Pre- and Post-Operative Diastolic Dysfunction in Patients With Valvular Heart Disease

Zaid, Rasheed; Barker, Colin M.; Little, Stephen H.; Nagueh, Sherif F.

doi:10.1016/j.jacc.2013.08.1619

Cited by 56 publications

(56 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…From these measurements, the transmitral E/A and E/E′ ratios were calculated indicators of diastolic function. Isovolumic relaxation time and mitral valve deceleration time were also reported as indicators of left ventricular diastolic dysfunction, with increasing isovolumic relaxation time and decreasing mitral valve deceleration time correlating with dysfunction [10,11]. …”

Section: Methodsmentioning

confidence: 99%

B-type natriuretic peptide and echocardiography reflect volume changes during pregnancy

Burlingame

Yamasato

Ahn

et al. 2017

Journal of Perinatal Medicine

View full text Add to dashboard Cite

Objective To evaluate B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) and cardiac structure and function in normal women through pregnancy and the postpartum. Methods In this prospective observational study, we obtained serial transthoracic echocardiograms, BNP, and NT-proBNP at seven intervals from 6 weeks’ gestation through 12 months postpartum. Women with hypertension or cardiac disease were excluded. Using 6–12 months postpartum as reference for non-pregnant levels, echocardiogram measurements and BNP/NT-proBNP were compared over time using linear mixed models with Tukey-Kramer adjustment for multiple comparisons. Results Of 116 patients, data was available for 78–114 healthy pregnant or postpartum women within each time interval, and 102 patients provided data for ≥ 4 intervals. Compared to 6–12 months postpartum, BNP and NT-proBNP remained stable through pregnancy and delivery, increased within 48 h postpartum (P < 0.0001), then returned to baseline. Left ventricular volume increased within 48 h postpartum (P = 0.021) while left atrial volume increased at 18–24 weeks (P = 0.0002), 30–36 weeks (P < 0.0001) and within 48 h postpartum (P = 0.002). The transmittal early/late diastolic velocity (E/A) ratio, transmittal early/peak mitral annulus diastolic velocity (E/E′) ratio, isovolumic relaxation times, and mitral valve deceleration times were similar within 48 h and 6–12 months postpartum. Conclusion In normal women, BNP/NT-proBNP, left atrial, and left ventricular volumes increase within 48 h postpartum without indications of altered diastolic function.

show abstract

Section: Methodsmentioning

confidence: 99%

B-type natriuretic peptide and echocardiography reflect volume changes during pregnancy

Burlingame

Yamasato

Ahn

et al. 2017

Journal of Perinatal Medicine

View full text Add to dashboard Cite

show abstract

“…In patients with moderate to severe aortic stenosis (AS) or aortic regurgitation (AR), LV hypertrophy and diastolic dysfunction are quite commonly caused by chronic pressure or volume overload and LV hypertrophy is related to impaired relaxation and increased LV chamber stiffness [5,6]. …”

Section: Introductionmentioning

confidence: 99%

Determinants and Prognostic Significance of Symptomatic Status in Patients with Moderately Dysfunctional Bicuspid Aortic Valves

et al. 2017

View full text Add to dashboard Cite

BackgroundWe aimed to identify the clinical and echocardiographic determinants of symptoms and their prognostic implications in patients with moderately dysfunctional bicuspid aortic valves (BAVs).MethodsAmong 1,019 subjects in the BAV registry treated in a single tertiary care center, the records of 127 patients (85 men, age 58±13 years) with moderately dysfunctional BAVs were comprehensively reviewed. The patients were divided into two groups based on symptom status: asymptomatic (n = 80) vs. symptomatic (n = 47). The primary end-point was defined as a composite of aortic valve surgery, hospitalization for heart failure, and any cause of death.ResultsThe symptomatic group had a higher proportion of females, hypertension, aortic stenosis, and aortopathy than did the asymptomatic group. The symptomatic group showed lower e′ (5.5±1.7 vs. 6.5±2.2 cm/s, p = 0.003), higher E/e′ (13.3 ± 4.9 vs. 10.9±3.7, p = 0.002), and larger left atrial volume index (29.9±11.4 vs. 24.6±9.1 ml/m2, p = 0.006) than did the asymptomatic group. In multivariate logistic regression analysis, female gender (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.10–7.36, p = 0.031), hypertension (OR 3.07, 95% CI 1.20–7.82, p = 0.019), moderate aortic stenosis (OR 5.33 5.78, 95% CI 1.99–16.83, p = 0.001), E/e′ >15 (OR 3.82, 95% CI 1.03–11.19, p = 0.015), and aortopathy (OR 2.76, 95% CI 1.07–7.10, p = 0.035) were independently correlated with symptom status. The symptomatic group showed a significantly lower rate of event-free survival during the 8-year follow-up period (54±9% vs. 68±10%, p = 0.001).ConclusionsIn patients with moderately dysfunctional BAVs, the presence of moderate aortic stenosis, aortopathy, and diastolic dysfunction determines symptom status, along with female gender and hypertension. Symptom status was associated with clinical outcomes.

show abstract

“…The left atrium is moderately dilated in the first trimester as may be seen in patients with anemia and other high-output states in the absence of diastolic dysfunction. [20][21][22] Likewise, it is often present in elite athletes in the absence of cardiovascular disease. 20,21 This increase in volume load triggers a remodeling response, which consists mainly of LV geometric changes and spherical dilatation along the LV short axis.…”

mentioning

confidence: 99%

Maternal Cardiovascular Function in Normal Pregnancy

et al. 2016

View full text Add to dashboard Cite

Abstract-The aim of this study was to investigate cardiac functional status in pregnancy using a comprehensive approach taking into account the simultaneous changes in loading and geometry, as well as maternal age and anthropometric indices. This was a prospective cross-sectional study of 559 nulliparous pregnant women assessed at 4 time points during pregnancy and at 1 year postpartum. All women underwent conventional echocardiography and tissue Doppler velocities and strain rate analysis at multiple cardiac sites. Mean arterial pressure and total vascular resistance index significantly decreased (both P<0.001) during the first 2 trimesters of pregnancy and increased thereafter. Stroke volume index and cardiac index showed the opposite trend compared with mean arterial pressure and total vascular resistance index (both P<0.05). Myocardial and ventricular function were significantly enhanced in the first 2 trimesters but progressively declined thereafter. By the end of pregnancy, significant chamber diastolic dysfunction and impaired myocardial relaxation was evident in 17.9% and 28.4% of women, respectively, whereas myocardial contractility was preserved. There was full recovery of cardiac function at 1 year postpartum. Cardiovascular changes during pregnancy are thought to represent a physiological adaptation to volume overload. The findings of a drop in stroke volume index, impaired myocardial relaxation with diastolic dysfunction, and a tendency toward eccentric remodeling in a significant proportion of cases at term are suggestive of cardiovascular maladaptation to the volume-overloaded state in some apparently normal pregnancies. These unexpected cardiovascular findings have important implications for the management of both normal and pathological pregnancy states. Melchiorre et al Cardiac Function and Geometry in Pregnancy 755changes in maternal loading conditions, cardiac geometry, as well as age and anthropometric indices. MethodsThis was a prospective cross-sectional study performed over a 5-year period from June 2008 to February 2013. Healthy nulliparous women with singleton viable pregnancy were recruited consecutively from the routine antenatal clinic at St George's Hospital, University of London. The local institutional review committee approved the study, and all participants provided written informed consent. Women who subsequently developed adverse maternal complications, such as diabetes mellitus, preeclampsia, peripartum cardiomyopathy, pregnancy complication, or any other medical comorbidity, were excluded from the analysis. Women were recruited at 4 time points during pregnancy (11-14, 20-23, 28-32, and 37-39 weeks' gestation) and at 1 year postpartum after pregnancy care in our institution. A group of 50 nonpregnant healthy volunteer nulliparous women matched for age was also assessed to derive baseline echocardiographic values. All groups were matched for ethnicity and maternal age. To ensure that we recruited optimally healthy women, we also excluded women with a prepregnancy body mass...

show abstract

Pre- and Post-Operative Diastolic Dysfunction in Patients With Valvular Heart Disease

Cited by 56 publications

References 45 publications

B-type natriuretic peptide and echocardiography reflect volume changes during pregnancy

B-type natriuretic peptide and echocardiography reflect volume changes during pregnancy

Determinants and Prognostic Significance of Symptomatic Status in Patients with Moderately Dysfunctional Bicuspid Aortic Valves

Maternal Cardiovascular Function in Normal Pregnancy

Contact Info

Product

Resources

About