Severe Aortic Stenosis and Myocardial Function

Bello, Vitantonio Di; Giorgi, Davide; Viacava, Paolo; Talini, Enrica; Nardi, Carmela; Palagi, Caterina; Donne, Maria Grazia Delle; Verunelli, F; Mariani, Massimo A.; Grandjean, Jan G.; Dell'Anna, R; Cori, Andrea Di; Zucchelli, Giulio; Romano, Maria Francesca; Mariani, Mario

doi:10.1161/01.cir.0000138930.12773.41

Cited by 56 publications

(29 citation statements)

References 23 publications

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“…In experimental studies, IBS absolute values have been shown to be reliable indices of LV fibrosis. In addition, they have been shown to reflect myocardial collagen content as assessed by endomyocardial biopsy in humans (15,16,18). It has been demonstrated that even mild reductions in renal function are associated with a greater prevalence of LVH (27,28); the increase in IBS reflectivity that was observed in our study also indicates an early increase in LV collagen deposition, beginning well before the development of ESRD.…”

Section: Discussionsupporting

confidence: 63%

“…Already in 1985 Wickline et al (29) observed in open-chest dogs that a reduced IBS CV may be paralleled by a reduction in LV contractile performance. At the same time, IBS CV was found to be significantly and inversely related to the percent fibrosis area as assessed by endomyocardial biopsy in patients with dilated cardiomyopathy (17) and to the myocardium/fibrosis ratio in patients with aortic stenosis (18). Furthermore, in patients with EH, a decreased CV of backscatter signal is associated with an increase in serum procollagen type I C-peptide, a specific circulating marker of cardiac collagen content (30).…”

Section: Discussionmentioning

confidence: 96%

“…Experimental studies have suggested that integrated backscatter (IBS) measures may be related to myocardial collagen content (11)(12)(13)(14). In humans, ultrasonic backscatter indices have been shown to be related to myocardial collagen content as assessed by endomyocardial biopsy (15)(16)(17)(18). Therefore, we considered it worthwhile to analyze myocardial ultrasonic backscatter (IBS) in patients who had CRF and were undergoing hemodialysis, in patients with mild to moderate CRF, and in patients with essential hypertension with comparable age, BP values and LVM to evaluate whether interstitial collagen deposition as evaluated by acoustic densitometry may appear early in the course of chronic kidney disease (CKD).…”

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confidence: 99%

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Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Salvetti¹,

Muiesan²,

Paini³

et al. 2007

Journal of the American Society of Nephrology

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The objective of this study was to detect ultrastructural changes in myocardium related to collagen content by ultrasound tissue characterization in patients with chronic kidney disease (CKD) and in uncomplicated hypertensive control subjects. In 25 hemodialysis (HD) patients, in 25 patients with moderate to severe chronic renal failure (CRF), and in 10 patients with essential hypertension (EH) and normal renal function matched for age, BP, and left ventricular mass index, left ventricular anatomy and function were evaluated by conventional echocardiography, and integrated backscatter signal (IBS) was analyzed by acoustic densitometry. IBS mean reflectivity increased from 48% in patients with EH to 56% in patients with CRF to 62% in HD patients (ANOVA P < 0.01). IBS mean cyclic variation was progressively increased from 4.35 ؎ 1.2 dB in HD patients to 5.27 ؎ 0.90 in patients with CRF to 6.50 ؎ 1.6 dB in patients with EH (ANOVA P < 0.01). At multivariate analysis, IBS mean reflectivity was positively related to age and serum creatinine (␤ 0.351, P ‫؍‬ 0.036; and ␤ ‫؍‬ 0.408, P ‫؍‬ 0.016, respectively). IBS mean cyclic variation was inversely related to age and serum creatinine (␤ ‫؍‬ ؊0.274, P ‫؍‬ 0.025; and ␤ ‫؍‬ ؊0.262, P ‫؍‬ 0.025, respectively) and positively related to left ventricular midwall fractional shortening and transmitral E/A ratio (␤ ‫؍‬ 0.269, P < 0.05; and ␤ ‫؍‬ 0.314, P < 0.001, respectively). The data support the hypothesis that interstitial collagen deposition may appear early in the course of CKD and suggest that acoustic densitometry may represent a useful tool for the assessment of myocardial tissue changes in patients with CKD. 18: 195318: -195818: , 200718: . doi: 10.1681 L eft ventricular hypertrophy (LVH) is an independent predictor of cardiovascular morbidity and mortality in patients with ESRD as well as in hypertensive patients, in patients with coronary artery disease, and in the general population (1). It has been demonstrated that changes in LV mass index (LVMI) over time are associated with cardiovascular prognosis (2-4), and LVH is currently considered an important intermediate end point in the treatment of hypertensive patients (5,6). A greater prevalence of LVH has been reported in patients with chronic renal failure (CRF) (7), possibly contributing to the greater risk for cardiovascular events in these patients (8,9). Experimental studies have demonstrated that the typical changes in uremic cardiomyopathy are increased cardiac size, interstitial and perivascular fibrosis, reduced capillary density, and thickening of intramural myocardial arterioles (10). J Am Soc NephrolAcoustic densitometry is a noninvasive tool for the evaluation of myocardial tissue characteristics and provides an integrated on-line capability to measure, display, and analyze the average acoustic image intensity within a user-specified region of interest (ROI). Experimental studies have suggested that integrated backscatter (IBS) measures may be related to myocardial collagen content (11)(12)(13)(14). I...

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

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Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Salvetti¹,

Muiesan²,

Paini³

et al. 2007

Journal of the American Society of Nephrology

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“…However, these indexes sometimes correlate poorly with patient symptoms and depend on stroke volume. 7,8 Furthermore, ejection fraction may be related mainly to global radial function, which is reduced only in end-stage disease. 9 Importantly, fibrotic changes induced by aortic stenosis start subendocardially 1 and affect mainly longitudinal function, which is not well represented by ejection fraction.…”

Section: Clinical Perspective On P 584mentioning

confidence: 99%

Impact of Myocardial Fibrosis in Patients With Symptomatic Severe Aortic Stenosis

et al. 2009

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Background— In this prospective follow-up study, the effect of myocardial fibrosis on myocardial performance in symptomatic severe aortic stenosis was investigated, and the impact of fibrosis on clinical outcome after aortic valve replacement (AVR) was estimated. Methods and Results— Fifty-eight consecutive patients with isolated symptomatic severe aortic stenosis underwent extensive baseline characterization before AVR. Standard and tissue Doppler echocardiography and cardiac magnetic resonance imaging (late-enhancement imaging for replacement fibrosis) were performed at baseline and 9 months after AVR. Endomyocardial biopsies were obtained intraoperatively to determine the degree of myocardial fibrosis. Patients were analyzed according to the severity of interstitial fibrosis in cardiac biopsies (severe, n=21; mild, n=15; none, n=22). The extent of histologically determined cardiac fibrosis at baseline correlated closely with New York Heart Association functional class and markers of longitudinal systolic function (all P <0.001) but not global ejection fraction or aortic valve area. Nine months after AVR, the degree of late enhancement remained unchanged, implying that AVR failed to reduce the degree of replacement fibrosis. Patients with no fibrosis experienced a marked improvement in New York Heart Association class from 2.8±0.4 to 1.4±0.5 ( P <0.001). Only parameters of longitudinal systolic function predicted this functional improvement. Four patients with severe fibrosis died during follow-up, but no patient from the other groups died. Conclusions— Myocardial fibrosis is an important morphological substrate of postoperative clinical outcome in patients with severe aortic stenosis and was not reversible after AVR over the 9 months of follow-up examined in this study. Because markers of longitudinal systolic function appear to indicate sensitively both the severity of myocardial fibrosis and the clinical outcome, they may prove valuable for preoperative risk assessment in patients with aortic stenosis.

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“…10, 11 Although European and US guidelines advise using hemodynamic parameters that represent the severity and parameters of global LV systolic function at rest, 12,13 these indices sometimes correlate poorly with patient symptoms. 14, 15 Recent investigations have confirmed that myocardial fibrosis is an important morphological substrate of LVH and is not reversible after AVR. 16 Together, these findings indicate the need to comprehensively evaluate diastolic function in AS patients to characterize the hemodynamic derangements that take place in AS.…”

mentioning

confidence: 99%

Evaluation of Left Ventricular Diastolic Function After Valve Replacement in Aortic Stenosis Using Exercise Doppler Echocardiography

Seo

Jang

Lee

et al. 2012

Circ J

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Severe Aortic Stenosis and Myocardial Function

Cited by 56 publications

References 23 publications

Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Myocardial Ultrasound Tissue Characterization in Patients with Chronic Renal Failure

Impact of Myocardial Fibrosis in Patients With Symptomatic Severe Aortic Stenosis

Evaluation of Left Ventricular Diastolic Function After Valve Replacement in Aortic Stenosis Using Exercise Doppler Echocardiography

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