1
|
Amador AF, Costa C, Pinto R, Carvalho M, Proença T, Calvão J, Amorim S, Paiva M, Silva JC, Rodrigues R. 20-year follow-up of rheumatic mitral stenosis patients after percutaneous mitral commissurotomy: invasive transmitral gradient differential as a predictor of events. Monaldi Arch Chest Dis 2024. [PMID: 38470469 DOI: 10.4081/monaldi.2024.2941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
Percutaneous mitral valve commissurotomy (PMC) is a viable alternative to mitral valve (MV) surgery in the treatment of patients with rheumatic mitral stenosis (RMS). In this single-center retrospective study of consecutive patients with RMS submitted to PMC from 1991 to 2008, we analyzed clinical, echocardiographic, and hemodynamic data and events during follow-up (FUP) until December 2021. Major adverse cardiovascular events (MACE) were a combined endpoint of all-cause death, cardiovascular hospitalization, and MV re-intervention. A total of 124 patients were enrolled: 108 (87.1%) were female, with a mean age at PMC of 46 [standard deviation (SD) 11] years. PMC was successful in 91.1%, with a mean reduction in invasive transmitral pressure gradient (TMPG) of 8 (SD 7) mmHg at PMC time. During the mean FUP of 20 (SD 6) years, 51 (41.1%) patients had MV re-intervention (86.3% surgery and 13.7% redo-PMC), 37 (29.8%) were hospitalized, and 30 (24.2%) died. Approximately 75% of patients remained MACE-free after 10 years, and this percentage decreased to around 40% after 20 years; at this time mark, about 8 in 10 patients were alive. A reduction of <5 mmHg in TMPG at PMC time was associated with a 2.7-fold greater rate of MACE compared to a reduction of ≥5 mmHg, independent of MV regurgitation after PMC and moderate disease of other valves (adjusted hazard ratio 2,7; 95% confidence interval 1.395-5.298, p=0.003). In this cohort with favorable long-term results after PMC, a reduction of <5 mmHg in TMPG at PMC time was associated with MACE during FUP. More studies are needed to validate this independent predictor.
Collapse
Affiliation(s)
- Ana Filipa Amador
- Department of Cardiology, São João University Hospital Center, Porto; Faculty of Medicine, University of Porto.
| | - Catarina Costa
- Department of Cardiology, São João University Hospital Center, Porto; Faculty of Medicine, University of Porto.
| | - Ricardo Pinto
- Department of Cardiology, São João University Hospital Center, Porto; Faculty of Medicine, University of Porto.
| | - Miguel Carvalho
- Department of Cardiology, São João University Hospital Center, Porto; Faculty of Medicine, University of Porto.
| | - Tânia Proença
- Department of Cardiology, São João University Hospital Center, Porto; Faculty of Medicine, University of Porto.
| | - João Calvão
- Department of Cardiology, São João University Hospital Center, Porto; Faculty of Medicine, University of Porto.
| | - Sandra Amorim
- Department of Cardiology, São João University Hospital Center, Porto; Faculty of Medicine, University of Porto.
| | - Mariana Paiva
- Department of Cardiology, São João University Hospital Center, Porto.
| | - João Carlos Silva
- Department of Cardiology, São João University Hospital Center, Porto.
| | - Rui Rodrigues
- Department of Cardiology, São João University Hospital Center, Porto.
| |
Collapse
|
2
|
Rudiktyo E, Wind A, Doevendans P, Siswanto BB, Cramer MJ, Soesanto AM. Characteristics of patients with rheumatic heart disease in a national referral hospital in Indonesia. MEDICAL JOURNAL OF INDONESIA 2022. [DOI: 10.13181/mji.oa.226150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is one of the most common cardiovascular problems in Indonesia. Comprehensive data regarding patient characteristics are critical in planning optimal treatment strategies to relieve the burden of RHD. This study aimed to describe the clinical and echocardiographic characteristics of patients across several types of valvular lesions in RHD in the Indonesian population.
METHODS This retrospective study was performed between January 2016 and June 2019 at the National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. The study population comprised all patients with significant valve disease aged ≥18 years. Patient characteristics and echocardiographic parameters were collected retrospectively from medical records and hospital information systems. Patients were classified into several groups based on etiologies of valve disease.
RESULTS Of 5,482 patients with significant valve lesions, 2,333 (42.6%) were RHD patients. They were predominantly female (64.1%) and younger (mean [standard deviation] age 42.61 [12.01] years). Atrial fibrillation (AF) was the most frequent rhythm disorder observed in RHD (65.4%). Isolated mitral stenosis was the most common valve lesion in RHD patients (46.5%). Most patients with RHD had preserved left ventricular (LV) ejection fraction. Half of the patients with mitral stenosis had reduced right ventricular (RV) contractility (tricuspid annular plane systolic excursion <17 mm).
CONCLUSIONS Isolated mitral stenosis was the most observed condition of valve lesions in RHD. Characteristics of RHD patients in this study were predominantly female, younger age, had preserved LV function, reduced RV function, and high prevalence of AF.
Collapse
|
3
|
Foppa M, Santos ABS. Percutaneous transvenous mitral commissurotomy in rheumatic mitral stenosis with atrial dysfunction. Opening the valve…and a window of opportunity. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1499-1500. [PMID: 38819546 DOI: 10.1007/s10554-022-02548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Murilo Foppa
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio grande do Sul, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brasil.
- Postgraduate studies Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.
| | - Angela Barreto Santiago Santos
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio grande do Sul, Rua Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brasil
- Postgraduate studies Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| |
Collapse
|
4
|
Yang ZY, Li PF, Li ZQ, Tang T, Liu W, Wang Y. Altered Expression of Transfer-RNA-Derived Small RNAs in Human With Rheumatic Heart Disease. Front Cardiovasc Med 2021; 8:716716. [PMID: 34926598 PMCID: PMC8671610 DOI: 10.3389/fcvm.2021.716716] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022] Open
Abstract
Rheumatic heart disease (RHD) remains a severe public health problem in developing countries. Atrial fibrillation (AF) is a medical complication of RHD. Although the understanding of disease pathogenesis has advanced in recent years, the key questions need to be addressed. Transfer RNA–derived small RNAs (tsRNAs) are a novel type of short non-coding RNAs with potential regulatory functions in various physiological and pathological processes. The present study used tsRNAs sequencing to investigate the relationship between RHD and atrial fibrillation (AF). Three paired cardiac papillary muscles were taken from six rheumatic RHD patients with AF (3 cases) or without AF (3 cases) from January 2016 to January 2017 in Xiangya Hospital, Central South University. A total of 219 precisely matched tsRNAs were identified, and 77 tsRNAs (fold change > 2.0 and P < 0.05) were differently changed. Three tsRNAs (AS-tDR-001269, AS-tDR-001363, AS-tDR-006049) were randomly selected and confirmed by qRT-PCR. The results of qRT-PCR were consistent with tsRNAs sequencing, suggesting the tsRNAs sequencing was reliable. Subsequently, we predicted the target mRNAs of the three tsRNAs. Moreover, we verified the functions of tsRNAs targeting mRNAs in vitro. Finally, bioinformatics analysis indicated that the target genes were abundant in regulation of transcription, DNA binding, intracellular. Most of the genes were predicted to interplay with cytokine-cytokine receptor by KEGG analysis. Our findings uncover the pathological process of AF in RHD through tsRNAs sequencing. This research provides a new perspective for future research on elucidating the mechanism of AF in RHD and offers potential new candidates for the treatment and diagnosis.
Collapse
Affiliation(s)
- Zhao-Yu Yang
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Peng-Fei Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhi-Qing Li
- Hunan University of Chinese Medicine, Changsha, China
| | - Tao Tang
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Liu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Cardiovascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Yang Wang
- Department of Integrated Traditional Chinese and Western Medicine, Institute of Integrative Medicine, Xiangya Hospital, Central South University, Changsha, China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
5
|
|