5,467 results on '"Aortic Valve Stenosis diagnosis"'
Search Results
2. Severe functional mitral regurgitation and cardiogenic shock after transcatheter aortic valve replacement.
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Akinmolayemi O, McCreery C, Prandi FR, Samtani R, Mehta A, Suleman U, Kapoor AB, Kayani J, Gidwani UK, Lerakis S, and Dangas GD
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- Humans, Aged, 80 and over, Female, Severity of Illness Index, Coronary Angiography, Treatment Outcome, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Coronary Artery Disease complications, Postoperative Complications diagnosis, Postoperative Complications etiology, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement methods, Mitral Valve Insufficiency surgery, Mitral Valve Insufficiency diagnosis, Mitral Valve Insufficiency etiology, Mitral Valve Insufficiency physiopathology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis complications, Shock, Cardiogenic etiology, Shock, Cardiogenic diagnosis, Shock, Cardiogenic therapy, Cardiac Catheterization methods
- Abstract
An 83-year-old woman with symptomatic severe aortic stenosis was referred for transcatheter aortic valve replacement. Diagnostic left heart catheterization documented diffuse 3-vessel coronary artery disease.
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- 2024
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3. Valve-in-valve implantation to seal post-dilation-induced annular rupture in transcatheter aortic valve replacement.
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Wang K, Qi Y, and Pan W
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- Humans, Female, Aged, 80 and over, Tomography, X-Ray Computed, Heart Valve Prosthesis adverse effects, Bicuspid Aortic Valve Disease surgery, Bicuspid Aortic Valve Disease diagnosis, Treatment Outcome, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Echocardiography, Transesophageal methods, Aortic Valve surgery, Aortic Valve diagnostic imaging
- Abstract
An 85-year-old woman was admitted to our hospital with severe symptomatic aortic stenosis. Preoperative computed tomography and transesophageal echocardiography (TEE) revealed a type I bicuspid aortic valve.
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- 2024
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4. In between the cracks.
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Keh YS, Chin CY, Chin CT, and Lim ST
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- Humans, Male, Aged, Coronary Vessels diagnostic imaging, Coronary Vessels surgery, Treatment Outcome, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Percutaneous Coronary Intervention methods, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement adverse effects, Kidney Failure, Chronic therapy, Kidney Failure, Chronic complications, Coronary Angiography, Coronary Artery Disease diagnosis, Coronary Artery Disease surgery, Coronary Artery Disease therapy
- Abstract
A 65-year-old man with end-stage renal failure, severe aortic stenosis, and triple vessel coronary artery disease was admitted for percutaneous coronary intervention to the left anterior descending artery prior to transcatheter aortic valve replacement.
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- 2024
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5. Unlocking Sex-Specific Therapies in Aortic Stenosis: A Leap Forward With Angiotensin II Receptor Blockers.
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Hillier E and Luu J
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- Humans, Female, Male, Angiotensin Receptor Antagonists therapeutic use, Sex Factors, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis drug therapy
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- 2024
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6. Imaging in severe aortic stenosis: Looking at the future.
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Martín M and Rozado J
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- Humans, Forecasting, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis diagnosis, Severity of Illness Index
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- 2024
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7. Angiotensin II Receptor Blockers Are Associated With Reduced Valvular Fibrosis in Women With Aortic Stenosis.
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Carter-Storch R, Le Nezet E, Ali M, Powers A, Haujir A, Demers K, Couture C, Dumont É, Trahan S, Pagé S, Dagenais F, Pibarot P, Dahl JS, and Clavel MA
- Subjects
- Humans, Female, Male, Aged, Sex Factors, Retrospective Studies, Echocardiography, Middle Aged, Severity of Illness Index, Heart Valve Prosthesis Implantation methods, Disease Progression, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis surgery, Fibrosis, Aortic Valve pathology, Aortic Valve surgery, Aortic Valve diagnostic imaging, Angiotensin Receptor Antagonists therapeutic use
- Abstract
Background: Angiotensin receptor blockers (ARBs) may slow down the progression of aortic stenosis (AS) through their antifibrotic effect. Women present more valvular fibrosis than men, so ARBs may have more effect in females. Our aim was to assess the impact of ARBs on the remodelling of the aortic valve in men and women., Methods: We included patients who had an aortic valve replacement with or without coronary bypass grafting from 2006 to 2013. Patients with missing echocardiographic or histologic data were excluded. Warren-Yong and fibrosis scores of the explanted valves were performed. Patients were divided into 4 phenotypes according to their Warren-Yong and fibrosis scores: mild calcification/fibrosis, severe calcification/fibrosis group, predominant fibrosis group, predominant calcification group., Results: Among the 1321 included patients, the vast majority (89%) has severe AS. Patients in the predominant fibrosis group, compared with the predominant calcium group, were more often female (39% vs 31%; P = 0.008) with bicuspid valves (44% vs 34%; P = 0.002), and less often used ARBs (25% vs 30%; P = 0.046). Female sex was independently associated with being in the predominant fibrosis group (odds ratio 1.45, 95% confidence interval 1.08-1.95; P = 0.01), with a significant interaction between female sex and ARBs. Women taking ARBs compared with women not taking ARBs had significantly lower fibrosis scores (P < 0.001). This difference was not seen in men., Conclusions: In this large series of patients with moderate-severe AS, among the women there was a negative association between intake of ARBs and valvular fibrosis. Thus, the possible effects of ARBs may be sex specific, with a larger therapeutic role in women., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2024
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8. Comparison between transcatheter versus surgical intervention for pediatric aortic valvular stenosis: a multicenter study in Japan.
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Muneuchi J, Kuraoka A, Nagatomo Y, Yatsunami K, Sagawa K, Yamamura K, Nagata H, Sugitani Y, and Watanabe M
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- Humans, Male, Female, Retrospective Studies, Japan epidemiology, Child, Child, Preschool, Infant, Adolescent, Treatment Outcome, Heart Valve Prosthesis Implantation methods, Transcatheter Aortic Valve Replacement methods, Case-Control Studies, Balloon Valvuloplasty methods, Balloon Valvuloplasty adverse effects, Follow-Up Studies, Time Factors, Risk Factors, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis mortality, Aortic Valve surgery, Aortic Valve diagnostic imaging
- Abstract
It is controversial whether children with isolated aortic valvular stenosis (vAS) initially undergo transcatheter or surgical aortic valvuloplasty (BAV or SAV). This multicenter retrospective case-control study aimed to explore outcomes after BAV or SAV for pediatric vAS. We studied children (aged < 15 years) with vAS treated at 4 tertiary congenital heart centers, and compared the rates of survival, reintervention, and valve replacement between patients with BAV and SAV. A total of 73 subjects (BAV: N = 52, SAV: N = 21) were studied. Age and aortic annulus z-score at the first presentation were 85 (26-530) days and - 0.45 (- 1.51-0.59), respectively. During the follow-up period of 121 (47-185) months, rates of 10-year survival (BAV: 88% vs. SAV: 92%, P = 0.477), reintervention (BAV: 58% vs. SAV: 31%, P = 0.626), and prosthetic/autograft valve replacement (BAV: 21% vs. SAV: 19%, P = 0.563) did not differ between the groups. Freedom from reintervention rate significantly correlated with aortic annulus z-score (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.49-0.88, P = 0.005), and freedom from prosthetic/autograft valve replacement rate significantly correlated to the degree of aortic regurgitation after the first intervention (HR: 4.58, 95% CI 1.19-17.71, P = 0.027). Propensity score-matched analysis (N = 16) did not show the differences in survival and reintervention rates between the groups. Long-term survival was acceptable, and the rates of freedom from reintervention and prosthetic/autograft valve replacement were comparable between children with vAS who underwent BAV and SAV., (© 2024. Springer Nature Japan KK, part of Springer Nature.)
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- 2024
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9. Prognostic effect of the TyG index on patients with severe aortic stenosis following transcatheter aortic valve replacement: a retrospective cohort study.
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Li W, Li H, Peng S, Li J, Feng Y, Peng Y, Wei J, Zhao Z, Xiong T, Yang H, Song C, Bai L, Yao Y, Chen F, Yin Y, and Chen M
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- Humans, Male, Female, Retrospective Studies, Aged, Risk Assessment, Risk Factors, Aged, 80 and over, Time Factors, Treatment Outcome, China epidemiology, Cause of Death, Insulin Resistance, Aortic Valve Stenosis surgery, Aortic Valve Stenosis blood, Aortic Valve Stenosis mortality, Aortic Valve Stenosis diagnosis, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement mortality, Severity of Illness Index, Biomarkers blood, Predictive Value of Tests, Blood Glucose metabolism, Triglycerides blood
- Abstract
Background: The triglyceride glucose (TyG) index, as a reliable marker of insulin resistance, is associated with the incidence and poor prognosis of various cardiovascular diseases. However, the relationship between the TyG index and clinical outcomes in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR) remains unclear., Methods: This study consecutively enrolled 1569 patients with AS underwent TAVR at West China Hospital of Sichuan University between April 2014 and August 2023. The outcomes of interest included all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). Multivariate adjusted Cox regression and restricted cubic splines (RCS) regression analyses were used to assess the associations between the TyG index and the clinical outcomes. The incremental prognostic value of the TyG index was further assessed by the time-dependent Harrell's C-index, integrated discrimination improvement (IDI) and the net reclassification improvement (NRI)., Results: During a median follow-up of 1.09 years, there were 146, 70, and 196 patients experienced all-cause death, cardiovascular death, and MACE, respectively. After fully adjusting for confounders, a per-unit increase of TyG index was associated with a 441% (adjusted HR: 5.41, 95% CI: 4.01-7.32), 385% (adjusted HR: 4.85, 95% CI: 3.16-7.43), and 347% (adjusted HR: 4.47, 95% CI: 3.42-5.85) higher risk of all-cause mortality, cardiovascular mortality and MACE, respectively. The RCS regression analyses revealed a linear association between TyG index and endpoints (all P for non-linearity > 0.05) with 8.40 as the optimal binary cutoff point. Furthermore, adding TyG index to the basic risk model provided a significant incremental value in predicting poor prognosis (Time-dependent Harrell's C-index increased for all the endpoints; All-cause mortality, IDI: 0.11, P < 0.001; NRI: 0.32, P < 0.001; Cardiovascular mortality, IDI: 0.043, P < 0.001; NRI: 0.37, P < 0.001; MACE, IDI: 0.092, P < 0.001; NRI: 0.32, P < 0.001)., Conclusions: In patients with severe AS receiving TAVR, there was a positive linear relationship between TyG index and poor prognosis, with 8.4 as the optimal bivariate cutoff value. Our findings suggest TyG index holds potential value for risk stratification and guiding therapeutic decisions in patients after TAVR., (© 2024. The Author(s).)
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- 2024
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10. Plasma Proteomic Biomarkers of Aortic Stenosis: A Mendelian Randomization Study.
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Yang TY, Small AM, Dufresne L, Peloso GM, Natarajan P, Engert JC, and Thanassoulis G
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- Humans, Female, Male, Aortic Valve Stenosis blood, Aortic Valve Stenosis genetics, Aortic Valve Stenosis diagnosis, Mendelian Randomization Analysis, Biomarkers blood, Proteomics methods
- Abstract
Competing Interests: Funding Support and Author Disclosures This study has been funded by the Canadian Institutes of Health Research (CIHR), the Heart and Stroke Foundation of Canada (HSFC), the National Institutes of Health, and the U.S. Department of Veterans Affairs. Dr Natarajan has received research grants from Allelica, Apple, Amgen, Boston Scientific, Genentech/Roche, and Novartis; has received personal fees from Allelica, Apple, AstraZeneca, Blackstone Life Sciences, Eli Lilly & Co, Foresite Labs, Genentech/Roche, GV, HeartFlow, Magnet Biomedicine, and Novartis; has held scientific advisory board membership for Esperion Therapeutics, Preciseli, and TenSixteen Bio; has served as a scientific cofounder of TenSixteen Bio; has held equity in MyOme, Preciseli, and TenSixteen Bio; and has disclosed spousal employment at Vertex Pharmaceuticals, all unrelated to the present work. Dr Thanassoulis has received consulting fees from Ionis Pharmaceuticals; and has participated in advisory boards for Amgen, Sanofi, Novartis, HLS Therapeutics, and Silence. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
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- 2024
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11. Diagnostic accuracy of Murray law-based quantitative flow ratio in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.
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Yuta F, Kawamori H, Toba T, Hiromasa T, Sasaki S, Hamana T, Fujii H, Osumi Y, Iwane S, Yamamoto T, Naniwa S, Sakamoto Y, Matsuhama K, Hirata KI, and Otake H
- Subjects
- Humans, Male, Female, Aged, 80 and over, Aged, Retrospective Studies, Reproducibility of Results, Predictive Value of Tests, Coronary Vessels physiopathology, Coronary Vessels diagnostic imaging, Coronary Artery Disease diagnosis, Coronary Artery Disease physiopathology, Coronary Artery Disease surgery, Aortic Valve Stenosis surgery, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis diagnosis, Transcatheter Aortic Valve Replacement, Fractional Flow Reserve, Myocardial physiology, Severity of Illness Index, Coronary Angiography, Aortic Valve surgery, Aortic Valve physiopathology, Aortic Valve diagnostic imaging
- Abstract
Background: Murray law-based quantitative flow ratio (μQFR) is a novel computational method that enables accurate estimation of fractional flow reserve (FFR) using a single angiographic projection. However, its diagnostic value in patients with severe aortic stenosis (AS) remains unclear., Method: We included 25 consecutive patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS with intermediate or greater (30-90%) coronary artery disease (CAD). Pre- and post-TAVR μQFR, QFR, instantaneous flow reserve (iFR), and post-TAVR invasive FFR values were measured. We evaluated the diagnostic performance of pre-TAVR μQFR, QFR, and iFR using post-TAVR FFR ≤ 0.80 as a reference standard of ischemia., Result: Pre-TAVR μQFR was significantly correlated with post-TAVR FFR (r = 0.73, p < 0.0001). The area under the curve of pre-TAVR μQFR on post-TAVR FFR ≤ 0.8 was 0.91 (95% confidence interval [CI] 0.77-0.98), comparable to that of pre-TAVR iFR (0.86 [95% CI 0.71-0.98], p = 0.97). The accuracy, sensitivity, specificity, and positive and negative predictive values of pre-TAVR μQFR on post-TAVR FFR ≤ 0.8 were 84.2% (95% CI 68.7-93.4), 61.6% (95% CI 31.6-86.1), 96.0% (95% CI 79.6-99.9), 88.9% (95% CI 52.9-98.3), and 82.8% (95% CI 70.6-90.6), respectively. For pre-TAVR iFR, these values were 76.5% (95% CI 58.8-89.3), 90.9% (95% CI 58.7-99.8), 69.6% (95% CI 47.1-86.8), 58.8% (95% CI 42.8-73.1), and 94.1% (95% CI 70.8-99.1), respectively., Conclusion: μQFR could be useful for the physiological evaluation of patients with severe AS with concomitant CAD., (© 2024. Springer Nature Japan KK, part of Springer Nature.)
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- 2024
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12. Clinical efficacy of tolvaptan in acute decompensated heart failure patients with severe aortic stenosis and atrial fibrillation: a sub-analysis from the LOHAS registry.
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Murakami T, Watanabe Y, Nakamura N, Natsumeda M, Ohno Y, Nakazawa G, Ikari Y, Kataoka A, Nishihata Y, Hayashida K, Yamamoto M, Tanaka J, Jujo K, Izumo M, Mizutani K, and Kozuma K
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- Humans, Male, Female, Aged, 80 and over, Treatment Outcome, Severity of Illness Index, Retrospective Studies, Aged, Acute Disease, Japan epidemiology, Hemodynamics drug effects, Tolvaptan therapeutic use, Atrial Fibrillation drug therapy, Atrial Fibrillation physiopathology, Atrial Fibrillation complications, Atrial Fibrillation diagnosis, Heart Failure drug therapy, Heart Failure physiopathology, Heart Failure etiology, Heart Failure complications, Heart Failure diagnosis, Aortic Valve Stenosis complications, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis drug therapy, Aortic Valve Stenosis diagnosis, Registries, Antidiuretic Hormone Receptor Antagonists therapeutic use
- Abstract
Background: Severe aortic valve stenosis (AS) and atrial fibrillation (AF) are risk factors of hemodynamic instability in heart failure (HF) management due to low cardiac output, respectively. Therefore, the treatment of HF due to severe AS complicated with AF is anticipated to be difficult. Tolvaptan, a vasopressin V2 receptor inhibitor, is effective in controlling acute decompensated heart failure (ADHF) with hemodynamic stability. However, its clinical efficacy against ADHF caused by AS with AF remains to be determined., Methods: Clinical information (from September 2014 to December 2017) of 59 patients diagnosed with ADHF due to severe AS (20 patients with AF; 39 patients with sinus rhythm [SR]) was obtained from the LOHAS registry. The registry collected data from seven hospitals and assessed the short-term effects of tolvaptan in patients hospitalized for ADHF with severe AS. We attempted to identify clinical differences from baseline up to 4 days, comparing patients with AF (AF group) versus those with SR (SR group)., Results: There were no significant differences between the groups in age (83.7 ± 4.5 vs. 85.8 ± 6.9 years, respectively; p = 0.11) and aortic valve area (0.60 [0.46-0.73] vs. 0.56 [0.37-0.70] cm
2 , respectively; p = 0.50). However, left atrial volume was larger (104 [85-126] vs. 87 [64-103] mL, respectively; p < 0.01), whereas stroke volume was lower (51.6 ± 14.8 vs. 59.0 ± 18.7 mL, respectively; p = 0.08) in the AF group versus the SR group. Body weight decreased daily from baseline up to day 4 in both groups (from 55.4 to 53.2 kg [p < 0.01] and from 53.5 to 51.0 kg [p < 0.01], respectively) without change in heart rate. Notably, the systolic blood pressure decreased slightly in the AF group after 2 days of treatment with tolvaptan., Conclusions: Short-term treatment with tolvaptan improved HF in patients hospitalized for severe AS, regardless of the presence of AF or SR. After achieving sufficient diuresis, a slight decrease in blood pressure was observed in the AF group, suggesting an appropriate timeframe for safe and effective use of tolvaptan., (© 2024. Springer Nature Japan KK, part of Springer Nature.)- Published
- 2024
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13. Simple but useful: DI in the assessment of patients with aortic stenosis.
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Schneider-Reigbert M and Dreger H
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- Humans, Echocardiography methods, Aortic Valve diagnostic imaging, Severity of Illness Index, Fractional Flow Reserve, Myocardial physiology, Reproducibility of Results, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis diagnostic imaging
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- 2024
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14. Transcatheter aortic valve replacement in a patient with quadricuspid aortic valve stenosis and regurgitation.
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Bienstock SW, Krishnamoorthy P, Tang GHL, Lerakis S, Sharma SK, Kini AS, and Safi LM
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- Humans, Aged, 80 and over, Female, Echocardiography, Transesophageal methods, Severity of Illness Index, Treatment Outcome, Heart Valve Prosthesis, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis complications, Transcatheter Aortic Valve Replacement methods, Aortic Valve surgery, Aortic Valve abnormalities, Aortic Valve diagnostic imaging, Aortic Valve Insufficiency surgery, Aortic Valve Insufficiency diagnosis, Aortic Valve Insufficiency etiology
- Abstract
We report the case of an 80-year-old woman with known quadricuspid aortic valve (QAV), severe aortic stenosis, and moderate-to-severe regurgitation who recently underwent a transcatheter aortic valve replacement (TAVR).
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- 2024
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15. Images of an ectopic balloon expandable valve deployed at the aortic arch level following valve embolization.
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Chalikias G, Foutzitzi S, Stakos D, and Tziakas D
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- Humans, Male, Aged, 80 and over, Echocardiography, Transesophageal methods, Prosthesis Design, Treatment Outcome, Cardiac Catheterization methods, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic surgery, Aortic Valve surgery, Aortic Valve diagnostic imaging, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement adverse effects, Heart Valve Prosthesis adverse effects
- Abstract
An 83-year-old man with severe aortic stenosis underwent implantation of a 29-mm SAPIEN-3 (Edwards Lifesciences) transcatheter aortic valve (TAV) appropriately sized for an aortic annulus area of 543.6 mm2.
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- 2024
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16. Association between evolocumab use and slow progression of aortic valve stenosis.
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Terasaka K, Gohbara M, Abe T, Yoshii T, Hanajima Y, Kirigaya J, Horii M, Kikuchi S, Nakahashi H, Matsushita K, Minamimoto Y, Okada K, Matsuzawa Y, Iwahashi N, Kosuge M, Sugano T, Ebina T, and Hibi K
- Subjects
- Humans, Male, Female, Retrospective Studies, Aged, Aortic Valve diagnostic imaging, Treatment Outcome, Anticholesteremic Agents therapeutic use, Follow-Up Studies, Time Factors, Aged, 80 and over, Severity of Illness Index, Echocardiography, Japan epidemiology, Middle Aged, Antibodies, Monoclonal, Humanized therapeutic use, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis drug therapy, Disease Progression
- Abstract
No medications have been reported to inhibit the progression of aortic valve stenosis (AS). The present study aimed to investigate whether evolocumab use is related to the slow progression of AS evaluated by serial echocardiography. This was a retrospective observational study from 2017 to 2022 at Yokohama City University Medical Center. Patients aged ≥ 18 with moderate AS were included. Exclusion criteria were (1) mild AS; (2) severe AS defined by maximum aortic valve (AV) velocity ≥ 4.0 m/s; and/or (3) no data of annual follow-up echocardiography. The primary endpoint was the association between evolocumab use and annual changes in the maximum AV-velocity or peak AV-pressure gradient (PG). A total of 57 patients were enrolled: 9 patients treated with evolocumab (evolocumab group), and the other 48 patients assigned to a control group. During a median follow-up of 33 months, the cumulative incidence of AS events (a composite of all-cause death, AV intervention, or unplanned hospitalization for heart failure) was 11% in the evolocumab group and 58% in the control group (P = 0.012). Annual change of maximum AV-velocity or peak AV-PG from the baseline to the next year was 0.02 (- 0.18 to 0.22) m/s per year or 0.60 (- 4.20 to 6.44) mmHg per year in the evolocumab group, whereas it was 0.29 (0.04-0.59) m/s per year or 7.61 (1.46-16.48) mmHg per year in the control group (both P < 0.05). Evolocumab use was associated with slow progression of AS and a low incidence of AS events in patients with moderate AS., (© 2024. Springer Nature Japan KK, part of Springer Nature.)
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- 2024
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17. From the archives of MD Anderson Cancer Center. Mesothelial/monocytic incidental cardiac excrescence with a review of the literature.
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Mallick J, Thakral B, Wei Q, and Medeiros LJ
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- Humans, Male, Aged, Monocytes pathology, Epithelium pathology, Epithelium metabolism, Antigens, CD metabolism, Immunohistochemistry methods, Atrial Appendage pathology, Antigens, Differentiation, Myelomonocytic metabolism, Diagnosis, Differential, Pericardial Effusion pathology, Pericardial Effusion diagnosis, CD68 Molecule, Aortic Valve Stenosis pathology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis
- Abstract
Mesothelial/monocytic incidental cardiac excrescence (MICE) is a rare benign lesion composed of monocytes and mesothelial cells that is most often encountered during cardiothoracic surgery. We describe a case in a 71-year-old man with known aortic valve stenosis who presented with gradual onset dyspnea over a few weeks, made worse with minimal exertion. A transesophageal echocardiogram revealed severe aortic stenosis and mild pericardial effusion. The patient underwent aortic valve replacement, coronary artery bypass, and amputation of the left atrial appendage. Histological examination of a 0.8 cm blood clot received along with the atrial appendage showed an aggregation of bland cells with features of monocytes associated with small strands and nodules of mesothelial cells, fat cells, fibrin and a minute fragment of bone. Immunohistochemical analysis showed that the monocytic cells were positive for CD4 and CD68 (strong) and negative for calretinin and keratin. By contrast, the mesothelial cells were positive for calretinin and keratin and negative for all other markers. In sum, the morphologic and immunohistochemical findings support the diagnosis of MICE. Based on our review of the literature, about 60 cases of MICE have been reported previously which we have tabulated. We also discuss the differential diagnosis., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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18. Hemodynamic performance of self-expandable transcatheter aortic valve replacement systems during valve deployment.
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Alperi A, Moris C, Del Valle R, Pascual I, Antuna P, Almendárez M, Hernández-Vaquero D, Betanzos JL, Rodés-Cabau J, and Avanzas P
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- Humans, Male, Female, Aged, 80 and over, Treatment Outcome, Pilot Projects, Aged, Follow-Up Studies, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve Stenosis surgery, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis diagnosis, Hemodynamics physiology, Prosthesis Design, Heart Valve Prosthesis, Aortic Valve surgery, Aortic Valve physiopathology
- Abstract
Objectives: Little is known about valve hemodynamic performance during the Evolut and Neo deployment course. We aimed to evaluate transvalvular mean and peak-to-peak gradients over several intraprocedural timepoints during TAVR with Evolut PRO+ (Medtronic) and Neo (Boston Scientific) systems., Methods: This was single-center pilot sub-study from the SavvyWire EFficacy and SafEty in Transcatheter Aortic Valve Implantation Procedures (SAFE-TAVI) trial. Participants received either the Evolut PRO+ or Neo for native valve severe aortic stenosis and the SavvyWire (OpSens Medical) was used for device delivery, pacing, and continuous left ventricular and aortic pressure measurements. For the Evolut, evaluation was done for baseline, two-thirds of valve deployment (still recapturable), 90% of valve deployment (no longer recapturable), and post-deployment hemodynamics. For the Neo, analysis was done at baseline, after the first step (top-crown deployment), and at final status., Results: Nineteen patients were included (Evolut = 15; Neo = 4). There were no statistically significant changes in peak-to-peak gradients (44 mm Hg [IQR:33-69] vs 43 mm Hg [IQR:26-62], P = .41) between baseline and two-thirds of valve deployment in the Evolut patients. There was a significant decrease in mean (40 mm Hg [IQR:32-54] vs 14 mm Hg [IQR:10-18], P less than .001) and peak-to-peak (43 mmHg [IQRS:26-62] vs 9 mm Hg [IQR:8-13], P less than .001) transvalvular gradients between two-thirds and 90% of valve deployment for Evolut. Neo patients exhibited a decrease in transvalvular gradients after top-crown deployment (42.5 mm Hg baseline vs 13 mm Hg)., Conclusions: Transvalvular gradients did not vary between the point of "no-recapture" compared to baseline values in patients receiving the Evolut, whereas a significant reduction in transvalvular gradients was observed when the valve was deployed at 90% and fully deployed. The Neo valve was slightly obstructive after the first step of deployment.
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- 2024
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19. Multimodality Imaging in Aortic Stenosis: Beyond the Valve - Focusing on the Myocardium.
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Gaznabi S, Miranda J, Lorenzatti D, Piña P, Balasubramanian SS, Desai D, Desai A, Ho EC, Scotti A, Gongora CA, Schenone AL, Garcia MJ, Latib A, Parwani P, and Slipczuk L
- Subjects
- Humans, Aortic Valve diagnostic imaging, Aortic Valve pathology, Myocardium pathology, Magnetic Resonance Imaging, Cine methods, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis physiopathology, Multimodal Imaging methods
- Abstract
Current guidelines of aortic stenosis (AS) management focus on valve parameters, LV systolic dysfunction, and symptoms; however, emerging data suggest that there may be benefit of aortic valve replacement before it becomes severe by present criteria. Myocardial assessment using novel multimodality imaging techniques exhibits subclinical myocardial injury and remodeling at various stages before guideline-directed interventions, which predicts adverse outcomes. This raises the question of whether implementing serial myocardial assessment should become part of the standard appraisal, thereby identifying high-risk patients aiming to minimize adverse outcomes., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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20. Prognostic value of left ventricular and left atrial strain imaging in moderate to severe aortic stenosis: Insights from an Asian population.
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Lee CY, Tsai CM, Chiang KC, Huang CC, Lin MS, Hung CL, Ho YL, Nkomo VT, Takeuchi M, and Yang LT
- Subjects
- Humans, Male, Female, Aged, Prognosis, Aged, 80 and over, Heart Atria diagnostic imaging, Heart Atria physiopathology, Follow-Up Studies, Ventricular Function, Left physiology, Atrial Function, Left physiology, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Cohort Studies, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Aortic Valve Stenosis mortality, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis diagnosis, Severity of Illness Index, Echocardiography methods, Asian People
- Abstract
Background: Data regarding the prognostic value of left atrial (LA) strain in aortic stenosis (AS) is scarce, especially in Asian population and moderate AS., Method: Left ventricular global longitudinal strain (LVGLS), LA reservoir strain (LASr), conduit strain (LAScd), and contractile strain (LASct) were measured using automated speckle-tracking echocardiography in consecutive patients with moderate or severe AS. The primary endpoint was a composite of all-cause death (ACD) and major adverse cardiovascular events (MACE; myocardial infarction, syncope, and heart failure hospitalization)., Results: Of 712 patients (mean age, 78 ± 12 years; 370 [52%] moderate AS; 342 [48%] severe AS), average LV ejection fraction (LVEF) was 68 with SD of 12%. At a median follow-up of 18 months (interquartile range, 11-26 months), the primary endpoint occurred in 93 patients (60 deaths and 35 MACEs) and 221 patients underwent surgical or transcatheter aortic valve replacement (AVR). In the entire cohort, separate multivariable models adjusted for age, Charlson index, symptomatic status, time-dependent AVR, AS-severity, LA volume index and LVEF demonstrated that only LASr was associated with MACE+ACD (Hazard ratio, 0.97; P = 0.014). Subgroup analysis for MACE+ACD demonstrated consistent prognostication for LASr in moderate and severe AS; LVGLS was prognostic only in severe AS (all P ≤ 0.023). The optimal MACE+ACD cutoff for LASr from spline curves was 21.3%. Adjusted Kaplan-Meier curves demonstrated better event-free survival in patients with LASr >21.3% versus those with LASr ≤21.3% (P = 0.04)., Conclusions: In both moderate and severe AS, only LASr robustly predicted outcomes; thus, including LASr in the AS staging algorithm should be considered., (Copyright © 2023. Published by Elsevier B.V.)
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- 2024
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21. Sarcopenia and aortic valve disease.
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Kumar M, Pettinato A, Ladha F, Earp JE, Jain V, Patil S, Engelman DT, Robinson PF, Moumneh MB, Goyal P, and Damluji AA
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- Humans, Quality of Life, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis physiopathology, Aortic Valve surgery, Risk Factors, Aged, Aortic Valve Disease surgery, Aortic Valve Disease therapy, Treatment Outcome, Sarcopenia diagnosis, Sarcopenia therapy, Sarcopenia physiopathology, Sarcopenia etiology, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement methods
- Abstract
Valvular heart disease, including calcific or degenerative aortic stenosis (AS), is increasingly prevalent among the older adult population. Over the last few decades, treatment of severe AS has been revolutionised following the development of transcatheter aortic valve replacement (TAVR). Despite improvements in outcomes, older adults with competing comorbidities and geriatric syndromes have suboptimal quality of life outcomes, highlighting the cumulative vulnerability that persists despite valve replacement. Sarcopenia, characterised by loss of muscle strength, mass and function, affects 21%-70% of older adults with AS. Sarcopenia is an independent predictor of short-term and long-term outcomes after TAVR and should be incorporated as a prognostic marker in preprocedural planning. Early diagnosis and treatment of sarcopenia may reduce morbidity and mortality and improve quality of life following TAVR. The adverse effects of sarcopenia can be mitigated through resistance training and optimisation of nutritional status. This is most efficacious when administered before sarcopenia has progressed to advanced stages. Management should be individualised based on the patient's wishes/preferences, care goals and physical capability. Exercise during the preoperative waiting period may be safe and effective in most patients with severe AS. However, future studies are needed to establish the benefits of prehabilitation in improving quality of life outcomes after TAVR procedures., Competing Interests: Competing interests: AAD receives research funding from the Pepper Scholars Program of the Johns Hopkins University Claude D Pepper Older Americans Independence Center funded by the National Institute on Aging (P30-AG021334), mentored patient-oriented research career development award from the National Heart, Lung, and Blood Institute (K23-HL153771), the NIH National Institute on Aging (R01-AG078153) and the Patient-Centered Outcomes Research Institute (PCORI)., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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22. Association between serum phosphate, magnesium, calcium and aortic valve sclerosis: a propensity score-matched case-control study.
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Tao J, Wang J, Peng H, Yuan Y, Lai H, Gu P, Xier Z, Li G, and Yang YN
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- Humans, Female, Male, Middle Aged, Case-Control Studies, China epidemiology, Echocardiography, Sclerosis blood, Risk Factors, Phosphates blood, Aged, Retrospective Studies, Biomarkers blood, Aortic Valve Stenosis blood, Aortic Valve Stenosis epidemiology, Aortic Valve Stenosis diagnosis, Magnesium blood, Aortic Valve diagnostic imaging, Aortic Valve pathology, Propensity Score, Calcium blood
- Abstract
Objectives: Aortic valve sclerosis has been proposed to signify greater cardiovascular risk; the correlation between serum trace elements and aortic valve sclerosis has been reported. Therefore, an in-depth exploration of the risk factors for aortic valve sclerosis and early intervention may reduce the risk of cardiovascular disease., Methods: In this study, Patients with aortic valve sclerosis and non-aortic valve sclerosis who underwent echocardiographic diagnosis in the People's Hospital of Xinjiang Uygur Autonomous Region during the period from 2019 to 2021 were selected for this study. The correlation between aortic valve sclerosis and serum phosphorus, calcium, and magnesium levels was explored using the propensity score matching technique by pairing the two groups of patients 1:1., Results: A total of 1,533 non-aortic valve sclerosis and 1,533 aortic valve sclerosis patients were included. Logistic regression analysis showed that serum magnesium [OR: 0.346; 95%CI: 0.227, 0.528] and serum calcium [OR: 7.022; 95%CI: 4.755, 10.369] were influential factors. Patients with low, intermediate, and high serum magnesium levels had a significantly lower risk of aortic valve sclerosis compared to patients with very low micronutrient levels ( p < 0.05). Comparatively, patients with low or high serum calcium levels had an elevated risk of aortic valve sclerosis ( p < 0.05)., Conclusion: Serum magnesium may have a protective role against aortic valve sclerosis, while both low and high levels of serum calcium could be risk factor for the condition. These serum micronutrients may be indications of cardiovascular disease risk prediction or prevention, and more research is required.
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- 2024
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23. Recent updates on asymptomatic and symptomatic aortic valve stenosis its diagnosis, pathogenesis, management and future perspectives.
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Sandeep B, Liu X, Wu Q, Gao K, and Xiao Z
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- Humans, Aortic Valve pathology, Disease Management, Incidence, Risk Factors, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis epidemiology, Aortic Valve Stenosis etiology, Aortic Valve Stenosis therapy, Asymptomatic Diseases therapy
- Abstract
Aortic stenosis (AS) is very common in mid-aged and elderly patients, and it has been reported to have a negative impact on both short and long-term survival with a high mortality rate. The current study identified methods of diagnosis, incidence, and causes of AS, pathogenesis, intervention and management and future perspectives of Asymptomatic and Symptomatic Aortic stenosis. A systematic literature search was conducted using PubMed, Scopus and CINAHL, using the Mesh terms and key words "Aortic stenosis", "diagnostic criteria", "pathogenesis", "incidence and causes of AS" and" intervention and management strategies". Studies were retained for review after meeting strict inclusion criteria that included studies evaluating Asymptomatic and Symptomatic AS. Studies were excluded if duplicate publication, overlap of patients, subgroup studies of a main study, lack of data on AS severity, case reports and letters to editors. Forty-five articles were selected for inclusion. Incidence of AS across the studies ranged from 3 % to 7 %. Many factors have been associated with incidence and increased risk of AS, highest incidence of AS was described after aortic valve calcification, rheumatic heart disease, degenerative aortic valve disease, bicuspid aortic valve and other factors. AS is common and can be predicted by aortic root calcification volume, rheumatic heart disease, degenerative aortic valve disease, bicuspid aortic valve. Intervention and management for AS patients is a complex decision that takes into consideration multiple factors. On the other hand, there is not enough progress in preventive pharmacotherapy to slow the progression of AS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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24. Aortic stenosis: Update in monitoring and management.
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Rahman A and Rowe MK
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- Humans, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis complications, Aortic Valve Stenosis therapy, Echocardiography methods
- Abstract
Background: Aortic stenosis (AS) remains one of the most commonly encountered valvular pathologies. Medical management does not alter the progression of the disease, making assessment of severity and timing of referral for valve replacement the most important aspects of caring for patients with AS., Objective: To review the contemporary management of AS, including signs and symptoms, echocardiography and decision making in management., Discussion: Severe symptomatic AS is frequently accompanied by dyspnoea, chest pain or syncope and a physical examination might reveal the presence of an ejection systolic murmur. Echocardiography is the first and most useful investigation to stratify risk and determine requirement for valve replacement by assessing valve gradients and left ventricular function. Surgical and transcatheter options now exist for treatment of AS and decision making is usually multidisciplinary and based on individual patient parameters.
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- 2024
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25. [Cardiac amyloidosis and aortic stenosis: what do we know?]
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Sena G, Ruotolo I, Zaccaro A, Ponziani A, Saturi G, Gagliardi C, Biagini E, and Longhi S
- Subjects
- Humans, Prognosis, Amyloidosis diagnosis, Amyloidosis therapy, Amyloidosis complications, Cardiomyopathies etiology, Cardiomyopathies therapy, Cardiomyopathies diagnosis, Amyloid Neuropathies, Familial complications, Amyloid Neuropathies, Familial diagnosis, Amyloid Neuropathies, Familial therapy, Echocardiography, Aortic Valve Stenosis etiology, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis surgery
- Abstract
Aortic valve stenosis and cardiac amyloidosis, particularly transthyretin-related, often coexist and share a common clinical and demographic profile. Several pathophysiological hypotheses have been proposed regarding the causes of this association, neither of which fully substantiated in practice. The key to detect the coexistence of cardiac amyloidosis and aortic valve stenosis lies in clinical suspicion. It is possible to hypothesize concurrent cardiac amyloidosis in patients with aortic valve stenosis with the aid of clinical, electrocardiographic, echocardiographic, and extracardiac "red flags". Subsequent non-invasive diagnostic steps are often sufficient to establish a definitive diagnosis. The early diagnosis of this condition is pivotal since the presence of dual pathology worsens patient's prognosis, especially without intervention. Available data on treatment show a better outcome in terms of survival and cardiovascular events in patients undergoing percutaneous correction of valvular heart disease rather than medical therapy alone, regardless of the presence of cardiac amyloidosis. Furthermore, it seems that cardiac amyloidosis does not impact survival after transcatheter aortic valve replacement, even if higher rates of rehospitalizations have been described. Indeed, percutaneous treatment of valvular heart disease is currently considered the primary therapeutic option. Subsequently a disease-modifying treatment for transthyretin amyloidosis may be considered in order to delay disease progression and improve outcomes, even if specific data are still lacking.
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- 2024
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26. Contemporary Risk Assessment of Aortic Root Injury for New-Generation Balloon-Expandable Transcatheter Heart Valves.
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Kim WK, Charitos E, Renker M, Hamm C, Seidler T, Hamm CW, Choi YH, and Sossalla S
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- Humans, Risk Assessment methods, Heart Valve Prosthesis adverse effects, Prosthesis Design, Aortic Valve surgery, Aortic Valve diagnostic imaging, Male, Female, Aged, Aged, 80 and over, Aorta injuries, Aorta diagnostic imaging, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement methods, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis
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- 2024
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27. How to evacuate when Sapien3 transcatheter heart valve cannot pass through a severely calcified aortic valve.
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Tsuchida Y, Kawashima H, Kozuma K, and Watanabe Y
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- Humans, Heart Valve Prosthesis, Aged, 80 and over, Male, Female, Aged, Transcatheter Aortic Valve Replacement methods, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Calcinosis surgery, Calcinosis diagnostic imaging, Calcinosis diagnosis, Aortic Valve surgery, Aortic Valve diagnostic imaging, Aortic Valve pathology
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- 2024
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28. Editorial commentary: Screening for aortic stenosis in at risk older patients - A new paradigm in valvular heart disease care?
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Ilonze OJ
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- Humans, Risk Assessment, Age Factors, Risk Factors, Aged, Mass Screening methods, Prognosis, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Predictive Value of Tests
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- 2024
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29. [Aortic valve stenosis - current developments in treatment procedures and follow-up care].
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Demirel C, Hengstenberg C, and Bartko P
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- Humans, Heart Valve Prosthesis Implantation, Transcatheter Aortic Valve Replacement, Aftercare, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis
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- 2024
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30. A call to consider an aortic stenosis screening program.
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Bae JY, Fallahi A, Miller W, Leon MB, Abraham TP, Bangalore S, and Hsi DH
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- Humans, Aged, Risk Factors, Prevalence, Risk Assessment, Aged, 80 and over, Female, Age Factors, Mass Screening, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve surgery, Prognosis, Echocardiography, Male, Kidney Failure, Chronic diagnosis, Kidney Failure, Chronic epidemiology, Kidney Failure, Chronic therapy, Asymptomatic Diseases, Severity of Illness Index, Aortic Valve Stenosis epidemiology, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Predictive Value of Tests
- Abstract
Aortic stenosis (AS) is the most common age-related valvular condition with a prevalence of 13.1% in patients older than 75 years of age. Based on the severity of AS and symptoms, current guidelines recommend interval monitoring with transthoracic echocardiogram (TTE). However, no guidelines exist regarding screening asymptomatic persons for AS. Prevalence of AS is comparable to conditions such as colorectal cancer, lung cancer, breast cancer, and abdominal aortic aneurysm where dedicated screening programs are offered resulting in reduction of overall morbidity and mortality. We review recent advancements in treatment options, and we propose an AS screening program for high-risk individuals without known history of AS including all persons over age 75 and persons aged 70 years and older with dialysis dependent end-stage renal disease (ESRD)., (Copyright © 2023. Published by Elsevier Inc.)
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- 2024
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31. Measuring the aortic valvular area: Key challenges in aortic stenosis assessment.
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Springhetti P, Tomaselli M, and Clavel MA
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- Humans, Severity of Illness Index, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Aortic Valve diagnostic imaging, Aortic Valve pathology
- Abstract
Competing Interests: Declaration of competing interest Dr. Clavel received funding from Edwards Lifesciences for computed tomography core laboratory analyses in the field of surgical aortic valve prosthesis with no direct personal compensation and research grant from Medtronic, Edwards Lifesciences and Pi-Cardia. All other authors reported no conflict of interest to disclose.
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- 2024
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32. Prognostic relevance of pre-procedural plasma volume status estimation in patients undergoing transcatheter aortic valve implantation: A meta-analysis.
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Papazoglou AS, Moysidis DV, Anastasiou V, Daios S, Kamperidis V, Ziakas A, and Giannakoulas G
- Subjects
- Humans, Postoperative Complications epidemiology, Prognosis, Risk Assessment methods, Risk Factors, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Plasma Volume physiology, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement adverse effects
- Abstract
Background: To systematically evaluate the prognostic utility of estimated plasma volume status (ePVS) on the outcomes of patients undergoing transcatheter aortic valve implantation (TAVI)., Methods: The exposure variable of interest was the ePVS, enumerating the percentage change of the actual plasma volume from the ideal plasma volume, and being calculated on the basis of weight and hematocrit using sex-specific constants. A random-effects meta-analysis was performed after a systematic literature search in PubMed, Scopus and Web Of Science., Results: The systematic literature search yielded 5 eligible observational cohort studies encompassing a total of 7,121 patients undergoing TAVI. The meta-analysis suggested that "high ePVS" status was independently associated with increased risk for 1-year all-cause mortality (pooled adjusted hazard ratio: 1.63, 95 % confidence intervals: 1.36-1.95) compared to "low ePVS". Also, the pooled unadjusted odds for 1-year mortality, 30-day mortality, peri-procedural stroke, major bleeding, and acute kidney injury were significantly increased in the "high ePVS" group of patients. Conversely, the unadjusted risk of pacemaker implantation and major vascular complications did not differ significantly between the 2 groups., Conclusions: Plasma volume expansion appears to be linked with a worse peri-procedural and long-term prognostic course in TAVI. Its use in clinical practice could refine risk stratification and candidate selection practices., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)
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- 2024
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33. Electronic physician notification to facilitate the recognition and management of severe aortic stenosis: Rationale, design, and methods of the randomized controlled DETECT AS trial.
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Abou-Karam R, Tanguturi V, Cheng F, and Elmariah S
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- Humans, Severity of Illness Index, Quality Improvement, Heart Valve Prosthesis Implantation methods, Disease Management, Practice Guidelines as Topic, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis surgery, Echocardiography methods
- Abstract
Background: Symptomatic severe aortic stenosis causes substantial morbidity and mortality when left untreated, yet recent data suggest its undertreatment., Objective: To evaluate the efficacy of electronic physician notification to facilitate the guideline-directed management of patients with severe aortic stenosis., Hypothesis: We hypothesize that patients with severe aortic stenosis who are in the care of physicians who receive the notification are more likely to undergo aortic valve replacement within one year., Methods/design: The Electronic Physician Notification to Facilitate the Recognition and Management of Severe Aortic Stenosis (DETECT AS) trial is a randomized controlled trial and quality improvement initiative designed to evaluate the efficacy of electronic provider notification versus usual clinical care in the management of patients with severe aortic stenosis. Providers ordering an echocardiogram with findings potentially indicative of severe aortic stenosis are randomized to receive electronic notification with customized guideline recommendations for the management of severe aortic stenosis or usual care (no notification). Randomization continues until 940 patients are enrolled., Setting: Multicentered, academic health system., Outcomes: The primary endpoint is the proportion of patients with severe aortic stenosis receiving an aortic valve replacement within one year of the index echocardiogram. Secondary endpoints include mortality, heart failure hospitalization, transthoracic echocardiogram utilization, aortic stenosis billing code, and cardiology/Valve Team referral., Conclusion: The DETECT AS trial will provide insight into whether electronic notification of providers on the presence of severe aortic stenosis and associated clinical guideline recommendations will facilitate recognition and guideline-directed management of severe aortic stenosis., Trial Registration: ClinicalTrials.gov, NCT05230225, https://clinicaltrials.gov/ct2/show/NCT05230225., Competing Interests: Conflict of interest Dr Elmariah has received research grants from the American Heart Association (19TPA34910170), National Institutes of Health (R01 HL151838), Edwards Lifesciences, Svelte Medical, Abbott Vascular, and Medtronic; and has received consulting fees from Edwards Lifesciences. Dr. Tanguturi is a co-principal investigator of a grant funded by Edwards Lifesciences for the institution. Dr. Abou-Karam reports receiving consulting fees from Goodpath., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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34. Identifying People at High Risk for Severe Aortic Stenosis: Aortic Valve Calcium Versus Lipoprotein(a) and Low-Density Lipoprotein Cholesterol.
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Marrero N, Jha K, Razavi AC, Boakye E, Anchouche K, Dzaye O, Budoff MJ, Tsai MY, Shah SJ, Rotter JI, Guo X, Yao J, Blumenthal RS, Thanassoulis G, Post WS, Blaha MJ, and Whelton SP
- Subjects
- Humans, Female, Male, Middle Aged, Aged, Risk Factors, Risk Assessment, Incidence, United States epidemiology, Aged, 80 and over, Predictive Value of Tests, Time Factors, Prospective Studies, Proportional Hazards Models, Tomography, X-Ray Computed, Prognosis, Aortic Valve Stenosis blood, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis epidemiology, Aortic Valve Stenosis diagnostic imaging, Lipoprotein(a) blood, Cholesterol, LDL blood, Aortic Valve diagnostic imaging, Aortic Valve pathology, Calcinosis blood, Calcinosis diagnostic imaging, Calcinosis diagnosis, Calcinosis epidemiology, Calcinosis ethnology, Severity of Illness Index, Biomarkers blood
- Abstract
Background: Aortic valve calcification (AVC), Lp(a) [lipoprotein(a)], and low-density lipoprotein cholesterol (LDL-C) are associated with severe aortic stenosis (AS). We aimed to determine which of these risk factors were most strongly associated with the risk of incident severe AS., Methods: A total of 6792 participants from the MESA study (Multi-Ethnic Study of Atherosclerosis) had computed tomography-quantified AVC, Lp(a), and LDL-C values at MESA visit 1 (2000-2002). We calculated the absolute event rate of incident adjudicated severe AS per 1000 person-years and performed multivariable adjusted Cox proportional hazards regression., Results: The mean age was 62 years old, and 47% were women. Over a median 16.7-year follow-up, the rate of incident severe AS increased exponentially with higher AVC, regardless of Lp(a) or LDL-C values. Participants with AVC=0 had a very low rate of severe AS even with elevated Lp(a) ≥50 mg/dL (<0.1/1000 person-years) or LDL-C ≥130 mg/dL (0.1/1000 person-years). AVC >0 was strongly associated with severe AS when Lp(a) <50 mg/dL hazard ratio (HR) of 33.8 (95% CI, 16.4-70.0) or ≥50 mg/dL HR of 61.5 (95% CI, 7.7-494.2) and when LDL-C <130 mg/dL HR of 31.1 (95% CI, 14.4-67.1) or ≥130 mg/dL HR of 50.2 (95% CI, 13.2-191.9)., Conclusions: AVC better identifies people at high risk for severe AS compared with Lp(a) or LDL-C, and people with AVC=0 have a very low long-term rate of severe AS regardless of Lp(a) or LDL-C level. These results suggest AVC should be the preferred prognostic risk marker to identify patients at high risk for severe AS, which may help inform participant selection for future trials testing novel strategies to prevent severe AS., Competing Interests: Disclosures None.
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- 2024
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35. Histological assessment of cardiac amyloidosis in patients undergoing transcatheter aortic valve replacement.
- Author
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Beuthner BE, Elkenani M, Evert K, Mustroph J, Jacob CF, Paul NB, Beißbarth T, Zeisberg EM, Schnelle M, Puls M, Hasenfuß G, and Toischer K
- Subjects
- Humans, Male, Female, Prospective Studies, Aged, 80 and over, Aged, Biopsy, Cardiomyopathies diagnosis, Cardiomyopathies etiology, Myocardium pathology, Myocardium metabolism, Follow-Up Studies, Prevalence, Transcatheter Aortic Valve Replacement, Amyloidosis complications, Amyloidosis diagnosis, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis
- Abstract
Aims: Studies have reported a strongly varying co-prevalence of aortic stenosis (AS) and cardiac amyloidosis (CA). We sought to histologically determine the co-prevalence of AS and CA in patients undergoing transcatheter aortic valve replacement (TAVR). Consequently, we aimed to derive an algorithm to identify cases in which to suspect the co-prevalence of AS and CA., Methods and Results: In this prospective, monocentric study, endomyocardial biopsies of 162 patients undergoing TAVR between January 2017 and March 2021 at the University Medical Centre Göttingen were analysed by one pathologist blinded to clinical data using haematoxylin-eosin staining, Elastica van Gieson staining, and Congo red staining of endomyocardial biopsies. CA was identified in only eight patients (4.9%). CA patients had significantly higher N-terminal pro-brain natriuretic peptide (NT-proBNP) levels (4356.20 vs. 1938.00 ng/L, P = 0.034), a lower voltage-to-mass ratio (0.73 vs. 1.46 × 10
-2 mVm2 /g, P = 0.022), and lower transaortic gradients (Pmean 17.5 vs. 38.0 mmHg, P = 0.004) than AS patients. Concomitant CA was associated with a higher prevalence of post-procedural acute kidney injury (50.0% vs. 13.1%, P = 0.018) and sudden cardiac death [SCD; P (log-rank test) = 0.017]. Following propensity score matching, 184 proteins were analysed to identify serum biomarkers of concomitant CA. CA patients expressed lower levels of chymotrypsin (P = 0.018) and carboxypeptidase 1 (P = 0.027). We propose an algorithm using commonly documented parameters-stroke volume index, ejection fraction, NT-proBNP levels, posterior wall thickness, and QRS voltage-to-mass ratio-to screen for CA in AS patients, reaching a sensitivity of 66.6% with a specificity of 98.1%., Conclusions: The co-prevalence of AS and CA was lower than expected, at 4.9%. Despite excellent 1 year mortality, AS + CA patients died significantly more often from SCD. We propose a multimodal algorithm to facilitate more effective screening for CA containing parameters commonly documented during clinical routine. Proteomic biomarkers may yield additional information in the future., (© 2024 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)- Published
- 2024
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36. Usefulness of endomyocardial biopsy using three-dimensional delivery system for the diagnosis of cardiac amyloidosis with complete atrioventricular block after transcatheter aortic valve implantation.
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Sudo K, Nakamura K, and Sato A
- Subjects
- Humans, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Biopsy methods, Cardiomyopathies diagnosis, Myocardium pathology, Amyloidosis diagnosis, Atrioventricular Block etiology, Atrioventricular Block diagnosis, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement methods
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- 2024
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37. Hybrid robotic-assisted coronary revascularization and transcatheter aortic valve replacement: a single-center experience.
- Author
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Yamashita Y, Sicouri S, Torregrossa G, Gray WA, Sutter FP, and Ramlawi B
- Subjects
- Humans, Male, Female, Aged, 80 and over, Aged, Retrospective Studies, Coronary Artery Disease surgery, Coronary Artery Disease diagnosis, Coronary Artery Bypass methods, Coronary Artery Bypass adverse effects, Treatment Outcome, Percutaneous Coronary Intervention methods, Coronary Angiography methods, Follow-Up Studies, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement adverse effects, Robotic Surgical Procedures methods, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis
- Abstract
Objectives: The efficacy of hybrid robotic-assisted coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR) for coronary and aortic valve disease is poorly reported. Herein, we report our experience with this hybrid approach., Methods: Between January 2018 and June 2022, 10 (7 male, 3 female) patients with a mean age of 81 years underwent the hybrid procedure. Coronary revascularization was performed prior to TAVR with robotic-assisted left internal mammary artery-to-left anterior descending (LAD) bypass grafting for left main or proximal LAD lesions with or without multivessel disease with or without hybrid percutaneous coronary intervention (PCI)., Results: Five patients had left main disease, and 5 had proximal LAD disease with or without multivessel disease. All patients tolerated the robotic-assisted CABG procedure well; 9 patients were extubated in the operating room and all patients were ambulatory on postoperative day 1. Five patients underwent hybrid PCI for non-LAD lesions. TAVR was subsequently performed at intervals ranging from 3 days to 5 months after CABG. One patient with end-stage renal disease on hemodialysis required hospitalization for heart failure during the interval period. The 1-year mortality rate was 0%, and 3 patients died during late follow-up (24-43 months)., Conclusions: This innovative, less invasive approach demonstrates the potential for early recovery in appropriately selected patients with complex coronary and aortic valve disease with promising mid-term outcomes.
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- 2024
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38. Optimal oversizing in transcatheter aortic valve replacement with the self-expanding Evolut valve system.
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Mas-Peiro S, Alperi A, Avvedimento M, Regueiro A, Avanzas P, Angellotti D, Esposito G, Vidal-Cales P, Mohammadi S, Farjat-Pasos J, Moris C, and Rodés-Cabau J
- Subjects
- Humans, Female, Male, Aged, 80 and over, Aged, Retrospective Studies, Treatment Outcome, Follow-Up Studies, Postoperative Complications prevention & control, Postoperative Complications epidemiology, Postoperative Complications diagnosis, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Multidetector Computed Tomography methods, Aortic Valve surgery, Aortic Valve diagnostic imaging, Prosthesis Design, Heart Valve Prosthesis
- Abstract
Objectives: Valve oversizing has been associated with reduced paravalvular leaks (PVL) and valve migration risk. However, no optimal cut-off oversizing value has been defined for the Evolut system (Medtronic). The aim of this study was to assess the relationship between the degree of oversizing and moderate-to-severe PVL and determine the optimal oversizing cut-off value., Methods: We conducted a multicenter study that included 740 consecutive patients with multidetector computed tomography (CT) data. Valve size was selected according to manufacturer recommendations, with oversizing ranging from 10% to 30%. The primary endpoint was moderate-to-severe PVL., Results: The median age was 84 years (79-87 years), with 58.4% women, and a median EuroSCORE II of 4.1% (2.4-7.3%). Moderate-to-severe PVL was observed in 7.0% of the patients. An inverse relationship was found between oversizing and both PVL (11.3%, 8.6%, 5.4%, and 2.7% for quartiles Q1 to Q4; P = .007) and the need for post-dilation (P = .016). The multivariable analysis showed an association between oversizing and PVL (OR: 0.915 for each 1%-increase, P = .002). The optimal oversizing cut-off value to predict PVL was 20%, and PVL was significantly higher in patients with oversizing less than 20% (10.5% vs.4.2%, P less than .001). There were no differences in major clinical events according to the degree of oversizing, and a higher oversizing did not translate into an increased risk of permanent pacemaker (18.4% vs18.3%, P = .976)., Conclusions: In TAVR with the Evolut valve, a higher oversizing was associated with lower rates of moderate-to-severe PVL and a lower need for post-dilation, with no negative impact on procedural and early clinical outcomes. A 20% oversizing threshold could be suggested to reduce PVLs. Further prospective studies are warranted to validate optimal oversizing for this valve system.
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- 2024
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39. Uncommon presentations of type A quadricuspid aortic valve in the Septuagenarian.
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Choi P, Paulsen M, Lin Y, Moskalik W, Ji A, Jackson E, Malik S, Burton E, Woo YJ, and Burdon T
- Subjects
- Aged, Humans, Aortic Valve Insufficiency surgery, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis diagnosis, Echocardiography, Heart Valve Prosthesis Implantation, Aortic Valve abnormalities, Aortic Valve surgery, Aortic Valve diagnostic imaging
- Abstract
Background: Quadricuspid aortic valve (QAV) is a rare congenital anomaly characterized by the presence of four cusps instead of the usual three. It is estimated to occur in less than 0.05% of the population, with Type A (four equal-sized leaflets) accounting for roughly 30% of QAV subtypes. Based on limited clinical series, the usual presentation is progressive aortic valve regurgitation (AR) with symptoms occurring in the fourth to sixth decade of life. Severe aortic valve stenosis (AS) and acute AR are very uncommon., Case Presentation: We describe two cases of Type A QAV in patients who remained asymptomatic until their seventies with very uncommon presentations: one with severe AS and one with acute, severe AR and flail leaflet. In Case A, a 72-year-old patient with history of moderate AS presents to clinic with progressive exertional dyspnea. During work-up for transcatheter vs. surgical replacement pre-operative computed tomography angiogram (CTA) reveals a quadricuspid aortic valve with severe AS, and the patient undergoes surgical aortic valve replacement. Pre-discharge transthoracic echocardiography (TTE) shows good prosthetic valve function with no gradient or regurgitation. In Case B, a 76-year-old patient is intubated upon arrival to the hospital for acute desaturation, found to have wide open AR on catheterization, and transferred for emergent intervention. Intraoperative TEE reveals QAV with flail leaflet and severe AR. Repair is considered but deferred ultimately due to emergent nature. Post-operative TTE demonstrates good prosthetic valve function with no regurgitation and normal biventricular function., Conclusions: QAV can present as progressive severe AS and acute AR, with symptoms first occurring in the seventh decade of life. The optimal treatment for QAV remains uncertain. Although aortic valve repair or transcatheter option may be feasible in some patients, aortic valve replacement remains a tenable option., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
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- 2024
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40. Role of aortic valve replacement in moderate aortic stenosis: a 10-year outcomes study.
- Author
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Hariri EH, Badwan O, Kassab J, Layoun H, Skoza W, Burton R, Harb SC, Puri R, Reed GW, Krishnaswamy A, Svensson LG, and Kapadia S
- Subjects
- Humans, Female, Male, Retrospective Studies, Aged, Treatment Outcome, Time Factors, Severity of Illness Index, Follow-Up Studies, Risk Factors, Echocardiography methods, Aged, 80 and over, Survival Rate trends, Risk Assessment methods, Stroke Volume physiology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis mortality, Aortic Valve Stenosis diagnosis, Heart Valve Prosthesis Implantation methods, Ventricular Function, Left physiology, Aortic Valve surgery, Aortic Valve diagnostic imaging, Aortic Valve physiopathology
- Abstract
Objective: Patients with moderate aortic stenosis (AS) exhibit high morbidity and mortality. Limited evidence exists on the role of aortic valve replacement (AVR) in this patient population. To investigate the benefit of AVR in moderate AS on survival and left ventricular function., Methods: In a retrospective cohort study, patients with moderate AS between 2008 and 2016 were selected from the Cleveland Clinic echocardiography database and followed until 2018. Patients were classified as receiving AVR or managed medically (clinical surveillance). All-cause and cardiovascular mortality were assessed by survival analyses. Temporal haemodynamic and structural changes were assessed with longitudinal analyses using linear mixed effects models., Results: We included 1421 patients (mean age, 75.3±5.4 years and 39.9% women) followed over a median duration of 6 years. Patients in the AVR group had lower risk of all-cause (adjusted HR (aHR)=0.51, 95% CI: 0.34 to 0.77; p=0.001) and cardiovascular mortality (aHR=0.50, 95% CI: 0.31 to 0.80; p=0.004) compared with those in the clinical surveillance group irrespective of sex, receipt of other open-heart surgeries and underlying malignancy. These findings were seen only in those with preserved left ventricular ejection fraction (LVEF) ≥50%. Further, patients in the AVR group had a significant trend towards an increase in LVEF and a decrease in right ventricular systolic pressure compared with those in the clinical surveillance group., Conclusions: In patients with moderate AS, AVR was associated with favourable clinical outcomes and left ventricular remodelling., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2024
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41. Concomitant transthyretin cardiac amyloidosis in patients undergoing TAVR for aortic stenosis: A systemic review and meta-analysis.
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Fatima K, Uddin QS, Tharwani ZH, Kashif MAB, Javaid SS, Kumar P, Zia MT, Javed M, Butt MS, and Asim Z
- Subjects
- Humans, Prealbumin, Treatment Outcome, Aortic Valve surgery, Risk Factors, Transcatheter Aortic Valve Replacement, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis surgery, Aortic Valve Stenosis complications, Amyloidosis
- Abstract
Objective: Transcatheter aortic valve replacement (TAVR) is a successful treatment for aortic stenosis (AS) patients, and previous studies indicate favorable outcomes for those with concomitant aortic stenosis and transthyretin-associated cardiac amyloidosis (TTRCA-AS). However, the impact of TAVR on more adverse outcomes in TTRCA-AS patients compared to those with AS alone is still uncertain, with conflicting findings reported in the literature., Methods: PubMed and Scopus were extensively searched from inception till August 2021. Studies were included if they reported data for prevalence and outcomes including mortality and cardiovascular-related hospitalization events in TTRCA-AS patients referred for TAVR. The data for these outcomes were pooled using a random effects model and forest plots were created., Results: After initially screening 146 articles, 6 were shortlisted for inclusion in our analysis. Pooled analysis demonstrated a 13.3% [95% CI: 10.9-16.5; p = 0.307] prevalence of TTRCA in patients with AS undergoing TAVR. The incidence of mortality and cardiovascular (CV) hospitalization in patients with TTRCA-AS undergoing TAVR were 28.3% [95% CI: 18.7-39.0, p = 0.478] and 21.1% [95% CI: 10.2-34.5, p = 0.211], respectively., Conclusion: The overall pooled TTRCA-AS prevalence was reported to be 13.3% in AS patients who underwent TAVR. Furthermore, transthyretin-associated CA was found to be associated with an increased risk of mortality and hospitalization. Large patient population studies are required to assess the safety and efficacy of TAVR in TTRCA-AS patients, as current research report data from small patient cohorts., Competing Interests: Declaration of competing interest None to declare., (Copyright © 2024 Elsevier Ireland Ltd. All rights reserved.)
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- 2024
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42. Kissing shockwave balloon in a case of extensive calcified abdominal aorta during transfemoral TAVI.
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Buonpane A, Trimarchi G, Palmieri C, Jabri AAAA, Berti S, and Rizza A
- Subjects
- Male, Humans, Aged, 80 and over, Treatment Outcome, Aorta, Abdominal diagnostic imaging, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis
- Abstract
An 84-year-old man with extensive calcified atherosclerosis of the infrarenal abdominal aorta was diagnosed with severe aortic valve stenosis, presenting with dyspnea. To facilitate transfemoral approach during the TAVI procedure, IVUS-guided intravascular lithotripsy was successfully performed using Kissing Shockwave Balloon Technique., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)
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- 2024
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43. Evaluation of Instantaneous Wave-Free Ratio and Fractional Flow Reserve in Severe Aortic Valve Stenosis.
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Jo HH, Kang DY, Lee JM, Lim SM, Park YS, Choi Y, Kim H, Lee J, Ahn JM, Park DW, and Park SJ
- Subjects
- Humans, Male, Female, Retrospective Studies, Aged, Aged, 80 and over, Aortic Valve physiopathology, Aortic Valve diagnostic imaging, Aortic Valve surgery, Risk Factors, Coronary Angiography, Fractional Flow Reserve, Myocardial, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis diagnosis, Severity of Illness Index, Predictive Value of Tests, Registries, Coronary Stenosis physiopathology, Coronary Stenosis diagnosis, Cardiac Catheterization
- Abstract
Background: The optimal functional evaluation of coronary artery stenosis in patients with severe aortic stenosis (AS) has not been established. The objective of the study was to evaluate the instantaneous wave-free ratio (iFR) and fractional flow reserve (FFR) in patients with and without severe AS., Methods: We retrospectively investigated 395 lesions in 293 patients with severe AS and 2257 lesions in 1882 patients without severe AS between 2010 and 2022 from a subgroup of the Interventional Cardiology Research In-Cooperation Society FFR Registry. All patients had FFR values, and iFR was analyzed post hoc using dedicated software only in lesions with adequate resting pressure curves (311 lesions in patients with severe AS and 2257 lesions in patients with nonsevere AS)., Results: The incidence of iFR ≤0.89 was 66.6% and 31.8% ( P <0.001), while the incidence of FFR ≤0.80 was 45.3% and 43.9% ( P =0.60) in the severe AS group and the nonsevere AS group, respectively. In the severe AS group, most lesions (95.2%) with iFR >0.89 had FFR >0.80, while 36.2% of lesions with iFR ≤0.89 had FFR >0.80. During a median follow-up of 2 years, FFR ≤0.80 was significantly associated with deferred lesion failure (adjusted hazard ratio, 2.71 [95% CI, 1.08-6.80]; P =0.034), while iFR ≤0.89 showed no prognostic value (adjusted hazard ratio, 1.31 [95% CI, 0.47-3.60]; P =0.60) in the severe AS group. Lesions with iFR ≤0.89 and FFR >0.80, in particular, were not associated with a higher rate of deferred lesion failure at 3 years compared with lesions with iFR >0.89 (15.4% versus 17.0%; P =0.58)., Conclusions: This study suggested that FFR appears to be less affected by the presence of severe AS and is more associated with prognosis. iFR may overestimate the functional severity of coronary artery disease without prognostic significance, yet it can be useful for excluding significant stenosis in patients with severe AS., Competing Interests: Disclosures None.
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- 2024
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44. Impact of mitral stenosis on early and late outcomes of transcatheter aortic valve replacement for aortic stenosis: a single-center analysis.
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Yamashita Y, Sicouri S, Dokollari A, Senzai M, Rodriguez R, Gnall EM, Coady PM, Jarrett H, Abramson SV, Hawthorne KM, Goldman SM, Gray WA, and Ramlawi B
- Subjects
- Humans, Female, Male, Aged, 80 and over, Retrospective Studies, Follow-Up Studies, Severity of Illness Index, Treatment Outcome, Aged, Survival Rate trends, Time Factors, Risk Factors, Postoperative Complications epidemiology, Mitral Valve Stenosis surgery, Mitral Valve Stenosis diagnosis, Mitral Valve Stenosis complications, Transcatheter Aortic Valve Replacement methods, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve Stenosis surgery, Aortic Valve Stenosis complications, Aortic Valve Stenosis diagnosis
- Abstract
Objectives: To assess the impact of concomitant mitral stenosis (MS) on early and late outcomes of transcatheter aortic valve replacement (TAVR) for aortic stenosis., Methods: This study involved 952 patients undergoing TAVR for severe tricuspid aortic stenosis. The patients were classified into 3 groups: without MS, with progressive MS, and severe MS (mitral valve area ≤ 1.5 cm2). Clinical outcomes between these groups were compared., Results: The median age of the overall cohort was 82 years, and patients in the progressive (n = 49) and severe (n = 24) MS groups were more likely to be female than those in the no-MS group (n = 879). Periprocedural mortality rate was lowest in the no-MS group (1.8%) compared with the progressive (4.1%) and severe (4.2%) MS groups, which were not significantly different (P = .20). During 5 years of follow-up (median: 27, range: 0-72 months), there was no significant difference in all-cause mortality (log-rank P = .99), a composite of all-cause mortality or rehospitalization for heart failure (log-rank P = .84), or cardiovascular death (log-rank P = .57) between groups. Although crude analysis showed a significant difference in rehospitalization for heart failure in the severe MS group compared with the no-MS group (P = .049), the difference was not significant in the multivariate analysis (adjusted hazard ratio: 1.36 [95% CI, 0.66-2.80], P = .41)., Conclusions: TAVR can be safely performed in patients with severe tricuspid aortic stenosis and concomitant MS, with early and mid-term outcomes comparable to those in patients without MS.
- Published
- 2024
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45. Association Between Aortic Valve Sclerosis and Clonal Hematopoiesis of Indeterminate Potential.
- Author
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Kim M, Kim JJ, Lee ST, Shim Y, Lee H, Bae S, Son NH, Shin S, and Jung IH
- Subjects
- Humans, Male, Middle Aged, Aged, Aged, 80 and over, Female, Aortic Valve diagnostic imaging, Aortic Valve pathology, Clonal Hematopoiesis, Sclerosis pathology, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis genetics, Aortic Valve Stenosis pathology, Calcinosis pathology
- Abstract
Background: The mechanism and medical treatment target for degenerative aortic valve disease, including aortic stenosis, is not well studied. In this study, we investigated the effect of clonal hematopoiesis of indeterminate potential (CHIP) on the development of aortic valve sclerosis (AVS), a calcified aortic valve without significant stenosis., Methods: Participants with AVS (valves ≥2 mm thick, high echogenicity, and a peak transaortic velocity of <2.5 m/sec) and an age- and sex-matched control group were enrolled. Twenty-four CHIP genes with common variants in cardiovascular disease were used to generate a next-generation sequencing panel. The primary endpoint was the CHIP detection rate between the AVS and control groups. Inverse-probability treatment weighting (IPTW) analysis was performed to adjust for differences in baseline characteristics., Results: From April 2020 to April 2022, 187 participants (125 with AVS and 62 controls) were enrolled; the mean age was 72.6±8.5 yrs, and 54.5% were male. An average of 1.3 CHIP variants was observed. CHIP detection, defined by a variant allele frequency (VAF) of ≥0.5%, was similar between the groups. However, the AVS group had larger CHIP clones: 49 (39.2%) participants had a VAF of ≥1% (vs. 13 [21.0%] in the control group; P =0.020), and 25 (20.0%) had a VAF of ≥2% (vs. 4 [6.5%]; P =0.028). AVS is independently associated with a VAF of ≥1% (adjusted odds ratio: 2.44, 95% confidence interval: 1.11-5.36; P =0.027). This trend was concordant and clearer in the IPTW cohort., Conclusions: Participants with AVS more commonly had larger CHIP clones than age- and sex-matched controls. Further studies are warranted to identify causality between AVS and CHIP.
- Published
- 2024
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46. Acute Mitral Valve Regurgitation Caused by Left Ventricular Pacing Wire During Transcatheter Aortic Valve Replacement.
- Author
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Son BJ, Kim U, Nam JH, Choi KU, Park JI, and Son JW
- Subjects
- Humans, Acute Disease, Cardiac Pacing, Artificial methods, Heart Ventricles diagnostic imaging, Heart Ventricles physiopathology, Mitral Valve surgery, Mitral Valve diagnostic imaging, Pacemaker, Artificial adverse effects, Treatment Outcome, Ventricular Function, Left physiology, Aortic Valve Stenosis surgery, Aortic Valve Stenosis diagnosis, Mitral Valve Insufficiency surgery, Mitral Valve Insufficiency etiology, Mitral Valve Insufficiency diagnosis, Mitral Valve Insufficiency physiopathology, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement methods
- Abstract
Transcatheter aortic valve replacement is quickly becoming the standard of care for patients with severe aortic stenosis thanks to its minimally invasive nature and favorable outcomes. Recently, left ventricular pacing has been proposed as a safer alternative to traditional right heart pacing, which could simplify the transcatheter aortic valve replacement procedure overall, although procedural complications may still occur. This report describes a rare case of left ventricular pacing wire-induced acute severe mitral valve regurgitation during transcatheter aortic valve replacement., (© 2024 The Authors. Published by The Texas Heart Institute®.)
- Published
- 2024
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47. Predictors of outcome in patients with moderate mixed aortic valve disease.
- Author
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Patel KP, McKenna M, Thornton GD, Vandermolen S, Abdulelah ZA, Awad W, Baumbach A, Mathur A, Treibel TA, Lloyd G, Mullen MJ, and Bhattacharyya S
- Subjects
- Aged, Aged, 80 and over, Female, Humans, Male, Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Echocardiography, Heart Failure physiopathology, Heart Failure mortality, Hemodynamics, Prognosis, Registries, Retrospective Studies, Risk Assessment methods, Risk Factors, Aortic Valve Insufficiency physiopathology, Aortic Valve Insufficiency mortality, Aortic Valve Insufficiency diagnosis, Aortic Valve Stenosis physiopathology, Aortic Valve Stenosis complications, Aortic Valve Stenosis mortality, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis diagnostic imaging, Severity of Illness Index
- Abstract
Objectives: Grading the severity of moderate mixed aortic stenosis and regurgitation (MAVD) is challenging and the disease poorly understood. Identifying markers of haemodynamic severity will improve risk stratification and potentially guide timely treatment. This study aims to identify prognostic haemodynamic markers in patients with moderate MAVD., Methods: Moderate MAVD was defined as coexisting moderate aortic stenosis (aortic valve area (AVA) 1.0-1.5 cm
2 ) and moderate aortic regurgitation (vena contracta (VC) 0.3-0.6 cm). Consecutive patients diagnosed between 2015 and 2019 were included from a multicentre registry. The primary composite outcome of death or heart failure hospitalisation was evaluated among these patients. Demographics, comorbidities, echocardiography and treatment data were assessed for their prognostic significance., Results: 207 patients with moderate MAVD were included, aged 78 (66-84) years, 56% male sex, AVA 1.2 (1.1-1.4) cm2 and VC 0.4 (0.4-0.5) cm. Over a follow-up of 3.5 (2.5-4.7) years, the composite outcome was met in 89 patients (43%). Univariable associations with the primary outcome included older age, previous myocardial infarction, previous cerebrovascular event, atrial fibrillation, New York Heart Association >2, worse renal function, tricuspid regurgitation ≥2 and mitral regurgitation ≥2. Markers of biventricular systolic function, cardiac remodelling and transaortic valve haemodynamics demonstrated an inverse association with the primary composite outcome. In multivariable analysis, peak aortic jet velocity (Vmax) was independently and inversely associated with the composite outcome (HR: 0.63, 95% CI 0.43 to 0.93; p=0.021) in an adjusted model along with age (HR: 1.05, 95% CI 1.03 to 1.08; p<0.001), creatinine (HR: 1.002, 95% CI 1.001 to 1.003; p=0.005), previous cerebrovascular event (85% vs 42%; HR: 3.04, 95% CI 1.54 to 5.99; p=0.001) and left ventricular ejection fraction (LVEF) (HR: 0.97, 95% CI 0.95 to 0.99; p=0.007). Patients with Vmax ≤2.8 m/s and LVEF ≤50% (n=27) had the worst outcome compared with the rest of the population (72% vs 41%; HR: 3.87, 95% CI 2.20 to 6.80; p<0.001)., Conclusions: Patients with truly moderate MAVD have a high incidence of death and heart failure hospitalisation (43% at 3.5 (2.5-4.7) years). Within this group, a high-risk group characterised by disproportionately low aortic Vmax (≤2.8 m/s) and adverse remodelling (LVEF ≤50%) have the worst outcomes., Competing Interests: Competing interests: KPP has an unrestricted research grant from Edwards Lifesciences. TAT is directly and indirectly supported by the UCLH and Barts NIHR Biomedical Research Units. MJM has received grants and personal fees from Edwards Lifesciences and personal fees from Abbott Vascular., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)- Published
- 2024
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48. Heyde's syndrome: a challenging case of severe aortic stenosis and gastrointestinal bleeding.
- Author
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Abouzid M, Abdelhakeem A, Elshafie S, and Ghorab A
- Subjects
- Male, Humans, Aged, Gastrointestinal Hemorrhage diagnosis, Colonoscopy, Aortic Valve Stenosis diagnosis, von Willebrand Diseases, Angiodysplasia diagnosis
- Abstract
We present the case of an elderly man with a history of diastolic congestive heart failure, severe aortic stenosis and atrial fibrillation, who presented with fatigue, weakness, coffee ground emesis and black tarry stool. Haemoglobin was 68 g/L. Lactate dehydrogenase was elevated at 1038. Evaluation by cardiology and gastroenterology specialists revealed reflux oesophagitis and a mild hiatal hernia on oesophagogastroduodenoscopy, normal colonoscopy and small bowel series without obstruction. Capsule endoscopy identified angiodysplasia in the small intestine.The patient was diagnosed with Heyde's syndrome based on the triad of severe aortic stenosis, gastrointestinal bleeding from angiodysplasia and acquired von Willebrand syndrome. The patient underwent transcatheter aortic valve replacement, resulting in the resolution of symptoms.Heyde's syndrome represents a challenging clinical entity requiring a multidisciplinary approach for accurate diagnosis and management. Early recognition, prompt intervention and interdisciplinary collaboration are crucial in optimising patient outcomes., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2024
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49. Treatment and Prognosis of Less Than Severe Aortic Stenosis: The Importance of Context.
- Author
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Jaber WA and Rodriguez LL
- Subjects
- Humans, Prognosis, Severity of Illness Index, Aortic Valve, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis surgery
- Published
- 2024
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50. mPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis.
- Author
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Hoedemakers S, Pugliese NR, Stassen J, Vanoppen A, Claessens J, Gojevic T, Bekhuis Y, Falter M, Moura Ferreira S, Dhont S, De Biase N, Del Punta L, Di Fiore V, De Carlo M, Giannini C, Colli A, Dulgheru RE, Geers J, Yilmaz A, Claessen G, Bertrand P, Droogmans S, Lancellotti P, Cosyns B, Verbrugge FH, Herbots L, Masi S, and Verwerft J
- Subjects
- Humans, Middle Aged, Aged, Aged, 80 and over, Prognosis, Echocardiography, Stress methods, Prospective Studies, Cardiac Output, Oxygen, Atrial Fibrillation diagnosis, Atrial Fibrillation complications, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis surgery, Aortic Valve Stenosis complications, Heart Failure complications
- Abstract
Background: Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg·L
-1 ·min-1 . A peak systolic pulmonary artery pressure >60 mm Hg during exercise has been associated with an increased risk of cardiovascular death, heart failure rehospitalization, and aortic valve replacement in aortic valve stenosis. The prognostic value of the mPAP/CO slope in aortic valve stenosis remains unknown., Methods: In this prospective cohort study, consecutive patients (n=143; age, 73±11 years) with an aortic valve area ≤1.5 cm2 underwent cardiopulmonary exercise testing with echocardiography. They were subsequently evaluated for the occurrence of cardiovascular events (ie, cardiovascular death, heart failure hospitalization, new-onset atrial fibrillation, and aortic valve replacement) during a follow-up period of 1 year. Findings were externally validated (validation cohort, n=141)., Results: One cardiovascular death, 32 aortic valve replacements, 9 new-onset atrial fibrillation episodes, and 4 heart failure hospitalizations occurred in the derivation cohort, whereas 5 cardiovascular deaths, 32 aortic valve replacements, 1 new-onset atrial fibrillation episode, and 10 heart failure hospitalizations were observed in the validation cohort. Peak aortic velocity (odds ratio [OR] per SD, 1.48; P =0.036), indexed left atrial volume (OR per SD, 2.15; P =0.001), E/e' at rest (OR per SD, 1.61; P =0.012), mPAP/CO slope (OR per SD, 2.01; P =0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59; P =0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28; P =0.219). Peak Vo2 (percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area ( P <0.001). These results were confirmed in the validation cohort., Conclusions: In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak Vo2 were independent predictors of cardiovascular events, whereas peak systolic pulmonary artery pressure was not. In addition to aortic valve area and indexed left atrial volume, percent-predicted peak Vo2 and mPAP/CO slope cumulatively improved risk stratification., Competing Interests: Disclosures None.- Published
- 2024
- Full Text
- View/download PDF
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