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Sénéchal, Mario

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Sénéchal

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Mario

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Université Laval. Faculté de médecine

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ncf11892176

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  • PublicationRestreint
    Usefulness of global left ventricular longitudinal strain for risk stratification in low ejection fraction, low-gradient aortic stenosis : results from the multicenter true or pseudo-severe aortic stenosis study
    (American Heart Association, 2015-02-13) Dahou, Abdellaziz; Bartko, Philipp Emanuel; O'Connor, Kim; Sénéchal, Mario; Capoulade, Romain; Mundigler, Gerald; Pibarot, Philippe; Larue-Grondin, Samuel; Dumesnil, Jean G.; Bergler-Klein, Jutta; Clavel, Marie-Annick; Burwash, Ian; Baumgartner, Helmut
    Background — The objective of this study was to examine the impact of left ventricular (LV) global longitudinal strain (GLS) measured at rest and at dobutamine stress echocardiography on the outcome of patients with low LV ejection fraction and low-gradient aortic stenosis. Methods and Results — Among the 202 patients with low LV ejection fraction (=40%), low-gradient aortic stenosis (mean transvalvular gradient <40 mm¿Hg and indexed aortic valve area =0.6 cm2/m2) prospectively enrolled in the multicenter True or Pseudo-Severe Aortic Stenosis study, 126 patients with resting GLS and 73 patients with stress GLS available were included in this substudy. Three-year survival rate was 49% in patients with rest GLS <|9|% compared with 68% in patients with GLS >|9|% (P=0.02). In a multivariable Cox model adjusted for age, coronary artery disease, projected aortic valve area at a normal flow rate and type of treatment (aortic valve replacement versus conservative), rest GLS <|9|% (hazard ratio, 2.18; P=0.015) remained independently associated with all-cause mortality. GLS <|10|% measured during dobutamine stress echocardiography was also independently associated with mortality (hazard ratio, 2.67; P=0.01). In the subset of patients with stress GLS (n=73), the ¿2 of the multivariable model to predict all-causes mortality was 21.96 for stress GLS versus 17.78 for rest GLS. Conclusions — GLS is independently associated with mortality in patients with low LV ejection fraction, low-gradient aortic stenosis. Stress GLS measured during dobutamine stress echocardiography may provide incremental prognostic value beyond GLS measured at rest. Hence, measurement of GLS at rest and during dobutamine stress echocardiography may be helpful to enhance risk stratification in low LV ejection fraction, low-gradient aortic stenosis.
  • PublicationRestreint
    Right ventricular longitudinal strain for risk stratification in low-flow, low-gradient aortic stenosis with low ejection fraction
    (BMJ, 2016-01-13) Dahou, Abdellaziz; Sénéchal, Mario; Larose, Éric; Bartko, Philipp Emanuel; Magne, Julien; Rodés-Cabau, Josep; Mundigler, Gerald; Capoulade, Romain; Bergler-Klein, Jutta; Pibarot, Philippe; Burwash, Ian; Dumesnil, Jean G.; Mascherbauer, Julia; Clavel, Marie-Annick; Ribeiro, Henrique B.; O’Connor, Kim; Mathieu, Patrick; Baumgartner, Helmut; Rosenhek, Raphael
    Background : Left ventricular global longitudinal strain (LVLS) is a powerful predictor of outcome in patients with low-flow, low-gradient aortic stenosis (LF-LG AS) and low LV ejection fraction (LVEF). However, the impact of right ventricular (RV) function on the outcome of these patients remains unknown. Objectives : The aim of this study was to examine the impact of RV function as evaluated by RV free wall longitudinal strain (RVLS) on mortality in patients with LF-LG AS and low LVEF. Methods : 211 patients with LF-LG AS (mean gradient <40 mm Hg and indexed aortic valve area (AVA) =0.6 cm2/m2) and low LVEF (=40%)) were prospectively recruited in the True or Pseudo-severe Aortic Stenosis study. AS severity was assessed using the projected AVA (AVAproj) at normal flow rate. Among the 211 patients, 128 had RVLS measurement available at rest and were included in this analysis. RVLS measurement at dobutamine stress echocardiography (DSE) was available in 58 of the 128 patients. Results : Two-year survival was lower in patients with RVLS<|13|% (53%±9%) compared with those with RVLS>|13|% (69%±5%) (p=0.04). In multivariable Cox analysis stratified for the type of treatment (aortic valve replacement vs conservative) and adjusted for age, AS severity, previous myocardial infarction and LVLS, rest RVLS<|13|% (HR=2.70; 95% CI 1.19 to 6.11; p=0.018) was independently associated with all-cause mortality. RVLS had incremental prognostic value over baseline risk factors and LVLS (¿2=20.13 vs 13.56; p=0.01). Reduced stress RVLS was also associated with increased risk of mortality (stress RVLS<|14|%: HR=2.98; 95% CI 1.30 to 6.52; p=0.01). In multivariable Cox analysis, stress RVLS<|14|% remained independently associated with mortality (HR=2.94; 95% CI 1.23 to 7.02; p=0.015). After further adjustment for rest RVLS, stress RVLS<|14|% remained independently associated with mortality (HR=3.29; 95% CI 1.17 to 9.25; p=0.024), whereas rest RVLS was not (p>0.05). Conclusions : In this series of patients with LF-LG AS and low LVEF, reduced RVLS was independently associated with increased risk of mortality. Furthermore, stress RVLS provided incremental prognostic value beyond that obtained from rest RVLS. Thus, RVLS measurement at rest and at DSE may be helpful to enhance risk stratification in this high-risk population.
  • PublicationRestreint
    Outcome of patients with aortic stenosis, small valve area, and low-flow, low-gradient despite preserved left ventricular ejection fraction
    (American College of Cardiology, 2012-10-02) Sénéchal, Mario; Capoulade, Romain; Pibarot, Philippe; Dumesnil, Jean G.; Clavel, Marie-Annick; Mathieu, Patrick
    Objectives : The aim of this case match study was to compare the outcome of patients with paradoxical low-flow (left ventricular ejection fraction [LVEF] =50% but stroke volume index <35 ml/m2), low-gradient (mean gradient [MG] <40 mm Hg), a priori severe (aortic valve area [AVA] =1.0 cm2) aortic stenosis (AS) (PLG-SAS group) with that of patients with a severe AS (AVA =1.0 cm2) and consistent high-gradient (MG =40 mm Hg) (HG-SAS group) and with that of patients with a moderate AS (AVA >1.0 cm2 and MG <40 mm Hg) (MAS group).
  • PublicationRestreint
    Reply : to PMID 22657269
    (American College of Cardiology, 2013-04-30) Sénéchal, Mario; Pibarot, Philippe; Capoulade, Romain; Dumesnil, Jean G.; Clavel, Marie-Annick; Mathieu, Patrick
  • PublicationRestreint
    Direction of persistent ischemic mitral jet after restrictive valve annuloplasty: implications for interpretation of perioperative echocardiography
    (Elsevier, 2007-10-01) Dubois, Michelle; Magne, Julien; Sénéchal, Mario; Charbonneau, Éric; Pibarot, Philippe; Dumesnil, Jean G.; Dagenais, François
    BACKGROUND: Ischemic mitral regurgitation (MR) often persists after restrictive mitral valve annuloplasty (MVA) and is associated with a poor prognosis. It was hypothesized that the anterior displacement of the posterior aspect of the annulus caused by annuloplasty could induce a change in the direction of MR jet. METHODS: The echocardiograms of 21 patients who underwent restrictive MVA for ischemic MR and who had detectable postoperative MR were analyzed before and early after surgery to evaluate the direction of MR jet. RESULTS: The MR jet direction was posterior in 15 patients (72%) and central or anterior in six patients (28%) before the operation, compared with four patients (20%) and 17 patients (80%), respectively, after MVA (P<0.001). Overall, the jet direction was modified in 16 of 21 7patients (76%) following MVA. Among the subset of 11 patients with clinically significant persistent MR (vena contracta width greater than 3 mm), the MR jet direction changed in nine patients (82%) compared with their preoperative evaluation. Importantly, the initial clinical interpretation, based on a subjective evaluation, had classified MR severity as nonsignificant in six of 11 patients (55%), likely due to the eccentricity of the jet and its change in direction. CONCLUSION: The direction of the persistent MR jet early after annuloplasty is often different from that of preoperative MR jet and may lead to significant misinterpretation of the postoperative echocardiogram
  • PublicationRestreint
    A simple Doppler echocardiography method to evaluate pulmonary capillary wedge pressure in patients with atrial fibrillation
    (Wiley-Blackwell Publishing, 2007-08-22) O'Connor, Kim; Deblois, Jonathan; Sénéchal, Mario; Magne, Julien; Bergeron, Sébastien; Poirier, Paul; Pibarot, Philippe; Dumesnil, Jean G.
    OBJECTIVE: The accuracy of E/E' ratio has not been validated in atrial fibrillation (AF). The objective of this study is to compare the accuracy of the E/E' ratio averaged over a sample of 10 cardiac cycles and E/E' ratio obtained in the cycle with the longest RR interval for the estimation of wedge pressure in patients with AF using a simultaneous pulmonary artery occlusive pressure measured with a Swan-Ganz catheter. DESIGN: Twenty-four consecutive patients with AF with a Swan-Ganz catheter were recruited in this study. The majority of patients (92%) were in the early postoperative phase of cardiac surgery. RESULTS: The best sensitivity and specificity was reached with E/E' ratio in the medial position using the one-beat method; E/E' ratio > or = 16 with one beat predicts a wedge pressure >15 mmHg with a sensitivity and specificity of 91% and 85%, respectively. CONCLUSIONS: Measuring E/E' ratio using the one-beat method is a simple and clinically accurate way to estimate wedge pressure in patients with AF.
  • PublicationRestreint
    Continued global left ventricular remodeling is not the sole mechanism responsible for the late recurrence of ischemic mitral regurgitation after restrictive annuloplasty
    (Elsevier, 2009-11-01) Sénéchal, Mario; Magne, Julien; Pibarot, Philippe; Dumesnil, Jean G.
    Background: Recurrence of ischemic mitral regurgitation (MR) late after mitral valve annuloplasty (MVA) is generally believed to be due to continued left ventricular (LV) remodeling. The aim of this study was to determine if other mechanisms could be involved in MR recurrence. Methods and Results: Preoperative (10 ± 11 days), early postoperative (6 ± 4 days), and late postoperative (1.5 ± 0.6 years) transthoracic echocardiograms of 26 patients (68 ± 7 years, 23 male [88%]) who underwent restrictive MVA and coronary artery bypass graft surgery were reviewed. Mitral valve geometry and MR severity were assessed using anterior leaflet and posterior leaflet angles and the anterior leaflet concavity area, defined as the area enclosed between the AL and a line connecting the tip of the leaflet and its basal insertion at the annulus. Recurrent MR (vena contracta > 3 mm) was observed in 10 patients (38.5%). Among the 10 patients with recurrent MR, 5 had significant late postoperative increase in LV end-systolic (preoperative: 66 ± 27 mL; early postoperative: 61 ± 11 mL; late postoperative: 89 ± 30 mL, P = .04) and end-diastolic (preoperative: 122 ± 39 mL; early postoperative: 108 ± 22 mL; late postoperative: 139 ± 39 mL, P = .04) volumes and PL angle (early postoperative: 65 ± 12 degrees; late postoperative: 77 ± 8 degrees, P = .04), suggesting that recurrent MR is related to continued adverse LV remodeling and ensuing worsening of leaflet tethering. However, in the remaining 5 patients with recurrent MR, there was no significant change in LV end-systolic and end-diastolic volumes, but there was a significant increase in anterior leaflet concavity area (early postoperative: 6 ± 11 mm2; late postoperative: 50 ± 3 mm2, P = .012). Conclusion: Although recurrent MR is often associated with continued adverse LV remodeling after restrictive MVA, this mechanism fails to explain all recurrences. In the absence of LV dilatation, recurrent MR might be explained by localized LV remodeling in the vicinity of papillary muscles resulting in increased AL tethering at the bending point.
  • PublicationAccès libre
    Usefulness of NT-pro BNP monitoring to identify echocardiographic responders following cardiac resynchronization therapy
    (BioMed Central, 2009-08-20) Dubois, Michelle; Sénéchal, Mario; Magne, Julien; Champagne, Jean; Philippon, François; Pibarot, Philippe; Dumesnil, Jean G.; O'Hara, Gilles
    Background: Cardiac resynchronization therapy (CRT) improves left ventricular (LV) volumes, mitral regurgitation (MR) severity and symptoms of patients with heart failure (HF). However, = 30% of patients have no significant clinical or echocardiographic improvement following CRT. Reverse remodeling after CRT correlates with improved clinical outcomes. We hypothesized that in NT-pro BNP monitoring is accurate to identify responders following CRT. Methods: 42 consecutive patients (mean age 66 ± 12 years, male 68%) with HF undergoing CRT were prospectively enrolled. Responders at follow-up were defined by echocardiography (decrease in LV end systolic volume = 15%). Echocardiography and NT-pro BNP measurement were performed at baseline and repeated 3 to 6 month after CRT. Results: There was no significant difference between responders (n = 29, 69%) and non-responders (n = 13, 31%) regarding baseline NT-pro BNP level. Responders had significantly higher decrease in NT-pro BNP levels during follow-up than non-responders (absolute: -1428 ± 1333 pg.ml -1 vs. -61 ± 959 pg.ml -1 , p = 0.002; relative: -45 ± 28% vs. 2 ± 28%, p < 0.0001). A decrease of = 15% in NT-pro BNP 3–6 months after CRT identifies echocardiographic responders with a sensitivity of 90% and a specificity of 77%. Conclusion: NT-pro BNP monitoring can accurately identify echocardiographic responders after CRT.
  • PublicationRestreint
    Preoperative posterior leaflet angle accurately predicts outcome after restrictive mitral valve annuloplasty for ischemic mitral regurgitation
    (American Heart Association, 2007-02-13) Sénéchal, Mario; Magne, Julien; Hachicha, Zeineb; Pibarot, Philippe; Dumesnil, Jean G.; Dagenais, François
    BACKGROUND: Ischemic mitral regurgitation (MR) often persists after restrictive mitral valve annuloplasty, in which case it is associated with worse clinical outcomes. The goal of the present study was to determine whether persistence of MR and/or clinical outcome could be predicted from preoperative analysis of mitral valve configuration METHODS AND RESULTS : In 51 consecutive patients undergoing restrictive annuloplasty for ischemic MR, posterior leaflet (PL) angle, anterior leaflet angle, coaptation distance, and tenting area were quantified by echocardiography before surgery (6+/-3 days), and MR severity was assessed before and early after surgery (9+/-4 days). Postoperatively, persistence of mild to moderate MR (vena contracta > 3 mm) was observed in 11 (22%) of the patients. The best predictor of postoperative persistence of MR was a PL angle > or = 45 degrees (sensitivity 100%, specificity 97%, positive predictive value 92%, negative predictive value 100%). Patients with persistent MR had markedly lower 3-year event-free survival (26+/-20%) compared with those with nonpersistent MR (75+/-12%, P=0.01). Preoperative presence of a PL angle > or = 45 degrees also was associated with a markedly lower 3-year event-free survival (22+/-17% versus 76+/-12%; P<0.001). CONCLUSIONS: In patients undergoing restrictive annuloplasty for ischemic MR, persistence of MR and 3-year event-free survival can accurately be predicted by preoperative analysis of mitral valve configuration. Patients with a PL angle > or = 45 degrees (ie, with high PL restriction) should thus be considered poor candidates for this procedure, and concomitant or alternative procedures should be contemplated.
  • PublicationRestreint
    Determinants of aortic bioprosthetic valve calcification assessed by multidetector CT
    (BMJ, 2015-03-01) Dahou, Abdellaziz; Sénéchal, Mario; Larose, Éric; Mahjoub, Haïfa; Pibarot, Philippe; Dumesnil, Jean G.; Després, Jean-Pierre; Mathieu, Patrick
    Background Cusp calcification is the main mechanism leading to bioprosthetic heart valve (BPV) failure. Recent studies suggest that BPV calcification is an active rather than passive process probably modulated by several mechanisms including lipid-mediated inflammation and dysfunctional phosphocalcic metabolism. Objective To identify the clinical and metabolic determinants of BPV calcification assessed by multidetector CT (MDCT). Methods and results Presence of BPV calcification was assessed by MDCT in 194 patients who had undergone aortic valve replacement. A calcification score was individually calculated and expressed in mm3. Patients also underwent a clinical evaluation, a Doppler echocardiographic exam, and a plasma lipid and phosphocalcic profile. 46 patients (24%) had BPV calcification (cusp calcification score >0 mm3). After adjustment for age, gender, and time interval since BPV implantation, increased calcium–phosphorus product (OR 1.11, 95% CI 1.01 to 1.23 per 1 unit; p=0.02) and the presence of prosthesis-patient mismatch (OR 3.67, 95% CI 1.25 to 10.6; p=0.01) were the strongest independent factors associated with BPV calcification. Calcium supplement intake, age and female gender were independently associated with increased calcium–phosphorus product. Conclusions This study suggests that higher calcium–phosphorus product and prosthesis–patient mismatch promote BPV calcification. Furthermore, this study reports that calcium supplements, which are extensively prescribed in elderly patients, are independently associated with higher calcium–phosphorus product.