PNCDI-II Program

An integrated approach to cardiovascular function for outcome prediction in severe aortic stenosis: the role of exercise echocardiography

Contract no.  21 /08/2013
Project code: PN-II-ID-PCE-2012-4-0560

Source of funding:
UEFISCDI (UNITATEA EXECUTIVA PENTRU FINANTAREA INVATAMANTULUI SUPERIOR, A CERCETARII DEZVOLTARII SI INOVARII)

Abstract
Calcific aortic stenosis (AS) is the most common valvular heart disease, with an increasing prevalence. Management of asymptomatic patients (pts) with severe AS is still under debate due to difficulties in accurately balancing the risk of intervention versus that of watchful waiting. Based on pathophysiological data we hypothesised that a comprehensive assessment of arterial stiffness, left ventricular (LV) and left atrial (LA) function at rest and during exercise could identify markers of increased risk in asymptomatic severe AS. Using exercise echocardiography, we aim to assess for the first time the predictive value of exercise-induced response of parameters of LV systolic and diastolic function (LV myocardial deformation parameters, LV untwisting, E/E’ ratio, BNP serum level) and LA functional reserve in asymptomatic pts with severe AS. We also intend to perform a comparative assessment of vascular and cardiac function in asymptomatic versus symptomatic pts with severe AS and preserved LV ejection fraction and to assess the impact of aortic valve replacement on different parameters of cardiac function in symptomatic pts with severe AS evaluated at rest by state-of-the-art imaging techniques (carotid e-tracking, tissue Doppler/speckle tracking echocardiography, 3D-echocardiography). Incorporating these new parameters into a risk score for outcome prediction in asymptomatic severe AS may provide an useful tool for clinical decision making.

Research team:
Assoc.  Prof. Bogdan Alexandru Popescu – Project Manager
Prof Dr Carmen Ginghina
Dr Monica Rosca
Dr Andreea Calin
Dr Carmen Beladan
Dr Roxana Enache
Dr Daniel Gherasim
Prof Dr Cristian Baicus

Expected results
Two articles published in ISI-indexed journals
Original abstracts presented at national and international congresses of cardiology
Developing a risk score for outcome prediction in asymptomatic severe AS

Activity reports

Activity report 2013
Activity report 2014
Activity report 2015

Obtained results

Articles published in ISI-indexed journals, with impact factor:
Popescu BA, Roşca M. Imaging of myocardial fibrosis in hypertrophic cardiomyopathy: what is the gold standard? Heart. 2014 Apr;100(8):605-6. doi: 10.1136/heartjnl-2013-305359. Epub 2014 Jan 23.

Abstracts presented at the National Congress of Cardiology 2013, published as original abstracts in the Romanian Journal of Cardiology
Beladan CC, Popescu BA, Călin A, Roșca M, Matei FL, Gurzun M, Popară A, Curea F, Ginghină C. Electrocardiografia la pacienții cu hipertrofie ventriculară stângă: o expresie a funcției ventriculare? Romanian Journal of Cardiology 2013; 23(supliment B): B2. ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+). Oral presentation.
Roșca M, Popescu BA, Gurzun M, Călin A, Beladan CC, Enache R, Avram A, Ginghină C. Afectarea mecanicii ventriculare stângi la pacienții cu cardiomiopatie hipertrofică cu risc de moarte subită. Revista Romanian Journal of Cardiology 2013; 23(supliment B):B18. ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+) - Oral presentation.
Roșca M, Popescu BA, Botezatu D, Beladan CC, Gurzun M, Enache R, Ginghină C. Hipertrofia ventriculară dreaptă se corelează independent cu funcția longitudinală a ventriculului stâng la pacienții cu cardiomiopatie hipertrofică. Romanian Journal of Cardiology 2013; 23(supliment B):B51. ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+). Poster presentation.
Enache R, Muraru D, Popescu BA, Călin A, NăstaseO, Botezatu D, Purcărea F, Roșca M, Beladan CC, Ginghină C. Evaluarea funcției și dimensiunilor atriului stâng la pacienți cu regurgitare aortică cronică și fracție de ejecție normală a ventriculului stâng prin ecocardiografie speckle-tracking. Romanian Journal of Cardiology 2013;23(supliment B):B62. ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+)
Buture A, Enache R, Năstase O, Ghiorghiu I, Popescu BA, Bălan A, State S, Așchie D, Călin A, Ginghină C. Caracteristici clinice şi ecocardiografice ale diferitelor fenotipuri de bicuspidie aortică. Romanian Journal of Cardiology 2013;23(supliment B):B189. ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+)
Năstase OA, Enache R, Popescu BA, Botezatu D, Aşchie D, State S, Beladan CC, Roşca M, Călin A, Ginghină C. Dilatarea arterei pulmonare la pacienții cu bicuspidie aortică: prevalență şi corelații. Romanian Journal of Cardiology 2013;23(supliment B):B195. ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+).
Enache R, Muraru D, Piazza R, Popescu BA, Coman M, Călin A, Roșca M, Beladan CC, Nicolosi GL, Ginghină C. Modificări dinamice ale strain-ului longitudinal global la pacienții cu regurgitare aortică cronică și fracție de ejecție normală a ventriculului stâng. Romanian Journal of Cardiology 2013;23(supliment B):B199. ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+).
State S, Enache R, Buture A, Năstase O, Ghiorghiu I, Popescu BA, Bălan A, Așchie D, Călin A, Ginghină C. Bicuspidia aortică: aspecte clinice și ecocardiografice în timpul urmăririi pe termen mediu în funcție de fenotipul și funcția valvei. Romanian Journal of Cardiology 2013;23(supliment B):B251. ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+)

Abstracts presented at EuroEcho-Imaging Congress - Istanbul 2013, published in summary in European Heart Journal - Cardiovascular Imaging
Roşca M, Popescu BA, Botezatu D, Călin A, Beladan CC, Gurzun M, Enache R, Ginghină C. Right ventricular hypertrophy is independently related to longitudinal left ventricular function in patients with hypertrophic cardiomyopathy. Poster presentation.
Enache R, Muraru D, Popescu BA, Calin A, Nastase O, Botezatu D, Purcarea F, Rosca M, Beladan CC, Ginghina C. Left atrial size and function in patients with chronic aortic regurgitation and normal left ventricular ejection fraction. A speckle-tracking echocardiography study. Poster presentation.
Enache R, Muraru D, Piazza R, Popescu BA, Coman M, Calin A, Rosca M, Beladan CC, Nicolosi GL, Ginghina C. Dynamic behaviour of global longitudinal strain during follow-up in patients with chronic aortic regurgitation and normal left ventricular ejection fraction. Poster presentation.

Lectures held by the team members as part of scientific events - 2013:
Popescu BA. Novel techniques for the assessment of diastolic function. Al 57-lea Congres al Societatii de Cardiologie din Coreea de Sud, noiembrie 2013. Invited lecture.
Popescu BA. Assessment of diastolic function. Teaching course, Euroecho 2013, Istanbul. Invited lecture.
Ginghina C. Teaching Course „Heart valve diseases”. Euroecho Istanbul 2013. Moderator.
Rosca M. Assessment of left atrial size and function: role of advanced imaging. Size or function in cardiomyopathies? Euroecho Istanbul 2013. Invited lecture.
Călin A. Evaluarea completa actuala a pacientului cu stenoza aortica. National Congress of Cardiology, Sinaia 2013. Invited lecture.

Abstracts presented at the National Congress of Cardiology 2014, published in summary in the Romanian Journal of Cardiology
Călin A, Roșca M, Beladan CC, Crăciun Mirescu A, Gurzun MM, Mateescu A, Enache R, Ginghină C, Popescu BA. Dinamica torsiunii ventriculului stâng la pacienţii cu stenoză aortică strânsă şi fracţie de ejecţie ventriculară stângă păstrată – relaţia cu statusul simptomatic; Romanian Journal of Cardiology; Supliment A, 2014; 177-178; ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+) (Oral presentation)
Beladan CC, Călin A, Roșca M, Craciun A, Gurzun MM, Călin C, Enache R, Ginghină C, Popescu BA. Impactul severității hipertensiunii arteriale sistemice asupra statusului funcțional și al funcției ventriculare stângi la pacienți cu stenoză aortică strânsă. Romanian Journal of Cardiology; BDI; Supliment A, 2014; 107-108. ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+) (Poster presentation)
A.D. Mateescu, R. Enache, O. Nastase, D. Botezatu, A. Buture, B.A. Popescu, C. Ginghină. Proprietățile elastice ale vaselor mari la pacienții cu valva aortică bicuspidă. Romanian Journal of Cardiology; BDI; Supliment A, 2014; 49-50; ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+) (Poster presentation)
R. Enache, A.D. Mateescu, O. Năstase, B.A. Popescu, A. Buture, C. Ginghină. Cuplarea ventriculo-arterială la pacienții cu bicuspidie aortică – evaluare ecocardiografică. Romanian Journal of Cardiology; BDI; Supliment A, 2014; 87-88; ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+) (Oral presentation)
R. Enache, B.A. Popescu, D. Muraru, R. Piazza, A. Călin, C.C. Beladan, M. Roșca, G.L. Nicolosi, C.Ginghină. Influența remodelării ventriculare stângi asupra dinamicii torsionale la pacienții cu regurgitare aortică cronică și fracție de ejecție a ventriculului stâng normală. Romanian Journal of Cardiology; BDI; Supliment A, 2014; 108-109; ISSN: 1583-2996. Cod CNCSIS 379 (Categoria B+) (Poster presentation)

Abstracts presented at EuroEcho-Imaging Congress - Vienna 2014, published in summary in European Heart Journal - Cardiovascular Imaging
Călin A, Roșca M, Beladan CC, Crăciun Mirescu A, Gurzun MM, Mateescu A, Enache R, Ginghină C, Popescu BA. Left ventricular torsional dynamics in symptomatic versus asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction. European Heart Journal Cardiovascular Imaging, 2014, Suppl – Poster presentation.
Beladan CC, Călin A, Roșca M, Craciun A, Gurzun MM, Călin C, Enache R, Ginghină C, Popescu BA. Systemic hypertension in patients with severe aortic stenosis: does the severity of hypertension make a difference? European Heart Journal Cardiovascular Imaging, 2014, Suppl – Poster presentation.

Lectures held by the team members as a part of scientific events - 2014:
Andreea Calin. "Stenoza aortica asimptomatica - continua provocare". Invited lecture. National Congress of Cardiology 2014.
B.A. Popescu. Cardiomiopatia hipertrofica, Invited lecture during the session "Assessment of left ventricular function in different clinical scenarios", COMMON SESSION, Romanian Society of Cardiology– European Association of Cardiovascular Imaging (EACVI) - National Congress of Cardiology 2014
B.A. Popescu. Evaluarea riscului şi informarea pacientului, Invited lecture during the session "Guidelines on myocardial revascularization", COMMON SESSION, Romanian Society of Cardiology – European Association for Cardio-thoracic Surgery (EACTS) - National Congress of Cardiology 2014
Rosca M. Atrial function and ventricular cavity filling. Invited lecture at EuroEcho-Imaging Congress 2014
Rosca M. Imaging evaluation of left atrium. Invited lecture at EuroEcho-Imaging Congress 2014