Association between Comorbidities and Progression of Transvalvular Pressure Gradients in Patients with Moderate and Severe Aortic Valve Stenosis

Background. Fast progression of the transaortic mean gradient (Pmean) is relevant for clinical decision making of valve replacement in patients with moderate and severe aortic stenosis (AS) patients. However, there is currently little knowledge regarding the determinants affecting progression of transvalvular gradient in AS patients. Methods. This monocentric retrospective study included consecutive patients presenting with at least two transthoracic echocardiography examinations covering a time interval of one year or more between April 2006 and February 2016 and diagnosed as moderate or severe aortic stenosis at the final echocardiographic examination. Laboratory parameters, medication, and prevalence of eight known cardiac comorbidities and risk factors (hypertension, diabetes, coronary heart disease, peripheral artery occlusive disease, cerebrovascular disease, renal dysfunction, body mass index ≥30 Kg/m2, and history of smoking) were analyzed. Patients were divided into slow (Pmean < 5 mmHg/year) or fast (Pmean ≥ 5 mmHg/year) progression groups. Results. A total of 402 patients (mean age 78 ± 9.4 years, 58% males) were included in the study. Mean follow-up duration was 3.4 ± 1.9 years. The average number of cardiac comorbidities and risk factors was 3.1 ± 1.6. Average number of cardiac comorbidities and risk factors was higher in patients in slow progression group than in fast progression group (3.3 ± 1.5 vs 2.9 ± 1.7; P=0.036). Patients in slow progression group had more often coronary heart disease (49.2% vs 33.6%; P=0.003) compared to patients in fast progression group. LDL-cholesterol values were lower in the slow progression group (100 ± 32.6 mg/dl vs 110.8 ± 36.6 mg/dl; P=0.005). Conclusion. These findings suggest that disease progression of aortic valve stenosis is faster in patients with fewer cardiac comorbidities and risk factors, especially if they do not have coronary heart disease. Further prospective studies are warranted to investigate the outcome of patients with slow versus fast progression of transvalvular gradient with regards to comorbidities and risk factors.

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P1692 The past returns after 20 years: a case report

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1055 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Habjan ◽

D Cantisani ◽

I S Scarfo` ◽

M C Guarneri ◽

G Semeraro ◽

...

Keyword(s):

Heart Disease ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Stenosis ◽

Valvular Heart Disease ◽

Radiation Treatment ◽

Severe Aortic Stenosis ◽

Aortic Valve Area ◽

Radiation Induced ◽

Valve Area

Abstract Introduction Radiation therapy is one of the cornerstones of treatment for many types of cancer. These patients can later in life develop cardiovascular complications associated with radiation treatment. Late cardiovascular effects of radiation treatment include coronary artery disease (CAD), valvular heart disease, congestive heart failure, pericardial disease and sudden death. The most common sign of radiation-induced valvular heart disease is the calcification of the intervalvular fibrosa between the aortic and mitral valve. Case presentation A 71-year-old male patient with a history of Non-Hodgkin lymphoma treated with radiotherapy and chemotherapy 20 years ago, CAD, arterial hypertension, diabetes type II, dyslipidemia, obesity and currently smoking presented in the emergency room in our medical facility with acute pulmonary edema. The patient had unstable angina pectoris in 2018, the coronary angiography showed two-vessel disease with a non-significant stenosis of the left main coronary artery (LMCA) and 70% stenosis of the left anterior descending artery (LAD), for which he refused the percutaneous coronary intervention. At the same time, a transthoracic echocardiography (TTE) showed severe aortic stenosis and moderately severe mitral stenosis, at that time the patient refused the operation. After the initial treatment for pulmonary edema, TTE and transesophageal echocardiography (TEE) were performed and showed a tricuspid aortic valve with calcification of the cusps and a very severe aortic stenosis (planimetric aortic valve area 0.74 cm², functional aortic valve area 0.55 cm², indexed functional aortic valve area 0.25 cm²/m², mean gradient 61 mmHg, peak gradient 100 mmHg, stroke volume (SV) 69 ml, stroke volume index (SVI) 31 ml/m², flow rate 221 ml/s, aortic annulus 20x26 mm). The left ventricle was severely dilated (end diastolic volume 268 ml) with diffuse hypokinesia and severe systolic dysfunction (ejection fraction 32%). We appreciated a calcification of the mitral-aortic intervalvular fibrosa and the mitral annulus, without mitral stenosis but with moderate mitral regurgitation. The calcification of the intervalvular fibrosa suggested our final diagnosis of radiation-induced valvular heart disease with a severe aortic stenosis in low-flow conditions. The patient was successfully treated with transcatheter aortic valve implantation (TAVI). Conclusion Radiation-induced heart disease is a common reality and is destinated to raise due to the increasing number of cancer survivors. Effects are seen also many years after the radiation treatment. The exact primary mechanism of radiation injury to the heart is still unknown. The treatment of radiation-induced valve disease is the same as the treatment of valve disease in the general population. Abstract P1692 Figure. Radiation-induced valvular heart disease

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One-stop PCI+TAVR intraoperative circulatory collapse and successful rescue of 1 case report

10.22541/au.162854109.98113034/v1 ◽

2021 ◽

Author(s):

Hang Zhang ◽

Jinghui An ◽

SU Liu ◽

Qianli Ma ◽

Feng-wu Shi

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Cardiopulmonary Bypass ◽

Aortic Stenosis ◽

Aortic Root ◽

Severe Aortic Stenosis ◽

Aortic Insufficiency ◽

Circulatory Collapse ◽

Chest Compressions ◽

One Stop

Background and Aim: We report a case of severe aortic stenosis accompanied by severe aortic insufficiency complicated with coronary heart disease who underwent one-stop PCI+TAVR intraoperative circulation collapse and was successfully rescued. Case Summary:A 73-year-old male patient with severe aortic stenosis with severe aortic insufficiency and coronary heart disease underwent one-stop TAVR+PCI with the aid of Cardiopulmonary bypass(CPB). PCI was successfully performed in the patient, and a 2.5*33cm Nano coronary stent was implanted. No residual stenosis was observed in angiography. During TAVR, A Venus-A L26mm interventional valve was inserted, and the valve slid slightly downward with poor position. Aortic root angiography showed A large amount of regurgitation and A progressive decrease in blood pressure, which could not be maintained even after the application of vasoactive drugs. Chest compressions were performed, and the extracorporeal circulation machine was opened to assist circulation. In the same way, A Venus-A L26mm interventional valve was placed in the previous valve. Aortic root angiography was performed without regurgitation. TEE examination showed that the valve opened and closed well and the orifice velocity was normal without regurgitation. After surgery, the patient returned to ICU smoothly. Conclusion: One-stop PCI+TAVR is a reasonable method for the treatment of aortic valve disease complicated with coronary heart disease. Cardiopulmonary bypass (CPB) is an effective method to deal with circulatory collapse in time.

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Surgical treatment of a patient with coronary heart disease and post-infarction left ventricular aneurism associated with aortic stenosis

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2017-95-8-758-761 ◽

2017 ◽

Vol 95 (8) ◽

pp. 758-761

Author(s):

I. A. Borisov ◽

Vadim V. Dalinin ◽

P. E. Krainyukov ◽

N. O. Travin

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Surgical Treatment ◽

Aortic Valve ◽

Aortic Stenosis ◽

Left Ventricular ◽

Unique Combination ◽

Heart Pathology ◽

Valve Prostheses

The paper reports a case of successful surgical treatment of a patient with coronary heart disease and post-infarction left ventricular aneurism associated with aortic stenosis. The unique combination of these two conditions is discussed along with advantages of seamless aortic valve prostheses for the treatment of combined heart pathology.

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Abstract 4290: Risk Factors and Prognostic Implications of Mitral Regurgitation in Severe Aortic Stenosis

Circulation ◽

10.1161/circ.118.suppl_18.s_859-d ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Padmini Varadarajan ◽

Ramdas G Pai

Keyword(s):

Risk Factors ◽

Aortic Valve ◽

Mitral Regurgitation ◽

Aortic Stenosis ◽

Independent Predictor ◽

Severe Aortic Stenosis ◽

Aortic Valve Area ◽

List Type ◽

Prognostic Implications ◽

Valve Area

Introduction: Mitral regurgitation (MR) is present in nearly half of the patients with severe aortic stenosis (AS). Risk factors for its development and its prognostic implications are not clear. Methods: Search of our echocardiographic database between 1993 to 2003 yielded 740 patients with severe AS defined as aortic valve area (AVA) ≤ 0.8cm2. Thorough chart reviews were conducted to collect clinical and pharmacological data. Mortality data was obtained from National death index. Results: Patient characteristics: age 74±13 years; females 60%, EF 54±20%, aortic valve area 0.67±0.17 cm2. MR grade ≥2+ were present in 339 (46%) patients: 2+ in 166 (22%), 3+ in 115 (16%) and 4+ in 58 (8%). There was a progressive decrease in survival with each grade of MR in the whole cohort as well as the surgically and medically treated subsets (p<0.0001, figure ). Presence of 3 and 4+ MR was associated with a larger LV (p<0.0001), lower EF (p<0.0001), greater age (p=0.0001), a smaller aortic valve area (p=0.001) and female gender (p=0.003). It remained an independent predictor of lower survival after adjusting for group differences using the Cox regression model. There was a lower AVR rate in those with 3 or 4+ MR compared to the rest (32 vs. 41%, p=0.03) despite a distinct independent survival advantage with AVR (RR 0.40, p<0.0001). Conclusion: Significant MR is present in nearly half of the patients with severe AS. The risk factors for its development include age, greater AS severity and LV dysfunction. It is an independent predictor of reduced survival.

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Abstract 258: Prevalence and Clinical Correlates of LVH by Sokolow-lyon and Cornell ECG Voltage Criteria in TAVR Patients

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.258 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Robert Zhang ◽

Emily Xiao ◽

Tarek Ibrahim ◽

Augustin Delago ◽

Mohammad El-Hajjar ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Stenosis ◽

Severe Aortic Stenosis ◽

Retrospective Chart Review ◽

Female Gender ◽

Transfemoral Approach ◽

Critical Aortic Stenosis ◽

Ecg Criteria ◽

Cornell Voltage

Background and Hypothesis: LV hypertrophy (LVH) due to critical aortic stenosis is expected in the TAVR patients. In a patient with a murmur and suspected aortic stenosis, absence of LVH by ECG criteria may suggest less severe aortic valve disease. However, the sensitivity of LVH analysis by ECG voltage criteria in patients with severe aortic valve stenosis undergoing trans-catheter aortic valve replacement (TAVR) has not yet been studied. Methods: A retrospective chart review was conducted in 388 consecutive TAVR patients (57.7% females, transfemoral approach in 59.3%, 77.9% with Sapien valve) without ventricular-paced rhythm. ECG data was collected and analyzed by Sokolow-Lyon and Cornell Voltage criteria. Results were compared to transthoracic echocardiogram. Analyses of variation, correlation, chi-square, and logistic regression were used. The study was approved by the institutional IRB. Results: LVH by echocardiographic criteria was present in all patients. Sokolow-Lyon and Cornell Voltage criteria for LVH were present and concordant in 15% of patients; and in 53% of patients, neither criteria was suggestive for LVH. Only 37% of patients had LVH by Cornell Voltage and 25% by Sokolow-Lyon criteria, indicative of poor concordance between these two commonly used ECG criteria for LVH (p<0.0001). Older age was strongly associated with presence of LVH voltage criteria by both Sokolow-Lyon (OR=1.052, 95%CI 1.019-1.085, p=0.001) and Cornell criteria (OR=1.030, 95%CI 1.002-1.059, p=0.035). However, female gender was only predictive of LVH voltage criteria by Sokolow-Lyon (OR=2.844, 95%CI 1.672-4.837, p=0.001) and not by Cornell criteria (OR=1.160, 95%CI 0.663-2.030, p=0.603). Conclusion: The presence of LVH by Sokolow-Lyon and Cornell ECG voltage criteria poorly correlates with the presence of LVH in critical aortic stenosis patients undergoing TAVR. Sokolow-Lyon may predict LVH better in female patients, Therefore, ECG does not appear to be a suitable method of screening patients with severe aortic stenosis for LVH and the lack of LVH by voltage criteria does not imply non-critical aortic valve stenosis.

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In Vitro Beating Heart Simulator for Minimally Invasive Heart Valve Therapy Research

ASME 2012 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2012-80743 ◽

2012 ◽

Author(s):

Michael B. Gogarty ◽

Lakshmi P. Dasi

Keyword(s):

Heart Disease ◽

Aortic Valve ◽

Aortic Stenosis ◽

Minimally Invasive ◽

Severe Aortic Stenosis ◽

Beating Heart ◽

First Year ◽

Major Contributor ◽

Typical Treatment

Heart disease is the number one cause of death today with aortic valve stenosis (AVS) being a major contributor to the mortality rate1. Because of the invasive nature of Aortic Valve Resection (AVR), the typical treatment for AVS, between 30–60% of patients affected by severe aortic stenosis cannot be treated surgically, usually due to age and advanced comorbidities. Qualifying individuals must undergo extensive rehabilitation and of those who qualify 4.3% to 25% do not survive the first year following the procedure3,4.

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One-stage treatment of aortic coarctation associated with coronary heart disease, ascending aortic aneurysm, and aortic valve stenosis with an extra-anatomic ascending-descending aortic bypass

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2005.02.053 ◽

2005 ◽

Vol 130 (2) ◽

pp. 582-583 ◽

Cited By ~ 2

Author(s):

Christian Kühn ◽

Omke E. Teebken ◽

Bernhard Gohrbandt ◽

Joachim Lotz ◽

Matthias Karck ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Aortic Valve ◽

Aortic Aneurysm ◽

Aortic Valve Stenosis ◽

Aortic Coarctation ◽

Ascending Aortic Aneurysm ◽

One Stage ◽

Aortic Bypass

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Elevated autotaxin plasma level as a marker of aortic valve stenosis in patients with coronary heart disease

Atherosclerosis ◽

10.1016/j.atherosclerosis.2018.06.493 ◽

2018 ◽

Vol 275 ◽

pp. e164

Author(s):

O. Afanasieva ◽

O. Razova ◽

N. Tmoyan ◽

H. Klesareva ◽

M. Afanasieva ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Aortic Valve ◽

Plasma Level ◽

Aortic Valve Stenosis

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Outcomes in Patients With Obstructive Hypertrophic Cardiomyopathy and Concomitant Aortic Stenosis Undergoing Surgical Myectomy and Aortic Valve Replacement

Journal of the American Heart Association ◽

10.1161/jaha.120.018435 ◽

2021 ◽

Author(s):

Milind Y. Desai ◽

Alaa Alashi ◽

Zoran B. Popovic ◽

Per Wierup ◽

Brian P. Griffin ◽

...

Keyword(s):

Risk Factors ◽

Aortic Valve ◽

Aortic Stenosis ◽

Left Ventricular Outflow Tract ◽

Severe Aortic Stenosis ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Outflow Tract ◽

Left Ventricular Outflow ◽

Surgical Myectomy

Background Hypertrophic cardiomyopathy (HCM) and aortic stenosis can cause obstruction to the flow of blood out of the left ventricular outflow tract into the aorta, with obstructive HCM resulting in dynamic left ventricular outflow tract obstruction and moderate or severe aortic stenosis causing fixed obstruction caused by calcific degeneration. We sought to report the characteristics and longer‐term outcomes of patients with severe obstructive HCM who also had concomitant moderate or severe aortic stenosis requiring surgical myectomy and aortic valve replacement. Methods and Results We studied 191 consecutive patients (age 67±6 years, 52% men) who underwent myectomy and aortic valve (AV) replacement (90% bioprosthesis) at our center between June 2002 and June 2018. Clinical and echo data including left ventricular outflow tract gradient and indexed AV area were recorded. The primary outcome was death. Prevalence of hypertension (63%) and hyperlipidemia (75%) were high, with a Society of Thoracic Surgeons score of 5±4, and 70% of participants had no HCM‐related sudden death risk factors. Basal septal thickness and indexed AV area were 1.9±0.4 cm and 0.72±0.2 cm 2 /m 2 , respectively, while 100% of patients had dynamic left ventricular outflow tract gradient >50 mm Hg. At 6.5±4 years, 52 (27%) patients died (1.5% in‐hospital deaths). One‐, 2‐, and 5‐year survival in the current study sample was 94%, 91%, and 83%, respectively, similar to an age‐sex–matched general US population. On multivariate Cox survival analysis, age (hazard ratio [HR], 1.65; 95% CI, 1.24–2.18), chronic kidney disease (HR, 1.58; 95% CI, 1.21–2.32), and right ventricular systolic pressure on preoperative echocardiography (HR, 1.28; 95% CI, 1.05–1.57) were associated with longer‐term mortality, but traditional HCM risk factors did not. Conclusions In symptomatic patients with severely obstructive HCM and moderate or severe aortic stenosis undergoing a combined surgical myectomy and AV replacement at our center, the observed postoperative mortality was significantly lower than the expected mortality, and the longer‐term survival was similar to a normal age‐sex–matched US population.

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