Seung Woo Park

BACKGROUND: Moderate aortic stenosis (AS) poses a substantial risk for adverse outcomes, yet its prognostic determinants and cardiac remodeling markers remain underexplored. This study aimed to evaluate prognostic factors, including left atrial strain, and their predictive value for adverse cardiac events in patients with moderate AS. METHODS: A retrospective cohort study included 1125 patients diagnosed with moderate AS between 2008 and 2019. Cardiac remodeling indices, including left atrial reservoir strain (LARS) and left ventricular global longitudinal strain, were assessed using speckle-tracking echocardiography. The primary outcome was cardiac death, while the secondary outcome was a composite of cardiac death or heart failure hospitalization. RESULTS: Among the study population (median age, 74 years; 47.2% women), the Kaplan-Meier–estimated 5-year rates of cardiac mortality and the composite outcome were 16.7% and 33.9%, respectively, during a median follow-up of 42.8 months. Of the cardiac remodeling indices evaluated, LARS emerged as the most sensitive and independent predictor of cardiac death (adjusted hazard ratio, 0.948 per 1% increase; P =0.003) and the composite outcome (adjusted hazard ratio, 0.940 per 1% increase; P P =0.024). Furthermore, among all cardiac remodeling parameters analyzed, LARS showed the highest predictive performance for the composite outcome (C-index, 0.586 [95% CI, 0.541–0.632]) compared with other parameters. CONCLUSIONS: LARS is a sensitive and independent prognostic marker in moderate AS, reflecting cardiac remodeling. Regular assessment of left atrial strain could enhance risk stratification and guide clinical management strategies in patients with moderate AS.

Background: The accuracy of echocardiographic estimation of pulmonary artery pressure has been questioned in patients with severe tricuspid regurgitation (TR). This study aimed to evaluate the accuracy of echocardiographic estimates of pulmonary artery pressure compared with simultaneous right heart catheterization (RHC) in patients with severe TR. Methods: In this prospective observational study, a total of 48 patients with severe TR were enrolled between September 2021 and August 2024 at an experienced RHC center. Data were obtained by simultaneously measuring echocardiography and RHC parameters. The correlation between pulmonary arterial systolic pressure (PASP) measured by echocardiography and RHC was analyzed using Pearson correlation and Bland–Altman analysis. Results: The median age was 71.5 years, and 26 (54.2%) of the patients were women. Forty‐three (89.6%) patients had secondary TR as the underlying pathogenesis. There was a good correlation ( r =0.85 as Pearson correlation, P P r =0.90, P <0.001). Conclusions: Echocardiography demonstrated good agreement with invasively measured PASP. Incorporating additional echocardiographic parameters significantly enhanced the accuracy of PASP estimation, suggesting a refined noninvasive diagnostic approach in severe TR.

Background: Aortic stenosis (AS) is a representative geriatric disease, and there is an anticipated rise in the number of patients requiring noncardiac surgeries in patients with AS. However, there is still a lack of research on the primary predictors of noncardiac perioperative complications in patients with asymptomatic significant AS. Methods and Results: Among the cohort of noncardiac surgeries under general anesthesia, with an intermediate to high risk of surgery from 2011 to 2019, at Samsung Medical Center, 221 patients were identified to have asymptomatic significant AS. First, to examine the impact of significant AS on perioperative adverse events, the occurrences of major adverse cardiovascular events and perioperative adverse cardiovascular events were compared between patients with asymptomatic significant AS and the control group. Second, to identify the factors influencing the perioperative adverse events in patients with asymptomatic significant AS, a least absolute shrinkage and selection operator regression model was used. There was no significant difference between the control group and the asymptomatic significant AS group in the event rate of major adverse cardiovascular events (4.6% at control group versus 5.5% at asymptomatic significant AS group; P =0.608) and perioperative adverse cardiovascular events (13.8% at control group versus 18.3% at asymptomatic significant AS group; P =0.130). Cardiac damage stage was a significant risk factor of major adverse cardiovascular events and perioperative adverse cardiovascular events. Conclusions: There was no significant difference in major postoperative cardiovascular events between patients with asymptomatic significant AS and the control group. Advanced cardiac damage stage in significant AS is an important factor in perioperative risk of noncardiac surgery.

Cha JH, et al. Korean Circ J. 2024 Jun;54:e74. https://doi.org/10.4070/kcj.2023.0316

Kim J, et al. J Korean Med Sci. 2023 Dec;39(2):e18. https://doi.org/10.3346/jkms.2024.39.e18

BACKGROUND: Aortic valve stenosis (AS) is a representative geriatric disease, and there is an anticipated rise in the number of patients requiring non-cardiac surgeries in patients with AS. However, there is still a lack of research on the primary predictors of non-cardiac perioperative complications in patients with asymptomatic significant AS. METHOD AND RESULT: Among the cohort of non-cardiac surgeries under general anesthesia, with an intermediate-to-high risk of surgery from 2011 to 2019, at Samsung Medical Center, 221 patients were identified to have asymptomatic significant AS. First, to examine the impact of significant AS on perioperative adverse events, the occurrences of Major Adverse Cardiovascular Events (MACE) and Perioperative Adverse Cardiovascular Events (PACE) were compared between patients with asymptomatic significant AS and the control group. Second, to identify the factors influencing the perioperative adverse events in patients with asymptomatic significant AS, multivariable logistic regression model was used. There was no significant difference between the three groups consisting of control group, moderate asymptomatic AS group, and severe asymptomatic AS group in the event rate of MACE (p value 0.971) and PACE (p value 0.185). Cardiac damage stage was significant risk factor of MACE (OR 9.241, 95% CI: 1.314 - 64.976, p-value = 0.025) and PACE (OR 2.199, 95% CI: 1.055 - 4.584, p-value = 0.036). CONCLUSION: There was no significant difference in major post-operative cardiovascular events between patients with asymptomatic significant AS and the control group. Advanced cardiac damage stage in significant AS is a key factor in perioperative risk of non-cardiac surgery. CLINICAL PERSPECTIVE: What Is New?: Advanced cardiac damage is a major risk factor for perioperative complications in non-cardiac surgeries of patients with asymptomatic significant AS. What Are the Clinical Implications?: Patients with asymptomatic significant AS showed no significant difference in perioperative complications compared to the control group, but caution is needed in those with advanced cardiac damage, as they are more likely to experience adverse events.

Purpose: We evaluated the clinical characteristics of patients undergoing cardiac magnetic resonance (CMR) examinations over 10 years at a tertiary referral hospital.Methods: This retrospective study included 11,087 CMR examinations performed between November 2009 and September 2020. The number of adults aged ≥20 years was 10,648 (72.8% males). A total of 439 children or young adults aged < 20 years underwent CMR (66.5% males). Indications for CMR examinations were classified according to the Consensus Panel recommendations of the Society for Cardiovascular Magnetic Resonance (SCMR).Results: The mean age was 55.9±12.4 years for adults. Forty percent of patients were obese. Leading cardiovascular risk factors were hypertension, dyslipidemia, diabetes mellitus, and current smoking status in 28.2%, 19.1%, 13.8%, and 25.4% of patients, respectively. The proportion of stress CMR examinations performed was 57.2%. For children, the mean age was 12.6±5.3 years. Most children underwent a non-stress CMR test. In adults without congenital heart disease, indication numbers for SCMR classes were 5,682 for class I (49.4%), 772 for class II (6.7%), 313 for class III (0.3%), and 4,714 for investigational group (41.1%). In pediatric patients and adults with congenital heart disease, indication numbers for SCMR classes were 539 for class I (80.3%), 62 for class II (9.2%), and 70 for the investigational group (10.4%).Conclusion: CMR is most commonly performed in men in their 50s or 60s. CMR may be used as the first-line imaging technique (SCMR class I) in around a half of adult patients and in most pediatric patients.

Jang SY, et al. J Korean Med Sci. 2023 Nov;38:e375. https://doi.org/10.3346/jkms.2023.38.e375

Despite similar brachial blood pressure, central hemodynamics could be different. The objective of the present study was to investigate the factors, which could influence the discrepancy between central BP (cBP) and brachial blood pressure. Six hundred forty-seven patients (364 males, 48 ± 12 years old) were enrolled. Using applanation tonometry, cBP was noninvasively derived. The median difference between brachial systolic BP (bSBP) and central systolic BP (cSBP) was 8 mm Hg. We defined the discrepancy between bSBP and cSBP as differences >8 mm Hg. For adjustment of cBP, population was divided into 3 groups according to the cBP: group 1, cSBP < 160 mm Hg; group 3, =160 mm Hg of cSBP. All the central hemodynamic parameters of the patients, including augmentation pressure, augmentation index (AI), heart rate (75 bpm) adjusted augmentation index (AI@HR75), and subendocardial viability ratio, were measured. Using multivariate logistic regression analysis, we evaluated the factors which could influence the discrepancy between bSBP and cSBP. Age, gender, augmentation pressure, AI, and AI@HR75 were correlated with the discrepancy between bSBP and cSBP. AI@HR75 was significantly correlated with the discrepancy between bSBP and cSBP (β-coefficient = −0.376, P < .001 in group 1; β-coefficient = −0.297, P < .001 in group 2; and β-coefficient = −0.545, P < .001 in group 3). In groups 1 and 2, male gender was significantly correlated with the discrepancy between bSBP and cSBP (β-coefficient = −0.857, P = .035 in group 1; β-coefficient = −1.422, P = .039 in group 2). In present study, arterial stiffness might affect the discrepancy between bSBP and cSBP. Also, male gender was closely related to the discrepancy between bSBP and cSBP especially with cSBP <160 mm Hg. Not only cSBP, the discrepancy between cSBP and bSBP should be considered for understanding the central hemodynamics.