Pour savoir comment effectuer et gérer un dépôt de document, consultez le « Guide abrégé – Dépôt de documents » sur le site Web de la Bibliothèque. Pour toute question, écrivez à corpus@ulaval.ca.
 

Personne :
Larose, Éric

En cours de chargement...
Photo de profil

Adresse électronique

Date de naissance

Projets de recherche

Structures organisationnelles

Fonction

Nom de famille

Larose

Prénom

Éric

Affiliation

Université Laval. Faculté de médecine

ISNI

ORCID

Identifiant Canadiana

ncf11860485

person.page.name

Résultats de recherche

Voici les éléments 1 - 10 sur 28
  • PublicationAccès libre
    Dobutamine 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 libre
    Impact 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
  • PublicationRestreint
    Normalized left ventricular workload using phase-contrast magnetic resonance imaging in patients with aortic stenosis.
    (Institute of Electrical and Electronics Engineers, 2014-08-31) Garcia, Julio; Keshavarz-Motamed, Zahra; Larose, Éric; Kadem, Lyes; Le Ven, Florent; Capoulade, Romain; Pibarot, Philippe
    Aortic stenosis (AS) severity contributes to the left ventricle (LV) deterioration due to the aortic valve narrowing and the alteration of systemic hemodynamic load. This load increment may also increase the LV stroke work (SW) which represent the required energy to deliver the blood at ejection. In this study, SW was derived from in-vivo cardiovascular magnetic resonance (CMR) velocity measurements (n=57) using a lumped-parametric model. Furthermore, normalized SW (N-SW) was evaluated as AS severity parameter. SW differentiated from normal flow (>35 mL/m 2 ) and low flow (<35 mL/m 2 ) states (p<0.05). N-SW showed a good association with valve effective orifice area (EOA, r=-0.5, p<0.001) and valvulo-arterial impedance (ZVA, r=0.65, p<0.001). A severity threshold for N-SW (1.5 cJ/mL) was found using an EOA=1 cm 2 as AS severity marker. CMR-derived SW and N-SW may be useful to the assessment and grading of AS patients.
  • PublicationAccès libre
    Relationship between QT interval and outcome in low-flow low-gradient aortic stenosis with low left ventricular ejection fraction
    (John Wiley & Sons, 2016-10-20) Dahou, Abdellaziz; Toubal, Oumhani; Larose, Éric; Magne, Julien; Rodés-Cabau, Josep; Beaudoin, Jonathan; Philippon, François; Pibarot, Philippe; Dumesnil, Jean G.; Clavel, Marie-Annick; Puri, Rishi; Mathieu, Patrick; Ribeiro, Henrique B.
    Background QT interval has been shown to be associated with cardiovascular events. There is no data regarding the association between QT interval and left ventricular (LV) function and prognosis in patients with low LV ejection fraction (LVEF), low‐flow, low‐gradient aortic stenosis (LF‐LG AS). We aimed to examine the relationship between corrected QT interval (QTc) and LV function and outcome in these patients. Methods and Results Ninety‐three patients (73±10 years; 74% men) with LF‐LG AS (mean gradient <40 mm Hg and indexed aortic valve area ≤0.6 cm2/m2) and reduced LVEF (≤40%) were prospectively included in this analysis and 63 of them underwent aortic valve replacement within 3 months following inclusion. Prolonged QTc was defined as QTc >450 ms in men and >470 ms in women. LV global longitudinal strain was measured by speckle tracking and expressed in absolute value |%|. QTc correlated with the following: global longitudinal strain (r=−0.40, P=0.005), LVEF (r=−0.27, P=0.02), stroke volume (r=−0.35, P=0.007), and B‐type natriuretic peptide (r=0.45, P=0.0006). During a median follow‐up of 2.0 years, 49 patients died. Prolonged QTc was associated with a 2‐fold increase in all‐cause mortality (hazard ratio=2.05; P=0.01) and cardiovascular mortality (hazard ratio=1.89; P=0.04). In multivariable analysis adjusted for EuroSCORE, aortic valve replacement, previous myocardial infarction, LVEF, and ß‐blocker medication, prolonged QTc was independently associated with all‐cause mortality (hazard ratio=2.56; P=0.008) and cardiovascular mortality (hazard ratio=2.50; P=0.02). Conclusions In patients with LF‐LG AS and reduced LVEF, longer QTc interval was associated with worse LV function and increased risk of death. Assessment of QTc may provide a simple and inexpensive tool to enhance risk stratification in LF‐LG AS patients.
  • PublicationAccès libre
    Effect of age and aortic valve anatomy on calcification and haemodynamic severity of aortic stenosis
    (British Cardiac Society, 2016-12-09) Larose, Éric; Shen, Mylène; Chetaille, Philippe; Bédard, Élisabeth; Capoulade, Romain; Pibarot, Philippe; Dumesnil, Jean G.; Clavel, Marie-Annick; Tastet, Lionel; Mathieu, Patrick; Arsenault, Marie
    Objective: To evaluate the effect of age and aortic valve anatomy (tricuspid [TAV] versus bicuspid [BAV] aortic valve) on the relationship between the aortic valve calcification (AVC) and the hemodynamic parameters of aortic stenosis (AS) severity. Methods: Two hundred patients with AS and preserved left ventricular ejection fraction were prospectively recruited in the PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis) study and underwent a comprehensive Doppler echocardiography and multidetector computed tomography (MDCT). Mean transvalvular gradient (MG) measured by Doppler echocardiography was used to assess AS hemodynamic severity and AVC was evaluated by MDCT using the Agatston method and indexed to the left ventricular outflow tract area to obtain AVC density (AVCd). All analyses were adjusted for sex. Results: Thirty-nine patients had a BAV and 161 a TAV. Median age was 51 and 72 years for BAV and TAV patients respectively. There was a modest correlation between MG and AVCd (ρ=0.51, p<0.0001) in the whole cohort. After dichotomization for valve anatomy, there was a good correlation between AVCd and MG in the TAV group (ρ=0.61, p<0.0001) but weak correlation in the BAV group (ρ=0.32, p=0.046). In the TAV group, the strength of the AVCd-MG correlation was similar in younger (<72 years old; ρ=0.59, p<0.0001) versus older (≥72 years old; ρ=0.61, p<0.0001) patients. In the BAV group, there was no correlation between AVCd and MG in younger patients (<51 years old; ρ=0.12, p=0.65), whereas there was a good correlation in older patients (≥51 years old; ρ=0.55, p=0.009). AVCd (p=0.005) and age (p=0.02) were both independent determinants of MG in BAV patients while AVCd (p<0.0001) was the only independent determinant of MG in TAV patients. Conclusion: In patients with TAV as well as in older patients with BAV, AVCd appears to be the main factor significantly associated with the hemodynamic severity of AS and so it may be used to corroborate AS severity in case of uncertain or discordant findings at echocardiography. However, among younger patients with BAV, some may have a hemodynamically significant stenosis with minimal AVCd. The results of MDCT AVCd should thus be interpreted cautiously in this subset of patients.
  • PublicationAccès libre
    Hemodynamic deterioration of surgically implanted bioprosthetic aortic valves
    (Elsevier Biomedical, 2018-07-09) Dahou, Abdellaziz; Arsenault, Benoit; Larose, Éric; Mahjoub, Haïfa; Rodés-Cabau, Josep; Pibarot, Philippe; Clavel, Marie-Annick; Puri, Rishi; Després, Jean-Pierre; Mathieu, Patrick; Salaun, Erwan
    BACKGROUND: Dysmetabolic profile has been associated with native aortic valve stenosis. However, there are imited data on the effects of an atherogenic milieu and its potential implications on the structural and hemodynamic deterio- ration of aortic bioprosthetic valves. OBJECTIVES: This prospective longitudinal study sought to determine the predictors and impact on outcomes of he- modynamic valve deterioration (HVD) of surgically implanted aortic bioprostheses. METHODS: A total of 137 patients with an aortic bioprosthesis implanted for a median time of 6.7 (interquartile range: 5.1 to 9.1) years prospectively underwent a first (baseline) assessment with complete Doppler echocardiography, quantitation of bioprosthesis leaflet calcification by multidetector computed tomography (CT), and a fasting blood sample to assess cardiometabolic risk profile. All patients underwent a second (follow-up) Doppler echocardiography examination at 3 (interquartile range: 2.9 to 3.3) years post-baseline visit. HVD was defined by an annualized change in mean transprosthetic gradient $3 mm Hg/year and/or worsening or transprosthetic regurgitation by $1/3 class. The primary endpoint was a nonhierarchical composite of death from any cause or aortic reintervention procedure (redo surgical valve replacement or transcatheter valve-in-valve implantation) for bioprosthesis failure. RESULTS Thirty-four patients (25.6%) had leaflet calcification on baseline CT, and 18 patients (13.1%) developed an HVD between baseline and follow-up echocardiography. Fifty-two patients (38.0%) met the primary endpoint during subsequent follow-up after the second echocardiographic examination. Leaflet calcification (hazard ratio [HR]: 2.58; 95% confidence interval [CI]: 1.35 to 4.82; p ¼ 0.005) and HVD (HR: 5.12; 95% CI: 2.57 to 9.71; p < 0.001) were independent predictors of the primary endpoint. Leaflet calcification, insulin resistance (homeostatic model assessment index $2.7), lipoprotein-associated phospholipase A2 activity (Lp-PLA2 per 0.1 nmol/min/ml increase), and high level of proprotein convertase subtilisin/kexin 9 (PCSK9) ($305 ng/ml) were associated with the development of HVD after adjusting for age, sex, and time interval since aortic valve replacement. CONCLUSIONS: HVD identified by Doppler echocardiography is independently associated with a marked increase in the risk of valve reintervention or mortality in patients with a surgical aortic bioprosthesis. A dysmetabolic profile charac- terized by elevated plasma Lp-PLA2, PCSK9, and homeostatic model assessment index was associated with increased risk of HVD. The presence of leaflet calcification as detected by CT was a strong predictor of HVD, providing incremental risk- predictive capacity. (J Am Coll Cardiol 2018;72:241–51) © 2018 by the American College of Cardiology Foundation.
  • PublicationRestreint
    Progression of hypertrophy and myocardial fibrosis in aortic stenosis : a multicenter cardiac magnetic resonance study
    (Lippincott Williams & Wilkins, 2018-06-18) Everett, Russell J.; Larose, Éric; Capoulade, Romain; Pibarot, Philippe; Chin, Calvin W.L.; Clavel, Marie-Annick; Tastet, Lionel; Vassiliou, Vassilios; Kwiecinski, Jacek; Gomez, Miquel; Beek, Edwin J. R. van; White, Audrey C.; Prasad, Sanjay K.; Tuck, Christopher; Semple, Scott; Newby, David E.; Dweck, Marc
    Background: Aortic stenosis is accompanied by progressive left ventricular hypertrophy and fibrosis. We investigated the natural history of these processes in asymptomatic patients and their potential reversal post-aortic valve replacement (AVR). Methods: Asymptomatic and symptomatic patients with aortic stenosis underwent repeat echocardiography and magnetic resonance imaging. Changes in peak aortic-jet velocity, left ventricular mass index, diffuse fibrosis (indexed extracellular volume), and replacement fibrosis (late gadolinium enhancement [LGE]) were quantified. RESULTS: In 61 asymptomatic patients (43% mild, 34% moderate, and 23% severe aortic stenosis), significant increases in peak aortic-jet velocity, left ventricular mass index, indexed extracellular volume, and LGE mass were observed after 2.1±0.7 years, with the most rapid progression observed in patients with most severe stenosis. Patients with baseline midwall LGE (n=16 [26%]; LGE mass, 2.5 g [0.8–4.8 g]) demonstrated particularly rapid increases in scar burden (78% [50%–158%] increase in LGE mass per year). In 38 symptomatic patients (age, 66±8 years; 76% men) who underwent AVR, there was a 19% (11%–25%) reduction in left ventricular mass index (P<0.0001) and an 11% (4%–16%) reduction in indexed extracellular volume (P=0.003) 0.9±0.3 years after surgery. By contrast midwall LGE (n=10 [26%]; mass, 3.3 g [2.6–8.0 g]) did not change post-AVR (n=10; 3.5 g [2.1–8.0 g]; P=0.23), with no evidence of regression even out to 2 years. Conclusions: In patients with aortic stenosis, cellular hypertrophy and diffuse fibrosis progress in a rapid and balanced manner but are reversible after AVR. Once established, midwall LGE also accumulates rapidly but is irreversible post valve replacement. Given its adverse long-term prognosis, prompt AVR when midwall LGE is first identified may improve clinical outcomes.
  • PublicationAccès libre
    Effect of regional upper septal hypertrophy on echocardiographic assessment of left ventricular mass and remodeling in aortic stenosis
    (ScienceDirect, 2020-10-14) Guzzetti, Ezequiel; Garcia, Julio; Larose, Éric; Shen, Mylène; Le Ven, Florent; Bédard, Élisabeth; Capoulade, Romain; Annabi, Mohamed Salah; Pibarot, Philippe; Clavel, Marie-Annick; Tastet, Lionel; Arsenault, Marie
    Background: Transthoracic echocardiography (TTE) is the reference method for evaluation of aortic stenosis (AS), and it is extensively used to quantitate left ventricular (LV) mass and volumes. Regional upper septal hypertrophy (USH) or septal bulge is a frequent finding in patients with AS and may lead to overestimation of LV mass when using linear measurements. The objective of this study was to compare estimates of LV mass obtained by two-dimensional transthoracic echocardiographic LV dimensions measured at different levels of the LV cavity with those obtained by cardiovascular magnetic resonance (CMR). Methods: One hundred six patients (mean age, 63 ± 15 years; 68% men) with AS were included in this subanalysis of the PROGRESSA study. Two-dimensional transthoracic echocardiographic measurements of LV dimensions were obtained at the basal level (BL; as recommended in guidelines), immediately below the septal bulge (BSB), and at a midventricular level (ML). Regional USH was defined as a basal interventricular septal thickness ≥ 13 mm and >1.3 times the thickness of the septal wall at the ML. Agreement between transthoracic echocardiographic and CMR measures was evaluated using Bland-Altman analysis. Results: The distribution of AS severity was mild in 23%, moderate in 57%, and severe in 20% of patients. Regional USH was present in 28 patients (26%). In the whole cohort, two-dimensional TTE overestimated LV mass (bias: BL, +60 ± 31 g; BSB, +59 ± 32 g; ML, +54 ± 32 g; P = .02). The biplane Simpson method slightly but significantly underestimated LV end-diastolic volume (bias -10 ± 20 mL, P < .001) compared with CMR. Overestimation of LV mass was more marked in patients with USH when measuring at the BL and was significantly lower when measuring LV dimensions at the ML (P < .025 vs BL and BSB). Conclusions: Two-dimensional TTE systematically overestimated LV mass and underestimated LV volumes compared with CMR. However, the bias between TTE and CMR was less important when measuring at the ML. Measurements at the BL as suggested in guidelines should be avoided, and measurements at the ML should be preferred in patients with AS, especially in those with USH.
  • PublicationAccès libre
    Accuracy of stroke volume measurement with phase-contrast cardiovascular magnetic resonance in patients with aortic stenosis
    (Marcel Dekker, 2021-11-04) Guzzetti, Ezequiel; Racine, Hugo-Pierre; Larose, Éric; Shen, Mylène; Beaudoin, Jonathan; Pibarot, Philippe; Clavel, Marie-Annick; Tastet, Lionel
    Background: Phase contrast (PC) cardiovascular magnetic resonance (CMR) in the ascending aorta (AAo) is widely used to calculate left ventricular (LV) stroke volume (SV). The accuracy of PC CMR may be altered by turbulent fow. Measurement of SV at another site is suggested in the presence of aortic stenosis, but very few data validates the accuracy or inaccuracy of PC in that setting. Our objective is to compare fow measurements obtained in the AAo and LV outfow tract (LVOT) in patients with aortic stenosis. Methods: Retrospective analysis of patients with aortic stenosis who had CMR and echocardiography. Patients with mitral regurgitation were excluded. PC in the AAo and LVOT were acquired to derive SV. LV SV from end-systolic and end-diastolic tracings was used as the reference measure. A diference≥10% between the volumetric method and PC derived SVs was considered discordant. Metrics of turbulence and jet eccentricity were assessed to explore the predictors of discordant measurements. Results: We included 88 patients, 41% with bicuspid aortic valve. LVOT SV was concordant with the volumetric method in 79 (90%) patients vs 52 (59%) patients for AAo SV (p=0.015). In multivariate analysis, aortic stenosis fow jet angle was a strong predictor of discordant measurement in the AAo (p=0.003). Mathematical correction for the jet angle improved the concordance from 59 to 91%. Concordance was comparable in patients with bicuspid and trileafet valves (57% and 62% concordance respectively; p=0.11). Accuracy of SV measured in the LVOT was not infuenced by jet eccentricity. For aortic regurgitation quantifcation, PC in the AAo had better correlation to volumetric assessments than LVOT PC. Conclusion: LVOT PC SV in patients with aortic stenosis and eccentric jet might be more accurate compared to the AAo SV. Mathematical correction for the jet angle in the AAo might be another alternative to improve accuracy.
  • PublicationRestreint
    Systolic hypertension and progression of aortic valve calcification in patients with aortic stenosis : results from the PROGRESSA study
    (Oxford University Press, 2016-02-18) Larose, Éric; Shen, Mylène; Capoulade, Romain; Bossé, Yohan; Pibarot, Philippe; Dumesnil, Jean G.; Tremblay, Alexe; Clavel, Marie-Annick; Després, Jean-Pierre; Tastet, Lionel
    Background : Systolic hypertension is one of the most frequent comorbidities encountered in patients with aortic stenosis (AS). In a recent study, we reported that systolic hypertension is associated with faster hemodynamic progression of AS and reduced survival. However, the impact of hypertension on the progression of aortic valve calcification (AVC), which is the culprit lesion of AS, is unknown. The main objective of this prospective study was to assess the impact of systolic hypertension on the progression of AVC in AS patients. Methods : One hundred and one patients with AS were prospectively recruited in the PROGRESSA study (NCT01679431). AVC and coronary artery calcification (CAC) were measured by multidetector computed tomography at baseline and at 2-year follow-up using the Agatston method. Results : The mean age was 65 ±13 years and 74% were male. During the 2-year follow-up, patients with systolic hypertension (i.e. systolic blood pressure =140 mmHg; n=37) at baseline had faster progression of AVC compared to those with no systolic hypertension (AVC: +370 [126-824] vs. +157 [58-303] AU; p=0.007; Figure). In multivariable analysis adjusted for age, sex, antihypertensive treatment, dyslipidemia, diabetes, metabolic syndrome, creatinine level, baseline hemodynamic AS severity, and baseline AVC, systolic hypertension remained an independent predictor of faster progression of AVC (p=0.001). In contrast, there was no significant difference in the progression of CAC between patients with versus without systolic hypertension (CAC: +39 [3-199] vs. +116 [28-189] AU; p=0.17; Figure). Conclusion : This prospective study shows that systolic hypertension is a powerful and independent predictor of faster progression of AVC but not of CAC in patients with AS. These findings emphasize the difference in the pathological processes leading to valvular versus vascular mineralization, and provide further to support the elaboration of randomized clinical trials targeting the treatment of hypertension in patients with AS