Clinical Outcomes after Mitral Valve Repair with the Physio II Annuloplasty Ring

2021 ◽  
Author(s):  
Thilo Noack ◽  
Franz Sieg ◽  
Mateo Marin Cuartas ◽  
Ricardo Spampinato ◽  
David Holzhey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Clinical Outcomes ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Class Iii ◽  
Annuloplasty Ring ◽  
Ventricular Ejection Fraction

Abstract Background Mitral valve (MV) repair with annuloplasty is the standard of care in patients with primary degenerative mitral regurgitation (DMR). Newer generations of annuloplasty rings have been developed with the goals of closer reproduction of native annular geometry and easier implantation. This study investigates the short-term and 5-year clinical outcomes of MV repair with the Carpentier-Edwards (CE) Physio II annuloplasty ring. Methods This is an observational study including a total of 486 patients who underwent MV repair for DMR using the CE Physio II annuloplasty ring between 2011 and 2016. Results Mean age was 54.8 ± 12.1 years, 364 patients (74.9%) were males, and 84 patients (17.3%) presented with atrial fibrillation. Mean left ventricular ejection fraction was 62.3 ± 7.3%. Mean logistic EuroSCORE was 2.7 ± 2.4%. New York Heart Association functional class III–IV symptoms were present in 134 (27.6%) patients preoperatively. Isolated MV repair was performed via a right-sided mini-thoracotomy in 479 patients (98.6%). Concomitant procedures included ablation for atrial fibrillation in 83 patients (17.1%) and closure of atrial septum defect in 88 patients (18.1%). Median size of implanted annuloplasty rings was 34 mm (interquartile range: 34–38 mm). Mean cardiopulmonary bypass time was 116 ± 34 minutes and mean cross-clamp time was 74 ± 25 minutes. Thirty-day mortality was 0.4%. The Kaplan–Meier 4-year survival was 98.5%. Freedom from MV reoperation was 96.2 and 94.0% at 1 and 4 years. Conclusion MV repair with the CE Physio II annuloplasty ring is associated with excellent midterm clinical outcome.

P3541Change in left ventricular ejection fraction and outcome in heart failure patients with mid-range ejection fraction: from the HIJ-HF prospective study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Tsukamoto ◽  
A Suzuki ◽  
T Shiga ◽  
M W Sakai ◽  
Y Tanaka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Hospital Discharge ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Class Iii ◽  
Ventricular Ejection Fraction

Abstract Introduction Heart failure (HF) is categorized on the basis of the eft ventricular ejection fraction (LVEF). The European Society of Cardiology has proposed mid-range EF (HFmrEF) as a new category of HF that includes patients with an LVEF of 40–49%. However, the clinical characteristics, change in LVEF following treatment, and outcome of patients with HFmrEF remain clear. Methods We conducted a prospective observational study of Japanese hospitalized HF patients between 2015 and 2018 at a single-center (HIJ-HF III). HFmrEF was defined as 40–49% of LVEF on echocardiography at admission. We followed these patients and performed echocardiography to assess LVEF per year after hospital discharge. Clinical outcome was death from any cause. Methods and results We studied 138 patients with HFmrEF (median age 71 years, 69% male). They had 32% of ischemic heart disease, 9% of New York Heart Association functional class III or IV at discharge. During median follow-up of 20 [13–28] months, we assessed change in LVEF for 110 patients with HFmrEF. One year after hospital discharge, 49 patients (44%) improved LVEF (≥50%) and 21 patients (19%) reduced LVEF (<40%). HFmrEF patients who reduced LVEF (<40%) were significantly higher mortality rate than those who improved LVEF (≥50%) (14% vs. 2%, p<0.05) (Figure). Conclusions This study demonstrated that 44% of HFmrEF patients improved LVEF following treatment but 19% patients reduced LVEF. Reduced LVEF was associated with poor prognosis.

scholarly journals Risk Stratification in Atrial Fibrillation Patients – A Review Focused on Mortality

2012 ◽  
Vol 1 ◽  
pp. 8
Author(s):  
Federico Lombardi ◽  
Keyword(s):  
Atrial Fibrillation ◽  
New York ◽  
Oral Anticoagulant Therapy ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Ventricular Ejection Fraction

Atrial fibrillation (AF) is associated with increased mortality that is largely due to the severe co-morbidities of patients with this rhythm disturbance rather than to its electrocardiographic features. Available evidence indicated that ageing, heart failure and stroke are the most important predictors of all-cause mortality. Additional clinical parameters such as smoking, renal impairment, chronic obstructive pulmonary disease may also identify patients at risk. The prevention of thromboembolic events is based on oral anticoagulant therapy, which reduces the severity and mortality of ischaemic strokes but slightly increase the rate of haemorrhagic events. Most of the traditional risk stratifiers commonly used in patients in sinus rhythm such as New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF) and resting heart rate seem to be less effective in AF patients thus leaving to the physician judgment the main responsibility of identifying patients with an increased mortality risk.

Characteristics of Children with Acute Rheumatic Carditis from a High-Incidence Region: Importance of Unexplained Worsening of Functional Class

Cardiology ◽  
2020 ◽  
Vol 145 (8) ◽  
pp. 522-528
Author(s):  
Rajiv Narang ◽  
Anita Saxena ◽  
Sivasubramanian Ramakrishnan ◽  
Saurabh K. Gupta ◽  
Rajnish Juneja ◽  
...  
Keyword(s):  
Nyha Class ◽  
Public Health Problem ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
First Episode ◽  
Major Public Health Problem ◽  
Class Iii ◽  
Rheumatic Carditis ◽  
Ventricular Ejection Fraction

Background: Acute rheumatic fever (ARF) and acute rheumatic carditis (ARC) continue to be a major public health problem in developing countries. Objective: To study the characteristics of children with ARC being treated at a tertiary centre. Methods and Results: We studied 126 children (mean age 10.4 ± 2.3 years, range 5–15 years, 60% males) diagnosed with ARC by treating cardiologists. Most had lower socio-economic status. Fifty of 126 (40%) presented with a first episode of ARC. Joint symptoms were present in 29% and fever in 25%. Only 2.4% had subcutaneous nodules and none had erythema marginatum or chorea. Fifty-one percent presented in NYHA class II and 29% in NYHA class III or IV. Tachycardia and heart failure were present in 53% and 21%, respectively. Recent worsening of NYHA class (dyspnoea) was the commonest feature (48%). Laboratory investigations showed raised antistreptolysin O titres (>333 units) in only 36.7% of patients. Raised C-reactive protein (CRP) was present in 70%, while raised erythrocyte sedimentation rate was found in only 37% of patients. On the basis of above findings, the modified Jones criteria (2015) for the diagnosis of ARF were satisfied only in 46% of children. Echocardiography showed mitral valve thickening in 77% and small nodules on the tip of the leaflets in 43% (27 and 8%, respectively for aortic valve). Left ventricular ejection fraction was <50% in only 3 patients. The dominant valve lesion was mitral regurgitation (MR) (present in 95% of patients; severe in 78%, moderate in 15%), while aortic regurgitation was present in 44% (severe in 14%). Conclusions: The criteria are often not satisfied by patients being treated for ARC. Recent unexplained worsening of dyspnoea, young age, significant MR, echocardiographic nodules, and elevated CRP are important indicators.

Long-term outcomes and left ventricular diastolic function of sarcomere mutation-positive and mutation-negative patients with hypertrophic cardiomyopathy: a prospective cohort study

2020 ◽  
Author(s):  
Ching-Yu Julius Chen ◽  
Mao-Yuan Marine Su ◽  
Ying-Chieh Liao ◽  
Fu-Lan Chang ◽  
Cho-Kai Wu ◽  
...  
Keyword(s):  
New York ◽  
Hypertrophic Cardiomyopathy ◽  
Nyha Class ◽  
Global Longitudinal Strain ◽  
Heart Association ◽  
Left Ventricular Diastolic Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Class Iii ◽  
Ventricular Ejection Fraction

Abstract Aims Hypertrophic cardiomyopathy (HCM) is an inheritable disease that leads to sudden cardiac death and heart failure (HF). Sarcomere mutations (SMs) have been associated with HF. However, the differences in ventricular function between SM-positive and SM-negative HCM patients are poorly characterized. Methods and results  Of the prospectively enrolled 374 unrelated HCM patients in Taiwan, 115 patients underwent both 91 cardiomyopathy-related gene screening and cardiovascular magnetic resonance (45.6 ± 10.6 years old, 76.5% were male). Forty pathogenic/likely pathogenic mutations were identified in 52 patients by next-generation sequencing. The SM-positive group were younger at first cardiovascular event (P = 0.04) and progression to diastolic HF (P = 0.02) with higher N-terminal pro-brain natriuretic peptide (NT-proBNP) [New York Heart Association (NYHA) Class III/IV symptoms with left ventricular ejection fraction &gt; 55%] than the SM-negative group (P &lt; 0.001). SM-positive patients had a greater extent of late gadolinium enhancement (P = 0.01), larger left atrial diameter (P = 0.03), higher normalized peak filling rate (PFR) and PFR ratio, and a greater reduction in global longitudinal strain than SM-negative patients (all P ≤ 0.01). During mean lifelong follow-up time (49.2 ± 15.6 years), SM-positive was a predictor of earlier HF (NYHA Class III/IV symptoms) after multivariate adjustment (hazard ratio 3.5; 95% confidence interval 1.3–9.7; P = 0.015). Conclusion SM-positive HCM patients had a higher extent of myocardial fibrosis and more severe ventricular diastolic dysfunction than those without, which may contribute to earlier onset of advanced HF, suggesting the importance of close surveillance and early treatment throughout life.

Late Pulmonary Valve Implantation after Repair of Tetralogy of Fallot

2005 ◽  
Vol 13 (2) ◽  
pp. 139-142
Author(s):  
Shengli Yin ◽  
Jorge Salazar ◽  
Lars Nolke ◽  
Anthony Azakie ◽  
Tom R Karl
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Class Iii ◽  
Ventricular Ejection Fraction ◽  
Significant Difference ◽  
Valve Implantation ◽  
Pulmonary Valve Implantation

Ten cases of elective late pulmonary valve implantation after repair of tetralogy of Fallot were reviewed. The interval after initial repair ranged from 1.5 to 43 years (mean, 20.0 ± 12.3 years). There was no hospital mortality or late death during a mean follow-up of 12.5 months. Preoperatively, 9 patients were in New York Heart Association functional class III–IV; after pulmonary valve implantation, all 10 patients were in class I–II (average improvement, 1.7 classes). Left ventricular ejection fraction improved significantly (from 62.1% ± 4.7% to 70.2% ± 4.9%), as did fractional shortening (from 34.0% ± 5.0% to 40.0% ± 4.2%). Right ventricular diameter decreased significantly (from 32.3 ± 7.5 to 24.4 ± 5.4 mm). QRS duration decreased significantly (155.2 ± 27.1 vs. 140.0 ± 21.2 msec), but there was no significant difference in QT interval (460.9 ± 29.6 vs. 451.9 ± 50.6 msec). Hospital stay was 4–7 days. One patient had preoperative ventricular fibrillation requiring resuscitation and an implantable cardiac defibrillator; another needed a defibrillator at the time of pulmonary valve implantation, because of ventricular arrhythmias. It was concluded that late pulmonary valve implantation after tetralogy of Fallot repair had significant benefits and carried low operative risk.

Association of Physical Activity and Prognostic Parameters in Elderly Patients With Heart Failure

2011 ◽  
Vol 19 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Melissa Jehn ◽  
Arno Schmidt-Trucksäss ◽  
Henner Hanssen ◽  
Tibor Schuster ◽  
Martin Halle ◽  
...  
Keyword(s):  
Physical Activity ◽  
Heart Failure ◽  
Nyha Class ◽  
Clinical Status ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Patients With Heart Failure

Objective:Assessment of habitual physical activity (PA) in patients with heart failure.Methods:This study included 50 patients with heart failure (61.9 ± 4.0 yr). Seven days of PA were assessed by questionnaire (AQ), pedometer, and accelerometer and correlated with prognostic markers including VO2peak, percent left-ventricular ejection fraction, N-terminal pro-B-type natriuretic peptide, and New York Heart Association (NYHA) functional class.Results:Accelerometry showed a stronger correlation with VO2peak and NYHA class (R = .73 and R = −.68; p < .001) than AQ (R = .58 and R = −.65; p < .001) or pedometer (R = .52 and R = −.50; p < .001). In the multivariable regression model accelerometry was the only consistent independent predictor of VO2peak (p = .002). Moreover, when its accuracy of prediction was tested, 59% of NYHA I and 95% of NYHA III patients were correctly classified into their assigned NYHA classes based on their accelerometer activity.Conclusion:PA assessed by accelerometer is significantly associated with exercise capacity in patients with heart failure and is predictive of disease severity. The data suggests that PA monitoring can aid in evaluating clinical status.

scholarly journals Effect of systolic dysfunction and elevated left ventricular end diastolic pressure on 3-year clinical outcomes in patients with atrial fibrillation

2021 ◽  
Author(s):  
YU HYEYON ◽  
JIHUN AHN
Keyword(s):  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Systolic Dysfunction ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diastolic Filling ◽  
Ventricular Ejection Fraction

Objectives: Systolic and diastolic dysfunctions are related to adverse clinical outcomes in patients with sinus rhythm. The aim of this study was to clarify the prognostic significance of systolic and diastolic dysfunctions in patients with chronic persistent atrial fibrillation (AF). Methods: We evaluated data for 114 consecutive patients with chronic AF who underwent measurement of LVEDP at our hospital between 1 March 2011 and 31 December 2014. In total, 114 consecutive patients with chronic AF were divided into two groups according to the left ventricular ejection fraction (LVEF): LVEF < 50 (reduced ejection fraction, REF group) and LVEF ≥50 (preserved EF, PEF group). The PEF group was further divided into two subgroups according to the left ventricular end-diastolic filling pressure (LVEDP): LVEDP >15 mmHg and LVEDP ≤ 15 mmHg. The 3-year clinical outcomes were compared between the PEF and REF groups and the LVEDP ≥15 mmHg and LVEDP <15 mmHg groups. Results: During the 3-year follow-up period, the rate of heart failure (HF) hospitalisation and incidence of AF with rapid ventricular rhythm (RVR) were higher in the REF group than in the PEF group. Multivariate analysis revealed that REF was the only significant predictor of HF hospitalisation (hazard ratio, 4.71; 95% confidence interval, 1.48–15.02; p=0.009). Conclusions: Our observations during a mid-term follow-up period revealed that systolic dysfunction could be an important predictor of HF hospitalisation in patients with AF. However, elevated LVEDP may not be associated with mid-term adverse clinical outcomes in patients without systolic dysfunction.

P1025Clinical predictors for the improvement of left ventricular ejection fraction and prognosis after catheter ablation of atrial fibrillation in patients with systolic dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Nagaoka ◽  
Y Mukai ◽  
S Kawai ◽  
S Takase ◽  
K Sakamoto ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Lower Plasma ◽  
Ventricular Ejection Fraction

Abstract Background Catheter ablation (CA) of atrial fibrillation (AF) improves left ventricular ejection fraction (LVEF) and clinical outcomes in patients with left ventricular systolic dysfunction (LVSD). However, predictors of the improvement of LV function and clinical outcomes by CA were poorly understood. Purpose We examined the efficacy of CA in AF patients with LVSD and predictive factors associated with clinical outcomes. Method Among consecutive 795 patients undergone initial RFCA at our hospital, we studied 51 patients with LVSD (LVEF ≤50%). Improved LVEF more then 5% at 1-year after CA was classified as “responder” to CA. We analyzed clinical variables and echocardiographic parameters before and after the CAs. Results In the responder group, LVEF was significantly improved 1-year after catheter ablation compared with the non-responder group. (ΔLVEF 22±12% vs. −1±4%, p<0.001). The responder group was significantly younger, had more non-paroxysmal AF, smaller LV systolic diameter and lower plasma BNP level before CA (Table). Late gadolinium enhancement (LGE)-positive rate in cardiovascular magnetic resonance imaging (CMR) before CA was higher in the non-responder group than in the responder group (100% [6/6] vs. 38% [5/13], p<0.005). After CAs of AF, event-free survival from hospitalization for heart failure was significantly higher in the responder group (Figure) with less AF recurrence (27% vs. 47%, p=0.04) than in the non-responder group. Baseline characteristics Responder (N=35) Non-Responder (N=16) P value Age, y 62±11 69±8 p<0.01 Male, n (%) 26 (74) 13 (76) NS Non-pAF 26 (74) 4 (24) p<0.01 LAD, mm 48±7 48±8 NS LAVI, ml/m2 54±17 58±20 NS LVDd, mm 54±7 58±10 NS LVDs, mm 43±7 48±10 p=0.05 EF, % 37±8 38±8 NS BNP (pg/ml) 278±225 684±848 p<0.05 Conclusion Younger age, absence of LV dilatation, lower plasma BNP, or absence of LGE may well predict favorable clinical outcomes after CA in patients with LVSD.

scholarly journals P966 Impact of systolic dysfunction and elevated left ventricular end diastolic pressure on three years clinical outcome in patients with atrial fibrillation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
J Ahn ◽  
H Y Yu
Keyword(s):  
Atrial Fibrillation ◽  
Diastolic Dysfunction ◽  
Clinical Outcomes ◽  
Systolic Dysfunction ◽  
Prognostic Significance ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Diastolic Filling ◽  
Ventricular Ejection Fraction

Abstract Background Systolic and diastolic dysfunction is related with adverse clinical outcomes in the patients with sinus rhythm. Purpose: The aim of this study is to clarify the prognostic significance of both systolic and diastolic dysfunction in the patients with chronic persistent atrial fibrillation (AF). Methods: A total of 114 consecutive patients who have chronic persistent AF. Whole patients were divided into 2 groups according to left ventricular ejection fraction (LVEF): those with an LVEF &lt; 50 (n = 24) (REF) and those with an LVEF ≥ 50 (n = 90) (PEF). And PEF group was also divided into two groups according to left ventricular end diastolic filling pressure (LVEDP): patients with LVEDP ≥ 15 mmHg (n = 38) and those with &lt; 15 mmHg (n = 52). Results: 3-year clinical outcomes were compared between each groups (PEF groups vs. REF groups and LVEDP ≥ 15 mmHg vs LVEDP &lt; 15 mmHg). The incidence of death, hospitalization, stroke, bleeding, AF with rapid ventricular rhythm (RVR) and heart failure (HF) hospitalization were similar PEF and REF group. However, during 3-year follow up period, the incidence of HF hospitalization (29.2% vs 8.9%, p &lt; 0.02) and AF with RVR (20.8% vs 3.3%, p &lt; 0.01) were frequent in REF group compared with PEF group. In multivariate analysis, REF is an only predictor of HF hospitalization (Table 1). Conclusion: During 3-year follow up period, systolic dysfunction is an important predictor of HF hospitalization in AF patients. However, elevated LVEDP is not related with 3-year adverse clinical outcomes in AF patients without systolic dysfunction. Table 1 variable Odd Ratio (HR) 95% Confidence Interval (CI) P Age .973 .925-1.023 .286 Diabetes mellitus .487 .138-1.721 .264 BNP 1.000 1.000-1.000 .908 Hypertension 1.061 .330-3.413 .921 LVEDP &gt; 15 mmHg 1.302 .396-4.285 .664 EF &lt; 50 4.712 1.478-15.016 .009 Predictors of 3-year follow-up clinical outcomes of all participants

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