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[PMID]:29297076
[Au] Autor:Feldman TE; Reardon MJ; Rajagopal V; Makkar RR; Bajwa TK; Kleiman NS; Linke A; Kereiakes DJ; Waksman R; Thourani VH; Stoler RC; Mishkel GJ; Rizik DG; Iyer VS; Gleason TG; Tchétché D; Rovin JD; Buchbinder M; Meredith IT; Götberg M; Bjursten H; Meduri C; Salinger MH; Allocco DJ; Dawkins KD
[Ad] Endereço:Evanston Hospital Cardiology Division, Northshore University Health System, Evanston, Illinois.
[Ti] Título:Effect of Mechanically Expanded vs Self-Expanding Transcatheter Aortic Valve Replacement on Mortality and Major Adverse Clinical Events in High-Risk Patients With Aortic Stenosis: The REPRISE III Randomized Clinical Trial.
[So] Source:JAMA;319(1):27-37, 2018 01 02.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Transcatheter aortic valve replacement (TAVR) is established for selected patients with severe aortic stenosis. However, limitations such as suboptimal deployment, conduction disturbances, and paravalvular leak occur. Objective: To evaluate if a mechanically expanded valve (MEV) is noninferior to an approved self-expanding valve (SEV) in high-risk patients with aortic stenosis undergoing TAVR. Design, Setting, and Participants: The REPRISE III trial was conducted in 912 patients with high or extreme risk and severe, symptomatic aortic stenosis at 55 centers in North America, Europe, and Australia between September 22, 2014, and December 24, 2015, with final follow-up on March 8, 2017. Interventions: Participants were randomized in a 2:1 ratio to receive either an MEV (n = 607) or an SEV (n = 305). Main Outcomes and Measures: The primary safety end point was the 30-day composite of all-cause mortality, stroke, life-threatening or major bleeding, stage 2/3 acute kidney injury, and major vascular complications tested for noninferiority (margin, 10.5%). The primary effectiveness end point was the 1-year composite of all-cause mortality, disabling stroke, and moderate or greater paravalvular leak tested for noninferiority (margin, 9.5%). If noninferiority criteria were met, the secondary end point of 1-year moderate or greater paravalvular leak was tested for superiority in the full analysis data set. Results: Among 912 randomized patients (mean age, 82.8 [SD, 7.3] years; 463 [51%] women; predicted risk of mortality, 6.8%), 874 (96%) were evaluable at 1 year. The primary safety composite end point at 30 days occurred in 20.3% of MEV patients and 17.2% of SEV patients (difference, 3.1%; Farrington-Manning 97.5% CI, -∞ to 8.3%; P = .003 for noninferiority). At 1 year, the primary effectiveness composite end point occurred in 15.4% with the MEV and 25.5% with the SEV (difference, -10.1%; Farrington-Manning 97.5% CI, -∞ to -4.4%; P<.001 for noninferiority). The 1-year rates of moderate or severe paravalvular leak were 0.9% for the MEV and 6.8% for the SEV (difference, -6.1%; 95% CI, -9.6% to -2.6%; P < .001). The superiority analysis for primary effectiveness was statistically significant (difference, -10.2%; 95% CI, -16.3% to -4.0%; P < .001). The MEV had higher rates of new pacemaker implants (35.5% vs 19.6%; P < .001) and valve thrombosis (1.5% vs 0%) but lower rates of repeat procedures (0.2% vs 2.0%), valve-in-valve deployments (0% vs 3.7%), and valve malpositioning (0% vs 2.7%). Conclusions and Relevance: Among high-risk patients with aortic stenosis, use of the MEV compared with the SEV did not result in inferior outcomes for the primary safety end point or the primary effectiveness end point. These findings suggest that the MEV may be a useful addition for TAVR in high-risk patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02202434.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/cirurgia
Valva Aórtica/cirurgia
Próteses Valvulares Cardíacas
Substituição da Valva Aórtica Transcateter/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estenose da Valva Aórtica/mortalidade
Bioprótese
Doenças Cardiovasculares/etiologia
Doenças Cardiovasculares/mortalidade
Feminino
Seguimentos
Seres Humanos
Masculino
Complicações Pós-Operatórias/etiologia
Desenho de Prótese
Fatores de Risco
Substituição da Valva Aórtica Transcateter/métodos
Substituição da Valva Aórtica Transcateter/mortalidade
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180104
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.19132


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[PMID]:28453816
[Au] Autor:Shimura T; Yamamoto M; Kagase A; Kodama A; Kano S; Koyama Y; Tada N; Takagi K; Araki M; Yamanaka F; Shirai S; Watanabe Y; Hayashida K
[Ad] Endereço:Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan.
[Ti] Título:The incidence, predictive factors and prognosis of acute pulmonary complications after transcatheter aortic valve implantation.
[So] Source:Interact Cardiovasc Thorac Surg;25(2):191-197, 2017 08 01.
[Is] ISSN:1569-9285
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Although acute pulmonary complications (APCs), such as the exacerbation of pulmonary disease (PD) or a newly developed pulmonary event, are thought to be catastrophic after invasive therapy, little is known about the occurrence of APCs after transcatheter aortic valve implantation (TAVI). This study aims to clarify the incidence, predictive factors and impact of APCs on prognosis after TAVI. METHODS: We identified 749 patients who underwent TAVI, using data from the Optimized CathEter vAlvular iNtervention (OCEAN-TAVI) Japanese multicentre registry. APCs were defined as exacerbation of a comorbidity or newly developed PD during hospitalization. Patients were divided into 2 groups: an APC group (1.5%, 11/749) and a non-APC group (98.5%, 738/749). Clinical and prognostic outcomes were compared, and predictive factors for APCs were assessed. RESULTS: Procedure-related death did not differ between the groups (0.4% vs 0.0%, P = 1.00), although 30-day mortality was significantly higher in the APC group than in the non-APC group (27.3% vs 1.6%, P = 0.001) and the difference in cumulative 1-year mortality increased further (72.7% vs 8.6%, log-rank test: P < 0.001). In particular, concomitant PD and transapical (TA) approach were identified as predictors of APCs after TAVI [univariable odds ratio (uOR) = 24.2, 95% confidence interval (CI) = 3.08-189.9, P = 0.002; uOR = 3.69, 95% CI = 1.11-12.3, P = 0.033, respectively]. CONCLUSIONS: Although rare, the occurrence of APCs after TAVI was associated with extremely poor prognosis. Patients undergoing TAVI with concomitant PD and/or TA require careful consideration to avoid the risk of APCs.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/cirurgia
Pneumopatias/epidemiologia
Complicações Pós-Operatórias/epidemiologia
Sistema de Registros
Medição de Risco
Substituição da Valva Aórtica Transcateter/efeitos adversos
[Mh] Termos MeSH secundário: Doença Aguda
Idoso de 80 Anos ou mais
Feminino
Fluoroscopia
Seres Humanos
Incidência
Japão/epidemiologia
Pneumopatias/diagnóstico
Masculino
Complicações Pós-Operatórias/diagnóstico
Prognóstico
Estudos Prospectivos
Fatores de Risco
Taxa de Sobrevida/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivx075


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[PMID]:28453794
[Au] Autor:Kawahito K; Kimura N; Komiya K; Nakamura M; Misawa Y
[Ad] Endereço:Division of Cardiovascular Surgery, Jichi Medical University, Tochigi, Japan.
[Ti] Título:Blood flow competition after aortic valve bypass: an evaluation using computational fluid dynamics.
[So] Source:Interact Cardiovasc Thorac Surg;24(5):670-676, 2017 05 01.
[Is] ISSN:1569-9285
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Aortic valve bypass (AVB) (apico-aortic conduit) remains an effective surgical alternative for patients in whom surgical aortic valve replacement or transcatheter aortic valve implantation is not feasible. However, specific complications include thrombus formation, possibly caused by stagnation arising from flow competition between the antegrade and retrograde flow, but this has not been fully investigated. The aim of this study was to analyse flow characteristics after AVB and to elucidate mechanisms of intra-aortic thrombus using computational fluid dynamics (CFD). METHODS: Flow simulation was performed on data obtained from a 73-year-old postoperative AVB patient. Three-dimensional cine phase-contrast magnetic resonance imaging at 3 Tesla was used to acquire flow data and to set up the simulation. The vascular geometry was reconstructed using computed tomography angiograms. Flow simulations were implemented at various ratios of the flow rate between the ascending aorta and the graft. Results were visualized by streamline and particle tracing. RESULTS: CFD demonstrated stagnation in the ascending aorta-arch when retrograde flow was dominant, indicating that the risk of thrombus formation exists in the ascending arch in cases with severe aortic stenosis and/or poor left ventricular function. Meanwhile, stagnation was observed in the proximal descending aorta when the antegrade and retrograde flow were equivalent, suggesting that the descending aorta is critical when aortic stenosis is not severe. CONCLUSIONS: Flow stagnation in the aorta which may cause thrombus was observed when retrograde flow was dominant and antegrade/retrograde flows were equivalent. Our results suggest that anticoagulants might be recommended even in patients who receive biological valves.
[Mh] Termos MeSH primário: Aorta Torácica/cirurgia
Estenose da Valva Aórtica/cirurgia
Valva Aórtica/cirurgia
Apêndice Atrial/cirurgia
Velocidade do Fluxo Sanguíneo/fisiologia
Simulação por Computador
Imagem Cinética por Ressonância Magnética/métodos
[Mh] Termos MeSH secundário: Idoso
Anastomose Cirúrgica/métodos
Aorta Torácica/diagnóstico por imagem
Aorta Torácica/fisiopatologia
Valva Aórtica/diagnóstico por imagem
Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/fisiopatologia
Apêndice Atrial/diagnóstico por imagem
Apêndice Atrial/fisiopatologia
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivw428


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[PMID]:28457950
[Au] Autor:Bettinger N; Khalique OK; Krepp JM; Hamid NB; Bae DJ; Pulerwitz TC; Liao M; Hahn RT; Vahl TP; Nazif TM; George I; Leon MB; Einstein AJ; Kodali SK
[Ad] Endereço:Division of Cardiology, New-York-Presbyterian Hospital and Columbia University Medical Center, New York, NY, United States; Division of Cardiology, Hospital Charles Nicolle, University Hospital of Rouen, Rouen, France.
[Ti] Título:Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs.
[So] Source:J Cardiovasc Comput Tomogr;11(4):302-308, 2017 Jul - Aug.
[Is] ISSN:1876-861X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The threshold for the optimal computed tomography (CT) number in Hounsfield Units (HU) to quantify aortic valvular calcium on contrast-enhanced scans has not been standardized. Our aim was to find the most accurate threshold to predict paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). METHODS: 104 patients who underwent TAVR with the CoreValve prosthesis were studied retrospectively. Luminal attenuation (LA) in HU was measured at the level of the aortic annulus. Calcium volume score for the aortic valvular complex was measured using 6 threshold cutoffs (650 HU, 850 HU, LA × 1.25, LA × 1.5, LA+50, LA+100). Receiver-operating characteristic (ROC) analysis was performed to assess the predictive value for > mild PVR (n = 16). Multivariable analysis was performed to determine the accuracy to predict > mild PVR after adjustment for depth and perimeter oversizing. RESULTS: ROC analysis showed lower area under the curve (AUC) values for fixed threshold cutoffs (650 or 850 HU) compared to thresholds relative to LA. The LA+100 threshold had the highest AUC (0.81), and AUC was higher than all studied protocols, other than the LA x 1.25 and LA + 50 protocols, where the difference approached statistical significance (p = 0.05, and 0.068, respectively). Multivariable analysis showed calcium volume determined by the LAx1.25, LAx1.5, LA+50, and LA+ 100 HU protocols to independently predict PVR. CONCLUSIONS: Calcium volume scoring thresholds which are relative to LA are more predictive of PVR post-TAVR than those which use fixed cutoffs. A threshold of LA+100 HU had the highest predictive value.
[Mh] Termos MeSH primário: Insuficiência da Valva Aórtica/etiologia
Estenose da Valva Aórtica/diagnóstico por imagem
Valva Aórtica/diagnóstico por imagem
Valva Aórtica/patologia
Calcinose/diagnóstico por imagem
Meios de Contraste/administração & dosagem
Tomografia Computadorizada por Raios X
Substituição da Valva Aórtica Transcateter/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Valva Aórtica/fisiopatologia
Valva Aórtica/cirurgia
Insuficiência da Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/cirurgia
Área Sob a Curva
Calcinose/fisiopatologia
Calcinose/cirurgia
Ecocardiografia Transesofagiana
Feminino
Próteses Valvulares Cardíacas
Seres Humanos
Modelos Logísticos
Masculino
Análise Multivariada
Valor Preditivo dos Testes
Modelos de Riscos Proporcionais
Curva ROC
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Índice de Gravidade de Doença
Substituição da Valva Aórtica Transcateter/instrumentação
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contrast Media)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE


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[PMID]:29249634
[Au] Autor:Hirose M; Takano H; Hasegawa H; Tadokoro H; Hashimoto N; Takemura G; Kobayashi Y
[Ad] Endereço:Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan.
[Ti] Título:The effects of dipeptidyl peptidase-4 on cardiac fibrosis in pressure overload-induced heart failure.
[So] Source:J Pharmacol Sci;135(4):164-173, 2017 Dec.
[Is] ISSN:1347-8648
[Cp] País de publicação:Japan
[La] Idioma:eng
[Ab] Resumo:Dipeptidyl peptidase-4 (DPP-4) inhibitors are hypoglycemic agents. DPP-4 inhibitor has cardioprotective effects after transverse aortic constriction (TAC), but role of DPP-4 on cardiac fibrosis after TAC is not well known. Our aim was to determine the effects of DPP-4 on cardiac fibrosis in murine TAC model. Wild-type mice and DPP-4 knockout mice were subjected to TAC. Wild-type mice were then treated with vehicle or DPP-4 inhibitor. DPP-4 activities in serum and heart tissue were significantly increased at 2 weeks after TAC, but they were significantly decreased by DPP-4 inhibitor treatment. The inhibition of DPP-4 did not affect left ventricular hypertrophy, but improved cardiac function and decreased myocardial and perivascular fibrosis after TAC. The inhibition of DPP-4 decreased the collagen type III/I ratio in myocardium. These results suggest that DPP-4 inhibition ameliorates the progression of heart failure after TAC by changing the quality and quantity of cardiac fibrosis.
[Mh] Termos MeSH primário: Cardiotônicos
Dipeptidil Peptidase 4/fisiologia
Inibidores da Dipeptidil Peptidase IV/farmacologia
Inibidores da Dipeptidil Peptidase IV/uso terapêutico
Insuficiência Cardíaca/tratamento farmacológico
Insuficiência Cardíaca/etiologia
Miocárdio/patologia
[Mh] Termos MeSH secundário: Animais
Aorta
Estenose da Valva Aórtica/complicações
Colágeno Tipo I/metabolismo
Colágeno Tipo III/metabolismo
Constrição Patológica
Dipeptidil Peptidase 4/metabolismo
Modelos Animais de Doenças
Fibrose
Insuficiência Cardíaca/patologia
Hipertensão/complicações
Hipertrofia
Masculino
Camundongos Endogâmicos C57BL
Miocárdio/metabolismo
Pressão
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Cardiotonic Agents); 0 (Collagen Type I); 0 (Collagen Type III); 0 (Dipeptidyl-Peptidase IV Inhibitors); EC 3.4.14.5 (Dipeptidyl Peptidase 4)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180222
[Lr] Data última revisão:
180222
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE


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[PMID]:29223434
[Au] Autor:Baron SJ; Arnold SV; Reynolds MR; Wang K; Deeb M; Reardon MJ; Hermiller J; Yakubov SJ; Adams DH; Popma JJ; Cohen DJ; US CoreValve Investigators
[Ad] Endereço:Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, MO.
[Ti] Título:Durability of quality of life benefits of transcatheter aortic valve replacement: Long-term results from the CoreValve US extreme risk trial.
[So] Source:Am Heart J;194:39-48, 2017 Dec.
[Is] ISSN:1097-6744
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: For patients with severe aortic stenosis (AS) at extreme surgical risk, transcatheter aortic valve replacement (TAVR) leads to improved survival and health status when compared with medical therapy. Whether the early health status benefits of TAVR in these patients are sustained beyond 1 year of follow-up is unknown. METHODS AND RESULTS: Six hundred thirty-nine patients with severe AS at extreme surgical risk underwent TAVR in the CoreValve US Extreme Risk Pivotal trial. Health status was evaluated at baseline and at 1, 6, 12, 24, and 36 months using the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Short-Form-12, and the EuroQoL-5D. Analyses were performed using pattern mixture models to account for both death and missing data and were stratified by iliofemoral (IF) and non-iliofemoral (non-IF) access. After TAVR, there was substantial health status improvement in disease-specific and generic scales by 6 to 12 months. Although there were small declines in health status after 12 months, the initial benefits of TAVR were largely sustained through 3 years for both IF and non-IF cohorts (change from baseline in KCCQ Overall Summary score 19.0 points in IF patients and 14.9 points in non-IF patients; P<.01 for both comparisons). Among surviving patients, clinically meaningful (≥10 point) improvements in the KCCQ Overall Summary Score at 3 years were observed in 85.0% and 83.4% of IF and non-IF patients respectively. CONCLUSIONS: Among extreme risk patients with severe AS, TAVR resulted in large initial health status benefits that were sustained through 3-year follow-up. Although late mortality was high in this population, these findings demonstrate that TAVR offers substantial and durable health status improvements for surviving patients.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/cirurgia
Valva Aórtica/cirurgia
Nível de Saúde
Qualidade de Vida
Substituição da Valva Aórtica Transcateter/métodos
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Valva Aórtica/diagnóstico por imagem
Estenose da Valva Aórtica/diagnóstico
Estenose da Valva Aórtica/mortalidade
Feminino
Seguimentos
Seres Humanos
Masculino
Estudos Retrospectivos
Fatores de Risco
Índice de Gravidade de Doença
Inquéritos e Questionários
Taxa de Sobrevida/tendências
Fatores de Tempo
Resultado do Tratamento
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180223
[Lr] Data última revisão:
180223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171211
[St] Status:MEDLINE


  7 / 19674 MEDLINE  
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[PMID]:28468272
[Au] Autor:Bobrowska B; Wieczorek-Surdacka E; Kruszelnicka O; Chyrchel B; Surdacki A; Dudek D
[Ad] Endereço:Second Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 17 Kopernika Street, 31-501 Cracow, Poland. bobrowska.beata@gmail.com.
[Ti] Título:Clinical Correlates and Prognostic Value of Plasma Galectin-3 Levels in Degenerative Aortic Stenosis: A Single-Center Prospective Study of Patients Referred for Invasive Treatment.
[So] Source:Int J Mol Sci;18(5), 2017 Apr 29.
[Is] ISSN:1422-0067
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:Galectin-3 (Gal-3), a ß-galactoside-binding lectin, has been implicated in myocardial fibrosis, development of left ventricular (LV) dysfunction and transition from compensated LV hypertrophy to overt heart failure (HF), being a novel prognostic marker in HF. Risk stratification is crucial for the choice of the optimal therapy in degenerative aortic stenosis (AS), affecting elderly subjects with coexistent diseases. Our aim was to assess correlates and prognostic value of circulating Gal-3 in real-world patients with degenerative AS referred for invasive treatment. Gal-3 levels were measured at admission in 80 consecutive patients with symptomatic degenerative AS (mean age: 79 ± 8 years; aortic valve area (AVA) index: 0.4 ± 0.1 cm²/m²). The therapeutic strategy was chosen following a dedicated multidisciplinary team-oriented approach, including surgical valve replacement ( = 11), transcatheter valve implantation ( = 19), balloon aortic valvuloplasty (BAV) ( = 25) and optimal medical therapy ( = 25). Besides routine echocardiographic indices, valvulo-arterial impedance (Zva), an index of global LV afterload, was computed. There were 22 deaths over a median follow-up of 523 days. Baseline Gal-3 correlated negatively with estimated glomerular filtration rate (eGFR) ( = -0.61, < 0.001) and was unrelated to age, symptomatic status, AVA index, LV ejection fraction, LV mass index or Zva. For the study group as a whole, Gal-3 tended to predict mortality (Gal-3 >17.8 vs. Gal-3 <17.8 ng/mL; hazard ratio (HR): 2.03 (95% confidence interval, 0.88-4.69), = 0.09), which was abolished upon adjustment for eGFR (HR: 1.70 (0.61-4.73), = 0.3). However, in post-BAV patients multivariate-adjusted pre-procedural Gal-3 was associated with worse survival (HR: 7.41 (1.52-36.1), = 0.01) regardless of eGFR. In conclusion, the inverse eGFR-Gal-3 relationship underlies a weak association between Gal-3 and adverse outcome in patients with degenerative AS referred for invasive therapy irrespective of type of treatment employed. In contrast, pre-procedural Gal-3 appears an independent mortality predictor in high-risk AS patients undergoing BAV.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/sangue
Estenose da Valva Aórtica/diagnóstico
Galectina 3/sangue
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Angioplastia com Balão
Valva Aórtica/cirurgia
Estenose da Valva Aórtica/cirurgia
Estenose da Valva Aórtica/terapia
Feminino
Taxa de Filtração Glomerular
Seres Humanos
Masculino
Prognóstico
Estudos Prospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Galectin 3); 0 (galectin-3, human)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE


  8 / 19674 MEDLINE  
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[PMID]:28454636
[Au] Autor:Udesh R; Mehta A; Gleason T; Thirumala PD
[Ad] Endereço:Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
[Ti] Título:Carotid artery disease and perioperative stroke risk after surgical aortic valve replacement: A nationwide inpatient sample analysis.
[So] Source:J Clin Neurosci;42:91-96, 2017 Aug.
[Is] ISSN:1532-2653
[Cp] País de publicação:Scotland
[La] Idioma:eng
[Ab] Resumo:To study the role of carotid stenosis (CS) and cerebrovascular disease as independent risk factors for perioperative stroke following surgical aortic valve replacement (SAVR). The National Inpatient Sample (NIS) database was used for our study. All patients who underwent SAVR from 1999 to 2011 were identified using ICD-9 codes. Univariate and multivariate analysis of baseline characteristics, Elixhauser comorbidities and other covariates were examined to identify independent predictors of perioperative strokes following SAVR. Data on 50,979 patients who underwent SAVR from 1999 to 2011 was obtained. The mean age of the study cohort was 60.5. The study patients were predominantly Caucasian (79.3%) and males (60.01%). The incidence of perioperative stroke was 2.48%. CS (OR 1.8, 95%CI 1.1-2.8, p=0.009) and cerebral arterial occlusion (OR 3.4, 95% CI 1.3-8.9) significantly increased perioperative stroke risk following SAVR. Infective endocarditis (OR 4.6, 95%CI 3.8-5.6, p=0.00) and neurological disorders (OR 4.8, 95% CI 4-5.8, p=0.00) appeared to be the strongest risk factors for strokes. Other risk factors found to be significant predictors of perioperative strokes (p<0.05) were - age, higher VWR scores, CS, cerebral arterial occlusion, infective endocarditis, DM, HTN, renal failure, neurological disorders, coagulopathy and hypothyroidsm. In conclusion, perioperative stroke risk has remained more or less constant despite advancements in surgical techniques with risk having gone up in patients <65years of age. CS and cerebral arterial occlusion significantly increase stroke risk following SAVR. Improved patient selection with pre-operative risk stratification and institution of preventive strategies are necessary to improve operative outcomes following SAVR.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/epidemiologia
Valva Aórtica/cirurgia
Estenose das Carótidas/epidemiologia
Transtornos Cerebrovasculares/epidemiologia
Complicações Intraoperatórias/epidemiologia
Acidente Vascular Cerebral/epidemiologia
[Mh] Termos MeSH secundário: Idoso
Comorbidade
Feminino
Próteses Valvulares Cardíacas
Seres Humanos
Incidência
Pacientes Internados
Masculino
Meia-Idade
Fatores de Risco
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29241492
[Au] Autor:Steiner J; Rodés-Cabau J; Holmes DR; LeWinter MM; Dauerman HL
[Ad] Endereço:Division of Cardiology and Cardiovascular Research Institute, University of Vermont Medical Center, Burlington, Vermont; Division of Cardiovascular Medicine, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Mechanical Intervention for Aortic Valve Stenosis in Patients With Heart Failure and Reduced Ejection Fraction.
[So] Source:J Am Coll Cardiol;70(24):3026-3041, 2017 Dec 19.
[Is] ISSN:1558-3597
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The risk and benefit of mechanical interventions in valvular heart disease have been primarily described among patients with normal ejection fraction. The advent of nonsurgical mechanical interventions for aortic stenosis (transcatheter aortic valve replacement) may alter the risk-benefit ratio for patients who would otherwise be at increased risk for valve surgery. This review describes the epidemiology and pathophysiology of aortic stenosis with heart failure and reduced ejection fraction and summarizes the current registry and clinical trial data applicable to this frequently encountered high-risk group. It concludes with discussion of ongoing trials, new approaches, emerging indications, and a potential clinical algorithm incorporating optimal mechanical intervention for patients with aortic stenosis and concomitant reduced ejection fraction.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/cirurgia
Insuficiência Cardíaca/complicações
Volume Sistólico/fisiologia
Substituição da Valva Aórtica Transcateter/métodos
[Mh] Termos MeSH secundário: Estenose da Valva Aórtica/complicações
Estenose da Valva Aórtica/fisiopatologia
Insuficiência Cardíaca/fisiopatologia
Insuficiência Cardíaca/cirurgia
Seres Humanos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180208
[Lr] Data última revisão:
180208
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171216
[St] Status:MEDLINE


  10 / 19674 MEDLINE  
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[PMID]:29222121
[Au] Autor:Carter-Storch R; Møller JE; Christensen NL; Irmukhadenov A; Rasmussen LM; Pecini R; Øvrehus KA; Søndergård EV; Marcussen N; Dahl JS
[Ad] Endereço:From the Departments of Cardiology (R.C.-S., J.E.M., N.L.C., R.P., K.A.Ø., E.V.S., J.E.M.), Thoracic Surgery (A.I.), Clinical Biochemistry (L.M.R.), and Pathology (N.M.), Odense University Hospital, Denmark; and OPEN Odense Patient data Explorative Network, Denmark (R.C.-S., J.E.M.). rcarterstorch@g
[Ti] Título:Postoperative Reverse Remodeling and Symptomatic Improvement in Normal-Flow Low-Gradient Aortic Stenosis After Aortic Valve Replacement.
[So] Source:Circ Cardiovasc Imaging;10(12), 2017 Dec.
[Is] ISSN:1942-0080
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Severe aortic stenosis (AS) most often presents with reduced aortic valve area (<1 cm ), normal stroke volume index (≥35 mL/m ), and either high mean gradient (≥40 mm Hg; normal-flow high-gradient AS) or low mean gradient (normal-flow low-gradient [NFLG] AS). The benefit of aortic valve replacement (AVR) among NFLG patients is controversial. We compared the impact of NFLG condition on preoperative left ventricular (LV) remodeling and myocardial fibrosis and postoperative remodeling and symptomatic benefit. METHODS AND RESULTS: Eighty-seven consecutive patients with reduced aortic valve area and normal stroke volume index undergoing AVR underwent echocardiography, magnetic resonance imaging, a 6-minute walk test, and measurement of natriuretic peptides before and 1 year after AVR. Myocardial fibrosis was assessed from magnetic resonance imaging. Patients were stratified as NFLG or normal-flow high-gradient. In total, 33 patients (38%) had NFLG. Before AVR, they were characterized by similar symptom burden but less severe AS measured by aortic valve area index (0.50±0.09 versus 0.40±0.08 cm /m ; <0.0001), lower LV mass index (74±18 versus 90±26 g/m ; =0.01), but the same degree of myocardial fibrosis. After AVR, NFLG had a smaller reduction in LV mass index (-3±10 versus -±18 g/m ; <0.0001) and a smaller reduction in natriuretic peptides. Both groups experienced similar symptomatic improvement. Normal-flow high-gradient condition independently predicted change in LV mass index. CONCLUSIONS: Patients with NFLG had less severe AS and LV remodeling than patients with normal-flow high-gradient. Furthermore, NFLG patients experienced less reverse remodeling but the same symptomatic benefit. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02316587.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/cirurgia
Valva Aórtica/cirurgia
Implante de Prótese de Valva Cardíaca
Hemodinâmica
Função Ventricular Esquerda
Remodelação Ventricular
[Mh] Termos MeSH secundário: Idoso
Valva Aórtica/diagnóstico por imagem
Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/diagnóstico por imagem
Estenose da Valva Aórtica/fisiopatologia
Ecocardiografia Doppler de Pulso
Feminino
Fibrose
Implante de Prótese de Valva Cardíaca/efeitos adversos
Implante de Prótese de Valva Cardíaca/instrumentação
Seres Humanos
Imagem por Ressonância Magnética
Masculino
Meia-Idade
Tomografia Computadorizada Multidetectores
Miocárdio/patologia
Estudos Prospectivos
Recuperação de Função Fisiológica
Índice de Gravidade de Doença
Fatores de Tempo
Resultado do Tratamento
Teste de Caminhada
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171210
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE



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