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Gegenava T, Bijl P, Vollema M, Kley F, Weger A, Hautemann D, Reiber J, Ajmone-Marsan N, Bax J, Delgado V. Impact of baseline feature tracking multi-detector row computed tomography-derived left ventricular global longitudinal strain on left ventricular functional recovery in TAVI patients. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Advances in left ventricular (LV) analysis with dynamic multi-detector row computed tomography (MDCT) permit measurement of LV global longitudinal strain (GLS) and have shown their impact on risk stratification of patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI).
Purpose
To evaluate the influence of baseline feature tracking (FT) MDCT- derived LV GLS on LV functional recovery in severe AS patients undergoing TAVI.
Methods
A total of 194 patients with severe AS (50% male, 80±7 years) with dynamic MDCT data allowing LV GLS measurement with a novel FT algorithm and having complete echocardiography evaluation at baseline, at 3–6 months and at 1 year follow-up were evaluated. FT MDCT-derived LV GLS was measured at baseline and the study population was divided according to a cut-off value of MDCT LV GLS −14% (≤−14% [more preserved LV systolic function] vs. >−14% [more impaired LV systolic function]).
Results
Transthoracic echocardiography (TTE)-derived Left ventricular ejection fraction (LVEF) increased over time in both groups: in patients with preserved and reduced MDCT LV GLS, and reached a higher value in patients with preserved MDCT LV GLS (52±7% at baseline, 55±7% at 3–6 months, 58±7% at 1 year follow-up vs. 43±10% at baseline, 49±10% at 3–6 months, 53±11% at 1 year follow-up; p=0.016) (Figure 1). TTE-derived LV GLS also showed greater improvement for patients with preserved MDCT LV GLS (−17±3% at baseline, −18±3% at 3–6 months, −20±3% at 1 year follow-up vs. −12±3% at baseline, −15±3% at 3–6 months, −16±3% at 1 year follow-up; p=0.027) (Figure 1).
Conclusions
In severe AS patients treated with TAVI, LV function improves significantly at 3–6 and at 12 months' follow-up and shows superior recovery in patients with more preserved baseline MDCT LV GLS, suggesting that MDCT-derived LV GLS has an important impact on LV functional recovery after TAVI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Gegenava
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - P Bijl
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - M Vollema
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - F Kley
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - A Weger
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - D Hautemann
- Leiden University Medical Center, LKEB, Leiden, Netherlands (The)
| | - J Reiber
- Leiden University Medical Center, LKEB, Leiden, Netherlands (The)
| | | | - J Bax
- Leiden University Medical Centre, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Centre, Leiden, Netherlands (The)
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Gegenava T, Bijl P, Vollema M, Kley F, Weger A, Hautemann D, Reiber J, Ajmone-Marsan N, Bax J, Delgado V. P3377MDCT-derived left ventricular global longitudinal strain and left ventricular ejection fraction in patients with aortic stenosis: a comparative analysis with echocardiographic measurements. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Known predictors of poor outcome in aortic valve stenosis patients include older age, significant valvular calcification, rapid hemodynamic progression and impaired left ventricular (LV) systolic function. LV global longitudinal strain (GLS) quantifies myocardial deformation and LV function and is associated with prognosis in patients with severe aortic stenosis (AS). Multi-detector row computed tomography (MDCT) data are key in the evaluation of patients undergoing transcatheter aortic valve implantation (TAVI) and when acquired throughout the entire cardiac cycle, LV systolic function can be assessed. Novel software can assess LV GLS from MDCT-data.
Purpose
The present study aimed at assessing the feasibility of determining novel MDCT-derived LV GLS as well as MDCT-derived LV ejection fraction (EF) and their agreement with echocardiographic LV GLS and LVEF in patients treated with TAVI.
Methods
LVEF and LV GLS were measured on echocardiography and dynamic MDCT using novel CT-software. Agreement between the measurements of two different modalities was assessed using Bland-Altman analysis.
Results
A total 214 patients (51% male, mean age: 80±7 years) were analysed retrospectively. Mean value of LV GLS on echocardiography was −14±4% whereas mean MDCT-derived GLS was −12.5±4%. Mean value of LVEF on echocardiography was 47±10% and mean MDCT-derived LVEF was 39±11%. On Bland-Altman analysis, MDCT-derived strain analysis underestimated LV GLS compared to echocardiography with a mean difference of 1.44% (95% limits of agreement −3.8 to 6.7%). LVEF was also underestimated on CT with a mean difference of 7.68% (95% limits of agreement −11.5% to −26%). Correlation of measurements between MDCT-derived LV GLS and echocardiographic LV GLS was significant (r=0.791, p<0.001), as well as the correlation between MDCT-derived LVEF and echocardiographic LVEF (r=0.590, p<0.001) (Figure).
Conclusions
Assessment of LV GLS and LVEF on dynamic MDCT data provides similar values to those obtained with echocardiography and could be used in the risk-stratification of severe AS patients undergoing TAVI.
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Affiliation(s)
- T Gegenava
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - P Bijl
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - M Vollema
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - F Kley
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - A Weger
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - D Hautemann
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - J Reiber
- Leiden University Medical Center, Leiden, Netherlands (The)
| | | | - J Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
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Gegenava T, Bijl P, Vollema M, Kley F, Weger A, Hautemann D, Reiber J, Ajmone-Marsan N, Bax J, Delgado V. 4935Prognostic influence of MDCT-derived global left ventricular longitudinal strain in patients with aortic stenosis treated with transcatheter aortic valve implantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Transcatheter aortic valve implantation (TAVI) is an effective treatment for patients with severe aortic stenosis (AS), It can lead to an improvement in symptoms and quality of life but there is also an increasing recognition that some patients simply fail to derive a functional, morbidity, or mortality benefit post-TAVI. Left ventricular (LV) ejection fraction is the LV systolic function parameter to risk stratify patients with severe AS. However, LV global longitudinal strain (GLS) provides incremental prognostic value to LVEF. Computed tomography plays an essential role in the evaluation of TAVI candidates. Novel software permits analysis of LV GLS from dynamic Multi-detector row computed tomography (MDCT) data.
Purpose
The present study aimed at investigating the prognostic value of MDCT-derived LV GLS in patients undergoing TAVI.
Methods
LV GLS was measured on dynamic MDCT using novel CT-software (Figure, panel A) at baseline. Patients were followed up for all-cause mortality and cumulative event rates were analyzed with Kaplan-Meier method.
Results
A total 214 patients (51% male, 80±7 years) were analysed retrospectively. Mean value of MDCT-derived LV GLS was −12.5±4%. During a median follow-up of 1378 days (interquartile range: 881–1895 days), 67 (31%) patients died. The Kaplan-Meier curve shows, that TAVI recipients with MDCT-derived LV GL S>−14% experienced higher cumulative rates of all-cause mortality, compared to patients with MDCT-derived LV GLS ≤−14% (Chi-square 10.549; Log rank p=0.001) (Figure, panel B). On uni- and multivariate Cox-regression models, MDCT-derived LV GLS demonstrated significant association with all-cause mortality (hazard ratio [HR]: 0.851; 95% confidence interval [CI]: 0.772–0.937; p=0.001).
MDCT LV GLS and survival
Conclusions
MDCT-derived LV GLS is independently associated with all-cause mortality in patients treated with TAVI.
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Affiliation(s)
- T Gegenava
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - P Bijl
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - M Vollema
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - F Kley
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - A Weger
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - D Hautemann
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - J Reiber
- Leiden University Medical Center, Leiden, Netherlands (The)
| | | | - J Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Leiden, Netherlands (The)
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Gegenava T, Bijl P, Vollema M, Kley F, Weger A, Ajmone Marsan N, Delgado V. 80CT-derived left ventricular global longitudinal strain in patients treated with transcatheter aortic valve implantation: comparison with 2-dimensional speckle tracking global longitudinal strain. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Gegenava
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - P Bijl
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - M Vollema
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - F Kley
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - A Weger
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - N Ajmone Marsan
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands (The)
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Gegenava T, Vollema M, Abou R, Goedemans L, Rosendael A, Kley F, Weger A, Ajmone N, Bax J, Delgado V. P4501Prognostic value of thoracic aorta calcification burden in patients after transcatheter aortic valve implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T Gegenava
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - M Vollema
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - R Abou
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - L Goedemans
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - A Rosendael
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - F Kley
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - A Weger
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - N Ajmone
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
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Gegenava T, Vollema EM, Rosendael A, Abou R, Goedemans L, Kley F, Weger A, Ajmone N, Bax J, Delgado V. P4496Changes in valvulo-arterial impedance after transcatheter aortic valve implantation according to calcification burden of thoracic aorta. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Gegenava
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - E M Vollema
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - A Rosendael
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - R Abou
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - L Goedemans
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - F Kley
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - A Weger
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - N Ajmone
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - V Delgado
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
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Neuhaus AH, Opgen-Rhein C, Urbanek C, Hahn E, Ta TMT, Seidelsohn M, Strathmann S, Kley F, Wieseke N, Sander T, Dettling M. COMT Val 158 Met polymorphism is associated with cognitive flexibility in a signal discrimination task in schizophrenia. Pharmacopsychiatry 2009; 42:141-4. [PMID: 19585392 DOI: 10.1055/s-0028-1112132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Associations between the well-known functional single nucleotide polymorphism Val (158)Met in the gene encoding catechol- O-methyltransferase (COMT) and cognitive do-mains affected in schizophrenia are inconsistent regarding directionality and specific impact and call for a more fundamental cognitive endophenotype. Recent studies suggest that the COMT genotype contributes to cognitive flexibility, a fundamental cognitive ability that potentially influences an individual's performance in a variety of other neurocognitive tasks. METHODS We investigated the association between COMT Val (158)Met genotype and cognitive flexibility as assessed by signal discrimination in the Continuous Performance Test - Identical Pairs version in a cohort of 111 German schizophrenic patients. RESULTS COMT genotype was significantly associated with signal discrimination index d' in schizophrenia. The Val/Val genotype was associated with the highest and the Met/Met genotype with the lowest scores; heterozygous individuals displayed an intermediate performance. CONCLUSIONS Our data suggest that allelic variation at the COMT Val (158)Met locus may influence signal discrimination capacity in schizophrenia and confirm that Val loading, probably due to decreased prefrontal dopamine availability, is associated with greater cognitive flexibility, which in turn may influence other cognitive measures that have been associated with COMT to date.
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Affiliation(s)
- A H Neuhaus
- Department of Psychiatry, Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany.
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