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See detailThe use of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association.
Lancellotti, Patrizio ULg; Price, Susanna; Edvardsen, Thor et al

in European Heart Journal. Acute Cardiovascular Care (2015)

Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioner. Currently, there is a lack of specific European Association of ... [more ▼]

Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiac care scenarios are also described. [less ▲]

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See detailThe multi-modality cardiac imaging approach to the Athlete's heart: an expert consensus of the European Association of Cardiovascular Imaging.
Galderisi, Maurizio; Cardim, Nuno; D'Andrea, Antonello et al

in European heart journal cardiovascular Imaging (2015)

The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate ... [more ▼]

The term 'athlete's heart' refers to a clinical picture characterized by a slow heart rate and enlargement of the heart. A multi-modality imaging approach to the athlete's heart aims to differentiate physiological changes due to intensive training in the athlete's heart from serious cardiac diseases with similar morphological features. Imaging assessment of the athlete's heart should begin with a thorough echocardiographic examination. Left ventricular (LV) wall thickness by echocardiography can contribute to the distinction between athlete's LV hypertrophy and hypertrophic cardiomyopathy (HCM). LV end-diastolic diameter becomes larger (>55 mm) than the normal limits only in end-stage HCM patients when the LV ejection fraction is <50%. Patients with HCM also show early impairment of LV diastolic function, whereas athletes have normal diastolic function. When echocardiography cannot provide a clear differential diagnosis, cardiac magnetic resonance (CMR) imaging should be performed. With CMR, accurate morphological and functional assessment can be made. Tissue characterization by late gadolinium enhancement may show a distinctive, non-ischaemic pattern in HCM and a variety of other myocardial conditions such as idiopathic dilated cardiomyopathy or myocarditis. The work-up of athletes with suspected coronary artery disease should start with an exercise ECG. In athletes with inconclusive exercise ECG results, exercise stress echocardiography should be considered. Nuclear cardiology techniques, coronary cardiac tomography (CCT) and/or CMR may be performed in selected cases. Owing to radiation exposure and the young age of most athletes, the use of CCT and nuclear cardiology techniques should be restricted to athletes with unclear stress echocardiography or CMR. [less ▲]

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See detailReporting nuclear cardiology: a joint position paper by the European Association of Nuclear Medicine (EANM) and the European Association of Cardiovascular Imaging (EACVI).
Tragardh, Elin; Hesse, Birger; Knuuti, Juhani et al

in European heart journal cardiovascular Imaging (2015)

The report of an imaging procedure is a critical component of an examination, being the final and often the only communication from the interpreting physician to the referring or treating physician. Very ... [more ▼]

The report of an imaging procedure is a critical component of an examination, being the final and often the only communication from the interpreting physician to the referring or treating physician. Very limited evidence and few recommendations or guidelines on reporting imaging studies are available; therefore, an European position statement on how to report nuclear cardiology might be useful. The current paper combines the limited existing evidence with expert consensus, previously published recommendations as well as current clinical practices. For all the applications discussed in this paper (myocardial perfusion, viability, innervation, and function as acquired by single photon emission computed tomography and positron emission tomography or hybrid imaging), headings cover laboratory and patient demographics, clinical indication, tracer administration and image acquisition, findings, and conclusion of the report. The statement also discusses recommended terminology in nuclear cardiology, image display, and preliminary reports. It is hoped that this statement may lead to more attention to create well-written and standardized nuclear cardiology reports and eventually lead to improved clinical outcome. [less ▲]

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See detailRole of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association.
Cardim, Nuno; Galderisi, Maurizio; Edvardsen, Thor et al

in European heart journal cardiovascular Imaging (2015)

Taking into account the complexity and limitations of clinical assessment in hypertrophic cardiomyopathy (HCM), imaging techniques play an essential role in the evaluation of patients with this disease ... [more ▼]

Taking into account the complexity and limitations of clinical assessment in hypertrophic cardiomyopathy (HCM), imaging techniques play an essential role in the evaluation of patients with this disease. Thus, in HCM patients, imaging provides solutions for most clinical needs, from diagnosis to prognosis and risk stratification, from anatomical and functional assessment to ischaemia detection, from metabolic evaluation to monitoring of treatment modalities, from staging and clinical profiles to follow-up, and from family screening and preclinical diagnosis to differential diagnosis. Accordingly, a multimodality imaging (MMI) approach (including echocardiography, cardiac magnetic resonance, cardiac computed tomography, and cardiac nuclear imaging) is encouraged in the assessment of these patients. The choice of which technique to use should be based on a broad perspective and expert knowledge of what each technique has to offer, including its specific advantages and disadvantages. Experts in different imaging techniques should collaborate and the different methods should be seen as complementary, not as competitors. Each test must be selected in an integrated and rational way in order to provide clear answers to specific clinical questions and problems, trying to avoid redundant and duplicated information, taking into account its availability, benefits, risks, and cost. [less ▲]

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See detailEACVI/HFA Cardiac Oncology Toxicity Registry in breast cancer patients: rationale, study design, and methodology (EACVI/HFA COT Registry)-EURObservational Research Program of the European Society of Cardiology.
Lancellotti, Patrizio ULg; Anker, Stefan D.; Donal, Erwan et al

in European heart journal cardiovascular Imaging (2015)

The goal of adjuvant anti-cancer therapies is cure with limited or no side effects, in particular long-term side effects with negative impact on quality of life. In the palliative setting disease control ... [more ▼]

The goal of adjuvant anti-cancer therapies is cure with limited or no side effects, in particular long-term side effects with negative impact on quality of life. In the palliative setting disease control, quality of life and overall survival are important end points. Partly due to improvements in treatment, the population of cancer survivors is large and growing. However, anti-cancer drug-related cardiotoxicity (ADRC) is the leading cause of treatment-associated mortality in cancer survivors. It is one of the most common post-treatment problems among 5- to 10-year survivors of adult cancer. This is particularly true for breast cancer, the most common cancer in women. The EACVI/HFA COT registry is designed for comprehensive data collection and evaluation of the current European practice in terms of diagnosis and management of ADRC in breast cancer patients. The COT registry will be carried out in two continuing phases, the pilot study phase involving 13 countries followed by the long-term registry in which all the 56 ESC countries will be invited to participate. With the COT registry, several critical information will be obtained: on predisposing factors for the development of ADRC, the rate of subclinical LV dysfunction and its transition to overt heart failure, the clinical impact and outcome of ADRC. [less ▲]

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See detailReply: valvular disease, myocardial mechanics, and valve guidelines.
Donal, Erwan; Lancellotti, Patrizio ULg; Sengupta, Partho P. et al

in JACC. Cardiovascular imaging (2015), 8(3), 383

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See detailEchocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study.
Caballero, Luis; Kou, Seisyou; DULGHERu et al

in European heart journal cardiovascular Imaging (2015)

AIMS: Reference values for Doppler parameters according to age and gender are recommended for the assessment of heart physiology, specifically for left ventricular (LV) diastolic function. In this study ... [more ▼]

AIMS: Reference values for Doppler parameters according to age and gender are recommended for the assessment of heart physiology, specifically for left ventricular (LV) diastolic function. In this study, we report normal reference ranges for Doppler parameters obtained in a large group of healthy volunteers. Echocardiographic data were acquired using state-of-the-art cardiac ultrasound equipment following Doppler acquisition and measurement protocols approved by the European Association of Cardiovascular Imaging. METHODS AND RESULTS: A total of 449 (mean age: 45.8 +/- 13.7 years) healthy volunteers (198 men and 251 women) were enrolled at the collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. A comprehensive echocardiographic examination was obtained from all subjects following predefined protocols. The majority of the Doppler diastolic parameters (e', E/e') as well as right ventricle systolic s' wave velocity were similar in men and women. Left ventricle s' wave velocity was higher in men than in women. E wave and e' were higher in younger subjects and decreased progressively in the older ones. E/e' ratio increased with ageing. Septal e' <8 cm/s was present in 19.7% of the subjects in the 40-60 year group and in 55% of those in the >/=60 year group. However, the cut-off value of average E/e' or lateral E/e' remained <15 or 13, respectively, in the majority of patients. CONCLUSION: The NORRE study provides the reference values for the most useful Doppler parameters in the evaluation of heart physiology. These data highlight the need of using age-specific reference values especially for the diagnosis of LV systolic and diastolic dysfunction and for the estimation of LV filling pressures. [less ▲]

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See detailPulmonary Hypertension in Valvular Disease: A Comprehensive Review on Pathophysiology to Therapy From the HAVEC Group.
Magne, Julien; Pibarot, Philippe; Sengupta, Partho P. et al

in JACC. Cardiovascular imaging (2015), 8(1), 83-99

Pulmonary hypertension (PH) is a classic pathophysiological consequence of left-sided valvular heart disease (VHD). However, as opposed to other forms of PH, there are relatively few published data on the ... [more ▼]

Pulmonary hypertension (PH) is a classic pathophysiological consequence of left-sided valvular heart disease (VHD). However, as opposed to other forms of PH, there are relatively few published data on the prevalence, impact on outcome, and management of PH with VHD. The objective of this paper is to present a systematic review of PH in patients with VHD. PH is found in 15% to 60% of patients with VHD and is more frequent among symptomatic patients. PH is associated with higher risk of cardiac events under conservative management, during valve replacement or repair procedures, and even following successful corrective procedures. In addition to its usefulness in assessing the presence and severity of VHD, Doppler echocardiography is a key tool in diagnosis of PH and assessment of its repercussion on right ventricular function. Assessment of pulmonary arterial pressure during exercise stress echocardiography may provide additional prognostic information beyond resting evaluation. Cardiac magnetic resonance is also useful for assessing right ventricular geometry and function, which provide additional prognostic information in patients with VHD and PH. [less ▲]

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See detailLV Mechanics in Mitral and Aortic Valve Diseases: Value of Functional Assessment Beyond Ejection Fraction.
Galli, Elena; LANCELLOTTI, Patrizio ULg; Sengupta, Partho P. et al

in JACC. Cardiovascular imaging (2014), 7(11), 1151-1166

The assessment of myocardial function in the context of valvular heart disease remains highly challenging. The myocardium deforms simultaneously in 3 dimensions, and global left ventricular (LV) function ... [more ▼]

The assessment of myocardial function in the context of valvular heart disease remains highly challenging. The myocardium deforms simultaneously in 3 dimensions, and global left ventricular (LV) function parameters such as volume and ejection fraction may remain compensated despite the changes in myocardial deformation properties. Current guidelines recommend valve replacement/repair in the presence of symptoms or reduced LV ejection fraction, but the resolution of symptoms or recovery of LV function post-surgery may not be reliably predicted. A wealth of evidence currently suggests that LV dysfunction is frequently subclinical despite normal ejection fraction. It may precede the onset of symptoms and portend a poor outcome due to progressive myocardial remodeling and dysfunction during the post-operative period. The advent of novel tissue-tracking echocardiography techniques has unleashed new opportunities for the clinical identification of early abnormalities in LV function. This review gathers and summarizes current evidence regarding the use of these techniques to assess myocardial deformation in patients with valvular heart disease. [less ▲]

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See detailImpact of exercise pulmonary hypertension on postoperative outcome in primary mitral regurgitation.
Magne, Julien; Donal, Erwan; Mahjoub, Haifa et al

in Heart (British Cardiac Society) (2014)

AIMS: The management of asymptomatic patients with mitral regurgitation (MR) remains controversial. Exercise-induced pulmonary hypertension (ExPHT) was recently reported as a strong predictor of rapid ... [more ▼]

AIMS: The management of asymptomatic patients with mitral regurgitation (MR) remains controversial. Exercise-induced pulmonary hypertension (ExPHT) was recently reported as a strong predictor of rapid onset of symptoms. We hypothesised that ExPHT is a predictor of postoperative cardiovascular events in patients with primary MR. METHODS AND RESULTS: One hundred and two patients with primary MR, no or mild symptoms (New York heart association (NYHA) </=2), and no LV dysfunction/dilatation, were prospectively recruited in 3 centres and underwent exercise-stress echocardiography. The presence of ExPHT was defined as an exercise systolic pulmonary arterial pressure >60 mm Hg. All patients were closely followed up and operated on when indication for surgery was reached. Postoperative events were defined as the occurrence of atrial fibrillation (AF), stroke, cardiac-related hospitalisation or death. Among the 102 patients included, 59 developed ExPHT (58%). These patients were significantly older than those without ExPHT (p=0.01). During a mean postoperative follow-up of 50+/-23 months, 28 patients (26%) experienced a predefined cardiovascular event. Patients with ExPHT had significantly higher rate of postoperative events (39% vs 12%, p=0.005); the rate of events was still higher in these patients (32% vs 9%, p=0.013), even when excluding early postoperative AF (ie, within 48 h). Event-free survival was significantly lower in the ExPHT group (all events: 5-year: 60+/-8% vs 88+/-5%, p=0.007, events without early AF: 5-year: 67+/-7% vs 90+/-4%, p=0.02). Using Cox multivariable analysis, ExPHT remained independently associated with higher risk of postoperative events in all models (all p</=0.04). CONCLUSIONS: ExPHT is associated with increased risk of adverse cardiac events following mitral valve surgery in patients with primary MR. [less ▲]

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See detailThe use of echocardiography in acute cardiovascular care: Recommendations of the European Association of Cardiovascular Imaging and the Acute Cardiovascular Care Association.
Lancellotti, Patrizio ULg; Price, Susanna; Edvardsen, Thor et al

in European heart journal. Acute cardiovascular care (2014)

Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioner. Currently, there is a lack of specific European Association of ... [more ▼]

Echocardiography is one of the most powerful diagnostic and monitoring tools available to the modern emergency/critical care practitioner. Currently, there is a lack of specific European Association of Cardiovascular Imaging/Acute Cardiovascular Care Association recommendations for the use of echocardiography in acute cardiovascular care. In this document, we describe the practical applications of echocardiography in patients with acute cardiac conditions, in particular with acute chest pain, acute heart failure, suspected cardiac tamponade, complications of myocardial infarction, acute valvular heart disease including endocarditis, acute disease of the ascending aorta and post-intervention complications. Specific issues regarding echocardiography in other acute cardiovascular care scenarios are also described. [less ▲]

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See detailEuropean multicentre validation study of the accuracy of E/e' ratio in estimating invasive left ventricular filling pressure: EURO-FILLING study.
Galderisi, Maurizio; Lancellotti, Patrizio ULg; Donal, Erwan et al

in European Heart Journal - Cardiovascular Imaging (2014)

AIMS: The non-invasive estimation of left ventricular filling pressures (LVFPs) represents a main goal in the clinical setting. Current recommendations encourage the use of pulsed-wave Tissue Doppler for ... [more ▼]

AIMS: The non-invasive estimation of left ventricular filling pressures (LVFPs) represents a main goal in the clinical setting. Current recommendations encourage the use of pulsed-wave Tissue Doppler for calculating the ratio between the preload-dependent transmitral E velocity and the average of septal and lateral early diastolic velocities (e') of the mitral annulus. Despite its wide use, real utility of the E/e' ratio has been recently challenged in patients with either very advanced heart failure or preserved left ventricular (LV) ejection fraction. However, only few studies performed the invasive and non-invasive estimation of LVFP simultaneously. The EURO-FILLING Study will validate the E/e' ratio (and additional non-invasive estimates) against simultaneously measured LVFP obtained by left heart catheterization in a multicentre study involving reference European echo laboratories collecting a wide population sample size of cardiac patients with and without heart failure. METHODS AND RESULTS: The EURO-FILLING study is a large, prospective observational study in which simultaneous assessment of invasive and non-invasive measurements of LVFP will be acquired in eight reference European centres. Centralized reading of the collected parameters will be performed in a core laboratory. Not only standardized echo Doppler measurements but also novel echo parameters such as LV global longitudinal strain and global atrial strain (obtainable by two-dimensional speckle tracking echocardiography) will be tested for predicting invasive measurements of LVFP. CONCLUSIONS: The EURO-FILLING study is expected to provide important information on non-invasive assessment of LVFP and to contribute to the standardization of this assessment in clinical practice. [less ▲]

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See detailEuroEcho-Imaging 2013: highlights.
Lancellotti, Patrizio ULg; Magne, Julien ULg; Cosyns, Bernard et al

in European Heart Journal - Cardiovascular Imaging (2014), 15(5), 483-488

The annual meeting of the European Association of Echocardiography (EuroEcho-Imaging) was held in Istanbul, Turkey. In the present paper, we present a summary of the 'Highlights' session.

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See detailEchocardiographic reference ranges for normal cardiac chamber size: results from the NORRE study.
Kou, Seisyou; Caballero, Luis; Dulgheru, Raluca et al

in European heart journal cardiovascular Imaging (2014), 15(6), 680-690

AIMS: Availability of normative reference values for cardiac chamber quantitation is a prerequisite for accurate clinical application of echocardiography. In this study, we report normal reference ranges ... [more ▼]

AIMS: Availability of normative reference values for cardiac chamber quantitation is a prerequisite for accurate clinical application of echocardiography. In this study, we report normal reference ranges for cardiac chambers size obtained in a large group of healthy volunteers accounting for gender and age. Echocardiographic data were acquired using state-of-the-art cardiac ultrasound equipment following chamber quantitation protocols approved by the European Association of Cardiovascular Imaging. METHODS: A total of 734 (mean age: 45.8 +/- 13.3 years) healthy volunteers (320 men and 414 women) were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. A comprehensive echocardiographic examination was performed on all subjects following pre-defined protocols. There were no gender differences in age or cholesterol levels. Compared with men, women had significantly smaller body surface areas, and lower blood pressure. Quality of echocardiographic data sets was good to excellent in the majority of patients. Upper and lower reference limits were higher in men than in women. The reference values varied with age. These age-related changes persisted for most parameters after normalization for the body surface area. CONCLUSION: The NORRE study provides useful two-dimensional echocardiographic reference ranges for cardiac chamber quantification. These data highlight the need for body size normalization that should be performed together with age-and gender-specific assessment for the most echocardiographic parameters. [less ▲]

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See detailAppropriateness criteria for cardiovascular imaging use in clinical practice: a position statement of the ESC/EACVI taskforce.
Garbi, Madalina; Habib, Gilbert; Plein, Sven et al

in European heart journal cardiovascular Imaging (2014), 15(5), 477-182

There is a growing interest from the scientific community in the appropriate use of cardiovascular imaging techniques for diagnosis and decision making in Europe. To develop appropriateness criteria for ... [more ▼]

There is a growing interest from the scientific community in the appropriate use of cardiovascular imaging techniques for diagnosis and decision making in Europe. To develop appropriateness criteria for cardiovascular imaging use in clinical practice in Europe, a dedicated taskforce has been appointed by the European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging (EACVI). The present paper describes the appropriateness criteria development process. [less ▲]

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See detailNormal Reference Ranges for Echocardiography: rationale, study design, and methodology (NORRE Study).
LANCELLOTTI, Patrizio ULg; Badano, Luigi P.; Lang, Roberto M. et al

in European Heart Journal - Cardiovascular Imaging (2013), 14(4), 303-8

BACKGROUND: Availability of normative reference values for cardiac chamber dimensions, volumes, mass, and function is a prerequisite for the accurate application of echocardiography for both clinical and ... [more ▼]

BACKGROUND: Availability of normative reference values for cardiac chamber dimensions, volumes, mass, and function is a prerequisite for the accurate application of echocardiography for both clinical and research purposes. However, due to the lack of consistency in current echocardiographic 'reference values', their use for clinical decision-making remains questionable. AIMS: The aim of the 'Normal Reference Ranges for Echocardiography Study (NORRE Study)' is to obtain a set of 'normal values' for cardiac chamber geometry and function in a large cohort of healthy Caucasian individuals aged over a wide range of ages (25-75 years) using both conventional and advanced echocardiographic techniques. METHODS: The NORRE Study is a large prospective, observational multicentre study in which transthoracic echocardiographic studies will be acquired in 22 laboratories accredited by the European Association of Cardiovascular Imaging and in one laboratory in the USA accredited by ICAEL. The final sample size has been estimated in 1100 normal subjects in whom M-mode, 2D, and 3D imaging, colour Doppler, pulsed-wave Doppler, pulsed-wave tissue Doppler, and colour tissue Doppler imaging data will be obtained. All studies will be sent to a central echocardiographic core laboratory for quantitative analysis. Multiple studies will be performed for reproducibility analysis. CONCLUSION: After completion of the NORRE Study, uniform reference limits according to age, gender, and anthropometric parameters will be available to standardize the quantitative interpretation of echocardiography. [less ▲]

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See detailResearch and innovations committee a new outlook for the European Association of Cardiovascular Imaging (EACVI).
Donal, Erwan; Badano, Luigi; Habib, Gilbert et al

in European Heart Journal - Cardiovascular Imaging (2013), 14(4), 400

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See detailRisk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay.
Lancellotti, Patrizio ULg; Donal, Erwan; Magne, Julien ULg et al

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 ▲]

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See detailImpact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study.
Lancellotti, Patrizio ULg; Donal, Erwan; Magne, Julien ULg et al

in European Journal of Echocardiography (2010), 11(6), 537-543

Aims: The present study sought to assess the effect of global left ventricular (LV) afterload on LV myocardial systolic function in patients with aortic stenosis (AS) and preserved LV ejection fraction ... [more ▼]

Aims: The present study sought to assess the effect of global left ventricular (LV) afterload on LV myocardial systolic function in patients with aortic stenosis (AS) and preserved LV ejection fraction. <br />Methods and results: We prospectively examined the LV myocardial deformation (i.e. longitudinal, radial, and circumferential) by two-dimensional speckle tracking in 173 patients with asymptomatic severe AS. Thirty-eight patients (22%) had lowflow as determined by a low stroke volume index (􏰀35 mL/m2). By multivariable analysis, four variables emerged as independently associated with low-flow AS: peak Ea velocity (P 1⁄4 0.01), left atrial area index (P 1⁄4 0.017), global LV afterload (P 1⁄4 0.024), and circumferential myocardial deformation (P 1⁄4 0.04). Forty-nine patients (28%) had an increased global LV afterload (􏰁5 mmHg mL/m2). Systemic arterial compliance (P 1⁄4 0.001), circumferential myocardial deformation (P 1⁄4 0.024), and left atrial area index (P 1⁄4 0.04) were independently associated with increased global LV load in multivariable analysis. <br />Conclusion: In asymptomatic patients with severe AS, LV ejection fraction markedly underestimates the extent of myocardial sys- tolic impairment. Intrinsic myocardial dysfunction is particularly common in patients with increased global LV after- load, and especially in the subset of patients with low-flow AS. [less ▲]

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See detailMyocardial contractile reserve during exercise predicts left ventricular reserve remodelling after cardiac resynchromization therapy
Lancellotti, Patrizio ULg; Senechal, Mario; Moonen, Marie ULg et al

in European Journal of Echocardiography (2009), 10(5), 663-8

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