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See detailPrognostic value of plasma B-type natriuretic peptide levels after exercise in patients with severe asymptomatic aortic stenosis.
Capoulade, Romain; Magne, Julien; Dulgheru, Raluca 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 ▲]

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See detailLate gadolinium enhancement CMR in primary mitral regurgitation.
Van De Heyning, Caroline M.; Magne, Julien; Pierard, Luc ULg 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 ▲]

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See detailExercise Testing and Stress Imaging in Valvular Heart Disease.
henri, Christine; Pierard, Luc ULg; Lancellotti, Patrizio ULg et al

in The Canadian journal of cardiology (2014), 30(9), 1012-1026

The role of exercise testing and stress imaging in the management of patients with valvular heart disease (VHD) is reviewed in this article. The American College of Cardiology/American Heart Association ... [more ▼]

The role of exercise testing and stress imaging in the management of patients with valvular heart disease (VHD) is reviewed in this article. The American College of Cardiology/American Heart Association and the European Society of Cardiology/European Association of Cardiothoracic Surgery have recently put emphasis on the role of exercise testing to clarify symptom status and the use of stress imaging to assess the dynamic component of valvular abnormalities and unmask subclinical myocardial dysfunction that could be missed at rest. Recent studies have demonstrated the incremental prognostic value of exercise echocardiography for asymptomatic patients with severe aortic stenosis, moderate-severe mitral stenosis, and severe primary mitral regurgitation. In patients with low-flow, low-gradient aortic stenosis, dobutamine stress echocardiography is recommended to differentiate true severe from pseudosevere aortic stenosis. Data on the prognostic value of stress echocardiography in aortic regurgitation and functional mitral regurgitation are less robust. Data are sparse on the use of stress imaging in right-sided VHD, however recent studies using stress cardiovascular magnetic resonance imaging offer some prognostic information. Although the strongest recommendations for surgical treatment continue to be based on symptom status and resting left ventricular repercussions, stress imaging can be useful to optimize risk stratification and timing of surgery in VHD. Randomized clinical trials are required to confirm that clinical decision-making based on stress imaging can lead to improved outcomes. [less ▲]

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See detailThe year 2013 in the European Heart Journal - Cardiovascular Imaging. Part I.
Edvardsen, Thor; Plein, Sven; Saraste, Antti et al

in European heart journal cardiovascular Imaging (2014), 15(7), 730-735

The new multimodality cardiovascular imaging journal, European Heart Journal - Cardiovascular Imaging, was created in 2012. Here, we summarize the most important studies from the journal's second year in ... [more ▼]

The new multimodality cardiovascular imaging journal, European Heart Journal - Cardiovascular Imaging, was created in 2012. Here, we summarize the most important studies from the journal's second year in two articles. Part I of the review will focus on studies in myocardial function, myocardial ischaemia, and emerging techniques in cardiovascular imaging, and Part II will focus on valvular heart diseases, heart failure, cardiomyopathies, and congenital heart diseases. [less ▲]

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See detailThe year 2013 in the European Heart Journal - Cardiovascular Imaging: Part II.
Plein, Sven; Edvardsen, Thor; Pierard, Luc ULg et al

in European heart journal cardiovascular Imaging (2014)

The new multi-modality cardiovascular imaging journal, European Heart Journal - Cardiovascular Imaging, was created in 2012. Here we summarize the most important studies from the journal's second year in ... [more ▼]

The new multi-modality cardiovascular imaging journal, European Heart Journal - Cardiovascular Imaging, was created in 2012. Here we summarize the most important studies from the journal's second year in two articles. Part I of the review has summarized studies in myocardial function, myocardial ischaemia, and emerging techniques in cardiovascular imaging. Part II is focussed on valvular heart diseases, heart failure, cardiomyopathies, and congenital heart diseases. [less ▲]

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See detailSurgery for severe ischemic mitral regurgitation.
Magne, Julien; Pierard, Luc ULg

in The New England journal of medicine (2014), 370(15), 1462

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See detailDeterminants of exercise-induced pulmonary arterial hypertension in systemic sclerosis.
Voilliot, Damien; Magne, Julien ULg; Dulgheru, Raluca et al

in International journal of cardiology (2014)

BACKGROUND: Exercise-induced pulmonary arterial hypertension (EIPH) in systemic sclerosis (SSc) has already been observed but its determinants remain unclear. The aim of this study was to determine the ... [more ▼]

BACKGROUND: Exercise-induced pulmonary arterial hypertension (EIPH) in systemic sclerosis (SSc) has already been observed but its determinants remain unclear. The aim of this study was to determine the incidence and the determinants of EIPH in SSc. METHODS AND RESULTS: We prospectively enrolled 63 patients with SSc (age 54+/-3years, 76% female) followed in CHU Sart-Tilman in Liege. All patients underwent graded semi-supine exercise echocardiography. Systolic pulmonary arterial pressure (sPAP) was derived from the peak velocity of the tricuspid regurgitation jet and adding the estimation of right atrial pressure, both at rest and during exercise. Resting pulmonary arterial hypertension (PH) was defined as sPAP >35mmHg and EIPH as sPAP >50mmHg during exercise. The following formulas were used: mean PAP (mPAP)=0.61xsPAP+2, left atrial pressure (LAP)=1.9+1.24xleft ventricular (LV) E/e' and pulmonary vascular resistance (PVR)=(mPAP-LAP)/LV cardiac output (CO) and slope of mPAP-LVCO relationship=changes in mPAP/changes in LVCO. Resting PH was present in 3 patients (7%) and 21 patients developed EIPH (47%). Patients with EIPH had higher resting LAP (10.3+/-2.2 versus 8.8+/-2.3mmHg; p=0.03), resting PVR (2.6+/-0.8 vs. 1.4+/-1.1Woods units; p=0.004), exercise LAP (13.3+/-2.3 vs. 9+/-1.7mmHg; p<0.0001), exercise PVR (3.6+/-0.7 vs. 2.1+/-0.9 Woods units; p=0.02) and slope of mPAP-LVCO (5.8+/-2.4 vs. 2.9+/-2.1mmHg/L/min; p<0.0001). After adjustment for age and gender, exercise LAP (beta=3.1+/-0.8; p=0.001) and exercise PVR (beta=7.9+/-1.7; p=0.0001) were independent determinants of exercise sPAP. CONCLUSION: EIPH is frequent in SSc patients and is mainly related to both increased exercise LV filling pressure and exercise PVR. [less ▲]

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See detailExercise testing in asymptomatic severe aortic stenosis.
Magne, Julien ULg; Lancellotti, Patrizio ULg; Pierard, Luc ULg

in JACC. Cardiovascular imaging (2014), 7(2), 188-99

The management and the clinical decision making in asymptomatic patients with aortic stenosis are challenging. An "aggressive" management, including early aortic valve replacement, is debated in these ... [more ▼]

The management and the clinical decision making in asymptomatic patients with aortic stenosis are challenging. An "aggressive" management, including early aortic valve replacement, is debated in these patients. However, the optimal timing for surgery remains controversial due to the lack of prospective data on the determinants of aortic stenosis progression, multicenter studies on risk stratification, and randomized studies on patient management. Exercise stress testing with or without imaging is strictly contraindicated in symptomatic patients with severe aortic stenosis. Exercise stress test is now recommended by current guidelines in asymptomatic patients and may provide incremental prognostic value. Indeed, the development of symptoms during exercise or an abnormal blood pressure response are associated with poor outcome and should be considered as an indication for surgery, as suggested by the most recently updated European Society of Cardiology 2012 guidelines. Exercise stress echocardiography may also improve the risk stratification and identify asymptomatic patients at higher risk of a cardiac event. When the test is combined with imaging, echocardiography during exercise should be recommended rather than post-exercise echocardiography. During exercise, an increase >18 to 20 mm Hg in mean pressure gradient, absence of improvement in left ventricular ejection fraction (i.e., absence of contractile reserve), and/or a systolic pulmonary arterial pressure >60 mm Hg (i.e., exercise pulmonary hypertension) are suggestive signs of advanced stages of the disease and impaired prognosis. Hence, exercise stress test may identify resting asymptomatic patients who develop exercise abnormalities and in whom surgery is recommended according to current guidelines. Exercise stress echocardiography may further unmask a subset of asymptomatic patients (i.e., without exercise stress test abnormalities) who are at high risk of reduced cardiac event free survival. In these patients, early surgery could be beneficial, whereas regular follow-up seems more appropriate in patients without echocardiographic abnormalities during exercise. [less ▲]

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See detailBrain natriuretic peptide release in patients with aortic stenosis: Resting and exercise echocardiographic determinants.
Henri, Christine; Magne, Julien ULg; Dulgheru, Raluca et al

in International journal of cardiology (2014), 172(3), 611-3

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See detailUsefulness of Serial B-type Natriuretic Peptide Assessment in Asymptomatic Aortic Stenosis.
Henri; Magne; DULGHERU, Raluca Elena ULg et al

in The American journal of cardiology (2014)

B-type natriuretic peptide (BNP) level may be a useful prognostic marker for the management of asymptomatic patients with aortic stenosis (AS). The aim of this study was to identify the echocardiographic ... [more ▼]

B-type natriuretic peptide (BNP) level may be a useful prognostic marker for the management of asymptomatic patients with aortic stenosis (AS). The aim of this study was to identify the echocardiographic determinants of BNP changes during follow-up in AS. We studied 61 asymptomatic patients with greater than moderate AS and preserved left ventricular (LV) ejection fraction who underwent rest and exercise Doppler echocardiography with concomitant BNP level measurement at baseline. BNP measurement was repeated after inclusion every 6 months. Patients were divided into 2 groups according to the median of BNP changes during follow-up. According to parameters at rest, patients in the high BNP changes group had significantly higher E/e' ratio. Statistically significant correlations were found between BNP changes and E/e' ratio and indexed left atrial area. According to exercise parameters, patients in the high BNP changes group had significantly lower exercise-induced increase in LV ejection fraction. Statistically significant correlations were found between BNP changes and exercise-induced changes in LV ejection fraction. After adjustment for age, mean aortic pressure gradient, and BNP level at baseline, multivariate analysis identified indexed left atrial area, E/e' at rest, and exercise-induced increase in ejection fraction as independent determinants of BNP changes during follow-up. In conclusion, this study shows that, in asymptomatic patients with preserved LV function and moderate AS, serial BNP measurements may widely vary. Subclinical LV diastolic and systolic dysfunctions are frequently present in patients with higher serial BNP changes. [less ▲]

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See detailThe appropriate and justified use of medical radiation in cardiovascular imaging: a position document of the ESC Associations of Cardiovascular Imaging, Percutaneous Cardiovascular Interventions and Electrophysiology.
Picano, Eugenio; Vano, Eliseo; Rehani, Madan M. et al

in European heart journal (2014), 35(10), 665-72

The benefits of cardiac imaging are immense, and modern medicine requires the extensive and versatile use of a variety of cardiac imaging techniques. Cardiologists are responsible for a large part of the ... [more ▼]

The benefits of cardiac imaging are immense, and modern medicine requires the extensive and versatile use of a variety of cardiac imaging techniques. Cardiologists are responsible for a large part of the radiation exposures every person gets per year from all medical sources. Therefore, they have a particular responsibility to avoid unjustified and non-optimized use of radiation, but sometimes are imperfectly aware of the radiological dose of the examination they prescribe or practice. This position paper aims to summarize the current knowledge on radiation effective doses (and risks) related to cardiac imaging procedures. We have reviewed the literature on radiation doses, which can range from the equivalent of 1-60 milliSievert (mSv) around a reference dose average of 15 mSv (corresponding to 750 chest X-rays) for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multidetector coronary angiography, or a myocardial perfusion imaging scintigraphy. We provide a European perspective on the best way to play an active role in implementing into clinical practice the key principle of radiation protection that: 'each patient should get the right imaging exam, at the right time, with the right radiation dose'. [less ▲]

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See detailCarotid artery and aortic stiffness evaluation in aortic stenosis.
Weisz, Sara Hana; Magne, Julien ULg; Dulgheru, Raluca et al

in Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography (2014), 27(4), 385-92

BACKGROUND: In aortic stenosis (AS), the combination of risk factors can progressively lead to an increased arterial rigidity, which can be evaluated by the carotid artery and aortic stiffness (beta index ... [more ▼]

BACKGROUND: In aortic stenosis (AS), the combination of risk factors can progressively lead to an increased arterial rigidity, which can be evaluated by the carotid artery and aortic stiffness (beta index). The aim of this study was to investigate the relationship between carotid and aortic beta index, left ventricular (LV) function, plasma brain natriuretic peptide (BNP) level, and symptoms in patients with AS. METHODS: Comprehensive echocardiography including Doppler tissue imaging of the mitral annulus was performed in 53 patients with AS (aortic valve area < 1.2 cm(2)) and preserved LV ejection fractions (>/=50%). Carotid beta index was automatically derived from ultrasound wall tracking of the right carotid artery. The mitral E/e' ratio was used to estimate LV filling pressures. RESULTS: Carotid beta index was higher in women than in men and was significantly correlated with age (P < .0001), diastolic arterial pressure (P = .046), pulse pressure (P = .006), and systemic arterial compliance (P = .001). Interestingly, carotid beta index was significantly correlated with E/e' ratio (P < .0001) and plasma BNP level (P = .011). In multivariate regression analysis, carotid beta index was an independent predictor of E/e' ratio (P < .0001) and of BNP level (P = .02). Moreover, carotid beta index was significantly higher in symptomatic patients (P = .009). Aortic beta index was significantly correlated with carotid beta index (P < .0001), E/e' ratio (P = .004), and BNP (P < .001) and was significantly higher in symptomatic patients (P = .037). CONCLUSIONS: In patients with moderate to severe AS and preserved LV ejection fractions, the presence of increased carotid artery and aortic stiffness, assessed using carotid and aortic beta index, is independently associated with elevated LV filling pressures, BNP level, and symptoms. [less ▲]

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See detailESC working group on valvular heart disease position paper-heart valve clinics: organization, structure, and experiences
LANCELLOTTI, Patrizio ULg; Rosenhek, R; Pibarot, P et al

in European Heart Journal (2013)

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See detailRevue de litterature illustree de la Cardiomyopathie du peripartum.
Nyssen, A.; Nellessen, E.; Pierard, Luc ULg

in Revue medicale de Liege (2013), 68(12), 625-30

Peripartum cardiomyopathy is defined by the development of heart failure with left ventricular systolic dysfunction at the end of pregnancy or in the months following childbirth. Its diagnosis remains ... [more ▼]

Peripartum cardiomyopathy is defined by the development of heart failure with left ventricular systolic dysfunction at the end of pregnancy or in the months following childbirth. Its diagnosis remains difficult due to lack of specificity. Its pathophysiology is still imperfectly understood, but involves both genetic and pregnancy related factors. From a therapeutic viewpoint, the recommendations of the European Society of Cardiology on heart failure are used, but the stage of pregnancy must be taken into account for the treatment choice. The chances of recovery are greater than in other non-ischemic cardiomyopathies. However, an early diagnosis remains crucial to increase the probability of recovery particularly with bromocriptine, which has shown positive results in recent years. [less ▲]

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See detailThe role of stress testing in evaluation of asymptomatic patients with aortic stenosis.
Lancellotti, Patrizio ULg; Magne, Julien ULg; Pierard, Luc ULg

in Current opinion in cardiology (2013), 28(5), 531-9

PURPOSE OF REVIEW: The emerging role of exercise and especially exercise echocardiography in aortic stenosis has been recently emphasized. In this clinical setting, stress testing can help identify ... [more ▼]

PURPOSE OF REVIEW: The emerging role of exercise and especially exercise echocardiography in aortic stenosis has been recently emphasized. In this clinical setting, stress testing can help identify patients who are falsely asymptomatic, unmask those who will rapidly become symptomatic and appraise the true haemodynamic consequences of aortic stenosis. RECENT FINDINGS: Both exercise stress test and exercise stress echocardiography are strictly contraindicated in symptomatic patients. In contrast, exercise testing is recommended by current guidelines in asymptomatic patients with aortic stenosis. During exercise, either the development of symptoms or an abnormal blood pressure response is associated with a poor outcome and should be considered as an indication for surgery. Exercise echocardiography permits stratification and identification of asymptomatic patients at a higher risk of a cardiac event: exercise-induced increase of more than 18-20 mmHg in mean pressure gradient, absence of left ventricular contractile reserve and/or exercise pulmonary hypertension are suggestive features of an advanced disease process. SUMMARY: Exercise echocardiography has the advantage of its wide availability, low cost and versatility. In asymptomatic severe aortic stenosis, exercise echocardiography can help unmask patients at a more advanced stage of the disease and could aid in identifying those who may benefit from an early elective aortic valve surgery. [less ▲]

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See detailLe cas clinique du mois. Amyloidose cardiaque, a propos d'un cas atypique.
Falque, B.; Davin, L.; Melon, P. et al

in Revue medicale de Liege (2013), 68(10), 497-503

A 64 year old patient with heart failure due to primary cardiac amyloidosis is described. This case offers the opportunity to review the literature dealing with the cardiac involvement associated with ... [more ▼]

A 64 year old patient with heart failure due to primary cardiac amyloidosis is described. This case offers the opportunity to review the literature dealing with the cardiac involvement associated with this disorder and the differential diagnosis of restrictive heart disease. [less ▲]

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See detailInsuffisance mitrate primaire: indications chirurgicales et dernieres avancees.
Voilliot, D.; Henri, C.; Pierard, Luc ULg

in Revue medicale suisse (2013), 9(395), 1518-21

Mitral regurgitation (MR) is, in Europe, the second most common valvular disease. Primary MR represents 61% of cases. The surgical indications for symptomatic patients with severe primary MR, are subject ... [more ▼]

Mitral regurgitation (MR) is, in Europe, the second most common valvular disease. Primary MR represents 61% of cases. The surgical indications for symptomatic patients with severe primary MR, are subject to a broad consensus with strong levels of recommendations. In asymptomatic patients, levels of recommendations are weaker despite the numerous publications. Exercise echocardiography has emerged as a useful tool for the management of the patients and appeared in the latest European recommendations. It continues to be the subject of numerous studies demonstrating its usefulness for risk stratification in asymptomatic patients. The next advances in this field will probably argue for an earlier surgery in these kinds of patients. [less ▲]

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See detailLinee guida per il trattamento delle valvulopatie (versione 2012). Task Force congiunta per il Trattamento delle Valvulopatie della Societa Europea di Cardiologia (ESC) e dell'Associazione Europea di Chirurgia Cardiotoracica (EACTS).
Vahanian, Alec; Alfieri, Ottavio; Andreotti, Felicita et al

in Giornale Italiano di Cardiologia (2006) (2013), 14(3), 167-214

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See detailAssessment of left ventricular volumes and primary mitral regurgitation severity by 2D echocardiography and cardiovascular magnetic resonance.
Van De Heyning, Caroline M.; Magne, Julien ULg; Pierard, Luc ULg et al

in Cardiovascular ultrasound (2013), 11

BACKGROUND: Two-dimensional transthoracic echocardiography (2DTTE) remains the first-line diagnostic imaging tool to assess primary mitral regurgitation although cardiovascular magnetic resonance (CMR ... [more ▼]

BACKGROUND: Two-dimensional transthoracic echocardiography (2DTTE) remains the first-line diagnostic imaging tool to assess primary mitral regurgitation although cardiovascular magnetic resonance (CMR) has proven to establish left ventricular function more accurately and might evaluate mitral regurgitation severity more reliably. We sought to compare routine evaluation of left ventricular function and mitral regurgitation severity by 2DTTE with assessment by CMR in moderate to severe primary mitral regurgitation without overt left ventricular dysfunction. METHODS: We prospectively included 38 patients (79% of male, age 57 +/- 14 years) with at least moderate primary mitral regurgitation, a left ventricular ejection fraction >/=60% and a left ventricular end-systolic diameter </=45 mm. Patients with evidence of coronary artery disease, arrhythmias or significant concomitant valvular disease were excluded. All patients were scheduled for 2DTTE and CMR. RESULTS: Left ventricular end-diastolic and end-systolic volumes were significantly underestimated by 2DTTE in comparison with CMR, although there was a strong correlation (Pearson r = 0.81, p < 0.00001 and r = 0.7, p < 0.00001, respectively). Measurement of the regurgitant orifice was similar between 2DTTE PISA method and planimetry by CMR (47 +/- 24 vs. 42 +/- 16 mm2, p = 0.12) with a strong correlation between both imaging techniques (Pearson r = 0.76, p < 0.0001). By contrast, assessment of the regurgitant volume by 2DTTE and by phase contrast velocity mapping by CMR showed poor agreement. CONCLUSIONS: In moderate to severe primary mitral regurgitation without overt left ventricular dysfunction, 2DTTE significantly underestimates left ventricular remodelling in comparison to CMR. Measurement of the regurgitant orifice with planimetry by CMR shows good agreement with the PISA method by 2DTTE and thus may be a valuable alternative to assess mitral regurgitation severity. [less ▲]

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See detailA simplified model for mitral valve dynamics.
Moorhead, K. T.; Paeme, Sabine ULg; Chase, J. G. et al

in Computer Methods & Programs in Biomedicine (2013), 109(2),

Located between the left atrium and the left ventricle, the mitral valve controls flow between these two cardiac chambers. Mitral valve dysfunction is a major cause of cardiac dysfunction and its dynamics ... [more ▼]

Located between the left atrium and the left ventricle, the mitral valve controls flow between these two cardiac chambers. Mitral valve dysfunction is a major cause of cardiac dysfunction and its dynamics are little known. A simple non-linear rotational spring model is developed and implemented to capture the dynamics of the mitral valve. A measured pressure difference curve was used as the input into the model, which represents an applied torque to the anatomical valve chords. A range of mechanical model hysteresis states were investigated to find a model that best matches reported animal data of chord movement during a heartbeat. The study is limited by the use of one dataset found in the literature due to the highly invasive nature of getting this data. However, results clearly highlight fundamental physiological issues, such as the damping and chord stiffness changing within one cardiac cycle, that would be directly represented in any mitral valve model and affect behaviour in dysfunction. Very good correlation was achieved between modeled and experimental valve angle with 1-10% absolute error in the best case, indicating good promise for future simulation of cardiac valvular dysfunction, such as mitral regurgitation or stenosis. In particular, the model provides a pathway to capturing these dysfunctions in terms of modeled stiffness or elastance that can be directly related to anatomical, structural defects and dysfunction. [less ▲]

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