Publications by authors named "Sorin V Pislaru"
Prevalence, Etiology and Outcomes of Native Pulmonary Regurgitation in the General Adult Population.
Eur Heart J Cardiovasc Imaging
January 2025
Aims: Pulmonary regurgitation (PR) after reparative intervention for congenital heart disease has been studied extensively. However, the burden, distribution of causes, and outcome of PR in adults is unknown. The study aimed to evaluate the prevalence, types, and outcomes of moderate/severe PR in adults in the community setting.
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- The study aimed to assess the prognostic value of right ventricle (RV) function and its coupling to pulmonary artery pressure in patients with tricuspid regurgitation (TR) to improve risk evaluation beyond an established clinical score.
- Researchers analyzed data from 417 patients with moderate TR and developed a new risk score by integrating RV function measures, finding significant correlations between these parameters and patient mortality during a median follow-up of nearly 4 years.
- Results showed that many patients initially categorized as low- or intermediate-risk were reclassified to higher risk when RV function metrics were included, indicating that incorporating these echocardiographic measures enhances mortality predictions in TR patients.
Background: The determination of left ventricular diastolic function (LVDF) in patients with significant (≥moderate) mitral regurgitation (MR) poses a complex challenge. We recently validated an artificial intelligence-enabled electrocardiogram (AI-ECG) algorithm to estimate LVDF.
Objectives: This study sought to evaluate the risk of all-cause mortality across AI-ECG LVDF-derived myocardial disease (MD) grades in MR.
Background: Aortic regurgitation (AR) is a prevalent valve disease with a long latent period to symptoms. Recent data has suggested the role of novel markers of myocardial overload in assessing onset of decompensation.
Method: We sought to evaluate the role of unsupervised cluster analyses in identifying different clinical clusters, including clinical status, and a large number of echocardiographic variables including left ventricular (LV) volumes, and their association with mortality.
Background: The ideal timing for surgery in asymptomatic chronic aortic regurgitation (AR) remains unclear. New thresholds for left ventricular ejection fraction (LVEF), left ventricular (LV) indexed end-systolic volume (iESV), and global longitudinal strain (GLS) have been associated with mortality in these patients. These represent markers of early LV dysfunction.
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- Secondary tricuspid regurgitation (STR) can occur due to various heart and lung diseases, with heart failure and precapillary pulmonary hypertension being common causes that may sometimes be missed.
- This study aimed to determine how often heart failure with preserved ejection fraction (HFpEF) and precapillary pulmonary hypertension (PH) are seen in patients with severe STR and to assess the effectiveness of noninvasive tests in identifying HFpEF.
- Out of 54 adults with severe isolated STR, the majority were evaluated for tricuspid regurgitation, and the study aimed to analyze the prevalence of HFpEF and the usefulness of noninvasive methods for diagnosis.
Right Ventricular Perforation by Fractured Sternal Wires: A Narrative Review.
Braz J Cardiovasc Surg
October 2024
Article Synopsis
- Migration of a fragmented sternal wire is a rare complication after cardiovascular surgery, with clinical symptoms ranging from being asymptomatic to severe hemodynamic instability.* -
- A retrospective review revealed 13 cases of this issue, primarily affecting older men (median age 64), with nearly half experiencing hemorrhagic shock, and most cases presenting either shortly after surgery or years later.* -
- Identifying this complication often involves CT scans, but successful management requires careful attention to the patient's specific situation following diagnosis.*
Article Synopsis
- An AI-based ECG model is effective in identifying patients at risk for low ejection fraction (EF), particularly noting that those with abnormal AI-ECG scores and normal EF (false positives or FPs) were more likely to develop low EF later on.
- This study analyzed echocardiographic features and all-cause mortality risk in a large cohort of patients, categorizing them into groups like true negatives (TN), false positives (FP), true positives (TP), and false negatives (FN), using these categorization techniques to assess heart health.
- Results showed that 97% of FPs had some echocardiographic abnormality; they faced a significantly higher risk of mortality compared to
Article Synopsis
- * Results from 30,428 patients showed a notable increase in the likelihood of developing severe or moderate DD as severity of FTR increased, alongside an increased risk of heart failure and impaired left atrial strain.
- * Patients with moderate or severe FTR and DD faced the worst outcomes over time, suggesting that addressing DD could be crucial in managing FTR's impact on heart health.
Objective: The selection of valve prostheses for patients undergoing surgical aortic valve replacement remains controversial. In this study, we compared the long-term outcomes of patients undergoing aortic valve replacement with biological or mechanical aortic valve prostheses.
Methods: We evaluated late results among 5762 patients aged 45 to 74 years who underwent biological or mechanical aortic valve replacement with or without concomitant coronary artery bypass from 1989 to 2019 at 4 medical centers.
Background And Aims: Incidence and types of secondary tricuspid regurgitation (TR) are not well defined in atrial fibrillation (AFib) and sinus rhythm (SR). Atrial secondary TR (A-STR) is associated with pre-existing AFib; however, close to 50% of patients with A-STR do not have AFib. The aim of this study was to assess incidence, types, and outcomes of ≥ moderate TR in AFib vs.
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- Researchers used AI to analyze echocardiogram video clips to identify patients with heart failure with preserved ejection fraction (HFpEF), a condition where heart muscle works well but has filling issues.
- The AI model was trained on nearly 6,000 cases, showing strong accuracy in distinguishing between HFpEF and non-HFpEF patients, achieving an area under the curve of 0.97 in training and 0.95 in validation.
- The AI successfully reclassified a majority of indeterminate results from existing clinical scores during testing, indicating its potential to improve heart failure diagnosis over traditional methods.
Background: Pulmonary hypertension (PH) has been shown to be associated with worse outcomes in patients with aortic regurgitation (AR) in small older studies.
Objectives: The authors sought to evaluate the prevalence of PH in patients with severe AR, its impact on mortality and symptoms, and regression after aortic valve replacement (AVR).
Methods: A total of 821 consecutive patients with chronic ≥ moderate-severe AR on echocardiography from 2004 to 2019 were retrospectively analyzed.
Aims: This study aimed to evaluate the clinical significance of secondary mitral regurgitation (MR) in patients with heart failure with preserved ejection fraction (HFpEF).
Methods And Results: We conducted a prospective study enrolling consecutively evaluated patients with HFpEF undergoing invasive haemodynamic exercise testing with simultaneous echocardiography. Compared to HFpEF without MR (n = 145, 79.
Prognostic value of aortic valve calcification in non-severe aortic stenosis with preserved ejection fraction.
Eur Heart J Cardiovasc Imaging
September 2024
Article Synopsis
- Aortic valve calcification (AVC) is a significant predictor of survival in patients with non-severe aortic stenosis (AS), and specific cut-offs were identified for men (1185 AU) and women (850 AU) which are lower than those for severe AS.
- In a study of 395 patients, those with sub-severe and severe AVC had a significantly higher risk of death compared to those with low AVC, regardless of other health factors.
- The findings suggest that sub-severe AVC can guide the timing of aortic valve interventions, as these procedures reduced mortality risks in patients with higher AVC levels.
Artificial intelligence-based classification of echocardiographic views.
Eur Heart J Digit Health
May 2024
Article Synopsis
- * Researchers trained two- and three-dimensional convolutional neural networks (CNNs) on a large dataset of echocardiogram videos, achieving high accuracy rates (over 96%) in classifying different cardiac view categories.
- * The success of the CNN-based view classifier paves the way for further applications of deep learning in analyzing echocardiograms, potentially enhancing diagnostic capabilities in cardiology.
Aims: Doppler mean gradient (MG) can underestimate aortic stenosis (AS) severity in patients with atrial fibrillation (AF) compared with patients with sinus rhythm (SR), potentially delaying intervention in AF. This study compared outcomes in patients with AF and SR following transcatheter aortic valve replacement (TAVR) and investigated delay in TAVR based on computed tomography aortic valve calcium score (AVCS).
Methods And Results: Patients who underwent TAVR from 2013 to 2017 for native valve severe AS were identified from an institutional database.
Severe tricuspid regurgitation (TR) is a progressive condition associated with substantial morbidity, poor quality of life, and increased mortality. Patients with TR commonly have coexisting conditions including congestive heart failure, pulmonary hypertension, chronic lung disease, atrial fibrillation, and cardiovascular implantable electronic devices, which can increase the complexity of medical and surgical TR management. As such, the optimal timing of referral for isolated tricuspid valve (TV) intervention is undefined, and TV surgery has been associated with elevated risk of morbidity and mortality.
View Article and Find Full Text PDFBackground: The natural history of moderate/severe atrial functional mitral regurgitation (AFMR) is unknown.
Objectives: The authors sought to study the incidence of left ventricular (LV) systolic dysfunction (LVSD), progression or regression of ≥mild-moderate AFMR, and impact on mortality.
Methods: Adults with left atrial (LA) volume index ≥40 mL/m, ≥mild-moderate AFMR, and follow-up echocardiogram were followed for incident LVSD (ejection fraction <50% and ≥10% lower than baseline), progression of mild-moderate/moderate AFMR to severe, and persistent regression of AFMR to no/trivial.
Background: Data on the prognostic factors after mitral valve (MV) transcatheter edge-to-edge repair (TEER; MV-TEER) are limited. Pulsed-wave Doppler interrogation of pulmonary vein flow (PVF) is a convenient method to assess the hemodynamic burden of residual mitral regurgitation (MR), which could be of utility as a predictor of outcomes.
Methods: Patients that underwent MV-TEER between May 2014 and December 2021 at our institution were evaluated.