Publications by authors named "Vuyisile T Nkomo"
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.
Article Synopsis
- 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.
Article Synopsis
- This study focuses on patients with high-gradient aortic stenosis (AS) who have an aortic valve area greater than 1.0 cm, analyzing their clinical features and outcomes.
- It found that this group was younger, mostly male, had fewer health issues, and a higher prevalence of a bicuspid valve compared to other AS patients.
- The results indicated that while these patients had a better overall prognosis, those who underwent aortic valve replacement experienced even better survival rates, emphasizing the benefits of timely treatment.
Article Synopsis
- The study compares patients with degenerative mitral regurgitation (DMR) from Asian institutions (AsIs) and European/American institutions (EAIs) to understand differences in their presentation, management, and outcomes.
- AsI patients were generally younger, had fewer symptoms, and presented with smaller heart dimensions, yet underwent fewer interventions and experienced higher mortality rates compared to EAI patients.
- The findings suggest that imaging may not accurately reflect the severity of DMR in AsI patients due to their smaller body size, indicating a potential issue with under-treatment in this population.
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.
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.
View Article and Find Full Text PDFPrognostic 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.
Multimodality imaging for acquired supravalvular aortic stenosis.
Eur Heart J Cardiovasc Imaging
September 2024
Article Synopsis
- The study assessed how left atrial (LA) strain, particularly LA reservoir strain (LASr), predicts outcomes in patients with moderate to severe aortic stenosis (AS), especially in an Asian population, where data was limited.
- Findings indicated that LASr was significantly linked to all-cause death and major cardiovascular events, suggesting it could be a crucial marker for patient prognosis, while left ventricular global longitudinal strain (LVGLS) was only predictive in severe AS.
- The researchers propose that incorporating LASr into the AS staging process could improve outcome predictions for patients undergoing evaluations for treatment.
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.
Objective: Tricuspid regurgitation (TR) is a prevalent valve disease associated with significant morbidity and mortality. We aimed to apply machine learning (ML) to assess risk stratification in patients with ≥moderate TR.
Methods: Patients with ≥moderate TR on echocardiogram between January 2005 and December 2016 were retrospectively included.
Transcatheter aortic valve replacement (TAVR) is now widely approved for the treatment of aortic stenosis, regardless of the patients' surgical risk. However, the outcomes of TAVR and their determinants in patients with chronic kidney disease (CKD) beyond 1 year of follow-up are unknown. We aimed to assess the medium-term outcomes of TAVR in CKD, develop a risk score to estimate the 2-year mortality in patients with CKD, and evaluate the changes in kidney function at discharge after TAVR.
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