scholarly journals Serum Biomarkers of Cardiovascular Remodelling Reflect Extra-Valvular Cardiac Damage in Patients with Severe Aortic Stenosis

2020 ◽  
Vol 21 (11) ◽  
pp. 4174
Author(s):  
Laura Bäz ◽  
Gudrun Dannberg ◽  
Katja Grün ◽  
Julian Westphal ◽  
Sven Möbius-Winkler ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Serum Levels ◽  
Serum Biomarkers ◽  
Tissue Remodelling ◽  
Cardiac Damage ◽  
Right Heart ◽  
Cardiovascular Tissue ◽  
Left And Right ◽  
Staging Classification

In patients with aortic stenosis (AS), a novel staging classification of extra-valvular left and right heart damage with prognostic relevance was introduced in 2017. The aim of the study was to evaluate the biomarkers of cardiovascular tissue remodelling in relation to this novel staging classification. Patients were categorized according to the novel staging classification into stages 0 to 4. The levels of matrix metalloproteinase 9 (MMP-9), tissue inhibitor of metalloproteinases 1 (TIMP-1), B and C domain containing tenascin-C (B+ Tn-C, C+ Tn-C), the ED-A and ED-B domain containing fibronectin (ED-A+ Fn, ED-B+ Fn), endothelin 1 (ET-1) and neutrophil gelatinase-associated lipocalin (NGAL) were determined in serum by ELISA. There were significantly decreased serum levels of MMP-9 and increased levels of B+ Tn-C and C+ Tn-C when comparing stages 0 and 1 with stage 2, with no further dynamics in stages 3 and 4. In contrast, for TIMP-1, C+ Tn-C, ED-A+ Fn, ET-1 and NGAL, significantly increased serum levels could be detected in stages 3 and 4 compared to both stages 0 and 1 and stage 2. ED-A+ Fn and ET-1 could be identified as independent predictors of the presence of stage 3 and/or 4. To the best of our knowledge, this is the first study identifying novel serum biomarkers differentially reflecting the patterns of left and right heart extra-valvular damage in patients suffering from AS. Our findings might indicate a more precise initial diagnosis and risk stratification.

scholarly journals Incremental value of left ventricular global longitudinal strain in a newly proposed staging classification based on cardiac damage in patients with severe aortic stenosis

2020 ◽  
Vol 21 (11) ◽  
pp. 1248-1258 ◽  
Author(s):  
E Mara Vollema ◽  
Mohammed R Amanullah ◽  
Edgard A Prihadi ◽  
Arnold C T Ng ◽  
Pieter van der Bijl ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Prognostic Value ◽  
Longitudinal Strain ◽  
Severe Aortic Stenosis ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Cardiac Damage ◽  
All Cause Mortality ◽  
Incremental Prognostic Value ◽  
Staging Classification

Abstract Aims Cardiac damage in severe aortic stenosis (AS) can be classified according to a recently proposed staging classification. The present study investigated the incremental prognostic value of left ventricular (LV) global longitudinal strain (GLS) over stages of cardiac damage in patients with severe AS. Methods and results From an ongoing registry, a total of 616 severe symptomatic AS patients with available LV GLS by speckle tracking echocardiography were selected and retrospectively analysed. Patients were categorized according to cardiac damage on echocardiography: Stage 0 (no damage), Stage 1 (LV damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). LV GLS was divided by quintiles and assigned to the different stages. The endpoint was all-cause mortality. Over a median follow-up of 44 [24–89] months, 234 (38%) patients died. LV GLS was associated with all-cause mortality independent of stage of cardiac damage. After incorporation of LV GLS by quintiles into the staging classification, Stages 2–4 were independently associated with outcome. LV GLS showed incremental prognostic value over clinical characteristics and stages of cardiac damage. Conclusion In this large single-centre cohort of severe AS patients, incorporation of LV GLS by quintiles in a novel proposed staging classification resulted in refinement of risk stratification by identifying patients with more advanced cardiac damage. LV GLS was shown to provide incremental prognostic value over the originally proposed staging classification.

scholarly journals Effect of the Extent of Cardiac Damage on Transcatheter Aortic Valve Replacement Outcome: A New Aortic Stenosis Staging System

2020 ◽  
Vol 13 (2) ◽  
pp. 69-73
Author(s):  
Miho Fukui ◽  
João L Cavalcante
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Staging System ◽  
Cardiac Damage ◽  
Transcatheter Aortic Valve ◽  
Staging Classification

Severe aortic stenosis (AS) causes chronic pressure overload of the left ventricle (LV), resulting in progressive cardiac change that can extend beyond the LV. A new AS staging classification has been recently proposed encompassing the extent of cardiac changes in AS. The AS staging classification has important prognostic implications for clinical outcomes after aortic valve replacement. This article introduces the AS staging system and demonstrates the association of the extent of cardiac change with outcomes after transcatheter aortic valve replacement.

Cardiac Damage Staging Classification and Prognosis in Low Flow Low Gradient Severe Aortic Stenosis

2021 ◽  
Vol 30 ◽  
pp. S178
Author(s):  
A. Snir ◽  
M. Ng ◽  
G. Strange ◽  
D. Playford ◽  
S. Stewart ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Cardiac Damage ◽  
Staging Classification

Exploring myocardial fibrosis in severe aortic stenosis: echo, CMR and histology data from FIB-AS study

2021 ◽  
Author(s):  
Giedrė Balčiūnaitė ◽  
Justinas Besusparis ◽  
Darius Palionis ◽  
Edvardas Žurauskas ◽  
Viktor Skorniakov ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Myocardial Fibrosis ◽  
Volume Fraction ◽  
Severe Aortic Stenosis ◽  
Systolic Dysfunction ◽  
Global Longitudinal Strain ◽  
Surrogate Marker ◽  
Serum Biomarkers ◽  
Cardiac Remodelling ◽  
Native T1

Abstract PurposeMyocardial fibrosis in aortic stenosis (AS) is associated with worse survival following aortic valve replacement (AVR). We assessed myocardial fibrosis in severe AS patients, integrating echocardiographic, cardiovascular magnetic resonance (CMR) and histological data. MethodsA total of 83 severe AS patients (age 66.4 ± 8.3, 42% male) who were scheduled for surgical AVR underwent CMR with late gadolinium enhancement (LGE) and T1 mapping and global longitudinal strain (GLS) analysis. Collagen volume fraction (CVF) was measured in myocardial biopsies (71) that were sampled at the time of AVR. ResultsCVF correlated with imaging and serum biomarkers of LV systolic dysfunction and left side chamber enlargement and was higher in the sub-endocardium compared with midmyocardium (p<0.001). CVF median values were higher in LGE-positive versus LGE-negative patients [28.7% (19-33) vs 20.7% (15-30), respectively, p=0.040]. GLS was associated with invasively (CVF; r=-0.303, p=0.013) and non-invasively (native T1; r=-0.321, p<0.05) measured myocardial fibrosis. GLS and native T1 correlated with parameters of adverse LV remodelling, systolic and diastolic dysfunction and serum biomarkers of heart failure and myocardial injury. ConclusionOur data highlight the role of myocardial fibrosis in adverse cardiac remodelling in AS. GLS has potential as a surrogate marker of myocardial fibrosis, and high native T1 and low GLS values differentiated patients with more advanced cardiac remodelling.

Invasive Hemodynamic Staging Classification of Cardiac Damage in Patients With Aortic Stenosis Undergoing Valve Replacement

2020 ◽  
Vol 36 (10) ◽  
pp. 1667-1674 ◽  
Author(s):  
Micha T. Maeder ◽  
Lukas Weber ◽  
Daniel Weilenmann ◽  
Philipp K. Haager ◽  
Lucas Joerg ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Valve Replacement ◽  
Cardiac Damage ◽  
Staging Classification

scholarly journals Central Sleep Apnea in Patients due to Severe Aortic Stenosis

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Christian Prinz ◽  
Thomas Bitter ◽  
Olaf Oldenburg ◽  
Lothar Faber ◽  
Dieter Horstkotte ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Aortic Stenosis ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Severe Aortic Stenosis ◽  
Central Sleep Apnea ◽  
Right Heart Catheterization ◽  
Left Ventricular ◽  
Heart Catheterization ◽  
Right Heart

History. We report about the course of central sleep apnea (CSA) in 3 patients ( years) with severe aortic stenosis (AS) ( cm2, NYHA ).Investigations. Every patient received echocardiography, left/right-heart catheterization, and cardiorespiratory polygraphy before and 6 months after surgical aortic valve replacement (without right-heart catheterization during follow up).Course. Preoperatively all patients demonstrated reduced systolic left ventricular function (EF ). They had elevated pulmoraryarterialy pressures and severe CSA. After valve replacement left ventricular function and exercise capacity improved, as well as the severity of CSA.Conclusion. Patients with severe AS can develop CSA, which seems to improve after surgery. Patients with severe AS should be screened for CSA, because CSA might be an additional risk factor and hint that myocardial adaptation is exhausting.

scholarly journals Impact of Early Surgery and Staging Classification on Survival in Asymptomatic Very Severe Aortic Stenosis

2021 ◽  
Vol 77 (4) ◽  
pp. 506-508
Author(s):  
Sung-Ji Park ◽  
Sahmin Lee ◽  
Seung-Ah Lee ◽  
Dae-Hee Kim ◽  
Hyung-Kwan Kim ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Early Surgery ◽  
Staging Classification
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