Clinical Significance of Exercise Pulmonary Hypertension in Secondary Mitral Regurgitation.
Lancellotti, Patrizio ; ; DULGHERU, Raluca Elena et al
in The American journal of cardiology (2015)
In patients with heart failure, exercise echocardiography can help in risk stratification and decision making. The prognostic significance of exercise pulmonary hypertension (PH) in patients with ... [more ▼]
In patients with heart failure, exercise echocardiography can help in risk stratification and decision making. The prognostic significance of exercise pulmonary hypertension (PH) in patients with secondary mitral regurgitation (MR) remains unknown. The aim of the present study was to assess the prognostic value of exercise PH in patients with secondary MR and narrow QRS intervals. From 2005 to 2012, 159 consecutive patients with secondary MR, narrow QRS intervals, left ventricular dysfunction (mean ejection fraction 36 +/- 7%), and measurable systolic pulmonary arterial pressure (SPAP) during exercise echocardiography were included. Resting and exercise PH were defined as SPAP >50 and >60 mm Hg, respectively. Exercise PH was more frequent than resting PH (40% vs 13%, p <0.0001). On multivariate logistic regression, the independent determinants of exercise PH were resting SPAP (p <0.0001), exercise MR severity (p <0.0001), and e'-wave velocity (p = 0.004). The incidence of cardiac events during follow-up was significantly higher in patients with exercise PH compared with those without exercise PH (4 years: 40 +/- 7% vs 20 +/- 5%, p <0.0001). Patients with exercise PH exhibited higher rates of cardiac events and death than those with resting PH. In a multivariate Cox proportional hazards model, exercise PH was independently associated with the occurrence of cardiac events (p <0.0001). In conclusion, in patients with secondary MR, exercise PH is determined mainly by resting SPAP, left ventricular diastolic burden, and exercise MR severity. Exercise PH is a powerful predictor of poor outcomes, with a 5.3-fold increased risk for cardiac-related death during follow-up. These results highlight the added value of exercise echocardiography in secondary MR. [less ▲]
Echocardiographic reference ranges for normal cardiac Doppler data: results from the NORRE Study.
; ; 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 ▲]
Pulmonary Hypertension in Valvular Disease: A Comprehensive Review on Pathophysiology to Therapy From the HAVEC Group.
; ; 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 ▲]Detailed reference viewed: 10 (0 ULg)
Elevated heart rate at 24-36h after admission and in-hospital mortality in acute in non-arrhythmic heart failure.
Lancellotti, Patrizio ; ANCION, Arnaud ; et al
in International journal of cardiology (2015), 182C
BACKGROUND: Elevated resting heart rate is associated with worse outcomes in chronic heart failure (HF) but little is known about its prognostic impact in acute setting. The main aim of the present study ... [more ▼]
BACKGROUND: Elevated resting heart rate is associated with worse outcomes in chronic heart failure (HF) but little is known about its prognostic impact in acute setting. The main aim of the present study was to examine the relationship between resting heart rate obtained 24-36h after admission for acute non-arrhythmic HF and in-hospital mortality. METHODS AND RESULTS: We examined the association of heart rate with in-hospital mortality in a cohort of 712 patients admitted for acute HF. None of the patients had significant arrhythmias, required invasive ventilation, or presented with acute coronary syndrome or primary valvular disease. Forty patients (5.6%) died during the hospital stay. Those patients were significantly older (78+/-9 vs. 72+/-12years; p=0.0021), had higher heart rate (92+/-22 vs. 78+/-18bpm; p<0.0001), NT pro-BNP (p=0.0005), creatinine (p=0.023), were often diabetics (p=0.026) and had lower systolic and diastolic blood pressures (p<0.05). There was a significant graded relationship between the increase in mortality rate and tertile of heart rate (p<0.01). With multivariable analysis, age (p=0.037), heart rate (p<0.0001), diastolic blood pressure (p<0.001), prior ischemic heart disease (p=0.02) and creatinine (p=0.019) emerged as independent predictors of in-hospital mortality. After adjusting for predictors of poor prognosis, patients in the highest heart rate tertile had worst outcomes when compared with those in the lowest heart rate group (p=0.007). CONCLUSIONS: Higher heart rate 24-36h after admission for acute non-arrhythmic HF is associated with increased risk of in-hospital mortality. Early targeting of elevated heart rate might represent a complementary therapeutic challenge. [less ▲]Detailed reference viewed: 14 (1 ULg)
Impact of gender difference in hospital outcomes following percutaneous coronary intervention. Results of the Belgian Working Group on Interventional Cardiology (BWGIC) registry
LEMPEREUR, Mathieu ; ; et al
in EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology (2014)
Aims: To determine whether there are gender-based differences in in-hospital outcomes among patients undergoing percutaneous coronary intervention (PCI). Methods and results: We studied a large cohort ... [more ▼]
Aims: To determine whether there are gender-based differences in in-hospital outcomes among patients undergoing percutaneous coronary intervention (PCI). Methods and results: We studied a large cohort using clinical data from a registry of 130,985 PCI procedures in Belgium, from January 2006 to February 2011. Compared to males, females were significantly older (70.3 vs. 64.8 years), and were more frequently diabetic or hypertensive. Men smoked more and more frequently had previous myocardial infarction (MI), previous PCI or previous coronary artery bypass graft (CABG) surgery. Coronary artery disease (CAD) was less severe in women, and PCI to the left anterior descending artery was more common in female patients. Unadjusted in-hospital mortality rates were higher in females versus males (2.5% for women and 1.6% for men, p<0.0001). After multivariable analysis, female gender remained an independent predictor of mortality (odds ratio 1.35, 95% CI: 1.22-1.49, p<0.0001). Conclusions: Gender-based differences in hospital mortality rates after PCI were observed in this large registry. Female sex remained an independent predictor of mortality after multivariable adjustment. [less ▲]Detailed reference viewed: 36 (4 ULg)
Réserve contractile dans l’insuffisance mitrale primaire asymptomatique
PIERARD, Luc ; ; DULGHERU, Raluca Elena et al
in Revue Médicale de Liège (2014), 69(S2), 8-11
Résumé : L’étude rapportée avait pour but de quantifier la réserve contractile ventriculaire gauche (VG) et d’évaluer son utilité pour la stratification du risque chez les patients asymptomatiques avec ... [more ▼]
Résumé : L’étude rapportée avait pour but de quantifier la réserve contractile ventriculaire gauche (VG) et d’évaluer son utilité pour la stratification du risque chez les patients asymptomatiques avec insuffisance mitrale (IM) primaire. Une échocardiographie au repos et à l’effort, incluant le suivi des marqueurs acoustiques, a été effectuée chez 115 patients consécutifs, présentant une IM primaire modérée ou sévère.La réserve contractile du VG est définie comme une augmentation induite par l’effort de la fraction d’éjection VG ≥ 4% ou de la déformation longitudinale VG ≥ 2%. La réserve contractile VG est absente dans approximativement la moitié de la population. Cette absence est un facteur prédictif indépendant d’événement cardiaque, s’il est évalué par les changements induits par l’effort de la fonction longitudinale VG, mais pas ceux de la fraction d’éjection VG. [less ▲]Detailed reference viewed: 16 (2 ULg)
Impact of exercise pulmonary hypertension on postoperative outcome in primary mitral regurgitation.
; ; 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 ▲]Detailed reference viewed: 8 (0 ULg)
Prognostic value of plasma B-type natriuretic peptide levels after exercise in patients with severe asymptomatic aortic stenosis.
; ; et al
in Heart (British Cardiac Society) (2014)
BACKGROUND: Exercise-stress echocardiography is useful in management and risk stratification of patients with asymptomatic aortic stenosis (AS). Resting B-type natriuretic peptide (BNP) level is ... [more ▼]
BACKGROUND: Exercise-stress echocardiography is useful in management and risk stratification of patients with asymptomatic aortic stenosis (AS). Resting B-type natriuretic peptide (BNP) level is associated with increased risk of adverse events. The incremental prognostic value of BNP response during exercise is unknown. OBJECTIVE: The purpose of this study was to assess the usefulness of plasma level of BNP during exercise to predict occurrence of events in asymptomatic patients with severe AS. METHODS: Resting and exercise-stress echocardiographic data and plasma BNP levels were prospectively collected in 211 asymptomatic AS patients in whom 157 had severe AS with preserved LVEF in two centres. The study end-point was the occurrence of death or aortic valve replacement. RESULTS: Plasma BNP level increased from rest to exercise (p<0.0001). During a mean follow-up of 1.5+/-1.2 years, 87 patients with severe AS reached the predefined end-point. Higher peak-exercise BNP level was associated with higher occurrence of adverse events (p<0.0001). In multivariate analysis, second and third tertiles of peak-exercise BNP (T2: HR=2.9; p=0.002 and T3: HR=5.3; p<0.0001, respectively) were powerful predictors of events compared with the first tertile. Further adjustment for resting BNP provided comparable results (T2: HR=2.8; p=0.003 and T3: HR=5.0; p<0.0001). This relationship persisted in both subsets of patients with low or high resting BNP. CONCLUSIONS: This study reports that peak-exercise BNP level provides significant incremental prognostic value beyond what is achieved by demographic and echocardiographic data, as well as resting BNP level. [less ▲]Detailed reference viewed: 12 (0 ULg)
Late gadolinium enhancement CMR in primary mitral regurgitation.
; ; Pierard, Luc et al
in European journal of clinical investigation (2014), 44(9), 840-7
AIMS: The appropriate timing for surgery in severe asymptomatic primary mitral regurgitation (MR) remains controversial. It has been shown that late gadolinium enhancement on cardiovascular magnetic ... [more ▼]
AIMS: The appropriate timing for surgery in severe asymptomatic primary mitral regurgitation (MR) remains controversial. It has been shown that late gadolinium enhancement on cardiovascular magnetic resonance (LGE CMR), which may identify myocardial fibrosis, is associated with a worse outcome in various cardiomyopathies. We sought to investigate the prevalence and significance of delayed enhancement in primary MR. METHODS: We prospectively included 41 patients with at least moderate primary MR and without overt signs of left ventricular (LV) dysfunction. Patients with evidence of coronary artery disease, arrhythmias or significant concomitant valvular disease were excluded. All patients were scheduled for transthoracic echocardiography and LGE CMR. RESULTS: A total of 39 patients had interpretable LGE CMR images. Among them, 12 (31%) had late contrast uptake of the LV wall. LGE CMR showed an infarct pattern in three patients, a pattern of mid-wall fibrosis in seven patients and two patients had a combined pattern. Patients with delayed enhancement on CMR had significant higher LV diameters (LV end-systolic diameter 39 +/- 4 vs. 34 +/- 5 mm, P = 0.002; LV end-diastolic diameter 57 +/- 5 vs. 50 +/- 5 mm, P = 0.001). There was a trend towards a higher indexed left atrial volume (55 +/- 21 vs. 44 +/- 13 mL/m(2), P = 0.06). By contrast, there was no significant association between myocardial contrast uptake and age, LV ejection fraction and MR severity. CONCLUSION: Left ventricular remodelling seems to be associated with the presence of delayed enhancement on CMR in primary MR. Further data are needed to determine whether LGE CMR can predict a less favourable outcome or could improve risk stratification in asymptomatic primary MR. [less ▲]Detailed reference viewed: 16 (0 ULg)