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Tastet, Lionel

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Lionel

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Université Laval. Faculté de médecine

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Voici les éléments 1 - 10 sur 44
  • PublicationAccès libre
    Impact of vascular hemodynamics on aortic stenosis evaluation : new insights into the pathophysiology of normal flow - small aortic valve area - low gradient pattern
    (John Wiley & Sons, 2017-07-07) Clisson, Marine; Shen, Mylène; Côté, Nancy; Zenses, Anne-Sophie; Clavel, Marie-Annick; Tastet, Lionel; Simard, Louis
    Background: About 50% of normal‐flow/low‐gradient patients (ie, low mean gradient [MG] or peak aortic jet velocity and small aortic valve area) have severe aortic valve calcification as measured by computed tomography. However, they are considered to have moderate aortic stenosis (AS) in current American College of Cardiology/American Heart Association guidelines. The objective was thus to evaluate the effect of hypertension and reduced arterial compliance (rAC) on MG and Vpeak measurements. Methods and Results: Doppler‐echocardiography was performed in 4 sheep with experimentally induced severe and critical AS at: (1) normal aortic pressure, (2) during hypertension, and (3) with rAC. Hypertension and rAC induced a substantial decrease in MG/Vpeak compared with normal stage (both P≤0.03) despite a stable transvalvular flow (P>0.16). Hypertension and rAC resulted in a greater reduction of MG in critical (−42%) compared with severe (−35%) AS (P˂0.0001). Comprehensive Doppler‐echocardiography and computed tomography were performed in 220 AS patients (mean age: 69±13 years; MG 29±18 mm Hg) with normal flow. The population was divided in 3 groups according to the presence of hypertension and rAC. The slope of the linear association between MG/Vpeak and aortic valve calcification divided by the cross‐sectional area of the aortic annulus was significantly reduced in patients with hypertension and/or rAC compared with normotensive/normal AC patients (P<0.01). Accordingly, patients with normal‐flow/low‐gradient and severe aortic valve calcification density were more frequent in hypertension and rAC groups compared with the normotensive/normal‐AC group (16% and 12% compared with 2%; P=0.03). Conclusions: Hypertension and rAC are associated with a substantial reduction in MG/Vpeak for similar aortic valve calcification (ie, similar AS anatomic severity), which may lead to underestimation of AS hemodynamic severity
  • PublicationRestreint
    Sex differences in the progression of aortic valve calcification and clinical outcomes : the PROGRESSA study
    (Elsevier, 2022-07-04) Tastet, Lionel; Shen, Mylène; Capoulade, Romain; Arsenault, Marie; Bédard, Élisabeth; Ternacle, Julien; Salaun, Erwan; Côté, Nancy; Pibarot, Philippe; Clavel, Marie-Annick
  • 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
  • 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
    Prognostic utility of N-terminal pro- B-type natriuretic peptide ratio in mixed aortic valve disease
    (BMJ Group, 2023-07-19) Bernard, Jérémy; Jean, Guillaume; Bienjonetti-Boudreau, David; Jacques, Frédéric; Tastet, Lionel; Salaun, Erwan; Clavel, Marie-Annick
    Objective: We aimed to assess the incremental prognostic value of N-terminal-pro-B-type natriuretic peptide (Nt-proBNP) for risk stratification in mixed aortic valve disease (MAVD) patients. Methods: We included 556 (73±12 years, 37% women) consecutive patients with at least a moderate aortic stenosis (AS) or aortic regurgitation (AR) lesion with a concomitant AS or AR of any severity in whom Nt-proBNP was measured and expressed as its ratio (measured Nt-proBNP divided by the upper limit of normal Nt-proBNP for age and sex). The primary endpoint was all-cause mortality. Results: Baseline median Nt-proBNP ratio was 3.8 (IQR: 1.5-11.3), and the median follow-up was 5.6 years (4.8-6.1). Early aortic valve replacement (AVR) was performed within 3 months in 423 (76%) patients, while 133 (24%) remained initially under medical treatment. In comprehensive multivariable analyses, Nt-proBNP ratio was significantly associated with excess mortality (continuous variable: HR (95% CI): 1.24 (1.04 to 1.47), p=0.02; Nt-proBNP ratio ≥3: 2.41 (1.33 to 4.39), p=0.004). The independent prognostic value was also observed in patients with severe or non-severe AS/AR, and those treated by early-AVR (all p<0.04). Nt-proBNP ratio as continuous and dichotomic (≥3) variables showed incremental prognostic value (all net reclassification index >0.42, all p≤0.008). After early-AVR, Nt-proBNP ratio ≥3 was associated with higher 30-day mortality (9 (4%) vs 1 (0.5%), p=0.02). Conclusions: In this series of MAVD patients, Nt-proBNP ratio was a powerful predictor of early and long-term mortality, even in patients with both non-severe AS/AR. Moreover, early-AVR may be an option for patients with Nt-proBNP ratio ≥3. Further randomised studies are needed to validate this last point.
  • PublicationAccès libre
    Cardiac damage staging classification in asymptomatic moderate or severe primary mitral regurgitation
    (Elsevier, 2022-03-21) Bernard, Jérémy; Altes, Alexandre; Dupuis, Marlène; Toubal, Oumhani; Mahjoub, Haïfa; Tastet, Lionel; Côté, Nancy; Clavel, Marie-Annick; O'Connor, Kim; Bernier, Mathieu; Beaudoin, Jonathan; Pibarot, Philippe
    Background Optimal timing for intervention remains uncertain in asymptomatic patients with primary mitral regurgitation (MR). We aimed to assess the prognostic value of a new cardiac damage staging classification in patients with asymptomatic moderate or severe primary MR. Methods Clinical, Doppler-echocardiographic, and outcome data prospectively collected in 338 asymptomatic patients (64 ± 15 years, 68% men) with at least moderate primary MR were retrospectively analyzed. Patients were hierarchically classified as per the following staging classification: no cardiac damage (stage 0), mild left ventricular or left atrial damage (stage 1), moderate or severe left ventricular or left atrial damage (stage 2), pulmonary vasculature or tricuspid valve damage (stage 3), or right ventricular damage (stage 4). Results There was a stepwise increase in 10-year mortality rates as per cardiac damage stage: 20.0% in stage 0, 25.6% in stage 1, 31.5% in stage 2, and 61.3% in stage 3-4 (p < 0.001). The staging classification was significantly associated with increased risk of mortality (hazard ratio = 1.41 per one-stage increase, 95% confidence interval: 1.07-1.85, p = 0.015) and the composite of cardiovascular mortality or hospitalization (hazard ratio = 1.51 per one-stage increase, 95% confidence interval: 1.07-2.15, p = 0.020) in multivariable analysis adjusted for EuroSCORE II, mitral valve intervention as a time-dependent variable, and other risk factors. The proposed scheme showed incremental value over several clinical variables (net reclassification index = 0.40, p = 0.03). Conclusions The new staging classification provides independent and incremental prognostic value in patients with asymptomatic moderate or severe MR.
  • PublicationAccès libre
    Determinants of aortic stenosis progression in bicuspid and tricuspid aortic valves.
    (Elsevier, 2022-08-26) Shen, Mylène; Tastet, Lionel; Capoulade, Romain; Bédard, Élisabeth; Arsenault, Marie; Clavel, Marie-Annick; Pibarot, Philippe
    Contexte La bicuspidie valvulaire aortique (BVA) est associée à une progression plus rapide de la sténose aortique (SA). On ignore toutefois si les facteurs en cause dans la progression de la SA sont les mêmes chez les patients qui présentent une BVA et chez ceux qui présentent une valve aortique tricuspide. Le but de cette étude était de déterminer les facteurs associés à la progression de la SA chez les patients présentant une BVA par rapport à ceux ayant une valve aortique tricuspide. Méthodologie Des patients présentant une SA ont été recrutés dans l’étude PROGRESSA (Metabolic Determinants of the Progression of Aortic Stenosis), une étude prospective sur les déterminants métaboliques de la progression de la SA (ClinicalTrials.gov : NCT01679431). Pour calculer le taux de progression hémodynamique de la SA, on a utilisé les mesures annualisées de la vélocité maximale du jet transaortique (Vmax). Des analyses de régression linéaire univariées et multivariées ont permis de mettre en évidence les facteurs associés à une progression plus rapide de la SA en présence d’une BVA par rapport à une valve aortique tricuspide. Résultats Parmi les patients évalués, 79 présentaient une BVA et 208, une valve aortique tricuspide. La gravité de la SA au départ était comparable entre les deux groupes de patients, tout comme le taux de progression annualisé de la SA. Chez les patients avec BVA, l’obésité (β = 0,25, P = 0,04), le diabète (β = 0,26, P = 0,02) et la BVA avec fusion des feuillets coronaire droit et non coronaire (β = 0,29, P = 0,01) ont été associés de manière indépendante à une progression plus rapide de la SA, tandis que chez les patients ayant une valve tricuspide, la gravité de la SA au départ (Vmax initiale, β = 0,14, P = 0,04) et la présence d’une néphropathie chronique (β = 0,16, P = 0,02) ont été significativement associées à une progression de la SA. Conclusion Les facteurs associés au taux de progression de la SA sont différents selon qu’il y a ou non présence d’une BVA. Les principaux facteurs associés à une progression plus rapide de la SA semblent être l’obésité, le diabète et la fusion des feuillets coronaire droit et non coronaire pour la BVA, tandis que la néphropathie chronique serait le facteur aggravant chez les patients présentant une valve aortique tricuspide.
  • PublicationAccès libre
    Severe and asymptomatic aortic stenosis management challenge : knowing that we do not really know
    (Current Science, Inc., 2017-03-31) Clavel, Marie-Annick; Tastet, Lionel; Simard, Louis
  • PublicationAccès libre
    Les biomarqueurs de la progression de la sténose aortique calcifiante
    (2023) Tastet, Lionel; Pibarot, Philippe; Clavel, Marie-Annick
    La sténose aortique calcifiante est l'une des valvulopathies les plus prévalentes dans les pays à haut revenu. C'est une maladie caractérisée par le remodelage fibro-calcique progressif des feuillets valvulaires aortique, conduisant à l'obstruction de l'éjection ventriculaire gauche, la détérioration de la structure et de la fonction cardiaque, et ultimement le décès en l'absence de traitement. Actuellement, il n'existe pas de traitement non-invasif pour la sténose aortique; la chirurgie de remplacement valvulaire ou l'implantation transcathéter demeurent les seuls traitements disponibles pour les stades avancés de la maladie. Les évidences accumulées au cours des deux dernières décennies démontrent que la sténose aortique n'est pas une simple maladie avec une problématique purement d'ordre mécanique. Au contraire, la pathophysiologie de la sténose aortique est très complexe et hautement régulée par de multiples mécanismes cellulaires et moléculaires. Ces mécanismes semblent être divisés en deux phases : i.) une phase d'initiation présentant des similitudes avec l'athérosclérose, et ii.) une phase de propagation et de progression impliquant, entre autres, l'altération du métabolisme osseux et/ou phosphocalcique, ainsi que la minéralisation valvulaire aortique active. Dans l'avenue du développement de pharmacothérapies efficaces pour prévenir le développement et/ou la progression de la sténose aortique, il est primordial d'approfondir les connaissances sur les mécanismes pathologiques impliqués dans la progression de la maladie. Dans le cadre des travaux de cette thèse de doctorat, deux grands enjeux peuvent être définis : i.) identifier les facteurs associés à la progression plus rapide de la sténose aortique, afin de mieux comprendre la pathophysiologie de la maladie valvulaire, et ii.) améliorer la stratification du risque dans la sténose aortique, en identifiant les prédicteurs d'évènements cliniques adverses, mais aussi les facteurs axés sur les patients ainsi que leurs changements durant la progression de la maladie.
  • PublicationRestreint
    Markers of myocardial damage predict mortality in patients with aortic stenosis
    (ScienceDirect, 2021-08-10) Kwak, Soongu; Pibarot, Philippe; Everett, Russell J.; Clavel, Marie-Annick; Treibel, Thomas Alexander; Tastet, Lionel; Yang, Seokhun; Hwang, Doyeon; Ko, Taehoon; Williams, Michelle C.; Bing, Rong; Singh, Trisha; Joshi, Shruti; Lee, Heesun; Lee, Whal; Kim, Yong-Jin; Chin, Calvin W.L.; Fukui, Miho; Musa, Tarique Al; Rigolli, Marzia; Singh, Anvesha; Dobson, Laura; Wiesemann, Stephanie; Ferreira, Vanessa M.; Captur, Gabriella; Lee, Sahmin; Schulz-Menger, Jeanette; Schelbert, Erik B.; Park, Sung-Ji; Rheude, Tobias; Hadamitzky, Martin; Gerber, Bernhard L.; Newby, David E.; Myerson, Saul G.; Cavalcante, João L.; McCann, Gerry P.; Greenwood, John P.; Moon, James C.; Dweck, Marc R.; Lee, Seung-Pyo
    Background: Cardiovascular magnetic resonance (CMR) is increasingly used for risk stratification in aortic stenosis (AS). However, the relative prognostic power of CMR markers and their respective thresholds remains undefined. Objectives: Using machine learning, the study aimed to identify prognostically important CMR markers in AS and their thresholds of mortality. Methods: Patients with severe AS undergoing AVR (n = 440, derivation; n = 359, validation cohort) were prospectively enrolled across 13 international sites (median 3.8 years' follow-up). CMR was performed shortly before surgical or transcatheter AVR. A random survival forest model was built using 29 variables (13 CMR) with post-AVR death as the outcome. Results: There were 52 deaths in the derivation cohort and 51 deaths in the validation cohort. The 4 most predictive CMR markers were extracellular volume fraction, late gadolinium enhancement, indexed left ventricular end-diastolic volume (LVEDVi), and right ventricular ejection fraction. Across the whole cohort and in asymptomatic patients, risk-adjusted predicted mortality increased strongly once extracellular volume fraction exceeded 27%, while late gadolinium enhancement >2% showed persistent high risk. Increased mortality was also observed with both large (LVEDVi >80 mL/m2) and small (LVEDVi ≤55 mL/m2) ventricles, and with high (>80%) and low (≤50%) right ventricular ejection fraction. The predictability was improved when these 4 markers were added to clinical factors (3-year C-index: 0.778 vs 0.739). The prognostic thresholds and risk stratification by CMR variables were reproduced in the validation cohort. Conclusions: Machine learning identified myocardial fibrosis and biventricular remodeling markers as the top predictors of survival in AS and highlighted their nonlinear association with mortality. These markers may have potential in optimizing the decision of AVR.