Remodeling classification system considering left ventricular volume in patients with aortic valve stenosis: Association with adverse cardiovascular outcomes

Barbieri, Andréa; Bartolacelli, Ylenia; Bursi, Francesca; Manicardi, Marcella; Boriani, Giuseppe

doi:10.1111/echo.14299

Cited by 6 publications

(11 citation statements)

References 44 publications

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“…7 shows clinical data on EDVI, MI and RWT in terms of prevalence in the patient population (Barbieri et al. 2019a , b ). It shows that growth upon MR is most clearly apparent in MI and EDVI.…”

Section: Resultsmentioning

confidence: 99%

“…These differences might be caused by the presence of simultaneous moderate diseases in (Barbieri et al. 2019a , b ) which led to secondary effects. Due to a lack of clinical occurrence data for a severe MR, in Fig.…”

Section: Discussionmentioning

confidence: 99%

“… 2019 ), while on the right side patient data are represented as clinical occurrence in percentage (Barbieri et al. 2019a ). The left ventricle is considered dilated if EDVI > 79 ml/ , hypertrophic if MI > 105 g/ , and with an eccentric geometry, with RWT < 0.32, normal geometry, with 0.32 RWT 0.42, and concentric geometry, with RWT > 0.42 (Gaasch and Zile 2011 ).…”

Section: Methodsmentioning

confidence: 99%

“…On the right side, patient data are represented as clinical occurrence in percentage (Barbieri et al. 2019a , b ) …”

Section: Methodsmentioning

confidence: 99%

“…Data from (Barbieri et al. 2019a , b ) are presented in terms of clinical occurrence, see the right panels of the same figures.…”

Section: Methodsmentioning

confidence: 99%

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Stimulus–effect relations for left ventricular growth obtained with a simple multi-scale model: the influence of hemodynamic feedback

Rondanina

Bovendeerd

2020

Biomech Model Mechanobiol

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Cardiac growth is an important mechanism for the human body to respond to changes in blood flow demand. Being able to predict the development of chronic growth is clinically relevant, but so far models to predict growth have not reached consensus on the stimulus–effect relation. In a previously published study, we modeled cardiac and hemodynamic function through a lumped parameter approach. We evaluated cardiac growth in response to valve disease using various stimulus–effect relations and observed an unphysiological decline pump function. Here we extend that model with a model of hemodynamic feedback that maintains mean arterial pressure and cardiac output through adaptation of peripheral resistance and circulatory unstressed volume. With the combined model, we obtain stable growth and restoration of pump function for most growth laws. We conclude that a mixed combination of stress and strain stimuli to drive cardiac growth is most promising since it (1) reproduces clinical observations on cardiac growth well, (2) requires only a small, clinically realistic adaptation of the properties of the circulatory system and (3) is robust in the sense that results were fairly insensitive to the exact choice of the chosen mechanics loading measure. This finding may be used to guide the choice of growth laws in more complex finite element models of cardiac growth, suitable for predicting the response to spatially varying changes in tissue load. Eventually, the current model may form a basis for a tool to predict patient-specific growth in response to spatially homogeneous changes in tissue load, since it is computationally inexpensive.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…On the right side, patient data are represented as clinical occurrence in percentage (Barbieri et al. 2019a , b ) …”

Section: Methodsmentioning

confidence: 99%

“…Data from (Barbieri et al. 2019a , b ) are presented in terms of clinical occurrence, see the right panels of the same figures.…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Stimulus–effect relations for left ventricular growth obtained with a simple multi-scale model: the influence of hemodynamic feedback

Rondanina

Bovendeerd

2020

Biomech Model Mechanobiol

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Surgical aortic valve replacement and left ventricular remodeling: Survival and sex‐related differences

et al. 2021

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Objectives To analyze how left ventricular (LV) remodeling and hypertrophy geometry evolve after surgical aortic valve replacement (SAVR) in octogenarian patients, and identify potential sex‐related differences and implications for long‐term outcomes. Methods In 170 patients with aortic stenosis ([AS], age 80 ± 4 years, 59% women), hypertrophy geometry and remodeling (LV index) were reanalyzed one year post‐SAVR. The six‐year outcomes were evaluated. Results Pre‐SAVR, 65% of the women and 38.6% of the men (P < .001) showed adaptive remodeling. Concentric hypertrophy was prevalent in adaptive remodeling, and mixed and dilated hypertrophy were more prevalent in maladaptive remodeling. At one year, the remodeling patterns and sex distribution were similar to those observed pre‐SAVR, but the LV index decreased in women and increased in men (P < .0001). Women with adaptive remodeling had a higher incidence of persistent concentric hypertrophy with higher LV filling pressures. Long‐term survival was better in women and worse in men with adaptive remodeling (P = .039). Men with adaptive remodeling and men with concentric hypertrophy had the highest risk of cardiac death. This risk was similar between sexes for patients with maladaptive remodeling and dilated hypertrophy. Women with LV ejection fraction >55% had a lower risk of cardiac death than men. Conclusions The long‐term outcomes of SAVR differ between sexes in older patients with AS and adaptive LV remodeling. The LV index facilitates studying the pathways of adaptation to AS. The follow‐up shifts help explain the sex differences in long‐term outcomes post‐SAVR. Concentric hypertrophy is associated with the highest risk of cardiac death in men.

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Staging Cardiac Damage in Patients With Hypertension

et al. 2019

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Ventricular and extraventricular response to pressure overload may be a common process in aortic stenosis and hypertension. We aimed to evaluate the association of a newly defined staging classification characterizing the extent of cardiac damage, originally developed for aortic stenosis, with long-term outcomes in patients with hypertension. We retrospectively analyzed 1639 patients with hypertension who had undergone both scheduled transthoracic echocardiography and electrocardiography in 2013 in a Japanese hospital, after excluding severe and moderate aortic stenosis, aortic regurgitation, mitral stenosis, previous myocardial infarction, or cardiomyopathy. We classified patients according to the presence or absence of cardiac damage as detected on echocardiography as follows: stage 0, no cardiac damage (n=858; 52.3%); stage 1, left ventricular damage (n=358; 21.8%); stage 2, left atrial or mitral valve damage (n=360; 22.0%); or stage 3 and 4, pulmonary vasculature, tricuspid valve, or right ventricular damage (n=63; 3.8%). The primary outcome was a composite of all-cause death and major adverse cardiac events. Cumulative 3-year incidence of the primary outcome was 15.5% in stage 0, 20.7% in stage 1, 31.8% in stage 2, and 60.6% in stage 3. After adjusting for confounders, the stage was incrementally associated with higher risk of the primary outcome (per 1-stage increase: hazard ratio, 1.46 [95% CI, 1.31–1.61]; P <0.001). The staging classification characterizing the extent of cardiac damage, originally developed for aortic stenosis, was associated with long-term outcomes in patients with hypertension in a stepwise manner.

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Remodeling classification system considering left ventricular volume in patients with aortic valve stenosis: Association with adverse cardiovascular outcomes

Cited by 6 publications

References 44 publications

Stimulus–effect relations for left ventricular growth obtained with a simple multi-scale model: the influence of hemodynamic feedback

Stimulus–effect relations for left ventricular growth obtained with a simple multi-scale model: the influence of hemodynamic feedback

Surgical aortic valve replacement and left ventricular remodeling: Survival and sex‐related differences

Staging Cardiac Damage in Patients With Hypertension

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