RESUMEN
Introduction: Reconstruction surgery of the proximal aorta in most cases involves the use of an aortic conduit, followed by reimplantation of the coronary ostia. Although uncommon, the origin of the coronary arteries in certain anatomical variants poses additional difficulties when performing surgery on the aortic root and requires a different treatment rationale. Case report: We hereby present the case of a 60-year-old patient with multiple cardiovascular risk factors (smoking, arterial hypertension and dyslipidemia), suffering from severe degenerative stenosis of a bicuspid aortic valve, associated with ascending aorta aneurysm and a significant extrinsic stenosis of the left coronary artery caused by the aneurysm. The patient presented with severe degenerative bicuspid aortic valve stenosis associated with ascending aorta aneurysm and a significant extrinsic stenosis of the left coronary artery caused by the aneurysm. Following the preoperative assessment, it was decided that the best course of action was to perform surgery on the aortic valve and ascending aorta. During the surgery, the origin of the right and left coronary ostia were found at the level of the left coronary cusp, both forming a common coronary button. Due to this particular anatomical variant, it was decided to reimplant them as a common button onto the main conduit by means of an interposed No.10 PTFE (Polytetrafluoroethylene) vascular prosthesis. Conclusion: A rare case of aortic root surgery associated with coronary ostia origin variant "shotgun barrel", which required a different method of reimplantation: modified Cabrol technique.
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Estenosis de la Válvula Aórtica , Válvula Aórtica , Humanos , Masculino , Persona de Mediana Edad , Válvula Aórtica/cirugía , Válvula Aórtica/anomalías , Resultado del Tratamiento , Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis Vascular/métodos , Enfermedad de la Válvula Aórtica Bicúspide/cirugía , Enfermedad de la Válvula Aórtica Bicúspide/complicaciones , Anomalías de los Vasos Coronarios/cirugía , Anomalías de los Vasos Coronarios/complicaciones , Enfermedades de las Válvulas Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/complicaciones , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/complicaciones , Enfermedad de la Válvula Aórtica/cirugía , Enfermedad de la Válvula Aórtica/complicaciones , Estenosis Coronaria/cirugía , Estenosis Coronaria/complicaciones , Estenosis Coronaria/etiología , Implantación de Prótesis de Válvulas Cardíacas/métodos , Reimplantación/métodosRESUMEN
Although mitral annular calcification is a common degenerative condition of the fibrous mitral annulus, tricuspid annular calcification, especially isolated, is rare. We report the case of a 73-year-old male, with a history of hypertension and severe kyphoscoliosis, referred to the emergency department for progressive dyspnea and leg swelling. Echocardiography revealed a dilated right heart with a homogeneous, hyperechoic, crescent shaped mass along the tricuspid annulus. Computed tomography confirmed the calcific nature of the lesion. Right heart catheterization revealed mild pre-capillary pulmonary hypertension and a mild spirometrically-defined restrictive ventilatory defect. Kyphoscoliosis has recently been associated with alterations in cardiac deformation and with an increased risk of restrictive lung disease. In our patient, we hypothesized that both these anomalies could have led to premature tricuspid annular degeneration resulting in a giant tricuspid calcification.
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Calcinosis , Cifosis , Escoliosis , Válvula Tricúspide , Humanos , Masculino , Anciano , Calcinosis/complicaciones , Calcinosis/diagnóstico por imagen , Válvula Tricúspide/diagnóstico por imagen , Cifosis/complicaciones , Escoliosis/complicaciones , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , EcocardiografíaRESUMEN
BACKGROUND: Transthoracic echocardiography (TTE) is essential in the diagnosis of cardiovascular diseases (CVD), including but not limited to heart failure (HF) and heart valve disease (HVD). However, its dependence on expert acquisition means that its accessibility in rural areas may be limited, leading to delayed management decisions and potential missed diagnoses. Artificial intelligence-guided (AI)-TTE offers a solution by permitting non-expert image acquisition. The impact of AI-TTE on the timing of diagnosis and early initiation of cardioprotection is undefined. METHODS: AGILE-Echo (use of Artificial intelligence-Guided echocardiography to assIst cardiovascuLar patient managEment) is a randomized-controlled trial conducted in 5 rural and remote areas around Australia. Adults with CV risk factors and exercise intolerance, or concerns regarding HVD are randomized into AI-TTE or usual care (UC). AI-TTE participants may have a cardiovascular problem excluded, identified (leading to AI-guided interventions) or unresolved (leading to conventional TTE). UC participants undergo usual management, including referral for standard TTE. The primary endpoint is a composite of HVD or HF diagnosis at 12-months. Subgroup analysis, stratified based on age range and sex, will be conducted. All statistical analyses will be conducted using R. RESULTS: Of the first 157 participants, 78 have been randomized into AI-TTE (median age 68 [IQR 17]) and 79 to UC (median age 65 [IQR 17], P = .034). HVD was the primary concern in 37 participants (23.6%) while 84.7% (n = 133) experienced exercise intolerance. The overall 10-year HF incidence risk was 13.4% and 20.0% (P = .089) for UC and AI-TTE arm respectively. Atrial remodeling, left ventricular remodeling and valvular regurgitation were the most common findings. Thirty-three patients (42.3%) showed no abnormalities. CONCLUSIONS: This randomized-controlled trial of AI-TTE will provide proof-of-concept for the role of AI-TTE in identifying pre-symptomatic HF or HVD when access to TTE is limited. Additionally, this could promote the usage of AI-TTE in rural or remote areas, ultimately improving health and quality of life of community dwelling adults with risks, signs or symptoms of cardiac dysfunction.
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Inteligencia Artificial , Ecocardiografía , Enfermedades de las Válvulas Cardíacas , Población Rural , Humanos , Ecocardiografía/métodos , Enfermedades de las Válvulas Cardíacas/complicaciones , Femenino , Masculino , Australia/epidemiología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/diagnóstico , Anciano , Persona de Mediana EdadRESUMEN
A young female patient was referred by her general practitioner to the ear, nose and throat outpatient clinic with a 5-year history of progressive hoarseness and loss of voice. A chest radiograph was reported as showing marked dilatation of the left pulmonary artery without any other features to suggest underlying pulmonary arterial hypertension. A provisional diagnosis of left recurrent laryngeal nerve palsy secondary to its compression between the left pulmonary artery and the undersurface of the aortic arch-Ortner's or cardiovocal syndrome-was suggested and confirmed on further investigation including CT, microlaryngoscopy and echocardiography.
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Aneurisma , Arteria Pulmonar , Parálisis de los Pliegues Vocales , Femenino , Humanos , Aneurisma/diagnóstico , Aneurisma/etiología , Dilatación Patológica , Ecocardiografía , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/diagnóstico , Ronquera/diagnóstico , Ronquera/etiología , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/patología , Válvula Pulmonar/diagnóstico por imagen , Síndrome , Tomografía Computarizada por Rayos X , Parálisis de los Pliegues Vocales/diagnóstico , Parálisis de los Pliegues Vocales/etiologíaRESUMEN
BACKGROUND: Identifying bicuspid aortic valve (BAV) patients at risk for cardiac events remains challenging and the role of the electrocardiogram (ECG) has not yet been described. Therefore, this study aims to describe ECG parameters in BAV patients, and investigate their prognostic value. METHODS: In this single-center prospective study patients with BAV without a prior aortic valve replacement (AVR) were included. Transthoracic echocardiogram and 12lead resting-ECG were obtained. Associations between ECG parameters and the composite endpoint of all-cause mortality and AVR were assessed using Cox-proportional hazard analysis. RESULTS: 120 patients with BAV were included (median age 30 years, 61% male). Median aortic jet velocity was 2.4 m/s [IQR: 1.7-3.4] and 5 patients (4%) had severe aortic regurgitation. All patients were in sinus rhythm. Any ECG abnormality was present in 57 patients (48%). Median PR-interval was 156 [IQR: 138-170] msec. A deviating QRS axis was found in 17 patients (14%) and Cornell criteria for LVH were fulfilled in 20 patients (17%). Repolarization abnormalities were present in 12 patients (10%). Median follow-up duration was 7.0 [6.3-9.8] years, during which 23 patients underwent AVR and 2 patients died. After adjusting for age, a longer PR-interval was associated with worse intervention-free survival (HR 1.02, 95% CI: 1.01-1.04). CONCLUSION: Almost half of the patients with BAV had abnormalities on their ECG. Moreover, the PR-interval may be an interesting prognostic marker for intervention-free survival in BAV patients.
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Válvula Aórtica , Enfermedad de la Válvula Aórtica Bicúspide , Electrocardiografía , Humanos , Masculino , Femenino , Enfermedad de la Válvula Aórtica Bicúspide/complicaciones , Enfermedad de la Válvula Aórtica Bicúspide/fisiopatología , Enfermedad de la Válvula Aórtica Bicúspide/cirugía , Pronóstico , Adulto , Válvula Aórtica/anomalías , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Estudios Prospectivos , Enfermedades de las Válvulas Cardíacas/complicaciones , Ecocardiografía , Enfermedad de la Válvula Aórtica/cirugíaRESUMEN
Objective: To analysis the risk factors for major adverse cardiovascular event (MACE) in pregnant women with valvular heart disease (VHD) and to construct a risk prediction model. Methods: The clinical data of 245 pregnant women with VHD who were hospitalized in Beijing Anzhen Hospital from January 1, 2012, to June 1, 2023 were retrospectively analyzed, including general information, pre-pregnancy and pregnancy-associated cardiac conditions, and MACE. Univariate analysis and logistic regression models were employed to identify risk factors for MACE during pregnancy among pregnant women with VHD. Furthermore, a predictive model was constructed and internal validation was conducted using bootstrap techniques. Results: (1) Among 245 pregnant women with VHD, the incidence of MACE was 18.0% (44/245), and the most common MACE was heart failure (61.4%, 27/44). The mitral valve was the most frequently affected valve (64.9%, 159/245). Prior to pregnancy, the most common type of valve surgery undertaken was mechanical valve replacement, representing 31.4% (77/245) of surgeries. In contrast, among those pregnant women who did not undergo valve surgery before pregnancy, the most common lesion type was mitral regurgitation (17.6%, 43/245). (2) Comparing the maternal and infant outcomes of warfarin, low molecular weight heparin (LMWH) and LMWH sequential with warfarin, the fetal loss rate (36%, 15/42) and malformation rate (7%, 3/42) were the highest, but the MACE rate (12%, 5/42) was the lowest in warfarin group. The fetal loss rate (1/19), malformation rate (1/19) and artificial valve thrombosis rate (0) of LMWH sequential with warfarin were the lowest, and the fetal loss rate and artificial valve thrombosis rate of the three anticoagulation methods were statistically significant (all P<0.05). (3) There were no significant differences in gestational age, age of diagnosis of heart disease, weight at delivery, pre-pregnancy body mass index, proportion of multiparous women and chronic medical history between women with MACE and those without MACE (all P>0.05). (4) Binary logistic regression analysis identified the following as risk factors for MACE during the second trimester of pregnancy among pregnant women with VHD: pre-pregnancy cardiac symptoms, history of corrective surgery for congenital heart disease, pregnancy risk grade â ¤, anticoagulation with LMWH during pregnancy, and arrhythmia (all P<0.05). Based on the results of multivariate analysis, a receiver operating characteristic curve was constructed, with an area under the curve of 0.837, indicating good discriminative ability. The calibration plot demonstrated a close alignment between the standard curve and the calibration prediction curve, suggesting excellent calibration of the model. Conclusions: Pregnant women with VHD are at a high risk of experiencing MACE during gestation. Five risk factors, including pre-pregnancy cardiac symptoms, history of corrective surgery for congenital heart disease, pregnancy risk grade â ¤, anticoagulation with LMWH, and arrhythmia, could aid in identifying high-risk pregnant women.
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Enfermedades de las Válvulas Cardíacas , Complicaciones Cardiovasculares del Embarazo , Humanos , Femenino , Embarazo , Factores de Riesgo , Enfermedades de las Válvulas Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/epidemiología , Estudios Retrospectivos , Complicaciones Cardiovasculares del Embarazo/epidemiología , Anticoagulantes/administración & dosificación , Anticoagulantes/uso terapéutico , Adulto , Incidencia , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiologíaRESUMEN
Whipple disease is a rare systemic illness associated with weight loss, diarrhea, and arthralgia. Asymptomatic carriage is common, but the disease can be complicated by cardiac involvement and may result in culture-negative endocarditis. Cardiac manifestations of the disease can lead to death. This report presents the case of a 66-year-old man with Whipple disease and biventricular heart failure with cardiogenic shock. Medical therapy followed by successful replacement of the aortic and mitral valves resulted in substantial improvement.
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Endocarditis Bacteriana , Insuficiencia Cardíaca , Implantación de Prótesis de Válvulas Cardíacas , Tropheryma , Enfermedad de Whipple , Humanos , Masculino , Anciano , Enfermedad de Whipple/diagnóstico , Enfermedad de Whipple/complicaciones , Enfermedad de Whipple/tratamiento farmacológico , Enfermedad de Whipple/microbiología , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/microbiología , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/etiología , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/terapia , Tropheryma/aislamiento & purificación , Resultado del Tratamiento , Antibacterianos/uso terapéutico , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/microbiología , Válvula Mitral/cirugía , Choque Cardiogénico/etiología , Choque Cardiogénico/terapia , Choque Cardiogénico/diagnóstico , Choque Cardiogénico/microbiología , Válvula Aórtica/microbiología , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/microbiología , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/complicacionesRESUMEN
BACKGROUND: Advanced heart failure (AHF) secondary to myxomatous mitral valve disease (MMVD) in dogs has unclear predictive variables and survival time. METHODS: This retrospective study included 38 dogs with AHF and 38 with stable congestive heart failure (CHF), both due to MMVD. Predictive variables for AHF were analysed, and survival times were calculated using logistic regression and the Kaplan-Meier method. RESULTS: Left atrium to aortic root ratio, normalised left ventricular dimension at the end-diastole and end-systole, isovolumic relaxation time (IVRT) and early transmitral inflow velocity to IVRT ratio were associated with AHF progression. The median survival times were significantly longer in the stable group than in the AHF group. After AHF diagnosis, the median survival times for all-cause and cardiogenic mortality were 194 and 354 days, respectively. LIMITATIONS: This was a single-centre retrospective observational study. The study population was small, with breed bias (overrepresentation of Maltese dogs). Additionally, the treatment plans depended on clinical experience. CONCLUSIONS: AHF in dogs with CHF secondary to MMVD is linked to left heart chamber enlargement and increased left ventricular dimensions, significantly reducing survival time to around six months post-diagnosis. Early recognition and appropriate management may improve outcomes, highlighting the importance of advanced treatment strategies.
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Enfermedades de los Perros , Insuficiencia Cardíaca , Perros , Animales , Enfermedades de los Perros/mortalidad , Insuficiencia Cardíaca/veterinaria , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/etiología , Estudios Retrospectivos , Masculino , Femenino , Pronóstico , Insuficiencia de la Válvula Mitral/veterinaria , Insuficiencia de la Válvula Mitral/mortalidad , Enfermedades de las Válvulas Cardíacas/veterinaria , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/mortalidadAsunto(s)
Calcinosis , Válvula Mitral , Humanos , Calcinosis/diagnóstico por imagen , Calcinosis/fisiopatología , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Válvula Mitral/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/fisiopatología , Enfermedades de las Válvulas Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/complicaciones , Resultado del Tratamiento , Lesiones Cardíacas/diagnóstico por imagen , Lesiones Cardíacas/etiologíaRESUMEN
OBJECTIVES: The aims of the present study were to compare the long-term outcomes for ascending aortic dilatation and adverse aortic events after isolated aortic valve replacement between patients with bicuspid aortic valve (BAV) and tricuspid aortic valve ( TAV). METHODS: This retrospective study included 310 patients who had undergone isolated aortic valve replacement with an ascending aorta diameter ≤ 45 mm between January 2010 and September 2021. The patients were divided into BAV group (n=90) and TAV group (n=220). The differences in the dilation rate of the ascending aorta and long-term outcomes were analyzed. RESULTS: Overall survival was 89 ± 4% in the BAV group vs. 75 ± 6% in the TAV group at 10 years postoperatively (P=0.007), yet this difference disappeared after adjusting exclusively for age (P=0.343). The mean annual growth rate of the ascending aorta was similar between the two groups during follow-up (0.5 ± 0.6 mm/year vs. 0.4 ± 0.5 mm/year; P=0.498). Ten-year freedom from adverse aortic events was 98.1% in the BAV group vs. 95.0% in the TAV group (P=0.636). Multivariable analysis revealed preoperative ascending aorta diameter to be a significant predictor of adverse aortic events (hazard ratio: 1.76; 95% confidence interval: 1.33 to 2.38; P<0.001). CONCLUSION: Our study revealed that the long-term survival and the risks of adverse aortic events between BAV and TAV patients were similar after isolated aortic valve replacement. BAV was not a risk factor of adverse aortic events.
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Aorta , Válvula Aórtica , Enfermedad de la Válvula Aórtica Bicúspide , Enfermedades de las Válvulas Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Femenino , Estudios Retrospectivos , Enfermedad de la Válvula Aórtica Bicúspide/cirugía , Enfermedad de la Válvula Aórtica Bicúspide/complicaciones , Persona de Mediana Edad , Válvula Aórtica/cirugía , Válvula Aórtica/anomalías , Anciano , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Aorta/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/mortalidad , Válvula Tricúspide/cirugía , Progresión de la Enfermedad , Factores de Riesgo , Resultado del Tratamiento , Complicaciones PosoperatoriasAsunto(s)
Estenosis de la Válvula Aórtica , Válvula Aórtica , Enfermedad de la Válvula Aórtica Bicúspide , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/fisiopatología , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/instrumentación , Resultado del Tratamiento , Válvula Aórtica/cirugía , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Válvula Aórtica/anomalías , Enfermedad de la Válvula Aórtica Bicúspide/cirugía , Enfermedad de la Válvula Aórtica Bicúspide/diagnóstico por imagen , Enfermedad de la Válvula Aórtica Bicúspide/fisiopatología , Enfermedad de la Válvula Aórtica Bicúspide/complicaciones , Factores de Riesgo , Prótesis Valvulares Cardíacas , Enfermedades de las Válvulas Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/fisiopatología , Enfermedades de las Válvulas Cardíacas/complicaciones , Toma de Decisiones Clínicas , Recuperación de la Función , Medición de RiesgoRESUMEN
The presence of bright resonance of more than 1 mm or more cusps of the aortic valve, mitral valve or mitral annulus is termed as cardiac valve calcification. If an intense echo producing structure located at the junction of the atrioventricular groove and posterior mitral valve leaflet on Echocardiography that is Mitral annular calcification (MAC). This study was conducted to observe the association of MAC with clinical and echocardiographic findings of ischemic heart disease (IHD) and the role of trans-thoracic echocardiography to detect MAC which is a marker IHD. In this prospective, observational, case-control study, total of 100 IHD patients, 50 patients with MAC were assigned as case group and 50 patients without MAC were control group after fulfilling inclusion criteria. All the detailed history, clinical examination and relevant investigation reports of each patient were recorded in pre designed data collection sheet. MAC was detected with transthorasic echocardiography. Analysis was done to observe the association and correlation of MAC with clinical findings of IHD. Mean age of the case control was 55.16±10.73 years and control was 49.80±8.84 years. MAC was noted highest about 56.0% in between age 45 to 60 years. Eighty two percent (82.0%) of cases and 84.0% of controls were male, 18.0% of cases and 16.0% of controls were female. BMI among the MAC group 2.0% were underweight, 72.0% normal, 24.0% over weight and 2.0% were obese and among non MAC controls group 10.0% were underweight, 68.0% normal, 20.0% over weight and 2.0% were obese. Clinically among cases 14(28.0%) had Stable angina, 8(16.0%) had UA, 3(6.0%) had Non STEMI, 2(4.0%) had AMI, 2(4.0%) had Recent myocardial infarction and 21(42.0%) had OMI. Diabetes mellitus was significantly higher in the case groups (p=0.006). Significant p-value was noted in hyper-triyglyceridemia and low HDL in case group than control. Echocardiographic studies showed 52.0% of cases and 32.0% of controls had regional wall motion abnormality (RWMA). Transthorasic echocardiographically detected MAC is an independent predictor of Ischemic heart disease. The low cost, portable and radiation free nature of the ultrasound approach make MAC an attractive parameter in the ongoing search for IHD.
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Calcinosis , Ecocardiografía , Válvula Mitral , Isquemia Miocárdica , Centros de Atención Terciaria , Humanos , Masculino , Femenino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico por imagen , Calcinosis/diagnóstico por imagen , Estudios de Casos y Controles , Ecocardiografía/métodos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/patología , Estudios Prospectivos , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/complicaciones , Anciano , AdultoRESUMEN
Mitral annular calcification (MAC) may be a potential marker of biologic aging. However, the association of MAC with noncardiovascular measures, including bone mineral density (BMD), incident renal failure, dementia, and noncardiovascular mortality, is not well-studied in a multiracial cohort. We used data from 6,814 participants (mean age: 62.2 ± 10.2 years, 52.9% women) without cardiovascular disease at baseline in the Multi-Ethnic Study of Atherosclerosis. MAC was assessed with noncontrast cardiac computed tomography at study baseline. Using multivariable-adjusted linear and logistic regression, we assessed the cross-sectional association of MAC with BMD and walking pace. Furthermore, using Cox proportional hazards, we evaluated the association of MAC with incident renal failure, dementia, and all-cause mortality. In addition, we assessed the association of MAC with cardiovascular and noncardiovascular mortality using competing risks regression. The prevalence of MAC was 9.5% and was higher in women (10.7%) than in men (8.0%). MAC was associated with low BMD (coefficient -0.04, 95% confidence interval [CI] -0.06 to -0.02), with significant interaction by gender (p-interaction = 0.035). MAC was, however, not associated with impaired walking pace (odds ratio 1.09, 95% CI 0.89 to 1.33). Compared with participants without MAC, those with MAC had an increased risk of incident renal failure, albeit nonsignificant (hazard ratio [HR] 1.18, 95% CI 0.95 to 1.45), and a significantly higher hazards of dementia (HR 1.36, 95% CI 1.10 to 1.70). In addition, participants with MAC had a substantially higher risk of all-cause (HR 1.47, 95% CI 1.29 to 1.69), cardiovascular (subdistribution HR 1.39, 95% CI 1.04 to 1.87), and noncardiovascular mortality (subdistribution HR 1.35, 95% CI 1.14 to 1.60) than those without MAC. MAC ≥100 versus <100 was significantly associated with reduced BMD, incident renal failure, dementia, all-cause, cardiovascular, and noncardiovascular mortality. In conclusion, MAC was associated with reduced BMD and dementia and all-cause, cardiovascular, and noncardiovascular mortality in this multiracial cohort. Thus, MAC may be a marker not only for atherosclerotic burden but also for other metabolic and inflammatory factors that increase the risk of noncardiovascular outcomes and death from other causes.
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Válvula Mitral , Humanos , Femenino , Masculino , Válvula Mitral/diagnóstico por imagen , Persona de Mediana Edad , Anciano , Calcinosis/diagnóstico por imagen , Calcinosis/epidemiología , Calcinosis/etnología , Estados Unidos/epidemiología , Aterosclerosis/etnología , Demencia/epidemiología , Densidad Ósea , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/complicaciones , Tomografía Computarizada por Rayos X , Etnicidad/estadística & datos numéricos , Insuficiencia Renal/epidemiología , Estudios Transversales , Factores de Riesgo , Prevalencia , Incidencia , Velocidad al Caminar , Enfermedades Cardiovasculares/etnología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/epidemiología , Causas de Muerte/tendenciasRESUMEN
AIMS: Data regarding the characterization and outcomes of patients with heart failure (HF) with mildly reduced ejection fraction (HFmrEF) is scarce. This study investigates the characteristics and prognostic impact of native aortic valve diseases (AVD) in patients with HFmrEF. METHODS AND RESULTS: Consecutive patients hospitalized with HFmrEF (i.e. left ventricular ejection fraction 41-49% and signs and/or symptoms of HF) were retrospectively included at one institution from 2016 to 2022. The prognostic impact of native aortic valve stenosis (AS), aortic valve regurgitation (AR) and mixed AVD (MAVD) was investigated for the primary endpoint of long-term all-cause mortality during a median follow-up of 30 months. Kaplan-Meier, univariable and multivariable Cox proportional analyses were applied. From a total of 2106 patients hospitalized with HFmrEF, the prevalence of AS and AR was 16.5% and 31.2%, respectively (MAVD 7.8%). The presence of moderate/severe AS was associated with a higher risk of long-term all-cause mortality (44.8% vs. 28.7%; p = 0.001) and HF-related rehospitalization (18.6% vs. 12.0%; p = 0.001), even after multivariable adjustment (mortality: hazard ratio [HR] 1.320; 95% confidence interval [CI] 1.035-1.684; p = 0.025; HF-related rehospitalization: HR 1.570; 95% CI 1.101-2.241; p = 0.013). Interestingly, even mild AS was associated with increased risk of long-term all-cause mortality compared to patients without AS (HR 1.477; 95% CI 1.101-1.982; p = 0.009). In contrast, the presence of AR was not associated with long-term outcomes after multivariable adjustment. CONCLUSIONS: The presence of AS, but not AR, was independently associated with increased risk of all-cause mortality and HF-related rehospitalization in patients with HFmrEF. Even milder stages of AS were associated with impaired prognosis.
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Insuficiencia Cardíaca , Hospitalización , Volumen Sistólico , Humanos , Femenino , Masculino , Insuficiencia Cardíaca/fisiopatología , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/mortalidad , Volumen Sistólico/fisiología , Anciano , Pronóstico , Prevalencia , Estudios Retrospectivos , Hospitalización/estadística & datos numéricos , Estenosis de la Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/complicaciones , Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/epidemiología , Insuficiencia de la Válvula Aórtica/fisiopatología , Persona de Mediana Edad , Enfermedades de las Válvulas Cardíacas/fisiopatología , Enfermedades de las Válvulas Cardíacas/epidemiología , Enfermedades de las Válvulas Cardíacas/complicaciones , Anciano de 80 o más AñosRESUMEN
AIMS: The aim of this study is to evaluate the effect of beta-blockers and angiotensin receptor blockers in reducing the aortic growth rate in children with bicuspid aortic valve (BAV)-related aortopathy and ascending phenotype. METHODS: Consecutive paediatric patients (≤16 years) with BAV and ascending aorta (AsAo) dilation (z-score > 3) were enrolled in this observational retrospective cohort study. Patients receiving prophylactic treatment with either atenolol (0.5 to 1.0 mg/kg/daily) or losartan (0.7 to 1.4 mg/kg/daily) were compared with those who did not receive medical prophylaxis (control group). The primary outcome of interest was the annual rate of change in maximal AsAo diameter z-score in the treatment and control groups. RESULTS: From a cohort of 1005 patients, 120 (mean age 11.3 ± 4.5 years, 82% males) fulfilled the inclusion criteria and were included in the study. Patients in the treatment and control group had similar age, sex, family history of BAV, BAV morphology, and baseline AsAo diameter. During a median follow-up of 7.1 years (interquartile range 3.8-10.2), no differences were observed in the annual growth rate of aortic diameter z-score between patients on treatment and controls. The prevalence of aortic diameter progression was similar in the treatment and control groups, and treatment with atenolol or losartan was not associated with a lower rate of aortic disease progression. CONCLUSIONS: The findings revealed no significant difference in the annual aortic growth rate between treated and untreated patients. Larger cohort studies or, ideally, randomized clinical controlled trials are needed to validate these findings.
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Antagonistas Adrenérgicos beta , Válvula Aórtica , Enfermedad de la Válvula Aórtica Bicúspide , Humanos , Masculino , Femenino , Niño , Estudios Retrospectivos , Adolescente , Antagonistas Adrenérgicos beta/uso terapéutico , Válvula Aórtica/anomalías , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/patología , Válvula Aórtica/efectos de los fármacos , Antagonistas de Receptores de Angiotensina/uso terapéutico , Losartán/uso terapéutico , Estudios de Seguimiento , Estudios de Cohortes , Atenolol/uso terapéutico , Resultado del Tratamiento , Aorta/efectos de los fármacos , Aorta/diagnóstico por imagen , Enfermedad de la Válvula Aórtica/tratamiento farmacológico , Enfermedades de las Válvulas Cardíacas/tratamiento farmacológico , Enfermedades de las Válvulas Cardíacas/complicaciones , Bloqueadores del Receptor Tipo 1 de Angiotensina II/uso terapéuticoAsunto(s)
Válvula Aórtica , Enfermedad de la Válvula Aórtica Bicúspide , Enfermedades de las Válvulas Cardíacas , Complicaciones Cardiovasculares del Embarazo , Resultado del Embarazo , Humanos , Embarazo , Femenino , Válvula Aórtica/anomalías , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Enfermedad de la Válvula Aórtica Bicúspide/complicaciones , Enfermedad de la Válvula Aórtica Bicúspide/cirugía , Enfermedad de la Válvula Aórtica Bicúspide/fisiopatología , Enfermedad de la Válvula Aórtica Bicúspide/diagnóstico , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/complicaciones , AdultoRESUMEN
BACKGROUND: Observational studies suggest that valvular surgery can reduce mortality in selected patients with infective endocarditis (IE). However, the benefit of this intervention according to frailty levels remains unclear. Our study aims to assess the effect of valvular surgery according to frailty status in this population. METHODS: We performed a retrospective study using the 2016-2019 National Inpatient Sample database. Adult patients with a primary diagnosis of IE were included. Frailty was assessed using the Hospital Frailty Risk Score. Inverse probability of treatment weighting (IPTW) was used to balance baseline differences between groups. RESULTS: A total of 53,275 patients with IE were included, with 18.3% underwent valvular surgery. The median age was 52 (34-68) years, with 41% females. Overall, 42.7% had low risk of frailty, 53.1% intermediate risk, and 4.2% high risk. After IPTW adjustment, in-hospital mortality was similar both for the entire cohort between valvular and non-valvular surgery groups (3.7% vs. 4.1%, p = .483), and low (1% vs. 0.9%, p = .952) or moderate (5.4% vs. 6%, p = .548) risk of frailty. However, patients at high risk of frailty had significantly lower in-hospital mortality in the valvular surgery group (4.6% vs. 13.9%, p = .016). Renal replacement therapy was similar between groups across frailty status. In contrast, surgery was associated with increased use of mechanical circulatory support and pacemaker implantation. CONCLUSIONS: Our findings suggest that there was no difference in survival between valve surgery and medical management in patients at low/intermediate frailty risk, but not for high-risk individuals.
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Endocarditis , Fragilidad , Mortalidad Hospitalaria , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fragilidad/complicaciones , Fragilidad/diagnóstico , Anciano , Endocarditis/cirugía , Endocarditis/mortalidad , Endocarditis/complicaciones , Factores de Riesgo , Medición de Riesgo/métodos , Adulto , Estados Unidos/epidemiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Enfermedades de las Válvulas Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/complicaciones , Tasa de Supervivencia/tendenciasRESUMEN
BACKGROUND: We conducted this study to assess the compliance with secondary rheumatic prophylaxis among preoperative patients with rheumatic mitral valve disease undergoing valvular heart surgery at a tertiary care cardiac hospital in a developing country. METHODS: This is a descriptive cross-sectional study conducted at a tertiary care cardiac hospital in Karachi, Pakistan. The inclusion criteria encompassed patients of any sex, aged between 18 and 80 years, who had been diagnosed with rheumatic mitral valve disease through transthoracic echocardiography and had undergone valvular heart surgery. The level of compliance with secondary rheumatic prophylaxis and barriers toward noncompliance was assessed during routine preoperative interview session. This preventive measure plays a crucial role in reducing the progression of the disease and improving patient outcomes. RESULTS: Out of the 239 patients included in the study, 125 (52.3%) were females, with a mean age of 38.8 ± 11.8 years. The majority of patients (88.7%) came from rural areas. Among the patients, 79 (33.1%) received rheumatic prophylaxis, while 160 (66.9%) did not adhere to it regularly. The common barriers for receiving rheumatic prophylaxis were non availability (41.0%) and nonaffordability (40.6%). Additionally, 28.0% of patients had lacked awareness of the importance of rheumatic prophylaxis, and 2.5% expressed fear of injection site pain and subsequent symptoms. CONCLUSIONS: A concerning level of noncompliance with secondary rheumatic prophylaxis was observed. The barriers identified in patients who did not receive rheumatic prophylaxis were primarily related to affordability, availability, lack of awareness, and fear of injection site pain and subsequent symptoms.
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Conocimientos, Actitudes y Práctica en Salud , Válvula Mitral , Cardiopatía Reumática , Prevención Secundaria , Humanos , Femenino , Masculino , Cardiopatía Reumática/cirugía , Cardiopatía Reumática/diagnóstico por imagen , Estudios Transversales , Adulto , Persona de Mediana Edad , Pakistán , Válvula Mitral/cirugía , Válvula Mitral/diagnóstico por imagen , Adulto Joven , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Adolescente , Cooperación del Paciente , Anciano , Factores de Riesgo , Enfermedades de las Válvulas Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/complicaciones , Concienciación , Resultado del Tratamiento , Adhesión a Directriz , Anciano de 80 o más Años , Países en Desarrollo , Centros de Atención Terciaria , Cuidados Preoperatorios , Educación del Paciente como AsuntoRESUMEN
BACKGROUND: Despite comprising almost half of all patients undergoing valvular repair, data on transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic stenosis (BAS) are limited. OBJECTIVE: We aimed to evaluate whether there are any sex differences in trends and outcomes of TAVR in this population. METHODS: We utilized the National Inpatient Sample from 2012 to 2020 to identify admissions with BAS who underwent TAVR and analyzed trends and outcomes. Our primary outcome was in-hospital mortality and secondary outcomes were in-hospital complications. We used two models to adjust for demographics (A) and interventions (B). RESULTS: Between 2012 to 2020, there were 76,540 hospitalizations for BAS patients who underwent AVR, among which 6,010 (7.9 %) underwent TAVR. There was an overall increasing trend in number of TAVR cases with a decreasing trend in mortality (2013: 8.7 %, 2020: 1.3 %). TAVR was performed more in males (61.1% vs 38.9 %). Despite the worse baseline characteristics in males, in-hospital mortality (2.4% vs. 1.5 %; OR: 1.584; 95 % CI: 0.621-4.038; p = 0.335) and secondary outcomes were similar across both sexes, even after adjusting for demographics and interventions. CONCLUSION: TAVR in BAS has grown rapidly in the last decade. Males comprised the majority and had more comorbidities, but mortality and complications were similar in both sexes. Despite the increasing number of cases, a decreasing trend in mortality was observed for both sexes ultimately approaching that of SAVR, suggesting that TAVR may be a safe alternative among eligible males and females with bicuspid AS.