1
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Michelena HI, Della Corte A, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernández B, Asch FM, Barker AJ, Sierra LM, de Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkar R, Leon MB, Sanders SP, Markl M, Ferrari VA, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, El Khoury G, de Paulis R, Enriquez-Sarano M, Bax JJ, Otto CM, Schäfers HJ. [Summary: International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes]. Arch Cardiol Mex 2024; 94:219-239. [PMID: 38325117 DOI: 10.24875/acm.24000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 02/09/2024] Open
Abstract
This consensus of nomenclature and classification for congenital bicuspid aortic valve and its aortopathy is evidence-based and intended for universal use by physicians (both pediatricians and adults), echocardiographers, advanced cardiovascular imaging specialists, interventional cardiologists, cardiovascular surgeons, pathologists, geneticists, and researchers spanning these areas of clinical and basic research. In addition, as long as new key and reference research is available, this international consensus may be subject to change based on evidence-based data1.
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Affiliation(s)
- Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, EE.UU
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania L. Vanvitelli, Nápoles, Italia
| | - Arturo Evangelista
- Departmento de Cardiología, Hospital Vall d´Hebron, Vall d´Hebron Research Institute (VHIR) Ciber-CV, Barcelona, España
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, EE.UU
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, EE.UU
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, Nueva York, NY, EE.UU
| | | | - Borja Fernández
- Departamento de Biología Animal, Facultad de Ciencias, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Ciber-CV, Málaga, España
| | | | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Colorado, EE.UU
| | - Lilia M Sierra
- Cardiovascular Division, American British Cowdray Medical Center, Ciudad de México, México
| | - Laurent de Kerchove
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruselas, Bélgica
| | - Susan M Fernandes
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, California, EE.UU
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, California, EE.UU
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canadá
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburgo, Alemania
| | - Victoria Delgado
- Department of Cardiology; Leiden University Medical Center, Leiden, Países Bajos
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, EE.UU
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, París, Francia
| | - Siddharth K Prakash
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, EE.UU
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, Reino Unido
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy Carol Davila - Euroecolab, Emergency Institute for Cardiovascular Diseases Prof. Dr. C. C. Iliescu, Bucarest, Rumanía
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, EE.UU
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, Spain. IDIBAPS, CIBERCV, ISCIII, CERCA Programme
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, EE.UU
| | - Phillippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, Québec, Canadá
| | | | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Department of Cardiology, CHU Sart Tilman, Liège, Bélgica
- Departamento o Servicio o División, Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Italia
- Anthea Hospital, Bari, Italia
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Alemania
| | - John K Forrest
- Yale University School of Medicine, Yale New Haven Hospital, New Haven CT, EE.UU
| | - John Webb
- St Paul's Hospital, University of British Columbia, Vancouver, Canadá
| | - Dianna M Milewicz
- Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, Texas, EE.UU
| | - Raj Makkar
- Cedars Sinai Heart, Institute, Los Angeles, CA, EE.UU
| | - Martin B Leon
- Columbia University Irving Medical Center/NY Presbyterian Hospital. EE.UU
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, EE.UU
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, EE.UU
| | - Victor A Ferrari
- University of Pennsylvania Medical Center, Penn Cardiovascular Institute, PA, EE.UU
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, and Texas, A & M School of Medicine, Dallas Campus, Dallas, Texas, EE.UU
| | - Jae-Kwan Song
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canadá
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Maryland, EE.UU
| | - Samuel Siu
- Schulich School of Medicine and Dentistry, London, Ontario, Canadá
| | - Lars G Svensson
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Ohio, EE.UU
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, EE.UU
| | - Joseph Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, PA, EE.UU
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, EE.UU
| | - Gebrine El Khoury
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Bruselas, Bélgica
| | | | | | - Jeroen J Bax
- Department of Cardiology; Leiden University Medical Center, Leiden, Países Bajos
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA, EE.UU
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2
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Bonnet G, Panagides V, Vincent F, Faroux L, Corona S, Modine T, Metz D, Van Belle E, Pibarot P, Leroux L, Rodes-Cabau J, Ternacle J. Bioprosthetic valve fracture during valve-in-valve transcatheter aortic valve replacement: multicenter propensity matched analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) can be completed by bioprosthetic valve fracture (BVF) to reduce final transvalvular gradients. The aim was to compare outcomes in ViV-TAVI patients with versus without BVF.
Methods
Consecutive patients undergoing ViV-TAVI procedure in four international centers were included, from 2010 to 2021. We used a 1:2 propensity score-matching method to compare postprocedural hemodynamic, complications, and long-term outcomes. Patients were matched for baseline characteristics, time since prior surgery, and characteristics of surgical bioprothesis (type and size).
Results
A total of 390 patients were analyzed, including 40 BVF. Propensity matching 1:2 yielded 38 patients in BVF group and 76 patients in no-BVF group. There was no difference in procedural complications rate and in-hospital deaths (5.1%) between the two groups. Post-procedural hemodynamic parameters significantly improved using BVF: aortic valve area (1.4 cm2 [IQR: 1.23 to 2.3] vs. 1.3 cm2 [IQR: 1.05 to 1.61], p=0.008), mean aortic gradient (12mmHg [IQR: 7.5 to 16.5] vs. 17mmHg [IQR: 11 to 22], p=0.008) and peak velocity (2.2m/s [IQR: 1.8 to 2.7] vs. 2.6m/s [IQR: 2.2 to 3.1], p=0.027). BVF had an additional benefit in the smallest surgical valve (≤21 mm). The use of BVF was independently associated with improved hemodynamic parameters. Overall survival in the matched cohort was 87.8±3.7% at 2-year follow-up, without difference between groups (87.5±6.9% in the BVF group vs. 88.4±4.2% in the no-BVF group, p=0.85).
Conclusion
Compared to ViV-TAVI alone, BVF was safe and improved immediate hemodynamic and long-term outcomes, especially in patients with small surgical aortic bioprosthesis.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- G Bonnet
- Hospital Haut Leveque , Bordeaux , France
| | - V Panagides
- Quebec Heart and Lung Institute , Quebec , Canada
| | - F Vincent
- Chru De Lille - Institut Coeur-Poumons , Lille , France
| | - L Faroux
- Hospital Robert Debre - University Hospital Centre of Reims , Reims , France
| | - S Corona
- Hospital Haut Leveque , Bordeaux , France
| | - T Modine
- Hospital Haut Leveque , Bordeaux , France
| | - D Metz
- Hospital Robert Debre - University Hospital Centre of Reims , Reims , France
| | - E Van Belle
- Chru De Lille - Institut Coeur-Poumons , Lille , France
| | - P Pibarot
- Quebec Heart and Lung Institute , Quebec , Canada
| | - L Leroux
- Hospital Haut Leveque , Bordeaux , France
| | | | - J Ternacle
- Hospital Haut Leveque , Bordeaux , France
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Hudon G, Clavel M, Pibarot P, Jean G, Salaun E. DIFFERENCES IN RIGHT VENTRICULAR REMODELING AND ITS IMPACT ON SURVIVAL BETWEEN MEN AND WOMEN WITH AORTIC STENOSIS. Can J Cardiol 2022. [DOI: 10.1016/j.cjca.2022.08.133] [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: 11/02/2022] Open
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4
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Sandhu G, Ash J, Pibarot P, Clavel M, Duval S, Nijjar P. 480 Performance Of CT-based Aortic Valve Area For Assessment Of Aortic Stenosis. J Cardiovasc Comput Tomogr 2022. [DOI: 10.1016/j.jcct.2022.06.091] [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]
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5
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Delbarre M, Zaroui A, Annabi M, Galat A, Duhaut P, Schmidt J, Tribouilloy C, Pibarot P, Damy T. Amylose cardiaque sénile et rétrécissement aortique: l’œuf et la poule. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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6
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Fukui M, Annabi MS, Rosa VEE, Ribeiro HB, Tarasoutchi F, Shelbert EB, Bergler-Klein J, Mascherbauer J, Rochitte CE, Pibarot P, Cavalcante JL. Impact of left ventricular fibrosis and longitudinal systolic strain on outcomes in low gradient aortic stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The clinical utility of comprehensive cardiac magnetic resonance (CMR) for the assessment of myocardial structure and function remains unknown in patients with low gradient (LG) aortic stenosis (AS).
Purpose
This study sought to compare CMR characteristics of myocardial structure and function according to different flow / gradient patterns of AS: classical low flow LG (LFLG); paradoxical LFLG; normal flow LG; and high gradient, and to evaluate their impact on the outcomes of these patients.
Methods
International multicentric prospective study included 147 patients with LG moderate to severe AS and 18 patients with high gradient severe AS who underwent comprehensive CMR evaluation of left ventricular global longitudinal strain (LVGLS), extracellular volume fraction (ECV), and late gadolinium enhancement (LGE).
Results
Patients with classical LFLG (n=90) had more LV adverse remodeling and impaired longitudinal function including higher ECV, and higher LGE and volume, and worst LVGLS, compared to other patterns of AS. Over a median follow-up of 2-years, 43 deaths and 48 composite outcomes of death or heart failure hospitalization occurred in LG AS patients. As LVGLS or ECV worsened, risks of adverse events also increased (per tertile of LVGLS: HR [95% CI] for mortality, 1.50 [1.02–2.20]; p=0.04; HR [95% CI] for composite outcome, 1.45 [1.01–2.09]; p<0.05) (per tertile of ECV: HR [95% CI] for mortality, 1.63 [1.07–2.49]; p=0.02; HR [95% CI] for composite outcome, 1.54 [1.02–2.33]; p=0.04). LGE presence was also associated with higher mortality (HR [95% CI], 2.27 [1.01–5.11]; p<0.05) and risk of the composite outcome (HR [95% CI], 3.00 [1.16–7.73]; p=0.02). The risk of all-cause death and of the composite outcome increased in proportion to the number of impaired components (i.e. LVGLS, ECV and LGE) (Figure) with and without adjustment for age, true severe AS, classical LFLG, and aortic valve replacement as a time-varying covariate.
Conclusions
In this international multicentric study of LG AS, comprehensive CMR assessment of myocardial structure and function provides independent prognostic value that is cumulative and incremental to clinical and echocardiographic characteristics.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
| | - M S Annabi
- University Institute of Cardiology and Respirology of Quebec (IUCPQ), Quebec, Canada
| | - V E E Rosa
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - F Tarasoutchi
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - E B Shelbert
- University of Pittsburgh, Pittsburgh, United States of America
| | - J Bergler-Klein
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | | | - C E Rochitte
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - P Pibarot
- University Institute of Cardiology and Respirology of Quebec (IUCPQ), Quebec, Canada
| | - J L Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, United States of America
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7
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Tastet L, Shen M, Capoulade R, Arsenault M, Bédard E, Côté N, Clavel M, Pibarot P. TIMING AND DETERMINANTS OF THE DETERIORATION OF FUNCTIONAL STATUS IN PATIENTS WITH AORTIC STENOSIS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.170] [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: 11/29/2022] Open
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8
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Michelena HI, Corte AD, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernández B, Asch FM, Barker AJ, Sierra-Galan LM, De Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkaar R, Leon MB, Sanders SP, Markl M, Ferrari VA, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, El Khoury G, De Paulis R, Enriquez-Sarano M, Bax JJ, Otto CM, Schäfers HJ. International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes. Radiol Cardiothorac Imaging 2021; 3:e200496. [PMID: 34505060 DOI: 10.1148/ryct.2021200496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes. © 2021 Jointly between the RSNA, the European Association for Cardio-Thoracic Surgery, The Society of Thoracic Surgeons, and the American Association for Thoracic Surgery. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. All rights reserved. Keywords: Bicuspid Aortic Valve, Aortopathy, Nomenclature, Classification.
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Affiliation(s)
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Arturo Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) Ciber-CV, Barcelona, Spain
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Borja Fernández
- Departamento de Biologia Animal, Facultad de Ciencias, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Ciber-CV, Málaga, Spain
| | | | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Lilia M Sierra-Galan
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Laurent De Kerchove
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Susan M Fernandes
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERCV, ISCIII (CB16/11/00354), CERCA Programme, Barcelona, Spain
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Phillippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University Québec, Québec, Canada
| | | | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - John K Forrest
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, CT, USA
| | - John Webb
- St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Raj Makkaar
- Cedars Sinai Heart Institute, Los Angeles, CA, USA
| | - Martin B Leon
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael Markl
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, CT, USA
| | - Victor A Ferrari
- Cardiovascular Medicine Division, University of Pennsylvania Medical Center and Penn Cardiovascular Institute, Philadelphia, PA, USA
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Texas A&M School of Medicine, Dallas Campus, Dallas, TX, USA
| | - Jae-Kwan Song
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samuel Siu
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Lars G Svensson
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Gebrine El Khoury
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital and Unicamillus University Rome, Rome, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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9
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Bansal P, Maini A, Abbas A, Pibarot P, Maini B, Khalili H. Transaortic Flow in Aortic Stenosis: Stroke Volume Index versus Transaortic Flow Rate. J Am Soc Echocardiogr 2021; 34:1317-1320. [PMID: 34461252 DOI: 10.1016/j.echo.2021.08.016] [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] [Received: 06/01/2021] [Revised: 08/19/2021] [Accepted: 08/19/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Priya Bansal
- University of Southern California + LA County, Los Angeles, California; Florida Atlantic University, Boca Raton, Florida
| | - Aneel Maini
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Amr Abbas
- William Beaumont Hospital, Royal Oak, Michigan
| | | | - Brijeshwar Maini
- Delray Medical Center, Delray Beach, Florida; Florida Atlantic University, Boca Raton, Florida
| | - Houman Khalili
- Delray Medical Center, Delray Beach, Florida; Florida Atlantic University, Boca Raton, Florida
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10
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Michelena HI, Della Corte A, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernández B, Asch FM, Barker AJ, Sierra-Galan LM, De Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkar R, Leon MB, Sanders SP, Markl M, Ferrari VA, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, El Khoury G, De Paulis R, Enriquez-Sarano M, Bax JJ, Otto CM, Schäfers HJ. Summary: international consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. Eur J Cardiothorac Surg 2021; 60:481-496. [PMID: 34292332 DOI: 10.1093/ejcts/ezab039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/12/2022] Open
Abstract
This International evidence-based nomenclature and classification consensus on the congenital bicuspid aortic valve and its aortopathy recognizes 3 types of bicuspid aortic valve: 1. Fused type, with 3 phenotypes: right-left cusp fusion, right-non cusp fusion and left-non cusp fusion; 2. 2-sinus type with 2 phenotypes: Latero-lateral and antero-posterior; and 3. Partial-fusion or forme fruste. This consensus recognizes 3 bicuspid-aortopathy types: 1. Ascending phenotype; root phenotype; and 3. extended phenotypes.
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Affiliation(s)
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Arturo Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) Ciber-CV, Barcelona, Spain
| | - Joseph J Maleszewski
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Borja Fernández
- Departamento de Biología Animal, Facultad de Ciencias, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Ciber-CV, Málaga, Spain
| | | | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Colorado, USA
| | - Lilia M Sierra-Galan
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Laurent De Kerchove
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Susan M Fernandes
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, CA, USA.,Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, IDIBAPS; CIBERCV, ISCIII (CB16/11/00354); CERCA Programme
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Phillippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, Québec, Canada
| | | | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège,Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Italy.,Anthea Hospital, Bari, Italy
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - John K Forrest
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, CT, USA
| | - John Webb
- St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Raj Makkar
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, CT, USA
| | - Martin B Leon
- St Paul's Hospital, University of British Columbia, Vancouver, Canada.,Cedars Sinai Heart Institute, Los Angeles, CA, USA.,Division of Cardiology, Columbia University Irving Medical Center/NY Presbyterian Hospital, New York, NY, USA
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Victor A Ferrari
- Cardiovascular Medicine Division, University of Pennsylvania Medical Center and Penn Cardiovascular Institute, Philadelphia, PA, USA
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA.,Texas A & M School of Medicine, Dallas, TX, USA
| | - Jae-Kwan Song
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samuel Siu
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Lars G Svensson
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Gebrine El Khoury
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital and Unicamillus University, Rome, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Hans-Joachim Schäfers
- Division of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Saar, Germany
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11
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Michelena HI, Della Corte A, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernández B, Asch FM, Barker AJ, Sierra-Galan LM, De Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkar R, Leon MB, Sanders SP, Markl M, Ferrari VA, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, El Khoury G, De Paulis R, Enriquez-Sarano M, Bax JJ, Otto CM, Schäfers HJ. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. J Thorac Cardiovasc Surg 2021; 162:e383-e414. [PMID: 34304896 DOI: 10.1016/j.jtcvs.2021.06.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes.
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Affiliation(s)
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Arturo Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) Ciber-CV, Barcelona, Spain
| | | | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, New York, NY
| | | | - Borja Fernández
- Departamento de Biologia Animal, Facultad de Ciencias, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Ciber-CV, Málaga, Spain
| | | | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, Colo
| | - Lilia M Sierra-Galan
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Laurent De Kerchove
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Susan M Fernandes
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, Calif; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, Calif
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, Tex
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, Universitat de Barcelona, IDIBAPS, CIBERCV, ISCIII (CB16/11/00354), CERCA Programme, Barcelona, Spain
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Phillippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University Québec, Québec, Canada
| | | | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - John K Forrest
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, Conn
| | - John Webb
- St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex
| | - Raj Makkar
- Cedars Sinai Heart Institute, Los Angeles, Calif
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center/NY Presbyterian Hospital, New York, NY
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Victor A Ferrari
- Cardiovascular Medicine Division, University of Pennsylvania Medical Center and Penn Cardiovascular Institute, Philadelphia, Pa
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Texas A& M School of Medicine, Dallas Campus, Dallas, Tex
| | - Jae-Kwan Song
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Md
| | - Samuel Siu
- Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Lars G Svensson
- Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Joseph Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Gebrine El Khoury
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital and Unicamillus University Rome, Rome, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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12
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Michelena HI, Della Corte A, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernández B, Asch FM, Barker AJ, Sierra-Galan LM, De Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkar R, Leon MB, Sanders SP, Markl M, Ferrari VA, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, Khoury GE, De Paulis R, Enriquez-Sarano M, Bax JJ, Otto CM, Schäfers HJ. Summary: International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional, and research purposes. J Thorac Cardiovasc Surg 2021; 162:781-797. [PMID: 34304894 DOI: 10.1016/j.jtcvs.2021.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 11/30/2022]
Abstract
This International evidence-based nomenclature and classification consensus on the congenital bicuspid aortic valve and its aortopathy recognizes 3 types of bicuspid aortic valve: 1. Fused type, with 3 phenotypes: right-left cusp fusion, right-non cusp fusion and left-non cusp fusion; 2. 2-sinus type with 2 phenotypes: Latero-lateral and antero-posterior; and 3. Partial-fusion or forme fruste. This consensus recognizes 3 bicuspid-aortopathy types: 1. Ascending phenotype; root phenotype; and 3. extended phenotypes.
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Affiliation(s)
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli," Naples, Italy
| | - Arturo Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) Ciber-CV, Barcelona, Spain
| | - Joseph J Maleszewski
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, New York, NY
| | | | - Borja Fernández
- Departamento de Biología Animal, Facultad de Ciencias, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Ciber-CV, Málaga, Spain
| | | | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Colo
| | - Lilia M Sierra-Galan
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Laurent De Kerchove
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Susan M Fernandes
- Department of Pediatrics, Division of Pediatric Cardiology, Stanford University, Palo Alto, Calif; Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, Calif
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, Tex
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu," Bucharest, Romania
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, Spain, IDIBAPS; CIBERCV, ISCIII (CB16/11/00354); and CERCA Programme
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Phillippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, Québec, Canada
| | | | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Italy; Anthea Hospital, Bari, Italy
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - John K Forrest
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, Conn
| | - John Webb
- St Paul's Hospital, University of British Columbia, Vancouver, Canada; aeCedars Sinai Heart Institute, Los Angeles, Calif; afDivision of Cardiology, Columbia University Irving Medical Center/NY Presbyterian Hospital, New York, NY
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Tex
| | - Raj Makkar
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, Conn
| | - Martin B Leon
- St Paul's Hospital, University of British Columbia, Vancouver, Canada; aeCedars Sinai Heart Institute, Los Angeles, Calif; afDivision of Cardiology, Columbia University Irving Medical Center/NY Presbyterian Hospital, New York, NY
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Victor A Ferrari
- Cardiovascular Medicine Division, University of Pennsylvania Medical Center and Penn Cardiovascular Institute, Philadelphia, Pa
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Tex; Texas A & M School of Medicine, Dallas, Tex
| | - Jae-Kwan Song
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Md
| | - Samuel Siu
- Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Lars G Svensson
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Mo
| | - Joseph Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pa
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Mass
| | - Gebrine El Khoury
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital and Unicamillus University, Rome, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Hans-Joachim Schäfers
- Division of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Saar, Germany
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13
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Michelena HI, Della Corte A, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernández B, Asch FM, Barker AJ, Sierra-Galan LM, De Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkar R, Leon MB, Sanders SP, Markl M, Ferrari VA, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, El Khoury G, De Paulis R, Enriquez-Sarano M, Bax JJ, Otto CM, Schäfers HJ. International consensus statement on nomenclature and classification of the congenital bicuspid aortic valve and its aortopathy, for clinical, surgical, interventional and research purposes. Eur J Cardiothorac Surg 2021; 60:448-476. [PMID: 34293102 DOI: 10.1093/ejcts/ezab038] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes.
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Affiliation(s)
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Arturo Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) Ciber-CV, Barcelona, Spain
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, New York, NY, USA
| | | | - Borja Fernández
- Departamento de Biología Animal, Facultad de Ciencias, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Ciber-CV, Málaga, Spain
| | | | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Lilia M Sierra-Galan
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Laurent De Kerchove
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Susan M Fernandes
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERCV, ISCIII (CB16/11/00354), CERCA Programme, Barcelona, Spain
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Phillippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University Québec, Québec, Canada
| | | | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - John K Forrest
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, CT, USA
| | - John Webb
- St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Raj Makkar
- Cedars Sinai Heart Institute, Los Angeles, CA, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center/NY Presbyterian Hospital, New York, NY, USA
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, MA, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Victor A Ferrari
- Cardiovascular Medicine Division, University of Pennsylvania Medical Center and Penn Cardiovascular Institute, Philadelphia, PA, USA
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Texas A & M School of Medicine, Dallas Campus, Dallas, TX, USA
| | - Jae-Kwan Song
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, BC, Canada
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Samuel Siu
- Schulich School of Medicine and Dentistry, London, ON, Canada
| | - Lars G Svensson
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Joseph Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Gebrine El Khoury
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital and Unicamillus University Rome, Rome, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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Michelena HI, Della Corte A, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernández B, Asch FM, Barker AJ, Sierra-Galan LM, De Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkar R, Leon MB, Sanders SP, Markl M, Ferrari VA, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, El Khoury G, De Paulis R, Enriquez-Sarano M, Bax JJ, Otto CM, Schäfers HJ. International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and Its Aortopathy, for Clinical, Surgical, Interventional and Research Purposes. Ann Thorac Surg 2021; 112:e203-e235. [PMID: 34304860 DOI: 10.1016/j.athoracsur.2020.08.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/30/2020] [Indexed: 01/17/2023]
Abstract
This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, right-non-coronary cusp fusion and left-non-coronary cusp fusion phenotypes); 2. The 2-sinus type (latero-lateral and antero-posterior phenotypes); and 3. The partial-fusion (forme fruste) type. The presence of raphe and the symmetry of the fused type phenotypes are critical aspects to describe. The International Consensus also recognizes 3 types of bicuspid valve-associated aortopathy: 1. The ascending phenotype; 2. The root phenotype; and 3. Extended phenotypes.
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Affiliation(s)
- Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Arturo Evangelista
- Department of Cardiology, Hospital Vall d'Hebron, Vall d'Hebron Research Institute (VHIR) Ciber-CV, Barcelona, Spain
| | - Joseph J Maleszewski
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - William D Edwards
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Mary J Roman
- Division of Cardiology, Weill Cornell Medicine, New York, New York
| | | | - Borja Fernández
- Departamento de Biología Animal, Facultad de Ciencias, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Ciber-CV, Málaga, Spain
| | | | - Alex J Barker
- Department of Radiology, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Aurora, Colorado
| | - Lilia M Sierra-Galan
- Cardiovascular Division, American British Cowdray Medical Center, Mexico City, Mexico
| | - Laurent De Kerchove
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Susan M Fernandes
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, California
| | - Paul W M Fedak
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, Dallas, Texas
| | - Emmanuel Lansac
- Department of Cardiac Surgery, Institute Mutualiste Montsouris, Paris, France
| | - Siddharth K Prakash
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Malenka M Bissell
- Department of Biomedical Imaging Science, Leeds Institute to Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Michael D Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clínic, Universitat de Barcelona, IDIBAPS, CIBERCV, ISCIII (CB16/11/00354), CERCA Programme, Barcelona, Spain
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Phillippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University Québec, Québec, Canada
| | | | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - John K Forrest
- Yale University School of Medicine & Yale New Haven Hospital, New Haven, Connecticut
| | - John Webb
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Raj Makkar
- Cedars Sinai Heart Institute, Los Angeles, California
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center/NY Presbyterian Hospital, New York, New York
| | - Stephen P Sanders
- Cardiac Registry, Departments of Cardiology, Pathology and Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michael Markl
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Victor A Ferrari
- Cardiovascular Medicine Division, University of Pennsylvania Medical Center and Penn Cardiovascular Institute, Philadelphia, Pennsylvania
| | - William C Roberts
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Texas A & M School of Medicine, Dallas Campus, Dallas, Texas
| | - Jae-Kwan Song
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Philipp Blanke
- Department of Radiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Charles S White
- Department of Radiology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Samuel Siu
- Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Lars G Svensson
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Alan C Braverman
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph Bavaria
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Gebrine El Khoury
- Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital and Unicamillus University Rome, Rome, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, Washington
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
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15
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Sengupta PP, Shrestha S, Kagiyama N, Hamirani Y, Kulkarni H, Yanamala N, Bing R, Chin CWL, Pawade TA, Messika-Zeitoun D, Tastet L, Shen M, Newby DE, Clavel MA, Pibarot P, Dweck MR. A Machine-Learning Framework to Identify Distinct Phenotypes of Aortic Stenosis Severity. JACC Cardiovasc Imaging 2021; 14:1707-1720. [PMID: 34023273 DOI: 10.1016/j.jcmg.2021.03.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/02/2021] [Accepted: 03/16/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The authors explored the development and validation of machine-learning models for augmenting the echocardiographic grading of aortic stenosis (AS) severity. BACKGROUND In AS, symptoms and adverse events develop secondarily to valvular obstruction and left ventricular decompensation. The current echocardiographic grading of AS severity focuses on the valve and is limited by diagnostic uncertainty. METHODS Using echocardiography (ECHO) measurements (ECHO cohort, n = 1,052), we performed patient similarity analysis to derive high-severity and low-severity phenogroups of AS. We subsequently developed a supervised machine-learning classifier and validated its performance with independent markers of disease severity obtained using computed tomography (CT) (CT cohort, n = 752) and cardiovascular magnetic resonance (CMR) imaging (CMR cohort, n = 160). The classifier's prognostic value was further validated using clinical outcomes (aortic valve replacement [AVR] and death) observed in the ECHO and CMR cohorts. RESULTS In 1,964 patients from the 3 multi-institutional cohorts, 1,346 (68%) subjects had either nonsevere or discordant AS severity. Machine learning identified 1,117 (57%) patients as having high-severity and 847 (43%) as having low-severity AS. High-severity patients in CT and CMR cohorts had higher valve calcium scores and left ventricular mass and fibrosis, respectively than the low-severity group. In the ECHO cohort, progression to AVR and progression to death in patients who did not receive AVR was faster in the high-severity group. Compared with the conventional classification of disease severity, machine-learning-based severity classification improved discrimination (integrated discrimination improvement: 0.07; 95% confidence interval: 0.02 to 0.12) and reclassification (net reclassification improvement: 0.17; 95% confidence interval: 0.11 to 0.23) for the outcome of AVR at 5 years. For both ECHO and CMR cohorts, we observed prognostic value of the machine-learning classifications for subgroups with asymptomatic, nonsevere or discordant AS. CONCLUSIONS Machine learning can integrate ECHO measurements to augment the classification of disease severity in most patients with AS, with major potential to optimize the timing of AVR.
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Affiliation(s)
- Partho P Sengupta
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA.
| | - Sirish Shrestha
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Nobuyuki Kagiyama
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Yasmin Hamirani
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Hemant Kulkarni
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA; M&H Research, LLC, San Antonio, Texas, USA
| | - Naveena Yanamala
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Rong Bing
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Tania A Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Lionel Tastet
- Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Canada
| | - Mylène Shen
- Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Canada
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Marie-Annick Clavel
- Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Canada
| | - Phillippe Pibarot
- Department of Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Québec, Canada.
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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16
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Vamvakidou A, Pibarot P, Plonska-Gosciniak E, Almeida AG, Kukulski T, Kasprzak JD, Flachskamf F, Senior R. Clinical value of stress transaortic flow rate during dobutamine echocardiography in low-gradient aortic stenosis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.208] [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
Funding Acknowledgements
Type of funding sources: None.
BACKGROUND/INTRODUCTION
The clinical value of rest transaortic flow rate (FR) has been shown previously in low-gradient aortic stenosis (LGAS) for the prediction of outcome. However limited data exists on the prognostic value of stress FR in LGAS following low-dose dobutamine stress echocardiography (LDDSE).
PURPOSE
We aimed to assess the value of stress FR in patients with LGAS in the diagnosis of AS severity and the prediction of mortality.
METHODS
This is a multi-centre cohort study of patients with low left ventricular ejection fraction (LVEF) and LGAS (aortic valve area –AVA <1cm²) who underwent LDDSE.
RESULTS
Of the 287 patients (mean age: 75.1 ±10 years, males: 71%) over the mean follow-up of 24 ±30 months there were 127 (44.3%) deaths and 147 (51.2%) patients underwent aortic valve intervention. Lower stress FR was independently associated with increased risk of mortality (HR= 0.99, 95%CI= 0.99-0.999, p= 0.02) after adjusting for age, chronic kidney disease, presence of symptoms (NYHA II-IV), aortic valve intervention, rest LVEF and guideline-defined severe AS (AV mean gradient- AVMG ≥40mmHg with AVA <1cm² at peak stress). The minimum cut-off for prediction of mortality was stress FR 210ml/sec. Among the different criteria of AS severity during stress, i.e. guideline-defined criterion, or stress AVMG ≥40mmHg, or stress AVA <1cm² at stress FR ≥210ml/s, only the latter was independently associated with mortality (HR= 1.81, 95%CI= 1.04-3.2, p= 0.04) (Table 1) and was the parameter of AS severity that predicted improved outcome following aortic valve intervention (p <0.005) (Figure 1). Guideline-defined stroke volume flow reserve did not predict mortality.
CONCLUSIONS
Assessment of stress FR during LDDSE is important for the detection of both AS severity and flow reserve.
Table 1 Multivariable analysis for prediction of all-cause mortality (N = 287) for the different criteria of aortic stenosis HR 95%CI p Age 1 0.98-1.03 0.84 Chronic kidney disease 1..84 1.13-2.99 0.01 Aortic valve intervention 0.37 0.22-0.61 <0.005 Presence of symptoms (NYHA II-IV) 1.87 0.66-5.31 0.24 Rest LVEF (by 1%) increase 0.97 0.95-1 0.06 Stress AVA < 1cm² with stress AVMG≥40mmHg 1.02 0.31-3.34 0.97 Stress AVMG≥40mmHg 0.57 0.2-1.59 0.28 Stress AVA < 1cm² at stress FR≥210mmHg 1.81 1.04-3.2 0.04 Abstract Figure 1
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Affiliation(s)
- A Vamvakidou
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - P Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Quebec, Canada
| | | | - AG Almeida
- Lisbon University; Hospital Santa Maria/CHULN, Lisbon, Portugal
| | - T Kukulski
- The Medical University of Silesia, Zabrze, Poland
| | | | | | - R Senior
- Royal Brompton and Harefield Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Paquin A, Annabi M, Bienjonetti-Boudreau D, Pibarot P, Clavel M. Increased mortality and intervention delay in female patients with severe aortic stenosis and reduced ejection fraction undergoing aortic valve replacement. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2020.02.007] [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: 11/16/2022] Open
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Paquin A, Beaudoin J, Marsit O, Hadjadj S, Rouabhia D, Pibarot P, Clavel M. EFFECT OF MYOCARDIAL INFARCTION ON AORTIC STENOSIS PROGRESSION. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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19
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Paquin A, Annabi M, Bienjonetti-Boudreau D, Pibarot P, Clavel M. INCREASED MORTALITY IN WOMEN WITH SEVERE AORTIC STENOSIS AND LOW EJECTION FRACTION. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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20
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Hadjadj S, Freitas-Ferraz A, Paquin A, Bernier M, O'Connor K, Salaun E, Pibarot P, Clavel M, Rodes-Cabau J, Paradis J, Beaudoin J. ECHOCARDIOGRAPHIC PREDICTORS OF MITRAL TRANSVALVULAR GRADIENTS AFTER MITRACLIP INSERTION. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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21
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Racine H, Guzzetti E, Tastet L, Shen M, É Larose, Clavel M, Pibarot P, Beaudoin J. ACCURACY OF STROKE VOLUME BY PHASE CONTRAST CARDIOVASCULAR MAGNETIC RESONANCE IN AORTIC STENOSIS: A COMPARISON OF MEASURE IN LEFT VENTRICULAR OUTFLOW TRACT VS. ASCENDING AORTA. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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22
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Dehghani P, Singer Z, Morrison J, Booker J, Lavoie A, Zimmermann R, Basran P, Webb JG, Cheema AN, Pibarot P, Clavel MA. Characteristics and usefulness of unintended premature ventricular contraction during invasive assessment of aortic stenosis. Int J Cardiol 2020; 313:35-38. [PMID: 32201098 DOI: 10.1016/j.ijcard.2020.02.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 02/18/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postextrasystolic potentiation (PESP)-associated augmentation in left ventricular-aorta pressure gradient (LVAoG) observed after incidental premature ventricular contraction (PVC) during resting echocardiography is similar to dobutamine stress echocardiography (DSE)-associated augmentation in LVAoG in patients with low-flow, low-gradient (LF-LG) aortic stenosis (AS). What is not known is whether a similar relationship exists when unintended PVC causes PESP during cardiac catheterization in patients with AS. METHODS We retrospectively reviewed all catheterizations performed for patients with at least moderate AS who had LVAoG assessment. Univariate and multivariate analyses were conducted to determine the predictors of pre- and post-PVC mean LVAoG ≥ 40 mmHg. RESULTS Between September 2015 to September 2017, of 140 individuals undergoing cardiac catheterization, 34 met study criteria. Mean pre-PVC gradient was 38.9 ± 22.8 mmHg. All patients exhibited PESP-associated augmentation of LVAoG by an average of 28 ± 12%. In multivariate analysis, the only significant predictor of post-PVC mean LVAoG ≥ 40 mmHg was preserved LV function (OR 6.81; 95% CI 1.41-32.82, p = 0.02). Inability to generate ≥ 40 mmHg of mean LVAoG post-PVC had 100% specificity for nonsevere AS in our observational cohort. CONCLUSIONS Unintended but interpretable PVCs occurred in one in four patients with AS undergoing cardiac catheterization with measurable hemodynamics. All of our patients with PVCs, regardless of underlying LVEF, exhibited PESP-associated augmentation of LVAoG. Our exploratory analysis suggests that inability to generate ≥40 mmHg of mean LVAoG post-PVC is highly specific for nonsevere AS.
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Affiliation(s)
- Payam Dehghani
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada.
| | - Zachary Singer
- College of Medicine, University of Saskatchewan, Regina, Canada.
| | - Jamie Morrison
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada.
| | - Jeffery Booker
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada.
| | - Andrea Lavoie
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada.
| | - Rodney Zimmermann
- Prairie Vascular Research Network, University of Saskatchewan, Regina, Canada.
| | - Paul Basran
- Royal University Hospital, University of Saskatchewan, Saskatoon, Canada.
| | - John G Webb
- St Paul's Hospital, University of British Columbia, Vancouver, Canada.
| | - Asim N Cheema
- St. Michael's Hospital, University of Toronto, Toronto, Canada.
| | - Phillippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada.
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie, Université Laval, Québec, Canada.
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Sellers SL, Sathananthan J, Bouchareb R, Mostaço-Guidolin LB, Lau KPL, Bugis J, Hensey M, Blanke P, Payne GW, Lebeche D, Pibarot P, Hackett TL, Webb JG, Leipsic JA. Impact of Over-Expansion on SAPIEN 3 Transcatheter Heart Valve Pericardial Leaflets. Structural Heart 2020. [DOI: 10.1080/24748706.2020.1742950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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Piche M, Clavel MA, Pibarot P, Poirier P. P924 Benefits of bariatric surgery on subclinical myocardial function using global longitudinal strain in severely obese individuals with and without diabetes. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.559] [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
Background/Introduction: The presence of subclinical myocardial disease confers an increased cardiovascular disease risk. The effects of bariatric surgery on subclinical myocardial function assessed using left ventricular (LV) global longitudinal strain (GLS) in severely obese individuals with preserved LV ejection fraction is unclear.
Purpose
To evaluate changes in subclinical LV myocardial function following bariatric surgery in obese individuals with and without diabetes.
Methods
Thirty-eight severely obese individuals [body mass index (BMI) >35kg/m2] with preserved LV ejection fraction (≥ 50%) who underwent bariatric surgery (Surgery group) (BMI 48 ± 7 kg/m2), 19 obese individuals managed conservatively (Cons. group) (BMI 47 ± 9 kg/m2), and 18 age and sex-matched non-obese controls (Non-obese group) were included. Echocardiography with GLS measurements was performed at the beginning of the study and at 6 months. Abnormal myocardial function was defined as a GLS >-17%.
Results
Mean age of obese patients was 42 ± 11, BMI 48 ± 8 kg/m2, and 82% were female. The percentage of total weight loss at 6 months after bariatric surgery (Surgery group) was 26.3 ± 5.2%. Body weight remains unchanged at 6 months in the Cons. group. Proportions of hypertension (61 vs. 30%, P = 0.0005), dyslipidemia (42 vs. 5%, P = 0.0001) and type 2 diabetes (40 vs. 13%, P = 0.002) were reduced in the Surgery group. At the beginning, severely obese patients (Surgery group) displayed subclinical myocardial dysfunction vs. non-obese controls (LV GLS, -17.3 ± 2.5 vs. -19.6 ± 1.7%, P = 0.003). Six months after bariatric surgery, the subclinical myocardial function was comparable between both groups (LV GLS, -19.2 ± 2.1 vs. -19.6 ± 1.7%, P = NS). 22 severely obese individuals (58%) in the Surgery group showed abnormal GLS, which normalized in 82% after bariatric surgery (P = 0.0001). On the contrary, half of severely obese individuals managed conservatively (n = 10, 53%) worsened their GLS during the follow-up (P = 0.002). Remission of type 2 diabetes 6 months after bariatric surgery was associated with improvement in GLS (-17.5 ± 2.6 vs. -18.6± 1.8%), whereas obese individuals with type 2 diabetes managed conservatively showed a worsening in their subclinical myocardial function during the follow-up (-18.0 ± 2.4 vs. -17.4 ± 1.7%).
Conclusions
A great proportion of severely obese individuals with preserved LV ejection fraction have subclinical myocardial dysfunction. Bariatric surgery in obese individuals was associated with significant improvements in the metabolic profile and in subclinical myocardial function.
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Affiliation(s)
- M Piche
- Quebec Heart and Lung Institute, Quebec, Canada
| | - M A Clavel
- Quebec Heart and Lung Institute, Quebec, Canada
| | - P Pibarot
- Quebec Heart and Lung Institute, Quebec, Canada
| | - P Poirier
- Quebec Heart and Lung Institute, Quebec, Canada
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Sathananthan J, Sellers S, Barlow AM, Stanová V, Fraser R, Toggweiler S, Allen KB, Chhatriwalla A, Murdoch DJ, Hensey M, Lau K, Alkhodair A, Dvir D, Asgar AW, Cheung A, Blanke P, Ye J, Rieu R, Pibarot P, Wood D, Leipsic J, Webb JG. Valve-in-Valve Transcatheter Aortic Valve Replacement and Bioprosthetic Valve Fracture Comparing Different Transcatheter Heart Valve Designs: An Ex Vivo Bench Study. JACC Cardiovasc Interv 2019; 12:65-75. [PMID: 30621980 DOI: 10.1016/j.jcin.2018.10.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/04/2018] [Accepted: 10/23/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors assessed the effect of valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) followed by bioprosthetic valve fracture (BVF), testing different transcatheter heart valve (THV) designs in an ex vivo bench study. BACKGROUND Bioprosthetic valve fracture can be performed to improve residual transvalvular gradients following VIV TAVR. METHODS The authors evaluated VIV TAVR and BVF with the SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) and ACURATE neo (Boston Scientific Corporation, Natick, Massachusetts) THVs. A 20-mm and 23-mm S3 were deployed in a 19-mm and 21-mm Mitroflow (Sorin Group USA, Arvada, Colorado), respectively. A small ACURATE neo was deployed in both sizes of Mitroflow tested. VIV TAVR samples underwent multimodality imaging, and hydrodynamic evaluation before and after BVF. RESULTS A high implantation was required to enable full expansion of the upper crown of the ACURATE neo and allow optimal leaflet function. Marked underexpansion of the lower crown of the THV within the surgical valve was also observed. Before BVF, VIV TAVR in the 19-mm Mitroflow had high transvalvular gradients using either THV design (22.0 mm Hg S3, and 19.1 mm Hg ACURATE neo). After BVF, gradients improved and were similar for both THVs (14.2 mm Hg S3, and 13.8 mm Hg ACURATE neo). The effective orifice area increased with BVF from 1.2 to 1.6 cm2 with the S3 and from 1.4 to 1.6 cm2 with the ACURATE neo. Before BVF, VIV TAVR with the ACURATE neo in the 21-mm Mitroflow had lower gradients compared with S3 (11.3 mm Hg vs. 16 mm Hg). However, after BVF valve gradients were similar for both THVs (8.4 mm Hg ACURATE neo vs. 7.8 mm Hg S3). The effective orifice area increased from 1.5 to 2.1 cm2 with the S3 and from 1.8 to 2.2 cm2 with the ACURATE neo. CONCLUSIONS BVF performed after VIV TAVR results in improved residual gradients. Following BVF, residual gradients were similar irrespective of THV design. Use of a small ACURATE neo for VIV TAVR in small (≤21 mm) surgical valves may be associated with challenges in achieving optimum THV position and expansion. BVF could be considered in selected clinical cases.
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Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Sellers
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron M Barlow
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada
| | | | - Rob Fraser
- ViVitro Labs Inc., Victoria, British Columbia, Canada
| | | | - Keith B Allen
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Adnan Chhatriwalla
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Dale J Murdoch
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; University of Queensland, Brisbane, Australia
| | - Mark Hensey
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Lau
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdullah Alkhodair
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danny Dvir
- University of Washington, Seattle, Washington
| | | | - Anson Cheung
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Régis Rieu
- Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, Marseille, France
| | | | - David Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Perrot N, Moschetta D, Boekholdt SM, Valerio V, Martinsson A, Capoulade R, Mass E, Mathieu P, Bosse Y, Pibarot P, Smith JG, Camera M, Theriault Y, Poggio P, Arsenault B. P4667Loss of function in PCSK9, atherogenic lipoprotein concentrations, and calcific aortic valve stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition reduces plasma concentrations of most atherogenic lipoproteins such as low-density lipoprotein cholesterol (LDL-C), apolipoprotein B (apoB) and lipoprotein(a) [Lp(a)]. Atherogenic lipoprotein concentrations have also been linked with calcific aortic valve stenosis (CAVS).
Purpose
1) To determine the association between genetic variants in PCSK9 and lipoprotein-lipid levels, 2) to determine whether loss of function (LOF) in PCSK9 is associated with CAVS and 3) to evaluate if PCSK9 could be implicated in aortic valve interstitial cells (VICs) calcification.
Methods
We built a weighted genetic risk score (wGRS) using 10 single nucleotide polymorphisms at the PCSK9 locus associated with LDL-C in the Global Lipids Genetics Consortium. We determined the association between the wGRS and LDL-C, apoB and Lp(a)] in 9692 participants of the EPIC-Norfolk study using linear regression. We investigated the association between the LOF PCSK9 R46L variant and CAVS risk in a meta-analysis of published (three Copenhagen studies, 1463 cases and 101,620 controls) and unpublished studies (UK Biobank, 1350 cases and 349,043 controls, Malmö Diet and Cancer study, 682 cases and 5963 controls and EPIC-Norfolk, 508 cases and 20,421 controls) prospective, population-based studies using logistic regression adjusted for age and sex. We evaluated PCSK9 expression and localization in explanted aortic valves by capillary Western blot and immunohistochemistry in patients with and without CAVS. Von Kossa staining was used to visualize aortic leaflet calcium deposits. We also assessed VICs calcification potential under oxidative stress condition.
Results
In EPIC-Norfolk, the wGRS was significantly associated with TC, LDL-C, and apoB (all p<0.0001), but not with VLDL-C, HDL-C, triglycerides apoA-I, or Lp(a). Carriers of the R46L variant were at lower CAVS risk (odds ratio=0.71 (95% CI, 0.57–0.88, p<0.001)). Aortic valves of patients with aortic sclerosis (n=12) and CAVS (n=8) presented elevated PCSK9 levels (log2 fold change [FC]=+28.6±5.1, p=0.008 and FC=+39.3±15.2, p=0.02, respectively) compared to controls (n=4).In calcified leaflets, PCSK9 expression co-localized with calcium deposits. PCSK9 expression in VICs was induced by oxidative stress (FC=+2.3±0.4, p=0.02), and subsequent increment in calcification potential was observed.
Conclusion
PCSK9LOF variants are associated with lifelong reductions in non-Lp(a) apoB-containing lipoprotein levels and a lower risk of coronary artery disease and CAVS. PCSK9 is abundant in fibrotic and calcified aortic leaflets. Oxidative stress increases PCSK9 expression in VICs. These results support randomized clinical trials of PCSK9 inhibition in the prevention of CAVS.
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Affiliation(s)
- N Perrot
- Quebec Heart and Lung Institute research centre, Quebec, Canada
| | - D Moschetta
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - S M Boekholdt
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - V Valerio
- Cardiology Center Monzino IRCCS, Milan, Italy
| | | | | | - E Mass
- University of Bonn, Bonn, Germany
| | - P Mathieu
- Quebec Heart and Lung Institute research centre, Quebec, Canada
| | - Y Bosse
- Quebec Heart and Lung Institute research centre, Quebec, Canada
| | - P Pibarot
- Quebec Heart and Lung Institute research centre, Quebec, Canada
| | - J G Smith
- Skane University Hospital, Lund, Sweden
| | - M Camera
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - Y Theriault
- Quebec Heart and Lung Institute research centre, Quebec, Canada
| | - P Poggio
- Cardiology Center Monzino IRCCS, Milan, Italy
| | - B Arsenault
- Quebec Heart and Lung Institute research centre, Quebec, Canada
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Tastet L, Shen M, Capoulade R, Arsenault M, Bédard É, Clavel M, Pibarot P. BONE MINERAL DENSITY AND PROGRESSION RATE OF CALCIFIC AORTIC VALVE STENOSIS - RESULTS FROM THE PROGRESSA STUDY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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28
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Guzzetti E, Annabi M, Poulin A, Zhang B, Kalavrouziotis D, Couture C, Dagenais F, Pibarot P, Clavel M. PARADOXICAL LOW-FLOW AORTIC STENOSIS: SHOULD WE WAIT FOR THE GRADIENT TO REACH 40 MMHG? Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.198] [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
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29
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Annabi MS, Bergler-Klein J, Dahou A, Burwash IG, Ong G, Tastet L, Guzetti E, Orwat S, Baumgartner H, Bartko PE, Mascherbauer J, Mundigler G, Cavalcante J, Pibarot P, Clavel MA. 6097Aminoterminal proB-type natriuretic peptide: a key parameter to optimise therapeutic management of low-flow, low-gradient aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
B-type natriuretic peptide (BNP) and aminoterminal-proBNP (NT-proBNP) are well established surrogates of LV function impairment. However, data are scarce regarding their prognostic value to risk-stratify patients with classical low-flow, low-gradient aortic stenosis (LFLG-AS, with low left ventricular [LV] ejection fraction).
Methods
The TOPAS study is a prospective observational cohort of 240 patients with aortic valve area <0.6 cm2/m2, mean gradient<40 mmHg and LVEF<50%. True severe AS was adjudicated using flow independent grading schemes.
Results
BNP significantly predicted one-year (area under the receiver operating-characteristic curve [AUC]) 0.62±0.04, p=0.026) but not three-year mortality. After adjustment for the severity of AS, initial treatment (aortic valve replacement [AVR] vs. conservative management [ConsRx]), age, sex and the EuroSCORE (Model#1), BNP-ratio>550 pg/ml had a trend to predict time to death (HR=2.14 [1.00–4.58], p=0.05). In contrast, NT-proBNP ratio significantly predicted both one and three-year mortality (AUC=0.67±0.04 and 0.66±0.05, both p=0.001), and independently predicted time to death (HR=1.39 per 1 unit of Log transformed NT-proBNP [1.11–1.74], p=0.004). In a head-to-head comparison (108 patients with both biomarkers), the AUCs to predict one and thre-year mortality were significantly higher with NT-proBNP versus BNP (p<0.009). NT-proBNP but not BNP independently predicted mortality and significantly improved Model#1 (Likelihood ratio test Chi2=15.95, p<0.001). The category-free net reclassification index of NT-proBNP was 0.71 (p=0.008) versus 0.38 (p=0.15) for BNP. Furthermore, there was a marked survival benefit associated with AVR in patients with NT-proBNP ≥1700 pg/ml (adjusted hazard ratio (aHR) associated to AVR vs conservative management=0.52 [0.31–0.85], p=0.009), while those<1700 pg/ml had excellent one-year survival under ConsRx (only one death [4.5±4.4%] at one year as compared to 23 [37±6.2%] for ConsRx-NTproBNP>1700, aHR=0.11 [0.01–0.83], p=0.033). The survival benefit associated with AVR interacted with NT-proBNP (p<0.001) but not with true or pseudosevere AS (p=0.53 for interaction), suggesting that NT-proBNP might identify moderate AS patients but sufficiently severe valvulo-ventricular disease to justify AVR.
Survival according to NT-proBNP and AVR
Conclusion
NT-proBNP appears to be an excellent biomarker for the clinical purpose of risk-stratifying classical LFLG-AS. A threshold of 1700 pg/ml i.e. close to the diagnostic threshold for heart failure in acute dyspnea, was a strong independent determinant of the survival benefit associated with aortic valve replacement. Our findings suggest that NT-proBNP should be preferred over BNP.
Acknowledgement/Funding
Canadian Institute of Health Research
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Affiliation(s)
- M S Annabi
- Quebec Heart and Lung Institute, Quebec, Canada
| | - J Bergler-Klein
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - A Dahou
- Quebec Heart and Lung Institute, Quebec, Canada
| | - I G Burwash
- University of Ottawa Heart Institute, Ottawa, Canada
| | - G Ong
- Quebec Heart and Lung Institute, Quebec, Canada
| | - L Tastet
- Quebec Heart and Lung Institute, Quebec, Canada
| | - E Guzetti
- Quebec Heart and Lung Institute, Quebec, Canada
| | - S Orwat
- University Hospital of Munster, Muenster, Germany
| | | | - P E Bartko
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Mundigler
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Cavalcante
- University of Pittsburgh, Division of Cardiology, Pittsburgh, United States of America
| | - P Pibarot
- Quebec Heart and Lung Institute, Quebec, Canada
| | - M A Clavel
- Quebec Heart and Lung Institute, Quebec, Canada
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30
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Grenier-Delaney J, Annabi M, Burwash I, Bergler-Klein J, Mascherbauer J, Bartko P, Pibarot P, Clavel M. COMPARISION OF INDEXED PROJECTED AORTIC VALVE AREA AND AORTIC VALVE CALCIFICATION DENSITY IN PATIENTS WITH LOW FLOW, LOW GRADIENT AORTIC STENOSIS. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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31
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Zhang B, Gilbert-Nadeau A, Salaun E, Côté N, Mahjoub H, Pibarot P, Clavel M. ASSOCIATION OF AORTIC BIOPROSTHETIC CALCIFICATION MEASURED BY CT WITH HEMODYNAMIC AND CLINICAL OUTCOMES. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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32
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Kumar A, Tizon-Marcos H, Bertrand O, Pibarot P, Larose E. EARLY VENTRICULAR AND TISSUE REMODELING IN THE FIRST WEEK AFTER ACUTE MYOCARDIAL INFARCTION: A PILOT STUDY. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.528] [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: 11/24/2022] Open
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33
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Annabi MS, Dahou A, Bergler-Klein J, Burwash IG, Orwat S, Baumgartner H, Bartko PE, Mascherbauer J, Mundigler G, Cavalcante J, Ribeiro HB, Rodes-Cabau J, Clavel MA, Pibarot P. 6099Impact of aortic valve replacement on outcomes of patients with low-flow, low-gradient moderate aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0133] [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
Background
Aortic valve replacement (AVR) is recommended for patients with low-flow, low-gradient (LFLG) and true-severe aortic stenosis (TSAS). However, there is very few data on the potential benefit of AVR in patients with LFLG pseudo-severe (i.e. moderate) AS (PSAS).
Methods
Consecutive patients with aortic valve area ≤0.6 cm2/m2, mean gradient <40 mmHg were prospectively recruited in a multicenter observational cohort study. The patients were categorized in TSAS vs. PSAS using previously reported thresholds of flow-independent parameters of AS severity (projected valve area at normal flow rate ≤1.0 cm2 and/or aortic valve calcium score by CT >1200 AU in women and >2000 AU in men). To account for between-treatment-group differences, inverse probability-of-treatment weighting was combined to Cox proportional hazards regression.
Results
Among the 430 patients included in this study, 297 (69%) were classified as TSAS and 274 (57%) underwent AVR. Of note, 21% of the patients treated by AVR were classified as PSAS. In patients managed conservatively (ConsRx), 52% had PSAS and 48% TSAS. During a median follow-up of 28 months [8–60], 198 patients died. The adjusted weighted hazard ratio (awHR) of death associated with AVR as compared to ConsRx was 0.42 [0.24–0.73] (p<0.0001, Figure1-Panel-A). This survival benefit associated with AVR was observed not only in patients with TSAS but also in those with PSAS (awHR: 0.29 [0.12–0.70]; p=0.006, Figure1-Panel-B).
Figure 1
Conclusion
The results of this study suggest that AVR is associated with a survival benefit not only in LFLG patients with TSAS but also in those with PSAS. Randomized trials are needed to confirm the benefit of AVR in patients with moderate AS and depressed LV systolic function.
Acknowledgement/Funding
Canadian Institute of Health Research
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Affiliation(s)
- M S Annabi
- Quebec Heart and Lung Institute, Quebec, Canada
| | - A Dahou
- Quebec Heart and Lung Institute, Quebec, Canada
| | - J Bergler-Klein
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - I G Burwash
- University of Ottawa Heart Institute, Ottawa, Canada
| | - S Orwat
- University Hospital of Munster, Muenster, Germany
| | | | - P E Bartko
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Mascherbauer
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - G Mundigler
- Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria
| | - J Cavalcante
- University of Pittsburgh, Division of Cardiology, Pittsburgh, United States of America
| | - H B Ribeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | | | - M A Clavel
- Quebec Heart and Lung Institute, Quebec, Canada
| | - P Pibarot
- Quebec Heart and Lung Institute, Quebec, Canada
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O'leary J, Clavel MA, Chen S, Goel K, O'neill B, Elmariah S, Crowley A, Alu M, Thourani V, Leon M, Pibarot P, Lindman B. P4666Higher BNP levels after transcatheter aortic valve implantation are associated with increased mortality and hospitalizations. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Among patients with aortic stenosis (AS), the adverse association between increased B-type natriuretic peptide (BNP) levels and worse clinical outcomes, including mortality and hospitalization after valve replacement, has been demonstrated. However, little attention has been paid to the clinical consequences of BNP levels after valve replacement, which may have implications for medical therapy prescribed after the procedure.
Purpose
Evaluate the association between BNP levels after transcatheter aortic valve implantation (TAVI) and subsequent mortality and hospitalizations.
Methods
Among intermediate, high, and extreme risk patients with severe symptomatic AS who received TAVI for native valve AS in the PARTNER II and S3 clinical trials or registries, we included 3260 patients who had BNP measured at baseline. Patients from sites which measured NTproBNP were excluded. To account for factors that influence BNP levels, we developed a regression equation–including age, sex, BMI, creatinine, study site, and the upper limit of normal of the BNP assay used for a given measurement–to determine expected BNP. BNP ratio was determined pre-TAVR and at discharge, 30 days, and 1 year and calculated as the actual BNP/expected BNP. Using a landmark approach, the relationships between (1) BNP ratio at 30 days or (2) delta BNP ratio between discharge and 30 days and subsequent outcomes between 30 days and 1 year were assessed. The primary outcome was a composite of cardiovascular (CV) mortality or hospitalization. Adjustment was made for 20 baseline and post-procedural factors known to influence outcomes.
Results
Higher BNP ratio at 30 days was associated with higher CV mortality or hospitalization between 30 days and 1 year (adjusted hazard ratio [aHR] 1.07 per increase of 1 in the BNP ratio, 95% CI 1.04–1.10, p<0.001), whereas baseline BNP ratio was not (p=0.38). A similar relationship was shown for the components of this composite: CV mortality (aHR 1.08, 95% CI 1.04–1.12, p<0.001) and hospitalizations (aHR 1.04, 95% CI 1.01–1.08, p=0.01). Adjusted for discharge BNP ratio and other factors, a greater decrease in BNP ratio between discharge and 30 days was also associated with lower CV mortality or hospitalization between 30 days and 1 year (aHR 0.95 per decrease of 1 in the BNP ratio, 95% CI 0.92–0.99, p=0.006). Similar relationships were observed for all-cause mortality and when examining the relationship between 1 year BNP ratio and outcomes between 1 and 2 years.
Conclusion
Higher BNP ratio after TAVI is associated with higher subsequent all-cause and CV mortality and hospitalizations, whereas baseline BNP ratio was not. Greater decrease in BNP ratio between discharge and 30 days is associated with better outcomes. Further investigation is warranted to understand these findings and determine whether intensification of medical therapy to decrease BNP after TAVR may improve patient outcomes.
Acknowledgement/Funding
The PARTNER 2 Trial was funded by Edwards Lifesciences
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Affiliation(s)
- J O'leary
- Vanderbilt University, Nashville, United States of America
| | - M.-A Clavel
- Quebec Heart and Lung Institute, Quebec, Canada
| | - S Chen
- Cardiovascular Research Foundation, New York, United States of America
| | - K Goel
- Vanderbilt University, Nashville, United States of America
| | - B O'neill
- Temple University Hospital, Philadelphia, United States of America
| | - S Elmariah
- Massachusetts General Hospital, Boston, United States of America
| | - A Crowley
- Cardiovascular Research Foundation, New York, United States of America
| | - M Alu
- Columbia University Medical Center, New York, United States of America
| | - V Thourani
- Medstar Research Institute, Washington, United States of America
| | - M Leon
- Columbia University Medical Center, New York, United States of America
| | - P Pibarot
- Quebec Heart and Lung Institute, Quebec, Canada
| | - B Lindman
- Vanderbilt University, Nashville, United States of America
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35
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Shen M, Tastet L, Capoulade R, Arsenault M, É Bédard, Clavel M, Pibarot P. HEMODYNAMIC AND ANATOMIC PROGRESSION OF AORTIC STENOSIS IN PATIENTS WITH BICUSPID AND TRICUSPID AORTIC VALVES. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.192] [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: 11/24/2022] Open
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McConkey HZR, Marber M, Lee J, Ellis H, Joseph J, Allen C, Rahman H, Patterson T, Scannell C, Pibarot P, Chiribiri A, Redwood S, Prendergast BD. P6484Invasive and non-invasive characterisation of low gradient aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Low gradient severe aortic stenosis (LGAS) is associated with unfavourable outcomes when compared to high gradient aortic stenosis (HGAS), yet the contributing pathophysiology is poorly understood.
Methods
Symptomatic LGAS and HGAS patients undergoing trans-catheter aortic valve implantation (TAVI) underwent 3T stress perfusion cardiac magnetic resonance imaging (CMR) pre-(within 24 hours) and post-(4–6 months) TAVI. Left ventricular (LV) contractility and coronary flow/pressure were measured during hyperaemia and rapid pacing, immediately before and after TAVI, using a conductance LV catheter and dual-pressure and Doppler sensor–tipped guidewire in the mid-left anterior descending coronary artery.
Results
24 patients were recruited resulting in 19 suitable datasets (LGAS N=9, HGAS N=10, equally matched for comorbidities and B-natriuretic peptide level). LGAS patients had a smaller LV end diastolic volume index (p=0.035) and lower LV mass index (LVMI) (p=0.037). Pre-TAVI stress global endocardium-epicardium gradient was 0.88±0.09 and global myocardial perfusion reserve (MPR) 2.0±0.48 in 14 patients (6 LGAS and 8 HGAS patients, no difference between groups). Pre-TAVI, baseline coronary data demonstrated lower augmentation pressure (AP, p=0.035) and augmentation index (AIx, p=0.02) in the LGAS group. LGAS patients also exhibited a shorter ejection time (p=0.015), larger forward compression waves during rest, hyperaemia and rapid pacing, and smaller backward expansion waves (BEW) (p=0.001). Lower baseline end systolic pressure (p=0.004), inotropy (dP/dt+, p=0.045), lusitropy (dP/dt-, p=0.069), and stroke work (p=0.019) were observed in the LGAS group. Whilst LV size was smaller the LGAS group, rapid pacing induced a more significant drop in end systolic volume (p=0.045) and ejection fraction (p=0.015) in patients with HGAS. Post-TAVI, the hyperaemic BEW fell sharply (p<0.001), along with coronary VTI (p=0.02), and average pulse velocity (p=0.028), and AP and AIx remained lower (p=0.034 and p=0.031, respectively). The forward expansion wave was reduced in LGAS during rapid pacing. The HGAS group displayed a more profound drop in dP/dt+ (p=0.011) and dP/dt- p=0.014) at rest following intervention. Repeat CMR demonstrated statistically significant reduction in LV size and LVMI (p=0.012 and p<0.001, respectively) with significant increase in 3D global peak radial, circumferential and longitudinal strain (p=0.004, p=0.001 and p=0.018, respectively). Post-TAVI stress global endocardium-epicardium gradient was 0.88±0.13 and MPR 2.46±0.59 (improved from pre-TAVI, p=0.05). There was no difference in remodelling patterns or perfusion between the two groups.
Conclusion
This is the first study detailing the combined invasive and CMR pathophysiological changes in LGAS. Despite invasive parameters indicating a disease of less severe AS, the level of perfusion abnormality is disproportionate which may in part, relate to their adverse prognosis.
Acknowledgement/Funding
This research is funded by a Clinical Research Training Fellowship grant from the British Heart Foundation (FS/16/51/32365).
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Affiliation(s)
- H Z R McConkey
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - M Marber
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - J Lee
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom
| | - H Ellis
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - J Joseph
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - C Allen
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - H Rahman
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - T Patterson
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - C Scannell
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom
| | - P Pibarot
- Centre de Recherche de lInstitut Universitaire de Cardiologie et de Pneumologie de Quebec, Department of Medicine, Laval University, Quebec, Canada
| | - A Chiribiri
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom
| | - S Redwood
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - B D Prendergast
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
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Guzzetti E, Poulin A, Annabi M, Zhang B, Kalavrouziotis D, Couture C, Dagenais F, Pibarot P, Clavel M. IMPACT OF SEX AND LOW-FLOW ON SURVIVAL AFTER AORTIC VALVE REPLACEMENT FOR SEVERE AORTIC STENOSIS AND PRESERVED LEFT VENTRICULAR EJECTION FRACTION. Can J Cardiol 2019. [DOI: 10.1016/j.cjca.2019.07.306] [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: 11/29/2022] Open
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Després A, Perrot N, Tastet L, Pouliot A, Shen M, Chen H, Bourgeois R, Trottier M, Guimond J, Tessier M, Nadeau M, Sebastien T, Couture P, Dweck M, Tsimikas S, Thanassoulis G, Pibarot P, Marie-Annick Clavel M, Arsenault B. Lipoprotein(A), Oxidized Phospholipids, And Aortic Valve Microcalcification Assessed By 18f-Naf Pet/Ct. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.322] [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: 11/17/2022]
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Annabi M, Dahou A, Bartko P, Burwash I, Bergler-Klein J, Mascherbauer J, Orwat S, Mundigler G, Baumgartner H, Ribeiro H, Rodes-Cabau J, Cavalcante J, Clavel M, Pibarot P. Classical low-flow aortic stenosis with very low left ventricular ejection fraction or no flow reserve: Do they benefit from aortic valve replacement? Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.02.159] [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: 11/13/2022]
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Annabi M, Dahou A, Burwash I, Bartko P, Bergler-Klein J, Mascherbauer J, Mundigler G, Orwat S, Baumgartner H, Cavalcante J, Ribeiro H, Rodes-Cabau J, Clavel M, Pibarot P. Aortic Valve Replacement is Superior to Conservative Management in Low-Flow, Low-Gradient Aortic Stenosis independently of the presence of true severe stenosis. Archives of Cardiovascular Diseases Supplements 2019. [DOI: 10.1016/j.acvdsp.2019.02.140] [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: 11/28/2022]
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Sathananthan J, Sellers S, Barlow A, Hensey M, Landes U, Cheung A, Ye J, Alkhodair A, Blanke P, Søndergaard L, Pibarot P, Wood D, Leipsic J, Webb J. Overexpansion of older generation balloon expandable transcatheter heart valves: An ex-vivo bench study. Catheter Cardiovasc Interv 2019; 94:806-811. [PMID: 30851079 DOI: 10.1002/ccd.28160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/09/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The SAPIEN 3 (S3) transcatheter heart valve (THV) can be over-expanded beyond its labeled diameter. Overexpansion can be achieved with use of either a compliant or non-compliant balloon. Objective data regarding the ability to over-expand older generation balloon expandable valves are limited. We sought to assess the effects of over-expanding the SAPIEN and SAPIEN XT (Edwards Lifesciences, Irvine, CA) valve beyond labeled size (diameter) through an ex-vivo bench study. METHODS AND RESULTS We assessed SAPIEN and SAPIEN XT THVs, sized 23/26 mm and 23/26/29 mm, respectively. The SAPIEN THVs were explanted samples. Valves were expanded to nominal dimensions, and then incrementally overexpanded with balloons sized 1-, 2-, and 3-mm larger than the recommended diameter. When an appropriate sized non-compliant balloon was not available, a compliant balloon was utilized. Valves underwent visual and radiographic assessment of overexpansion. SAPIEN THVs with labeled size of 23 and 26 mm could be incrementally overexpanded to midvalve (MV) diameters of 26.7 and 27.4 mm, respectively. SAPIENT XT THVs with labeled size of 23, 26, and 29 mm could be incrementally overexpanded to MV diameters of 26.8, 28.3, and 28.8 mm, respectively. The desired degree of overexpansion was only achieved with use of non-compliant balloons and not with compliant balloons. The outflow of the SAPIEN and SAPIEN XT had larger diameters than the MV and inflow of the THV. CONCLUSION Overexpansion of older generation SAPIEN and SAPIEN XT THVs is possible. Achieving the desired degree of overexpansion was only achieved with use of non-compliant balloons. This has potential implications for the treatment of failed THVs.
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Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Sellers
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron Barlow
- Centre for Heart Lung Innovation, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Hensey
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Uri Landes
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anson Cheung
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdullah Alkhodair
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Phillippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec, Quebec, Canada
| | - David Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Leipsic
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Shen M, Tastet L, Capoulade R, Arsenault M, Bédard É, Pibarot P, Clavel M. IMPACT OF THE RENIN-ANGIOTENSIN SYSTEM ACTIVATION ON THE PROGRESSION RATE OF AORTIC STENOSIS. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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LeBlanc S, Coulombe F, Bibeau K, Bertrand O, Pibarot P, Després J, Larose É. SEX-RELATED DIFFERENCES IN ATHEROSCLEROSIS BURDEN AND COMPOSITION BY MAGNETIC RESONANCE: A COMPLEX INTERACTION BETWEEN VISCERAL ADIPOSITY AND ATHEROGENIC LIPOPROTEINS. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.155] [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: 11/16/2022] Open
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Bernard J, Tastet L, Capoulade R, Shen M, Bédard R, Guzzetti E, Clisson M, Côté N, Arsenault M, Bédard É, Pibarot P, Clavel M. DETERMINANTS AND IMPACT OF LEFT VENTRICULAR ASYMMETRIC REMODELING ON LEFT VENTRICULAR FUNCTION IN PATIENTS WITH AORTIC STENOSIS - RESULTS FROM THE PROGRESSA STUDY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Tastet L, Kwiecinski J, Pibarot P, Capoulade R, Everett R, Newby D, Shen M, Guzzetti E, Arsenault M, Bédard É, Larose É, Beaudoin J, Dweck M, Clavel M. SEX-RELATED DIFFERENCES IN THE EXTENT OF MYOCARDIAL FIBROSIS IN PATIENTS WITH AORTIC VALVE STENOSIS. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.315] [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: 11/29/2022] Open
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Devillers R, Bourgeois R, Perrot N, Boulanger M, Rosa M, Bossé Y, Thériault S, Pibarot P, Arsenault B, Mathieu P. AUTOTAXIN CARRIED BY LP(A): A NEW BIOMARKER OF THE CALCIFIC AORTIC VALVE STENOSIS. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.188] [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: 12/01/2022] Open
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Blais C, Gamache P, Pibarot P, Clavel M. TEMPORAL TRENDS BETWEEN 2000 AND 2016 IN THE BURDEN OF AORTIC STENOSIS IN THE PROVINCE OF QUÉBEC, CANADA. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Stanová V, Zenses AS, Rieu R, Kadem L, Pibarot P. Effect of Valve- and Patient- Related Factors on the Effective and Geometric Orifice Areas: An In Vitro Study with the CoreValve. Comput Methods Biomech Biomed Engin 2017; 20:195-196. [DOI: 10.1080/10255842.2017.1382929] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- V. Stanová
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, GIBoc, Marseille, France
| | - AS. Zenses
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, GIBoc, Marseille, France
- Quebec Heart and Lung Institute, Laval Univ, Quebec, Canada
| | - R. Rieu
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, GIBoc, Marseille, France
| | - L. Kadem
- Department of Mechanical and Industrial Engineering, Concordia Univ, Montreal, QC, Canada
| | - P. Pibarot
- Quebec Heart and Lung Institute, Laval Univ, Quebec, Canada
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Abu-Alhayja'a R, Dahou A, Clavel M, Aldahoun K, Tastet L, Côté N, Beaudoin J, Rodés-Cabau J, Lindman B, Pibarot P. HUMAN EPIDIDYMIS PROTEIN 4 (HE4) IS ASSOCIATED WITH OUTCOME IN LOW-FLOW, LOW-GRADIENT AORTIC STENOSIS. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.323] [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: 11/28/2022] Open
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Toubal O, Mahjoub H, Thébault C, O'Connor K, Beaudoin J, Bernier M, Clavel M, Pibarot P. PROGNOSTIC VALUE OF BRAIN NATRIURETIC PEPTIDE IN ASYMPTOMATIC PATIENTS WITH DEGENERATIVE MR -THE PROGRAM STUDY-. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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