Renin-Angiotensin System Inhibition Following Transcatheter Aortic Valve Replacement.

BACKGROUND: Several studies have demonstrated the benefits of transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis, but the presence of persistent fibrosis and myocardial hypertrophy has been related to worse prognosis. OBJECTIVES: The aim of this study was to explore the potential benefits of renin-angiotensin system (RAS) inhibitors on left ventricular remodeling and major clinical outcomes following successful transcatheter aortic valve replacement (TAVR). METHODS: Patients from 10 institutions with severe aortic stenosis who underwent TAVR between August 2007 and August 2017 were included. All baseline data were prospectively recorded, and pre-specified follow-up was performed. Doses and types of RAS inhibitors at discharge were recorded, and matched comparison according to their prescription at discharge was performed. RESULTS: A total of 2,785 patients were included. Patients treated with RAS inhibitors (n = 1,622) presented similar surgical risk scores but a higher rate of all cardiovascular risk factors, coronary disease, and myocardial infarction. After adjustment for these baseline differences, reduction of left ventricular volumes and hypertrophy was greater and cardiovascular mortality at 3-year follow-up was lower (odds ratio: 0.59; 95% confidence interval: 0.41 to 0.87; p = 0.007) in patients treated with RAS inhibitors. Moreover, RAS inhibitors demonstrated a global cardiovascular protective effect with significantly lower rates of new-onset atrial fibrillation, cerebrovascular events, and readmissions. CONCLUSIONS: Post-TAVR RAS inhibitors are associated with lower cardiac mortality at 3-year follow-up and offer a global cardiovascular protective effect that might be partially explained by a positive left ventricular remodeling. An ongoing randomized trial will help confirm these hypothesis-generating findings. (Renin-Angiotensin System Blockade Benefits in Clinical Evolution and Ventricular Remodeling After Transcatheter Aortic Valve Implantation [RASTAVI]; NCT03201185).

Predictores de esterilidad de la válvula aórtica tras endocarditis infecciosa aórtica. Análisis preliminar de potenciales candidatos para TAVI / Predictors of sterile aortic valve following aortic infective endocarditis. Preliminary analysis of potential candidates for TAVI

No disponible

Unsupervised 4D myocardium segmentation with a Markov Random Field based deformable model.

A stochastic deformable model is proposed for the segmentation of the myocardium in Magnetic Resonance Imaging. The segmentation is posed as a probabilistic optimization problem in which the optimal time-dependent surface is obtained for the myocardium of the heart in a discrete space of locations built upon simple geometric assumptions. For this purpose, first, the left ventricle is detected by a set of image analysis tools gathered from the literature. Then, the segmentation solution is obtained by the Maximization of the Posterior Marginals for the myocardium location in a Markov Random Field framework which optimally integrates temporal-spatial smoothness with intensity and gradient related features in an unsupervised way by the Maximum Likelihood estimation of the parameters of the field. This scheme provides a flexible and robust segmentation method which has been able to generate results comparable to manually segmented images for some derived cardiac function parameters in a set of 43 patients affected in different degrees by an Acute Myocardial Infarction.