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Valvular Heart Disease: A World in Constant Motion

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 29892

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Special Issue Editors

Prof. Piero Montorsi

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Guest Editor

Department of Clinical Science and Community Health, University of Milan. Centro Cardiologico Monzino, Milan, Italy
Interests: prosthetic valve dysfunction; cardiovascular imaging; structural heart disease interventions

Dr. Nina Ajmone Marsan

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Guest Editor

Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherland
Interests: mitral valve prolapse; mitral regurgitation; aortic stenosis; cardiovascular imaging
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Special Issue Information

Dear Colleagues,

This is a formal invitation to be part of a new Special Issue of the Journal of Clinical Medicine. The title is self-explaining: ‘’Valvular Heart Disease: A World in Constant Motion’’. Due to the technological advancement of the diagnostic tools and a better clinical knowledge of pathophysiology, we are rethinking old concepts and facing new topics every single day. The consolidation of endovascular treatment of valvular heart diseases has substantially contributed to the growing interest in this field.

Among the several topics of interest, we would like to focus on prosthetic heart valve dysfunction (still a diagnostic and therapeutic dilemma in 2020), echocardiographic assessment of mitral and tricuspid valve disease (the new frontier of valve interventional treatment), controversial aortic stenosis presentations (i.e., low-flow, low-gradient aortic stenosis), and treatment aspects.

Therefore, the aim of this Special Issue is to give to the JCM readers an update on the pathophysiology, diagnosis, and treatment of heart valve disease.

Prof. Piero Montorsi
Dr. Nina Ajmone Marsan
Guest Editors

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Keywords

prosthetic heart valve
cine-fluoroscopy
heart valve pathophysiology
structural heart valve interventions
echocardiographic assessment
cardiovascular imaging

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Published Papers (11 papers)

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Research

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12 pages, 2011 KiB

Open AccessArticle

Assessment of Asymptomatic Severe Aortic Regurgitation by Doppler-Derived Echo Indices: Comparison with Magnetic Resonance Quantification

by Zuzana Hlubocká, Radka Kočková, Hana Línková, Alena Pravečková, Jaroslav Hlubocký, Gabriela Dostálová, Martin Bláha, Martin Pěnička and Aleš Linhart

J. Clin. Med. 2022, 11(1), 152; https://doi.org/10.3390/jcm11010152 - 28 Dec 2021

Cited by 5 | Viewed by 2197

Abstract

Reliable quantification of aortic regurgitation (AR) severity is essential for clinical management. We aimed to compare quantitative and indirect echo-Doppler indices to quantitative cardiac magnetic resonance (CMR) parameters in asymptomatic chronic severe AR. Methods and Results: We evaluated 104 consecutive patients using echocardiography and CMR. A comprehensive 2D, 3D, and Doppler echocardiography was performed. The CMR was used to quantify regurgitation fraction (RF) and volume (RV) using the phase-contrast velocity mapping technique. Concordant grading of AR severity with both techniques was observed in 77 (74%) patients. Correlation between RV and RF as assessed by echocardiography and CMR was relatively good (r_s = 0.50 for RV, r_s = 0.40 for RF, p < 0.0001). The best correlation between indirect echo-Doppler and CMR parameters was found for diastolic flow reversal (DFR) velocity in descending aorta (r_s = 0.62 for RV, r_s = 0.50 for RF, p < 0.0001) and 3D vena contracta area (VCA) (r_s = 0.48 for RV, r_s = 0.38 for RF, p < 0.0001). Using receiver operating characteristic analysis, the largest area under curve (AUC) to predict severe AR by CMR RV was observed for DFR velocity (AUC = 0.79). DFR velocity of 19.5 cm/s provided 78% sensitivity and 80% specificity. The AUC for 3D VCA to predict severe AR by CMR RV was 0.73, with optimal cut-off of 26 mm² (sensitivity 80% and specificity 66%). Conclusions: Out of the indirect echo-Doppler indices of AR severity, DFR velocity in descending aorta and 3D vena contracta area showed the best correlation with CMR-derived RV and RF in patients with chronic severe AR. Full article

(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)

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10 pages, 10821 KiB

Open AccessArticle

Implications of Elevated Fibrosis-4 Index in Patients Receiving Trans-Catheter Aortic Valve Replacement

by Teruhiko Imamura, Nikhil Narang, Hiroshi Onoda, Shuhei Tanaka, Ryuichi Ushijima, Mitsuo Sobajima, Nobuyuki Fukuda, Hiroshi Ueno and Koichiro Kinugawa

J. Clin. Med. 2021, 10(24), 5778; https://doi.org/10.3390/jcm10245778 - 10 Dec 2021

Cited by 2 | Viewed by 2132

Abstract

Background: The prognostic implication of the fibrosis-4 index, which represents the degree of hepatic injury, on patients receiving trans-catheter aortic valve replacement (TAVR) remains unknown. Methods: Patients who underwent TAVR to treat severe aortic stenosis at our institute between 2015 and 2020 were included in this retrospective study and followed for 2 years from the index discharge. The impact of the fibrosis-4 index, which was calculated using age, hepatic enzymes, and platelet count, on 2-year heart failure readmissions was investigated. Results: A total of 272 patients (median age 85 (82, 88) years old, 76 (28%) men) were included. The median baseline fibrosis-4 index was 2.8 (2.2, 3.7). A high fibrosis-4 index (>3.79) was associated with higher cumulative incidence of the primary endpoint (18% versus 4%, p < 0.001) and higher event rates (0.1041 versus 0.0222 events/year, p < 0.001), with an adjusted hazard ratio of 1.27 (95% confidence interval 1.04–1.54, p = 0.019). Conclusion: an elevated fibrosis-4 index at baseline, indicating the existence of persistent hepatic congestion, was associated with incidences of heart failure following TAVR. Calculating the fibrosis-4 index before TAVR is highly encouraged for risk stratification and shared decision making. Full article

(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)

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17 pages, 1022 KiB

Open AccessArticle

Impact of Rhythm vs. Rate Control in Atrial Fibrillation on the Long-Term Outcome of Patients Undergoing Transcatheter Edge-to-Edge Mitral Valve Repair

by Christian Waechter, Felix Ausbuettel, Georgios Chatzis, Juan Cheko, Dieter Fischer, Holger Nef, Sebastian Barth, Philipp Halbfass, Thomas Deneke, Sebastian Kerber, Jan Kikec, Hans-Helge Mueller, Dimitar Divchev, Bernhard Schieffer and Ulrich Luesebrink

J. Clin. Med. 2021, 10(21), 5044; https://doi.org/10.3390/jcm10215044 - 28 Oct 2021

Cited by 3 | Viewed by 1956

Abstract

Atrial fibrillation (AF) is a highly prevalent comorbidity in patients with severe mitral valve regurgitation (MR) undergoing transcatheter mitral valve repair (TMVR) and has been shown to significantly worsen their outcome. However, data on the impact of AF treatment strategy in this rapidly growing cohort of patients is unknown. In a multicenter, observational cohort study, 542 consecutive patients undergoing TMVR were enrolled, and subsequently, comprehensive survival analyses according to AF status and therapy were performed using propensity score matching and Cox regression. In the analyzed cohort, 373 (73.3%) of the TMVR patients had concomitant AF. Of these patients, 212 (59%) were on rate control therapy and 161 (41%) were on rhythm control therapy. At 3 years, significantly reduced cumulative survival was observed for patients on rhythm compared to patients on rate control (46.7% (75/161) vs. 56.5% (91/161), p = 0.032). Amiodarone was used to a substantial extent for rhythm control and found to be an independent mortality predictor (Hazard Ratio 1.5, 95%CI 1.1–2.1, p = 0.04). The adverse outcome of concomitant AF in TMVR patients was confirmed (AF: 47.3% (126/266) vs. non-AF: 58.3% (78/133), p = 0.047). Rhythm control achieved almost exclusively pharmacologically is associated with an adverse outcome compared to the rate control of AF in TMVR. This raises awareness of the importance of AF and its treatment, as this seems to be a promising key point for improving the prognosis of TMVR patients. Full article

(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)

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25 pages, 1901 KiB

Open AccessArticle

What Can We Learn from the Past by Means of Very Long-Term Follow-Up after Aortic Valve Replacement?

by Ben Swinkels, Jurriën ten Berg, Johannes Kelder, Freddy Vermeulen, Wim Jan van Boven and Bas de Mol

J. Clin. Med. 2021, 10(17), 3925; https://doi.org/10.3390/jcm10173925 - 31 Aug 2021

Cited by 2 | Viewed by 1736

Abstract

Background: Studies on very long-term outcomes after aortic valve replacement are sparse. Methods: In this retrospective cohort study, long-term outcomes during 25.1 ± 2.8 years of follow-up were determined in 673 patients who underwent aortic valve replacement with or without concomitant coronary artery bypass surgery for severe aortic stenosis and/or regurgitation. Independent predictors of decreased long-term survival were determined. Cumulative incidence rates of major adverse events in patients with a mechanical versus those with a biologic prosthesis were assessed, as well as of major bleeding events in patients with a mechanical prosthesis under the age of 60 versus those above the age of 60. Results: Impaired left ventricular function, severe prosthesis–patient mismatch, and increased aortic cross-clamp time were independent predictors of decreased long-term survival. Left ventricular hypertrophy, a mechanical or biologic prosthesis, increased cardiopulmonary bypass time, new-onset postoperative atrial fibrillation, and the presence of symptoms did not independently predict decreased long-term survival. The risk of major bleeding events was higher in patients with a mechanical in comparison with those with a biologic prosthesis. Younger age (under 60 years) did not protect patients with a mechanical prosthesis against major bleeding events. Conclusions: Very long-term outcome data are invaluable for careful decision-making on aortic valve replacement. Full article

(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)

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11 pages, 1667 KiB

Open AccessArticle

Long-Term Results (up to 20 Years) of 19 mm or Smaller Prostheses in the Aortic Position. Does Size Matter? A Propensity-Matched Survival Analysis

by Horea Feier, Andrei Grigorescu, Lucian Falnita, Oana Rachita, Marian Gaspar and Constantin T. Luca

J. Clin. Med. 2021, 10(10), 2055; https://doi.org/10.3390/jcm10102055 - 11 May 2021

Viewed by 1873

Abstract

Background: The long-term performance of prostheses in the small aortic root is still unclear. Methods: Patients who received a 21 mm or smaller aortic valve between 2000–2018 were retrospectively analyzed. Propensity matching was used in order to account for baseline differences in 19 mm vs. 21 mm valve subgroups. Results: Survival at 10 years was 55.87 ± 5.54% for 19 mm valves vs. 57.17 ± 2.82% for 21 mm ones in the original cohort (p = 0.37), and 58.69 ± 5.61% in 19 mm valve recipients vs. 53.60 ± 5.66% for 21 mm valve subgroups in the matched cohort (p = 0.55). Smaller valves exhibited significantly more patient–prothesis mismatch (PPM) than larger ones (87.30% vs. 57.94%, p < 0.01). All-cause mortality was affected by PPM at 10 years (52.66 ± 3.28% vs. 64.38 ± 3.87%, p = 0.04) in the unmatched population. This difference disappeared, however, after matching: survival at 10 years was 51.82 ± 5.26% in patients with PPM and 63.12 ± 6.43% in patients without PPM. (p = 0.14) Conclusions: There is no survival penalty in using 19 mm prostheses in the small aortic root in the current era. Although PPM is more prevalent in smaller sized valve recipients, this does not translate into reduced survival at 10 years of follow-up. Full article

(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)

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8 pages, 1084 KiB

Open AccessArticle

Mitral Valve Annulus Dimensions Assessment with Three-Dimensional Echocardiography Versus Computed Tomography: Implications for Transcatheter Interventions

by Kensuke Hirasawa, N. Mai Vo, Tea Gegenava, Stephan Milhorini Pio, Suzanne E. van Wijngaarden, Nina Ajmone Marsan, Jeroen J. Bax and Victoria Delgado

J. Clin. Med. 2021, 10(4), 649; https://doi.org/10.3390/jcm10040649 - 8 Feb 2021

Cited by 4 | Viewed by 3240

Abstract

The aim of this study is to evaluate the agreement between three-dimensional (3D) transesophageal echocardiography (TEE) and multidetector computed tomography (MDCT) for assessing mitral annular (MA) dimensions. A total of 105 patients (79 ± 9 years old, 52% male) who underwent clinically indicated 3D TEE and MDCT feasible for MA geometrical assessment were included. Using dedicated semi-automated postprocessing software, MA geometry, including mitral annular area (MAA), perimeter, septal-lateral (SL) diameter, and inter-trigonal (TT) diameter, was evaluated using 3D TEE and MDCT. Compared to 3D TEE, MAA, perimeter, and SL distance measured on MDCT data were larger (9.9 ± 3.0 vs. 9.3 ± 3.1 cm² for MAA; 115 ± 18 vs. 108 ± 18 mm for perimeter; and 35 ± 5 vs. 32 ± 5 cm for SL distance, all p < 0.001). By contrast, the TT distance was comparable between MDCT and 3D TEE (26 ± 4 vs. 26 ± 4 cm, p = 0.258). The correlations of all the MA dimensions were good to excellent between the two modalities (R = 0.911 for MAA, 0.890 for perimeter, 0.739 for TT distance, and 0.857 for SL distance, respectively, all p < 0.001). This study showed good agreement between 3D TEE- and MDCT-derived MA measurements although MDCT systematically provided larger MAA, perimeter, and SL distance compared with 3D TEE. Full article

(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)

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Review

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17 pages, 2928 KiB

Open AccessReview

Diagnosis and Management of Aortic Valve Stenosis: The Role of Non-Invasive Imaging

by Gloria Santangelo, Andrea Rossi, Filippo Toriello, Luigi Paolo Badano, David Messika Zeitoun and Pompilio Faggiano

J. Clin. Med. 2021, 10(16), 3745; https://doi.org/10.3390/jcm10163745 - 23 Aug 2021

Cited by 6 | Viewed by 6568

Abstract

Aortic stenosis is the most common heart valve disease necessitating surgical or percutaneous intervention. Imaging has a central role for the initial diagnostic work-up, the follow-up and the selection of the optimal timing and type of intervention. Referral for aortic valve replacement is currently driven by the severity and by the presence of aortic stenosis-related symptoms or signs of left ventricular systolic dysfunction. This review aims to provide an update of the imaging techniques and seeks to highlight a practical approach to help clinical decision making. Full article

(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)

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11 pages, 1128 KiB

Open AccessReview

Surgical Aortic Mitral Curtain Replacement: Systematic Review and Metanalysis of Early and Long-Term Results

by Ilaria Giambuzzi, Giorgia Bonalumi, Michele Di Mauro, Maurizio Roberto, Silvia Corona, Francesco Alamanni and Marco Zanobini

J. Clin. Med. 2021, 10(14), 3163; https://doi.org/10.3390/jcm10143163 - 17 Jul 2021

Cited by 17 | Viewed by 3124

Abstract

The Commando procedure is challenging, and aims to replace the mitral valve, the aortic valve and the aortic mitral curtain, when the latter is severely affected by pathological processes (such as infective endocarditis or massive calcification). Given the high complexity, it is seldomly performed. We aim to review the literature on early (hospitalization and up to 30 days) and long-term (at least 3 years of follow-up) results. Bibliographical research was performed on PubMed and Cochrane with a dedicated string. Papers regarding double valve replacement or repair in the context of aortic mitral curtain disease were included. The metaprop function was used to assess early survival and complications (pacemaker implantation, stroke and bleeding). Nine papers (540 patients, median follow-up 41 (IQR 24.5–51.5) months) were included in the study. Pooled proportion of early mortality, stroke, pacemaker implant and REDO for bleeding were, respectively 16.2%, 7.8%, 25.1% and 13.1%. The long-term survival rate ranged from 50% to 92.2%. Freedom from re-intervention was as high as 90.9% when the endocarditis was not the first etiology and 78.6% in case of valvular infection (one author had 100%). Freedom from IE recurrences reached 85% at 10 years. Despite the high mortality, the rates of re-intervention and infective endocarditis recurrences following the Commando procedure are satisfactory and confirm the need for an aggressive strategy to improve long-term outcomes. Full article

(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)

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11 pages, 2750 KiB

Open AccessReview

Novelties in 3D Transthoracic Echocardiography

by Gianpiero Italiano, Laura Fusini, Valentina Mantegazza, Gloria Tamborini, Manuela Muratori, Sarah Ghulam Ali, Marco Penso, Anna Garlaschè, Paola Gripari and Mauro Pepi

J. Clin. Med. 2021, 10(3), 408; https://doi.org/10.3390/jcm10030408 - 21 Jan 2021

Cited by 10 | Viewed by 2775

Abstract

Cardiovascular imaging is developing at a rapid pace and the newer modalities, in particular three-dimensional echocardiography, allow better analysis of heart structures. Identifying valve lesions and grading their severity represents crucial information and nowadays is strengthened by the introduction of new software, such as transillumination, which provide detailed morphology descriptions. Chambers quantification has never been so rapid and accurate: machine learning algorithms generate automated volume measurements, including left ventricular systolic and diastolic function, which is extremely important for clinical decisions. This review provides an overview of the latest innovations in the echocardiography field, and is helpful by providing a better insight into heart diseases. Full article

(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)

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2 pages, 169 KiB

Open AccessReply

Reply to Chen et al. Improvements in Outcomes and Expanding Indications for the Commando Procedure. Comment on “Giambuzzi et al. Surgical Aortic Mitral Curtain Replacement: Systematic Review and Metanalysis of Early and Long-Term Results. J. Clin. Med. 2021, 10, 3163”

by Ilaria Giambuzzi, Giorgia Bonalumi, Michele Di Mauro, Francesco Alamanni and Marco Zanobini

J. Clin. Med. 2022, 11(6), 1601; https://doi.org/10.3390/jcm11061601 - 14 Mar 2022

Viewed by 1323

Abstract

We would like to thank Lin Chen et al. [...] Full article

(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)

2 pages, 157 KiB

Open AccessComment

Improvements in Outcomes and Expanding Indications for the Commando Procedure. Comment on Giambuzzi et al. Surgical Aortic Mitral Curtain Replacement: Systematic Review and Metanalysis of Early and Long-Term Results. J. Clin. Med. 2021, 10, 3163

by Lin Chen, Rashed Mahboubi, Mona Kakavand, Ozgun Erten, Eugene H. Blackstone and Douglas R. Johnston

J. Clin. Med. 2022, 11(4), 1125; https://doi.org/10.3390/jcm11041125 - 21 Feb 2022

Cited by 2 | Viewed by 1601

Abstract

We read with interest the authors’ review and metanalysis of the Commando procedure in “Surgical Aortic Mitral Curtain Replacement: Systematic Review and Metanalysis of Early and Long-Term Results” [...] Full article

(This article belongs to the Special Issue Valvular Heart Disease: A World in Constant Motion)

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