Metabolic signatures of cardiac dysfunction, multimorbidity, and post-transcatheter aortic valve implantation death

Background Studies in mice and small patient subsets implicate metabolic dysfunction in cardiac remodeling in aortic stenosis, but no large comprehensive studies of human metabolism in aortic stenosis with long-term follow-up and characterization currently exist. Methods and Results Within a multicenter prospective cohort study, we used principal components analysis to summarize 12 echocardiographic measures of left ventricular structure and function pre-transcatheter aortic valve implantation in 519 subjects (derivation). We used least absolute shrinkage and selection operator regression across 221 metabolites to define metabolic signatures for each structural pattern and measured their relation to death and multimorbidity in the original cohort and up to 2 validation cohorts (N=543 for overall validation). In the derivation cohort (519 individuals; median age, 84 years, 45% women, 95% White individuals), we identified 3 axes of left ventricular remodeling, broadly specifying systolic function, diastolic function, and chamber volumes. Metabolite signatures of each axis specified both known and novel pathways in hypertrophy and cardiac dysfunction. Over a median of 3.1 years (205 deaths), a metabolite score for diastolic function was independently associated with post-transcatheter aortic valve implantation death (adjusted hazard ratio per 1 SD increase in score, 1.54 [95% CI, 1.25-1.90]

Global longitudinal strain and biomarkers of cardiac damage and stress as predictors of outcomes after transcatheter aortic valve implantation

Background Global longitudinal strain (GLS) is a sensitive measure of left ventricular function and a risk marker in severe aortic stenosis. We sought to determine whether biomarkers of cardiac damage (cardiac troponin) and stress (NT-proBNP [N-terminal pro-B-type natriuretic peptide]) could complement GLS to identify patients with severe aortic stenosis at highest risk. Methods and Results From a multicenter prospective cohort of patients with symptomatic severe aortic stenosis who underwent transcatheter aortic valve implantation, we measured absolute GLS (aGLS), cardiac troponin, and NT-proBNP at baseline in 499 patients. Left ventricular ejection fraction \u3c50% was observed in 19% and impaired GLS (aGLS \u3c15%) in 38%. Elevations in cardiac troponin and NT-proBNP were present in 79% and 89% of those with impaired GLS, respectively, as compared with 63% and 60% of those with normal GLS, respectively

Left ventricular hypertrophy and biomarkers of cardiac damage and stress in aortic stenosis

Background Left ventricular hypertrophy (LVH) is associated with increased mortality risk and rehospitalization after transcatheter aortic valve replacement among those with severe aortic stenosis. Whether cardiac troponin (cTnT) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) risk stratify patients with aortic stenosis and without LVH is unknown. Methods and Results In a multicenter prospective registry of 923 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement, we included 674 with core-laboratory-measured LV mass index, cTnT, and NT-proBNP. LVH was defined by sex-specific guideline cut-offs and elevated biomarker levels were based on age and sex cut-offs. Adjusted Cox proportional hazards models evaluated associations between LVH and biomarkers and all-cause death out to 5 years. Elevated cTnT and NT-proBNP were present in 82% and 86% of patients with moderate/severe LVH, respectively, as compared with 66% and 69% of patients with no/mild LVH, respectively

Washington University Manual of Echocardiography.

""Title Page""; ""Copyright""; ""Dedication""; ""Contributors""; ""Foreword""; ""Preface""; ""Contents""; ""1 Introduction to Echocardiographic Principles""; ""2 The Comprehensive Transthoracic Echocardiographic Examination""; ""3 The Role of Contrast in Echocardiography""; ""4 Quantification of Left Ventricular Systolic and Diastolic Function""; ""5 Right Ventricular Function and Pulmonary Hemodynamics""; ""6 Stress Testing for Ischemia and Viability""; ""7 Ischemic Heart Disease and Complications of Myocardial Infarction""; ""8 Cardiomyopathies""; ""9 Hypertrophic Cardiomyopathy""""10 Aortic Valve Disease""""11 Mitral Valve Disease""; ""12 Pulmonic Valve""; ""13 Tricuspid Valve Disorders""; ""14 Evaluation of Prosthetic Valves""; ""15 Infective Endocarditis""; ""16 Pericardial Disease and Cardiac Tamponade""; ""17 Diseases of the Great Vessels: Aorta and Pulmonary Artery""; ""18 Congenital Heart Disease""; ""19 Cardiac Masses""; ""20 Cardiac Manifestations of Systemic Illness""; ""21 Transesophageal Echocardiography""; ""22 Cardiac Devices in Heart Failure""1 online resource (398 pages

Radiation exposure to the interventional echocardiographers and sonographers: A call to action

Interventional echocardiography is a rapidly growing field with the disciplines of cardiology and anesthesiology, with the rise of advanced transcatheter procedures making skilled imagers more important than ever. However, these procedures also involve frequent manipulation of the transesophageal echocardiography (TEE) probe, which means interventional echocardiographers (IE) are at risk of long-term occupational radiation exposure. Studies have shown that radiation exposure is linked to various health issues, including cancer, cataracts, hypertension, hyperlipidemia, endothelial dysfunction, vascular aging, and early atherosclerosis. While there is increasing awareness of the occupational radiation dose limits and the need for better shielding methods, the importance of radiation safety for the IE is still not sufficiently prioritized in most cardiac catheterization laboratories/hybrid operating rooms. This is partly due to a paucity of studies looking at long-term radiation exposure to the IE, as this field is newer than that of interventional cardiologists