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1.
Am J Physiol Heart Circ Physiol ; 317(5): H1116-H1124, 2019 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-31625778

RESUMO

Vascular stiffness plays a key role in the pathogenesis of hypertension. Recent studies indicate that the age-associated reduction in miR-181b levels in vascular smooth muscle cells (VSMCs) contributes to increased vascular stiffness. As these findings suggest that inhibiting degradation of miR-181b might prevent vascular stiffening, we have assessed whether the microRNA-degrading translin/trax (TN/TX) complex mediates degradation of miR-181b in the aorta.We found that TN-/- mice display elevated levels of miR-181b expression in the aorta. Therefore, we tested whether TN deletion prevents vascular stiffening in a mouse model of hypertension, induced by chronic high-salt intake (4%NaCl in drinking water for 3 wk; HSW). TN-/- mice subjected to HSW stress do not show increased vascular stiffness, as monitored by pulse wave velocity and tensile testing. The protective effect of TN deletion in the HSW paradigm appears to be mediated by its ability to increase miR-181b in the aorta since HSW decreases levels of miR-181b in WT mice, but not in TN KO mice. We demonstrate for the first time that interfering with microRNA degradation can have a beneficial impact on the vascular system and identify the microRNA-degrading TN/TX RNase complex as a potential therapeutic target in combatting vascular stiffness.NEW & NOTEWORTHY While the biogenesis and mechanism of action of mature microRNA are well understood, much less is known about the regulation of microRNA via degradation. Recent studies have identified the protein complex, translin(TN)/trax(TX), as a microRNA-degrading enzyme. Here, we demonstrate that TN/TX is expressed in vascular smooth muscle cells. Additionally, deletion of the TN/TX complex selectively increases aortic miR-181b and prevents increased vascular stiffness caused by ingestion of high-salt water. To our knowledge, this is first report describing the role of a microRNA RNAse in cardiovascular biology or pathobiology.


Assuntos
Aorta/enzimologia , Proteínas de Ligação a DNA/deficiência , Proteínas de Ligação a DNA/metabolismo , Hipertensão/enzimologia , MicroRNAs/metabolismo , Rigidez Vascular , Animais , Aorta/fisiopatologia , Proteínas de Ligação a DNA/genética , Modelos Animais de Doenças , Deleção de Genes , Hipertensão/genética , Hipertensão/fisiopatologia , Masculino , Camundongos Endogâmicos C57BL , Camundongos Knockout , MicroRNAs/genética , Estabilidade de RNA , Proteínas de Ligação a RNA/genética , Cloreto de Sódio na Dieta , Regulação para Cima
2.
Clin Geriatr Med ; 40(4): 539-550, 2024 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-39349030

RESUMO

Vascular stiffness is an age-related pathophysiological process that represents a significant risk of cardiovascular morbidity and mortality in the older adult.


Assuntos
Envelhecimento , Hipertensão , Rigidez Vascular , Humanos , Envelhecimento/fisiologia , Rigidez Vascular/fisiologia , Hipertensão/fisiopatologia , Idoso , Fatores de Risco
3.
J Am Heart Assoc ; 12(14): e028421, 2023 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-37421280

RESUMO

Background The identification of large-artery stiffness as a major, independent risk factor for cardiovascular disease-associated morbidity and death has focused attention on identifying therapeutic strategies to combat this disorder. Genetic manipulations that delete or inactivate the translin/trax microRNA-degrading enzyme confer protection against aortic stiffness induced by chronic ingestion of high-salt water (4%NaCl in drinking water for 3 weeks) or associated with aging. Therefore, there is heightened interest in identifying interventions capable of inhibiting translin/trax RNase activity, as these may have therapeutic efficacy in large-artery stiffness. Methods and Results Activation of neuronal adenosine A2A receptors (A2ARs) triggers dissociation of trax from its C-terminus. As A2ARs are expressed by vascular smooth muscle cells (VSMCs), we investigated whether stimulation of A2AR on vascular smooth muscle cells promotes the association of translin with trax and, thereby increases translin/trax complex activity. We found that treatment of A7r5 cells with the A2AR agonist CGS21680 leads to increased association of trax with translin. Furthermore, this treatment decreases levels of pre-microRNA-181b, a target of translin/trax, and those of its downstream product, mature microRNA-181b. To check whether A2AR activation might contribute to high-salt water-induced aortic stiffening, we assessed the impact of daily treatment with the selective A2AR antagonist SCH58261 in this paradigm. We found that this treatment blocked aortic stiffening induced by high-salt water. Further, we confirmed that the age-associated decline in aortic pre-microRNA-181b/microRNA-181b levels observed in mice also occurs in humans. Conclusions These findings suggest that further studies are warranted to evaluate whether blockade of A2ARs may have therapeutic potential in treating large-artery stiffness.


Assuntos
MicroRNAs , Receptor A2A de Adenosina , Humanos , Camundongos , Animais , Receptor A2A de Adenosina/genética , Proteínas de Ligação a DNA/genética , Proteínas de Transporte/genética , MicroRNAs/genética , MicroRNAs/metabolismo , Aorta/metabolismo , Adenosina , Água/metabolismo
4.
Aging Cell ; 22(2): e13767, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36637079

RESUMO

Aging results in an elevated burden of senescent cells, senescence-associated secretory phenotype (SASP), and tissue infiltration of immune cells contributing to chronic low-grade inflammation and a host of age-related diseases. Recent evidence suggests that the clearance of senescent cells alleviates chronic inflammation and its associated dysfunction and diseases. However, the effect of this intervention on metabolic function in old age remains poorly understood. Here, we demonstrate that dasatinib and quercetin (D&Q) have senolytic effects, reducing age-related increase in senescence-associated ß-galactosidase, expression of p16 and p21 gene and P16 protein in perigonadal white adipose tissue (pgWAT; all p ≤ 0.04). This treatment also suppressed age-related increase in the expression of a subset of pro-inflammatory SASP genes (mcp1, tnf-α, il-1α, il-1ß, il-6, cxcl2, and cxcl10), crown-like structures, abundance of T cells and macrophages in pgWAT (all p ≤ 0.04). In the liver and skeletal muscle, we did not find a robust effect of D&Q on senescence and inflammatory SASP markers. Although we did not observe an age-related difference in glucose tolerance, D&Q treatment improved fasting blood glucose (p = 0.001) and glucose tolerance (p = 0.007) in old mice that was concomitant with lower hepatic gluconeogenesis. Additionally, D&Q improved insulin-stimulated suppression of plasma NEFAs (p = 0.01), reduced fed and fasted plasma triglycerides (both p ≤ 0.04), and improved systemic lipid tolerance (p = 0.006). Collectively, results from this study suggest that D&Q attenuates adipose tissue inflammation and improves systemic metabolic function in old age. These findings have implications for the development of therapeutic agents to combat metabolic dysfunction and diseases in old age.


Assuntos
Senescência Celular , Quercetina , Camundongos , Animais , Dasatinibe/farmacologia , Dasatinibe/uso terapêutico , Senescência Celular/genética , Quercetina/farmacologia , Quercetina/uso terapêutico , Senoterapia , Tecido Adiposo/metabolismo , Inflamação/tratamento farmacológico , Inflamação/metabolismo , Glucose/metabolismo
5.
Circ Res ; 107(1): 117-25, 2010 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-20489165

RESUMO

RATIONALE: Although an age-related decrease in NO bioavailability contributes to vascular stiffness, the underlying molecular mechanisms remain incompletely understood. We hypothesize that NO constrains the activity of the matrix crosslinking enzyme tissue transglutaminase (TG2) via S-nitrosylation in young vessels, a process that is reversed in aging. OBJECTIVE: We sought to determine whether endothelium-dependent NO regulates TG2 activity by S-nitrosylation and whether this contributes to age-related vascular stiffness. METHODS AND RESULTS: We first demonstrate that NO suppresses activity and increases S-nitrosylation of TG2 in cellular models. Next, we show that nitric oxide synthase (NOS) inhibition leads to increased surface and extracellular matrix-associated TG2. We then demonstrate that endothelium-derived bioactive NO primarily mediates its effects through TG2, using TG2(-/-) mice chronically treated with the NOS inhibitor l-N(G)-nitroarginine methyl ester (L-NAME). We confirm that TG2 activity is modulated by endothelium-derived bioactive NO in young rat aorta. In aging rat aorta, although TG2 expression remains unaltered, its activity increases and S-nitrosylation decreases. Furthermore, TG2 inhibition decreases vascular stiffness in aging rats. Finally, TG2 activity and matrix crosslinks are augmented with age in human aorta, whereas abundance remains unchanged. CONCLUSIONS: Decreased S-nitrosylation of TG2 and increased TG activity lead to enhanced matrix crosslinking and contribute to vascular stiffening in aging. TG2 appears to be the member of the transglutaminase family primarily contributing to this phenotype. Inhibition of TG2 could thus represent a therapeutic target for age-associated vascular stiffness and isolated systolic hypertension.


Assuntos
Envelhecimento/metabolismo , Endotélio Vascular/enzimologia , Proteínas de Ligação ao GTP/metabolismo , Óxido Nítrico/fisiologia , Transglutaminases/metabolismo , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Envelhecimento/patologia , Animais , Células Cultivadas , Endotélio Vascular/patologia , Proteínas de Ligação ao GTP/antagonistas & inibidores , Humanos , Masculino , Camundongos , Camundongos Transgênicos , Pessoa de Meia-Idade , Células NIH 3T3 , Óxido Nítrico/antagonistas & inibidores , Proteína 2 Glutamina gama-Glutamiltransferase , Ratos , Ratos Endogâmicos F344 , Transglutaminases/antagonistas & inibidores
6.
Eur J Appl Physiol ; 112(8): 2933-41, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22160208

RESUMO

Arginase-II (Arg-II) reciprocally regulates nitric oxide synthase (NOS) and offsets basal myocardial contractility. Furthermore, decreased or absent myocardial NOS activity is associated with a depression in myocardial contractile reserve. We therefore hypothesized that upregulation of Arg-II might in part be responsible for depressed myocardial contractility associated with age. We studied arginase activity/expression, NOS expression, NO production in the presence and absence of the arginase inhibitor S-(2-boronoethyl)-L: -cysteine (BEC) in old (22 months) and young (3 months) rat hearts and myocytes. The spatial confinement of Arg-II and NOS was determined with immuno-electron-miocrographic (IEM) and immuno-histochemical studies. We tested the effect of BEC on the force frequency response (FFR) in myocytes, as well as NOS abundance and activity. Arginase activity and Arg-II expression was increased in old hearts (2.27 ± 0.542 vs. 0.439 ± 0.058 nmol urea/mg protein, p = 0.02). This was associated with a decrease in NO production, which was restored with BEC (4.54 ± 0.582 vs. 12.88 ± 0.432 µmol/mg, p < 0.01). IEM illustrates increased mitochondrial density in old myocytes (51.7 ± 1.8 vs. 69 ± 2.2 × 10(6)/cm(2), p < 0.01), potentially contributing to increased Arg-II abundance and activity. Immunohistochemistry revealed an organized pattern of mitochondria and Arg-II that appears disrupted in old myocytes. The FFR was significantly depressed in old myocytes (61.42 ± 16.04 vs. -5.15 ± 5.65%), while inhibition of Arg-II restored the FFR (-5.15 ± 5.65 vs. 70.98 ± 6.10%). NOS-2 is upregulated sixfold in old hearts contributing to increased production of reactive oxygen species which is attenuated with NOS-2 inhibition by 1400 W (4,735 ± 427 vs. 4,014 ± 314 RFU/min/mg protein, p = 0.005). Arg-II upregulation in aging rat hearts contributes to age-related decreased contractile function.


Assuntos
Envelhecimento/metabolismo , Arginase/metabolismo , Cardiopatias/etiologia , Contração Miocárdica , Miócitos Cardíacos/enzimologia , Fatores Etários , Animais , Arginase/antagonistas & inibidores , Ácidos Borônicos/farmacologia , Inibidores Enzimáticos/farmacologia , Cardiopatias/enzimologia , Cardiopatias/patologia , Cardiopatias/fisiopatologia , Imuno-Histoquímica , Microscopia Imunoeletrônica , Mitocôndrias Cardíacas/enzimologia , Mitocôndrias Cardíacas/ultraestrutura , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/ultraestrutura , Óxido Nítrico/metabolismo , Óxido Nítrico Sintase Tipo II/metabolismo , Ratos , Ratos Wistar , Regulação para Cima
7.
Front Physiol ; 12: 747789, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34646165

RESUMO

Large artery stiffness (LAS) is a major, independent risk factor underlying cardiovascular disease that increases with aging. The emergence of microRNA signaling as a key regulator of vascular structure and function has stimulated interest in assessing its role in the pathophysiology of LAS. Identification of several microRNAs that display age-associated changes in expression in aorta has focused attention on defining their molecular targets and deciphering their role in age-associated arterial stiffening. Inactivation of the microRNA-degrading enzyme, translin/trax, which reverses the age-dependent decline in miR-181b, confers protection from aging-associated arterial stiffening, suggesting that inhibitors targeting this enzyme may have translational potential. As LAS poses a major public health challenge, we anticipate that future studies based on these advances will yield innovative strategies to combat aging-associated arterial stiffening.

9.
Circ Res ; 102(8): 923-32, 2008 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-18309100

RESUMO

Oxidized low-density lipoproteins increase arginase activity and reciprocally decrease endothelial NO in human aortic endothelial cells. Here, we demonstrate that vascular endothelial arginase activity is increased in atherogenic-prone apolipoprotein E-null (ApoE(-/-)) and wild-type mice fed a high cholesterol diet. In ApoE(-/-) mice, selective arginase II inhibition or deletion of the arginase II gene (Arg II(-/-) mice) prevents high-cholesterol diet-dependent decreases in vascular NO production, decreases endothelial reactive oxygen species production, restores endothelial function, and prevents oxidized low-density lipoprotein-dependent increases in vascular stiffness. Furthermore, arginase inhibition significantly decreases plaque burden. These data indicate that arginase II plays a critical role in the pathophysiology of cholesterol-mediated endothelial dysfunction and represents a novel target for therapy in atherosclerosis.


Assuntos
Arginase/fisiologia , Aterosclerose/etiologia , Animais , Apolipoproteínas E/deficiência , Arginase/antagonistas & inibidores , Arginase/genética , Aterosclerose/patologia , Colesterol/administração & dosagem , Células Endoteliais/patologia , Endotélio Vascular/patologia , Endotélio Vascular/fisiopatologia , Camundongos , Camundongos Knockout , Óxido Nítrico/biossíntese , Óxido Nítrico Sintase Tipo III , Regulação para Cima , Resistência Vascular
10.
Eur J Appl Physiol ; 110(2): 395-404, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20512503

RESUMO

Emerging evidence suggests that nitric oxide (NO) plays a pivotal role in the mechanism of vascular hyporesponsiveness contributing to microgravity-induced orthostatic intolerance. The cellular and enzymatic source of the NO, however, remains controversial. In addition, the time course of the endothelial-dependent contribution remains unstudied. We tested the hypotheses that the change in vasoresponsiveness seen in acute (3-day) hindlimb unweighted (HLU) animals is due to an endothelium-dependent mechanism and that endothelial-dependent attenuation in vasoreactivity is due to endothelial nitric oxide synthase (NOS-3) dependent activation. Vasoreactivity was investigated in rat aortic rings following acute HLU treatment. Dose responsiveness to norepinepherine (NE) was depressed after 3-day HLU [1,338 +/- 54 vs. 2,325 +/- 58 mg at max (NE), HLU vs. C, P < 0.001]. However, removal of the endothelium restored the vascular contractility to that of C. In addition, 1H-oxadiazole quinoxalin-1-one (ODQ), a soluble guanylyl cyclase inhibitor, restored the reduced vasoconstrictor responses to phenylephrine (PE) seen in 3-day HLU rings (1.30 +/- 0.10 vs. 0.53 +/- 0.07 g, HLU + ODQ vs. HLU, P = 0.0001). Ca(+) dependent nitric oxide synthase (NOS) activity was increased, as was vascular NO products as a result of HLU. While NOS-3 expression was not increased in HLU rats, phosphorylation of NOS-3 at serine-1177 (an activator of NOS-3) was increased while phosphorylation of serine-495 (an inactivator of NOS-3) was decreased. These findings demonstrate that changes in vasoresponsiveness in the acute HLU model of microgravity are due to an upregulation of the endothelial-dependent NO/cGMP pathway through NOS phosphorylation.


Assuntos
Aorta/metabolismo , GMP Cíclico/metabolismo , Endotélio Vascular/metabolismo , Óxido Nítrico/metabolismo , Sistemas do Segundo Mensageiro , Vasoconstrição , Vasodilatação , Simulação de Ausência de Peso , Animais , Aorta/efeitos dos fármacos , Caveolina 1/metabolismo , Relação Dose-Resposta a Droga , Endotélio Vascular/efeitos dos fármacos , Ativação Enzimática , Inibidores Enzimáticos/farmacologia , Guanilato Ciclase/antagonistas & inibidores , Guanilato Ciclase/metabolismo , Proteínas de Choque Térmico HSP90/metabolismo , Elevação dos Membros Posteriores , Masculino , Óxido Nítrico Sintase Tipo III/metabolismo , Fosforilação , Ratos , Receptores Citoplasmáticos e Nucleares/antagonistas & inibidores , Receptores Citoplasmáticos e Nucleares/metabolismo , Sistemas do Segundo Mensageiro/efeitos dos fármacos , Serina , Guanilil Ciclase Solúvel , Fatores de Tempo , Vasoconstrição/efeitos dos fármacos , Vasoconstritores/farmacologia , Vasodilatação/efeitos dos fármacos , Vasodilatadores/farmacologia
11.
J Appl Physiol (1985) ; 106(6): 2002-8, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19299573

RESUMO

We have previously shown that microgravity and simulated microgravity induce an increase in human and rat aortic stiffness. We attempted to elucidate the mechanism(s) responsible for this increase in stiffness. We hypothesize that an alteration in vessel wall collagen or elastin content or in extracellular matrix (ECM) cross-linking either individually or in a combination is responsible for the increased vessel stiffness. Rats underwent hindlimb unweighting (HLU) for a period of 7 days to simulate microgravity. The contribution of ECM cross-linking to the vessel wall stiffness was evaluated by measuring aortic pulse wave velocity following inhibition of the cross-linking enzymes lysyl oxidase (LOX) and transglutaminase (tTG) and the nonenzymatic advanced glycation end product cross-linking pathway during HLU. Aortic collagen and elastin content was quantified using established colorimetric assays. Collagen subtype composition was determined via immunofluorescent staining. The increase in aortic pulse wave velocity after HLU was significantly attenuated in the LOX and tTG inhibition groups compared with saline (1.13 +/- 0.11 vs. 3.00 +/- 0.15 m/s, LOX vs. saline, P < 0.001; 1.16 +/- 0.25 vs. 3.00 +/- 0.15 m/s, tTG vs. saline, P < 0.001). Hydroxyproline content, a measure of collagen content, was increased in all groups after HLU (2.01 +/- 0.62 vs. 3.69 +/- 0.68% dry weight, non-HLU vs. HLU, P = 0.009). Collagen subtype composition and aortic elastin content were not altered by HLU. Together, these data indicate that HLU-induced increases in aortic stiffness are due to both increased aortic collagen content and enzyme cross-linking activity.


Assuntos
Aorta Torácica/patologia , Matriz Extracelular/metabolismo , Elevação dos Membros Posteriores/fisiologia , Simulação de Ausência de Peso/efeitos adversos , Animais , Aorta Torácica/metabolismo , Aorta Torácica/fisiopatologia , Velocidade do Fluxo Sanguíneo , Pressão Sanguínea , Colágeno/metabolismo , Elastina/metabolismo , Produtos Finais de Glicação Avançada/metabolismo , Hidroxiprolina/metabolismo , Masculino , Maleabilidade , Proteína-Lisina 6-Oxidase/antagonistas & inibidores , Fluxo Pulsátil , Ratos , Ratos Wistar , Transglutaminases/metabolismo
13.
J Appl Physiol (1985) ; 102(3): 853-8, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17082368

RESUMO

Microgravity (microG)-induced orthostatic intolerance (OI) in astronauts is characterized by a marked decrease in cardiac output (CO) in response to an orthostatic stress. Since CO is highly dependent on venous return, alterations in the resistance to venous return (RVR) may be important in contributing to OI. The RVR is directly dependent on arterial compliance (C(a)), where aortic compliance (C(ao)) contributes up to 60% of C(a). We tested the hypothesis that microG-induced changes in C(a) may represent a protective mechanism against OI. A retrospective analysis on hemodynamic data collected from astronauts after 5- to 18-day spaceflight missions revealed that orthostatically tolerant (OT) astronauts showed a significant decrease in C(a) after spaceflight, while OI astronauts showed a slight increase in C(a). A ground-based animal model simulating microG, hindlimb-unweighted rats, was used to explore this phenomenon. Two independent assessments of C(ao), in vivo pulse wave velocity (PWV) of the thoracic aorta and in vitro pressure-diameter squared relationship (PDSR) measurements of the excised thoracic aorta, were determined. PWV showed a significant increase in aortic stiffness compared with control, despite unchanged blood pressures. This increase in aortic stiffness was confirmed by the PDSR analysis. Thus both actual microG in humans and simulated microG in rats induces changes in C(ao). The difference in C(a) in OT and OI astronaut suggests that the microG-induced decrease in C(a) is a protective adaptation to spaceflight that reduces the RVR and allows for the maintenance of adequate CO in response to an orthostatic stress.


Assuntos
Adaptação Fisiológica , Aorta/fisiologia , Astronautas , Postura/fisiologia , Ausência de Peso/efeitos adversos , Animais , Artérias/fisiologia , Elevação dos Membros Posteriores , Humanos , Masculino , Pressão , Pulso Arterial , Ratos , Ratos Wistar
14.
BMC Neurosci ; 7: 58, 2006 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-16863593

RESUMO

BACKGROUND: Earlier observations in our lab had indicated that large, time-varying magnetic fields could elicit action potentials that travel in only one direction in at least some of the myelinated axons in peripheral nerves. The objective of this study was to collect quantitative evidence for magnetically induced unidirectional action potentials in peripheral nerves of human subjects. A magnetic coil was maneuvered to a location on the upper arm where physical effects consistent with the creation of unidirectional action potentials were observed. Electromyographic (EMG) and somatosensory evoked potential (SEP) recordings were then made from a total of 20 subjects during stimulation with the magnetic coil. RESULTS: The relative amplitudes of the EMG and SEP signals changed oppositely when the current direction in the magnetic coil was reversed. This effect was consistent with current direction in the coil relative to the arm for all subjects. CONCLUSION: A differential evocation of motor and sensory fibers was demonstrated and indicates that it may be possible to induce unidirectional action potentials in myelinated peripheral nerve fibers with magnetic stimulation.


Assuntos
Magnetismo/instrumentação , Neurônios Motores/fisiologia , Fibras Nervosas Mielinizadas/fisiologia , Vias Neurais/fisiologia , Neurônios Aferentes/fisiologia , Nervos Periféricos/fisiologia , Potenciais de Ação/fisiologia , Vias Aferentes/fisiologia , Vias Eferentes/fisiologia , Estimulação Elétrica/instrumentação , Estimulação Elétrica/métodos , Eletromiografia , Potenciais Somatossensoriais Evocados/fisiologia , Humanos , Mecanorreceptores/fisiologia , Córtex Motor/fisiologia , Contração Muscular/fisiologia , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Condução Nervosa/fisiologia , Inibição Neural/fisiologia , Córtex Somatossensorial/fisiologia
17.
Eur J Cardiothorac Surg ; 40(1): 43-8, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21232970

RESUMO

OBJECTIVE: Aortic valve replacement (AVR) is the standard treatment for severe, symptomatic aortic stenosis (AS). However, many patients are not referred for surgery and fewer undergo AVR. Transcatheter aortic valve implantation (TAVI) has emerged as a solution for high-risk AS patients. We sought to measure the impact of TAVI on the undertreatment of AS. METHODS: Patients with AS were identified by retrospective medical record review and evaluation of echocardiograms were performed in a single-center tertiary-care institution. A total of 179, 183, 214, and 265 patients had AS in 2006, 2007, 2008, and 2009, respectively, with the introduction of TAVI occurring in 2008 and continuing through 2009. The primary endpoints were the rates of unoperated AS and surgical referral. RESULTS: The rates of unoperated AS were 50.6% before TAVI and 40.7% after TAVI (p = 0.002). Referral rates to surgery were 63.6% before TAVI and 74.1% after TAVI (p = 0.003). Reasons for nonreferral were patient-family decision, perceived high operative risk, and the presence of comorbidities. Operative mortality was 3.7% and not statistically significant different between years. Three-year patient survival was 82.5% in the AVS group and 43.9% in the UNOP group (p < 0.001). CONCLUSIONS: The introduction of TAVI was associated with an increase in surgical referrals and a decrease in the rate of unoperated AS. This positive impact was due to increases in both TAVI and AVR volume. Increased volume was not associated with worse patient survival. A significant population of patients with AS are still treated medically.


Assuntos
Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/diagnóstico por imagem , Cateterismo Cardíaco/métodos , Contraindicações , Métodos Epidemiológicos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Resultado do Tratamento , Ultrassonografia
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