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- Lam, Yat-Yin, et al.
(författare)
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Prolonged total isovolumic time is related to reduced long-axis functional recovery following valve replacement surgery for severe aortic stenosis
- 2012
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Ingår i: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 159:3, s. 187-191
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The left ventricular (LV) long axis (Lax) function is very sensitive in documenting myocardial abnormalities in aortic stenosis (AS). We hypothesized that Lax recovery after aortic valve replacement (AVR) is related to the extent of cavity dyssynchrony measured by total isovolumic time (t-IVT).METHODS: A consecutive 107 patients (aged 70±7years, 70 male) with severe AS and Lax impairment were studied. T-IVT was measured before and after AVR. Reduced Lax function and its post-operative recovery were defined as mitral annular plane systolic excursion (MAPSE) ≦10mm and an increase of MAPSE >10%, respectively.RESULTS: LV function improved (EF: 43±8 to 48±10%; MAPSE: 7.9±1.0 to 11.0±2.4mm) and t-IVT shortened (9.7±3.7 to 7.0±2.8s/min, p<0.01 for all) after AVR. Sixty-five (61%) patients had Lax recovery after a median of 32-month follow-up. Univariate predictors were LV size, LA dimensions, the presence of restrictive LV filling and prolonged t-IVT. Only LV end-systolic dimension, restrictive filling and t-IVT (OR 0.61, 95% CI 0.47-0.79, p<0.01) were independent predictors. A pre-operative t-IVT≦9.3s/min was 81% sensitive and 63% specific in predicting Lax recovery (AUC 0.81, p<0.001). The prevalence of CAD or concomitant CABG were similar in 2 patient groups with different t-IVT.CONCLUSIONS: Lax recovery was evident in the majority of AS patients after AVR. The lower prevalence of Lax recovery seen in patients with prolonged t-IVT suggests that dyssynchrony may play an important role in the process of adverse LV remodeling.
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- Lindqvist, Per, et al.
(författare)
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Effect of pericardial repair after aortic valve replacement on septal and right ventricular function
- 2012
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Ingår i: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 155:3, s. 388-393
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Aortic valve replacement (AVR) is associated with reversed septal motion and right ventricular (RV) dysfunction but the cause remains uncertain. The aim of this study was to investigate the role of pericardial repair after AVR on septal and RV function.METHODS: Thirty patients (62±11years, 18 males) with severe aortic stenosis were studied before and after AVR surgery using echocardiography. Patients were randomly allocated to pericardial repair vs. open pericardium. RV long axis displacement and outflow tract fractional shortening (fs) were measured. RV and right atrial (RA) tissue Doppler and strain rate (SR) were measured as well as RA area. Systolic interventricular septal motion towards and away from the RV was also determined. Stroke volume (SV) was measured by conventional Doppler method. Pre-operative data were compared with those from 30 normal gender and age matched controls.RESULTS: Post-operatively, global RV ejection function was preserved as shown by SV. However, RV outflow tract fs and long axis displacement both fell (p<0.01) but not SR. RA area remained unchanged but RA SR fell (p<0.01). RV displacement correlated with the extent of reversed septal motion (r=0.60, p<0.001) as well as RA SR (r=0.54, p<0.001). None of the RV or septal measurements was affected by the pericardial repair procedure.CONCLUSION: After AVR, septal motion is reversed and correlated directly with RV long axis function. The latter is not affected by pericardial repair but likely related to right atrial surgery injury.
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- Vorkas, Panagiotis A., et al.
(författare)
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Perturbations in fatty acid metabolism and apoptosis are manifested in calcific coronary artery disease : An exploratory lipidomic study
- 2015
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Ingår i: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 197, s. 192-199
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Tidskriftsartikel (refereegranskat)abstract
- Background: Controversy exists concerning the beneficial or harmful effects of the presence of ectopic calcification in the coronary arteries. Additionally, further elucidation of the exact pathophysiological mechanism is needed. In this study, we sought to identify metabolic markers of vascular calcification that could assist in understanding the disease, monitoring its progress and generating hypotheses describing its pathophysiology. Methods: Untargeted lipid profiling and complementary modeling strategies were employed to compare serum samples from patients with different levels of calcific coronary artery disease (CCAD) based on their calcium score (CS). Subsequently, patients were divided into three groups: no calcification (NC; CS = 0; n = 26), mild calcification (MC; CS: 1-250; n = 27) and severe (SC; CS > 250; n = 17). Results: Phosphatidylcholine levels were found to be significantly altered in the disease states (p = 0.001-0.04). Specifically, 18-carbon fatty acyl chain (FAC) phosphatidylcholines were detected in lower levels in the SC group, while 20:4 FAC lipid species were detected in higher concentrations. A statistical trend was observed with phosphatidylcholine lipids in the MC group, showing the same tendency as with the SC group. We also observed several sphingomyelin signals present at lower intensities in SC when compared with NC or MC groups (p = 0.000001-0.01). Conclusions: This is the first lipid profiling study reported in CCAD. Our data demonstrate dysregulations of phosphatidylcholine lipid species, which suggest perturbations in fatty acid elongation/desaturation. The altered levels of the 18-carbon and 20:4 FAC lipids may be indicative of disturbed inflammation homeostasis. The marked sphingomyelin dysregulation in SC is consistent with profound apoptosis as a potential mechanism of CCAD. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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- Zhao, Ying, et al.
(författare)
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Accentuated left ventricular lateral wall function compensates for septal dyssynchrony after valve replacement for aortic stenosis
- 2013
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 164:3, s. 339-344
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The interventricular septal motion becomes reversed after aortic valve replacement (AVR) for aortic stenosis (AS) despite maintained stroke volume (SV). We hypothesis that left ventricular (LV) lateral wall compensates for such disturbances, in order to secure normal SV. METHODS: We studied 29 severe AS patients (age 63±11years, 18 males) with normal ejection fraction (EF) before, 6months and 12months after AVR and compared them with 29 age- and gender-matched controls, using speckle tracking echocardiography. RESULTS: In patients, the LVEF and SV remained unchanged throughout. Before AVR, the septal radial motion, septal and lateral strain were reduced (p<0.001). Peak septal and lateral displacements, times from QRS to peak displacement were all not different from controls. Six months after AVR, septal radial motion reversed (p<0.001), lateral strain increased (p<0.05), peak septal displacement reduced (p<0.01) while lateral displacement increased (p<0.05). Time to peak septal displacement delayed (p<0.01) in contrast to lateral displacement which became early (p<0.05), resulting in a significant septal-lateral time delay (p<0.01). The accentuation of LV lateral wall correlated with septal displacement time delay (r=0.60, p<0.001) and septal-lateral time delay (r=0.64, p<0.001). SV correlated with lateral displacement (r=0.39, p<0.05). The systolic strain was correlated with opposite wall displacement (p<0.05 for both). There was no correlation between these measurements before and 12month after AVR. CONCLUSIONS: Accentuated lateral wall displacement compensates for septal dyssynchrony in order to maintain normal LVEF and SV. The continuing recovery of these disturbances 12months after complete mass regression suggests an ongoing reverse remodeling.
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