Aortic stenosis and right ventricular dysfunction.

At the present time, right ventricular function in patients with aortic stenosis is insufficiently taken into account in the decision-making process of aortic valve replacement. The aim of our study was to evaluate significance of right ventricular dysfunction in patients with severe aortic stenosis by modern 3D echocardiographic methods. This is prospective analysis of 68 patients with severe high and low-gradient aortic stenosis. We evaluated function of left and right ventricle on the basis of 3D reconstruction. Enddiastolic, endsystolic volumes, ejection fraction and stroke volumes of both chambers were assessed. There were more patients with right ventricular dysfunction in low-gradient group (RVEF < 45%) than in the high-gradient group (63.6% vs 39%, p = 0.02). Low-gradient patients had worse right ventricular function than high-gradient patients (RVEF 36% vs 46%, p = 0.02). There wasn't any significant correlation between the right ventricular dysfunction and pulmonary hypertension (r = - 0.25, p = 0.036). There was significant correlation between left and right ejection fraction (r = 0.78, p < 0.0001). Multiple regression analysis revealed that the only predictor of right ventricular function is the left ventricular function. According to our results we can state that right ventricular dysfunction is more common in patients with low-gradient than in high-gradient aortic stenosis and the only predictor of right ventricular dysfunction is left ventricular dysfunction, probably based on ventriculo-ventricular interaction. Pulmonary hypertension in patients with severe AS does not predict right ventricular dysfunction.

Vitamin D insufficiency is not associated with thyroid autoimmunity in Slovak women with Hashimoto´s disease.

The role of vitamin D (VD) in the etiopathogenesis of autoimmune diseases (AI) is extensively studied. However, its association with autoimmune thyroid disease (AITD) is still controversial. AIM of this study was to assess the relationship between the vitamin D status and thyroid autoimmunity in Slovak premenopausal women with newly diagnosed AITD. SUBJECTS AND METHODS: This prospective case-control study included 57 women with AITD and 41 age- and BMI-matched controls. All subjects were examined for summer and winter serum 25(OH)D, thyroid autoantibodies (a-TPO, a-TG), freeT4 and TSH concentrations. Thyroid volume was measured by ultrasound. RESULTS: There were no significant differences in serum 25(OH)D between AITD and control groups. No significant correlation between 25(OH)D and thyroid autoantibodies was found either in the whole cohort or in AITD women. The prevalence of vitamin D insufficiency was 60.31 % in AITD women and 52.5 % in the control group. No significant association between VD and thyroid autoantibodies, thyroid hormones and thyroid volume was detected in this study. CONCLUSION: Authors conclude that VD insufficiency is common in Slovak premenopausal women independently of the presence of AITD. Vitamin D insufficiency is not associated with thyroid autoimmunity in patients with early diagnosis of AITD (Tab. 3, Ref. 31). Text in PDF www.elis.sk Keywords: vitamin D, autoimmune thyroid disease, thyroid autoantibodies.

Gut microbiome in heart failure and aortic stenosis.

The gut microbiome is linked to the development of individual diseases. Patients with congestive heart failure (HF) develop intestinal wall edema due to venous congestion, which impairs absorption function and allows bacterial overgrowth. Consequently, the pathogenous bacterial strains produce many harmful substances, including trimethylamine N-oxide (TMAO) and endotoxin (LPS - lipopolysaccharide), which lead to deterioration of HF. These discoveries led to hypothesis about the heart-bowel axis. High levels of TMAO present in patients with HF predispose to higher long-term mortality, even after correlation with traditional risk factors and cardiorenal indices. Most LPS is generated by the intestinal microbiome, and the osteogenic response in aortic stenosis to LPS stimulation of valve interstitial cells (VIC) is closely linked to inflammation and immunity. Thus, the concentration of intestinal microbiome research may provide new insights into the investigation of new therapeutic targets for HF and aortic stenosis.

Aortic stenosis and right ventricular dysfunction.

Cardiac damage in severe aortic stenosis (AS) is not limited to the aortic valve and left ventricle, but is a systemic disease characterized by a significant alteration in cardiac structure and function. Therefore, a new classification of AS based on the degree of myocardial damage was proposed. A significant number of patients with AS have right ventricular dysfunction likely due to ventricular interdependence. Relationship between right ventricular dysfunction and increased mortality in both symptomatic and asymptomatic patients with severe AS was demonstrated. These patients could benefit more from intervention. Therefore, a standardized echocardiographic examination of a patients with severe aortic stenosis should provide a detailed analysis of right ventricular function.