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Serum and Vascular Stiffness Biomarkers Associated with the Severity of Degenerative Aortic Valve Stenosis and Cardiovascular Outcomes. J Cardiovasc Dev Dis 2022; 9:jcdd9060193. [PMID: 35735822 PMCID: PMC9225443 DOI: 10.3390/jcdd9060193] [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: 05/20/2022] [Revised: 06/07/2022] [Accepted: 06/16/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Although degenerative aortic valve stenosis (DAS) is the most prevalent growth-up congestive heart valve disease, still little known about relationships between DAS severity, vascular stiffness (VS), echocardiographic parameters, and serum biomarkers in patients undergoing transcatheter (TAVR) or surgical aortic valve replacement (SAVR). The objective of this study was to identify biomarkers associated with DAS severity, and those that are associated with cardiovascular death (CVD) and episodes of chronic heart failure (CHF) exacerbation. Methods: A total of 137 patients with initially moderate-to-severe DAS were prospectively evaluated for the relationship between DAS severity, baseline VS, and serum biomarkers (uPAR, GDF-15, Gal-3, IL-6Rα, ET-1, PCSK9, RANTES/CCL5, NT-proBNP, and hs-TnT), and were followed-up for 48 months. The prognostic significance of each variable for CVD and CHF risk was measured by hazard ratio of risk (HR), which was calculated by Cox’s proportional hazard model. Results: DAS severity showed correlations with IL-6Rα (r = 0.306, p < 0.001), uPAR (r = 0.184, p = 0.032), and NT-proBNP (r = −0.389, p < 0.001). Levels of ET-1 and Gal-3 were strongly correlated with VS parameters (r = 0.674, p < 0.001; r = 0.724, p < 0.001). Out of 137 patients, 20 were referred to TAVR, 88 to SAVR, and 29 to OMT. In TAVR patients, the highest levels of ET-1, Gal-3, and VS were found as compared to other patients. The highest incidence of CVD was observed in patients who underwent TAVR (35%), compared to SAVR (8%) and OMT (10.3%) (p = 0.004). In a multivariate analysis, ET-1 occurred predictive of CVD risk (HR 25.1, p = 0.047), while Gal-3 > 11.5 ng/mL increased the risk of CHF exacerbation episodes requiring hospital admission by 12%. Conclusions: Our study indicated that ET-1 and Gal-3 levels may be associated with the outcomes in patients with DAS.
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Association of Increased Vascular Stiffness with Cardiovascular Death and Heart Failure Episodes Following Intervention on Symptomatic Degenerative Aortic Stenosis. J Clin Med 2022; 11:jcm11082078. [PMID: 35456171 PMCID: PMC9024730 DOI: 10.3390/jcm11082078] [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: 02/01/2022] [Revised: 03/30/2022] [Accepted: 04/05/2022] [Indexed: 12/04/2022] Open
Abstract
Background. The resistive (RI) and pulsatile (PI) indices are markers of vascular stiffness (VS) which are associated with outcomes in patients with cardiovascular disease. We aimed to assess whether VS might predict incidence of cardiovascular death (CVD) and heart failure (HF) episodes following intervention on degenerative aortic valve stenosis (DAS). Methods. The distribution of increased VS (RI ≥ 0.7 and PI ≥ 1.3) from supra-aortic arteries was assessed in patients with symptomatic DAS who underwent aortic valve replacement (AVR, n = 127) or transcatheter aortic valve implantation (TAVI, n = 119). During a 3-year follow-up period (FU), incidences of composite endpoint (CVD and HF) were recorded. Results. Increased VS was found in 100% of TAVI patients with adverse event vs. 88.9% event-free TAVI patients (p = 0.116), and in 93.3% of AVR patients with event vs. 70.5% event-free (p = 0.061). Kaplan–Mayer free-survival curves at 1-year and 3-year FU were 90.5% vs. 97.1 % and 78% vs. 97.1% for patients with increased vs. lower VS. (p = 0.014). In univariate Cox analysis, elevated VS (HR 7.97, p = 0.04) and age (HR 1.05, p = 0.024) were associated with risk of adverse outcomes; however, both failed in Cox multivariable analysis. Conclusions. Vascular stiffness is associated with outcome after DAS intervention. However, it cannot be used as an independent outcome predictor.
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Baran J, Kleczyński P, Niewiara Ł, Podolec J, Badacz R, Gackowski A, Pieniążek P, Legutko J, Żmudka K, Przewłocki T, Kabłak-Ziembicka A. Importance of Increased Arterial Resistance in Risk Prediction in Patients with Cardiovascular Risk Factors and Degenerative Aortic Stenosis. J Clin Med 2021; 10:jcm10102109. [PMID: 34068323 PMCID: PMC8153260 DOI: 10.3390/jcm10102109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Cardiovascular disease is a leading cause of heart failure (HF) and major adverse cardiac and cerebral events (MACCE). Objective: To evaluate impact of vascular resistance on HF and MACCE incidence in subjects with cardiovascular risk factors (CRF) and degenerative aortic valve stenosis (DAS). Methods: From January 2016 to December 2018, in 404 patients with cardiovascular disease, including 267 patients with moderate-to-severe DAS and 137 patients with CRF, mean values of resistive index (RI) and pulsatile index (PI) were obtained from carotid and vertebral arteries. Patients were followed-up for 2.5 years, for primary outcome of HF and MACCE episodes. Results: RI and PI values in patients with DAS compared to CRF were significantly higher, with optimal cut-offs discriminating arterial resistance of ≥0.7 for RI (sensitivity: 80.5%, specificity: 78.8%) and ≥1.3 for PI (sensitivity: 81.3%, specificity: 79.6%). Age, female gender, diabetes, and DAS were all independently associated with increased resistance. During the follow-up period, 68 (16.8%) episodes of HF-MACCE occurred. High RI (odds ratio 1.25, 95% CI 1.13–1.37) and PI (odds ratio 1.21, 95% CI 1.10–1.34) were associated with risk of HF-MACCE. Conclusions: An accurate assessment of vascular resistance may be used for HF-MACCE risk stratification in patients with DAS.
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Affiliation(s)
- Jakub Baran
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.B.); (P.K.); (Ł.N.); (J.P.); (R.B.); (P.P.); (J.L.); (K.Ż.); (T.P.)
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.B.); (P.K.); (Ł.N.); (J.P.); (R.B.); (P.P.); (J.L.); (K.Ż.); (T.P.)
| | - Łukasz Niewiara
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.B.); (P.K.); (Ł.N.); (J.P.); (R.B.); (P.P.); (J.L.); (K.Ż.); (T.P.)
- Department of Emergency Medicine, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Krakow, Poland
| | - Jakub Podolec
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.B.); (P.K.); (Ł.N.); (J.P.); (R.B.); (P.P.); (J.L.); (K.Ż.); (T.P.)
| | - Rafał Badacz
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.B.); (P.K.); (Ł.N.); (J.P.); (R.B.); (P.P.); (J.L.); (K.Ż.); (T.P.)
| | - Andrzej Gackowski
- Department of Coronary Disease and Heart Failure, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland;
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, 31-202 Krakow, Poland
| | - Piotr Pieniążek
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.B.); (P.K.); (Ł.N.); (J.P.); (R.B.); (P.P.); (J.L.); (K.Ż.); (T.P.)
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.B.); (P.K.); (Ł.N.); (J.P.); (R.B.); (P.P.); (J.L.); (K.Ż.); (T.P.)
| | - Krzysztof Żmudka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.B.); (P.K.); (Ł.N.); (J.P.); (R.B.); (P.P.); (J.L.); (K.Ż.); (T.P.)
| | - Tadeusz Przewłocki
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.B.); (P.K.); (Ł.N.); (J.P.); (R.B.); (P.P.); (J.L.); (K.Ż.); (T.P.)
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland
| | - Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Krakow, Poland; (J.B.); (P.K.); (Ł.N.); (J.P.); (R.B.); (P.P.); (J.L.); (K.Ż.); (T.P.)
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, 31-202 Krakow, Poland
- Correspondence:
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Elvira-Ruiz G, Caro-Martínez C, Flores-Blanco PJ, Cerezo-Manchado JJ, Albendín-Iglesias H, Lova-Navarro A, Arregui-Montoya F, Muñoz-Franco FM, García-Iniesta N, García-Alberola A, Bailén-Lorenzo JL, Pascual-Figal DA, Manzano-Fernández S. Aortic valve stenosis provides complementary information to bleeding risk scores in non-valvular atrial fibrillation patients initiating anticoagulation. J Geriatr Cardiol 2020; 17:141-148. [PMID: 32280330 PMCID: PMC7118015 DOI: 10.11909/j.issn.1671-5411.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/30/2020] [Accepted: 02/20/2020] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND The identification of modifiable bleeding risk factors may be of relevance. The aim is to evaluate if aortic stenosis (AS) provides additional information to bleeding risk scores for predicting major bleeding (MB) in non-valvular atrial fibrillation (AF). METHODS We designed a retrospective multi-center study including 2880 consecutive non-valvular AF patients initiating oral anticoagulation between January 2013 and December 2016. AS was defined as moderate or severe according to European echocardiography guidelines criteria. HASBLED, ATRIA and ORBIT scores were used to evaluate the bleeding risk. MB was defined according to the International Society on Thrombosis and Haemostasia criteria and registered at 18 months of follow-up. RESULTS 168 (5.8%) patients had AS. Patients with AS had higher risk for MB compared to those without AS (HR = 2.13, 95% CI: 1.40-3.23, P < 0.001). Patients without AS and low-intermediate bleeding risk (0 points) showed the lowest MB rate, whereas the MB rate observed among patients with AS and high bleeding risk (2 points) was the highest one. Discrimination and reclassification analyses showed that AS provided additional information to bleeding risk scores for predicting MB at 18 months of follow-up. CONCLUSIONS In this population, AS was associated with an increased risk for MB at midterm follow-up. The three scoring systems showed a moderate discriminatory ability for MB. Moreover, the addition of AS was associated with a significant improvement in their predictive accuracy. We suggest that the presence of this valvulopathy should be taken into account for bleeding risk assessment.
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Affiliation(s)
- Ginés Elvira-Ruiz
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
| | - César Caro-Martínez
- Department of Cardiology, University Hospital Morales Meseguer, Murcia, Spain
- Department of Hematology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Pedro José Flores-Blanco
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
| | - Juan José Cerezo-Manchado
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
- Department of Hematology, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Helena Albendín-Iglesias
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
- Department of Internal Medicine, University Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Alejandro Lova-Navarro
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
| | - Francisco Arregui-Montoya
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
| | - Francisca María Muñoz-Franco
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
| | - Natalia García-Iniesta
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
| | - Arcadio García-Alberola
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
- School of Medicine, University of Murcia, Murcia, Spain
| | | | - Domingo Andrés Pascual-Figal
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
- School of Medicine, University of Murcia, Murcia, Spain
| | - Sergio Manzano-Fernández
- Department of Cardiology, University Hospital Virgen de la Arrixaca, Murcia, Spain
- Instituto Murciano de Investigación en Biomedicina (IMIB), Murcia, Spain
- School of Medicine, University of Murcia, Murcia, Spain
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