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INTRODUCTION: Prior investigations assessing the impact of race/ethnicity on outcomes after mitral valve (MV) surgery have reported conflicting findings. This analysis aimed to examine the association between race/ethnicity and operative presentation and outcomes of patients undergoing MV and tricuspid valve (TV) surgery. METHODS: We retrospectively analyzed 5984 patients (2730 female, median age 63 y) who underwent MV (n = 4,534, 76%), TV (n = 474, 8%) or both MV and TV (n = 976, 16%) surgery in a statewide collaborative from 2012 to 2021. The influence of race/ethnicity on preoperative characteristics, MV and TV repair rates, and postoperative outcomes was assessed for White (n = 4,244, 71%), Black (n = 1,271, 21%), Hispanic (n = 144, 2%), Asian (n = 171, 3%), and mixed/other race (n = 154, 3%) patients. RESULTS: Black patients, compared to White patients, had higher Society of Thoracic Surgeons predicted risk of morbidity/mortality (24.5% versus 13.1%; P < 0.001) and more comorbid conditions. Compared to White patients, Black and Hispanic patients were less likely to undergo an elective procedure (White 71%, Black 55%, Hispanic 58%; P < 0.001). Degenerative MV disease was more prevalent in White patients (White 62%, Black 41%, Hispanic 43%, Asian 51%, mixed/other 45%; P < 0.05), while rheumatic disease was more prevalent in non-White patients (Asian 28%, Hispanic 26%, mixed/other 25%, Black 17%, White 10%;P < 0.05). After multivariable adjustment, repair rates and adverse postoperative outcomes, including mortality, did not differ by racial/ethnic group. CONCLUSIONS: Patient race/ethnicity is associated with a higher burden of comorbidities at operative presentation and MV disease etiology. Strategies to improve early detection of valvular heart disease and timely referral for surgery may improve outcomes.
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Valva Mitral , Valva Tricúspide , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Etnicidade , Disparidades em Assistência à Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Doenças das Valvas Cardíacas/cirurgia , Doenças das Valvas Cardíacas/etnologia , Valva Mitral/cirurgia , Complicações Pós-Operatórias/etnologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/cirurgia , Negro ou Afro-Americano , Asiático , Hispânico ou Latino , BrancosRESUMO
Valvular heart disease (VHD) is a major global public health problem. Many regions of the world continue to grapple with the adverse consequences of untreated rheumatic heart disease, a condition that is largely preventable with timely access to diagnosis and treatment. In turn, middle- and high-income countries have experienced a rise in the prevalence of calcific aortic and mitral disease, owing in part to population aging. This public health problem is further compounded by high rates of infective endocarditis, which is associated with substantial morbidity and mortality. Yet, considerations of race and ethnicity have not taken center stage in VHD research. This is despite evidence of major health care disparities in socioeconomic and medical risk factors, access to diagnosis, and provision of appropriate treatment. In this paper, the authors review differences in the etiology, diagnosis, and treatment of VHD within the context of race, ethnicity, and health care disparities.
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Etnicidade , Doenças das Valvas Cardíacas/etnologia , Publicações Periódicas como Assunto , Grupos Raciais , Saúde Global , Humanos , Incidência , Prevalência , Fatores de RiscoRESUMO
ABSTRACT: Warfarin is a commonly prescribed anticoagulant for valvular heart disease that plays an important role in clinical management to prevent thrombotic events. In this study, we aim to perform a comprehensive study to investigate the genetic biomarkers of stable warfarin dose in the Han Chinese population. We performed an integrative study on 211 Han Chinese patients with valvular heart disease. A total of 40 single nucleotide polymorphisms (SNPs) in 10 important genes (CYP2C9, VKORC1, ABCB1, CYP4F2, APOE, PROC, GGCX, EPHX1, CALU, and SETD1A) which are involved in the warfarin metabolic pathway and equilibrium of coagulation and anticoagulation were selected. We applied MassARRAY technology to genotype the 40 SNPs identified in these Han Chinese patients. Our results showed that 13 SNPs on 6 genes (CYP2C9, VKORC1, ABCB1, PROC, EPHX1, and SETD1A) were associated with the individual stable warfarin dose. Two VKORC1 SNPs (rs9934438 and rs2359612) were the strongest genetic factors determining warfarin dose requirements (P = 8 × 10-6 and 9 × 10-6, respectively). Rs4889599 in SETD1A was first reported to be associated with warfarin dose at a significant level of 0.001 in our study (Padjust = 0.040 after Bonferroni correction). We discovered that genetic variants in CYP2C9, VKORC1, ABCB1, PROC, EPHX1, and SETD1A may affect the stable warfarin dose requirement in Han Chinese patients with valvular disease. The discovery of these potential genetic markers will facilitate the development of advanced personalized anticoagulation therapy in Han Chinese patients.
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Anticoagulantes/administração & dosagem , Povo Asiático/genética , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Variantes Farmacogenômicos , Polimorfismo de Nucleotídeo Único , Tromboembolia/prevenção & controle , Varfarina/administração & dosagem , Adulto , Idoso , Anticoagulantes/efeitos adversos , Anticoagulantes/farmacocinética , China/epidemiologia , Tomada de Decisão Clínica , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/etnologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Farmacogenética , Testes Farmacogenômicos , Valor Preditivo dos Testes , Fatores de Risco , Tromboembolia/diagnóstico , Tromboembolia/etnologia , Fatores de Tempo , Resultado do Tratamento , Varfarina/efeitos adversos , Varfarina/farmacocinéticaRESUMO
The value of echocardiography in the screening of athletes in addition to the electrocardiogram is debated and still unclear. 336 rugby players in French professional divisions (Top 14, Pro D2) were prospectively assessed with electrocardiogram and echocardiography. 75% were Caucasian, 16.4% Pacific Islanders, and 8.6% Afro-Caribbean. Six (1.8%) players had electrocardiogram abnormalities, exclusively negative T waves. Twenty-one (6.25%) of them had abnormal echocardiography findings: one possible early hypertrophic cardiomyopathy, one anomalous origin of coronary artery, two left ventricular dilatations, one isolated bicuspid aortic valve, two aortic regurgitations, and 14 ascending aortic dilatations. The median aortic diameter was modestly correlated with age: 32 mm [23-48] in players aged ≤25 years vs 33.5 mm [24-50] in those aged >25 years (P = 0.02, correlation coefficient -.01). This tendency increased with cumulative hours of weight training: 34 mm [24-50] in forwards vs 32 mm [25-44] in backs (P = 0.01); and ethnicity, with Pacific Islanders having higher values in both raw data and body surface area or height-indexed data than Afro-Caribbeans and Caucasians: 34 [25-50] vs 32 [27-48] and 33 [23-49] mm (P = 0.017); 15 [12.2-21] vs 14.8 [11-19.9] and 14.8 [10-20.9] mm/m2 (P < 0.0001); 18.5 [14-25] mm/m vs 17.4 [14.8-25] mm/m and 17.6 [12.2-25.3] mm/m (P = 0.0125). In a population of professional rugby players, echocardiography was contributive. The main anomaly was aortic dilatation (14/336, 4.2%). While this is proportionally much higher than in other sports, the cutoffs need to be defined more precisely by including the criterion of ethnicity, as is already the case for electrocardiography.
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Aorta/diagnóstico por imagem , Aorta/patologia , Dilatação Patológica/diagnóstico por imagem , Ecocardiografia , Futebol Americano/fisiologia , Adulto , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/etnologia , Comportamento Competitivo/fisiologia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/etnologia , Dilatação Patológica/etnologia , Eletrocardiografia , França , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/etnologia , Humanos , Masculino , Estudos Prospectivos , Treinamento Resistido , Adulto JovemRESUMO
BACKGROUND: Lipoprotein (a) [Lp(a)] is a risk factor for coronary heart disease and calcific aortic valve disease. We determined the relationships of Lp(a) with prevalence and progression of coronary artery calcification (CAC), mitral annular calcification (MAC), and thoracic aortic calcification (TAC) in a multi-ethnic cohort of middle to older-aged adults. METHODS: This analysis included 6705 Multi-Ethnic Study of Atherosclerosis participants. Lp(a) was measured with a turbidimetric immunoassay. CAC, MAC, and TAC were assessed by cardiac computed tomography both at baseline and once during follow-up. RESULTS: In adjusted relative risk regression cross-sectional analysis, a Lp(a) level ≥50 âmg/dL was associated with a 22% higher prevalence of MAC (relative risk (RR) â= â1.22, 95% confidence interval (CI) 1.00, 1.49). No significant associations were observed for prevalent CAC or TAC. In adjusted prospective analyses, participants with Lp(a) ≥50 âmg/dL were at significantly higher risk for rapid CAC progression (median follow-up â= â8.9 years), defined as ≥100 units/year, compared to those with lower Lp(a) levels (RR â= â1.67, 95% CI â= â1.23, 2.27). The association between higher Lp(a) levels and incident CHD was no longer significant after adjusting for CAC progression. No significant associations were observed for MAC or TAC progression (median follow-up â= â2.6 years). CONCLUSIONS: Higher Lp(a) levels are associated with more rapid CAC progression. Additional study is needed to better understand how this relationship can further improve the ability of Lp(a) to enhance cardiovascular disease risk prediction.
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Aorta Torácica , Doenças da Aorta/sangue , Calcinose/sangue , Doença da Artéria Coronariana/sangue , Doenças das Valvas Cardíacas/sangue , Lipoproteína(a)/sangue , Valva Mitral , Calcificação Vascular/sangue , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etnologia , Biomarcadores/sangue , Calcinose/diagnóstico por imagem , Calcinose/etnologia , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etnologia , Estudos Transversais , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/etnologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Prevalência , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/etnologiaRESUMO
AIMS: The risk of HeartMate II (HMII) left ventricular assist device (LVAD) thrombosis has been reported, and serum lactate dehydrogenase (LDH), a biomarker of haemolysis, increases secondary to LVAD thrombosis. This study evaluated longitudinal measurements of LDH post-LVAD implantation, hypothesizing that LDH trends could timely predict future LVAD thrombosis. METHODS AND RESULTS: From October 2004 to October 2014, 350 HMIIs were implanted in 323 patients at Cleveland Clinic. Of these, patients on 339 HMIIs had at least one post-implant LDH value (7996 total measurements). A two-step joint model combining longitudinal biomarker data and pump thrombosis events was generated to assess the effect of changing LDH on thrombosis risk. Device-specific LDH trends were first smoothed using multivariate boosted trees, and then used as a time-varying covariate function in a multiphase hazard model to analyse time to thrombosis. Pre-implant variables associated with time-varying LDH values post-implant using boostmtree were also investigated. Standardized variable importance for each variable was estimated as the difference between model-based prediction error of LDH when the variable was randomly permuted and prediction error without permuting the values. The larger this difference, the more important a variable is for predicting the trajectory of post-implant LDH. Thirty-five HMIIs (10%) had either confirmed (18) or suspected (17) thrombosis, with 15 (43%) occurring within 3 months of implant. LDH was associated with thrombosis occurring both early and late after implant (P < 0.0001 for both hazard phases). The model demonstrated increased probability of HMII thrombosis as LDH trended upward, with steep changes in LDH trajectory paralleling trajectories in probability of pump thrombosis. The most important baseline variables predictive of the longitudinal pattern of LDH were higher bilirubin, higher pre-implant LDH, and older age. The effect of some pre-implant variables such as sodium on the post-implant LDH longitudinal pattern differed across time. CONCLUSIONS: Longitudinal trends in surveillance LDH for patients on HMII support are useful for dynamic prediction of pump thrombosis, both early after implant and late. Incorporating upward and downward trends in LDH that dynamically update a model of LVAD thrombosis risk provides a useful tool for clinical management and decisions.
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Doenças das Valvas Cardíacas/cirurgia , Coração Auxiliar/efeitos adversos , L-Lactato Desidrogenase/sangue , Isquemia Miocárdica/cirurgia , Trombose/etiologia , Adulto , Idoso , Bilirrubina/sangue , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Doenças das Valvas Cardíacas/etnologia , Coração Auxiliar/estatística & dados numéricos , Hemólise/fisiologia , Humanos , Doença Iatrogênica/epidemiologia , Doença Iatrogênica/prevenção & controle , Análise de Intenção de Tratamento/tendências , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/etnologia , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
OBJECTIVE: To explore the burden and clinical correlates of valvular heart disease in Hispanics/Latinos in the United States. PATIENTS AND METHODS: A total of 1818 individuals from the population-based study of Latinos/Hispanics from 4 US metropolitan areas (Bronx, New York; Chicago, Illinois; San Diego, California; and Miami, Florida) underwent a comprehensive clinical and echocardiographic examination from October 1, 2011, through June 24, 2014. Logistic regression analysis was used to examine the associations of clinical and sociodemographic variables with valvular lesions. RESULTS: The mean age was 55.2±0.2 years; 57.4% were female. The prevalence of any valvular heart disease (AVHD) was 3.1%, with no considerable differences across sex, and a higher prevalence with increasing age. The proportion of US-born vs foreign-born individuals was similar in those with vs without AVHD (P=.31). The weighted prevalence of AVHD was highest in Central Americans (8.4%) and lowest in Mexicans (1.2%). Regurgitant lesions of moderate or greater severity were present in 2.4% of the population and stenotic lesions of moderate or greater severity in 0.2%. Compared with those without AVHD, individuals with AVHD were more likely to have health insurance coverage (59.6% vs 79.2%; P=.007) but similar income (P=.06) and educational status (P=.46). Univariate regression models revealed that regurgitant lesions were associated with lower body mass index whereas stenotic lesions were associated with higher body mass index. CONCLUSION: Our data provide the first population-based estimates of the prevalence of valvular heart disease in Hispanic/Latinos. Valvular heart disease is fairly common in the Hispanic/Latino population and may constitute an important public health problem.
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Efeitos Psicossociais da Doença , Ecocardiografia/métodos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/etnologia , Hispânico ou Latino/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Estudos de Coortes , Feminino , Seguimentos , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo , Estados Unidos , População UrbanaAssuntos
Ecocardiografia , Disparidades em Assistência à Saúde/etnologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/etnologia , Adulto , Negro ou Afro-Americano , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etnologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/etnologia , Bases de Dados Factuais , Feminino , Humanos , Cobertura do Seguro , Masculino , Medicaid , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/etnologia , Valor Preditivo dos Testes , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Background: Transcatheter aortic valve replacement (TAVR) has been shown safe and feasible in patients with bicuspid aortic valve (BAV) morphology. Evaluation of inter-ethnic differences in valve morphology and function and aortic root dimensions in patients with BAV is important for the worldwide spread of this therapy in this subgroup of patients. Comparisons between large European and Asian cohorts of patients with BAV have not been performed, and potential differences between populations may have important implications for TAVR. Aim: The present study evaluated the differences in valve morphology and function and aortic root dimensions between two large cohorts of European and Asian patients with BAV. Methods and results: Aortic valve morphology was defined on transthoracic echocardiography according to the number of commissures and raphe: type 0 = no raphe and two commissures, type 1 = one raphe and two commissures, type 2 = two raphes and one commissure. Aortic stenosis and regurgitation were graded according to current recommendations. For this study, aortic root dimensions were manually measured on transthoracic echocardiograms at the level of the aortic annulus, sinus of Valsalva (SOV), sinotubular junction (STJ), and ascending aorta (AA). Of 1427 patients with BAV (45.2 ± 18.1 years, 71.9% men), 794 (55.6%) were Europeans and 633 (44.4%) were Asians. The groups were comparable in age and proportion of male sex. Asians had higher prevalence of type 1 BAV with raphe between right and non-coronary cusps than Europeans (19.7% vs. 13.6%, respectively; P < 0.001), whereas the Europeans had higher prevalence of type 0 BAV (two commissures, no raphe) than Asians (14.5% vs. 6.8%, respectively; P < 0.001). The prevalence of moderate and severe aortic regurgitation was higher in Europeans than Asians (44.2% vs. 26.8%, respectively; P < 0.001) whereas there were no differences in BAV with normal function or aortic stenosis. After adjusting for demographics, comorbidities, and valve function, the dimensions of the aortic annulus [mean difference 1.17 mm/m2, 95% confidence interval (CI) 0.96-1.39], SOV (mean difference 1.86 mm/m2, 95% CI 1.47-2.24), STJ (mean difference 0.52 mm/m2, 95% CI 0.14-0.90) and AA (mean difference 1.05 mm/m2, 95% CI 0.57-1.52) were significantly larger among Asians compared with Europeans. Conclusions: This large multicentre registry reports for the first time that Asians with BAV showed more frequently type 1 BAV (with fusion between right and non-coronary cusp) and have larger aortic dimensions than Europeans. These findings have important implications for prosthesis type and size selection for TAVR.
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Valva Aórtica/anormalidades , Valva Aórtica/anatomia & histologia , Valva Aórtica/patologia , Doenças das Valvas Cardíacas/etnologia , Doenças das Valvas Cardíacas/cirurgia , Adulto , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/epidemiologia , Insuficiência da Valva Aórtica/etnologia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/etnologia , Estenose da Valva Aórtica/cirurgia , Povo Asiático/etnologia , Doença da Válvula Aórtica Bicúspide , Ecocardiografia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Seio Aórtico/anatomia & histologia , Seio Aórtico/diagnóstico por imagem , Substituição da Valva Aórtica Transcateter/métodos , População Branca/etnologiaRESUMO
BACKGROUND: Long-term exposure to high ambient air pollution has been associated with coronary artery calcium (CAC), a marker of cardiovascular disease (CVD). Calcifications of left-sided heart valves are also markers of CVD risk. We investigated whether air pollution was associated with valvular calcification and its progression. METHODS: We studied 6253 MESA participants aged 45-84 years who underwent two cardiac CT scans 2.5 years apart to quantify aortic valve calcium (AVC) and mitral annular calcium (MAC). CAC was included for the same timeframe for comparison with AVC/MAC. Ambient particulate matter <2.5 µm (PM2.5) and oxides of nitrogen (NOx) concentrations were predicted from residence-specific spatio-temporal models. RESULTS: The mean age (SD) of the study sample was 62 (10) years, 39% were white, 27% black, 22% Hispanic, and 12% Chinese. The prevalence of AVC and MAC at baseline were 13% and 9% respectively, compared to 50% prevalence of CAC. The adjusted prevalence ratios of AVC and MAC for each 5 µg/m3 higher PM2.5 was 1.19 (95% CI 0.87, 1.62) and 1.20 (0.81, 1.77) respectively, and for CAC was 1.14 (1.01, 1.27). Over 2.5 years, the mean change in Agatston units/year for each 5 µg/m3 higher PM2.5 concentration was 0.29 (-5.05, 5.63) for AVC and 4.38 (-9.13, 17.88) for MAC, compared to 8.66 (0.61, 16.71) for CAC. We found no significant associations of NOx with AVC and MAC. CONCLUSION: Our findings suggest a trend towards increased 2.5-year progression of MAC with exposure to outdoor PM2.5, although this association could not be confirmed. Additional well-powered studies with longer periods of follow-up are needed to further study associations of air pollution with valvular calcium. TRIAL REGISTRATION: Although MESA is not a clinical trial, this cohort is registered at ClinicalTrials.gov Identifier: NCT00005487; Date of registration May 25, 2000.
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Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Calcinose/etiologia , Exposição Ambiental/efeitos adversos , Doenças das Valvas Cardíacas/etiologia , Valva Mitral/efeitos dos fármacos , Material Particulado/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/efeitos dos fármacos , Aterosclerose , Calcinose/diagnóstico por imagem , Calcinose/etnologia , Exposição Ambiental/análise , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/etnologia , Hispânico ou Latino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Óxidos de Nitrogênio/análise , Material Particulado/análise , Grupos Raciais , Tomografia Computadorizada por Raios XRESUMO
Serum 25-hydroxyvitamin D [25(OH)D] concentration has been identified as a possible modifiable risk factor for cardiovascular disease (CVD). We hypothesized that serum 25(OH)D concentration would be associated with calcifications of the left-sided heart valves, which are markers of CVD risk. Aortic valve calcium (AVC) and mitral annular calcium (MAC) were quantified from cardiac computed tomography scans performed on 5,530 Multi-Ethnic Study of Atherosclerosis participants at the baseline examination (2000 to 2002) and at a follow-up visit at either Examination 2 (2002 to 2004) or Examination 3 (2004 to 2005). 25(OH)D was measured from serum samples collected at the baseline examination. Using relative risk regression, we evaluated the multivariable-adjusted risk of prevalent and incident AVC and MAC in this ethnically diverse population free of clinical CVD at baseline. The mean age of participants was 62 ± 10 years; 53% were women, 40% white, 26% black, 21% Hispanic, and 12% Chinese. Prevalent AVC and MAC were observed in 12% and 9% of study sample, respectively. There were no significant associations between 25(OH)D and prevalent AVC or MAC. Over a mean follow-up of 2.5 years, 4% developed incident AVC and 5% developed incident MAC. After adjusting for demographic variables, each 10 ng/ml higher serum 25(OH)D was associated with a 15% (relative risk 0.85, 95% confidence interval 0.74 to 0.98) lower risk of incident MAC but not AVC. However, this association was no longer significant after adjusting for lifestyle and CVD risk factors. Results suggest a possible link between serum 25(OH)D and the risk for incident MAC, but future studies with longer follow-up are needed to further test this association.
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Valva Aórtica/diagnóstico por imagem , Aterosclerose/sangue , Calcinose/etiologia , Etnicidade , Doenças das Valvas Cardíacas/etiologia , Valva Mitral/diagnóstico por imagem , Vitamina D/análogos & derivados , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/etnologia , Aterosclerose/metabolismo , Calcinose/etnologia , Calcinose/metabolismo , Cálcio/metabolismo , Feminino , Seguimentos , Doenças das Valvas Cardíacas/etnologia , Doenças das Valvas Cardíacas/metabolismo , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Estados Unidos/epidemiologia , Vitamina D/sangueRESUMO
BACKGROUND: Valvular heart diseases (VHD) is very common in clinical practice and has became the subject of growing attention in the field of cardiovascular medicine. Our aim was to assess the prevalence and correlates of VHD in the general population in Xinjiang, China. METHODS: Using a 4-stage stratified cluster random sampling method, a total of 14618 participants were recruited in the Cardiovascular Risk Survey (CRS) study. The participants' personal information, medical history were assessed by questionnaire. VHD was diagnosed by transthoracic echocardiography. We carried out the statistical analysis utilizing SPSS Statistics version 19.0. RESULTS: In the total study group, VHD was observed in 1397 (9.65%) individuals. The prevalence rates of VHD in Han, Uygur and Kazak group are 13.51%, 2.71% and 12.29% respectively. The prevalence rates of VHD increased strikingly with age (all P < 0.001). The results of multinomial regression analysis indicated that VHD were related to age in Han group, to age smoking and hypertension in Uygur group, to age and hypertension in Kazak group. CONCLUSION: Our research provides a unique prevalence rate of VHD in Xinjiang natural population. The result suggests that VHD are notably common in this population (9.65%) and increase with age. There exists significant difference of prevalence rate between ethnics. The main risk factors of VHD are age, hypertension and smoking. Valvular heart diseases should be regarded as a serious and growing public-health problem.
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Doenças das Valvas Cardíacas/epidemiologia , Adulto , Distribuição por Idade , Idoso , China/epidemiologia , Feminino , Doenças das Valvas Cardíacas/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores de RiscoRESUMO
BACKGROUND: Atrial fibrillation (AF) is the most common preoperative arrhythmia in heart valve surgery patients and its prevalence is rising. This study aims to investigate the impact of AF on valve surgery early complications and survival and on valve disease of different aetiologies and populations with particular reference to Indigenous Australians with rheumatic heart disease (RHD). METHODS: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to determine the association between preoperative AF and valve surgery outcome. Its association with demographics, co-morbidities, preoperative status and short and long term outcome was assessed. RESULTS: Outcome of 1594 RHD and 19,029 non-RHD-related surgical procedures was analysed. Patients with preoperative AF were more likely to be older, female, Indigenous, to have RHD and to bear a greater burden of comorbidities. Patients with RHD and preoperative AF had a longer hospital stay and were more likely to require reoperation. Adjusted short (OR 1.4, 95% CI 1.2-1.7) and long term (HR 1.5, 95% CI 1.3-1.7) survival was inferior for patients with non-RHD preoperative AF but was no different for Indigenous and non-Indigenous Australians with RHD. CONCLUSIONS: In this prospective Australian study, patients with valve disease and preoperative AF had inferior short and long term survival. This was particularly the case for patients with non-RHD valve disease. Earlier intervention or more aggressive AF management should be investigated as mechanisms for enhancing postoperative outcomes. This may influence treatment choice and the need for ongoing anticoagulation.
Assuntos
Fibrilação Atrial/etnologia , Fibrilação Atrial/cirurgia , Doenças das Valvas Cardíacas/etnologia , Doenças das Valvas Cardíacas/cirurgia , Complicações Pós-Operatórias/etnologia , Complicações Pós-Operatórias/cirurgia , Fatores Etários , Idoso , Fibrilação Atrial/diagnóstico , Austrália/etnologia , Efeitos Psicossociais da Doença , Bases de Dados Factuais , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Havaiano Nativo ou Outro Ilhéu do Pacífico/etnologia , Nova Zelândia/etnologia , Complicações Pós-Operatórias/diagnóstico , Cuidados Pré-Operatórios/tendências , Estudos Prospectivos , Sistema de Registros , Fatores Sexuais , Taxa de Sobrevida/tendênciasRESUMO
BACKGROUND: Globally, rheumatic heart disease (RHD) remains an important cause of heart disease. In Australia it particularly affects younger Indigenous and older non-Indigenous Australians. Despite its impact there is limited understanding of the factors influencing outcome following surgery for RHD. METHODS: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to assess outcomes following surgical procedures for RHD and non-RHD valvular disease. The association with demographics, co-morbidities, pre-operative status, valve(s) affected and operative procedure was evaluated. RESULTS: Outcome of 1384 RHD and 15843 non-RHD valve procedures was analysed. RHD patients had longer ventilation, experienced fewer strokes and had more readmissions to hospital and anticoagulant complications. Mortality following RHD surgery at 30 days was 3.1% (95% CI 2.2 - 4.3), 5 years 15.3% (11.7 - 19.5) and 10 years 25.0% (10.7 - 44.9). Mortality following non-RHD surgery at 30 days was 4.3% (95% CI 3.9 - 4.6), 5 years 17.6% (16.4 - 18.9) and 10 years 39.4% (33.0 - 46.1). Factors independently associated with poorer longer term survival following RHD surgery included older age (OR1.03/additional year, 95% CI 1.01 - 1.05), concomitant diabetes (OR 1.7, 95% CI 1.1 - 2.5) and chronic kidney disease (1.9, 1.2 - 2.9), longer invasive ventilation time (OR 1.7 if greater than median value, 1.1- 2.9) and prolonged stay in hospital (1.02/additional day, 1.01 - 1.03). Survival in Indigenous Australians was comparable to that seen in non-Indigenous Australians. CONCLUSION: In a large prospective cohort study we have demonstrated survival following RHD valve surgery in Australia is comparable to earlier studies. Patients with diabetes and chronic kidney disease, were at particular risk of poorer long-term survival. Unlike earlier studies we did not find pre-existing atrial fibrillation, being an Indigenous Australian or the nature of the underlying valve lesion were independent predictors of survival.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Doenças das Valvas Cardíacas/cirurgia , Valvas Cardíacas/cirurgia , Cardiopatia Reumática/cirurgia , Fatores Etários , Idoso , Austrália/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Distribuição de Qui-Quadrado , Comorbidade , Bases de Dados Factuais , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/etnologia , Doenças das Valvas Cardíacas/mortalidade , Humanos , Estimativa de Kaplan-Meier , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Readmissão do Paciente , Estudos Prospectivos , Respiração Artificial , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/etnologia , Cardiopatia Reumática/mortalidade , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Based on the revised AHA/ACC guidelines, it might be necessary to take into consideration the average life expectancy of Japanese people and revise the Japanese guidelines accordingly. Accordingly, we performed the present study to compare the long-term outcome in patients aged 65 years or older who underwent prosthetic valve replacement at our hospital using mechanical valves or biological valves. METHODS: We have performed valve replacement in 416 patients aged 65 years or older (mechanical: 157; biological: 244). RESULTS: There was no significant difference between the mechanical and biological valve for the actuarial survival rate. As for the valve-related complication free rate, in the mechanical valve group, the rates were significantly higher for all patients, aortic valve replacement (AVR) patients, and mitral valve replacement (MVR) patients. CONCLUSIONS: Following revision of the AHA/ACC guidelines for selection of prosthetic valves, it is necessary to investigate whether patients aged 60-70 represent the gray zone for selecting valves as in US and European guidelines, or whether a higher age is more appropriate in view of the longer average life expectancy in Japan. Accordingly, further evaluation of the long-term outcome for mechanical and biological valves in Japanese patients is needed to obtain evidence for preparation of original Japanese guidelines on prosthetic valve selection.
Assuntos
Povo Asiático , Bioprótese , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valvas Cardíacas/cirurgia , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bioprótese/normas , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/etnologia , Doenças das Valvas Cardíacas/mortalidade , Próteses Valvulares Cardíacas/normas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Implante de Prótese de Valva Cardíaca/normas , Humanos , Japão/epidemiologia , Estimativa de Kaplan-Meier , Expectativa de Vida/etnologia , Masculino , Guias de Prática Clínica como Assunto/normas , Desenho de Prótese , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: We sought to describe the morphological characteristics of aortic valve disease in a Chinese population presenting for transcatheter aortic valve replacement (TAVR). BACKGROUND: Racial and regional differences are known to exist in aortic stenosis (AS), but limited data exist comparing the specific anatomical variations between populations. METHODS: Patients were prospectively evaluated in a Chinese population presenting for TAVR in the Venus A-Valve trial, the first trial evaluating TAVR in China. A systematic anatomical assessment protocol employed contrast-enhanced computed tomography (CT) in all the cases. RESULTS: A total of 120 consecutive patients were studied. Of these, 61 (50.7%) were patients with tricuspid, 57 (47.5%) bicuspid, and 2 (1.7%) unicuspid valve morphologies. Of the 57 cases with bicuspid valve, 31 (54.4%) had no raphe (Sievers classification, type 0) and 26 (45.6%) were of raphe type. Although the incidence of bicuspid valve morphology was more than a third in the northern Chinese population, this was lower than the eastern Chinese population (P = 0.035), in whom the incidence was more than half. A comparison of tricuspid morphologies in China versus a Western series of 229 consecutive patients undergoing TAVR assessed with CT showed a threefold excess of leaflet calcium burden in China, with a leaflet calcium volume of 421 mm(3) (IQR, 188-688 mm(3) ) versus 142 mm(3) (IQR, 58-267 mm(3) ). CONCLUSIONS: Patients presenting for TAVR in China have a very high frequency of bicuspid valve morphology. Even in tricuspid disease, there are clear differences to Western patients, with a high calcium burden, which presents challenges for TAVR in this population (ClinicalTrials.gov NCT01683474).
Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/terapia , Valva Aórtica/anormalidades , Cateterismo Cardíaco , Doenças das Valvas Cardíacas/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/métodos , Tomografia Computadorizada Multidetectores , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/etnologia , Povo Asiático , Doença da Válvula Aórtica Bicúspide , China/epidemiologia , Feminino , Doenças das Valvas Cardíacas/etnologia , Humanos , Incidência , Masculino , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Índice de Gravidade de DoençaRESUMO
OBJECTIVES: The aim of this study was to explore the influence of the characteristics of Japanese patients on the long-term outcomes after aortic valve replacement with either mechanical or biological prostheses by means of a microsimulation. METHODS: A microsimulation model was used to simulate the lives of patients living in Japan and in the United States after aortic valve replacement. The background mortality data taken from the 21st complete life table of Japan and the bleeding hazard determined from a meta-analysis of long-term results in Japanese institutions were used to simulate Japanese patients. The life expectancy, event-free life expectancy, and lifetime risk of structural valve degeneration were calculated. A sensitivity analysis for various bleeding hazards was performed. RESULTS: Regarding the event-free life expectancy, the age crossover points between the two valve types were 64-65 and 57-58 years for Japanese and American patients, respectively. Regarding the life expectancy, the age crossover points were 88-89 and 64-65 years, respectively, for Japanese and American patients. The lifetime risk of structural valve degeneration was higher in Japanese patients than in American patients. The sensitivity analysis showed that the age crossover points were sensitive to the hazard of bleeding complications. CONCLUSIONS: The long-term clinical outcomes after aortic valve replacement were simulated with a microsimulation model. The results indicated that the age crossover points in the advantages and disadvantages between mechanical valves and bioprostheses may be higher in Japanese patients than in American subjects.
Assuntos
Bioprótese/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/mortalidade , Próteses Valvulares Cardíacas/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Simulação por Computador , Feminino , Doenças das Valvas Cardíacas/etnologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Japão/etnologia , Expectativa de Vida/etnologia , Masculino , Pessoa de Meia-Idade , Método de Monte Carlo , Hemorragia Pós-Operatória/etnologia , Hemorragia Pós-Operatória/etiologia , Hemorragia Pós-Operatória/mortalidade , Reoperação/mortalidade , Resultado do Tratamento , Estados Unidos/etnologiaRESUMO
OBJECTIVE: The purpose of the present study was to evaluate the early clinical outcomes of aortic root surgery in the United States. METHODS: The Society of Thoracic Surgeons database was queried to identify all patients who had undergone aortic root replacement from 2004 to early 2010 (n = 13,743). The median age was 58 years (range, 18-96); 3961 were women (29%) and 12,059 were white (88%). The different procedures included placement of a mechanical valve conduit (n = 4718, 34%), stented pericardial (n = 879, 6.4%) or porcine (n = 478, 3.5%) bioprosthesis, stentless root (n = 4309, 31%), homograft (n = 498, 3.6%), and valve sparing root replacement (n = 1918, 14%). RESULTS: The median number of aortic root surgeries per site was 2, and only 5% of sites performed >16 aortic root surgeries annually. An increased trend to use biostented (porcine or pericardial) valves during the study period (7% in 2004 vs 14% in 2009). The operative (raw) mortality was greater among the patients with aortic stenosis (6.2%) who had undergone aortic root replacement, independent of age. Mortality was greater in patients who had undergone concomitant valve or coronary artery bypass grafting or valve surgery (21%). The lowest operative mortality was observed in patients who had undergone aortic valve sparing procedures (1.9%). CONCLUSIONS: Most cardiac centers performed aortic root surgery in small volumes. The unadjusted operative mortality was greater for patients >80 years old and those with aortic stenosis, regardless of age. Valve sparing root surgery was associated with the lowest mortality. A trend was seen toward an increased use of stented tissue valves from 2004 to 2009.