Archives of Cardiovascular Diseases Supplements最新文献

{"title":"Impact of sex on severity assessment and cardiac remodeling in primary mitral regurgitation due to valve prolapse","authors":"A. Altes ,&nbsp;F. Levy ,&nbsp;V. Hanet ,&nbsp;D. De Azevedo ,&nbsp;P. Krug ,&nbsp;L. Iacuzio ,&nbsp;M. Toledano ,&nbsp;V. Silvestri ,&nbsp;D. Vancraeynest ,&nbsp;A. Pasquet ,&nbsp;A. Vincentelli ,&nbsp;A. Eker ,&nbsp;S. Marechaux ,&nbsp;B. Gerber","doi":"10.1016/j.acvdsp.2023.04.002","DOIUrl":"10.1016/j.acvdsp.2023.04.002","url":null,"abstract":"<div><h3>Introduction</h3><p>The current recommended cut-off values for primary mitral regurgitation (MR) quantification (Effective Regurgitant Orifice Area [EROA], regurgitant volume [RegVol]) and left ventricular (LV) remodeling in MR (end-systolic diameter [ESD]) are not sex-specific.</p></div><div><h3>Method</h3><p>We retrospectively evaluated 470 patients (27% women, median age 63 years) with chronic significant primary MR due to prolapse who underwent echocardiography<span> (Echo) and cardiac magnetic resonance imaging (CMR) in 3 tertiary centers between 2005 and 2022.</span></p></div><div><h3>Results</h3><p><span>Women were older than men, had higher NYHA class, larger left atrial volume, higher pulmonary pressure, and more symptoms-triggered MV intervention (all </span><em>P</em> <!-->&lt;<!--> <!-->0.035). However, both MR EROA, Echo-RegVol and CMR-RegVol were lower in women than in men (all <em>P</em> <!-->&lt;<!--> <span>0.003), while CMR regurgitant fraction (RegFrac) values were similar (</span><em>P</em> <!-->=<!--> <!-->0.890). Abnormally increased CMR- (&gt; upper limit bound of UK Biobank reference values) indexed LV end-diastolic (indLVEDV), end-systolic volume (indLVESV) were observed in 55%, 29% of patients, respectively, without sex difference (<em>P</em> <!-->=<!--> <!-->1, <em>P</em> <!-->=<!--> <!-->0.9). The optimal cut-off values of MR EROA, Echo-RegVol and CMR-RegVol associated with enlarged indLVEDV were lower in women (40 mm², 60<!--> <!-->mL, 50<!--> <!-->mL) than in men (45 mm²,77<!--> <!-->mL, 62<!--> <!-->mL). LVESD ≥ 40<!--> <!-->mm showed in women and men high specificity [Sp] (91%, 79%) but poor sensitivity [Se] (40% 50%) to predict enlarged indLVESV, while the optimal threshold was slightly lower in women (35<!--> <!-->mm, Se<!--> <!-->=<!--> <!-->65%, Sp<!--> <!-->=<!--> <!-->71%) than in men (37<!--> <!-->mm, Se<!--> <!-->=<!--> <!-->65%, Sp<!--> <!-->=<!--> <!-->68%).</p></div><div><h3>Conclusion</h3><p>Despite clear hallmarks of more advanced valve disease, women with primary MR have lower mitral RegVol and lower ventricular volumes than men. Then, cut-off values of mitral RegVol, EROA and LV dimensions for predicting abnormal LV dilatation are lower in women than in men. Hence, guideline-based criteria for grading MR and timing of intervention could be sex-specific (<span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 243"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49005846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic contribution of left ventricular myocardial work assessment in mitral valve prolapse","authors":"J. Thierry,&nbsp;D. Stevant,&nbsp;N. Piriou,&nbsp;P.Y. Turgeon,&nbsp;K. Warin-Fresse,&nbsp;J.M. Serfaty,&nbsp;D. Grimault,&nbsp;T. Le Tourneau","doi":"10.1016/j.acvdsp.2023.04.004","DOIUrl":"10.1016/j.acvdsp.2023.04.004","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Mitral Valve Prolapse (MVP) is the leading cause of primary </span>mitral regurgitation<span> (MR). Due to volume overload-induced changes in severe MR, assessment of left ventricular systolic function, an important marker to refer patients to surgery, is difficult. The aim of our study was to assess cardiac mechanics based on the non-invasive evaluation of myocardial work, by analysing the left ventricular pressure-strain loop, taking into account loading conditions.</span></p></div><div><h3>Method</h3><p><span>In total, 321 patients (63% male) with MVP (with or without severe MR), who underwent a comprehensive echocardiography<span><span> and cardiac magnetic resonance (CMR) between 2010 and 2021, were included. Myocardial work parameters were assessed using a dedicated software. The primary endpoint associated cardiovascular death, sustained </span>ventricular arrhythmia, heart failure, </span></span>new onset atrial fibrillation<span>, or arterial embolism.</span></p></div><div><h3>Results</h3><p><span>Of the 321 patients 186 (58%) had a GWW (global wasted work) &lt; 120 mmHg% and 135 (42%) a GWW ≥ 120 mmHg%. GWW &lt; 120 mmHg% was associated with echographic and CMR parameters of abnormal filling, volume overload and more severe regurgitation. During a mean follow-up of 4.5</span> <!-->±<!--> <span>2.8 years, censored at the time of mitral valve surgery, 36 cardiovascular events were recorded in the GWW</span> <!-->&lt;<!--> <!-->120 mmHg% group versus 14 in the GWW ≥ 120 mmHg% group (19% vs. 10%; <em>P</em> <!-->=<!--> <!-->0.028). Heart failure (15 vs. 6%; <em>P</em> <!-->=<!--> <!-->0.011) and mitral valve intervention (69 vs. 59%; <em>P</em> <!-->=<!--> <span>0.045) rates were higher in the GWW &lt; 120 mmHg% group. Five-year cardiovascular event-free survival was decreased in patients with GWW</span> <!-->&lt;<!--> <!-->120 mmHg% (46.6<!--> <!-->±<!--> <!-->7.7% vs. 59.1<!--> <!-->±<!--> <!-->12.4%; <em>P</em> <!-->=<!--> <!-->0.023). In multivariable analysis, MR severity, the presence of late enhancement on CMR, and GWW<!--> <!-->&lt;<!--> <!-->120 mmHg% (HR 1.76; 95% CI 0.93–3.34; <em>P</em> <!-->=<!--> <!-->0.085) were associated with impaired event-free survival.</p></div><div><h3>Conclusion</h3><p>Myocardial work-up provides additional diagnostic and prognostic information to echocardiography and cardiac MRI in MV.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 244"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47351570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic valve calcification of surgical bioprostheses and its impact on clinical outcome","authors":"G. Guimbretiere,&nbsp;T. Senage,&nbsp;A.S. Boureau,&nbsp;N. Piriou,&nbsp;K. Warin-Fresse,&nbsp;J.M. Serfaty,&nbsp;J.C. Roussel,&nbsp;T. Le Tourneau","doi":"10.1016/j.acvdsp.2023.04.005","DOIUrl":"10.1016/j.acvdsp.2023.04.005","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Aortic valve calcification (AVC) of surgical valve bioprostheses (BP) has been poorly explored. We aimed to evaluate </span><em>in vivo</em> and <span><em>ex vivo</em></span> BP AVC and its prognosis value.</p></div><div><h3>Method</h3><p>Between 2011 and 2019, AVC was assessed in 361 patients with surgical BP on <em>in vivo</em><span> computed tomography (CT) scanner (6.4</span> <!-->±<!--> <!-->4.3 years after surgery). Follow-up was obtained in all patients. <em>Ex vivo</em> CT-scans were performed in 37 explanted BP.</p></div><div><h3>Results</h3><p>After exclusion of 19 (5.2%) CT-scans, mean <em>in vivo</em> AVC was 307<!--> <!-->±<!--> <!-->500 AU in the remaining 342 BP (77<!--> <!-->±<!--> <!-->9 years, 64% male). Of these, 183 (53.5%) had a structural valve degeneration (SVD) with an AVC of 562<!--> <!-->±<!--> <!-->570 AU compared with 13<!--> <!-->±<!--> <!-->43 AU (<em>P</em> <!-->&lt;<!--> <!-->0.0001) for non-SVD BP. Early calcification was observed in around 10% of BP (12/124) examined before the 3rd postoperative year. In explanted BP <em>in vivo</em> AVC correlated strongly with <em>ex vivo</em> AVC (<em>r</em> <!-->=<!--> <!-->0.88, <em>P</em> <!-->&lt;<!--> <!-->0.0001). An <em>in vivo</em> AVC<!--> <!-->&gt;<!--> <!-->100 AU (<em>n</em> <!-->=<!--> <!-->147, 43%) had an excellent specificity (96%) for diagnosing stage 2–3 SVD. Patients with AVC<!--> <!-->&gt;<!--> <!-->100 AU had worse survival compared with those with an AVC<!--> <!-->&lt;<!--> <!-->100 (<em>n</em> <!-->=<!--> <!-->195, 57%). In multivariable analyses, AVC value was a predictor of overall mortality (HR<!--> <!-->=<!--> <!-->1.16 [1.04–1.29]; <em>P</em> <!-->=<!--> <span>0.009), cardiovascular mortality (HR</span> <!-->=<!--> <!-->1.21 [1.03–1.41]; <em>P</em> <!-->=<!--> <!-->0.021) and cardiovascular events (HR<!--> <!-->=<!--> <!-->1.19 [1.08–1.31]; <em>P</em> <!-->=<!--> <!-->0.001). After further adjustment for SVD diagnosis, AVC remained a predictor of overall mortality (HR<!--> <!-->=<!--> <!-->1.24 [1.07–1.44]; <em>P</em> <!-->=<!--> <!-->0.005), and cardiovascular events (HR<!--> <!-->=<!--> <!-->1.16 [1.02–1.32]; <em>P</em> <!-->=<!--> <!-->0.029).</p></div><div><h3>Conclusion</h3><p>CT-scan AVC of surgical BP is a reliable tool for assessing leaflets calcification. Whereas calcification can develop early after surgery, an AVC &gt; 100 AU is tightly associated with SVD, and is a strong predictor of overall mortality and cardiovascular events, even after adjustment for SVD diagnosis. Hence, AVC scoring is a complementary tool to echocardiography that should be used in the follow-up of patients with surgical aortic BP.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Pages 244-245"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43584878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of echocardiography in estimating functional status and event-risk in patients with hypertrophic cardiomyopathy","authors":"M. Lacout","doi":"10.1016/j.acvdsp.2023.04.037","DOIUrl":"10.1016/j.acvdsp.2023.04.037","url":null,"abstract":"<div><h3>Introduction</h3><p>The prognosis in patients<span> with hypertrophic cardiomyopathy (HCM) remains complicated to estimate. Exercise testing is recommended. We sought to assess whether the echocardiographic evaluation could help in best understanding the clinical consequences and the event-risk of patients referred for HCM.</span></p></div><div><h3>Method</h3><p>In total, 302 HCM-patients (57.4<!--> <!-->±<!--> <!-->16.8<!--> <span><span>years old) were analysed. All patients underwent transthoracic rest and stress echocardiography for the evaluation of size and function including strain measurements. A </span>cardiopulmonary exercise test (CPET) was performed by all the patients at the time of echocardiography. The patients were followed for 3.4</span> <span>years for the occurrence of a composite endpoint including heart failure requiring hospitalization, syncope, ventricular tachycardia (VT) sustained or not, atrial heart rate episode registered by pacemaker or implanted defibrillator<span>, symptomatic supraventricular tachycardia, asymptomatic supraventricular tachycardia detected by Holter, defibrillator implantation, myomectomy/septal alcoholising, or HCM related death.</span></span></p></div><div><h3>Results</h3><p>Mean VO² peak for all patients was 21.57<!--> <!-->±<!--> <!-->7.6<!--> <!-->mL/kg/min. The best predictors of peak VO² were increased exercise mean E/Ea (9.17 [6.30–12.9]), decreased resting TAPSE (22.5<!--> <!-->±<!--> <!-->4.99<!--> <!-->mm) and decreased exercise LV GLS (−17.6<!--> <!-->±<!--> <!-->3.97%). Among the 302 patients, 132 (43.8%) met the composite endpoint. Among clinical, CPET and echocardiographic parameters recorded, PLAS was the best predictor of event with linear association.</p></div><div><h3>Conclusion</h3><p>The decrease in PLAS was strongly associated with the risk of event. It takes over CPET results. On top of this prognostic value, echocardiographic evaluation was demonstrated extremely relevant for our daily evaluation of HCM-patients.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 261"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45965443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ours SFC","authors":"","doi":"10.1016/S1878-6480(23)00213-6","DOIUrl":"https://doi.org/10.1016/S1878-6480(23)00213-6","url":null,"abstract":"","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page iii"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49726514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associated factors and clinical implications of dynamic changes in late gadolinium enhancement after acute myocarditis","authors":"Y. Bohbot ,&nbsp;F. Sanguineti ,&nbsp;C. Renard ,&nbsp;T. Hovasse ,&nbsp;I. Limouzineau ,&nbsp;T. Unterseeh ,&nbsp;C. Di Lena ,&nbsp;W. Boukefoussa ,&nbsp;C. Tawa ,&nbsp;S. Duhamel ,&nbsp;P. Garot ,&nbsp;C. Tribouilloy ,&nbsp;J. Garot","doi":"10.1016/j.acvdsp.2023.04.011","DOIUrl":"https://doi.org/10.1016/j.acvdsp.2023.04.011","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Although follow-up cardiac magnetic resonance (CMR) is often performed after acute </span>myocarditis<span> (AM), the prognostic implications of dynamic changes in late gadolinium enhancement (LGE) are unknown. We aimed to determine the prognostic implications of dynamic LGE changes after acute AM.</span></p></div><div><h3>Method</h3><p>In a two-centre study, 204 consecutive hemodynamically stable patients (mean age 35<!--> <!-->±<!--> <span>16 years, 78.9% males) with a CMR-based diagnosis of AM were included and underwent repeat CMR 3–12 months after diagnosis. Quantitative LGE was expressed as percent of left ventricular (LV) myocardium<span>. The primary endpoint was the occurrence of major adverse cardiac events (MACE) at median 7.3 [IQR: 5.7–8.7] years.</span></span></p></div><div><h3>Results</h3><p><span>Compared to index CMR, there was an increase in LV ejection fraction (EF) (59% vs. 55%, </span><em>P</em> <!-->&lt;<!--> <!-->0.001) and a decrease in LGE extent (7.6% vs. 12.0%, <em>P</em> <!-->&lt;<!--> <!-->0.001) at follow-up (mean 5.7<!--> <!-->±<!--> <!-->2.6 months after index CMR). LGE persisted in 175 patients at follow-up (85.8%). LGE decreased by ≥ 50% from baseline in 94 patients (46%), by &lt; 50% in 86 (42%) and increased in 24 (12%). Female gender (OR [95%CI]<!--> <!-->=<!--> <!-->3.27 [1.17–9.12], <em>P</em> <!-->=<!--> <!-->0.023), low baseline LVEF (OR [95%CI]<!--> <!-->=<!--> <!-->0.93 [0.88–0.98] per %, <em>P</em> <!-->=<!--> <!-->0.010) and LGE involving both septal and lateral walls (OR [95%CI]<!--> <!-->=<!--> <!-->4.64 [1.77–12.17], <em>P</em> <!-->=<!--> <span>0.002) were independently associated with increased LGE. By multivariate Cox analysis, only baseline LVEF (HR [95%CI]</span> <!-->=<!--> <!-->0.94 [0.89–0.99] per %, <em>P</em> <!-->=<!--> <!-->0.031), a &lt; 50% LGE decrease (HR [95%CI]<!--> <!-->=<!--> <!-->3.78 [1.04–10.70], <em>P</em> <!-->=<!--> <!-->0.044) and an increase in LGE (HR [95%CI]<!--> <!-->=<!--> <!-->8.35 [2.05–24.00], <em>P</em> <!-->=<!--> <!-->0.003) were significantly associated with MACE.</p></div><div><h3>Conclusion</h3><p><span>After AM, LGE persists at 6 months in the vast majority of patients but tends to decrease. A &lt; 50% decrease or an increase in LGE are associated with MACE, indicating that follow-up CMR is relevant for risk stratification (</span><span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 248"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49737860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility, efficacy and safety of PFO closure under local anesthesia with transoesophageal echocardiography microprobe: A single-center study of 383 patients","authors":"S. Lagrange,&nbsp;B. Mouhat,&nbsp;M. Besutti,&nbsp;O. Zbitou,&nbsp;R. Chopard,&nbsp;N. Meneveau","doi":"10.1016/j.acvdsp.2023.04.029","DOIUrl":"10.1016/j.acvdsp.2023.04.029","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Percutaneous patent foramen ovale (PFO) closure is usually performed under </span>general anesthesia<span><span> (GA) with guidance by transesophageal echocardiograpy (TEE). Microrobe makes this procedure possible under local anesthesia (LA). Our study aimed to assess the feasibility, efficacy and safety of PFO closure under LA with </span>microprobe guidance.</span></p></div><div><h3>Method</h3><p><span>The aim was to evaluate the rate of PFO closure failure in patients who underwent a procedure under LA with a TEE microprobe (micro-LA group) vs. under GA with a conventional probe (conventional-GA group). The primary endpoint was the persistence of inter-atrial shunt (&gt;</span> <!-->10 microbubbles) 6 months after procedure, screened by contrast transthoracic ultrasound. The secondary objectives were: identification of risk markers for the persistence of inter-atrial shunt at 6 months, post-procedure complication rates and major cardiovascular events rate.</p></div><div><h3>Results</h3><p>Three hundred and eighty three patients were included: 303 (79%) in the conventional-GA group, 79 (21%) in the micro-AL group. The median follow-up was 28.0 (14.0–49.0) months. The average age was 49.9<!--> <!-->±<!--> <!-->12.6 years, 61.9% of men. There was no failure of PFO closure under AL. Six months after PFO closure, there was no difference in persistence of inter-atrial shunt between the conventional-GA group and the micro-AL group (29.3% vs. 25.5%, <em>P</em> <!-->=<!--> <span>0.583). There was no difference in the occurrence of complications related to the procedure between the 2 groups. In multivariate analysis, the presence of interatrial septal aneurysm [OR 1.88 (95% CI 1.07–3.31), </span><em>P</em> <!-->=<!--> <!-->0.029], ROPE score<!--> <!-->&gt;<!--> <!-->6 [OR 1.22 (1.04–1.43), <em>P</em> <!-->=<!--> <!-->0.015] and the occurrence of stroke following the procedure [OR 4.48 (1.12–17.87), <em>P</em> <!-->=<!--> <!-->0.034] were independently associated with the presence of a residual inter-atrial shunt at 6 months.</p></div><div><h3>Conclusion</h3><p>Our study identified that PFO closure under LA with TEE microprobe is feasible and safe. There was no difference in efficacy of 6-month FOP closure, regardless of conventional-GA or micro-AL method.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 258"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43931709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of therapeutic decision-making process and prognosis in patients referred to the Valvular Heart Team for management of mitral regurgitation","authors":"M.L. Marie Luciani","doi":"10.1016/j.acvdsp.2023.04.003","DOIUrl":"10.1016/j.acvdsp.2023.04.003","url":null,"abstract":"<div><h3>Introduction</h3><p><span>Due to the aging of the population and the diversification of treatment options, finding the right treatment for the right patient becomes a challenge, especially </span>in patients<span> with mitral regurgitation (MR), which is a heterogenous and complex disease, with numerous etiologies. Aims of this study are to describe the profile of patients referred to the Valvular Heart Team (VHT) for management of mitral regurgitation, to highlight the selection process and the main factors guiding allocation for different treatment options, to assess clinical outcomes after treatment.</span></p></div><div><h3>Method</h3><p>All patients with mitral regurgitation referred to the VHT between January 1st, 2014, and April 30th, 2021, in University Hospital of Tours, were included.</p></div><div><h3>Results</h3><p>MR patients referred to our VHT were, mostly, old (mean: 74.2 years), symptomatic (96%), at high or intermediate risk according to “European Society of Cardiology” criteria (44%). Most of them had comorbidities, 34% had LVEF<!--> <!-->&lt;<!--> <span>50% and 70% a severe primary MR. In 81% of cases, invasive management was decided (surgery [44%], percutaneous edge- to-edge mitral repair [TEER] [35%], transcatheter mitral valve replacement [1.6%]) and in 19% of cases, medical treatment was decided. Distribution of treatments changed significantly (</span><em>P</em> <!-->&lt;<!--> <!-->0.01) over time, with a progressive increase in TEER. History of cardiac surgery (<em>P</em> <!-->=<!--> <!-->0.015), EuroScore II<!--> <!-->&gt;<!--> <!-->4% (<em>P</em> <!-->=<!--> <span>0.012), STS score &gt; 8% (</span><em>P</em> <!-->=<!--> <span>0.037), frailty<span> according to the Katz index (</span></span><em>P</em> <!-->=<!--> <!-->0.029), LVEF &lt; 50% (<em>P</em> <!-->&lt;<!--> <!-->0.001), TAPSE<!--> <!-->&lt;<!--> <!-->15 mm (<em>P</em> <!-->&lt;<!--> <!-->0,01) secondary MR (<em>P</em> <!-->&lt;<!--> <!-->0.001) and leaflets calcifications (<em>P</em> <!-->=<!--> <!-->0.027) were the main factors significantly associated with the choice of a conservative treatment. In 86% of cases, VHT decisions could be implemented.</p></div><div><h3>Conclusion</h3><p>VHT is a centerpiece in the current management of patients with MR, it opts and more and more, for percutaneous treatments. The organization and the smooth running of VHT meetings will be a real issue in the future, with the increase in patients referred and we will have to find solutions (<span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Pages 243-244"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44474971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic assessment of right ventricular function and right ventriculoarterial coupling in tricuspid regurgitation","authors":"L. Trousselle ,&nbsp;F. Eggenspieler ,&nbsp;L. Faroux ,&nbsp;P. Nazeyrollas ,&nbsp;O. Huttin ,&nbsp;N. Pace ,&nbsp;L. Filippetti ,&nbsp;A. Fraix ,&nbsp;B. Carquin ,&nbsp;C. Selton-Suty ,&nbsp;D. Metz","doi":"10.1016/j.acvdsp.2023.04.032","DOIUrl":"10.1016/j.acvdsp.2023.04.032","url":null,"abstract":"<div><h3>Introduction</h3><p>Echographic evaluation of the cardiopulmonary unit may be difficult in the presence of TR. Purpose: To assess the variation of simple and combined echographic parameters analysing the cardiopulmonary unit according to the severity of TR.</p></div><div><h3>Method</h3><p>Echographic images were reviewed in 179 patients to assess TR grade according to Hahn's 5 grades classification. Classical morphological (RV end diastolic length and area), function [TAPSE, RVFAC, S’,RVFWS (RV free wall longitudinal strain)] and load [PASP,TRTVI (TR Time-velocity integral)] parameters analysing RV were assessed. Combined parameters of function and load (TAPSE/PASP, TR TVI<!--> <!-->×<!--> <!-->RVFWS), morphology and load (load adaptation index<!--> <!-->=<!--> <!-->TRTVIxRVED length/area) and morphology, load, and function [myomechanical index (MMI<!--> <!-->=<!--> <!-->RV-RA mean pressure gradient<!--> <!-->×<!--> <!-->RVFWS/indexed RAED area<!--> <!-->×<!--> <!-->10–2) and morphology-load-function index (MLF<!--> <!-->=<!--> <!-->RVED length/area xTRTVIx RVFWS)] were calculated. We used ROC curves to analyze the diagnostic value of echocardiographic parameters to predict potential high (&gt;<!--> <!-->3) or low (&lt;<!--> <!-->6) surgical risk of mortality according to TRISCORE.</p></div><div><h3>Results</h3><p>Simple parameters were significatively different among groups with a nonlinear progression between the 5 levels of TR. Combined parameters were also significatively different. Among them, MMI and MLF had a linear progression (MMI: grade 1: 0.20<!--> <!-->±<!--> <!-->0.09; grade 2: 0.15<!--> <!-->±<!--> <!-->0.08; grade 3: 0.10<!--> <!-->±<!--> <!-->0.05, grade 4: 0.09<!--> <!-->±<!--> <!-->0.08; grade 5: 0.05<!--> <!-->±<!--> <!-->0.04 <em>P</em> <em>=</em> <!-->0.000; MLF: grade 1: 7.56<!--> <!-->±<!--> <!-->2.06; grade 2: 6.57<!--> <!-->±<!--> <!-->2.14; grade 3: 4.85<!--> <!-->±<!--> <!-->2.29, grade 4: 4.79<!--> <!-->±<!--> <!-->3.17; grade 5: 3.06<!--> <!-->±<!--> <!-->1.82 <em>P</em> <em>=</em> <!-->0.000) and had the best predictive value for TRISCORE (MMI: AUC<!--> <!-->=<!--> <!-->0.889 <em>P</em> <em>=</em> <!-->0.000 for low risk, 0.855 <em>P</em> <em>=</em> <!-->0.000 for high risk; MLF: AUC<!--> <!-->=<!--> <!-->0.873 <em>P</em> <em>=</em> <!-->0.000 and 0.822 <em>P</em> <em>=</em> <!-->0.000).</p></div><div><h3>Conclusion</h3><p>Combined parameters are relevant to evaluate cardiopulmonary unit in a population presenting with TR, especially when combining morphology, function and load (<span>Fig. 1</span>).</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Page 259"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45527314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Right Ventricular-Pulmonary arterial (RV-PA) coupling is load independent and accurately predicts right ventricular function","authors":"V.C.F.S. Chong Fah Shen ,&nbsp;C.V. Venner ,&nbsp;E.A. Abergel","doi":"10.1016/j.acvdsp.2023.04.030","DOIUrl":"10.1016/j.acvdsp.2023.04.030","url":null,"abstract":"<div><h3>Introduction</h3><p>RV-PA coupling can be evaluated, using non-invasive surrogates such as Tricuspid annular plane systolic excursion/Systolic pulmonary artery pressure<span> (TAPSE/SPAP) or RV free wall longitudinal strain/SPAP (RVFWLS/SPAP) emerged. The aim of the present study was: 1) Population 1: in Hemodialysis population (HD), to evaluate RV parameters during important load variations, immediately before and after HD. 2) Population 2: in routine cardiologic population, to evaluate the diagnostic value of RV-PA coupling for RV dysfunction</span></p></div><div><h3>Method</h3><p>Population 1: 85 patients (53 men), 64<!--> <!-->±<!--> <span>16 years old, had an echocardiography with RV analysis (s’, TAPSE, RVFWLS)immediately before starting HD(Pre-HD)and at the end of HD(Post-HD). Population 2: 96 patients (60 men), 64</span> <!-->±<!--> <span>14 years old with various disease in the Department of cardiology had an echocardiography including RVFWLS,RV fractional area change(RVFAC), TAPSE,S’, Tei index, Isovolumic acceleration(IVA),and 3D RVEF. Patients were split in normal RV function (defined by 6 concordant normal indices) and RV dysfunction (defined by the presence of at least 3 abnormal indices)</span></p></div><div><h3>Results</h3><p>Population 1: TAPSE, s’, RVFWLS were significantly decreased in post-HD as compared to pre-HD; when indexing these parameters by SPAP (s’/SPAP, TAPSE/SPAP, RVFWLS/SPAP), they remain unchanged. Population 2: RVFWLS/SPAP and TAPSE/SPAP were significantly higher in normal RV function compared to dysfunction (1.02<!--> <!-->±<!--> <!-->0.31 vs 0.57<!--> <!-->±<!--> <!-->0.34 and 0.83<!--> <!-->±<!--> <!-->0.20 vs 0.47<!--> <!-->±<!--> <!-->0.21); diagnostic thresholds for RV dysfunction were 0.67 for RVFWLS/SPAP(sensitivity:95%, specificity:78%)and 0.63 for TAPSE/SPAP (sensitivity:86%, specificity:80%)</p></div><div><h3>Conclusion</h3><p>Surrogates of RV-PA coupling, such as TAPSE/SPAP or RVFWLS/SPAP are load independent in a HD population. Moreover, these parameters may contribute to precisely evaluate RV function.</p></div>","PeriodicalId":8140,"journal":{"name":"Archives of Cardiovascular Diseases Supplements","volume":"15 3","pages":"Pages 258-259"},"PeriodicalIF":18.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41560826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}