RESUMO
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis, primarily in elderly patients. With an increasing number of procedures and younger patients, understanding the valve degeneration and its risk factors becomes crucial. OBJECTIVES: We aimed to utilize 18Fsodium fluoride (18FNaF) and 18Ffluorodeoxyglucose (18FFDG) positron emission tomography/computed tomography (PET/CT) to evaluate early TAVI valve degeneration. PATIENTS AND METHODS: In this prospective study with a prespecified followup protocol, 71 TAVI patients underwent baseline transthoracic and transesophageal echocardiography, and PET/CT with 18FNaF and 18FFDG. Of these, 31 patients completed 24month control examinations, while the others were lost to mortality and the COVID19 pandemic. We measured PET tracer activity and compared 18FNaF and 18FFDG PET/CT uptake at baseline and 24month followup. RESULTS: PET/CT and echocardiography data were analyzed for 31 of the 71 enrolled TAVI patients at a median age of 84 years (interquartile range, 80-86). After TAVI, an improvement in the valve function was observed. During followup, the valve function remained stable. PET/CT demonstrated an increase in 18FFDG maximal uptake in the inner (tissuetobackground ratio, P = 0.009) and outer (P = 0.01) sides of the TAVI valve stent, but no difference in 18FNaF maximal activity (inner, P = 0.17; outer, P = 0.57). CONCLUSIONS: Twentyfour months postTAVI, an increase in 18FFDG uptake, indicative of inflammation, was observed in the valve, while the uptake of the calcification marker (18FNaF) remained stable. Theseobservations might suggest early stages of TAVI valve degeneration, although further investigation is required to confirm this interpretation.
Assuntos
Fluordesoxiglucose F18 , Substituição da Valva Aórtica Transcateter , Humanos , Idoso , Idoso de 80 Anos ou mais , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Fluoreto de Sódio , Substituição da Valva Aórtica Transcateter/efeitos adversos , Compostos Radiofarmacêuticos , Estudos Prospectivos , Pandemias , Tomografia por Emissão de PósitronsAssuntos
Coartação Aórtica , Estenose Aórtica Subvalvar , Estenose da Valva Aórtica , Doença da Válvula Aórtica Bicúspide , Permeabilidade do Canal Arterial , Cardiopatias Congênitas , Comunicação Interventricular , Humanos , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Permeabilidade do Canal Arterial/complicações , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/cirurgia , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgiaRESUMO
BACKGROUND AND AIMS: Primary percutaneous coronary intervention (PCI) is regarded as the most preferred strategy in ST-segment elevation myocardial infarction (STEMI). Thrombolysis in Myocardial Infarction (TIMI) flow grade has been an important and cohesive predictor of outcomes in STEMI patients. We sought to evaluate potential variables associated with the risk of suboptimal TIMI flow after PCI in patients with anterior wall STEMI. METHODS: We evaluated 107 patients admitted to our hospital between 1 January 2019 and 31 December 2021 with a diagnosis of anterior wall STEMI treated with primary PCI. RESULTS: Suboptimal TIMI flow grade (≤2) after PCI occurred in 14 (13%) patients while grade 3 was found in 93 (87%) of them presenting with anterior wall STEMI. Failure to achieve optimal TIMI 3 flow grade after PCI was associated with lower TIMI grade prior to PCI (OR 0.5477, 95% CI 0.2589-0.9324, p = 0.02), greater troponin concentration before (OR 1.0001, 95% CI 1-1.0001, p = 0.0028) and after PCI (OR 1.0001, 95% CI 1-1.0001, p = 0.0452) as well as lower mean minimal systolic blood pressure (OR 0.9653, 95% CI 0.9271-0.9985, p = 0.04). CONCLUSIONS: Among predictors of suboptimal TIMI flow grade after PCI, we noted lower TIMI grade flow pre-PCI, greater serum troponin concentrations in the periprocedural period and lower mean minimal systolic blood pressure.