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See detailImpact of Serial B-Type Natriuretic Peptide Changes for Predicting Outcome in Asymptomatic Patients With Aortic Stenosis.
Henri, Christine; DULGHERU, Raluca Elena ULiege; Magne, Julien et al

in The Canadian journal of cardiology (2016)

BACKGROUND: The aim of this study was to determine the impact on the outcome of serial B-type natriuretic peptide (BNP) changes during follow-up in asymptomatic patients with >/= moderate aortic stenosis ... [more ▼]

BACKGROUND: The aim of this study was to determine the impact on the outcome of serial B-type natriuretic peptide (BNP) changes during follow-up in asymptomatic patients with >/= moderate aortic stenosis (AS) and preserved left ventricular ejection fraction. METHODS: We prospectively screened 69 patients who underwent comprehensive transthoracic echocardiography, BNP level measurement at baseline and after every 6 or 12 months. Annualized BNP changes were calculated as the difference between the last and baseline BNP measurements divided by the duration of follow-up. The primary endpoint was the occurrence of symptoms, aortic valve replacement, or cardiovascular death. RESULTS: During a follow-up of 30 +/- 19 months, 43 patients experienced a cardiac event. These patients were significantly older (73 +/- 9 vs 65 +/- 16 years; P = 0.010), had more often dyslipidemia (79% vs 42%; P = 0.038), more severe AS (peak velocity: 3.9 +/- 0.6 vs 3.5 +/- 0.6 m/s; P = 0.002), larger indexed left atrial area (10.2 +/- 2.5 vs 8.7 +/- 1.9 cm2/m2; P = 0.006), and a higher increase in annualized BNP (+90 +/- 155 vs +7 +/- 49 pg/mL/y; P = 0.010). Patients with higher annualized BNP changes (> 20 pg/mL/y) had a significantly lower cardiac event-free survival (1 year: 63 +/- 8% vs 97 +/- 3%; 3 years: 31 +/- 8% vs 68 +/- 8%; P < 0.001). Using the multivariate Cox proportional hazards model, higher annualized BNP changes were significantly associated with increased risk of cardiac events (hazard ratio: 2.73, 95% confidence interval: 1.27-5.86; P = 0.010) after adjustment for age, dyslipidemia, and echocardiographic parameters. CONCLUSIONS: In asymptomatic patients with AS and preserved left ventricular ejection fraction, the use of serial BNP changes may help to anticipate development of class I indication for aortic valve replacement. [less ▲]

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See detailValue of cardiac MRI to evaluate ischemia-related ventricular arrhythmia substrates.
Nchimi, Alain; Davin, Laurent; Georgiopoulos, Andreas et al

in Expert review of cardiovascular therapy (2015)

During the course of and after a myocardial ischemia-reperfusion insult, ventricular arrhythmia (VA) may have several single or overlapping potential substrates. Some of these may not be associated with ... [more ▼]

During the course of and after a myocardial ischemia-reperfusion insult, ventricular arrhythmia (VA) may have several single or overlapping potential substrates. Some of these may not be associated with morphological and functional changes, whereas others may have individual susceptibility. Nevertheless, cardiac magnetic resonance currently offers a comprehensive and highly effective toolset for the evaluation of a risk of VA on a patient basis after a myocardial infarction. Indeed, cardiac magnetic resonance has established itself as a reference for the evaluation of the myocardial function and properties, using respectively, cine and tissue characterization imaging to detect and evaluate the extent of acute myocardial injuries, scars and remodeling. This article describes and discusses imaging strategies used to evaluate the substrates for VA in the setting of a myocardial infarction. [less ▲]

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