Acute expansion of nitinol-based self-expandable device in patients undergoing transfemoral aortic valve implantation.

BACKGROUND: The acute adaptation of the nitinol-based stent frame self expandable valve to the aortic root after deployment is poorly understood. Accordingly, this study aimed to assess the occurrence, degree and determinants of acute adaptation of the nitinol-based stent frame self-expandable valves after implantation. METHODS: This is a single-site prospective registry including patients undergoing transcatheter aortic valve replacement (TAVR) with a widely used second-generation nitinol-based self-expandable device (Evolut R, Medtronic, Minneapolis, Minnesota, USA). We measured valve diameters at three different sections: distal (aortic) level, central (annulus) level and proximal (ventricular) level. Valve expansion was estimated by the difference between the diameters calculated immediately after valve deployment (A) and at the end of the procedure (B). The absolute and relative stent changes were defined as B-A and (B-A)/B∗100, respectively. A linear regression model was performed to test the association between the degree of valve extension at each segment with baseline and procedural characteristics. RESULTS: A total of 58 consecutive TAVR patients were included in this analysis, with a mean age of 82.12 ±â€Š5.28 years. Out of the total, 46% of the patients had chronic kidney disease, 32% had diabetes and 76% had dyslipidaemia. The mean procedural time was 28.11 ±â€Š11.6 min, with 53.45% of predilation. Postdilation was performed only in 3.5% of patients. Final stent diameters were significantly higher than those achieved immediately after valve implantation - an observation that was consistent for all the segments: 0.50 ±â€Š0.51 mm and 2.48 ±â€Š2.57% ( P  < 0.01) in the proximal, 0.46 ±â€Š0.57 mm and 2.39 ±â€Š2.96% ( P  < 0.01) in the central, as well as 0.58 ±â€Š0.59 mm and 2.14 ±â€Š2.14% ( P  < 0.01) at the distal segments. Postdilation significantly affected the expansion of the central segment, and, albeit not significantly, the proximal one, while no changes were observed for the distal portion of the platform. CONCLUSION: This is the first study to have documented a significant degree of the Evolut R self-expandable valve expansion after deployment. However, further studies are required to assess the short- and long-term time course of self-expandable valve enlargement and the clinical relevance of this finding.

Assessment of Non-Invasive Measurements of Oxygen Saturation and Heart Rate with an Apple Smartwatch: Comparison with a Standard Pulse Oximeter.

The most commonly used method to assess peripheral oxygen saturation (SpO2) in clinical practice is pulse oximetry. The smartwatch Apple Watch 6 was developed with a new sensor and an app that allows taking on-demand readings of blood oxygen and background readings, day and night. The present study aimed to assess the feasibility and agreement of the Apple Watch 6 compared with a standard SpO2 monitoring system to assess normal and pathological oxygen saturation. We recruited study participants with lung disease or cardiovascular disease and healthy subjects. A total of 265 subjects were screened for enrolment in this study. We observed a strong positive correlation between the smartwatch and the standard commercial device in the evaluation of SpO2 measurements (r = 0.89, p < 0.0001) and HR measurements (r = 0.98, p < 0.0001). A very good concordance was found between SpO2 (bias, −0.2289; SD, 1.66; lower limit, −3.49; and upper limit, 3.04) and HR (bias, −0.1052; SD, 2.93; lower limit, −5.84; and upper limit, 5.63) measured by the smartwatch in comparison with the standard commercial device using Bland−Altman analysis. We observed similar agreements and concordance even in the different subgroups. In conclusion, our study demonstrates that the wearable device used in the present study could be used to assess SpO2 in patients with cardiovascular or lung diseases and in healthy subjects.

[Role of proteinuria in clinical research: for each old-answer, a new key-question.] / Ruolo della proteinuria nella ricerca clinica: per ogni vecchia risposta, una nuova domanda.

The presence of proteinuria, i.e. an abnormal amount of proteins in the urine is a well documented cardiovascular (CV) and renal risk factor either in the general population or in high-risk populations such as patients with type 2 diabetes, previous CV disease and patients under regular nephrology care. Indeed, the increase in proteinuria levels, even if of small entity, is associated to a faster decline in renal function over time, increased risk of End-Stage-Kidney-Disease and CV mortality. The deleterious effect of proteinuria on the kidney is attributable to the primitive glomerular damage as well as to the direct toxicity the proteinuria exerts on the tubule-interstitium. In addition, the more general association with the increased CV risk can be explained by the evidence that proteinuria can be considered a marker of systemic and renal endothelial damage. A reduction in proteinuria over time (a 30% decrease after 6 months of treatment in proteinuria is considered acceptable) as response to antihypertensive or antiproteinuric drugs protects against the development of all mentioned endpoints. Further studies are needed to better clarify: what is the normal value of proteinuria excretion, how many measures should be done during follow-up to truely assess the risk of future outcomes, what is the exact prognostic role of proteinuria.

[Temporal variation of Chronic Kidney Disease's epidemiology].

Chronic Kidney Disease (CKD) is a major risk factor for mortality and morbidity, as well as a growing public health problem. Several studies describe the epidemiology of CKD (i.e. prevalence, incidence) by examining short time intervals. Conversely, the trend of epidemiology over time has not been well investigated, although it may provide useful information on how to improve prevention measures and the allocation of economic resources. Our aim here is to describe the main aspects of the epidemiology of CKD by focusing on its temporal variation. The global incidence of CKD has increased by 89% in the last 27 years, primarily due to the improved socio-demographic index and life-expectancy. Prevalence has similarly increased by 87% over the same period. Mortality rate has however decreased over the last decades, both in the general and CKD populations, due to a reduction in cardiovascular and infectious disease mortality. It is important to emphasize that the upward trend of incidence and prevalence of CKD can be explained by the ageing of the population, as well as by the increase in the prevalence of comorbidities such as hypertension, diabetes and obesity. It seems hard to compare trends between Italy and other countries because of the different methods used to assess epidemiologic measures. The creation of specific CKD Registries in Italy appears therefore necessary to monitor the trend of CKD and its comorbidities over time.