scholarly journals Early Outcomes in Patients with Severe Dilated Left Ventricle Disease after Heart Valve Surgery

2021 ◽  
Author(s):  
Siming Zhu ◽  
Shengli Jiang
Keyword(s):  
Mechanical Ventilation ◽  
Left Ventricle ◽  
Heart Valve ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Heart Valve Surgery ◽  
Vasoactive Agents

Objectives: The study sought to examine the prognostic impact of valvular surgery in patients with severe dilated left ventricle(DL) and assess morphological and functional changes of DL in the early period after operation. Methods: From January 2013 to December 2018, at a single center, 126 patients with severe dilated left ventricle (DL group) and 511 patients with 511 patients with normal sized left ventricle (NL group) underwent heart valve surgery. Retrospective review of the procedure and the postoperative clinical course, including echocardiography were analyzed in 6 to 12-month follow up. Results: Compared with NL group, DL group had significantly higher postoperative all-cause mortality (3.2% vs 1.4%) and complication rate, as well as longer duration of mechanical ventilation and vasoactive agents support. In DL group, 4 (3.2%) patients died in the early postoperative stage among which 2 (1.6%) patients died from multiple organ failure (MOF) secondary to severe low-output syndrome, 2 (1.6%) patients died from ventricular fibrillation. The DL group had longer time of mechanical ventilation and vasoactive agents support than NL group postoperatively. In DL group, the progressive regression of end-diastole diameter (LVEDD) was observed during the follow-up; whereas left ventricular ejection function (LVEF) and left ventricular fractional shortening (LVFS) showed a temporary decrease in early postoperative stage and then improved gradually. Conclusion: Heart valve surgery performed in an experienced center, along with sophisticated perioperative management, could bring satisfying early outcomes to patients with severe dilated left ventricle.

Beating Heart Valve Surgery in Patients with Low Left Ventricular Ejection Fraction

2010 ◽  
Vol 25 (3) ◽  
pp. 267-271 ◽  
Author(s):  
Francisco Igor B. Macedo ◽  
Enisa M. Carvalho ◽  
Mohammed Hassan ◽  
Marco Ricci ◽  
Edward Gologorsky ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Heart Valve ◽  
Left Ventricular ◽  
Beating Heart ◽  
Valve Surgery ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Heart Valve Surgery ◽  
Ventricular Ejection Fraction

scholarly journals Predictors and Early Outcome of Prolonged Mechanical Ventilation in Contemporary Heart valve Surgery

2015 ◽  
Vol 74 (1) ◽  
Author(s):  
Mahmood Shirzad ◽  
Abbasali Karimi ◽  
Seyed Hossein Ahmadi ◽  
Mehrab Marzban ◽  
Mokhtar Tazik ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Heart Valve ◽  
Prolonged Mechanical Ventilation ◽  
Postoperative Management ◽  
Valve Surgery ◽  
Heart Valve Surgery ◽  
Emergent Operation ◽  
Prophylactic Measures ◽  
Study Results ◽  
Patients At Risk

Background: During last decades mechanical ventilation has been an important support in the postoperative management of patients undergoing cardiac surgery. This study was designed to determine the predictors of prolonged mechanical ventilation (PMV) in patients undergoing heart valve surgery. Methods: This retrospective study considered of 1056 patients who underwent isolated valve surgery at Tehran Heart Center from March 2002 to March 2009. PMV is considered as mechanical ventilation period of ≥24 hours at postoperative hospital stay in this study. Results: PMV occurred in 6.6% of patients. Initial ventilation hours, atrial fibrillation, cardiac arrest and reintubation were the most prevalent postoperative complications. Preoperative renal failure, postoperative stroke, intra aortic balloon pump insertion, emergent operation, complete heart block, longer perfusion time were independent predictors of PMV in our patients. Conclusion: PMV is associated with significant comorbidities and increased hospital mortality. Strategies to delineate the patients at risk and to modify these risk factors by prophylactic measures should probably lead to a lower incidence of prolonged mechanical ventilation for patients undergoing isolated valve surgery.

Atrial mechanics and their prognostic impact in Takotsubo syndrome: a cardiovascular magnetic resonance imaging study

2019 ◽  
Vol 20 (9) ◽  
pp. 1059-1069 ◽  
Author(s):  
Sören J Backhaus ◽  
Thomas Stiermaier ◽  
Torben Lange ◽  
Amedeo Chiribiri ◽  
Johannes Uhlig ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricular ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Takotsubo Syndrome ◽  
Pump Function ◽  
Booster Pump

AbstractAimsThe exact pathophysiology of Takotsubo syndrome (TTS) remains not fully understood with most studies focussing on ventricular pathology. Since atrial involvement may have a significant role, we assessed the diagnostic and prognostic potential of atrial cardiovascular magnetic resonance feature tracking (CMR-FT) in TTS.Methods and resultsThis multicentre study recruited 152 TTS patients who underwent CMR on average within 3 days after hospitalization. Reservoir [total strain εs and peak positive strain rate (SR) SRs], conduit (passive strain εe and peak early negative SRe), and booster pump function (active strain εa and peak late negative SRa) were assessed in a core laboratory. Results were compared with 21 control patients with normal biventricular function. A total of 20 patients underwent follow-up CMR (median 3.5 months, interquartile range 3–5). All patients were approached for general follow-up. Left atrial (LA) but not right atrial (RA) reservoir and conduit function were impaired during the acute phase (εs: P = 0.043, εe: P < 0.001, SRe: P = 0.047 vs. controls) and recovered until follow-up (εs: P < 0.001, SRs: P = 0.04, εe: P = 0.001, SRe: P = 0.04). LA and RA booster pump function were increased in the acute setting (LA-εa: P = 0.045, SRa: P = 0.002 and RA-εa: P = 0.004, SRa: P = 0.002 vs. controls). LA-εs predicted mortality [hazard ratio 1.10, 95% confidence interval (CI) 1.01–1.20; P = 0.037] irrespectively of established cardiovascular risk factors (P = 0.019, multivariate analysis) including left ventricular ejection fraction (LVEF) (area under the curve 0.71, 95% CI 0.55–0.86, P = 0.048).ConclusionTTS pathophysiology comprises transient impairments in LA reservoir and conduit functions and enhanced bi-atrial active booster pump functions. Atrial CMR-FT may evolve as a superior marker of adverse events over and above established parameters such as LVEF and atrial volume.

scholarly journals Use of Sacubitril/valsartan in patients with cardio toxicity and heart failure due to chemotherapy

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Vanesa Gregorietti ◽  
Teresa Lopez Fernandez ◽  
Diego Costa ◽  
Elías Ortega Chahla ◽  
Andrés J. Daniele
Keyword(s):  
Heart Failure ◽  
Left Ventricle ◽  
Serum Creatinine ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Internal Diameter ◽  
Walk Test ◽  
Aldosterone Antagonists ◽  
Treatment Standard

Abstract Background Cancer therapy-related cardiac dysfunction (CTRCD) is a critical problem with an impact on both oncological and cardiovascular prognosis, especially when it prevents patients from receiving cancer treatment. Standard therapy for heart failure (HF) is recommended for CTRCD, but there is no well-established evidence on how sacubitril/valsartan may help cancer patients with cardiotoxicity. Objectives The aim of this trial was to study the effectiveness of sacubitril-valsartan in patients with CTRCD treated in cardio-oncology units. Methods We enrolled 635 patients with breast cancer and followed them with echocardiography and NT- proBNP. Patients who developed left ventricular dysfunction and heart failure were treated with angiotensin-converting enzyme inhibitors (ACEI) (enalapril) or angiotensin receptor blockers (ARB) (valsartan), aldosterone antagonists (eplerenone), digitalis and diuretics (furosemide), as needed. When patients remained symptomatic and met the PARADIGM-HF inclusion criteria, sacubitril/valsartan was started instead of enalapril or valsartan. We analyzed clinical, laboratory and echocardiographic variables to determine the beneficial effects of sacubitril/valsartan on left ventricular remodeling (improvement of left ventricular ejection fraction (LVEF), left ventricle internal diameter in diastole), diastolic dysfunction (E/e’ ratio), reduction in NT-proBNP levels, New York Heart Association (NHYA) class and improvement in the 6-min walk test. Also, we analyzed serum creatinine and potassium levels to determine treatmentsafety in this population. Median follow-up was 20 months. Results Twenty-eight patients developed cardiotoxicity and were treated with sacubitril/valsartan. The sacubitril/valsartan dose was 100 mg (sacubitril 49 mg/valsartan 51 mg) in 12 patients (42.85%) and 200 mg (sacubitril 97 mg/valsartan 103 mg) in 16 patients (57.15%). No deaths were reported, and one patient underwent heart transplantation. Baseline median NT-proBNP was 997.5 pg/ml (IQR 663.8 — 2380.8), which decreased to a median of 416.5 pg/ml (IQR 192.0–798.2) on follow-up with p < 0.001. Baseline NYHA functional class was III (78.6%) or IV (21.4%), and it improved to I (57.1%) or II (42.9%) on follow-up. LVEF increased with treatment from 26.7 ± 5.4% to 32.3 ± 5.5% (p < 0.001). There were also significant improvements in left ventricle internal diameter in diastole (LVIDD), diastolic function, 6-min walk test, and mitral valve regurgitation. There were no differences between basal and follow-up levels of serum creatinine or potassium. Conclusion Sacubitril/valsartan might be a promising treatment option in patients with refractory CTRCD.

scholarly journals Long-year follow-up of acute myocardial infarction with preserved initial LVEF: prognostic impact of progressively reduced LVEF

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Yoshioka ◽  
N Watanabe ◽  
Y Shibata ◽  
K Node
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Analysis ◽  
Risk Factor ◽  
Acute Phase ◽  
Chronic Phase ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Acute Mi

Abstract Background Severely reduced left ventricular ejection fraction (LVEF ≤35%) is commonly seen in approximately 5% of the myocardial infarction (MI) survivors in its acute-phase, which is recognized as a risk factor of post-MI cardiac death. However, clinical incidence and risk factor of the progressively reduced LVEF in the chronic-phase after MI has not been clarified. Purpose To evaluate clinical incidence and risk factor of the progressively reduced LVEF in the chronic-phase after MI by serial echocardiography. Method We evaluated 1144 consecutive patients with acute MI with preserved LVEF (≥50%) in acute-phase. Primary outcome was severely reduced LVEF (&lt;35%) in the chronic-pahse. We analyzed the predictive factor using multivariate analysis. Result During follow-up (median:1097 days), severely reduced LVEF newly developed in 8.6% of AMI survivors. Kaplan-meier curve is shown in the Figure. Multivariate analysis showed that men, eGFR &lt;30, AMI of LAD and absence of renin-angiotensin system blocking drugs was an independent predictor of severely reduced LVEF. Conclusions Progressively reduced LVEF during chronic-phase occurred 8.6% in acute MI survivors with preserved initial LVEF. Especially patients with these risk factors, careful long-term follow-up after MI should be needed to identify possible candidate for the implantable cardioverter-defibrillator. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Coronary computed tomography angiography detection of short- and long-term outcomes after heart valve surgery with high risk cardiovascular patients

2018 ◽  
Vol 38 (2) ◽  
Author(s):  
Zhi Zhu ◽  
Shuofeng Li
Keyword(s):  
High Risk ◽  
Heart Valve ◽  
Coronary Computed Tomography Angiography ◽  
Left Ventricular ◽  
Valve Surgery ◽  
Heart Valve Surgery ◽  
Long Term Outcomes ◽  
Cardiovascular Patients ◽  
Short And Long Term

Coronary computed tomography angiography (CCTA) is a promising alternative technique to detect significant coronary artery lesions in high-risk cardiovascular patients with left ventricular dysfunction (left ventricular ejection fractions < 40%) referred for elective valve surgery, while little research about the use of CCTA to detect the outcomes of heart valve surgery was performed. Forty-six consecutive high-risk cardiovascular patients with the New York Heart Association (NYHA) classification were retrospectively studied. Immediate, 10-week, 20-week, and 40-week outcomes after heart valve surgery were assessed with CCTA. Patients’ average age at the time of surgery was 73 years, with the majority being male (54.35%). Among the CCTA parameters detected after 10, 20, and 40 weeks after heart valve surgery, only segment involvement score (SIS) did reach statistical significance when compared with baseline levels. The cumulative mortality rate at 10, 20, and 40 weeks were 19.56%, 30.43%, and 39.13% respectively. It can be seen that the early death is mainly due to complications, and with the time-lapse of surgery, the impact of complications on death is gradually eliminated. CCTA might be a useful tool to detect the outcomes of short- and long-term outcomes after heart valve surgery with high risk cardiovascular patients, and SIS level is associated with the short- and long-term outcomes.

Fluorouracil Induces Myocardial Ischemia With Increases of Plasma Brain Natriuretic Peptide and Lactic Acid but Without Dysfunction of Left Ventricle

2010 ◽  
Vol 28 (36) ◽  
pp. 5280-5286 ◽  
Author(s):  
Søren Astrup Jensen ◽  
Philip Hasbak ◽  
Jann Mortensen ◽  
Jens Benn Sørensen
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Lactic Acid ◽  
Left Ventricle ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Left Ventricular ◽  
Left Ventricular Ejection

Purpose Fluorouracil (FU) is a cornerstone of colorectal cancer treatment; however, it has clinical and subclinical influence on the heart. This study aimed to clarify the pathophysiology, risk factors, and long-term effects of FU cardiotoxicity. Patients and Methods The study prospectively accrued colorectal cancer patients (n = 106) completely resected and adjuvantly treated with FU and oxaliplatin according to the FOLFOX4 regimen (infusional FU, folinic acid, and oxaliplatin). Serial measurements were made of systolic and diastolic features of the left ventricle by radionuclide ventriculography, plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), lactic acid, and ECG before chemotherapy, immediately after a treatment infusion, and at follow-up 2 weeks after cessation of the intended 12 treatment courses and were further evaluated by multivariate regression analysis that included cardiovascular history and its risk factors. Results In the entire cohort, NT-proBNP significantly increased from baseline 14.5 ± 3.2 pmol/L (mean ± standard error) to 28.3 ± 5.3 pmol/L during FU therapy (P < .001). Nine patients (8.5%) with cardiotoxicity had significantly higher NT-proBNP of 55.3 ± 40.8 pmol/L compared with 25.4 ± 4.1 pmol/L in those without (P < .001). In multivariate analysis, the FU-induced rise of NT-proBNP was significantly higher in females (P < .001). Plasma lactic acid significantly increased from baseline (1.3 ± 0.1 mmol/L to 1.8 ± 0.1 mmol/L) during FU therapy (P < .001). Left ventricular ejection fraction at baseline of 0.66 ± 0.01 remained unchanged at 0.65 ± 0.01 during FU therapy and 0.66 ± 0.01 at follow-up (P = .4). Conclusion FU therapy generally induces myocardial neuroendocrine changes with increasing plasma NT-proBNP and lactic acid but without long-term dysfunction of the left ventricle. The usability of NT-proBNP as a predictive marker for FU cardiotoxicity remains to be clarified.

scholarly journals Early follow-up after open heart valve surgery reduces healthcare costs: a propensity matched study

Open Heart ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. e001122 ◽  
Author(s):  
Britt Borregaard ◽  
Jacob Eifer Møller ◽  
Jordi Sanchez Dahl ◽  
Lars Peter Schødt Riber ◽  
Selina Kikkenborg Berg ◽  
...  
Keyword(s):  
Heart Valve ◽  
Healthcare Costs ◽  
Intervention Group ◽  
Valve Surgery ◽  
Control Group ◽  
Heart Valve Surgery ◽  
Open Heart ◽  
The Mean ◽  
The Cost

ObjectivesThe objective was to assess differences in healthcare costs within 180 days after discharge from open heart valve surgery in an intervention group receiving early, individualised and intensified follow-up compared with a historical control group.MethodsA cost-minimisation analysis comparing costs from a consecutive prospective cohort compared with a propensity matched cohort. Costs related to the intervention, hospital (outpatient visits and readmissions) and general practitioners (all contacts) were included. Data were obtained from electronic patient records and registry data. A logistic propensity model was used to identify the historical control group. Main results are presented as mean differences and 95% CIs based on bootstrapping.ResultsAfter matching, the analysis included 300 patients from the intervention group and 580 controls. The mean intervention cost was €171 (SD 79) per patient. After 180 days, the mean healthcare costs were €1284 (SD 2567) for the intervention group and €2077 (SD 4773) for the controls. The cost of the intervention group was €793 (p<0.001) less per patient. The cost differences were explained mainly by fewer readmissions, fewer overall emergency visits and fewer contacts to the general practitioner during out-of-hours in the intervention group.ConclusionsThe intervention consisting of early, individualised and intensified follow-up after open heart valve surgery significantly reduced the healthcare costs within 180 days after discharge.

scholarly journals Prognostic impact of non-improvement of global longitudinal strain in patients with revascularized acute myocardial infarction

2021 ◽  
Author(s):  
Jan Erik Otterstad ◽  
Ingvild Billehaug Norum ◽  
Vidar Ruddox ◽  
An Chau Maria Le ◽  
Bjørn Bendz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Longitudinal Strain ◽  
Cox Regression ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Prognostic Impact ◽  
Ventricular Ejection Fraction

AbstractGlobal longitudinal strain (GLS) is a more sensitive prognostic factor than left ventricular ejection fraction (LVEF) in various cardiac diseases. Little is known about the clinical impact of GLS changes after acute myocardial infarction (AMI). The present study aimed to explore if non-improvement of GLS after 3 months was associated with higher risk of subsequent composite cardiovascular events (CCVE). Patients with AMI were consecutively included at a secondary care center in Norway between April 2016 and July 2018 within 4 days following percutaneous coronary intervention. Echocardiography was performed at baseline and after 3 months. Patients were categorized with non-improvement (0 to − 100%) or improvement (0 to 100%) in GLS relative to the baseline value. Among 214 patients with mean age 65 (± 10) years and mean LVEF 50% (± 8) at baseline, 50 (23%) had non-improvement (GLS: − 16.0% (± 3.7) to − 14.2% (± 3.6)) and 164 (77%) had improvement (GLS: − 14.0% (± 3.0) to − 16.9% (± 3.0%)). During a mean follow-up of 3.3 years (95% CI 3.2 to 3.4) 77 CCVE occurred in 52 patients. In adjusted Cox regression analyses, baseline GLS was associated with all recurrent CCVE (HR 1.1, 95% CI 1.0 to 1.2, p < 0.001) whereas non-improvement versus improvement over 3 months follow-up was not. Baseline GLS was significantly associated with the number of CCVE in revascularized AMI patients whereas non-improvement of GLS after 3 months was not. Further large-scale studies are needed before repeated GLS measurements may be recommended in clinical practice.Trial registration: Current Research information system in Norway (CRISTIN). Id: 506563

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