Predictors and Progression of Aortic Stenosis in Patients With Preserved Left Ventricular Ejection Fraction

Phelan

et al. 2017

JAHA

Self Cite

BackgroundChronic kidney disease (CKD) is an adverse prognostic marker for valve intervention patients; however, the prevalence and related outcomes of valvular heart disease in CKD patients is unknown.Methods and ResultsIncluded patients underwent echocardiography (1999–2013), had serum creatinine values within 6 months before index echocardiogram, and had no history of valve surgery. CKD was defined as diagnosis based on the International Classification of Diseases, Ninth Revision or an estimated glomerular filtration rate <60 mL/min per 1.73 m2. Qualitative assessment determined left heart stenotic and regurgitant valve lesions. Cox models assessed CKD and aortic stenosis (AS) interaction for subsequent mortality; analyses were repeated for mitral regurgitation (MR). Among 78 059 patients, 23 727 (30%) had CKD; of these, 1326 were on hemodialysis. CKD patients were older; female; had a higher prevalence of hypertension, hyperlipidemia, diabetes, history of coronary artery bypass grafting/percutaneous coronary intervention, atrial fibrillation, and heart failure ≥mild AS; and ≥mild MR (all P<0.001). Five‐year survival estimates of mild, moderate, and severe AS for CKD patients were 40%, 34%, and 42%, respectively, and 69%, 54%, and 67% for non‐CKD patients. Five‐year survival estimates of mild, moderate, and severe MR for CKD patients were 51%, 38%, and 37%, respectively, and 75%, 66%, and 65% for non‐CKD patients. Significant interaction occurred among CKD, AS/MR severity, and mortality in adjusted analyses; the CKD hazard ratio increased from 1.8 (non‐AS patients) to 2.0 (severe AS) and from 1.7 (non‐MR patients) to 2.6 (severe MR).ConclusionsPrevalence of at least mild AS and MR is substantially higher and is associated with significantly lower survival among patients with versus without CKD. There is significant interaction among CKD, AS/MR severity, and mortality, with increasingly worse outcomes for CKD patients with increasing AS/MR severity.

Section: Discussionmentioning

confidence: 97%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Data Sourcesmentioning

confidence: 99%

See 2 more Smart Citations

Prevalence and Outcomes of Left‐Sided Valvular Heart Disease Associated With Chronic Kidney Disease

Samad

Phelan

et al. 2017

JAHA

Self Cite

“…The set up of DELD has been previously described. 8 Briefly, the DELD is a prospectively maintained digital archive of all echocardiograms performed at Duke University Hospital and satellite clinics since 1995. This is linked to a corresponding searchable reporting database with clinical information derived from the electronic health record.…”

Section: Methodsmentioning

confidence: 99%

An Approach to Improve the Negative Predictive Value and Clinical Utility of Transthoracic Echocardiography in Suspected Native Valve Infective Endocarditis

Journal of the American Society of Echocardiography

Vora

Návar

et al. 2016

Self Cite

Background In patients with suspected native valve infective endocarditis (IE), current guidelines recommend an initial transthoracic echocardiogram (TTE) followed by a transesophageal echocardiogram (TEE) if clinical suspicion remains. The guidelines do not account for quality of the initial TTE or other findings that may alter the study’s diagnostic characteristics. This may lead to unnecessary TEE procedures where the initial TTE was sufficient to rule out vegetation. Methods Patients with suspected native valve endocarditis that underwent a TTE followed by a TEE within 7 days between 1/1/2007 and 2/28/2014 were included. A negative TTE for vegetation was defined by either the standard approach (at least possible vegetation seen on TTE), or by applying a set of strict negative criteria incorporating other findings on TTE. Using TEE as the gold standard for presence of vegetation, the diagnostic performance of the two TTE approaches were compared. Results In total, 790 TTE/TEE pairs were identified. With the standard approach, 671 of the TTEs were negative, compared to 107 negative studies using the strict negative approach. The sensitivity and negative predictive value (NPV) of TTE for detecting vegetation were substantially improved using the strict negative approach (sensitivity: 98% [95% C.I. 95–99%] vs. 39% [95% C.I. 31%–47%], NPV: 97% [95% C.I. 92–99%] vs. 86% [95% C.I. 83–88%]). Conclusions The ability for TTE to exclude vegetation in patients is excellent when strict criteria for a negative study are applied. In low to intermediate risk patients with a strict negative TTE, follow up TEE may be unnecessary.

Improving on the diagnostic characteristics of echocardiography for pulmonary hypertension

Broderick-Forsgren

Davenport

Int J Cardiovasc Imaging

et al. 2017

This retrospective study evaluated the diagnostic characteristics of a combination of echocardiographic parameters for pulmonary hypertension (PH). Right ventricular systolic pressure (RVSP) estimation by echocardiography (echo) is used to screen for PH. However, the sensitivity of this method is suboptimal. We hypothesized that RVSP estimation in conjunction with other echo parameters would improve the value of echo for PH. The Duke Echo database was queried for adult patients with known or suspected PH who had undergone both echo and right heart catheterization (RHC) within a 24 h period between 1/1/2008 and 12/31/2013. Patients with complex congenital heart disease, heart transplantation, ventricular assist device, or on mechanical ventilation at time of study were excluded. Diagnostic characteristics of several echo parameters (right atrial enlargement, pulmonary artery (PA) enlargement, RV enlargement, RV dysfunction, and RVSP) for PH (mean PA pressure 25 mmHg on RHC) were evaluated among 1007 patients. RVSP ≥40 had a sensitivity of 77% (accuracy 77), while RVSP ≥35 had the highest sensitivity at 88% (81% accuracy). PA enlargement had the lowest sensitivity at 17%. The area under the curve (AUC) for RVSP was 0.844. A model including RVSP, RA, PA, RV enlargement and RV dysfunction had a higher AUC (AUC = 0.87) than RVSP alone. The value of echo as a screening test for PH is improved by a model incorporating a lower RVSP in addition to other right heart parameters. These findings need to be validated in prospective cohorts.