Abstract 15265: Trace or Mild Valvular Heart Disease With Cardiac Remodeling, Damage, and Overload in Older Adults: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yumin Gao ◽  
Jonathan Rubin ◽  
Susan Cheng ◽  
Lena Mathews ◽  
Ajay Kirtane ◽  
...  
Keyword(s):  
Older Adults ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Cardiac Remodeling ◽  
Troponin T ◽  
Color Doppler ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index

Background: Few studies have evaluated the link between trace or mild valvular disease with measures of cardiac structure, function, and damage in a general population of older adults. Hypothesis: Three left-sided valvular conditions (aortic stenosis, aortic regurgitation, and mitral regurgitation) will be independently associated with cardiac remodeling, damage, and overload. Methods: In 4,935 ARIC participants aged 66-99 years in 2011-13, we examined the cross-sectional associations of these three valvular conditions, only in trace or mild forms, with echocardiographic measures (left ventricular mass index, left ventricular end-diastolic diameter [LVDd], ejection fraction [EF], left atrial volume index [LAVI]) and biomarkers (high sensitivity troponin-T [hs-TnT] and natriuretic peptide) using multivariable linear regression. Aortic stenosis was categorized as none or mild by peak transaortic jet velocity and mean transaortic gradient. Regurgitation was categorized as none, trace, or mild based on color Doppler signal (see the Table footnote for detailed definitions). Results: The prevalence was 4.3% for mild aortic stenosis, 10.8% for aortic regurgitation (10.3% trace, 0.5% mild), and 44.0% for mitral regurgitation (39.9% trace, 4.1% mild). Each valvular condition showed independent and graded associations with all measures tested (Table), with the exception of aortic stenosis with LVDd and aortic regurgitation with hs-TnT. There was a positive association between aortic stenosis and EF. The associations remained consistent when all three valvular conditions were modeled simultaneously. Conclusions: Three prevalent valvular conditions were independently associated with cardiac remodeling, damage, and overload. Although this study cannot determine the directionality of these associations, our results suggest the involvement of mild valvular abnormalities in the pathophysiology of functional and structural alteration of the heart.

scholarly journals P1518 Relationship between post-operative asymptomatic status and reverse remodeling of large left atrium in patients with aortic stenosis who underwent aortic valve replacement

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
T Hozumi ◽  
J Morimoto ◽  
T Nishi ◽  
K Takemoto ◽  
S Fujita ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Reverse Remodeling ◽  
Atrial Volume

Abstract Introduction Recently, we have reported that large left atrial volume (minimum left atrial volume index : LAVImin ≥30ml/m²) at end-diastole determined by direct exposure of left ventricular (LV) end-diastolic pressure can predict post-operative symptomatic status after aortic valve replacement (AVR) in aortic stenosis (AS) patients with high sensitivity and modest specificity. Reverse remodeling of large LAVImin after AVR may contribute to false positive for the prediction of post-operative symptomatic status in patients with AS. Purpose The purpose of this study was to evaluate relationship between post-operative symptomatic status and reverse remodeling of large LAVImin in patients with AS who underwent AVR. Methods The study population consisted of 75 patients with AS who underwent AVR and were followed up for 600 days after AVR, after the exclusion of the followings; atrial fibrillation, significant coronary artery disease, significant mitral valve disease, pacemaker rhythm, and inadequate echocardiographic images. We measured LAVImin by biplane Simpson"s method before and after AVR. Preoperative large LAVImin (≥30ml/m²) according to the previous study was observed in 32 (43%) of 75 patients. We divided these 32 patients into two groups according to the post-operative symptomatic status during the follow-up period. Results There was no significant difference in pre-operative LAVImin between patients with and without post-operative symptom (46.5 ± 13.4 vs 40.4 ± 8.6 ml/m²). On the other hand, post-operative LAVImin in patients without post-operative symptom was significantly smaller than that in patients with post-operative symptom (31.5 ± 8.6 vs 54.8 ± 14.0 ml/m², p < 0.01). While significant regression in LAVImin after AVR was observed in patients without post-operative symptom (40.4 ± 8.6 to 31.5 ± 8.6 ml/m², p < 0.05), no regression in LAVImin after AVR was observed in patients with post-operative symptom (46.5 ± 13.4 to 54.8 ± 14.0 ml/m²). Conclusions Reverse remodeling of large LAVmin in patients with AS who underwent AVR was observed in post-operative asymptomatic group, but not in symptomatic group. These results suggest that reverse remodeling of large LAVImin after AVR could contribute to the post-operative asymptomatic status in patients with AS who underwent AVR.

scholarly journals Short-term adverse remodeling progression in asymptomatic aortic stenosis

2020 ◽  
Author(s):  
Anvesha Singh ◽  
Daniel C. S. Chan ◽  
Prathap Kanagala ◽  
Kai Hogrefe ◽  
Damian J. Kelly ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Cardiac Remodeling ◽  
Extracellular Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Area Index ◽  
Asymptomatic Patients ◽  
Adverse Remodeling

Abstract Objectives Aortic stenosis (AS) is characterised by a long and variable asymptomatic course. Our objective was to use cardiovascular magnetic resonance imaging (MRI) to assess progression of adverse remodeling in asymptomatic AS. Methods Participants from the PRIMID-AS study, a prospective, multi-centre observational study of asymptomatic patients with moderate to severe AS, who remained asymptomatic at 12 months, were invited to undergo a repeat cardiac MRI. Results Forty-three participants with moderate-severe AS (mean age 64.4 ± 14.8 years, 83.4% male, aortic valve area index 0.54 ± 0.15 cm2/m2) were included. There was small but significant increase in indexed left ventricular (LV) (90.7 ± 22.0 to 94.5 ± 23.1 ml/m2, p = 0.007) and left atrial volumes (52.9 ± 11.3 to 58.6 ± 13.6 ml/m2, p < 0.001), with a decrease in systolic (LV ejection fraction 57.9 ± 4.6 to 55.6 ± 4.1%, p = 0.001) and diastolic (longitudinal diastolic strain rate 1.06 ± 0.2 to 0.99 ± 0.2 1/s, p = 0.026) function, but no overall change in LV mass or mass/volume. Late gadolinium enhancement increased (2.02 to 4.26 g, p < 0.001) but markers of diffuse interstitial fibrosis did not change significantly (extracellular volume index 12.9 [11.4, 17.0] ml/m2 to 13.3 [11.1, 15.1] ml/m2, p = 0.689). There was also a significant increase in the levels of NT-proBNP (43.6 [13.45, 137.08] pg/ml to 53.4 [19.14, 202.20] pg/ml, p = 0.001). Conclusions There is progression in cardiac remodeling with increasing scar burden even in asymptomatic AS. Given the lack of reversibility of LGE post-AVR and its association with long-term mortality post-AVR, this suggests the potential need for earlier intervention, before the accumulation of LGE, to improve the long-term outcomes in AS. Key Points • Current guidelines recommend waiting until symptom onset before valve replacement in severe AS. • MRI showed clear progression in cardiac remodeling over 12 months in asymptomatic patients with AS, with near doubling in LGE. • This highlights the need for potentially earlier intervention or better risk stratification in AS.

scholarly journals Co-existing aortic regurgitation associated with adverse clinical outcomes in patients with moderate to severe aortic stenosis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Ngiam ◽  
N Chew ◽  
C.H Sia ◽  
B.Y.Q Tan ◽  
H.W Sim ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Clinical Outcomes ◽  
Aortic Regurgitation ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Volume Index ◽  
Left Ventricular Ejection ◽  
Exclusion Criterion ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Background Aortic regurgitation (AR) is a common comorbidity in patients with aortic stenosis (AS), but co-existing AR has often been an exclusion criterion from major clinical trials. The impact of co-existing AR on the natural history of AS has not been well-described. Purpose We compared clinical outcomes in patients with moderate to severe AS with or without co-existing AR. Methods Consecutive patients (n=1188) with index echocardiographic diagnosis of moderate to severe AS (AVA &lt;1.5cm2) were studied. They were divided into those with co-existing AR (at least moderate severity) and those without. Adverse composite clinical outcomes were defined as either mortality or admissions for congestive cardiac failure on subsequent follow-up for at least five years. Appropriate univariate and multivariable analyses were employed to compare the two groups. Results There were 88 patients (7.4%) with co-existing AR and AS. These patients did not differ significantly in age, but had lower body mass index (22.9±3.8 vs 25.3±5.1 kg/m2). They also had lower diastolic blood pressure (68.7±10.7 vs 72.2±12.3 mmHg), larger end-diastolic volume index (68.8±18.8 vs 60.4±17.8 ml/m2) and left ventricular mass index (118.6±36.4 vs 108.9±33.1 g/m2). The prevalence of cardiovascular risk factors did not differ significantly between the groups. Co-existing AR was associated with adverse outcomes (log-rank 4.20, p=0.040). On multivariable Cox-regression, co-existing AR remained independently associated with adverse outcomes (hazard ratio 1.51, 95% CI 1.13–2.02) after adjusting for age, AS severity and left ventricular ejection fraction. Conclusion In patients with AS, co-existing AR was associated with a distinct echocardiographic profile and adverse outcomes. Funding Acknowledgement Type of funding source: None

scholarly journals Athlete’s Heart in Elite Biathlon, Nordic Cross—Country and Ski-Mountaineering Athletes: Cardiac Adaptions Determined Using Echocardiographic Data

2021 ◽  
Vol 9 (1) ◽  
pp. 8
Author(s):  
Paul Zimmermann ◽  
Othmar Moser ◽  
Max L. Eckstein ◽  
Jan Wüstenfeld ◽  
Volker Schöffl ◽  
...  
Keyword(s):  
Cardiac Remodeling ◽  
Left Atrial ◽  
Systolic Function ◽  
Global Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Atrial Remodeling ◽  
Winter Sports ◽  
Cross Country

Twelve world elite Biathlon (Bia), ten Nordic Cross Country (NCC) and ten ski-mountaineering (Ski-Mo) athletes were evaluated for pronounced echocardiographic physiological cardiac remodeling as a primary aim of our descriptive preliminary report. In this context, sports-related cardiac remodeling was analyzed by performing two-dimensional echocardiography including speckle tracking analysis as left ventricular global longitudinal strain (LV-GLS). A multicenter retrospective analysis of echocardiographic data was performed in 32 elite world winter sports athletes, which were obtained between 2020 and 2021 during the annual medical examination. The matched data of the elite world winter sports athletes (14 women, 18 male athletes, age: 18–35 years) were compared for different echocardiographic parameters. Significant differences could be revealed for left ventricular systolic function (LV-EF, p = 0.0001), left ventricular mass index (LV Mass index, p = 0.0078), left atrial remodeling by left atrial volume index (LAVI, p = 0.0052), and LV-GLS (p = 0.0003) between the three professional winter sports disciplines. This report provides new evidence that resting measures of cardiac structure and function in elite winter sport professionals can identify sport specific remodeling of the left heart, against the background of training schedule and training frequency.

Abstract 14264: The Impact of Bariatric Surgery on Echocardiographic Features of Cardiac Remodeling and Diastolic Function

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Raj K Dalsania ◽  
Kaitlyn Ibrahim ◽  
Rohit Soans ◽  
Abdullah Haddad ◽  
Vikram J Eddy ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Cardiac Remodeling ◽  
Systolic Pressure ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Pulmonary Artery Systolic Pressure ◽  
Increased Risk ◽  
Lv Mass ◽  
The Impact

Introduction: Candidates for bariatric surgery are at increased risk for cardiovascular disease and often develop adverse cardiac remodeling as a result of obesity. Bariatric surgery can alter cardiac structure and function in these patients; however, this has not been fully investigated. Hypothesis: We hypothesized that patients undergoing bariatric surgery would demonstrate favorable cardiac remodeling and improvement in diastolic parameters according to the American Society of Echocardiography (ASE) guidelines. Methods: All patients undergoing bariatric surgery at our institution from 2014-2018 were reviewed. In patients with pre- and post-operative echocardiograms, the following were measured: left ventricular (LV) size, pulmonary artery systolic pressure (PASP), LV mass, mitral E/A, LV ejection fraction (EF), medial and lateral E/e’, medial e’ and a’, lateral e’ and a’, tricuspid regurgitation (TR) velocity, left atrial volume index (LAVI), degree of LV hypertrophy, and relative wall thickness (RWT). The grade of diastolic dysfunction (DD) was calculated according to ASE guidelines. Results: A total of 69 patients met criteria for inclusion, with 77% (n=53) female, 87% (n=60) non-white, and mean age 49±10.7. Mean decrease in BMI one year post-operatively was 14.6±5.7 kg/m 2 . Median time between bariatric surgery and post-operative echocardiogram was 21.8 months. Post-operatively, there was a mean 17.8 cm/s decrease in TR velocity (p=0.0064) and 4.2 mmHg decrease in PASP (p=0.02). LAVI increased by 3.4 mL/m 2 (p=0.048). There was no significant change in LV size, LV mass, LVEF, LV hypertrophy, or RWT. Out of the 29 patients with pre-existing DD (grade 1, n=20; grade 2, n=8; grade 3, n=1), 45% (n=13) demonstrated improvement in grade of DD. When compared to pre-operative DD, post-operatively, 5 of 20 patients with G1DD had no DD, 2 of 8 patients with G2DD had no DD, 5 of 8 patients with G2DD had G1DD, and 1 patient with G3DD had G1DD. This was driven by a decrease in TR velocity and medial E/e’. Conclusions: In patients undergoing bariatric surgery, TR velocity and PASP improved while LAVI paradoxically increased. Patients with pre-existing DD demonstrated improvement in diastology, driven by changes in TR velocity and medial E/e’.

scholarly journals Reducing Morbidity and Mortality in Patients With Coarctation Requires Systematic Differentiation of Impacts of Mixed Valvular Disease on Coarctation Hemodynamics

2022 ◽  
Author(s):  
Reza Sadeghi ◽  
Benjamin Tomka ◽  
Seyedvahid Khodaei ◽  
Julio Garcia ◽  
Javier Ganame ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Aortic Regurgitation ◽  
Surgical Techniques ◽  
Left Ventricular ◽  
Valvular Disease ◽  
Morbidity And Mortality ◽  
Long Term Results ◽  
Patient Specific ◽  
Valvular Diseases

Background Despite ongoing advances in surgical techniques for coarctation of the aorta (COA) repair, the long‐term results are not always benign. Associated mixed valvular diseases (various combinations of aortic and mitral valvular pathologies) are responsible for considerable postoperative morbidity and mortality. We investigated the impact of COA and mixed valvular diseases on hemodynamics. Methods and Results We developed a patient‐specific computational framework. Our results demonstrate that mixed valvular diseases interact with COA fluid dynamics and contribute to speed up the progression of the disease by amplifying the irregular flow patterns downstream of COA (local) and exacerbating the left ventricular function (global) (N=26). Velocity downstream of COA with aortic regurgitation alone was increased, and the situation got worse when COA and aortic regurgitation coexisted with mitral regurgitation (COA with normal valves: 5.27 m/s, COA with only aortic regurgitation: 8.8 m/s, COA with aortic and mitral regurgitation: 9.36 m/s; patient 2). Workload in these patients was increased because of the presence of aortic stenosis alone, aortic regurgitation alone, mitral regurgitation alone, and when they coexisted (COA with normal valves: 1.0617 J; COA with only aortic stenosis: 1.225 J; COA with only aortic regurgitation: 1.6512 J; COA with only mitral regurgitation: 1.3599 J; patient 1). Conclusions Not only the severity of COA, but also the presence and the severity of mixed valvular disease should be considered in the evaluation of risks in patients. The results suggest that more aggressive surgical approaches may be required, because regularly chosen current surgical techniques may not be optimal for such patients.

scholarly journals Left atrial volume stress echocardiography in chronic coronary syndromes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Morrone ◽  
R Arbucci ◽  
K Wierzbowska-Drabik ◽  
Q Ciampi ◽  
J Peteiro ◽  
...  
Keyword(s):  
Left Atrial ◽  
Stress Echocardiography ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Contractile Reserve ◽  
Atrial Volume ◽  
Reservoir Function ◽  
Coronary Syndromes ◽  
B Lines

Abstract Background An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify LAVI within minutes. Purpose To assess the feasibility and functional correlates of LAVI-stress echocardiography (SE) Methods Out of 514 subjects referred to 10 quality-controlled labs, LAVI-SE was completed in 490 (359 male, age 67±12 yrs, ejection fraction 60±10%) with suspected or known chronic coronary syndromes (n=462) or asymptomatic controls (n=28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAVI was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. In a single center sub-study in 50 subjects, including 28 controls and 22 patients, also peak longitudinal atrial strain (PALS, %) was measured as an index of LA reservoir function. Results The intra-observer and inter-observer LAVI variability were 5% and 8%, respectively. Δ-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r=−0.271, p&lt;0.001), heart rate reserve (r=−0.239, p&lt;0.001), and Δ-PALS (n=50, r=−0.374, p=0.007).LAVI-dilators were defined as those with stress-rest increase ≥6.8 ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAVI dilation (see figure) occurred in 56 patients (11%). At multivariable logistic regression analysis, B-lines ≥2 (OR: 2.586, 95% CI =1.1293–5.169, p=0.007) and abnormal left ventricular contractile reserve (OR: 2.207, 95% CI=1.111–4.386, p=0.024) were associated with LAVI dilation. Conclusion LAVI-SE is feasible, with high success rate and low variability, in patients with chronic coronary syndromes. A wet (increased B-lines) and weak (reduced LV contractile reserve and LA reservoir function) heart frequently portends LAVI dilation during stress. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Features of the relationship between the parameters of left ventricular mechanics and the level of biomarkers of heart failure in patients with epicardial obesity

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
O Gritsenko ◽  
GA Chumakova
Keyword(s):  
Heart Failure ◽  
Diastolic Dysfunction ◽  
Speckle Tracking ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Serum Biomarker ◽  
Volume Index ◽  
Time To Peak ◽  
Ventricular Mechanics ◽  
The Relationship

Abstract Funding Acknowledgements Type of funding sources: None. Currently, there is no serum biomarker that is a marker of the presence of heart failure (HF) at an early stage. It is also shown that the traditional indicators used for the diagnosis diastolic dysfunction (DD) of left ventricular (LV) using echocardiography (ECG) are not informative enough. Thus, it is currently relevant to study new serum biomarkers of DD, such as sST2, as well as to study the mechanics of LV. Objective to study the relationship between mechanics of LV and the level of sST2 (bioamarker of HF) in patients with epicardial obesity (EO). Materials and methods The study included 110 men with general obesity. According to the results of echocardiography (ECG), patients were divided into 2 groups: EO (+) with epicardial fat thickness (tEAT) ≥7 mm (n = 70); EO (-) with tEAT &lt;7 mm (n = 40) without diastolic dysfunction according to the results of ECG. All patients were assessed for sST2 and NT-pro-BNP levels using enzyme immunoassay. Using speckle-tracking ECG, the mechanics of LV were studied (twist LV, peak twist ratio LV, time to peak twist of LV, peak untwist ratio LV, time to peak untwist of LV). The exclusion criteria were the presence of coronary pathology, arterial hypertension, and type 2 diabetes mellitus. Results In the group patients with EO ( + ) a statistically significant increase in the level of sST2 was revealed in comparison with the group of EO (-) [21,55 ng/ml (26,52; 15,40) and 9.89 ng/ml (11.12; 7.95); p = 0.001, respectively], while the levels of NT-pro-BNP in both groups were not statistically different [211.36 pg / ml (254.0; 156.0) and 204.81 pg / ml (268.0; 157.0), respectively, p = 0.85]. When determining the parameters of DD LV by ECG, there were no statistical differences between the EO (+) and EO (-) groups [e ", cm / sec 0.09 (0.11; 0.09) and 0.09 (0.11; 0.09), respectively, p = 0.63; E/e " , units, 7.80 (8.90; 6.55) in the EO (+) and 8.53 (9.70; 7.20) in the EO group ( - ), p = 0.08; left atrial volume index, ml / sq2, in the EO group (+) 28.39 (31.25; 24.17) and in the EO group(-) 27,82 (30,21; 25,66), p = 0.55; in the EO group ( + ), the maximum speed of tricuspid regurgitation, m / sec, is 2.78 (2.9; 2.58) in the EO group(-) 2,67 (2,87; 2,41), p = 0.13]. According to the results of speckle-tracking ECG in the EO (+) group, an increase peak untwist ratio LV to -128.31 (-142.0; -118.0) deg/s-1 (p = 0.002) and an increase time to peak untwist of LV of 476.44 (510.0; 411.0) msec was determined in comparison with the EO ( - ) group (p = 0.03). A significant relationship between peak untwist ratio LV and sST2 was revealed (r = 0.37; p = 0.02). Conclusion Thus, it can be assumed that patients with EO have DD LV at the preclinical stage, which is not diagnosed using traditional ECG indicators. The serum biomarker sST2 is an early marker of the presence of HF.

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