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Bellino M, Antonini-Canterin F, Bossone E, Faggiano P, Chirillo F, La Carrubba S, Faganello G, Cecconi M, Zito C, Dasseni N, Nistri S, Moreo A, Fabiani I, Faden G, Agostini F, Manuppelli V, Cameli M, Cresti A, Dentamaro I, Monte IP, Barbieri A, Ciampi Q, Giorgi M, Galasso G, Carerj S, Pepi M, Benedetto F, Colonna P, Citro R. Aortopathy and aortic valve surgery in patients with bicuspid aortic valve with and without raphe. Int J Cardiol 2024:132000. [PMID: 38561108 DOI: 10.1016/j.ijcard.2024.132000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/04/2024]
Abstract
AIM To evaluate the association between raphe in bicuspid aortic valve (BAV) patients and valve dysfunction, aortopathy and aortic valve surgery in the REBECCA registry [REgistro della valvola aortica Bicuspide della Società Italiana di ECocardiografia e CArdiovascular Imaging (SIECVI)]. METHODS Prevalence of aortic valve dysfunction and aortopathy was investigated in BAV patients with and without raphe. Aortic valve dysfunction (regurgitation or stenosis) was categorized as mild, moderate and severe. Aortopathy was defined as annulus ≥14 mm/m2; root ≥20 mm/m2; sinotubular junction ≥16 mm/m2; ascending aorta ≥17 mm/m2, and classified in Type A, isolated ascending aorta dilatation; Type B, aortic root and ascending aorta dilatation; and Type C, isolated aortic root dilatation. RESULTS Overall, 695 patients with BAV were enrolled; 520 (74.8%) with raphe and 175 (25.2%) without raphe. BAV patients with raphe presented more frequently with moderate or severe aortic stenosis than BAV patients without raphe (183 [35.2%] vs 34 [19.4%], p < 0.001). A higher prevalence of aortopathy, particularly Type B, was observed in patients with vs without raphe. At multivariable analysis, raphe was a predictor of aortic valve surgery at three-year follow-up (odds ratio 2.19, 95% confidence interval 1.08-4.44, p < 0.001). CONCLUSIONS Patients with BAV and raphe have a higher prevalence of significant aortic stenosis, aortopathy, especially Type B, and a higher risk of undergoing aortic valve surgery at three-year follow-up.
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Affiliation(s)
- Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | | | - Eduardo Bossone
- Department of Public Health, "Federico II" University of Naples, Naples, Italy
| | - Pompilio Faggiano
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Fabio Chirillo
- Department of Cardiology, Ospedale San Bassiano, Bassano del Grappa (VI), Italy
| | | | - Giorgio Faganello
- Cardiovascular Department, University Hospital and Health Services of Trieste, Trieste, Italy
| | - Moreno Cecconi
- Department of Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria, Ospedali Riuniti, Ancona, Italy
| | - Concetta Zito
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino", Messina, Italy
| | - Nicolò Dasseni
- Cardiology Division, ASST Franciacorta, Chiari (BS), Italy
| | - Stefano Nistri
- Department of Cardiology, CMSR, Altavilla Vicentina (VI), Italy
| | - Antonella Moreo
- Cardiology IV, "A. De Gasperis" Department, ASST Niguarda Metropolitan Hospital, Milan, Italy
| | - Iacopo Fabiani
- Division of Cardiology and Cardiovascular Medicine, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | | | | | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Alberto Cresti
- Cardiology, Cardio Neuro Vascular Department, Asl Sudest Toscana, Hospital of Grosseto, Grosseto, Italy
| | - Ilaria Dentamaro
- Cardiology Department and Cardiovascular Imaging Laboratory, Hospital Miulli, Bari, Italy
| | - Ines Paola Monte
- Department of General Surgery and Medical Surgery Specialties, University of Catania, AOU Policlinico G. Rodolico-San Marco, Catania, Italy
| | - Andrea Barbieri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Mauro Giorgi
- Department of Cardiology, University Hospital Città della Scienza e Salute, Molinette Hospital, Turin, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | - Scipione Carerj
- Section of Cardiology, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino", Messina, Italy
| | - Mauro Pepi
- Department of Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Frank Benedetto
- Cardiology, G.O.M. "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - Paolo Colonna
- Department of Cardiology, Hospital Policlinico of Bari, Bari, Italy
| | - Rodolfo Citro
- Cardio-Thoracic and Vascular Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy; Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli (IS), Italy.
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You YJ, Ko SM. Computed Tomography and Magnetic Resonance Imaging Findings of Bicuspid Aortic Valve and Related Abnormalities of the Heart and Thoracic Aorta. Korean J Radiol 2023; 24:960-973. [PMID: 37724590 PMCID: PMC10550744 DOI: 10.3348/kjr.2023.0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 09/21/2023] Open
Abstract
The bicuspid aortic valve (BAV) is the most common congenital cardiovascular malformation. Patients with BAV are at higher risk of other congenital cardiovascular malformations and valvular dysfunction, including aortic stenosis/regurgitation and infective endocarditis. BAV may also be related to aortic wall abnormalities such as aortic dilatation, aneurysm, and dissection. The morphology of the BAV varies with the presence and position of the raphe and is associated with the type of valvular dysfunction and aortopathy. Therefore, accurate diagnosis and effective treatment at an early stage are essential to prevent complications in patients with BAV. This pictorial essay highlights the characteristics of BAV and its related congenital cardiovascular malformations, valvular dysfunction, aortopathy, and other rare cardiac complications using multimodal imaging.
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Affiliation(s)
- You Jin You
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Sung Min Ko
- Department of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
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Castelo A, Grazina A, Teixeira B, Mendonça T, Rodrigues I, Garcia Brás P, Vaz Ferreira V, Ramos R, Fiarresga A, Cacela D, Cruz Ferreira R. Outcomes and predictors of periprocedural stroke after transcatheter aortic valve implantation. J Stroke Cerebrovasc Dis 2023; 32:107054. [PMID: 36881984 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/18/2023] [Accepted: 02/06/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Risk factors for stroke after transcatheter aortic valve implantation (TAVI) are currently incompletely understood. PURPOSE To identify possible predictors of early post-TAVI stroke and explore its short-term outcomes. METHODS Retrospective analysis of consecutive patients (pts) submitted to TAVI between 2009 and 2020 in a tertiary center. Baseline characteristics, procedural information and stroke in first 30 days after TAVI were collected. In-hospital and 12 months outcomes were analyzed. RESULTS A total of 512pts (56,1% female, mean age of 82 ± 6years.) were included. In the first 30 days after TAVI 19pts (3,7%) had a stroke. In univariate analysis stroke was associated with higher body mass index (29 vs 27kg/m2, p=0.035), higher triglyceridemia (> 117,5mg/dL, p=0,002), lower high-density lipoprotein (< 38,5mg/dL, p=0,009) and porcelain aorta (36,8% vs 15,5%, p=0,014) and more frequent use of post-dilatation (58,8% vs 32%, p=0,021). In multivariate analysis, triglycerides > 117,5mg/dL (p=0,032, OR = 3,751) and post-dilatation (p=0,019, OR = 3,694) were the independent predictors. Stroke after TAVI was associated with longer intensive care unit stay (12 vs 4 days, p<0,001) and post-TAVI hospital stay (25 vs 10 days, p<0,0001), higher intra-hospital mortality (21,1% vs 4,3%, p=0,003), cardiovascular 30-day mortality (15,8% vs 4,1%, p=0,026) and 1-year stroke (13,2% vs 1,1%, p=0,003). CONCLUSION Periprocedural and 30-day stroke is a relatively uncommon but potentially devastating complication after TAVI. In this cohort, 30-day stroke rate after TAVI was 3.7%. Hypertriglyceridemia and post-dilatation were found to be the only independent risk predictors. Outcomes after stroke, including 30-day mortality, were significantly worse.
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Chounta S, Lemler S, Haddy N, Fresneau B, Mansouri I, Bentriou M, Demoor-Goldschmidt C, Diallo I, Souchard V, Do TD, Veres C, Surun A, Doz F, Llanas D, Vu-Bezin G, Rubino C, de Vathaire F, Letort V, Allodji RS. The risk of valvular heart disease in the French Childhood Cancer Survivors' Study: Contribution of dose-volume histogram parameters. Radiother Oncol 2023; 180:109479. [PMID: 36657724 DOI: 10.1016/j.radonc.2023.109479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/17/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Valvular Heart Disease (VHD) is a known complication of childhood cancer after radiotherapy treatment. However, the dose-volume-effect relationships have not been fully explored. MATERIALS AND METHODS We obtained individual heart Dose Volume Histograms (DVH) for survivors of the French Childhood Cancer Survivors Study (FCCSS) who had received radiotherapy. We calculated the Mean Dose to the Heart (MHD) in Gy, as well as the heart DVH parameters (Vd Gy, which represents the percentage of heart volume receiving at least d Gy), fixing the thresholds to 0.1 Gy, 5 Gy, 20 Gy, and 40 Gy. We analyzed them furtherly in the subpopulation of the cohort that was treated with a dose lower than 5 Gy (V0.1Gy|V5Gy=0%), 20 Gy (V5Gy|V20Gy=0%), and 40 Gy (V20Gy|V40Gy=0%), respectively. We investigated their role in the occurrence of a VHD in this population-based observational cohort study using the Cox proportional hazard model, adjusting for age at cancer diagnosis and chemotherapy exposure. RESULTS Median follow-up was 30.6 years. Eighty-one patients out of the 7462 (1 %) with complete data experienced a severe VHD (grade ≥ 3). The risk of VHD increased along with the MHD, and it was associated with high doses to the heart (V40Gy < 50 %, hazard ratio (HR) = 7.96, 95 % CI: 4.26-14.88 and V20Gy|V40Gy=0% >50 %, HR = 5.03, 95 % CI: [2.35-10.76]). Doses 5-20 Gy to more than 50 % (V5Gy|V20Gy=0% >50 %) of the heart induced a marginally non-significant estimated risk. We also observed a remarkable risk increase with attained age. CONCLUSIONS Our results provide new insight into the VHD risk that may impact current treatments and long-term follow-up of childhood cancer survivors.
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Affiliation(s)
- Stefania Chounta
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Sarah Lemler
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Nadia Haddy
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Université Paris-Saclay, Department of Pediatric oncology, Villejuif, F-94805, France
| | - Imene Mansouri
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; EPI-PHARE Scientific Interest Group, Saint-Denis, France; French National Agency for the Safety of Medicines and Health Products (ANSM), Saint-Denis, France
| | - Mahmoud Bentriou
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Charlotte Demoor-Goldschmidt
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; Chu de Nantes, Pediatric Oncology, 38 Bd Jean Monnet, Nantes 44093, France
| | - Ibrahima Diallo
- Department of Radiation Oncology, Gustave Roussy, Villejuif, Paris, France; Gustave Roussy, Inserm, Radiothérapie Moléculaire et Innovation Thérapeutique, Paris-Saclay University, Villejuif, Île-de-France, France
| | - Vincent Souchard
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Thi-Duyen Do
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Cristina Veres
- Department of Radiation Oncology, Gustave Roussy, Villejuif, Paris, France; Gustave Roussy, Inserm, Radiothérapie Moléculaire et Innovation Thérapeutique, Paris-Saclay University, Villejuif, Île-de-France, France
| | - Aurore Surun
- SIREDO Oncology Center (Care, Innovation, Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France
| | - François Doz
- SIREDO Oncology Center (Care, Innovation, Research for Children, Adolescents and Young Adults with Cancer), Institut Curie, Paris, France; Université Paris Cité, Paris, France
| | - Damien Llanas
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Giao Vu-Bezin
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Carole Rubino
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Florent de Vathaire
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France
| | - Véronique Letort
- Université Paris-Saclay, CentraleSupélec, Mathématiques et Informatique pour la Complexité et les Systèmes, 91190, Gif-sur-Yvette, France
| | - Rodrigue Setcheou Allodji
- Université Paris-Saclay, Univ. Paris-Sud, UVSQ, CESP, Cancer and Radiation Team, Villejuif, France; INSERM, CESP, Cancer and Radiation Team, F-94805 Villejuif, France; Gustave Roussy, Department of Clinical Research, Cancer and Radiation Team, F-94805 Villejuif, France; Polytechnic School of Abomey-Calavi (EPAC), University of Abomey-Calavi, 01 P.O. Box 2009, Cotonou, Benin.
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Paul JF. [Assessment of intracardiac flows by Magnetic Resonance Imaging: The 4D Flow imaging]. Ann Cardiol Angeiol (Paris) 2020; 69:273-275. [PMID: 33039114 DOI: 10.1016/j.ancard.2020.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
2D flow cardiac MRI is a well-established technique but has some current limitations in routine practice. New 4D flow MRI may overcome these limitations, providing dramatic dynamic imaging, easily understandable, allowing robust quantification of flows. 4D flow imaging should become soon the reference technic for valvular regurgitations and congenital heart disease.
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Affiliation(s)
- J-F Paul
- Service de radiologie, institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France.
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Abstract
The surveillance strategy for patients taking low dose cabergoline for hyperprolactinaemia is controversial. As more evidence has emerged that the risks of cardiac valvulopathy in this population of patients are low, fewer and fewer endocrinologists adhere strictly to the original medicines and healthcare products agency MHRA guidance of "at least" annual echocardiography. Strict adherence to this guidance would be costly in monetary terms (£5.76 million/year in the UK) and also in resource use (90,000 extra echocardiograms/year). This article reviews the proposed pathophysiological mechanism underlying the phenomenon of dopamine agonist valvulopathy, the characteristic echocardiographic changes seen, summarises the published literature on the incidence of valvulopathy with low dose cabergoline and examines the previous and current evidence-based screening guidelines.
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Affiliation(s)
- C E Stiles
- Department of Endocrinology, Queen Mary University of London, E1 4NS London, United Kingdom; Department of Endocrinology, Saint-Bartholomew's Hospital, EC1A 7BE London, United Kingdom.
| | - R P Steeds
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, B15 2GW Birmingham, United Kingdom; Institute of Cardiovascular Sciences, University of Birmingham, B15 2TT Birmingham, United Kingdom
| | - W M Drake
- Department of Endocrinology, Queen Mary University of London, E1 4NS London, United Kingdom; Department of Endocrinology, Saint-Bartholomew's Hospital, EC1A 7BE London, United Kingdom
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Stefek HA, Berhane H, Robinson JD, Reilly B, Ruh A, Markl M, Rigsby CK. Comprehensive MR Analysis of Cardiac Function, Aortic Hemodynamics and Left Ventricular Strain in Pediatric Cohort with Isolated Bicuspid Aortic Valve. Pediatr Cardiol 2019; 40:1450-9. [PMID: 31342116 DOI: 10.1007/s00246-019-02157-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/13/2019] [Indexed: 02/08/2023]
Abstract
Bicuspid aortic valve (BAV) disease demonstrates a range of clinical presentations and complications. We aim to use cardiac MRI (CMR) to evaluate left ventricular (LV) parameters, myocardial strain and aortic hemodynamics in pediatric BAV patients with and without aortic stenosis (AS) or regurgitation (AR) compared to tricuspid aortic valve (TAV) controls. We identified 58 pediatric BAV patients without additional cardiovascular pathology and 25 healthy TAV controls (15.3 ± 2.2 years) who underwent CMR with 4D flow. BAV cohort included subgroups with no valvulopathy (n = 13, 14.3 ± 4.7 years), isolated AS (n = 19, 14.5 ± 4.0 years), mixed valve disease (AS + AR) (n = 13, 17.1 ± 3.2 years), and prior valvotomy/valvuloplasty (n = 13, 13.9 ± 3.2 years). CMR data included LV volumetric and mass indices, myocardial strain and aortic hemodynamics. BAV patients with no valvulopathy or isolated AS had similar LV parameters to controls excepting cardiac output (p < 0.05). AS + AR and post-surgical patients had abnormal LV volumetric and mass indices (p < 0.01). Post-surgical patients had decreased global longitudinal strain (p = 0.02); other subgroups had comparable strain to controls. Patients with valvulopathy demonstrated elevated velocity and wall shear stress (WSS) in the ascending aorta (AAo) and arch (p < 0.01), while those without valve dysfunction had only elevated AAo velocity (p = 0.03). Across the cohort, elevated AAo velocity and WSS correlated to higher LV mass (p < 0.01), and abnormal hemodynamics correlated to decreased strain rates (p < 0.045). Pediatric BAV patients demonstrate abnormalities in LV parameters as a function of valvular dysfunction, most significantly in children with AS + AR or prior valvotomy/valvuloplasty. Correlations between aortic hemodynamics, LV mass and strain suggest valvular dysfunction could drive LV remodeling. Multiparametric CMR assessment in pediatric BAV may help stratify risk for cardiac remodeling and dysfunction.
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Ayme-Dietrich E, Lawson R, Da-Silva S, Mazzucotelli JP, Monassier L. Serotonin contribution to cardiac valve degeneration: new insights for novel therapies? Pharmacol Res 2019; 140:33-42. [PMID: 30208338 DOI: 10.1016/j.phrs.2018.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/07/2018] [Accepted: 09/07/2018] [Indexed: 01/13/2023]
Abstract
Heart valve disease (HVD) is a complex entity made by different pathological processes that ultimately lead to the abnormal structure and disorganization of extracellular matrix proteins resulting to dysfunction of the leaflets. At its final evolutionary step, treatments are limited to the percutaneous or surgical valve replacement, whatever the original cause of the degeneration. Understanding early molecular mechanisms that regulate valve interstitial cells remodeling and disease progression is challenging and could pave the way for future drugs aiming to prevent and/or reverse the process. Some valve degenerative processes such as the carcinoid heart disease, drug-induced valvulopathy and degenerative mitral valve disease in small-breed dogs are clearly linked to serotonin. The carcinoid heart is typically characterized by a right-sided valve dysfunction, observed in patients with carcinoid tumors developed from serotonin-producing gut enterochromaffin cells. Fenfluramine or ergot derivatives were linked to mitral and aortic valve dysfunction and share in common the pharmacological property of being 5-HT2B receptor agonists. Finally, some small-breed dogs, such as the Cavalier King Charles Spaniel are highly prone to degenerative mitral valve disease with a prevalence of 40% at 4 years-old, 70% at 7 years-old and 100% in 10-year-old animals. This degeneration has been linked to high serum serotonin, 5-HT2B receptor overexpression and SERT downregulation. Through the comprehension of serotonergic mechanisms involved into these specific situations, new therapeutic approaches could be extended to HVD in general. More recently, a serotonin dependent/ receptor independent mechanism has been suggested in congenital mitral valve prolapse through the filamin-A serotonylation. This review summarizes clinical and molecular mechanisms linking the serotonergic system and heart valve disease, opening the way for future pharmacological research in the field.
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Buss N, Lapointe JM, de Haan L, Price S, Ahnmark A, Irving L, Buchanan A, Keyes F, Davidsson P, Dixit R, Lindén D. Monoclonal antibody targeting of fibroblast growth factor receptor 1c causes cardiac valvulopathy in rats. Toxicol Appl Pharmacol 2018; 355:147-55. [PMID: 30008375 DOI: 10.1016/j.taap.2018.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 06/21/2018] [Accepted: 06/30/2018] [Indexed: 11/23/2022]
Abstract
Fibroblast Growth Factors (FGFs) and their receptors (FGFRs) have been proposed as potential drug targets for the treatment of obesity. The aim of this study was to assess the potential toxicity in rats of three anti-FGFR1c mAbs with differential binding activity prior to clinical development. Groups of male rats received weekly injections of either one of two FGFR1c-specific mAbs or an FGFR1c/FGFR4-specific mAb at 10 mg/kg for up to 4 weeks. All three mAbs caused significant reductions in food intake and weight loss leading to some animals being euthanized early for welfare reasons. In all three groups given these mAbs, microscopic changes were seen in the bones and heart valves. In the bones of the femoro-tibial joint, thickening of the diaphyseal cortex of long bones, due to deposition of well organized new lamellar bone, indicated that an osteogenic effect was observed. In the heart, valvulopathy described as an endocardial myxomatous change affecting the mitral, pulmonary, tricuspid and aortic valves was observed in all mAb-treated animals. The presence of FGFR1 mRNA expression in the heart valves was confirmed using in situ hybridization. Targeting the FGF-FGFR1c pathway with anti-FGFR1c mAbs leads to drug induced valvulopathy in rats. In effect, this precluded the development of these mAbs as potential anti-obesity drugs. The valvulopathy observed was similar to that described for fenfluramine and dexafenfluramine. The pathogenesis of the drug-induced valvulopathy is considered FGFR1c-mediated, based on the specificity of the mAbs and FGFR1 mRNA expression in the heart valves.
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Képénékian L, Cebula H, Castinetti F, Graillon T, Brue T, Goichot B. Long-term outcome of macroprolactinomas. Ann Endocrinol (Paris) 2016; 77:641-648. [PMID: 27641080 DOI: 10.1016/j.ando.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Management of macroprolactinomas has dramatically changed in recent decades, from surgical to medical treatment as first-line therapy, with the development of dopamine agonists (DA). But few data exist on the long-term outcome of these patients. PATIENTS AND METHODS Retrospective descriptive multicenter study of patients with macroprolactinoma followed for at least 5 years between 1973 and 2008 at the University Hospitals of Strasbourg and Marseille. RESULTS Forty-eight patients were included with 27 men, hypopituitarism in 33.3% of all patients and mean serum prolactin (PRL) level at diagnosis 2218.2±4154.7μg/L. Among the patients, 58.3% received medical treatment, 25% had additional surgery and 12.5% surgery and radiotherapy. The mean follow-up duration was 196±100 months. At the end of follow-up, 10 patients (20.8%) were cured (i.e. normal PRL level and normal imaging, no symptoms and withdrawal of DA≥1 year), 33 (68.8%) were controlled (i.e. normal PRL level, normal or abnormal imaging, no symptoms, DA in progress) and 5 (10.4%) were uncontrolled. Uncontrolled patients had significant higher baseline PRL level (P=0.0412) and cabergoline cumulative dose (P=0.0065) compared to the controlled group. There was no increase in frequency of hypopituitarism. Clinically significant valvular heart disease was found in 2 patients but screening was not systematic. CONCLUSIONS Macroprolactinoma is currently most often a chronic disease controlled with DA. However, uncertainty about the adverse effects associated with high cumulative doses and the lack of data on the prognosis at very long-term should incite to revisit current strategies, including the role of surgery combined to medical treatment.
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Affiliation(s)
- Lori Képénékian
- Service de médecine interne, nutrition et endocrinologie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Hélène Cebula
- Service de neurochirurgie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - Frédéric Castinetti
- CRN2M-UMR7286, service d'endocrinologie et centre de référence des maladies rares d'origine hypophysaire DEFHY, Aix-Marseille University, CNRS, Assistance publique-Hôpitaux de Marseille (AP-HM), hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 15, France
| | - Thomas Graillon
- Service de neurochirurgie, hôpital Timone, Assistance publique-Hôpitaux de Marseille (AP-HM), 264, rue Saint-Pierre, 13385 Marseille cedex 15, France
| | - Thierry Brue
- CRN2M-UMR7286, service d'endocrinologie et centre de référence des maladies rares d'origine hypophysaire DEFHY, Aix-Marseille University, CNRS, Assistance publique-Hôpitaux de Marseille (AP-HM), hôpital Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 15, France
| | - Bernard Goichot
- Service de médecine interne, nutrition et endocrinologie, hôpital de Hautepierre, University Hospital of Strasbourg, 1, avenue Molière, 67098 Strasbourg cedex, France; Faculty of Medicine, University of Strasbourg, 4, rue Kirschleger, 67000 Strasbourg, France.
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Kelley C, Lazkani M, Farah J, Pershad A. Percutaneous mitral valve repair: A new treatment for mitral regurgitation. Indian Heart J 2016; 68:399-404. [PMID: 27316505 DOI: 10.1016/j.ihj.2015.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 07/27/2015] [Accepted: 08/18/2015] [Indexed: 10/22/2022] Open
Abstract
Mitral valve disease affects more than 4 million people in the United States. The gold standard of treatment in these patients is surgical repair or replacement of the valve with a prosthesis. The MitraClip (Abbott Vascular, Menlo Park, CA) is a new technology, which offers an alternative to open surgical repair or replacement via a minimally invasive route. We present an evidence-based clinical update that provides an overview of this technology as it relates to managing patients with significant mitral regurgitation. This review article is particularly useful to noninterventional cardiologists and interventional cardiologists who will be managing patients with this novel technology in increased volumes over the next decade but who do not perform this procedure.
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Affiliation(s)
- Claire Kelley
- Cavanagh Heart Center, Banner University Medical Center, Phoenix, AZ, United States
| | - Mohamad Lazkani
- Cavanagh Heart Center, Banner University Medical Center, Phoenix, AZ, United States.
| | - Jennifer Farah
- Cavanagh Heart Center, Banner University Medical Center, Phoenix, AZ, United States
| | - Ashish Pershad
- Cavanagh Heart Center, Banner University Medical Center, Phoenix, AZ, United States
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12
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Steed E, Boselli F, Vermot J. Hemodynamics driven cardiac valve morphogenesis. Biochim Biophys Acta 2016; 1863:1760-6. [PMID: 26608609 DOI: 10.1016/j.bbamcr.2015.11.014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 11/13/2015] [Accepted: 11/17/2015] [Indexed: 11/22/2022]
Abstract
Mechanical forces are instrumental to cardiovascular development and physiology. The heart beats approximately 2.6 billion times in a human lifetime and heart valves ensure that these contractions result in an efficient, unidirectional flow of the blood. Composed of endocardial cells (EdCs) and extracellular matrix (ECM), cardiac valves are among the most mechanically challenged structures of the body both during and after their development. Understanding how hemodynamic forces modulate cardiovascular function and morphogenesis is key to unraveling the relationship between normal and pathological cardiovascular development and physiology. Most valve diseases have their origins in embryogenesis, either as signs of abnormal developmental processes or the aberrant re-expression of fetal gene programs normally quiescent in adulthood. Here we review recent discoveries in the mechanobiology of cardiac valve development and introduce the latest technologies being developed in the zebrafish, including live cell imaging and optical technologies, as well as modeling approaches that are currently transforming this field. This article is part of a Special Issue entitled: Cardiomyocyte Biology: Integration of Developmental and Environmental Cues in the Heart edited by Marcus Schaub and Hughes Abriel.
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Boeuf MC, Rohel G, Lamour G, Piquemal M, Paleiron N, Fouilland X, Le Nestour C, Vinsonneau U, Paez S, Paule P. [Diagnosis of a systolic murmur among young asymptomatic patient: An assessment of professional practices for the expertise in military medicine]. Ann Cardiol Angeiol (Paris) 2015; 64:352-61. [PMID: 26482624 DOI: 10.1016/j.ancard.2015.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
Abstract
UNLABELLED The finding of a systolic heart murmur is common in medical military practice. Albeit often benign among young healthy adults, it can reveal a valvular or a cardiac disease, which could worsen during workout or expose to risk of a sudden death. This study aims to evaluate the diagnostic efficiency of the military general practitioner when discovering a systolic murmur among young asymptomatic patients. MATERIALS AND METHODS During one year, this study involved all the general practitioners of the medical military centres of Brittany and the cardiologists of the military hospital in Brest. It prospectively enrolled a cohort of all military asymptomatic patients under 40, without any underlying known heart condition. Military general practitioners listed, thanks to an anonymous form, the main features of the systolic murmur and of the ECG and proposed an auscultatory diagnosis: innocent or organic murmur. Then cardiologists did the same and finally performed a transthoracic echocardiography giving the diagnosis. RESULTS Fifty-eight patients were referred, 5 not meeting the inclusion criteria. Of the 53 patients included, military general practitioners found 46 innocent murmurs and 7 organic ones. Cardiologists found 51 innocent murmurs and 2 organic. Transthoracic echocardiography just took on one organic murmur (linked with a bicuspid aortic valve), spotted by the specialist, though judged innocent by the general practitioner. DISCUSSION Most of innocent murmurs diagnosed by general practitioners (45/46) were confirmed. Regarding the seven organic murmurs, the main selected criteria (intensity over 3, orthostatic persistence, diffuse irradiation) are mostly in accordance with the literature, proving right medical instincts. Authors propose a practical management of systolic murmurs among asymptomatic young patients. CONCLUSION Military general practitioners seem to master symptoms of organic murmur. This assessment argues for a promotion of a holistic clinical examination, which will help not only to rationalize the use of transthoracic echocardiography in economic terms but also to value the medical expertise.
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Affiliation(s)
- M-C Boeuf
- Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest, CC 41, 29240 Brest cedex 9, France
| | - G Rohel
- Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest, CC 41, 29240 Brest cedex 9, France
| | - G Lamour
- Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest, CC 41, 29240 Brest cedex 9, France
| | - M Piquemal
- Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest, CC 41, 29240 Brest cedex 9, France
| | - N Paleiron
- Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest, CC 41, 29240 Brest cedex 9, France
| | - X Fouilland
- Centre médical des armées de Brest-Lorient, BCRM de Brest, CC 74, 29240 Brest cedex 9, France
| | - C Le Nestour
- Centre médical des armées de Brest-Lorient, BCRM de Brest, CC 74, 29240 Brest cedex 9, France
| | - U Vinsonneau
- Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest, CC 41, 29240 Brest cedex 9, France
| | - S Paez
- Centre médical des armées de Brest-Lorient, BCRM de Brest, CC 74, 29240 Brest cedex 9, France
| | - P Paule
- Service de cardiologie, hôpital d'instruction des armées Clermont-Tonnerre, BCRM de Brest, CC 41, 29240 Brest cedex 9, France.
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Klein SK, Redfern WS. Cardiovascular safety risk assessment for new candidate drugs from functional and pathological data: Conference report. J Pharmacol Toxicol Methods 2015; 76:1-6. [PMID: 26126834 DOI: 10.1016/j.vascn.2015.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 06/24/2015] [Indexed: 02/03/2023]
Abstract
This is a report on a 2-day joint meeting between the British Society of Toxicological Pathology (BSTP) and the Safety Pharmacology Society (SPS) held in the UK in November 2013. Drug induced adverse effects on the cardiovascular system are associated with the attrition of more marketed and candidate drugs than any other safety issue. The objectives of this meeting were to foster inter-disciplinary approaches to address cardiovascular risk assessment, improve understanding of the respective disciplines, and increase awareness of new technologies. These aims were achieved. This well attended meeting covered both 'purely functional' cardiovascular adverse effects of drugs (e.g., electrophysiological and haemodynamic changes) as well as adverse effects encompassing both functional and pathological changes. Most of the presentations focused on nonclinical safety data, with information on translation to human where known. To reflect the content of the presentations we have cited key references and review articles.
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Affiliation(s)
- Stephanie K Klein
- Drug Safety & Metabolism, Alderley Park, Macclesfield, Cheshire SK10 4TG, United Kingdom
| | - Will S Redfern
- Drug Safety & Metabolism, Alderley Park, Macclesfield, Cheshire SK10 4TG, United Kingdom.
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Atkins SK, Sucosky P. Etiology of bicuspid aortic valve disease: Focus on hemodynamics. World J Cardiol 2014; 6:1227-1233. [PMID: 25548612 PMCID: PMC4278157 DOI: 10.4330/wjc.v6.i12.1227] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 10/08/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
The bicuspid aortic valve (BAV) is the most common form of inheritable cardiac defect. Although this abnormality may still achieve normal valvular function, it is often associated with secondary valvular and aortic complications such as calcific aortic valve disease and aortic dilation. The clinical significance and economic burden of BAV disease justify the need for improved clinical guidelines and more robust therapeutic modalities, which address the root-cause of those pathologies. Unfortunately, the etiology of BAV valvulopathy and aortopathy is still a debated issue. While the BAV anatomy and its secondary complications have been linked historically to a common genetic root, recent advances in medical imaging have demonstrated the existence of altered hemodynamics near BAV leaflets prone to calcification and BAV aortic regions vulnerable to dilation. The abnormal mechanical stresses imposed by the BAV on its leaflets and on the aortic wall could be transduced into cell-mediated processes, leading ultimately to valvular calcification and aortic medial degeneration. Despite increasing evidence for this hemodynamic etiology, the demonstration of the involvement of mechanical abnormalities in the pathogenesis of BAV disease requires the investigation of causality between the blood flow environment imposed on the leaflets and the aortic wall and the local biology, which has been lacking to date. This editorial discusses the different hypothetical etiologies of BAV disease with a particular focus on the most recent advances in cardiovascular imaging, flow characterization techniques and tissue culture methodologies that have provided new evidence in support of the hemodynamic theory.
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