Maurice E Sarano

Publications (219) View all

• Article: Tumor Thrombus.

  Hector I Michelena, John Stulak, Maurice Enriquez-Sarano, Stephen A Boorjian
  Journal of the American College of Cardiology 04/2013; · 14.16 Impact Factor
• Article: Right Ventricular Systolic Function in Organic Mitral Regurgitation: Impact of Biventricular Impairment.

  Thierry Le Tourneau, Guillaume Deswarte, Nicolas Lamblin, Claude Foucher-Hossein, Georges Fayad, Marjorie Richardson, Anne-Sophie Polge, Claire Vannesson, Yan Topilsky, Francis Juthier, Jean-Noel Trochu, Maurice Enriquez-Sarano, Christophe Bauters
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  ABSTRACT: BACKGROUND: To assess the prevalence, determinants and prognosis value of right ventricular (RV) ejection fraction (EF) impairment in organic mitral regurgitation (MR). METHODS AND RESULTS: Two-hundred-eight patients (62±12 years, 138 males) with chronic organic MR referred to surgery underwent an echocardiography and bi-ventricular radionuclide angiography with regional function assessment. Mean RV EF was 40.4±10.2%, ranging from 10 to 65%. RV EF was severely impaired (≤35%) in 63 patients (30%), and biventricular impairment (LV EF<60% and RV EF≤35%) was found in 34 patients (16%). Pathophysiologic correlates of RV EF were LV septal function (β-hat=0.42, P<0.0001), LV end diastolic diameter index (β-hat =-0.22, P=0.002) and PASP (β-hat =-0.14, P=0.047). Mitral effective regurgitant orifice size (n=84) influenced RV EF (β-hat =-0.28, P=0.012). In 68 patients examined after surgery, RV EF increased strongly (27.5±4.3 to 37.9±7.3, P<0.0001) in patients with depressed RV EF while it did not change in others (P=0.91). RV EF≤35% impaired 10-year cardiovascular survival (71.6±8.4% versus 89.8±3.7%, P=0.037). Biventricular impairment dramatically reduced 10-year cardiovascular survival (51.9±14.3% versus 90.3±3.2%, P<0.0001; HR: 5.2, P<0.0001) even after adjustment for known predictors (HR: 4.6, P=0.004). Biventricular impairment reduced also 10-year overall survival (34.8±13.0% versus 72.6±4.5%, P=0.003; HR: 2.5, P=0.005) even after adjustment for known predictors (P=0.048). CONCLUSIONS: In patients with organic MR referred to surgery RV function impairment is frequent (30%) and depends weakly on PASP but mainly on LV remodelling and septal function. RV function is a predictor of postoperative cardiovascular survival while biventricular impairment is a powerful predictor of both cardiovascular and overall survival.
  Circulation 03/2013; · 14.74 Impact Factor
• Article: Eclipse of the right ventricular outflow tract: natural history of a sinus of valsalva aneurysm.

  Steven L Driver, Hayan Jouni, Daniel L McCullough, Maurice Enriquez-Sarano, Hector I Michelena
  Journal of the American College of Cardiology 03/2013; 61(9):981. · 14.16 Impact Factor
• Article: Hemodynamic Patterns for Symptomatic Presentations of Severe Aortic Stenosis.

  Sung-Ji Park, Maurice Enriquez-Sarano, Sung-A Chang, Jin-Oh Choi, Sang-Chol Lee, Seung Woo Park, Duk-Kyung Kim, Eun-Seok Jeon, Jae K Oh
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  ABSTRACT: OBJECTIVES: The aim of this study was to investigate intracardiac hemodynamic idiosyncrasies responsible for various presentations of severe aortic stenosis (AS). BACKGROUND: Syncope, dyspnea, and chest pain are well-established indications for aortic valve replacement in patients with severe AS. Patients' survival is limited once they develop symptoms from AS, and survival depends on what type of symptoms a patient develops. We hypothesized that there would be a relationship between the type of AS symptoms and intracardiac hemodynamics as well as AS severity. METHODS: We analyzed 498 patients (men: 58.4%, 66 ± 12 years of age) with severe AS and normal left ventricular ejection fraction from 2003 to 2009 who had comprehensive echocardiography examination for AS. The study population was divided into 4 groups based on presenting symptom(s) (341 in group I, asymptomatic; 15 in group II, syncope; 110 in group III, dyspnea; 32 in group IV, chest pain). Echocardiographic measurements for cardiac structure, function, and intracardiac hemodynamic parameters were compared among these 4 groups. RESULTS: Mean aortic valve pressure gradient and aortic valve area were 57.1 ± 15.2 mm Hg and 0.74 ± 0.19 cm(2), respectively. AS severity based on mean gradient and aortic valve area was similar among 4 groups. Compared with the asymptomatic group, symptomatic patients were older and had lower cardiac output, and higher E/e' ratio while having a similar aortic valve area and gradient. Group II (syncope) displayed smaller LV dimension, stroke volume, cardiac output, left atrial volume index, and E/e' ratio. Conversely, group III (dyspnea) was found to have the worst diastolic function with largest left atrial volume index and highest E/e' ratio. CONCLUSIONS: Among patients with severe AS, their symptoms are often linked to specific hemodynamic patterns associated with AS: smaller left ventricular cavity and reduced output for syncope versus more advanced diastolic dysfunction for dyspnea. Hence, comprehensive intracardiac hemodynamics including diastolic function and stroke volume need to be evaluated in addition to aortic valve area and pressure gradient for assessment of AS.
  JACC. Cardiovascular imaging 02/2013; 6(2):137-146. · 14.29 Impact Factor
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  Article: Inconsistent echocardiographic grading of aortic stenosis: is the left ventricular outflow tract important?

  Hector I Michelena, Edit Margaryan, Fletcher A Miller, Mackram Eleid, Joseph Maalouf, Rakesh Suri, David Messika-Zeitoun, Patricia A Pellikka, Maurice Enriquez-Sarano
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  ABSTRACT: OBJECTIVE: Discrepancy in the echocardiographic severity grading of aortic stenosis (AS) based on current guidelines has been reported. We sought to investigate the left ventricular outflow tract diameter (LVOTd) as a source of inconsistencies, and to explore hypothetical alternatives for discrepancy improvement. DESIGN: Retrospective echocardiographic cross-sectional analysis. SETTING: From 2000 to 2010, we identified all AS patients with left ventricular EF ≥50%, mean gradient (MG) ≥20 mm Hg, aortic valve area (AVA) ≤2.5 cm(2), <moderate (2+) aortic regurgitation; and divided them into three groups: patients with 'small ' LVOTd 1.7-1.9 cm, 'average' LVOTd 2.0-2.2 cm and 'large' LVOTd ≥2.3 cm. In each group, inconsistency of data for classification of severity of AS was assessed and alternative thresholds explored. RESULTS: Of 9488 total patients, 58% were men, LVOTd 2.18±0.19 cm, peak velocity (Vmax) 3.9±0.8 m/s, MG 37±16 mm Hg, and AVA 1.09±0.34 cm(2). Small LVOTd patients were older women (91%) with worse systemic haemodynamics and more prevalent paradoxical low-flow, compared with average and large LVOTd patients (all parameters p <0.001). Despite clinically similar MG and Vmax across all groups, mean AVA ranged from 0.88 to 1.25 cm(2) (p <0.001), classifying small LVOTd patients as severe, average LVOTd as moderate-severe and large LVOTd as moderate. For patients with large, average and small LVOTd, an AVA of 1 cm(2) corresponded to MG of 42, 35 and 29 mm Hg, Vmax of 4.1, 3.8 and 3.5 m/s and dimensionless index (DI) of 0.22, 0.29 and 0.36, respectively. An AVA cut-off of 0.8 cm(2) reduced severe AS inconsistency from 48% to 26% for small LVOTd patients. An AVA cut-off of 0.9 cm(2) reduced severe AS inconsistency from 37% to 26% for average LVOTd patients. The current AVA cut-off of 1 cm(2) was consistent for large LVOTd patients. CONCLUSIONS: The LVOTd is associated with significant inconsistencies in AS assessment by current guidelines. For patients with normal EF and normal flow, current guideline definition of severe AS is most consistent for patients with large LVOTd, but not so for patients with average or small LVOTd in whom lower AVA cut-offs should be further studied. The DI cut-off for severe AS is highly variable depending on the LVOTd and guideline revision of this threshold should be considered.
  Heart (British Cardiac Society) 01/2013; · 4.22 Impact Factor