Three-dimensional echocardiography in the evaluation and management of paravalvular regurgitation.

Paravalvular regurgitation is an uncommon but serious complication that can be encountered after either surgical or percutaneous valve replacement and is associated with increased morbidity and mortality. Early detection and accurate assessment of paravalvular regurgitation are crucial to identify those who would benefit from intervention. Recent advances in 3-dimensional echocardiography have increased the feasibility of percutaneous approaches for the management of paravalvular regurgitation. Percutaneous closure of paravalvular regurgitation has emerged as a favorable alternative for redo surgery in selected cases. This article will review the role of 3-dimensional echocardiography in the assessment and management of paravalvular regurgitation.

Association of growth differentiation factor 11/8, putative anti-ageing factor, with cardiovascular outcomes and overall mortality in humans: analysis of the Heart and Soul and HUNT3 cohorts.

AIMS: Growth differentiation factor 11 and/or its homologue growth differentiation factor 8 (GDF11/8) reverses age-related cardiac hypertrophy and vascular ageing in mice. We investigated whether GDF11/8 associates with cardiovascular outcomes, left ventricular hypertrophy (LVH), or age in humans. METHODS AND RESULTS: We measured plasma GDF11/8 levels in 928 participants with stable ischaemic heart disease in the Heart and Soul study. We adjudicated heart failure hospitalization, stroke, myocardial infarction, death, and their composite endpoint. Left ventricular hypertrophy was evaluated by echocardiography. We used multivariable Cox proportional hazards models to compare rates of cardiovascular events and death across GDF11/8 quartiles and logistic regression models to evaluate the association between GDF11/8 and LVH. Four hundred and fifty participants (48.5%) experienced a cardiovascular event or death during 8.9 years of follow-up. The adjusted risk of the composite endpoint was lower in the highest compared with the lowest GDF11/8 quartile [hazard ratio (HR), 0.45; 95% confidence interval (CI), 0.33-0.60; P < 0.001]. We replicated this relationship of GDF11/8 to adverse events in 971 participants in the HUNT3 cohort (adjusted HR, 0.34; 95% CI, 0.23-0.51; P < 0.001). Left ventricular hypertrophy was present in 368 participants (39.7%) at baseline. Participants in the highest quartile of GDF11/8 were less likely to have LVH than those in the lowest quartile (adjusted OR, 0.55; 95% CI, 0.35-0.86; P = 0.009). GDF11/8 levels were lower in older individuals (P < 0.001). CONCLUSION: In patients with stable ischaemic heart disease, higher GDF11/8 levels are associated with lower risk of cardiovascular events and death. Our findings suggest that GDF11/8 has similar cardioprotective properties in humans to those demonstrated in mice.

Long-term prognosis associated with J-point elevation in a large middle-aged biracial cohort: the ARIC study.

AIMS: An association has been described between death from arrhythmia and early repolarization, an electrocardiogram pattern characterized by elevation of the QRS-ST junction (J-point). Little is known about this relationship in non-white populations. This study examines the relationship between J-point elevation (JPE) and sudden cardiac death (SCD) and whether this relationship differs by race or sex. METHODS AND RESULTS: A total of 15 141 middle-aged subjects from the prospective, population-based Atherosclerosis Risk in Communities (ARIC) study were included in this analysis. The primary endpoint was physician-adjudicated SCD occurring from baseline (1987-1989) through December 2002, secondary endpoints were fatal and non-fatal coronary events and all-cause mortality occurring through December 2007. J-point elevation was defined as J-point amplitude ≥ 0.1 mV. Pre-specified subgroup analyses by sex and race were conducted. J-point elevation in any lead was present in 1866 subjects (12.3%). After adjustment for demographic, clinical, lifestyle, and laboratory variables, JPE was not significantly related to SCD in the overall sample [adjusted hazard ratio (HR), 1.23; 95% confidence interval (CI), 0.87-1.75]. However, significant interactions were present between race and JPE (P = 0.006) and between sex and JPE (P = 0.020). J-point elevation was significantly predictive of SCD in whites (adjusted HR, 2.03; 95% CI, 1.28-3.21) and in females (adjusted HR, 2.54; 95% CI, 1.34-4.82). CONCLUSION: Our results suggest that JPE is associated with an increased risk of SCD in whites and in females, but not in blacks or males. Further studies are needed to clarify which subgroups of individuals with JPE are at increased risk for adverse cardiac events.

Sudden Cardiac Death Risk Distribution in the United States Population (from NHANES, 2005 to 2012).

Sudden cardiac death (SCD) accounts for more than half of all deaths from cardiovascular disease and is the first manifestation of heart disease in 50% of these subjects. We aimed to describe the distribution of predicted SCD risk in the general US population using a recently developed risk score. We previously developed a population-based, 10-year risk score for SCD using data from the multiracial Atherosclerosis Risk in Communities cohort, validated in the Framingham Study. We now estimate 10-year predicted SCD risk in National Health and Nutrition Examination Survey participants (pooled from cycles in 2005 to 2012) and evaluate the clinical profile of participants in lower risk (0 to 80th percentile of risk) or high risk (81st to 100th percentile of risk) strata. A total of 10,811 participants were included; the mean age of participants was 48 years, and 50% were women. The average predicted 10-year risk of SCD was 3.6% in high-risk participants (81st to 100th percentile), and 0.37% in low-risk participants (0 to 80th percentile). High-risk participants were older, had higher blood pressure, total cholesterol and body mass index, lower high-density lipoprotein, and were more likely to be men, black, smokers, and diabetic. In US adults free of cardiovascular disease, the majority of SCD risk appears confined to 10% to 20% of the population. This risk score, comprised of readily available clinical variables, identifies a subset of individuals in the population who are at an appreciably higher risk of SCD. This enriched cohort represents candidates for additional nuanced and selective screening techniques to further quantify SCD risk.