L, Cruz Ferreira R. Poster session 6. Eur Heart J Cardiovasc Imaging 2014; 15:ii235-ii264. [PMCID: PMC4453635 DOI: 10.1093/ehjci/jeu271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2023] Open
|
17
|
Clavel MA, Pibarot P, Messika-Zeitoun D, Capoulade R, Malouf J, Aggarval S, Araoz PA, Michelena HI, Cueff C, Larose E, Miller JD, Vahanian A, Enriquez-Sarano M. Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol 2014; 64:1202-13. [PMID: 25236511 DOI: 10.1016/j.jacc.2014.05.066] [Citation(s) in RCA: 311] [Impact Index Per Article: 31.1] [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: 04/15/2014] [Revised: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Aortic valve calcification (AVC) load measures lesion severity in aortic stenosis (AS) and is useful for diagnostic purposes. Whether AVC predicts survival after diagnosis, independent of clinical and Doppler echocardiographic AS characteristics, has not been studied. OBJECTIVES This study evaluated the impact of AVC load, absolute and relative to aortic annulus size (AVCdensity), on overall mortality in patients with AS under conservative treatment and without regard to treatment. METHODS In 3 academic centers, we enrolled 794 patients (mean age, 73 ± 12 years; 274 women) diagnosed with AS by Doppler echocardiography who underwent multidetector computed tomography (MDCT) within the same episode of care. Absolute AVC load and AVCdensity (ratio of absolute AVC to cross-sectional area of aortic annulus) were measured, and severe AVC was separately defined in men and women. RESULTS During follow-up, there were 440 aortic valve implantations (AVIs) and 194 deaths (115 under medical treatment). Univariate analysis showed strong association of absolute AVC and AVCdensity with survival (both, p < 0.0001) with a spline curve analysis pattern of threshold and plateau of risk. After adjustment for age, sex, coronary artery disease, diabetes, symptoms, AS severity on hemodynamic assessment, and LV ejection fraction, severe absolute AVC (adjusted hazard ratio [HR]: 1.75; 95% confidence interval [CI]: 1.04 to 2.92; p = 0.03) or severe AVCdensity (adjusted HR: 2.44; 95% CI: 1.37 to 4.37; p = 0.002) independently predicted mortality under medical treatment, with additive model predictive value (all, p ≤ 0.04) and a net reclassification index of 12.5% (p = 0.04). Severe absolute AVC (adjusted HR: 1.71; 95% CI: 1.12 to 2.62; p = 0.01) and severe AVCdensity (adjusted HR: 2.22; 95% CI: 1.40 to 3.52; p = 0.001) also independently predicted overall mortality, even with adjustment for time-dependent AVI. CONCLUSIONS This large-scale, multicenter outcomes study of quantitative Doppler echocardiographic and MDCT assessment of AS shows that measuring AVC load provides incremental prognostic value for survival beyond clinical and Doppler echocardiographic assessment. Severe AVC independently predicts excess mortality after AS diagnosis, which is greatly alleviated by AVI. Thus, measurement of AVC by MDCT should be considered for not only diagnostic but also risk-stratification purposes in patients with AS.
Collapse
Affiliation(s)
| | - Philippe Pibarot
- University Institute of Cardiology and Pneumology of Québec, Laval University Québec, Québec, Canada
| | - David Messika-Zeitoun
- Department of Cardiology, Public Assistance-Paris Hospitals, Bichat Hospital, Paris, France; Institut national de la santé et de la recherche médicale U698, University of Paris, Paris, France
| | - Romain Capoulade
- University Institute of Cardiology and Pneumology of Québec, Laval University Québec, Québec, Canada
| | - Joseph Malouf
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Shivani Aggarval
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Phillip A Araoz
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Caroline Cueff
- Department of Cardiology, Public Assistance-Paris Hospitals, Bichat Hospital, Paris, France
| | - Eric Larose
- University Institute of Cardiology and Pneumology of Québec, Laval University Québec, Québec, Canada
| | - Jordan D Miller
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Alec Vahanian
- Department of Cardiology, Public Assistance-Paris Hospitals, Bichat Hospital, Paris, France; Institut national de la santé et de la recherche médicale U698, University of Paris, Paris, France
| | | |
Collapse
|
18
|
Casado E, Malouf J, Salas E, Caamaño M, Castañeda S, Sánchez-Bursόn J, Herrero-Beaumont G. SAT0466 Bisphosphonate Drug Holiday: Results from the ESTRATOS Survey. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4749] [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: 11/03/2022]
|
19
|
Clavel MA, Pibarot P, Messika-Zeitoun D, Capoulade R, Malouf J, Araoz P, Tastet L, Michelena H, Larose E, Cueff C, Miller JD, Vahanian A, Sarano M. USEFULNESS OF AORTIC VALVE CALCIFICATION MEASURED BY COMPUTED TOMOGRAPHY TO PREDICT HEMODYNAMIC PROGRESSION OF AORTIC STENOSIS. J Am Coll Cardiol 2014. [DOI: 10.1016/s0735-1097(14)62018-0] [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] [Indexed: 10/25/2022]
|
20
|
Clavel MA, Malouf J, Michelena HI, Suri RM, Jaffe AS, Mahoney DW, Enriquez-Sarano M. B-type natriuretic peptide clinical activation in aortic stenosis: impact on long-term survival. J Am Coll Cardiol 2014; 63:2016-25. [PMID: 24657652 DOI: 10.1016/j.jacc.2014.02.581] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [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: 11/06/2013] [Revised: 02/15/2014] [Accepted: 02/25/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVES This study was conducted to define the association between serum B-type natriuretic peptide (BNP) activation and survival after the diagnosis of aortic stenosis (AS). BACKGROUND In AS, the link between BNP levels and clinical outcome is in dispute. Failure to account for the normal shifting of BNP ranges with aging in men and women, not using hard endpoints (survival), and not enrolling large series of patients have contributed to the uncertainty. METHODS A program of prospective measurement of BNP levels with Doppler echocardiographic AS assessment during the same episode of care was conducted. BNP ratio (measured BNP/maximal normal BNP value specific to age and sex) >1 defined BNP clinical activation. RESULTS In 1,953 consecutive patients with at least moderate AS (aortic valve area 1.03 ± 0.26 cm(2); mean gradient 36 ± 19 mm Hg), median BNP level was 252 pg/ml (interquartile range: 98 to 592 pg/ml); BNP ratio 2.46 (interquartile range 1.03 to 5.66); ejection fraction (EF) 57% ± 15%, and symptoms present in 60% of patients. After adjustment for all survival determinants, BNP clinical activation (BNP ratio >1) independently predicted mortality after diagnosis (p < 0.0001; hazard ratio [HR]: 1.91; 95% CI: 1.55 to 2.35) and provided incremental power to the survival predictive model (p < 0.0001). Eight-year survival was 62 ± 3% with normal BNP levels, 44 ± 3% with BNP ratio of 1 to 2 (adjusted HR: 1.49; 95% CI: 1.17 to 1.90), 25 ± 4% with BNP ratio of 2 to 3 (adjusted HR: 2.12; 95% CI: 1.63 to 2.75), and 15 ± 2% with BNP ratio of ≥3 (adjusted HR: 2.43; 95% CI: 1.94 to 3.05). This strong link to survival was confirmed in asymptomatic patients with normal EF (adjusted HR: 2.35 [95% CI: 1.57 to 3.56] for BNP clinical activation and 2.10 [95% CI: 1.32 to 3.36] for BNP ratio of 1 to 2, 2.25 [95% CI: 1.31 to 3.87] for BNP ratio of 2 to 3, 3.93 [95% CI: 2.40 to 6.43] for BNP ratio of ≥3). Aortic valve replacement was associated with survival improved by a similarly high margin (p = 0.54) with BNP ratio of <2 (HR: 0.68; 95% CI: 0.52 to 0.89; p = 0.003) or BNP ratio of >2 (HR: 0.56; 95% CI: 0.47 to 0.66; p < 0.0001). CONCLUSIONS In this large series of patients with AS, BNP clinical activation was associated with excess long-term mortality incrementally and independently of all baseline characteristics. Higher mortality with higher BNP clinical activation, even in asymptomatic patients, emphasizes the importance of appropriate clinical interpretation of BNP levels in managing patients with AS.
Collapse
Affiliation(s)
- Marie-Annick Clavel
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph Malouf
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hector I Michelena
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rakesh M Suri
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Allan S Jaffe
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Douglas W Mahoney
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
21
|
Hariyadi D, Ma Y, Wang Y, Bostrom T, Malouf J, Turner M, Bhandari B, Coombes A. The potential for production of freeze-dried oral vaccines using alginate hydrogel microspheres as protein carriers. J Drug Deliv Sci Technol 2014. [DOI: 10.1016/s1773-2247(14)50029-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
22
|
Clavel M, Malouf J, Michelena H, Enriquez-Sarano M. Usefulness of Type-B Natriuretic Peptide in Decision Making in Aortic Stenosis. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.526] [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] Open
|
23
|
Clavel MA, Messika-Zeitoun D, Pibarot P, Aggarwal SR, Malouf J, Araoz PA, Michelena HI, Cueff C, Larose E, Capoulade R, Vahanian A, Enriquez-Sarano M. The complex nature of discordant severe calcified aortic valve disease grading: new insights from combined Doppler echocardiographic and computed tomographic study. J Am Coll Cardiol 2013; 62:2329-38. [PMID: 24076528 DOI: 10.1016/j.jacc.2013.08.1621] [Citation(s) in RCA: 369] [Impact Index Per Article: 33.5] [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: 05/02/2013] [Revised: 07/17/2013] [Accepted: 08/17/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVES With concomitant Doppler echocardiography and multidetector computed tomography (MDCT) measuring aortic valve calcification (AVC) load, this study aimed at defining: 1) independent physiologic/structural determinants of aortic valve area (AVA)/mean gradient (MG) relationship; 2) AVC thresholds best associated with severe aortic stenosis (AS); and 3) whether, in AS with discordant MG, severe calcified aortic valve disease is generally detected. BACKGROUND Aortic stenosis with discordant markers of severity, AVA in severe range but low MG, is a conundrum, unresolved by outcome studies. METHODS Patients (n = 646) with normal left ventricular ejection fraction AS underwent Doppler echocardiography and AVC measurement by MDCT. On the basis of AVA-indexed-to-body surface area (AVAi) and MG, patients were categorized as concordant severity grading (CG) with moderate AS (AVAi >0.6 cm²/m², MG <40 mm Hg), severe AS (AVAi ≤0.6 cm²/m², MG ≥ 40 mm Hg), discordant-severity-grading (DG) with low-MG (AVAi ≤0.6 cm(2)/m(2), MG <40 mm Hg), or high-MG (AVAi >0.6 cm(2)/m(2), MG ≥40 mm Hg). RESULTS The MG (discordant in 29%) was strongly determined by AVA and flow but also independently and strongly influenced by AVC-load (p < 0.0001) and systemic arterial compliance (p < 0.0001). The AVC-load (median [interquartile range]) was similar within patients with DG (low-MG: 1,619 [965 to 2,528] arbitrary units [AU]; high-MG: 1,736 [1,209 to 2,894] AU; p = 0.49), higher than CG-moderate-AS (861 [427 to 1,519] AU; p < 0.0001) but lower than CG-severe-AS (2,931 [1,924 to 4,292] AU; p < 0.0001). The AVC-load thresholds separating severe/moderate AS were defined in CG-AS with normal flow (stroke-volume-index >35 ml/m(2)). The AVC-load, absolute or indexed, identified severe AS accurately (area under the curve ≥0.89, sensitivity ≥86%, specificity ≥79%) in men and women. Upon application of these criteria to DG-low MG, at least one-half of the patients were identified as severe calcified aortic valve disease, irrespective of flow. CONCLUSIONS Among patients with AS, MG is often discordant from AVA and is determined by multiple factors, valvular (AVC) and non-valvular (arterial compliance) independently of flow. The AVC-load by MDCT, strongly associated with AS severity, allows diagnosis of severe calcified aortic valve disease. At least one-half of the patients with discordant low gradient present with heavy AVC-load reflective of severe calcified aortic valve disease, emphasizing the clinical yield of AVC quantification by MDCT to diagnose and manage these complex patients.
Collapse
Affiliation(s)
| | - David Messika-Zeitoun
- Cardiology Department, AP-HP, Bichat Hospital, Paris, France; INSERM U698 and University Paris 7-Diderot, Paris, France
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Québec, Canada
| | | | - Joseph Malouf
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Phillip A Araoz
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Caroline Cueff
- Cardiology Department, AP-HP, Bichat Hospital, Paris, France
| | - Eric Larose
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Québec, Canada
| | - Romain Capoulade
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Québec, Canada
| | - Alec Vahanian
- Cardiology Department, AP-HP, Bichat Hospital, Paris, France; INSERM U698 and University Paris 7-Diderot, Paris, France
| | | |
Collapse
|
24
|
Zhang B, Malouf J, Young P, Kohli M, Dronca R. Cardiac Metastasis in Renal Cell Carcinoma without Vena Cava or Atrial Involvement: an Unusual Presentation of Metastatic Disease. Rare Tumors 2013; 5:e29. [PMID: 24179641 PMCID: PMC3804804 DOI: 10.4081/rt.2013.e29] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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: 11/14/2012] [Accepted: 01/16/2013] [Indexed: 12/31/2022] Open
Abstract
Cardiac metastasis in renal cell carcinoma is a very rare entity, with only a few previously reported cases. In this series, we report two cases of ventricular metastases from renal cell carcinoma without vena cava or right atrial involvement. The first case involves an initially isolated inoperable metastasis to the left ventricle, which was treated with systemic targeted therapy with favorable local response. Our second case illustrates a patient with an isolated cardiac metastasis in the interventricular septum with extension into the right ventricle, which has also remained stable in size on systemic targeted therapy. Although anti-angiogenic agents such as tyrosine kinase inhibitors have transformed the treatment of metastatic renal cell carcinoma in recent years, their efficacy and safety in treating patients with metastatic disease in highly vascular organs such as the heart are currently unknown, with no prior reports on this topic. We describe our novel management of these unique cases and discuss the current medical and surgical approaches to treating cardiac metastases from renal cell carcinoma.
Collapse
Affiliation(s)
- Ben Zhang
- Department of Internal Medicine, Mayo Clinic and Medical School , Rochester, MN, USA
| | | | | | | | | |
Collapse
|
25
|
Moya P, Rodriguez de la Serna A, Magallares B, Diaz-Torné C, Sarmiento M, Cόrica E, Castellví I, Geli C, Laiz A, Malouf J, Perez A, de Llobet J. SAT0435 Profile and degree of hyperglycemia after the infiltration of intrarticular corticosteroids to patients with and without type 2 diabetes mellitus. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.3381] [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: 11/04/2022]
|
26
|
Aggarwal SR, Clavel MA, Messika-Zeitoun D, Cueff C, Malouf J, Araoz PA, Mankad R, Michelena H, Vahanian A, Enriquez-Sarano M. Sex differences in aortic valve calcification measured by multidetector computed tomography in aortic stenosis. Circ Cardiovasc Imaging 2012; 6:40-7. [PMID: 23233744 DOI: 10.1161/circimaging.112.980052] [Citation(s) in RCA: 174] [Impact Index Per Article: 14.5] [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: 12/18/2022]
Abstract
BACKGROUND Aortic valve calcification (AVC) is the intrinsic mechanism of valvular obstruction leading to aortic stenosis (AS) and is measurable by multidetector computed tomography. The link between sex and AS is controversial and that with AVC is unknown. METHODS AND RESULTS We prospectively performed multidetector computed tomography in 665 patients with AS (aortic valve area, 1.05±0.35 cm(2); mean gradient, 39±19 mm Hg) to measure AVC and to assess the impact of sex on the AVC-AS severity link in men and women. AS severity was comparable between women and men (peak aortic jet velocity: 4.05±0.99 versus 3.93±0.91 m/s, P=0.11; aortic valve area index: 0.55±0.20 versus 0.56±0.18 cm(2)/m(2); P=0.46). Conversely, AVC load was lower in women versus men (1703±1321 versus 2694±1628 arbitrary units; P<0.0001) even after adjustment for their smaller body surface area or aortic annular area (both P<0.0001). Thus, odds of high-AVC load were much greater in men than in women (odds ratio, 5.07; P<0.0001). Although AVC showed good associations with hemodynamic AS severity in men and women (all r>0.67; P<0.0001), for any level of AS severity measured by peak aortic jet velocity or aortic valve area index, AVC load, absolute or indexed, was higher in men versus women (all P≤0.01). CONCLUSIONS In this large AS population, women incurred similar AS severity than men for lower AVC loads, even after indexing for their smaller body size. Hence, the relationship between valvular calcification process and AS severity differs in women and men, warranting further pathophysiological inquiry. For AS severity diagnostic purposes, interpretation of AVC load should be different in men and in women.
Collapse
Affiliation(s)
- Shivani R Aggarwal
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Malouf J, Le Tourneau T, Pellikka P, Sundt TM, Scott C, Schaff HV, Enriquez-Sarano M. Aortic valve stenosis in community medical practice: Determinants of outcome and implications for aortic valve replacement. J Thorac Cardiovasc Surg 2012; 144:1421-7. [DOI: 10.1016/j.jtcvs.2011.09.075] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 08/26/2011] [Accepted: 09/26/2011] [Indexed: 10/14/2022]
|
28
|
Vallano A, Malouf J, Payrulet P, Baños JE. Prevalence of pain in adults admitted to Catalonian hospitals: A cross-sectional study. Eur J Pain 2012; 10:721-31. [PMID: 16413801 DOI: 10.1016/j.ejpain.2005.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Revised: 11/07/2005] [Accepted: 11/24/2005] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To survey the prevalence of pain in patients admitted to different hospitals of Catalonia and to describe which factors are related to pain. METHODS A cross-sectional study was performed in 1675 patients from fifteen hospitals in Catalonia (Spain). Clinical and demographic data, as well as the existence of pain intensity evaluations and analgesic therapy, were obtained from medical charts. Characteristics of pain were given by patients after being interviewed by trained interviewers. The main-outcome measure was the existence of pain (at the interview, in the previous 24h, at the admission and at any time after admission) that was assessed by a visual analogue scale (VAS). The relationship of prevalence of pain to patients' characteristics was carried out by means of a multiple-logistic-regression model with pain presence as the dependent variable of interest. RESULTS A great variability in the prevalence and intensity of pain among different hospitals was observed. At the time of the interview, 48.5% (95% CI: 46.1-50.9%) of the patients had pain and the median VAS was 40mm (range: 10-100mm), and the prevalence of pain during the previous 24h was similar (47.6%; 95% CI: 45.2-50%). At admission, 26.7% (95% CI: 24.6-28.8%) of patients were in pain, whereas 62% (95% CI: 59.7-64.3%) reported having pain at some time during their stay. Pain intensity annotations were absent in 51.3% (95% CI: 47.9-54.7%) of the medical records of the patients with pain. The factors associated with pain were younger age, female gender, presence of surgery, orthopaedic surgery wards, large hospital and prescribed analgesics. CONCLUSION A high prevalence of clinically relevant pain in in-patients was found as well as a great variability according to type of patients, clinical wards and hospitals. This study gives clear evidence of the lack of adequate management of pain in the majority of the hospitals and calls for the implementation of organisational and educational measurements that may settle this epidemic problem.
Collapse
Affiliation(s)
- A Vallano
- Fundació Institut Català de Farmacología, Servicio de Farmacología Clínica, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Passeig Vall d' Hebron no. 119-129, 08035 Barcelona, Spain.
| | | | | | | |
Collapse
|
29
|
Franco M, Geli C, Diaz C, Mestres J, Malouf J. PO14-370 ASSESSMENT OF CARDIOVASCULAR RISKS AND CAROTID ULTRASOUND IN A POPULATION WITH RHEUMATOID ARTHRITIS. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71380-6] [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]
|
30
|
Abstract
AIM The aim of this study was to assess the analgesic treatment and the prevalence of pain in patients treated with analgesics in hospitals. METHODS Adult patients treated with analgesics were selected from a sample of 1,675 patients in a cross-sectional study carried out in 15 Catalonian hospitals (Spain). Patient characteristics, type of analgesics, treatment schedules, patients' pain intensity and clinical ward and hospital characteristics were assessed. Adherence to analgesic use guidelines was established according to the principles and recommendations of internationally recognised guidelines for pain management. Pain was determined by asking patients about pain intensity by means of a visual analogue scale (VAS). RESULTS Analgesics were prescribed for 1,173 patients (70%; 95% CI: 67.4-72.6), in whom 57% (95% CI: 54.2-59.8) had pain and in whom 30.5% (95% CI: 27.9-33.1) pain intensity was greater than 30 mm. Adherence to analgesic treatment guidelines was judged appropriate in only 26.9% (95% CI: 24.4-29.4%) of all patients. The administered analgesic dose was in the recommended dose range in 42% (95% CI: 54-58) of all analgesics and in 28% (95% CI: 24-32) of opioid analgesics. A minority of patients was treated with a rescue schedule or patient-controlled analgesia (2%; 95% CI: 1.4-2.6). Pain prevalence was higher in those with analgesic treatment that did not adhere to guidelines (63.6%; 95% CI: 60.4-66.8) than in those considered as having appropriate adherence to guidelines (39.3%; 95% CI: 33.8-44.6) (p < 0.001). Adherence to analgesic treatment guidelines was higher in the large hospitals (21%; 95% CI: 18-24) than in medium and small hospitals (13%; 95% CI: 9-16) (p < 0.001). CONCLUSIONS Although analgesic use is high in the hospital settings, adherence to the principles and recommendations of pain guidelines is low, and pain is usually common in patients treated with analgesics. These results once again emphasise the need to improve analgesic use and pain management in hospitals.
Collapse
Affiliation(s)
- A Vallano
- Fundació Institut Català de Farmacología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | | | | | | |
Collapse
|
31
|
Vallano A, Payrulet P, Malouf J, Baños JE. [Multicenter study of pain assessment in hospitals]. Rev Esp Anestesiol Reanim 2007; 54:140-6. [PMID: 17436651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To evaluate the recording of pain intensity in hospital charts. METHODS A cross-sectional study was carried out in 15 hospitals in a sample of admitted patients with pain. Clinical data, including pain intensity, were gathered from the hospital records. Multiple analysis of variance was used to identify factors related to the intensity of pain recorded in the patients' charts. RESULTS A total of 1038 patients with a mean (SD) age of 56.1 (18.9) years were included. Pain intensity was noted in the charts of 47.9% (95% confidence interval [CI], 44.9%-50.9%) of the patients. Pain intensity had been noted for 68.9% (95% CI, 61.4%-76.4%) of the patients with cancer, 43% (95% CI, 38.2%-47.8%) of postoperative patients, 38.2% (95% CI, 35%-41.4%) of trauma patients, and 26.6% (95% CI, 16.9%-36.3%) of postpartum women. There was great interhospital variability. Factors associated with the recording of pain intensity in medical charts were hospital characteristics (large hospitals, teaching hospitals, hospitals and internal medicine and surgical specialities) and type of patient (cancer and trauma cases and patients reporting pain to the staff). CONCLUSION There is inadequate written recording of intensity of pain in hospitals, even though there is considerable interhospital variation. Pain intensity assessment and recording is an indicator of quality of health care and should become a routine practice in hospital health care.
Collapse
Affiliation(s)
- A Vallano
- Fundació Institut Català de Farmacología, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona.
| | | | | | | |
Collapse
|
32
|
Al Ahmari S, Malouf J, Al Atawi F, Schaff H, Chandrasekaran K. Anatomical basis for acquired intracardiac shunt postaortic valve replacement: Doppler echocardiographic diagnosis. European Journal of Echocardiography 2004; 5:68-71. [PMID: 15113014 DOI: 10.1016/s1525-2167(03)00040-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We report a case of postoperative intracardiac shunts across the membranous septum detected by Doppler echocardiography and discuss the anatomical basis for the development of such a complication.
Collapse
Affiliation(s)
- S Al Ahmari
- Cardiovascular Division, Echocardiography Laboratory, Mayo Clinic, 200 First Street SW, Gonda 6-138 NW, Rochester, MN 55905, USA
| | | | | | | | | |
Collapse
|
33
|
Al-Ahmari S, Chandrasekaran K, Brilakas E, Tahlil W, Dearani J, Malouf J, Gilman G, Seward JB, Tajik AJ. Isolated partial anomalous pulmonary venous connection: Diagnostic value of suprasternal color flow imaging and contrast echocardiography. J Am Soc Echocardiogr 2003; 16:884-9. [PMID: 12878999 DOI: 10.1067/s0894-7317(03)00332-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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] [Indexed: 11/22/2022]
Abstract
Isolated partial anomalous pulmonary venous connection is frequently missed even when patients present with mild right ventricular enlargement. We describe the value of imaging from suprasternal window with color flow and ultrasound contrast echocardiography in aiding the diagnosis.
Collapse
Affiliation(s)
- Saeed Al-Ahmari
- Cardiovascular Division, Echocardiography Laboratory, Mayo Clinic 55905, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
The clinical, cross-sectional echocardiographic, haemodynamic, and angiographic features of a case of cardiac fibroma in a newborn with unexplained pulmonary hypertension, and direct tumor involvement of the posterior leaflet of the mitral valve, are presented. The role of echocardiography in the pre-operative evaluation of cardiac tumors is discussed.
Collapse
Affiliation(s)
- F Kutayli
- Department of Pediatrics, American University of Beirut Medical Center, Lebanon
| | | | | | | | | |
Collapse
|
35
|
Malouf J, Gharzuddine W, Kutayli F. A reappraisal of the prevalence and clinical importance of left ventricular false tendons in children and adults. Br Heart J 1986; 55:587-91. [PMID: 3718798 PMCID: PMC1236766 DOI: 10.1136/hrt.55.6.587] [Citation(s) in RCA: 32] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The prevalence and clinical importance of false tendons were studied in 488 consecutive patients referred for echocardiography. Two hundred and eighty three (58%) patients had acquired heart disease, 91 (19%) had congenital heart disease, and 114 (23%) had normal hearts. Sixty six patients with normal hearts had innocent systolic murmurs and one had recurrent ventricular tachycardia. The overall prevalence of false tendons was 25% compared with 1.6% in a retrospective analysis of 763 cross sectional echocardiograms. When patients with innocent murmurs were excluded from statistical analysis, there was no significant difference in the prevalence of these tendons between children and adults, boys and girls, men and women, or between patients with acquired or congenital heart disease and normal patients. The prevalence of false tendons in patients with dilated left ventricles (57%), however, resembled that seen in necropsy studies. The prevalence of false tendons in patients with an innocent systolic murmur was 76% in children and 40% in adults, with an overall prevalence of 52%. False tendons are a common echocardiographic finding of no clinical importance except for their possible role in the genesis of innocent murmurs and ventricular arrhythmias. The echocardiographic detection of false tendons increases considerably when these structures are specifically sought and in conditions that result in left ventricular chamber dilatation.
Collapse
|
36
|
Abstract
Apical hypertrophic cardiomyopathy is described in a father and his daughter. In both, identical segments of the left ventricle were involved by the hypertrophic process with differing degrees of severity. We suggest that the morphologic findings described are due to a single gene with an autosomal dominant mode of inheritance.
Collapse
|
37
|
Der Kaloustian VM, Ratl H, Malouf J, Hatem J, Slim M, Tomeh A, Khouri J, Kutayli F. Tetralogy of Fallot with pulmonary atresia in siblings. Am J Med Genet 1985; 21:119-22. [PMID: 4003436 DOI: 10.1002/ajmg.1320210117] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We present two sisters with tetralogy of Fallot and pulmonary valve atresia. Both had identical anatomical findings as seen at cardiac catheterization and angiography and verified operatively, with, in particular, identical bronchial circulation and pulmonary valve structure. The parents are first cousins and there is no history of other affected relatives. We suggest that this is a specific, recessively inherited type of tetralogy of Fallot.
Collapse
|
38
|
|
39
|
Malouf J, Alam S, Kanj H, Mufarrij A, Der Kaloustian VM. Hypergonadotropic hypogonadism with congestive cardiomyopathy: an autosomal-recessive disorder? Am J Med Genet 1985; 20:483-9. [PMID: 3993676 DOI: 10.1002/ajmg.1320200309] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report on two sisters with ovarian dysgenesis and secondary hypergonadotropic hypogonadism and congestive cardiomyopathy. Their parents are first cousins. It is suggested that these are the main manifestations of a previously unreported autosomal-recessive syndrome.
Collapse
|
40
|
Malouf J, Nasrallah A, Daghir I, Harake M, Mufarrij A. Candida tropicalis Endocarditis in Idiopathic Hypertrophic Subaortic Stenosis. Chest 1984; 86:508. [PMID: 6540654 DOI: 10.1378/chest.86.3.508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
41
|
Abstract
Foreign-body aspiration in adults is usually associated with asphyxiation after aspiration of food particles. The present report documents a case of foreign-body aspiration that resulted from poor tracheostomy care in an alcoholic patient, and caused fulminant pneumonitis.
Collapse
|
42
|
Hannun YA, Abdel Malak S, Malouf J, Alam S. Emergency valve replacement during acute carditis--case reports. Middle East J Anaesthesiol 1984; 7:363-71. [PMID: 6530967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Two patients are described with acute rheumatic carditis and severe heart failure who failed to respond to aggressive medical treatment with steroids, salicylates, inotropic agents and afterload reduction. In both cases, cardiac catheterization revealed severe aortic and mitral regurgitation with preserved myocardial contractility. Emergency double valve replacement was successfully performed with marked improvement in both patients. The diagnosis and evaluation of the condition, as well as the unique problems confronted in the post-operative course are discussed.
Collapse
|
43
|
Malouf J. Heart failure: current concepts. Middle East J Anaesthesiol 1984; 7:313-7. [PMID: 6530964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
44
|
Abstract
Transplantation of involved psoriatic and nonpsoriatic human skin onto congenitally athymic (nude) mice has been performed successfully. Although biopsies at selected intervals demonstrate that the excess glycogen deposition normally seen in psoriasis is no longer consistently present, the psoriatic grafts did retain the usual characteristic histologic differences throughout the life of the animal, up to 11 weeks. This grafting procedure potentially represents a useful method whereby the study of psoriasis can be made in a nonhuman, living system.
Collapse
|