Valvular heart disease: mitral valve disease

in The EAE textbook of echocardiography (2011)

Assessment and management of aortic stenosis [Evaluation et traitement de la sténose aortique]

in Revue Medicale Suisse (2011), 7(306), 1606-1611

ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

in European Heart Journal (2011), 32(23), 2999-3054

ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC).

in European Heart Journal (2011), 32(23), 2999-3054

Minimal cardiovascular system model including physiological mitral valve opening

Poster (2010, November 26)

This research describes a new closed-loop cardiovascular system (CVS) model including a model of the left atrium and a model describing the progressive aperture of the mitral valve

Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay.

in Heart (2010), 96(17), 1364-71

OBJECTIVE: We sought to evaluate prognostic markers of clinical outcome in asymptomatic patients with moderate to severe aortic stenosis (AS). DESIGN: Prospective follow-up of asymptomatic patients with ... [more ▼]

OBJECTIVE: We sought to evaluate prognostic markers of clinical outcome in asymptomatic patients with moderate to severe aortic stenosis (AS). DESIGN: Prospective follow-up of asymptomatic patients with moderate to severe AS. The patients underwent clinical and Doppler echocardiographic evaluation. SETTING: Department of Cardiology. PATIENTS: 163 patients with moderate to severe AS (aortic valve area < or =0.6 cm(2)/m(2)). MAIN OUTCOME MEASURES: Risk stratification. Predefined endpoints for assessing the outcome were the occurrence during follow-up of symptoms, aortic valve replacement or death. RESULTS: During follow-up (mean, 20 (19) months), 11 patients developed symptoms but were not operated on, 57 required aortic valve replacement and six patients died. In multivariable Cox regression analysis, four parameters that were associated with the outcome were identified: peak aortic jet velocity, left ventricular systolic (LV) longitudinal deformation, valvulo-arterial impedance and indexed left atrial area. Using receiver-operator characteristic curve analysis, a peak aortic jet velocity > or =4.4 m/s, a LV longitudinal myocardial deformation < or =15.9%, a valvular-arterial impedance > or =4.9 mm Hg/ml per m(2) and an indexed left atrial area > or =12.2 cm(2)/m(2) were identified as the best cut-off values to be associated with events. CONCLUSIONS: In asymptomatic patients with moderate to severe AS, measurements that integrate the ventricular, vascular and valvular components of the disease improve risk stratification. [less ▲]

Etude échocardiographique longitudinale chez des patients atteints de prolactinome et traités par Cabergoline

in 27ème Congrès de la Société Française d'Endocrinologie - Deauville, 29 septembre - 2 octobre 2010 (2010, September)

Stress echocardiography for selecting potential responders to cardiac resynchronisation therapy.

in Heart (2010), 96(14), 1142-6

In the current ESC/ACC/AHA guidelines, the selection of patients for cardiac resynchronisation therapy (CRT) is based upon the QRS duration, which reflects interventricular dyssynchrony. However, about 30 ... [more ▼]

In the current ESC/ACC/AHA guidelines, the selection of patients for cardiac resynchronisation therapy (CRT) is based upon the QRS duration, which reflects interventricular dyssynchrony. However, about 30% of patients do not respond to CRT. It has previously been demonstrated that the presence of left ventricular mechanical dyssynchrony is predictive of response to CRT after implantation. Most criteria assessing such dyssynchrony were derived from data obtained with resting Doppler echocardiography. The recently published PROSPECT (Predictors of Response to CRT) trial failed to identify echocardiographic measures of dyssynchrony that could routinely be recommended for patient selection before CRT implantation. Therefore, solutions may come from other echocardiographic modalities, such as dobutamine stress echocardiography and exercise echocardiography. The purpose of this review is to evaluate the usefulness of stress echocardiography to predict response to CRT. This review will show how exercise-induced changes in dyssynchrony and severity of mitral regurgitation and the role of preserved contractile reserve may help to better identify potential responders. [less ▲]

Does echocardiographic stress test induced release of hsTnT and TnI II?

in Clinical Chemistry (2010, July), 56(S6), 128

Background: Cardiac troponins (cTn) are considered as the best biomarkers for detection of myocardial cell injury. In this study, cTnT and cTnI were measured by new commercially available high-sensitive ... [more ▼]

Background: Cardiac troponins (cTn) are considered as the best biomarkers for detection of myocardial cell injury. In this study, cTnT and cTnI were measured by new commercially available high-sensitive methods in patients undergoing brief exercise- or pharmacologicinduced stress. Our aim was to compare cTnT and cTnI levels before and after the stress tests, in the patients with or without reversible ischemia. Materials and Methods: Fifty patients (28 men and 22 women) underwent an echographic stress test (ST) for suspected ischemic heart disease. Of these 50 patients, 28 received pharmacological ST (dobutamine injection) and 22 dynamic ST (bicycle exercise). The patients were subdivided into two groups according to the presence or absence of documented transient reversible ischemia: 14 with reversible ischemia ( mean age: 67.71±9.66 y) and 36 without ischemia ( mean age: 63.17±11.72 y). In all patients, cTnT and cTnI concentrations were measured by high sensitive methods (hsTnT, Roche Diagnostics and TnI II, Abbott Diagnostics) on heparin plasma immediately before (T0) and after ST (T1).The lower detection limit of these assays was 0.005μg/L for hsTnT and 0.01μg/L for TnI II. The protocol was approved by the ethics committee of the University of Liège (Belgium). All patients gave informed consent. All statistical analyses were performed using Medcalc version 8.1 for Windows. P value <0.05 was regarded as statistically significant. Results: There was no significant difference between hsTnT concentrations at T0 and T1, neither in the whole patient group, nor in the subgroups of subjects who received pharmacological ST or dynamic ST. The same was true for TnI II. Although there was no change in hsTnT levels during test in ischemic and in non ischemic patients, the latter tend to demonstrate higher median T0 levels (25th, 75th percentiles) than the others [0.011 (0.007, 0.029) vs 0.007 (0.0047, 0.1125) ng/ml, p=0.09]. They also showed higher median T1 levels [0.014 (0.065, 0.03) vs 0.007 (0.003, 0.0102) ng/ml, p=0.08]. Higher TnI II levels were also recorded in ischemic patients as compared to non ischemic patients at T0[ 0.014 (0.0072; 0.0265) vs 0.005 (0.003; 0.01) ng/ml, p=0.08] and T1[ 0.013 (0.0085- 0.03) vs 0.006 (0.0035-0.008) ng/ml, p=0.08]. Also, TnI II levels did not change during test in both subgroups. Conclusions: Measurement of cardiac troponins by high sensitive methods did not allow to detect significant release of biomarkers from the heart during exercise-or pharmacologic-induced ST, even in patients who demonstrated reversible myocardial ischemia. The type of test – pharmacological or dynamic - was without effect. The patients with induced transient ischemia had however higher troponin T and I levels at baseline, this difference remaining during test. [less ▲]

Inertie clinique et observance thérapeutique dans les valvulopathies chroniques du coeur gauche.

in Revue Médicale de Liège (2010), 65(5-6), 290-8

Valvular heart diseases are of increasing importance among the general adult population. When compared with other heart diseases, there are few trials in the field of valvular heart disease and randomized ... [more ▼]

Valvular heart diseases are of increasing importance among the general adult population. When compared with other heart diseases, there are few trials in the field of valvular heart disease and randomized clinical trials are particularly scarce. Two sets of guidelines exist: one in the USA and the other in Europe. However, they are not always consistent due to the lack of randomized data and it appears that, frequently, there is a gap between the existing guidelines and their effective application. [less ▲]