Left ventricular (LV) strain (ԑ)-volume loops are examined to provide novel insight into the haemodynamic cardiac consequences of aortic valve 46 stenosis (AS) and aortic valve regurgitation (AR) to provide novel insight into the haemodynamic cardiac consequences of aortic valve regurgitation.
In individuals free of overt cardiovascular disease, MRI-derived LV filling dynamics were associated with structural alterations of the left atrium and pulmonary vasculature, suggesting that changes across the cardiopulmonary axis may already be detectable by whole-body MRI before clinical disease becomes apparent.
C. Wintergerst, R. Lorbeer, Susanne Rospleszcz et al.· Frontiers in Cardiovascular...· 0 citations
BACKGROUND
Patients with low gradient severe aortic stenosis (AS) are clinically challenging cohort requiring additional imaging modalities to secure diagnosis of severe AS. We aimed to assess whether resting aortic valve area (AVA) can determine hemodynamic severity of AS in patients with high trans-valvular flow rate (TFR).
METHODS AND RESULTS
This was a retrospective single centre analysis of consecutive patients undergoing dobutamine stress echo (DSE) for AS work-up. A standard protocol for low-dose DSE was performed and data on resting as well as stress echocardiographic parameters were prospectively entered in a dedicated database. The accuracy of resting aortic valve area was assessed at various TFR. Of 201 patients in this study, the mean age was 78 ± 8 years, and 69% were male. True severe aortic stenosis was identified in 102 (50.7%) of patients. Unlike indexed stroke volume and left ventricle ejection fraction (LVEF), TFR was an independent predictor of true severe AS, even after adjustment for mean gradient and AVA [odds ratio (OR) 0.86, 95%CI (0.74-1.00), P = 0.044]. Receiver-operator characteristics (ROC) analysis using resting aortic valve area demonstrated an area under the curve (AUC) of 0.91, 95% CI 0.82-0.99, P < 0.001 in patients with TFR ≥220 ml/s. A TFR of ≥220 ml/s, with a resting AVA <1.0 cm2 had a 100% positive predictive value for true severe AS.
CONCLUSIONS
TFR is an easily applied echo measurement. In situations with discordant echo data, TFR ≥220 ml/s supports the diagnosis of severe aortic stenosis and negates the need for further diagnostic imaging.
H. Elzein, Alexandra Thompson, Tim Irvine et al.· International Journal of Car...· 0 citations
Given its high sensitivity in evaluating left ventricular systolic function in patients with HCM, EF1 represents a promising adjunctive parameter for the multimodal assessment of systolic function in this population.
There are no significant correlations between AAPSE and LV rotational parameters, but the trends observed in subgroup analyses could serve as hypothesis-generating observations for future studies.
A. Nemes, Barbara Bordács, N. Ambrus et al.· Journal of Clinical Medicine· 0 citations
BACKGROUND
Left ventricular (LV) remodeling in mitral valve prolapse (MVP) may occur disproportionally to mitral regurgitation (MR) severity, especially in patients with Barlow disease. This study hypothesized an underlying MVP cardiomyopathy, potentially driven by ventricular arrhythmias or a genetic substrate. We investigated the determinants of LV remodeling in patients with MVP beyond MR volume load.
METHODS
Prospective inclusion of patients with nonsyndromic MVP at 3 centers. Patients were scheduled for cardiac magnetic resonance scans, 24-hour Holter monitoring, and the presence of an underlying cardiomyopathy-associated genetic variant was assessed. Disproportionate LV remodeling was defined as LV end-diastolic volume above the age- and sex-specific upper limit of normal after correction for the total MR volume load, using the following formula: (LV end-diastolic volume-MR volume)/body surface area-LVEDViULN >0.
RESULTS
A total of 103 patients with MVP were included (58% males, age 52±17 years). Disproportionate LV remodeling was present in 37% and was more frequent in Barlow disease compared with nonclassic MVP (P=0.067). After correction for age, sex, and MR volume load, Barlow disease phenotypic features like mitral annular dilatation are independently associated with LV dilatation (P<0.001 at multivariable regression analysis for left ventricular end-systolic volume index, R2=0.518). The total volume load (MR volume+prolapse volume) had a stronger correlation with LV remodeling than MR volume alone. In addition, ventricular arrhythmia-particularly ≥3% premature ventricular contractions-was independently associated with increased left ventricular end-systolic volume index even after correction for other classical risk factors (P=0.024, R2=0.518). None of the patients carried a likely pathogenic or pathogenic variant in cardiomyopathy-associated genes.
CONCLUSIONS
LV remodeling in MVP is a multifactorial process, where, especially in patients with Barlow disease, the associated mitral annular dilatation and larger prolapse volume drive LV dilatation beyond MR severity. In addition, a burden of ≥3% ventricular ectopy is strongly correlated with LV dilatation and dysfunction. Finally, a monogenic cardiomyopathy substrate appears unlikely.
L. Pype, O. Marchenko, S. V. Van Laer et al.· Circulation Cardiovascular I...· 0 citations
BACKGROUND
The TVARC (Tricuspid Valve Academic Research Consortium) and the ASE (American Society of Echocardiography) have proposed echocardiography cutoffs to define right ventricular (RV) dysfunction in secondary tricuspid regurgitation (STR), although these thresholds have not yet been validated.
OBJECTIVES
This study aims to evaluate the prognostic value of the proposed thresholds for the main RV function parameters in a large real-world STR cohort.
METHODS
Consecutive patients with ≥ moderate-to-severe STR were included. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), fractional area change, right ventricular global longitudinal strain, and right ventricular free wall longitudinal strain (RVFWLS). The study outcome was the composite of all-cause mortality and heart failure hospitalization, censored for tricuspid valve intervention.
RESULTS
A total of 1,550 patients (mean age: 69 ± 13 years, 50% men) were included. During a median follow-up of 22 months (Q1-Q3: 3-63 months), 703 patients (45%) reached the composite endpoint. All proposed cutoffs were associated with outcomes in univariable Cox analyses, but after multivariable adjustment, mainly strain parameters remained significant. A multiparametric approach combining echocardiographic measures was evaluated, and a stepwise combined grading using TAPSE and RVFWLS showed the strongest association with the composite endpoint; the different grades of RV dysfunction (mild, moderate, and severe, respectively) also remained independently associated (overall value of P < 0.001 and P < 0.005 for TVARC and ASE cutoffs, respectively) with the endpoint.
CONCLUSIONS
The TVARC and ASE cutoffs for RV dysfunction showed prognostic value in patients with significant STR. Combining TAPSE and RVFWLS may provide a pragmatic, exploratory framework for risk stratification of these patients.
X. Galloo, M. Dietz, E. Prihadi et al.· JACC Cardiovascular Imaging· 0 citations
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