Personne : Larose, Éric
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Université Laval. Faculté de médecine
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- PublicationAccès libreDobutamine stress echocardiography for management of low-flow, low-gradient aortic stenosis(Elsevier Biomedical, 2018-01-29) Dahou, Abdellaziz; Larose, Éric; Annabi, Mohamed Salah; Burwash, Ian G.; Touboul, Eden; Bergler-Klein, Jutta; Pibarot, Philippe; Enriquez-Sarano, Maurice; Clavel, Marie-Annick; Orwat, Stefan; Baumgartner, Helmut; Mascherbauer, Julia; Mundigler, Gerald; Cavalcante, João L.Background: Dobutamine stress echocardiography (DSE) is useful to differentiate true from pseudo severe aortic stenosis in patients with low left ventricular ejection fraction (LVEF), low-flow, low-gradient aortic stenosis (LF-LG AS). In the ACC/AHA guidelines, patients are considered having true-severe stenosis when the mean gradient (MG) is ≥40mmHg with an aortic valve area (AVA) ≤1cm2 during DSE. However these criteria have not been previously validated. The aim of this study was to assess the value of these criteria to predict the presence of true-severe AS and the occurrence of death in patients with LFLG AS. Methods: In the TOPAS (“True or Pseudo-Severe Aortic Stenosis”) study, 186 patients with low LVEF LF-LG AS were prospectively recruited and underwent DSE with measurement of the MG, AVA and projected AVA, an estimate of the AVA at a standardized normal flow rate (AVAProj). Severity of AS was independently corroborated by macroscopic evaluation of the valve at the time of valve replacement in 54 patients and by measurement of the aortic valve calcium by computed tomography in 25 patients and by both methods in 8. According to these assessments, 50/87 (57%) of the study cohort had true-severe stenosis. Results: Peak stress MG ≥40 mmHg, peak stress AVA ≤1cm2, and the combination of peak stress MG ≥40 mmHg and peak stress AVA≤1cm2 correctly classified AS severity in 48%, 60%, and 47% of patients, respectively, whereas AVAProj ≤1cm2 was better than all the previous markers (p<0.007) with 70% of correct classification. Among the subset of 88 patients managed conservatively (47% of cohort), 52 died during a follow-up of 2.8±2.5 years. After adjustment for age, sex, functional capacity, chronic kidney failure and peak stress LVEF, peak stress MG and AVA were not predictors of mortality in this subset. In contrast, AVAProj ≤1cm2 was a strong predictor of mortality under medical management (HR: 3.65; p=0.0003). Conclusion: In patients with low LVEF LF-LG AS, the DSE criteria of peak stress MG≥40 mmHg, or the composite of peak stress MG≥40 mmHg and peak stress AVA≤1cm2 proposed in the guidelines to identify true-severe AS and recommend valve replacement, have limited value to predict actual stenosis severity and outcomes. In contrast, AVAProj better distinguishes true from pseudo-severe aortic stenosis and is strongly associated with mortality in patients under conservative management.
- PublicationAccès libreImpact of aortic valve calcification and sex on hemodynamic progression and clinical outcomes in AS(Elsevier Biomedical, 2017-04-17) Larose, Éric; Enriquez-Sarano, Maurice; Shen, Mylène; Bédard, Élisabeth; Malouf, Joseph F.; Capoulade, Romain; Araoz, Philip A.; Pibarot, Philippe; Clavel, Marie-Annick; Michelena, Hector I.; Tastet, Lionel; Arsenault, Marie
- PublicationAccès libreCorrelates of coronary artery calcification prevalence and severity in patients with heterozygous familial hypercholesterolemia(Elsevier, 2020-09-16) Clisson, Marine; Godbout, Dominic; Gagnon, Alexandre; Larose, Éric; Drouin-Chartier, Jean-Philippe; Tremblay, André; Arsenault, Benoit; Pibarot, Philippe; Clavel, Marie-Annick; Couture, PatrickBackground Determinants of coronary artery calcification (CAC) prevalence and severity in heterozygous familial hypercholesterolemia (HeFH) remain understudied. The objective of this cross-sectional study was to investigate correlates of CAC in patients with HeFH. Methods A CAC score was calculated by a noncontrast computed tomography scan in women (n = 68) and men (n = 78) with genetically defined HeFH. We classified CAC prevalence and severity using 3 categories: CAC score = 0 Agatston Unit (AU), CAC score = 1-100 AU, and CAC score > 100 AU. Information on potential correlates of CAC including familial and personal health history, cardiovascular risk factors, lipid-lowering medication, and lifestyle habits was collected. Results A total of 95 patients had prevalent CAC. Independent correlates of CAC prevalence and severity included age (odds ratio [OR] per 10 years: 5.06, 95% confidence interval [CI]: 3.19, 7.93, P < 0.0001), family history of premature cardiovascular disease (OR: 3.88, 95% CI: 1.71, 8.81, P = 0.001), male sex (OR: 3.40, 95% CI: 1.49, 7.78, P = 0.004), statin use (OR: 15.5, 95% CI: 1.89, 126, P = 0.01), diet quality assessed with the Alternative Healthy Eating Index score (OR per 1 standard deviation: 0.59, 95% CI: 0.39, 0.90, P = 0.01), ever smoking (OR: 3.06, 95% CI: 1.20, 7.81, P = 0.02), receptor-negative genotype (OR: 3.17, 95% CI: 1.16, 8.66, P = 0.02), lipoprotein(a) year-score (OR per 1 standard deviation of log-transformed year-score: 1.53, 95% CI: 0.99, 2.36, P = 0.05). Conclusions In individuals with HeFH, age, family history of premature cardiovascular disease, sex, statin use, diet quality, smoking status, the LDLR genotype, and lipoprotein(a) concentrations were independently associated with CAC prevalence and severity.
- PublicationRestreintLeft ventricular asymmetric remodeling and subclinical left ventricular dysfunction in patients with calcific aortic valve stenosis : results from a subanalysis of the PROGRESSA study(Elsevier Science Publishers, 2021-03-13) Clisson, Marine; Guzzetti, Ezequiel; Bernard, Jérémy; Larose, Éric; Shen, Mylène; Bédard, Élisabeth; Côté, Nancy; Capoulade, Romain; Pibarot, Philippe; Clavel, Marie-Annick; Tastet, Lionel; Arsenault, MarieBackground: LV asymmetric remodeling (LVAR) is a feature commonly found in AS patients and it is presumed to be mainly related to the severity of valve stenosis. The aim of this study was to determine the associated factors and impact on left ventricular (LV) systolic function of LVAR in patients with mild and moderate aortic valve stenosis (AS). Methods: Clinical, Doppler-echocardiographic and computed-tomographic data of 155 AS patients with preserved LV ejection fraction (≥50%) prospectively recruited in the PROGRESSA study (NCT01679431) were analyzed. LVAR was defined as a septal wall thickness ≥ 13 mm and a ratio of septal/posterior wall thickness > 1.5. LV global longitudinal strain (LV-GLS) was available in 129 patients. Plasma levels of N-terminal natriuretic B-type peptides (Nt-proBNP) were also measured. Results: Mean age was 63 ± 15 years (70% men). LVAR was present in 21% (n = 33) of patients. A series of nested multivariate analysis revealed that age was the only factor associated with LVAR (all p ≤ 0.03). Additionally, these patients had higher baseline Nt-proBNP ratio (median [25–75 percentiles]: 1.04 [0.66–2.41] vs. 0.65 [0.33–1.19], p = 0.02), and significantly reduced LV-GLS (17.9[16.6–19.5] vs. 19.3[17.4–20.7] |%|, p = 0.04). A 1:1 matched analysis showed a significant association of LVAR with reduced LV-GLS (17.9[16.6–19.5] vs. 19.8[18.1–20.7] |%|, p = 0.02) and elevated Nt-proBNP (134[86–348] vs. 83[50–179]pg/ml, p = 0.03). Multivariable analysis also revealed that LVAR remains significantly associated with reduced LV-GLS (p = 0.03) and elevated Nt-proBNP (p = 0.001). LVAR was significantly associated with increased risk of major adverse cardiac events and death (Hazard ratio [95% confidence interval]: 2.32[1.28–4.22], p = 0.006). Conclusions: LVAR was found in ~20% of patients with mild or moderate AS and was not related to the degree of AS severity or concomitant comorbidities, but rather to older age. LVAR was significantly associated with reduced LV longitudinal systolic function, increased Nt-proBNP levels, and higher risk of major adverse events and death. These findings provide support for closer clinical and echocardiographic surveillance of patients harboring this adverse LV remodeling feature.
- PublicationAccès libreSex-related differences in the extent of myocardial fibrosis in patients with aortic valve stenosis(American College of Cardiology Foundation, 2018-09-22) Guzzetti, Ezequiel; Kwiecinski, Jacek; Larose, Éric; Shen, Mylène; Bédard, Élisabeth; Everett, Russell J.; Capoulade, Romain; Newby, David E.; Beaudoin, Jonathan; Pibarot, Philippe; Clavel, Marie-Annick; Tastet, Lionel; Arsenault, Marie; Dweck, Marc
- PublicationAccès libreCardiovascular magnetic resonance evaluation of aortic stenosis severity using single plane measurement of effective orifice area(M. Dekker, 2012-04-06) Garcia, Julio; Marrufo, Oscar R.; Larose, Éric; Rodriguez, Alfredo O.; Kadem, Lyes; Pibarot, PhilippeBACKGROUND: Transthoracic echocardiography (TTE) is the standard method for the evaluation of the severity of aortic stenosis (AS). Valve effective orifice area (EOA) measured by the continuity equation is one of the most frequently used stenotic indices. However, TTE measurement of aortic valve EOA is not feasible or not reliable in a significant proportion of patients. Cardiovascular magnetic resonance (CMR) has emerged as a non-invasive alternative to evaluate EOA using velocity measurements. The objectives of this study were: 1) to validate a new CMR method using jet shear layer detection (JSLD) based on acoustical source term (AST) concept to estimate the valve EOA; 2) to introduce a simplified JSLD method not requiring vorticity field derivation. METHODS AND RESULTS: We performed an in vitro study where EOA was measured by CMR in 4 fixed stenoses (EOA = 0.48, 1.00, 1.38 and 2.11 cm²) under the same steady flow conditions (4-20 L/min). The in vivo study included eight (8) healthy subjects and 37 patients with mild to severe AS (0.72 cm² = EOA = 1.71 cm²). All subjects underwent TTE and CMR examinations. EOA was determinated by TTE with the use of continuity equation method (TTE(CONT)). For CMR estimation of EOA, we used 3 methods: 1) Continuity equation (CMR(CONT)); 2) Shear layer detection (CMR(JSLD)), which was computed from the velocity field of a single CMR velocity profile at the peak systolic phase; 3) Single plane velocity truncation (CMR(SPVT)), which is a simplified version of CMR(JSLD) method. There was a good agreement between the EOAs obtained in vitro by the different CMR methods and the EOA predicted from the potential flow theory. In the in vivo study, there was good correlation and concordance between the EOA measured by the TTE(CONT) method versus those measured by each of the CMR methods: CMR(CONT) (r = 0.88), CMR(JSLD) (r = 0.93) and CMR(SPVT) (r = 0.93). The intra- and inter- observer variability of EOA measurements was 5 ± 5% and 9 ± 5% for TTE(CONT), 2 ± 1% and 7 ± 5% for CMR(CONT), 7 ± 5% and 8 ± 7% for CMR(JSLD), 1 ± 2% and 3 ± 2% for CMR(SPVT). When repeating image acquisition, reproducibility of measurements was 10 ± 8% and 12 ± 5% for TTE(CONT), 9 ± 9% and 8 ± 8% for CMR(CONT), 6 ± 5% and 7 ± 4% for CMR(JSLD) and 3 ± 2% and 2 ± 2% for CMR(SPVT). CONCLUSION: There was an excellent agreement between the EOA estimated by the CMR(JSLD) or CMR(SPVT) methods and: 1) the theoretical EOA in vitro, and 2) the TTE(CONT) EOA in vivo. The CMR(SPVT) method was superior to the TTE and other CMR methods in terms of measurement variability. The novel CMR-based methods proposed in this study may be helpful to corroborate stenosis severity in patients for whom Doppler-echocardiography exam is inconclusive.
- PublicationRestreintModeling the impact of concomitant aortic stenosis and coarctation of the aorta on left ventricular workload(Pergamon Press., 2011-09-26) Keshavarz-Motamed, Zahra; Garcia, Julio; Larose, Éric; Kadem, Lyes; Pibarot, PhilippeCoarctation of the aorta (COA) is an obstruction of the aorta and is usually associated with bicuspid and tricuspid aortic valve stenosis (AS). When COA coexists with AS, the left ventricle (LV) is facing a double hemodynamic load: a valvular load plus a vascular load. The objective of this study was to develop a lumped parameter model, solely based on non-invasive data, allowing the description of the interaction between LV, COA, AS and the arterial system. First, a formulation describing the instantaneous net pressure gradient through the COA was introduced and the predictions were compared to in vitro results. The model was then used to determine LV work induced by coexisting AS and COA with different severities. The results show that LV stroke work varies from 0.98 J (no-AS; no-COA) up to 2.15 J (AS: 0.61 cm2+COA: 90%). Our results also show that the proportion of the total flow rate that will cross the COA is significantly reduced with the increasing COA severity (from 85% to 40%, for a variation of COA severity from 0% to 90%, respectively). Finally, we introduced simple formulations capable of, non-invasively, estimating both LV peak systolic pressure and workload. As a conclusion, this study allowed the development of a lumped parameter model, based on non-invasive measurements, capable of accurately investigating the impact of coexisting AS and COA on LV workload. This model can be used to optimize the management of patients with COA and AS in terms of the sequence of lesion repair.
- PublicationRestreintTransient myocardial tissue and function changes during a marathon in less fit marathon runners(Elsevier, 2013-10-01) Bertrand, Olivier; Gaudreault, Valérie; Tizón-Marcos, Helena; Larose, Éric; Rodés-Cabau, Josep; Gilbert, Philippe; Amyot, Marc; Poirier, Paul; Pibarot, Philippe; Després, Jean-PierreBackground : Although regular physical activity improves health, strenuous exercise might transiently increase cardiac risk. Training and fitness might provide protection. Methods : We prospectively studied 20 recreational marathon runners without known cardiovascular disease or symptoms: at peak training before, immediately after, and 3 months after a 42.2-km marathon. Changes in global/segmental myocardial function, edema, resting perfusion, and fibrosis were measured. Results : At peak training, runners exercised 8.1 ± 2.3 hours and 62 ± 18 km per week with mean maximal oxygen consumption (VO2max) of 53.2 ± 8.3 mL/kg/min. In response to the marathon, global left ventricular and right ventricular ejection fraction decreased in half of the runners; these runners had poorer peak training distance, training time, and fitness level. Change in global left ventricular ejection fraction was associated with VO2max. Overall, 36% of segments developed edema, 53% decreased function, and 59% decreased perfusion. Significant agreement was observed between segment decreasing function, decreasing perfusion, and developing edema. Myocardial changes were reversible at 3 months. Conclusions : Completing a marathon leads to localized myocardial edema, diminished perfusion, and decreased function occurring more extensively in less trained and fit runners. Although reversible, these changes might contribute to the transient increase in cardiac risk reported during sustained vigorous exercise.
- PublicationAccès libreAlternative imaging modalities in ischemic heart failure (AIMI-HF) IMAGE HF project I-A : study protocol for a randomized controlled trial(2013-07-16) O'Meara, Eileen; Larose, Éric; Mielniczuk, Lisa Marie; Cantin, Bernard; Wells, George A.; Pibarot, Philippe; deKemp, Robert A.; Klein, Ran; Coyle, Douglas; McArdle, Brian; Paterson, Ian; White, James A.; Arnold, Malcom; Friedrich, Matthias G.; Dick, Alexander; Chow, Benjamin; Dennie, Carole; Haddad, Haissam; Ruddy, Terrence; Ukkonen, Heikki; Wisenberg, Gerald; Freeman, Michael; Turcotte, Éric; Connelly, Kim; Clarke, James; Williams, Kathryn; Racine, Normand; Garrard, Linda; Tardif, Jean-Claude; DaSilva, Jean; Knuuti, Juhani; Beanlands, Robert S. B.BACKGROUND: Ischemic heart disease (IHD) is the most common cause of heart failure (HF); however, the role of revascularization in these patients is still unclear. Consensus on proper use of cardiac imaging to help determine which candidates should be considered for revascularization has been hindered by the absence of clinical studies that objectively and prospectively compare the prognostic information of each test obtained using both standard and advanced imaging. METHODS/DESIGN: This paper describes the design and methods to be used in the Alternative Imaging Modalities in Ischemic Heart Failure (AIMI-HF) multi-center trial. The primary objective is to compare the effect of HF imaging strategies on the composite clinical endpoint of cardiac death, myocardial infarction (MI), cardiac arrest and re-hospitalization for cardiac causes.In AIMI-HF, patients with HF of ischemic etiology (n = 1,261) will follow HF imaging strategy algorithms according to the question(s) asked by the physicians (for example, Is there ischemia and/or viability?), in agreement with local practices. Patients will be randomized to either standard (SPECT, Single photon emission computed tomography) imaging modalities for ischemia and/or viability or advanced imaging modalities: cardiac magnetic resonance imaging (CMR) or positron emission tomography (PET). In addition, eligible and consenting patients who could not be randomized, but were allocated to standard or advanced imaging based on clinical decisions, will be included in a registry. DISCUSSION: AIMI-HF will be the largest randomized trial evaluating the role of standard and advanced imaging modalities in the management of ischemic cardiomyopathy and heart failure. This trial will complement the results of the Surgical Treatment for Ischemic Heart Failure (STICH) viability substudy and the PET and Recovery Following Revascularization (PARR-2) trial. The results will provide policy makers with data to support (or not) further investment in and wider dissemination of alternative 'advanced' imaging technologies.
- PublicationRestreintThe impact of integration of a multidetector computed tomography annulus area sizing algorithm on outcomes of transcatheter aortic valve replacement : a prospective, multicenter, controlled trial(Elsevier Biomedical, 2013-07-30) Binder, Ronald K.; Dumont, Éric; Webb, John G. (John Graydon); Larose, Éric; Willson, Alexander B.; Rodés-Cabau, Josep; Freeman, Melanie; Hansson, Nicolaj C.; Pasian, Sergio; Nørgaard, Bjarne Linde; Urena Alcazar, Marina; Pibarot, Philippe; Barbanti, Marco; Thompson, Chris; Wheeler, Miriam; Moss, Robert; Yang, Tae-Hyun; Hague, Cameron J.; Nguyen, Giang; Raju, Rekha; Toggweiler, Stefan; Min, James K.; Wood, David A.; Leipsic, JonathonOBJECTIVES: This study prospectively investigated the impact of integration of a multidetector computed tomography (MDCT) annular area sizing algorithm on transcatheter aortic valve replacement (TAVR) outcomes. BACKGROUND: Appreciation of the 3-dimensional, noncircular geometry of the aortic annulus is important for transcatheter heart valve (THV) sizing. METHODS: Patients being evaluated for TAVR in 4 centers underwent pre-procedural MDCT. Recommendations for balloon-expandable THV size selection were based on an MDCT sizing algorithm with an optimal goal of modest annulus area oversizing (5% to 10%). Consecutive patients who underwent TAVR with the algorithm (MDCT group) were compared with consecutive patients without the algorithm (control group). The primary endpoint was the incidence of more than mild paravalvular regurgitation (PAR), and the secondary endpoint was the composite of in-hospital death, aortic annulus rupture, and severe PAR. RESULTS: Of 266 patients, 133 consecutive patients underwent TAVR (SAPIEN XT THV) in the MDCT group and 133 consecutive patients were in the control group. More than mild PAR was present in 5.3% (7 of 133) of the MDCT group and in 12.8% (17 of 133) in the control group (p = 0.032). The combined secondary endpoint occurred in 3.8% (5 of 133) of the MDCT group and in 11.3% (15 of 133) of the control group (p = 0.02), driven by the difference of severe PAR. CONCLUSIONS: The implementation of an MDCT annulus area sizing algorithm for TAVR reduces PAR. Three-dimensional aortic annular assessment and annular area sizing should be considered for TAVR.