Left ventricular outflow tract velocity-time integral improves outcome prediction  in patients with secondary mitral regurgitation.

Gentile, Francesco; Buoncristiani, Francesco; Sciarrone, Paolo; Bazan, Lorenzo; Panichella, Giorgia; Gasparini, Simone; Chubuchny, Vlad; Taddei, Claudia; Poggianti, Elisa; Fabiani, Iacopo; Petersen, Christina; Lancellotti, Patrizio; Passino, Claudio; Emdin, Michele; Giannoni, Alberto

doi:10.1016/j.ijcard.2023.131272

Article (Scientific journals)

Left ventricular outflow tract velocity-time integral improves outcome prediction in patients with secondary mitral regurgitation.

Gentile, Francesco; Buoncristiani, Francesco; Sciarrone, Paolo et al.

2023 • In International Journal of Cardiology, p. 131272

Peer Reviewed verified by ORBi

Permalink
https://hdl.handle.net/2268/306253

DOI
10.1016/j.ijcard.2023.131272

PubMed
37604287

Files (1)Send to Details Statistics Bibliography Similar publications

Files

Full Text

1-s2.0-S0167527323011518-main.pdf

Author postprint (1.34 MB)

Download

All documents in ORBi are protected by a user license.

Send to

RIS BibTex APA Chicago Permalink X Linkedin

Details

Keywords :

Cardiac output; Ejection fraction; Heart failure; LVOT-VTI; Mitral regurgitation; Stroke volume; Systolic function

Abstract :

[en] AIMS: Left ventricular outflow velocity-time integral (LVOT-VTI) has been shown to improve outcome prediction in different patients' subsets, with or without heart failure (HF). Nevertheless, the prognostic value of LVOT-VTI in patients with HF and secondary mitral regurgitation (MR) has never been investigated so far. Therefore, in the present study, we aimed to assess the prognostic value different metrics of LV forward output, including LVOT-VTI, in HF patients with secondary MR. METHODS AND RESULTS: Consecutive patients with HF and moderate-to-severe/severe secondary MR and systolic dysfunction (i.e., left ventricular ejection fraction [LVEF] <50%) were retrospectively selected and followed-up for the primary endpoint of cardiac death. Out of the 287 patients analyzed (aged 74 ± 11 years, 70% men, 46% ischemic etiology, mean LVEF 30 ± 9%, mean LVOT-VTI 20 ± 5 cm), 71 met the primary endpoint over a 33-month median follow-up (16-47 months). Patients with an LVOT-VTI ≤17 cm (n = 96, 32%) showed the greatest risk of cardiac death (Log Rank 44.3, p < 0.001) and all-cause mortality (Log rank 8.6, p = 0.003). At multivariable regression analysis, all the measures of LV forward volume (namely LVOT-VTI, stroke volume index, cardiac output, and cardiac index) were predictors of poor outcomes. Among these, LVOT-VTI was the most accurate in risk prediction (univariable C-statistics 0.70 [95%CI 0.64-0.77]). CONCLUSION: Left ventricular forward output, noninvasively estimated through LVOT-VTI, improves outcome prediction in HF patients with low LVEF and secondary MR.

Disciplines :

Cardiovascular & respiratory systems

Author, co-author :

Gentile, Francesco; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy.

Buoncristiani, Francesco; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.

Sciarrone, Paolo; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.

Bazan, Lorenzo; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy.

Panichella, Giorgia; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy.

Gasparini, Simone; Health Science Interdisciplinary Center, Scuola Superiore Sant'Anna, Pisa, Italy.

Chubuchny, Vlad; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.

Taddei, Claudia; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.

Poggianti, Elisa; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.

Fabiani, Iacopo; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.

More authors (5 more)

Language :

English

Title :

Left ventricular outflow tract velocity-time integral improves outcome prediction in patients with secondary mitral regurgitation.

Publication date :

19 August 2023

Journal title :

International Journal of Cardiology

ISSN :

0167-5273

eISSN :

1874-1754

Publisher :

Elsevier, Nl

Pages :

131272

Peer reviewed :

Peer Reviewed verified by ORBi

Commentary :

Available on ORBi :

since 05 September 2023

Statistics

Number of views

56 (6 by ULiège)

Number of downloads

75 (1 by ULiège)

More statistics

Scopus citations^®

Scopus citations^®
without self-citations

OpenCitations

Bibliography

Mele, D., Andrade, A., Bettencourt, P., Moura, B., Pestelli, G., Ferrari, R., From left ventricular ejection fraction to cardiac hemodynamics: role of echocardiography in evaluating patients with heart failure. Heart Fail. Rev. 25 (2020), 217–230.
Haites, N.E., McLennan, F.M., Mowat, D.H., Rawles, J.M., Assessment of cardiac output by the Doppler ultrasound technique alone. Br. Heart J. 53 (1985), 123–129.
Evangelista, A., Garcia-Dorado, D., Garcia del Castillo, H., Gonzalez-Alujas, T., Soler-Soler, J., Cardiac index quantification by Doppler ultrasound in patients without left ventricular outflow tract abnormalities. J. Am. Coll. Cardiol. 25 (1995), 710–716.
Blanco, P., Rationale for using the velocity-time integral and the minute distance for assessing the stroke volume and cardiac output in point-of-care settings. Ultrasound J., 12, 2020, 21.
Metcalfe, M.J., Rawles, J.M., Stroke distance in acute myocardial infarctton: a simple measurement of left ventricular function. Lancet, 1989, 333.
Trent, R.J., Rawles, J.M., Risk stratification after acute myocardial infarction by Doppler stroke distance measurement. Heart, 82, 1999.
Stevens, S.M., Farzaneh-Far, R., Na, B., Whooley, M.A., Schiller, N.B., Development of an echocardiographic risk-stratification index to predict heart failure in patients with stable coronary artery disease. The heart and soul study. JACC Cardiovasc. Imaging, 2009, 2.
Tan, C., Rubenson, D., Srivastava, A., Mohan, R., Smith, M.R., Billick, K., Bardarian, S., Heywood, J.T., Left ventricular outflow tract velocity time integral outperforms ejection fraction and Doppler-derived cardiac output for predicting outcomes in a select advanced heart failure cohort. Cardiovasc. Ultrasound, 15, 2017.
Zhong, Y., Almodares, Q., Yang, J.F., Wang, F., Fu, M., Johansson, M.C., Reduced stroke distance of the left ventricular outflow tract is independently associated with long-term mortality, in patients hospitalized due to heart failure. Clin. Physiol. Funct. Imaging, 38, 2018.
Omote, K., Nagai, T., Iwano, H., Tsujinaga, S., Kamiya, K., Aikawa, T., Konishi, T., Sato, T., Kato, Y., Komoriyama, H., Kobayashi, Y., Yamamoto, K., Yoshikawa, T., Saito, Y., Anzai, T., Left ventricular outflow tract velocity time integral in hospitalized heart failure with preserved ejection fraction. ESC Heart Failure, 2020, 7.
Yuriditsky, E., Mitchell, O.J.L., Sibley, R.A., Xia, Y., Sista, A.K., Zhong, J., Moore, W.H., Amoroso, N.E., Goldenberg, R.M., Smith, D.E., Jamin, C., Brosnahan, S.B., Maldonado, T.S., Horowitz, J.M., Low left ventricular outflow tract velocity time integral is associated with poor outcomes in acute pulmonary embolism. Vasc. Med. (U. K.), 2020, 25.
Jentzer, J.C., Tabi, M., Wiley, B.M., Lanspa, M.J., Anavekar, N.S., Oh, J.K., Doppler-derived haemodynamics performed during admission echocardiography predict in-hospital mortality in cardiac intensive care unit patients. Eur. Heart J. Acute Cardiovasc. Care 11 (2022), 640–650.
Dupuis, M., Mahjoub, H., Clavel, M.-A., Côté, N., Toubal, O., Tastet, L., Dumesnil, J.G., O'Connor, K., Dahou, A., Thébault, C., Bélanger, C., Beaudoin, J., Arsenault, M., Bernier, M., Pibarot, P., Forward left ventricular ejection fraction: a simple risk marker in patients with primary mitral regurgitation. J. Am. Heart Assoc., 6, 2017, e006309.
Arora, S., Sivaraj, K., Hendrickson, M., Chang, P.P., Weickert, T., Qamar, A., Vaduganathan, M., Caughey, M.C., Pandey, A., Cavender, M.A., Rosamond, W., Vavalle, J.P., Prevalence and prognostic significance of mitral regurgitation in acute decompensated heart failure. JACC: Heart Failure vol. 9 (2021), 179–189.
Del Forno, B., De Bonis, M., Agricola, E., Melillo, F., Schiavi, D., Castiglioni, A., Montorfano, M., Alfieri, O., Mitral valve regurgitation: a disease with a wide spectrum of therapeutic options. Nat. Rev. Cardiol. 17 (2020), 807–827.
Vahanian, A., Beyersdorf, F., Praz, F., Milojevic, M., Baldus, S., Bauersachs, J., Capodanno, D., Conradi, L., Bonis, M.D., Paulis, R.D., Delgado, V., Freemantle, N., Gilard, M., Haugaa, K.H., Jeppsson, A., Jüni, P., Pierard, L., Prendergast, B.D., Sadaba, J.R., Tribouilloy, C., Wojakowski, W., Neumann, F.J., Myers, P., Abdelhamid, M., Achenbach, S., Asteggiano, R., Barili, F., Borger, M.A., Carrel, T., Collet, J.P., Foldager, D., Habib, G., Hassager, C., Irs, A., Iung, B., Jahangiri, M., Katus, H.A., Koskinas, K.C., Massberg, S., Mueller, C.E., Nielsen, J.C., Pibarot, P., Rakisheva, A., Roffi, M., Rubboli, A., Shlyakhto, E., Siepe, M., Sitges, M., Sondergaard, L., Sousa-Uva, M., Tarantini, G., Zamorano, J.L., Benchabi, Y., Chilingaryan, A., Metzler, B., Rustamova, Y., Shumavets, V., Lancellotti, P., Smajic, E., Trendafilova-Lazarova, D., Samardzic, J., Karakyriou, M., Palecek, T., Dahl, J.S., Meshaal, M.S., Palm, K., Virtanen, M., Bouleti, C., Bakhutashvili, Z., Boutsikou, M., Kertész, A.B., Danielsen, R., Topilsky, Y., Golino, P., Tuleutayev, R., Elezi, S., Kerimkulova, A., Rudzitis, A., Glaveckaite, S., Sow, R., Demarco, D.C., Bulatovic, N., Aouad, A., Brink, R.V.D., Antova, E., Beitnes, J.O., Ochala, A., Ribeiras, R., Vinereanu, D., Irtyuga, O., Ivanovic, B., Simkova, I., Gomez, A.G., Sarno, G., Pedrazzini, G.B., Bsata, W., Zakhama, L., Korkmaz, L., Cherniuk, S., Khanji, M.Y., Sharipov, I., Baigent, C., Aboyans, V., Antoniou, S., Arbelo, E., Baumbach, A., Čelutkiene, J., Cikes, M., Falk, V., Fauchier, L., Gale, C.P., Halvorsen, S., Jaarsma, T., Konradi, A., Kotecha, D., Landmesser, U., Lewis, B.S., Linhart, A., Løchen, M.L., Neubeck, L., Petersen, S.E., Prescott, E., Touyz, R.M., Galletti, L., Hazekamp, M., Licht, P., Perier, P., Prager, R., Roessner, E., Tsagakis, K., Zientara, A., ESC/EACTS guidelines for the management of valvular heart disease. Eur. Heart J., 2022, 2021, 43.
Nagueh, S.F., Smiseth, O.A., Appleton, C.P., Byrd, B.F., Dokainish, H., Edvardsen, T., Flachskampf, F.A., Gillebert, T.C., Klein, A.L., Lancellotti, P., Marino, P., Oh, J.K., Popescu, B.A., Waggoner, A.D., Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 29 (2016), 277–314.
Lancellotti, P., Pibarot, P., Chambers, J., La Canna, G., Pepi, M., Dulgheru, R., Dweck, M., Delgado, V., Garbi, M., Vannan, M.A., Montaigne, D., Badano, L., Maurovich-Horvat, P., Pontone, G., Vahanian, A., Donal, E., Cosyns, B., Scientific document Committee of the European Association of cardiovascular imaging. Multi-modality imaging assessment of native valvular regurgitation: an EACVI and ESC council of valvular heart disease position paper. Eur. Heart J. Cardiovasc. Imaging 23 (2022), e171–e232.
Mitchell, C., Rahko, P.S., Blauwet, L.A., Canaday, B., Finstuen, J.A., Foster, M.C., Horton, K., Ogunyankin, K.O., Palma, R.A., Velazquez, E.J., Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J. Am. Soc. Echocardiogr. 32 (2019), 1–64.
Guzzetti, E., Capoulade, R., Tastet, L., Garcia, J., Ven, F.L., Arsenault, M., Bédard, E., Larose, E., Clavel, M.-A., Pibarot, P., Estimation of stroke volume and aortic valve area in patients with aortic stenosis: a comparison of echocardiography versus cardiovascular magnetic resonance. J. Am. Soc. Echocardiogr. 33 (2020), 953–963.e5.
Leye, M., Brochet, E., Lepage, L., Cueff, C., Boutron, I., Detaint, D., Hyafil, F., Iung, B., Vahanian, A., Messika-Zeitoun, D., Size-adjusted left ventricular outflow tract diameter reference values: a safeguard for the evaluation of the severity of aortic stenosis. J. Am. Soc. Echocardiogr. 22 (2009), 445–451.
Goldman, J.H., Schiller, N.B., Lim, D.C., Redberg, R.F., Foster, E., Usefulness of stroke distance by echocardiography as a surrogate marker of cardiac output that is independent of gender and size in a normal population. Am. J. Cardiol., 87(499–502), 2001, A8.
Ristow, B., Na, B., Ali, S., Whooley, M.A., Schiller, N.B., Left ventricular outflow tract and pulmonary artery stroke distances independently predict heart failure hospitalization and mortality: the heart and soul study. J. Am. Soc. Echocardiogr. 24 (2011), 565–572.
Haites, N.E., McLennan, F.M., Mowat, D.H.R., Rawles, J.M., Assessment of cardiac output by the Doppler ultrasound technique alone. Br. Heart J., 53, 1985.
Huntsman, L.L., Stewart, D.K., Barnes, S.R., Noninvasive Doppler determination of cardiac output in man. Clinical validation. Circulation, 1983, 67.
Kubo, S., Nakamura, M., Shiota, T., Itabashi, Y., Mizutani, Y., Nakajima, Y., Meemook, K., Hussaini, A., Makar, M., Siegel, R.J., Kar, S., Impact of forward stroke volume response on clinical and structural outcomes after percutaneous mitral valve repair with MitraClip. Circ.: Cardiovasc. Interv., 10, 2017, e004909.
Namazi, F., van der Bijl, P., Hirasawa, K., Kamperidis, V., van Wijngaarden, S.E., Mertens, B., Leon, M.B., Hahn, R.T., Stone, G.W., Narula, J., Ajmone Marsan, N., Delgado, V., Bax, J.J., Prognostic value of left ventricular global longitudinal strain in patients with secondary mitral regurgitation. J. Am. Coll. Cardiol. 75 (2020), 750–758.
Meucci, M.C., Stassen, J., Tomsic, A., Palmen, M., Crea, F., Bax, J.J., Ajmone Marsan, N., Delgado, V., Prognostic impact of left ventricular global longitudinal strain in atrial mitral regurgitation. Heart 109 (2022), 478–484.
Bartko, P.E., Heitzinger, G., Pavo, N., Heitzinger, M., Spinka, G., Prausmüller, S., Arfsten, H., Andreas, M., Gabler, C., Strunk, G., Mascherbauer, J., Hengstenberg, C., Hülsmann, M., Goliasch, G., Burden, treatment use, and outcome of secondary mitral regurgitation across the spectrum of heart failure: observational cohort study. BMJ, 373, 2021, n1421.
Igata, S., Cotter, B.R., Hang, C.T., Morikawa, N., Strachan, M., Raisinghani, A., Blanchard, D.G., Demaria, A.N., Optimal quantification of functional mitral regurgitation: comparison of volumetric and proximal isovelocity surface area methods to predict outcome. J. Am. Heart Assoc., 2021, 10.
Hagendorff, A., Doenst, T., Falk, V., Echocardiographic assessment of functional mitral regurgitation: opening Pandora's box?. ESC Heart Failure 6 (2019), 678–685.