Operative Risk Stratification and Predictors for Long- Term Outcome in Low-Gradient Aortic Stenosis
2004; Lippincott Williams & Wilkins; Volume: 109; Issue: 5 Linguagem: Inglês
10.1161/01.cir.0000115209.47022.9b
ISSN1524-4539
AutoresPaul A. Tunick, Itzhak Kronzon,
Tópico(s)Coronary Interventions and Diagnostics
ResumoHomeCirculationVol. 109, No. 5Operative Risk Stratification and Predictors for Long- Term Outcome in Low-Gradient Aortic Stenosis Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBOperative Risk Stratification and Predictors for Long- Term Outcome in Low-Gradient Aortic Stenosis Paul A. Tunick and Itzhak Kronzon Paul A. TunickPaul A. Tunick Department of Medicine, New York University School of Medicine, New York, NY and Itzhak KronzonItzhak Kronzon Department of Medicine, New York University School of Medicine, New York, NY Originally published10 Feb 2004https://doi.org/10.1161/01.CIR.0000115209.47022.9BCirculation. 2004;109:e33To the Editor:We would like to congratulate Monin et al1 for their important multicenter study concerning risk stratification for valve replacement in low-gradient aortic stenosis using dobutamine echocardiography. It is possible that the lack of correlation in their study between the presence of previous myocardial infarction (MI) and perioperative mortality (a correlation that we did find in our study2) occurred because of a difference in our patient populations (the average ejection fraction of their patients was 31%, and that of our patients was 21%). In our patient population, 90% of the perioperative deaths occurred in those with a previous MI (mortality was 45% in those with prior MI, and only 3% in those without, despite very poor left ventricular (LV) function and relatively low aortic gradients). Apparently when LV damage is permanent (scar) and severe, replacing the aortic valve, with or without revascularization, does not result in recovery of LV function.1 Monin J-L, Quéré J-P, Monchi M, et al. Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation. 2003; 108: 319–324.LinkGoogle Scholar2 Powell DS, Tunick PA, Katz ES, et al. Outcome of aortic valve replacement in patients with severe aortic stenosis and severe left ventricular dysfunction. Arch Intern Med. 2000; 160: 1337–1341.CrossrefMedlineGoogle ScholarcirculationahaCirculationCirculationCirculation0009-73221524-4539Lippincott Williams & WilkinsResponseMonin Jean-Luc, , Guéret Pascal, , Quéré Jean-Paul, , Tribouilloy Christophe, , Monchi Mehran, , Petit Hélène, , Ohlmann Patrick, , Baleynaud Serge, , Lelguen Claude, , Chauvel Christophe, , Dehant Patrick, , and Pop Camélia, 10022004We appreciate the interest of Drs Tunick and Kronzon regarding our recent article in Circulation.1 They raise the issue of the lack of correlation between previous myocardial infarction (MI) and perioperative mortality in our study. This is in contrast to their own series, in which previous infarction was the only independent predictor for operative mortality.2 In the series of Powell et al,2 36% of patients had previous MI, mean left ventricular (LV) ejection fraction (LVEF) was 0.22, and 9 patients (16%) had severe mitral regurgitation (MR) that required surgery in 6 cases. In contrast, in our series,1 among 95 operated patients, only 20% had previous MI, mean LVEF was 0.30, and patients with significant MR were excluded. Thus, we agree that the higher prevalence of previous MI, with lower LVEF and (for some patients) severe MR in the series of Powell et al,2 might explain the different predictors for operative mortality found in the 2 studies. Furthermore, the possible interaction between LV contractile reserve and previous MI might also explain, in part, the predictive value of this latter parameter in the study by Powell et al.2 Our results show that among 19 patients with previous MI, 4 died within 30 days (21%), 3 of whom had no contractile reserve on dobutamine hemodynamics. Conversely, among the 76 patients without MI, there were 9 perioperative deaths (12%), 7 of whom were without reserve. We agree that a large scar from previous MI prevents postoperative recovery of LV function; furthermore, LV contractile reserve is unlikely to be present in such patients. Thus, a lack of contractile reserve and previous MI may be related in some cases, but not all, considering that extensive myocardial fibrosis due to longstanding hypertrophy may also explain the lack of reserve in some other patients. This possible interaction between contractile reserve and previous MI might have been found in the population studied by Powell et al2 if the issue of LV contractile reserve had been addressed in this study. eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. 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Shapiro R, Zajarias A and Rich M (2013) Aortic stenosis in the older population, Aging Health, 10.2217/ahe.13.62, 9:6, (567-578), Online publication date: 1-Dec-2013. Khan T, Shah T, Prieto D, Zhang W, Price J, Fowkes G, Cooper J, Talmud P, Humphries S, Sundstrom J, Hubacek J, Ebrahim S, Lawlor D, Ben-Shlomo Y, Abdollahi M, Slooter A, Szolnoki Z, Sandhu M, Wareham N, Frikke-Schmidt R, Tybjærg-Hansen A, Fillenbaum G, Heijmans B, Katsuya T, Gromadzka G, Singleton A, Ferrucci L, Hardy J, Worrall B, Rich S, Matarin M, Whittaker J, Gaunt T, Whincup P, Morris R, Deanfield J, Donald A, Davey Smith G, Kivimaki M, Kumari M, Smeeth L, Khaw K, Nalls M, Meschia J, Sun K, Hui R, Day I, Hingorani A and Casas J (2013) Apolipoprotein E genotype, cardiovascular biomarkers and risk of stroke: Systematic review and meta-analysis of 14 015 stroke cases and pooled analysis of primary biomarker data from up to 60 883 individuals, International Journal of Epidemiology, 10.1093/ije/dyt034, 42:2, (475-492), Online publication date: 1-Apr-2013., Online publication date: 1-Apr-2013. Bochem A, van Wijk D, Holleboom A, Duivenvoorden R, Motazacker M, Dallinga-Thie G, de Groot E, Kastelein J, Nederveen A, Hovingh G and Stroes E (2012) ABCA1 mutation carriers with low high-density lipoprotein cholesterol are characterized by a larger atherosclerotic burden, European Heart Journal, 10.1093/eurheartj/ehs376, 34:4, (286-291), Online publication date: 2-Jan-2013. Kalantari M, Ramezanifard M, Dargahi J and Kövecses J (2011) 3D Graphical Rendering of Localized Lumps and Arteries for Robotic Assisted MIS, Journal of Medical Devices, 10.1115/1.4003736, 5:2, Online publication date: 1-Jun-2011. Plana N, Ferré R, Merino J, Aragonès G, Girona J, Heras M and Masana L (2011) Heterozygous Familial Hypercholesterolaemic Patients have Increased Arterial Stiffness, as Determined using the Augmentation Index, Journal of Atherosclerosis and Thrombosis, 10.5551/jat.9795, 18:12, (1110-1116), . Caserta C, Pendino G, Amante A, Vacalebre C, Fiorillo M, Surace P, Messineo A, Surace M, Alicante S, Cotichini R, Zuin M, Rosmini F, Mele A and Marcucci F (2010) Cardiovascular Risk Factors, Nonalcoholic Fatty Liver Disease, and Carotid Artery Intima-Media Thickness in an Adolescent Population in Southern Italy, American Journal of Epidemiology, 10.1093/aje/kwq073, 171:11, (1195-1202), Online publication date: 1-Jun-2010. Baldassarre D, Nyyssönen K, Rauramaa R, de Faire U, Hamsten A, Smit A, Mannarino E, Humphries S, Giral P, Grossi E, Veglia F, Paoletti R and Tremoli E (2009) Cross-sectional analysis of baseline data to identify the major determinants of carotid intima–media thickness in a European population: the IMPROVE study, European Heart Journal, 10.1093/eurheartj/ehp496, 31:5, (614-622), Online publication date: 1-Mar-2010., Online publication date: 1-Mar-2010. Asimos A, Rosamond W, Johnson A, Price M, Rose K, Murphy C, Tegeler C and Felix A (2009) Early Diffusion Weighted MRI as a Negative Predictor for Disabling Stroke After ABCD2 Score Risk Categorization in Transient Ischemic Attack Patients, Stroke, 40:10, (3252-3257), Online publication date: 1-Oct-2009. Pacifico L, Cantisani V, Anania C, Bonaiuto E, Martino F, Pascone R and Chiesa C Serum uric acid and its association with metabolic syndrome and carotid atherosclerosis in obese children, European Journal of Endocrinology, 10.1530/EJE-08-0618, 160:1, (45-52) Schuchert A (2008) Intima-Media-DickeIntima media thickness, Der Kardiologe, 10.1007/s12181-008-0103-z, 2:4, (288-293), Online publication date: 1-Aug-2008. February 10, 2004Vol 109, Issue 5 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000115209.47022.9BPMID: 14769694 Originally publishedFebruary 10, 2004 PDF download Advertisement
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