Structural valve deterioration (SVD) is a major flaw of bioprostheses. Early SVD has been suspected in the last models of Mitroflow bioprosthesis. We sought to assess the incidence, mode, and impact ...of SVD on outcome in a large series of Mitroflow aortic valve replacement.
Six hundred seventeen consecutive patients (aged 76.1±6.3 years) underwent aortic valve replacement with a Mitroflow prosthesis (models 12A/LX) between 2002 and 2007. By echocardiography, 39 patients developed early SVD (1.66% per patient-year), with stenosis as the main mode (n=36). Mean delay to SVD was only 3.8±1.4 years, and 5-year SVD-free survival was 91.6% (95% confidence interval CI, 88.7-94.7) for the whole cohort and 79.8% (95% CI, 71.2-89.4) and 94.0% (95% CI, 90.3-97.8) for 19- and 21-mm sizes, respectively. Among the 39 patients with SVD, 13 patients (33%) had an accelerated SVD once the mean gradient exceeded 30 mm Hg. Valve-related death was 46.2% in this SVD subgroup. Five-year overall survival was 69.6% (95% CI, 65.7-73.9). In multivariable analysis, SVD was the strongest correlate of overall mortality (hazard ratio=7.7; 95% CI, 4.4-13.6).
Early SVD is frequent in Mitroflow bioprosthesis (models 12A/LX), especially for small sizes (19 and 21 mm), and reduces overall survival. An unpredictable accelerated pattern of SVD constitutes a life-threatening condition. In view of the large number of Mitroflow valves implanted worldwide, one can expect an epidemic of SVD and valve-related deaths, which represents a major public health issue, especially in the elderly. Hence, a close follow-up with yearly echocardiography after Mitroflow implantation is advisable. An urgent reoperation should be discussed in patients with severe SVD even though they are still asymptomatic.
Myxomatous dystrophy of the cardiac valves is a heterogeneous group of disorders, including syndromic diseases such as Marfan syndrome and isolated valvular diseases. Mitral valve prolapse, the most ...common form of this disease, is presumed to affect approximately 2% to 3% of the population and remains one of the most common causes of valvular surgery. During the past years, important effort has been made to better understand the pathophysiological basis of mitral valve prolapse. Autosomal-dominant transmission is the usual inheritance with reduced penetrance and variable expressivity. Three loci have been mapped to chromosomes 16p11-p12, 11p15.4 and 13q31-32, but the underlying genetic defects are not currently known. An X-linked recessive form has been originally described by Monteleone and Fagan in 1969. Starting from one large French family and three smaller other families in which MVP was transmitted with an X-linked pattern, we have been able to identify three filamin A mutations p.Gly288Arg and p.Val711Asp and a 1,944-bp genomic deletion coding for exons 16 to 19. In this review, we describe the genetic, echocardiographic and functional aspects of the filamin-A-related myxomatous mitral valve dystrophy.
Aims Stress hyperglycaemia (SH) is associated with adverse outcome in patients with acute myocardial infarction (MI) but the mechanisms underlying this association are unknown. Our hypothesis was ...that SH on admission for acute MI may be associated with left ventricular (LV) remodelling.
Methods and results We analysed LV remodelling in 162 non-diabetic patients with anterior MI. SH was defined as a glycaemia on admission ≥7 mmol/L. Systematic echocardiographic follow-up was performed at 3 months and 1 year after MI. The changes in end-diastolic volume (EDV) and end-systolic volume (ESV) from baseline to 1 year were 11.4 ± 16.5 and 6.4 ± 12.4 ml/m2, respectively, in patients with SH vs. 1.9 ± 11.1 and 0.2 ± 8.5 ml/m2, respectively, in patients without SH (both P < 0.0001). When LV remodelling was defined as a >20% increase in EDV, it was observed in 46% patients in the SH group vs. 19% patients in the no SH group (P = 0.0008). By multivariable analysis, baseline wall motion score index (P = 0.001) and SH (P = 0.009) were independently associated with changes in EDV. SH was an independent predictor of LV remodelling adjusted OR: 3.22 (1.31-7.94).
Conclusion SH is a major and independent predictor of LV remodelling after anterior MI in non-diabetic patients.
Aims Abnormal exercise test defined as the occurrence of exercise limiting symptoms, fall in blood pressure below baseline, or complex ventricular arrhythmias is useful to predict clinical events in ...asymptomatic patients with aortic stenosis (AS). The purpose of this study was to determine whether exercise-stress echocardiography (ESE) adds any incremental prognostic value to resting echocardiography in patients with AS having a normal exercise response. Methods and results One hundred and eighty-six asymptomatic patients with at least moderate AS and preserved LV ejection fraction (≥50%) were assessed by Doppler-echocardiography at rest and during a maximum ramp semi-supine bicycle exercise test. Fifty-one (27%) patients had an abnormal exercise test and were excluded from the present analysis. Among the 135 patients with normal exercise test, 67 had an event (aortic valve replacement motivated by symptoms or cardiovascular death) at a mean follow-up of 20 ± 14 months. The variables independently associated with events were: age ≥65 years hazard ratio (HR) = 1.96; 95% confidence interval (CI): 1.15–3.47; P = 0.01, diabetes, (HR = 3.20; 95% CI: 1.33–6.87; P = 0.01), LV hypertrophy (HR = 1.96; 95% CI: 1.17–3.27; P = 0.01), resting mean gradient >35 mmHg (HR = 3.60; 95% CI: 2.11–6.37; P < 0.0001), and exercise-induced increase in mean gradient >20 mmHg (HR = 3.83; 95% CI: 2.16–6.67; P < 0.0001). Conclusion The exercise-induced increase in transvalvular gradient may be helpful to improve risk stratification in asymptomatic AS patients with normal exercise response. These results thus suggest that ESE may provide additional prognostic information over that obtained from standard exercise testing and resting echocardiography.
Current guidelines recommend cefazolin as an alternative to antistaphylococcal penicillins (ASPs) in methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis despite the lack of ...comparative study. The objective of this study was to evaluate the comparative outcomes of cefazolin vs. ASPs in MSSA infective endocarditis.
This was a retrospective analysis of an observational multicentre cohort study using prospectively collected data from patients with MSSA endocarditis confirmed by endocarditis team and treated either with cefazolin or ASPs between July 2013 and December 2018. Patients were excluded if they received both treatments. The primary outcome was 90-day all-cause mortality.
Of 210 patients included, 53 patients (25.2%) received cefazolin and 157 (74.8%) received ASPs. The overall 90-day mortality rate was 27.6% (58/210 patients), 24.5% (13/53) in the cefazolin group vs. 28.7% (45/157) in the ASP group (p 0.561). Premature antimicrobial discontinuation due to adverse events occurred less frequently with cefazolin than with ASPs (0/53 vs. 13/157 patients; p 0.042). In multivariate analysis, there was no difference in 90-day mortality between cefazolin and ASPs (adjusted odds ratio (aOR), 1.2; 95% confidence interval (CI), 0.49–2.91; p 0.681), while age (aOR, 1.06; 95% CI, 1.03–1.09; p < 0.001), Charlson comorbidity index (aOR, 1.18; 95% CI, 1.02–1.36 p 0.023), cerebral embolism (aOR, 2.83; 95% CI, 1.33–6.14; p 0.007) and intensive care unit admission (aOR, 4.16; 95% CI, 1.89–9.59; p 0.001) were factors significantly associated with higher mortality.
Cefazolin seems to be a possible alternative to ASPs in MSSA endocarditis. More studies are needed to confirm these results and determine which treatment should be recommended as first-line therapy.
Background Although mitral regurgitation (MR) has been associated with an increased risk of death and heart failure after myocardial infarction (MI), the relationship between post-MI MR and left ...ventricular (LV) remodeling has not been entirely clarified. In addition, the optimal timing for assessing MR after MI remains unknown. Methods Post-MI MR was assessed by Doppler echocardiography at hospital discharge (baseline) and after 3 months in 261 patients with an inaugural anterior MI. We studied LV remodeling during a 1-year period and clinical follow-up after 3 years, according to MR severity at baseline and at 3 months. Results Left ventricular remodeling was demonstrated as an increase in LV end-diastolic volume from 56 ± 15 mL/m2 at baseline to 63 ± 19 mL/m2 at 1 year ( P < .0001). MR severity at baseline was not significantly associated with LV remodeling. By contrast, MR severity at 3 months was a strong indicator of LV remodeling. There was a graded increase in the proportion of patients with a >20% increase in LV end-diastolic volume between baseline and 1 year according to MR severity at 3 months (no MR: 21%, mild MR: 32%, moderate/severe MR: 60%) ( P = .008). Both MR at baseline and at 3 months were associated with death or rehospitalization for heart failure by univariate analysis ( P = .014 and P < .0001, respectively). By multivariable analysis, MR at baseline was not an independent predictor of adverse outcome ( P = .66). By contrast, MR at 3 months was independently associated with adverse outcome with a hazard ratio of 2.23 (1.02-4.91 P = .04). Conclusions After an inaugural anterior MI, MR is associated with LV remodeling and adverse clinical outcome. For prognostic purpose, the optimal timing for assessing MR is the chronic post-MI stage rather than the early post-MI period.
18F-FDG-Based Radiomics and Machine Learning Godefroy, Thomas; Frécon, Gauthier; Asquier-Khati, Antoine ...
JACC. Cardiovascular imaging,
July 2023, 2023-07-00, Letnik:
16, Številka:
7
Journal Article
Recenzirano
Fluorine-18 fluorodeoxyglucose (18F-FDG)-positron emission tomography (PET)/computed tomography (CT) results in better sensitivity for prosthetic valve endocarditis (PVE) diagnosis, but visual image ...analysis results in relatively weak specificity and significant interobserver variability.
The primary objective of this study was to evaluate the performance of a radiomics and machine learning–based analysis of 18F-FDG PET/CT (PET-ML) as a major criterion for the European Society of Cardiology score using machine learning as a major imaging criterion (ESC-ML) in PVE diagnosis. The secondary objective was to assess performance of PET-ML as a standalone examination.
All 18F-FDG-PET/CT scans performed for suspected aortic PVE at a single center from 2015 to 2021 were retrospectively included. The gold standard was expert consensus after at least 3 months’ follow-up. The machine learning (ML) method consisted of manually segmenting each prosthetic valve, extracting 31 radiomics features from the segmented region, and training a ridge logistic regressor to predict PVE. Training and hyperparameter tuning were done with a cross-validation approach, followed by an evaluation on an independent test database.
A total of 108 patients were included, regardless of myocardial uptake, and were divided into training (n = 68) and test (n = 40) cohorts. Considering the latter, PET-ML findings were positive for 13 of 22 definite PVE cases and 3 of 18 rejected PVE cases (59% sensitivity, 83% specificity), thus leading to an ESC-ML sensitivity of 72% and a specificity of 83%.
The use of ML for analyzing 18F-FDG-PET/CT images in PVE diagnosis was feasible and beneficial, particularly when ML was included in the ESC 2015 criteria. Despite some limitations and the need for future developments, this approach seems promising to optimize the role of 18F-FDG PET/CT in PVE diagnosis.
Display omitted
Cardiac resynchronization therapy (CRT) acutely enhances forward stroke volume (FSV) during exercise by reducing the severity of functional mitral regurgitation (MR) in patients with systolic chronic ...heart failure. Whether CRT increases FSV in patients without functional MR at rest is unknown. Accordingly, the aim of the study was to compare the effect of CRT on exercise-induced increase in FSV in patients with chronic heart failure with or without functional MR at rest.
Forty-one patients with systolic chronic heart failure who had recently undergone CRT performed 2 exercise stress echocardiography tests, the first with CRT On and the second with CRT Off. Twenty-six patients had more than trivial MR (effective regurgitant orifice ERO < 10 mm2 in 16 patients, < 20 mm2 in 8 patients, and > or = 20 mm2 in 2 patients), and 15 patients had no MR at rest. Mean exercise-induced change (Delta) in mitral ERO was reduced by CRT (8 +/- 7 mm2 vs 1 +/- 4 mm2, P < .00001). In patients with functional MR at rest, Delta FSV during dynamic exercise was greater with CRT On than CRT Off (4 +/- 8 vs -2 +/- 7 mL, P = .0002), whereas CRT did not significantly affect Delta FSV in patients without MR at rest (9 +/- 9 mL vs 9 +/- 9 mL, P = .93). Similarly, Delta cardiac output was greater with CRT On than CRT Off (1.6 +/- 1.2 L/min vs 1.1 +/- 1.2 L/min, P = .002) in patients with functional MR at rest, whereas Delta cardiac output was similar with CRT On and CRT Off in patients without MR at rest (1.9 +/- 1.4 L/min vs 2.0 +/- 1.2 L/min, P = .59). Severity of functional MR decreased or failed to increase, whereas cardiac output improved during exercise in 9 of 26 patients (34%) with CRT On and in only 2 of 26 patients (8%) with CRT Off (P = .039).
Functional MR at rest may be an important determinant of the acute hemodynamic response to CRT during exercise.
PDF
