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: 18 (1 ULg)
Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay.
Lancellotti, Patrizio ; ; Magne, Julien 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 ▲]Detailed reference viewed: 61 (6 ULg)
Stress echocardiography for selecting potential responders to cardiac resynchronisation therapy.
Moonen, Marie ; ; Magne, Julien et al
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 ▲]Detailed reference viewed: 33 (10 ULg)
Impact of global left ventricular afterload on left ventricular function in asymptomatic severe aortic stenosis: a two-dimensional speckle-tracking study.
Lancellotti, Patrizio ; ; Magne, Julien 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 ▲]Detailed reference viewed: 37 (8 ULg)
Stress Doppler echocardiography in valvular heart diseases: utility and assessment.
; LANCELLOTTI, Patrizio ; Pierard, Luc
in Future Cardiology (2010), 6(5), 611-25
This article is a review on the role of stress echocardiography in valvular heart diseases, describing what the validated indications are, how to perform the test and the utility of performing this ... [more ▼]
This article is a review on the role of stress echocardiography in valvular heart diseases, describing what the validated indications are, how to perform the test and the utility of performing this examination. Most valve diseases are characteristically dynamic and this dynamic component is best appreciated by exercise Doppler echocardiography. Dobutamine stress echocardiography is also useful in patients with severe aortic stenosis and left ventricular dysfunction. The main advantage of stress echocardiography is to concomitantly allow the evaluation of symptoms, exercise capacity and the hemodynamic consequences of valve diseases, especially in patients with severe valve diseases who deny symptoms or present equivocal symptoms. It also provides important prognostic information and may help to optimize surgical timing in difficult cases. Whether these data should be integrated in the management of patients needs further validation. [less ▲]Detailed reference viewed: 16 (1 ULg)
Dynamic left ventricular dyssynchrony: a potential cause of no contractile reserve in patients with low-gradient aortic stenosis
Lancellotti, Patrizio ; ; Moonen, Marie et al
in European Journal of Echocardiography (2009)Detailed reference viewed: 26 (7 ULg)