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Xu C, Li X, Zhang X, Wu R, Zhou Y, Zhao Q, Zhang Y, Geng S, Gu Y, Hong S. Cardiac murmur grading and risk analysis of cardiac diseases based on adaptable heterogeneous-modality multi-task learning. Health Inf Sci Syst 2024; 12:2. [PMID: 38045019 PMCID: PMC10692066 DOI: 10.1007/s13755-023-00249-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/20/2023] [Indexed: 12/05/2023] Open
Abstract
Cardiovascular disease (CVDs) has become one of the leading causes of death, posing a significant threat to human life. The development of reliable Artificial Intelligence (AI) assisted diagnosis algorithms for cardiac sounds is of great significance for early detection and treatment of CVDs. However, there is scarce research in this field. Existing research mainly faces three major challenges: (1) They mainly limited to murmur classification and cannot achieve murmur grading, but attempting both classification and grading may lead to negative effects between different multi-tasks. (2) They mostly pay attention to unstructured cardiac sound modality and do not consider the structured demographic modality, as it is difficult to balance the influence of heterogeneous modalities. (3) Deep learning methods lack interpretability, which makes it challenging to apply them clinically. To tackle these challenges, we propose a method for cardiac murmur grading and cardiac risk analysis based on heterogeneous modality adaptive multi-task learning. Specifically, a Hierarchical Multi-Task learning-based cardiac murmur detection and grading method (HMT) is proposed to prevent negative interference between different tasks. In addition, a cardiac risk analysis method based on Heterogeneous Multi-modal feature impact Adaptation (HMA) is also proposed, which transforms unstructured modality into structured modality representation, and utilizes an adaptive mode weight learning mechanism to balance the impact between unstructured modality and structured modality, thus enhancing the performance of cardiac risk prediction. Finally, we propose a multi-task interpretability learning module that incorporates an important evaluation using random masks. This module utilizes SHAP graphs to visualize crucial murmur segments in cardiac sound and employs a multi-factor risk decoupling model based on nomograms. And then we gain insights into the cardiac disease risk in both pre-decoupled multi-modality and post-decoupled single-modality scenarios, thus providing a solid foundation for AI assisted cardiac murmur grading and risk analysis. Experimental results on a large real-world CirCor DigiScope PCG dataset demonstrate that the proposed method outperforms the state-of-the-art (SOTA) method in murmur detection, grading, and cardiac risk analysis, while also providing valuable diagnostic evidence.
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Affiliation(s)
- Chenyang Xu
- Department of Computer Science, Tianjin University of Technology, Tianjin, China
| | - Xin Li
- Department of Rehabilitation Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xinyue Zhang
- Department of Computer Science, Tianjin University of Technology, Tianjin, China
| | - Ruilin Wu
- Department of Computer Science, Tianjin University of Technology, Tianjin, China
| | - Yuxi Zhou
- Department of Computer Science, Tianjin University of Technology, Tianjin, China
- DCST, BNRist, RIIT, Institute of Internet Industry, Tsinghua University, Beijing, China
| | - Qinghao Zhao
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
| | - Yong Zhang
- DCST, BNRist, RIIT, Institute of Internet Industry, Tsinghua University, Beijing, China
| | | | - Yue Gu
- Department of Computer Science, Tianjin University of Technology, Tianjin, China
| | - Shenda Hong
- National Institute of Health Data Science, Peking University, Beijing, China
- Institute of Medical Technology, Peking University, Beijing, China
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Tarantino B, Wood M, Hancock D, Shah K. Does pre-injury anticoagulation make chest tubes any less safe? A nationwide retrospective analysis. Am J Emerg Med 2024; 82:47-51. [PMID: 38788529 DOI: 10.1016/j.ajem.2024.05.008] [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: 11/06/2023] [Revised: 03/26/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Oral anticoagulation is becoming more common with the aging population, which raises concern for the risk of invasive procedures that can cause bleeding, such as chest tube placement (thoracostomy). With the increase in CT imaging, more pneumothoraces and hemothoraces are being identified. The relative risk of thoracostomy in the presence of anticoagulation is not well-established. The objective of this study was to determine whether pre-injury anticoagulation affects the relative risk of tube thoracostomy following significant chest trauma. METHODS This retrospective cohort study used data from the 2019 American College of Surgeons-Trauma Quality Program (ACS-TQP) database using R version 4.2.2. Data from the database was filtered based on inclusion and exclusion criteria. Outcomes were then assessed with the population of interest. Demographics, vitals, comorbidities, and injury parameters were also collected for each patient. This study included all adult patients (≥18 years) presenting with traumatic hemothorax, pneumothorax, or hemopneumothorax. Patients with missing data in demographics, vitals, comorbidities, injury parameters, or outcomes, as well as those with no signs of life upon arrival, were excluded from the study. Patients were stratified into groups based on whether they had pre-injury anticoagulation and whether they had a chest tube placed in the hospital. The primary outcome was mortality, and the secondary outcome was hospital length of stay (LOS). Logistic and standard regressions were used by a statistician to control for age, sex, and Injury Severity Score (ISS). RESULTS Our study population included 72,385 patients (4250 with pre-injury anticoagulation and 68,135 without pre-injury anticoagulation). Pre-injury anticoagulation and thoracostomy were each independently associated with increased mortality and LOS. However, there was a non-significant interaction term between pre-injury anticoagulation and thoracostomy for both outcomes, indicating that their combined effects on mortality and LOS did not differ significantly from the sum of their individual effects. CONCLUSION This study suggests that both pre-injury anticoagulation and thoracostomy are risk factors for mortality and increased LOS in adult patients presenting with hemothorax, pneumothorax, or hemopneumothorax, but they do not interact with each other. We recommend further study of this phenomenon to potentially improve clinical guidelines. LEVEL OF EVIDENCE Therapeutic, Level III.
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Affiliation(s)
| | - Myles Wood
- Weill Cornell Medicine, United States of America
| | | | - Kaushal Shah
- Weill Cornell Medicine, United States of America
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Fan L, Yao D, Fan Z, Zhang T, Shen Q, Tong F, Qian X, Xu L, Jiang C, Dong N. Beyond VICs: Shedding light on the overlooked VECs in calcific aortic valve disease. Biomed Pharmacother 2024; 178:117143. [PMID: 39024838 DOI: 10.1016/j.biopha.2024.117143] [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: 04/29/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024] Open
Abstract
Calcific aortic valve disease (CAVD) is prevalent in developed nations and has emerged as a pressing global public health concern due to population aging. The precise etiology of this disease remains uncertain, and recent research has primarily focused on examining the role of valvular interstitial cells (VICs) in the development of CAVD. The predominant treatment options currently available involve open surgery and minimally invasive interventional surgery, with no efficacious pharmacological treatment. This article seeks to provide a comprehensive understanding of valvular endothelial cells (VECs) from the aspects of valvular endothelium-derived nitric oxide (NO), valvular endothelial mechanotransduction, valvular endothelial injury, valvular endothelial-mesenchymal transition (EndMT), and valvular neovascularization, which have received less attention, and aims to establish their role and interaction with VICs in CAVD. The ultimate goal is to provide new perspectives for the investigation of non-invasive treatment options for this disease.
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Affiliation(s)
- Lin Fan
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dingyi Yao
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhengfeng Fan
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tailong Zhang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiang Shen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fuqiang Tong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xingyu Qian
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Xu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Chen Jiang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Islas F, O’Neill-González P, Jiménez-Quevedo P, Nombela-Franco L, Gil-Abizanda S, Mahía-Casado P, Rivadeneira-Ruiz M, Pozo-Osinalde E, Carbone A, Olmos C. Aortic Stenosis and the Evolution of Cardiac Damage after Transcatheter Aortic Valve Replacement. J Clin Med 2024; 13:3539. [PMID: 38930068 PMCID: PMC11204698 DOI: 10.3390/jcm13123539] [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: 05/03/2024] [Revised: 06/02/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Background/Objectives: Severe aortic stenosis (AS) is the most frequent valvular heart disease. Models for stratifying cardiac damage associated with aortic stenosis have been developed to predict outcomes following valve replacement. However, evidence regarding morphological and functional evolution, as well as potential changes in the degree of cardiac damage, is limited. We aim to provide information on the evolution of cardiac morphology and the function of patients undergoing transcatheter aortic valve replacement (TAVR) who have been classified using a cardiac damage staging system. Methods: In total, 496 patients were included in the analysis, and were classified into four stages based on the extent of cardiac damage as follows: Stage 0, no cardiac damage: left ventricle global longitudinal strain (LV-GLS) < -17%; right ventricular-arterial coupling (RVAc) ≥ 0.35), and absence of significant mitral regurgitation (MR). Stage 1, left-sided subclinical damage: LV-GLS ≥ -17%. Stage 2, left-sided damage: significant MR. Stage 3, right-sided damage: RVAc < 0.35. Results: The mean age was 82.1 ± 5.9 years, and 53.0% were female. In total, 24.5% of patients met the criteria for Stage 0, and Stage 1 included 42.8% of patients, Stage 2 included 16.5%, and Stage 3 comprised 16.2% of patients. Mortality was 8.4% for stage 0, 17.4% for stage 1, 25.6% for stage 2, and 28.6% for stage 3 patients (p = 0.004). Diabetes mellitus (DM) (p = 0.047) and chronic kidney disease (CKD) (p = 0.024) were the only clinical predictors of no change or worsening in the stage of cardiac damage. Regarding echocardiographic variables, concomitant tricuspid, and mitral regurgitation, ≥ 2 were both significantly associated with no change or worsening, also (p < 0.001). Conclusions: Cardiac damage that is secondary to severe aortic stenosis has morphological and functional repercussions that, even after valve replacement, persist and might worsen the prognosis.
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Affiliation(s)
- Fabián Islas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (F.I.); (P.O.-G.)
- Unidad de Imagen Cardiaca, Hospital Universitario Nuestra Señora del Prado, 45600 Talavera de la Reina, Spain
| | - Patrick O’Neill-González
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (F.I.); (P.O.-G.)
| | - Pilar Jiménez-Quevedo
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (F.I.); (P.O.-G.)
| | - Luis Nombela-Franco
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (F.I.); (P.O.-G.)
| | - Sandra Gil-Abizanda
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (F.I.); (P.O.-G.)
| | - Patricia Mahía-Casado
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (F.I.); (P.O.-G.)
| | - María Rivadeneira-Ruiz
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (F.I.); (P.O.-G.)
| | - Eduardo Pozo-Osinalde
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (F.I.); (P.O.-G.)
| | - Andreina Carbone
- Cardiology Unit, University of Campania Luigi Vanvitelli, 81100 Naples, Italy
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (F.I.); (P.O.-G.)
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Hugelshofer S, de Brito D, Antiochos P, Tzimas G, Rotzinger DC, Auberson D, Vella A, Fournier S, Kirsch M, Muller O, Monney P. Energy Loss Index and Dimensionless Index Outperform Direct Valve Planimetry in Low-Gradient Aortic Stenosis. J Clin Med 2024; 13:3220. [PMID: 38892930 PMCID: PMC11173056 DOI: 10.3390/jcm13113220] [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: 04/23/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Background/Objectives: Among patients with suspected severe aortic stenosis (AS), discordance between effective orifice area (EOA) and transvalvular gradients is frequent and requires a multiparametric workup including flow assessment and calcium-scoring to confirm true severe AS. The aim of this study was to assess direct planimetry, energy loss index (Eli) and dimensionless index (DI) as stand-alone parameters to identify non-severe AS in discordant cases. Methods: In this prospective cohort study, we included consecutive AS patients > 70 years with EOA < 1.0 cm2 referred for valve replacement between 2014 and 2017. AS severity was retrospectively reassessed using the multiparametric work-up recommended in the 2021 ESC/EACTS guidelines. DI and ELi were calculated, and valve area was measured by direct planimetry on transesophageal echocardiography. Results: A total of 101 patients (mean age 82 y; 57% male) were included. Discordance between EOA and gradients was observed in 46% and non-severe AS found in 24% despite an EOA < 1 cm2. Valve planimetry performed poorly, with an area under the ROC curve (AUC) of 0.64. At a cut-off value of >0.82 cm2, sensitivity and specificity to identify non-severe AS were 67 and 66%, respectively. DI and ELi showed a higher diagnostic accuracy, with an AUC of 0.77 and 0.76, respectively. Cut-off values of >0.24 and >0.6 cm2/m2 identified non-severe AS, with a high specificity of 79% and 91%, respectively. Conclusions: Almost one in four patients with EOA < 1 cm2 had non-severe AS according to guideline-recommended multiparametric assessment. Direct valve planimetry revealed poor diagnostic accuracy and should be interpreted with caution. Usual prognostic cut-off values for DI > 0.24 and ELI > 0.6 cm2/m2 identified non-severe AS with high specificity and should therefore be included in the assessment of low-gradient AS.
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Affiliation(s)
- Sarah Hugelshofer
- Service de Cardiologie, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland (A.V.); (S.F.); (O.M.)
| | - Diana de Brito
- Service de Cardiologie, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland (A.V.); (S.F.); (O.M.)
| | - Panagiotis Antiochos
- Service de Cardiologie, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland (A.V.); (S.F.); (O.M.)
- Faculty of Biology and Medicine, University of Lausanne (Unil), 1011 Lausanne, Switzerland; (D.C.R.); (M.K.)
| | - Georgios Tzimas
- Service de Cardiologie, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland (A.V.); (S.F.); (O.M.)
| | - David C. Rotzinger
- Faculty of Biology and Medicine, University of Lausanne (Unil), 1011 Lausanne, Switzerland; (D.C.R.); (M.K.)
- Service de Radiodiagnostic et Radiologie Interventionnelle, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland
| | - Denise Auberson
- Service de Cardiologie, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland (A.V.); (S.F.); (O.M.)
| | - Agnese Vella
- Service de Cardiologie, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland (A.V.); (S.F.); (O.M.)
| | - Stephane Fournier
- Service de Cardiologie, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland (A.V.); (S.F.); (O.M.)
- Faculty of Biology and Medicine, University of Lausanne (Unil), 1011 Lausanne, Switzerland; (D.C.R.); (M.K.)
| | - Matthias Kirsch
- Faculty of Biology and Medicine, University of Lausanne (Unil), 1011 Lausanne, Switzerland; (D.C.R.); (M.K.)
- Service de Chirurgie Cardiaque, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland
| | - Olivier Muller
- Service de Cardiologie, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland (A.V.); (S.F.); (O.M.)
- Faculty of Biology and Medicine, University of Lausanne (Unil), 1011 Lausanne, Switzerland; (D.C.R.); (M.K.)
| | - Pierre Monney
- Service de Cardiologie, University Hospital of Lausanne (CHUV), 1011 Lausanne, Switzerland (A.V.); (S.F.); (O.M.)
- Faculty of Biology and Medicine, University of Lausanne (Unil), 1011 Lausanne, Switzerland; (D.C.R.); (M.K.)
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Oldham MA, Pigeon WR, Yurcheshen M, Hisamoto K, Knight PA, Lee HB. High prevalence of obstructive sleep apnea in a surgical aortic valve replacement cohort: an observational study. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae034. [PMID: 38947231 PMCID: PMC11212347 DOI: 10.1093/sleepadvances/zpae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/14/2024] [Indexed: 07/02/2024]
Abstract
Study Objectives A high prevalence of sleep apnea has been reported among transcatheter aortic valve replacement (AVR) patients; however, the prevalence of sleep apnea in the younger and relatively healthier population of surgical AVR (SAVR) patients is unknown. Methods We assessed the prevalence of sleep apnea and overall sleep quality in patients having SAVR. Participants aged 50-89 were eligible for recruitment. All participants completed type II HST before SAVR. Sleep apnea was defined as an apnea-hypopnea index (AHI) ≥ 5 events/hour. The current use of positive airway pressure was exclusionary. Results The 46 participants (32 males/14 females) had a mean age of 66.6 years, body mass index of 30, AHI of 23.5, and obstructive AHI of 22.0. Only four participants had a prior sleep apnea diagnosis, yet all but one had sleep apnea on type II sleep testing. Two-thirds of sleep apnea was moderate or severe (AHI ≥ 15). A quarter of respiratory events were defined by arousals without desaturations. Whereas most sleep parameters resembled those of similarly aged community cohorts, mean percentage of N3 was reduced, accounting for only 3.8% of total sleep time. Conclusions Type II home sleep testing (HST) revealed a 97.8% prevalence of sleep apnea in this sample, most of which was undiagnosed obstructive sleep apnea. Roughly two-thirds of sleep apnea was moderate or severe. Such a high impact of obstructive sleep apnea among patients with severe aortic valve disease deserves further investigation on potential underlying mechanisms and clinical implications.
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Affiliation(s)
- Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
- Center of Excellence for Suicide Prevention, U.S. Department of Veterans Affairs, Canandaigua, NY, USA
| | - Michael Yurcheshen
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
| | - Kazuhiro Hisamoto
- Division of Cardiac Surgery, Department of Surgery, University of Rochester, Medical Center, Rochester, NY, USA
| | - Peter A Knight
- Division of Cardiac Surgery, Department of Surgery, University of Rochester, Medical Center, Rochester, NY, USA
| | - Hochang B Lee
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
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Poulis N, Martin M, Hoerstrup SP, Emmert MY, Fioretta ES. Development of an iPSC-derived tissue-resident macrophage-based platform for the in vitro immunocompatibility assessment of human tissue engineered matrices. Sci Rep 2024; 14:12171. [PMID: 38806547 PMCID: PMC11133401 DOI: 10.1038/s41598-024-62745-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/21/2024] [Indexed: 05/30/2024] Open
Abstract
Upon implanting tissue-engineered heart valves (TEHVs), blood-derived macrophages are believed to orchestrate the remodeling process. They initiate the immune response and mediate the remodeling of the TEHV, essential for the valve's functionality. The exact role of another macrophage type, the tissue-resident macrophages (TRMs), has not been yet elucidated even though they maintain the homeostasis of native tissues. Here, we characterized the response of hTRM-like cells in contact with a human tissue engineered matrix (hTEM). HTEMs comprised intracellular peptides with potentially immunogenic properties in their ECM proteome. Human iPSC-derived macrophages (iMφs) could represent hTRM-like cells in vitro and circumvent the scarcity of human donor material. iMφs were derived and after stimulation they demonstrated polarization towards non-/inflammatory states. Next, they responded with increased IL-6/IL-1β secretion in separate 3/7-day cultures with longer production-time-hTEMs. We demonstrated that iMφs are a potential model for TRM-like cells for the assessment of hTEM immunocompatibility. They adopt distinct pro- and anti-inflammatory phenotypes, and both IL-6 and IL-1β secretion depends on hTEM composition. IL-6 provided the highest sensitivity to measure iMφs pro-inflammatory response. This platform could facilitate the in vitro immunocompatibility assessment of hTEMs and thereby showcase a potential way to achieve safer clinical translation of TEHVs.
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Affiliation(s)
- Nikolaos Poulis
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Marcy Martin
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
| | - Simon P Hoerstrup
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
- Wyss Zurich, University and ETH Zurich, Zurich, Switzerland
| | - Maximilian Y Emmert
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland.
- Wyss Zurich, University and ETH Zurich, Zurich, Switzerland.
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Institut für Regenerative Medizin (IREM), University of Zurich, Moussonstrasse 13, 8044, Zurich, Switzerland.
| | - Emanuela S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
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Niznik S, Rapoport MJ, Avnery O, Kidon M, Shavit R, Ellis MH, Agmon-Levin N. Heart valve disease in primary antiphospholipid syndrome. Rheumatology (Oxford) 2024; 63:1397-1402. [PMID: 37572296 DOI: 10.1093/rheumatology/kead399] [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: 01/24/2023] [Revised: 06/17/2023] [Accepted: 07/16/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVES APS-associated heart valve disease (HVD) is well described. Nonetheless, limited data exist on clinical parameters associated with the course of primary APS (pAPS) patients with HVD. The goal of this study was to assess clinical features and related outcomes in patients with APS-associated HVD. METHODS In this multicentre retrospective study, we identified 33 pAPS patients with HVD (pAPS-HVD group) and compared their clinical course with 128 pAPS patients with normal heart valves on echocardiography (pAPS-control group). RESULTS pAPS-HVD patients had more cerebrovascular events (56.3% vs 25%, P = 0.005) and livedo reticularis (24.2% vs 7.8%, P = 0.013) than pAPS-controls. Furthermore, catastrophic-APS (CAPS) (12.1% vs 2.4%, P = 0.034), recurrent thrombosis (33.3% vs 4.7%, P < 0.001) and need for advanced therapy (i.e. IVIG, plasmapheresis or rituximab) were more frequent in pAPS-HVD patients. Anti-β2-glycoprotein 1 IgG (84.8% vs 63.2%, P = 0.034), anti-cardiolipin IgG (90.9% vs 64.8%, P = 0.005) and triple positive aPL (75.8% vs 56.5%, P = 0.047) were commoner in pAPS-HVD patients vs pAPS-controls. Ten of the 33 patients with pAPS-HVD underwent valve surgery, which was associated with male gender, smoking, arterial limb ischaemia and livedo reticularis. CONCLUSION pAPS-HVD patients had a more severe APS clinical course including CAPS and thrombotic events as well as a specific serology, namely IgG isotype aPL antibodies and triple positivity. Our data suggest that pAPS-HVD represents a high-risk subgroup of APS patients.
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Affiliation(s)
- Stanley Niznik
- Clinical Immunology, Angioedema and Allergy Institute, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Micha J Rapoport
- Department of Internal Medicine 'C', Shamir Medical Center, Zerifin, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orly Avnery
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, Israel
| | - Mona Kidon
- Clinical Immunology, Angioedema and Allergy Institute, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronen Shavit
- Clinical Immunology, Angioedema and Allergy Institute, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
| | - Martin H Ellis
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Hematology Institute and Blood Bank, Meir Medical Center, Kfar Saba, Israel
| | - Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy Institute, The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ziacchi M, Spadotto A, Palmisano P, Guerra F, De Ponti R, Zanotto G, Bertini M, Biffi M, Boriani G. Conduction system disease management in patients candidate and/or treated for the aortic valve disease: an Italian Survey promoted by Italian Association of Arrhythmology and Cardiac Pacing (AIAC). Acta Cardiol 2024; 79:367-373. [PMID: 38441069 DOI: 10.1080/00015385.2024.2310930] [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: 07/04/2022] [Accepted: 01/01/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Conduction system disorders represent a frequent complication in patients undergoing surgical (surgical aortic valve replacement, SAVR) or percutaneous (transcatheter aortic valve implantation, TAVI) aortic valve replacement. The purpose of this survey was to evaluate experienced operators approach in this clinical condition. METHODS This survey was independently conducted by the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) and it consisted of 24 questions regarding the respondents' profile, the characteristics of participating centres, and conduction disease management in different scenarios. RESULTS Fifty-five physicians from 55 Italian arrhythmia centres took part in the survey. Prophylactic pacemaker implantation is rare. In case of persistent complete atrioventricular block (AVB), 49% and 73% respondents wait less than one week before implanting a definitive pacemaker after SAVR and TAVI, respectively. In case of second degree AVB, the respondents wait some days more for definitive implantation. Respondents consider bundle branch blocks, in particular pre-existing left bundle branch block (LBBB), the worst prognostic factors for pacemaker implantation after TAVI. The implanted valve type is considered a relevant element to evaluate. In patients with new-onset LBBB and severe/moderate left ventricular systolic dysfunction, respondents would implant a biventricular pacemaker in 100/55% of cases, respectively. CONCLUSIONS Waiting time before a definitive pacemaker implantation after aortic valve replacement has reduced compared to the past, and it is anticipated in TAVI vs. SAVR. Bundle branch blocks are considered the worse prognostic factor for pacemaker implantation after TAVI. The type of pacemaker implanted in new-onset LBBB patients without severe left ventricular systolic dysfunction is heterogeneous.
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Affiliation(s)
- Matteo Ziacchi
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alberto Spadotto
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pietro Palmisano
- Cardiology Unit, Azienda Ospedaliera "Card G. Panico", Tricase, Italy
| | - Federico Guerra
- Cardiology Unit, Università Politecnica delle Marche, Ancona, Italy
| | - Roberto De Ponti
- Division of Cardiology, Università degli studi dell'Insubria, Varese, Italy
| | | | - Matteo Bertini
- Division of Cardiology, Arcispedale S.Anna, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Mauro Biffi
- Division of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giuseppe Boriani
- Cardiology Unit, University of Modena and Reggio Emilia, Modena, Italy
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10
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Moore MK, Jones GT, McCormick S, Williams MJA, Coffey S. Association between lipoprotein(a), LPA genetic risk score, aortic valve disease, and subsequent major adverse cardiovascular events. Eur J Prev Cardiol 2024:zwae100. [PMID: 38593219 DOI: 10.1093/eurjpc/zwae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/18/2024] [Accepted: 03/01/2024] [Indexed: 04/11/2024]
Abstract
AIMS Cohort studies have demonstrated associations between calcific aortic valve disease (CAVD) and Lp(a). As Lp(a) is almost entirely genetically determined, in this study, we aim to determine whether Lp(a), when predicted from genetic data, is associated with CAVD and major adverse cardiovascular events (MACEs). METHODS AND RESULTS Patients undergoing coronary angiography between January 2012 and May 2013 were invited to participate in the study. Of 752 analysable participants, 446 had their Lp(a) measured and 703 had a calculable LPA genetic risk score (GRS). The primary outcomes were the presence of CAVD at baseline and MACE over a 7-year follow-up. The GRS explained 45% of variation in Lp(a). After adjustment for cardiac risk factors and coronary artery disease (CAD), the odds of CAVD increased with increasing Lp(a) [odds ratio (OR) 1.039 per 10-unit increase, 95% confidence interval (CI) 1.022-1.057, P < 0.001] and GRS (OR 1.054 per 10-unit increase, 95% CI 1.024-1.086; P < 0.001). Lipoprotein(a) and the GRS as continuous variables were not associated with subsequent MACEs. A dichotomized GRS (>54) was associated with MACE, but this relationship became non-significant when CAD classification was added into the model (OR 1.333, 95% CI 0.927-1.912; P = 0.12). CONCLUSION An LPA GRS can explain 45% of variation in Lp(a) levels, and both Lp(a) and the GRS are associated with CAVD. An elevated GRS is associated with future cardiac events in a secondary risk setting, but, if the CAD status is known, it does not provide additional prognostic information.
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Affiliation(s)
- Matthew K Moore
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, 201 Great King Street, Dunedin 9016, New Zealand
| | - Gregory T Jones
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, 201 Great King Street, Dunedin 9016, New Zealand
| | - Sally McCormick
- Department of Biochemistry, University of Otago, 710 Cumberland Street, Dunedin 9016, New Zealand
| | - Michael J A Williams
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, 201 Great King Street, Dunedin 9016, New Zealand
- Department of Cardiology, Dunedin Hospital, Te Whatu Ora/Health New Zealand, 201 Great King Street, Dunedin 9016, New Zealand
| | - Sean Coffey
- Department of Medicine, HeartOtago, Dunedin School of Medicine, University of Otago, 201 Great King Street, Dunedin 9016, New Zealand
- Department of Cardiology, Dunedin Hospital, Te Whatu Ora/Health New Zealand, 201 Great King Street, Dunedin 9016, New Zealand
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11
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Garcia Reinoso L, John S. A Rare Case of Severe Mitral Stenosis Presenting As Cardiogenic Shock. Cureus 2024; 16:e57627. [PMID: 38706999 PMCID: PMC11069467 DOI: 10.7759/cureus.57627] [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] [Accepted: 04/04/2024] [Indexed: 05/07/2024] Open
Abstract
We report a case of severe mitral stenosis (MS) in a 58-year-old female from Guyana. Though rheumatic MS continues to be less prevalent in third-world countries, it poses a significant threat as far as morbidity and mortality are concerned. The modern definition of "Third World" is used to classify countries that are poor or developing. Countries that are part of the "third world" are generally characterized by (1) high rates of poverty, (2) economic and/or political instability, and (3) high mortality. The standard method of diagnosing MS in patients has been established as transthoracic echocardiograms (TTE), along with pertinent historical and physical exam findings. Specifically, with TTE, criteria include a mitral valve area ≤1.5 cm2, severe left atrial enlargement, and elevated pulmonary artery systolic pressure >50 millimeters of mercury (mmHg). Once diagnosed with severe MS, treatment options for patients range from non-surgical percutaneous mitral balloon valvuloplasty to surgical mitral valve commissurotomy. In our case, she was a 58-year-old female with a past medical history of seizures of unknown etiology, not on any home medication regimen, presenting to the emergency department with shortness of breath, malaise, weight loss, and bilateral lower leg edema. Vitals were significant for tachycardia at 153 bpm, tachypnea at 24 breaths per minute, and saturating at 96% on room air. On the physical exam, there was an irregularly irregular rhythm, bilateral crackles at the bases, right upper quadrant tenderness to palpation, bilateral pitting edema, and no calf tenderness. Lab findings were significant for elevated brain natriuretic peptide, but three electrocardiograms were performed in the emergency department, all confirming the new onset of atrial fibrillation. A CT angiogram of the chest was performed, which ruled out pulmonary embolus but additionally found marked reflux of contrast noted within the inferior vena cava and hepatic veins, along with right atrial dilation reflective of right heart strain; additionally, mitral valve calcifications were noted. The cardiologist on duty confirmed the diagnosis using point-of-care ultrasound (POCUS) followed by TTE; the patient was rapidly transferred to a hospital with appropriate services for surgical management within the same day of arrival at the emergency department. This case highlights the importance of bedside POCUS as an additional diagnostic tool for cardiologists, along with pertinent history, physical examination findings, and laboratory findings. Proper utilization of POCUS can allow for the immediate diagnosis of severe pathologies and prevent the delay of appropriate treatment, as seen in our case. Wider adoption of POCUS practices as a part of the general initial evaluation of patients has not yet been recommended by the American Heart Association but can offer clinical benefit in morbidity/mortality with expedited progression to appropriate treatment.
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Affiliation(s)
- Lucas Garcia Reinoso
- Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Sabu John
- Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
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12
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Zhao Y, Zhao H, Huang J, Mei B, Xiang J, Wang Y, Lin J, Huang S. Availability and threshold of the vasoactive-inotropic score for predicting early extubation in adults after rheumatic heart valve surgery: a single-center retrospective cohort study. BMC Anesthesiol 2024; 24:102. [PMID: 38500035 PMCID: PMC10946098 DOI: 10.1186/s12871-024-02489-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Early extubation (EEx) is defined as the removal of the endotracheal tube within 8 h postoperatively. The present study involved determining the availability and threshold of the vasoactive-inotropic score (VIS) for predicting EEx in adults after elective rheumatic heart valve surgery. METHODS The present study was designed as a single-center retrospective cohort study which was conducted with adults who underwent elective rheumatic heart valve surgery with CPB. The highest VIS in the immediate postoperative period was used in the present study. The primary outcome, the availability of VIS for EEx prediction and the optimal threshold value were determined using ROC curve analysis. The gray zone analysis of the VIS was performed by setting the false negative or positive rate R = 0.05, and the perioperative risk factors for prolonged EEx were identified by multivariate logistic analysis. The postoperative complications and outcomes were compared between different VIS groups. RESULTS Among the 409 patients initially screened, 379 patients were ultimately included in the study. The incidence of EEx was determined to be 112/379 (29.6%). The VIS had a good predictive value for EEx (AUC = 0.864, 95% CI: [0.828, 0.900], P < 0.001). The optimal VIS threshold for EEx prediction was 16.5, with a sensitivity of 71.54% (65.85-76.61%) and a specificity of 88.39% (81.15-93.09%). The upper and lower limits of the gray zone for the VIS were determined as (12, 17.2). The multivariate logistic analysis identified age (OR, 1.060; 95% CI: 1.017-1.106; P = 0.006), EF% (OR, 0.798; 95% CI: 0.742-0.859; P < 0.001), GFR (OR, 0.933; 95% CI: 0.906-0.961; P < 0.001), multiple valves surgery (OR, 4.587; 95% CI: 1.398-15.056; P = 0.012), and VIS > 16.5 (OR, 12.331; 95% CI: 5.015-30.318; P < 0.001) as the independent risk factors for the prolongation of EEx. The VIS ≤ 16.5 group presented a greater success rate for EEx, a shorter invasive ventilation support duration, and a lower incidence of complications than did the VIS > 16.5 group, while the incidence of reintubation was similar between the two groups. CONCLUSION In adults, after elective rheumatic heart valve surgery, the highest VIS in the immediate postoperative period was a good predictive value for EEx, with a threshold of 16.5.
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Affiliation(s)
- Yang Zhao
- Department of anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
- Department of anesthesiology, First Affiliated Hospital of GuangXi Medical University, Nanning, China
| | - Hanlei Zhao
- Department of anesthesiology, Langzhong Hospital of Traditional Chinese Medicine, Langzhong, China
| | - Jiao Huang
- Department of anesthesiology, First Affiliated Hospital of GuangXi Medical University, Nanning, China
| | - Bo Mei
- Department of cardiovascular surgery, Dazhou Central Hospital, Dazhou, China
| | - Jun Xiang
- Department of cardiovascular surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Yizheng Wang
- Department of anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - Jingyan Lin
- Department of anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China
| | - San Huang
- Department of anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
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13
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Tucureanu MM, Ciortan L, Macarie RD, Mihaila AC, Droc I, Butoi E, Manduteanu I. The Specific Molecular Changes Induced by Diabetic Conditions in Valvular Endothelial Cells and upon Their Interactions with Monocytes Contribute to Endothelial Dysfunction. Int J Mol Sci 2024; 25:3048. [PMID: 38474293 DOI: 10.3390/ijms25053048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/28/2024] [Accepted: 03/02/2024] [Indexed: 03/14/2024] Open
Abstract
Aortic valve disease (AVD) represents a global public health challenge. Research indicates a higher prevalence of diabetes in AVD patients, accelerating disease advancement. Although the specific mechanisms linking diabetes to valve dysfunction remain unclear, alterations of valvular endothelial cells (VECs) homeostasis due to high glucose (HG) or their crosstalk with monocytes play pivotal roles. The aim of this study was to determine the molecular signatures of VECs in HG and upon their interaction with monocytes in normal (NG) or high glucose conditions and to propose novel mechanisms underlying valvular dysfunction in diabetes. VECs and THP-1 monocytes cultured in NG/HG conditions were used. The RNAseq analysis revealed transcriptomic changes in VECs, in processes related to cytoskeleton regulation, focal adhesions, cellular junctions, and cell adhesion. Key molecules were validated by qPCR, Western blot, and immunofluorescence assays. The alterations in cytoskeleton and intercellular junctions impacted VEC function, leading to changes in VECs adherence to extracellular matrix, endothelial permeability, monocyte adhesion, and transmigration. The findings uncover new molecular mechanisms of VEC dysfunction in HG conditions and upon their interaction with monocytes in NG/HG conditions and may help to understand mechanisms of valvular dysfunction in diabetes and to develop novel therapeutic strategies in AVD.
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Affiliation(s)
- Monica Madalina Tucureanu
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", 050568 Bucharest, Romania
| | - Letitia Ciortan
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", 050568 Bucharest, Romania
| | - Razvan Daniel Macarie
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", 050568 Bucharest, Romania
| | - Andreea Cristina Mihaila
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", 050568 Bucharest, Romania
| | - Ionel Droc
- Cardiovascular Surgery Department, Central Military Hospital, 010825 Bucharest, Romania
| | - Elena Butoi
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", 050568 Bucharest, Romania
| | - Ileana Manduteanu
- Biopathology and Therapy of Inflammation, Institute of Cellular Biology and Pathology "Nicolae Simionescu", 050568 Bucharest, Romania
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14
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Manini C, Nemchyna O, Akansel S, Walczak L, Tautz L, Kolbitsch C, Falk V, Sündermann S, Kühne T, Schulz-Menger J, Hennemuth A. A simulation-based phantom model for generating synthetic mitral valve image data-application to MRI acquisition planning. Int J Comput Assist Radiol Surg 2024; 19:553-569. [PMID: 37679657 PMCID: PMC10881710 DOI: 10.1007/s11548-023-03012-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE Numerical phantom methods are widely used in the development of medical imaging methods. They enable quantitative evaluation and direct comparison with controlled and known ground truth information. Cardiac magnetic resonance has the potential for a comprehensive evaluation of the mitral valve (MV). The goal of this work is the development of a numerical simulation framework that supports the investigation of MRI imaging strategies for the mitral valve. METHODS We present a pipeline for synthetic image generation based on the combination of individual anatomical 3D models with a position-based dynamics simulation of the mitral valve closure. The corresponding images are generated using modality-specific intensity models and spatiotemporal sampling concepts. We test the applicability in the context of MRI imaging strategies for the assessment of the mitral valve. Synthetic images are generated with different strategies regarding image orientation (SAX and rLAX) and spatial sampling density. RESULTS The suitability of the imaging strategy is evaluated by comparing MV segmentations against ground truth annotations. The generated synthetic images were compared to ones acquired with similar parameters, and the result is promising. The quantitative analysis of annotation results suggests that the rLAX sampling strategy is preferable for MV assessment, reaching accuracy values that are comparable to or even outperform literature values. CONCLUSION The proposed approach provides a valuable tool for the evaluation and optimization of cardiac valve image acquisition. Its application to the use case identifies the radial image sampling strategy as the most suitable for MV assessment through MRI.
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Affiliation(s)
- Chiara Manini
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany.
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany.
| | - Olena Nemchyna
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
| | - Serdar Akansel
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
| | - Lars Walczak
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Fraunhofer MEVIS, Berlin, Germany
| | | | - Christoph Kolbitsch
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
| | - Volkmar Falk
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Simon Sündermann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Titus Kühne
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jeanette Schulz-Menger
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology and Nephrology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Anja Hennemuth
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum Der Charité (DHZC), Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Berlin, Germany
- Fraunhofer MEVIS, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Inoue N, Ohtani H, Morikawa S, Takayama Y, Ogane T, Hiramatsu T, Kumihashi H, Murohara T. Risk of supranormal left ventricular ejection fraction in patients with aortic stenosis. Clin Cardiol 2024; 47:e24255. [PMID: 38469926 PMCID: PMC10928761 DOI: 10.1002/clc.24255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Cardiovascular events are increasing in patients with supranormal left ventricular ejection fraction (snLVEF). However, the effect of snLVEF in patients with aortic stenosis (AS) remains unclear, especially in patients with moderate AS. HYPOTHESIS This study aimed to evaluate the prognosis of mortality and heart failure (HF) in patients with LVEF ≥ 50% and moderate or severe AS. METHODS This retrospective study targeted patients with moderate or severe AS and LVEF > 50%. LVEF of 50%-65% was classified as normal LVEF (nLVEF, nEF group) and >65% as snLVEF (snEF group). AS severity was stratified based on the aortic valve area into moderate (1.0-1.5 cm²) and severe (<1.0 cm²). Primary outcomes included all-cause mortality and HF hospitalization. RESULTS A total of 226 participants were included in this study. There were 67 and 65 participants with moderate AS in snEF (m-snEF) and nEF groups (m-nEF), respectively, and 41 and 53 participants with severe AS in the snEF (s-snEF) and nEF groups (s-nEF), respectively. During the observation period (median: 554 days), the primary composite outcome occurred in 108 individuals. Cox hazard analysis revealed no significant differences among the four groups in primary composite outcomes. With respect to HF hospitalization, the adjusted hazard ratios (95% confidence intervals) with m-snEF as the reference were as follows: m-nEF, 0.41 (0.19-0.89); s-nEF, 1.43 (0.76-2.67); and s-snEF, 1.83 (1.00-3.35). CONCLUSIONS The risk of HF hospitalization for m-snLVEF was higher than m-nLVEF and not significantly different from s-nLVEF.
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Affiliation(s)
- Naoya Inoue
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Hayato Ohtani
- Division of Cardiology, Internal Medicine IIIHamamatsu University School of MedicineShizuokaHamamatsuJapan
| | - Shuji Morikawa
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Yohei Takayama
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Takashi Ogane
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
| | - Takehiro Hiramatsu
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Hiroki Kumihashi
- Department of CardiologyChutoen General Medical Center, KakegawaShizuokaJapan
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
| | - Toyoaki Murohara
- Department of CardiologyNagoya University Graduate School of MedicineNagoyaAichiJapan
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16
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Farina JM, Chao CJ, Pereyra M, Roarke M, Said EF, Barry T, Alsidawi S, Sell-Dottin K, Sweeney JP, Fortuin DF, Ayoub C, Lester SJ, Oh JK, Arsanjani R, Marcotte F. Role of lipoprotein(a) concentrations in bioprosthetic aortic valve degeneration. Heart 2024; 110:299-305. [PMID: 37643771 DOI: 10.1136/heartjnl-2023-322987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Lipoprotein(a) (Lp(a)) is associated with an increased incidence of native aortic stenosis, which shares similar pathological mechanisms with bioprosthetic aortic valve (bAV) degeneration. However, evidence regarding the role of Lp(a) concentrations in bAV degeneration is lacking. This study aims to evaluate the association between Lp(a) concentrations and bAV degeneration. METHODS In this retrospective multicentre study, patients who underwent a bAV replacement between 1 January 2010 and 31 December 2020 and had a Lp(a) measurement were included. Echocardiography follow-up was performed to determine the presence of bioprosthetic valve degeneration, which was defined as an increase >10 mm Hg in mean gradient from baseline with concomitant decrease in effective orifice area and Doppler Velocity Index, or new moderate/severe prosthetic regurgitation. Levels of Lp(a) were compared between patients with and without degeneration and Cox regression analysis was performed to investigate the association between Lp(a) levels and bioprosthetic valve degeneration. RESULTS In total, 210 cases were included (mean age 74.1±9.4 years, 72.4% males). Median time between baseline and follow-up echocardiography was 4.4 (IQR 3.7) years. Bioprostheses degeneration was observed in 33 (15.7%) patients at follow-up. Median serum levels of Lp(a) were significantly higher in patients affected by degeneration versus non-affected cases: 50.0 (IQR 72.0) vs 15.6 (IQR 48.6) mg/dL, p=0.002. In the regression analysis, high Lp(a) levels (≥30 mg/dL) were associated with degeneration both in a univariable analysis (HR 3.6, 95% CI 1.7 to 7.6, p=0.001) and multivariable analysis adjusted by other risk factors for bioprostheses degeneration (HR 4.4, 95% CI 1.9 to 10.4, p=0.001). CONCLUSIONS High serum Lp(a) is associated with bAV degeneration. Prospective studies are needed to confirm these findings and to investigate whether lowering Lp(a) levels could slow bioprostheses degradation.
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Affiliation(s)
- Juan M Farina
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Milagros Pereyra
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Michael Roarke
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Ebram F Said
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Timothy Barry
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Said Alsidawi
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Kristen Sell-Dottin
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - John P Sweeney
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - David F Fortuin
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Chadi Ayoub
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Steven J Lester
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
| | - Francois Marcotte
- Department of Cardiovascular Medicine, Mayo Clinic Arizona, Scottsdale, Arizona, USA
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Tsampasian V, Merinopoulos I, Ravindrarajah T, Ring L, Heng EL, Prasad S, Vassiliou VS. Prognostic Value of Cardiac Magnetic Resonance Feature Tracking Strain in Aortic Stenosis. J Cardiovasc Dev Dis 2024; 11:30. [PMID: 38276656 PMCID: PMC10816900 DOI: 10.3390/jcdd11010030] [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: 12/21/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Recent data have suggested that global longitudinal strain (GLS) could be useful for risk stratification of patients with severe aortic stenosis (AS). In this study, we aimed to investigate the prognostic role of GLS in patients with AS and also its incremental value in relation to left ventricular ejection fraction (LVEF) and late gadolinium enhancement (LGE). METHODS We analysed all consecutive patients with AS and LGE-CMR in our institution. Survival data were obtained from office of national statistics, a national body where all deaths in England are registered by law. Death certificates were obtained from the general register office. RESULTS Some 194 consecutive patients with aortic stenosis were investigated with CMR at baseline and followed up for 7.3 ± 4 years. On multivariate Cox regression analysis, only increasing age remained significant for both all-cause and cardiac mortality, while LGE (any pattern) retained significance for all-cause mortality and had a trend to significance for cardiac mortality. Kaplan-Meier survival analysis demonstrated that patients in the best and middle GLS tertiles had significantly better mortality compared to patients in the worst GLS tertiles. Importantly though, sequential Cox proportional-hazard analysis demonstrated that GLS did not have significant incremental prognostic value for all-cause mortality or cardiac mortality in addition to LVEF and LGE. CONCLUSIONS Our study has demonstrated that age and LGE but not GLS are significant poor prognostic indicators in patients with moderate and severe AS.
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Affiliation(s)
- Vasiliki Tsampasian
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK; (I.M.); (T.R.)
- Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7UG, UK
| | - Ioannis Merinopoulos
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK; (I.M.); (T.R.)
| | - Thuwarahan Ravindrarajah
- Department of Cardiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK; (I.M.); (T.R.)
| | - Liam Ring
- Department of Cardiology, West Suffolk Hospital, Hardwick Ln, Bury Saint Edmunds IP33 2QZ, UK;
| | - Ee Ling Heng
- Royal Brompton Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Sydney Street, London SW3 6NP, UK;
| | - Sanjay Prasad
- Faculty of Medicine, Imperial College London, London SW7 5NH, UK;
| | - Vassilios S. Vassiliou
- Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich Research Park, Norwich NR4 7UG, UK
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Chang WT, Lin CH, Lee WC, Kan WC, Lin YC, Hiremath P, Cheng S, Liao R, Chen ZC, Huang PS, Wu NC. Signal intensity coefficient as a detector of aortic stenosis-induced myocardial fibrosis and its correlation to the long term outcome. Int J Cardiol 2024; 394:131367. [PMID: 37726056 DOI: 10.1016/j.ijcard.2023.131367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/26/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Despite advanced aortic valve replacement techniques, aortic stenosis (AS)-induced irreversible myocardial fibrosis contributes to poorer outcomes. Therefore, in addition to early diagnosis of AS, detecting myocardial fibrosis is crucial for physicians to determine the timing of surgery. The Signal Intensity Coefficient (SIC) was used to detect subtle myocardial deformation. Hence, we aimed to investigate whether SIC correlated with myocardial dysfunction and fibrosis from both clinical and preclinical perspectives. METHODS We collected medical records and echocardiography images, including the SIC of patients who underwent surgical aortic valve replacement (AVR) for AS from 2010 to 2015. The endpoint of the study was mortality. Median follow-up period was 80 months. RESULTS Among 109 patients, 15 died due to cardiovascular causes. Although SIC decreased in all patients post-AVR, patients with an SIC ≥0.34 before surgeries presented with a higher probability of cardiovascular death. In contrast, changes in the left ventricular (LV) ejection fraction, LV mass index, and LV volume failed to predict outcomes. Similarly, SIC was obtained in mice undergoing aortic banding and debanding surgery for comparison with the degree of myocardial fibrosis. SIC was continuously elevated after aortic banding and declined gradually after debanding surgery in mice. Debanding surgery indicated the regression of aortic banding-induced myocardial fibrosis. CONCLUSION Pre-AVR SIC was associated with the risk of cardiovascular death and reflected the degree of myocardial fibrosis. Further investigations are required to study the clinical application of SIC in patients with AS.
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Affiliation(s)
- Wei-Ting Chang
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Chih-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Wei-Chieh Lee
- School of Medicine and Doctoral Program of Clinical and Experimental Medicine, College of Medicine and Center of Excellence for Metabolic Associated Fatty Liver Disease, National Sun Yat-Sen University, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Wei-Chih Kan
- Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - You-Cheng Lin
- Division of Plastic Surgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
| | | | - Susan Cheng
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ronglih Liao
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, MA, USA
| | - Zhih-Cherng Chen
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Po-Sen Huang
- Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
| | - Nan-Chun Wu
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
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19
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Todurov M, Zelenchuk O, Stan M, Khokhlov A, Sudakevych S, Ponych N, Marunyak S. Comparative analysis of early postoperative results of transcatheter aortic valve implantation and surgical aortic valve replacement with a biological prosthesis. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2024; 52:10-16. [PMID: 38518227 DOI: 10.36740/merkur202401102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE . Aim: The choice of aortic valve stenosis correction method is determined by a number of clinical and technical parameters. The task was to compare early postoperative outcomes in patients after correction of aortic valve stenosis using TAVI and surgical aortic valve replacement with a biological prosthesis. PATIENTS AND METHODS Materials and Methods: This retrospective study analyzed the medical records of adult patients (18 years of age and older) who had transcatheter aortic valve implantation or surgical aortic valve replacement with a biological prosthesis at the State Institution "Heart Institute of the Ministry of Health" in the period from 2018 to 2022. RESULTS Results: In 47 (47.5%) cases, TAVI was performed and in 52 (52.5%) cases, SAVR with a biological prosthesis was performed. Patients who underwent TAVI were significantly older (p=0.002) and had a higher EuroSCORE II operative risk score (p<0.001). In patients with TAVI, larger diameter aortic valve prostheses were significantly more often used compared with the SAVR group with biological prosthesis (27.5±2.74 vs. 22.5±1.84, p<0.001). The early postoperative period in patients with TAVI was characterized by an 11.4% (p=0.046) and 15.4% (p=0.006). The length of stay in the ICU (p=0.024), as well as the duration of hospitalization in general (p=0.005), was also significantly lower in patients with TAVI compared with patients with biological prosthesis SAVR. CONCLUSION Conclusions: Despite the higher surgical risk of surgery according to EuroSCORE II, TAVI was characterized by a lower incidence of postoperative complications, with shorter duration of stay in ICU and hospitalization in general in comparison with patients undergoing SAVR with a biological prosthesis.
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Affiliation(s)
- Mykhailo Todurov
- SHUPYK NATIONAL UNIVERSITY OF HEALTH CARE OF UKRAINE, KYIV, UKRAINE
| | - Oleh Zelenchuk
- SHUPYK NATIONAL UNIVERSITY OF HEALTH CARE OF UKRAINE, KYIV, UKRAINE, STATE INSTITUTION "HEART INSTITUTE MINISTRY OF HEALTH OF UKRAINE", KYIV, UKRAINE
| | - Mykola Stan
- SHUPYK NATIONAL UNIVERSITY OF HEALTH CARE OF UKRAINE, KYIV, UKRAINE, STATE INSTITUTION "HEART INSTITUTE MINISTRY OF HEALTH OF UKRAINE", KYIV, UKRAINE
| | - Andrii Khokhlov
- SHUPYK NATIONAL UNIVERSITY OF HEALTH CARE OF UKRAINE, KYIV, UKRAINE, STATE INSTITUTION "HEART INSTITUTE MINISTRY OF HEALTH OF UKRAINE", KYIV, UKRAINE
| | - Serhii Sudakevych
- SHUPYK NATIONAL UNIVERSITY OF HEALTH CARE OF UKRAINE, KYIV, UKRAINE, STATE INSTITUTION "HEART INSTITUTE MINISTRY OF HEALTH OF UKRAINE", KYIV, UKRAINE
| | - Nataliia Ponych
- SHUPYK NATIONAL UNIVERSITY OF HEALTH CARE OF UKRAINE, KYIV, UKRAINE, STATE INSTITUTION "HEART INSTITUTE MINISTRY OF HEALTH OF UKRAINE", KYIV, UKRAINE
| | - Stepan Marunyak
- SHUPYK NATIONAL UNIVERSITY OF HEALTH CARE OF UKRAINE, KYIV, UKRAINE, STATE INSTITUTION "HEART INSTITUTE MINISTRY OF HEALTH OF UKRAINE", KYIV, UKRAINE
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20
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Yang Y, Chen J, Dong L, Lu Y, Lv M, Guo K, Bagaber G, Yang J, Wang C, Wei L. Transcatheter mitral valve replacement with Mi-thos system: First-in-human experience. Catheter Cardiovasc Interv 2024; 103:153-159. [PMID: 38071423 DOI: 10.1002/ccd.30926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/12/2023] [Accepted: 11/23/2023] [Indexed: 01/04/2024]
Abstract
BACKGROUND Transcatheter mitral valve replacement (TMVR) has become an alternative for high-risk patients with severe mitral regurgitation (MR). The aim of this study was to evaluate the safety and feasibility of the Mi-thos TMVR system (NewMed Medical) for high-risk patients with severe MR. METHODS This was a prospective, two-center, single-arm early feasibility study. Baseline characteristics, procedural data and 30-day follow-up outcomes were collected and analyzed. The primary endpoint was intraoperative success rate of device implantation. The second endpoints were all-cause mortality and major post-procedural complications. Echocardiographic data were evaluated by an independent core laboratory. Clinical events were adjudicated by a clinical events committee. RESULTS Ten high-risk patients with severe MR were enrolled at two sites from August 2021 to November 2022. The median age was 70.5 years, and 60% of patients were female. The median Society of Thoracic Surgeons Predicted Risk of Mortality was 9.5%. The Mi-thos TMVR system was successfully implanted via transapical access in all patients. There was no pericedural mortality or major postpericedural complications during the 30-day follow-up. All implanted prosthetic valves had no or trace valvular or paravalvular MR, and the median mitral valve gradient at 30 days was 2.0 mmHg (IQR: 2.0-3.0 mmHg). There was one mild left ventricular outflow tract obstruction. CONCLUSIONS The favorable short-term outcomes of the Mi-thos TMVR system demonstrated that it might be a feasible and safe therapeutic alternative for high-risk patients with severe MR. Nevertheless, further evaluation of the Mi-thos TMVR system is warranted.
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Affiliation(s)
- Ye Yang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jinmiao Chen
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lili Dong
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuntao Lu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kefang Guo
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lai Wei
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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21
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Braghieri L, Kaur S, Black CK, Cremer PC, Unai S, Kapadia SR, Mentias A. Endocarditis after Transcatheter Aortic Valve Replacement. J Clin Med 2023; 12:7042. [PMID: 38002656 PMCID: PMC10672470 DOI: 10.3390/jcm12227042] [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: 09/11/2023] [Revised: 10/07/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) use is gaining momentum as the mainstay for the treatment of aortic stenosis compared to surgical aortic valve replacement (SAVR). Unfortunately, TAVR-related infective endocarditis (TAVR-IE) is expected to be detected more and more as a result of the ever-expanding indications in younger patients. Given the overall poor prognosis of TAVR-IE, it is imperative that clinicians familiarize themselves with common presentations, major risk factors, diagnostic pitfalls, therapeutic approaches, and the prevention of TAVR-IE. Herein, we review all of the above in detail with the most updated available literature.
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Affiliation(s)
- Lorenzo Braghieri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (L.B.); (C.K.B.)
| | - Simrat Kaur
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Christopher K. Black
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (L.B.); (C.K.B.)
| | - Paul C. Cremer
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Shinya Unai
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Samir R. Kapadia
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
| | - Amgad Mentias
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; (S.K.); (P.C.C.); (S.U.); (S.R.K.)
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22
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Wen S, Naqvi TZ. Point-of-Care Ultrasound in Detection, Severity and Mechanism of Significant Valvular Heart Disease and Clinical Management. J Clin Med 2023; 12:6474. [PMID: 37892613 PMCID: PMC10607262 DOI: 10.3390/jcm12206474] [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: 08/26/2023] [Revised: 09/15/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Early diagnosis of significant valvular heart disease (VHD) enables appropriate implementation of the best therapeutic strategy and follow-up. Cardiac auscultation remains suboptimal in early detection of VHD. The aim of this study was to evaluate the utility of point-of-care ultrasound (POCUS) for early detection of VHD and its severity. METHODS All consecutive patients with VHD who did not have a standard echocardiogram prior to first outpatient cardiology consultation underwent history and physical examination followed by POCUS study by an experienced physician in a general cardiology clinic from June 2017 to August 2022 at our institution. Subsequent standard transthoracic echocardiography (sTTE) was performed as the gold standard. Comparison was performed between POCUS and sTTE for the presence and severity of VHD. sTTE was performed by registered cardiac sonographers and interpreted by another cardiologist blinded to the POCUS results. RESULTS A total of 77 patients were studied (ge 72 ± 11 years, 58.4% males). A total of 89 significant valvular abnormalities were diagnosed. There were 39 (43.8%) cases of regurgitant VHD, 16 (18.0%) of stenotic VHD and 34 (38.2%) had evaluation for prosthetic valve function. The sensitivity (90.9%; 82.4%; 83.3%; 100%) and specificity (100%; 96.7%; 100%; 100%) were high for detecting ≥ moderate aortic regurgitation (AR), mitral regurgitation (MR), aortic stenosis (AS) and prosthetic valvular abnormality, respectively. The weighted κ coefficient between POCUS and sTTE for the assessment of ≥ moderate MR, AR and AS was 0.81 (95% CI, 0.65-0.97), 0.94 (95% CI, 0.84-1.00) and 0.88 (95% CI, 0.76-1.0), respectively, indicating excellent agreement. CONCLUSIONS POCUS can identify patients with significant VHD and may serve as a powerful screening tool for early detection of significant VHD in the outpatient clinical practice with downstream impact on clinical management of significant VHD.
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Affiliation(s)
| | - Tasneem Z. Naqvi
- Department of Cardiovascular Medicine, Division of Echocardiography, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA;
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Arrieta V, Jover E, Navarro A, Martín-Núñez E, Garaikoetxea M, Matilla L, García-Peña A, Fernández-Celis A, Gainza A, Álvarez V, Sádaba R, López-Andrés N. Soluble ST2 levels are related to replacement myocardial fibrosis in severe aortic stenosis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:679-689. [PMID: 36565751 DOI: 10.1016/j.rec.2022.12.007] [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: 07/05/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES Patients with aortic stenosis (AS) exhibit left ventricular (LV) remodeling and replacement myocardial fibrosis (RMF). Whether sST2 is associated with RMF measured by cardiac magnetic resonance and with sex remains unknown. METHODS We recruited 79 consecutive patients (73.0 [68.0-78.0] years; 61% men) with severe isolated AS underdoing valve replacement. RMF was identified and quantified by late gadolinium enhancement (LGE). Serum sST2 levels were determined. RESULTS RMF was associated with higher circulating sST2 levels, LV hypertrophy and dilation, and lower LV ejection fraction. All patients with LV dysfunction had RMF. Circulating levels of sST2 ≥ 28.8 ng/mL were associated with RMF and greater LV hypertrophy. LGE mass was correlated with LV remodeling and sST2. Of note, sST2 levels were also associated with the RMF pattern, being higher in midwall than in subendocardial fibrosis. Multivariate analyses showed that only LV ejection fraction and sST2 levels were associated with RMF. Moreover, men had higher levels of sST2 and RMF. RMF was associated with higher LV dilation and hypertrophy only in men and was correlated with LGE mass. CONCLUSIONS SST2 was an independent factor for RMF in patients with severe isolated AS. The presence of RMF was predicted by sST2 ≥ 28.2 ng/mL, and was associated with greater LV hypertrophy. sST2 expression and clinical associations may be sex-specific.
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Affiliation(s)
- Vanessa Arrieta
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Eva Jover
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Adela Navarro
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Ernesto Martín-Núñez
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Mattie Garaikoetxea
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Lara Matilla
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Amaia García-Peña
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Amaya Fernández-Celis
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Alicia Gainza
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Virginia Álvarez
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Rafael Sádaba
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Natalia López-Andrés
- Cardiovascular Translational Research, Navarrabiomed, Hospital Universitario de Navarra (HUN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.
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24
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Adere A, Bedru M, Afework M. Etiologies and Patterns of Valvular Heart Disease Among Cardiac Patients at the Cardiac Center of Ethiopia During February 2000 to April 2022. Int J Gen Med 2023; 16:2849-2856. [PMID: 37426520 PMCID: PMC10329463 DOI: 10.2147/ijgm.s420591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/23/2023] [Indexed: 07/11/2023] Open
Abstract
Background The leading global contributor to cardiovascular morbidity and mortality is valvular heart disease. It is on the rise worldwide, including in the developing countries. However, the prevalence, patterns, and etiologies of valvular heart disease have not been well studied in Ethiopia. Hence, the purpose of this study was to evaluate the prevalence, patterns, and etiologies of valvular heart disease at the Cardiac Center of Ethiopia from February 2000 to April 2022. Methods This institution-based retrospective cross-sectional study was conducted between February 2000 and April 2022. Data from three thousand two hundred fifty-seven VHD were extracted from the electronic medical records and analyzed using SPSS version 25. Descriptive statistics, such as the frequency, mean ± standard deviation, and cross tabulations, were used to summarize the data. Results Of 10,588 total cardiac cases registered and treated at the Cardiac Centre of Ethiopia from February 2000 to April 2022, 30.8% (3257) were diagnosed with VHD. The most typical diagnosis for VHD was multi-valvular involvement, which accounted for 49.5% of cases (1612), followed by pulmonary stenosis (15%) and mitral regurgitation (14.3%). Females were more likely to develop valve diseases than males, being at the highest risk for each identified etiology of valve disease 1928 (59.2%). The majority percentages of the population affected by VHD were between 18 and 44 age category 1473 (45.2%). The most common etiology of VHD was rheumatic 2015 (61.87%), followed by congenital origin 828 (25.42%). Conclusion VHD affects nearly one-third of all cardiac cases admitted to the hospital. Multi-valvular involvement is the most commonly diagnosed form of VHD. Rheumatic causes were more prevalent in this study. As found in this study, VHD affects a significant percentage of the population, which in turn could have an impact on the country's economy and deserve attention as a possible means of intervention.
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Affiliation(s)
- Ashete Adere
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mohammed Bedru
- Department of Adult Cardiology, Cardiac Center of Ethiopia, Addis Ababa, Ethiopia
| | - Mekbeb Afework
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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25
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Rogers JH, Asch F, Sorajja P, Mahoney P, Price MJ, Maisano F, Denti P, Morse MA, Rinaldi M, Bedogni F, De Marco F, Rollefson W, Chehab B, Williams MR, Leurent G, Morikawa T, Asgar AW, Rodriguez E, von Bardeleben RS, Kar S. Expanding the Spectrum of TEER Suitability: Evidence From the EXPAND G4 Post Approval Study. JACC Cardiovasc Interv 2023; 16:1474-1485. [PMID: 37380229 DOI: 10.1016/j.jcin.2023.05.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Anatomical and clinical criteria to define mitral transcatheter edge-to-edge repair (TEER) "unsuitability" have been proposed on the basis of a Heart Valve Collaboratory consensus opinion from physician experience with early-generation TEER devices but lacked an evidence-based approach. OBJECTIVES The aim of this study was to explore the spectrum of TEER suitability using echocardiographic and clinical outcomes from the EXPAND G4 real-world postapproval study. METHODS EXPAND G4 is a global, prospective, multicenter, single-arm study that enrolled 1,164 subjects with mitral regurgitation (MR) treated with the MitraClip G4 System. Three groups were defined using the Heart Valve Collaboratory TEER unsuitability criteria: 1) risk of stenosis (RoS); 2) risk of inadequate MR reduction (RoIR); and 3) subjects with baseline moderate or less MR (MMR). A TEER-suitable (TS) group was defined by the absence of these characteristics. Endpoints included independent core laboratory-assessed echocardiographic characteristics, procedural outcomes, MR reduction, NYHA functional class, Kansas City Cardiomyopathy Questionnaire score, and major adverse events through 30 days. RESULTS Subjects in the RoS (n = 56), RoIR (n = 54), MMR (n = 326), and TS (n = 303) groups had high 30-day MR reduction rates (≤1+: RoS 97%, MMR 93%, and TS 91%; ≤2+: RoIR 94%). Thirty-day improvements in functional capacity (NYHA functional class I or II at 30 days vs baseline: RoS 94% vs 29%, RoIR 88% vs 30%, MMR 79% vs 26%, and TS 83% vs 33%) and quality of life (change in Kansas City Cardiomyopathy Questionnaire score: RoS +27 ± 26, RoIR +16 ± 26, MMR +19 ± 26, and TS +19 ± 24) were safely achieved in all groups, with low major adverse events (<3%) and all-cause mortality (RoS 1.8%, RoIR 0%, MMR 1.5%, and TS 1.3%). CONCLUSIONS Patients previously deemed TEER unsuitable can be safely and effectively treated with the mitral TEER fourth-generation device.
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Affiliation(s)
- Jason H Rogers
- University of California Davis Medical Center, Sacramento, California, USA.
| | - Federico Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Paul Sorajja
- Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Paul Mahoney
- Sentara Heart and Valve and Structural Disease Center, Norfolk, Virginia, USA
| | | | | | - Paolo Denti
- San Raffaele University Hospital, Milan, Italy
| | | | | | | | | | | | - Bassem Chehab
- Ascension Via Christi Hospital, University of Kansas, Wichita, Kansas, USA
| | | | | | - Takao Morikawa
- The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Anita W Asgar
- Institut de Cardiologie de Montréal, Montreal, Quebec, Canada
| | | | | | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA
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Nucera M, Miazza J, Praz F, Kaiser C, Siepe M, Reineke D, Reuthebuch O. Transapical Transcatheter Mitral Valve Implantation with the Tendyne Valve: The Swiss Experience. Thorac Cardiovasc Surg 2023. [PMID: 37327913 DOI: 10.1055/s-0043-1769099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND The aim of this study was to report outcomes of all patients undergoing transcatheter mitral valve implantation with the Tendyne Mitral Valve System (Tendyne) in Switzerland. METHODS We retrospectively analyzed preoperative echocardiographic and computed tomography (CT) data, procedural findings, and 30-day and 1-year follow-up echocardiographic and clinical data of patients who underwent transcatheter mitral valve implantation with Tendyne in Switzerland. RESULTS A total of 24 patients (age, 74.8 ± 7.8 years; 67% male) underwent transapical transcatheter mitral valve implantation with Tendyne between June 2020 and October 2022. Technical success rate was 96%. In five patients, concomitant interventions in the form of transcatheter aortic valve implantation (one patient), minimally invasive direct coronary artery bypass (one patient), and transcatheter edge-to-edge repair (three patients) were performed prior to or after the index procedure. There was one device embolization, and two patients required valve retrieval. In-hospital outcomes included one stroke and three major bleeding events. None of the patients died within 30 days. Two patients were rehospitalized for decompensated heart failure. At 1-year follow-up, there were three noncardiovascular-related deaths. CONCLUSION Transcatheter mitral valve implantation with Tendyne is feasible to treat polymorbid patients suffering from complex mitral valve disease as well as patients with previous mitral interventions. Perioperative risk was acceptable and procedural success high.
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Affiliation(s)
- Maria Nucera
- Department of Cardiac Surgery, Cardiovascular Center, Inselspital University Hospital Bern, Bern, Switzerland
| | - Jules Miazza
- Department of Cardiac Surgery, Universitätsspital Basel, Basel, BS, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Christoph Kaiser
- Department of Cardiology, Universitätsspital Basel, Basel, BS, Switzerland
| | - Matthias Siepe
- Department of Cardiac Surgery, Cardiovascular Center, Inselspital University Hospital Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Cardiovascular Center, Inselspital University Hospital Bern, Bern, Switzerland
| | - Oliver Reuthebuch
- Department of Cardiac Surgery, Universitätsspital Basel, Basel, BS, Switzerland
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Arrotti S, Sgura FA, Monopoli DE, Siena V, Leo G, Morgante V, Cataldo P, Magnavacchi P, Gabbieri D, Guiducci V, Benatti G, Vignali L, Boriani G, Rossi R. The Importance of Mehran Score to Predict Acute Kidney Injury in Patients with TAVI: A Large Multicenter Cohort Study. J Cardiovasc Dev Dis 2023; 10:228. [PMID: 37367393 DOI: 10.3390/jcdd10060228] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/16/2023] [Accepted: 05/20/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has developed as an alternative to surgery for symptomatic high-risk patients with aortic stenosis (AS). An important complication of TAVI is acute kidney injury. The purpose of the study was to investigate if the Mehran Score (MS) could be used to predict acute kidney injury (AKI) in TAVI patients. METHODS This is a multicenter, retrospective, observational study including 1180 patients with severe AS. The MS comprised eight clinical and procedural variables: hypotension, congestive heart failure class, glomerular filtration rate, diabetes, age >75 years, anemia, need for intra-aortic balloon pump, and contrast agent volume use. We assessed the sensitivity and specificity of the MS in predicting AKI following TAVI, as well as the predictive value of MS with each AKI-related characteristic. RESULTS Patients were categorized into four risk groups based on MS: low (≤5), moderate (6-10), high (11-15), and very high (≥16). Post-procedural AKI was observed in 139 patients (11.8%). MS classes had a higher risk of AKI in the multivariate analysis (HR 1.38, 95% CI, 1.43-1.63, p < 0.01). The best cutoff for MS to predict the onset of AKI was 13.0 (AUC, 0.62; 95% CI, 0.57-0.67), whereas the best cutoff for eGFR was 42.0 mL/min/1.73 m2 (AUC, 0.61; 95% CI, 0.56-0.67). CONCLUSIONS MS was shown to be a predictor of AKI development in TAVI patients.
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Affiliation(s)
- Salvatore Arrotti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Fabio Alfredo Sgura
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Daniel Enrique Monopoli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Valerio Siena
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Giulio Leo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Vernizia Morgante
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Paolo Cataldo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | | | - Davide Gabbieri
- Cardiac Surgery Division, Hesperia Hospital, 41125 Modena, Italy
| | - Vincenzo Guiducci
- Division of Cardiology, AUSL-IRCCS Reggio Emilia, 42121 Reggio Emilia, Italy
| | - Giorgio Benatti
- Cardiology Division, Parma University Hospital, 44129 Parma, Italy
| | - Luigi Vignali
- Cardiology Division, Parma University Hospital, 44129 Parma, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
| | - Rosario Rossi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy
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Wal P, Rathore S, Aziz N, Singh YK, Gupta A. Aortic stenosis: a review on acquired pathogenesis and ominous combination with diabetes mellitus. Egypt Heart J 2023; 75:26. [PMID: 37027109 PMCID: PMC10082141 DOI: 10.1186/s43044-023-00345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/08/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Aortic stenosis (AS) is a progressive disease, with no pharmacological treatment. The prevalence of diabetes mellitus (DM) among AS patients is higher than in the general population. DM significantly increases the risk of AS development and progression from mild to severe. The interplay between AS and DM's mechanism is not entirely known yet. MAIN BODY The increased accumulation of advanced glycation end products (AGEs) was linked to increased valvular oxidative stress, inflammation, expression of coagulation factors, and signs of calcification, according to an analysis of aortic stenotic valves. It is interesting to note that in diabetic AS patients, valvular inflammation did not correlate with serum glucose levels but rather only with long-term glycemic management markers like glycated haemoglobin and fructosamine. Transcatheter aortic valve replacement, which has been shown to be safer than surgical aortic valve replacement, is advantageous for AS patients who also have concurrent diabetes. Additionally, novel anti-diabetic medications have been proposed to lower the risk of AS development in DM patients, including sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonist that target reduction of AGEs-mediated oxidative stress. CONCLUSIONS There are little data on the effects of hyperglycemia on valvular calcification, but understanding the interactions between them is essential to develop a successful treatment strategy to stop or at least slow the progression of AS in DM patients. There is a link among AS and DM and that DM negatively impacts the quality of life and longevity of AS patients. The sole successful treatment, despite ongoing efforts to find new therapeutic modalities, involves aortic valve replacement. More research is required to find methods that can slow the advancement of these conditions, enhancing the prognosis and course of people with AS and DM.
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Affiliation(s)
- Pranay Wal
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India.
| | - Shruti Rathore
- LCIT School of Pharmacy, Bilaspur, Chhattisgarh, 495220, India
| | - Namra Aziz
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India
| | - Yash Kumar Singh
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India
| | - Arpit Gupta
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India
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Guo R, Fan C, Sun Z, Zhang H, Sun Y, Song L, Jiang Z, Liu L. Clinical efficacy and safety of Cox-maze IV procedure for atrial fibrillation in patients with aortic valve calcification. Front Cardiovasc Med 2023; 10:1092068. [PMID: 37077739 PMCID: PMC10106572 DOI: 10.3389/fcvm.2023.1092068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
ObjectiveAtrial fibrillation is associated with a high incidence of heart valve disease. There are few prospective clinical research comparing aortic valve replacement with and without surgical ablation for safety and effectiveness. The purpose of this study was to compare the results of aortic valve replacement with and without the Cox-maze IV procedure in patients with calcific aortic valvular disease and atrial fibrillation.MethodsWe analyzed one hundred and eight patients with calcific aortic valve disease and atrial fibrillation who underwent aortic valve replacement. Patients were divided into concomitant Cox maze surgery (Cox-maze group) and no concomitant Cox-maze operation (no Cox-maze group). After surgery, freedom from atrial fibrillation recurrence and all-cause mortality were evaluated.ResultsFreedom from all-cause mortality after aortic valve replacement at 1 year was 100% in the Cox-maze group and 89%, respectively, in the no Cox-maze group. No Cox-maze group had a lower rate of freedom from atrial fibrillation recurrence and arrhythmia control than those in the Cox-maze group (P = 0.003 and P = 0.012, respectively). Pre-operatively higher systolic blood pressure (hazard ratio, 1.096; 95% CI, 1.004–1.196; P = 0.04) and post-operatively increased right atrium diameters (hazard ratio, 1.755; 95% CI, 1.182–2.604; P = 0.005) were associated with atrial fibrillation recurrence.ConclusionThe Cox-maze IV surgery combined with aortic valve replacement increased mid-term survival and decreased mid-term atrial fibrillation recurrence in patients with calcific aortic valve disease and atrial fibrillation. Pre-operatively higher systolic blood pressure and post-operatively increased right atrium diameters are associated with the prediction of recurrence of atrial fibrillation.
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30
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Galloo X, Bax JJ. The importance of big databases in understanding valvular heart disease. Eur Heart J Cardiovasc Imaging 2023; 24:424-425. [PMID: 36464940 DOI: 10.1093/ehjci/jeac244] [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: 12/12/2022] Open
Affiliation(s)
- Xavier Galloo
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2330 RC Leiden, The Netherlands
- Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2330 RC Leiden, The Netherlands
- Heart Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
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31
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Poulis N, Breitenstein P, Hofstede S, Hoerstrup SP, Emmert MY, Fioretta ES. Multiscale analysis of human tissue engineered matrices for next generation heart valve applications. Acta Biomater 2023; 158:101-114. [PMID: 36638939 DOI: 10.1016/j.actbio.2023.01.007] [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: 08/02/2022] [Revised: 12/15/2022] [Accepted: 01/03/2023] [Indexed: 01/12/2023]
Abstract
Human tissue-engineered matrices (hTEMs) have been proposed as a promising approach for in situ tissue engineered heart valves (TEHVs). However, there is still a limited understanding on how ECM composition in hTEMs develops over tissue culture time. Therefore, we performed a longitudinal hTEM assessment by 1) multiscale evaluation of hTEM composition during culture time (2, 4, 6-weeks), using (immuno)histology, biochemical assays, and mass spectrometry (LC-MS/MS); 2) analysis of protein pathways involved in ECM development using gene set enrichment analysis (GSEA); and 3) assessment of hTEM mechanical characterization using uniaxial tensile testing. Finally, as a proof-of-concept, TEHVs manufactured using 6-weeks hTEM samples were tested in a pulse duplicator. LC-MS/MS confirmed the tissue culture time-dependent increase in ECM proteins observed in histology and biochemical assays, revealing the most abundant collagens (COL6, COL12), proteoglycans (HSPG2, VCAN), and glycoproteins (FN, TNC). GSEA identified the most represented protein pathways in the hTEM at 2-weeks (mRNA metabolic processes), 4-weeks (ECM production), and 6-weeks (ECM organization and maturation). Uniaxial mechanical testing showed increased stiffness and stress at failure, and reduction in strain over tissue culture time. hTEM-based TEHVs demonstrated promising in vitro performance at both pulmonary and aortic pressure conditions, with symmetric leaflet coaptation and no stenosis. In conclusion, ECM protein abundance and maturation increased over tissue culture time, with consequent improvement of hTEM mechanical characteristics. These findings suggest that longer tissue culture impacts tissue organization, leading to an hTEM that may be suitable for high-pressure applications. STATEMENT OF SIGNIFICANCE: It is believed that the composition of the extracellular matrix (ECM) in the human tissue engineered matrices (hTEM) may favor tissue engineered heart valve (TEHV) remodeling upon implantation. However, the exact protein composition of the hTEM, and how this impacts tissue mechanical properties, remains unclear. Hence, we developed a reproducible rotation-based tissue culture method to produce hTEM samples. We performed a longitudinal assessment using different analytical techniques and mass spectrometry. Our data provided an in-depth characterization of the hTEM proteome with focus on ECM components, their development, and how they may impact the mechanical properties. Based on these results, we manufactured functional hTEM-based TEHVs at aortic-like condition in vitro. These outcomes pose an important step in translating hTEM-based TEHVs into clinics and in predicting their remodeling potential upon implantation.
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Affiliation(s)
- N Poulis
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - P Breitenstein
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - S Hofstede
- Laboratory for Orthopaedic Biomechanics, Institute for Biomechanics, ETH Zurich, Lengghalde 5, 8008 Zurich, Switzerland
| | - S P Hoerstrup
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland; Wyss Zurich, University and ETH Zurich, Zurich, Switzerland
| | - M Y Emmert
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland; Wyss Zurich, University and ETH Zurich, Zurich, Switzerland; Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany.
| | - E S Fioretta
- Institute for Regenerative Medicine (IREM), University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
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A parametric geometry model of the aortic valve for subject-specific blood flow simulations using a resistive approach. Biomech Model Mechanobiol 2023; 22:987-1002. [PMID: 36853513 PMCID: PMC10167200 DOI: 10.1007/s10237-023-01695-5] [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: 07/19/2022] [Accepted: 01/22/2023] [Indexed: 03/01/2023]
Abstract
Cardiac valves simulation is one of the most complex tasks in cardiovascular modeling. Fluid-structure interaction is not only highly computationally demanding but also requires knowledge of the mechanical properties of the tissue. Therefore, an alternative is to include valves as resistive flow obstacles, prescribing the geometry (and its possible changes) in a simple way, but, at the same time, with a geometry complex enough to reproduce both healthy and pathological configurations. In this work, we present a generalized parametric model of the aortic valve to obtain patient-specific geometries that can be included into blood flow simulations using a resistive immersed implicit surface (RIIS) approach. Numerical tests are presented for geometry generation and flow simulations in aortic stenosis patients whose parameters are extracted from ECG-gated CT images.
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Kong Y, Liu J, Jiang H, Song L, Kong D, Wang Z, Leng X. Immunogenicity assessment of swim bladder-derived biomaterials. Biomater Sci 2023; 11:2738-2749. [PMID: 36807688 DOI: 10.1039/d2bm01419j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Fish swim bladder-derived biomaterials are prospective cardiovascular materials due to anti-calcification, adequate mechanical properties, and good biocompatibility. However, their immunogenic safety profile, which primarily determines their feasibility as medical devices in clinical practice, remains unknown. Herein, the immunogenicity of glutaraldehyde crosslinked fish swim bladder (Bladder-GA) and un-crosslinked swim bladder (Bladder-UN) samples was examined using in vitro and in vivo assays according to ISO 10993-20. The in vitro splenocyte proliferation assay showed that cell growth was lower in the extract medium of Bladder-UN and Bladder-GA, compared to the LPS-or Con A-treated group. Similar results were obtained in in vivo assays. In the subcutaneous implantation model, the thymus coefficient, spleen coefficient and ratio of immune cell subtypes showed no significant difference between the bladder groups and the sham group. In terms of the humoral immune response, the total IgM concentration was lower in the Bladder-GA and Bladder-UN groups (988 ± 238 μg ml-1 and 1095 ± 296 μg ml-1, respectively) than that in the sham group (1329 ± 132 μg ml-1) at 7 days. The total IgG concentrations were 422 ± 78 μg ml-1 in Bladder-GA and 469 ± 172 μg ml-1 in Bladder-UN at 30 days, which were slightly higher than that in the sham group (276 ± 95 μg ml-1) but there was no significant difference compared with Bovine-GA (468 ± 172 μg ml-1), indicating that these materials did not elicit a strong humoral immune response. Systemic immune response-related cytokines and C-reactive protein were stable during implantation, while IL-4 levels increased with time. The classical foreign body response was not observed around all the implants, and the ratio of CD163+/iNOS macrophages in Bladder-GA and Bladder-UN was higher than that in the Bovine-GA group at the implanted site at 7 and 30 days. Finally, no organ toxicity was observed in any of the groups. Collectively, the swim bladder-derived material did not elicit significant aberrant immune responses in vivo, giving strong confidence for its application in tissue engineering or medical devices. Furthermore, more dedicated research on immunogenic safety assessment in large animal models is encouraged to facilitate the clinical practice of swim bladder-derived materials.
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Affiliation(s)
- Yuanyuan Kong
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China.
| | - Jing Liu
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China.
| | - Honghui Jiang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China.
| | - Lili Song
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China. .,College of Life Sciences, Tiangong University, Tianjin 300387, China
| | - Deling Kong
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China. .,Key Laboratory of Bioactive Materials of Ministry of Education, State Key Laboratory of Medicinal Chemical Biology, College of Life Science, Nankai University, Tianjin 300071, China
| | - Zhihong Wang
- Tianjin Key Laboratory of Biomaterial Research, Institute of Biomedical Engineering, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300192, China.
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Pereira C, Nogueira F, Cunha Marques J, Ferreira JP, Almeida JS. Endocarditis by Streptococcus pasteurianus. Cureus 2023; 15:e34529. [PMID: 36879704 PMCID: PMC9984912 DOI: 10.7759/cureus.34529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 02/05/2023] Open
Abstract
The diagnosis of infective endocarditis is challenging because it has a variable clinical presentation and nonspecific symptoms and can present in different forms, especially when an unusual etiological agent is involved. We present the case of a female in her 70s admitted to the hospital with a medical history of bicytopenia, severe aortic stenosis, and rheumatoid arthritis. She had several consultations during which she presented with asthenia and general malaise. A septic screen test was performed that would determine that Streptococcus pasteurianus was present in a blood culture (BC), which was not valued. About three months later, she was hospitalized. In the first 24 hours of admission, the septic screen test was repeated and Streptococcus pasteurianus was isolated in BC. Splenic infarctions and transthoracic echocardiography suggested probable endocarditis, which was confirmed with transesophageal echocardiography. She underwent surgical intervention to remove the perivalvular abscess and replace the aortic prosthesis.
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Affiliation(s)
- Catarina Pereira
- Internal Medicine, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - Fernando Nogueira
- Internal Medicine, Centro Hospitalar e Universitário de São João, Porto, PRT
| | - José Cunha Marques
- Internal Medicine, Centro Hospitalar e Universitário de São João, Porto, PRT
| | | | - Jorge S Almeida
- Medicine, Faculdade de Medicina da Universidade do Porto (FMUP), Porto, PRT.,Internal Medicine, Centro Hospitalar Universitário de São João, Porto, PRT
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Teramoto M, Yamagishi K, Cui R, Shirai K, Tamakoshi A, Iso H. Body Mass Index and Mortality from Nonrheumatic Aortic Valve Disease among Japanese Men and Women. J Atheroscler Thromb 2023; 30:150-159. [PMID: 35418541 PMCID: PMC9925207 DOI: 10.5551/jat.63452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
AIM We aimed to examine the impact of overweight and obesity on mortality from nonrheumatic aortic valve disease. METHODS In the Japan Collaborative Cohort Study, we analyzed data of 98,378 participants aged 40-79 years, with no history of coronary heart disease, stroke, or cancer at baseline (1988-1990) and who completed a lifestyle questionnaire including height and body weight; they were followed for mortality until the end of 2009. The Cox proportional hazards model was used to calculate the multivariable hazard ratios (HRs) with 95% confidence intervals (CIs) of nonrheumatic aortic valve disease mortality according to body mass index (BMI) after adjusting for potential confounding factors. RESULTS During the median 19.2 years follow-up, 60 deaths from nonrheumatic aortic valve disease were reported. BMI was positively associated with the risk of mortality from nonrheumatic aortic valve disease; the multivariable HRs (95% CIs) were 0.90 (0.40-2.06) for persons with BMI <21 kg/m2, 1.71 (0.81-3.58) for BMI 23-24.9 kg/m2, 1.65 (0.69-3.94) for BMI 25-26.9 kg/m2, and 2.83 (1.20-6.65) for BMI ≥ 27 kg/m2 (p for trend=0.006), compared with persons with BMI 21-22.9 kg/m2. Similar associations were observed between men and women (p for interaction=0.56). Excluding those who died during the first ten years of follow-up or a competing risk analysis with other causes of death as competing risk events did not change the association materially. CONCLUSIONS Overweight and obesity may be independent risk factors for nonrheumatic aortic valve disease mortality in Asian populations.
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Affiliation(s)
- Masayuki Teramoto
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
| | - Renzhe Cui
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kokoro Shirai
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Akiko Tamakoshi
- Department of Preventive Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan,Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan
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Welker CC, Huang J, Khromava M, Boswell MR, Gil IJN, Ramakrishna H. Analysis of the 2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery Guidelines for the Management of Valvular Heart Disease. J Cardiothorac Vasc Anesth 2023; 37:803-811. [PMID: 36775745 DOI: 10.1053/j.jvca.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Affiliation(s)
- Carson C Welker
- Division of Anesthesia and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Jeffrey Huang
- Division of Critical Care Medicine, Mayo Clinic, Rochester, MN
| | | | | | - Iván J Núñez Gil
- Interventional Cardiology, Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Biomedical Science Faculty, Universidad Europea de Madrid, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Rochester, MN; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Ismayl M, Machanahalli Balakrishna A, Fahmy MM, Thandra A, Gill GS, Niu F, Agarwal H, Aboeata A, Goldsweig AM, Smer A. Impact of sex on in-hospital mortality and 90-day readmissions in patients undergoing transcatheter mitral valve replacement (TMVR): Analysis from the nationwide readmission database. Catheter Cardiovasc Interv 2023; 101:407-416. [PMID: 36617383 DOI: 10.1002/ccd.30549] [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: 02/14/2022] [Revised: 08/13/2022] [Accepted: 12/27/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To evaluate sex differences in in-hospital mortality and 90-day readmission rates among patients undergoing transcatheter mitral valve replacement (TMVR) in the United States of America. BACKGROUND Women have higher rates of mortality and rehospitalization than men following many cardiac procedures. TMVR has grown as an alternative to mitral valve surgery for patients at high surgical risk. The rates of TMVR mortality and rehospitalization by sex are unknown. METHODS We analyzed the Nationwide Readmissions Database (NRD) from 2016 to 2019 to identify hospitalizations for TMVR. Sex differences in in-hospital mortality and 90-day readmissions were determined using logistic regression models. RESULTS Between 2016 and 2019, 4109 hospitalizations for TMVR were identified, comprised of 1758 (42.8%) men and 2351 (57.2%) women. The median age was 74 years for both men and women. There was no significant difference in in-hospital mortality during index hospitalization (6.51% vs. 6.69%; p = 0.852) and all-cause 90-day readmission (28.19% vs. 29.59%; p = 0.563) between men and women. Across the study period, trend analysis did not reveal a significant change in in-hospital mortality (men p = 0.087, women p = 0.194) or 90-day readmission rates (men p = 0.569, women p = 0.454). CONCLUSIONS In patients undergoing TMVR, in-hospital mortality and 90-day readmissions are similar between men and women. Between 2016 and 2019, TMVR in-hospital mortality and 90-day readmission rates remained unchanged. Further research is necessary to confirm these findings.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | | | - Mostafa Mahmoud Fahmy
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Abhishek Thandra
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Gauravpal S Gill
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Fang Niu
- Department of Medicine, Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Himanshu Agarwal
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Ahmed Aboeata
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Andrew M Goldsweig
- Department of Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Aiman Smer
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska, USA
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Albert BJ, Butcher JT. Future prospects in the tissue engineering of heart valves: a focus on the role of stem cells. Expert Opin Biol Ther 2023; 23:553-564. [PMID: 37171790 PMCID: PMC10461076 DOI: 10.1080/14712598.2023.2214313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/11/2023] [Indexed: 05/13/2023]
Abstract
INTRODUCTION Heart valve disease is a growing burden on the healthcare system. Current solutions are insufficient for young patients and do not offer relief from reintervention. Tissue engineered heart valves (TEHVs) offer a solution that grows and responds to the native environment in a similar way to a healthy valve. Stem cells hold potential to populate these valves as a malleable source that can adapt to environmental cues. AREAS COVERED This review covers current methods of recapitulating features of native heart valves with tissue engineering through use of stem cell populations with in situ and in vitro methods. EXPERT OPINION In the field of TEHVs, we see a variety of approaches in cell source, biomaterial, and maturation methods. Choosing appropriate cell populations may be very patient specific; consistency and predictability will be key to long-term success. In situ methods are closer to translation but struggle with consistent cellularization. In vitro culture requires specialized methods but may recapitulate native valve cell populations with higher fidelity. Understanding how cell populations react to valve conditions and immune response is vital for success. Detrimental valve pathologies have proven to be difficult to avoid in early translation attempts.
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Affiliation(s)
- Benjamin J Albert
- Cornell University, Meinig School of Biomedical Engineering, Ithaca, NY, USA
| | - Jonathan T Butcher
- Cornell University, Meinig School of Biomedical Engineering, Ithaca, NY, USA
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Rosillo N, Vicent L, Martín de la Mota Sanz D, Elola FJ, Moreno G, Bueno H. Time trends in the epidemiology of nonrheumatic aortic valve disease in Spain, 2003-2018. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:1020-1028. [PMID: 35662678 DOI: 10.1016/j.rec.2022.06.005] [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: 02/27/2022] [Accepted: 05/19/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES The impact of therapeutic improvements in nonrheumatic aortic valve disease (NRAVD) has been assessed at the patient level but not in the whole population with the disease. Our objective was to assess temporal trends in hospitalization rates, treatment and fatality rates in patients with a main or secondary NRAVD diagnosis. METHODS Retrospective analysis of administrative claims from patients hospitalized with a main or secondary NRAVD diagnosis between 2003 and 2018 in Spain. Time trends in age- and sex-standardized hospitalization and procedure rates, baseline characteristics and case fatality rates by diagnosis type were assessed by Poisson regression and joinpoint analysis. RESULTS Hospital admissions in patients with NRAVD increased from 69 213 in 2003 to 136 185 in 2018. The crude in-hospital fatality rate increased from 6.7% to 8.7% (IRR, 1.015; 95%CI, 1.012-1.018; P <.001) without changes after adjustment. Adjusted fatality rates decreased in patients with a main NRAVD diagnosis (5.5% to 3.5%; IRR, 0.953; 95%CI, 0.942-0.964) but increased in those with a secondary diagnosis (8.0% to 8.8%; IRR, 1.005; 95%CI, 1.002-1.009). Aortic valve replacements increased from 10.5 to 17.1 procedures per 100 000 population (IRR, 1.033; 95%CI, 1.030-1.037), mainly driven by transcatheter procedures (IRR, 1.345; 95%CI, 1.302-1.389). CONCLUSIONS Hospitalizations in patients with NRAVD are increasing, with most being secondary diagnoses. The use of aortic valve replacement is increasing with a reduction in fatality rates but only in patients with a main diagnosis.
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Affiliation(s)
- Nicolás Rosillo
- Servicio de Medicina Preventiva, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Lourdes Vicent
- Servicio de Cardiología, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | | | | | - Guillermo Moreno
- Servicio de Cardiología, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain
| | - Héctor Bueno
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Servicio de Cardiología, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Sibilitz KL, Tang LH, Berg SK, Thygesen LC, Risom SS, Rasmussen TB, Schmid JP, Borregaard B, Hassager C, Køber L, Taylor RS, Zwisler AD. Long-term effects of cardiac rehabilitation after heart valve surgery - results from the randomised CopenHeart VR trial. SCAND CARDIOVASC J 2022; 56:247-255. [PMID: 35811477 DOI: 10.1080/14017431.2022.2095432] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/15/2022] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
Aims. The CopenHeartVR trial found positive effects of cardiac rehabilitation (CR) on physical capacity at 4 months. The long-term effects of CR following valve surgery remains unclear, especially regarding readmission and mortality. Using data from he CopenHeartVR Trial we investigated long-term effects on physical capacity, mental and physical health and effect on mortality and readmission rates as prespecified in the original protocol. Methods. A total of 147 participants were included after heart valve surgery and randomly allocated 1:1 to 12-weeks exercise-based CR including a psycho-educational programme (intervention group) or control. Physical capacity was assessed as peak oxygen uptake (VO2 peak) measured by cardiopulmonary exercise testing, mental and physical health by Short Form-36 questionnaire, Hospital Anxiety and Depression Scale, and HeartQol. Mortality and readmission were obtained from hospital records and registers. Groups were compared using mixed regression model analysis and log rank test. Results. No differences in VO2 peak at 12 months or in self-assessed mental and physical health at 24 months (68% vs 75%, p = .120) was found. However, our data demonstrated reduction in readmissions in the intervention group at intermediate time points; after 3, 6 (43% vs 59%, p = .03), and 12 (53% vs 67%, p = .04) months, respectively, but no significant effect at 24 months. Conclusions. Exercise-based CR after heart valve surgery reduces combined readmissions and mortality up to 12 months despite lack of improvement in exercise capacity, physical and mental health long-term. Exercise-based CR can ensure short-term benefits in terms of physical capacity, and lower readmission within a year, but more research is needed to sustain these effects over a longer time period. These considerations should be included in the management of patients after heart valve surgery.
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Affiliation(s)
- Kirstine L Sibilitz
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Hermann Tang
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care and University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Signe Stelling Risom
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Institute for Nursing and Nutrition, University College Copenhagen, Tagensvej, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Copenhagen, Denmark
| | - Jean-Paul Schmid
- Swiss Cardiovascular Centre Bern, Cardiovascular Prevention and Rehabilitation Unit, University Hospital, Bern, Switzerland
| | - Britt Borregaard
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Rod S Taylor
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute of Health and Well Being, University of Glasgow, Glasgow, UK
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Ann-Dorthe Zwisler
- REHPA - The Danish Knowledge Centre for Rehabilitation and Palliative Care and University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Jain P, Mohammed AN, Fischer C, Aljure O. Current and Investigational Transcatheter Mitral Valve Replacement Systems: A Narrative Review for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2022; 36:4108-4128. [PMID: 35915003 DOI: 10.1053/j.jvca.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/21/2022] [Accepted: 05/13/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Pankaj Jain
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL.
| | - Asif Neil Mohammed
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
| | - Charles Fischer
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
| | - Oscar Aljure
- Department of Anesthesiology University of Miami Miller School of Medicine, Miami, FL
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Yasmin F, Najeeb H, Fareed Siddiqui H, Hamayl Zeeshan M, Mehdi A, Sohaib Asghar M, Shaikh A, Aamir M. Mitral Valve Replacement: A Review of Current Practices and Considerations in Low and High-Risk Patients. Curr Probl Cardiol 2022; 48:101413. [PMID: 36155202 DOI: 10.1016/j.cpcardiol.2022.101413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/08/2022] [Accepted: 09/20/2022] [Indexed: 10/14/2022]
Abstract
Mitral Regurgitation (MR) is the most common form of severe valvular disease occurring in developed countries, being caused either primarily on its own or secondary to cardiac disease. Surgical intervention is required for the correction of MR, which could include the replacement or repair of the affected valve. Transcatheter Mitral Valve Replacement (TMVR) in selected patients is of increasing importance, especially after the success of Transcatheter Aortic Valve Replacement (TAVR). TMVR can be divided into three types i.e., valve-in-valve (ViV) for severe mitral valve disease, valve-in-ring (ViR) for failed surgical repairs, and valve-in-mitral annular calcifications (ViMAC) for mitral valvular disease with severe mitral annular calcifications and poor surgical criteria. The FDA approved Mitral ViV for patients with a high surgical risk in 2017, while ViR and ViMAC are still currently under consideration. The SAPIEN M3 valve is relatively new with a trans-septal system, with a success rate of 86%, and no mortality in a 30-day outcome. The Cardiovalve is a bovine pericardium device that has a dual nitinol frame with a custom surgical design to facilitate TMVR. The AHEAD trial will evaluate whether the device is safe to use in a clinical setting and how effective it is for reducing MR in these patients. The trial consists of 30 patients in which the first 5 patients showed 100% technical success and a reduction of MR. This evolution of modern medicine has assisted in many different countries, including Pakistan where there is a higher prevalence of MR and hence, a greater need to apply TMVR in clinical practice.
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Affiliation(s)
- Farah Yasmin
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hala Najeeb
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hasan Fareed Siddiqui
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Asad Mehdi
- Department of Medicine, Civil Hospital Sukkur, Sukkur, Pakistan
| | | | - Asim Shaikh
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Aamir
- Department of Cardiovascular Medicine, Lehigh Valley Heart and Vascular Institute, Philadelphia, PA, USA
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Hecht S, Butcher SC, Pio SM, Kong WKF, Singh GK, Ng ACT, Perry R, Poh KK, Almeida AG, González A, Shen M, Yeo TC, Shanks M, Popescu BA, Gay LG, Fijałkowski M, Liang M, Tay E, Marsan NA, Selvanayagam J, Pinto F, Zamorano JL, Evangelista A, Delgado V, Bax JJ, Pibarot P. Impact of Left Ventricular Ejection Fraction on Clinical Outcomes in Bicuspid Aortic Valve Disease. J Am Coll Cardiol 2022; 80:1071-1084. [PMID: 36075677 DOI: 10.1016/j.jacc.2022.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/13/2022] [Accepted: 06/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The prognostic impact of left ventricular ejection fraction (LVEF) in patients with bicuspid aortic valve (BAV) disease has not been previously studied. OBJECTIVES The purpose of this study was to determine the prognostic impact of LVEF in BAV patients according to the type of aortic valve dysfunction. METHODS We retrospectively analyzed the data collected in 2,672 patients included in an international registry of patients with BAV. Patients were classified according to the type of aortic valve dysfunction: isolated aortic stenosis (AS) (n = 749), isolated aortic regurgitation (AR) (n = 554), mixed aortic valve disease (MAVD) (n = 190), or no significant aortic valve dysfunction (n = 1,179; excluded from this analysis). The study population was divided according to LVEF strata to investigate its impact on clinical outcomes. RESULTS The risk of all-cause mortality and the composite endpoint of aortic valve replacement or repair (AVR) and all-cause mortality increased when LVEF was <60% in the whole cohort as well as in the AS and AR groups, and when LVEF was <55% in MAVD group. In multivariable analysis, LVEF strata were significantly associated with increased rate of mortality (LVEF 50%-59%: HR: 1.83 [95% CI: 1.09-3.07]; P = 0.022; LVEF 30%-49%: HR: 1.97 [95% CI: 1.13-3.41]; P = 0.016; LVEF <30%: HR: 4.20 [95% CI: 2.01-8.75]; P < 0.001; vs LVEF 60%-70%, reference group). CONCLUSIONS In BAV patients, the risk of adverse clinical outcomes increases significantly when the LVEF is <60%. These findings suggest that LVEF cutoff values proposed in the guidelines to indicate intervention should be raised from 50% to 60% in AS or AR and 55% in MAVD.
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Affiliation(s)
- Sébastien Hecht
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - William K F Kong
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, Brisbane, Queensland, Australia
| | - Rebecca Perry
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Ana G Almeida
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Ariana González
- Department of Cardiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Mylène Shen
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada
| | - Tiong Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Miriam Shanks
- Division of Cardiology, University of Alberta, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr C. C. Iliescu," Bucharest, Romania
| | - Laura Galian Gay
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Marcin Fijałkowski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michael Liang
- Department of Cardiology, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Edgar Tay
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Joseph Selvanayagam
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
| | - Fausto Pinto
- Cardiology Department, Santa Maria University Hospital (CHLN), CAML, CCUL, Lisbon School of Medicine of the Universidade de Lisboa, Lisbon, Portugal
| | - Jose L Zamorano
- Department of Cardiology, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Arturo Evangelista
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec, Quebec, Canada.
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Mutagaywa RK, Vroon JC, Fundikira L, Wind AM, Kunambi P, Manyahi J, Kamuhabwa A, Kwesigabo G, Chamuleau SAJ, Cramer MJ, Chillo P. Infective endocarditis in developing countries: An update. Front Cardiovasc Med 2022; 9:1007118. [PMID: 36172579 PMCID: PMC9510687 DOI: 10.3389/fcvm.2022.1007118] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Despite advances in diagnostic and treatment, morbidity and mortality due to infective endocarditis (IE) has not decreased. There is a discrepancy in epidemiology of IE between developed and developing countries. Over the last years, increased early detection and consequently prevalence of rheumatic heart disease (RHD) and congenital heart disease (CHD) which are considered predisposing conditions for IE, is noted. Here, we present a review of literature on IE in developing countries. Methods We conducted a systematic literature search of IE studies in developing countries through PubMed and Embase. We have divided the studies into two groups: studies published before 2015 (group 1) and studies ≥ 2015 (group 2). The outcome was defined as a difference in epidemiology, microbiology, treatment, and mortality over time. The Scale for Assessment of Narrative Review Articles guidelines was applied. Findings In total, 16 studies were included. The total number of IE cases was 1,098 and 1,505 in groups 1 and 2, respectively. We compared 4/7 cohorts from group 1 (n = 789) with 5/9 cohorts from group 2 (n = 636). Six studies were not included in the comparison because they were interacting between the two cohorts. Males predominated in all studies. Rheumatic heart disease was higher in group 1 than in group 2 (42.3% vs. 30.3%, p < 0.001) while for CHD there was no change (17.6% vs. 16.7%, p = 0.672). Streptococci infections was lower in group 1 than group 2 (26.2% vs. 37.7%, p < 0.001). The proportion of Staphylococcus aureus was 15.3% in group 1 and 23.6% in group 2, p < 0.001. Negative blood culture (NBC) was higher in group 1 than in group 2 (42.2% vs. 34.1%, p = 0.002). Patients in group 1 received more surgery than in group 2 (38.8% vs. 28.8%, p < 0.001). Mortality was similar in the two groups (20.9% vs. 22.3%, p = 0.518). Conclusion This review shows a scarcity of studies on IE in developing countries. Rheumatic heart disease and congenital heart disease are common predisposing conditions. Other risk factors are prosthetic valves, degenerative valve disease (DVD), intravenous drug use, and human immunodeficiency virus infection. While the proportion of IE cases caused by Streptococcus and Staphylococcus has increased, the number of NBC and patients getting surgery has decreased. Mortality has not changed over time. Timely diagnosis and management of patients with RHD and CHD and comprehensive management of IE are warranted.
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Affiliation(s)
- Reuben K. Mutagaywa
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- *Correspondence: Reuben K. Mutagaywa
| | - Josephine C. Vroon
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Lulu Fundikira
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna Maria Wind
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
- Department of Cardiology, Diakonessen Hospital, Utrecht, Netherlands
| | - Peter Kunambi
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joel Manyahi
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Apollinary Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gideon Kwesigabo
- Department of Epidemiology and Biostatistics, School of Public Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Steven A. J. Chamuleau
- Amsterdam UMC Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Maarten J. Cramer
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Pilly Chillo
- Department of Internal Medicine, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Fatehi Hassanabad A, King MA, Di Martino E, Fedak PWM, Garcia J. Clinical implications of the biomechanics of bicuspid aortic valve and bicuspid aortopathy. Front Cardiovasc Med 2022; 9:922353. [PMID: 36035900 PMCID: PMC9411999 DOI: 10.3389/fcvm.2022.922353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 07/25/2022] [Indexed: 11/27/2022] Open
Abstract
Bicuspid aortic valve (BAV), which affects up to 2% of the general population, results from the abnormal fusion of the cusps of the aortic valve. Patients with BAV are at a higher risk for developing aortic dilatation, a condition known as bicuspid aortopathy, which is associated with potentially life-threatening sequelae such as aortic dissection and aortic rupture. Although BAV biomechanics have been shown to contribute to aortopathy, their precise impact is yet to be delineated. Herein, we present the latest literature related to BAV biomechanics. We present the most recent definitions and classifications for BAV. We also summarize the current evidence pertaining to the mechanisms that drive bicuspid aortopathy. We highlight how aberrant flow patterns can contribute to the development of aortic dilatation. Finally, we discuss the role cardiac magnetic resonance imaging can have in assessing and managing patient with BAV and bicuspid aortopathy.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Melissa A. King
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Elena Di Martino
- Department of Civil Engineering, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
- Centre for Bioengineering Research and Education, University of Calgary, Calgary, AB, Canada
| | - Paul W. M. Fedak
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, AB, Canada
| | - Julio Garcia
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, Calgary, AB, Canada
- Department of Radiology, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- *Correspondence: Julio Garcia
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Rawshani A, Sattar N, McGuire DK, Wallström O, Smith U, Borén J, Bergström G, Omerovic E, Rosengren A, Eliasson B, Bhatt DL, Rawshani A. Left-Sided Degenerative Valvular Heart Disease in Type 1 and Type 2 Diabetes. Circulation 2022; 146:398-411. [PMID: 35678729 DOI: 10.1161/circulationaha.121.058072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The role of diabetes in the development of valvular heart disease, and, in particular, the relation with risk factor control, has not been extensively studied. METHODS We included 715 143 patients with diabetes registered in the Swedish National Diabetes Register and compared them with 2 732 333 matched controls randomly selected from the general population. First, trends were analyzed with incidence rates and Cox regression, which was also used to assess diabetes as a risk factor compared with controls, and, second, separately in patients with diabetes according to the presence of 5 risk factors. RESULTS The incidence of valvular outcomes is increasing among patients with diabetes and the general population. In type 2 diabetes, systolic blood pressure, body mass index, and renal function were associated with valvular lesions. Hazard ratios for patients with type 2 diabetes who had nearly all risk factors within target ranges, compared with controls, were as follows: aortic stenosis 1.34 (95% CI, 1.31-1.38), aortic regurgitation 0.67 (95% CI, 0.64-0.70), mitral stenosis 1.95 (95% CI, 1.76-2.20), and mitral regurgitation 0.82 (95% CI, 0.79-0.85). Hazard ratios for patients with type 1 diabetes and nearly optimal risk factor control were as follows: aortic stenosis 2.01 (95% CI, 1.58-2.56), aortic regurgitation 0.63 (95% CI, 0.43-0.94), and mitral stenosis 3.47 (95% CI, 1.37-8.84). Excess risk in patients with type 2 diabetes for stenotic lesions showed hazard ratios for aortic stenosis 1.62 (95% CI, 1.59-1.65), mitral stenosis 2.28 (95% CI, 2.08-2.50), and excess risk in patients with type 1 diabetes showed hazard ratios of 2.59 (95% CI, 2.21-3.05) and 11.43 (95% CI, 6.18-21.15), respectively. Risk for aortic and mitral regurgitation was lower in type 2 diabetes: 0.81 (95% CI, 0.78-0.84) and 0.95 (95% CI, 0.92-0.98), respectively. CONCLUSIONS Individuals with type 1 and 2 diabetes have greater risk for stenotic lesions, whereas risk for valvular regurgitation was lower in patients with type 2 diabetes. Patients with well-controlled cardiovascular risk factors continued to display higher risk for valvular stenosis, without a clear stepwise decrease in risk between various degrees of risk factor control.
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Affiliation(s)
- Araz Rawshani
- Department of Molecular and Clinical Medicine (Araz Rawshani, O.W., U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden.,Wallenberg Laboratory for Cardiovascular and Metabolic Research (Araz Rawshani, U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, United Kingdom (N.S.)
| | - Darren K McGuire
- Department of Internal Medicine, University of Texas Southwestern Medical Center, and Parkland Health and Hospital System, Dallas (D.K.M.)
| | - Oskar Wallström
- Department of Molecular and Clinical Medicine (Araz Rawshani, O.W., U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden
| | - Ulf Smith
- Department of Molecular and Clinical Medicine (Araz Rawshani, O.W., U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden.,Wallenberg Laboratory for Cardiovascular and Metabolic Research (Araz Rawshani, U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden.,Institute of Medicine, The Lundberg Laboratory for Diabetes Research, Department of Molecular and Clinical Medicine (U.S., B.E., Aidin Rawshani), University of Gothenburg, Sweden
| | - Jan Borén
- Department of Molecular and Clinical Medicine (Araz Rawshani, O.W., U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden.,Wallenberg Laboratory for Cardiovascular and Metabolic Research (Araz Rawshani, U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden
| | - Göran Bergström
- Wallenberg Laboratory for Cardiovascular and Metabolic Research (Araz Rawshani, U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden (G.B., Aidin Rawshani)
| | - Elmir Omerovic
- Department of Molecular and Clinical Medicine (Araz Rawshani, O.W., U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden.,Wallenberg Laboratory for Cardiovascular and Metabolic Research (Araz Rawshani, U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden
| | - Annika Rosengren
- Department of Molecular and Clinical Medicine (Araz Rawshani, O.W., U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden.,Wallenberg Laboratory for Cardiovascular and Metabolic Research (Araz Rawshani, U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden
| | - Björn Eliasson
- Institute of Medicine, The Lundberg Laboratory for Diabetes Research, Department of Molecular and Clinical Medicine (U.S., B.E., Aidin Rawshani), University of Gothenburg, Sweden
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, MA (D.L.B.)
| | - Aidin Rawshani
- Department of Molecular and Clinical Medicine (Araz Rawshani, O.W., U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden.,Wallenberg Laboratory for Cardiovascular and Metabolic Research (Araz Rawshani, U.S., J.B., G.B., E.O., A. Rosengren, Aidin Rawshani), University of Gothenburg, Sweden.,Institute of Medicine, The Lundberg Laboratory for Diabetes Research, Department of Molecular and Clinical Medicine (U.S., B.E., Aidin Rawshani), University of Gothenburg, Sweden.,Department of Clinical Physiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden (G.B., Aidin Rawshani)
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Rosillo N, Vicent L, Martín de la Mota Sanz D, Elola FJ, Moreno G, Bueno H. Epidemiología de las enfermedades valvulares aórticas no reumáticas en España, 2003-2018. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Passive Leg Raise Stress Echocardiography in Severe Paradoxical Low-Flow, Low-Gradient Aortic Stenosis. J Am Soc Echocardiogr 2022; 35:1123-1132. [PMID: 35863544 DOI: 10.1016/j.echo.2022.07.005] [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: 08/30/2021] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Dobutamine stress echocardiography (DSE) is used to increase the transvalvular flow in patients with low-flow, low-gradient aortic stenosis. Dobutamine fails to increase the stroke volume index (SVI) in a third of patients. In this study, we tested whether passive leg raise (PLR) added to dobutamine could increase SVI and transvalvular flow in patients with severe paradoxical low-flow, low-gradient aortic stenosis. METHODS Forty-five patients with apparent severe low-flow, low-gradient AS based on traditional measurements were included. Twenty-five were categorized as belonging to the "Paradox"-Group (LVEF≥50%), and twenty to the "LowEF"-Group (LVEF<50% or "classical" low-flow, low-gradient AS) for comparison. A four-step stress echocardiographic exam was performed: resting conditions ("Rest"), PLR alone ("PLR"), maximal dobutamine infusion rate ("Dmax"), and combination of Dmax and PLR ("Dmax+PLR"). AVA, (aortic valve area, cm2) SVI (ml/m2) and mean transvalvular flow (ml/s) were calculated using both, velocity-time-integral (VTI) of LV outflow tract and the Simpson-method. Changes compared to "Rest" and between the stress maneuvers were analysed. RESULTS In the "Paradox"-Group, compared to "Rest", LV end-diastolic volume significantly decreased under "Dmax" but was completely restored with "Dmax+PLR" ("Rest", "Dmax", "Dmax+PLR": 61±15 vs 49±18 (p<0.001) vs 61±18 ml (ns)). The smallest SVI-increase in the "Paradox"-Group was observed during "Dmax" ("PLR", "Dmax", "Dmax+PLR": VTI: 38±4 (p<0.001), 36±7 (p=0.019), 41±7 (p<0.001); Simpson: 28±6 (p<0.001), 21±7 (ns), 27±7 ml/m2 (ns)). Compared to "Dmax", "Dmax+PLR" was able to achieve a higher SVI (VTI: 36±7 vs 41±7, p<0.001, Simpson: 21±7 vs 27±7 ml/m2, p<0.001), and transvalvular flow in the Simpson-method only (179±56 vs 219±56 ml/s, p<0.001) as well as, additionally, a higher mean gradient (34±10 vs 39±12 mmHg, p=0.003) and AVA in the Simpson-method (0.64±0.21 vs 0.73±0.21 cm2, p=0.026). In the "LowEF"-Group, only SVI VTI (31±8 vs 35±7 ml/m2, p=0.034) and mean gradient (29±12 vs 34±14 mmHg, p=0.003) were higher in "Dmax+PLR". The proportion of patients with SVI VTI ≥ 35 ml/m2 and an increase of SVI VTI of more than 20% compared to "Rest" was highest in "Dmax+PLR" in both groups. CONCLUSIONS Dobutamine decreases the preload in paradoxical low-flow, low-gradient aortic stenosis. Adding PLR counteracts this effect, resulting in increased SVI and flow (in one method). The combined stress maneuver allowed reclassification of some patients from severe to moderate AS and may therefore be useful in selected cases in this population where the severity is uncertain.
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Exposure of the heart and cardiac valves in women irradiated for breast cancer 1970-2009. Clin Transl Radiat Oncol 2022; 36:132-139. [PMID: 36034326 PMCID: PMC9399376 DOI: 10.1016/j.ctro.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 07/11/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022] Open
Abstract
Cardiac exposure decreased substantially 1970–2009. Direct megavoltage IMC beams likely increase the risks of IHD and VHD. Cardiac dosimetry from past regimens is highly heterogeneous. Dosimetry from past decades is key for dose–response relationships for late effects. A wide variation in valve doses may enable a dose–response relationship for VHD.
Purpose To describe cardiac exposure from breast cancer radiotherapy regimens used during 1970–2009 for the development of dose–response relationships and to consider the associated radiation-risks using existing dose–response relationships. Material and methods Radiotherapy charts for 771 women in the Netherlands selected for case control studies of heart disease after breast cancer radiotherapy were used to reconstruct 44 regimens on a typical CT-dataset. Doses were estimated for the whole heart (WH), left ventricle (LV) and cardiac valves. Results For breast/chest wall radiotherapy average WH doses decreased during 1970–2009. For internal mammary chain (IMC) radiotherapy WH doses were highest during the 1980s and 1990s when direct anterior fields were used and reduced in the 2000s when oblique fields were introduced. Average doses varied substantially for IMC regimens (WH 2–33 Gy, LV < 1–23 Gy). For cardiac valves, at least one valve received >30 Gy from most regimens. Conclusions Radiation-risks of IHD from breast/chest wall regimens likely reduced during 1970–2009. Direct anterior IMC regimens likely increased the risks of IHD and VHD over this time period but the use of oblique IMC fields from 2003 may have lowered these risks. These data provide a unique opportunity to develop dose–response relationships.
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Barua PD, Karasu M, Kobat MA, Balık Y, Kivrak T, Baygin M, Dogan S, Demir FB, Tuncer T, Tan RS, Acharya UR. An accurate valvular heart disorders detection model based on a new dual symmetric tree pattern using stethoscope sounds. Comput Biol Med 2022; 146:105599. [DOI: 10.1016/j.compbiomed.2022.105599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 02/02/2023]
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