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Rahman F, Mehta HH, Resar JR, Hasan RK, Marconi W, Aziz H, Czarny MJ. Outcomes among patients undergoing transcatheter aortic valve replacement with very low baseline gradients. Front Cardiovasc Med 2023; 10:1194360. [PMID: 37600049 PMCID: PMC10436597 DOI: 10.3389/fcvm.2023.1194360] [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: 03/27/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background While there is evidence that patients with low-flow, low-gradient aortic stenosis (AS) benefit from transcatheter aortic valve replacement (TAVR), data are lacking regarding outcomes of patients with a very low gradient (VLG). Methods In this retrospective, single-center study of patients with severe AS who underwent TAVR, three groups were defined using baseline mean aortic valve gradient: VLG (≤25 mmHg), low gradient (LG, 26-39 mmHg), and high gradient (HG, ≥40 mmHg). The primary outcome was the composite of Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 of <45, decrease in KCCQ-12 of ≥10 compared with baseline, or death at 1 year. Results One-thousand six patients were included: 571 HG, 353 LG, and 82 VLG. The median age was 82.1 years [interquartile range (IQR) 76.3-86.9]; VLG patients had more baseline comorbidities compared with the other groups. The primary outcome was highest at 1 year in the VLG group (VLG, 46.7%; LG, 29.9%; HG, 23.1%; p = 0.002), with no difference between groups after adjustment for baseline characteristics. At baseline, <30% of VLG patients had an excellent or good (50-100) KCCQ-12, whereas more than 75% and 50% had an excellent or good KCCQ-12 at 30-day and 1-year follow-up, respectively. Conclusion Although patients with VLG undergoing TAVR have a higher rate of poor outcomes at 1 year compared with patients with LG and HG severe AS, this difference is largely attributable to baseline comorbidities. Patients with severe AS undergoing TAVR have significant improvement in health status outcomes regardless of resting mean gradient.
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Affiliation(s)
- Faisal Rahman
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Hetal H. Mehta
- Division of Cardiology, Doylestown Health, Doylestown, PA, United States
| | - Jon R. Resar
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Rani K. Hasan
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Wendy Marconi
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Hamza Aziz
- Division of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Matthew J. Czarny
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
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Zhang S, Liu C, Zhang Y, Wu Z, Feng K, Lai Y, Pei J, Guan T. Different heart failure phenotypes of valvular heart disease: the role of mitochondrial dysfunction. Front Cardiovasc Med 2023; 10:1135938. [PMID: 37273869 PMCID: PMC10235483 DOI: 10.3389/fcvm.2023.1135938] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/28/2023] [Indexed: 06/06/2023] Open
Abstract
Valvular heart disease (VHD)-related heart failure (HF) is a special subtype of HF with an increasingly concerned heterogeneity in pathophysiology, clinical phenotypes, and outcomes. The mechanism of VHD-related HF involves not only mechanical damage to the valve itself but also valve lesions caused by myocardial ischemia. The interactions between them will lead to the occurrence and development of VHD-related HF subtypes. Due to the spatial (combination of different valvular lesions) and temporal effects (sequence of valvular lesions) of valvular damages, it can make the patient's condition more complicated and also make the physicians deal with a dilemma when deciding on a treatment plan. This indicates that there is still lack of deep understanding on the pathogenic mechanism of VHD-related HF subtypes. On the other hand, mitochondrial dysfunction (MitD) is not only associated with the development of numerous cardiac diseases such as atherosclerosis, hypertension, diabetes, and HF but also occurs in VHD. However, the role of MitD in VHD-related HF is still not fully recognized. In this comprehensive review, we aim to discuss the current findings and challenges of different valvular damages derived from HF subtypes as well as the role of MitD in VHD-related HF subtypes.
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Affiliation(s)
- Shenghui Zhang
- Department of Cardiology, The Second Affiliated Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
| | - Cheng Liu
- Department of Cardiology, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yingyuan Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zongjian Wu
- City School, Guangzhou Academy of Fine Arts, Guangzhou, China
| | - Kaiwei Feng
- Department of Cardiology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yanxian Lai
- Department of Cardiology, Guangzhou First People’s Hospital, South China University of Technology, Guangzhou, China
- Department of Cardiology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jingxian Pei
- Department of Cardiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tianwang Guan
- Department of Cardiology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
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Li HB, Fu BQ, Tan T, Li XH, Wang SH, Wei XB, Wang ZH. Low-Density Lipoprotein Cholesterol and Mortality Risk in Elderly Patients Undergoing Valve Replacement Surgery: A Propensity Score Matching Analysis. Front Nutr 2022; 9:842734. [PMID: 35592628 PMCID: PMC9113219 DOI: 10.3389/fnut.2022.842734] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/16/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The prognostic value of low-density lipoprotein cholesterol (LDL-C) in elderly patients is controversial. This study aimed to elucidate the relationship between the preoperative LDL-C and adverse outcomes in elderly patients undergoing valve replacement surgery (VRS). METHODS A total of 2,552 aged patients (age ≥ 60 years) undergoing VRS were retrospectively recruited and divided into two groups according to LDL-C level on admission: low LDL-C (<70 mg/dL, n = 205) and high LDL-C groups (≥ 70 mg/dL, n = 2,347). The association between the preoperative LDL-C with in-hospital and one-year mortality was evaluated by propensity score matching analysis and multivariate analysis. RESULTS The mean age was 65 ± 4 years and 1,263 (49.5%) were men. Patients in the low LDL-C group were significantly older (65.9 ± 4.6 vs. 64.9 ± 4.1, p = 0.002), with more male (65.4 vs. 48.1%, p < 0.001), higher alanine transaminase (ALT) (21 vs. 19, p = 0.001), lower serum albumin (35.3 ± 4.6 vs. 37.1 ± 4.1, p < 0.001), higher serum creatinine (92.2 ± 38.2 vs.84.6 ± 26.1, p = 0.006), lower lymphocyte count (1.7 ± 0.7 vs. 1.9 ± 0.6, p < 0.001), lower hemoglobin (121.9 ± 22.3 vs. 130.2 ± 16.5, p < 0.001), lower platelet count (171.3 ± 64.3 vs. 187.7 ± 58.7, p < 0.001), lower prognostic nutrition index (44 ± 6.2 vs. 46.7 ± 5.8, p < 0.001), and more severe tricuspid regurgitation (33.7 vs. 25.1%, p = 0.008). The rates of in-hospital death (11.2 vs. 3.7%, p < 0.001) and major adverse clinical events (17.6 vs. 9.6%, p < 0.001) were significantly higher in the low LDL-C group. The cumulative one-year death rate was significantly higher in the low LDL-C group (Log-Rank = 16.6, p < 0.001). After matching analysis and multivariate analysis, no association between LDL-C level and adverse outcomes was detected (all p > 0.05). CONCLUSION Our study did not support the negative relationship between LDL-C level and mortality risk in elderly patients undergoing VRS.
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Affiliation(s)
- Han-biao Li
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bing-qi Fu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Shantou University Medical College, Shantou, China
| | - Tong Tan
- Shantou University Medical College, Shantou, China
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xiao-hua Li
- Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shou-hong Wang
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Shou-hong Wang
| | - Xue-biao Wei
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Xue-biao Wei
| | - Zhong-hua Wang
- Department of Geriatric Intensive Medicine, Guangdong Provincial Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Zhong-hua Wang
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Li N, Zhu L, Zhu C, Zhou H, Zheng D, Xu G, Shi H, Gao J, Li AJ, Wang Z, Sun L, Li X, Shao G. BMPR2 promoter methylation and its expression in valvular heart disease complicated with pulmonary artery hypertension. Aging (Albany NY) 2021; 13:24580-604. [PMID: 34793329 DOI: 10.18632/aging.203690] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 10/28/2021] [Indexed: 11/25/2022]
Abstract
Valvular heart disease (VHD) is a common heart disease that affects blood flow. It usually requires heart surgery. Valvular heart disease complicated with pulmonary artery hypertension (VHD-PAH) may be lethal due to heart failure that results from increased heart burden. It is important for these patients to seek early treatment in order to minimize the heart damage. However, there is no reliable diagnosis method in VHD. In this study, we found DNA methylation was increased at the promoter of BMPR2 gene in the VHD patients compared with the healthy controls. This finding was confirmed by an independent cohort study of VHD patients and healthy controls. In addition, BMPR2 mRNA levels were reduced in the plasma of the VHD patients. There is strong correlation between BMPR2 promoter DNA methylation and the severity of VHD. Indeed, we found that both BMPR2 promoter DNA methylation and BMPR2 mRNA levels in the plasma are good biomarkers of VHD by themselves, with the respective AUC value of 0.879 and 0.725, respectively. When they were used in combination, the diagnostic value was even better, with the AUC value of 0.93. Consistent with the results in the VHD patients, we observed decreased BMPR2 and increased fibrosis in the lung of a PAH model mouse. BMPR2 was also decreased in the hearts of the PAH mice, whereas BMP4 was increased. Furthermore, BMPR2 was reduced in the heart valve tissue samples of human VHD patients after valve replacement with moderate/severe PAH compared with those with mild PAH. There was also increased apoptosis in the hearts of the PAH mice. BMPR2 promoter DNA methylation and its expression appear to be good biomarkers for VHD. Our results also suggest that DNA methylation may cause PAH through deregulation of BMP signaling and increased apoptosis.
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Lestuzzi C, Mascarin M, Coassin E, Canale ML, Turazza F. Cardiologic Long-Term Follow-Up of Patients Treated With Chest Radiotherapy: When and How? Front Cardiovasc Med 2021; 8:671001. [PMID: 34760934 PMCID: PMC8572927 DOI: 10.3389/fcvm.2021.671001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/27/2021] [Indexed: 01/12/2023] Open
Abstract
Introduction: Radiotherapy may cause valvular (VHD), pericardial, coronary artery disease (CAD), left ventricular dysfunction (LVD), arrhythmias. The risk of radiation induced heart disease (RIHD) increases over time. The current guidelines suggest a screening for RIHD every 5 years in the long-term survivors who had been treated by chest RT. Methods: We reviewed the clinical and instrumental data of 106 patients diagnosed with RIHD. In one group (Group A: 69 patients) RIHD was diagnosed in an asymptomatic phase through a screening with ECG, echocardiogram and stress test. A second group (37 patients) was seen when RIHD was symptomatic. We compared the characteristics of the two groups at the time of RT, of RIHD detection and at last follow-up. Results: Overall, 64 patients (60%) had CAD (associated to other RIHD in 18); 39 (36.7%) had LVD (isolated in 20); 24 (22.6%) had VHD (isolated in 10 cases). The interval between the last negative test and the diagnosis of moderate or severe RIHD was <5 years in 26 patients, and <4 years in 18. In group A, 63% of the patients with CAD had silent ischemia. The two groups did not differ with regard to type of tumor, cardiovascular risk factors, use of anthracycline-based chemotherapy, age at RT treatment, radiation dose and interval between RT and toxicity detection. The mean time from RT and RIHD was 16 years in group A and 15 in group B. Interventional therapy at RIHD diagnosis was more frequent in group B (54 vs. 30%, p < 0.05). At last follow-up, 27 patients had died (12 of cancer, 9 of cardiac causes, 6 of other causes); mean ejection fraction was 60% in group A and 50% in group B (p < 0.01). Patients with ejection fraction ≤ 50% were 14.5% in group A and 40% in group B (p < 0.01). Conclusions: Clinically relevant RIHD become evident at a mean interval of 16 years after RT. The most frequent clinical manifestations are CAD and LVD. RIHD diagnosis in asymptomatic patients may preserve their cardiac function with timely interventions. We suggest -after 10 years from radiotherapy- a screening every 2–3 years.
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Affiliation(s)
- Chiara Lestuzzi
- Azienda Sanitaria Friuli Occidentale (ASFO) Department of Cardiology, Cardiology and Cardio-Oncology Rehabilitation Service, Centro di Riferimento Oncologico (CRO), Istituto di Ricerca e Cura di Carattere Scientifico (IRCCS), Aviano, Italy
| | - Maurizio Mascarin
- Adolescents and Young Adults (AYA) Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico (CRO), Istituto di Ricerca e Cura di Carattere Scientifico (IRCCS), Aviano, Italy
| | - Elisa Coassin
- Adolescents and Young Adults (AYA) Oncology and Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico (CRO), Istituto di Ricerca e Cura di Carattere Scientifico (IRCCS), Aviano, Italy
| | - Maria Laura Canale
- Cardiology Department, Azienda Usl Toscana Nord-Ovest, Ospedale Versilia, Camaiore, Italy
| | - Fabio Turazza
- Cardiology Unit, Istituto Nazionale Tumori (INT), Istituto di Ricerca e Cura di Carattere Scientifico (IRCCS), Milan, Italy
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Li S, Jiang Z, Chao X, Jiang C, Zhong G. Identification of key immune-related genes and immune infiltration in atrial fibrillation with valvular heart disease based on bioinformatics analysis. J Thorac Dis 2021; 13:1785-1798. [PMID: 33841968 PMCID: PMC8024788 DOI: 10.21037/jtd-21-168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Atrial fibrillation (AF) is the most common persistent arrhythmia. Valvular heart disease (VHD) and AF frequently coexist. In our study, from performing bioinformatics analysis, we sought to identify immune-related genes (IRGs) and explore the role of immune cell infiltration in AF-VHD in depth, aiming at investigating the potential molecular mechanism and developing new therapeutic targets for AF, including AF-VHD. Methods The gene expression of the GSE41177 and GSE79768 datasets were downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were analyzed via the limma package in Bioconductor with R software. Differentially expressed immune-related genes (DEIRGs) were selected via combination ImmPort database with DEGs, and the enrichment function and pathway analysis were explored. A protein-protein interaction (PPI) network was built with a Search Tool for the Retrieval of Interacting Genes/Proteins plugin in Cytoscape. The CIBERSORT algorithm was used to evaluate immune infiltration in the left atrial (LA) tissues between AF-VHD and sinus rhythm (SR) patients. Finally, a correlation analysis between key DEIRGs and infiltrating immune cells was performed. Results A total of 130 DEIRGs were detected. Enrichment function of DEIRGs demonstrated that they are significant in immune and inflammatory responses. The key DEIRGs assessed by the PPI network and involved in both the immune and inflammatory responses were the C-X-C motif chemokine ligand (CXCL) 1, pro-platelet basic protein (PPBP), CXCL12, and C-C motif chemokine ligand 4 (CCL4). The immune infiltration findings indicated that, compared with the LA tissues from SR patients, the tissues from AF-VHD patients contained a higher proportion of gamma delta T cells, but a lower proportion of CD8 and regulatory T cells. The results of correlation analysis demonstrated that CXCL1 was positively correlated with activated mast cells and significantly negatively correlated with resting mast cells. PPBP, CXCL12, and CCL4 were positively correlated with the infiltration of various immune cells, such as neutrophils, plasma cells, and resting dendritic cells. Conclusions The key immune-related genes and the differences in immune infiltration in LA tissues play an essential role in the occurrence and progression of AF-VHD.
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Affiliation(s)
- Shuo Li
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Zhiyuan Jiang
- Department of Cardiology, Division of Hypertension, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Xiaoying Chao
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Chenyang Jiang
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Guoqiang Zhong
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
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Wen S, Qiao W, Zhang Y, Dong N. Development and trend in the field of valvular heart disease in China: an analysis based on the National Natural Science Foundation of China. Ann Transl Med 2020; 8:449. [PMID: 32395493 PMCID: PMC7210194 DOI: 10.21037/atm.2020.03.165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background National Natural Science Foundation of China (NSFC) plays a vital role promoting advancement of science in China. The incidence and mortality rate of valvular heart disease (VHD) increase with aging population. Therefore, it is of significance to discuss the development and trend in the field of VHD and provide references for scholars to carry out further Foundations. Methods Internet-based Science Information System and other websites were used to search for projects supported by NSFC related to VHD in 2008–2019 and related information of applicants. Publications, citations and impact factors were queried by Google Scholar and InCites Journal Citation Reports 2.0 and analyzed by SPSS for Windows version 24.0. Key words extracted from these project titles were imported into Citespace for analysis. Results A total of 117 projects and related information were acquired. Although the annual amount of projects and funding has fluctuated in recent years, they still maintained an upward trend. Institutes were mainly distributed over Hubei Province, Shanghai and Jiangsu Province. Applicants characterized as senior title, male, cardiac surgeon have accounted for a larger proportion of projects, with a greater amount of funding. Through the analysis of keywords and subject distribution, molecular-biology-based mechanism study combined with tissue engineering has become the principal research hot spot and trend in recent years. Annual changes in output in scientific research were consistent with changes in the amount of funding. Conclusions This paper collated funding situation supported by NSFC in VHD, analyzed distribution of keywords and summarized the research trend, so as to supply guidance to researchers for advanced researches.
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Affiliation(s)
- Shuyu Wen
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China.,School of Medicine, Shandong University, Jinan 250012, China
| | - Weihua Qiao
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yuan Zhang
- Clinical Epidemiology Unit, Qilu Hospital of Shandong University, Jinan 250012, China.,Clinical Research Center, Shandong University, Jinan 250012, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Liu FZ, Xue YM, Liao HT, Zhan XZ, Guo HM, Huang HL, Fang XH, Wei W, Rao F, Deng H, Liu Y, Lin WD, Wu SL. Five-year epidemiological survey of valvular heart disease: changes in morbidity, etiological spectrum and management in a cardiovascular center of Southern China. J Thorac Dis 2015; 6:1724-30. [PMID: 25589965 DOI: 10.3978/j.issn.2072-1439.2014.11.21] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 10/15/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The objective of the present study is to analyze the epidemiological profile of patients with abnormal valvular structure and function and highlight the etiological spectrum and management of valvular heart disease (VHD) in a single cardiovascular center of Southern China in five years. METHODS The retrospective study included 19,428 consecutive patients (9,441 men and 9,987 women with a mean age of 52.03±20.50 years) with abnormal valvular structure and function who were screened by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) at the in-patient department of Guangdong General Hospital from January 2009 to December 2013. Data on baseline characteristics, potential etiology, treatment strategies and discharge outcomes were collected from electronic medical records. RESULTS There were 13,549 (69.7%) patients with relatively definite etiology for VHD. VHD was rheumatic in 7,197 (37.0%) patients, congenital in 2,697 (13.9%), degenerative in 2,241 (11.5%), ischemic in 2,460 (12.7%). The prevalence decreased significantly in rheumatic VHD from 2009 to 2013 (from 42.8% to 32.8%, P<0.001), but increased markedly in congenital VHD (from 9.0% to 12.3%, P<0.001), ischemic VHD (from 9.2% to 11.3%, P=0.003) and degenerative VHD (from 8.8% to 14.5%, P<0.001). Meantime, the prevalence of ischemic VHD increased after the age of 45, similar to that of degenerative VHD. From 2009 to 2013, the proportion of patients with VHD undergoing open cardiac valvular surgery decreased (from 49.5% to 44.3%, P<0.001) and that of patients treated with general medication increased (from 49.2% to 54.1%, P<0.001). However, there was markedly increment in video-assisted thoracoscopic surgery (VATS) from 2009 to 2013 (from 0.3% to 4.4%, P<0.001). Increasing tendencies were showed in aortic mechanical valve replacement (from 32.1% to 34.5%, P=0.001) and double mechanical valve replacement (from 20.9% to 22.3%, P=0.035), especially in mitral valvuloplasty (from 8.5% to 15.7%, P<0.001). However, the proportion of patients undergoing bioprosthetic valve replacement decreased from 2009 to 2013 (from 26.3% to 15.5%, P<0.001). CONCLUSIONS Despite a significant shift from rheumatic towards degenerative etiology from 2009 to 2013, rheumatic VHD remains the leading etiology in Southern China, with a significant increase in the prevalence of ischemic, congenital and degenerative VHD. General medication and cardiac valvular surgery remain the main treatment options. The proportion of VATS increased markedly from 2009 to 2013, and mechanical valve replacement and mitral valvuloplasty showed an increasing tendency.
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Affiliation(s)
- Fang-Zhou Liu
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yu-Mei Xue
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Hong-Tao Liao
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xian-Zhang Zhan
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Hui-Ming Guo
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Huan-Lei Huang
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Xian-Hong Fang
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wei Wei
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Fang Rao
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Hai Deng
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Yang Liu
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Wei-Dong Lin
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Shu-Lin Wu
- 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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