Presence Of Aortic Stenosis Research Articles

Echocardiographic Phenotype in Severe Aortic Stenosis With and Without Transthyretin Cardiac Amyloidosis: The AMY-TAVI Study.

The relative apical sparing pattern of left ventricular (LV) longitudinal strain (RELAPS]>1) has been described as a typical sign of cardiac amyloidosis (CA). The objective was to validate this pattern in concomitant CA and aortic stenosis (AS) and to identify new echocardiographic variables suggestive of CA in the presence of AS. 324 consecutive patients (age 81.5±5.8 years, 51% women) with AS who underwent transcatheter aortic valve implantation (TAVI) were prospectively included. 2D-Speckle-tracking echocardiography was performed. Following TAVI, 99mTc-DPD-scintigraphy and protein electrophoresis were performed to screen for CA. 38 patients (11.7%) showed cardiac uptake in scintigraphy: 14 patients (4.3%) with grade 1, 13 (4%) with grade 2, and 11 (3.4%) with grade 3. Patients with grades 2 and 3 (AS-CA group) had more LV hypertrophy (LV mass index: 188 vs.172 g/m2, p=0.032), lower transvalvular aortic pressure gradient (p<0.003), and higher prevalence of low-gradient AS (50% vs.19%, p=0.001), as well as greater diastolic and systolic dysfunction. Strain analysis was limited to 243 patients due to poor acoustic window and COVID-19 restrictions (81 lost: 79 in AS alone, 1 each in AS-DPD1 and AS-CA groups). RELAPS>1 was more prevalent in AS-CA group (74% vs.44%, p=0.006). An echocardiographic prediction model (GRAM score) for CA in the presence of AS, that is more sensitive and specific than RELAPS>1 alone, is proposed using the LV mass, maximum aortic gradient, and RELAPS>1, in addition to age (AUC:0.85, 95%CI: 0.77-0.93). RELAPS>1 is more prevalent in AS-CA but can occur in almost half of AS patients without CA, which reduces its value as a screening tool. A more sensitive and specific prediction score for CA in patients with severe AS is proposed.

Prevalence, Clinical Features, Treatment, and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries.

To study clinical and demographic characteristics, treatment options, and clinical outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) compared with patients with myocardial infarction with obstructive coronary arteries (MIOCA). This single-center prospective observational study included 712 successive patients diagnosed with acute myocardial infarction (MI), who routinely underwent direct coronary angiography. Based on the presence of stenosing coronary atherosclerosis, the patients were divided into two groups: MIOCA (coronary stenosis ≥50%) and MINOCA (coronary stenosis &lt;50% without other, alternative causes). Clinical outcomes included in-hospital and long-term overall mortality, and cardiovascular rehospitalization. The median follow-up was 1.5 years. MINOCA was diagnosed in 73 (10.3%) patients, 37 (50%) of whom were women. The median age of patients with MINOCA was 61 years and in the MIOCA group 65 years. No significant differences in cardiovascular risk factors were found between patients with MINOCA and MIOCA. In 53.4% of cases, the cause of MINOCA was a discrepancy between the myocardial oxygen demand and supply, and in 35.6% of cases, the cause was hypertensive crisis and pulmonary edema. The factors associated with MINOCA included an age ≤58 years, female gender, absence of the ST-segment elevation, absence of areas of impaired local contractility, and presence of aortic stenosis and bronchopulmonary infection. Patients with MINOCA were less likely to be prescribed acetylsalicylic acid, P2Y12 inhibitors, dual antiplatelet therapy, beta-blockers, and statins (p&lt;0.05). Data on long-term outcomes were available for 87.5% of patients (n=623). The prognosis of patients with MIOCA was comparable for in-hospital mortality (1.5% vs. 6.2%; p=0.161) and long-term overall mortality (6.1% vs. 14.7%; p=0.059). Cardiovascular rehospitalizations were more frequent in the MINOCA group (33.3% vs. 21.5%; p=0.042). The prevalence of MINOCA in our study was 10.3% among all patients with acute MI. MINOCA patients had comparable generally recognized cardiovascular risk factors with MIOCA patients. MINOCA patients had a comparable prognosis for in-hospital and long-term mortality and more often required cardiovascular rehospitalization.

AORTIC STENOSIS AND ULTRASOUND EVALUATION OF RENAL VESSELS IN HYPERTENSIVE PATIENTS

Objective: Aortic stenosis (AS) and arterial hypertension often clusterize and increase cardiovascular disease burden. Renal artery (RA) stenosis, the main form of secondary hypertension, can act as an upstream factor of resistance at the same way of AS. Aim of the study: to investigate if the presence of AS is able to interfere with the ultrasound (US) parameters in the diagnosis of RA stenosis. Design and method: In hypertensive subjects with AS we evaluated US indirect parenchymal parameters: resistive index (RI) and index of maximal systolic acceleration (AImax: the maximal acceleration of flow waveform in early systole divided by the peak systolic velocity), and US direct RA parameters: peak systolic velocity (PSV) and Renal/Aortic Ratio (RAR). Results: We compared hypertensive patients (mean age 74 years) with preserved left ventricular function with severe AS (n=18) or mild AS (n=21). No statistically differences were detected between groups regarding gender, age, smoke, ABI, CV risk factors, lipids, and renal function. Direct US parameters of RA did not differ significantly between patients with severe or mild AS (mean PSV 113 vs 127 cm/sec; mean RAR 1.3 vs 1.6). RI showed the same behavior (0.75 vs 0.73). AImax was significantly lower in patients with severe vs mild AS (8.74 vs 15.56 1/sec, p&lt;0.0005). We found an inverse correlation between AImax and the mean (r2=0.435) and peak (r2=0.424) transvalvular gradient. Among 14 patients with severe AS underwent correction of valvular disease. At 6 months, US showed a significant increase in AImax (from 10.0 to 19.8 1/sec, p&lt;0.005), while RI did not differ significantly (0.74 vs 0.73). Conclusions: Severe AS act as a proximal resistance that can attenuate the systolic acceleration phase of the flow profile of the renal intraparenchymal vessels, in particular of AImax, which is restored after surgical correction of the valve defect. Presence of AS may affect the diagnostic workup of RA stenosis.

Algorithm for predicting valvular heart disease from heart sounds in an unselected cohort.

This study aims to assess the ability of state-of-the-art machine learning algorithms to detect valvular heart disease (VHD) from digital heart sound recordings in a general population that includes asymptomatic cases and intermediate stages of disease progression. We trained a recurrent neural network to predict murmurs from heart sound audio using annotated recordings collected with digital stethoscopes from four auscultation positions in 2,124 participants from the Tromsø7 study. The predicted murmurs were used to predict VHD as determined by echocardiography. The presence of aortic stenosis (AS) was detected with a sensitivity of 90.9%, a specificity of 94.5%, and an area under the curve (AUC) of 0.979 (CI: 0.963-0.995). At least moderate AS was detected with an AUC of 0.993 (CI: 0.989-0.997). Moderate or greater aortic and mitral regurgitation (AR and MR) were predicted with AUC values of 0.634 (CI: 0.565-703) and 0.549 (CI: 0.506-0.593), respectively, which increased to 0.766 and 0.677 when clinical variables were added as predictors. The AUC for predicting symptomatic cases was higher for AR and MR, 0.756 and 0.711, respectively. Screening jointly for symptomatic regurgitation or presence of stenosis resulted in an AUC of 0.86, with 97.7% of AS cases (n = 44) and all 12 MS cases detected. The algorithm demonstrated excellent performance in detecting AS in a general cohort, surpassing observations from similar studies on selected cohorts. The detection of AR and MR based on HS audio was poor, but accuracy was considerably higher for symptomatic cases, and the inclusion of clinical variables improved the performance of the model significantly.

Aortic Stenosis Associated with an Increase in Mortality in Surgical Hip Fracture Patients

The majority of hip fracture patients in the United States are older adult patients with multiple comorbidities. Aortic stenosis (AS) in older adult patients with traumatic hip fracture is not uncommon. This study investigated the association between AS and postoperative mortality and serious complications. In this retrospective cohort study, a chart review was performed of patients with AS who underwent hip fracture surgical repair between January 2011 and December 2019 within one health system. A control group of hip fracture patients without AS was identified and matched based on body mass index, age, sex, date of surgery and Charlson Comorbidity Index. The primary outcome of interest was 90-day mortality; secondary outcomes included 30-day postoperative complications, intensive care unit admission (ICU), and hospital length of stay. In total, 146 hip fracture patients with AS and 146 without AS were identified. In the AS group, there was an increased odds of 90-day mortality (odds ratio 2.64, 95% confidence interval 1.32-5.28, P = 0.005), and an increased odds of ICU admission (odds ratio 3.00, 95% confidence interval 1.36-6.68, P = 0.004). The presence of AS was independently associated with an increase in 90-day mortality and postoperative ICU stay in patients undergoing surgical repair of a hip fracture.

The Role of Cardiac Magnetic Resonance in patients with Amyloidosis and Aortic Stenosis

Cardiac magnetic resonance imaging (CMR) plays an important role in the diagnosis and prognosis of various heart diseases. The incidence of cardiac amyloidosis and aortic stenosis has been increasing in recent years, especially with the aging population, and their possible coexistence has created frequent diagnostic challenges in clinical practice. CMR assumes an important value in this context due to its unique capacity for multiparametric assessment evaluations that include anatomical, functional, and histopathological aspects. The present review aimed to increase our knowledge of the diagnosis and prognosis of amyloidosis in the presence of aortic stenosis and highlighted the importance of CMR in this scenario.

The Role of Cardiac Magnetic Resonance in patients with Amyloidosis and Aortic Stenosis

Cardiac magnetic resonance imaging (CMR) plays an important role in the diagnosis and prognosis of various heart diseases. The incidence of cardiac amyloidosis and aortic stenosis has been increasing in recent years, especially with the aging population, and their possible coexistence has created frequent diagnostic challenges in clinical practice. CMR assumes an important value in this context due to its unique capacity for multiparametric assessment evaluations that include anatomical, functional, and histopathological aspects. The present review aimed to increase our knowledge of the diagnosis and prognosis of amyloidosis in the presence of aortic stenosis and highlighted the importance of CMR in this scenario.

Left vs. right radial approach for coronary catheterization: Relation to age and severe aortic stenosis.

Old age and the presence of aortic stenosis are associated with the unfolding of the intrathoracic aorta. This may result in increased difficulties navigating catheters from the right compared to the left radial approach. To investigate whether increasing age or presence of severe aortic stenosis was associated with increased catheterization success rates from left (LRA) compared to right radial artery approach (RRA). We compared coronary angiography success rates of RRA and LRA according to different age groups and in a subgroup of patients with severe aortic stenosis. A total of 21,259 coronary angiographies were evaluated. With increasing age, the first pass success rate from either radial access decreased significantly (p < 0.001). In patients aged <85 years, there was no difference between LRA and RRA. However, in patients aged ≥85 years, LRA was associated with significantly higher success rates compared to RRA (90.1 vs. 82.8%, p = 0.003). Patients aged ≥85 years received less contrast agent and had shorter fluoroscopy time when LRA was used [86.6 ± 41.1 vs. 99.6 ± 48.7 ml (p < 0.001) and 4.5 ± 4.1 min vs. 6.2 ± 5.7 min (p < 0.001), mean (±SD)]. In patients with severe aortic stenosis (n = 589) better first pass success rates were observed via LRA compared to the RRA route (91.9 vs. 85.1%, p = 0.037). LRA, compared to RRA, is associated with a higher first-pass catheter success rate for coronary artery angiography in patients aged ≥85 years and those with severe aortic stenosis.

Cardiovascular Predictors of Intracerebral Hematoma Expansion

BackgroundThere is limited evidence on the effect and relevance of cardiovascular parameters on the cerebrovascular system when an intracerebral hemorrhage (ICH) occurs. While recent studies evaluating this relationship are conflicting, one evaluating the effect of systolic cardiac function on clinical outcomes in ICH patients, found low cardiac ejection fractions to be associated with poor clinical outcomes. Our primary objective was to study such correlations and identify various cardiovascular disease states that may be associated with hematoma expansion. MethodsThis is an IRB-approved single-center retrospective study utilizing our institutional “Get with the Guidelines”-Stroke registry between 2013 and 2017. Patients included were older than 18 years of age, admitted with an acute ICH, and had an echocardiogram during their hospitalization. Univariate and multivariate logistical regression analyses were used to identify cardiovascular predictors of hematoma expansion. ResultsTwo-hundred forty-nine patients were identified from our GWTG-S registry that met initial inclusion criteria. Of these patients, a history of peripheral arterial disease (PAD) (p = 0.015), presence of aortic stenosis (AS) on the echocardiogram (p = 0.025), and a positive spot sign on the CT-angiogram (CTA) of the head (p < 0.001) were found to be independently associated with ICH expansion. Both a history of hypertension and elevated blood pressure on presentation were not significant predictors. Additionally, patients with a history of congestive heart failure had decreased odds of hematoma expansion (p = 0.027). ConclusionThis exploratory study highlights potential novel cardiac predictors of hematoma expansion, including PAD and AS, which warrant further study. Larger prospective studies are needed to further investigate such associations to ultimately optimize cardio-cerebral health.

Prognostic value of calcific aortic stenosis in patients of the PROGNOZ IBS registry

Aim. To assess the impact of calcific aortic stenosis on long-term prognosis in patients with stable coronary artery disease (CAD) included in the PROGNOZ IBS registry.Material and methods. The analysis included data of patients (n=541; men, 432; women, 109) from the CHD PROGNOSIS registry, in whom diagnosis of CAD was confirmed using coronary angiography during reference hospitalization in the National Medical Research Center for the period from January 1, to December 31, 2007. The mean age of men was 57,5±0,4, women — 60,9±0,9 years. The survival analysis included 504 patients (93%). The mean follow-up period was 7,3±2,19 years. We assessed the presence of calcific aortic stenosis (CAS) according to echocardiography and data on endpoints after 4 and 7 years of follow-up.Results. CAS according to echocardiography during reference hospitalization was found in 29 patients (5,4%) with a confirmed CAD. After four-year followup, 7 patients (24,1%) died, after 7 years — 15 (51,7%). Fatal and non-fatal cardiovascular events (primary endpoint) after 4 years were revealed in 10 patients (34,5%), and after 7 years, all cardiovascular events were fatal (n=15; 51,7%). In the presence of aortic stenosis, the relative risk (RR) of all-cause death at 4-year follow-up increased by 2,9 times (p&lt;0,01), while at 7-year follow-up — by 3,2 (p&lt;0,0001). The RR for the primary endpoint at 4-year follow-up increased by 2,8 times (p&lt;0,01), while at 7-year follow-up — by 2,3 times (p&lt;0,001). The RR of death in CAS patients at 7-year follow-up was comparable to severe heart failure — 3,3 (p&lt;0,01), stroke — 2,4 (p&lt;0,05) and left main coronary artery stenosis — 2,5 (p&lt;0,0001).Conclusion. The presence of calcific aortic stenosis had a pronounced negative effect on the long-term prognosis of CAD patients, comparable with those in left main coronary artery stenosis, severe heart failure and stroke.

Efficient detection of aortic stenosis using morphological characteristics of cardiomechanical signals and heart rate variability parameters

Recent research has shown promising results for the detection of aortic stenosis (AS) using cardio-mechanical signals. However, they are limited by two main factors: lacking physical explanations for decision-making on the existence of AS, and the need for auxiliary signals. The main goal of this paper is to address these shortcomings through a wearable inertial measurement unit (IMU), where the physical causes of AS are determined from IMU readings. To this end, we develop a framework based on seismo-cardiogram (SCG) and gyro-cardiogram (GCG) morphologies, where highly-optimized algorithms are designed to extract features deemed potentially relevant to AS. Extracted features are then analyzed through machine learning techniques for AS diagnosis. It is demonstrated that AS could be detected with 95.49–100.00% confidence. Based on the ablation study on the feature space, the GCG time-domain feature space holds higher consistency, i.e., 95.19–100.00%, with the presence of AS than HRV parameters with a low contribution of 66.00–80.00%. Furthermore, the robustness of the proposed method is evaluated by conducting analyses on the classification of the AS severity level. These analyses are resulted in a high confidence of 92.29%, demonstrating the reliability of the proposed framework. Additionally, game theory-based approaches are employed to rank the top features, among which GCG time-domain features are found to be highly consistent with both the occurrence and severity level of AS. The proposed framework contributes to reliable, low-cost wearable cardiac monitoring due to accurate performance and usage of solitary inertial sensors.

Abstract 12396: Association of Lipid Profiles With Presence of Aortic Stenosis in Older Adults: Atherosclerosis Risk in Communities Study

Introduction: Many risk factors for atherosclerosis are also risk factors for aortic stenosis. We sought to determine if novel and traditional lipid parameters are associated with aortic stenosis in a population-based study. Methods: We conducted a prospective analysis of participants without aortic stenosis at visit 4 (1996-98) of the ARIC Study. We used logistic regression to assess the association between lipoprotein (a) [Lp(a)], remnant-like particle cholesterol (RLP-C), low-density lipoprotein triglycerides (LDL-TG), small dense low-density lipoprotein-cholesterol (sdLDLc), non-high-density lipoprotein-cholesterol (non-HDLc), triglycerides (TG), and low-density lipoprotein-cholesterol (LDL-C) and incident aortic stenosis (defined as peak aortic valve velocity ≥2.0 m/s) on transthoracic echocardiogram (TTE) performed during visits 5 (2011-13) and 7 (2018-19). Results: Our study population included 11,587 individuals (mean age (SD): 76 (5) years, 56% women, 23% Black). 49% and 24.8% had TTE performed at visits 5 and 7 and the presence of aortic stenosis was 5% and 8%, respectively. In adjusted models, LDL-TG, RLP-C, sdLDLc, non-HDLc, TG, and LDLc at visit 4 were associated with aortic stenosis at visit 5. Lp(a) at visit 4 was predictive of aortic stenosis at visit 7 (table). Conclusions: Among persons who survived to old age, novel lipid parameters (including Lp(a), LDL-TG, RLP-C, and sdLDLc) in mid-life were associated with aortic stenosis in late-life. Further studies should determine if lipid-lowering therapies can prevent the development of aortic stenosis.

Hyperemic versus non-hyperemic indexes for coronary physiology assessment in patients with severe aortic stenosis

PurposeRecent data suggests that fractional flow reserve (FFR) may underestimate intermediate coronary stenosis in the presence of severe aortic stenosis (AS), whereas instantaneous wave-free ratio (iFR) values may remain similar after treatment of AS, yet the evidence still lacks to use iFR as the reference. We aimed to compare FFR/iFR values in the AS setting. Materials and methodsThe functional significance of 416 coronary lesions in 221 patients with severe AS was investigated with iFR and FFR. ResultsThe diagnostic agreement between iFR and FFR has been tested, using the cut-off value of 0.89 for iFR and 0.80 for FFR. The mean diameter stenosis was 58.6 ​± ​13.4% with FFR of 0.85 ​± ​0.07 and iFR of 0.90 ​± ​0.04. FFR ≤0.80 was identified in 26.0% and iFR≤0.89 in 33.2% of interrogated vessels. Good agreement between iFR and FFR was confirmed (Intraclass Correlation Coefficient 0.83 [95%CI 0.79-0.85]). The overall diagnostic accuracy (AUC in ROC analysis) of FFR in detecting iFR≤0.89 was 0.997 (95%CI 0.986 to 1.000; p<0.001) and of iFR in detecting FFR≤0.80 was 0.995 (95%CI 0.983 to 0.999; p<0.001). The optimal cut-off value for FFR to detect iFR≤0.89 was 0.82 with sensitivity, specificity, and accuracy of 97.1%, 98.9%, and 97.7%, respectively, and for IFR to detect FFR≤0.80 was 0.88 with sensitivity, specificity, and accuracy of 99.1%, 95.8%, and 97.4%, respectively. ConclusionIn the presence of AS, FFR has good agreement with iFR. However, the optimal FFR/iFR threshold to identify iFR≤0.89/FFR≤0.80 may be different from the standard thresholds of ischemia.

MO925VALVULAR HEART DISEASE EVOLUTION IN KIDNEY TRANSPLANT RECIPIENTS AND RELATED RISK FACTORS

Abstract Background and Aims Cardiovascular diseases remains the leading cause of death in recipients of kidney transplantation (KT). Valvular heart disease (VHD) is not an exclusion criteria for KT, however it’s repercussion on KT follow-up has been less studied. Our objective was to analyse the impact of VHD in KT recipients and related risk factors of VHD progression (VHDp). Method Observational retrospective cohort study of all patients who underwent KT at Hospital del Mar (Barcelona, Spain) between January 1980 and December 2018. VHD was defined as presence of aortic stenosis (AS), aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, tricuspid regurgitation or double valve injury of any degree diagnosed by echocardiography. We analysed the VHDp, defined as worsening of the initial valvular degree on heart ultrasound after KT, risk factors related with VHDp, recipients and graft survival. Results During the study period, 1422 patient underwent KT and 48 of them (3.4%) had VHD diagnosed prior to KT. In the median time of follow-up of 56.3 months (IQR25-75 17.7-119 month), 17 patients (35.4%) presented VHDp and 31 patients did not (64.6%). Figure 1 shows the primary outcome in the different types of VHD, AS was the valve with more VHDp after KT. Statistical evaluation revealed that recipients with VHDp had a higher body mass index (BMI) (27.4 ± 6.3 vs 24.3 ± 3.8 kg/m2, p=0.04) and worse PTH control (427.0 ± 309.3 vs 186.2 ± 140.6 pg/ml, p=0.02) at the moment of the KT. Also, patients with VHDp reached a worse nadir glomerular filtration rate (GFR) (44.1 ± 17.5 vs 56.0 ± 13.9 ml/min/1.73m2, p=0.01) during the follow-up, needed more time to reach their nadir GFR (4 [2-13] vs 1.2 [1.0-4.7] months, p&amp;lt;0.001) and required more furosemide dose at that time (72.7 ± 21.7 vs 15.8 ± 5.6 mg/day, p=0.02). At the end of follow-up, 213 KT recipients had died, 16 with preKT-VHD (33.3% of all patients with VHD) and 197 without preKT-VHD (14.3% of all cases without VHD). There was a statistical significant association between preKT-VHD status and all-cause mortality after KT (log rank &amp;lt; 0.001). However, there wasn’t statistical association between preKT-VHD status and death-censored graft survival (log rank = 0.2). Conclusion VHD has a significant impact on increased pos-KT mortality but it is not associated with graft survival. More than one third of recipients with preKT-VHD presented deterioration after KT. We found that increased preKT BMI and PTH, nadir GFR after KT, time to reach this nadir GFR and diuretic dose at that time are related with VHD progression.

On the Left Ventricular Remodeling of Patients with Stenotic Aortic Valve: A Statistical Shape Analysis.

The left ventricle (LV) constantly changes its shape and function as a response to pathological conditions, and this process is known as remodeling. In the presence of aortic stenosis (AS), the degenerative process is not limited to the aortic valve but also involves the remodeling of LV. Statistical shape analysis (SSA) offers a powerful tool for the visualization and quantification of the geometrical and functional patterns of any anatomic changes. In this paper, a SSA method was developed to determine shape descriptors of the LV under different degrees of AS and thus to shed light on the mechanistic link between shape and function. A total of patients underwent computed tomography (CT) for the evaluation of valvulopathy were segmented to obtain the LV surface and then were automatically aligned to a reference template by rigid registrations and transformations. Shape modes of the anatomical LV variation induced by the degree of AS were assessed by principal component analysis (PCA). The first shape mode represented nearly 50% of the total variance of LV shape in our patient population and was mainly associated to a spherical LV geometry. At Pearson’s analysis, the first shape mode was positively correlated to both the end-diastolic volume (, ) and end-systolic volume (, and ), suggesting LV impairment in patients with severe AS. A predictive model built with PCA-related shape modes achieved better performance in stratifying the occurrence of adverse events with respect to a baseline model using clinical demographic data as risk predictors. This study demonstrated the potential of SSA approaches to detect the association of complex 3D shape features with functional LV parameters.

Accuracy of stroke volume measurement with phase-contrast cardiovascular magnetic resonance in patients with aortic stenosis

BackgroundPhase contrast (PC) cardiovascular magnetic resonance (CMR) in the ascending aorta (AAo) is widely used to calculate left ventricular (LV) stroke volume (SV). The accuracy of PC CMR may be altered by turbulent flow. Measurement of SV at another site is suggested in the presence of aortic stenosis, but very few data validates the accuracy or inaccuracy of PC in that setting. Our objective is to compare flow measurements obtained in the AAo and LV outflow tract (LVOT) in patients with aortic stenosis.MethodsRetrospective analysis of patients with aortic stenosis who had CMR and echocardiography. Patients with mitral regurgitation were excluded. PC in the AAo and LVOT were acquired to derive SV. LV SV from end-systolic and end-diastolic tracings was used as the reference measure. A difference ≥ 10% between the volumetric method and PC derived SVs was considered discordant. Metrics of turbulence and jet eccentricity were assessed to explore the predictors of discordant measurements.ResultsWe included 88 patients, 41% with bicuspid aortic valve. LVOT SV was concordant with the volumetric method in 79 (90%) patients vs 52 (59%) patients for AAo SV (p = 0.015). In multivariate analysis, aortic stenosis flow jet angle was a strong predictor of discordant measurement in the AAo (p = 0.003). Mathematical correction for the jet angle improved the concordance from 59 to 91%. Concordance was comparable in patients with bicuspid and trileaflet valves (57% and 62% concordance respectively; p = 0.11). Accuracy of SV measured in the LVOT was not influenced by jet eccentricity. For aortic regurgitation quantification, PC in the AAo had better correlation to volumetric assessments than LVOT PC.ConclusionLVOT PC SV in patients with aortic stenosis and eccentric jet might be more accurate compared to the AAo SV. Mathematical correction for the jet angle in the AAo might be another alternative to improve accuracy.

Comparison of iFR and FFR for coronary physiology evaluation in patients with severe aortic stenosis

Abstract Background Reliable coronary physiology assessment with pressure derived indexes in patients with aortic stenosis (AS) rises problems due to its complex nature. Recent data suggest that fractional flow reserve (FFR) may underestimate intermediate coronary stenosis in a presence of AS whereas instantaneous wave-free ratio (iFR) values may remain similar after treatment of AS. Furthermore, both indices has not been validated yet in AS. Aim We aimed to find a thresholds for coronary ischemia in the setting of aortic Material and methods The functional significance of 416 coronary lesions was investigated with iFR and FFR measurements in 221 AS patients. The iFR-FFR diagnostic agreement has been tested using the cut-off value for iFR of 0.89. Results Mean value of %DS was 58.6±13.4%, FFR was 0.85±0.07 and iFR – 0.90±0.04. FFR ≤0.80 was measured in 26.0% of interrogated vessels, iFR ≤0.89 – in 33.2%. The correlation between iFR and FFR was good (r=0.83, p&amp;lt;0.001) and with good agreement between iFR and FFR (mean difference −0.0059, 95% CI −0.056–0.062). The AUC at ROC curve analysis for iFR ≤0.89 was 0,997 (0,986 to 1,000, p&amp;lt;0.001) for FFR. According to ROC analysis, the best FFR cut-off in predicting iFR ≤0.89 was ≤0.82 (J=0.96). The diagnostic accuracy for identifying iFR ≤0.89 was 97.7% for FFR. Conclusion In the presence of AS, FFR had good agreement with iFR values. However, FFR threshold for predicting iFR below 0.89 may be different from a standard threshold and that should be taken into account while assessing coronary physiology in the setting of AS. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Science Center

On the severity of aortic stenosis in ascending aortic aneurysm: A computational tool to examine ventricular-arterial interaction and aortic wall stress

An ascending thoracic aortic aneurysm (ATAA) is a life-threatening cardiovascular consequence of vessel dilatation that portends adverse events and death. From a clinical perspective, ATAA should not be treated as an isolated disease, and surgery is often carried out in the presence of AS, aortic insufficiency or a calcified valve leaflet. Aortic stenosis (AS) is common in ATAAs and leads to both vessel rigidity and left ventricular (LV) impairment. In this study, lumped-parameter modeling and computational analysis were used to assess the change in the wall shear stress (WSS) and intramural wall stress of patient-specific ATAA models with different degrees of AS (i.e., mild to severe). The ATAAs of four patients were reconstructed from imaging data and AS was simulated virtually using the lumped-based CircAdapt tool using clinical and echocardiographic data. Results show that LV work derived from pressure-volume loops increased with the severity of AS. Post-stenotic hemodynamic and structural variables markedly increased with AS severity, with WSS showing a 10-fold increase for the most severe AS model as compared to the baseline model with a well-functioning aortic valve. Most importantly, the increase in WSS and aortic wall stress was associated with pronounced values of valvulo-arterial impedance as an indicator of LV dysfunction. This study provides novel insights into progression of AS in patients with ATAAs at high risk of adverse events, and the potential value of valvulo-arterial impedance to predict changes in hemodynamic and structural parameters with the severity of AS.

ACCURACY OF STROKE VOLUME BY PHASE CONTRAST CARDIOVASCULAR MAGNETIC RESONANCE IN AORTIC STENOSIS: A COMPARISON OF MEASURE IN LEFT VENTRICULAR OUTFLOW TRACT VS. ASCENDING AORTA

Phase contrast (PC) imaging in the ascending aorta (AA) is widely used to calculate left ventricular stroke volume (SV) with cardiovascular magnetic resonance (CMR). The accuracy of PC may be altered by the presence of turbulent flow. Incorrect measurement could have a significant impact on the calculation of other variables such as mitral regurgitation. Although SV measurement at another site (pulmonary valve or left ventricular outflow tract [LVOT]) is suggested in the presence of aortic stenosis (AS), there are very few data validating the accuracy of aortic PC in that setting.

Discrete Left Ventricle Outflow Tract Obstruction in Children: Incidence and Predictors of Recurrence. A Multi-Center Study.

ObjectivesThe purpose of this study is to measure the incidence of recurrence of discrete subaortic stenosis (DSS) after primary resection in two major cardiac centers in Saudi Arabia and to identify risk factors associated with recurrence.MethodsData on 234 patients who were diagnosed with DSS and underwent surgical resection between 1999 and 2018 were retrospectively reviewed. Patient demographics as well as echocardiographic, surgical, and pathological data were compared between patients with recurrence and non-recurrence.ResultsThe overall recurrence incidence after primary resection was 44.87% (N = 105). Most patients were male (59%). The median age at the 1st operation was 60 months (range 3 months to 133 months). The presence of aortic stenosis at the time of diagnosis was significantly associated with recurrence (p-value = 0.002). The overall median peak gradient in which the primary resection was indicated is 60 mmHg (range 11 to 152 mmHg). The median peak gradient pre-operation and post-operation were significantly higher for the recurrence group (p-value=0.018 and p<0.001, respectively). We used univariate and multivariate analysis and controlled for the follow-up time, but there were no significant independent predictors of recurrence.ConclusionThe recurrence rate of DSS after the primary resection is relatively high in this study. Further prospective studies are needed to draw a definite conclusion on risk factors for recurrence after primary resection.