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Magne, Julien

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Julien

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Faculté de médecine, Université Laval

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  • PublicationAccès libre
    Outcomes of patients with asymptomatic aortic stenosis followed up in heart valve clinics
    (American Medical Association, 2018-10-03) Lancellotti, Patrizio; Magne, Julien; Dulgheru, Raluca; Capoulade, Romain; Pibarot, Philippe; Donal, Erwan; Clavel, Marie-Annick; Vannan, Mani A.; Tastet, Lionel; Chambers, John; Rosenhek, Raphael; Habib, Gilbert; Lloyd, Guy; Nistri, Stefano; Garbi, Madalina; Marchetta, Stella; Fattouch, Khalil; Coisne, Augustin; Montaigne, David; Modine, Thomas; Davin, Laurent; Gach, Olivier; Radermecker, Marc; Liu, Shizhen; Gillam, Linda; Rossi, Andrea; Galli, Elena; Ilardi, Federica; Zilberszac, Robert; Vollema, E. Mara; Delgado, Victoria; Cosyns, Bernard; Lafitte, Stephane; Bernard, Anne; Pierard, Luc A.; Bax, Jeroen J.; Oury, Cécile
    Importance: The natural history and the management of patients with asymptomatic aortic stenosis (AS) have not been fully examined in the current era. Objective: To determine the clinical outcomes of patients with asymptomatic AS using data from the Heart Valve Clinic International Database. Design, Setting, and Participants: This registry was assembled by merging data from prospectively gathered institutional databases from 10 heart valve clinics in Europe, Canada, and the United States. Asymptomatic patients with an aortic valve area of 1.5 cm2 or less and preserved left ventricular ejection fraction (LVEF) greater than 50% at entry were considered for the present analysis. Data were collected from January 2001 to December 2014, and data were analyzed from January 2017 to July 2018. Main Outcomes and Measures: Natural history, need for aortic valve replacement (AVR), and survival of asymptomatic patients with moderate or severe AS at entry followed up in a heart valve clinic. Indications for AVR were based on current guideline recommendations. Results: Of the 1375 patients included in this analysis, 834 (60.7%) were male, and the mean (SD) age was 71 (13) years. A total of 861 patients (62.6%) had severe AS (aortic valve area less than 1.0 cm2). The mean (SD) overall survival during medical management (mean [SD] follow up, 27 [24] months) was 93% (1%), 86% (2%), and 75% (4%) at 2, 4, and 8 years, respectively. A total of 104 patients (7.6%) died under observation, including 57 patients (54.8%) from cardiovascular causes. The crude rate of sudden death was 0.65% over the duration of the study. A total of 542 patients (39.4%) underwent AVR, including 388 patients (71.6%) with severe AS at study entry and 154 (28.4%) with moderate AS at entry who progressed to severe AS. Those with severe AS at entry who underwent AVR did so at a mean (SD) of 14.4 (16.6) months and a median of 8.7 months. The mean (SD) 2-year and 4-year AVR-free survival rates for asymptomatic patients with severe AS at baseline were 54% (2%) and 32% (3%), respectively. In those undergoing AVR, the 30-day postprocedural mortality was 0.9%. In patients with severe AS at entry, peak aortic jet velocity (greater than 5 m/s) and LVEF (less than 60%) were associated with all-cause and cardiovascular mortality without AVR; these factors were also associated with postprocedural mortality in those patients with severe AS at baseline who underwent AVR (surgical AVR in 310 patients; transcatheter AVR in 78 patients). Conclusions and Relevance: In patients with asymptomatic AS followed up in heart valve centers, the risk of sudden death is low, and rates of overall survival are similar to those reported from previous series. Patients with severe AS at baseline and peak aortic jet velocity of 5.0 m/s or greater or LVEF less than 60% have increased risks of all-cause and cardiovascular mortality even after AVR. The potential benefit of early intervention should be considered in these high-risk 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.
  • PublicationRestreint
    Increasing pulmonary arterial pressure at low level of exercise in asymptomatic, organic mitral regurgitation
    (Elsevier Science, 2018-02-06) Toubal, Oumhani; Dahou, Abdellaziz; O'Connor, Kim; Thébault, Christophe; Mahjoub, Haïfa; Magne, Julien; Le Ven, Florent; Beaudoin, Jonathan; Bernier, Mathieu; Pibarot, Philippe; Clavel, Marie-Annick
  • PublicationRestreint
    Outcome and impact of aortic valve replacement in patients with preserved LVEF and low-gradient aortic stenosis
    (Elsevier Biomedical, 2015-12-15) Dayan, Victor; Magne, Julien; Vignolo, Gustavo; Mohty, Dania; Pibarot, Philippe; Clavel, Marie-Annick
    Background : Low mean transvalvular gradient (<40 mm Hg) and small aortic valve area (<1.0 cm2) in patients with aortic stenosis (AS) and preserved left ventricular ejection fraction raises uncertainty about the actual severity of the stenosis and survival benefit of aortic valve replacement (AVR). Objectives : This study analyzed studies of mortality and survival impact of AVR in patients with low-gradient (LG) AS and preserved left ventricular ejection fraction, including paradoxical low-flow (i.e., stroke volume index <35 ml/m2), low-gradient (LF-LG) and normal-flow, low-gradient (NF-LG), and those with high-gradient (=40 mm Hg) AS or moderate AS. Methods : Studies published between 2005 and 2015 were analyzed. Primary outcome was the survival benefit associated with AVR. Secondary outcome was overall mortality regardless of treatment. Results : Eighteen studies were included in the analysis. Patients with LF-LG AS have increased mortality compared with patients with moderate AS (hazard ratio [HR]: 1.68; 95% confidence interval [CI]: 1.31 to 2.17), NF-LG (HR: 1.80; 95% CI: 1.29 to 2.51), and high-gradient (HR: 1.67; 95% CI: 1.16 to 2.39) AS. AVR was associated with reduced mortality in patients with LF-LG (HR: 0.44; 95% CI: 0.25 to 0.77). Similar benefit occurred with AVR in patients with NF-LG (HR: 0.48; 95% CI: 0.28 to 0.83). Compared with patients with high-gradient AS, those with LF-LG were less likely to be referred to AVR (odds ratio: 0.32; 95% CI: 0.21 to 0.49). Conclusions : Patients with paradoxical LF-LG AS and NF-LG AS have increased risk of mortality compared with other subtypes of AS with preserved left ventricular ejection fraction, and improved outcome with AVR.
  • 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
    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
    Left ventricular contractile reserve in asymptomatic primary mitral regurgitation
    (Oxford University Press, 2014-06-21) Mahjoub, Haïfa; Magne, Julien; Dulgheru, Raluca; Pibarot, Philippe; Piérard, Luc A.; Lancellotti, Patrizio
    AIMS: There are very few data regarding the assessment and prognostic value of left ventricular contractile reserve (LVCR) in asymptomatic patients with primary mitral regurgitation (MR). We aimed to quantify LVCR and to evaluate its usefulness for risk stratification in asymptomatic patients with primary MR. METHODS AND RESULTS: Comprehensive resting and exercise (EX) transthoracic echocardiography, including two-dimensional speckle tracking quantification, were performed in 115 consecutive asymptomatic patients with = moderate degenerative MR and no LV dysfunction/dilatation. Left ventricular contractile reserve was defined as an EX-induced increase in LV ejection fraction (LVCR(LVEF)) = 4% or in LV global longitudinal strain (LVCR(GLS)) = 2%. LVCR(LVEF) was present in 54 patients (47%) and LVCR(GLS) in 58 (50%). The brain natriuretic peptide (BNP) level was significantly correlated with EX-induced changes in GLS (r = 0.45, P < 0.0001), but not in LVEF (r = 0.09, P = 0.31). Patients with no LVCR(GLS) had significant lower 3-year cardiac event-free survival (42 ± 8 vs. 69 ± 7%, P = 0.0008). In contrast, there was no significant difference in outcome regarding to the presence or absence of LVCR(LVEF) (60 ± 7 vs. 51 ± 8%, P = 0.40). The multivariable Cox proportional hazard model showed that the absence of LVCR(GLS) was a strong independent predictor of cardiac events (HR = 2.27, 95% CI: 1.05-4.76, P = 0.037), even after adjustment for Ex-echo variables and BNP level. The association between LVCR(GLS) and outcome remained significant (HR = 1.6, 95% CI: 1.1-2.3, P = 0.01) after further adjustment for the resting echocardiographic parameters included in the ESC Guidelines. CONCLUSION: In asymptomatic primary MR, LVCR seems to be better assessed using EX-induced changes in LV myocardial longitudinal function rather than in LVEF. In patients with preserved LV function, the absence of LVCR is independently associated with two-fold increase in risk of cardiac events. Left ventricular contractile reserve may be useful to improve risk stratification and clinical decision-making in these patients.
  • PublicationRestreint
    Multimodality imaging strategies for the assessment of aortic stenosis : viewpoint of the heart valve clinic international database (HAVEC) group.
    (Lippincott Williams & Wilkins, 2016-02-01) Dulgheru, Raluca; Magne, Julien; Bernard, Anne; Sengupta, Partho; Pibarot, Philippe; Piérard, Luc A.; Rosenhek, Raphael; Donal, Erwan; Fattouch, Khalil; Cosyns, Bernard; Vannan, Mani A.; Gillam, Linda D.; Lancellotti, Patrizio
    Aortic stenosis is the most frequent valvular heart disease. In aortic stenosis, therapeutic decision essentially depends on symptomatic status, stenosis severity, and status of left ventricular systolic function. Surgical aortic valve replacement or transcatheter aortic valve implantation is the sole effective therapy in symptomatic patients with severe aortic stenosis, whereas the management of asymptomatic patients remains controversial and is mainly based on individual risk stratification. Imaging is fundamental for the initial diagnostic work-up, follow-up, and selection of the optimal timing and type of intervention. The present review provides specific recommendations for utilization of multimodality imaging to optimize risk stratification and therapeutic decision-making processes in aortic stenosis.
  • PublicationAccès libre
    Pulmonary hypertension in valvular disease : a comprehensive review on pathophysiology to therapy from the HAVEC Group.
    (Elsevier, 2015-01-12) Magne, Julien; Pibarot, Philippe; Sengupta, Partho; Donal, Erwan; Rosenhek, Raphael; Lancellotti, Patrizio
    Pulmonary hypertension (PH) is a classic pathophysiological consequence of left-sided valvular heart disease (VHD). However, as opposed to other forms of PH, there are relatively few published data on the prevalence, impact on outcome, and management of PH with VHD. The objective of this paper is to present a systematic review of PH in patients with VHD. PH is found in 15% to 60% of patients with VHD and is more frequent among symptomatic patients. PH is associated with higher risk of cardiac events under conservative management, during valve replacement or repair procedures, and even following successful corrective procedures. In addition to its usefulness in assessing the presence and severity of VHD, Doppler echocardiography is a key tool in diagnosis of PH and assessment of its repercussion on right ventricular function. Assessment of pulmonary arterial pressure during exercise stress echocardiography may provide additional prognostic information beyond resting evaluation. Cardiac magnetic resonance is also useful for assessing right ventricular geometry and function, which provide additional prognostic information in patients with VHD and PH.
  • PublicationRestreint
    Prevalence and long-term outcome of aortic prosthesis-patient mismatch in patients with paradoxical low-flow severe aortic stenosis
    (American Heart Association, 2014-09-09) Magne, Julien; Boulogne, Cyrille; Mohty, Dania; Pibarot, Philippe; Dumesnil, Jean G.; Echahidi, Najmeddine; Cornu, Elisabeth; Laskar, Marc; Virot, Patrice; Aboyans, Victor
    Background—Patients with severe aortic stenosis (AS) and paradoxical low flow (PLF) have worse outcome compared with those with normal flow. Furthermore, prosthesis–patient mismatch (PPM) after aortic valve replacement is a predictor of reduced survival. However, the prevalence and prognostic impact of PPM in patients with PLF-AS are unknown. We aimed to analyze the prevalence and long-term survival of PPM in patients with PLF-AS. Methods and Results—Between 2000 and 2010, 677 patients with severe AS, preserved left ventricular ejection fraction, and aortic valve replacement were included (74±8 years; 42% women; aortic valve area, 0.69±0.16 cm2). A PLF (indexed stroke volume =35 mL/m2) was found in 26%, and after aortic valve replacement, 54% of patients had PPM, defined as an indexed effective orifice area =0.85 cm2/m2 . The combined presence of PLF and PPM was found in 15%. Compared with patients with noPLF/noPPM, those with PLF/PPM were significantly older, with more comorbidities. They also received smaller and biological bioprosthesis more often (all P<0.01). Although early mortality was not significantly different between groups, the 10-year survival rate was significantly reduced in case of PLF/PPM compared with noPLF/noPPM (38±9% versus 70±5%; P=0.002), even after multivariable adjustment (hazard ratio, 2.58; 95% confidence interval, 1.5–4.45; P=0.0007). Conclusions—In this large catheterization-based study, the coexistence of PLF-AS before surgery and PPM after surgery is associated with the poorest outcome