Personne : Clavel, Marie-Annick
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Université Laval. Faculté de médecine
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- PublicationRestreintReply : valve-in-valve transcatheter aortic valve replacement versus redo surgical aortic valve replacement(Elsevier, 2021-04-19) Sá, Michel Pompeu; Pibarot, Philippe; Van den Eynde, Jef; Clavel, Marie-Annick; Simonato, Matheus
- PublicationRestreintReply : inconsistency of hemodynamic data in low-gradient severe aortic stenosis : paradoxical low-gradient aortic stenosis : the HFpEF of aortic stenosis.(Elsevier Biomedical, 2016-05-24) Dayan, Victor; Mohty, Dania; Vignolo, Gustavo; Pibarot, Philippe; Magne, Julien; Clavel, Marie-Annick
- PublicationRestreintImpact of AVR on LV remodeling and function in paradoxical low-flow, low-gradient aortic stenosis with preserved LVEF(Elsevier, 2016-11-09) Dahou, Abdellaziz; O'Connor, Kim; Larose, Éric; Rodés-Cabau, Josep; Ribeiro, Henrique Barbosa; Capoulade, Romain; Beaudoin, Jonathan; Pibarot, Philippe; Dumesnil, Jean G.; Clavel, Marie-Annick; Mathieu, Patrick
- PublicationRestreintDoppler echocardiographic quantitation of aortic valve stenosis : a science in constant evolution(C.V. Mosby, 2016-10-01) Pibarot, Philippe; Clavel, Marie-AnnickAortic valve replacement is indicated in patients with severe aortic stenosis (AS) with symptoms or depressed left ventricular (LV) ejection fraction.1 Doppler echocardiography is the primary imaging modality used to assess the severity of AS, and this modality therefore plays a crucial role in the therapeutic management of patients with AS.2 In a well-reasoned and elegantly written viewpoint, Shah3 rightfully states that the quantitation of AS severity by Doppler echocardiography is not a settled science, and he underlines some very important limitations of this technique, which merit further discussion.
- PublicationAccès libreEffect of age and aortic valve anatomy on calcification and haemodynamic severity of aortic stenosis(BMJ, 2016-08-08) Larose, Éric; Shen, Mylène; Chetaille, Philippe; Bédard, Élisabeth; Capoulade, Romain; Pibarot, Philippe; Dumesnil, Jean G.; Clavel, Marie-Annick; Tastet, Lionel; Mathieu, Patrick; Arsenault, MarieOBJECTIVE: To evaluate the effect of age and aortic valve anatomy (tricuspid (TAV) vs bicuspid (BAV) aortic valve) on the relationship between the aortic valve calcification (AVC) and the haemodynamic 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 CT (MDCT). Mean transvalvular gradient (MG) measured by Doppler echocardiography was used to assess AS haemodynamic 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 (p=0.51, p<0.0001) in the whole cohort. After dichotomisation for valve anatomy, there was a good correlation between AVCd and MG in the TAV group (p=0.61, p<0.0001) but weak correlation in the BAV group (p=0.32, p=0.046). In the TAV group, the strength of the AVCd-MG correlation was similar in younger (<72 years old; p=0.59, p<0.0001) versus older (=72 years old; p=0.61, p<0.0001) patients. In the BAV group, there was no correlation between AVCd and MG in younger patients (<51 years old; p=0.12, p=0.65), whereas there was a good correlation in older patients (=51 years old; p=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. CONCLUSIONS: In patients with TAV as well as in older patients with BAV, AVCd appears to be the main factor significantly associated with the haemodynamic 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 haemodynamically significant stenosis with minimal AVCd. The results of MDCT AVCd should thus be interpreted cautiously in this subset of patients.
- PublicationAccès libreSex-related discordance between aortic valve calcification and hemodynamic severity of aortic stenosis : is valvular fibrosis the explanation?(Grune & Stratton, 2016-11-22) Trahan, Sylvain; Couture, Christian; Mohammadi, Siamak; Côté, Nancy; Joubert, Philippe; Bossé, Yohan; Clavel, Marie-Annick; Pagé, Sylvain; Dagenais, François.; Mathieu, Patrick; Simard, LouisRationale: Calcific aortic stenosis (AS) is characterized by calcium deposition in valve leaflets. However, women present lower aortic valve calcification (AVC) loads than men for the same AS hemodynamic severity. Objective: We thus aimed to assess sex-differences in aortic valve fibro-calcific remodelling. Methods and Results: One hundred and twenty-five patients underwent Doppler-echocardiography and multidetector-computed-tomography within 3 months prior to aortic valve replacement. Explanted stenotic tricuspid aortic valves were weighed and fibrosis degree was determined. Sixty-four men and 39 women were frequency-matched for age, body mass index (BMI), hypertension, renal disease, diabetes, and AS severity. Mean age was 75±9years, mean gradient (41±18mmHg) and indexed aortic valve area (0.41±0.12cm2/m2) were similar between men and women (all p=0.18). Median AVC (1973[1124-3490]AU) and mean valve weight (2.36±0.99g) were lower in women compared to men (both p<0.0001). AVC density correlated better with valve weight in men (r2=0.57; p<0.0001) than in women (r2=0.26; p=0.0008). After adjustment for age, BMI, AVC density and aortic annulus diameter, female sex was an independent risk factor for higher fibrosis score in AS valves (p=0.003). Picrosirius red staining of explanted valves showed greater amount of collagen fibers (p=0.01) and Masson's trichrome staining revealed a greater proportion of dense connective tissue (p=0.02) in women compared to men. Conclusions: In this series with tricuspid aortic valve and similar AS severity, women have less valvular calcification but more fibrosis compared to men. These findings suggest that the pathophysiology of the disease and thus potential targets for drug development may be different according to sex.
- PublicationAccès libreTwenty-year outcome after mitral repair versus replacement for severe degenerative mitral regurgitation. analysis of a large, prospective, multicenter international registry(American Heart Association, 2016-11-29) Lazam, Siham; Pasquet, Agnès; Vanoverschelde, Jean-Louis; Clavel, Marie-Annick; Tribouilloy, Christophe; Grigioni, Francesco; Suri, Rakesh M.; Avierinos, Jean-Francois; De Meester, Christophe; Barbieri, Andrea; Rusinaru, Dan; Russo, Antonio; Michelena, Hector I.; Huebner, Marianne; Maalouf, Joseph; Szymanski, Catherine; Enriquez-Sarano, MauriceBackground—Mitral valve (MV) repair is preferred over replacement in clinical guidelines and is an important determinant of the indication for surgery in degenerative mitral regurgitation (MR). Yet, the level of evidence supporting current recommendations is low, and recent data cast doubts on its validity in the current era. Accordingly, the aim of the present study was to analyze very long-term outcome after MV repair and replacement for degenerative MR with a flail leaflet. Methods—MIDA is a multicenter registry enrolling patients with degenerative MR with a flail leaflet in 6 tertiary European and US centers. We analyzed the outcome after MV repair (n=1,709) and replacement (n= 213), overall, by propensity score matching and by inverse probability-of-treatment weighting. Results—At baseline, patients undergoing MV repair were younger, had more comorbidities and were more likely to present with a posterior leaflet prolapse than those undergoing MV replacement. After propensity score matching as well as after inverse probability-of-treatment weighting, the 2 treatments groups were balanced and absolute standardized differences were usually below 10%, indicating adequate match. Operative mortality (defined as a death occurring within 30 days from surgery or during the same hospitalization) was lower after MV repair than after replacement, both in the entire (1.3 vs 4.7%; p<0.001) and in propensity-matched population (0.2% vs 4.4%; p<0.001). During a mean follow-up of 9.2 years, 552 deaths were observed, of which 207 were of cardiovascular origin. Twenty-year survival was better after MV repair than after MV replacement, both in the entire (46% vs 23%, p<0.001) and in matched population (41% vs 24%, p<0.001). Similar superiority of MV repair were obtained in patients' subsets based on age, sex or any stratification criteria (all p<0.001). MV repair was also associated with reduced incidence of reoperations and valve-related complications. Conclusions—Among patients with degenerative MR with a flail leaflet, referred to mitral surgery, MV repair was associated with lower operative mortality, better long-term survival and fewer valve-related complications compared to MV replacement.
- PublicationAccès libreSex differences and survival in adults with bicuspid aortic valves : verification in 3 contemporary echocardiographic cohorts(John Wiley & Sons, 2016-09-29) Michelena, Hector I.; Clavel, Marie-Annick; Suri, Rakesh M.; Katan, Ognjen; Eleid, Mackram F.; Maurer, Matthew J.; Pellikka, Patricia A.; Mahoney, Douglas W.; Enriquez-Sarano, MauriceBackground Sex‐related differences in morbidity and survival in bicuspid aortic valve (BAV) adults are fundamentally unknown. Contemporary studies portend excellent survival for BAV patients identified at early echocardiographic‐clinical stages. Whether BAV adults incur a survival disadvantage throughout subsequent echocardiographic‐clinical stages remains undetermined. Methods and Results Analysis was done of 3 different cohorts of consecutive patients with echocardiographic diagnosis of BAV identified retrospectively: (1) a community cohort of 416 patients with first BAV diagnosis (age 35±21 years, follow‐up 16±7 years), (2) a tertiary clinical referral cohort of 2824 BAV adults (age 51±16 years, follow‐up 9±6 years), and (3) a surgical referral cohort of 2242 BAV adults referred for aortic valve replacement (AVR) (age 62±14 years, follow‐up 6±5 years). For the community cohort, 20‐year risks of aortic regurgitation (AR), AVR, and infective endocarditis were higher in men (all P≤0.04); for a total BAV‐related morbidity risk of 52±4% vs 35±6% in women (P=0.01). The cohort's 25‐year survival was identical to that in the general population (P=0.98). AR independently predicted mortality in women (P=0.001). Baseline AR was more common in men (P≤0.02) in the tertiary cohort, with 20‐year survival lower than that in the general population (P<0.0001); age‐adjusted relative death risk was 1.16 (95% confidence interval [CI] 1.05‐1.29) for men versus 1.67 (95% CI 1.38‐2.03) for women (P=0.001). AR independently predicted mortality in women (P=0.01). Baseline AR and infective endocarditis were higher in men (both ≤0.001) for the surgical referral cohort, with 15‐year survival lower than that in the general population (P<0.0001); age‐adjusted relative death risk was 1.34 (95% CI 1.22‐1.47) for men versus 1.63 (95% CI 1.40‐1.89) for women (P=0.026). AR and NYHA class independently predicted mortality in women (both P≤0.04). Conclusions Within evolving echocardiographic‐clinical stages, the long‐term survival of adults with BAV is not benign, as both men and women incur excess mortality. Although BAV‐related morbidity is higher in men in the community, and AR and infective endocarditis are more prevalent in men, women exhibit a significantly higher relative risk of death in tertiary and surgical referral cohorts, which is independently associated with AR.
- PublicationRestreintAssociation of B-Type natriuretic peptide with survival in patients with degenerative mitral(Elsevier Biomedical, 2016-09-12) Clavel, Marie-Annick; Tribouilloy, Christophe; Vanoverschelde, Jean-Louis; Pizarro, Rodolfo; Suri, Rakesh M.; Szymanski, Catherine; Lazam, Siham; Oberti, Pablo; Michelena, Hector I.; Jaffe, Allan; Enriquez-Sarano, MauriceBackground: Studies suggesting that B-type natriuretic peptide (BNP) may predict outcomes of mitral regurgitation (MR) are plagued by small size, inconsistent etiologies, and lack of accounting for shifting normal BNP ranges with age and sex. Objectives: This study assessed the effect of BNP activation on mortality in a large, multicenter cohort of patients with degenerative MR. Methods: In 1,331 patients with degenerative MR, BNP was prospectively measured at diagnosis and expressed as BNPratio (ratio to upper limit of normal for age, sex, and assay). Initial surgical management was performed within 3 months of diagnosis in 561 patents. Results: The cohort had a mean age of 64 ± 15 years, was 66% male, and had a mean ejection fraction 64 ± 9%, mean regurgitant volume 67 ± 31 ml, and low mean Charlson comorbidity index of 1.09 ± 1.76. Median BNPratio was 1.01 (25th and 75th percentiles: 0.42 to 2.36). Overall, BNPratio was a powerful, independent predictor of mortality (hazard ratio: 1.33 [95% confidence interval: 1.15 to 1.54]; p < 0.0001), whereas absolute BNP was not (p = 0.43). In patients who were initially treated medically (n = 770; 58%), BNPratio was a powerful, independent, and incremental predictor of mortality after diagnosis (hazard ratio: 1.61 [95% confidence interval: 1.34 to 1.93]; p < 0.0001). Higher BNP activation was associated with higher mortality (p < 0.0001). All subgroups, particularly severe MR, incurred similar excess mortality with BNP activation. After initial surgical treatment (n = 561, 42%) BNP activation did not impose excess long-term mortality (p = 0.23). Conclusions: In patients with degenerative MR, BNPratio is a powerful, independent, and incremental predictor of long-term mortality under medical management. BNPratio should be incorporated into the routine clinical assessment of patients with degenerative MR.
- PublicationRestreintOutcome of flow-gradient patterns of aortic stenosis after aortic valve replacement : an analysis of the PARTNER 2 trial and registry(Lippincott Williams & Wilkins, 2020-07-17) Dahou, Abdellaziz; Rodés-Cabau, Josep; Hahn, Rebecca T.; Beaudoin, Jonathan; Jaber, Wael A.; Annabi, Mohamed Salah; Asch, Federico M.; Bernier, Mathieu; Rodriguez, L. Leonardo; Pibarot, Philippe; Weissman, Neil J.; Clavel, Marie-Annick; Gertz, Zachary M.; Ong, Géraldine; Herrmann, Howard C.; Salaun, Erwan; Toubal, Oumhani; Leipsic, Jonathon; Blanke, Philipp; Ridard, Carine; Webb, John G. (John Graydon); Zhang, Yiran; Alu, Maria C.; Douglas, Pamela S.; Makkar, Rajendra; Miller, D. Craig; Lindman, Brian R.; Thourani, Vinod H.; Leon, Martin B.Background : Although aortic valve replacement is associated with a major benefit in high-gradient (HG) severe aortic stenosis (AS), the results in low-gradient (LG, mean gradient <40 mm Hg) AS are conflicting. LG severe AS may be subdivided in classical low-flow (left ventricular ejection fraction <50%) and LG (CLF-LG); paradoxical low-flow (left ventricular ejection fraction ≥50% but stroke volume index <35 mL/m2) and LG; and normal-flow (left ventricular ejection fraction ≥50% and stroke volume index ≥35 mL/m2) and LG. The primary objective is to determine in the PARTNER 2 trial (The Placement of Aortic Transcatheter Valves) and registry the outcomes after aortic valve replacement of the 4 flow-gradient groups. Methods : A total of 3511 patients from the PARTNER 2 Cohort A randomized trial (n=1910) and SAPIEN 3 registry (n=1601) were included. The flow-gradient pattern was determined at baseline transthoracic echocardiography and classified as follows: (1) HG; (2) CLF-LG; (3) paradoxical low-flow-LG; and (4) normal-flow-LG. The primary end point for this analysis was the composite of (1) death; (2) rehospitalization for heart failure symptoms and valve prosthesis complication; or (3) stroke. Results : The distribution was HG, 2229 patients (63.5%); CLF-LG, 689 patients (19.6%); paradoxical low-flow-LG, 247 patients (7.0%); and normal-flow-LG, 346 patients (9.9%). The 2-year rate of primary end point was higher in CLF-LG (38.8%) versus HG: 31.8% (P=0.002) and normal-flow-LG: 32.1% (P=0.05) but was not statistically different from paradoxical low-flow-LG: 33.6% (P=0.18). There was no significant difference in the 2-year rates of clinical events between transcatheter aortic valve replacement versus surgical aortic valve replacement in the whole cohort and within each flow-gradient group. Conclusions : The LG AS pattern was highly prevalent (36.5%) in the PARTNER 2 trial and registry. CLF-LG was the most common pattern of LG AS and was associated with higher rates of death, rehospitalization, or stroke at 2 years compared with the HG group. Clinical outcomes were as good in the LG AS groups with preserved left ventricular ejection fraction compared with the HG group.