Abstract 13512: Sex-related Differences on Valvular Calcifications in Patients With Aortic Stenosis

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Marianne Deslandes ◽  
Marine Clisson ◽  
Ezequiel Guzzetti ◽  
Alexandra Barriault ◽  
Erwan Salaun ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Aortic Valve ◽  
Independent Predictor ◽  
Cross Sectional Study ◽  
Aortic Valve Area ◽  
Mitral Annular Calcification ◽  
Cross Sectional ◽  
Multidetector Compute Tomography ◽  
Annular Calcification ◽  
Valve Area

Introduction: It has been shown that women present lower coronary artery (CAC) and aortic valve calcification (AVC) loads while heavier mitral annular calcification (MAC) than men. However, the sex-specific predictors to these cardiac calcifications remain poorly characterized. Methods: We conducted a cross-sectional study in patients with at least mild AS (indexed aortic valve area: AVAi < 1.5 cm 2 /m 2 , Peak aortic jet velocity: Vpeak > 2.0 m/s, or Mean gradient: MG >15 mmHg). Doppler-echocardiography and non-contrast multidetector compute tomography were performed within 3 months. Ascending aorta calcification (AAC), AVC, CAC and MAC scores were measured using the Agatston method. Descriptive statistical analyses (t-test, Wilcoxon, univariate and multivariate analysis) were performed. Results: We studied 406 patients (71±11 years, 33% women) with AVAi= 0.59±0.21 cm 2 /cm 2 , Vpeak= 3.1±9.8 m/s, MG= 24.7±17.8 mmHg (equivalent between men and women, all p>0.34). Women present less AVC (480[222-1191] vs 1005[485-2364]AU; p<0.0001), and CAC (366[50-914] vs 626[167-1354]AU; p=0.006), but more MAC (60[1-887] vs 48[0-363]AU; p=0.05) and AAC (227[43-863] vs 142[7-493]AU; p=0.03) than men. Even after comprehensive adjustment, sex remained an independent predictor of each cardiac calcification (all p<0.01). In multivariate analysis, correlates with higher AVC or higher MAC were sex dependent (cf. table). Collinearity was avoided with all variance inflating factor <2.5. Conclusion: In AS patients, sex is a powerful and independent predictor of cardiac calcifications. Moreover, predictors of valvular calcification appear to be sex specific.

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

Circulation ◽  
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.

scholarly journals Clinical and echocardiographic predictors of silent cerebral infarctions in patients with persistent atrial fibrillation

2014 ◽  
Vol 20 (2) ◽  
pp. 10-17
Author(s):  
Oleg Sychov ◽  
Artem Borodai ◽  
Svetlana Fedkiv ◽  
Elina Borodai ◽  
Taisia Getman ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Creatinine Clearance ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Persistent Atrial Fibrillation ◽  
Cross Sectional Study ◽  
Neurological Dysfunction ◽  
Cross Sectional ◽  
History Of

Summary Aim. The aims of the study were to evaluate prevalence of silent cerebral infarctions (SCI) and determine their clinical and echocardiographic predictors in patients with atrial fibrillation (AF). Patients and methods. In prospective cross sectional study we examined 134 patients with non-valvular AF. Clinical examination, laboratory tests, transoesophageal, transthoracic echocardiography and multislice computed tomography of the brain were performed for all patients. According to current guidelines, SCI was defined as imaging (≥3 mm) or neuropathological evidence of central nervous system infarction, without a history of acute neurological dysfunction attributable to the lesion. Results. Silent cerebral infarctions were detected in 34.3% (n = 46) of patients, and infarctions ≥ 15 mm (mean diameter 31.3 mm) were detected in 11.2% (n = 15) of patients. Superficial SCIwere found in 12.7%and basal SCI in 21.6% of cases. In multivariate analysis low creatinine clearance < 90 ml/min was independently associated with small basal SCI (p = 0.04). In univariate analysis age ≥ 65 years was significantly associated with basal SCI, p = 0.004, but not with SCI ≥ 15 mm or superficial SCI. The results of multivariate analysis showed that CHA2DS2VASc score was an independent predictor of superficial SCI; low left atrial appendage velocity (LAAV) < 30 cm/s was independently associated both with SCI ≥ 15 mm (p = 0.03) and superficial SCI (p = 0.02). Conclusions. Large and superficial SCI were significantly and independently associated with low LAAV < 30 cm/s and other echocardiographic embolic risk factors and in case of absence of significant large arteries atherosclerosis may be considered as those of cardiac origin. Small basal SCI were associated with age and low creatinine clearance < 90 ml/min which was their independent predictor. CHA2DS2VASc score is useful for assessment of risk of cerebral infarctions even those without history of acute symptoms

scholarly journals Effects of mitral annular calcification on the outcomes of transcatheter aortic valve implantation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y Z Sener ◽  
S L Tokgozoglu ◽  
S Ardali ◽  
U N Karakulak ◽  
A H Ates ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Independent Predictor ◽  
Pacemaker Implantation ◽  
Left Ventricular ◽  
Permanent Pacemaker ◽  
Mitral Annular Calcification ◽  
Permanent Pacemaker Implantation ◽  
All Cause Mortality ◽  
Annular Calcification

Abstract Background Transcatheter aortic valve implantation (TAVI) has become the standard of care treatment in patients with severe aortic stenosis who carry intermediate or high risk for surgical aortic valve replacement. Mitral annular calcification (MAC) is frequently seen in patients with aortic stenosis and it is associated with increased cardiovascular morbidity and mortality. It is reported that MAC is an independent predictor of all cause mortality after TAVI. Aim The aim of this study is to both evaluate the relationship between mitral annular calcification and TAVI related complications and mortality; and to define the predictors of both all cause mortality and permanent pacemaker implantation after TAVI. Methods All of the patients who underwent TAVI procedure due to severe aortic stenosis between 01.01.2020 and 01.06.2020 in our University Hospital were screened and patients fullfilling including criterias were enrolled. Patients' baseline demographic datas, laboratory, echocardiography and TAVI procedure related parameters were recorded. Outcomes are identified as follows; association between mitral annular calcification and TAVI related complications, establishment of the predictors of all cause mortality and permanent pacemaker implantation, definition of the in-hospital and all cause mortality rates. Results A total of 245 patients including 98 males (40%) and 147 females (60%) were enrolled in the study. The mean age of the population was 76,3±8,3 years. The mean left ventricular ejection fraction was % 54,8±11,4; aortic valve area was 0,74±0,14 cm2 and mean aortic transvalvular gradient was 47,0±14,3 mmHg. MAC was detected in 148 (% 60,4) patients (Table 1). In-hospital mortality was occurred in 14 (5,7%) cases. Permanent pacemaker implantation was performed in %17,8 (n=42) patients and all cause mortality was developed in 89 (36,3%) cases during the median 23,1 (11,6–44,3) months follow-up. Pericardial effusion (26,4% vs 12,4%; p=0,013) and contrast induced nephropathy (21,6% vs 7,2%; p=0,005) were developed more frequently in patients with MAC than without MAC (Table-2). Only the presence of MAC extending to left ventricular outflow tract was detected to be independent predictor of permanent pacemaker implantation requirement (HR: 3,32; p=0,002). All cause mortality predictors were established as; use of renin-angiotensin-aldosterone system blockers (HR: p=0,012), level of hemoglobin (HR: 0,79; p=0,006), severe mitral annular calcification (HR: 1,94; p=0,024) and atrial fibrillation development after TAVI (HR: 2,39; p=0,002). There was not any correlation between aortic valve area and MAC vloume (r=0,03; p=0,689), MAC Hounsfield Unit (r=−0,007; p=0,934) and MAC Agatston score (r=−0,08; p=0,290). Discussion MAC is associated with all cause mortality after TAVI and MAC extending to left ventricular outflow tract is an independent predictor of permanent pacemaker implantation requirement. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Size-adjusted aortic valve area: refining the definition of severe aortic stenosis

2020 ◽  
Author(s):  
Branka Vulesevic ◽  
Naozumi Kubota ◽  
Ian G Burwash ◽  
Claire Cimadevilla ◽  
Sarah Tubiana ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Predictive Accuracy ◽  
Severe Aortic Stenosis ◽  
Aortic Valve Area ◽  
Obese Patients ◽  
Derivation Cohort ◽  
Wide Range ◽  
Definition Of ◽  
Diagnostic And Prognostic Value ◽  
Valve Area

Abstract Aims Severe aortic valve stenosis (AS) is defined by an aortic valve area (AVA) &lt;1 cm2 or an AVA indexed to body surface area (BSA) &lt;0.6 cm/m2, despite little evidence supporting the latter approach and important intrinsic limitations of BSA indexation. We hypothesized that AVA indexed to height (H) might be more applicable to a wide range of populations and body morphologies and might provide a better predictive accuracy. Methods and results In 1298 patients with degenerative AS and preserved ejection fraction from three different countries and continents (derivation cohort), we aimed to establish an AVA/H threshold that would be equivalent to 1.0 cm2 for defining severe AS. In a distinct prospective validation cohort of 395 patients, we compared the predictive accuracy of AVA/BSA and AVA/H. Correlations between AVA and AVA/BSA or AVA/H were excellent (all R2 &gt; 0.79) but greater with AVA/H. Regressions lines were markedly different in obese and non-obese patients with AVA/BSA (P &lt; 0.0001) but almost identical with AVA/H (P = 0.16). AVA/BSA values that corresponded to an AVA of 1.0 cm2 were markedly different in obese and non-obese patients (0.48 and 0.59 cm2/m2) but not with AVA/H (0.61 cm2/m for both). Agreement for the diagnosis of severe AS (AVA &lt; 1 cm2) was significantly higher with AVA/H than with AVA/BSA (P &lt; 0.05). Similar results were observed across the three countries. An AVA/H cut-off value of 0.6 cm2/m [HR = 8.2(5.6–12.1)] provided the best predictive value for the occurrence of AS-related events [absolute AVA of 1 cm2: HR = 7.3(5.0–10.7); AVA/BSA of 0.6 cm2/m2 HR = 6.7(4.4–10.0)]. Conclusion In a large multinational/multiracial cohort, AVA/H was better correlated with AVA than AVA/BSA and a cut-off value of 0.6 cm2/m provided a better diagnostic and prognostic value than 0.6 cm2/m2. Our results suggest that severe AS should be defined as an AVA &lt; 1 cm2 or an AVA/H &lt; 0.6 cm2/m rather than a BSA-indexed value of 0.6 cm2/m2.

scholarly journals P1692 The past returns after 20 years: a case report

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

scholarly journals Stenotic Aortic Valve Area

2015 ◽  
Vol 8 (3) ◽  
pp. 258-260 ◽  
Author(s):  
Frank A. Flachskampf
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Area ◽  
Valve Area
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