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1.
Int J Cardiovasc Imaging ; 39(1): 13-22, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36598683

ABSTRACT

The impact of left ventricle (LV) hypertrophy (LVH) regression on contractility-associated measures, the extent of residual cardiac dysfunction and prognostic implications after the initial remodeling process after transcatheter aortic valve replacement (TAVR) has not been investigated. We aimed to assess whether greater LV mass regression from pre-TAVR to 12-months after TAVR was associated with increased systolic function; and assess the prognostic value of residual LVH, systolic function and contractility-associated measures 12-months after TAVR. A total of 439 symptomatic patients were included and examined by echocardiography. LVH regression was assessed as percentage change in LV mass index (LVMi) from baseline to 12-months after TAVR. Midwall fractional shortening (mFS) and stress-corrected (SC-mFS) were used as contractility-associated measures. Primary outcome was all-cause mortality. SC-mFS increased from 0.94 (0.7) at baseline (BS) to 1.22 (0.7) (p < 0.05) 12-months after TAVR for patients with the most LVH regression, compared to patients with no LV regression (BS 1.06 (0.7) to 1.04 (0.5), NS). At 12-months after TAVR, multivariate analysis showed independent prognostic value of LVEF < 50% or GLS < 15% (HR 1.59, p = 0.049) and mFS < 14% (HR 1.99, p = 0.002) for future all cause death. LVH regression in AS after TAVR is associated with significant improvements of LV systolic function in contrast to patients without LV regression. Residual LVH and subsequent LV systolic dysfunction is substantial 12 months after TAVR and are associated with reduced survival. Impaired mFS and the combination of abnormal LVEF or GLS independently predicted all-cause mortality beyond 12 months after TAVR.


Subject(s)
Aortic Valve Stenosis , Transcatheter Aortic Valve Replacement , Humans , Transcatheter Aortic Valve Replacement/adverse effects , Hypertrophy, Left Ventricular/diagnostic imaging , Hypertrophy, Left Ventricular/etiology , Prognosis , Predictive Value of Tests , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Aortic Valve Stenosis/complications , Ventricular Function, Left , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Treatment Outcome , Severity of Illness Index
2.
BMC Cardiovasc Disord ; 20(1): 506, 2020 12 02.
Article in English | MEDLINE | ID: mdl-33267772

ABSTRACT

AIMS: The aim of present study was to examine the preoperative prevalence and distribution of impaired left ventricular global longitudinal strain (LVGLS) in elderly patients with symptomatic aortic stenosis (AS) undergoing transcutaneous aortic valve replacement (TAVR) and to determine the predictive value of LVGLS on survival. METHODS: We included 411 patients with symptomatic severe AS treated with TAVR during a 5-year period, where a baseline echocardiography including LVGLS assessment was available. RESULTS: Mean age was 80.1 ± 7.1 years and aortic valve area (AVA) index 0.4 ± 0.1 cm2. 78 patients died during a median follow-up of 762 days. Mean left ventricular ejection fraction (LVEF) was 50 ± 13% and mean LVGLS was - 14.0%. LVEF was preserved in 60% of patients, while impaired LVGLS > - 18% was seen in 75% of the patients. Previous myocardial infarction, LVEF < 50%, LVGLS > - 14%, low gradient AS (< 4.0 m/s), tricuspid regurgitant gradient > 30 mmHg were identified as significant univariate predictors of all-cause mortality. On multivariate analysis LVGLS > - 14% (HR 1.79 [1.02-3.14], p = 0.04) was identified as the only independent variable associated with all-cause mortality. Reduced survival was observed with an impaired LVGLS > - 14% in the total population (p < 0.002) but also in patients with high AS gradient with preserved LVEF. LVGLS provided incremental prognostic value with respect to clinical characteristics, AVA and LVEF (χ2 19.9, p = 0.006). CONCLUSIONS: In patients with symptomatic AS undergoing TAVR, impaired LVGLS was highly prevalent despite preserved LVEF. LVGLS > - 14% was an independent predictor of all-cause mortality, and survival was reduced if LVGLS > - 14%.


Subject(s)
Aortic Valve Stenosis/surgery , Stroke Volume , Transcatheter Aortic Valve Replacement , Ventricular Dysfunction, Left/physiopathology , Ventricular Function, Left , Age Factors , Aged , Aged, 80 and over , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/mortality , Aortic Valve Stenosis/physiopathology , Denmark , Female , Humans , Male , Prevalence , Recovery of Function , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/mortality , Treatment Outcome , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Dysfunction, Left/mortality
3.
Catheter Cardiovasc Interv ; 88(7): 1174-1176, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27976548

ABSTRACT

More than half of patients with carcinoid syndrome develop carcinoid valve disease. Both the tricuspid and pulmonary valve are often involved. Symptoms of carcinoid syndrome with flushing, diarrhea, and bronchospasm often precedes cardiac symptoms. We report a case of carcinoid initially presenting with rapid development of right heart failure due to severe pulmonary valve stenosis. In untreated carcinoid, there is a risk of carcinoid crisis with anesthesia and surgery. In local anesthesia, we performed a sub-acute balloon pulmonary valvuloplasty. The procedure was successful without any residual pulmonary valve stenosis and with immediately relief of dyspnea. The final diagnostic workup for the underlying malignancy continued the day after valvuloplasty. © 2015 Wiley Periodicals, Inc.


Subject(s)
Balloon Valvuloplasty , Carcinoid Heart Disease/therapy , Pulmonary Valve Stenosis/therapy , Pulmonary Valve , Anesthesia, Local , Angiography , Carcinoid Heart Disease/diagnostic imaging , Carcinoid Heart Disease/etiology , Carcinoid Heart Disease/physiopathology , Female , Heart Failure/etiology , Humans , Middle Aged , Pulmonary Valve/diagnostic imaging , Pulmonary Valve/physiopathology , Pulmonary Valve Stenosis/diagnostic imaging , Pulmonary Valve Stenosis/etiology , Pulmonary Valve Stenosis/physiopathology , Recovery of Function , Treatment Outcome
4.
Ugeskr Laeger ; 178(39)2016 Sep 26.
Article in Danish | MEDLINE | ID: mdl-27697124

ABSTRACT

Cardiovascular complications following thoracic radiotherapy in patients with cancer are well described. Advancements in surgery, radiotherapy and systemic treatments have led to an increasing number of cancer survivors and thus an increasing number of patients with long-term side effects of their cancer treatments. This article describes the short- and long-term cardiovascular morbidity and mortality following thoracic radiotherapy and further, optimal cardiovascular assessments and diagnostic tools in asymptomatic and symptomatic patients.


Subject(s)
Cardiovascular Diseases/etiology , Neoplasms/radiotherapy , Radiation Injuries/complications , Biomarkers/analysis , Cardiomyopathies/etiology , Coronary Disease/etiology , Heart/radiation effects , Heart Valve Diseases/etiology , Humans , Myocarditis/etiology , Pericarditis/etiology , Vascular Diseases/etiology
6.
Mov Disord ; 26(5): 801-6, 2011 Apr.
Article in English | MEDLINE | ID: mdl-21671508

ABSTRACT

OBJECTIVES: Several observational studies suggest an association between treatment with ergoline-derived dopamine agonists and valvular regurgitation. In this article, we present an overview of the literature and conduct a meta-analysis. METHODS: Observational studies addressing the frequency of moderate or severe valvular regurgitation among ergoline-treated patients with Parkinson's disease were considered for a meta-analysis. Pooled risk estimates and the risk of increased pulmonary artery pressure were calculated. RESULTS: The pooling of data from well-designed observational studies documented that both pergolide (RR = 3.05 [1.71-5.44]) and cabergoline (RR = 6.38 [3.17-12.81]) represent a substantially increased risk of developing moderate to severe valvular regurgitation. In addition, pergolide, but not cabergoline, was associated with an increase in pulmonary artery pressure. CONCLUSIONS: The present meta-analysis confirmed a statistically significant association between pergolide and cabergoline treatment and the risk of moderate to severe valvular regurgitation. An association between bromocriptine and valvular regurgitation cannot be entirely ruled out.


Subject(s)
Dopamine Agonists/adverse effects , Heart Valve Diseases/chemically induced , Parkinson Disease/drug therapy , Databases, Factual/statistics & numerical data , Humans , Models, Statistical , Observation , Risk Factors
7.
Eur J Echocardiogr ; 9(6): 803-8, 2008 Nov.
Article in English | MEDLINE | ID: mdl-18490274

ABSTRACT

AIMS: Ergot-derived dopamine agonists (EDDA) induce fibrotic heart valve disease. We aimed to investigate whether EDDA treatment also affects left ventricular (LV) function. METHODS AND RESULTS: Myocardial function was evaluated in 110 Parkinson patients [mean age (63.4 +/- 9.0 years)] treated for at least 6 months with either EDDA (n = 71) or non-EDDA (n = 39). LV ejection fraction did not differ between EDDA and non-EDDA patients [63 +/- 4% vs. 65 +/- 4% (ns)]. There was no difference in prevalence of diastolic dysfunction between EDDA and non-EDDA patients [7% vs. 8% (ns)]. Finally, averaged LV systolic myocardial strain and longitudinal displacement analysed by means of two-dimensional speckle tracking showed no difference between EDDA and non-EDDA patients [strain: 19 +/- 3% vs. 19 +/- 2% (ns) and longitudinal displacement: 12 +/- 2 mm vs. 12 +/- 2 mm (ns)]. Elevated p-NT-proBNP was found in 38% of EDDA patients and in 59% of non-EDDA patients (ns). CONCLUSION: In contrast to the well-established association between EDDA treatment and valvular fibrosis, EDDA did not have a detectable adverse impact on myocardial systolic and diastolic function.


Subject(s)
Dopamine Agonists/adverse effects , Echocardiography/methods , Ergotamine/adverse effects , Image Interpretation, Computer-Assisted/methods , Parkinson Disease/diagnostic imaging , Ventricular Function, Left , Aged , Analysis of Variance , Biomarkers/blood , Diastole , Dopamine Agonists/therapeutic use , Echocardiography, Doppler, Pulsed , Ergotamine/therapeutic use , Female , Heart Valve Diseases/diagnostic imaging , Humans , Male , Middle Aged , Multivariate Analysis , Natriuretic Peptide, Brain/blood , Parkinson Disease/blood , Parkinson Disease/drug therapy , Retrospective Studies , Systole , Ventricular Dysfunction, Left/diagnostic imaging , Ventricular Function, Left/drug effects
8.
Ugeskr Laeger ; 168(26-32): 2542-4, 2006 Jun 26.
Article in Danish | MEDLINE | ID: mdl-16824407

ABSTRACT

Ergot derivatives (EDs) are used in the treatment of Parkinson's disease, but recent reports indicate induction of valvular heart disease. This survey reviews the documentation and reports on the design of a blinded study of 160 Parkinson's patients treated with either EDs or non-EDs. The present recommendations regarding monitoring of patients treated with ED are also described.


Subject(s)
Antiparkinson Agents/adverse effects , Dopamine Agonists/adverse effects , Ergotamines/adverse effects , Heart Valve Diseases/chemically induced , Parkinson Disease/drug therapy , Humans
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