RESUMO
The afterload increase imposed by severe aortic valve stenosis (AS) creates concentric left ventricular (LV) remodeling and diastolic dysfunction (DD), which are both markers of poor clinical outcome. Ideally, a correctly timed surgery for isolated AS can reverse the LV remodeling. However, data on LV DD after aortic valve replacement (AVR) are sparse and contrasting. Aims of the study are to define the markers of a favorable evolution of the DD at follow-up. Patients with severe isolated AS, scheduled for AVR were prospectively enrolled. Transthoracic echocardiography with DD assessment was performed before surgery, and at 12 months after surgery. Global LV longitudinal and circumferential strain, peak atrial longitudinal and contraction strain (PALS, PACS) were obtained at baseline. LV septal biopsy to assess fibrosis was performed at the time of AVR. Sixty-seven patients were enrolled, age 72 ± 8 years, 66% female, ejection fraction 61 ± 8%, E/e' 13 ± 6, PALS 23 ± 7%. Normal estimated left atrial pressure was detected in 19/67 (28%) versus 43/67 (64%) at follow-up (p <0.0001). In the 37 patients with biopsy available, fibrosis was 24 ± 12%. PALS and AS severity were correlated with LV fibrosis (R2â¯=â¯0.19; pâ¯=â¯0.006, and R2â¯=â¯0.15; pâ¯=â¯0.02, respectively). PALS (odds ratio: 1.19 [1.05 to 1.41], pâ¯=â¯0.02) and PACS (odds ratio: 1.24 [1.06 to 1.50], pâ¯=â¯0.006) were the only baseline noninvasive parameters independently associated with normal left atrial pressure at follow-up. Mean follow-up time was 791 ± 245 days, and 8 (12%) patients had cardiovascular events (death, hospital admission due to heart failure or ischemic disease, and onset of atrial fibrillation). Myocardial fibrosis (pâ¯=â¯0.05), baseline PALS (pâ¯=â¯0.004), and PACS (pâ¯=â¯0.03) were associated with cardiovascular events. In conclusion, LV diastolic function generally improves after AVR for severe AS. Baseline PALS, PACS, and LV fibrosis were related to the DD and clinical outcome at follow-up; these parameters might cue a better diastolic response to the afterload correction.
Assuntos
Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Função Ventricular Esquerda/fisiologia , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Biópsia , Diástole , Ecocardiografia , Feminino , Humanos , Masculino , Estudos ProspectivosRESUMO
We monitored 48 patients, considering ECG, Oxygen Saturation and arterial pressure. Our aim was to evaluate the incidence of cardiovascular and respiratory complications of colonoscopy. In 40% of the cases, these parameters showed significant modifications and in 9 cases (19%), patients showed cardiovascular events to such an extent as to constitute a potential life-threatening situation. These cardiovascular events were in relation statistically significant with pre-existing cardiovascular pathology, COLD and hypoxia. Hypoxia, in turn, depended almost exclusively on i.v. sedation, and returned to normal values when the patient received oxygen. In most cases, events were not correlated to any specific symptom. This study demonstrated a rate of cardiovascular complications higher than previous retrospective analyses would lead one to believe. We recognize the value of accurate history-taking and have adopted its use in selecting high risk patients before colonoscopy, especially if sedation is contemplated.