Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement

Carter-Storch, Rasmus; Møller, Jacob Eifer; Christensen, Nicolaj Lyhne; Irmukhadenov, Akhmadjon; Rasmussen, Lars Melholt; Pecini, Redi; Øvrehus, Kristian Altern; Søndergård, Eva V; Marcussen, Niels; Dahl, Jordi S.

doi:10.1161/circimaging.117.006580

Cited by 16 publications

(7 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is thus interesting that we demonstrate that EF1 provided the strongest prognostic data among patient with low gradient severe AS (discordant AS), as the management of these patients is controversial. Although there may be some symptomatic benefit after AVR among patients with normal-flow, low-gradient AS, 7 the prognostic benefit is debated 28 29 and recommendations are to generally manage them as moderate AS. 1 Paradoxical low-flow, low-gradient AS patients often have a slower progression of disease than AS patients with a high gradient and more rarely progress to AVR.…”

Section: Discussionmentioning

confidence: 99%

“…This was a retrospective study including two previously well-described prospective cohort studies performed at our institution between 2014 and 2017. 7 8 The first cohort included asymptomatic patients with aortic valve area (AVA) <1 cm 2 , maximal aortic peak velocity >3.5 m/s and LVEF >50% recruited at the outpatient clinic. Patients underwent a conventional cycle ergometer test to ascertain that they were truly asymptomatic.…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

First-phase ejection fraction: association with remodelling and outcome in aortic valve stenosis

et al. 2021

Self Cite

View full text Add to dashboard Cite

BackgroundFirst-phase ejection fraction (EF1), the left ventricular (LV) ejection fraction (EF) until the time of peak transaortic velocity, is a novel marker of subclinical LV dysfunction able to predict adverse events in aortic stenosis (AS). This study investigated the association between end-systolic wall stress (ESWS) and EF1 in severe AS, as well as the prognostic value of EF1 in severe asymptomatic AS.MethodsTwo prospectively gathered cohorts of 94 asymptomatic patients and 108 symptomatic patients scheduled for aortic valve replacement (AVR), all with severe AS (aortic valve area <1 cm2) were stratified according to the median value of EF1 (33%). EF1 was defined as the EF at peak transaortic velocity. Asymptomatic patients were followed up for 3 years for the combined end-point of death, AVR or admission with heart failure.ResultsEF1 correlated with EF and was inversely associated with ESWS. In multivariate regression analysis, ESWS (p<0.001) and replacement fibrosis measured by MRI (p=0.02) were associated with EF1. Among asymptomatic patients, EF1 above the median was associated with the combined primary endpoint (HR=0.53 (95% CI 0.33 to 0.87)), while global longitudinal strain and EF were not. Among 42 patients with discordant AS (mean gradient <40 mm Hg), EF1 above median was associated with the primary endpoint (HR 0.28 (95% CI 0.12 to 0.61)).ConclusionEF1 is an afterload-dependent measure that is associated with events in patients with asymptomatic severe AS. The afterload dependency of EF1 may be useful in timing of risk stratification in patients with discordant AS.Trial registration numbersNCT02395107 and NCT02316587.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

First-phase ejection fraction: association with remodelling and outcome in aortic valve stenosis

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…More than 24,000 cardiac computed tomography (CT) scans were performed between 2007 and 2017 as part of clinical examinations at Odense University Hospital, or as part of research studies at five centres (Odense, Svendborg, Vejle, Esbjerg, Silkeborg). After approval from the Danish Data Protection Agency, traditional cardiovascular risk factors and CAC scores were collected from the electronic patient databases at Odense University Hospital, the Western Denmark Heart Registry [ 12 ], The National Danish Ablation Database [ 13 ], and research databases (DANCAVAS [ 14 ], DanRisk [ 15 ], IDA [ 16 ], MYODAN [ 17 ], NOTICE [ 18 ], AMFAST [ 19 ], and Ilangkovan N et al [ 20 ].). The study participants’ medication status since 2004 was collected from the Danish National Health Service Prescription Database (DNHSPD) [ 21 ].…”

Section: Methodsmentioning

confidence: 99%

“…Ablation Database [13], and research databases (DANCAVAS [14], DanRisk [15], IDA [16], MYODAN [17], NOTICE [18], AMFAST [19], and Ilangkovan N et al [20].). The study participants' medication status since 2004 was collected from the Danish National Health Service Prescription Database (DNHSPD) [21].…”

Section: Plos Onementioning

confidence: 99%

Extent of arterial calcification by conventional vitamin K antagonist treatment

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background and aims Vitamin K antagonists (VKA) remain the most frequently prescribed oral anticoagulants worldwide despite the introduction of non-vitamin K antagonist oral anticoagulants (NOAC). VKA interfere with the regeneration of Vitamin K1 and K2, essential to the activation of coagulation factors and activation of matrix-Gla protein, a strong inhibitor of arterial calcifications. This study aimed to clarify whether VKA treatment was associated with the extent of coronary artery calcification (CAC) in a population with no prior cardiovascular disease (CVD). Methods We collected data on cardiovascular risk factors and CAC scores from cardiac CT scans performed as part of clinical examinations (n = 9,672) or research studies (n = 14,166) in the period 2007–2017. Data on use of anticoagulation were obtained from the Danish National Health Service Prescription Database. The association between duration of anticoagulation and categorized CAC score (0, 1–99, 100–399, ≥400) was investigated by ordered logistic regression adjusting for covariates. Results The final study population consisted of 17,254 participants with no prior CVD, of whom 1,748 and 1,144 had been treated with VKA or NOAC, respectively. A longer duration of VKA treatment was associated with higher CAC categories. For each year of VKA treatment, the odds of being in a higher CAC category increased (odds ratio (OR) = 1.032, 95%CI 1.009–1.057). In contrast, NOAC treatment duration was not associated with CAC category (OR = 1.002, 95%CI 0.935–1.074). There was no significant interaction between VKA treatment duration and age on CAC category. Conclusions Adjusted for cardiovascular risk factors, VKA treatment–contrary to NOAC—was associated to higher CAC category.

show abstract

“…This was a retrospective study including two previously well described prospective cohort studies performed at our institution between 2014 and 2017 9,10 . The first cohort included asymptomatic patients with aortic valve area (AVA) < 1 cm 2 , maximal aortic peak velocity > 3.5 m/sec and LV ejection fraction (EF) > 50% recruited at the outpatient clinic.…”

Section: Methodsmentioning

confidence: 99%

Assessment of diastolic function in aortic stenosis: A comparison between 2009 and 2016 guidelines

et al. 2021

Self Cite

View full text Add to dashboard Cite

Aims New diastolic dysfunction (DD) guidelines were introduced in 2016 to replace the 2009 guidelines, but have not yet been evaluated in aortic stenosis (AS). We aimed to compare the 2009 and 2016 DD guidelines in severe AS patients in terms of association with left ventricular (LV) and left atrial (LA) remodeling, with pulmonary capillary wedge pressure (PCWP) at rest and exercise, and with prognosis. Methods and results We included 212 patients with severe AS (112 undergoing AVR, 100 asymptomatic). Echocardiography, magnetic resonance imaging, and brain natriuretic peptides (BNP) were performed/measured. Thirty‐nine asymptomatic patients had PCWP measured during rest and maximal exertion. Asymptomatic patients were followed for 3.1 years for the combined endpoint of death, AVR or admission with heart failure. The 2009 and 2016 DD guidelines agreed poorly with each other (Cohens’ κ = .15). 2009 guidelines showed many ambiguous DD findings. With the 2016 guidelines, 20% of patients had indeterminate DD. DD grade 2 according to 2016 guidelines showed stronger association with symptom status, BNP, global longitudinal strain (GLS) and peak exercise PCWP than 2009 guidelines. For indeterminate DD patients according to 2009 guidelines, GLS above the median was associated with event‐free survival (HR .11 (95% CI .02–.53)). For neither guideline was DD associated with the combined endpoint in asymptomatic patients. Conclusion The 2016 guidelines show a stronger association with BNP, GLS, and exercise PCWP than the 2009 guidelines. The 2016 guidelines result in 20% of patients with indeterminate DD; however, these patients may possibly be stratified according to GLS.

show abstract

Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement

Cited by 16 publications

References 32 publications

First-phase ejection fraction: association with remodelling and outcome in aortic valve stenosis

First-phase ejection fraction: association with remodelling and outcome in aortic valve stenosis

Extent of arterial calcification by conventional vitamin K antagonist treatment

Assessment of diastolic function in aortic stenosis: A comparison between 2009 and 2016 guidelines

Contact Info

Product

Resources

About