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Chen SY, Kong XQ, Zhang JJ. Pathological Mechanism and Treatment of Calcified Aortic Stenosis. Cardiol Rev 2024; 32:320-327. [PMID: 38848535 DOI: 10.1097/crd.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
Calcified aortic stenosis (AS) is one of the most common valvular heart diseases worldwide, characterized by progressive fibrocalcific remodeling and thickening of the leaflets, which ultimately leads to obstruction of blood flow. Its pathobiology is an active and complicated process, involving endothelial cell dysfunction, lipoprotein deposition and oxidation, chronic inflammation, phenotypic transformation of valve interstitial cells, neovascularization, and intravalvular hemorrhage. To date, no targeted drug has been proven to slow down or prevent disease progression. Aortic valve replacement is still the optimal treatment of AS. This article reviews the etiology, diagnosis, and management of calcified aortic stenosis and proposes novel potential therapeutic targets.
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Affiliation(s)
- Si-Yu Chen
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China, Nanjing 210006, China
| | - Xiang-Quan Kong
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China, Nanjing 210006, China
- Department of Cardiology, Nanjing Heart Centre, Nanjing, China
| | - Jun-Jie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China, Nanjing 210006, China
- Department of Cardiology, Nanjing Heart Centre, Nanjing, China
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2
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Hecht S, Giuliani C, Nuche J, Farjat Pasos JI, Bernard J, Tastet L, Abu-Alhayja'a R, Beaudoin J, Côté N, DeLarochellière R, Paradis JM, Clavel MA, Arsenault BJ, Rodés-Cabau J, Pibarot P. Multimarker Approach to Improve Risk Stratification of Patients Undergoing Transcatheter Aortic Valve Implantation. JACC. ADVANCES 2024; 3:100761. [PMID: 38939373 PMCID: PMC11198363 DOI: 10.1016/j.jacadv.2023.100761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 06/29/2024]
Abstract
Background A blood multimarker approach may be useful to enhance risk stratification in patients undergoing TAVI. Objectives The objective of this study was to determine the prognostic value of multiple blood biomarkers in transcatheter aortic valve implantation (TAVI) patients. Methods In this prospective study, several blood biomarkers of cardiovascular function, inflammation, and renal function were measured in 362 patients who underwent TAVI. The cohort was divided into 3 groups according to the number of elevated blood biomarkers (ie, ≥ median value for the whole cohort) for each patient before the procedure. Survival analyses were conducted to evaluate the association between blood biomarkers and risk of adverse event following TAVI. Results During a median follow-up of 2.5 (IQR: 1.9-3.2) years, 34 (9.4%) patients were rehospitalized for heart failure, 99 (27%) patients died, and 113 (31.2%) met the composite endpoint of all-cause mortality or heart failure rehospitalization. Compared to patients with 0 to 3 elevated biomarkers (referent group), those with 4 to 7 and 8 to 9 elevated biomarkers had a higher risk of all-cause mortality (HR: 1.54 [95% CI: 0.84-2.80], P = 0.16, and HR: 2.81 [95% CI: 1.53-5.15], P < 0.001, respectively) and of the composite endpoint (HR: 1.65 [95% CI: 0.95-2.84], P = 0.07, and HR: 2.67 [95% CI: 1.52-4.70] P < 0.001, respectively). Moreover, adding the number of elevated blood biomarkers into the clinical multivariable model provided significant incremental predictive value for all-cause mortality (Net Reclassification Index = 0.71, P < 0.001). Conclusions An increasing number of elevated blood biomarkers is associated with higher risks of adverse clinical outcomes following TAVI. The blood multimarker approach may be helpful to enhance risk stratification in TAVI patients.
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Affiliation(s)
- Sébastien Hecht
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Carlos Giuliani
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Jorge Nuche
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Julio I. Farjat Pasos
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Jérémy Bernard
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Lionel Tastet
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Rami Abu-Alhayja'a
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Nancy Côté
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Robert DeLarochellière
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Jean-Michel Paradis
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Marie-Annick Clavel
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Benoit J. Arsenault
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
| | - Philippe Pibarot
- Department of Cardiology, Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Québec, Canada
- Faculté de médecine, Université Laval, Québec, Canada
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3
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Magruder JT, Holst KA, Stewart J, Yadav PK, Thourani VH. Early Intervention in Asymptomatic Aortic Stenosis: What Are We Waiting For? Can J Cardiol 2024; 40:201-209. [PMID: 38036025 DOI: 10.1016/j.cjca.2023.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/06/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023] Open
Abstract
Aortic stenosis (AS) contributes to significant cardiovascular morbidity and mortality worldwide, and the natural history from symptoms to ventricular decompensation, heart failure, and death has been well documented. For more than 2 decades, technologies including imaging and biomarkers have shown a promising ability to detect myocardial damage associated with AS before symptoms arise. Current treatment guidelines rely heavily on symptoms or ventricular decompensation as triggers for aortic valve intervention. There is increasing appreciation of the relationship between myocardial damage due to AS before the emergence of symptoms, and a number of published randomised trials suggest a benefit to early intervention in asymptomatic AS, with additional trials actively enrolling. Future treatment paradigms may incorporate early detection of ventricular damage by noninvasive new technologies as triggers for asymptomatic intervention. Enthusiasm for early aortic valve replacement should be tempered by consideration of the competing risks of early valve intervention, but an increasing preponderance of evidence continues to suggest that earlier intervention in AS is warranted.
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Affiliation(s)
- J Trent Magruder
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Athens, Georgia, USA
| | - Kimberly A Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jim Stewart
- Department of Cardiology, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Pradeep K Yadav
- Department of Cardiology, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Marcus Valve Center, Atlanta, Georgia, USA.
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Ranard LS, Bonow RO, Nishimura R, Mack MJ, Thourani VH, Bavaria J, O'Gara PT, Bax JJ, Blanke P, Delgado V, Leipsic J, Lang RM, Michelena HI, Cavalcante JL, Vahl TP, Leon MB, Rigolin VH. Imaging Methods for Evaluation of Chronic Aortic Regurgitation in Adults: JACC State-of-the-Art Review. J Am Coll Cardiol 2023; 82:1953-1966. [PMID: 37940233 DOI: 10.1016/j.jacc.2023.08.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 11/10/2023]
Abstract
A global multidisciplinary workshop was convened to discuss the multimodality diagnostic evaluation of aortic regurgitation (AR). Specifically, the focus was on assessment tools for AR severity and analyzing evolving data on the optimal timing of aortic valve intervention. The key concepts from this expert panel are summarized as: 1) echocardiography is the primary imaging modality for assessment of AR severity; however, when data is incongruent or incomplete, cardiac magnetic resonance may be helpful; 2) assessment of left ventricular size and function is crucial in determining the timing of intervention; 3) recent evidence suggests current cutpoints for intervention in asymptomatic severe AR patients requires further scrutiny; 4) left ventricular end-systolic volume index has emerged as an additional parameter that has promise in guiding timing of intervention; and 5) the role of additional factors (including global longitudinal strain, regurgitant fraction, and myocardial extracellular volume) is worthy of future investigation.
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Affiliation(s)
- Lauren S Ranard
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Robert O Bonow
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Rick Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Mack
- Division of Cardiothoracic Surgery, Heart Hospital Baylor Plano, Baylor Healthcare System, Plano, Texas, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Joseph Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Patrick T O'Gara
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Philipp Blanke
- Department of Radiology, St Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Victoria Delgado
- Department of Cardiology, Hospital University Germans Trias i Pujol, Badalona, Spain
| | - Jonathon Leipsic
- Department of Radiology, St Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Roberto M Lang
- Section of Cardiology, Heart and Vascular Center, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - João L Cavalcante
- Division of Cardiology, Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Torsten P Vahl
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Vera H Rigolin
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, Illinois, USA.
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González-Gómez A, Fernández-Golfín C, Hinojar R, Monteagudo JM, García A, García-Sebastián C, García-Lunar I, Sánchez-Recalde Á, Salido L, Pardo A, Zamorano JL. The 4A classification for patients with tricuspid regurgitation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:845-851. [PMID: 36898521 DOI: 10.1016/j.rec.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES Significant tricuspid regurgitation (TR) is associated with increased morbidity and mortality. Clinical evaluation of TR patients is challenging. Our aim was to establish a new clinical classification specific for patients with TR, the 4A classification, and evaluate its prognostic performance. METHODS We included patients with isolated TR that was at least severe and without previous episodes of heart failure (HF) who were assessed in the heart valve clinic. We registered signs and symptoms of asthenia, ankle swelling, abdominal pain or distention and/or anorexia and followed up the patients every 6 months. The 4A classification ranged from A0 (no A) to A3 (3 or 4 As present). We defined a combined endpoint consisting of hospital admission due to right HF or cardiovascular mortality. RESULTS We included 135 patients with significant TR between 2016 and 2021 (69% females, mean age 78±7 years). During a median follow-up of 26 [IQR, 10-41] months, 39% (n=53) patients had the combined endpoint: 34% (n=46) were admitted for HF and 5% (n=7) died. At baseline, 94% of the patients were in NYHA I or II, while 24% were in classes A2 or A3. The presence of A2 or A3 conferred a high incidence of events. The change in 4A class remained an independent marker of HF and cardiovascular mortality (adjusted HR per unit of change of 4A class, 1.95 [1.37-2.77]; P<.001). CONCLUSIONS This study reports a novel clinical classification specifically for patients with TR that is based on signs and symptoms of right HF and has prognostic value for events.
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Affiliation(s)
- Ariana González-Gómez
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Covadonga Fernández-Golfín
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Rocío Hinojar
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Manuel Monteagudo
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ana García
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | | | - Inés García-Lunar
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Laboratorio de Investigación en Imagen Cardiovascular Humana, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Ángel Sánchez-Recalde
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Luisa Salido
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ana Pardo
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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6
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Harskamp RE, De Clercq L, Veelers L, Schut MC, van Weert HCPM, Handoko ML, Moll van Charante EP, Himmelreich JCL. Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care. Diagnosis (Berl) 2023; 10:432-439. [PMID: 37667563 DOI: 10.1515/dx-2023-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Heart failure (HF) is a prevalent syndrome with considerable disease burden, healthcare utilization and costs. Timely diagnosis is essential to improve outcomes. This study aimed to compare the diagnostic performance of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in detecting HF in primary care. Our second aim was to explore if personalized thresholds (using age, sex, or other readily available parameters) would further improve diagnostic accuracy over universal thresholds. METHODS A retrospective study was performed among patients without prior HF who underwent natriuretic peptide (NP) testing in the Amsterdam General Practice Network between January 2011 and December 2021. HF incidence was based on registration out to 90 days after NP testing. Diagnostic accuracy was evaluated with AUROC, sensitivity and specificity based on guideline-recommended thresholds (125 ng/L for NT-proBNP and 35 ng/L for BNP). We used inverse probability of treatment weighting to adjust for confounding. RESULTS A total of 15,234 patients underwent NP testing, 6,870 with BNP (4.5 % had HF), and 8,364 with NT-proBNP (5.7 % had HF). NT-proBNP was more accurate than BNP, with an AUROC of 89.9 % (95 % CI: 88.4-91.2) vs. 85.9 % (95 % CI 83.5-88.2), with higher sensitivity (95.3 vs. 89.7 %) and specificity (59.1 vs. 58.0 %). Differentiating NP cut-off by clinical variables modestly improved diagnostic accuracy for BNP and NT-proBNP compared with a universal threshold. CONCLUSIONS NT-proBNP outperforms BNP for detecting HF in primary care. Personalized instead of universal diagnostic thresholds led to modest improvement.
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Affiliation(s)
- Ralf E Harskamp
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Lukas De Clercq
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Lieke Veelers
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn C Schut
- Department of Laboratory Medicine, Translational AI. Amsterdam UMC, Amsterdam, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC Location VU University, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jelle C L Himmelreich
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
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Sunder-Plassmann G, Graf S, Gatterer C. Staging of Fabry Cardiomyopathy by Echocardiography: Back to the Roots? J Am Coll Cardiol 2023; 82:1535-1537. [PMID: 37793751 DOI: 10.1016/j.jacc.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Gere Sunder-Plassmann
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria.
| | - Senta Graf
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Constantin Gatterer
- Division of Cardiology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
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8
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Anastasiou V, Bazmpani MA, Daios S, Moysidis DV, Zegkos T, Didagelos M, Karamitsos T, Toutouzas K, Ziakas A, Kamperidis V. Unmet Needs in the Assessment of Right Ventricular Function for Severe Tricuspid Regurgitation. Diagnostics (Basel) 2023; 13:2885. [PMID: 37761251 PMCID: PMC10529663 DOI: 10.3390/diagnostics13182885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/06/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Tricuspid regurgitation (TR) is a highly prevalent valvular heart disease that has been long overlooked, but lately its independent association with adverse cardiovascular outcomes was recognized. The time point to intervene and repair the tricuspid valve is defined by the right ventricular (RV) dilation and dysfunction that comes up at a later stage. While guidelines favor tricuspid valve repair before severe RV dysfunction ensues, the definition of RV dysfunction in a universal manner remains vague. As a result, the candidates for transcatheter or surgical TR procedures are often referred late, when advanced RV dysfunction is established, and any derived procedural survival benefit is attenuated. Thus, it is of paramount importance to establish a universal means of RV function assessment in patients with TR. Conventional echocardiographic indices of RV function routinely applied have fundamental flaws that limit the precise characterization of RV performance. More recently, novel echocardiographic indices such as strain via speckle-tracking have emerged, demonstrating promising results in the identification of early RV damage. Additionally, evidence of the role of alternative imaging modalities such as cardiac computed tomography and cardiac magnetic resonance, for RV functional assessment in TR, has recently arisen. This review provides a systematic appraisal of traditional and novel multimodality indices of RV function in severe TR and aims to refine RV function assessment, designate future directions, and ultimately, to improve the outcome of patients suffering from severe TR.
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Affiliation(s)
- Vasileios Anastasiou
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Maria-Anna Bazmpani
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Stylianos Daios
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Dimitrios V. Moysidis
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Thomas Zegkos
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Matthaios Didagelos
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Theodoros Karamitsos
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Konstantinos Toutouzas
- 1st Department of Cardiology, Hippokration Hospital, School of Medicine, National and Kapodistrian University of Athens, 157 72 Athens, Greece;
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA Hospital, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (V.A.); (M.-A.B.); (S.D.); (D.V.M.); (T.Z.); (M.D.); (T.K.); (A.Z.)
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9
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Bernard J, Jean G, Bienjonetti-Boudreau D, Jacques F, Tastet L, Salaun E, Clavel MA. Prognostic utility of N-terminal pro B-type natriuretic peptide ratio in mixed aortic valve disease. Open Heart 2023; 10:e002361. [PMID: 37474135 PMCID: PMC10357672 DOI: 10.1136/openhrt-2023-002361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/30/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVE We aimed to assess the incremental prognostic value of N-terminal-pro-B-type natriuretic peptide (Nt-proBNP) for risk stratification in mixed aortic valve disease (MAVD) patients. METHODS We included 556 (73±12 years, 37% women) consecutive patients with at least a moderate aortic stenosis (AS) or aortic regurgitation (AR) lesion with a concomitant AS or AR of any severity in whom Nt-proBNP was measured and expressed as its ratio (measured Nt-proBNP divided by the upper limit of normal Nt-proBNP for age and sex). The primary endpoint was all-cause mortality. RESULTS Baseline median Nt-proBNP ratio was 3.8 (IQR: 1.5-11.3), and the median follow-up was 5.6 years (4.8-6.1). Early aortic valve replacement (AVR) was performed within 3 months in 423 (76%) patients, while 133 (24%) remained initially under medical treatment. In comprehensive multivariable analyses, Nt-proBNP ratio was significantly associated with excess mortality (continuous variable: HR (95% CI): 1.24 (1.04 to 1.47), p=0.02; Nt-proBNP ratio ≥3: 2.41 (1.33 to 4.39), p=0.004). The independent prognostic value was also observed in patients with severe or non-severe AS/AR, and those treated by early-AVR (all p<0.04). Nt-proBNP ratio as continuous and dichotomic (≥3) variables showed incremental prognostic value (all net reclassification index >0.42, all p≤0.008). After early-AVR, Nt-proBNP ratio ≥3 was associated with higher 30-day mortality (9 (4%) vs 1 (0.5%), p=0.02). CONCLUSIONS In this series of MAVD patients, Nt-proBNP ratio was a powerful predictor of early and long-term mortality, even in patients with both non-severe AS/AR. Moreover, early-AVR may be an option for patients with Nt-proBNP ratio ≥3. Further randomised studies are needed to validate this last point.
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Affiliation(s)
- Jérémy Bernard
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Quebec, Canada
| | - Guillaume Jean
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Quebec, Canada
| | - David Bienjonetti-Boudreau
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Quebec, Canada
| | - Frédéric Jacques
- Cardiac Surgery, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Quebec, Canada
| | - Lionel Tastet
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Quebec, Canada
| | - Erwan Salaun
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Quebec, Canada
| | - Marie-Annick Clavel
- Cardiology, Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval, Quebec, Quebec, Canada
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10
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Ryazanov AS, Shikh EV, Makarovskaya MV, Kudryavtsev AA. Angiotensin receptor-neprilysin inhibitors and cardiac remodeling. Braz J Med Biol Res 2023; 56:e12616. [PMID: 37042870 PMCID: PMC10085762 DOI: 10.1590/1414-431x2023e12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/24/2023] [Indexed: 04/13/2023] Open
Abstract
The aim of this study was to determine how sacubitril/valsartan compared with valsartan in an outpatient setting affects left ventricular remodeling in heart failure with reduced ejection fraction and functional (or secondary) mitral regurgitation (SMR) due to the effect of dual inhibition of the renin-angiotensin system and neprilysin. The outpatient study included 90 patients with chronic SMR who were followed up for 12 months. They received sacubitril/valsartan or valsartan instead of the more commonly used angiotensin-converting enzyme inhibitor enalapril for heart failure, in addition to standard medical therapy for heart failure. The difference in NT-proBNP change between groups was the primary endpoint. Changes in effective regurgitation orifice area, left ventricular ejection fraction, left ventricular end-systolic and end-diastolic volume indices, left atrial volume index, E/e' index, and exercise tolerance on the 6-minute walk test were secondary endpoints. In the treatment efficacy analysis, NT-proBNP levels decreased significantly by 37% in the sacubitril/valsartan group and by 11% in the valsartan group (P<0.001). Ejection fraction and exercise tolerance (increase in walking distance in the 6-min test) increased in the sacubitril/valsartan group (P<0.05). Also, in this group, the effective area of the regurgitation orifice, the left atrial volume index, the E/e' index, and the indices of the end-systolic and end-diastolic volume of the left ventricle (P<0.05) decreased more pronouncedly. Compared with valsartan, treatment with sacubitril/valsartan led to a significant improvement in cardiac remodeling in patients with SMR and heart failure with reduced ejection fraction.
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Affiliation(s)
- A S Ryazanov
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - E V Shikh
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - M V Makarovskaya
- Clinical and Diagnostic Center No. 4, Moscow Department of Health, Moscow, Russia
| | - A A Kudryavtsev
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia
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11
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Carpenito M, Gelfusa M, Mega S, Cammalleri V, Benfari G, De Stefano D, Ussia GP, Tribouilloy C, Enriquez-Sarano M, Grigioni F. Watchful surgery in asymptomatic mitral valve prolapse. Front Cardiovasc Med 2023; 10:1134828. [PMID: 37123469 PMCID: PMC10130568 DOI: 10.3389/fcvm.2023.1134828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
The most common organic etiology of mitral regurgitation is degenerative and consists of mitral valve prolapse (MVP). Volume overload because of mitral regurgitation is the most common complication of MVP. Advocating surgery before the consequences of volume overload become irreparable restores life expectancy, but carries a risk of mortality in patients who are often asymptomatic. On the other hand, the post-surgical outcome of symptomatic patients is dismal and life expectancy is impaired. In the present article, we aim to bridge the gap between these two therapeutic approaches, unifying the concepts of watchful waiting and early surgery in a "watchful surgery approach".
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Affiliation(s)
- Myriam Carpenito
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Martina Gelfusa
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Simona Mega
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Valeria Cammalleri
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Domenico De Stefano
- Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Correspondence: Francesco Grigioni
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12
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Zhou Y, Zhu Q, Hu P, Li H, Lin X, Liu X, Pu Z, Wang J. NT-proBNP trajectory after transcatheter aortic valve replacement and its association with 5-year clinical outcomes. Front Cardiovasc Med 2023; 10:1098764. [PMID: 36873418 PMCID: PMC9981663 DOI: 10.3389/fcvm.2023.1098764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/06/2023] [Indexed: 02/19/2023] Open
Abstract
Background There are only limited reports on the trends of NT-proBNP after transcatheter aortic valve replacement (TAVR) in aortic stenosis (AS) and even fewer report on the prognostic value of the NT-proBNP trajectory following TAVR. Objectives This study aims to investigate short-term NT-proBNP trajectory following TAVR and explore its association with clinical outcomes in TAVR recipients. Methods Aortic stenosis patients undergoing TAVR were included if they had NT-proBNP levels recorded at baseline, prior to discharge, and within 30 days after TAVR. We used latent class trajectory models to identify NT-proBNP trajectories based on their trends over time. Results Three distinct NT-proBNP trajectories were identified from 798 TAVR recipients, which were named class 1 (N = 661), class 2 (N = 102), and class 3 (N = 35). Compared to those with trajectory class 1, patients with trajectory class 2 had a more than 2.3-fold risk of 5-year all-cause death and 3.4-fold risk of cardiac death, while patients with trajectory class 3 had a more than 6.6-fold risk of all-cause death and 8.8-fold risk of cardiac death. By contrast, the groups had no differences in 5-year hospitalization rates. In multivariable analyses, the risk of 5-year all-cause mortality was significantly higher in patients with trajectory class 2 (HR 1.90, 95% CI 1.03-3.52, P = 0.04) and class 3 (HR 5.70, 95% CI 2.45-13.23, P < 0.01). Conclusion Our findings implied different short-term evolution of NT-proBNP levels in TAVR recipients and its prognostic value for AS patients following TAVR. NT-proBNP trajectory may have further prognostic value, in addition to its baseline level. This may aid clinicians with regards to patient selection and risk prediction in TAVR recipients.
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Affiliation(s)
- Yaoyao Zhou
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Department of Cardiology, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Qifeng Zhu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Po Hu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Huajun Li
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinping Lin
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xianbao Liu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaoxia Pu
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian'an Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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13
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Role of myocardial strain and rotation for predicting prosthetic aortic valve stenosis. Int J Cardiovasc Imaging 2021; 38:551-560. [PMID: 34626295 DOI: 10.1007/s10554-021-02431-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
Pressure overload due to aortic stenosis leads to subclinical left ventricular (LV) dysfunction and global longitudinal strain (GLS) impairment even if ejection fraction is preserved. However, little is known about LV mechanics in aortic prosthetic valve (APV) stenosis. The study aimed to determine the role of myocardial strain and rotation in predicting prosthetic valve stenosis in mechanical APV patients. 60 patients with mechanical APV and 30 healthy individuals were evaluated. APV patients were analyzed in two groups; aortic valve mean gradient < 20 mmHg (27 normal gradient patients) and ≥ 20 mmHg (33 high gradient patients). Strain, rotation, and twist values were assessed using the speckle tracking method, and brain natriuretic peptide (BNP) levels were measured. Four-chamber (p < 0.001) and two-chamber (p = 0.008) longitudinal strain (LS) were higher in the control group. GLS was lower in the high gradient group than control and normal gradient groups (p < 0.001, p = 0.022). LS of lateral wall's basal and mid segments were lower in normal and high gradient groups than the control group (p = 0.003, p = 0.008). While basal rotation was lower in the high gradient group than the control group (p = 0.048), there was no difference between the groups in terms of apical rotation, and twist. BNP levels were significantly different between the groups (p = 0.048). No correlation was found between aortic valve mean gradient and GLS, basal rotation, and BNP. In conclusions, LV GLS and basal rotation are depressed in high APV gradient patients; however, these parameters are not independent predictors of gradient increment.
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14
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Cediel G, Codina P, Spitaleri G, Domingo M, Santiago-Vacas E, Lupón J, Bayes-Genis A. Gender-Related Differences in Heart Failure Biomarkers. Front Cardiovasc Med 2021; 7:617705. [PMID: 33469552 PMCID: PMC7813809 DOI: 10.3389/fcvm.2020.617705] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/09/2020] [Indexed: 12/13/2022] Open
Abstract
Important differences in comorbidities and clinical characteristics exist between women and men with heart failure (HF). In particular, differences in the kinetics of biological circulating biomarkers—a critical component of cardiovascular care—are highly relevant. Most circulating HF biomarkers are assessed daily by clinicians without taking sex into account, despite the multiple gender-related differences observed in plasma concentrations. Even in health, compared to men, women tend to exhibit higher levels of natriuretic peptides and galectin-3 and lower levels of cardiac troponins and the cardiac stress marker, soluble ST2. Many biological factors can provide a reliable explanation for these differences, like body composition, fat distribution, or menopausal status. Notwithstanding, these sex-specific differences in biomarker levels do not reflect different pathobiological mechanisms in HF between women and men, and they do not necessarily imply a need to use different diagnostic cut-off levels in clinical practice. To date, the sex-specific prognostic value of HF biomarkers for risk stratification is an unresolved issue that future research must elucidate. This review outlines current evidence regarding gender-related differences in circulating biomarkers widely used in HF, the pathophysiological mechanisms underlying these differences, and their clinical relevance.
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Affiliation(s)
- Germán Cediel
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Pau Codina
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Giosafat Spitaleri
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Mar Domingo
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Evelyn Santiago-Vacas
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Josep Lupón
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
| | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.,Department of Medicine, CIBERCV, Autonomous University of Barcelona, Barcelona, Spain
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15
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Regional Differences in the Ghrelin-Growth Hormone Secretagogue Receptor Signalling System in Human Heart Disease. CJC Open 2020; 3:182-194. [PMID: 33644732 PMCID: PMC7893201 DOI: 10.1016/j.cjco.2020.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 10/27/2020] [Indexed: 12/20/2022] Open
Abstract
Background The hormone ghrelin and its receptor, the growth hormone secretagogue receptor (GHSR) are expressed in myocardium. GHSR binding activates signalling pathways coupled to cardiomyocyte survival and contractility. These properties have made the ghrelin-GHSR axis a candidate for a biomarker of cardiac function. The dynamics of ghrelin-GHSR are altered significantly in late stages of heart failure (HF) and cardiomyopathy, when left ventricular (LV) function is failing. We examined the relationship of GHSR with ghrelin in cardiac tissue from patients with valvular disease with no detectable changes in LV function. Methods Biopsy samples from the left ventricle and left atrium were obtained from 25 patients with valvular disease (of whom 13 also had coronary artery disease) and preserved LV ejection fraction, and compared to control samples obtained via autopsy. Using quantitative confocal fluorescence microscopy, levels of GHSR were determined using [Dpr3(n-octanoyl),Lys19(sulfo-Cy5)]ghrelin(1-19), and immunofluorescence determined ghrelin, the heart failure marker natriuretic peptide type-B (BNP), and contractility marker sarcoplasmic reticulum ATPase pump (SERCA2a). Results A positive correlation between GHSR and ghrelin was apparent in only diseased tissue. Ghrelin and BNP significantly correlated in the left ventricle and strongly colocalized to the same intracellular compartment in diseased and control tissue. GHSR, ghrelin, and BNP all strongly and significantly correlated with SERCA2a in the left ventricle of diseased tissue only. Conclusions Our results suggest that the dynamics of the myocardial ghrelin-GHSR axis is altered in cardiovascular disease in the absence of measurable changes in heart function, and might accompany a regional shift in endocrine programming.
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16
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Izumi C, Eishi K, Ashihara K, Arita T, Otsuji Y, Kunihara T, Komiya T, Shibata T, Seo Y, Daimon M, Takanashi S, Tanaka H, Nakatani S, Ninami H, Nishi H, Hayashida K, Yaku H, Yamaguchi J, Yamamoto K, Watanabe H, Abe Y, Amaki M, Amano M, Obase K, Tabata M, Miura T, Miyake M, Murata M, Watanabe N, Akasaka T, Okita Y, Kimura T, Sawa Y, Yoshida K. JCS/JSCS/JATS/JSVS 2020 Guidelines on the Management of Valvular Heart Disease. Circ J 2020; 84:2037-2119. [DOI: 10.1253/circj.cj-20-0135] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kiyoyuki Eishi
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University Hospital
| | - Takeshi Arita
- Division of Cardiovascular Medicine Heart & Neuro-Vascular Center, Fukuoka Wajiro
| | - Yutaka Otsuji
- Department of Cardiology, Hospital of University of Occupational and Environmental Health
| | - Takashi Kunihara
- Department of Cardiac Surgery, The Jikei University School of Medicine
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Postgraduate of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- Department of Clinical Laboratory/Cardiology, The University of Tokyo Hospital
| | | | | | - Satoshi Nakatani
- Division of Health Sciences, Osaka University Graduate School of Medicine
| | - Hiroshi Ninami
- Department of Cardiac Surgery, Tokyo Women’s Medical University
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center
| | | | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | | | - Kazuhiro Yamamoto
- Division of Cardiovascular Medicine, Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | | | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital
| | - Makoto Amaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kikuko Obase
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center
| | - Takashi Miura
- Division of Cardiovascular Surgery, Nagasaki University Graduate School of Biomedical Sciences
| | | | - Mitsushige Murata
- Department of Laboratory Medicine, Tokai University Hachioji Hospital
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Kiyoshi Yoshida
- Department of Cardiology, Sakakibara Heart Institute of Okayama
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Todd N, Lai YC. Current Understanding of Circulating Biomarkers in Pulmonary Hypertension Due to Left Heart Disease. Front Med (Lausanne) 2020; 7:570016. [PMID: 33117832 PMCID: PMC7575769 DOI: 10.3389/fmed.2020.570016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/31/2020] [Indexed: 01/19/2023] Open
Abstract
Pulmonary hypertension due to left heart disease (PH-LHD; Group 2), especially in the setting of heart failure with preserved ejection fraction (HFpEF), is the most frequent cause of PH. Despite its prevalence, no effective therapies for PH-LHD are available at present. This is largely due to the lack of a concise definition for hemodynamic phenotyping, existence of significant gaps in the understanding of the underlying pathology and the impact of associated comorbidities, as well as the absence of specific biomarkers that can aid in the early diagnosis and management of this challenging syndrome. Currently, B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are guideline-recommended biomarkers for the diagnosis and prognosis of heart failure (HF) and PH. Endothelin-1 (ET-1), vascular endothelial growth factor-D (VEGF-D), and microRNA-206 have also been recently identified as new potential circulating biomarkers for patients with PH-LHD. In this review, we aim to present the current state of knowledge of circulating biomarkers that can be used to guide future research toward diagnosis, refine specific patient phenotype, and develop therapeutic approaches for PH-LHD, with a particular focus on PH-HFpEF. Potential circulating biomarkers identified in pre-clinical models of PH-LHD are also summarized here.
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Affiliation(s)
- Noah Todd
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Yen-Chun Lai
- Division of Pulmonary, Critical Care, Sleep and Occupational Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States.,Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, United States
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18
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Ito S, Miranda WR, Jaffe AS, Oh JK. Prognostic Value of N-Terminal Pro-form B-Type Natriuretic Peptide in Patients With Moderate Aortic Stenosis. Am J Cardiol 2020; 125:1566-1570. [PMID: 32204871 DOI: 10.1016/j.amjcard.2020.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/02/2020] [Accepted: 02/04/2020] [Indexed: 10/25/2022]
Abstract
Plasma B-type natriuretic peptide (BNP) and its N-terminal pro-form, NT-proBNP, can predict outcomes in patients with severe aortic stenosis (AS). However, their prognostic value in moderate AS is currently unknown. The present study included 261 patients diagnosed with moderate AS (1.0 <aortic valve area ≤1.5 cm2) in 2012 with serum NT-pro BNP level collected within ±3 months of the echocardiographic assessment. Patients were divided into 2 groups according to the median NT-proBNP value (888 pg/dl) and all-cause mortality compared. Median age was 78 years and 64% of patients were male. There were 131 (50%) patients with lower-median NT-pro BNP levels (≤888 pg/dl) and 130 (50%) with higher-median NT-pro BNP levels (>888 pg/dl). During a median follow up of 2.7 years, there were 136 (52%) deaths. Mortality rate was much higher in patients with higher-median NT-pro BNP compared to those with lower-median NT-pro BNP levels (p <0.001). Higher-median NT-pro BNP level was significantly associated with higher mortality rate (hazard ratio 3.11; 95% confidence interval 1.78 to 5.46, p <0.001) even after adjusting for confounders. Aortic valve replacement (AVR) was performed in 82 (31%) patients and median time to AVR was 2.1 years. Patients with higher-median NT-pro BNP had higher mortality rate compared to patients with lower-median NT-pro BNP even after AVR (p <0.01). In conclusion, higher NT-proBNP level is associated with higher mortality rates in patients with moderate AS even among those undergoing AVR.
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19
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NT-proBNP as a Cornerstone for Prognosis in Valve Disease: All We Need Is Blood. J Am Coll Cardiol 2020; 75:1673-1675. [PMID: 32273032 DOI: 10.1016/j.jacc.2020.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 12/20/2022]
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20
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Yan Q, Chen S. Hemoconcentration is a valuable predictor of prognosis in patients with acute heart failure. Exp Ther Med 2020; 19:2792-2798. [PMID: 32256762 DOI: 10.3892/etm.2020.8515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 09/27/2019] [Indexed: 11/06/2022] Open
Abstract
The present study was designed to investigate the value of the hemoconcentration (HCT) in predicting the prognosis of patients with acute heart failure (AHF). A total of 188 patients with AHF were enrolled in the present retrospective study and divided into four groups based on their HCT values. The endpoint was either cardiac-associated death or re-hospitalization due to aggravated HF. The 2-year survival rates of patients in these four groups were compared. The area under the receiver operating characteristic curve (AUC) was determined to evaluate the significance of HCT for assessing the prognosis of patients with AHF. Cox-proportional hazards regression models were performed to determine whether the HCT is an independent factor for predicting the prognosis of patients with AHF in comparison with other traditional predictors, including B-type natriuretic peptide (BNP) and creatinine. Of these 188 patients with AHF, 99 experienced aggravated cardiac HF resulting in death or re-hospitalization within 2 years. The AUC for HCT, as a prognostic criterion, was 0.610 (95% confidence interval: 0.528-0.691, P<0.001) with a sensitivity of 54.5% and a specificity of 65.2%. Kaplan-Meier analysis indicated that patients with a higher HCT had a lower rate of death or re-hospitalization due to cardiogenic events (χ2=9.442, P=0.024). Cox regression analysis revealed that HCT, hemoglobin, BNP, New York Heart Association cardiac function classification and serum creatinine were independent prognostic factors in AHF. HCT may serve as a valuable predictor of prognosis in patients with AHF. Compared with that of BNP, measurement of the HCT is more convenient and economical and may be widely performed at primary hospitals.
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Affiliation(s)
- Qian Yan
- Department of Emergency, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, P.R. China
| | - Sanfeng Chen
- Department of Internal Medicine, Aged Care Hospital of Zhejiang, Hangzhou, Zhejiang 310015, P.R. China
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Zelis JM, Zimmermann FM, Andriessen FPJ, Houthuizen P, Van de Ven J, Leuverman J, Johnson NP, Pijls NHJ, Scharnhorst V, Van 't Veer M, Tonino PAL. Assessment of exercise-induced changes in von Willebrand factor as a marker of severity of aortic stenosis. Open Heart 2020; 7:e001138. [PMID: 32518657 PMCID: PMC7254138 DOI: 10.1136/openhrt-2019-001138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 12/12/2019] [Accepted: 02/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background Loss of high-molecular-weight multimers (HMWMs) of von Willebrand factor (vWF) occurs due to high shear stress in patients with aortic stenosis. As symptoms of aortic stenosis occur during exercise, measurement of vWF during exercise might identify patients with aortic stenosis of clinical importance. The aim of this pilot study is to evaluate whether vWF changes over time as a result of exercise in patients with asymptomatic moderate or severe aortic stenosis. Methods Ten subjects were analysed for changes in vWF by measuring HMWMs and closure time with adenosine diphosphate (CT-ADP). All subjects underwent a full stress test on a bicycle ergometer. At rest and at peak exercise, a transthoracic echocardiogram was performed. HMWMs and CT-ADP were assessed at baseline, during and after exercise. Results HMWMs and CT-ADP did not change significantly during exercise, p=0.45 and p=0.65, respectively. HMWMs and CT-ADP correlated well, Spearman's rho -0.621, p<0.001. HMWMs during peak exercise did not correlate with maximal velocity measured, p=0.21. CT-ADP during exercise correlated well with the maximal echocardiographic velocity over the aortic valve (AV), rho 0.82, p=0.04. Conclusions In a cohort of 10 patients with moderate or severe aortic stenosis, we observed no significant change in vWF biomarkers during exercise. Peak CT-ADP during exercise showed a good correlation with peak AV velocity measured with echo. Although CT-ADP is an easy test to perform and could be an alternative for peak AV velocity measured during exercise, our results suggest that it can only detect large changes in shear stress.
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Affiliation(s)
- Jo M Zelis
- Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | | | - Jop Van de Ven
- Laboratory, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Nils P Johnson
- Division of Cardiology Department of Medicine, Weatherhead Pet Center McGovern Medical School at UTHealth and Memorial Hermann Hospital, Houston, Texas, USA
| | - Nico H J Pijls
- Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | | | | | - Pim A L Tonino
- Cardiology, Catharina Hospital, Eindhoven, The Netherlands
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22
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Nader J, Metzinger L, Maitrias P, Caus T, Metzinger-Le Meuth V. Aortic valve calcification in the era of non-coding RNAs: The revolution to come in aortic stenosis management? Noncoding RNA Res 2020; 5:41-47. [PMID: 32195449 PMCID: PMC7075756 DOI: 10.1016/j.ncrna.2020.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/04/2020] [Accepted: 02/24/2020] [Indexed: 01/08/2023] Open
Abstract
Aortic valve stenosis remains the most frequent structural heart disease, especially in the elderly. During the last decade, we noticed an important consideration and a huge number of publications related to the medical and surgical treatment of this disease. However, the molecular aspect of this degenerative issue has also been more widely studied recently. As evidenced in oncologic but also cardiac research fields, the emergence of microRNAs in the molecular screening and follow-up makes them potential biomarkers in the future, for the diagnosis, follow-up and treatment of aortic stenosis. Herein, we present a review on the implication of microRNAs in the aortic valve disease management. After listing and describing the main miRNAs of interest in the field, we provide an outline to develop miRNAs as innovative biomarkers and innovative therapeutic strategies, and describe a groundbreaking pre-clinical study using inhibitors of miR-34a in a pre-clinical model of aortic valve stenosis.
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Affiliation(s)
- Joseph Nader
- Department of Cardiac Surgery, Amiens University Hospital, Amiens, France
| | - Laurent Metzinger
- HEMATIM EA4666, C.U.R.S, Université de Picardie Jules Verne, 80025, AMIENS Cedex 1, France
| | - Pierre Maitrias
- Department of Vascular Surgery, Polyclinique Saint Côme, Compiègne, France
| | - Thierry Caus
- Department of Cardiac Surgery, Amiens University Hospital, Amiens, France
| | - Valérie Metzinger-Le Meuth
- HEMATIM EA4666, C.U.R.S, Université de Picardie Jules Verne, 80025, AMIENS Cedex 1, France.,INSERM U1148, Laboratory for Vascular Translational Science (LVTS), UFR SMBH, Université Paris 13-Sorbonne Paris Cité, 93017, BOBIGNY CEDEX, France
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23
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Long B, Koyfman A, Gottlieb M. Diagnosis of Acute Heart Failure in the Emergency Department: An Evidence-Based Review. West J Emerg Med 2019; 20:875-884. [PMID: 31738714 PMCID: PMC6860389 DOI: 10.5811/westjem.2019.9.43732] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/09/2019] [Indexed: 01/01/2023] Open
Abstract
Heart failure is a common presentation to the emergency department (ED), which can be confused with other clinical conditions. This review provides an evidence-based summary of the current ED evaluation of heart failure. Acute heart failure is the gradual or rapid decompensation of heart failure, resulting from either fluid overload or maldistribution. Typical symptoms can include dyspnea, orthopnea, or systemic edema. The physical examination may reveal pulmonary rales, an S3 heart sound, or extremity edema. However, physical examination findings are often not sensitive or specific. ED assessments may include electrocardiogram, complete blood count, basic metabolic profile, liver function tests, troponin, brain natriuretic peptide, and a chest radiograph. While often used, natriuretic peptides do not significantly change ED treatment, mortality, or readmission rates, although they may decrease hospital length of stay and total cost. Chest radiograph findings are not definitive, and several other conditions may mimic radiograph findings. A more reliable modality is point-of-care ultrasound, which can facilitate the diagnosis by assessing for B-lines, cardiac function, and inferior vena cava size. These modalities, combined with clinical assessment and gestalt, are recommended.
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Affiliation(s)
- Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Alex Koyfman
- University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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24
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Affiliation(s)
- Aldrin V Gomes
- Department of Neurobiology, Physiology, and Behavior (A.V.G.).,Department of Physiology and Membrane Biology (A.V.G.), University of California, Davis
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25
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Mueller C, McDonald K, de Boer RA, Maisel A, Cleland JG, Kozhuharov N, Coats AJ, Metra M, Mebazaa A, Ruschitzka F, Lainscak M, Filippatos G, Seferovic PM, Meijers WC, Bayes‐Genis A, Mueller T, Richards M, Januzzi JL. Heart Failure Association of the European Society of Cardiology practical guidance on the use of natriuretic peptide concentrations. Eur J Heart Fail 2019; 21:715-731. [DOI: 10.1002/ejhf.1494] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/04/2019] [Accepted: 04/23/2019] [Indexed: 12/11/2022] Open
Affiliation(s)
- Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital Basel, University of Basel Basel Switzerland
| | - Kenneth McDonald
- Department of CardiologySt. Vincent's University Hospital Dublin Ireland
| | - Rudolf A. de Boer
- University of Groningen, University Medical CenterGroningen, Department of Cardiology The Netherlands
| | | | - John G.F. Cleland
- Robertson Institute of Biostatistics and Clinical Trials UnitUniversity of Glasgow Glasgow UK
| | - Nikola Kozhuharov
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital Basel, University of Basel Basel Switzerland
| | - Andrew J.S. Coats
- University of Warwick Coventry UK
- Monash University Melbourne Australia
- Pharmacology, Centre of Clinical and Experimental Medicine, San Raffaele Pisana Scientific Institute Rome Italy
| | - Marco Metra
- Institute of Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of Brescia Brescia Italy
| | - Alexandre Mebazaa
- Université de Paris, APHP Département d'Anethésie‐Réanimation Hôpitaux Universitaires Saint Louis Lariboisière Paris France
| | - Frank Ruschitzka
- Department of Cardiology, University Heart CentreUniversity Hospital Zurich Zurich Switzerland
| | - Mitja Lainscak
- Department of Internal MedicineGeneral Hospital Murska Sobota Murska Sobota Slovenia
- Faculty of MedicineUniversity of Ljubljana Slovenia
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital AttikonUniversity of Athens Greece
- University of CyprusMedical School Nicosia Cyprus
| | | | - Wouter C. Meijers
- University of Groningen, University Medical CenterGroningen, Department of Cardiology The Netherlands
| | - Antoni Bayes‐Genis
- Heart InstituteHospital Universitari Germans Trias i Pujol, CIBERCV Barcelona Spain
- Department of MedicineAutonomous University of Barcelona Barcelona Spain
| | - Thomas Mueller
- Department of Clinical PathologyHospital of Bolzano Bolzano Italy
| | - Mark Richards
- Christchurch Heart InstituteUinversity of Otago New Zealand
- Cardiovascular Research InstituteNational University of Singapore Singapore
| | - James L. Januzzi
- Cardiology Division of the Department of MedicineMassachusetts General Hospital, Harvard Medical School Boston MA USA
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26
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Takagi H, Hari Y, Kawai N, Kuno T, Ando T. Meta-Analysis of Impact of Baseline N-TerminalPro-Brain Natriuretic Peptide Levels on SurvivalAfter Transcatheter Aortic Valve Implantation for Aortic Stenosis. Am J Cardiol 2019; 123:820-826. [PMID: 30587374 DOI: 10.1016/j.amjcard.2018.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/18/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022]
Abstract
We performed a meta-analysis of currently available studies investigating impact of baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) on mortality after transcatheter aortic valve implantation (TAVI) for aortic stenosis (AS). MEDLINE and EMBASE were searched through August 2018 using PubMed and OVID. Studies considered for inclusion met the following criteria: the design was a study researching impact of baseline NT-proBNP levels on survival; the study population was patients underwent TAVI for AS; outcomes included all-cause mortality. For each study, we directly extracted odds ratio (ORs) or hazard ratios (HRs) of mortality (for high vs low baseline NT-proBNP); and generated ORs using mortality rates in both patients with high and low levels of baseline NT-proBNP. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs/HRs in the random-effects model. We identified 16 eligible studies including a total of 3,679 patients who underwent TAVI for AS. Pooled analyses demonstrated that high levels of baseline NT-proBNP were associated with a statistically nonsignificant increase in early (30-day or 2-month) mortality (pooled OR, 1.60; 95% confidence interval, 0.84 to 3.04; p = 0.15) and a statistically significant increase in midterm (6-month to 4-year) mortality (pooled OR/HR, 1.88; 95% confidence interval, 1.54 to 2.28; p < 0.00001). Although funnel-plot asymmetry suggesting publication bias was detected, adjusting for funnel-plot asymmetry indicated an association of high levels of baseline NT-proBNP with a still significant increase in midterm mortality. In conclusion, high levels of baseline NT-proBNP predict increased midterm, not early, mortality after TAVI for AS.
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27
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The level of Brain natriuretic Peptide as a Predictor of the Postoperative Period at Operations with Artificial Blood circulation. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2018-3.6.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The level of natriuretic peptide is regarded as a prognostic predictor of postoperative heart failure in modern cardiac surgery, and moreover, this hormone is included in the standards of its early diagnosis around the world. This study was conducted at the Irkutsk Cardiac Surgery Center. The results of treatment of 78 patients were analyzed in order to determine the relationship between the dynamics of brain natriuretic peptides and the course of the early postoperative period in operations with artificial cardiopulmonary bypass. Patients were divided into three groups according to the level of natriuretic peptide elevation in the postoperative period. The study proved the dependence of the postoperative period on the multiplicity of the increase in the level of natriuretic peptide B-type.It was found that the higher the rate of increase in the hormone, the lower the numbers of the cardiac index in the postoperative period, longer duration of inotropic support (p > 0.05) and higher doses of adrenomimetics (p > 0.05). The duration of mechanical ventilation was also longer in the groups where a high level of natriuretic peptide was recorded (p > 0.05). Thus, the multiplicity of natriuretic peptide elevation can be a prognostic criterion for the postoperative period in cardiac patients. It is important to note that a single determination of the level of natriuretic peptide should not be used as a marker of postoperative heart failure and this study confirmed the necessity to monitor the dynamics of brain natriuretic peptide’s level in the perioperative period in patients operated with extracorporeal cardiopulmonary bypass.
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28
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Boccellino M, Di Domenico M, Donniacuo M, Bitti G, Gritti G, Ambrosio P, Quagliuolo L, Rinaldi B. AT1-receptor blockade: Protective effects of irbesartan in cardiomyocytes under hypoxic stress. PLoS One 2018; 13:e0202297. [PMID: 30356256 PMCID: PMC6200178 DOI: 10.1371/journal.pone.0202297] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 07/31/2018] [Indexed: 12/21/2022] Open
Abstract
Hypoxia induces myocardial injury through the activation of inflammatory and oxidative processes. The pivotal role of the renin angiotensin system (RAS) in the pathogenesis of cardiovascular diseases has been firmly established in clinical trials and practice; in fact many experimental and clinical data have highlighted that its inhibition has a cardioprotective role. Activated RAS also stimulates inflammation directly inducing proinflammatory and oxidative gene expression. This study aimed to investigate the protective role of a pre-treatment (10 and 100 μM) with irbesartan on injury induced by 24 h of hypoxia in HL-1 cardiomyocytes; in particular, we have analyzed the natriuretic peptide (BNP) expression, a biomarker able to modulate inflammatory reaction to cardiac injury and some markers involved in oxidative stress and inflammation. Our results demonstrated that a pre-treatment with 100 μM irbesartan significantly increased SOD activity and catalase expression of 15 and 25%, respectively, compared to hypoxic cells (P<0.05). On the other hand, it was able to reduce the release of peroxynitrite and iNOS protein expression of 20 and 50% respectively (P<0.05). In addition irbesartan exerts an anti-inflammatory activity reducing Toll-like receptors (TLRs)-2 and -4 mRNA expression, TNF-alpha expression and activity (20%) and increasing the expression of the cytokine IL-17 (40%) (P<0.05 vs hypoxia). Our findings also showed that BNP induced by ischemia was significantly and in a concentration-dependent manner reduced by irbesartan. The findings of our study demonstrated that the AT1 receptor antagonist irbesartan exerts a protective role in an in vitro hypoxic condition reducing oxidative stress and inflammation.
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Affiliation(s)
- Mariarosaria Boccellino
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marina Di Domenico
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Biology, College of Science and Technology, Temple University, Philadelphia, PA, United States of America
- * E-mail:
| | - Maria Donniacuo
- Department of Experimental Medicine, Section of Pharmacology, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giuseppe Bitti
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giulia Gritti
- Department of Experimental Medicine, Section of Pharmacology, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Pasqualina Ambrosio
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Lucio Quagliuolo
- Department of Precision Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Barbara Rinaldi
- Department of Experimental Medicine, Section of Pharmacology, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
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29
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Ljungberg J, Janiec M, Bergdahl IA, Holmgren A, Hultdin J, Johansson B, Näslund U, Siegbahn A, Fall T, Söderberg S. Proteomic Biomarkers for Incident Aortic Stenosis Requiring Valvular Replacement. Circulation 2018; 138:590-599. [DOI: 10.1161/circulationaha.117.030414] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background:
Aortic valve stenosis (AS) is the most common indication for cardiac valve surgery; untreated AS is linked to high mortality. The etiological background of AS is unknown. Previous human studies were typically based on case-control studies. Biomarkers identified in prospective studies could lead to novel mechanistic insights.
Methods:
Within a large population survey with blood samples obtained at baseline, 334 patients were identified who later underwent surgery for AS (median age [interquartile range], 59.9 [10.4] years at survey and 68.3 [12.7] at surgery; 48% female). For each case, 2 matched referents were allocated. Plasma was analyzed with the multiplex proximity extension assay for screening of 92 cardiovascular candidate proteins. Conditional logistic regression models were used to assess associations between each protein and AS, with correction for multiple testing. A separate set of 106 additional cases with 212 matched referents was used in a validation study.
Results:
Six proteins (growth differentiation factor 15, galectin-4, von Willebrand factor, interleukin 17 receptor A, transferrin receptor protein 1, and proprotein convertase subtilisin/kexin type 9) were associated with case status in the discovery cohort; odds ratios ranged from 1.25 to 1.37 per SD increase in the protein signal. Adjusting the multivariable models for classical cardiovascular risk factors at baseline yielded similar results. Subanalyses of case-referent triplets (n=133) who showed no visible coronary artery disease at the time of surgery in the index person supported associations between AS and growth differentiation factor 15 (odds ratio, 1.40; 95% confidence interval, 1.10-1.78) and galectin-4 (odds ratio, 1.27; 95% confidence interval, 1.02-1.59), but these associations were attenuated after excluding individuals who donated blood samples within 5 years before surgery. In triplets (n=201), which included index individuals with concurrent coronary artery disease at the time of surgery, all 6 proteins were robustly associated with case status in all sensitivity analyses. In the validation study, the association of all but 1 (interleukin 17 receptor A) of these proteins were replicated in patients with AS with concurrent coronary artery disease but not in patients with AS without coronary artery disease.
Conclusions:
We provide evidence that 5 proteins were altered years before AS surgery and that the associations seem to be driven by concurrent atherosclerotic disease.
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Affiliation(s)
- Johan Ljungberg
- Departments of Public Health and Clinical Medicine (J.L., A.H., B.J., U.N., S.S.)
| | - Mikael Janiec
- Umeå University, Sweden. Departments of Cardiothoracic Surgery and Anaesthesia (M.J.)
- Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (M.J., T.F.)
| | | | - Anders Holmgren
- Departments of Public Health and Clinical Medicine (J.L., A.H., B.J., U.N., S.S.)
| | | | - Bengt Johansson
- Departments of Public Health and Clinical Medicine (J.L., A.H., B.J., U.N., S.S.)
| | - Ulf Näslund
- Departments of Public Health and Clinical Medicine (J.L., A.H., B.J., U.N., S.S.)
| | - Agneta Siegbahn
- Medical Sciences, Clinical Chemistry and Science for Life Laboratory (A.S.), Uppsala University, Sweden
| | - Tove Fall
- Medical Sciences, Molecular Epidemiology and Science for Life Laboratory (M.J., T.F.)
| | - Stefan Söderberg
- Departments of Public Health and Clinical Medicine (J.L., A.H., B.J., U.N., S.S.)
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30
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Abstract
Natriuretic peptides are structurally related, functionally diverse hormones. Circulating atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are delivered predominantly by the heart. Two C-type natriuretic peptides (CNPs) are paracrine messengers, notably in bone, brain, and vessels. Natriuretic peptides act by binding to the extracellular domains of three receptors, NPR-A, NPR-B, and NPR-C of which the first two are guanylate cyclases. NPR-C is coupled to inhibitory proteins. Atrial wall stress is the major regulator of ANP secretion; however, atrial pressure changes plasma ANP only modestly and transiently, and the relation between plasma ANP and atrial wall tension (or extracellular volume or sodium intake) is weak. Absence and overexpression of ANP-related genes are associated with modest blood pressure changes. ANP augments vascular permeability and reduces vascular contractility, renin and aldosterone secretion, sympathetic nerve activity, and renal tubular sodium transport. Within the physiological range of plasma ANP, the responses to step-up changes are unimpressive; in man, the systemic physiological effects include diminution of renin secretion, aldosterone secretion, and cardiac preload. For BNP, the available evidence does not show that cardiac release to the blood is related to sodium homeostasis or body fluid control. CNPs are not circulating hormones, but primarily paracrine messengers important to ossification, nervous system development, and endothelial function. Normally, natriuretic peptides are not powerful natriuretic/diuretic hormones; common conclusions are not consistently supported by hard data. ANP may provide fine-tuning of reno-cardiovascular relationships, but seems, together with BNP, primarily involved in the regulation of cardiac performance and remodeling. © 2017 American Physiological Society. Compr Physiol 8:1211-1249, 2018.
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Affiliation(s)
- Peter Bie
- Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
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31
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Clinical use of submaximal treadmill exercise testing and assessments of cardiac biomarkers NT-proBNP and cTnI in dogs with presymptomatic mitral regurgitation. PLoS One 2018; 13:e0199023. [PMID: 29902265 PMCID: PMC6002043 DOI: 10.1371/journal.pone.0199023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 05/30/2018] [Indexed: 12/15/2022] Open
Abstract
Exercise intolerance is the first symptom of heart disease. Yet an objective and standardised method in canine cardiology to assess exercise capacity in a clinical setting is lacking. In contrast, exercise testing is a powerful diagnostic tool in humans, providing valuable information on prognosis and impact of therapeutic intervention. To investigate whether an exercise test reveals differences between dogs with early stage mitral regurgitation (MR) and dogs without cardiac disease, 12 healthy beagles (healthy group, HG) and 12 dogs with presymptomatic MR (CHIEF B1 / B2, patient group, PG) underwent a six-stage submaximal exercise test (ET) on a motorised treadmill. They trotted in their individual comfort speed for three minutes per stage, first without incline, afterwards increasing it by 4% for every subsequent stage. Blood samples were taken at rest and during two 3-minute breaks in the course of the test. Further samples were taken after the completion of the exercise test and again after a 3-hour recovery period. Measured parameters included heart rate, lactate and the cardiac biomarkers N-terminal pro-B-Type natriuretic peptide and cardiac Troponin I. The test was performed again under the same conditions in the same dogs three weeks after the first trial to evaluate individual repeatability. Cardiac biomarkers increased significantly in both HG and PG in the course of the test. The increase was more pronounced in CHIEF B1 / B2 dogs than in the HG. N-terminal pro-B-Type natriuretic peptide increased from 435 ± 195 to 523 ± 239 pmol/L (HG) and from 690 to 815 pmol/L (PG). cTnI increased from 0.020 to 0.024 ng/mL (HG) and from 0.06 to 0.08 ng/ml (PG). The present study provides a method to assess exercise-induced changes in cardiac biomarkers under clinical conditions. The increase of NT-proBNP and cTnI is more pronounced in dogs with early-stage MR than in healthy dogs. Results indicate that measuring the parameters before and after exercise is adequate and taking blood samples between the different stages of the ET does not provide additional information. Also, stress echocardiography was inconclusive. It can be concluded that exercise testing, especially in combination with measuring cardiac biomarkers, could be a helpful diagnostic tool in canine cardiology.
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Oury C, Nchimi A, Lancellotti P, Bergler-Klein J. Can Blood Biomarkers Help Predicting Outcome in Transcatheter Aortic Valve Implantation? Front Cardiovasc Med 2018; 5:31. [PMID: 29644220 PMCID: PMC5882866 DOI: 10.3389/fcvm.2018.00031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/16/2018] [Indexed: 12/14/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become the method of choice for patients with severe aortic valve stenosis, who are ineligible or at high risk for surgery. In this high risk patient population, early and late mortality and rehospitalization rates after TAVI are still relatively high. In spite of recent improvements in procedural TAVI, and establishment of risk models for poor outcome, determining individual risk remains challenging. In this context, current data from several small studies strongly suggest that blood biomarkers of myocardial injury, cardiac mechanical stretch, inflammation, and hemostasis imbalance might play an important role by providing informations on patient risk at baseline, and postprocedural progression of patient clinical conditions from days up to years post-TAVI. Although the role of biomarkers for predicting survival post-TAVI remains to be validated in large randomized studies, implementing biomarkers in clinical practice might improve risk stratification, thereby further reducing TAVI-associated morbidity and mortality.
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Affiliation(s)
- Cécile Oury
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Alain Nchimi
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- Department of Cardiology, Heart Valve Clinic, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU Sart Tilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
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Shen M, Tastet L, Bergler-Klein J, Pibarot P, Clavel MA. Blood, tissue and imaging biomarkers in calcific aortic valve stenosis: past, present and future. Curr Opin Cardiol 2018; 33:125-133. [PMID: 29194051 DOI: 10.1097/hco.0000000000000487] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Calcific aortic valve stenosis is the most prevalent valvular heart disease in the high-income countries. To this date, no medical therapy has been proven to prevent or to stop the progression of aortic valve stenosis. The physiopathology of aortic valve stenosis is highly complex and involves several signalling pathways, as well as genetic related factors, which delay the elaboration of effective pharmacotherapies. Moreover, it is difficult to predict accurately the progression of the valve stenosis and finding the optimal timing for aortic valve replacement remains challenging. Therefore, the present review makes an inventory of the most recent and promising circulating and imaging biomarkers related to the underlying mechanisms involved in the physiopathology of aortic valve stenosis, as well as the biomarkers associated with the left ventricular (LV) remodelling and subsequent dysfunction in patients with aortic valve stenosis. RECENT FINDINGS Over the last decade, several blood, tissue and imaging biomarkers have been investigated in aortic valve stenosis patients. At the aortic valve level, these biomarkers are mostly associated and/or involved with processes such as lipid infiltration and oxidation, chronic inflammation and fibrocalcific remodelling of the valve. Moreover, recent findings suggest that aging and sex hormones might interact with these multiple processes. Several studies demonstrated the usefulness of circulating biomarkers such as lipoprotein(a), brain natriuretic peptides and high-sensitivity cardiac troponin, which are very close to clinical routine. Furthermore, noninvasive imaging biomarkers including positron emission tomography and cardiac magnetic resonance, which provide a detailed view of the disease activity within the aortic valve and its repercussion on the left ventricle, may help to improve the understanding of aortic valve stenosis physiopathology and enhance the risk stratification. Other biomarkers such as von Willebrand factor and microRNAs are promising but further studies are needed to prove their additive value in aortic valve stenosis. SUMMARY Most of the biomarkers are used in research and thus, are still being investigated. However, some biomarkers including plasma level of lipoprotein(a), F-sodium fluoride, brain natriuretic peptides and high-sensitivity cardiac troponin can be or are very close to be used for the clinical management of patients with aortic valve stenosis. Moreover, a multibiomarker approach might provide a more global view of the disease activity and improve the management strategies of these patients.
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Affiliation(s)
- Mylène Shen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Université Laval, Québec, Canada
| | - Lionel Tastet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Université Laval, Québec, Canada
| | | | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Université Laval, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (Quebec Heart and Lung Institute), Université Laval, Québec, Canada
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Impact of underlying heart disease per se on the utility of preoperative NT-proBNP in adult cardiac surgery. PLoS One 2018; 13:e0192503. [PMID: 29420603 PMCID: PMC5805306 DOI: 10.1371/journal.pone.0192503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/24/2018] [Indexed: 12/14/2022] Open
Abstract
Objective The primary aim was to investigate the role of underlying heart disease on preoperative NT-proBNP levels in patients admitted for adult cardiac surgery, after adjusting for the known confounders age, gender, obesity and renal function. The second aim was to investigate the predictive value of preoperative NT-proBNP with regard to severe postoperative heart failure (SPHF) and postoperative mortality. Methods A retrospective cohort study based on preoperative NT-proBNP measurements in an unselected cohort including all patients undergoing first time surgery for coronary artery disease (CAD; n = 2226), aortic stenosis (AS; n = 406) or mitral regurgitation (MR; n = 346) from April 2010 to August 2016 in the southeast region of Sweden (n = 2978). Concomitant procedures were not included, with the exception of Maze or tricuspid valve procedures. Results Preoperative NT-proBNP was 1.67 times (p<0.0001) and 1.41 times (p<0.0001) higher in patients with AS or MR respectively, than in patients with CAD after adjusting for confounders. NT-proBNP demonstrated significant discrimination with regard to SPHF in CAD (AUC = 0.79, 95%CI 0.73–0.85, p<0.0001), MR (AUC = 0.80, 95%CI 0.72–0.87, p<0.0001) and AS (AUC = 0.66, 95%CI 0.51–0.81, p = 0.047). In CAD patients NT-proBNP demonstrated significant discrimination with regard to postoperative 30-day or in-hospital mortality (AUC = 0.78; 95%CI 0.71–0.85, p<0.0001). The number of deaths was too few in the AS and MR group to permit analysis. Elevated NT-proBNP emerged as an independent risk factor for SPHF, and postoperative mortality in CAD. Conclusions Patients with AS or MR have higher preoperative NT-proBNP than CAD patients even after adjusting for confounders. The predictive value of NT-proBNP with regard to SPHF was confirmed in CAD and MR patients but was less convincing in AS patients.
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Yamamoto M, Hayashida M, Kakemizu-Watanabe M, Ando N, Mukaida H, Kawagoe I, Yusuke S, Inada E. B-Type Natriuretic Peptide and Hemoglobin are Two Major Factors Significantly Associated With Baseline Cerebral Oxygen Saturation Measured Using the INVOS Oximeter in Patients Undergoing Off-Pump Coronary Artery Bypass Graft Surgery. J Cardiothorac Vasc Anesth 2018; 32:187-196. [DOI: 10.1053/j.jvca.2017.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Indexed: 12/14/2022]
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Laszlo R, Konz H, Kunz K, Dallmeier D, Klenk J, Denkinger M, Koenig W, Rothenbacher D, Steinacker For The ActiFE Study Group JM. Evaluation of left and right ventricular systolic and diastolic electromechanical synchrony in older people: a population-based observational study. Physiol Res 2017; 66:933-948. [PMID: 28937256 DOI: 10.33549/physiolres.933453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
It is unknown whether physiological ageing also goes along with electromechanical asynchrony of contraction. Aim of the study was to evaluate synchrony of contraction in older people with ("non-healthy") or without ("healthy") evidence for structural cardiac disease. In 547 persons (age 76.7+/-5.5 years, 306 male, 241 female) recruited from a population-based cohort of the ActiFE-Ulm study including a random sample of people >/=65 years old living in the region of Ulm, Germany, various PW- and TDI-Doppler based markers for asynchrony were obtained by echocardiography. Within a subgroup of 84 healthy subjects, at most minimal systolic and diastolic asynchrony was found. Concerning systolic asynchrony, similar observations were made within the non-healthy subgroup. However, extent of diastolic left ventricular intraventricular asynchrony and also - by tendency - diastolic interventricular asynchrony was increased in comparison to the healthy subgroup. To conclude, no evidence that physiological ageing might go along with relevant left or right ventricular systolic or diastolic electromechanical asynchrony was found in our study. Furthermore, our population-based data support the results from other clinical studies with rather selected cohorts that structural heart diseases might go along with increased diastolic asynchrony.
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Affiliation(s)
- R Laszlo
- Division of Sports and Rehabilitation Medicine, Ulm University, Ulm, Germany.
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Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Rodriguez Muñoz D, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017; 38:2739-2791. [PMID: 28886619 DOI: 10.1093/eurheartj/ehx391] [Citation(s) in RCA: 4244] [Impact Index Per Article: 606.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Mauermann E, Bolliger D, Fassl J, Grapow M, Seeberger EE, Seeberger MD, Filipovic M, Lurati Buse GAL. Absolute Postoperative B-Type Natriuretic Peptide Concentrations, but Not Their General Trend, Are Associated With 12-Month, All-Cause Mortality After On-Pump Cardiac Surgery. Anesth Analg 2017; 125:753-761. [PMID: 28753169 DOI: 10.1213/ane.0000000000002291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND B-type natriuretic peptide (BNP) is a predictor of mortality after on-pump cardiac surgery. However, previous limited and heterogeneous studies have focused on peak concentrations at 3 to 5 days after surgery and may not offer clinicians much help in early decision-making. After confirming the predictive value of first-postoperative-day BNP in a preliminary analysis, we explored the association between isolated second-postoperative-day BNP concentrations, second-day BNP concentrations in conjunction with first-day BNP concentrations, and the change in BNP (ie, ΔBNP) from the first to the second postoperative day and 12-month, all-cause mortality. METHODS We included consecutive patients undergoing on-pump cardiac surgery in this observational, secondary analysis of prospectively collected data. We analyzed biomarkers on the first and second postoperative day. ΔBNP was defined as BNP on the second postoperative day minus BNP on the first postoperative day. The primary end point was 12-month, all-cause mortality. The secondary end point was a composite of major adverse cardiac events (MACEs) at 12 months and/or all-cause mortality at 12 months. MACE was defined as nonfatal cardiac arrest, myocardial infarction, and congestive heart failure. The association between BNP and outcomes was examined by receiver operating characteristic curves, as well as univariate and multivariable logistic regression, adjusting for the EuroSCORE II, cross-clamp time, and first-postoperative-day troponin T. RESULTS We included 1199 patients in the preliminary analysis focused on BNP on postoperative day 1. In the analyses examining BNP variables requiring second-postoperative-day BNP measurement (n = 708), we observed 66 (9.3%) deaths, 48 (6.8%) MACE, and 104 (14.7%) deaths and/or MACE. Both first- and second-postoperative-day BNP were significant independent predictors of all-cause, 12-month mortality per 100 ng/L increase (adjusted odds ratio [aOR], 1.040 [95% confidence interval (CI), 1.019-1.065] and 1.064 [95% CI, 1.031-1.105], respectively). When used in conjunction with one another, first-day BNP was not significant (aOR, 1.021 [95% CI, 0.995-1.048]), while second-day BNP remained significant (aOR, 1.046 [95% CI, 1.008-1.091]). The ΔBNP per 100 ng/L increase was not associated with 12-month, all-cause mortality in the univariable (OR, 0.977 [95% CI, 0.951-1.007]) or multivariable analysis (aOR, 0.989 [95% CI, 0.962-1.021]). CONCLUSIONS Both absolute concentrations of first- and second-postoperative-day BNP are independent predictors of 12-month, all-cause mortality. When modeled together, second-postoperative-day BNP is more predictive of 12-month, all-cause mortality. Although intuitively appealing, the change in BNP from the first to the second postoperative day is a complex variable and should not routinely be used for prognostication.
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Affiliation(s)
- Eckhard Mauermann
- From the *Department for Anesthesia, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, and †Department of Cardiac Surgery, Basel University Hospital, Basel, Switzerland; and ‡Basel University Medical School, Basel, Switzerland
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Falk V, Baumgartner H, Bax JJ, De Bonis M, Hamm C, Holm PJ, Iung B, Lancellotti P, Lansac E, Muñoz DR, Rosenhek R, Sjögren J, Tornos Mas P, Vahanian A, Walther T, Wendler O, Windecker S, Zamorano JL, Roffi M, Alfieri O, Agewall S, Ahlsson A, Barbato E, Bueno H, Collet JP, Coman IM, Czerny M, Delgado V, Fitzsimons D, Folliguet T, Gaemperli O, Habib G, Harringer W, Haude M, Hindricks G, Katus HA, Knuuti J, Kolh P, Leclercq C, McDonagh TA, Piepoli MF, Pierard LA, Ponikowski P, Rosano GM, Ruschitzka F, Shlyakhto E, Simpson IA, Sousa-Uva M, Stepinska J, Tarantini G, Tchétché D, Aboyans V. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2017; 52:616-664. [DOI: 10.1093/ejcts/ezx324] [Citation(s) in RCA: 429] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Auensen A, Hussain AI, Falk RS, Walle-Hansen MM, Bye J, Pettersen KI, Aukrust P, Ueland T, Gullestad LL. Associations of brain-natriuretic peptide, high-sensitive troponin T, and high-sensitive C-reactive protein with outcomes in severe aortic stenosis. PLoS One 2017; 12:e0179304. [PMID: 28604834 PMCID: PMC5467862 DOI: 10.1371/journal.pone.0179304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/26/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Among patients with severe aortic stenosis (AS), we investigated the associations of N-terminal pro-natriuretic peptide (NT-proBNP), high-sensitive troponin T (hsTnT), and high-sensitive C-reactive protein (hs-CRP) with 3-year mortality and major adverse cardiovascular events (MACE) during 1 year. METHODS This observational cohort study prospectively enrolled 442 patients with severe AS who were referred for evaluation of possible valve replacement. Clinical data was recorded before the decision of whether to operate was made. We studied the prognostic value of assessing biomarkers by serum levels, and tested associations of NT-proBNP, hsTnT, and hs-CRP with clinical outcomes (3-year all-cause mortality and risk of MACE in the year following study inclusion) using adjusted multivariable analysis. RESULTS Elevated serum levels of these biomarkers at baseline evaluation were associated with increased all-cause 3-year mortality regardless of treatment assignment. Adjusted analysis showed that none of the studied biomarkers (NT-proBNP, hsTnT or hs-CRP) or any other covariates were associated with 3-year all-cause mortality following surgical aortic valve replacement (SAVR). However, adjusted analyses showed that hsTnT (HR, 1.51; 95% CI, 1.11-2.05; P = 0.008) and left ventricular ejection fraction (HR 0.97; 95% CI 0.94-0.97, P = 0.043) was associated with MACE for operated patients. CONCLUSIONS Whereas NT-proBNP, hsTnT and hs-CRP had no independently prognostic value in relation to all-cause mortality following SAVR, hsTnT was independently associated with MACE following operation. The use of these clinically available biomarkers, in particular hsTnT, should be clarified in larger studies.
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Affiliation(s)
- Andreas Auensen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Centre for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Amjad Iqbal Hussain
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Centre for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ragnhild Sørum Falk
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Ullevål, Oslo, Norway
| | | | - Jorun Bye
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kjell Ingar Pettersen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pål Aukrust
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Ueland
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- K.G. Jebsen Thrombosis Research and Expertise Center, University of Tromsø, Tromsø, Norway
| | - Lars Lysgaard Gullestad
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Centre for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Hwang JW, Park SJ, Cho EJ, Kim EK, Lee GY, Chang SA, Choi JO, Lee SC, Park SW. Relation of N-Terminal Pro-B-Type Natriuretic Peptide and Left Ventricular Diastolic Function to Exercise Tolerance in Patients With Significant Valvular Heart Disease and Normal Left Ventricular Systolic Function. Am J Cardiol 2017; 119:1846-1853. [PMID: 28391990 DOI: 10.1016/j.amjcard.2017.02.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/23/2017] [Accepted: 02/23/2017] [Indexed: 12/20/2022]
Abstract
An association between N-terminal prohormone brain natriuretic peptide (NT-proBNP) and exercise tolerance in patients with valvular heart disease (VHD) has been suggested; however, there are few data available regarding this relation. The aim of this study is to evaluate the correlation between exercise tolerance and NT-proBNP in patients with asymptomatic or mildly symptomatic significant VHD and normal left ventricular ejection fraction (LV EF). A total of 96 patients with asymptomatic or mildly symptomatic VHD and normal LV EF (≥50%) underwent cardiopulmonary exercise echocardiography. NT-proBNP levels were determined at baseline and after exercise in 3 hours. Patients were divided in 2 groups based on lower (<26 ml/kg/min, n = 47) or higher (≥26 ml/kg/min, n = 49) peak oxygen consumption (VO2) as a representation of exercise tolerance. In the 2 groups, after adjusting for age and gender, the NT-proBNP level after exercise in 3 hours, left atrial volume index before exercise, right ventricular systolic pressure before exercise, E velocity after exercise, and E/e' ratio after exercise varied significantly. In addition, peak VO2 was inversely related to NT-proBNP before (r = -0.352, p <0.001) and after exercise (r = -0.351, p <0.001). The NT-proBNP level before exercise was directly related to the left atrial volume index, E/e' ratio, and right ventricular systolic pressure before and after exercise. NT-proBNP after exercise was also directly related to the same parameters. NT-proBNP levels both before and after exercise were higher in the group with lower exercise tolerance. In conclusion, through the correlation among exercise tolerance, NT-proBNP, and parameters of diastolic dysfunction, we demonstrated that diastolic dysfunction and NT-proBNP could predict exercise tolerance in patients with significant VHD and normal LV EF.
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Baumgartner H. Challenge of Timing Redo Aortic Valve Replacement. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.117.006556. [DOI: 10.1161/circimaging.117.006556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Helmut Baumgartner
- From the Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Germany
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Laszlo R, Baumann T, Konz H, Dallmeier D, Klenk J, Denkinger M, Koenig W, Rothenbacher D, Steinacker JM. Right ventricular function assessed by tissue Doppler echocardiography in older subjects without evidence for structural cardiac disease. Aging Clin Exp Res 2017; 29:557-562. [PMID: 27245355 DOI: 10.1007/s40520-016-0590-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/18/2016] [Indexed: 12/23/2022]
Abstract
The aim of our study was to obtain right ventricular (RV) tissue Doppler imaging (TDI) data in older subjects (n = 95, mean age: 74.5 ± 4.6 years) without evidence of hemodynamically significant structural heart disease recruited from a large population-based cohort (ActiFE-Ulm study). Our data indicate that aging may be accompanied by decreasing RV diastolic function and at most little alterations of RV systolic function. Mean values of all parameters were still within the guideline-suggested reference range with most of them closer to the abnormality thresholds. On an individual basis, respective thresholds were also exceeded in some subjects (almost all parameters <20 %) despite the absence of evidence for structural cardiac disease. RV-TDI is a feasible method for evaluation of RV systolic and diastolic function also in a geriatric population as sufficient TDI data was obtainable in the majority of our participants. Published reference values also seem to be mostly suitable although among older subjects, presumed pathological measures might still be compatible with physiological age-related alterations. Therefore, they always have to be interpreted across the clinical context and in relation to other parameters of morphology and function obtained by other ultrasound imaging techniques (M-mode, B-mode, etc.) in the context of echocardiographic evaluation of the right heart.
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Affiliation(s)
- Roman Laszlo
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany.
| | - Tobias Baumann
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
| | - Hanna Konz
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
| | - Dhayana Dallmeier
- AGAPLESION Bethesda Clinic, Geriatric Medicine, University of Ulm, Zollernring 26, 89073, Ulm, Germany
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Michael Denkinger
- AGAPLESION Bethesda Clinic, Geriatric Medicine, University of Ulm, Zollernring 26, 89073, Ulm, Germany
| | - Wolfgang Koenig
- Klinik für Herz-& Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Juergen Michael Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
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Buccheri S, Capodanno D, Barbanti M, Popolo Rubbio A, Di Salvo ME, Scandura S, Mangiafico S, Ronsivalle G, Chiarandà M, Capranzano P, Grasso C, Tamburino C. A Risk Model for Prediction of 1-Year Mortality in Patients Undergoing MitraClip Implantation. Am J Cardiol 2017; 119:1443-1449. [PMID: 28274574 DOI: 10.1016/j.amjcard.2017.01.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 01/26/2017] [Accepted: 01/26/2017] [Indexed: 11/28/2022]
Abstract
There is a lack of specific tools for risk stratification in patients who undergo MitraClip implantation. We aimed at combining preprocedural variables with prognostic impact into a specific risk model for the prediction of 1-year mortality in patients undergoing MitraClip implantation. A total of 311 consecutive patients who underwent MitraClip implantation were included. A lasso-penalized Cox-proportional hazard regression model was used to identify independent predictors of 1-year all-cause mortality. A nomogram (GRASP [Getting Reduction of mitrAl inSufficiency by Percutaneous clip implantation] nomogram) was obtained from the Cox model. Validation was performed using internal bootstrap resampling. Forty-two deaths occurred at 1-year follow-up. The Kaplan-Meier estimate of 1-year survival was 0.845 (95% confidence interval, 0.802 to 0.895). Four independent predictors of mortality (mean arterial blood pressure, hemoglobin natural log-transformed pro-brain natriuretic peptide levels, New York Heart Association class IV at presentation) were identified. At internal bootstrap resampling validation, the GRASP nomogram had good discrimination (area under receiver operating characteristic curve of 0.78, Somers' Dxy statistic of 0.53) and calibration (le Cessie-van Houwelingen-Copas-Hosmer p value of 0.780). Conversely, the discriminative ability of the EuroSCORE II (the European System for Cardiac Operative Risk Evaluation II) and the STS-PROM (the Society of Thoracic Surgeons Predicted Risk of Mortality score) was fairly modest with area under the curve values of 0.61 and 0.55, respectively. A treatment-specific risk model in patients who undergo MitraClip implantation may be useful for the stratification of mortality at 1 year. Further studies are needed to provide external validation and support the generalizability of the GRASP nomogram.
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Affiliation(s)
- Sergio Buccheri
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.
| | - Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | | | - Maria Elena Di Salvo
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Salvatore Scandura
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Sarah Mangiafico
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Giuseppe Ronsivalle
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Marta Chiarandà
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Piera Capranzano
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Carmelo Grasso
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
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Kraen M, Frantz S, Nihlén U, Engström G, Löfdahl CG, Wollmer P, Dencker M. Brain natriuretic peptide levels in middle aged subjects with normal left ventricular function in relation to mild-moderate COPD. CLINICAL RESPIRATORY JOURNAL 2017; 12:1061-1067. [PMID: 28294547 DOI: 10.1111/crj.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 01/11/2017] [Accepted: 02/26/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Levels of plasma brain natriuretic peptide (BNP) have been shown to be elevated in chronic obstructive pulmonary disease (COPD) especially in connection with cor pulmonale (CP) and the late stages of the disease. BNP is also raised in left sided heart failure which sometimes coincides with COPD. Whether BNP is elevated in subjects with mild-moderate stable COPD and normal left ventricular function is not clear. OBJECTIVE To investigate BNP levels in subjects with mild-moderate COPD and normal left ventricular function. METHODS This was a cross sectional study of 450 subjects from a population-based respiratory questionnaire survey. All subjects were examined with echocardiography and spirometry and blood samples were drawn for BNP measurements. Subjects with left sided heart disease (n = 26) or echocardiographic signs of elevated filling pressure (n = 75), COPD stages III and IV (n = 5) or missing data (n = 13) were excluded. RESULTS In the final study population (n = 331) spirometry identified 86 subjects with COPD (GOLD stage I, n = 65 and GOLD stage II, n = 21). In comparison with the rest of the study population subjects with COPD were significantly older, longer and with a male predominance. In a multivariate linear regression analysis with log-normalized (lnBNP) as the dependent variable a significant correlation was found with age, left atrial volume, body surface area and haemoglobin, but not with any pulmonary variables. Even when comparing groups no significant difference could be found between the plasma levels of lnBNP in normal subjects (1.8 ± 0.7 mean ± SD, pmol/L) subjects and in COPD subjects (1.9 ± 0.7, P = 0.47). CONCLUSIONS In a population with normal left ventricular function no significant differences in BNP levels between stable mild-moderate COPD subjects and normal individuals could be found.
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Affiliation(s)
- Morten Kraen
- Clinical Physiology and Nuclear Medicine unit, Department of Translational Medicine, Malmö, Lund University, Malmö, 205 02, Sweden
| | - Sophia Frantz
- Clinical Physiology and Nuclear Medicine unit, Department of Translational Medicine, Malmö, Lund University, Malmö, 205 02, Sweden
| | - Ulf Nihlén
- Respiratory Medicine and Allergology unit, Department of Clinical Sciences, Lund, Lund University, Lund, 221 85, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology research group, Department of Clinical Science, Malmö, Lund University, Malmö, 205 02, Sweden
| | - Claes-Göran Löfdahl
- Respiratory Medicine and Allergology unit, Department of Clinical Sciences, Lund, Lund University, Lund, 221 85, Sweden
| | - Per Wollmer
- Clinical Physiology and Nuclear Medicine unit, Department of Translational Medicine, Malmö, Lund University, Malmö, 205 02, Sweden
| | - Magnus Dencker
- Clinical Physiology and Nuclear Medicine unit, Department of Translational Medicine, Malmö, Lund University, Malmö, 205 02, Sweden
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MicroRNA Expression Signature in Human Calcific Aortic Valve Disease. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4820275. [PMID: 28497051 PMCID: PMC5405367 DOI: 10.1155/2017/4820275] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/13/2017] [Indexed: 12/13/2022]
Abstract
Altered microRNA (miRNA, miR) expression has been related to many disease processes; however, the miRNA expression signature in calcific aortic valve disease (CAVD) is unclear. In this study, microarrays were used to determine the miRNA expression signature of tissue samples from healthy individuals (n = 4) and patients with CAVD (n = 4). TargetScan, PITA, and microRNAorg 3-way databases were used to predict the potential target genes. DIANA-miRPath was used to incorporate the aberrant miRNAs into gene pathways. miRNA microarrays identified 92 differentially expressed miRNAs in CAVD tissues. The principal component analysis (PCA) of these samples and the unsupervised hierarchical clustering analysis based on the 92 aberrantly expressed miRNAs noted that miRNA expression could be categorized into two well-defined clusters that corresponded to healthy control and CAVD. Bioinformatic analysis showed the miRNA targets and potential molecular pathways. Collectively, our study reported the miRNA expression signature in CAVD and may provide potential therapeutic targets for CAVD.
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Small A, Kiss D, Giri J, Anwaruddin S, Siddiqi H, Guerraty M, Chirinos JA, Ferrari G, Rader DJ. Biomarkers of Calcific Aortic Valve Disease. Arterioscler Thromb Vasc Biol 2017; 37:623-632. [PMID: 28153876 PMCID: PMC5364059 DOI: 10.1161/atvbaha.116.308615] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 01/23/2017] [Indexed: 01/08/2023]
Abstract
Calcific aortic valve disease (CAVD) is a highly prevalent cardiovascular disorder accounting for a rising economic and social burden on aging populations. In spite of continuing study on the pathophysiology of disease, there remain no medical therapies to prevent the progression of CAVD. The discovery of biomarkers represents a potentially complementary approach in stratifying risk and timing of intervention in CAVD and has the advantage of providing insight into causal factors for the disease. Biomarkers have been studied extensively in atherosclerotic cardiovascular disease, with success as additive for clinical and scientific purposes. Similar research in CAVD is less robust; however, the available studies of biomarkers in CAVD show promise for enhanced clinical decision making and identification of causal factors for the disease. This comprehensive review summarizes available established and novel biomarkers in CAVD, their contributions toward an understanding of pathophysiology, their potential clinical utility, and provides an outline to direct future research in the field.
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Affiliation(s)
- Aeron Small
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel Kiss
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jay Giri
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Saif Anwaruddin
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Hasan Siddiqi
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Marie Guerraty
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Julio A Chirinos
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Giovanni Ferrari
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel J Rader
- From the Division of Cardiology, Department of Medicine, Hospital of the University of Pennsylvania (A.S., D.K., J.G., S.A., H.S., M.G., J.A.C., D.J.R.), Division of Cardiovascular Surgery, Department of Surgery (G.F.), and Department of Genetics (D.J.R.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
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Johl MM, Malhotra P, Kehl DW, Rader F, Siegel RJ. Natriuretic peptides in the evaluation and management of degenerative mitral regurgitation: a systematic review. Heart 2017; 103:738-744. [PMID: 28274956 DOI: 10.1136/heartjnl-2016-310547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/06/2017] [Accepted: 01/27/2017] [Indexed: 11/04/2022] Open
Abstract
Progression of degenerative mitral regurgitation (MR) leads to irreversible cardiac damage. Therefore, longitudinal follow up to determine the optimal timing of surgery is critical. Current data indicates that in addition to the standard of care-assessing for symptoms and signs of left ventricular (LV) decompensation with routine echocardiography-serial measurement of natriuretic peptides offers a quantitative means to identify patients who may benefit from closer supervision, if not surgery. Natriuretic peptide levels, and specifically changes from baseline, identify both symptomatic patients and others likely to develop cardiac dysfunction. Moreover, because natriuretic peptides are complimentary to the echocardiographic assessment of MR. Finally, changes in natriuretic peptides levels are predictive of pre- and post-operative outcomes. In short, natriuretic peptides add objectivity to the management of degenerative MR, which may aid practitioners in identifying patients who could benefit from intensive monitoring, stress testing, and perhaps mitral surgery.
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Affiliation(s)
- Michael M Johl
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Pankaj Malhotra
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Devin W Kehl
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Florian Rader
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Robert J Siegel
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Tan MK, Jarral OA, Thong EHE, Kidher E, Uppal R, Punjabi PP, Athanasiou T. Quality of life after mitral valve intervention. Interact Cardiovasc Thorac Surg 2016; 24:265-272. [DOI: 10.1093/icvts/ivw312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/05/2016] [Indexed: 12/26/2022] Open
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Laszlo R, Baumann T, Konz H, Dallmeier D, Klenk J, Denkinger M, Koenig W, Rothenbacher D, Steinacker JM. Echocardiographic B-mode evaluation of the right heart in older people: The ActiFE Study. Arch Gerontol Geriatr 2016; 67:145-52. [PMID: 27518473 DOI: 10.1016/j.archger.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Right heart B-mode echocardiography reference values have been predominantly obtained in younger age cohorts (<65years). Aims of the study were to describe and evaluate the feasibility of right heart B-mode echocardiography in a large geriatric cohort and to analyze standard parameters in defined subgroups with or without any evidence for structural cardiac disease. METHODS ActiFE-Ulm study is a population-based cohort study including a sample of people≥65years old living in the region of Ulm, Germany. Echocardiography including right heart parameters was performed within a cardiovascular follow-up of 688 subjects. PRINCIPAL RESULTS Non-obtainability of right heart B-mode data was rather not a consequence of accompanying cardiac diseases or risk factors but of a more obese body composition. Mean values of right heart measurements of our subpopulation of subjects without evidence for structural cardiac disease were continuously higher than those of the guidelines (e.g. mean right ventricular end diastolic area 23.5±5.6cm(2) (males), 20.3±5.0cm(2) (females)). On an individual basis, guideline-suggested abnormality thresholds were also often exceeded, whereas this situation occurred more often in male than in female subjects. MAJOR CONCLUSIONS Methodically, right heart B-mode echocardiography in older subjects is challenging. Our results suggest an ageing-associated right heart enlargement. Utilization of published right heart reference values in older adults seems to be problematic and in clinical practice, they always have to be interpreted within the clinical and functional context and in relation to other right heart echocardiographic parameters.
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Affiliation(s)
- Roman Laszlo
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany.
| | - Tobias Baumann
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany
| | - Hannah Konz
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany
| | - Dhayana Dallmeier
- University of Ulm, AGAPLESION Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, Zollernring 26, 89073 Ulm, Germany
| | - Jochen Klenk
- University of Ulm, Institute of Epidemiology and Medical Biometry, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Michael Denkinger
- University of Ulm, AGAPLESION Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, Zollernring 26, 89073 Ulm, Germany
| | - Wolfgang Koenig
- Klinik für Herz-& Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Dietrich Rothenbacher
- University of Ulm, Institute of Epidemiology and Medical Biometry, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Juergen Michael Steinacker
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany
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