1
|
Mao Y, Zhu G, Zhai M, Ma Y, Li L, Jin P, Liu Y, Yang J. Transcatheter Aortic Valve Replacement and Coronary Protection Guided by Deep Learning and 3-Dimensional Printing. Surg Innov 2024; 31:256-262. [PMID: 38565982 DOI: 10.1177/15533506241244571] [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] [Indexed: 04/04/2024]
Abstract
OBJECTIVE In this case report, the auxiliary role of deep learning and 3-dimensional printing technology in the perioperative period was discussed to guide transcatheter aortic valve replacement and coronary stent implantation simultaneously. CASE PRESENTATION A 68-year-old man had shortness of breath and chest tightness, accompanied by paroxysmal nocturnal dyspnea, 2 weeks before presenting at our hospital. Echocardiography results obtained in the outpatient department showed severe aortic stenosis combined with regurgitation and pleural effusion. The patient was first treated with closed thoracic drainage. After 800 mL of pleural effusion was collected, the patient's symptoms were relieved and he was admitted to the hospital. Preoperative transthoracic echocardiography showed severe bicuspid aortic valve stenosis combined with calcification and aortic regurgitation (mean pressure gradient, 42 mmHg). Preoperative computed tomography results showed a type I bicuspid aortic valve with severe eccentric calcification. The leaflet could be seen from the left coronary artery plane, which indicated an extremely high possibility of coronary obstruction. After preoperative imaging assessment, deep learning and 3-dimensional printing technology were used for evaluation and simulation. Guided transcatheter aortic valve replacement and a coronary stent implant were completed successfully. Postoperative digital subtraction angiography showed that the bioprosthesis and the chimney coronary stent were in ideal positions. Transesophageal echocardiography showed normal morphology without paravalvular regurgitation. CONCLUSION The perioperative guidance of deep learning and 3-dimensional printing are of great help for surgical strategy formulation in patients with severe bicuspid aortic valve stenosis with calcification and high-risk coronary obstruction.
Collapse
Affiliation(s)
- Yu Mao
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Guangyu Zhu
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Mengen Zhai
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yanyan Ma
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Lanlan Li
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Ping Jin
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Yang Liu
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, Xi'an, China
| |
Collapse
|
2
|
Ovsenik A, Podbregar M, Lakič N, Brešar M, Boškoski P, Verdenik I, Fabjan A. Neurovascular coupling in severe aortic valve stenosis. Brain Behav 2023; 13:e3155. [PMID: 37475651 PMCID: PMC10454277 DOI: 10.1002/brb3.3155] [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: 02/28/2023] [Revised: 05/18/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Aortic stenosis (AS) is characterized by obstruction of blood outflow from the left ventricle, which can impair target organ perfusion such as the brain. We hypothesized that hemodynamic changes in AS may lead to dysfunction of cerebral blood flow regulatory mechanisms. The aim of our study was to evaluate neurovascular coupling in patients with AS by Transcranial Doppler ultrasonography. METHODS Neurovascular coupling was assessed using visually evoked cerebral blood flow velocity responses (VEFR) calculated as relative blood flow velocity changes in the posterior cerebral artery upon visual stimulation. We analyzed peak systolic, mean and end diastolic VEFR in 54 patients with severe AS and 43 controls in 10 consecutive cycles of visual stimulation. Repeated-measures ANOVA test was used to compare cerebral hemodynamic data by group. RESULTS Patients with AS had significantly higher peak systolic (12.9% ± 5.6% and 10.5% ± 4.5%; p = .009) and mean VEFR (14.4% ± 5.8% and 12.2% ± 4.9%; p = .021) compared to controls, whereas only a tendency for higher end diastolic VEFR was observed (16.7% ± 6.9% and 14.4% ± 6.2%; p = .061). CONCLUSION We have shown for the first time that patients with severe AS exhibit higher VEFR than controls indicating dysregulation of neurovascular coupling, which can be one of the factors contributing to development of cognitive decline.
Collapse
Affiliation(s)
- Ana Ovsenik
- Faculty of Medicine, Department of BiomedicineUniversity of LjubljanaLjubljanaSlovenia
- Department of CardiologyUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Matej Podbregar
- Faculty of Medicine, Department of Internal MedicineUniversity of LjubljanaLjubljanaSlovenia
- Department of Intensive CareGeneral Hospital CeljeCeljeSlovenia
| | - Nikola Lakič
- Department of Cardiovascular SurgeryUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Martin Brešar
- Jožef Stefan International Postgraduate SchoolLjubljanaSlovenia
- Department of Systems and ControlJožef Stefan InstituteLjubljanaSlovenia
| | - Pavle Boškoski
- Department of Systems and ControlJožef Stefan InstituteLjubljanaSlovenia
| | - Ivan Verdenik
- Department of Obstetrics and Gynaecology, Division for ResearchUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Andrej Fabjan
- Faculty of Medicine, Institute for PhysiologyUniversity of LjubljanaLjubljanaSlovenia
- Department of Vascular Neurology and Neurological Intensive CareUniversity Medical Centre LjubljanaLjubljanaSlovenia
| |
Collapse
|
3
|
Ugovšek S, Šebeštjen M. Lipoprotein(a)—The Crossroads of Atherosclerosis, Atherothrombosis and Inflammation. Biomolecules 2021; 12:biom12010026. [PMID: 35053174 PMCID: PMC8773759 DOI: 10.3390/biom12010026] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022] Open
Abstract
Increased lipoprotein(a) (Lp(a)) levels are an independent predictor of coronary artery disease (CAD), degenerative aortic stenosis (DAS), and heart failure independent of CAD and DAS. Lp(a) levels are genetically determinated in an autosomal dominant mode, with great intra- and inter-ethnic diversity. Most variations in Lp(a) levels arise from genetic variations of the gene that encodes the apolipoprotein(a) component of Lp(a), the LPA gene. LPA is located on the long arm of chromosome 6, within region 6q2.6–2.7. Lp(a) levels increase cardiovascular risk through several unrelated mechanisms. Lp(a) quantitatively carries all of the atherogenic risk of low-density lipoprotein cholesterol, although it is even more prone to oxidation and penetration through endothelia to promote the production of foam cells. The thrombogenic properties of Lp(a) result from the homology between apolipoprotein(a) and plasminogen, which compete for the same binding sites on endothelial cells to inhibit fibrinolysis and promote intravascular thrombosis. LPA has up to 70% homology with the human plasminogen gene. Oxidized phospholipids promote differentiation of pro-inflammatory macrophages that secrete pro-inflammatory cytokines (e. g., interleukin (IL)-1β, IL-6, IL-8, tumor necrosis factor-α). The aim of this review is to define which of these mechanisms of Lp(a) is predominant in different groups of patients.
Collapse
Affiliation(s)
- Sabina Ugovšek
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Miran Šebeštjen
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia;
- Department of Cardiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence:
| |
Collapse
|
4
|
Erinne I, Sethi A, Johannesen J, Kassotis J. Racial disparities in the treatment of aortic stenosis: Has transcatheter aortic valve replacement bridged the gap? Catheter Cardiovasc Interv 2021; 98:148-156. [PMID: 33527675 DOI: 10.1002/ccd.29487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/14/2020] [Accepted: 01/08/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Racial disparities in outcomes and utilization of surgical aortic valve replacement (SAVR) for the treatment of severe aortic stenosis (AS) is well known. While transcatheter aortic valve replacement (TAVR) has become more widespread, its impact on racial disparities remains unclear. OBJECTIVES Our goal was to assess the utilization of SAVR and TAVR and their clinical outcomes among various racial groups. METHODS The National Inpatient database (2009-2015) was used to study the racial distribution of admissions for SAVR and TAVR, and their impact on inpatient outcomes. Survey estimation commands were used to determine weighted national estimates. RESULTS There were 3,445,267; 294,108; and 52,913 inpatient visits for AS, SAVR, and TAVR, respectively. SAVR visits were 86% White, 3.8% Black, 5.5% Hispanic, 1.2% Asian/Pacific Islander (A/PI), 0.4% Native American (NA), and 2.9%; TAVR were 87.7% White, 3.7% Black, 3.8% Hispanic, 1.0% A/PI, 0.2% NA, and 3.5% Other while AS visits were 83.7% White, 6.7% Black, 5.3% Hispanic, 1.7% A/PI, 0.4% NA, and 2.2% Other. Racial minorities generally had more co-morbidities compared with Whites. After SAVR, Black patients had a higher unadjusted inpatient mortality than Whites, however, there was no difference after adjustment for other variables. A/PI were more likely to require a permanent pacemaker after SAVR. Need for blood transfusion was significantly higher among the minorities compared with Whites, except for NA, but there were no racial differences in stroke rates. There was no difference in inpatient mortality, pacemaker implantation, stroke, and bleeding after TAVR, but acute kidney injury occurred more often in Hispanics, A/PI, and "others" compared with Whites. CONCLUSIONS Racial disparities in the treatment of AS continues in the contemporary era; however it was found that TAVR resulted in comparable inpatient outcomes, despite higher comorbidities, and adverse socioeconomic factors in minorities.
Collapse
Affiliation(s)
- Ikenna Erinne
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ankur Sethi
- Department of Cardiology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
| | - Justin Johannesen
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - John Kassotis
- Division of Cardiology, Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| |
Collapse
|
5
|
Torres-Arellano JM, Echeverría JC, Ávila-Vanzzini N, Springall R, Toledo A, Infante O, Bojalil R, Cossío-Aranda JE, Fajardo E, Lerma C. Cardiac Autonomic Response to Active Standing in Calcific Aortic Valve Stenosis. J Clin Med 2021; 10:2004. [PMID: 34067025 PMCID: PMC8124878 DOI: 10.3390/jcm10092004] [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: 03/27/2021] [Revised: 04/25/2021] [Accepted: 05/03/2021] [Indexed: 01/02/2023] Open
Abstract
Aortic stenosis is a progressive heart valve disorder characterized by calcification of the leaflets. Heart rate variability (HRV) analysis has been proposed for assessing the heart response to autonomic activity, which is documented to be altered in different cardiac diseases. The objective of the study was to evaluate changes of HRV in patients with aortic stenosis by an active standing challenge. Twenty-two volunteers without alterations in the aortic valve (NAV) and twenty-five patients diagnosed with moderate and severe calcific aortic valve stenosis (AVS) participated in this cross-sectional study. Ten minute electrocardiograms were performed in a supine position and in active standing positions afterwards, to obtain temporal, spectral, and scaling HRV indices: mean value of all NN intervals (meanNN), low-frequency (LF) and high-frequency (HF) bands spectral power, and the short-term scaling indices (α1 and αsign1). The AVS group showed higher values of LF, LF/HF and αsign1 compared with the NAV group at supine position. These patients also expressed smaller changes in meanNN, LF, HF, LF/HF, α1, and αsign1 between positions. In conclusion, we confirmed from short-term recordings that patients with moderate and severe calcific AVS have a decreased cardiac parasympathetic supine response and that the dynamic of heart rate fluctuations is modified compared to NAV subjects, but we also evidenced that they manifest reduced autonomic adjustments caused by the active standing challenge.
Collapse
Affiliation(s)
- José M. Torres-Arellano
- Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.M.T.-A.); (O.I.)
- Programa de Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autonoma de Mexico, Mexico City 04510, Mexico
| | - Juan C. Echeverría
- Department of Electrical Engineering, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Mexico City 09340, Mexico
| | - Nydia Ávila-Vanzzini
- Department of Outpatients Clinic, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (N.Á.-V.); (J.E.C.-A.); (E.F.)
| | - Rashidi Springall
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (R.S.); (A.T.)
| | - Andrea Toledo
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (R.S.); (A.T.)
| | - Oscar Infante
- Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.M.T.-A.); (O.I.)
| | - Rafael Bojalil
- Department of Health Care, Universidad Autónoma Metropolitana, Unidad Xochimilco, Mexico City 04960, Mexico;
| | - Jorge E. Cossío-Aranda
- Department of Outpatients Clinic, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (N.Á.-V.); (J.E.C.-A.); (E.F.)
| | - Erika Fajardo
- Department of Outpatients Clinic, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (N.Á.-V.); (J.E.C.-A.); (E.F.)
| | - Claudia Lerma
- Department of Electromechanical Instrumentation, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico; (J.M.T.-A.); (O.I.)
| |
Collapse
|
6
|
Burton BN, Prophete L, Carter D, Betancourt J, Schmidt UH, Gabriel RA. Demographic and Clinical Variables Associated With 30-day Re-Intubation Following Surgical Aortic Valve Replacement. Respir Care 2021; 66:248-252. [PMID: 32934099 PMCID: PMC9994214 DOI: 10.4187/respcare.08066] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND A retrospective study was performed to evaluate factors associated with 30-d re-intubation following surgical aortic valve repair. We hypothesized a significant increase in the odds of re-intubation among patients with preoperative comorbidities. METHODS The American College of Surgery National Surgical Quality Improvement Program database from 2007 to 2016 was used to evaluate demographic and clinical factors associated with 30-d re-intubation following surgical aortic valve repair. Multivariable logistic regression was used to report factors associated with 30-d re-intubation while controlling for various patient characteristics. RESULTS The study population consisted of 5,766 adult subjects who underwent surgical aortic valve repair, of whom 258 (4.47%) were re-intubated within 30 d of surgery. The mean ± SD age was 69 ± 12.98 y, and 3,668 (63.6%) were male. The prevalence of diabetes mellitus, shortness of breath, poor functional status, COPD, congestive heart failure, hypertension, and bleeding disorder was higher among subjects who were re-intubated compared to those who were not (P < .05). Age, severe COPD, congestive heart failure, and bleeding disorder were associated with this outcome. CONCLUSIONS Age, COPD, congestive heart failure, and bleeding disorder were associated with 30-d re-intubation in this surgical cohort. If surgical aortic valve repair is deemed non-emergent, patients should be optimized preoperatively and receive careful postoperative planning to reduce the risk of postoperative complications.
Collapse
Affiliation(s)
- Brittany N Burton
- Department of Anesthesiology and Perioperative Medicine, University of California Los Angeles, Los Angeles, California.
| | | | - Devon Carter
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jaime Betancourt
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
- Pulmonary & Critical Care Section, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ulrich H Schmidt
- Department of Anesthesiology, University of California San Diego, La Jolla, California
| | - Rodney A Gabriel
- Department of Anesthesiology, University of California San Diego, La Jolla, California
- Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, California
| |
Collapse
|
7
|
Cardiovascular Outcome of Pediatric Patients With Bi-Allelic (Homozygous) Familial Hypercholesterolemia Before and After Initiation of Multimodal Lipid Lowering Therapy Including Lipoprotein Apheresis. Am J Cardiol 2020; 136:38-48. [PMID: 32946862 DOI: 10.1016/j.amjcard.2020.09.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
Twenty-four patients with bi-allelic familial hypercholesterolemia commencing chronic lipoprotein apheresis (LA) at a mean age of 8.5 ± 3.1 years were analysed retrospectively and in part prospectively with a mean follow-up of 17.2 ± 5.6 years. Mean age at diagnosis was 6.3 ± 3.4 years. Untreated mean LDL-C concentrations were 752 mg/dl ± 193 mg/dl (19.5 mmol/l ± 5.0 mmol/l). Multimodal lipid lowering therapy including LA resulted in a mean LDL-C concentration of 184 mg/dl (4.8 mmol/l), which represents a 75.5% mean reduction. Proprotein convertase subtilisin/kexin type 9-antibodies contributed in 3 patients to LDL-C lowering with 5 patients remaining to be tested. After commencing chronic LA, 16 patients (67%) remained clinically stable with only subclinical findings of atherosclerotic cardiovascular disease (ASCVD), and neither cardiovascular events, nor need for vascular interventions or surgery. In 19 patients (79%), pathologic findings were detected at the aortic valve (AV), which in the majority were mild. AV replacement was required in 2 patients. Mean Lipoprotein(a) concentration was 42.4 mg/dl, 38% had >50 mg/dl. There was no overt correlation of AV pathologies with other ASCVD complications, or Lipoprotein(a) concentration. Physicochemical elimination of LDL particles by LA appears indispensable for patients with bi-allelic familial hypercholesterolemia and severe hypercholesterolemia to maximize the reduction of LDL-C. In conclusion, in this rare patient group regular assessment of both the AV, as well as all arteries accessible by ultrasound should be performed to adjust the intensity of multimodal lipid lowering therapy with the goal to prevent ASCVD events and aortic surgery.
Collapse
|
8
|
Tomova VD, Alexandrova ML, Atanasova MA, Tzekova ML, Rashev TR, Ahmad S. Plasma lipoprotein(a) concentration as an independent predictor of hemodynamic progression of aortic valve stenosis. Mol Cell Biochem 2020; 472:199-207. [PMID: 32577944 DOI: 10.1007/s11010-020-03797-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 06/14/2020] [Indexed: 10/24/2022]
Abstract
Calcific aortic valve disease (CAVD) is a common cardiovascular disorder of high social significance. This study aimed to identify independent predictors of hemodynamic progression of CAVD. The relationship between some risk factors, including the rs10455872 polymorphism in the intron 25 of the lipoprotein(a) [Lp(a)] coding region and the plasma Lp(a) concentration, and CAVD severity were prospectively examined in 114 patients. Age (p = 0.023), smoking (p = 0.038), lack of obesity (p = 0.005), triglyceride levels (p = 0.039), and plasma Lp(a) (p < 0.0001) levels were found to be significant determinants of stenosis progression. The rs10455872 polymorphism; however, was not found to be a significant factor for neither the stenosis severity (p = 0.773) nor for plasma Lp(a) levels (p = 0.617). We established a highly significant Lp(a) cut-off concentration (21.2 mg/dL) distinguishing the aortic valve calcification without stenosis from the significant stenosis. Plasma Lp(a) concentration was the only independent predictor of disease progression (p < 0.0001). Moreover, patients with plasma levels of Lp(a) ≥ 21.2 mg/dL were 55 times more likely to develop aortic valve stenosis. We conclude that Lp(a) concentration may prove valuable for more reliable identification of patients at risk of accelerated CAVD development. Future studies are desirable to determine whether plasma Lp(a) levels could be used as a potential biomarker for aortic stenosis progression.
Collapse
Affiliation(s)
- Vesela D Tomova
- Department of Internal Diseases, University Hospital "St. Marina" - Pleven, Medical University - Pleven, 5800, Pleven, Bulgaria.
| | | | | | - Maria L Tzekova
- Second Clinic of Cardiology, University Hospital, "Dr. G. Stranski" - Pleven, Medical University - Pleven, Pleven, Bulgaria
| | - Tihomir R Rashev
- Department of Anatomy, Histology, Cytology and Biology, Medical University - Pleven, Pleven, Bulgaria
| | - Sarfraz Ahmad
- AdventHealth Medical Center, 2501 N. Orange Ave., Suite 786, Orlando, FL, 32804, USA.
| |
Collapse
|
9
|
Kurt IH, Şen Ö, Kuçükosmanoğlu M, Salkın FÖ, Urgun ÖD, Şahin Ş, Çolak S, Kılıç S. The Influence of Aortic Pulse Wave Velocity on Short-Term Functional Capacity in Patients with Mild Paravalvular Regurgitation Following Transcatheter Aortic Valve Implantation. Braz J Cardiovasc Surg 2020; 35:504-511. [PMID: 32864931 PMCID: PMC7454626 DOI: 10.21470/1678-9741-2019-0454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Recently, the clinical significance of mild paravalvular aortic regurgitation (PAR) has been evaluated and suggested that it can be predictor of clinical outcomes. In our study, we aimed to investigate the interaction of aortic pulse wave velocity (PWV) and mild PAR and their effects on the functional status of patients after transcatheter aortic valve implantation (TAVI). METHODS A total of 109 consecutive patients with symptomatic severe aortic stenosis were enrolled prospectively. After TAVI procedure, they were divided in to three groups according to PAR and PWV measurements. Patients without PAR were defined as the NonePAR group (n=60), patients with mild PAR and normal PWV were defined as the MildPAR-nPWV group (n=23), and patients with mild PAR and high PWV were defined as the MildPAR-hPWV group (n=26). RESULTS Compared with other groups, the MildPAR-hPWV group was older (P<0.001), hypertensive (P=0.015), and had a higher pulse pressure (P=0.018). In addition to PWV, this group had lower aortic regurgitation index (ARI) (P=0.010) and higher rate of New York Heart Association (NYHA) class II (at least) patients (P<0.001) in 30-day follow-up period. On multivariate regression analysis, the MildPARhPWV group (odds ratio=1.364, 95% confidence interval 1.221-1.843; P=0.011) as well as N-terminal-pro-brain natriuretic peptide levels and ARI were independently related with 30-day functional NYHA classification. However, NonePAR or MildPAR-nPWV group was not an independent predictor of early functional status. CONCLUSION It was concluded that high PWV may adversely affect early functional status in patients with mild PAR in contrast to normal values following TAVI.
Collapse
Affiliation(s)
- Ibrahim Halil Kurt
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Ömer Şen
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Mehmet Kuçükosmanoğlu
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Fatma Özge Salkın
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Örsan Deniz Urgun
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Şeyda Şahin
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Salih Çolak
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| | - Salih Kılıç
- Department of Cardiology, Health Sciences University, Adana Research and Training Hospital, Adana, Turkey
| |
Collapse
|
10
|
Yoshikawa Y, Okada Y, Okita Y, Yaku H, Kobayashi J, Uesugi H, Takanashi S, Ito T, Nakao T, Koyama T, Sakaguchi T, Yamamoto K, Sawa Y. Long-Term Outcomes of the Mosaic Aortic Porcine Bioprosthesis in Japan ― Results From the Japan Mosaic Valve Long-Term Multicenter Study ―. Circ J 2020; 84:1261-1270. [DOI: 10.1253/circj.cj-19-1113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
11
|
Alishiri G, Heshmat-Ghahdarijani K, Hashemi M, Zavar R, Farahani MM. Alendronate slows down aortic stenosis progression in osteoporotic patients: An observational prospective study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2020; 25:65. [PMID: 33088302 PMCID: PMC7554420 DOI: 10.4103/jrms.jrms_408_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 04/21/2020] [Accepted: 05/14/2020] [Indexed: 11/07/2022]
Abstract
Background: Aortic stenosis (AS) is the most common primary valvular disease. Currently, there is no pharmacological approach for the medical management of AS. We investigated the effect of osteoporosis therapy with alendronate on hemodynamic progression in patients concurrently affected by AS and osteoporosis. Materials and Methods: In this observational prospective study, we enrolled 37 women more than 60 years old with diagnosis of AS and concurrent osteoporosis from August 2017 to December 2019. These patients were treated with alendronate 70 mg every week added to their routine treatment for AS, and their outcomes were compared with 33 patients only affected by AS. Echocardiographic changes and N-terminal-prohormone of brain natriuretic peptide (NT-pro-BNP) level were evaluated during about 2 years of follow-up. Results: The mean follow-up time for the treated and nontreated groups was 20.89 ± 2.73 and 20.84 ± 2.76 months, respectively. Mean gradient (P = 0.02) and peak gradient (P = 0.04) of aortic valve were significantly different between the groups after follow-up. Aortic valve area was decreased 0.09 cm2 in the treated group by alendronate and 0.23 cm2 in the other group (P = 0.001). Furthermore, NT-pro-BNP was significantly decreased in patients treated by alendronate (P = 0.01), but it was increased in nontreated patients (P = 0.04). Conclusion: Treatment with alendronate in patients with AS and concurrent osteoporosis slows down the progression of stenosis and improves their prognosis. This study could open a new pathway for the treatment of AS. Further studies, particularly randomized controlled clinical trial, should be done for providing more evidence.
Collapse
Affiliation(s)
- Gholamhossein Alishiri
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Hashemi
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reihaneh Zavar
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | |
Collapse
|
12
|
Abstract
Bicuspid aortic valve (BAV) is the most common congenital heart defect, found in up to 2% of the population and associated with a 30% lifetime risk of complications. BAV is inherited as an autosomal dominant trait with incomplete penetrance and variable expressivity due to a complex genetic architecture that involves many interacting genes. In this review, we highlight the current state of knowledge about BAV genetics, principles and methods for BAV gene discovery, clinical applications of BAV genetics, and important future directions.
Collapse
|
13
|
Sattar Y, Rauf H, Bareeqa SB, Ullah W, Myla M. Transcatheter Aortic Valve Replacement versus Surgical Aortic Valve Replacement: A Review of Aortic Stenosis Management. Cureus 2019; 11:e6431. [PMID: 31993269 PMCID: PMC6970438 DOI: 10.7759/cureus.6431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Severe aortic stenosis (AS) affects 3.4% of the elderly over 60 years of age. It presents with exertional dyspnea, syncope, angina, and progression to irreversible congestive heart failure. Early intervention produces a better outcome in preventing the clinical deterioration of AS. The choice of intervention is transcatheter aortic valve implantation or surgical aortic valve replacement (SAVR). The decision should be made after evaluating an individual case based on its clinical features and the user’s experience with transcatheter aortic valve replacement (TAVR). We reviewed available data to illustrate the types of ASs, the background of interventions, current guidelines for TAVR, and its comparison with SAVR in terms of adverse effects.
Collapse
Affiliation(s)
- Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Hiba Rauf
- Internal Medicine, Dow Medical College, Karachi, PAK
| | | | - Waqas Ullah
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
| | - Madhura Myla
- Cardiovascular Disease, University of New Mexico Health Sciences Center, Albuquerque, USA
| |
Collapse
|
14
|
Pathophysiological and clinical implications of high intramural coronary blood flow velocity in aortic stenosis. Heart Vessels 2019; 35:637-646. [PMID: 31712910 DOI: 10.1007/s00380-019-01532-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022]
Abstract
We sought to recognize the blood flow velocity (BFV) through the left anterior descending (LAD) coronary artery and its small intramyocardial (IM) branches by transthoracic Doppler-echocardiography in patients with aortic stenosis (AS). Sixty-two patients, aged 74.0 ± 9.6 years, 37 women, with preserved left ventricular (LV) function, apparently free of active ischemic disease, were enrolled and classified into 3 groups according to the mean gradient (MG) across the aortic valve: 13 patients (21%) entered the group A (MG ≤ 20 mmHg), 29 (48%) group B (MG 21-40 mmHg) and 20 (31%) group C (MG > 40 mmHg). Peak and mean coronary BFVs were demonstrated to gradually increase according to AV gradient, especially through the IM arteries. Peak IM-BFV was 58.9 cm/s (95% CI 46.4-71.4) in group A, 73.2 cm/s (95% CI 64.8-81.6) in group B, and 96.4 cm/s (95% CI 86.3-106.5) in group C (p < 0.001), whereas peak LAD-BFV was 38.1 cm/s (95% CI 32.8-43.3), 44.4 cm/s (95% CI 40.9-47.9) and 47.3 cm/s (95% CI 43.1-52.5), respectively (p = 0.03). Also, 34 patients complaining with unspecific symptoms showed much higher IM-BFV than those who were not. High values were also recognized in patients with LV ejection fraction/velocity ratio (EFVR) ≤ 0.90 (IM-BFV 91 ± 26 cm/s vs. 72 ± 24 cm/s in those with EFVR > 0.90, p = 0.001). In conclusion, AS patients in the present study showed gradually higher coronary BFVs according to AS gradient, especially through the IM vessels, and both peak and mean velocities were discriminating specific patient subsets. Pathophysiological mechanisms and potential clinical implications are discussed.
Collapse
|
15
|
Park J, Suradi HS. State-of-the-art Structural Interventions in Heart Failure. Card Fail Rev 2019; 5:147-154. [PMID: 31768271 PMCID: PMC6848934 DOI: 10.15420/cfr.2019.12.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/05/2019] [Indexed: 11/04/2022] Open
Abstract
Heart failure (HF) is a leading cause of hospitalisation and healthcare costs worldwide. Acute decompensated heart failure accounts for more than 1 million hospitalisations in the US. Despite advances in the quality of acute and chronic HF disease management, gaps in knowledge about effective interventions to support the transition of care for patients with HF remain. Despite multiple trials of promising therapies, standard care consists of decongestion with IV diuretics and haemodynamic support with vasodilators and inotropes and this has remained largely unchanged during the past 45 years. Newer advances in medical innovations and structural heart disease interventions have now given promise to improved survival, outcomes and quality of life for patients with advanced HF of multiple aetiologies. In this article, we focus on structural interventions in the treatment of patients with HF.
Collapse
Affiliation(s)
- Jeffrey Park
- Department of Internal Medicine, Division of Cardiovascular Medicine, Rush University Medical Center Chicago, IL, US
| | - Hussam S Suradi
- Department of Internal Medicine, Division of Cardiovascular Medicine, Rush University Medical Center Chicago, IL, US
| |
Collapse
|
16
|
Ozkan U, Ozcelik F, Yildiz M, Budak M. Lipoprotein(a) Gene Polymorphism Increases a Risk Factor for Aortic Valve Calcification. J Cardiovasc Dev Dis 2019; 6:jcdd6030031. [PMID: 31455005 PMCID: PMC6787733 DOI: 10.3390/jcdd6030031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 07/24/2019] [Accepted: 08/23/2019] [Indexed: 12/11/2022] Open
Abstract
Calcific aortic valve disease (CAVD) is a multifactorial condition. Both environmental and genetic factors play an important role in its etiology. CAVD exhibits a broad spectrum, varying from mild valve thickening to severe valve calcification and stenosis. Progression of the disease consists of chronic inflammation, lipoprotein deposition, and active leaflet calcification. It is a process similar to coronary artery disease. In this study, we investigated Lp(a) levels and gene polymorphisms associated with calcific aortic stenosis from blood samples after echocardiography in the evaluation of 75 patients diagnosed with CAVD and 77 controls. Blood tests were run in our laboratory to rule out certain risk factors before echocardiography examination. A significant association among smoking, elevated LDL level and creatinine, low albumin levels, Lp(a) level, rs10455872, and rs3798220 polymorphisms may be considered genetic risk factors for the development of calcific aortic stenosis.
Collapse
Affiliation(s)
- Ugur Ozkan
- Department of Cardiology, Faculty of Medicine, Trakya University, 22030 Edirne, Turkey
- Department of Cardiology, Edirne Sultan 1. Murat State Hospital, 22030 Edirne, Turkey
| | - Fatih Ozcelik
- Department of Cardiology, Faculty of Medicine, Trakya University, 22030 Edirne, Turkey
| | - Mustafa Yildiz
- Department of Biophysics, Faculty of Medicine, Trakya University, 22030 Edirne, Turkey.
| | - Metin Budak
- Department of Biophysics, Faculty of Medicine, Trakya University, 22030 Edirne, Turkey
- Molecular Research Lab, Prof. Mirko Tos Ear and Hearing Research Center, Trakya University,22030 Edirne, Turkey
| |
Collapse
|
17
|
Yamaura Y, Watanabe N, Shimaya M, Tomita Y, Fukaya T, Yoshida K. Impact of Cumulative Smoking Exposure on Subclinical Degenerative Aortic Valve Disease in Apparently Healthy Male Workers. Circ Cardiovasc Imaging 2019; 12:e008901. [DOI: 10.1161/circimaging.119.008901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background:
Little is known regarding the impact of cumulative smoking exposure and smoking cessation on subclinical degenerative aortic valve (DAV) disease.
Methods:
We examined associations of smoking status, cigarette-years of smoking, and years since quitting smoking with subclinical DAV disease defined by echocardiography.
Results:
Of 756 apparently healthy male workers, 154 had DAV including 63 with DAV with ≥2 leaflets calcification (DAV ≥2 cal). Compared with never smokers, ever smokers had higher risk of DAV and DAV ≥2 cal; odds ratios (95% CI) were 2.883 (1.800–4.618) (
p
<0.001) and 5.281 (2.297–12.138) (
p
<0.001), respectively. Both current and former smokers had dose-dependent relationships of cigarette-years on DAV and DAV ≥2 cal (
P
for trend, <0.001 for both DAV, in both smokers). In current smokers with >400–≤800 and with >800 cigarette-years, odds ratios (95%CIs) were 3.201 (1.690–6.063) (
p
<0.001) and 5.326 (2.800–10.053) (
p
<0.001) for DAV, 7.460 (2.828–19.680) (
p
<0.001) and 8.397 (3.146–22.414) (
p
<0.001) for DAV ≥2 cal, respectively. In former smokers with >800 cigarette-years, odds ratios (95%CI) were 3.780 (1.970–7.254) (
p
<0.001) for DAV, 10.035 (3.801–26.496) (
p
<0.001) for DAV ≥2 cal. Compared with current smokers, former smokers with quitting smoking >10 years had significantly lower risk of DAV and DAV ≥2 cal.
Conclusions:
In apparently healthy male workers, DAV disease was strongly associated with smoking. Cumulative smoking exposure was associated with dose-dependent relationship on subclinical DAV disease both in current smokers and former smokers.
Collapse
Affiliation(s)
- Yasuko Yamaura
- Department of Cardiology, Hyogo Health Service Association, Kobe, Japan (Y.Y., M.S., Y.T., T.F.)
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center, Miyazaki, Japan (N.W.)
| | - Maki Shimaya
- Department of Cardiology, Hyogo Health Service Association, Kobe, Japan (Y.Y., M.S., Y.T., T.F.)
| | - Yasuhiko Tomita
- Department of Cardiology, Hyogo Health Service Association, Kobe, Japan (Y.Y., M.S., Y.T., T.F.)
| | - Takashi Fukaya
- Department of Cardiology, Hyogo Health Service Association, Kobe, Japan (Y.Y., M.S., Y.T., T.F.)
| | - Kiyoshi Yoshida
- Department of Cardiology, The Sakakibara Heart Institute of Okayama, Okayama, Japan (K.Y.)
| |
Collapse
|
18
|
Levy-Neuman S, Meledin V, Gandelman G, Goland S, Zilberman L, Edri O, Shneider N, Abaeh N, Bdolah-Abram T, George J, Shimoni S. The Association Between Longitudinal Strain at Rest and Stress and Outcome in Asymptomatic Patients With Moderate and Severe Aortic Stenosis. J Am Soc Echocardiogr 2019; 32:722-729. [PMID: 30926404 DOI: 10.1016/j.echo.2019.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Calcific aortic stenosis (AS) is a progressive disease, and once moderate AS is present, the likelihood of symptom onset within 5 years is significant. The aim of this study was to determine the incremental value of global longitudinal strain (GLS) and basal longitudinal strain (BLS) at rest and during exercise on outcomes among asymptomatic patients' with moderate and severe AS. METHODS Seventy-five patients with isolated, asymptomatic AS and preserved left ventricular function were retrospectively enrolled and underwent symptom-limited exercise echocardiography. Clinical and echocardiographic data, including GLS and BLS at rest and during exercise, were assessed. Occurrence of AS-related cardiovascular events was recorded. RESULTS The mean age was 71 ± 10 years, and 63% were men. The mean aortic valve gradient was 30 ± 11 mm Hg, and the mean aortic valve area was 0.98 ± 0.21 cm2. Resting GLS and BLS were -16.5 ± 4% and -16.9 ± 3.6%, respectively. Exercise stress test results were positive in 27 patients (36%). Mean exercise GLS was -17.8 ± 3.5%, and mean exercise BLS was -17.9 ± 4%. During mean follow-up of 34.5 ± 3.5 months, cardiovascular events were observed in 45 patients. In multivariate analysis, aortic valve mean gradient (HR, 1.073; 95% CI, 1.032-1.115; P < .001) and peak exercise BLS (HR, 1.177; 95% CI, 1.07-1.295; P = .001) were associated with cardiac events during follow-up. CONCLUSIONS Reduced exercise BLS is associated with future cardiovascular events in patients' with asymptomatic AS, independently of clinical factors and conventional echocardiographic parameters. Detection of postexercise myocardial dysfunction in patients with asymptomatic AS with preserved left ventricular function can aid in risk assessment of these patients.
Collapse
Affiliation(s)
| | - Valery Meledin
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
| | - Gera Gandelman
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
| | - Sorel Goland
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel; Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Liaz Zilberman
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
| | - Orly Edri
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
| | | | - Naama Abaeh
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
| | | | - Jacob George
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel; Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Sara Shimoni
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel; Hebrew University and Hadassah Medical School, Jerusalem, Israel.
| |
Collapse
|
19
|
Varshney R, Murphy B, Woolington S, Ghafoory S, Chen S, Robison T, Ahamed J. Inactivation of platelet-derived TGF-β1 attenuates aortic stenosis progression in a robust murine model. Blood Adv 2019; 3:777-788. [PMID: 30846427 PMCID: PMC6418501 DOI: 10.1182/bloodadvances.2018025817] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 01/24/2019] [Indexed: 11/20/2022] Open
Abstract
Aortic stenosis (AS) is a degenerative heart condition characterized by fibrosis and narrowing of aortic valves (AV), resulting in high wall shear stress (WSS) across valves. AS is associated with high plasma levels of transforming growth factor-β1 (TGF-β1), which can be activated by WSS to induce organ fibrosis, but the cellular source of TGF-β1 is not clear. Here, we show that platelet-derived TGF-β1 plays an important role in AS progression. We first established an aggressive and robust murine model of AS, using the existing Ldlr -/- Apob100/100 (LDLR) breed of mice, and accelerated AS progression by feeding them a high-fat diet (HFD). We then captured very high resolution images of AV movement and thickness and of blood flow velocity across the AV, using a modified ultrasound imaging technique, which revealed early evidence of AS and distinguished different stages of AS progression. More than 90% of LDLR animals developed AS within 6 months of HFD. Scanning electron microscopy and whole-mount immunostaining imaging of AV identified activated platelets physically attached to valvular endothelial cells (VEC) expressing high phosphorylated Smad2 (p-Smad2). To test the contribution of platelet-derived TGF-β1 in AS, we derived LDLR mice lacking platelet TGF-β1 (TGF-β1platelet-KO-LDLR) and showed reduced AS progression and lower p-Smad2 and myofibroblasts in their AV compared with littermate controls fed the HFD for 6 months. Our data suggest that platelet-derived TGF-β1 triggers AS progression by inducing signaling in VEC, and their subsequent transformation into collagen-producing-myofibroblasts. Thus, inhibiting platelet-derived TGF-β1 might attenuate or prevent fibrotic diseases characterized by platelet activation and high WSS, such as AS.
Collapse
Affiliation(s)
- Rohan Varshney
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| | - Brennah Murphy
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| | - Sean Woolington
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| | - Shahrouz Ghafoory
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Tyler Robison
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| | - Jasimuddin Ahamed
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, OK; and
| |
Collapse
|
20
|
|
21
|
Auensen A, Hussain AI, Bendz B, Aaberge L, Falk RS, Walle-Hansen MM, Bye J, Andreassen J, Beitnes JO, Rein KA, Pettersen KI, Gullestad L. Morbidity outcomes after surgical aortic valve replacement. Open Heart 2017; 4:e000588. [PMID: 28674629 PMCID: PMC5471875 DOI: 10.1136/openhrt-2017-000588] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/16/2022] Open
Abstract
Objective In patients with mild to moderate operative risk, surgical aortic valve replacement (SAVR) is still the preferred treatment for patients with severe symptomatic aortic stenosis (AS). Aiming to broaden the knowledge of postsurgical outcomes, this study reports a broad set of morbidity outcomes following surgical intervention. Methods Our cohort comprised 442 patients referred for severe AS; 351 had undergone SAVR, with the remainder (91) not operated on. All patients were evaluated using the 6-minute walk test (6MWT), were assigned a New York Heart Association class (NYHA) and Canadian Cardiovascular Society class (CCS), with additional scores for health-related quality of life (HRQoL), cognitive function (Mini-Mental State Examination (MMSE)) and myocardial remodelling (at inclusion and at 1-year follow-up). Adverse events and mortality were recorded. Results Three-year survival after SAVR was 90.0%. SAVR was associated with an improved NYHA class, CCS score and HRQoL, and provoked reverse ventricular remodelling. The 6MWT decreased, while the risks of major adverse cardiovascular events (death, non-fatal stroke/transient ischaemic attack or myocardial infarction) and all-cause hospitalisation (incidence rate per 100 patient-years) were 13.5 and 62.4, respectively. The proportion of cognitive disability measured by MMSE increased after SAVR from 3.2% to 8.8% (p=0.005). Proportion of patients living independently at home, having attained NYHA class I, was met by 49.1% at 1 year. Unoperated individuals had a poor prognosis in terms of any outcome. Conclusion This study provides knowledge of outcomes beyond what is known about the mortality benefit after SAVR to provide insight into the morbidity burden of modern-day SAVR.
Collapse
Affiliation(s)
- Andreas Auensen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Bjørn Bendz
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | | | - Jorun Bye
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johanna Andreassen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jan Otto Beitnes
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Kjell Arne Rein
- Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kjell Ingar Pettersen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| |
Collapse
|
22
|
Ringle A, Levy F, Ennezat PV, Le Goffic C, Castel AL, Delelis F, Menet A, Malaquin D, Graux P, Vincentelli A, Tribouilloy C, Maréchaux S. Relationship between exercise pressure gradient and haemodynamic progression of aortic stenosis. Arch Cardiovasc Dis 2017; 110:466-474. [PMID: 28395958 DOI: 10.1016/j.acvd.2016.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/02/2016] [Accepted: 12/15/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS We hypothesized that large exercise-induced increases in aortic mean pressure gradient can predict haemodynamic progression during follow-up in asymptomatic patients with aortic stenosis. METHODS We retrospectively identified patients with asymptomatic moderate or severe aortic stenosis (aortic valve area<1.5cm2 or<1cm2) and normal ejection fraction, who underwent an exercise stress echocardiography at baseline with a normal exercise test and a resting echocardiography during follow-up. The relationship between exercise-induced increase in aortic mean pressure gradient and annualised changes in resting mean pressure gradient during follow-up was investigated. RESULTS Fifty-five patients (mean age 66±15 years; 45% severe aortic stenosis) were included. Aortic mean pressure gradient significantly increased from rest to peak exercise (P<0.001). During a median follow-up of 1.6 [1.1-3.2] years, resting mean pressure gradient increased from 35±13mmHg to 48±16mmHg, P<0.0001. Median annualised change in resting mean pressure gradient during follow-up was 5 [2-11] mmHg. Exercise-induced increase in aortic mean pressure gradient did correlate with annualised changes in mean pressure gradient during follow-up (r=0.35, P=0.01). Hemodynamic progression of aortic stenosis was faster in patients with large exercise-induced increase in aortic mean pressure gradient (≥20mmHg) as compared to those with exercise-induced increase in aortic mean pressure gradient<20mmHg (median annualised increase in mean pressure gradient 19 [6-28] vs. 4 [2-10] mmHg/y respectively, P=0.002). Similar results were found in the subgroup of 30 patients with moderate aortic stenosis. CONCLUSION Large exercise-induced increases in aortic mean pressure gradient correlate with haemodynamic progression of stenosis during follow-up in patients with asymptomatic aortic stenosis. Further studies are needed to fully establish the role of ESE in the decision-making process in comparison to other prognostic markers in asymptomatic patients with aortic stenosis.
Collapse
Affiliation(s)
- Anne Ringle
- Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France
| | - Franck Levy
- Service de cardiologie B, CHU d'Amiens, 80054 Amiens, France
| | | | - Caroline Le Goffic
- Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France
| | - Anne-Laure Castel
- Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France
| | - François Delelis
- Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France
| | - Aymeric Menet
- Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France
| | | | - Pierre Graux
- Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France
| | | | - Christophe Tribouilloy
- Service de cardiologie B, CHU d'Amiens, 80054 Amiens, France; Inserm U 1088, université de Picardie, 80054 Amiens, France
| | - Sylvestre Maréchaux
- Service de cardiologie, GCS-groupement des hôpitaux de l'institut catholique de Lille, faculté libre de médecine, université catholique de Lille, 59000 Lille, France; Inserm U 1088, université de Picardie, 80054 Amiens, France.
| |
Collapse
|
23
|
Chang K, Yokose C, Tenner C, Oh C, Donnino R, Choy-Shan A, Pike VC, Shah BD, Lorin JD, Krasnokutsky S, Sedlis SP, Pillinger MH. Association Between Gout and Aortic Stenosis. Am J Med 2017; 130:230.e1-230.e8. [PMID: 27720853 PMCID: PMC5357081 DOI: 10.1016/j.amjmed.2016.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/14/2016] [Accepted: 09/15/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND An independent association between gout and coronary artery disease is well established. The relationship between gout and valvular heart disease, however, is unclear. The aim of this study was to assess the association between gout and aortic stenosis. METHODS We performed a retrospective case-control study. Aortic stenosis cases were identified through a review of outpatient transthoracic echocardiography (TTE) reports. Age-matched controls were randomly selected from patients who had undergone TTE and did not have aortic stenosis. Charts were reviewed to identify diagnoses of gout and the earliest dates of gout and aortic stenosis diagnosis. RESULTS Among 1085 patients who underwent TTE, 112 aortic stenosis cases were identified. Cases and nonaortic stenosis controls (n = 224) were similar in age and cardiovascular comorbidities. A history of gout was present in 21.4% (n = 24) of aortic stenosis subjects compared with 12.5% (n = 28) of controls (unadjusted odds ratio 1.90, 95% confidence interval 1.05-3.48, P = .038). Multivariate analysis retained significance only for gout (adjusted odds ratio 2.08, 95% confidence interval 1.00-4.32, P = .049). Among subjects with aortic stenosis and gout, gout diagnosis preceded aortic stenosis diagnosis by 5.8 ± 1.6 years. The age at onset of aortic stenosis was similar among patients with and without gout (78.7 ± 1.8 vs 75.8 ± 1.0 years old, P = .16). CONCLUSIONS Aortic stenosis patients had a markedly higher prevalence of precedent gout than age-matched controls. Whether gout is a marker of, or a risk factor for, the development of aortic stenosis remains uncertain. Studies investigating the potential role of gout in the pathophysiology of aortic stenosis are warranted and could have therapeutic implications.
Collapse
Affiliation(s)
- Kevin Chang
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Chio Yokose
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Craig Tenner
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Primary Care, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Primary Care, Department of Medicine, New York University School of Medicine
| | - Cheongeun Oh
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Department of Biostatistics, New York University
| | - Robert Donnino
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine; Department of Radiology, New York University School of Medicine
| | - Alana Choy-Shan
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Virginia C Pike
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Binita D Shah
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Jeffrey D Lorin
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Svetlana Krasnokutsky
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine
| | - Steven P Sedlis
- TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine; Section of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Cardiology, Department of Medicine, New York University School of Medicine
| | - Michael H Pillinger
- Section of Rheumatology, Department of Medicine, Veterans Affairs New York Harbor Healthcare System; Division of Rheumatology, Department of Medicine, New York University School of Medicine; TRIAD (Translational Research in Inflammation and Atherosclerotic Disease), New York University School of Medicine.
| |
Collapse
|
24
|
Arterial Stiffness in Aortic Stenosis: Relationship with Severity and Echocardiographic Procedures Response. High Blood Press Cardiovasc Prev 2017; 24:19-27. [DOI: 10.1007/s40292-016-0176-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/24/2016] [Indexed: 01/19/2023] Open
|
25
|
Bashir M, Harky A, Bleetman D, Adams B, Roberts N, Balmforth D, Yap J, Lall K, Shipolini A, Oo A, Uppal R. Aortic Valve Replacement: Are We Spoiled for Choice? Semin Thorac Cardiovasc Surg 2017; 29:265-272. [DOI: 10.1053/j.semtcvs.2017.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2017] [Indexed: 12/27/2022]
|
26
|
Platania I, Terranova V, Tomasello SD, Boukhris M, Cilia C, Di Marca S, Pisano M, Mastrosimone G, Cataudella E, Stancanelli B, Malatino L. Mean Transaortic Gradient is an Emerging Predictor of Chronic Kidney Disease in Elderly Patients. Angiology 2016; 68:528-534. [DOI: 10.1177/0003319716672527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Arterial hypertension (AH) is a major risk factor for chronic kidney disease (CKD). However, whether AH maintains this role in the development of CKD in elderly patients with aortic stenosis (AS) or whether transaortic gradient influences CKD remains unclear. Consecutive hospitalized patients were prospectively recruited to evaluate the relationship between AS and CKD. In all patients, transthoracic 2-dimensional echocardiography was performed to evaluate AS; renal function was evaluated using the Chronic Kidney Disease Epidemiology Collaboration formula. A total of 346 patients were included in the study (mean age: 79.5 ± 7.4 years): 104 had diabetes mellitus (DM), 298 had AH, and 59 (moderate: 52; severe: 7) showed AS. After multivariate analysis, age ( P <.01), DM ( P = .02), and mean transaortic gradient ( P = .03), but not AH, were independent predictors of CKD. Both in the presence (n = 59) or absence (n = 287) of AS, the estimated glomerular filtration rate did not differ in patients with (51 ± 24 mL/min/1.73 m2 and 59 ± 25 mL/min/1.73 m2, respectively) and those without AH (50 ± 21 mL/min/1.73 m2 and 65 ± 24 mL/min/1.73 m2, respectively). In the whole population, for each mm Hg of mean transaortic gradient, the risk of CKD increased by 2.5 times.
Collapse
Affiliation(s)
- Ingrid Platania
- Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Valentina Terranova
- Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salvatore Davide Tomasello
- Department of Clinical and Experimental Medicine, Unit of Cardiology, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Marouane Boukhris
- Department of Clinical and Experimental Medicine, Unit of Cardiology, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Chiara Cilia
- Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Salvatore Di Marca
- Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Marcella Pisano
- Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Gianluca Mastrosimone
- Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Emanuela Cataudella
- Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Benedetta Stancanelli
- Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Lorenzo Malatino
- Department of Clinical and Experimental Medicine, Unit of Internal Medicine, Cannizzaro Hospital, University of Catania, Catania, Italy
| |
Collapse
|
27
|
Jang JY, Seo JS, Sun BJ, Kim DH, Song JM, Kang DH, Song JK. Impact of Valvuloarterial Impedance on Concentric Remodeling in Aortic Stenosis and Its Regression after Valve Replacement. J Cardiovasc Ultrasound 2016; 24:201-207. [PMID: 27721950 PMCID: PMC5050308 DOI: 10.4250/jcu.2016.24.3.201] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 08/17/2016] [Accepted: 08/17/2016] [Indexed: 11/28/2022] Open
Abstract
Background Left ventricle (LV) in patients with aortic stenosis (AS) faces a double hemodynamic load incorporating both valvular stenosis and reduced systemic arterial compliance (SAC). This study aimed to evaluate the impact of global LV afterload on LV hypertrophy (LVH) before and after aortic valve replacement (AVR). Methods The study cohort included 453 patients (247 males; mean age, 64 ± 11 years) who underwent AVR. Pre- and post-AVR echocardiographic examinations were retrospectively analyzed including an index of valvuloarterial impedance (ZVA) and LV mass index/LV end-diastolic volume index (LVMI/LVEDVI) as a parameter of LVH. Results Pre-AVR LVMI/LVEDVI was 2.7 ± 0.9 g/mL with an aortic valve area (AVA) of 0.6 ± 0.2 cm2. ZVA was 5.9 ± 1.9 mm Hg/mL/m2 and showed a stronger correlation (β = 0.601, p < 0.001) with pre-AVR LVMI/LVEDVI than indexed AVA (β = 0.061, p = 0.19), transvalvular peak velocity (β = 0.211, p < 0.001). During a median follow-up of 3.5 years, patients had a 18.8 ± 10.4% decrease in the LV geometry index with a decrease in SAC from 1.20 ± 0.48 to 1.00 ± 0.38 mL/m2/mm Hg (p < 0.001). Pre-AVR LV ejection fraction (r = 0.284, p < 0.001) and ZVA (r = 0.523, p < 0.001) were independent factors associated with LVH regression in 322 patients with follow-up duration >1 year after AVR. Conclusion ZVA is a major determinant of concentric remodeling in AS before AVR and LVH regression after AVR, which should be incorporated in routine evaluation of AS.
Collapse
Affiliation(s)
- Jeong Yoon Jang
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea.; Division of Cardiology, Department of Internal Medicine, Gyeongsang National University School of Medicine, Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicinen, Busan, Korea
| | - Byung Joo Sun
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Dae-Hee Kim
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Min Song
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Duk-Hyun Kang
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae-Kwan Song
- Cardiac Imaging Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| |
Collapse
|
28
|
Schoen FJ. Morphology, Clinicopathologic Correlations, and Mechanisms in Heart Valve Health and Disease. Cardiovasc Eng Technol 2016; 9:126-140. [PMID: 27502286 DOI: 10.1007/s13239-016-0277-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
The clinical and pathological features of the most frequent intrinsic structural diseases that affect the heart valves are well established, but heart valve disease mechanisms are poorly understood, and effective treatment options are evolving. Major advances in the understanding of the structure, function and biology of native valves and the pathobiology, biomaterials and biomedical engineering, and the clinical management of valvular heart disease have occurred over the past several decades. This communication reviews contemporary considerations relative to the pathology of valvular heart disease, including (1) clinical significance and epidemiology of valvular heart disease; (2) functional and dynamic valvular macro-, micro- and ultrastructure; (3) causes, morphology and mechanisms of human valvular heart disease; and (4) pathologic considerations in valve replacement, repair and, potentially, regeneration of the heart valves.
Collapse
Affiliation(s)
- Frederick J Schoen
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| |
Collapse
|
29
|
Dominguez-Rodriguez A, Abreu-Gonzalez P. Is it Time for a New Paradigm in Asymptomatic Severe Aortic Stenosis? J Am Coll Cardiol 2016; 67:1968-9. [DOI: 10.1016/j.jacc.2016.01.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/12/2016] [Indexed: 11/24/2022]
|
30
|
Tang L, Jiang L, Pan XD, Chen PP, Wang W, Jiao J, Yang Y, Chen J, Wang LY. Extremely severe aortic stenosis developed in a young female patient with underdiagnosis of homozygous familial hypercholesterolemia: An 8-year follow-up. Int J Cardiol 2016; 207:372-4. [DOI: 10.1016/j.ijcard.2016.01.087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 01/03/2016] [Indexed: 12/26/2022]
|
31
|
Ramakrishna H, Gutsche JT, Patel PA, Fernando R, Agoustides JGT. Options for Incidental Moderate Aortic Stenosis During Concomitant Valve Surgery: A Clinical Update for the Perioperative Echocardiographer. J Cardiothorac Vasc Anesth 2015; 30:252-7. [PMID: 26627184 DOI: 10.1053/j.jvca.2015.08.016] [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: 08/13/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Harish Ramakrishna
- Department of Anesthesiology, Mayo Clinic, Scottsdale, AZ; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Department of Anesthesiology, Mayo Clinic, Scottsdale, AZ; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Prakash A Patel
- Department of Anesthesiology, Mayo Clinic, Scottsdale, AZ; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rohesh Fernando
- Department of Anesthesiology, Mayo Clinic, Scottsdale, AZ; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - John G T Agoustides
- Department of Anesthesiology, Mayo Clinic, Scottsdale, AZ; Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
32
|
Affiliation(s)
- Masao Daimon
- Department of Clinical Laboratory, the University of Tokyo Hospital
| |
Collapse
|