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Journal ArticleDOI

Noninvasive assessment of filling pressure and left atrial pressure overload in severe aortic valve stenosis: relation to ventricular remodeling and clinical outcome after aortic valve replacement

TL;DR: In patients with symptomatic severe aortic valve stenosis undergoing aortsic valve replacement, left atrial volume provides important prognostic information beyond standard risk factors.
About: This article is published in The Journal of Thoracic and Cardiovascular Surgery.The article was published on 2011-09-01 and is currently open access. It has received 53 citations till now. The article focuses on the topics: Aortic valve stenosis & Aortic valve replacement.
Citations
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Journal ArticleDOI
TL;DR: NoAF occurred in about one-third of the patients with no prior history of atrial fibrillation undergoing TAVI and its incidence was increased in patients with larger LA size and those undergoing transapical TAVi.

227 citations

Journal ArticleDOI
TL;DR: The trend of dσ*/dt max in differing severity of aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) is described and low dσ*dt max was independently associated with adverse clinical outcomes in moderate AS and severe AS with preserved LVEF.
Abstract: The global left ventricular (LV) contractility index, dσ*/dtmax measures the maximal rate of change in pressure-normalized LV wall stress. We aim to describe the trend of dσ*/dtmax in differing severity of aortic stenosis (AS) with preserved left ventricular ejection fraction (LVEF) and the association of dσ*/dtmax with clinical outcomes in moderate AS and severe AS. We retrospectively studied a total of 1738 patients with AS (550 mild AS, 738 moderate AS, 450 severe AS) and preserved LVEF ≥ 50% diagnosed from 1st January 2001 to 31st December 2015. dσ*/dtmax worsened with increasing severity of AS despite preserved LVEF (mild AS: 3.69 ± 1.28 s−1, moderate AS: 3.17 ± 1.09 s−1, severe AS: 2.58 ± 0.83 s−1, p < 0.001). Low dσ*/dtmax < 2.8 s−1 was independently associated with a higher composite outcome of aortic valve replacement, congestive cardiac failure admissions and all-cause mortality (adjusted hazard ratio 1.48, 95% CI: 1.25–1.77, p < 0.001). In conclusion, dσ*/dtmax declined with worsening AS despite preserved LVEF. Low dσ*/dtmax < 2.8 s−1 was independently associated with adverse clinical outcomes in moderate AS and severe AS with preserved LVEF.

206 citations

Journal ArticleDOI
TL;DR: NAFLD is independently associated with subclinical myocardial remodeling and dysfunction and provides further insight into a possible link between NAFLD and HF.

200 citations

Journal ArticleDOI
TL;DR: The importance of reduced preoperative global longitudinal systolic strain (GLS) on long-term outcome after aortic valve replacement is unknown as discussed by the authors, and the importance of reducing preoperative GLS is unknown.
Abstract: Background— Global longitudinal systolic strain (GLS) is often reduced in aortic stenosis despite normal ejection fraction. The importance of reduced preoperative GLS on long-term outcome after aortic valve replacement is unknown. Methods and Results— A total of 125 patients with severe aortic stenosis and ejection fraction >40% scheduled for aortic valve replacement were evaluated preoperatively and divided into 4 groups according to GLS quartiles. Patients were followed up for 4 years. The primary end points were major adverse cardiac events (MACEs) defined as cardiovascular mortality and cardiac hospitalization because of worsening of heart failure; the secondary end point was cardiovascular mortality. MACE and cardiac mortality were significantly increased in patients with lower GLS. Estimated 5-year MACE was increased: first quartile 19% (n=6) / second quartile 20% (n=6) / third quartile 35% (n=11) / fourth quartile 49% (n=15); P =0.04. Patients with increased age, left ventricular hypertrophy, and left atrial dilatation were at increased risk. In Cox regression analysis, after correcting for standard risk factors and ejection fraction, GLS was found to be significantly associated with cardiac morbidity and mortality. In a stepwise Cox model with forward selection, GLS was the sole independent predictor: hazard ratio=1.13 (95% confidence interval, 1.02–1.25), P =0.04. Comparing the overall log likelihood χ2 of the predictive power of the multivariable model containing GLS was statistically superior to models based on EuroScore, history with ischemic heart disease, and ejection fraction. Conclusions— In patients with symptomatic severe aortic stenosis undergoing aortic valve replacement, reduced GLS provides important prognostic information beyond standard risk factors. Clinical Trial Registration— URL: [http://www.clinicaltrials.gov][1]. Unique identifier: [NCT00294775][2]. [1]: http://www.clinicaltrial.gov [2]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT00294775&atom=%2Fcirccvim%2F5%2F5%2F613.atom

124 citations

Journal ArticleDOI
TL;DR: Lipid-lowering therapy, antihypertensive drugs, and anticalcific therapy have been the main drug classes studied in the medical treatment of patients with aortic stenosis and are reviewed in depth.
Abstract: Untreated, severe, symptomatic aortic stenosis is associated with a dismal prognosis. The only treatment shown to improve survival is aortic valve replacement; however, before symptoms occur, aortic stenosis is preceded by a silent, latent phase characterized by a slow progression at the molecular, cellular, and tissue levels. In theory, specific medical therapy should halt aortic stenosis progression, reduce its hemodynamic repercussions on left ventricular function and remodeling, and improve clinical outcomes. In the present report, we performed a systematic review of studies focusing on the medical treatment of patients with aortic stenosis. Lipid-lowering therapy, antihypertensive drugs, and anticalcific therapy have been the main drug classes studied in this setting and are reviewed in depth. A critical appraisal of the preclinical and clinical evidence is provided, and future research avenues are presented.

109 citations

References
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Journal ArticleDOI
TL;DR: Members of the Chamber Quantification Writing Group are: Roberto M. Lang, MD, Fase, Michelle Bierig, MPH, RDCS, FASE, Richard B. Devereux,MD, Frank A. Flachskampf, MD and Elyse Foster, MD.
Abstract: Members of the Chamber Quantification Writing Group are: Roberto M. Lang, MD, FASE, Michelle Bierig, MPH, RDCS, FASE, Richard B. Devereux, MD, Frank A. Flachskampf, MD, Elyse Foster, MD, Patricia A. Pellikka, MD, Michael H. Picard, MD, Mary J. Roman, MD, James Seward, MD, Jack S. Shanewise, MD, FASE, Scott D. Solomon, MD, Kirk T. Spencer, MD, FASE, Martin St John Sutton, MD, FASE, and William J. Stewart, MD

10,834 citations

Journal ArticleDOI
TL;DR: Recommendations for the evaluation of left ventricular diastolic function by echocardiography are made and further research is needed to determine the best method for this evaluation.
Abstract: Recommendations for the evaluation of left ventricular diastolic function by echocardiography

4,162 citations


"Noninvasive assessment of filling p..." refers background in this paper

  • ...In the remaining patients with an indeterminate E/e’ ratio, those with LAVi 34 mL/m(2) or greater were considered to have increased filling pressure and those with LAVi less than 34 mL/m(2) were considered to have normal filling pressure.(12)...

    [...]

Journal ArticleDOI
TL;DR: A report from the American Society of Echocardiography’s Nomenclature and Standards Committee and The Task Force on Valvular Regurgitation developed in conjunction with the American College of Cardiology EchOCardiography Committee.

3,769 citations


"Noninvasive assessment of filling p..." refers methods in this paper

  • ...Mitral regurgitation was quantified as none, mild, moderate, or severe using standard methods.(11) Mitral inflow was assessed in the apical 4-chamber view using pulsedwave Doppler with the sample volume placed at the tips of mitral leaflets during diastole....

    [...]

Journal ArticleDOI
TL;DR: The assessment of left ventricular (LV) diastolic function and filling pressures is of paramount clinical importance to distinguish this syndrome from other diseases such as pulmonary disease resulting in dyspnea, to assess prognosis, and to identify underlying cardiac disease and its best treatment.
Abstract: The assessment of left ventricular (LV) diastolic function should be an integral part of a routine examination, particularly in patients presenting with dyspnea or heart failure. About half of patients with new diagnoses of heart failure have normal or near normal global ejection fractions (EFs). These patients are diagnosed with “diastolic heart failure” or “heart failure with preserved EF.”1 The assessment of LV diastolic function and filling pressures is of paramount clinical importance to distinguish this syndrome from other diseases such as pulmonary disease resulting in dyspnea, to assess prognosis, and to identify underlying cardiac disease and its best treatment. LV filling pressures as measured invasively include mean pulmonary wedge pressure or mean left atrial (LA) pressure (both in the absence of mitral stenosis), LV end-diastolic pressure (LVEDP; the pressure at the onset of the QRS complex or after A-wave pressure), and pre-A LV diastolic pressure (Figure 1).Although these pressures are different in absolute terms, they are closely related, and they change in a predictable progression with myocardial disease, such that LVEDP increases prior to the rise in mean LA pressure. Figure 1 The 4 phases of diastole are marked in relation to high-fidelity pressure recordings from the left atrium (LA) and left ventricle (LV) in anesthetized dogs. The first pressure crossover corresponds to the end of isovolumic relaxation and mitral valve opening. In the first phase, left atrial pressure exceeds left ventricular pressure, accelerating mitral flow. Peak mitral E roughly corresponds to the second crossover. Thereafter, left ventricular pressure exceeds left atrial pressure, decelerating mitral flow. These two phases correspond to rapid filling. This is followed by slow filling, with almost no pressure differences. During atrial contraction, left atrial pressure again exceeds left ventricular pressure. The solid arrow points to left ventricular minimal pressure, the dotted arrow to left ventricular …

3,659 citations

Journal ArticleDOI
TL;DR: Mitral E velocity, corrected for the influence of relaxation (i.e., the E/Ea ratio), relates well to mean PCWP and may be used to estimate LV filling pressures.

2,911 citations

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