PMID- 27876412
OWN - NLM
STAT- MEDLINE
DCOM- 20171108
LR  - 20181202
IS  - 1876-4738 (Electronic)
IS  - 0914-5087 (Linking)
VI  - 70
IP  - 1
DP  - 2017 Jul
TI  - Advanced symptoms are associated with myocardial damage in patients with severe 
      aortic stenosis.
PG  - 41-47
LID - S0914-5087(16)30245-3 [pii]
LID - 10.1016/j.jjcc.2016.10.006 [doi]
AB  - BACKGROUND: Once aortic stenosis (AS) is severe, patients develop symptoms at 
      different stages. Indeed, symptom status may correlate poorly with the grade of 
      valve narrowing. Multiple pathophysiological mechanisms, other than valvular 
      load, may explain the link between AS and symptom severity. We aimed to describe 
      the relationship between the severity of symptoms and the characteristics of a 
      cohort of patients with severe AS already referred for aortic valve replacement 
      (AVR). METHODS: We analyzed 118 consecutive patients (70+/-9 years, 55% men) with 
      severe AS referred for AVR. We identified 84 patients with New York Heart 
      Association (NYHA) I-II, and 34 with NYHA III-IV symptoms. Clinical and 
      echocardiographic parameters were compared between these two groups. Left 
      ventricular ejection fraction (LVEF), global longitudinal peak systolic strain 
      (GLPS), NT-pro-B-type natriuretic peptide (BNP), and high-sensitive troponin T 
      (hs-TNT) were determined at the time of admission. RESULTS: AS severity was 
      similar between groups. Compared with the NYHA I-II group, patients in NYHA 
      III-IV group were older and more likely to have comorbidities, worse intracardiac 
      hemodynamics and more LV damage. Variables independently associated with NYHA 
      III-IV symptomatology were the absence of sinus rhythm, higher E/e' ratio, and 
      increased hs-TNT. GLPS showed a good correlation not only with hs-TNT as a marker 
      of myocardial damage, but also with markers of increased afterload imposed on LV, 
      being not directly related with advanced symptoms. CONCLUSIONS: Advanced symptoms 
      in patients with severe AS referred for AVR are associated with worse 
      intracardiac hemodynamics, absence of sinus rhythm, and more myocardial damage. 
      It supports the concept of transition from adaptive LV remodeling to myocyte 
      death as an important determinant of symptoms of heart failure.
CI  - Copyright (c) 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All 
      rights reserved.
FAU - Spampinato, Ricardo A
AU  - Spampinato RA
AD  - Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, 
      Leipzig, Germany. Electronic address: spampinatoricardo@gmail.com.
FAU - Tasca, Manuela
AU  - Tasca M
AD  - Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, 
      Leipzig, Germany.
FAU - Borger, Michael A
AU  - Borger MA
AD  - Division of Cardiac, Thoracic and Vascular Surgery, Columbia University Medical 
      Center, New York, NY, USA.
FAU - Schloma, Valerie
AU  - Schloma V
AD  - Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, 
      Leipzig, Germany.
FAU - Dmitrieva, Yaroslava
AU  - Dmitrieva Y
AD  - Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, 
      Leipzig, Germany.
FAU - Mende, Meinhard
AU  - Mende M
AD  - Center for Clinical Trials (KKS), University of Leipzig, Leipzig, Germany.
FAU - Noack, Thilo
AU  - Noack T
AD  - Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, 
      Leipzig, Germany.
FAU - Strotdrees, Elfriede
AU  - Strotdrees E
AD  - Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, 
      Leipzig, Germany.
FAU - Mohr, Friedrich-W
AU  - Mohr FW
AD  - Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, 
      Leipzig, Germany.
LA  - eng
PT  - Journal Article
DEP - 20161119
PL  - Netherlands
TA  - J Cardiol
JT  - Journal of cardiology
JID - 8804703
RN  - 0 (Biomarkers)
RN  - 0 (Peptide Fragments)
RN  - 0 (Troponin T)
RN  - 0 (pro-brain natriuretic peptide (1-76))
RN  - 114471-18-0 (Natriuretic Peptide, Brain)
SB  - IM
MH  - Aged
MH  - Aortic Valve/surgery
MH  - Aortic Valve Stenosis/blood/*physiopathology/surgery
MH  - Biomarkers
MH  - Echocardiography
MH  - Female
MH  - Heart/*physiopathology
MH  - Heart Valve Prosthesis Implantation
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Natriuretic Peptide, Brain/blood
MH  - Peptide Fragments/blood
MH  - Severity of Illness Index
MH  - Symptom Assessment
MH  - Troponin T/blood
MH  - Ventricular Function, Left/physiology
OTO - NOTNLM
OT  - Aortic valve stenosis
OT  - Biomarkers
OT  - Functional class
OT  - Global longitudinal strain
OT  - High-sensitive troponin T
EDAT- 2016/11/24 06:00
MHDA- 2017/11/09 06:00
CRDT- 2016/11/24 06:00
PHST- 2016/07/05 00:00 [received]
PHST- 2016/10/02 00:00 [revised]
PHST- 2016/10/18 00:00 [accepted]
PHST- 2016/11/24 06:00 [pubmed]
PHST- 2017/11/09 06:00 [medline]
PHST- 2016/11/24 06:00 [entrez]
AID - S0914-5087(16)30245-3 [pii]
AID - 10.1016/j.jjcc.2016.10.006 [doi]
PST - ppublish
SO  - J Cardiol. 2017 Jul;70(1):41-47. doi: 10.1016/j.jjcc.2016.10.006. Epub 2016 Nov 
      19.