RESUMO
BACKGROUND: Prevalence of bioprosthetic valve degeneration (BVD) is rising as the use of bioprosthetic aortic valves increases. Detecting early signs of BVD remains a challenge, with conventional imaging methods often failing to identify early deterioration stages. 18F-fuoride positron emission tomography (PET-CT) is an emerging technique that offers promising prospects to detect subclinical BVD. This study aimed to compare early PET parameters of fluoride uptake with echocardiographic hemodynamic parameters and compare outcomes according to anticoagulation in patients who received bioprosthetic valves. METHODS: This is a sub-study of the ANTIPRO clinical trial, which involved patients undergoing surgical aortic valve replacement (SAVR) with a porcine bioprosthesis and randomized them into anticoagulated and non-anticoagulated groups. Hemodynamic changes were assessed by transthoracic echocardiography (TTE), while 18F-fluoride PET-CT quantified fluoride uptake and divided the patients in two groups: high-uptake and low-uptake. Mean and maximum gradients by TTE at three years were compared between the two uptake groups. Fluoride uptake was also compared between the anticoagulated and control groups. RESULTS: We found no significant differences in transprosthetic gradients between high-uptake(21.4 ± 8.6 mmHg) and low-uptake(17.3 ± 11.2 mmHg.p = 0.244) PET-defined groups in this specific timeframe. Notably, anticoagulated patients exhibited significantly risk of higher fluoride uptake(OR = 4.34;95%CI:1.04-18.21.p = 0.045). CONCLUSIONS: No association was found between fluoride uptake and hemodynamic evaluation. Anticoagulation was associated with higher fluoride uptake. These findings highlight the emerging role of PET-CT in studying bioprosthetic aortic valves and emphasize the need for extended follow-up to evaluate the impact of anticoagulation on valve degeneration.
Assuntos
Anticoagulantes , Valva Aórtica , Bioprótese , Próteses Valvulares Cardíacas , Varfarina , Bioprótese/efeitos adversos , Humanos , Feminino , Masculino , Próteses Valvulares Cardíacas/efeitos adversos , Anticoagulantes/administração & dosagem , Idoso , Varfarina/administração & dosagem , Varfarina/farmacocinética , Varfarina/uso terapêutico , Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Radioisótopos de Flúor , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Pessoa de Meia-Idade , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Seguimentos , Falha de Prótese , Tomografia por Emissão de Pósitrons/métodosRESUMO
Mawsonia constitutes one of the most conspicuous fossil coelacanth taxa, due to its unique anatomy and possible maximum body size. It typifies Mesozoic coelacanth morphology, before the putative disappearance of the group in the fossil record. In this work, the three-dimensional cranial anatomy and body size estimations of this genus are re-evaluated from a recently described specimen from Upper Jurassic deposits of Uruguay. The 3D restoration was performed directly on the material based on anatomical information provided by the living coelacanth Latimeria and previous two-dimensional restorations of the head of Mawsonia. The montage was then scanned with computed tomography and virtually adjusted to generate an interactive online resource for future anatomical, taxonomic and biomechanical research. In general terms, the model constitutes a tool to improve both the anatomical knowledge of this genus and its comparison with other coelacanths. It also facilitates the evaluation of possible evolutionary trends and the discussion of particular features with potential palaeobiological implications, such as the anterior position of the eye and the development of the pseudomaxillary fold. Regarding the body size, a previous model for body size estimation based on the gular plate was submitted to OLS, RMA, segmented linear and PGLS regressions (including the evaluation of regression statistics, variance analysis, t-tests and residual analysis). The results point to a power relationship between gular and total lengths showing a better support than a simple linear relationship. The new resulting equations were applied to the studied individual and are provided for future estimates. Although an isometric evolutionary growth cannot be rejected with the available evidence, additional models developed with other bones will be necessary to evaluate possible hidden evolutionary allometric trends in this group of fishes, thus avoiding overestimates.