Articles de revues : « TAVI, AVR, carotid stenosis »

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Sperlongano, Simona, Francesca Renon, Maurizio Cappelli Bigazzi, Rossella Sperlongano, Giovanni Cimmino, Antonello D’Andrea et Paolo Golino. « Transcatheter Aortic Valve Implantation : The New Challenges of Cardiac Rehabilitation ». Journal of Clinical Medicine 10, n^o 4 (17 février 2021) : 810. http://dx.doi.org/10.3390/jcm10040810.

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Transcatheter aortic valve implantation (TAVI) is an increasingly widespread percutaneous intervention of aortic valve replacement (AVR). The target population for TAVI is mainly composed of elderly, frail patients with severe aortic stenosis (AS), multiple comorbidities, and high perioperative mortality risk for surgical AVR (sAVR). These vulnerable patients could benefit from cardiac rehabilitation (CR) programs after percutaneous intervention. To date, no major guidelines currently recommend CR after TAVI. However, emerging scientific evidence shows that CR in patients undergoing TAVI is safe, and improves exercise tolerance and quality of life. Moreover, preliminary data prove that a CR program after TAVI has the potential to reduce mortality during follow-up, even if randomized clinical trials are needed for confirmation. The present review article provides an overview of all scientific evidence concerning the potential beneficial effects of CR after TAVI, and suggests possible fields of research to improve cardiac care after TAVI.

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Bilkhu, Rajdeep, Michael A. Borger, Norman Paul Briffa et Marjan Jahangiri. « Sutureless aortic valve prostheses ». Heart 105, Suppl 2 (mars 2019) : s16—s20. http://dx.doi.org/10.1136/heartjnl-2018-313513.

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Conventional surgical aortic valve replacement (AVR) is the ‘gold standard’ for treatment of severe or symptomatic aortic valve stenosis. The increasing age of patients and increasing comorbidities has led to the development of procedures to minimise operative time and reduce risks of surgery. One method of reducing operative times is the use of sutureless aortic valves (SU-AVR). We examine the current literature surrounding the use of SU-AVR. Alternatives to AVR are SU-AVR, sometimes referred to as rapid deployment valves, or transcatheter aortic valve implantation (TAVI). TAVI has been demonstrated to be superior over medical therapy in patients deemed inoperable and non-inferior in high and intermediate-risk patients compared with surgical AVR. However, the lack of excision of the calcified aortic valve and annulus raises concerns regarding long-term durability and possibly thromboembolic complications. TAVI patients have increased rates of paravalvular leaks, major vascular complications and pacemaker implantation when compared with conventional AVR. SU-AVR minimises the need for suturing, leading to reduced operative times, while enabling complete removal of the calcified valve. The increase in use of SU-AVR has been mostly driven by minimally invasive surgery. Other indications include patients with a small and/or calcified aortic root, as well as patients requiring AVR and concomitant surgery. SU-AVR is associated with decreased operative times and possibly improved haemodynamics when compared with conventional AVR. However, this has to be weighed against the increased risk of paravalvular leak and pacemaker implantation when deciding which prosthesis to use for AVR.

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Shintoku, Ryosuke, Mikito Hayakawa, Tomoya Hoshi, Sho Okune, Takato Hiramine, Toshihide Takahashi, Hisayuki Hosoo et al. « Carotid artery stenosis concomitant with severe aortic stenosis treated by combination of staged angioplasty and transcatheter aortic valve implantation : A case report ». Surgical Neurology International 13 (14 octobre 2022) : 469. http://dx.doi.org/10.25259/sni_560_2022.

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Background: When severe aortic stenosis (AS) is concomitant with carotid stenosis, carotid artery stenting (CAS) will become a high-risk procedure because baroreceptor reflex-induced bradycardia and hypotension may cause irreversible circulatory collapse. When carotid stenosis-related misery perfusion is present, the risk of cerebral hyperperfusion syndrome increases after carotid revascularization. We report a case of severe carotid disease concomitant with severe AS successfully treated by a combination of staged angioplasty (SAP) and transcatheter aortic valve implantation (TAVI). Case Description: An 86-year-old man presented with transient deterioration of mental status and sluggish responsiveness continuous from the previous day. Magnetic resonance imaging of the brain revealed a right putaminal infarction, occlusion of the right internal carotid artery (ICA), and severe stenosis of the left ICA. Severe AS was diagnosed and single-photon emission computed tomography showed misery perfusion at the bilateral ICA territories. We performed a staged treatment consisting of SAP for the left carotid stenosis and TAVI. A first-stage carotid angioplasty was performed, followed by TAVI 2 weeks later and second-stage CAS 1 week after that. There were no apparent periprocedural complications throughout the clinical course. Conclusion: Combining SAP and TAVI may be an effective treatment option for severe carotid stenosis with misery perfusion concomitant with severe AS.

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Lutz, Matthias, David Messika-Zeitoun, Tanja K. Rudolph, Eberhard Schulz, Jeetendra Thambyrajah, Guy Lloyd, Alexander Lauten et al. « Differences in the presentation and management of patients with severe aortic stenosis in different European centres ». Open Heart 7, n^o 2 (septembre 2020) : e001345. http://dx.doi.org/10.1136/openhrt-2020-001345.

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BackgroundAn investigation into differences in the management and treatment of severe aortic stenosis (AS) between Germany, France and the UK may allow benchmarking of the different healthcare systems and identification of levers for improvement.MethodsPatients with a diagnosis of severe AS under management at centres within the IMPULSE and IMPULSE enhanced registries were eligible.ResultsData were collected from 2052 patients (795 Germany; 542 France; 715 UK). Patients in Germany were older (79.8 years), often symptomatic (89.5%) and female (49.8%) and had a lower EF (53.8%) than patients in France and UK. Comorbidities were more common and they had a higher mean Euroscore II.Aortic valve replacement (AVR) was planned within 3 months in 70.2%. This was higher (p<0.001) in Germany than France/ UK. Of those with planned AVR, 82.3% received it within 3 months with a gradual decline (Germany>France> UK; p<0.001). In 253 patients, AVR was not performed, despite planned. Germany had a strong transcatheter aortic valve implantation (TAVI) preference (83.2%) versus France/ UK (p<0.001). Waiting time for TAVI was shorter in Germany (24.9 days) and France (19.5 days) than UK (40.3 days).Symptomatic patients were scheduled for an AVR in 79.4% (Germany> France> UK; p<0.001) and performed in 83.6% with a TAVI preference (73.1%). 20.4% of the asymptomatic patients were intervened.ConclusionPatients in Germany had more advanced disease. The rate of intervention within 3 months after diagnosis was startlingly low in the UK. Asymptomatic patients without a formal indication often underwent an intervention in Germany and France.

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Rudolph, Tanja K., David Messika-Zeitoun, Norbert Frey, Jeetendra Thambyrajah, Antonio Serra, Eberhard Schulz, Jiri Maly et al. « Impact of selected comorbidities on the presentation and management of aortic stenosis ». Open Heart 7, n^o 2 (juillet 2020) : e001271. http://dx.doi.org/10.1136/openhrt-2020-001271.

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BackgroundContemporary data regarding the impact of comorbidities on the clinical presentation and management of patients with severe aortic stenosis (AS) are scarce.MethodsProspective registry of severe patients with AS across 23 centres in nine European countries.ResultsOf the 2171 patients, chronic kidney disease (CKD 27.3%), left ventricular ejection fraction (LVEF) <50% (22.0%), atrial fibrillation (15.9%) and chronic obstructive pulmonary disease (11.4%) were the most prevalent comorbidities (49.3% none, 33.9% one and 16.8% ≥2 of these). The decision to perform aortic valve replacement (AVR) was taken in a comparable proportion (67%, 72% and 69%, in patients with 0, 1 and ≥2 comorbidities; p=0.186). However, the decision for TAVI was more common with more comorbidities (35.4%, 54.0% and 57.0% for no, 1 and ≥2; p<0.001), while the decision for surgical AVR (SAVR) was decreased with increasing comorbidity burden (31.9%, 17.4% and 12.3%; p<0.001). The proportion of patients with planned AVRs that were performed within 3 months was significantly higher in patients with 1 or ≥2 comorbidities than in those without (8.7%, 10.0% and 15.7%; p<0.001). Furthermore, the mean time to AVR was significantly shorter in patients with one (30.5 days) or ≥2 comorbidities (30.8 days) than in those without (35.7 days; p=0.012). Patients with reduced LVEF tended to be offered an AVR more frequently and with a shorter delay while patients with CKD were less frequently treated.ConclusionsComorbidities in severe patients with AS affect the presentation and management of patients with severe AS. TAVI was offered more often than SAVR and performed within a shorter time period.

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Shekara, Reddy Chandra, Srinivas Arun et Chawath Siddarth Kumar. « Rescue Balloon Aortic Valvuloplasty for Malignant Ventricular Arrhythmias and Cardiogenic Shock ». International Journal of Current Research and Review 15, n^o 01 (2023) : 14–19. http://dx.doi.org/10.31782/ijcrr.2023.15103.

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Introduction: Severe Calcific Aortic Stenosis (AS) remains a major cause of morbidity and mortality in aged population. Asymptomatic with reduced LVEF has high risk of sudden death. Aim: To study the complexity of clinical course of Severe Calcific AS with LV Dysfunction. Case Report: A Seventy-Six-year-old male was admitted with ACS, NSTEMI, LVEF 35% and Severe Calcific AS. With plan of AVR, CAG was done and showed Mild CAD. Post-procedure he had sequence of catastrophic clinical events that includes, A systolic Cardiac Arrest (reverted after CPR) and Protracted Pulmonary edema (Connected to Mechanical Ventilation). Later had Malignant Ventricular Arrhythmias, treated with 34 times DC Shocks. He was not suitable for Surgical AVR or TAVI. After high-risk consent, he successfully underwent emergency Aortic Balloon Valvuloplasty (ABV) with significant drop in AV gradients. Post ABV, also had Paroxysmal AF. Arrhythmias were also treated with Beta blocker, Antiarrhythmics, Digoxin and Potassium supplementation. Gradually stabilized, discharged and followed up. Discussion: Aortic stenosis, a disease of elderly age group. Symptomatology varies widely. It has limited management options. In our case, Post CAG critical illness was probably due to “Pre -CAG” LV dysfunction with subclinical symptoms. ABV used as bail out the procedure in high-risk patients. Conclusion: ABV is considered as a viable palliative option, with the introduction of smaller profile balloons, rapid pacing and vascular closure devices. ABV can safely used as bridging procedure before Surgical AVR or TAVI in high-risk patients

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Baran, Jakub, Anna Kablak-Ziembicka, Pawel Kleczynski, Ottavio Alfieri, Łukasz Niewiara, Rafał Badacz, Piotr Pieniazek et al. « Association of Increased Vascular Stiffness with Cardiovascular Death and Heart Failure Episodes Following Intervention on Symptomatic Degenerative Aortic Stenosis ». Journal of Clinical Medicine 11, n^o 8 (7 avril 2022) : 2078. http://dx.doi.org/10.3390/jcm11082078.

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Background. The resistive (RI) and pulsatile (PI) indices are markers of vascular stiffness (VS) which are associated with outcomes in patients with cardiovascular disease. We aimed to assess whether VS might predict incidence of cardiovascular death (CVD) and heart failure (HF) episodes following intervention on degenerative aortic valve stenosis (DAS). Methods. The distribution of increased VS (RI ≥ 0.7 and PI ≥ 1.3) from supra-aortic arteries was assessed in patients with symptomatic DAS who underwent aortic valve replacement (AVR, n = 127) or transcatheter aortic valve implantation (TAVI, n = 119). During a 3-year follow-up period (FU), incidences of composite endpoint (CVD and HF) were recorded. Results. Increased VS was found in 100% of TAVI patients with adverse event vs. 88.9% event-free TAVI patients (p = 0.116), and in 93.3% of AVR patients with event vs. 70.5% event-free (p = 0.061). Kaplan–Mayer free-survival curves at 1-year and 3-year FU were 90.5% vs. 97.1 % and 78% vs. 97.1% for patients with increased vs. lower VS. (p = 0.014). In univariate Cox analysis, elevated VS (HR 7.97, p = 0.04) and age (HR 1.05, p = 0.024) were associated with risk of adverse outcomes; however, both failed in Cox multivariable analysis. Conclusions. Vascular stiffness is associated with outcome after DAS intervention. However, it cannot be used as an independent outcome predictor.

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Polomski, P., Z. Stankov, I. Petrov, I. Tasheva et G. Dobrev. « Balloon aortic valvuloplasty in degenerative aortic stenosis ». Bulgarian Cardiology 28, n^o 2 (20 juin 2022) : 35–43. http://dx.doi.org/10.3897/bgcardio.28.e82135.

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Balloon valvuloplasty of the aortic valve (BAV) in aortic stenosis has been practiced for over 35 years. The initial enthusiasm caused by the excellent immediate hemodynamic effect of the procedure disappears due to the rapid restenosis of the aortic valve after intervention. The results of modern methods for defi nitive treatment of aortic valve stenosis – AVR and TAVI are excellent, thanks to which they are fi rmly rooted in treatment guidelines. However, BAV has its indications in symptomatic patients who are not suitable for defi nitive interventions. This publication discusses current indications for BAV, the main stages of the procedure, possible complications, and treatment outcomes.

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Oterhals, Kjersti, Rune Haaverstad, Jan Erik Nordrehaug, Geir Egil Eide et Tone M. Norekvål. « Self-reported health status, treatment decision and survival in asymptomatic and symptomatic patients with aortic stenosis in a Western Norway population undergoing conservative treatment : a cross-sectional study with 18 months follow-up ». BMJ Open 7, n^o 8 (août 2017) : e016489. http://dx.doi.org/10.1136/bmjopen-2017-016489.

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ObjectivesTo investigate symptoms and self-reported health of patients conservatively treated for aortic stenosis (AS) and to identify factors associated with treatment decision and patient outcomes.DesignA cross-sectional survey with an 18-month follow-up.SettingOne tertiary university hospital in Western Norway.ParticipantsIn all, 1436 patients were diagnosed with AS between 2000 and 2012, and those 245 still under conservative treatment in 2013 were included in this study.Primary and secondary outcome measuresPrimary outcome measures were symptoms and self-reported health status. Secondary outcomes were treatment decision and patient survival after 18 months.ResultsA total of 136 patients with mean (SD) age 79 (12) years, 52% men responded. Among conservatively treated patients 77% were symptomatic. The symptom most frequently experienced was dyspnoea. Symptomatic patients reported worse physical and mental health compared with asymptomatic patients (effect size 1.24 and 0.74, respectively). In addition, symptomatic patients reported significantly higher levels of anxiety and depression compared with asymptomatic patients. However, symptom status did not correlate with haemodynamic severity of AS. After 18 months, 117 (86%) were still alive, 20% had undergone surgical aortic valve replacement (AVR) and 7% transcatheter aortic valve implantation (TAVI). When adjusting for age, gender, symptomatic status, severity of AS and European system for cardiac operative risk evaluation (EuroSCORE), patients with severe AS had more than sixfold chance of being scheduled for AVR or TAVI compared with those with moderate AS (HR 6.3, 95% CI 1.9 to 21.2, p=0.003). Patients with EuroSCORE ≥11 had less chance for undergoing AVR or TAVI compared with those with EuroSCORE ≤5 (HR 0.06, 95% CI 0.01 to 0.46, p=0.007).ConclusionsSymptoms affected both physical and mental health in conservatively treated patients with AS. Many patients with symptomatic severe AS are not scheduled for surgery, despite the recommendations in current guidelines. The referral practice for AVR is a path for further investigation.

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Lauten, Alexander, Tanja K. Rudolph, David Messika-Zeitoun, Jeetendra Thambyrajah, Antonio Serra, Eberhard Schulz, Norbert Frey et al. « Management of patients with severe aortic stenosis in the TAVI-era : how recent recommendations are translated into clinical practice ». Open Heart 8, n^o 1 (janvier 2021) : e001485. http://dx.doi.org/10.1136/openhrt-2020-001485.

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ObjectiveApproximately 3.4% of adults aged >75 years suffer from aortic stenosis (AS). Guideline indications for aortic valve replacement (AVR) distinguish between patients with symptomatic and asymptomatic severe AS. The present analysis aims to assess contemporary practice in the treatment of severe AS across Europe and identify characteristics associated with treatment decisions, namely denial of AVR in symptomatic patients and assignment of asymptomatic patients to AVR.MethodsParticipants of the prospective, multinational IMPULSE database of patients with severe AS were grouped according to AS symptoms, and stratified into subgroups based on assignment to/denial of AVR.ResultsOf 1608 symptomatic patients, 23.8% did not undergo AVR and underwent medical treatment. Denial was independently associated with multiple factors, including severe frailty (p=0.024); mitral (p=0.002) or tricuspid (p=0.004) regurgitation grade III/IV, and the presence of renal impairment (p=0.017). Of 392 asymptomatic patients, 86.5% had no prespecified indication for AVR. Regardless, 36.3% were assigned to valve replacement. Those with an indexed aortic valve area (AVA; p=0.045) or left ventricular ejection fraction (LVEF; p<0.001) below the study median; or with a left ventricular end systolic diameter above the study median (p=0.007) were more likely to be assigned to AVR.ConclusionsThere may be considerable discrepancies between guideline-based recommendations and clinical practice decision-making in the treatment of AS. It appears that guidelines may not fully capture the complete clinical spectrum of patients with AS. Thus, there is a need to find ways to increase their acceptance and the rate of adoption.

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Takahashi, Kan, Mamoru Satoh, Yuji Takahashi, Takuya Osaki, Takahito Nasu, Makiko Tamada, Hitoshi Okabayashi, Motoyuki Nakamura et Yoshihiro Morino. « Dysregulation of ossification-related miRNAs in circulating osteogenic progenitor cells obtained from patients with aortic stenosis ». Clinical Science 130, n^o 13 (23 mai 2016) : 1115–24. http://dx.doi.org/10.1042/cs20160094.

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CAVD (calcific aortic valve disease) is the defining feature of AS (aortic stenosis). The present study aimed to determine whether expression of ossification-related miRNAs is related to differentiation intro COPCs (circulating osteogenic progenitor cells) in patients with CAVD. The present study included 46 patients with AS and 46 controls. Twenty-nine patients underwent surgical AVR (aortic valve replacement) and 17 underwent TAVI (transcatheter aortic valve implantation). The number of COPCs was higher in the AS group than in the controls (P<0.01). Levels of miR-30c were higher in the AS group than in the controls (P<0.01), whereas levels of miR-106a, miR-148a, miR-204, miR-211, miR-31 and miR-424 were lower in the AS group than in the controls (P<0.01). The number of COPCs and levels of osteocalcin protein in COPCs were positively correlated with levels of miR-30a and negatively correlated with levels of the remaining miRNAs (all P<0.05). The degree of aortic valve calcification was weakly positively correlated with the number of COPCs and miR-30c levels. The number of COPCs and miR-30c levels were decreased after surgery, whereas levels of the remaining miRNAs were increased (all P<0.05). Changes in these levels were greater after AVR than after TAVI (all P<0.05). In vitro study using cultured peripheral blood mononuclear cells transfected with each ossification-related miRNA showed that these miRNAs controlled levels of osteocalcin protein. In conclusion, dysregulation of ossification-related miRNAs may be related to the differentiation into COPCs and may play a significant role in the pathogenesis of CAVD.

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Kleczynski, Pawel, Aleksandra Kulbat, Piotr Brzychczy, Artur Dziewierz, Jaroslaw Trebacz, Maciej Stapor, Danuta Sorysz et al. « Balloon Aortic Valvuloplasty for Severe Aortic Stenosis as Rescue or Bridge Therapy ». Journal of Clinical Medicine 10, n^o 20 (11 octobre 2021) : 4657. http://dx.doi.org/10.3390/jcm10204657.

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The study aimed to assess procedural complications, patient flow and clinical outcomes after balloon aortic valvuloplasty (BAV) as rescue or bridge therapy, based on data from our registry. A total of 382 BAVs in 374 patients was performed. The main primary indication for BAV was a bridge for TAVI (n = 185, 49.4%). Other indications included a bridge for AVR (n = 26, 6.9%) and rescue procedure in hemodynamically unstable patients (n = 139, 37.2%). The mortality rate at 30 days, 6 and 12 months was 10.4%, 21.6%, 28.3%, respectively. In rescue patients, the death rate raised to 66.9% at 12 months. A significant improvement in symptoms was confirmed after BAV, after 30 days, 6 months, and in survivors after 1 year (p < 0.05 for all). Independent predictors of 12-month mortality were baseline STS score [HR (95% CI) 1.42 (1.34 to 2.88), p < 0.0001], baseline LVEF <20% [HR (95% CI) 1.89 (1.55–2.83), p < 0.0001] and LVEF <30% at 1 month [HR (95% CI) 1.97 (1.62–3.67), p < 0.0001] adjusted for age/gender. In everyday clinical practice in the TAVI era, there are still clinical indications to BAV a standalone procedure as a bridge to surgery, TAVI or for urgent high risk non-cardiac surgical procedures. Patients may improve clinically after BAV with LV function recovery, allowing to perform final therapy, within limited time window, for severe AS which ameliorates long-term outcomes. On the other hand, in patients for whom an isolated BAV becomes a destination therapy, prognosis is extremely poor.

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Indolfi, Ciro, Jolanda Sabatino, Salvatore De Rosa, Annalisa Mongiardo, Pietrantonio Ricci et Carmen Spaccarotella. « Description and Validation of TAVIApp : A Novel Mobile Application for Support of Physicians in the Management of Aortic Stenosis—Management of Aortic Stenosis with TAVIApp ». BioMed Research International 2017 (2017) : 1–8. http://dx.doi.org/10.1155/2017/9027597.

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Background. Aortic stenosis (AS) is the most common heart valve disease in developed countries. The advent of transcatheter aortic valve implantation (TAVI) significantly improved patients’ outcome but made clinical management more complex. The aim of the present study was to describe TAVIApp, a mobile app we developed to guide the management of AS, and test its efficacy. Methods and Results. Clinical cases comprising 42 patients with AS were blindly evaluated by (A) an interventional cardiologist, assisted by the Heart Team (EXPERT), (B) young residents in cardiology, and (C) a young resident supported by TAVIApp. There was poor concordance between Group A and Group B with low performance by young residents (k=0.52; p<0.001). However, concordance increased to an optimal value when young residents were supported by TAVIApp (k=1.0; p<0.001) for the diagnosis of severe AS and eligibility assessment. Furthermore, regarding the selection of the most appropriate prosthesis size, concordance to Group A was poor without TAVIApp support (Group B) (k=0.78; p=0.430), but excellent with TAVIApp (k=1.0; p<0.001). Conclusions. This study is the first describing and validating a new mobile application to support the management of AS. TAVIApp supports cardiologists in the evaluation of stenosis severity, eligibility for TAVI or AVR, and selection of the most appropriate prosthesis size in individual patients.

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Ghobrial, Mina S. A., Kamal Khan, Mohamed Baguneid et Richard D. Levy. « Transcatheter aortic valve implantation facilitated by right common carotid cut-down and innominate artery angioplasty with simultaneous right coronary artery vein graft percutaneous coronary intervention in a patient with mid aortic syndrome : a case report ». European Heart Journal - Case Reports 4, n^o 4 (26 mai 2020) : 1–5. http://dx.doi.org/10.1093/ehjcr/ytaa134.

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Abstract Background Transcatheter aortic valve implantation (TAVI) is most commonly performed via the femoral approach. Small caliber ilio-femoral arteries, severe calcification and tortuosity are often prohibitive reasons for TAVI via the femoral approach. Mid-aortic syndrome is a rare condition describing congenital or acquired coarctation of the abdominal aorta. Case summary To the best of our knowledge, this case report describes the world’s first TAVI in a patient with mid-aortic syndrome with challenging vascular access that would preclude conventional TAVI access routes. A 76-year-old woman with intermittent claudication, underwent work-up for axillo-bifemoral bypass, underwent a TAVI for incidental severe asymptomatic severe aortic stenosis via right common carotid TAVI facilitated by innominate artery angioplasty achieved vascular access for TAVI. Percutaneous coronary intervention to a right coronary artery vein graft was simultaneously performed via a left brachial artery cut down. Discussion We demonstrate that complex angioplasty to coronary artery bypass grafts and the innominate artery alongside TAVI via a variety of arterial access sites is both safe and feasible.

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Maureira, Pablo, Yihua Liu, Neil Stafford, Antonio Fiore et Michael Angioi. « Transcatheter Aortic Valve Implantation via Right Carotid Artery Route for Severe Aortic Regurgitation Management in a Patient with Chronic Operated Type A Aortic Dissection ». Heart Surgery Forum 17, n^o 5 (3 novembre 2014) : 242. http://dx.doi.org/10.1532/hsf98.2014396.

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Background: Transcatheter aortic valve implantation (TAVI) technique is now widely accepted as an alternative for the treatment of very high-risk patients in cases of aortic stenosis. However, use of this technique in cases of pure native aortic regurgitation (AR) remains discussed.Case Report: We report the case of a 68-year-old patient with severe AR referred to our hospital 10 years after a supracoronary ascending aorta replacement surgery for acute type A aortic dissection. Because of respiratory contraindication to redo sternotomy, we treated this patient with the implantation of a CoreValve prosthesis inserted via right carotid access. We discuss the TAVI strategy in the case of severe AR and the possibility to use alternative vascular access.Conclusion: In very high-risk patients, TAVI can be discussed and considered as an alternative treatment for severe AR, with right carotid access proven as feasible.

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Steeds, Richard Paul, David Messika-Zeitoun, Jeetendra Thambyrajah, Antonio Serra, Eberhard Schulz, Jiri Maly, Marco Aiello et al. « IMPULSE : the impact of gender on the presentation and management of aortic stenosis across Europe ». Open Heart 8, n^o 1 (janvier 2021) : e001443. http://dx.doi.org/10.1136/openhrt-2020-001443.

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AimsThere is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).MethodsData from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age.ResultsOverall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001).ConclusionsThe present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.

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Steeds, Richard Paul, David Messika-Zeitoun, Jeetendra Thambyrajah, Antonio Serra, Eberhard Schulz, Jiri Maly, Marco Aiello et al. « IMPULSE : the impact of gender on the presentation and management of aortic stenosis across Europe ». Open Heart 8, n^o 1 (janvier 2021) : e001443. http://dx.doi.org/10.1136/openhrt-2020-001443.

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AimsThere is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).MethodsData from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age.ResultsOverall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001).ConclusionsThe present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.

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Voss, Stephanie, Johanna Schechtl, Christian Nöbauer, Sabine Bleiziffer et Rüdiger Lange. « Patient eligibility for application of a two-filter cerebral embolic protection device during transcatheter aortic valve implantation : does one size fit all ? » Interactive CardioVascular and Thoracic Surgery 30, n^o 4 (6 janvier 2020) : 605–12. http://dx.doi.org/10.1093/icvts/ivz306.

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Abstract OBJECTIVES This study sought to determine the percentage of patients potentially eligible for implantation of the Sentinel™ Cerebral Protection System (Sentinel-CPS) during transcatheter aortic valve implantation (TAVI) and to identify the reasons for treatment exclusion. METHODS We retrospectively performed an analysis of pre-TAVI multislice computed tomography (MSCT) aortograms and data review of all patients undergoing a TAVI procedure in 2017 (n = 317). MSCT evaluation included the assessment of aortic arch anatomy and the vascular dimensions of the brachiocephalic and left common carotid artery. Data analysis focused on comorbid conditions, precluding 6-Fr sheath radial access and filter deployment due to history of previous artery interventions. RESULTS MSCT and data analysis showed Sentinel-CPS compatibility in 61.5% of patients (n = 195). Sentinel-CPS would have been contraindicated in 38.5% (n = 122) due to one or more of the following: (i) measured diameters of the filter-landing zones <9 or >15 mm in the brachiocephalic artery and <6.5 or >10 mm in the left common carotid artery (n = 116; 88 with carotid dimensions too small); (ii) significant subclavian artery stenosis (n = 4) or an aberrant subclavian artery (n = 3) precluding Sentinel-CPS implantation and (iii) clinical characteristics including hypersensitivity to nickel–titanium (n = 1), radial artery occlusion (n = 1) or previous left common carotid artery interventions (n = 5). CONCLUSIONS MSCT and clinical data supported Sentinel-CPS compatibility in 61.5% of patients. The most common reason for treatment exclusion was inappropriate diameter within the target landing zone of the left carotid artery. Future device development should address this limitation.

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Wang, Hui, Hongyang Li, Xiaojie Zhang, Lanyan Qiu, Zhenchang Wang et Yanling Wang. « Ocular Image and Haemodynamic Features Associated with Different Gradings of Ipsilateral Internal Carotid Artery Stenosis ». Journal of Ophthalmology 2017 (2017) : 1–10. http://dx.doi.org/10.1155/2017/1842176.

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Objectives. To analyse the changes of ocular haemodynamics and morphology in Chinese patients with internal carotid artery (ICA) stenosis in the current study. Methods. A retrospective case-control study was conducted with 219 patients. The haemodynamic characteristics, the calibre of retinal vessels, and the subfoveal choroidal thickness (SFChT) were compared. We analysed the correlations with the degree of ipsilateral ICA stenosis. Results. There were no significant differences among the groups in the central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and AVR (p=0.073, p=0.188, and p=0.738, resp.). The peak systolic velocity (PSV) and end diastolic velocity (EDV) in the central retinal artery (CRA) and the posterior ciliary artery (PCA) were significantly lower than normal eyes (p<0.001). The outer retinal layer thickness and SFChT values of the ICA stenosis groups were significantly lower than normal eyes (p=0.030 and p<0.001, resp.). Conclusion. The PSV and EDV in CRA and PCA and the SFChT and outer retinal layer thickness of ICA eyes were significantly lower than normal eyes. ICA stenosis may impact choroidal haemodynamics, and decreased choroidal circulation might affect the discordance of the SFChT and the outer retinal layer thickness.

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Hammer, Yoav, Yeela Talmor-Barkan, Aryeh Abelow, Katia Orvin, Yaron Aviv, Noam Bar, Amos Levi et al. « Myocardial extracellular volume quantification by computed tomography predicts outcomes in patients with severe aortic stenosis ». PLOS ONE 16, n^o 3 (10 mars 2021) : e0248306. http://dx.doi.org/10.1371/journal.pone.0248306.

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Background The extent of myocardial fibrosis in patients with severe aortic stenosis might have an important prognostic value. Non-invasive imaging to quantify myocardial fibrosis by measuring extracellular volume fraction might have an important clinical utility prior to aortic valve intervention. Methods Seventy-five consecutive patients with severe aortic stenosis, and 19 normal subjects were prospectively recruited and underwent pre- and post-contrast computed tomography for estimating myocardial extracellular volume fraction. Serum level of galectin-3 was measured and 2-dimensional echocardiography was performed to characterize the extent of cardiac damage using a recently published aortic stenosis staging classification. Results Extracellular volume fraction was higher in patients with aortic stenosis compared to normal subjects (40.0±11% vs. 21.6±5.6%; respectively, p<0.001). In patients with aortic stenosis, extracellular volume fraction correlated with markers of left ventricular decompensation including New York Heart Association functional class, left atrial volume, staging classification of aortic stenosis and lower left ventricular ejection fraction. Out of 75 patients in the AS group, 49 underwent TAVI, 6 surgical AVR, 2 balloon valvuloplasty, and 18 did not undergo any type of intervention. At 12-months after aortic valve intervention, extracellular volume fraction predicted the combined outcomes of stroke and hospitalization for heart failure with an area under the curve of 0.77 (95% confidence interval: 0.65–0.88). A trend for correlation between serum galectin-3 and extracellular volume was noted. Conclusion In patients with severe aortic stenosis undergoing computed tomography before aortic valve intervention, quantification of extracellular volume fraction correlated with functional status and markers of left ventricular decompensation, and predicted the 12-months composite adverse clinical outcomes. Implementation of this novel technique might aid in the risk stratification process before aortic valve interventions.

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KAWANAMI, Reina, Kana SAWADA, Tomoyuki KINO, Natsumi TAMADA et Kuniyasu SAIGUSA. « Recent Results for Carotid Artery Stenosis Complicated with Severe Aortic Valve Stenosis : TAVI and CEA, from the Examination of Our Institution ». Surgery for Cerebral Stroke 50, n^o 1 (2022) : 44–49. http://dx.doi.org/10.2335/scs.50.44.

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Gunasekaran, Sengottuvelu, Muthukumaran Chinnasamy Sivaprakasam, Ganapathy Arumugam Chandrasekeran, C. S. Vijay Shankar, Periakaruppan Alagappan et Vinodh Kumar Paul Pandi. « TAVI in severe aortic stenosis with porcelain aorta : First reports from India with coronary and carotid support ». IHJ Cardiovascular Case Reports (CVCR) 2, n^o 3 (octobre 2018) : 177–80. http://dx.doi.org/10.1016/j.ihjccr.2018.08.005.

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Collas, V., Y. M. Chong, I. Rodrigus, A. De Hondt, M. Vandewoude et J. Bosmans. « Treatment of severe symptomatic aortic stenosis in the elderly : Surgical AVR (aortic valve replacement), TAVI (transcatheter aortic valve implantation) or medical therapy ». European Geriatric Medicine 4 (septembre 2013) : S147. http://dx.doi.org/10.1016/j.eurger.2013.07.481.

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Zhao, Ying, et Yi-hua He. « Echocardiographic evaluation of cardiac function response to removal of aortic stenosis : Surgical and trans-catheter aortic valve implantation (TAVI) ». International Cardiovascular Forum Journal 1, n^o 1 (29 mars 2015) : 16. http://dx.doi.org/10.17987/icfj.v1i1.9.

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Aortic stenosis (AS) is the commonest valve disease in theWest, with a prevalence varying between 0.02% in adultsunder 44 years and 3-9% in those over 80 years of age 1, 2. Thedisease may remain “silent” and hence unnoticed for years,particularly in the elderly with naturally limited exercise. With thedevelopment of symptoms, patients may carry a mortality of36-52%, 52-80% and 80-90% at 3, 5 and 10 years, respectivelyif left untreated, with a potential high risk of sudden death 3.Surgical aortic valve replacement (SAVR) used to be the onlyeffective treatment for severe AS, being the second indicationfor open heart surgery after coronary artery bypass grafting(CABG) 4. Trans-catheter aortic valve implantation (TAVI) is arecently developed procedure which aims at non-surgical AVRin patients with severe, symptomatic and calcified AS whoare at high surgical risk because of either poor left ventricular(LV) function, ejection fraction (EF) <50%, or other significantco-morbidities e.g. age >80 years, previous CABG surgery and/or aorta or other heart valve surgery, impaired kidney function,chronic obstructive pulmonary disease (COPD) or pulmonaryhypertension 5. Currently, this technique is not recommendedin bicuspid AS patients due to the risk of incomplete andsuboptimal deployment of the aortic prosthesis [6]. TAVIavoids open heart surgery and hence is likely to protectmyocardial function. The purpose of this paper is to review theechocardiographic evaluation of LV, right ventricular (RV), andleft atrial (LA) function response to SAVR and TAVI for AS.

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Kaier, Klaus, Anja Gutmann, Werner Vach, Stefan Sorg, Matthias Siepe, Constantin von zur Mühlen, Martin Moser et al. « “Heart Team” decision making in elderly patients with symptomatic aortic valve stenosis who underwent AVR or TAVI – a look behind the curtain. Results of the prospective TAVI Calculation of Costs Trial (TCCT) ». EuroIntervention 11, n^o 8 (novembre 2015) : 793–98. http://dx.doi.org/10.4244/eijy14m12_06.

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Siddiqui, Abdul Hameed, Sohail Aziz, Ghulam Rasool Maken, Ali Nawaz Khan, Mohsin Saif, Farhan Tuyyab, Kumail Abbas Khan, Waseem Raja, Javeria Kamran et Anam Fatima Janjua. « TRANS-CATHETER AORTIC VALVE IMPLANTATION (TAVI)-A CASE SERIES AT AFIC/NIHD ». Pakistan Armed Forces Medical Journal 70, Suppl-4 (5 janvier 2021) : S674–77. http://dx.doi.org/10.51253/pafmj.v70isuppl-4.5998.

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Objective: To share our experience of percutaneous trans-catheter aortic valve implantation in patients with severe symptomatic aortic stenosis. Study Design: A retrospective cross sectional study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) Rawalpindi, from Mar 2015 to Feb 2020. Methodology: Retrospective analysis of all consecutive patients who underwent percutaneous trans-catheter aortic valve implantation was done to assess its immediate, short and long term outcome and safety. Twenty patients have undergone trans-catheter aortic valve implantation since 2015 in the institute. Base line blood chemistry including creatinine clearance, ultra-sonography abdomen, carotid Doppler, chest X-ray, High-Resolution Computed Tomography chest was done in all cases as part of the protocol. Mean age of the patients was 73 ± 7.91. There were sixteen males (80.0%) and four females (20.0%). All patients under went procedure through transfemoral route. Valve structure and peripheral vasculature for suitability of the procedure was assessed by computerized coronary tomographic angiography with TAVI protocol. In eleven patients aortic valve was trileaflet (55.0%) and in remaining nine it was bicuspid (45.0%). Mean gradient across the valve pre-procedure was 56.37 ± 9.14. Thirteen patients (65.0%) presented with angina/dysnoea NYHA III, 6 patients with syncope (30.0%) and one (5.0%) had heart failure. Two patients had undergone previous coronary artery bypass surgery. Procedure was carried out under general anesthesia in all patients except one. Balloon expandable Edwards Sapienvalve was implanted in two patients and self-expandable Core Valve/Evolut R in eighteen patients. Results: Seventeen patients underwent the procedure successfully with reduction of the mean gradients immediately after valve implantation to less than 15 mmHg recorded in the cath labangiographically subsequently complemented by transthoracic echocardiography. There were 3 deaths during the index hospitalization. Two occurred in the catheterization laboratory, one death was due to development of severe acute aortic regurgitation and second was due to acute coronary obstruction. Third death occurred due to acute kidney injury after seven days. Five patients died in next three months during follow up. One patient required permanent pacemaker because of development of left bundle branch block and second degree atrio-ventricular block post procedure. Conclusion: Transcatheter aortic valve implantation in patients with severe symptomatic aortic stenosis is a very effective and procedurally safe option and reasonable alternative to surgical valve replacement in high operative risk individuals.

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Kedev, Sasko, Biljana Zafirovska, Elizabeta Srbinovska-Kostovska, Slobodan Antov, Aleksandar Nikolic, Omer Dzemali et Matjaz Bunc. « Minimalistic Approach for Transcatheter Aortic Valve Implantation (TAVI) : Open Vascular Vs. Fully Percutaneous Approach ». PRILOZI 40, n^o 2 (1 octobre 2019) : 5–14. http://dx.doi.org/10.2478/prilozi-2019-0009.

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Abstract Background: Aortic stenosis (AS) is the most common valvular heart disease in elderly people. Transcatheter aortic valve implantation (TAVI) has emerged as a revolutionary treatment for elderly patients with symptomatic severe aortic stenosis. The authors present the first experiences with transcatheter aortic valve implantation treatment in Macedonia and compare their findings in regard to differences between open vascular vs. minimalistic transfemoral TAVI approach. Methods: The procedure was performed in 54 patients with severe and symptomatic AS in the period from December 2014 until February 2018. All patients were deemed having high surgical risk or were denied surgery. Pre-procedural screening included detailed clinical and echocardiographic evaluation, coronary, peripheral and carotid angiography and computed tomography scan of the aortic root. A self-expandable aortic valve (Core Valve/Evolut R, Medtronic, USA) was implanted in all patients. Results: Mean patient age was 75 ± 7.2 years, 28 (52%) were female, 26 patients (48%) male. All interventions were successfully performed through right transfemoral approach with 100% implantation success. Ancillary right radial and ulnar approach was used for correct valve positioning and control. 22(40%) cases were performed under general anesthesia and open vascular access to the femoral artery. All other 32(60%) cases were performed with minimalistic approach (local anaesthesia and analgosedation of the patients, access site was closed with closure devices). Patients in the minimalistic approach group were older, with more chronic conditions as anaemia, chronic kidney disease, poor mobility and peripheral vascular disease (p<0.0001). Also 4(12.5%) patients in the minimalistic group had bicuspid valve TAVI implantation (p<0.0001). Procedural time and contrast amount spent were shorter in this group with 97± 38 vs. 121± 38.3(p<0.0001) and 287± 122 vs. 330± 115 ml, while fluoroscopy time was similar in both groups. Immediate hemodynamic improvement was obtained in all patients. Echocardiographic peak gradient decreased from 85 ± 25 to 17 ± 8 mmHg (p < 0.001) and mean pressure gradient from 49 ± 26 to 8.3 ± 4.2 mmHg, (p < 0.001). Effective valve orifice area was 1.8±0.4 cm2 after intervention. None of the patients had significant aortic regurgitation after implantation. After intervention 7(12%) patients developed a permanent heart block and required implantation of a permanent pacemaker. There was a larger Hgb drop after intervention with open vs. minimalistic approach 1,9±0.9 vs. 0.7±0,2 g/dL (p<0.0001). 3 (13% vs.0%) patients from the open vascular access group had a major bleeding complication with 2 requiring transfusion after intervention (p<0.0001). Mortality was 5.5%, 2 with open-vascular and 1 with minimalistic approach. MACCE rate that included MI, Stroke, Major bleeding and Death rate, was recorded in 5(18%) patients with open vascular approach vs. 1(3.1%) in minimalistic approach (p<0.0001). Hospital discharge was 8.7±3.1 vs. 4±3.1 days respectively (p<0.0001). All TAVI patients with minimalistic approach were discharged the following day after intervention. All discharged patients had a good neurological condition, which was assessed based on the CPC-1 (Cerebra Performance Categories Scale). After median follow up of 26 months, the survival rate was 95% with clinical improvement in all patients. Conclusion: Percutaneous aortic valve implantation can be successfully conducted with high success rate and low rate of complications in patients with severe aortic stenosis. Using a less invasive approach with local anaesthesia and analgosedation is associated with shorter length of stay and a decrease in post-procedural complication rates and MACCE.

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Wassmuth, R., K. Hristova, P. Monney, RFW Olander, D. Rodriguez Munoz, X. Huayan, E. Pagourelias et al. « Poster Session 6Assessment of morphology and functionP1222Multimodality imaging for left atrial appendage occluder sizingP1223Longitudinal left atrial strain is a main predictor for long term prognosis on atrial fibrillation after CABG operation patientsP1224Comparison of 2D and 3D left ventricular volumes measurements : results from the SKIPOGH II studyP1225Adjusting for thoracic circumference is superior to body surface area in the assessment of neonatal cardiac dimensions in foetal growth abnormalityP1226Maximal vortex suction pressure : an equivocal marker for optimization of atrio-ventricular delayP1227Volume-time curve of cardiac magnetic resonance assessed left ventricular dysfunction in coronary artery disease patients with type 2 diabetes mellitusP1228Thickness matters, but not in the same way for all strain parametersP1229Digging deeper in postoperative modifications of right ventricular function : impact of pericardial approach and cardioplegiaP1230Left atrial function evaluated by 2D-speckle tracking echocardiography in diabetes mellitus populationP1231The influence of arterial hypertension duration on left ventricular diastolic parameters in patients with well regulated arterial blood pressureP1232Investigation of factors affecting left ventricular diastolic dysfunction determined using mitral annulus velocityP1233High regulatory T-lymphocytes after ST-elevation myocardial infarction relate with adverse left ventricular remodelling assessed by 3D-echocardiographyP1234Prevalence of paradoxical low flow/low gradient severe aortic stenosis measure with 3 dimensional transesophageal echocardiographyP1235Coronary microvascular and diastolic dysfunctions after aortic valve replacement : comparison between mechanical and biological prosthesesP1236Normal-flow, low gradient aortic stenosis is common in a population of patients with severe aortic valve stenosis undergoing aortic valve replacementP1237Analysis of validity and reproducibility of calcium burden visual estimation by echocardiographyP12383D full automatic software in the evaluation of aortic stenosis severity in TAVI patients. Preliminary resultsP1239Differential impact of net atrioventricular compliance on clinical outcomes in patients with mitral stenosis according to cardiac rhythmP1240Aortic regurgitation affects the intima-media thickness of the right and left common carotid artery differentlyP1241Global longitudinal strain : an hallmark of cardiac damage in mitral valve regurgitation. Experience from the european registry of mitral regurgitationP1242Echocardiographic characterisation of Barlow's disease versus fibroelastic deficiencyP1243Echocardiographic screening for rheumatic heart disease in a ugandan orphanage - feasibility and outcomesP1244Alterations in right ventricular mechanics upon follow-up period in patients with persistent ischemic mitral regurgitation after inferoposterior myocardial infarctionP1245Ten-years conventional mitral surgery in patients with mitral regurgitation and left ventricular dysfunction : clinical and echocardiographic outcomes ». European Heart Journal – Cardiovascular Imaging 17, suppl 2 (décembre 2016) : ii256.1—ii280. http://dx.doi.org/10.1093/ehjci/jew266.

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Kubota, N., J. Petrini, A. Gonzalez Gomez, DS Sorysz, JM Monteagudo Ruiz, E. Tamulenaite, C. Dumont et al. « P650Influence of fetunin-a level on progression of calcific aortic valve stenosis The COFRASA - GENERAC StudyP651Common carotid artery remodeling 1 year after aortic valve surgeryP652Low gradient aortic stenosis with preserved ejection fraction : reclassification of severity by 3D transesophageal echocardiography. P653Results of balloon aortic valvuloplasty in patients with impaired left ventricle ejection fraction.P654Burden of associated aortic regurgitation in patients with mitral regurgitationP655Differences in right ventricular mechanics in acute and chronic ischemic mitral regurgitation after inferoposterior myocardial infarctionP656Tricuspid regurgitation in patients operated for severe symptomatic native aortic stenosis : pre-operative determinantsP657Echocardiographic diagnosis in patients with prosthetic or annuloplasty ring dysfunction : correlation with surgical findingsP659Agreement analisys of different three-dimensional transoesophageal echocardiographic modalities and cardiac CT scan in aortic annulus sizing for transapical heart valve implantationP660Elevated gradients after TAVR are associated with increased rehospitalization, but have no impact on mortality and major adverse cardiac eventsP661Echocardiographic characteristics of post-TAVI thrombosis and endocarditis : single-centre experienceP662Impact of mixed aortic valve disease in long-term mortality after transcatheter aortic valve implantationP663Quantification of mitral regurgitation during interventional valve repair : correlation between haemodynamic parameters and 3D color Doppler echocardiographyP664Mitraclip in functional mitral regurgitation : are immediate results the same in ischemic and non ischemic etiology?P665Left ventricular contractile reserve by stress echocardiography as a predictor of response to cardiac resynchronization therapy in heart failure : a meta-analysisP666Regardless of the definition used, left ventricular reverse remodeling is not different in fibrosis positive and negative dilated cardiomyopathy patientsP667Heterogeneity of LV contractile function by multidimensional strain in patients with EF<35% : Insights for the hemodynamic burdenP668Ability of 99mTc-DPD scintigraphy to predict conduction disorders requiring permanent pacemaker in patients with transthyretin-related cardiac amyloidosisP669Provocation of left ventricular outflow tract obstruction using nitrate inhalation in hypertrophic cardiomyopathy : relation to electromechanical delayP670Could echocardiographic features differentiate Fabry cardiomyopathy from sarcomeric forms of hypertrophic cardiomyopathy?P671Pregnancy is well tolerated in women with arrhythmogenic right ventricular cardiomyopathy P672Glycogen storage cardiomyopathy (PRKAG2) : do particular echocardiography findings in established and advanced techniques are helpful in suggesting the diagnosis?P673Improvement of arterial stiffness and myocardial deformation in patients with poorly controlled diabetes mellitus type 2 after optimization of antidiabetic medication ». European Heart Journal – Cardiovascular Imaging 17, suppl 2 (décembre 2016) : ii130—ii136. http://dx.doi.org/10.1093/ehjci/jew250.001.

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Martins Fernandes, S., L. Badano, A. Garcia Campos, T. Erdei, G. Mehdipoor, N. Hanboly, BW Michalski et al. « Poster session 2THE IMAGING EXAMINATIONP536Appropriate use criteria of transthoracic echocardiography and its clinical impact : a continuous challengeP537Implementation of proprietary plug-ins in the DICOM-based computerized echo reporting system fuels the use of 3D echo and deformation imaging in the clinical routine of a multivendor laboratoryP538Exercise stress echocardiography appropriate use criteria : real-life cases classification ease and agreement among cardiologistsANATOMY AND PHYSIOLOGY OF THE HEART AND GREAT VESSELSP539Functional capacity in older people with normal ejection fraction correlates with left ventricular functional reserve and carotid-femoral pulse wave velocity but not with E/e and augmentation indexP540Survey of competency of practitioners for diagnosis of acute cardiopulmonary diseases manifest on chest x-rayASSESSMENT OF DIAMETERS, VOLUMES AND MASSP541Left atrium remodeling in dialysis patients with normal ejection fractionP542The prediction of postinfarction left ventricular remodeling and the role of of leptin and MCP-1 in regard to the presence of metabolic syndromeP543Ascending aorta and common carotid artery : diameters and stiffness in a group of 584 healthy subjectsAssessments of haemodynamicsP544Alternate echo parameters in patients without estimable RVSPAssessment of systolic functionP545Reduced contractile performance in heart failure with preserved ejection fraction : determination using novel preload-adjusted maximal left ventricular ejection forceP546Left ventricular dimensions and prognosis in acute coronary syndromesP547Time course of myocardial alterations in a murine model of high fat diet : A strain rate imaging studyP548Subclinical left ventricular systolic dysfunction in patients with premature ventricular contractionsP549Global myocardial strain by CMR-based feature tracking (FT) and tagging to predict development of severe left ventricular systolic dysfunction after acute st-elevation myocardial infarctionP550Echocardiographic analysis of left and right ventricular function in patients after mitral valve reconstructionP551The role of regional longitudinal strain assessment in predicting response to cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and left bundle branch blockP552Speckle tracking automatic border detection improves echocardiographic evaluation of right ventricular systolic function in repaired tetralogy of fallot patients : comparison with MRI findingsP553Echocardiography : a reproducible and relevant tool in pah ? intermediate results of the multicentric efort echogardiographic substudy (evaluation of prognostic factors and therapeutic targets in pah)Assessment of diastolic functionP554Relationship between left ventricular filling pressures and myocardial fibrosis in patients with uncomplicated arterial hypertensionP555Cardiac rehabilitation improves echocardiographic parameters of diastolic function in patients with ischemic heart diseaseP556Diastolic parameters in the calcified mitral annulusP557Biomarkers and echocardiography - combined weapon to diagnose and prognose heart failure with and without preserved ejection fractionP558Diastolic function changes of the maternal heart in twin and singleton pregnancyIschemic heart diseaseP559Syntax score as predictor for the correlation between epicardial adipose tissue and the severity of coronary lesions in patients with significant coronary diseaseP560Impact of strain analysis in ergonovine stress echocardiography for diagnosis vasospastic anginaP561Cardiac magnetic resonance tissue tracking : a novel method to predict infarct transmurality in acute myocardial infarctionP562Infarct size is correlated to global longitudinal strain but not left ventricular ejection fraction in the early stage of acute myocardial infarctionP563Magnetic resonance myocardial deformation assessment with tissue tracking and risk stratification in acute myocardial infarction patientsP564Increase in regional end-diastolic wall thickness by transthoracic echocardiography as a biomarker of successful reperfusion in anterior ST elevation acute myocardial infarctionP565Mitral regurgitation is associated with worse long-term prognosis in ST-segment elevation myocardial infarction treated with primary percutaneous coronary interventionP566Statistical significance of 3D motion and deformation indexes for the analysis of LAD infarctionHeart valve DiseasesP567Paradoxical low gradient aortic stenosis : echocardiographic progression from moderate to severe diseaseP568The beneficial effects of TAVI in mitral insufficiencyP569Impact of thoracic aortic calcification on the left ventricular hypertrophy and its regression after aortic valve replacement in patients with severe aortic stenosisP570Additional value of exercise-stress echocardiography in asymptomatic patients with aortic valve stenosisP571Valvulo-arterial impedance in severe aortic stenosis : a dual imaging modalities studyP572Left ventricular mechanics : novel tools to evaluate left ventricular performance in patients with aortic stenosisP573Comparison of long-term outcome after percutaneous mitral valvuloplasty versus mitral valve replacement in moderate to severe mitral stenosis with left ventricular dysfunctionP574Incidence of de novo left ventricular dysfunction in patient treated with aortic valve replacement for severe aortic regurgitationP575Transforming growth factor-beta dependant progression of the mitral valve prolapseP576Quantification of mitral regurgitation with multiple jets : in vitro validation of three-dimensional PISA techniqueP577Impaired pre-systolic contraction and saddle-shape deepening of mitral annulus contributes to atrial functional regurgitation : a three-dimensional echocardiographic studyP578Incidence and determinants of left ventricular (lv) reverse remodeling after MitraClip implantation in patients with moderate-to severe or severe mitral regurgitation and reduced lv ejection fractionP579Severe functional tricuspid regurgitation in rheumatic heart valve disease. New insights from 3D transthoracic echocardiographyP58015 years of evolution of the etiologic profile for prosthetic heart valve replacement through an echocardiography laboratoryP581The role of echocardiography in the differential diagnosis of prolonged fever of unknown originP582Predictive value for paravalvular regurgitation of 3-dimensional anatomic aortic annulus shape assessed by multidetector computed tomography post-transcatheter aortic valve replacementP583The significance and advantages of echo and CT imaging & ; measurement at transcatherter aortic valve implantation through the left common carotid accessP584Comparison of the self-expandable Medtronic CoreValve versus the balloon-expandable Edwards SAPIEN bioprostheses in high-risk patients undergoing transfemoral aortic valve implantationP585The impact of transcatheter aortic valve implantation on mitral regurgitation severityP586Echocardiographic follow up of children with valvular lesions secondary to rheumatic heart disease : Data from a prospective registryP587Valvular heart disease and different circadian blood pressure profilesCardiomyopathiesP588Comparison of transthoracic echocardiography versus cardiac magnetic for implantable cardioverter defibrillator therapy in primary prevention strategy dilated cardiomyopathy patientsP589Incidence and prognostic significance of left ventricle reverse remodeling in a cohort of patients with idiopathic dilated cardiomyopathyP590Early evaluation of diastolic function in fabry diseaseP591Echocardiographic predictors of atrial fibrillation development in hypertrophic cardiomyopathyP592Altered Torsion mechanics in patients with hypertrophic cardiomyopathy : LVOT-obstruction is the topdog?P593Prevention of sudden cardiac death in hypertrophic cardiomyopathy : what has changed in the guidelines?P594Coronary microcirculatory function as determinator of longitudinal systolic left ventricular function in hypertrophic cardiomyopathyP595Detection of subclinical myocardial dysfunction by tissue Doppler ehocardiography in patients with muscular dystrophiesP596Speckle tracking myocardial deformation analysis and three dimensional echocardiography for early detection of chemotherapy induced cardiac dysfunction in bone marrow transplantation patientsP597Left ventricular non compaction or hypertrabeculation : distinguishing between physiology and pathology in top-level athletesP598Role of multi modality imaging in familiar screening of Danon diseaseP599Early impairment of global longitudinal left ventricular systolic function independently predicts incident atrial fibrillation in type 2 diabetes mellitusP600Fetal cardiovascular programming in maternal diabetes mellitus and obesity : insights from deformation imagingP601Longitudinal strain stress echo evaluation of aged marginal donor hearts : feasibility in the Adonhers project.P602Echocardiographic evaluation of left ventricular size and function following heart transplantation - Gender mattersSystemic diseases and other conditionsP603The impact of septal kinetics on adverse ventricular-ventricular interactions in pulmonary stenosis and pulmonary arterial hypertensionP604Improvement in right ventricular mechanics after inhalation of iloprost in pulmonary hypertensionP605Does the treatment of patients with metabolic syndrome correct the right ventricular diastolic dysfunction?P606Predictors of altered cardiac function in breast cancer survivors who were treated with anthracycline-based therapyP607Prevalence and factors related to left ventricular systolic dysfunction in asymptomatic patients with rheumatoid arthritis : a prospective tissue-doppler echocardiography studyP608Diastolic and systolic left ventricle dysfunction presenting different prognostic implications in cardiac amyloidosisP609Diagnostic accuracy of Bedside Lung Ultrasonography in Emergency (BLUE) protocol for the diagnosis of pulmonary embolismP610Right ventricular systolic dysfunction and its incidence in breast cancer patients submitted to anthracycline therapyP611Right ventricular dysfunction is an independent predictor of survival among cirrhotic patients undergoing liver transplantCongenital heart diseaseP612Hypoplasia or absence of posterior leaflet : a rare congenital anomaly of the mitral valveP613ECHO screening for Barlow disease in proband's relativesDiseases of the aortaP614Aortic size distribution and prognosis in an unselected population of patients referred for standard transthoracic echocardiographyP615Abdominal aorta aneurysm ultrasonographic screening in a large cohort of asympromatic volounteers in an Italian urban settingP616Thoracic aortic aneurysm and left ventricular systolic functionStress echocardiographyP617Wall motion score index, systolic mitral annulus velocity and left ventricular mass predicted global longitudinal systolic strain in 238 patients examined by stress echocardiographyP618Prognostic parameters of exercise-induced severe mitral valve regurgitation and exercise-induced systolic pulmonary hypertensionP619Risk stratification after myocardial infarction : prognostic value of dobutamine stress echocardiographyP620relationship between LV and RV myocardial contractile reserve and metabolic parameters during incremental exercise and recovery in healthy children using 2-D strain analysisP621Increased peripheral extraction as a mechanism compensatory to reduced cardiac output in high risk heart failure patients with group 2 pulmonary hypertension and exercise oscillatory ventilationP622Can exercise induced changes in cardiac synchrony predict response to CRT?Transesophageal echocardiographyP623Fully-automated software for mitral valve assessment in chronic mitral regurgitation by three-dimensional transesophageal echocardiographyP624Real-time 3D transesophageal echocardiography provides more accurate orifice measurement in percutaneous transcatheter left atrial appendage closureP625Percutaneous closure of left atrial appendage : experience of 36 casesReal-time three-dimensional TEEP626Real-time three-dimensional transesophageal echocardiography during pulmonary vein cryoballoon ablation for atrial fibrilationP627Three dimensional ultrasound anatomy of intact mitral valve and in the case of type 2 disfunctionTissue Doppler and speckle trackingP629Left ventricle wall motion tracking from echocardiographic images by a non-rigid image registrationP630The first experience with the new prototype of a robotic system for remote echocardiographyP631Non-invasive PCWP influence on a loop diuretics regimen monitoring model in ADHF patients.P632Normal range of left ventricular strain, dimensions and ejection fraction using three-dimensional speckle-tracking echocardiography in neonatesP633Circumferential ascending aortic strain : new parameter in the assessment of arterial stiffness in systemic hypertensionP634Aortic vascular properties in pediatric osteogenesis imperfecta : a two-dimensional echocardiography derived aortic strain studyP635Assessment of cardiac functions in children with sickle cell anemia : doppler tissue imaging studyP636Assessment of left ventricular function in type 1 diabetes mellitus patients by two-dimensional speckle tracking echocardiography : relation to duration and control of diabetesP637A study of left ventricular torsion in l-loop ventricles using speckle-tracking echocardiographyP638Despite No-Reflow, global and regional longitudinal strains assessed by two-dimensional speckle tracking echocardiography are predictive indexes of left ventricular remodeling in patients with STEMIP639The function of reservoir of the left atrium in patients with medicaly treated arterial hypertensionP640The usefulness of speckle tracking analysis for predicting the recovery of regional systolic function after myocardial infarctionP641Two dimensional speckle tracking echocardiography in assessment of left ventricular systolic function in patients with rheumatic severe mitral regurgitation and normal ejection fractionP642The prediction of left-main and tripple vessel coronary artery disease by tissue doppler based longitudinal strain and strain rate imagingP643Role of speckle tracking in predicting arrhythmic risk and occurrence of appropriate implantable defibrillator Intervention in patients with ischemic and non-ischemic cardiomyopathyComputed Tomography & ; Nuclear CardiologyP644Cardiac adrenergic activity in patients with nonischemic dilated cardiomyopathy. Correlation with echocardiographyP645Different vascular territories and myocardial ischemia, there is a gradient of association ? » European Heart Journal – Cardiovascular Imaging 16, suppl 2 (décembre 2015) : S73—S101. http://dx.doi.org/10.1093/ehjci/jev278.

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Lapinskas, Tomas, Chiodi Elisabetta, Chrysanthos Grigoratos, Ricardo Ladeiras-Lopes, GJ Fent, E. Abdul Rahman, Jonathan Rodrigues et al. « VIEWING ONLY POSTERS1323Evaluation of right ventricular transverse strain and strain rate in patients with acute ST-segment elevation myocardial infarction : a cardiac magnetic resonance feature tracking study1333Cardiac resynchronization in ischemic heart failure patients : a comparison between therapy guided by cardiac magnetic resonance imaging and 2D-speckle tracking echocardiography1338Cardiac magnetic resonance versus bisphosphonate scintigraphy for diagnosis of cardiac amyloidosis1341Strain relaxation index, a novel tagged MRI-derived diastolic function parameter, is impaired in metabolic syndrome1349Global Longitudinal Strain Predicts Chronic Myocardial Infarction in Patients with Normal Ejection Fraction1352Optimal Dose Of Dobutamine During Low-Dose Dobutamine Stress Echocardiography In Correctly Identify Viable Segments On Cardiovascular Magnetic Resonance1368Absolute wall thickening and left ventricular ejection fraction–a unifying theory of myocardial contraction and heart failure?1376Transient St Elevation in Acs Like Myocarditis1379Patients after Fontan with a “total cavopulmonary connection” Fontan modification develop more collateral flow compared to “old-fashioned” Fontan modifications1387A MRI–derived 3D patient specific model for fibrosis quantification in atrial fibrillation1391Scar burden and survival in patients with ischemic cardiomyopathy and poor LV ejection fraction1392Relation of inflammatory markers with myocardial and microvascular injury in patients with reperfused ST- elevation myocardial infarction1406Equivalence of segmented conventional and fast single-shot late gadolinium enhancement (LGE) techniques for1410Cardiac Mri Appearances of Tuberculosis - A Review of Varied Presentations in India1415Atheroma burden, cardiac remodelling and epicardial fat : A comparison between healthy South Asian and European adults using Whole Body Cardiovascular MR1418Symptomatic Ventricular Arrhythmias : Diagnostic Yield of Cardiac Magnetic Resonance1421CMR assessment of aortic stiffness in asymptomatic low risk patients with type 2 diabetes mellitus1436Shock index as a predictor of myocardial damage and clinical outcome in ST-elevation myocardial infarction1451Combined biomarker testing for the prediction of microvascular obstruction after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction1452A novel oscillometric technique compared with cardiac magnetic resonance for the assessment of aortic pulse wave velocity in ST-segment elevation myocardial infarction1456Aorto-pulmonary collaterals evaluated by CMR is associated to reduced “effective” cardiac index late after Fontan palliation1458Evaluation of pulmonary transit time and Pulmonary Blood Volume with first-pass perfusion CMR imaging in adult with repaired Congenital Heart disease1459Prognostic value of the cardiac magnetic resonance as a predictor of improvement in ventricular function after TakoTsubo syndrome1462Diagnostic performance of ECG detection of left atrial enlargement in patients with arterial hypertension relative to the cardiac magnetic resonance gold-standard : impact of obesity1463Utility of cardiac magnetic resonance imaging for diagnosis of cardiac sarcoidosis and prediction of therapeutic effects in patients with complete heart block and implanted magnetic resonance-conditional pacemaker : A multicenter study1467Cardiac magnetic resonance late gadolinium enhancement in patients with genetic dilated cardiomyopathy14712.Left ventricular hypertrophy in hypertensive patients–comparison of Cardiac Magnetic Resonance and Echocardiographic analysis of morphological and functional LV-parameters1472Is Angiographic Perfusion Score assessed in patients with acute myocardial infarction correlated with Cardiac Magnetic Resonance infarct size and N-terminal pro-brain natriuretic peptide in 6-month follow-up1476Cardiac Magnetic Resonance Patterns of Left Ventricular Diastolic Function In Hypertrophic Cardiomyopathy1477Impact of platelet volume on thrombus burden and tissue reperfusion in patients with STEMI treated with primary angioplasty : MRI study1479Right ventricle systolic function assessment and its prognostic implications in cardiac amyloidosis1484Cardiac MRI - an important tool in the evaluation of multsystemic inflamatory diseases. An Erdheim-Chester Disease case report1485Predictive value of cardiac magnetic resonance for future adverse cardiac events in patients with ST-segment elevation myocardial infarction1486Time-to-treatment but not thrombectomy influence infarct size and microvascular obstruction in patients with acute ST-segment elevation myocardial infarction treated with primary coronary intervention1489Primary PCI versus Early Routine Post Fibrinolysis PCI for ST Elevation Myocardial Infarction1490Evaluation of ventricular function in Fontan patients undergoing feature tracking magnetic resonance strain1491Impacts of atrialized right ventricle and left ventricular displacement in Ebstein's anomaly on left ventricular function assessed by cardiovascular MRI1494Final diagnosis for patients presenting with chest pain, electrocardiographic changes or troponin rise and normal coronary arteries : insights from Cardiovascular MRI in our population1495Early Predictive Factors of LV Remodeling after STEMI ; Assessment by Coronary Angiogram and Cadiovascular Magnetic Resonance1497The Pathobiologic Mechanisms and the Prognostic Meaning of t wave Inversion in Acute Myocarditis. a Study Performed by Cardiac Magnetic Resonance1501The Influence of Left Atrial Function on Exercise Tolerance in Patients with Heart Failure and Preserved Ejection Fraction : A Cardiac Magnetic Resonance Feature Tracking Study1504Microvascular Obstruction in Patients with Anterior ST-Elevation Myocardial Infarction who Underwent Primary Percutaneous Coronary Intervention : Predictors and Impact on the Left Ventricular Function1508Histological Validation of ECV Quantification by Cardiac Magnetic Resonance T1 Mapping in Cardiac Amyloidosis1513Comparative Evaluation of Flow Quantification Across the Atrioventricular Valve in Patients with Functional Univentricular Heart After Fontan's Surgery and Healthy Controls : Measurement by 4D Flow Magnetic Resonance Imaging and Streamline Visualization1515Does arterial switch for d-transposition of the great arteries alter myocardial deformation of the ventricles?1527Accuracy of T1 Mapping by multi-professional CMR operators to predict myocardial infarct1531Detecting hypertensive heart disease : the additive value of cardiovascular magnetic resonance imaging1534Diagnostic Performance of Cardiac Magnetic Resonance Strain Parameters in Assesment of Myocardial Ischemia1535Relationships between left ventricular filling pressures and longitudinal dysfunction with myocardial fibrosis in uncomplicated hypertensive patients1539Predictive Clinical Factors of Tissue Damage Severity in Reperfused Acute Myocardial Infarction as Visualized by Cardiac Magnetic Resonance1541Which CMR derived parameter predicts better the need of invasive treatment in aortic coarctation?1543Contrast-enhanced magnetic resonance tomography in patients with supraventricular tachyarrhythmias1546Prognostic Value of CMR Imaging Biomarkers on Outcome in Peripheral Arterial Disease : a 6-year Follow-up Pilot Study1549Dobutamine-Stress-CMR in Young Adults after Arterial Switch Operation as Neonates1553Impact of posteromedial papillary muscle infarction on mitral regurgitation after ST-segment elevation myocardial infarction1556Role of cardiac magnetic resonance imaging in assessment of left ventricular hypertrophy1569Using intrinsic Cardiac Shear Waves to measure Myocardial Stiffness : Preliminary results from Patients with Heart failure with preserved Ejection Fraction1571Relationship of cerebrovascular reactivity and MRI pattern of carotid atherosclerotic plaque1577Feasibility study of an MR conditional pedal ergometer for cardiac stress MRI–preliminary results in healthy volunteers and patients with suspected coronary artery disease1581Pulmonary valve replacement for severe pulmonary stenosis has a positive effect on left ventricular remodeling1582The RV after cardiac surgery, more resilient than thought : multiparametric quantification shows altered rather than reduced function1584Usefulness of cardiovascular magnetic resonance to differentate coronary artery disease from non ischemic cardiomyoptathy in patients with heart failure1593What does CMR add to the ESC Risk Prediction Model to Assess the Occurrence of Sudden Cardiac Death in Patients with HCM?1597Detecting Progression of Diffuse Interstitial Fibrosis in Alstrom Syndrome1612Diffuse fibrosis in the ventricles of patients with transposition of great arteries late after atrial switch1631Utility of Cardiac Magnetic Resonance in the diagnosis and stratification of arrhythmic risk in patients with confirmed or suspected ventricular arrhythmias1635Size matters : pulmonary veins geometry by cardiac magnetic resonance imaging in atrial fibrillation patients1642How do the differences in Left Ventricular wall measurements from Echocardiography and CMR in patients with Hypertrophic Cardiomyopathy affect current Sudden Cardiac Death Risk Scores?1651Noninvasive assessment of intracardiac viscous energy loss in Fontan patients from 4D Flow CMR1653Behcet and Myocardial Infarction : A Rare Combination1328Impact of New Cerebral Ischemic Lesions On the Occurrence of Delirium after Transcatheter Aortic Valve Implantation1329Heart T2* assessment to measure iron overload using different software tools in patients with Thalassemia Major1332Hypertrabeculated Left Ventricle at Cardiac Magnetic Resonance Imaging : β-Thalassemia Major vs. Left Ventricular Non -Compaction Disease1335Aortic Regurgitation following Transcatheter Aortic Valve Implantation (TAVI) : a CMR Study of two prosthesis designs1336Incremental value of semi-quantitative evaluation of myocardium perfusion with 3T stress cardiac MRI1343Left ventricular morphological quantification with single shot and free-breathing SSFP cine imaging compared with standard breath-hold SSFP cine imaging1344Changes of cardiac iron and function during pregnancy in transfusion-dependent thalassemia patients1346Significant improvement of survival by T2* MRI in thalassemia major1350The impact of trans-catheter aortic valve implantation induced left-bundle branch block on cardiac reverse remodelling1351Value of magnetic resonance myocardial perfusion imaging in patients with indeterminate coronary computed tomography angiography results1353Gender differences in response to Transcatheter Aortic Valve implantation in patients with severe aortic stenosis assessed by feature tracking1354A qualitative assessment of first-pass perfusion bolus timings in the assessment of myocardial ischemia : A magnetic resonance study1355MRI prospective survey on cardiac iron and function and on hepatic iron in non transfusion-dependent thalassemia intermedia patients treated with desferrioxamine or non chelated1358Coronary Calcification Compromises Myocardial Perfusion Irrespective of Luminal Stenosis1359Non–contrast three–dimensional magnetic resonance imaging for pre–procedural assessment of aortic annulus dimensions in patients undergoing transcatheter aortic valve implantation1360“Systolic ventricularization” of the left atrium with bileaflet mitral valve prolapse : impact on quantification of mitral regurgitation1361CMR assessment of left ventricular remodeling 6 months after percutaneous edge-to-edge repair using Mitraclip1363Accuracy of Transthoracic Echocardiography (TTE) in comparison with Cardiac Magnetic Resonance (CMR)1374CMR for myocardial iron overload assessment : a new calibration curve from the MIOT project1381Can Speckle Tracking Imaging Reveal Myocardial Iron Overload in Thalassemia Major ? A Combined Echocardiography and Cardiac Magnetic Resonance Study1382Native myocardial T1 mapping in patients with pulmonary hypertension and age matched volunteers1384A Insidious Line Between Thalassemia Intermedia And Left Ventricular Non-Compaction Disease : The Role Of Cardiac Magnetic Resonance1388Pulmonary Artery : Ascending Aorta Diameter - An Important and Easily Measureable Prognostic Parameter1394Novel carotid artery ultrasound index–Extra-media thickness and a well-established cardiac magnetic resonance fat quantification method1403Validation of CMR-derived LVOT diameters against direct in-vivo measurements1409Early myocardial perfusion measured by CMR in acute myocardial infarction treated by primary PCI–a postconditioning study1420Assessment of paravalvular aortic regurgitation after transcatheter aortic valve implantation using cardiac magnetic resonance imaging : a comparative study with echocardiography and angiography1422Left atrial strain measured by feature tracking predicts left ventricular end diastolic filling pressure1426Validation of extracellular volume equation by serial cardiac magnetic resonance imaging measurements in patients with varying hematocrit1427Assessing diastolic function applying Cardiovascular Magnetic Resonance - comparison with the gold standard1475Role of Adenosine Stress Cardiac Mri in the Setting of Chronic Total Occlusion of Coronary Arteries1520Aortic Elasticity Indexes by Magnetic Resonance Predict Progression of Ascending Aorta Dilation1522Combined atrioventricular assessment of diastolic function by cardiac magnetic resonance1537Safety, image quality and clinical utility of cardiac magnetic resonance in patients with antiarrhythmic devices1538Usefulness of cardiac magnetic resonance to predict the need for surgical procedures in patients with mitral regurgitation1550Normal T1, T2, T2* and extracellular volume reference values in healthy volunteers at 3 Tesla cardiac magnetic resonance1551Comprehensive intra-ventricular myocardial deformation strain analysis in healthy volunteers : implications for regional myocardial disease processes1557Elastic properties changes of aorta in patients with dilatation of the ascending aorta evaluated by Magnetic Resonance1558The prevalence of active myocarditis assessed by cardiovascular magnetic resonance in patients with clinically suspected myocarditis1563Quantitative assessment of myocardial scar heterogeneity using texture analysis to risk stratify post–MI patients for ICD insertion1564Gender differences in exercise capacity and LV remodeling in response to pressure overload in aortic stenosis1572Myocardial wall stress as a novel CMR measure to assess cardiac function1573Feature tracking cardiac magnetic resonance to assess LV mechanics in pressure and volume overload1574Safety, feasibility and clinical impact of Cardiovascular Magnetic Resonance in patients with MR-conditional devices1576T1 Mapping at 1-Year Following Aortic Valve Replacement : Baseline Geometry Defines Magnitude of Fibrosis Regression1583Normal values of LV global myocardial mechanics using two and three-dimensional cardiovascular magnetic resonance1585Prediction of infarct transmurality in acute myocardial infarction based on cardiac magnetic resonance deformation analysis1595Measuring invasive blood pressure by catheters guided solely by Cardiovascular Magnetic Resonance by using a new guidewire without the need of a hybrid CMR-fluoroscopy suite1599Influence of active and passive cardiac implants on CMR image quality : results from a consecutive patient series1600Reproducibility of aortic 4D flow measurements in healthy volunteers1601An automatic approach to extract 4D flow hemodynamic markers : application in BAV-affected patients1602Global myocardial mechanics with 2 and 3-Dimensional cardiovascular magnetic resonance feature tracking in patients with myocarditis1603A CMR-based clinician-friendly assessment of in vivo left ventricle hemodynamics1604Reproducibility of left atrial strain using cardiovascular magnetic resonance myocardial feature tracking1605The severity of myocardial infarction in STEMI, determined by transmurality of infarct and infarct characteristics, impacts on myocardial T2 values1606MicroRNA as potential biomarkers of acute myocardial damage following STEMI1607Myocardial blush grade is associated with microvascular obstruction on CMR following STEMI16084D Flow CMR imaging : Comparison of conventional parallel imaging and variable density k-t acceleration1609In-vitro comparison of segmented-gradient-echo versus non-segmented echo planar imaging 4D Flow CMR : validation of flow volume and 3D vortex ring assessment1614Not just 2D but also 4D flow measurements in pulsatile phantom are accurate and reproducible1615Diffusion Tensor Imaging : Comparison of Hypertrophic Cardiomyopathy, Hypertension and Healthy Cohorts1624Impact of myocardial fibrosis measured by cardiac magnetic resonance imaging on reverse left ventricular remodelling after transcatheter aortic valve implantation1625Prosthetic valve regurgitation after transcatheter aortic valve implantation with new-generation devices compared to surgical aortic valve replacement–a cardiac magnetic resonance imaging flow measurement analysis1637Assessment of Aortic and Pulmonary Artery stiffness in Patients with COPD using Cardiac Magnetic Resonance1638Myocardial Mechanics implications using 2D Cardiovascular Magnetic Resonance in Aortic Regurgitation1639Delineation of myocardial infarction & ; viability by 12 lead ECG vs cardiac magnetic resonance1641Regional variation in native T1 values in normal healthy volunteers?1645Feasibility of myocardial strain assessment using tissue tracking at 3.0T CMR following ST-segment elevation myocardial infarction1648Diagnostic Impact of Cardiac Magnetic Resonance in patients with acute chest pain, troponin elevation and no significant angiographic coronary artery disease ». European Heart Journal – Cardiovascular Imaging 17, suppl 1 (mai 2016) : i37—i84. http://dx.doi.org/10.1093/ehjci/jew183.

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Elderia, Ahmed, Stephen Gerfer, Kaveh Eghbalzadeh, Matti Adam, Stephan Baldus, Parwis Rahmanian, Elmar W. Kuhn et Thorsten C. W. Wahlers. « Surgical vs. interventional treatment of aortic stenosis and coronary artery disease ». Thoracic and Cardiovascular Surgeon, 22 décembre 2022. http://dx.doi.org/10.1055/a-2003-2105.

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Coronary artery disease is frequently diagnosed in patients with aortic valve stenosis. Treatment options include surgical and interventional approaches. We therefore analyzed short-term outcomes of patients undergoing either coronary artery bypass grafting with simultaneous aortic valve replacement (CABG+AVR) or staged percutaneous coronary intervention and transcatheter aortic valve implantation (PCI+TAVI). Methods: From all patients treated since 2017 we retrospectively identified 237 patients undergoing TAVI within 6 months after PCI and 241 patients undergoing combined CABG+AVR surgery. Propensity score matching was performed resulting in 101 matched pairs. Results: patients in the CABG+AVR group were younger compared to patients in the PCI+TAVI group (71.9±4.9 vs. 81.4±3.6 years; p<0.001). The overall mortality at 30 days before matching was higher after CABG+AVR than after PCI+TAVI (7.8% vs. 2.1%; p=0.012). The paired cohort was balanced for both groups regarding demographic variables and the risk profile (age: 77.2±3.7 vs.78.5±2.7 years; p=0.141) and Euro Score II (6.2% vs. 7.6%; p=0.297). At 30 days, mortality was 4.9% in the CABG+AVR group and 1,0% in the PCI+TAVI group and (p=0.099). Re-thoracotomy was necessary in 7.9% in the CABG+AVR, while conversion to open heart surgery was necessary in 2 % in the PCI+TAVI group. The need for new pacemaker was lower after CABG+AVR than after PCI+TAVI (4.1% vs.6.9%; p=0.010). No paravalvular leak was noted in the CABG+AVR group, while the incidence of moderate to severe PVL after PCI+TAVI was 4.9 %; (p=0.027). Conclusion: A staged PCI+TAVI comprises a short-term survival advantage for management of CAD and AS. Long-term Trials are warranted.

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Graversen, P. L., J. H. Butt, L. Oestergaard, A. D. Jensen, P. E. Warming, J. E. Strange, C. H. Moeller et al. « Temporal changes in aortic valve replacement according to age in Denmark : nationwide data from 2008 to 2020 ». European Heart Journal 43, Supplement_2 (1 octobre 2022). http://dx.doi.org/10.1093/eurheartj/ehac544.1625.

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Abstract Background Since the introduction of transcatheter aortic valve implantation (TAVI), the management of symptomatic severe aortic stenosis has changed. Recent published European guidelines (2021) favours TAVI over surgical aortic valve replacements (SAVR) in patients with older age (≥75 years of age) or patients with high surgical risk. The study of nationwide practice patterns for AVR is important and renders the possibility to evaluate whether clinical practice differs from current guidelines. Purpose To evaluate temporal changes in use of isolated aortic valve replacement (AVR) procedures according to age in the era of TAVI in Denmark. Methods We identified all first-time aortic valve replacement procedures (TAVI or SAVR) from 2008 until the end of 2020 through administrative registries in Denmark. Patients with no prior diagnosis of aortic stenosis at time of AVR were excluded. Patients with prior AVR or valve repair were excluded. SAVR was divided according to type of prostheses: surgical bioprostheses and mechanical prostheses. To evaluate changes according to age the study cohort was divided into two age groups: <75 and ≥75 years of age. Results Between 2008 and 2020, 12,313 first-time isolated AVR procedures were performed in Denmark. Volume of isolated AVR increased from 621 to 1256 procedures per year (ptrend <0.001). Isolated SAVR was performed in 6,548 patients (53.2%) and TAVI in 5,765 patients (46.8%). Median age of TAVI patients was 81.4 [76.9–85.2] years of age compared to 73.1 [68.0-≥77.7] in patients receiving surgical bioprostheses and TAVI patients had a higher degree of comorbidity (TAVI: 70% of patients with Charlson comorbidity score ≥1, surgical bioprostheses: 50% of patients with Charlson comorbidty score ≥1). TAVI increased during study period compared to isolated SAVR, where a decreasing trend was observed from 2014 and onwards. In <75-year-old patients, volume of TAVI significantly increased during study period (ptrend<0.001), whereas volume of surgical bioprostheses remained stable. Volume of mechanical prostheses decreased over time (ptrend <0.001) TAVI increased in ≥75-year-old patients (ptrend <0.001) and TAVI accounted for 91.5% of all isolated AVR procedures in 2020. In contrast, volume of isolated SAVR declined driven by a decreasing use of surgical bioprostheses (ptrend=0.001). (Figure 1). Conclusions Volume of isolated aortic valve replacement (AVR) doubled from 2008 and 2020. The increase in isolated AVR was driven by transcatheter aortic valve implantation (TAVI). TAVI has become the predominant choice of isolated AVR in management of aortic stenosis and our results suggest that real-world practise patterns are in line with current guideline recommendations. Funding Acknowledgement Type of funding sources: None.

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Graversen, Peter Laursen, Jawad Haider Butt, Lauge Østergaard, Andreas Dalsgaard Jensen, Peder Emil Warming, Jarl Emanuel Strange, Christian H. Møller et al. « Changes in aortic valve replacement procedures in Denmark from 2008 to 2020 ». Heart, 5 décembre 2022, heartjnl—2022–321594. http://dx.doi.org/10.1136/heartjnl-2022-321594.

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IntroductionSince 2007, transcatheter aortic valve implantation (TAVI) has emerged as another treatment strategy for severe symptomatic aortic stenosis (AS) compared with surgical aortic valve replacement (SAVR). The objectives were to compare annual rates of aortic valve replacement (AVR) procedures performed in Denmark in the era of TAVI and to assess proportion of AVRs stratified by age with use of age recommendations presented in current guidelines.MethodsUsing Danish nationwide registries, we identified first-time AVRs between 2008 and 2020. Patients who were not diagnosed with AS prior to AVR were excludedResultsThe rate of AVRs increased by 39% per million inhabitants from 2008 to 2020. TAVI has steadily increased since 2008, accounting for 64.2% of all AVRs and 72.5% of isolated AVRs by 2020. Number of isolated SAVRs decreased from 2014 and onwards. The proportion of TAVI increased significantly across age groups (<75 and ≥75 years of age, ptrend<0.001), and TAVI accounted for 91.5% of isolated AVR procedures in elderly patients (aged ≥75 years). Length of hospital stay were significantly reduced for all AVRs during the study period (ptrendall<0.001).ConclusionsThe number of AVRs increased from 2008 to 2020 due to adaptation of TAVI, which represented 2/3 of AVRs and more than 70% of isolated AVRs. In elderly patients, the increased use of AVR procedures was driven by TAVI, in agreement with the age recommendations in current guidelines; however, TAVI was used more frequently in patients aged <75 years, accompanied by a flattening use of SAVR.

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« TAVI or AVR in severe aortic stenosis in the USA ? » PharmacoEconomics & ; Outcomes News 648, n^o 1 (mars 2012) : 7. http://dx.doi.org/10.2165/00151234-201206480-00024.

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Li, Shawn X., Nilay K. Patel, Laura Flannery, Alexandra Selberg, Ritvik R. Kandanelly, Fritha J. Morrison, Varsha K. Tanguturi et al. « Abstract 10788 : Temporal Trends in the Utilization of Aortic Valve Replacement for Symptomatic Severe Aortic Stenosis from 2000-2017 : Insights from a Multi-Centered Study ». Circulation 144, Suppl_1 (16 novembre 2021). http://dx.doi.org/10.1161/circ.144.suppl_1.10788.

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Introduction: Despite the rapid growth of aortic valve replacement (AVR) for aortic stenosis (AS), studies have suggested that symptomatic severe AS remains undertreated. Hypothesis: The growth in patients with an indication for AVR has outpaced the number of AVRs performed. Methods: We identified patients with severe AS (aortic valve area <1cm 2 ) on transthoracic echocardiograms from 2000-2017 at two large academic medical centers. Natural language processing (NLP) models were developed and validated to identify symptoms consistent with severe AS, and patients were classified based on ACC/AHA clinical guideline indications for AVR. Patients were divided into groups based on mean aortic valve gradient (mAVG≥ 40 or <40mmHg) and left ventricular ejection fraction (LVEF≥50% or <50%). Utilization of AVR (transcatheter aortic valve implantation [TAVI] or surgical aortic valve replacement [SAVR]) in patients with a clinical indication was examined over time, and clinical predictors of AVR were identified via multivariate logistic regression. Results: A total of 10,795 AS patients were included in this analysis, of whom 6,150 (57%) had an indication or potential indication for AVR and 2,976 (48%) received AVR. The frequency of AVR varied by AS subtype (HG-NEF: 69%, HG-LEF: 53%, LG-NEF: 32%, LG-LEF: 38%, p<0.001). The adoption of TAVI contributed to the growth in AVR volume over time, however there has been a parallel rise in the number of patients with an indication for AVR (Figure). In patients with a class I indication for AVR, younger age, coronary artery disease, smoking history, higher hematocrit, outpatient index TTE, and LVEF≥0.5 were independently associated with an increased likelihood of receiving an AVR. Conclusions: Over an 18-year study period, the proportion of patients with an indication for AVR who do not receive AVR has remained significant despite the rapid growth of AVR volumes.

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Kar, Subrata, Mehdi H. Shishehbor, E. Murat Tuzcu, Deepak L. Bhatt, Christopher Bajzer et Samir R. Kapadia. « Abstract 6190 : Outcomes of Carotid Stenting in Patients with Concomitant Severe Carotid and Aortic Stenosis Prior to Aortic Valve Replacement ». Circulation 118, suppl_18 (28 octobre 2008). http://dx.doi.org/10.1161/circ.118.suppl_18.s_1078.

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Introduction: Carotid stenosis increases the risk for perioperative stroke during open heart surgery. Patients with concomitant severe carotid and aortic stenosis (AS) are frequently referred for carotid intervention prior to aortic valve replacement. Hypothesis: We hypothesized that carotid stenting can be safe and efficacious in the setting of severe AS. Methods: Of the total of 829 consecutive patients that underwent carotid interventions from 1998 –2005 at the Cleveland Clinic, 52 patients (65% male, age 78.82 ± 26.16 years) with severe AS (aortic valve area ≤ 1.0 cm 2 , 0.71 ± 0.15 cm 2 ) were included. Demographic, echocardiographic, and angiographic data were obtained prospectively. Our primary endpoints were stroke, transient ischemic attacks (TIAs), or death. Results: The mean STS Mortality scores for all groups were 6.85 ± 4.53% (n=46), six patient scores were immeasurable. There were no procedural strokes or mortality. TIA occurred in 1 patient during carotid stenting. Thirty day mortality was 6% (2 patients with LV-EF <20% died from heart failure and arrhythmia and 1 died from pulmonary embolism). Two other patients with depressed EF expired >30 days after carotid stenting prior to planned aortic valve replacement (AVR). AVR was performed in 29 of the 52 patients (26 patients ≥ 30 days post carotid stenting and 3 patients <15 days post carotid stenting). Of the remaining 23 patients, AVR was not performed due to death (n=5), high surgical risk from medical comorbidities (n=7), and patient refusal (n=3). Close monitoring and reassessment was recommended in 8 patients with asymptomatic AS. The mean STS mortality scores for patients who underwent AVR and who did not have AVR were 6.88 ± 5.05% and 6.81 ± 4.08% respectively (p=ns). Conclusions: Carotid interventions can be safely accomplished in patients with severe AS prior to AVR.

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Brizido, C., M. Madeira, J. Brito, R. C. Teles, M. Goncalves, A. F. Oliveira, T. Nolasco et al. « P1795Impact of severe aortic stenosis treatment strategy in low-risk patients : a propensity matched analysis of surgical aortic valve replacement versus transcatheter aortic valve implantation ». European Heart Journal 40, Supplement_1 (1 octobre 2019). http://dx.doi.org/10.1093/eurheartj/ehz748.0547.

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Abstract Introduction Recent studies suggest that transcatheter aortic valve implantation (TAVI) benefits might extend to lower risk patients. Our goal was to compare the impact of treatment strategy in mortality and peri-procedural complications in a low-risk severe aortic stenosis population. Methods Single-center retrospective study which screened patients undergoing intervention from June/2009 to July/2016 (682 isolated aortic valve replacement patients) and from June/2009 to July/2017 (400 TAVI patients). Low-risk was defined as EuroScore II <4% for single non-CABG procedure. After excluding patients with EuroScore II ≥4%, previous cardiac surgery and/or undergoing pre-treatment PCI, 544 AVR and 119 TAVI patients were included. TAVI patients were propensity score paired in a 1:1 ratio with a group of AVR patients, matched by age, NYHA class, diabetes mellitus, COPD, atrial fibrillation, creatinine clearance and LVEF <50% (mean standardized difference <10% for matching variables). All patients completed at least 1 year of follow-up. Outcomes were adjudicated according to VARC2 criteria. Results A total of 158 patients (79 AVR and 79 TAVI) were matched (mean age 79±6 years, 79 men). Median EuroScore II was 2.3% (IQR 1.6–3.0%), 46% were in NYHA class ≥3 and 91% had preserved ejection fraction. Main comorbidities were hypertension (n=105, 67%), diabetes mellitus (n=48, 30%), COPD (n=35, 22%) and coronary artery disease (n=30, 19%). Most patients had at least mild renal function impairment and median creatinine clearance was 58 ml/min (IQR 43–62 ml/min). The 30-day mortality was 2.5% (n=2 in each group) and there were no differences in in-hospital complications. During a median follow-up of 3.8 years (IQR 2.1–6.1), 67 deaths occurred (39 on the AVR group and 28 on the TAVI group), and treatment strategy did not influence all-cause mortality (HR 0.97, 95% CI 0.60–1.60, log rank p=0.92) - figure 1. By multivariate analysis, need for dialysis during hospitalization remained the only independent predictor of all-cause mortality (adjusted HR 6.40, 95% CI 1.57–28.14, p=0.01). Figure 1 Conclusion In this low-risk matched population, treatment strategy did not influence mortality neither complications. Older age, higher NYHA class and renal impairment were the main contributors to the predicted surgical risk. These results suggest that both options are safe for low-risk patients, even though Heart Team remains essential to contemplate other variables that might alter patient management.

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Kim, Kitae, Natsuhiko Ehara, Tadaaki Koyama et Yutaka Furukawa. « Successful transcatheter aortic valve implantation in a patient after an apico-aortic conduit for severe aortic stenosis complicated by haemolytic anaemia : a case report ». European Heart Journal - Case Reports, 12 novembre 2020. http://dx.doi.org/10.1093/ehjcr/ytaa410.

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Abstract Background Apico-aortic conduit (AAC) which connects the left ventricular (LV) apex directly to the descending aorta through a valved conduit, is an alternative to surgical aortic valve replacement (AVR) for patients with aortic stenosis (AS) who are inoperable or high risk for surgical AVR and are not suitable candidates for transcatheter aortic valve implantation (TAVI). Case summary An 84-year-old man with severe AS underwent an AAC combined with coronary artery bypass grafting 8 years earlier. A saphenous vein graft was anastomosed from the conduit to the left anterior descending artery. He had developed haemolytic anaemia requiring frequent blood transfusions. The stenosis at the anastomosis of the left ventricle and the conduit might be the cause of a turbulent flow and a shear stress which led to mechanical haemolysis. We expected that dilatation of native aortic valve would reduce the blood flow at the anastomosis site and thereby improve haemolytic anaemia. Since balloon aortic valvuloplasty improved haemolytic anaemia without exacerbation of myocardial ischaemia, transsubclavian TAVI was performed. After the TAVI, significant reductions in the pressure gradient between the left ventricle and the ascending aorta and that between the left ventricle and the conduit were achieved, and the patient remained clinically stable without the recurrence of haemolytic anaemia. Discussion This is the first report regarding mechanical haemolytic anaemia after AAC which might result from a turbulence and a shear stress by the stenosis of the anastomosis of the LV apex and the conduit. A careful monitoring for conduit dysfunction should be made after AAC.

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Kowalowka, A., M. Kowalewski, W. Wanha, M. Kolodziejczak, S. Mariani, T. Li, S. Stefaniak et al. « Long-term survival benefit of SAVR over TAVR in low-risk elective patients ». European Heart Journal 42, Supplement_1 (1 octobre 2021). http://dx.doi.org/10.1093/eurheartj/ehab724.2207.

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Abstract Background Aortic valve (AV) stenosis can be treated either by surgical AV replacement (SAVR) or since 2002 by transcatheter aortic valve implantation (TAVI). Due to lower invasiveness, TAVI is a preferred approach in high- and prohibitive risk surgical candidates, yet outcome data is conflicting when lower risk patients are considered and in particular at long-term. Purpose Our study evaluates long-term survival in elective low-risk patients after AV replacement with severe AV stenosis. Methods We conducted a registry data analyses of patients scheduled for elective isolated AV with AV stenosis between 2015 and 2019 and underwent TAVI or SAVR. Urgent, emergent and salvage procedures were excluded. In TAVI group only transfemoral access was considered. Propensity score matching to determine SAVR controls for TAVI group in 1:3 ratio with caliper 0.2 of standardized deviation (figure 1). Results Study group included 2393 elective AVR patients 1765 was in SAVR group and 628 in TAVI group. Median follow-up was 2.72 years ([IQR: 1.32–4.08], max 6.0). Propensity matching with replacement returned 329 TAVI cases and 593 SAVR controls with median age 76 (Interquartile range [IQR:71–73]) and EuroScore II 1.81 [IQR:1.36–2.53]). 30-day mortality was 11/329 (3.32%) vs 18/593 (3.03%) in the TAVI vs SAVR respectively (RR 1.10 [0.52–2.37]; p=0.801). At two years, there was no difference between SAVR and TAVI in terms of mortality (HR 1.23 [0.83–1.83] P=0.309). At 6 years, overall survival analysis favored SAVR which was associated with 30% lower mortality (HR 0.70 [0.496–0.997]; p=0.048, see figure 2). Conclusions TAVI as compared to SAVR is equally safe in elective low-risk patients up to 2 years post-op. After that time survival is better in surgically managed patients. Extended observations from randomized trials in low-risk patients are warranted to draw definite conclusions regarding long-term safety of TAVI in this population. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The work was supported by the research non-commercial grant from Medical University of Silesia Figure 1Figure 2

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Kato, N., J. J. Thaden, W. R. Miranda, M. E. Sarano, K. L. Greason et P. A. Pellikka. « P1786Impact of surgery for mitral regurgitation at the time of aortic valve replacement ». European Heart Journal 40, Supplement_1 (1 octobre 2019). http://dx.doi.org/10.1093/eurheartj/ehz748.0538.

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Abstract Background Functional mitral regurgitation (MR) is expected to improve after aortic valve replacement (AVR) in patients with severe aortic stenosis (sAS) and MR. However, little is unknown about the impact of AVR on organic MR and whether concomitant mitral valve surgery (MVS) improves outcomes in patients with sAS and MR. Purpose We assessed the impact of AVR on MR severity according to MR mechanism. We also assessed the clinical outcomes in patients with sAS and MR that underwent AVR with vs without MVS. Methods We retrospectively investigated patients who received surgical AVR or transcatheter aortic valve implantation (TAVI) from 2008 to 2017. We identified patients with effective mitral regurgitant orifice area (ERO) ≥10 mm2 by the proximal isovelocity surface area method with transthoracic echocardiography. The change in MR after AVR was considered significant when there was at least one grade difference. We compared the all-cause mortality of patients with sAS and MR that underwent AVR with vs without MVS according to MR mechanism and patient age. Results We included 326 patients with sAS and MR (age 80 [Interquartile range 72–85] years, 53% male, 21% history of myocardial infarction). Organic and functional MR were present in 69% and 31%, respectively. Of these, 240 underwent AVR alone (AVR group) including TAVI in 112 while 86 underwent AVR and MVS (MVS group) including mitral valve replacement in 38 and mitral valve repair in 48. The median ERO at baseline was 17 (14–21) mm2 in AVR and 24 (19–33) mm2 in MVS (p<0.001). Improvement in MR was observed in 58% of AVR and 91% of MVS (p<0.001). In AVR group, organic MR improved as frequently as functional MR (58% vs. 59%, p=0.96). Predictors for improvement in organic MR were absence of atrial fibrillation and moderate or greater MR, and in functional MR, the only predictor was decrease in LV end-systolic diameter after AVR. During mean follow-up of 2.4±2.3 years, moderate or greater MR was observed in 23% of AVR and 7% of MVS (p=0.002). All-cause mortality was similar in AVR and MVS groups for organic and functional MR (hazard ratio for MVS group 0.68, 95% CI: 0.40–1.10, p=0.13 in organic MR and 0.62, 95% CI 0.29–1.22, p=0.68 in functional MR). All-cause mortality was lower in MVS group compared with AVR group in patients <80 years, and was similar in patients ≥80 years (Figure). Conclusion In patients with sAS and MR, MR improves after AVR, even in the majority of patients with organic MR. Compared with isolated AVR, concomitant MVS was associated with better prognosis in patients <80 years.

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Wu, Dong-hui, Lan-ting Wu, Yan-ling Wang et Jia-lin Wang. « Changes of retinal structure and function in patients with internal carotid artery stenosis ». BMC Ophthalmology 22, n^o 1 (15 mars 2022). http://dx.doi.org/10.1186/s12886-022-02345-7.

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Abstract Background To investigate the structural and functional changes of the retina in patients with different degrees of internal carotid artery (ICA) stenosis. Methods This cross-sectional study included patients with varying degrees ICA stenosis. Clinical characteristics of 41 patients were collected after being divided into four groups according to the ICA stenosis indicated by computed tomographic angiography (Group 0: without ICA stenosis, Group 1: ipsilateral slight ICA stenosis, Group 2: ipsilateral moderate ICA stenosis, Group 3: ipsilateral severe ICA stenosis). Retinal vessel caliber (RVC) was measured quantitatively with the Integrative Vessel Analysis software. The retinal sensitivity was examined with the MP-3 microperimeter. The relationships among central retinal artery equivalent (CRAE), central retinal vein equivalent, arteriole to venule ratio (AVR), mean retinal sensitivity (MS) and ICA stenosis degree were analysed. Results The CRAE in Group 3 were significantly smaller compared with Group 0, Group 1 and Group 2 (P < 0.001, P < 0.001, P = 0.002). Significant decrease was found between Group 3 with other groups in MS at fovea (P < 0.001, P < 0.001, P = 0.002). Moreover, there was a positive correlation found between MS and CRAE (Beta = 0.60, P < 0.001 at fovea; Beta = 0.64, P < 0.001 at 2 degree; Beta = 0.60, P < 0.001 at 4 degree; Beta = 0.55, P < 0.001 at 8 degree; Beta = 0.53, P < 0.001 at 12 degree). Conclusions The present study revealed smaller CRAE and AVR in ipsilateral severe ICA stenosis patients. And the MS decreased in patients with severe ICA stenosis. In addition, MS had a positive correlation with CRAE.

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Reddy G.B, Chandra Shekara, siddarth Kumar Chawath et Arun Sriniivas. « BALLOON VALVULOPLASTY FOR EARLY BIOPROSTHETIC AORTIC VALVE STENOSIS IN SEPTUAGENARIAN - A RAY OF HOPE ». INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, 1 octobre 2021, 14–15. http://dx.doi.org/10.36106/ijsr/5009415.

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Calcic aortic stenosis (AS) remains a major cause of mortality and morbidity in the aging population . Surgical AV Replacement (SAVR) and Transfemoral Aortic Valve Implantation (TAVI) are available treatment options. With improvements in long term patient survival after AVR and increases in overall longevity, more patients are now seen with Prosthetic Aortic Valve failure. The management of patients with stenotic aortic bioprostheses is usually surgical. However, a proportion of such patients are unt for such procedures. The technique of aortic balloon valvuloplasty as an alternative treatment strategy for such patients is explored. We report a case of seventy-three-year-old male with prosthetic aortic valve stenosis treated with balloon valvuloplasty with promising intermediate term outcome and describe the growing valve in valve procedure. Hence this case is reported to enhance our knowledge and potentiate literature regarding the management strategy of prosthetic aortic valve stenosis in old age.

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Silva, C., S. Maltes, P. Freitas, A. M. Ferreira, R. C. Teles, M. J. Andrade, T. Nolasco et al. « External validation of a new staging system for severe aortic stenosis in a Portuguese cohort ». European Heart Journal 41, Supplement_2 (1 novembre 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.1876.

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Abstract Background Recently, a new staging system for severe aortic stenosis (AS) based upon the extent of extra-aortic-valve cardiac damage has been developed (Genereux et al. Eur Heart J 2017). The present study aimed to: 1) determine the prevalence of the different stages of extra-aortic valvular cardiac damage and its impact on prognosis in a real-world Portuguese cohort and; 2) evaluate the distribution of aortic valve calcium score (AV-CaSc) and its prognostic value. Methods Consecutive patients evaluated at a single-centre TAVI-programme between Nov/2015 and Nov/2018 were retrospective selected. The extent of extra-aortic valve cardiac damage was defined by echocardiography as stage 0 (no cardiac damage), stage 1 (left ventricular damage), stage 2 (mitral valve or left atrial damage), stage 3 (tricuspid valve or pulmonary artery vasculature damage) or stage 4 (right ventricular damage). AV-CaSc was estimated routinely at CT-angiography as per TAVI-programme protocol. The primary endpoint was 1-year all-cause mortality after CT-angiography. Survival analysis (Cox-regression hazards model and Kaplan-Meier) was performed. To account for the effect of aortic valve replacement (AVR), this variable entered the Cox-regression model as a time-dependent covariate. Results A total of 443 patients (mean age 82±7 years, 44% men, median euroSCORE II 4% [IQR 2.4–5.8]) were identified. After Heart Team discussion, 79% (n=349) underwent AVR (TAVI=307; surgical valve repair=42); 9% (n=42) await intervention; 6% (n=25) remain under medical treatment; 4% (n=19) died during the period of evaluation; and 2% (n=8) underwent palliative aortic balloon valvuloplasty. According to the proposed classification, the distribution of patients from stages 0 through 4 was: 0.2% (n=1), 7.5% (n=34), 67.8% (n=306), 14% (n=63), and 10.4% (n=47). Additionally, for each increasing stage of cardiac damage, the burden of AV-CaSc was higher (from stage 1 through 4: 1776 [IQR 1217–2448]; 2448 [1796–3442]; 2448 [1832–3622]; 2960 [1936–4878] units; p for trend = 0.002). All-cause mortality at 1-year was 14% (n=63). Mortality increased alongside with increasing extent of cardiac damage (from stage 0 through 4: 0% [n=0], 6% [n=2], 12% [n=36], 20% [n=12], and 30% [n=13]) – Fig. Multivariable analysis revealed chronic renal disease (HR 1.37 per stage [1.15–1.64], p<0.001), AV-CaSc (HR 1.02 per 100 units [1.01–1.03], p=0.007), AVR (HR 0.46 [0.26–0.81], p=0.007) and stage of cardiac damage (HR 1.54 per stage [1.15–2.05], p=0.004) as independent predictors of 1-year mortality. Conclusion In a real-world Portuguese cohort of severe AS patients, the extent of cardiac damage was associated with 1-year mortality. AV- CaSc grants additional prognostic information to this classification. Incorporation of this staging system into patient evaluation may be useful in the risk assessment of severe AS. Survival analysis Funding Acknowledgement Type of funding source: None

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Sultan, Sherif, Gordon Pate, Niamh Hynes et Darren Mylotte. « A case report of a transcarotid transcatheter aortic valve implantation with concomitant carotid endarterectomy ». European Heart Journal - Case Reports, 22 décembre 2020. http://dx.doi.org/10.1093/ehjcr/ytaa379.

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Abstract Background Transcarotid transcatheter aortic valve implantation (TAVI) is a worthwhile substitute in patients who might otherwise be inoperable; however, it is applied in <10% of TAVI cases. In patients with established carotid artery stenosis, the risk of complications is increased with the transcarotid access route. Case summary We report a case of concomitant transcarotid TAVI and carotid endarterectomy (CEA) in a patient with bovine aortic arch and previous complex infrarenal EndoVascular Aortic Repair (EVAR). The integrity and positioning of the previous EVAR endograft was risked by transfemoral access. The right subclavian artery was only 4.5 mm and the left subclavian was totally occluded so transcarotid access was chosen. The patient recovered well, with no neurological deficit and was discharged home after 72 h. He was last seen and was doing well 6 months post-procedure. Discussion In patients with severe aortoiliac disease, or previous aortic endografting, transfemoral access for TAVI can be challenging or even prohibitive. Alternative access sites such as transapical or transaortic are associated with added risk because they carry increased risk of major adverse cardiovascular events, longer intensive care unit and hospital stay, and increased cost. A transcaval approach for TAVI has also been reported but was not suitable for our patient due to prior EVAR. Concomitant TAVI via transcarotid access and CEA can be successful in experienced hands. This case highlights the importance of a team-based approach to complex TAVI cases in high-risk patients with complex vascular access.

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Toker, Mehmet Erdem, Cüneyt Arkan, Ahmet Erdal Taşçi, Erdal Polat, Üzeyi̇r Yilmaz, Tunahan Sari et Ömer Faruk Akardere. « Early and Long Term Results of Our Open Heart Surgical Operations in the Presence of Active Oncological Diseases ». Koşuyolu Heart Journal, 21 décembre 2021. http://dx.doi.org/10.51645/khj.2021.m198.

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Objectives: Active cancer and heart disease, which share similar environmental and biological characteristics, can occur concomitantly. Open heart surgery may be required for these patients when indicated. The aim of this study is to demonstrate the early and long-term results and discuss the intervention strategy in patients with different types of active malignancies, who underwent open heart surgery. Patients and Methods: Between January 2012 and May 2020, open heart surgery was performed on 10 patients with active malignancies. The mean age was 65.5 (52–77), and 4 of the patients were female. 2 patients were operated emergently due to advanced pleural effusion. AVR+CABG, CABG, CABG+left upper lobectomy and AVR+MVR were performed in 4 patients with lung cancer; AVR+CABG were performed in 1 patient with colon cancer; CABG was performed in 4 patients each with one of the following conditions: lymphoma, breast cancer, essential thrombocytosis, meningioma); and mass resection operation from the left atrium and left ventricle was performed in one patient with osteosarcoma. Results: 8 patients were discharged and 2 patients died in the early postoperative period. Postoperative left hemiparesis developed in 1 patient. 6-month, 1-year and 5-year survival rates were 79%, 37.5% and 25%, respectively. Conclusion: Open heart surgery can be successfully performed with acceptable mortality and morbidity rates on the high-risk patient group with active cancer. We believe that, where percutaneous coronary intervention and/or TAVI are not considered or deemed appropriate, surgical intervention should be performed with careful patient selection in patients with multi-vessel coronary artery disease, coronary artery stenosis +aortic stenosis, and in cases requiring double valve replacement.

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Cheung, Michael, Michael Tempelhof, Mark Tan et Nirat Beohar. « Abstract P57 : The Baseline Characteristics Predictive of a Poor Procedural Response to Balloon Aortic Valvuloplasty Among a Cohort of High–Surgical Risk Patients with Aortic Stenosis ». Circulation : Cardiovascular Quality and Outcomes 4, suppl_2 (novembre 2011). http://dx.doi.org/10.1161/circoutcomes.4.suppl_2.ap57.

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Background: Balloon aortic valvuloplasty (BAV) for high-surgical risk patients with severe aortic stenosis (AS) has been used as a palliative therapy, a bridge to surgical aortic valve replacement (AVR) or to transcatheter aortic valve implantation (TAVI). Poor procedural response, including poor improvements in the aortic valve area (AVA) and the mean aortic valve pressure gradient (AVPG) immediately following BAV have been demonstrated to predict mortality following BAV. Whether any baseline characteristics can predict a poor procedural response to BAV has not been assessed. Methods: We retrospectively reviewed the medical records of 74 consecutive, AS patients who underwent BAV. Patient's baseline demographics, comorbid medical conditions, medications, laboratory results and echocardiographic findings were correlated with changes in the AVA and the mean AVPG immediately post-BAV. Results: The mean age was 80 ± 4 years, the mean Society of Thoracic Surgeons Surgical Risk Score (STS) was 7.73 ± 6.26 and the mean logistic EuroSCORE was 23.8 ± 15.4. There was 1 periprocedural death, 16 (21.6%) patients were bridged to AVR or to TAVI and 58 (78.3%) of the patients received palliative or definitive therapy. The mean AVA increased from 0.72 ± 0.24 cm 2 to 1.12 ± 0.42 cm 2 and the mean AVPG decreased from 42.09 ± 16.54 mmHg to 24.41 ± 10.86 mmHg. Overall, no baseline characteristics were statistically significant predictors of poor AVA improvements following BAV (Table 1). Patient's age < 80 years old was the only significant, independent predictor of poor AVPG reduction post-BAV compared to patient's > 80 years of age (Table 1). Conclusion: Prior to BAV, age < 80 years of age was the only characteristic predictive of a poor procedural response. All other baseline characteristics including patient demographics, pre-existing medical conditions, active medications and laboratory values were poor predictors of the procedural response to BAV therapy.

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Gardikioti, V., D. Terentes-Printzios, K. Aznaouridis, G. Latsios, G. Siasos, M. Drakopoulou, E. Oikonomou et al. « The long-term impact of transcatheter aortic valve implantation on arterial stiffness and central hemodynamics ». European Heart Journal 41, Supplement_2 (1 novembre 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.2613.

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Abstract Background/Introduction The study of arterial properties in patients with aortic valve stenosis who undergo transcatheter aortic valve implantation (TAVI) remains challenging and results so far seem equivocal. Purpose We sought to investigate the acute and long-term effect of TAVI on arterial stiffness and wave reflections opting for a global approach. Methods We enrolled 90 patients (mean age 80.2±8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Arterial stiffness was assessed by both carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV). Augmentation index corrected for heart rate (AIx@75), an index of wave reflections, and central pressures were assessed with arterial tonometry. Measurements were conducted at baseline, after the procedure and at 1 year. Results Immediately post-TAVI there was a statistically significant increase in arterial stiffness (7.5±1.5 m/s vs 8.4±1.9 m/s, p=0.001 for cfPWV and 1,773±459 cm/s vs 2,383±645 cm/s, p<0.001 for baPWV) despite no change in systolic blood pressure. At 1-year follow-up, TAVI was still associated with an increase in arterial stiffness compared to pre-TAVI (7.5±1.5 m/s vs 8.7±1.7 m/s, p<0.001 for cfPWV and 1,773±459 cm/s vs 2,286±575 cm/s, p<0.001 for baPWV) but not to post-TAVI values. We also observed a decrease in AIx@75 (32.2±12.9% vs 27.9±8.4%, p=0.016) post-TAVI that was attenuated at 1 year (32.2±12.9% vs 29.8±9.1%, p=0.38). Conclusions Our study shows that after TAVI the arterial system exhibits an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term. Our findings further elucidate the immediate and long-term hemodynamic changes of TAVI to the aorta that may entail prognostic role in this growing population. Change of vascular biomarkers post-TAVI Funding Acknowledgement Type of funding source: None

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Gardikioti, Vasiliki, Dimitrios Terentes-printzios, Konstantinos Aznaouridis, George Latsios, Gerasimos Siasos, Maria Drakopoulou, Evangelos Oikonomou et al. « Abstract 13947 : The Acute and Long-term Effects of Transcatheter Aortic Valve Implantation on Aortic Stiffness and Hemodynamics ». Circulation 142, Suppl_3 (17 novembre 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.13947.

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Introduction: Transcatheter aortic valve implantation (TAVI) is a procedure that alters dramatically the hemodynamics in patients with severe aortic valve stenosis who undergo this procedure. Hypothesis: We investigated the hypothesis that arterial properties and hemodynamics are affected immediately after TAVI as well as in the long-term. Methods: We enrolled 90 patients (mean age 80.2 ± 8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV) were used for the assessment of arterial stiffness. Augmentation index corrected for heart rate (AIx@75) and subendocardial viability ratio (SEVR) were measured non-invasively. Measurements were conducted at baseline, after the procedure (during hospitalization) and at 1 year. Results: Acutely after TAVI we observed a statistically significant increase in arterial stiffness (7.5 ± 1.5 m/s vs 8.4 ± 1.9 m/s, p=0.001 for cfPWV and 1,773 ± 459 cm/s vs 2,383 ± 645 cm/s, p<0.001 for baPWV) without a concomitant change in systolic blood pressure (Figure). One year later, arterial stiffness was still increased compared to pre-TAVI measurements (7.5 ± 1.5 m/s vs 8.7 ± 1.7 m/s, p<0.001 for cfPWV and 1,773 ± 459 cm/s vs 2,286 ± 575 cm/s, p<0.001 for baPWV). We also found a decrease in AIx@75 (32.2 ± 12.9 % vs 27.9± 8.4 %, p=0.016) after TAVI that was attenuated at 1-year follow-up (32.2 ± 12.9 % vs 29.8± 9.1 %, p=0.38). SEVR displayed an increase acutely after TAVI (131.2 ± 30.0 % vs 148.4± 36.1 %, p=0.002) and remained improved 1 year after the procedure (131.2 ± 30.0 % vs 146± 32.2 %, p=0.01). Conclusions: In conclusion, shortly after TAVI the aorta exhibits a "stiffer" behavior in response to the acute change in hemodynamics, which settles in the long term. Our findings further elucidate the hemodynamic consequences of TAVI and may entail a prognostic role in this growing population.

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De Feo, Daniele. « 646 TAVI IN PATIENT SUFFERING FROM SITUS INVERSUS AND DEXTROCARDIA WITH CONCOMITANT NIEMANN-PICK DISEASE ». European Heart Journal Supplements 24, Supplement_K (14 décembre 2022). http://dx.doi.org/10.1093/eurheartjsupp/suac121.730.

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Abstract De Feo Daniele, D’ Anzi Anna, Pestrichella Vincenzo, Lafranceschina Carlo, Tiecco Fabio, Antonelli Gianfranco, Caragnano Vito, Scialpi Antonella, Laronga Giuliana, Ciccone Marco Matteo Università degli studi di Bari “Aldo Moro”, U.O.C. Malattie dell’apparato Cardiovascolare TAVI in Patient suffering from situs inversus and dextrocardia with concomitant Niemann – Pick disease (acid sphingomyelinase deficiency) Acid sphingomyelinase deficiency (ASMD), also known as Niemann-Pick (NP) disease is a rare, autosomal recessive disorder characterized by deficiency of the lysosomal enzyme acid sphingomyelinase (ASM), that results into an excessive storage of lipids in multiple organs including spleen, liver, lung, bone marrow, lymph nodes and most certainly also in vascular system, hence, some of them preciously present coronary artery disease. In literature, few cases of moderate to severe valvular heart disease are described too, although the precise pathogenetic mechanism is not understood. Most Acid sphingomyelinase deficiency (ASMD) reports in literature concern infantile forms, whilst way less cases about disease onset in adults are described, being consequently still poorly understood, and characterized. We report a case of a patient who recently discovered in his adulthood to be affected by Niemann-Pick (NP) disease subtype B. ASMD diagnosis is often delayed by months to years because of the complex signs and symptoms that overlap with other disorders. In fact, our patient firstly searched for medical attention for hepatosplenomegaly and thrombocytopenia and then he underwent to genetic tests that highlighted SMPD1 gene 6 exon homozygous mutation. Then, he performed deepening exams that also showed: Situs inversus (also called situs transversus or oppositus), a congenital condition in which the major visceral organs are reversed or mirrored from their normal positions; COPD for which he periodically submits to instrumental exam and pneumological visits, femoral osteoporosis and lumbar osteopenia, that cause walking deficits; and anxious – depressive syndrome. When the patient started complaining about dyspnoea for mild and moderate efforts and described some episodes of spontaneous vertigo he went to cardiologic visit and heart US that highlighted the presence of severe aortic stenosis. In literature, there are only few cases of patient affected by ASMD who were diagnosed with severe aortic stenosis. Most of them were submitted to AVR and they all developed some complications for which exitus occurred. Few cases of patients with situs inversus who underwent to TAVI are described in literature as well Although it was a high-risk patient, with no previous described experiences about it, he was eligible to be undergone to Trans Aortic Valvular Implantation (TAVI) which was successfully performed. Hence, here we describe a rare case of a patient suffering from Niemann-Pick (NP) disease with concomitant Situs inversus having severe aortic stenosis, but we also show that no complications occurred after performing TAVI, respect to literature described Aortic Valve Replacement. Further studies are surely needed, but we showed that TAVI, when feasible, may be considered the treatment of choice to solve severe aortic stenosis out.

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