93 Ejection Fraction by Cardiovascular Magnetic Resonance Predicts Adverse Outcomes Post Aortic Valve Replacement

Abstract

Introduction Predicting prognosis following aortic valve replacement (AVR) in patients with aortic stenosis (AS) remains challenging. Current guidelines recommend that surgery should be offered when ejection fraction (EF) is <50%. We sought to investigate the prognostic significance of EF calculated by cardiovascular magnetic resonance (CMR) in the long term survival of patients following AVR. Methods 80 patients (69 ± 11 years old at time of surgery; 55 male) scheduled for AVR underwent CMR assessment. 52 patients had severe AS (area <1cm2), 28 patients had moderate AS (area 1.0–1.5cm2) and other qualifying reasons for AVR. 44 patients had additional coronary artery disease.Patients were categorised into three groups according to EF prior to surgery: Group 1 (EF <50%; n = 26), Group 2 (EF of 50–70%; n = 26) and Group 3 (EF >70%; n = 28). A median 5.0 ± 1.8 years follow-up was completed using the National Strategic Tracing Scheme and hospital notes. Results Univariate analysis of all cause mortality using the Kaplan-Meier estimator demonstrated significantly higher mortality in patients with Group 1 (EF <50%) compared to those in group 3 (EF >70%; .03).There was no statistical difference between group 2 (EF of 50–70%) and the remaining 2 groups. Abstract 93 Figure 1 Kaplan-Meier survival curve of all cause mortality in Group 1 (EF <50%), Group 2 (EF 50–70%) and Group 3 (EF >70%) Conclusion Pre-operative EF is a significant predictor of mortality following AVR. Patients with EF <50% have the worst prognosis whereas those with EF >70% have the best prognosis. We aim to incease the sample size to determine whether a progressive decrease in EF per se even when above 50% should initiate consideration for AVR.

Animal models for the study of primary and secondary hypertension in humans

“…Different pharmacological, environmental and genetic models using different animal species have provided useful and valuable information on the aetiology, pathophysiology and complications of human cardiovascular and metabolic disorders, and a platform to examine the efficacy of pharmacotherapy (105–118). However, a major limitation of these experimental models is the anatomical differences between these animal species and humans (119).…”

Gap junction inhibition by heptanol increases ventricular arrhythmogenicity by reducing conduction velocity without affecting repolarization properties or myocardial refractoriness in Langendorff-perfused mouse hearts

“…For future experiments, the measurement of magnetic signals may be beneficial. It has been previously demonstrated to useful for characterizing cardiac structural abnormalities (60–62), and observed that functional mapping could be achieved using magnetocardiography in mouse models. Thus, it is suggested that its use in assessing abnormal cardiac electrophysiology in mice warrants future investigation (63–66).…”

Molecular and Electrophysiological Mechanisms Underlying Cardiac Arrhythmogenesis in Diabetes Mellitus

“…Both mechanisms lead to a decrease in CV. Cardiac magnetic resonance (CMR) with late gadolinium enhancement is used for the diagnosis and monitoring of cardiomyopathy [27–29] and is potentially useful for examining fibrosis in diabetic cardiomyopathy.…”

“…Cardiac magnetic resonance imaging is excellent for characterizing structural abnormalities, such as areas of fibrosis by late gadolinium enhancement [27–29]. Afferent and efferent neural pathways normally regulate inotropic, lusitropic, chronotropic, and dromotropic responses of the heart.…”