scholarly journals Prognosis and clinical outcomes after TAVI, regarding the extravalvular cardiac damage defined by echocardiography prior the procedural

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Borrego Rodriguez ◽  
J.C Echarte Morales ◽  
C Minguito Carazo ◽  
P.L Cepas-Guillen ◽  
C Garrote Coloma ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Cardiac Damage ◽  
Stage 4 ◽  
Transvalvular Gradient ◽  
Stage 1 ◽  
Staging Classification ◽  
Valve Area

Abstract Background Recent studies have shown that the extent of extravalvular (extra-aortic valve) cardiac damage in patients with severe aortic stenosis (AS) have important prognostic implications for clinical outcomes after aortic valve replacement (AVR). Aims The aim of the present study is to evaluate the prognostic impact of a defined staging classification (“Généreux Staging Classification”) (GSC) characterizing the extent of extravalvular cardiac damage in patients with severe AS undergoing percutaneous transcatheter aortic valve implantation (TAVI). Methods A total of 102 consecutive patients, admitted in our institution between 2011–2017, with severe AS (echo-defined by peak aortic velocity, mean transvalvular gradient or aortic valve area) and symptoms related to AS (dyspnea, heart failure, angina or syncope) undergoing TAVI, were included. These patients were pooled and classified according to the presence or absence of cardiac damage as detected by echocardiography prior to TAVI, regarding the GSC: no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4). Two-year outcomes were compared using Kaplan– Meier techniques and multivariable Cox proportional hazards models were used to identify 2-year predictors of mortality. Results Out of 102 patients, 57 were male (55.9%). Mean age was 83.46±4.23 years. 2 patients (2.1%) were classified as Stage 0; 20 patients (20.3%) as Stage 1; 55 patients (54.2%) as Stage 2; 22 (21.6%) as Stage 3; and 3 patients (2.9%) as Stage 4. Two-year mortality was 0.0% in Stage 0, 5.0% in Stage 1, 5.5% in Stage 2, and 44.0% in Stages 3–4. After multivariable and univariate analysis, stage of cardiac damage was independently associated as predictor for all-cause mortality at 2-years, after TAVI (HR 2.8 [1.3±6.2], p<0.01). There were not another identificable predictors of 2-years death (age, sex, hypertension [78.5% of total patients], dislipemia [64.7%], diabetes [30.3%], smoking [78.5%], O2-chronic obstructive pulmonary disease [27.5% of total patients], renal insufficiency [78.5%], previous coronary artery disease [37.3%], peak aortic velocity, mean transvalvular gradient, and aortic valve area). Conclusions Given the strong association demonstrated in this study between advanced staging of cardiac damage and worse clinical outcomes after TAVI in short-middle term survival, consideration of the GSC in patients with severe AS in future recommendations for risk stratification might be useful. Two-year all-cause death in TAVI by GSC. Funding Acknowledgement Type of funding source: None

Novel staging classification of primary mitral regurgitation based on the presence of cardiac damage

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.L Van Wijngaarden ◽  
Y.L Hiemstra ◽  
P Van Der Bijl ◽  
V Delgado ◽  
N Ajmone Marsan ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Kidney Function ◽  
Left Ventricular ◽  
Prognostic Impact ◽  
Cardiac Damage ◽  
Stage 4 ◽  
All Cause Mortality ◽  
Primary Mitral Regurgitation ◽  
Stage 1 ◽  
Staging Classification

Abstract Background The indication for surgery in patients with severe primary mitral regurgitation (MR) is currently based on the presence of symptoms, left ventricular (LV) dilatation and dysfunction, atrial fibrillation and pulmonary hypertension. The aim of this study was to evaluate the prognostic impact of a new staging classification based on cardiac damage including the known risk factors but also including global longitudinal strain (GLS), severe left atrial (LA) dilatation and right ventricular (RV) dysfunction. Methods In total 614 patients who underwent surgery for severe primary MR with available baseline transthoracic echocardiograms were included. Patients were classified according to the extent of cardiac damage (Figure): Stage 0-no cardiac damage, Stage 1-LV damage, Stage 2-LA damage, Stage 3-pulmonary vasculature or tricuspid valve damage and Stage 4-RV damage. Patients were followed for all-cause mortality. Results Based on the proposed classification, 172 (28%) patients were classified as Stage 0, 102 (17%) as Stage 1, 134 (21%) as Stage 2, 135 (22%) as Stage 3 and 71 (11%) as Stage 4. The more advanced the stage, the older the patients were with worse kidney function, more symptoms and higher EuroScore. Kaplan-Meier curve analysis revealed that patients with more advanced stages of cardiac damage had a significantly worse survival (log-rank chi-square 35.2; p<0.001) (Figure). On multivariable analysis, age, male, chronic obstructive pulmonary disease, kidney function, and stage of cardiac damage were independently associated with all-cause mortality. For each stage increase, a 22% higher risk for all-cause mortality was observed (95% CI: 1.064–1.395; p=0.004). Conclusion In patients with severe primary MR, a novel staging classification based on the extent of cardiac damage, may help refining risk stratification, particularly including also GLS, LA dilatation and RV dysfunction in the assessment. Funding Acknowledgement Type of funding source: None

scholarly journals Staging cardiac damage in aortic valve disease: one size fits all?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
G Silva ◽  
F Sampaio ◽  
C Espada Guerreiro ◽  
P Goncalves Teixeira ◽  
P Ribeiro Queiros ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Severe Aortic Stenosis ◽  
Multivariable Analysis ◽  
Staging System ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
Stage 4 ◽  
Stage 1

Abstract Background Nowadays, in patients with aortic regurgitation (AR), aortic valve surgery is indicated when severe and symptomatic or those with depressed LVEF. However, clinical outcomes of patients with significant aortic regurgitation are not influenced by these factors only. Recently, a new staging system for severe aortic stenosis has been proposed by Généreux on the basis of the extent of anatomic and functional cardiac damage. If this model could be applicable to an unselected significant AR population has not been tested. Purpose The aim of our study was to evaluate the prevalence of the different stages of extra-aortic valvular cardiac damage by the application of Généreux staging and its impact on prognosis in a large, real world cohort of significant AR patients. Methods This study retrospectively analysed the clinical, Doppler echocardiographic and outcome data in patients with grade III or greater AR between January 2014 and September 2019. According to the extent of cardiac damage on echocardiography, patients were classified as Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage) or Stage 4 (right ventricular damage). Exclusion criteria were severe aortic stenosis and previous valve repair or replacement. The primary end-point was all-cause mortality. Results A total of 572 patients, aged 70.1±13.9 years, 294 (51.3%) men were enrolled. One third of patients were in NYHA I. Based on the proposed classification, 82 patients (14.3%) were classified in stage 0, 130 (22.7%) in stage 1, 276 (48.2%) in stage 2, 68 (11.8%) in stage 3 and 17 (3.0%) in stage 4. Median follow-up time was 3.3±1.9 years. There was a progressive increase in mortality rates according to staging: 8.5% in stage 0, 10.8% in stage 1, 24.9% in stage 2, 42.6% in stage 3 and 52.9% in stage 4 (p<0.001). On multivariable analysis, the extent of cardiac damage was independently associated with excess mortality (HR 1.69, 95% CI 1.29 to 2.21) Conclusion Our study demonstrated that this new staging system studied for aortic stenosis also provides increased prognostic value to patients with significant aortic regurgitation. This staging system can be helpful to identify the degree of extra-aortic valvular cardiac damage and to optimize the time of valvular intervention. Further prospective studies are needed to confirm the benefit of the applicability of this model in clinical practice. FUNDunding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Centro Hospitalar Vila Nova de Gaia / Espinho Distribution of stages of cardiac damage Survival analysis according to stage

scholarly journals 572 Extent of cardiac damage and mortality in patients undergoing transcatheter aortic valve implantation

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N138-N141
Author(s):  
Marisa Avvedimento ◽  
Attilio Leone ◽  
Domenico Simone Castiello ◽  
Domenico Angellotti ◽  
Federica Ilardi ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Right Ventricular ◽  
Tricuspid Valve ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Pulmonary Vasculature ◽  
Cardiac Damage ◽  
Transcatheter Aortic Valve ◽  
Stage 4 ◽  
Staging Classification

Abstract Aims Degenerative aortic stenosis (AS) is the most common heart valve disease among people ≥65 years in developed countries, with an increasing prevalence due to population ageing. A recently proposed staging classification of AS is based on the assumption that there is a continuum in the pathophysiology of LV structural and functional changes induced by AS. Such system showed prognostic ability among patients from the PARTNER 2 trial as well as in asymptomatic subjects with moderate to severe AS, thus challenging the current management of the disease. The aim of our study was to assess the prognostic performance of this staging classification in a real-world cohort of patients undergoing transcatheter aortic valve implantation (TAVI) and to investigate the eventual impact of the procedure on the extent of extra-aortic valve cardiac damage. Methods and results A staging classification was applied to 262 patients from the EffecTAVI Registry. The following criteria for staging classification of cardiac damage were applied at baseline (within 1 month before TAVI) and after the procedure (within 30-day): Stage 0, no extra-aortic valve cardiac damage; Stage 1, LV damage as defined by the presence of LV hypertrophy (LV mass index >95 g/m2 for women, >115 g/m2 for men), severe LV diastolic dysfunction (E/e’ >14) or LV systolic dysfunction (LV ejection fraction, LVEF <50%); Stage 2, left atrial (LA) and/or mitral valve damage as defined by the presence of LA enlargement (LA volume > 34 ml/m2) and/or moderate-severe mitral regurgitation and/or atrial fibrillation; Stage 3, pulmonary vasculature and/or tricuspid valve damage as defined by the presence of systolic pulmonary hypertension (systolic pulmonary arterial pressure, PAPS > 60 mmHg) and/or moderate/severe tricuspid valve regurgitation; Stage 4, right ventricular (RV) damage as defined by the presence of moderate-severe RV systolic dysfunction (tricuspid annular systolic excursion, TAPSE < 17 mm). The primary endpoint of the study was all-cause mortality at 1-year. Secondary endpoints included cerebrovascular accident, myocardial infarction, permanent pacemaker implantation, endocarditis and re-hospitalization for all causes. At baseline, 23 (8.7%) patients were in Stage 0/1 (no cardiac damage/left ventricular damage), 106 (40.4%) in Stage 2 (left atrial or mitral valve damage), 59 (22.5%) in Stage 3 (pulmonary vasculature or tricuspid valve damage) and 74 (28.3%) in Stage 4 (right ventricular damage). At 30-day after TAVI, a lower prevalence of advanced stages of cardiac damage than baseline, mainly driven by a significant improvement in left ventricular diastolic parameters and right ventricular function, was reported. At 1-year, a stepwise increase in mortality rates was observed according to staging at baseline: 4.3% in Stage 0/1, 6.6% in Stage 2, 18.6% in Stage 3 and 21.6% in Stage 4 (p = 0.08). No differences were found in secondary endpoints. Conclusion TAVI has an early beneficial impact on the left ventricular diastolic and right ventricular function. However, the extent of cardiac damage at baseline significantly affects the risk of mortality at 1-year after the procedure.

scholarly journals Aortic valve area, stroke volume,left ventricular hypertrophy, remodeling and fibrosis in aortic stenosis assessed by cardiac MRI

2013 ◽  
Vol 34 (suppl 1) ◽  
pp. P277-P277
Author(s):  
G. Barone-Rochette ◽  
S. Pierard ◽  
S. Seldrum ◽  
C. De Meester De Ravensteen ◽  
J. Melchior ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Left Ventricular Hypertrophy ◽  
Aortic Stenosis ◽  
Stroke Volume ◽  
Cardiac Mri ◽  
Ventricular Hypertrophy ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Valve Area

scholarly journals Impact of left ventricular outflow tract flow acceleration on aortic valve area calculation in patients with aortic stenosis

2019 ◽  
Vol 6 (4) ◽  
pp. 97-103 ◽  
Author(s):  
Andaleeb A Ahmed ◽  
Robina Matyal ◽  
Feroze Mahmood ◽  
Ruby Feng ◽  
Graham B Berry ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Continuity Equation ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Area Measurement ◽  
Aortic Valve Area ◽  
Flow Acceleration ◽  
The Impact ◽  
Valve Area

Objective Due to its circular shape, the area of the proximal left ventricular tract (PLVOT) adjacent to aortic valve can be derived from a single linear diameter. This is also the location of flow acceleration (FA) during systole, and pulse wave Doppler (PWD) sample volume in the PLVOT can lead to overestimation of velocity (V1) and the aortic valve area (AVA). Therefore, it is recommended to derive V1 from a region of laminar flow in the elliptical shaped distal LVOT (away from the annulus). Besides being inconsistent with the assumptions of continuity equation (CE), spatial difference in the location of flow and area measurement can result in inaccurate AVA calculation. We evaluated the impact of FA in the PLVOT on the accuracy of AVA by continuity equation (CE) in patients with aortic stenosis (AS). Methods CE-based AVA calculations were performed in patients with AS once with PWD-derived velocity time integral (VTI) in the distal LVOT (VTILVOT) and then in the PLVOT to obtain a FA velocity profile (FA-VTILVOT) for each patient. A paired sample t-test (P < 0.05) was conducted to compare the impact of FA-VTILVOT and VTILVOT on the calculation of AVA. Result There were 46 patients in the study. There was a 30.3% increase in the peak FA-VTILVOT as compared to the peak VTILVOT and AVA obtained by FA-VTILVOT was 29.1% higher than obtained by VTILVOT. Conclusion Accuracy of AVA can be significantly impacted by FA in the PLVOT. LVOT area should be measured with 3D imaging in the distal LVOT.

Abstract 17783: Improved Aortic Valve Area Calculation Using a Novel Biplane Echo Continuity Equation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Thorsten M Leucker ◽  
Edward P Shapiro
Keyword(s):  
Aortic Valve ◽  
Continuity Equation ◽  
Simple Calculation ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Aortic Valve Area ◽  
Single Plane ◽  
Chamber View ◽  
Transcatheter Aortic Valve ◽  
Valve Area

The aim of this study was to improve the accuracy of transthoracic echo- cardiographic (TTE) assessment of the aortic valve area (AVA) in patients with aortic stenosis (AS). The traditional continuity equation (CE) for determining AVA requires a measurement of left ventricular outflow tract (LVOT) area, which is calculated from a linear LVOT dimension using the parasternal long axis view, assuming circular geometry. However, routine use of multidetector computed tomography (MDCT) in patients undergoing evaluation for transcatheter aortic valve replacement (TAVR) has shown that the LVOT is elliptical rather than round. Assumption of circular geometry may introduce inaccuracies into AVA assessment. A total of 61 patients (76 ± 11 years of age, 61% men) with isolated calcific AS (mean gradient 42 ± 9 mm Hg; ejection fraction 56 ± 11%) underwent Doppler TTE as part of pre TAVR or aortic valvuloplasty evaluation. AVA was calculated by TTE using two near- perpendicular planes (parasternal long axis and apical five chamber view) to evaluate the LVOT. A modified CE was used to calculate AVA (cm2) = (π((D1 x D2)/4)x LVOT VTI)/(AV VTI) in order to account for the elliptical rather than round shape of the LVOT. AVA measurements from the traditional and modified CE were compared to invasive AVA assessment. Biplane (Figure, Panel B+D) vs. traditional single plane (Panel A+C) TTE measurement of the LVOT yielded a significantly improved positive correlation between TTE and invasive AVA assessment (r2=0.861 vs. 0.296) and a markedly reduced mean error (0.07 cm2 vs. 0.18 cm2), p<0.001. Utilizing the proposed modified continuity equation greatly improves the accuracy of TTE guided AVA measurements. This simple calculation can be performed using standard TTE without additional costly equipment (ie, biplane transducers), without additional echo views (ie, more sonographer time), and without the need to subject patients to further invasive or non- invasive testing (ie, TEE or MDCT).

scholarly journals Dimensionless Index in Patients With Low-Gradient Severe Aortic Stenosis and Preserved Ejection Fraction

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Alexandre Altes ◽  
Nicolas Thellier ◽  
Dan Rusinaru ◽  
Wassima Marsou ◽  
Yohann Bohbot ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Aortic Valve ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Ventricular Ejection Fraction ◽  
Valve Area

Background Risk stratification of patients with low-gradient (LG) severe aortic stenosis (AS) despite preserved left ventricular ejection fraction remains challenging. We sought to evaluate the relationship between the dimensionless index (DI)—the ratio of the left ventricular outflow tract time-velocity integral to that of the aortic valve jet—and mortality in these patients. Methods Seven hundred fifty-five patients with LG severe AS (defined by aortic valve area ≤1 cm 2 or aortic valve area indexed to body surface area ≤0.6 cm 2 /m 2 and mean aortic pressure gradient <40 mm Hg) and preserved left ventricular ejection fraction ≥50% were studied. Flow status was defined according to stroke volume index <35 mL/m 2 (low flow, LF) or ≥35 mL/m 2 (normal flow, NF). Results After adjustment for age, sex, body mass index, Charlson comorbidity index, history of hypertension, history of atrial fibrillation, AS-related symptoms, left ventricular ejection fraction, indexed left ventricular ventricular mass, aortic valve area, and aortic valve replacement as a time-dependent covariate, patients with LG-LF and DI<0.25 exhibited a considerable increased risk of death compared with patients with LG-NF and DI≥0.25 (adjusted hazard ratio, 2.41 [95% CI, 1.61–3.62]; P <0.001), LG-NF and DI<0.25 (adjusted hazard ratio, 1.84 [95% CI, 1.24–2.73]; P =0.003), and LG-LF and D≥0.25 (adjusted hazard ratio, 2.27 [95% CI, 1.42–3.63]; P <0.001). In contrast, patients with LG-LF and DI≥0.25, LG-NF and DI<0.25, and LG-NF and DI≥0.25 had similar outcome. DI<0.25 showed incremental prognostic value in patients with LG-LF severe AS but not in patients with LG-NF severe AS. Conclusions Among patients with LG severe AS and preserved left ventricular ejection fraction, decreased DI<0.25 is a reliable parameter in patients with LF to identify a subgroup of patients at higher risk of death who may derive benefit from aortic valve replacement.

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