Significance of preoperative acute kidney injury in patients with acute type A aortic dissection.

BACKGROUND/PURPOSE: Acute type A aortic dissection (AAD) is a medical emergency with high mortality even with emergency repair. We explored the risk factors for in-hospital mortality and the impact of preoperative acute kidney injury (AKI) in patients with AAD. METHODS: Our hospital database contained records for 156 consecutive patients who underwent AAD repair between March 2000 and February 2013. They were assigned to the in-hospital mortality or the survival group. All data were collected retrospectively. RESULTS: The 30-day mortality, including intraoperative deaths, was 14.1% (22/156). Total in-hospital mortality was 19.2% (30/156). Patients who required preoperative cardiopulmonary resuscitation (CPR) (16.7 vs 3.2%; P = 0.012), or who presented with preoperative cardiac tamponade (46.7 vs 19.0%; P = 0.002), shock/hypotension (56.7 vs 21.4%; P < 0.001), or coma (20.0 vs 6.3%; P = 0.019) had a higher in-hospital mortality rate. There was no difference in in-hospital mortality rate between patients with preoperative AKI or not. Mortality and major complications were significantly correlated with the severity of AKI. Multivariate analysis confirmed that preoperative shock or hypotension (odds ratio = 5.2; 95% CI = 2.2-12.3), and preoperative AKI stage 3 (odds ratio = 4.9; 95% CI = 1.3-19.3) were independent preoperative prognostic factors of in-hospital mortality. CONCLUSION: On the basis of our results, preoperative stage 3 AKI is a crucial prognostic risk factor for patients with AAD repair, Cardiac surgeons should be aware of this condition when dealing with AAD patients.

Factors associated with demoralisation syndrome in patients before and after cardiac surgery.

AIMS AND OBJECTIVES: To investigate the incidence of and contributors to demoralisation syndrome among patients before and after cardiac surgery. BACKGROUND: Demoralisation syndrome is a common but neglected phenomenon in nursing practice. Patients who require cardiac surgery experience demoralisation syndrome more often than they experience depression. DESIGN: A prospective correlational design was applied. METHODS: A convenience sample of 76 participants undergoing cardiac surgery was recruited from the cardiovascular wards of two medical centres in Taiwan. The instruments applied included the Demoralization Scale (DS), the Patient Outcome Questionnaire-9 (PHQ-9) and the Perception of Intensive Care Unit (ICU) Stay Questionnaire. RESULTS: High demoralisation was present in 44.7% of the participants before surgery but significantly decreased to 36.8% after surgery (p < .05); conversely, depression was present in 15.8% of participants before surgery and did not significantly decrease after surgery (rate after surgery, 9.2%; p > .05). A multiple regression analysis using the backward-selection method showed that depression (p < .001) and retirement (p < .05) were important predictors of pre-operative demoralisation syndrome (R2  = 0.250), whereas depression (p < .001) and perceptions of ICU stay (p > .05) remained in the regression model after surgery (R2  = 0.291). CONCLUSIONS: The study findings suggest that demoralisation syndrome is highly prevalent in patients undergoing cardiac surgery but is significantly reduced after cardiac surgery. Before surgery, depression and retirement were significant predictors of demoralisation. After surgery, depression was the only predictor. Although the perception of ICU stay was not an important predictor, it was significantly correlated with demoralisation. RELEVANCE TO CLINICAL PRACTICE: Before cardiac surgery, nurses should emphasise the importance of demoralisation development among patients who suffer from depressive symptoms and are retired. After cardiac surgery, continued follow-up is needed for the early detection and minimisation of the effect of depression and the development of demoralisation.

Baicalein, an active component of Scutellaria baicalensis Georgi, prevents lysophosphatidylcholine-induced cardiac injury by reducing reactive oxygen species production, calcium overload and apoptosis via MAPK pathways.

BACKGROUND: Lysophosphatidylcholine (lysoPC), a metabolite from membrane phospholipids, accumulates in the ischemic myocardium and plays an important role in the development of myocardial dysfunction ventricular arrhythmia. In this study, we investigated if baicalein, a major component of Huang Qui, can protect against lysoPC-induced cytotoxicity in rat H9c2 embryonic cardiomyocytes. METHODS: Cell viability was detected by the MTT assay; ROS levels were assessed using DCFH-DA; and intracellular free calcium concentrations were assayed by spectrofluorophotometer. Cell apoptosis and necrosis were evaluated by the flow cytometry assay and Hoechst staining. Mitogen-Activated Protein Kinases (MAPKs), which included the ERK, JNK, and p38, and the apoptotic mechanisms including Bcl-2/Bax, caspase-3, caspase-9 and cytochrome c pathways were examined by Western blot analysis. The activation of MAPKs was examined by enzyme-linked immunosorbent assay. RESULTS: We found that lysoPC induced death and apoptosis of H9c2 cells in a dose-dependent manner. Baicalein could prevent lysoPC-induced cell death, production of reactive oxygen species (ROS), and increase of intracellular calcium concentration in H9c2 cardiomyoctes. In addition, baicalein also inhibited lysoPC-induced apoptosis, with associated decreased pro-apoptotic Bax protein, increased anti-apoptotic Bcl-2 protein, resulting in an increase in the Bcl-2/Bax ratio. Finally, baicalein attenuated lysoPC-induced the expression of cytochrome c, casapase-3, casapase-9, and the phosphorylations of ERK1/2, JNK, and p38. LysoPC-induced ERK1/2, JNK, and p38 activations were inhibited by baicalein. CONCLUSIONS: Baicalein protects cardiomyocytes from lysoPC-induced apoptosis by reducing ROS production, inhibition of calcium overload, and deactivations of MAPK signaling pathways.

Female showed favorable left ventricle hypertrophy regression during post-TAVR follow-up.

Transcatheter aortic valve replacement (TAVR) is a well-established procedure using a catheter-introduced valve prosthesis for patients with severe aortic stenosis (AS). This retrospective study investigated sex-related differences in pre- and post-TAVR clinical and hemodynamic outcomes and analyzed data of the first 100 cases at Kaohsiung Medical University Chung-Ho Memorial Hospital (KMUH) between December 2013 and December 2021. Baseline characteristics, procedural outcomes, mortality rates, and echocardiographic parameters were analyzed and compared between sexes. Among the 100 patients, male (46%) and female (54%) were of similar age (mean age, male 86.0 years vs. female 84.5 years) and of the same severity of AS (mean pressure gradient, male 47.5 mmHg vs. female 45.7 mmHg) at the time receiving the TAVR procedure. Women had smaller aortic valve areas calculated by continuity equation (0.8 ± 0.3 cm2 vs. 0.7 ± 0.2 cm2, p < 0.001). In addition, women had better left ventricle ejection fraction (59.6 ± 14.0% vs. men 54.7 ± 17.2%, p < 0.01). In the post-TAVR follow-up, regression of left ventricle mass and dimension was better in women than in men. None of the patient died within 30 days after the procedure, and women tended to have a more favorable survival than men (2-year mortality and overall mortality rate in 8.3 year, women 9.1% and 22.2% vs. men 22.2% and 34.8%; p = 0.6385 and 0.1277, respectively). In conclusion, the sex-based difference in post-TAVR regression of LV remodeling suggests a need for sex-based evaluation for patients with severe AS and their post TAVR follow-up.

Shock wave therapy effectively attenuates inflammation in rat carotid artery following endothelial denudation by balloon catheter.

BACKGROUND: This study investigates the effectiveness of extracorporeal shock wave (ECSW) in ameliorating inflammatory mediator expression and neointimal formation in a rat model of vascular injury. METHODS AND RESULTS: Male Sprague-Dawley rats with left carotid artery (LCA) injury induced by balloon dilatation (BD; group 1) were compared with group 2 [LCA injury plus ECSW-181 (defined as 181 total shocks given in LCA at 0.011 mJ/mm(2)) on day 2 post-LCA injury], and group 3 (normal controls). The rats in each group were further divided into 3 subgroups (n = 6, each) that were sacrificed on postoperative day 3, 7 and 14, respectively. The results demonstrated that, compared to groups 2 and 3, group 1 had significantly increased cellular expression of CD40, interleukin-18, and connexin 43 at each analyzed time point (all p < 0.001). Additionally, LCCA macrophage (CD68) recruitment was substantially increased in group 1 compared to groups 2 and 3 (all p < 0.001). Furthermore, LCA neointimal proliferation and media thickness were markedly higher in group 1 than in groups 2 and 3 on days 7 and 14 post-BD (all p < 0.001). CONCLUSIONS: ECSW markedly attenuates inflammatory responses, proliferation of neointima and smooth muscle cells in a rat vascular injury model.

Hyperbaric oxygen therapy with topical negative pressure: an alternative treatment for the refractory sternal wound infection.

Sternal osteomyelitis is a potentially lethal complication after cardiac surgery. It may be the cause of postoperative morbidity and mortality. We present a case of deep sternal wound infection after sternotomy. The patient received three treatments of surgical debridement, irrigation, topical negative pressure (TNP) dressing, and hyperbaric oxygen (HBO) therapy. Forty-five HBO therapy sessions were administered. After nine weeks, the sternal wound was healed and completely epithelialized. This conservative therapy can be an alternative and inexpensive method for the difficult sternal wound infection patient.

Fate of distal aorta after acute type A aortic dissection repair: Change and persistency of postoperative false lumen status.

BACKGROUND: The role of false lumen patency related to aortic growth, re-interventions, and post-discharge mortality in the chronic phase of repaired type A acute aortic dissection (TAAAD) remains controversial. We investigated the role of postoperative false lumen patency during long-term follow-up. METHODS: Based on postoperative CT images of 70 candidates, 58 eligible patients without alteration of false lumen status were assigned into three groups: complete patency, partial patency, and complete thrombosis. Aortic growth of 7 levels was analyzed. RESULTS: Persistent complete patency in post-operative TAAAD presents faster expansion of aortic diameter (95% CI, 0.35 to 11.52; P=0.038; B=5.935) and more patients with growth rate>5mm/year (P=0.029). The persistent status of false lumen does not predict post-discharge mortality (P=0.479). History of coronary artery disease (CAD) is the only independent predictor of post-discharge mortality. CONCLUSIONS: In TAAAD patients without change of postoperative false lumen status, completely patent false lumen presents faster aortic growth and more patients with growth rate>5mm/year. False lumen status does not correlate with late survival. Here we provide an insight into persistent postoperative false lumen in TAAAD patients and may help cast light on aortic dissection in this specific subgroup to improve their late outcomes.

The effects of debanding on the lung expression of ET-1, eNOS, and cGMP in rats with left ventricular pressure overload.

Pulmonary hypertension (PH) usually develops secondary to left ventricular (LV) dysfunction; therefore, it is also called retrograde PH. To investigate our hypothesis that PH is at least partially reversible, as in some congenital heart diseases, in a rat model we investigated whether release of constriction could attenuate pulmonary vascular remodeling and change the expression of endothelin (ET)-1 and endothelial nitric oxide synthase (eNOS). We used rats with LV dysfunction produced by an ascending aortic banding. In this study, there were four groups enrolled: 4-weeks banded (AOB(1-28); n = 7), 7-weeks banded (AOB(1-49); n = 7), debanded groups (AOB(1-28)/DeB(29-49); n = 7), and rats receiving a sham operation (n = 7). Subsequently, there was significant attenuation of medial hypertrophy in pulmonary arterioles and reversal of PH in the AOB(1-28)/DeB(29-49) group (sham, 19 +/- 1.3 mm Hg; AOB(1-28), 31 +/- 2.7 mm Hg; AOB(1-49), 32 +/- 2.7 mm Hg; and AOB(1-28)/DeB(29-49), 20 +/- 1.3 mm Hg). PreproET-1 mRNA and eNOS mRNA were measured by competitive reverse transcriptase (RT) polymerase chain reaction (PCR), and eNOS was measured by Western blotting. Compared with the banded groups, debanding significantly decreased pulmonary preproET-1 mRNA, pulmonary ET-1 (sham, 210 +/- 12 pg/g protein; AOB(1-28), 242 +/- 12 pg/g protein; AOB(1-49), 370 +/- 49 pg/g protein; and AOB(1-28)/DeB(29-49), 206 +/- 1.9 pg/g protein), and plasma ET-1 levels (sham, 10.1 +/- 1.5 pg/ml; AOB(1-28), 13.4 +/- 2.0 pg/ml; AOB(1-49), 15.4 +/- 2.0 pg/ml; and AOB(1-28)/DeB(29-49), 10.3 +/- 0.9 pg/ml protein). Debanding could not, however, alter pulmonary eNOS, eNOS mRNA, or cGMP. These findings suggest that pulmonary vascular remodeling, increased pulmonary arterial pressure, and upregulation of ET-1 gene expression are all reversible. We infer that it is the upregulated gene expression of ET-1, not eNOS, that is closely related to the development of the PH secondary to 4 weeks of aortic banding.

Protective effect of labedipinedilol-A, a novel dihydropyridine-type calcium channel blocker, on myocardial apoptosis in ischemia-reperfusion injury.

The effects of labedipinedilol-A, a novel dihydropyridine-type calcium channel blocker with alpha-/beta-adrenoceptor blocking activities, on myocardial infarct size, apoptosis and necrosis in the rat after myocardial ischemia/reperfusion (45 min/120 min) were investigated. Ten minutes prior to left coronary artery occlusion, rats were treated with vehicle or labedipinedilol-A (0.25 or 0.5 mg/kg, i.v.). In the vehicle group, myocardial ischemia-reperfusion induced creatine kinase (CK) release and caused cardiomyocyte apoptosis, as evidenced by DNA ladder formation and terminal dUTP deoxynucleotidyltransferase nick end-labeling (TUNEL) staining. Treatment with labedipinedilol-A (0.25 or 0.5 mg/kg) reduced infarct size significantly compared to vehicle group (18.75+/-0.65% and 8.27+/-0.29% vs. 41.72+/-0.73%, P<0.01). Labedipinedilol-A also reduced the CK, CK-MB, lactate dehydrogenase (LDH) and troponin T levels in blood. In addition, labedipinedilol-A (0.5 mg/kg) significantly decreased TUNEL positive cells from 19.21+/-0.52% to 9.73+/-0.81% (P<0.01), which is consistent with absence of DNA ladders in the labedipinedilol-A group. Moreover, labedipinedilol-A pretreatment also decreased calcium content in ischemic-reperfused myocardial tissue. In conclusion, these results demonstrate that labedipindielol-A, through reduction of calcium overload and apoptosis, exerts anti-infarct effect during myocardial ischemia-reperfusion and would be useful clinically in the prevention of acute myocardial infarction.

An avoidable complication of percutaneous coronary intervention-entrapment of stent and disconnected balloon catheter.

During percutaneous coronary intervention, entrapment of catheter materials is a rare but life-threatening complication that sometimes requires emergency surgical treatment. Coronary artery stents have been developed to prevent acute coronary closure and reduce restenosis after coronary angioplasty. The most frequently reported complications of coronary stents are related to stent thrombosis and anticoagulation problems. This case study describes a 60-year-old female who had stable angina pectoris and underwent stent insertion into the left circumflex artery. Unfortunately, the coronary stent with balloon catheter was entrapped while crossing the angulated segment between the left circumflex and left main coronary artery. The stent catheter was surgically removed, and the patient underwent coronary artery bypass grafting successfully. Physicians should keep in mind that extremely angulated segments may reduce the successful rate of coronary stenting and contribute to the stent entrapment complication.

Tuberculous pericardial abscess: a case report.

We present the case of a 71-year-old diabetic man who came to us complaining of dyspnea for 1 month. Chest X-ray showed cardiomegaly and bilateral pleural effusion. Echocardiography showed a pericardial cystic mass with external compression of the right ventricle. Because of clinically impending cardiac tamponade, we performed urgent sternotomy and removed the pericardial mass without event. Pathologic examination of the excised pericardial specimen showed caseous necrosis compatible with tuberculosis infection. The patient was put on a 1-year treatment regimen of anti-tuberculosis medication. This case is an important reminder that tuberculosis can occur as a pericardial abscess.

Ruptured aneurysm of the sinus of valsalva into the right atrium without ventricular septal defect: a case report and literature review.

Aneurysm of the sinus of Valsalva (ASV), frequently associated with ventricular septal defect (VSD), is a rare cardiac disease that may be acquired or congenital. Rupture of an ASV, rare in the noncoronary cusp, usually produces serious hemodynamic change and carries poor prognosis if not treated surgically. We present the case of a 55-year-old female who came to us complaining of exertional dyspnea. Transthoracic echocardiography and aortography showed a noncoronary cusp ASV with rupture into the right atrium but without VSD. Because of high left to right shunt flow, she underwent successful surgical intervention with aneurysm repair approached from both the aorta and right atrium with a knitted Dacron patch. This was a rare case of noncoronary cusp involvement in ASV that ruptured into the right atrium without VSD.

Epidemiology, Clinical Features, and Prescribing Patterns of Aortic Aneurysm in Asian Population From 2005 to 2011.

Aortic aneurysm (AA) is a leading cause of death in Asia and the world. The prevalence in Western countries is around 1.3% to 8%. However, it is still unclear about the incidence, prevalence, and mortality of AA in Asian population. The aim of this study is to investigate the epidemiology of AA for all subtypes in Taiwan, and describe the clinical features and prescribing patterns for AA population.A population-based study was conducted using information from National Health Insurance Research Database (NHIRD) in Taiwan. Patients who were diagnosed with AA and also received computed tomography (CT) were included in this study. Incidence, prevalence, and mortality were calculated in each year during 2005 to 2011. Prevalent comorbidities and prescribing patterns were both evaluated among study population.The average annual incidence of AA in Taiwan was 7.35 per 100,000 population, and the prevalence was 29.04 per 100,000 population. It showed an increased trend of incidence from 2005 to 2011, so as prevalence and mortality. The incidence was associated with age and sex difference. It was much higher in those older than 65 years, especially for male. Hypertension, coronary artery disease (CAD), and chronic obstructive pulmonary disease (COPD) were prevalent comorbidities. Eighty-eight percentages of patients were prescribed antihypertensive agents in acute phase, where 61.4% of calcium channel blocker (CCB) was the most one.Our study found that incidence of AA was lower in Taiwan than in other countries. Nevertheless, it showed an increased trend of AA disease for incidence, prevalence, and also mortality during 2005 to 2011.

Epidemiology and Medication Utilization Pattern of Aortic Dissection in Taiwan: A Population-Based Study.

Acute aortic dissection (AD) is a catastrophic condition associated with a high rate of mortality. However, current epidemiological information regarding AD remains sparse. The objective of the present study was to investigate the current epidemiological profile and medication utilization patterns associated with aortic dissection in Taiwan.In this population-based study, we identified cases of AD diagnosed during 2005 to 2012 in the complete Taiwan National Health Insurance (NHI) Research Database. Patients with AD were identified using the International Classification of Disease, Ninth Revision (ICD-9) code 441.0, and surgical interventions were defined using NHI procedure codes.A total of 9092 individuals with a mean age of 64.4 ±â€Š15.1 years were identified. The cases were divided into 3 groups: Group A included 2340 patients (25.74%) treated surgically for type A AD; Group B included 1144 patients (12.58%) treated surgically for type B AD, and Group C included 5608 patients (61.68%) with any type of AD treated with medical therapy only. The average annual incidence of AD was 5.6 per 100,000 persons, and the average prevalence was 19.9 per 100,000 persons. Hypertension was the most common risk factor, followed by coronary artery disease and chronic obstructive pulmonary disease. Within 1 year of AD diagnosis, 92% of patients were taking antihypertensive medication. Calcium channel blockers were the most frequently prescribed antihypertensive medication for long-term observation in Taiwan.The annual trends revealed statistically significant increases in the numbers and percentages of prevalence, incidence, and mortality. Changes in patients' drug utilization in patterns were observed after AD diagnosis. Our study provides a local profile that supports further in-depth analyses in AD-affected populations.

Upregulation of endothelial nitric oxide synthase and endothelin-1 in pulmonary hypertension secondary to heart failure in aorta-banded rats.

This study assessed alterations in expression of pulmonary endothelial nitric oxide synthase (eNOS) and endothelin-1 (ET-1) in rats with pulmonary hypertension (PH) after the ascending aorta had been banded. Rats were studied 12 weeks after banding, which resulted in left heart failure with elevated pulmonary arterial pressure (banded: 31.3 +/- 5.9 (mean +/- SD) mmHg; sham: 20.0 +/- 4.7 mmHg, P<0.05). Competitive reverse transcription-polymerase chain reaction demonstrated significant increases in pulmonary expression of preproET-1 mRNA and eNOS mRNA. Western blot analysis indicated increased pulmonary eNOS protein. Radioimmunoassays indicated increased plasma ET-1 concentrations in the pulmonary artery (banded: 12.4 +/- 1.5 pg/ml; sham: 9.0 +/- 1.3 pg/ml, P<0.01) and increased ET-1 content in lungs (banded: 240 +/- 21 ng/g protein; sham: 203 +/- 20 ng/g protein, P<0.05). There was increased immunohistochemical staining of eNOS and ET-1 in the pulmonary vascular endothelium of aorta-banded rats. Even in the presence of increased eNOS expression, it was not clear how nitric oxide (NO) production (decreased, unchanged, or increased) was involved in the compensatory mechanism to offset pulmonary vasoconstriction. Increased ET-1 expression may be important in mediating PH secondary to aortic banding, and may offer insights into the use of ET-1 antagonists in treating patients with PH secondary to heart failure.

Is pericardium a suitable calibration reference in integrated backscatter analysis?

To evaluate if pericardium is a suitable calibration reference in the integrated backscatter (IBS) analysis, the grossly normal pericardial specimens from 23 patients without a history of pericarditis were mounted on a steel platform and immersed in a 0.9% saline bath. The 2-D IBS images acquired at the uniform time gain compensation settings of 50 and 70 dB were analyzed. For the pericardial IBS, the limits of agreement for intraobserver and interobserver measurements were -1.2 to 1.4 dB and -1.6 to 2.2 dB, respectively. However, the calibrated IBS intensity of the pericardium presented a rather wide range of variation and was -13 +/- 5 (-5 to -29) and -10 +/- 4 (-4 to -22) dB at the overall gain settings of 50 and 70 dB, respectively. Conclusively, pericardium may not be an ideal IBS calibration reference in a population study of cardiac tissue characterization.

Exogenous lipoid pneumonia: serial chest plain roentgenography and high-resolution computerized tomography findings.

Between May 1988 and July 2002, six patients with pneumonia due to diesel, animal, or vegetable oil aspiration were admitted to Kaohsiung Medical University Hospital. The purpose of this study was to demonstrate distinctive radiographic findings of oil-induced lipoid pneumonitis on initial serial chest roentgenograms and high-resolution computerized tomography (CT) scans. Initial chest roentgenograms (n = 6), CT scans (n = 6), and roentgenography and CT follow-up studies were analyzed retrospectively by two chest radiologists and two surgeons, focusing on the pattern and distribution of parenchymal abnormalities. The most common location was the right middle lobe, followed by the right lower lobe, the left lower lobe, and the lingular lobe. Follow-up chest roentgenograms (n = 6) showed complete disappearance of the parenchymal lesions in only one patient and partial decrease in the extent of lesions in five patients. Lipoid pneumonia presents non-specific findings on chest roentgenography. It is commonly located in both lower and the right middle lobes. On high-resolution CT, the lesions appear most commonly as areas of consolidation, ground-glass attenuation mixed with paving pattern, and poorly defined nodules.

Coronary artery aneurysms in a young patient with acute myocardial infarction: a case report.

Coronary artery aneurysms are not uncommon. They are usually arteriosclerotic in origin, and may be congenital or secondary to injury, dissection, infection, inflammation, or Kawasaki disease (KD). Herein, we report a case involving a 25-year-old male smoker with acute myocardial infarction (AMI). Coronary angiography showed triple-vessel disease, coronary artery aneurysms, and diffuse ectasia. Coronary artery bypass grafting was performed without complications. Based on his history, serologic examinations, and angiographic findings, we suspected that his coronary artery aneurysms and ectasia were the adult sequelae of KD. This case is a good reminder that KD victims may suffer from young-onset AMI.

Impact of management of abdominal aortic dissection following the successful operation of annulo-aortic ectasia in Marfan's syndrome--a case report.

A 21-year-old female patient with Marfan's syndrome suffering from chronic ascending aortic dissection and aortic insufficiency was treated with total aortic root replacement by Cabrol technique (or procedure). The post-operative course was smooth and the patient recovered satisfactorily with very stable hemodynamic condition and good appetite. Unfortunately she complained of sudden severe abdominal pain followed by complete anuria on the fifth post-operative day. The MRI demonstrated abdominal aortic dissection with malperfusion of all the abdominal organs. Rapid increase of aminotransferases (SGOT and SGPT), severe acidosis and rapid deterioration of vital signs within 10 hours discouraged us from trying surgical intervention. The puzzle of management in those cases will be discussed.

Mitral tissue inhibitor of metalloproteinase 2 is associated with mitral valve surgery outcome.

BACKGROUND: Matrix metalloproteinases play a role in regulating cardiac remodeling. We previously reported an association between tissue inhibitor of metalloproteinase 2 (TIMP-2) expression and mitral valve (MV) disease. However, the determinants and prognostic value of mitral TIMP2 after MV surgery are unknown. METHODS: This retrospective study of 164 patients after MV surgery in a tertiary medical center in Taiwan assessed mitral TIMP2 on a semiquantitative scale (0-2) by immunohistochemical staining. The primary endpoints were the composite of cardiovascular death and heart failure admission. RESULTS: Mean age was 50.4±13.7 years. After a mean follow-up period of 101±59 months, primary endpoints had occurred in 25 (15.2%) subjects. Patients with and without primary endpoint events significantly differed in terms of age (56.6±14.4 vs. 49.2±13.4 years, respectively; p = 0.013) and left ventricular end-systolic diameter (LVESD) (39.7±8.2 vs. 35.5±7.5 mm, p = 0.010) at surgery. The TIMP2 had a significant dose-dependent association with development of a primary endpoint (p = 0.002). Kaplan-Meier analysis showed that TIMP2 expression has a significant positive association with primary endpoint-free survival (log-rank test; p = 0.004). Cox regression analysis showed that independent predictors of primary endpoints were TIMP2 (hazard ratio [HR] 0.28; 95% confidence interval [CI] 0.12-0.65; p = 0.003), age (HR 1.05; 95% CI 1.02-1.09; p = 0.003) and LVESD (HR 1.05; 95% CI 1.01-1.10; p = 0.020). CONCLUSIONS: The lack of mitral TIMP2 expression is associated with increases in cardiovascular death and heart failure following MV surgery.