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1. Contemporary Management of Severe Symptomatic Aortic Stenosis

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Iung, Bernard, Bax, Jeroen, De Bonis, Michele, Delgado, Victoria, Haude, Michael, Hindricks, Gerhard, Maggioni, Aldo P., Pierard, Luc, Popescu, Bogdan A., Prendergast, Bernard, Price, Susanna, Rosenhek, Raphael, Ruschitzka, Frank, Vahanian, Alec, Wendler, Olaf, Windecker, Stephan, Mekhaldi, Souad, Lemaitre, Katell, Authier, Sébastien, Laroche, Cécile, Abdelhamid, Magdy, Apor, Astrid, Bajraktari, Gani, Beleslin, Branko, Bogachev-Prokophiev, Alexander, Demarco, Daniela Cassar, Pasquet, Agnes, Dogan, Sait Mesut, Erglis, Andrejs, Evangelista, Arturo, Goda, Artan, Ihlemann, Nikolaj, Ince, Huseyin, Katsaros, Andreas, Linhartova, Katerina, Mascherbauer, Julia, Mirrakhimov, Erkin, Mizariene, Vaida, Rahman-Haley, Shelley, Ribeiras, Regina, Samadov, Fuad, Saraste, Antti, Simkova, Iveta, Kostovska, Elizabeta Srbinovska, Tomkiewicz-Pajak, Lidia, Tribouilloy, Christophe, Zera, Eliverta, Metalla, Mimoza, Shirka, Ervina, Dado, Elona, Bica, Loreta, Aleksi, Jorida, Knuti, Gerti, Gjyli, Lidra, Pjeci, Rudina, Shuperka, Eritinka, Lleshi, Erviola, Rustemaj, Joana, Qordja, Marsjon, Gina, Mirald, Husi, Senada, Basic, Daniel, Steringer-Mascherbauer, Regina, Huber, Charlotte, Ebner, Christian, Sigmund, Elisabeth, Ploechl, Andrea, Sturmberger, Thomas, Eder, Veronica, Koppler, Tanja, Heger, Maria, Kammerlander, Andreas, Duca, Franz, Binder, Christina, Koschutnik, Matthias, Perschy, Leonard, Puskas, Lisa, Ho, Chen-Yu, Aliyev, Farid, Guluzada, Vugar, Imanov, Galib, Ibrahimov, Firdovsi, Abbasaliyev, Abbasali, Ahmedov, Tahir, Muslumova, Fargana, Babayev, Jamil, Rustamova, Yasmin, Jahangirov, Tofig, Samadov, Rauf, Museyibov, Muxtar, Isayev, Elnur, Musayev, Oktay, Xalilov, Shahin, Huseynov, Saleh, Yuzbashova, Madina, Zamanov, Vuqar, Mammadov, Vusal, Van Camp, Gery, Penicka, Martin, Batjoens, Hedwig, Debonnaire, Philippe, Dendooven, Daniel, Knecht, Sebastien, Duytschaever, Mattias, Vandekerckhove, Yves, Missault, Luc, Muyldermans, Luc, Tavernier, René, De Grande, Tineke, Coussement, Patrick, DeTroyer, Joyce, Derycker, Katrien, De Jaegher, Kelly, Bondue, Antoine, Beauloye, Christophe, Goffinet, Céline, Mirica, Daniela Corina, Eynden, Frédéric Vanden, Van de Borne, Philippe, Van Frachen, Béatrice, Vancraeynest, David, Vanoverschelde, Jean Louis, Pierard, Sophie, Malanca, Mihaela, Sinnaeve, Florence, Tahon, Séverine, De Clippel, Marie, Gayet, Frederic, Loiseau, Jacques, Van de Veire, Nico, Moerman, Veronique, Willems, Anne-Marie, Cosyns, Bernard, Droogmans, Steven, Motoc, Andreea, Kerkhove, Dirk, Plein, Daniele, Roosens, Bram, Weytjens, Caroline, Lancellotti, Patrizio, Dulgheru, Elena Raluca, Parenicova, Ilona, Bedanova, Helena, Tousek, Frantisek, Sindelarova, Stepanka, Canadyova, Julia, Taborsky, Milos, Ostransky, Jiri, Ivona simkova, Vicha, Marek, Jelinek, Libor, Opavska, Irena, Homza, Miroslav, Kvrayola, Miriam, Brat, Radim, Mrozek, Dan, Lichnerova, Eva, Docekalova, Iveta, Zarybnicka, Marta, Peskova, Marketa, Roucka, Patrik, Stastna, Vlasta, Vondrackova, Dagmar Jungwirtova, Hornig, Alfred, Niznansky, Matus, Branny, Marian, Vodzinska, Alexandra, Dorda, Miloslav, Snkouril, Libor, Kluz, Krystyna, Kypusova, Jana, Nezvalova, Radka, Olsen, Niels Thue, Ali, Hosam Hasan, Taha, Salma, Hassan, Mohamed, Afifi, Ahmed, Kabil, Hamza, Mady, Amr, Ebaid, Hany, Ahmed, Yasser, Nour, Mohammad, Talaat, Islam, Sayed, CairoMaiy El, Mostafa, Ahmad Elsayed, Sadek, CairoYasser, Eltobgi, CairoSherif, Bakhoum, Sameh, Doss, Ramy, Sheashea, Mahmoud, Elasry, Abd Allah, Fouad, Ahmed, Baraka, Mahmoud, Samir, Sameh, Roshdy, Alaa, AbdelRazek, Yasmin, Abd Rabou, Mostafa M., Abobakr, Ahmed, Moaaz, Moemen, Mokhtar, Mohamed, Ashry, Mohamed, Elkhashab, Khaled, Ghareeb, Haytham Soliman, Kamal, Mostafa, AbdelRazek, Gomaa, Farag, GizaNabil, Elbarbary, Giza:Ahmed, Wahib, Evette, Kazamel, Ghada, Kamal, Diaa, Tantawy, Mahmoud, Alansary, Adel, Yahia, Mohammed, Mahmoud, Raouf, El Banna, Tamer, Atef, Mohamed, Nasr, Gamela, Ahmed, Salah, El Hefny, Ehab E., Saifelyazal, Islam, El Ghany, Mostafa Abd, El Rahman El Hadary, Abd, Khairy, Ahmed, Lommi, Jyri, Laine, Mika, Kylmala, Minna, Kankanen, Katja, Turpeinen, Anu, Hartikainen, Juha, Kujanen, Lari, Airaksinen, Juhani, Vasankari, Tuija, Szymanski, Catherine, Bohbot, Yohann, Gun, Mesut, Rousseaux, Justine, Biere, Loic, Mateus, Victor, Audonnet, Martin, Rautureau, Jérémy, Cornet, Charles, Sorbets, Emmanuel, Mear, BourgesKarine, Issa, Adi, Jobic, Yannick, Le Ven, Florent, Pouliquen, Marie-Claire, Gilard, Martine, Ohanessian, Alice, Farhat, Ali, Vlase, Alina, Said, Fkhar, Lasgi, Caroline, Sanchez, Carlos, Breil, Romain, Peignon, Marc, Elkaim, Jean-Philippe, Jan-Blin, Virginie, BertrandM'Ban, Sylvain Ropars, Bardet, Hélène, Sawadogo, Samuel, Muschoot, Aurélie, Tchatchoua, Dieudonné, Elhadad, Simon, Maubert, Aline, Lazizi, Tahar, Ourghi, Kais, Bonnet, Philippe, Menager-Gangloff, Clarisse, Gafsi, Sofiene, Mansouri, Djidjiga, Aboyans, Victor, Magne, Julien, Martins, Elie, Karm, Sarah, Mohty, Dania, Briday, Guillaume, David, Amandine, Marechaux, Sylvestre, Le Goffic, Caroline, Binda, Camille, Menet, Aymeric, Delelis, Francois, Ringlé, Anne, Castel, Anne-Laure, Appert, Ludovic, Tristram, Domitille, Trouillet, Camille, Nacer, Yasmine, Ngoy, Lucas, Habib, MarseilleGilbert, Thuny, Franck, Haentjens, Julie, Cautela, Jennifer, Lavoute, Cécile, Robin, Floriane, Armangau, Pauline, Vergeylen, Ugo, Sanhadji, Khalil, Abdallah, Nessim Hamed, Kerzazi, Hassan, Perianu, Mariana, Plurien, François, Oueslati, Chaker, Debauchez, Mathieu, Monin, Jean-Luc, Konstantinos, Zannis, Berrebi, Alain, Dibie, Alain, Lansac, Emmanuel, Veugeois, Aurélie, Diakov, Christelle, Caussin, Christophe, Czitrom, Daniel, Salvi, Suzanna, Amabile, Nicolas, Dervanian, Patrice, Lejeune, Stéphanie, Bagdadi, Imane, Mokrane, Yemmi, Rouault, Gilles, Abalea, Jerome, Leledy, Marion, Horen, Patrice, Donal, Erwan, Bosseau, Christian, Paven, Elise, Galli, Elena, Collette, Edouard, Urien, Jean-Marie, Bridonneau, Valentin, Gervais, Renaud, Bauer, Fabrice, Chopra, Houzefa, Charbonnier, Arthur, Attias, David, Dahouathi, Nesrine, Khounlaboud, Moukda, Daudin, Magalie, Thebault, Christophe, Hamon, Cécile, Couffon, Philippe, Bellot, Catherine, Vomscheid, Maelle, Bernard, Anne, Dion, Fanny, Naudin, Djedjiga, Mouzouri, Mohammed, Rudelin, Mathilde, Berenfeld, Alain, Vanzwaelmen, Thibault, Alloui, Tarik, Radovikj, Marija Gjerakaroska, Jordanova, Slavica, Scholtz, Werner, Liberda-Knoke, Eva, Wiemer, Melanie, Mugge, Andreas, Nickenig, Georg, Sinning, Jan-Malte, Sedaghat, Alexander, Heintzen, Matthias, Ballof, Jan, Frenk, Daniel, Hambrecht, Rainer, Wienbergen, Harm, Seidel, Annemarie, Osteresch, Rico, Kramer, Kirsten, Ziemann, Janna, Schulze, Ramona, Fehske, Wolfgang, Eifler, Clarissa, Wafaisade, Bahram, Kuhn, Andreas, Fischer, Sören, Lichtenberg, Lutz, Brunold, Mareike, Simons, Judith, Balling, Doris, Buck, Thomas, Plicht, Bjoern, Schols, Wolfgang, Ebelt, Henning, Chamieh, Marwan, Anacker, Jelena, Rassaf, Tienush, Janosi, Alexander, Lind, Alexander, Lortz, Julia, Lüdike, Peter, Kahlert, Philipp, Rittger, Harald, Eichinger, Gabriele, Kuhls, Britta, Felix, Stephan B., Lehnert, Kristin, Pedersen, Ann-Louise, Dorr, Marcus, Empen, Klaus, Kaczmarek, Sabine, Busch, Mathias, Baly, Mohammed, Er, Fikret, Duman, Erkan, Gabriel, Linda, Weinbrenner, Christof, Bauersachs, Johann, Wider, Julian, Kempf, Tibor, Bohm, Michael, Schulze, Paul-Christian, Poerner, C. Tudor, Möbius-Winkler, Sven, Lenk, Karsten, Heitkamp, Kerstin, Franz, Marcus, Krauspe, Sabine, Schumacher, Burghard, Windmuller, Volker, Kurwitz, Sarah, Thiele, Holger, Kurz, Thomas, Meyer-Saraei, Roza, Akin, Ibrahim, Fastner, Christian, Lossnitzer, Dirk, Hoffmann, Ursula, Borggrefe, Martin, Baumann, Stefan, Kircher, Brigitte, Foellinger, Claudia, Dietz, Heike, Schieffer, Bernhard, Niroomand, Feraydoon, Mudra, Harald, Maier, Lars, Camboni, Daniele, Birner, Christoph, Debl, Kurt, Paulus, Michael, Seither, Benedikt, El Mokhtari, Nour Eddine, Oner, Alper, Caglayan, Evren, Sherif, Mohammed, Yucel, Seyrani, Custodis, Florian, Schwinger, Robert, Vorpahl, Marc, Seyfarth, Melchior, Nover, Ina, Koehler, Till, Christiani, Sarah, Sanchez, David Calvo, Schanze, Barbel, Sigusch, Holger, Salman, Athir, Hancock, Jane, Chambers, John, Demetrescue, Camelia, Prendergast, Claire, Dalby, Miles, Smith, Robert, Rogers, Paula, Riley, Cheryl, Tousoulis, Dimitris, Kanakakis, Ioannis, Spargias, Konstantinos, Lampropoulos, Konstantinos, Panagiotis, Tolis, Koutsoukis, Athanasios, Michalis, Lampros, Goudevenos, Ioannis, Bellos, Vasileios, Papafaklis, Michail, Lakkas, Lampros, Hahalis, George, Makris, Athanasios, Karvounis, Haralampos, Kamperidis, Vasileios, Ninios, Vlasis, Sachpekidis, Vasileios, Rouskas, Pavlos, Poulimenos, Leonidas, Charalampidis, Georgios, Hamodraka, Eftihia, Manolis, Athanasios, Kiss, Robert Gabor, Borsanyi, Tunde, Jarai, Zoltan, Zsary, Andras, Bartha, Elektra, Kosztin, Annamaria, Doronina, Alexandra, Kovacs, Attila, Imre, Barabas Janos, Chao, Chun, Benke, Kalman, Karoczkai, Istvan, Keltai, Kati, Förchécz, Zsolt, Pozsonyi, Zoltán, Jenei, Zsigmond, Patthy, Adam, Sallai, Laszlo, Majoros, Zsuzsanna, Pál, Tamás, Bencze, Jusztina, Sagi, Ildiko, Molnar, Andrea, Kurczina, Anita, Kolodzey, Gabor, Edes, Istvan, Szatmari, Valeria, Zajacz, Zsuzsanna, Cziraki, Attila, Nemeth, Adam, Faludi, Reka, Vegh, Laszlone, Jebelovszki, Eva, Lupkovics, Geza Karoly, Kovacs, Zsofia, Horvath, Andras, Berisha, Gezim, Ibrahimi, Pranvera, Percuku, Luan, Arapova, Rano, Laahunova, Elmira, Neronova, Kseniia, Zhakypova, Zarema, Naizabekova, Gulira, Muratova, Gulnazik, Sime, Iveta, Sorokins, Nikolajs, Kamzola, Ginta, Cgojeva-Sproge, Irina, Rancane, Gita, Valentinaviciene, Ramune, Rudiene, Laima, Raugaliene, Rasa, Bardzilauske, Aiste, Jonkaitiene, Regina, Petrauskaite, Jurate, Bieseviciene, Monika, Verseckaite, Raimonda, Zvirblyte, Ruta, Kalibatiene, Danute, Radauskaite, Greta, Janaviciute-Matuzeviciene, Gabija, Jancauskaite, Dovile, Balkute, Deimile, Maneikyte, Juste, Mileryte, Ingrida, Vaisvilaite, Monika, Gedvilaite, Lina, Biliukas, Mykolas, Karpaviciene, Vaiva, Xuereb, Robert George, Pllaha, Elton, Djaberi, Roxana, Komor, Klaudiusz, Gorgon-Komor, Agnieszka, Loranc, Beata, Myszor, Jaroslaw, Mizia-Stec, Katarzyna, Berger-Kucza, Adrianna, Mizia, Magdalena, Polak, Mateusz, Bogacki, Piotr, Podolec, Piotr, Komar, Monika, Sedziwy, Ewa, Sliwiak, Dorota, Sobien, Bartosz, Rog, Beata, Hlawaty, Marta, Gancarczyk, Urszula, Libiszewska, Natasza, Sorysz, Danuta, Gackowski, Andrzej, Cieply, Malgorzata, Misiuda, Agnieszka, Racibor, Franciszek, Nytko, Anna, Widenka, Kazimierz, Kolowca, Maciej, Bak, Janusz, Curzytek, Andrzej, Regulski, Mateusz, Kamela, Malgorzata, Wisniowski, Mateusz, Hryniewiecki, Tomasz, Szymanski, Piotr, Rozewicz, Monika, Grabowski, Maciej, Duchnowski, Piotr, Budaj, Andrzej, Zaborska, Beata, Pilichowska-Paskiet, Ewa, Sikora-Frac, Malgorzata, Slomski, Tomasz, Joao, Isabel, Cruz, Ines, Pereira, Hélder, Cale, Rita, Marques, Ana, Pereira, Ana Rita, Morais, Carlos, Freitas, Antonio, Roque, David, Antunes, Nuno, Pereira, Antonio Costeira, Vieira, Catarina, Salome, Nuno, Martins, Juliana, Campos, Isabel, Cardoso, Goncalo, Silva, Claudia, Oliveira, Afonso, Goncalves, Mariana, Martins, Rui, Quintal, Nuno, Mendes, Bruno, Silva, Joseline, Ferreira, Joao, Milner, James, Alves, Patricia, Marinho, Vera, Gago, Paula, Amado, Jose, Bispo, Joao, Bento, Dina, Machado, Inocencia, Oliveira, Margarida, Calvo, Lucy, von Hate, Pedro, Faria, Bebiana, Galrinho, Ana, Branco, Luisa, Goncalves, Antonio, Mendonca, Tiago, Selas, Mafalda, Macedo, Filipe, Sousa, Carla, Cabral, Sofia, Oliveira, Filomena, Trepa, Maria, Fontes-Oliveira, Marta, Nunes, Alzira, Araújo, Paulo, Ribeiro, Vasco Gama, Almeida, Joao, Rodrigues, Alberto, Braga, Pedro, Dias, Sonia, Carvalho, Sofia, Ferreira, Catarina, Ferreira, Alberto, Mateus, Pedro, Moz, Miguel, Leao, Silvia, Margato, Renato, Moreira, Ilidio, Guimanaes, Jose, Ribeiro, Joana, Goncalves, Fernando, Cabral, Jose, Almeida, Ines, Goncalves, Luisa, Tarusi, Mariana, Pop, Calin, Matei, Claudia, Tint, Diana, Barbulescu, Sanziana, Micu, Sorin, Pop, Ioana, Baba, Costica, Dimulescu, Doina, Dorobantu, Maria, Ginghina, Carmen, Onut, Roxana, Popescu, Andreea, Zamfirescu, Brandusa, Aflorii, Raluca, Popescu, Mihaela, Ghilencea, Liviu, Rachieru, Andreeea, Stoian, Monica, Oprescu, Nicoleta, Iancovici, Silvia, Petre, Iona, Mateescu, Anca Doina, Calin, Andreea, Botezatu, Simona, Enache, Roxana, Rosca, Monica, Ciuperca, Daniela, Babalac, Evelyn, Beyer, Ruxandra, Cadis, Laura, Rancea, Raluca, Tomoaia, Raluca, Rosianu, Adela, Kovacs, Emese, Militaru, Constantin, Craciun, Alina, Mirea, Oana, Florescu, Mihaela, Grigorica, Lucica, Dragusin, Daniela, Nechita, Luiza, Marinescu, Mihai, Chiscaneanu, Teodor, Botezatu, Lucia, Corciova, Costela, Petris, Antoniu Octavian, Arsenescu-Georgescu, Catalina, Salaru, Delia, Alexandrescu, Dan Mihai, Plesoianu, Carmjen, Tanasa, Ana, Mitu, Ovidiu, Costache, Irina Iuliana, Tudorancea, Ionut, Usurelu, Catalin, Eminovici, Gabriela, Manitiu, Ioan, Stoia, Oana, Mitre, Adriana, Nistor, Dan-Octavian, Maier, Anca, Lupu, Silvia, Opris, Mihaela, Ionac, Adina, Popescu, Irina, Crisan, Simina, Mornos, Cristian, Goanta, Flavia, Gruescu, Liana, Voinescu, Oana, Petcu, Madalina, Cozlac, Ramona, Damrina, Elena, Khilova, Liliya, Ryazantseva, Irina, Kozmin, Dmitry, Kiseleva, Maria, Goncharova, Marina, Kitalaeva, Kamila, Demetskay, Victoria, Verevetinov, Artem, Fomenko, Mikhail, Skripkina, Elena, Tsoi, Viktor, Antipov, Georgii, Schneider, Yuri, Yazikov, Denis, Makarova, Marina, Cherkes, Aleksei, Ermakova, Natalya, Medvedev, Aleksandr, Sarosek, Anastasia, Isayan, Mikhail, Voronova, Tatyana, Kulumbegov, Oleg, Tuchina, Alina, Stefanov, Sergei, Klimova, Margarita, Smolyaninov, Konstantin, Dandarova, Zhargalma, Magamet, Victoriya, Spiropulos, Natalia, Boldyrev, Sergey, Barbukhatty, Kirill, Buyankov, Dmitrii, Yurin, Vladimir, Gross, Yuriy, Boronin, Maksim, Mikhaleva, Mariya, Shablovskaya, Mariya, Zotov, Alex, Borisov, Daniil, Tereshchenko, Vasily, Zubova, Ekaterina, Kuzmin, A., Tarasenko, Ivan, Gamzaev, Alishir, Borovkova, Natalya, Koroleva, Tatyana, Botova, Svetlana, Pochinka, Ilya, Dunaeva, Vera, Teplitskaya, Victoria, Semenova, Elena I., Korabel'Nikova, Olga V., Simonov, Denis S., Denisenko, Elena, Harina, Natalia, Yarohno, Natalia, Alekseeva, Svetlana, Abydenkova, Julia, Shabalkina, Lyubov, Mayorova, Olga, Tsechanovich, Valeriy, Medvedev, Igor, Lepilin, Michail, Nemchenko, PenzaEvgenii, Karnahin, Vadim, Safina, Vasilya, Slastin, Yaroslav, Gilfanova, Venera, Gorbunov, Roman, Jakubov, Ramis, Fazylova, Aigul, Poteev, Mansur, Vazetdinova, Laysan, Tarasova, Indira, Irgaliyev, Rishat, Moiseeva, Olga, Gordeev, Mikhail, Irtyuga, Olga, Moiseeva, Raisa, Ostanina, Nina, Zverev, Dmitry, Murtazalieva, Patimat, Kuznetsov, Dmitry, Skurativa, Mariya, Polyaeva, Larisa, Mihaiilov, Kirill, Obrenovic-Kircanski, Biljana, Putnik, Svetozar, Simic, Dragan, Petrovic, Milan, Nikolic, Natasa Markovic, Jovovic, Ljiljana, Ostric, Dimitra Kalimanovska, Brajovic, Milan, Manojlovic, Milica Dekleva, Novakovic, Vladimir, Zamaklar-Trifunovic, Danijela, Orbovic, Bojana, Petrovic, Olga, Boricic-Kostic, Marija, Andjelkovic, Kristina, Milanov, Marko, Despotovic-Nikolic, Maja, Budisavljevic, Sreten, Veljkovic, Sanja, Cvetinovic, Nataša, Lepojevic, Daniijela, Todorovic, Aleksandra, Nikolic, Aleksandra, Borzanovic, Branislava, Trkulja, Ljiljana, Tomic, Slobodan, Vukovic, Milan, Milosavljevic, Jelica, Milanovic, Mirjana, Stakic, Vladan, Cvetkovic, Aleksandra, Milutinovic, Suzana, Bozic, Olivera, Miladinovic, Miodrag, Nikolic, Zoran, Despotovic, Dinka, Jovanovic, Dimitrije, Stojsic-Milosavljevic, Anastazija, Ilic, Aleksandra, Sladojevic, Mirjana, Susak, Stamenko, Maletin, Srdjan, Pavlovic, Salvo, Kuzmanovic, Vladimir, Ivanovic, Nikola, Dejanovic, Jovana, Ruzicic, Dusan, Drajic, Dragana, Cvetanovic, Danijel, Mirkovic, Marija, Omoran, Jon, Margoczy, Roman, Sedminova, Katarina, Reptova, Adriana, Baranova, Eva, Valkovicova, Tatiana, Valocik, Gabriel, Kurecko, Marian, Vachalcova, Marianna, Kollarova, Alzbeta, Studencan, Martin, Alusik, Daniel, Kozlej, Marek, Macakova, Jana, Moral, Sergio, Cladellas, Merce, Luiso, Daniele, Calvo, Alicia, Palet, Jordi, Carballo, Juli, Tura, Gisela Teixido, Maldonado, Giuliana, Gutierrez, Laura, Gonzalez-Alujas, Teresa, Jose Fernando, Rodriguez Palomares, Villalva, Nicolas, Molina-Mora, Ma Jose, Paton, Ramon Rubio, Martinez Diaz, Juan Jose, Ruiz, Pablo Ramos, Valle, Alfonso, Rodriguez, Ana, Alania, Edgardo, Galcera, Emilio, Seller, Julia, Valenzuela, Gonzalo de la Morena, Espin, Daniel Saura, Garcia, Dolores Espinosa, Oliva Sandoval, Maria Jose, Gonzalez, Josefa, Navarro, Miguel Garcia, Perez-Martinez, Maria Teresa, Ortega Trujillo, Jose Ramon, Gallego, Irene Menduina, San Roman, Daniel, Perez Nogales, Eliu David, Medina, Olga, Montiel Quintero, Rodolfo Antonio, Bujanda Morun, Pablo Felipe, Perez, Marta Lopez, Huaripata, Jimmy Plasencia, Morales Gonzalez, Juan Jose, Nelson, Veronica Quevedo, Zamorano, Jose Luis, Gomez, Ariana Gonzalez, Fraile, Alfonso, Alberca, Maria Teresa, Martin, Joaquin Alonso, Fernandez-Golfin, Covadonga, Ramos, Javier, Jimenez, Sergio Hernandez, Mitroi, Cristina, Sanchez Fernandez, Pedro L., Diaz-Pelaez, Elena, Garde, Beatriz, Caballero, Luis, Garcia, Fermin Martinez, Cambronero, Francisco, Castro, Noelia, Castro, Antonio, De La Rosa, Alejandro, Gallego, Pastora, Mendez, Irene, Villegas, David Villagomez, Correa, Manuel Gonzalez, Calvo, Roman, Florian, Francisco, Paya, Rafael, Esteban, Esther, Buendia, Francisco, Cubillos, Andrés, Fernandez, Carmen, Cárdenas, Juan Pablo, Pérez-Boscá, José Leandro, Vano, Joan, Belchi, Joaquina, Iglesia-Carreno, Cristina, Iglesias, Francisco Calvo, Escudero-Gonzalez, Aida, Zapateria-Lucea, Sergio, Duarte, Juan Sterling, Perez-Davila, Lara, Cobas-Paz, Rafael, Besada-Montenegro, Rosario, Fontao-Romeo, Maribel, Lopez-Rodriguez, Elena, Paredes-Galan, Emilio, Caneiro-Queija, Berenice, Gonzalez, Alba Guitian, Bozkurt, Abdi, Demir, Serafettin, Unlu, Durmus, Cagliyan, Caglar Emre, Ikikardes, Muslum Firat, Tangalay, Mustafa, Kuloglu, Osman, Ozer, Necla, Canpolat, Ugur, Kemaloglu, Melek Didem, Demirtas, Abdullah Orhan, Akgün, Didar Elif, Avci, Eyup, Taylan, Gokay, Yilmaztepe, Mustafa Adem, Ucar, Fatih Mehmet, Altay, Servet, Gurdogan, Muhammet, Gudul, Naile Eris, Aktas, Mujdat, Buyuklu, Mutlu, Degirmenci, Husnu, Turan, Mehmet Salih, Mert, Kadir Ugur, Mert, Gurbet Ozge, Dural, Muhammet, Arslan, Sukru, Sayar, Nurten, Kanar, Batur, Sadic, Beste Ozben, Sahin, Ahmet Anil, Buyuk, Ahmet, Kilicarslan, Onur, Bostan, Cem, Yildirim, Tarik, Yildirim, Seda Elcim, Cosansu, Kahraman, Varim, Perihan, Ilguz, Ersin, Demirbag, Recep, Yesilay, Asuman, Cirit, Abdullah, Tusun, Eyyup, Erkus, Emre, Sayin, Muhammet Rasit, Kazaz, Zeynep, Kul, Selim, Karabag, Turgut, Kalayci, Belma, Eugène, Marc, and Bax, Jeroen J.

Published
2021
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3. Long-Term Implications of Atrial Fibrillation in Patients With Degenerative Mitral Regurgitation

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Suri, R., Clavel, M.A, Maalouf, J., Michelena, H., Nkomo, Vuyisile T., Enriquez-Sarano, M., Tribouilloy, C., Trojette, F., Szymanski, C., Rusinaru, D., Touati, G., Remadi, J.P., Guerra, F., Capucci, A., Grigioni, F., Russo, A., Biagini, E., Pasquale, F., Ferlito, M., Rapezzi, C., Savini, C., Marinelli, G., Pacini, D., Gargiulo, G.D., Di Bartolomeo, R., Boulif, J., de Meester, C., El Khoury, G., Gerber, B., Lazam, S., Pasquet, A., Noirhomme, P., Vancraeynest, D., Vanoverschelde, J-L., Avierinos, J.F., Collard, F., Théron, A., Habib, G., Barbieri, A., Bursi, F., Mantovani, F., Lugli, R., Modena, M.G., Boriani, G., Bacchi-Reggiani, L., Grigioni, Francesco, Benfari, Giovanni, Vanoverschelde, Jean-Louis, Tribouilloy, Christophe, Avierinos, Jean-Francois, Bursi, Francesca, Suri, Rakesh M., Guerra, Federico, Pasquet, Agnés, Rusinaru, Dan, Marcelli, Emanuela, Théron, Alexis, Barbieri, Andrea, Michelena, Hector, Lazam, Siham, Szymanski, Catherine, Capucci, Alessandro, Thapa, Prabin, and Enriquez-Sarano, Maurice

Published
2019
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9. Twenty-Year Outcome After Mitral Repair Versus Replacement for Severe Degenerative Mitral Regurgitation: Analysis of a Large, Prospective, Multicenter, International Registry

Author

Lazam, Siham, Vanoverschelde, Jean-Louis, Tribouilloy, Christophe, Grigioni, Francesco, Suri, Rakesh M., Avierinos, Jean-Francois, Meester, Christophe de, Barbieri, Andrea, Rusinaru, Dan, Russo, Antonio, Pasquet, Agnès, Michelena, Hector I., Huebner, Marianne, Maalouf, Joseph, Clavel, Marie-Annick, Szymanski, Catherine, and Enriquez-Sarano, Maurice

Published
2017
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16. Usefulness of Longitudinal Strain Adjusted to Regional Thickness in Hypertrophic Cardiomyopathy.

Author

Urtado, Sophie, Hergault, Hélène, Binsse, Stephen, Aidan, Vincent, Ouadahi, Mounir, Szymanski, Catherine, Mallet, Sophie, Hauguel-Moreau, Marie, Carlier, Robert Yves, Dubourg, Olivier, and Mansencal, Nicolas

Subjects
HYPERTROPHIC cardiomyopathy, CONTROL groups
Abstract

Background. We assessed the usefulness of a longitudinal strain adjusted to regional thickness in hypertrophic cardiomyopathy (HCM). Indeed, with conventional software, the width of the region of interest (ROI) is the same over the entire myocardial wall, wherein the software analyzes only partially the left ventricular (LV) hypertrophic segments. Methods. We included 110 patients: 55 patients with HCM (HCM group) and 55 healthy subjects (age- and sex-matched control group). The global longitudinal strain (GLS) and regional strain for each of the 17 segments was calculated with standard software (for two groups) and with software adjusted to the myocardial wall thickness (for the HCM group). Results. GLS was significantly decreased in the HCM group compared to the control group (−15.1 ± 4.8% versus −20.5 ± 4.3%, p < 0.0001). In the HCM group, GLS (standard method versus adjusted to thickness) measurements were not significantly different (p = 0.34). Interestingly, the regional strain adjusted to thickness was significantly lower than the standard strain in the hypertrophic segments, especially in the basal inferoseptal segment (p = 0.0002), median inferoseptal segment (p < 0.001) and median anteroseptal segment (p = 0.02). The strain adjusted to thickness was still significantly lower in the most hypertrophic segments (≥20 mm) (−3.7 ± 3%, versus −5.9 ± 4.4%, p = 0.049 in the basal inferoseptal segment and −5.7 ± 3.5% versus −8.3 ± 4.5%, p = 0.0007 in the median inferoseptal segment). In the segments with significant myocardial fibrosis, the longitudinal strain adjusted to thickness was significantly lower than the conventional strain (−8.3 ± 3.3% versus −11.4 ± 4.5%, p = 0.002). The analysis of the strain adjusted to thickness had a better feasibility (97.5% versus 99%, p = 0.01). Conclusions. The analysis of a longitudinal strain adjusted to regional thickness is feasible in HCM and allows a better evaluation of myocardial deformation, especially in the most LV hypertrophic segments. [ABSTRACT FROM AUTHOR]

Published
2022
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24. Assessment of atrial function by myocardial deformation techniques in hypertrophic cardiomyopathy.

Author

Siam‐Tsieu, Valerie, Urtado, Sophie, Charron, Philippe, Hergault, Hélène, Szymanski, Catherine, Mallet, Sophie, Dubourg, Olivier, and Mansencal, Nicolas

Subjects
ECHOCARDIOGRAPHY, CARDIAC hypertrophy, CARDIAC contraction, ATHLETES, COMPARATIVE studies, DESCRIPTIVE statistics, LEFT heart atrium, MEDICAL needs assessment
Abstract

Background: Diastolic dysfunction in hypertrophic cardiomyopathy (HCM) is common, but its assessment is difficult using conventional echocardiography. Aims: To assess left atrial (LA) function in HCM by longitudinal strain and determine its role in understanding of symptoms. Methods: We studied 144 patients divided into 3 age‐ and sex‐matched groups: 48 consecutive patients with HCM, 48 control subjects, and 48 athlete subjects. We assessed LA function by conventional echocardiographic parameters and by longitudinal atrial strain (early‐diastolic left atrial strain during reservoir phase [LASr]; end‐diastolic left atrial strain during conduit phase; end‐systolic peak of the left atrial strain during contraction phase). Results: NYHA classification was as follows in HCM group: I in 46%, II in 31%, III in 19%, and IV in 4%. Conventional echocardiographic parameters of diastolic function were depressed in the HCM group as compared to the control and athlete groups, but not related to symptoms. All longitudinal atrial strain parameters were significantly reduced in HCM group as compared to two groups (P <.0001). LASr was significantly correlated to peak VO2 (r = 0.44, P =.01) and was the best parameter for detecting symptomatic patients presenting with HCM, with a cutoff value of 15%: Sensitivity was 71%, specificity was 79%, PPV was 77%, and NPV was 73%. Conclusion: Assessment of LA function in HCM is feasible using longitudinal strain, and this technique is more reliable than conventional echocardiographic parameters for the understanding of determinants of symptoms. [ABSTRACT FROM AUTHOR]

Published
2021
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26. Myocardial Infarction Alters Adaptation of the Tethered Mitral Valve

Author

Dal-Bianco, Jacob P, Aikawa, Elena, Bischoff, Joyce, Guerrero, J Luis, Hjortnaes, Jesper, Beaudoin, Jonathan, Szymanski, Catherine, Bartko, Philipp E, Seybolt, Margo M, Handschumacher, Mark D, Sullivan, Suzanne, Garcia, Michael L, Mauskapf, Adam, Titus, James S, Wylie-Sears, Jill, Irvin, Whitney S, Chaput, Miguel, Messas, Emmanuel, Hagège, Albert A, Carpentier, Alain, Levine, Robert A, and Leducq Transatlantic Mitral Network

Subjects
Research Support, N.I.H., Extramural, inflammation, Research Support, Non-U.S. Gov't, Journal Article, echocardiography, mitral regurgitation, papillary muscle, endothelial-to-mesenchymal transition
Abstract

BACKGROUND: In patients with myocardial infarction (MI), leaflet tethering by displaced papillary muscles induces mitral regurgitation (MR), which doubles mortality. Mitral valves (MVs) are larger in such patients but fibrosis sets in counterproductively. The investigators previously reported that experimental tethering alone increases mitral valve area in association with endothelial-to-mesenchymal transition. OBJECTIVES: The aim of this study was to explore the clinically relevant situation of tethering and MI, testing the hypothesis that ischemic milieu modifies mitral valve adaptation. METHODS: Twenty-three adult sheep were examined. Under cardiopulmonary bypass, the papillary muscle tips in 6 sheep were retracted apically to replicate tethering, short of producing MR (tethered alone). Papillary muscle retraction was combined with apical MI created by coronary ligation in another 6 sheep (tethered plus MI), and left ventricular remodeling was limited by external constraint in 5 additional sheep (left ventricular constraint). Six sham-operated sheep were control subjects. Diastolic mitral valve surface area was quantified by 3-dimensional echocardiography at baseline and after 58 ± 5 days, followed by histopathology and flow cytometry of excised leaflets. RESULTS: Tethered plus MI leaflets were markedly thicker than tethered-alone valves and sham control subjects. Leaflet area also increased significantly. Endothelial-to-mesenchymal transition, detected as α-smooth muscle actin-positive endothelial cells, significantly exceeded that in tethered-alone and control valves. Transforming growth factor-β, matrix metalloproteinase expression, and cellular proliferation were markedly increased. Uniquely, tethering plus MI showed endothelial activation with vascular adhesion molecule expression, neovascularization, and cells positive for CD45, considered a hematopoietic cell marker. Tethered plus MI findings were comparable with external ventricular constraint. CONCLUSIONS: MI altered leaflet adaptation, including a profibrotic increase in valvular cell activation, CD45-positive cells, and matrix turnover. Understanding cellular and molecular mechanisms underlying leaflet adaptation and fibrosis could yield new therapeutic opportunities for reducing ischemic MR.

Published
2016

27. Evaluation of NT-proBNP in Inflammatory Bowel Disease

Author

Wacrenier, A., Bourgeois, A. -M., Ausseil, J., Szymanski, Catherine, Thiebault, H., Brazier, Franck, Galmiche, A., Nguyen-Khac, Eric, Dupas, Jean-Louis, Colombel, J. -F., Fumery, Mathurin, Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Immunologie moléculaire et biothérapies innovantes (IMBI), École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université d'Évry-Val-d'Essonne (UEVE)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Généthon, CHU Amiens-Picardie, Laboratoire de neurophysiologie cellulaire (LNPC), Université de la Méditerranée - Aix-Marseille 2-Centre National de la Recherche Scientifique (CNRS), Groupe de Recherche sur l'alcool et les pharmacodépendances - UMR INSERM_S 1247 (GRAP), Université de Picardie Jules Verne (UPJV)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'Hépato Gastroenterologie [CHU Amiens-Picardie], Périnatalité et Risques Toxiques - UMR INERIS_I 1 (PERITOX), Institut National de l'Environnement Industriel et des Risques (INERIS)-Université de Picardie Jules Verne (UPJV)-CHU Amiens-Picardie, and DESSAIVRE, Louise

Subjects
[SDV] Life Sciences [q-bio], [SDV]Life Sciences [q-bio], ComputingMilieux_MISCELLANEOUS
Abstract

International audience

Published
2015

28. 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.

Author

Szymanski, Catherine, Bohbot, Yohann, Rusinaru, Dan, Touati, Gilles, and Tribouilloy, Christophe

Subjects
*MITRAL valve prolapse, *MITRAL valve insufficiency, *MITRAL valve, *RHYTHM, *VALVES
Abstract

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. [ABSTRACT FROM AUTHOR]

Published
2019
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32. Clinical outcome in asymptomatic severe aortic stenosis: insights from the new proposed aortic stenosis grading classification

Author

Lancellotti, Patrizio, Magne, Julien, Donal, Erwan, Davin, Laurent, O'Connor, Kim, Rosca, Monica, Szymanski, Catherine, Cosyns, Bernard, Piérard, Luc A, Service de cardiologie, Université de Liège, Service de cardiologie et maladies vasculaires [Rennes] = Cardiac, Thoracic, and Vascular Surgery [Rennes], CHU Pontchaillou [Rennes], CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de cardiologie et maladies vasculaires, Université de Rennes 1 (UR1), and Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-CHU Pontchaillou [Rennes]

Subjects
MESH: Aged, MESH: Middle Aged, MESH: Humans, aortic stenosis, MESH: Asymptomatic Diseases, MESH: Follow-Up Studies, MESH: Prospective Studies, MESH: Male, MESH: Aged, 80 and over, classification, [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system, MESH: Risk Factors, MESH: Severity of Illness Index, MESH: Disease-Free Survival, outcome, echocardiography, [SDV.IB]Life Sciences [q-bio]/Bioengineering, valve, MESH: Cohort Studies, MESH: Female, MESH: Aortic Valve Stenosis, MESH: Treatment Outcome
Abstract

International audience; OBJECTIVES: This study examined the clinical course of patients with asymptomatic severe aortic stenosis (AS) according to the new proposed aortic valve stenosis grading classification. BACKGROUND: The management of patients with asymptomatic severe AS remains controversial. Moreover, under the same denomination of severe AS, several entities might be identified according to transvalvular flow rates and pressure gradients, resulting in 4 flow-gradient patterns. METHODS: Transthoracic echocardiography and measurement of B-type natriuretic peptide level from venous blood sample were performed in 150 consecutive patients with asymptomatic severe AS and normal exercise test. Patients were classified in 4 groups, depending on left ventricular flow state (normal flow [NF] vs. low flow [LF]: 35 ml/m(2)) and pressure gradient levels (low gradient [LG] vs. high gradient [HG]: 40 mm Hg). RESULTS: Patients with NF/LG had significantly lower B-type natriuretic peptide than those with LF/HG and LF/LG. The mean follow-up was 27 ± 12 months. At 2 years, cardiac event-free survival was 83 ± 6%, 44 ± 6%, 30 ± 12%, and 27 ± 13% in NF/LG, NF/HG, LF/HG, and LF/LG groups, respectively (p < 0.0001). On multivariable analysis, LF/LG (hazard ratio [HR]: 5.26, 95% confidence interval [CI]: 2.04 to 14.3, p = 0.045) and LF/HG (HR: 2.38, 95% CI: 1.02 to 5.55, p = 0.001) were identified as strong independent determinants of poor prognosis as compared with NF/HG. By limiting the multivariable analysis to patients with LF, LF/LG was an independent predictor of markedly reduced cardiac event-free survival when compared with LF/HG (HR: 5.4, 95% CI: 1.03 to 28.6, p = 0.046). CONCLUSIONS: The use of the new proposed AS grading classification integrating valve area and flow-gradient patterns allows a better characterization of the clinical outcome of patients with asymptomatic severe AS.

Published
2012

33. Outcomes in Mitral Regurgitation Due to Flail Leaflets. A Multicenter European Study

Author

Grigioni, Francesco, Tribouilloy, Christophe, Avierinos, Jean Francois, Barbieri, Andrea, Ferlito, Marinella, Trojette, Faouzi, Tafanelli, Laurence, Branzi, Angelo, Szymanski, Catherine, Habib, Gilbert, Modena, Maria G., and Enriquez-Sarano, Maurice

Subjects
Male, Time Factors, Left, Kaplan-Meier Estimate, Risk Assessment, Severity of Illness Index, Nuclear Medicine and Imaging, Atrial Fibrillation, Aged, Echocardiography, Doppler, Europe, Female, Heart Failure, Humans, Middle Aged, Mitral Valve, Mitral Valve Insufficiency, Patient Selection, Proportional Hazards Models, Prospective Studies, Registries, Stroke Volume, Treatment Outcome, Ventricular Function, Left, Cardiac Surgical Procedures, Cardiology and Cardiovascular Medicine, Radiology, Nuclear Medicine and Imaging, Ventricular Function, Doppler, Echocardiography, Radiology
Abstract

ObjectivesThe purpose of this study was to assess incidence and predictors of events associated with nonsurgical and surgical management of severe mitral regurgitation (MR) in European institutions.BackgroundThe management of patients with MR remains disputed, warranting multicenter studies to define clinical outcome in routine clinical practice.MethodsThe MIDA (Mitral Regurgitation International DAtabase) is a registry created for multicenter study of MR with echocardiographically diagnosed flail leaflet as a model of pure, organic MR. Our cases were collected from 4 European centers. We enrolled 394 patients (age 64 ± 11 years; 67% men; 64% in New York Heart Association functional class I to II; left ventricular ejection fraction 67 ± 10%).ResultsDuring a median follow-up of 3.9 years, linearized event rates/year under nonsurgical management were 5.4% for atrial fibrillation (AF), 8.0% for heart failure (HF), and 2.6% for death. Mitral valve (MV) surgery was performed in 315 (80%) patients (repair in 250 of 315, 80%). Perioperative mortality, defined as death within 30 days from the operation, was 0.7% (n = 2). Surgery during follow-up was independently associated with reduced risk of death (adjusted hazard ratio [HR] 0.42, 95% confidence interval [CI] 0.21 to 0.84; p = 0.014). Benefit was largely driven by MV repair (adjusted HR vs. replacement 0.37, 95% CI 0.18 to 0.76; p = 0.007). In 102 patients strictly asymptomatic and with normal ventricular function, 5-year combined incidence of AF, HF, or cardiovascular death (CVD) was 42 ± 8%. In these patients, surgery also reduced rates of CVD/HF (HR 0.26, 95% CI 0.08 to 0.89; p = 0.032).ConclusionsIn this multicenter study, nonsurgical management of severe MR was associated with notable rates of adverse events. Surgery especially MV repair performed during follow-up was beneficial in reducing rates of cardiac events. These findings support surgical consideration in patients with MR due to flail leaflets for whom MV repair is feasible.

Published
2008

37. Clinical and Prognostic Impact of a New Left Ventricular Ejection Index in Primary Mitral Regurgitation Because of Mitral Valve Prolapse.

Author

Magne, Julien, Szymanski, Catherine, Fournier, Alexandre, Malaquin, Dorothée, Avierinos, Jean François, and Tribouilloy, Christophe

Abstract

Background--To prevent left ventricular dysfunction (LVD), surgery is recommended in patients with severe primary mitral regurgitation as soon as ejection fraction (EF) ≥60% or LV end-systolic diameter ≥40 mm. However, LVD may be concealed behind preoperative normal LVEF and LV end-systolic diameter. We sought to identify whether a new composite echocardiographic Doppler marker of the LV ejection according to the LV dilatation may predict postoperative LVD and outcome after mitral valve repair in patients with primary mitral regurgitation. Methods and Results--Between 1991 and 2010, patients who underwent mitral valve repair for primary mitral regurgitation were studied. From preoperative echocardiography, we calculated LV ejection index (LVEI) using following formula: LVEI=indexed LV end-systolic diameter/LV outflow tract time-velocity integral. In the 278 patients included, the best correlation with postoperative LVEF was found with LVEI (r=-0.40; P<0.0001), even in patients with preoperative LVEF≥60% (r=-0.46; P<0.0001). In multivariable analysis, LCEI>1.13 was an independent predictor of postoperative LVD (P<0.0001). During a mean follow-up of 10±4.6 years, 67 (29%) deaths occurred. When compared with patients with preserved LVEI, those with LVEI>1.13 had significantly lower both survival and cardiac death-free survival (P=0.017 and P=0.008, respectively). Similar results were found in patients with preoperative LVEF≥60% (P=0.049 and P=0.016, respectively). In Cox proportional hazard model, after meticulous adjustment for cofactors, LVEI>1.13 remains independently associated with death (hazard ratio, 1.64; P=0.039) and cardiac-related death (hazard ratio, 3.27; P=0.026). Conclusions--After mitral valve repair for primary mitral regurgitation, the preoperative LVEI is a new and simple composite parameter of both LV dilatation and LV forward flow able to accurately predict postoperative LVD and outcome. [ABSTRACT FROM AUTHOR]

Published
2015
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38. Long-Term Mortality Associated With Left Ventricular Dysfunction in Mitral Regurgitation Due to Flail Leaflets.

Author

Tribouilloy, Christophe, Rusinaru, Dan, Grigioni, Francesco, Michelena, Hector I., Vanoverschelde, Jean-Louis, Avierinos, Jean-François, Barbieri, Andrea, Pislaru, Sorin V., Russo, Antonio, Pasquet, Agnès, Théron, Alexis, Szymanski, Catherine, Lévy, Franck, and Enriquez-Sarano, Maurice

Abstract

Ejection fraction (EF) as a marker of left ventricular (LV) dysfunction and the appropriate thresholds for diagnosing severe or mild/moderate LV dysfunction in mitral regurgitation are doubted and poorly followed in clinical practice. We aimed at assessing the role of EF in a large registry of organic mitral regurgitation to objectively establish thresholds for various degrees of LV dysfunction and to analyze whether mitral surgery remains beneficial in those subsets of patients.We investigated the relation between EF and mortality in 1875 patients with mitral regurgitation due to flail leaflets in sinus rhythm (65±13 years; median EF, 66% [60%-71%]) enrolled in the Mitral Regurgitation International Database (MIDA) registry. With EF <60%, mortality after diagnosis increased precipitously under medical management (adjusted hazard ratio [HR], 1.59 [1.19-2.12]) and during the entire follow-up (adjusted HR, 1.51 [1.22-1.87]). Severe LV dysfunction, if defined by EF <30%, would affect a minuscule number of patients (0.3%). Conversely, EF <45% was more frequent (2.9%) and was associated with considerable mortality under medical management (adjusted HR, 2.43 [1.50-3.95]) and during the entire follow-up (adjusted HR, 2.46 [1.67-3.61]). The group with EF of 45% to 60% represented a large proportion of patients (23%), exhibited rarely overt symptoms, and had higher mortality compared with EF >60%. Above 60%, no EF threshold further determined survival. The benefit of surgery remained considerable in the groups with EF <45% (adjusted HR, 0.28 [0.17-0.56]) and with EF of 45% to 60% (adjusted HR, 0.34 [0.21-0.64]).EF is valuable in defining presence and severity of LV dysfunction in organic mitral regurgitation. Patients with EF <45% have severe LV dysfunction, catastrophic outcome under medical management, and should not be denied surgery. Although there is no survival gain with EF ranges >60%, with EF dropping <60%, mortality increases precipitously and prompt surgical referral is critical to outcome. [ABSTRACT FROM AUTHOR]

Published
2014
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41. Comprehensive Annular and Subvalvular Repair of Chronic Ischemic Mitral Regurgitation Improves Long-Term Results With the Least Ventricular Remodeling.

Author

Szymanski, Catherine, Bel, Alain, Cohen, Iris, Touchot, Bernard, Handschumacher, Mark D., Desnos, Michel, Carpentier, Alain, Menasche, Philippe, Hagege, Albert A., Levine, Robert A., and Messas, Emmanuel

Subjects
*MITRAL valve insufficiency, *VENTRICULAR remodeling, *MYOCARDIAL infarction, *ECHOCARDIOGRAPHY, *LEFT heart ventricle
Abstract

Background-Undersized ring annuloplasty for ischemic mitral regurgitation (MR) is associated with variable results and >30% MR recurrence. We tested whether subvalvular repair by severing second-order mitral chordae can improve annuloplasty by reducing papillary muscle tethering. Methods and Results-Posterolateral myocardial infarction known to produce chronic remodeling and MR was created in 28 sheep. At 3 months, sheep were randomized to sham surgery versus isolated undersized annuloplasty versus isolated bileaflet chordal cutting versus the combined therapy (n = 7 each). At baseline, chronic myocardial infarction (3 months), and euthanasia (6.6 months), we measured left ventricular (LV) volumes and ejection fraction, wall motion score index, MR regurgitation fraction and vena contracta, mitral annulus area, and posterior leaflet restriction angle (posterior leaflet to mitral annulus area) by 2-dimensional and 3-dimensional echocardiography. All groups were comparable at baseline and chronic myocardial infarction, with mild to moderate MR (MR vena contracta, 4.6±0.1 mm; MR regurgitation fraction, 24.2±2.9%) and mitral annulus dilatation (P<0.01). At euthanasia, MR progressed to moderate to severe in controls but decreased to trace with ring plus chordal cutting versus trace to mild with chordal cutting alone versus mild to moderate with ring alone (MR vena contracta, 5.9±1.1 mm in controls, 0.5±0.08 with both, 1.0±0.3 with chordal cutting alone, 2.0±0.4 with ring alone; P<0.01). In addition, LV end-systolic volume increased by 108% in controls versus 28% with ring plus chordal cutting, less than with each intervention alone (P<0.01). In multivariate analysis, LV end-systolic volume and mitral annulus area most strongly predicted MR (r2=0.82, P<0.01). Conclusions-Comprehensive annular and subvalvular repair improves long-term reduction of both chronic ischemic MR and LV remodeling without decreasing global or segmental LV function at follow-up [ABSTRACT FROM AUTHOR]

Published
2012
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42. Left Atrial Size Is a Potent Predictor of Mortality in Mitral Regurgitation Due to Flail Leaflets.

Author

Rusinaru, Dan, Tribouilloy, Christophe, Grigioni, Francesco, Avierinos, Jean Francois, Suri, Rakesh M., Barbieri, Andrea, Szymanski, Catherine, Ferlito, Marinella, Michelena, Hector, Tafanelli, Laurence, Bursi, Francesca, Mezghani, Sonia, Branzi, Angelo, Habib, Gilbert, Modena, Maria G., and Enriquez-Sarano, Maurice

Subjects
HEART atrium, MITRAL valve insufficiency, MITRAL valve diseases, DIAGNOSIS, PROGNOSIS
Abstract

The article discusses the paper "Left Atrial Size Is a Potent Predictor of Mortality in Mitral Regurgitation Due to Flail Leaflets," by Dan Rusinaru, Christophe Tribouilloy, Francesco Grigioni, and others. It states that the enlargement of the left atrium (LA) is a good sign of organic mitral regurgitation (MR), but that such a relationship has yet to be understood in a routine clinical practice. A description of the research methods and results is presented.

Published
2011
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44. Relief of Mitral Leaflet Tethering Following Chronic Myocardial Infarction by Chordal Cutting Diminishes Left Ventricular Remodeling.

Author

Messas, Emmanuel, Bel, Alain, Szymanski, Catherine, Cohen, Iris, Touchot, Bernard, Handschumacher, Mark D., Desnos, Michel, Carpentier, Alain, Menasché, Philippe, Hagège, Albert A., and Levine, Robert A.

Subjects
CHORDAE tendineae, LEFT heart ventricle, MITRAL valve insufficiency, MYOCARDIAL infarction, HEART valves
Abstract

The article presents information on a study which determined whether the technique of cutting two second-order chordae to the anterior mitral leaflet minimizes the progression of left ventricle (LV) remodeling in the chronic ischemic mitral regurgitation (MR) setting. A review of the related literature on MR and chordae tendineae is offered. Obtuse marginal branch ligation was employed to create a posterolateral myocardial infarction (MI) in 18 sheep. A discussion on the research findings is detailed.

Published
2010
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