Publications by authors named "Yohann Bohbot"

46 Publications

Rational and Design of the SIMULATOR Study: A Multicentre Randomized Study to Assess the Impact of SIMULation-bAsed Training on Transoesophageal echocardiOgraphy leaRning for Cardiology Residents.

Front Cardiovasc Med 2021 24;8:661355. Epub 2021 May 24.

Department of Cardiovascular Explorations and Echocardiography-Heart Valve Clinic, CHU Lille, Lille, France.

Simulation-based training in transesophageal echocardiography (TEE) seems promising. However, data are limited to non-randomized or single-center studies. To assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology. Nationwide prospective randomized multicenter study involving 43 centers throughout France allowing for the inclusion of >70% of all French cardiology residents. All cardiology residents naive from TEE will be included. Randomization with stratification by center will allocate residents to either a control group receiving theoretical knowledge by e-learning only, or to an intervention group receiving two simulation-based training sessions on a TEE simulator in addition. All residents will undergo both a theoretical test (0-100 points) and a practical test on a TEE simulator (0-100 points) before and 3 months after the training. Satisfaction will be assessed by a 5-points Likert scale. The primary outcomes will be to compare the scores in the final theoretical and practical tests between the two groups, 3 months after the completion of the training. Data regarding simulation-based learning in TEE are limited to non-randomized or single-center studies. The randomized multicenter SIMULATOR study will assess the impact of simulation-based vs. traditional teaching on TEE knowledge and performance for medical residents in cardiology, and whether such an educational program should be proposed in first line for TEE teaching.
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http://dx.doi.org/10.3389/fcvm.2021.661355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180582PMC
May 2021

Non-contrast myocardial T1 global and regional reference values at 3 Tesla cardiac magnetic resonance in aortic stenosis.

Arch Cardiovasc Dis 2021 Apr 11;114(4):293-304. Epub 2021 Mar 11.

Monaco cardiothoracic centre, 11 bis, avenue d'Ostende, 98000 MC, Monaco. Electronic address:

Background: T1 mapping using cardiac magnetic resonance (CMR) was recently proposed as a promising non-contrast imaging technique for the assessment of diffuse myocardial fibrosis (MF) in aortic stenosis (AS).

Aims: To provide reference values for native T1 mapping at 3 Tesla magnetic field strength in subjects with moderate or severe AS and in control subjects; to identify factors associated with the presence of diffuse MF in severe AS; to assess the regional distribution of diffuse MF; and to compare the level of diffuse MF in the different types of AS, stratified by flow and gradient patterns.

Methods: Retrospective study based on 160 consecutive patients with moderate (n=11) to severe (n=149) AS and 47 control subjects referred for CMR.

Results: Mean native T1 increased progressively across controls (1221±23ms), moderate AS (1249±26ms) and severe AS (1273±43ms). T1 times correlated significantly with left ventricular (LV) remodelling (indexed LV mass and LV diastolic volume) and functional LV alterations (global longitudinal strain and LV ejection fraction). Native T1 appears to be elevated in the basal segments of the septum in moderate AS, and to extend to midventricular and apical segments in severe AS. Mean T1 time was higher in classical low-flow/low-gradient AS (1295±62ms) than in the other types of AS (P=0.006). The level of diffuse MF in paradoxical low-flow/low-gradient AS (1280±42ms) was higher than in moderate AS, but similar to that in high-gradient AS (1271±42ms) (P=0.07).

Conclusions: Assessment of diffuse MF in AS using T1 mapping is feasible and reproducible in clinical practice. T1 value increases with AS severity, along with morphological and functional LV alterations, particularly in the basal segments of the septum.
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http://dx.doi.org/10.1016/j.acvd.2020.11.009DOI Listing
April 2021

Clinical Outcomes of Adults With Bicuspid Aortic Valve: A European Perspective.

Mayo Clin Proc 2021 03;96(3):648-657

Department of Cardiology, Amiens University Hospital, France; EA 7517 MP3CV Université de Picardie Jules Verne, Amiens, France. Electronic address:

Objective: To describe the clinical history of patients with a wide age range diagnosed with bicuspid aortic valve (BAV) and no surgical indication and to evaluate the long-term outcome of patients with BAV referred for elective surgery.

Patients And Methods: Between 2005 and 2017, 350 consecutive patients with no surgical indication (surveillance group, mean age 53±16, 71% men) and 191 with a surgical indication (surgical group, mean age 59±13, 71% men) were prospectively included. Median follow-up was 80 (32 to 115) months.

Results: In the surveillance group, the 5-year and 10-year survival rates were 93±1% and 89±2%, respectively, with a relative survival of patients with BAV compared with an age- and sex-matched control population of 98.7%. During follow-up, the cumulative 10-year incidence of aortic valve and aorta surgery was high; of 35±4%, the incidence of native valve infective endocarditis (IE) of 0.2% per patient-year, and no cases of aortic dissection were observed. In the surgical group, the 5-year and 10-year survival rates were 97±1% and 89±3%, respectively, with a relative survival of 99.4% compared with the general population. The incidence of IE was 0.4% per patient-year, and no cases of aortic dissection were observed.

Conclusion: This regional cohort shows that the 10-year survival rates of patients with BAV and a wide age range, but mostly middle-aged adults, were similar to those of the general population with a very low rate of complications. Adherence to prophylactic surgical indications and younger age might have contributed to this lack of difference.
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http://dx.doi.org/10.1016/j.mayocp.2020.04.047DOI Listing
March 2021

Usefulness of Right Ventricular Longitudinal Shortening Fraction to Detect Right Ventricular Dysfunction in Acute Cor Pulmonale Related to COVID-19.

J Cardiothorac Vasc Anesth 2021 Jan 18. Epub 2021 Jan 18.

Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France.

Objective: To compare two-dimensional-speckle tracking echocardiographic parameters (2D-STE) and classic echocardiographic parameters of right ventricular (RV) systolic function in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (CARDS) complicated or not by acute cor pulmonale (ACP).

Design: Prospective, between March 1, 2020 and April 15, 2020.

Setting: Intensive care unit of Amiens University Hospital (France).

Participants: Adult patients with moderate-to-severe CARDS under mechanical ventilation for fewer than 24 hours.

Interventions: None.

Measurements And Main Results: Tricuspid annular displacement (TAD) parameters (TAD-septal, TAD-lateral, and RV longitudinal shortening fraction [RV-LSF]), RV global longitudinal strain (RV-GLS), and RV free wall longitudinal strain (RVFWLS) were measured using transesophageal echocardiography with a dedicated software and compared with classic RV systolic parameters (RV-FAC, S' wave, and tricuspid annular plane systolic excursion [TAPSE]). RV systolic dysfunction was defined as RV-FAC <35%. Twenty-nine consecutive patients with moderate-to-severe CARDS were included. ACP was diagnosed in 12 patients (41%). 2D-STE parameters were markedly altered in the ACP group, and no significant difference was found between patients with and without ACP for classic RV parameters (RV-FAC, S' wave, and TAPSE). In the ACP group, RV-LSF (17% [14%-22%]) had the best correlation with RV-FAC (r = 0.79, p < 0.001 v r = 0.27, p = 0.39 for RVGLS and r = 0.28, p = 0.39 for RVFWLS). A RV-LSF cut-off value of 17% had a sensitivity of 80% and a specificity of 86% to identify RV systolic dysfunction.

Conclusions: Classic RV function parameters were not altered by ACP in patients with CARDS, contrary to 2D-STE parameters. RV-LSF seems to be a valuable parameter to detect early RV systolic dysfunction in CARDS patients with ACP.
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http://dx.doi.org/10.1053/j.jvca.2021.01.025DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7832272PMC
January 2021

Excess Mortality and Undertreatment of Women With Severe Aortic Stenosis.

J Am Heart Assoc 2021 Jan 29;10(1):e018816. Epub 2020 Dec 29.

Division of Cardiology Mayo Clinic Rochester MN.

Background Although women represent half of the population burden of aortic stenosis (AS), little is known whether sex affects the presentation, management, and outcome of patients with AS. Methods and Results In a cohort of 2429 patients with severe AS (49.5% women) we aimed to evaluate 5-year excess mortality and performance of aortic valve replacement (AVR) stratified by sex. At presentation, women were older (<0.001), with less comorbidities (=0.030) and more often symptomatic (=0.007) than men. Women had smaller aortic valve area (<0.001) than men but similar mean transaortic pressure gradient (=0.18). The 5-year survival was lower compared with expected survival, especially for women (62±2% versus 71% for women and 69±1% versus 71% for men). Despite longer life expectancy in women than men, women had lower 5-year survival than men (66±2% [expected-75%] versus 68±2% [expected-70%], <0.001) after matching for age. Overall, 5-year AVR incidence was 79±2% for men versus 70±2% for women (<0.001) with male sex being independently associated with more frequent early AVR performance (odds ratio, 1.49; 1.18-1.97). After age matching, women remained more often symptomatic (=0.004) but also displayed lower AVR use (64.4% versus 69.1%; =0.018). Conclusions Women with severe AS are diagnosed at later ages and have more symptoms than men. Despite prevalent symptoms, AVR is less often performed in women and 5-year excess mortality is noted in women versus men, even after age matching. These imbalances should be addressed to ensure that both sexes receive equivalent care for severe AS.
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http://dx.doi.org/10.1161/JAHA.120.018816DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955469PMC
January 2021

Normative Reference Values of Cardiac Output by Pulsed-Wave Doppler Echocardiography in Adults.

Am J Cardiol 2021 02 2;140:128-133. Epub 2020 Nov 2.

Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France; EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France. Electronic address:

Cardiac output (CO) is routinely assessed by pulsed-wave Doppler echocardiography, yet reference values in adults are lacking. We aim to establish normative values of CO and cardiac index (CI) by pulsed-wave Doppler-echocardiography and to analyze their relation with gender and age in nonobese and obese adults. We included 4,040 adults (mean age: 55 years, 53% women, 950 obese [body mass index ≥30 kg/m²]) with normal blood pressure, no history of cardiovascular disease, and normal transthoracic echocardiography. Normative reference CO and CI values for were calculated in 3,090 nonobese patients by quantile regression. CO normal limits were lower in females than in males (lower limit: 3.3 vs 3.5 L/min, upper limit: 7.3 vs 8.2 L/min). CI normal limits were identical for both genders (lower limit: 1.9 L/min/m², upper limit: 4.3 L/min/m²). Although the relation of CO to age was weak and observed only in women, CI of both genders was not influenced by age. CO of obese patients was significantly greater than that of their nonobese counterparts. CI of obese patients was not influenced by age and gender and was not significantly different than that of nonobese patients (lower limit 1.8 L/min/m², upper limit 4.1 L/min/m² for both genders). In conclusion, in a large adult population we establish normative reference values for CO and CI measured by Doppler-echocardiography. CI is a remarkably stable parameter that is not influenced by age, gender, and body size and should be used to define low- and high-output states.
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http://dx.doi.org/10.1016/j.amjcard.2020.10.046DOI Listing
February 2021

Dimensionless Index in Patients With Low-Gradient Severe Aortic Stenosis and Preserved Ejection Fraction.

Circ Cardiovasc Imaging 2020 10 20;13(10):e010925. Epub 2020 Oct 20.

Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'échocardiographie, Service de Cardiologie Nord, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, France (A.A., N.T., W.M., B.L., P.P., S.M.).

Background Risk stratification of patients with low-gradient (LG) severe aortic stenosis (AS) despite preserved left ventricular ejection fraction remains challenging. We sought to evaluate the relationship between the dimensionless index (DI)-the ratio of the left ventricular outflow tract time-velocity integral to that of the aortic valve jet-and mortality in these patients. Methods Seven hundred fifty-five patients with LG severe AS (defined by aortic valve area ≤1 cm or aortic valve area indexed to body surface area ≤0.6 cm/m and mean aortic pressure gradient <40 mm Hg) and preserved left ventricular ejection fraction ≥50% were studied. Flow status was defined according to stroke volume index <35 mL/m (low flow, LF) or ≥35 mL/m (normal flow, NF). Results After adjustment for age, sex, body mass index, Charlson comorbidity index, history of hypertension, history of atrial fibrillation, AS-related symptoms, left ventricular ejection fraction, indexed left ventricular ventricular mass, aortic valve area, and aortic valve replacement as a time-dependent covariate, patients with LG-LF and DI<0.25 exhibited a considerable increased risk of death compared with patients with LG-NF and DI≥0.25 (adjusted hazard ratio, 2.41 [95% CI, 1.61-3.62]; <0.001), LG-NF and DI<0.25 (adjusted hazard ratio, 1.84 [95% CI, 1.24-2.73]; =0.003), and LG-LF and D≥0.25 (adjusted hazard ratio, 2.27 [95% CI, 1.42-3.63]; <0.001). In contrast, patients with LG-LF and DI≥0.25, LG-NF and DI<0.25, and LG-NF and DI≥0.25 had similar outcome. DI<0.25 showed incremental prognostic value in patients with LG-LF severe AS but not in patients with LG-NF severe AS. Conclusions Among patients with LG severe AS and preserved left ventricular ejection fraction, decreased DI<0.25 is a reliable parameter in patients with LF to identify a subgroup of patients at higher risk of death who may derive benefit from aortic valve replacement.
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http://dx.doi.org/10.1161/CIRCIMAGING.120.010925DOI Listing
October 2020

Reproducibility of reading echocardiographic parameters to assess severity of mitral regurgitation. Insights from a French multicentre study.

Arch Cardiovasc Dis 2020 Oct 29;113(10):599-606. Epub 2020 Sep 29.

Department of Cardiology and Heart Valve Center, University Hospital of Rangueil, Toulouse 31400, France.

Background: Poor reproducibility in assessment of mitral regurgitation (MR) has been reported.

Aim: To investigate the robustness of echocardiographic MR assessment in 2019, based on improvements in technology and the skill of echocardiographists regarding MR quantification.

Methods: Reproducibility in parameters of MR severity and global rating were tested using transthoracic echocardiography in 25 consecutive patients independently analysed by 16 junior and senior cardiologists specialized in echocardiography (400 analyses per parameter).

Results: Overall interobserver agreement for mechanism definition, effective regurgitant orifice area (EROA) and regurgitant volume (RVol) was moderate, and was lower in secondary MR. Interobserver agreement was substantial for EROA [0.61, 95% confidence interval (CI) 0.45-0.75] and moderate for RVol with the PISA method (0.50, 95% CI 0.33-0.56) in senior physicians and was fair in junior physicians (0.33, 95% CI 0.19-0.51 and 0.36, 95% CI 0.36-0.43, respectively). Using a multiparametric approach, overall interobserver agreement for grading MR severity was fair (0.30), was slightly better in senior than in junior physicians (0.31 vs. 0.28, respectively) with substantial or almost perfect agreement more frequently observed in senior versus junior physicians (52% vs. 36%, respectively).

Conclusion: Reproducible transthoracic echocardiography MR quantification remains challenging in 2019, despite the expected high skills of echocardiographers regarding MR at the time of dedicated percutaneous intervention. The multiparametric approach does not entirely alleviate the substantial dispersion in measurement of MR severity parameters, whereas reader experience seems to partially address the issue. Our study emphasizes the continuing need for multimodality imaging and education in the evaluation of MR among cardiologists.
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http://dx.doi.org/10.1016/j.acvd.2020.02.004DOI Listing
October 2020

Isolated tricuspid valve surgery: impact of aetiology and clinical presentation on outcomes.

Eur Heart J 2020 12;41(45):4304-4317

Department of Cardiology, University of Ottawa Heart Institute, 40 ruskin street, Ottawa, Ontario, Canada.

Aims: The aim of this study was to identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) and more specifically the impact of tricuspid regurgitation (TR) mechanism and clinical presentation.

Methods And Results: Among 5661 consecutive adult patients who underwent a tricuspid valve (TV) surgery at 12 French tertiary centres in 2007-2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease [47% in New York Heart Association (NYHA) III/IV, 57% with right-sided heart failure (HF) signs]. Tricuspid regurgitation was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31%, respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14% vs. 6%, P = 0.004), but presentation was more severe. Independent determinants of outcomes were NYHA Class III/IV [odd ratios (OR) = 2.7 (1.2-6.1), P = 0.01], moderate/severe right ventricular dysfunction [OR = 2.6 (1.2-5.8), P = 0.02], lower prothrombin time [OR = 0.98 (0.96-0.99), P = 0.008], and with borderline statistical significance, right-sided HF signs [OR = 2.4 (0.9-6.5), P = 0.06] while TR mechanism was not [OR = 0.7 (0.3-1.8), P = 0.88].

Conclusion: Isolated TV surgery was associated with high mortality and morbidity, both in hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease.
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http://dx.doi.org/10.1093/eurheartj/ehaa643DOI Listing
December 2020

Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement.

J Am Heart Assoc 2020 10 23;9(19):e017190. Epub 2020 Sep 23.

Department of Cardiology Amiens University Hospital Amiens France.

Background The prognostic significance of chronic kidney disease (CKD) in severe aortic stenosis is poorly understood and no studies have yet evaluated the effect of aortic-valve replacement (AVR) versus conservative management on long-term mortality by stage of CKD. Methods and Results We included 4119 patients with severe aortic stenosis. The population was divided into 4 groups according to the baseline estimated glomerular filtration rate: no CKD, mild CKD, moderate CKD, and severe CKD. The 5-year survival rate was 71±1% for patients without CKD, 62±2% for those with mild CKD, 54±3% for those with moderate CKD, and 34±4% for those with severe CKD (<0.001). By multivariable analysis, patients with moderate or severe CKD had a significantly higher risk of all-cause (hazard ratio [HR] [95% CI]=1.36 [1.08-1.71]; =0.009 and HR [95% CI]=2.16 [1.67-2.79]; <0.001, respectively) and cardiovascular mortality (HR [95% CI]=1.39 [1.03-1.88]; =0.031 and HR [95% CI]=1.69 [1.18-2.41]; =0.004, respectively) than patients without CKD. Despite more symptoms, AVR was less frequent in moderate (=0.002) and severe CKD (<0.001). AVR was associated with a marked reduction in all-cause and cardiovascular mortality versus conservative management for each CKD group (all <0.001). The joint-test showed no interaction between AVR and CKD stages (=0.676) indicating a nondifferentialeffect of AVR across stages of CKD. After propensity matching, AVR was still associated with substantially better survival for each CKD stage relative to conservative management (all <0.0017). Conclusions In severe aortic stenosis, moderate and severe CKD are associated with increased mortality and decreased referral to AVR. AVR markedly reduces all-cause and cardiovascular mortality, regardless of the CKD stage. Therefore, CKD should not discourage physicians from considering AVR.
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http://dx.doi.org/10.1161/JAHA.120.017190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792421PMC
October 2020

Severe Aortic Stenosis and Chronic Kidney Disease: Outcomes and Impact of Aortic Valve Replacement.

J Am Heart Assoc 2020 10 23;9(19):e017190. Epub 2020 Sep 23.

Department of Cardiology Amiens University Hospital Amiens France.

Background The prognostic significance of chronic kidney disease (CKD) in severe aortic stenosis is poorly understood and no studies have yet evaluated the effect of aortic-valve replacement (AVR) versus conservative management on long-term mortality by stage of CKD. Methods and Results We included 4119 patients with severe aortic stenosis. The population was divided into 4 groups according to the baseline estimated glomerular filtration rate: no CKD, mild CKD, moderate CKD, and severe CKD. The 5-year survival rate was 71±1% for patients without CKD, 62±2% for those with mild CKD, 54±3% for those with moderate CKD, and 34±4% for those with severe CKD (<0.001). By multivariable analysis, patients with moderate or severe CKD had a significantly higher risk of all-cause (hazard ratio [HR] [95% CI]=1.36 [1.08-1.71]; =0.009 and HR [95% CI]=2.16 [1.67-2.79]; <0.001, respectively) and cardiovascular mortality (HR [95% CI]=1.39 [1.03-1.88]; =0.031 and HR [95% CI]=1.69 [1.18-2.41]; =0.004, respectively) than patients without CKD. Despite more symptoms, AVR was less frequent in moderate (=0.002) and severe CKD (<0.001). AVR was associated with a marked reduction in all-cause and cardiovascular mortality versus conservative management for each CKD group (all <0.001). The joint-test showed no interaction between AVR and CKD stages (=0.676) indicating a nondifferentialeffect of AVR across stages of CKD. After propensity matching, AVR was still associated with substantially better survival for each CKD stage relative to conservative management (all <0.0017). Conclusions In severe aortic stenosis, moderate and severe CKD are associated with increased mortality and decreased referral to AVR. AVR markedly reduces all-cause and cardiovascular mortality, regardless of the CKD stage. Therefore, CKD should not discourage physicians from considering AVR.
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http://dx.doi.org/10.1161/JAHA.120.017190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7792421PMC
October 2020

Characteristics and Prognosis of Patients With Left-Sided Native Bivalvular Infective Endocarditis.

Can J Cardiol 2021 02 9;37(2):292-299. Epub 2020 Apr 9.

Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France. Electronic address:

Background: Most cases of left-sided native valve infective endocarditis (IE) involve a single valve and little is known concerning IE that simultaneously affects the aortic and mitral valves.

Methods: We aimed to determine the characteristics, identify the prognostic factors, and define the effect of early surgery for patients with left-sided native bivalvular IE. This analysis included 1340 consecutive patients who presented with definite acute left-sided native valve IE in a 2-centre cohort study.

Results: A bivalvular involvement was present in 257 patients (19%). Patients with bivalvular IE had more embolic events (P = 0.044), congestive heart failure (P = 0.016), vegetations, and perivalvular complications (both P < 0.001) than those with monovalvular IE. Early surgery was more frequent for patients with bivalvular IE (P < 0.001). Thirty-day mortality was higher for patients with bivalvular IE than for those with monovalvular IE (24.5% vs 17.6%; P = 0.008), even after adjustment (odds ratio, 1.86 [95% confidence interval, 1.26-2.73]; P < 0.001). Estimated 10-year survival was 70% ± 1% for monovalvular IE and 59% ± 3% for bivalvular IE (P = 0.002). Bivalvular IE was still associated with mortality in multivariable Cox analysis, after adjustment for covariates including age, neurological events, congestive heart failure, Staphylococcus spp infection, perivalvular complications, and early surgery (hazard ratio, 1.70 [95% confidence interval, 1.31-2.11]; P < 0.001). Early surgery was associated with increased survival for patients with bivalvular IE (79% ± 4% vs 35% ± 6%; P < 0.001).

Conclusions: Bivalvular involvement is frequent in left-sided native valve IE, is associated with more embolic events and congestive heart failure than monovalvular IE, and patients are at a high risk of death. Early surgery is associated with improved survival and should be systematically discussed in the absence of contraindication.
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http://dx.doi.org/10.1016/j.cjca.2020.03.046DOI Listing
February 2021

Improvement of the Prognosis Assessment of Severe Tricuspid Regurgitation by the Use of a Five-Grade Classification of Severity.

Am J Cardiol 2020 10 30;132:119-125. Epub 2020 Jun 30.

Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France. Electronic address:

It is well known that some patients present with "more than severe" tricuspid regurgitation (TR). We aimed to assess the prognosis of these very severe TR patients. We defined very severe TR using 3 simple echocardiographic parameters: a coaptation gap≥10mm, a laminar TR flow and a systolic reversal of the hepatic vein flow. We included 259 consecutive patients (76 ± 13 years; 46% men) with moderate-to-severe TR (n = 114) and severe TR (n = 145). The primary end point was the combination of hospitalisation for right heart failure (RHF) and cardiovascular mortality. Median follow-up was 24(7 to 47) months. In patients with severe TR, 52 (36%) met the definition of very severe TR. These patients were younger, had more history of RHF and were more frequently treated with loop diuretics than those with moderate-to-severe TR (all p < 0.001). Four-year event-free survival rates were 68 ± 5%, for moderate-to-severe TR, 48 ± 6% for severe TR and only 35 ± 7% for very-severe TR (p < 0.001). On multivariable analysis, after adjustment for outcome predictors including age, comorbidity, RHF, TR etiology, left and right ventricular dysfunction, and tricuspid valve surgery, patients with very severe TR had a worsened prognosis than those with moderate-to-severe TR (Adjusted Hazard Ratio [95% Confidence Interval] = 2.43 [1.18 to 5.53]; p = 0.002) and than those with severe TR (Adjusted Hazard Ratio [95% Confidence Interval] = 2.23 [1.06 to 5.56]; p = 0.015). In conclusion, very severe TR is frequent in patients with severe TR, corresponds to a more advanced stage of the disease and is associated with poor outcomes. Therefore, the use of a 5-grade classification of TR severity is justified in routine clinical practice. (ID-RCB: 2017-A03233-50).
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http://dx.doi.org/10.1016/j.amjcard.2020.06.044DOI Listing
October 2020

Mitral Regurgitation in Patients With Severe Aortic Regurgitation: When Misery Loves Company.

J Am Coll Cardiol 2020 07;76(3):247-250

Department of Cardiology, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium.

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http://dx.doi.org/10.1016/j.jacc.2020.05.055DOI Listing
July 2020

Progression of Normal Flow Low Gradient "Severe" Aortic Stenosis With Preserved Left Ventricular Ejection Fraction.

Am J Cardiol 2020 08 16;128:151-158. Epub 2020 May 16.

Department of Cardiology, Amiens University Hospital, Amiens, France; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France. Electronic address:

Normal-flow low-gradient severe aortic stenosis (NF-LG-SAS), defined by an aortic valve area (AVA) <1 cm², mean pressure gradient (MPG) <40 mm Hg and indexed stroke volume ≥35 ml/m², is the most prevalent form of low-gradient aortic stenosis (AS) with preserved ejection fraction (PEF). However, the true severity of AS in these patients is controversial. The aim of this Doppler echocardiographic study was to investigate changes over time in the hemodynamic severity of patients with NF-LG-SAS with PEF. We retrospectively identified 96 patients who had 2 Doppler echocardiographic examinations without an intervening event. After a median follow-up of 25 (interquartile range 15 to 52) months, progression was observed, with increased transaortic MPG (from 28 [25 to 33] to 39 [34 to 50] mm Hg; p<0.001), peak aortic jet velocity (from 3.46 [3.20 to 3.64] to 4.01 [3.70 to 4.39] m/s; p<0.001), and decreased AVA (from 0.87 [0.82 to 0.94] to 0.72 [0.62 to 0.81] cm²; p<0.001). Median annual rates of progression were 4.3 (1.7 to 8.1) mm Hg/year, 0.25 (0.08 to 0.44) m/s/year, and -0.05 (-0.10 to -0.02) cm²/year, respectively. There was no significant change in left ventricular ejection fraction over time (p = 0.74). At follow-up, 46 patients (48%) acquired the features of classical high-gradient severe AS (MPG ≥40 mm Hg). This study shows that most patients with NF-LG-SAS with PEF exhibit significant hemodynamic progression of AS severity without EF impairment. These findings suggest that NF-LG-SAS with PEF is an "intermediate" stage between moderate AS and classical high-gradient severe AS requiring close monitoring.
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http://dx.doi.org/10.1016/j.amjcard.2020.05.003DOI Listing
August 2020

Tricuspid Longitudinal Annular Displacement for the Assessment of Right Ventricular Systolic Dysfunction during Prone Positioning in Patients with COVID-19.

J Am Soc Echocardiogr 2020 08 20;33(8):1055-1057. Epub 2020 May 20.

Department of Anaesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France.

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http://dx.doi.org/10.1016/j.echo.2020.05.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237938PMC
August 2020

Spondylodiscitis complicating infective endocarditis.

Heart 2020 Dec 28;106(24):1914-1918. Epub 2020 May 28.

Cardiology Department, APHM, La Timone Hospital, Marseille, France

Objective: The primary objective was to assess the characteristics and prognosis of pyogenic spondylodiscitis (PS) in patients with infective endocarditis (IE). The secondary objectives were to assess the factors associated with occurrence of PS.

Methods: Prospective case-control bi-centre study of 1755 patients with definite IE with (n=150) or without (n=1605) PS. Clinical, microbiological and prognostic variables were recorded.

Results: Patients with PS were older (mean age 69.7±18 vs 66.2±14; p=0.004) and had more arterial hypertension (48% vs 34.5%; p<0.001) and autoimmune disease (5% vs 2%; p=0.03) than patients without PS. The lumbar vertebrae were the most frequently involved (84 patients, 66%), especially L4-L5. Neurological symptoms were observed in 59% of patients. Enterococci and were more frequent (24% vs 12% and 24% vs 11%; p<0001, respectively) in the PS group. The diagnosis of PS was based on contrast-enhanced MRI in 92 patients, bone CT in 88 patients and F-FDG PET/CT in 56 patients. In-hospital (16% vs 13.5%, p=0.38) and 1-year (21% vs 22%, p=0.82) mortalities did not differ between patients with or without PS.

Conclusions: PS is a frequent complication of IE (8.5% of IE), is observed in older hypertensive patients with enterococcal or IE, and has a similar prognosis than other forms of IE. Since PS is associated with specific management, multimodality imaging including MRI, CT and PET/CT should be used for early diagnosis of this complication of endocarditis.
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http://dx.doi.org/10.1136/heartjnl-2019-316492DOI Listing
December 2020

Aortic root dilatation in PFO-related cryptogenic stroke: A propensity score-matched analysis.

Echocardiography 2020 06 25;37(6):883-890. Epub 2020 May 25.

Department of Intensive Cardiac Care Unit, Amiens University Hospital, Amiens, France.

Background: Dilatation of the ascending aorta has an important role in the anatomical conformation of interatrial septum (IAS) especially when a patent foramen ovale (PFO) is present. The aim of the study was to investigate the relationship between ascending aortic dilation and PFO-related cryptogenic stroke in a cohort of cryptogenic strokes.

Methods: It is a retrospective, single-center echocardiographic study assessing aortic root dilatation in 315 consecutive patients with cryptogenic stroke between January 2011 and January 2019. Aortic root dilatation was defined by a diameter of the Valsalva sinuses of the proximal aorta >40 mm. Predictive factors of PFO were assessed by a multivariate analysis. Propensity score matching was applied to account for clinical differences.

Results: Of the 315 patients, 68 (22%) had an aortic root dilatation and 167 (53%) had a PFO. In the aortic root dilation group, PFO was more often diagnosed (n = 47/68 [69%], vs n = 120/247 [49%], P = .004). In the PFO group with aortic dilatation, IAS was more mobile (n = 37/47[79%] vs n = 69/120[57%], P < .012) and smaller (2.3 ± 0.5 vs 2.5 ± 0.5 mm, P < .009). On multivariate analysis, aortic root dilatation (OR: 2.6; 95% CI [1.2-5.6]; P = .001) and IAS hypermobility (OR: 5.2 95% CI [2.7-10]; P = .001) were associated with PFO. After propensity matching, aortic root dilatation remained strongly associated with PFO (n = 34/107 [32%] vs 15/107[14%], P = .002).

Conclusion: Aortic root dilation and IAS hypermobility were strongly associated with PFO-related cryptogenic stroke.
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http://dx.doi.org/10.1111/echo.14711DOI Listing
June 2020

Usefulness of Cardiac Magnetic Resonance Imaging in Aortic Stenosis.

Circ Cardiovasc Imaging 2020 05 6;13(5):e010356. Epub 2020 May 6.

Department of Cardiology (Y.B., C.T.), Amiens University Hospital, France.

The objective of this review is to provide an overview of the role of cardiac magnetic resonance (CMR) in aortic stenosis (AS). Although CMR is undeniably the gold standard for assessing left ventricular volume, mass, and function, the assessment of the left ventricular repercussions of AS by CMR is not routinely performed in clinical practice, and its role in evaluating and quantifying AS is not yet well established. CMR is an imaging modality integrating myocardial function and disease, which could be particularly useful in a pathology like AS that should be considered as a global myocardial disease rather than an isolated valve disease. In this review, we discuss the emerging potential of CMR for the diagnosis and prognosis of AS. We detail its utility for studying all aspects of AS, including valve anatomy, flow quantification, left ventricular volumes, mass, remodeling, and function, tissue mapping, and 4-dimensional flow magnetic resonance imaging. We also discuss different clinical situations where CMR could be useful in AS, for example, in low-flow low-gradient AS to confirm the low-flow state and to understand the reason for the left ventricular dysfunction or when there is a suspicion of associated cardiac amyloidosis.
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http://dx.doi.org/10.1161/CIRCIMAGING.119.010356DOI Listing
May 2020

Clinical significance of energy loss index in patients with low-gradient severe aortic stenosis and preserved ejection fraction.

Eur Heart J Cardiovasc Imaging 2020 06;21(6):608-615

Cardiology Department, Echocardiography Laboratory, Heart Valve Center, GCS-Groupement des Hôpitaux de l'Institut Catholique Lillois/Faculté de médecine et de maïeutique, UCLille, Rue du Grand But - BP 249 59462 Lomme Cedex, France.

Aims: We hypothesized that among patients with low-gradient severe aortic stenosis (AS) and preserved left ventricular ejection fraction (LVEF), reclassification of AS severity as moderate by pressure recovery adjusted indexed aortic valve area (AVAi) = energy loss index (ELI), may identify a subgroup of patients with a better outcome.

Methods And Results: Three hundred and seventy-nine patients with low-gradient AS (defined by AVAi ≤ 0.6 cm2/m2 and mean aortic pressure gradient < 40 mmHg) and preserved LVEF ≥50% were studied. Reclassification as moderate AS by ELI was defined as AVAi ≤0.6 cm2/m2 but with an ELI >0.6 cm2/m2. Cardiac events [cardiac mortality and/or need for aortic valve replacement (AVR)] during follow-up were studied. One hundred and forty-eight patients (39%) were reclassified as moderate AS by ELI. Reclassification as moderate AS was independently associated with decreased body surface area, normal flow status, decreased left ventricular mass index, and left atrial volume index (all P < 0.05). After adjustment for variables of prognostic interest, reclassification as moderate AS by ELI was associated with a considerable reduction of risk of cardiac events {adjusted hazard ratio (HR) 0.49 [95% confidence interval (CI) 0.33-0.72]; P < 0.001}, need for AVR [adjusted HR 0.52 (95% CI 0.34-0.81); P = 0.004], and cardiac mortality [adjusted HR 0.46 (95% CI 0.22-0.98); P = 0.044].

Conclusion: In patients with low-gradient severe AS and preserved LVEF, calculation of ELI permits to reclassify almost 40% of patients as having moderate AS. These reclassified patients have a considerable reduction of the risk of cardiac events during follow-up. Calculation of ELI is useful for decision-making in patients with low-gradient severe AS and preserved ejection fraction.
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http://dx.doi.org/10.1093/ehjci/jeaa010DOI Listing
June 2020

Impact of Right Ventricular Systolic Dysfunction on Outcome in Aortic Stenosis.

Circ Cardiovasc Imaging 2020 01 21;13(1):e009802. Epub 2020 Jan 21.

Department of Cardiology, Amiens University Hospital, France (Y.B., P.G., D.R., M.K., C.T.).

Background: Pulmonary hypertension is an established outcome predictor in patients with aortic stenosis (AS), but the prognostic impact of right ventricular dysfunction has not been well studied.

Methods: We included 2181 patients (50.4% men; mean age, 77 years) with aortic valve area <1.3 cm and analyzed the occurrence of all-cause death during follow-up according to tricuspid annular plane systolic excursion (TAPSE) quartiles.

Results: Patients in the lowest quartile (TAPSE <17 mm) were at a high risk of death, whereas survival was comparable for the 3 other quartiles. Five-year survival was 55±2% for TAPSE <17 mm, 72±2% for TAPSE of 17 to 20 mm, 71±2% for TAPSE of 20 to 24 mm, and 73±2% for TAPSE >24 mm (overall <0.001). TAPSE <17 mm was associated with increased mortality after adjustment for established prognostic factors (adjusted hazard ratio [HR], 1.55 [95% CI, 1.21-1.97]) and after further adjustment for aortic valve replacement (AVR; adjusted HR, 1.47 [95% CI, 1.15-1.87]). The excess mortality risk associated with TAPSE <17 mm was noticed in both patients managed initially conservatively (adjusted HR, 1.46 [95% CI, 1.20-1.76]) and patients who underwent early (within 3 months after diagnosis) AVR (adjusted HR, 1.61 [95% CI, 1.03-2.52]). In asymptomatic patients with severe AS and preserved ejection fraction, TAPSE <17 mm was independently predictive of mortality (adjusted HR, 2.14 [95% CI, 1.31-3.51]). Early AVR was associated with similar survival benefit in TAPSE <17 and ≥17 mm (adjusted HR, 0.23 [95% CI, 0.16-0.34] for TAPSE <17 mm, adjusted HR, 0.26 [95% CI, 0.19-0.35] for TAPSE ≥17 mm; for interaction, 0.97).

Conclusions: Right ventricular dysfunction is an important and independent predictor of mortality in AS. TAPSE <17 mm at the time of AS diagnosis is a marker of poor survival under conservative management and after AVR even in asymptomatic patients with severe AS. AVR was associated with a pronounced reduction in mortality independent of TAPSE suggesting that AVR should be discussed before right ventricular dysfunction occurs in severe AS.
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http://dx.doi.org/10.1161/CIRCIMAGING.119.009802DOI Listing
January 2020

Cardiac failure in patients treated with azacitidine, a pyrimidine analogue: Case reports and disproportionality analyses in Vigibase.

Br J Clin Pharmacol 2020 05 3;86(5):991-998. Epub 2020 Feb 3.

CHU de Bordeaux, Service d'Hématologie Clinique et Thérapie Cellulaire Bordeaux, France.

Aims: Azacitidine (AZA), a pyrimidine analogue, is validated for high-risk myelodysplastic syndrome or low-blast acute myeloid leukaemia in unfit patients for more intensive treatment. This study assessed the putative link between cardiac failure (CF) and AZA exposure.

Methods: Cases of CF in patients treated with AZA were retrospectively collected and described from several centres of the Groupe Francophone des Myélodysplasies. A description analysis and a disproportionality analysis using Vigibase, the WHO Global Individual Case Safety Reports (ICSRs) database, were conducted on ICSRs by the Standardized MedDRA Queries (SMQ broad) cardiac failure and by preferred terms cardiac failure and cardiac failure acute. The reported odds ratio (ROR) and its 95% 2-sided confidence interval was computed by comparing the proportion of CF reports with the suspected drug (AZA) and the proportion of reports of the same adverse drug reaction with all other suspected drugs in the database during the same period.

Results: In the 4 case reports, all patients presented a cardiovascular history. In 1 patient, CF recurred after AZA re-challenge. The pharmacovigilance analysis in Vigibase retrieved 307 ICSRs of CF (SMQ) with AZA. Significant disproportionality signals associated with AZA were identified by using the SMQ cardiac failure (ROR 1.3) and the preferred terms cardiac failure (ROR 5.1) and cardiac failure acute (ROR 23.2).

Conclusion: This study points to the potential role of AZA in the occurrence of CF. Cardiac evaluation before AZA initiation and regular monitoring of cardiac function during AZA treatment should be performed in patients with a history of cardiovascular disease.
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http://dx.doi.org/10.1111/bcp.14211DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7163380PMC
May 2020

An unexpected localization of papillary fibroelastoma.

Eur Heart J Cardiovasc Imaging 2020 05;21(5):591

Department of Cardiology, Amiens University Hospital, 1 Rue du Professeur Christian Cabrol, 80000 Amiens, France.

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http://dx.doi.org/10.1093/ehjci/jez295DOI Listing
May 2020

Allometric versus ratiometric normalization of left ventricular stroke volume by Doppler-echocardiography for outcome prediction in severe aortic stenosis with preserved ejection fraction.

Int J Cardiol 2020 02 9;301:235-241. Epub 2019 Oct 9.

Pôle Coeur-Thorax-Vaisseaux, Department of Cardiology, University Hospital Amiens, Amiens, France; EA 7517, MP3CV, Jules Verne University of Picardie, Amiens, France. Electronic address:

Background: Appropriate normalization methods to scale Doppler-derived stroke volume (SV) to body size in patients with aortic stenosis (AS) are poorly defined and reference values are lacking. We aim to establish reference values of normalized SV in adults, and to compare the prognostic value of SV normalized by different methods in AS patients.

Methods: In 2781 normotensive, non-obese adults without cardiovascular disease we defined normal relationships between SV and body size by nonlinear regression. Reference SV values were calculated by quantile regression. We subsequently analyzed by Cox analysis the prognostic performance of ratiometric and allometric normalized SV in 1450 patients with severe AS and preserved LVEF under medical and surgical management.

Results: Unlike ratiometric normalization, allometric indexation eliminated the residual relationships between normalized SV and body size. The allometric exponents that adequately described the SV-height (H) and SV-body surface area (BSA) relationships were 1.32, and respectively 0.88. In males, low-flow (LF) reference values were: <28 ml/m, <30 ml/m, <30ml/(m), and, respectively, <26 ml/m, and in females <27 ml/m, <28 ml/m, <29ml/(m), and, respectively, <24 ml/m. In patients with severe AS, SV/H was most consistently associated with mortality and showed better prognostic performance than other normalized SV parameters (adjusted hazard ratios: 1.86 for SV/H, 1.72 for SV/H, 1.64 for SV/BSA, and 1.61 for SV/BSA). Compared to H-normalization, BSA-normalization markedly overestimated the frequency of LF (3% vs. 9%).

Conclusions: We provide normative reference values and appropriate normalization methods for SV by Doppler-echocardiography. In severe AS, SV/H seems the most appropriate indexation method, especially in obese individuals.
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http://dx.doi.org/10.1016/j.ijcard.2019.09.056DOI Listing
February 2020

Characteristics and prognosis of patients with significant tricuspid regurgitation.

Arch Cardiovasc Dis 2019 Oct 23;112(10):604-614. Epub 2019 Sep 23.

Department of Cardiology, Amiens University Hospital, avenue René-Laënnec, 80054, Amiens cedex 1, France; EA 7517, MP3CV, Jules Verne University of Picardie, chemin du Thil, 80054, Amiens cedex, France. Electronic address:

Background: Severe tricuspid regurgitation (TR) usually remains asymptomatic for a long period, and the diagnosis is often delayed until an advanced stage of right heart failure (RHF). Only a minority of patients are referred for surgery.

Aim: To describe the characteristics and prognosis of patients with significant TR, according to aetiology.

Method: Two-hundred and eight consecutive patients with moderate-to-severe (grade III) or severe (grade IV) TR were included from echocardiography reports between 2013 and 2017. Median follow-up was 18 (6-38) months.

Results: Patients (mean age 75 years; 46.6% men) were divided into four groups according to TR aetiology: group 1, primary TR (14.9%); group 2, TR secondary to left heart disease with a history of left heart valve surgery (24.5%); group 3, TR secondary to left heart or pulmonary disease with no history of left valvular surgery (26.5%); and group 4, idiopathic TR (34.1%). During follow-up, 61 patients (29.3%) experienced at least one episode of RHF decompensation requiring hospitalization. Only 11 patients (5.3%) underwent tricuspid valve surgery during follow-up. The 4-year survival was much lower than the expected survival of age- and sex-matched individuals in the general population (56±4% vs. 74%). After adjustment for outcome predictors, patients with idiopathic TR had a higher risk of mortality (adjusted hazard ratio 1.83, 95% confidence interval 1.05-3.21; P=0.034) compared with other groups.

Conclusions: Moderate-to-severe or severe TR is associated with a high risk of hospitalization for RHF and death at 4 years, and a low rate of surgery. Idiopathic TR is associated with worse outcome than other aetiologies.
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http://dx.doi.org/10.1016/j.acvd.2019.06.011DOI Listing
October 2019

Outcome of Normal-Flow Low-Gradient Severe Aortic Stenosis With Preserved Left Ventricular Ejection Fraction: A Propensity-Matched Study.

J Am Heart Assoc 2019 10 25;8(19):e012301. Epub 2019 Sep 25.

Department of Cardiology Amiens University Hospital Amiens France.

Background Normal-flow, low-gradient severe aortic stenosis (NF-LG-SAS), defined by aortic valve area <1 cm, mean gradient <40 mm Hg, and indexed stroke volume >35 mL/m, is the most prevalent form of low-gradient aortic stenosis (AS). However, the true severity of AS and the management of NF-LG-SAS are controversial. The aim of this study was to evaluate the outcome of patients with NF-LG-SAS compared with moderate AS (MAS) and with high-gradient severe-AS (HG-SAS). Methods and Results A total of 154 patients with NF-LG-SAS, 366 with MAS (aortic valve area between 1.0 and 1.3 cm), and 1055 with HG-SAS were included. On multivariate analysis, after adjustment for covariates of prognostic importance, NF-LG-SAS patients did not exhibit an excess risk of mortality compared with MAS patients under medical management (hazard ratio=1.13 [95% CI, 0.82-1.56]; =0.45) and under medical and surgical management (hazard ratio 1.06 [95% CI, 0.79-1.43]; =0.70), even after further adjustment for aortic valve replacement (hazard ratio=1.09 [95% CI, 0.81-1.48]; =0.56). The 6-year cumulative incidence of aortic valve replacement (performed in accordance with guidelines) was comparable between the 2 groups (39±4% for NF-LG-SAS and 35±3% for MAS, =0.10). After propensity score matching (n=226), NF-LG-SAS and MAS patients also had comparable outcomes under medical (=0.41) and under medical and surgical management (=0.52). NF-LG-SAS had better outcomes than HG-SAS patients (adjusted hazard ratio 1.84 [95% CI, 1.18-2.88]; <0.001). Conclusions This study shows that patients with NF-LG-SAS have a comparable outcome to those with MAS when aortic valve replacement is performed during follow-up according to guidelines, mostly at the stage of HG-SAS. Rigorous echocardiographic assessment to rule out measurement errors and close follow-up are essential to detect progression to true severe AS in NF-LG-SAS.
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http://dx.doi.org/10.1161/JAHA.119.012301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6806034PMC
October 2019

Prognostic Impact of the Ratio of Acceleration Time to Ejection Time in Patients With Low Gradient Severe Aortic Stenosis and Preserved Ejection Fraction.

Am J Cardiol 2019 11 21;124(10):1594-1600. Epub 2019 Aug 21.

Université Lille Nord de France, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Laboratoire d'échocardiographie, service de cardiologie, Centre des Valvulopathies, Faculté de Médecine et de Maïeutique, Université Catholique de Lille, Lille, France; Laboratoire UPJCV, Université de Picardie, Amiens, France. Electronic address:

The clinical management of patients with low gradient severe aortic stenosis (LG-SAS) and preserved left ventricular ejection fraction (LVEF) remains challenging owing to their heterogeneity. The aim to this study was to evaluate the relation between an ejection dynamic parameter linked to AS severity and outcome, the ratio of acceleration time (AT) to ejection time (ET), in a cohort of patients with LG-SAS and preserved LVEF. Three hundred and fifty-six patients with LG-AS (defined by AVA ≤1 cm² and/or AVAi ≤0.6 cm²/m² and mean aortic pressure gradient <40 mm Hg) and preserved LVEF ≥50% were studied. The relation between AT/ET and all-cause and cardiac mortality during follow-up was studied. Median follow-up was 41 months (interquartile range, 35 to 47 months). Median AT/ET was 0.32 (interquartile range, 0.29 to 0.36). The 5-year estimates of all-cause and cardiac mortality were respectively 57 ± 7%, 36 ± 7% for patients with AT/ET >0.36 versus 43 ± 4%, 16 ± 3% for patients with AT/ET ≤0.36 (p = 0.024 and p <0.001, respectively). After adjustment on known predictors of outcome including aortic valve replacement used as a time-dependent covariate, there was a significant increase in all-cause mortality risk for patients with AT/ET >0.36 (adjusted hazard ratio 2.04 [95% confidence interval, 1.32 to 3.13]; p = 0.001) and cardiac mortality risk (adjusted hazard ratio 2.89 [95% confidence interval, 1.54 to 5.43]; p<0.001) compared with patients with AT/ET ≤0.36. The association of AT/ET >0.36 and all-cause or cardiac mortality risk was consistent in subgroups of patients with LG-SAS and preserved EF. In conclusion, an AT/ET ratio of more than 0.36 is an independent predictor of mortality in patients with LG-SAS and preserved EF.
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http://dx.doi.org/10.1016/j.amjcard.2019.07.064DOI Listing
November 2019

Correlates of the ratio of acceleration time to ejection time in patients with aortic stenosis: An echocardiographic and computed tomography study.

Arch Cardiovasc Dis 2019 Oct 8;112(10):567-575. Epub 2019 Aug 8.

Echocardiography Laboratory, Heart Valve Centre, Cardiology and Radiology Departments, Faculté de médecine et de Maïeutique, GCS-groupement des hôpitaux de l'institut catholique Lillois, UCLille, 59000 Lille, France; Laboratoire UPJV, université de Picardie, 80025 Amiens, France. Electronic address:

Background: An increased acceleration time to ejection time (AT/ET) ratio is associated with increased mortality in patients with aortic stenosis (AS).

Aim: To identify the factors associated with an increased AT/ET ratio.

Methods: The relationships between the AT/ET ratio and clinical and Doppler echocardiographic variables of interest in the setting of AS were analysed retrospectively in 1107 patients with AS and preserved left ventricular (LV) ejection fraction (LVEF). The computed tomography aortic valve calcium (CT-AVC) score was studied in a subgroup of 342 patients.

Results: In the univariate analysis, the AT/ET ratio was found to correlate with peak aortic jet velocity (r=0.57; P<0.0001), mean pressure gradient (r=0.60; P<0.0001), aortic valve area (r=-0.50; P<0.0001) and CT-AVC score (r=0.24; P<0.0001). The AT/ET ratio had good accuracy in predicting a peak aortic jet velocity≥4 m/s, a mean pressure gradient≥40mmHg and an aortic valve area≤1.0cm, with an optimal cut-off value of 0.34. Multivariable linear regression analysis showed that presence of AS-related symptoms, decreased LV stroke volume index, LVEF, absence of diabetes mellitus, systolic blood pressure, increased LV mass index, relative wall thickness and peak aortic jet velocity were independently associated with an increased AT/ET ratio (all P<0.05). In the subgroup of patients who underwent CT-AVC scoring, the CT-AVC score was independently associated with an increased AT/ET ratio (P<0.05).

Conclusions: The AT/ET ratio is related to echocardiographic and CT-AVC indices of AS severity. However, multiple intricate factors beyond the haemodynamic and anatomical severity of AS influence the AT/ET ratio, including LV geometry, function and systolic blood pressure. These findings should be considered when assessing the AT/ET ratio in patients with AS and preserved LVEF.
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http://dx.doi.org/10.1016/j.acvd.2019.06.004DOI Listing
October 2019

Impact of Preoperative Left Atrial Dimension on Outcome in Patients in Sinus Rhythm Undergoing Surgical Valve Repair for Severe Mitral Regurgitation due to Mitral Valve Prolapse.

Cardiology 2019;142(3):189-193. Epub 2019 Jun 21.

Department of Cardiology, Amiens University Hospital, Amiens, France,

Background: Left atrial (LA) enlargement has been previously identified as a predictor of mortality in patients with medically managed mitral regurgitation (MR) due to mitral valve prolapse (MVP). No study has specifically assessed the prognostic value of LA size in patients undergoing mitral valve repair (MVRp).

Objective: We aimed to investigate the relationship between LA area and mortality in patients in sinus rhythm (SR) undergoing MVRp for MVP.

Methods: We included 305 patients in SR who underwent MVRp for MVP. Median follow-up time was 7.9 years. Patients were divided into 3 groups: LA area ≤25 cm2 (reference group), LA 26-30 cm2, and LA >30 cm2.

Results: Compared with patients with an LA area ≤25 cm2, those with an LA area >30 cm2 had a lower 10-year survival (98 ± 2 vs. 86 ± 4%; p = 0.037). In multivariate analysis, after adjustment for established outcome predictors including age, symptoms, EuroSCORE, and left ventricular size and function, LA enlargement >30 cm2 was associated with increased mortality (adjusted HR = 2.20, 95% CI 1.03-4.90; p = 0.042), whereas LA enlargement between 26 and 30 cm2 was not (adjusted HR = 1.37, 95% CI 0.56-3.56; p = 0.52).

Conclusion: LA enlargement is independently predictive of long-term mortality after MVRp in patients in SR with severe MR due to MVP. Our findings suggest that MVRp should be considered before the LA area exceeds 30 cm2.
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http://dx.doi.org/10.1159/000499577DOI Listing
December 2019