Coronary Flow Reserve and Myocardial Resistance Reserve Changes After Transcatheter Aortic Valve Implantation in Aortic Stenosis.

Aortic valve stenosis (AS) induces an alteration in hemodynamic conditions that are responsible for coronary microvasculature impairment. Relief of AS by transcatheter aortic valve implantation (TAVI) is expected to improve the coronary artery hemodynamic. We aimed to assess the midterm effects of TAVI in coronary flow reserve (CFR) and myocardial resistance reserve (MRR) by a continuous intracoronary thermodilution technique. At-rest and hyperemic coronary flow was measured by a continuous thermodilution technique in 23 patients with AS and compared with that in 17 matched controls, and repeated 6 ± 3 months after TAVI in 11 of the patients with AS. In patients with AS, absolute coronary flow at rest was significantly greater, and absolute resistance at rest was significantly less, than in controls (p <0.01 for both), causing less CFR and MRR (1.73 ± 0.4 vs 2.85 ± 1.1, p <0.01 and 1.95 ± 0.4 vs 3.22 ± 1.4, p <0.01, respectively). TAVI implantation yielded a significant 35% increase in CFR (p >0.01) and a 39% increase in MRR (p <0.01) driven by absolute coronary flow at rest reduction (p = 0.03). In patients with AS, CFR and MRR determined by continuous thermodilution are significantly impaired. At 6-month follow-up, TAVI improves these indexes and partially relieves the pathophysiologic alterations, leading to a partial restoration of CFR and MRR.

Ratio of Acceleration Time to Ejection Time for Assessing Aortic Stenosis Severity.

BACKGROUND: Inconsistencies in the grading of aortic valve stenosis are frequent (24-38%). Guidelines highlight the waveform shape when discrepancies are present. Our aim was to evaluate the severity of aortic stenosis by the ratio of acceleration time to ejection time (AT/ET). METHODS: Between January 2011 and January 2013, patients with at least moderate aortic stenosis (valve area < 1.5 cm(2) ) evaluated in our echocardiography laboratory were enrolled. Clinical data were recorded including symptoms attributable to aortic stenosis. Quantitative echocardiographic Doppler parameters as ejection dynamics (ejection time and acceleration time) and conventional parameters, and usual laboratory test including natriuretic peptides (NT-proBNP) were analyzed. RESULTS: One hundred eight patients with aortic valve stenosis were recruited (mean age 77 ± 7 years; 57% women). Comorbidity of the patients was frequent: 85% hypertension, 59% diabetes, 31% chronic renal failure, 26% smokers, mean body mass index 30.0 ± 6.6 kg/m(2) . Ninety-six patients (90%) were symptomatic at the index visit. Using a cutoff of 0.35, AT/ET had a sensitivity of 77% and a specificity of 100% to discriminate symptomatic patients. Serum value of NT-proBNP was higher in patients with AT/ET > 0.35 (9885 ± 3111 vs. 2600 ± 1175, P < 0.001). This ratio showed a good correlation with indexed left ventricle mass (r = 0.60, P < 0.001), DVI (r = -0.56, P < 0.001), and AVA (r = -0.49, P < 0.001). CONCLUSIONS: Ejection dynamics through aortic valve, particularly AT/ET ratio, is a useful tool for assessing aortic stenosis severity, with a good correlation with flow-independent parameters in aortic stenosis.

A home-based treadmill training reduced epicardial and abdominal fat in postmenopausal women with metabolic syndrome.

INTRODUCTION: The current study was designed to determine the effect of home-based treadmill training on epicardial and abdominal adipose tissue in postmenopausal women with metabolic syndrome (MS). A secondary objective was to identify significant correlations between imaging and conventional anthropometric parameters. MATERIAL AND METHODS: Sixty postmenopausal women with MS volunteered for the current trial. Thirty were randomly assigned to perform a supervised home-based 16-week treadmill training program, 3 sessions/week, consisting of a warm-up, 30-40 min treadmill exercise (increasing 5-minutes each 4-weeks) at a work intensity of 60-75% of peak heart rate (increasing 5% each 4-weeks) and cooling-down. Epicardial fat thickness (EFT) was assessed by echocardiography. Abdominal fat mass in the lumbar regions L1-L4 and L4-L5 was determined by dual X-ray absorptiometry. RESULTS: Epicardial fat thickness and abdominal fat percentages were significantly improved after the completion of the training program. Another striking feature of the current study was the moderate correlation that was found between EFT and waist circumference (WC). CONCLUSION: Home-based treadmill training reduced epicardial and abdominal fat in postmenopausal women with MS. A secondary finding was that a moderate correlation was found between EFT and WC. While current investigations are promising, future studies are still required to consolidate this approach in clinical application.

Introducción: El presente estudio se diseñó para conocer la influencia de un programa de entrenamiento aeróbico domiciliario en la masa grasa epicárdica y abdominal de mujeres postmenopausicas con síndrome metabólico (SM). Un segundo objetivo fue identificar correlaciones significativas entre las variables antropométricas ensayadas. Material y Método: Participaron voluntariamente un total de 60 mujeres postmenopausicas con diagnóstico de SM que se distribuyeron aleatoriamente en el grupo de intervención (n=30) o control (n=30). El programa de intervención, desarrollado en el domicilio, consistió en un entrenamiento en tapiz rodante de 16 semanas, 3 sesiones/ semana. La parte principal se realizó a una intensidad del 60-75%FCmax (incrementando 5% cada 4 semanas) durante 30-40 minutos (incrementando 5-minutos cada 4-semanas). La masa grasa epicárdica se determinó mediante ecocardiografía. La masa grasa abdominal de las regiones de interés L1-L4 y L4-L5 se determinó mediante densitometría. Resultados: Se observó un descenso significativo tanto de la masa grasa epicárdica como abdominal tras completar el entrenamiento. Se identificó una correlación moderada entre la masa grasa epicárdica y el perímetro de la cintura de las participantes que podría facilitar su seguimiento clínico. Conclusión: Un programa de entrenamiento de resistencia redujo la masa grasa epicárdica y abdominal. Futuros estudios en esta línea son aún necesarios.

Elevated serum neopterin levels and adverse cardiac events at 6 months follow-up in Mediterranean patients with non-ST-segment elevation acute coronary syndrome.

BACKGROUND: Little information exists regarding the prognostic role of biomarkers of inflammation in Mediterranean patients. High C-reactive protein and neopterin levels - a marker of macrophage activation - predict cardiovascular events in stable angina patients and patients with acute coronary syndromes (ACS). We sought to assess whether plasma neopterin levels predict adverse clinical outcomes in Mediterranean patients with non-ST elevation (NSTE) ACS, i.e. unstable angina (UA) and NSTE myocardial infarction (MI). METHODS: We prospectively assessed 397 patients (74% men) admitted with NSTEACS, 147 (37%) had unstable angina and 250 (63%) NSTEMI. Blood samples for neopterin and CRP assessment were obtained at admission. The study endpoint was the composite of cardiac death, acute myocardial infarction and unstable angina at 180 days. RESULTS: Baseline neopterin concentrations (nmol/L) were similar in unstable angina and NSTEMI patients (8.3 [6.6-10.7] vs. 7.9 [6.2-10.9]; p=0.4). Fifty-nine patients (14.9%) had events during follow-up. Twenty-nine (21.5%) patients with neopterin levels in the highest third experienced the combined endpoint, compared to 30 (11.5%) patients with neopterin levels in the second and the lowest thirds (log-rank 7.435, p=0.024). On multivariable hazard Cox regression, neopterin (highest vs. 1st and 2nd thirds, HR 1.762, 95% CI [1.023-3.036]) was independently associated with the combined endpoint. CONCLUSION: Increased neopterin levels are an independent predictor of 180-day adverse cardiac events in Mediterranean patients with NSTEACS.