Zoran B Popovic

Cleveland Clinic · Cardiovascular Imaging

Background To date, moderate concomitant valvular heart diseases have been scarcely studied. This study aimed to further define predictors of long-term outcomes in patients diagnosed with concomitant moderate aortic and mitral valve disease at a tertiary center. Methods In this cohort we included 3257 patients (aged 71.7 ± 12.9 years; 55.2% male;...

Background Valvular heart diseases are common causes of morbidity and mortality worldwide. In this study we sought to assess the long-term outcomes of patients diagnosed with concomitant moderate aortic and mitral valves diseases at a tertiary center. Methods All 3257 patients (aged 71.7 ± 12.9 years old, 55.2% male, 83.1% white) who presented to...

Background Calcium and vitamin D supplement intake has increased among the elderly population, who are prone to deficiency. We sought to assess the association between calcium and vitamin D supplementation and the long-term outcomes in patients diagnosed with concomitant moderate aortic and mitral valve disease. Methods We included 3257 patients (...

Background: Left ventricular global longitudinal strain (LVGLS) by speckle-tracking is an established measure of left ventricular systolic function with many clinical applications. Most strain software traditionally can only analyze strain on scans of the same vendor, however recent advances have allowed them to analyze all scans, although external...

Introduction: Right atrial strain (reservoir RASr, conduit RAScd and contractile RASct) are increasingly utilized in the clinical and research setting such as for diastology grading, heart failure and valvular heart disease. However, the feasibility and reference ranges of right atrial strain measurements by contemporary strain software on differen...

Background: Right ventricle longitudinal strain (global: RVGLS and free-wall: RVFWLS) by speckle-tracking echocardiography is increasingly utilized to assess right ventricle systolic function with prognostic value demonstrated in several cardiovascular conditions. Contemporary strain software have addressed past limitations to be able to analyze sc...

Introduction: Aortic regurgitation (AR) leads to left ventricular (LV) remodeling by increasing LV load. We recently showed that LV dimensions, widely adopted marker of severe AR, are not reliable predictors of adverse CV outcomes in older patients and female sex. Here we sought to study the effects of chronic severe AR on left atrial (LA) size and...

Introduction: Surgery is recommended subaortic stenosis (SAS) patients with severe left ventricular outflow tract obstruction and symptoms, left ventricular dysfunction and sometimes aortic regurgitation, although how surgery modifies patient prognosis is not well understood. We compared the outcomes of SAS based on past and follow-up treatment dis...

Background: Left ventricular end-diastolic pressure (LVEDP) is clinically relevant due to its association with diastolic dysfunction and other outcomes. The gold-standard method of measuring LVEDP is invasive intra-cardiac catheterization. Echocardiography is routinely used for non-invasive estimation of left ventricular (LV) filling pressures; how...

Background: The severity classification of functional mitral regurgitation (FMR) remains controversial despite adverse prognosis and rapidly evolving interventions. Furthermore, it is unclear if quantitative assessment with cardiac magnetic resonance can provide incremental risk stratification for patients with ischemic cardiomyopathy (ICM) or non...

Background: There are limited data on the sex differences in the hemodynamic progression and outcomes of early-stage aortic stenosis (AS). Objectives: The authors sought to determine sex differences in hemodynamic progression and outcomes of mild to moderate native AS. Methods: This was a retrospective observational cohort study including pati...

Background: Patient reported outcomes (PRO) can assess quality of life (QOL) in obstructive hypertrophic cardiomyopathy (oHCM). In symptomatic oHCM patients, we sought to study the correlation between various PROs, their association with physician reported New York Heart Association (NYHA) class and changes after surgical myectomy. Methods: We p...

Data regarding the impact of pacing on outcomes after transcatheter aortic valve implantation (TAVI) is evolving especially with regards to pre-existing permanent pacemaker (PPM). We examined the impact of new and previous PPM on the clinical and hemodynamic outcomes after SAPIEN-3 TAVI. We included all consecutive patients who underwent transfemor...

Background: Current guidelines for aortic regurgitation (AR) recommend the same linear left ventricular (LV) dimension for intervention regardless of age and sex. Objectives: The purpose of this study was to evaluate the impact of age and sex on the degree of LV remodeling and outcomes. Methods: We included consecutive patients with severe AR...

Background: The implications of left ventricular remodeling and dysfunction before and after aortic valve replacement (AVR) for mixed aortic valve disease (MAVD) are not well understood. This study aims to evaluate the impact of AVR on left ventricular (LV) systolic function in MAVD, and determine the prognostic value of postoperative LV global lo...

Background: Obstructive hypertrophic cardiomyopathy (oHCM) is increasingly being diagnosed in elderly patients. Objectives: The authors sought to study long-term outcomes of septal reduction therapies (SRT) in Medicare patients with oHCM, and hospital volume-outcome relation. Methods: Medicare beneficiaries aged >65 years who underwent SRT, se...

Transthoracic echocardiography (TTE) grading of aortic stenosis (AS) is challenging when parameters are discrepant, and four-dimensional cardiac computed tomography (4D-CCT) is increasingly utilized for transcatheter intervention workup. We compared TTE and 4D-CCT measures contributing to AS quantification. AS patients (n = 80, age 86 ± 10 years, 7...

Abstract Background Significant aortic regurgitation (AR) leads to left ventricular (LV) remodeling; however, little data exist regarding sex-based differences in LV remodeling in this setting. We sought to compare LV remodeling and AR severity, assessed by echocardiography and cardiovascular magnetic resonance (CMR), to discern sex-based differenc...

Background: New-onset left bundle branch block (LBBB) can develop after transcatheter aortic valve replacement (TAVR) resulting in worse outcomes. Aims: Describe clinical and echocardiographic outcomes with new-onset LBBB after TAVR. Methods: We included consecutive patients who underwent transfemoral-TAVR with SAPIEN-3 (S3) valve between Apri...

Background: The prognostic significance of cardiac magnetic resonance (CMR) based left atrial ejection fraction (LAEF) is not well defined in the ischemic cardiomyopathy (ICM) cohort.We assess the additive effect of LAEF in a model to predict outcomes in patients with ICM. Methods: Patients with ICM, who underwent CMR between April 2001 and March 2...

Background: Cardiac magnetic resonance imaging (CMR) is the reference standard for right ventricle (RV) quantification, however predictors and prognosis of RV dysfunction in cardiomyopathy patients, including differences between ischemic (ICM) and non-ischemic (NICM) cardiomyopathies, remain not well understood. We evaluated the factors and outcome...

Introduction: Atrial functional tricuspid regurgitation (AFTR) is an increasingly recognized and prevalent clinical entity associated with adverse outcomes. Hypothesis: We evaluated the clinical and echocardiographic features of AFTR and those associated with poor prognosis. Methods: Consecutive patients with at least moderate-to-severe and isolate...

Background: Cardiac magnetic resonance (CMR) has become reference standard for chamber quantification, with complimentary utility of valvular heart disease CMR may provide additional insights to transthoracic echocardiography (TTE) into chamber remodeling in aortic valve disease. We prospectively compared chamber quantification measured by TTE and...

Introduction: Women and older patients with chronic aortic regurgitation (AR) have disproportionately higher rates of adverse events compared to men and younger patients, respectively. Yet, guidelines recommend same left ventricular (LV) dimension thresholds for intervention in all. While experimental animal models suggest different rates of LV rem...

Introduction: Patient reported outcomes (PRO) are used to assess quality of life (QOL) in obstructive hypertrophic cardiomyopathy (oHCM). Hypothesis: In symptomatic oHCM patients, we sought to prospectively study the association between various PROs & their association with physician reported New York Heart Association (NYHA) class. Methods: This w...

Introduction: Tricuspid regurgitation (TR) is associated with poor outcome and high operative mortality due to late presentation; yet the optimal timing for TR intervention remains controversial, especially in asymptomatic patients. We evaluated the prognostic value of echocardiographic parameters to inform early intervention in asymptomatic TR Met...

Background Post-systolic shortening index (PSI) is defined as myocardial shortening that occurs after aortic valve closure, and is an emerging measure of regional LV contractile dysfunction. PSI measurement variability amongst software vendor and its relationship with mechanical dyssynchrony and mechanical dispersion index (MDI) remains unknown. We...

Background Magnetic resonance imaging (MRI) has shown incremental prognostic value to transthoracic echocardiography (TTE) for valve diseases, however TTE remains more widely available and utilized. We sought to develop TTE-based algorithms that best identify severe AR and MR by MRI in a prospective study. Methods Patients with >moderate-to-severe...

Background Significant tricuspid regurgitation (TR) is associated with poor outcome and high operative mortality resulting from late presentation. Yet, the optimal timing for intervention is unknown. Objectives The purpose of this study was to evaluate the prognostic value of echocardiographic parameters to inform early intervention in asymptomati...

Background: Transcatheter aortic valve-in-valve implantation (ViV-TAVI) has emerged in recent years as a safe alternative to redo surgery in high-risk patients. Although early results are encouraging, data beyond short-term outcomes are lacking. Herein, we aimed to assess the 2-year outcomes after ViV-TAVI. Methods: Patients undergoing ViV-TAVI fo...

Degenerative calcific aortic stenosis (AS) is the most common valvular heart disease and often co-exists with left ventricular (LV) systolic dysfunction at the time of diagnosis. Impaired LV systolic function has been associated with worse outcomes in the setting of AS, even after successful aortic valve replacement (AVR). Myocyte apoptosis and myo...

BACKGROUND Patients with pure native aortic regurgitation (AR) were excluded from transcatheter aortic valve replacement (TAVR) trials. We sought to examine midterm outcomes with TAVR in AR compared to surgical AVR (SAVR) in a contemporary cohort. METHODS Medicare beneficiaries who underwent elective TAVR or SAVR for pure AR from 2016 to 2019 were...

Background Post-systolic shortening index (PSI) is defined as myocardial shortening that occurs after aortic valve closure, and is an emerging measure of regional LV contractile dysfunction. PSI measurement variability amongst software vendor and its relationship with mechanical dyssynchrony and mechanical dispersion index (MDI) remains unknown. We...

Background: The cerebral embolic protection (CEP) device captures embolic debris during transcatheter aortic valve replacement (TAVR). However, the impact of CEP on stroke severity following TAVR remains unclear. Therefore, we aimed to examine whether CEP was associated with reduced severity of stroke following TAVR. Methods: This was a retrospe...

Background We sought to determine the incremental prognostic value of age-sex adjusted N-terminal prohormone brain natriuretic peptide (NT-pro BNP) ratio in obstructive hypertrophic cardiomyopathy (oHCM) patients. Methods The study included 2119 consecutive oHCM patients (age 55 ± 13 years, 53% men, maximal LVOT ≥30 mmHg) evaluated between 6/2002–...

Objectives Guidelines suggest aortic valve replacement (AVR) for low-risk asymptomatic patients. Indications for transcatheter AVR now include low-risk patients, making it imperative to understand state-of-the-art surgical AVR (SAVR) in this population. Therefore, we compared SAVR outcomes in low-risk patients with those expected from Society of Th...

Background Coronary obstruction during transcatheter aortic valve replacement (TAVR) is a rare, yet life-threatening, complication. The routine use of left main (LM) protection with or without stent placement in high-risk patients remains controversial. The aim of this study was to evaluate the outcomes of LM protection during TAVR and identify ana...

Background: The incremental utility of right ventricular (RV) strain on predicting right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation, beyond clinical and haemodynamic indices, is not clear. Methods: Two hundred and forty-six (246) patients undergoing LVAD implantation, who had transthoracic echocardiogr...

Objective Calcium metabolism has long been implicated in aortic stenosis (AS). Studies assessing the long-term safety of oral calcium and/or vitamin D in AS are scarce yet imperative given the rising use among an elderly population prone to deficiency. We sought to identify the associations between supplemental calcium and vitamin D with mortality...

This cohort study assesses the association of septal myectomy with quality of life in patients with left ventricular outflow tract obstruction from hypertrophic cardiomyopathy.

Here we review the utility of strain measurements in patients with valvular diseases. The focus of the review is on using left ventricular global longitudinal strain in aortic regurgitation, aortic stenosis, and mitral regurgitation. We briefly cover the usefulness of right ventricular strain in these three disease states. Finally, we review the us...

Controversies remain in the management strategy for isolated tricuspid regurgitation (TR) because of adverse prognosis and uncertainties regarding the benefits of tricuspid valve surgery. We compared the characteristics and outcomes of a large cohort of patients with isolated TR, based on downstream tricuspid valve surgery versus medical management...

Background: Dobutamine stress echocardiography (DSE) is a useful tool for assessing low-gradient significant aortic stenosis (AS) and contractile reserve (CR), but its prognostic utility has become controversial in recent studies. We evaluated the impact of DSE on aortic valve physiological, structural and left ventricular parameters in low gradie...

Objectives The authors report etiologies and outcomes and devise a risk model in a large contemporary cohort of patients with isolated tricuspid regurgitation (TR). Background Isolated TR is a challenging clinical entity with heterogeneous etiology and often poor outcomes, with a paucity of recent research regarding the epidemiology of isolated TR...

Background: Left atrial (LA) size has been shown to be predictive of adverse outcomes in patients with various cardiac conditions. However, the significance of left atrial function (LAF) is not clearly defined in patients with advanced ischemic cardiomyopathy (ICM). We assess the effect of cardiac magnetic resonance imaging (CMR) based LA ejection...

Background: There is limited data on gender specific remodeling and its associated risk in patients with ischemic cardiomyopathy (ICM). We conducted gender based phenomapping analysis using Cardiac MRI (CMR) variables to identify novel sex-specific phenotypes in patients with ICM. We then assessed if these phenotypes were predictive of overall surv...

Background: Challenges remain in our understanding of implications of right ventricle (RV) dysfunction in heart failure. Cardiac magnetic resonance imaging (CMR) is the reference standard for RV quantification, but has seldomly been studied for this purpose in cardiomyopathy patients. We evaluated the predictors and outcomes of reduced CMR-derived...

Background: Transthoracic echocardiography (TTE) is the first-line imaging modality to evaluate isolated tricuspid regurgitation (TR), however comparisons with magnetic resonance imaging (MRI) measurements have seldomly been studied. We assessed the correlation, discriminative ability and derived a novel TTE-based algorithm using TR and right heart...

Background New left bundle branch block (LBBB) is a common finding after transcatheter aortic valve replacement (TAVR) that can result in worse outcomes after TAVR. We aim to investigate the impact of new-onset LBBB after TAVR using the SAPIEN-3 (S3) valve. Methods Consecutive patients who underwent transfemoral-TAVR with S3 valve between April 20...

Background: Valve-in-Valve transcatheter aortic valve implantation (ViV-TAVI) is a growing alternative for redo-surgery in patients with degenerated surgical valves. To our knowledge, data are lacking on the determinants on ViV-TAVI procedural success in patients with degenerated surgical valves. Methods: All consecutive patients undergoing ViV-TA...

Background Hypertrophic cardiomyopathy (HCM) and aortic stenosis can cause obstruction to the flow of blood out of the left ventricular outflow tract into the aorta, with obstructive HCM resulting in dynamic left ventricular outflow tract obstruction and moderate or severe aortic stenosis causing fixed obstruction caused by calcific degeneration. W...

Background Isolated tricuspid regurgitation (TR) remains a management dilemma with poor outcomes. Echocardiography and cardiac magnetic resonance imaging (CMR) are valuable tools for evaluating TR, but their prognostic utility has rarely been studied together in this setting. We aimed to determine the prognostic value and thresholds for echocardiog...

Background Isolated severe tricuspid regurgitation (TR) is a challenging valve lesion to manage because of adverse prognosis, and surgery remains controversial especially in secondary etiologies. We aimed to devise a risk model to predict one-year mortality in isolated secondary TR patients, and evaluated whether risk category influenced the associ...

Background ❑ New left bundle branch block (LBBB) is a common finding after transcatheter aortic valve replacement (TAVR) that can result in worse outcomes after TAVR. We aim to investigate the impact of new-onset LBBB after TAVR using the SAPIEN-3 (S3) valve. Methods: ❑ Consecutive patients who underwent transfemoral-TAVR with S3 valve between Apr...

Background Right ventricular (RV) systolic strain has recently demonstrated prognostic value in various cardiovascular diseases. Despite this, the reference range including the lower limit of normal (LLN) and factors associated with RV strain measurements are not well-established. This meta-analysis aimed to determine the mean and LLN of two- (2D)...

Background: Cardiovascular disease is a leading cause of death in general population and the second leading cause of mortality and morbidity in cancer survivors after recurrent malignancy in the United States. The growing awareness of cancer therapy-related cardiac dysfunction (CTRCD) has led to an emerging field of cardio-oncology; yet, there is...

Objectives To describe the use of echocardiography in patients hospitalised with suspected coronavirus infection and to assess its impact on clinical management. Methods We studied 79 adults from a prospective registry of inpatients with suspected coronavirus infection at a single academic centre. Echocardiographic indications included abnormal bi...

Background Balloon aortic valvuloplasty (BAV) is often performed for patients with aortic stenosis who are not candidates for transcatheter aortic valve replacement (TAVR) due to concomitant medical issues. However, little is known about BAV outcomes stratified by acuity of illness. We sought to compare the safety and efficacy of BAV across a range...

This systematic review examines temporal trends of retractions in cardiology literature and assesses their effect.

Background Mitral annular disjunction (MAD) is an increasingly recognized entity associated with mitral valve prolapse (MVP), ventricular arrhythmias and death. Few studies have investigated the utility of myocardial deformation analysis in MAD. We compared chamber quantification including strain by transthoracic echocardiography (TTE) and cardiac...

Objectives The aims of this study were to characterize the interplay between mixed aortic valve disease (MAVD) phenotypes (defined by concomitant severities of aortic stenosis and aortic regurgitation) and left ventricular global longitudinal strain (LV-GLS), and to assess the prognostic utility of LV-GLS in MAVD. Background Little is known about...

Surveillance of left ventricular function, part of current US Food and Drug Administration recommendations for anti-human epidermal growth factor receptor 2 (anti-HER2) chemotherapy, is based on historical data involving patients who received concomitant anthracycline therapy, a key enhancer of cardiac risk. More recent anti-HER2 treatment data sug...

Background Transfemoral access is the most common approach for transcatheter aortic valve replacement (TAVR). However, a subset of patients require alternative access. This study describes the evolution and outcomes of alternative access TAVR at Cleveland Clinic. Methods From January 2006 to January 2019, 2,446 patients underwent TAVR, 414 (17%) v...

Background We report characteristics and outcomes of elderly patients with hypertrophic cardiomyopathy (HCM) with basal septal hypertrophy and dynamic left ventricular outflow tract obstruction. Methods and Results We studied 1110 consecutive elderly patients with HCM (excluding moderate or greater aortic stenosis or subaortic membrane, age 80±5 y...