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1.
Ecotoxicol Environ Saf ; 209: 111753, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33348255

RESUMO

Emerging evidence demonstrated that traffic-related air pollution induced adverse effects on cardiovascular system. We designed a population-based cross-sectional study to explore the association between residential proximity to major roadways, traffic density and the prevalence of valvular heart disease (VHD). A total of 34040 subjects from a Rural Health Project between 2013 and 2018 were collected. According to the inclusion and exclusion criteria, 4158 participants were enrolled in the final analysis. And we calculated the subjects' proximity to major roadways and collected the traffic density on the major roadways. Transthoracic echocardiography (TTE) was performed to diagnose the VHD, according to the current AHA/ACC (the American Heart Association and the American College of Cardiology) guidelines. Differences between groups were examined by the one-way ANOVAs for continuous variables and the chi-square tests for categorical variables. A logistic regression models were used to assess the associations. The stratified analysis by age and sex were conducted to further analyze the association. The restricted cubic spline analysis was performed to further evaluate the association between road way distance and VHD. Bonferroni test was used to adjust the significance level. The subjects closer to the major roads had the higher risk of tricuspid regurgitation (TR) (odds risk, OR = 1.519, 95% confidence intervals, 95%CI: 1.058-2.181), especially in female. The risk of VHD was positive (high traffic density VS low traffic density, OR = 1.799, 95%CI: 1.221-2.651), especially in female. In addition, the high traffic density was associated with the risk of mitral regurgitation (MR) (OR = 1.758, 95%CI: 1.085-2.848). The restricted cubic spline analysis found a threshold distance of about 300 m, where had the lowest risk of VHD, aortic regurgitation (AR), MR, TR. Our results found a positive association between traffic-related air pollution and VHD especially in female.


Assuntos
Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Doenças das Valvas Cardíacas/epidemiologia , Emissões de Veículos/toxicidade , Adulto , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência
2.
J Card Surg ; 35(10): 2500-2505, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33043651

RESUMO

BACKGROUND: The disturbance in the international normalized ratio (INR) in patients receiving warfarin therapy is of concern. We aimed to evaluate coagulation features in hospitalized patients under warfarin treatment for prosthetic heart valves during the novel coronavirus disease 2019 (COVID-19) pneumonia pandemic. METHODS: Between 20 February and 28 March 2020, 10 patients (7 males) who were under warfarin therapy for prosthetic heart valves were hospitalized after a diagnosis of COVID-19 in Tehran Heart Center, Tehran, Iran. The clinical, paraclinical, and in-hospital outcomes were described. The patients were followed for 4 weeks. RESULTS: The median age was 62 years. All the patients received antiviral treatment, either lopinavir/ritonavir or oseltamivir. The serum level of high-sensitivity C-reactive protein ranged between 0.24 and 15.24 mg/dL. Alanine aminotransaminase was normal in all the patients except for two, with levels 1.6 and 4.2 times above normal values. The INR increased in all the patients. One (10%) patient died in the hospital. No bleeding, ischemic, or thrombotic events occurred during the hospital stay and within the 4-week follow-up. CONCLUSIONS: Antiviral therapy in patients with COVID-19 with prosthetic heart valves might be an issue responsible for an uncontrolled INR. Liver injury may happen in a minority of patients. Bridging in these patients during the antiviral treatment might be required and because of significant INR fluctuations, it might be safer to prescribe antiviral treatment in an inpatient setting.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas , Pandemias , Pneumonia Viral/epidemiologia , Tromboembolia/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Comorbidade , Infecções por Coronavirus/tratamento farmacológico , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/tratamento farmacológico , Estudos Retrospectivos
3.
Heart ; 106(20): 1549-1554, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32868279

RESUMO

The established processes for ensuring safe outpatient surveillance of patients with known heart valve disease (HVD), echocardiography for patients referred with new murmurs and timely delivery of surgical or transcatheter treatment for patients with severe disease have all been significantly impacted by the novel coronavirus pandemic. This has created a large backlog of work and upstaging of disease with consequent increases in risk and cost of treatment and potential for worse long-term outcomes. As countries emerge from lockdown but with COVID-19 endemic in society, precautions remain that restrict 'normal' practice. In this article, we propose a methodology for restructuring services for patients with HVD and provide recommendations pertaining to frequency of follow-up and use of echocardiography at present. It will be almost impossible to practice exactly as we did prior to the pandemic; thus, it is essential to prioritise patients with the greatest clinical need, such as those with symptomatic severe HVD. Local procedural waiting times will need to be considered, in addition to usual clinical characteristics in determining whether patients requiring intervention would be better suited having surgical or transcatheter treatment. We present guidance on the identification of stable patients with HVD that could have follow-up deferred safely and suggest certain patients that could be discharged from follow-up if waiting lists are triaged with appropriate clinical input. Finally, we propose that novel models of working enforced by the pandemic-such as increased use of virtual clinics-should be further developed and evaluated.


Assuntos
Assistência Ambulatorial/tendências , Infecções por Coronavirus , Doenças das Valvas Cardíacas , Pandemias , Pneumonia Viral , Triagem , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/terapia , Humanos , Modelos Organizacionais , Inovação Organizacional , Pacientes Ambulatoriais , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Triagem/métodos , Triagem/organização & administração
5.
Am J Cardiol ; 134: 99-107, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32917344

RESUMO

Heart failure (HF) is a leading cause of morbidity. Strategies for preventing HF are paramount. Prevalent extracoronary calcification is associated with HF risk but less is known about progression of mitral annular (MAC) and aortic valve calcification (AVC) and HF risk. Progression of valvular calcification (VC) [interval change of >0 units/yr] was assessed by 2 cardiac computed tomography scans over a median of 2.4 years. We used Cox regression to determine the risk of adjudicated HF and linear mixed effects models to determine 10-year change in left ventricular (LV) parameters measured by cardiac magnetic resonance imaging associated with VC progression. We studied 5,591 MESA participants free of baseline cardiovascular disease. Mean ± SD age was 62 ± 10 years; 53% women; 83% had no VC progression, 15% progressed at 1 site (AVC or MAC) and 3% at both sites. There were 251 incident HF over 15 years. After adjusting for cardiovascular risk factors, the hazard ratios (95% confidence interval) of HF associated with VC progression at 1 and 2 sites were 1.62 (1.21 to 2.17) and 1.88 (1.14 to 3.09), respectively, compared with no progression (p-for-trend <0.001). Hazard ratios were higher for HFpEF (2.52 [1.63 to 3.90] and 2.49 [1.19 to 5.25]) but nonsignificant for HFrEF. Both AVC (1.61 [1.19 to 2.19]) and MAC (1.50 [1.09 to 2.07]) progression were associated with HF. VC was associated with worsening of some LV parameters over 10 years. In conclusion, VC progression was associated with increased risk of HF and change in LV function. Interventions targeted at reducing VC progression may also impact HF risk, particularly HFpEF.


Assuntos
Valva Aórtica/diagnóstico por imagem , Calcinose/epidemiologia , Insuficiência Cardíaca/epidemiologia , Doenças das Valvas Cardíacas/epidemiologia , Ventrículos do Coração/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Idoso , Calcinose/diagnóstico por imagem , Técnicas de Imagem de Sincronização Cardíaca , Progressão da Doença , Feminino , Insuficiência Cardíaca/fisiopatologia , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Volume Sistólico , Tomografia Computadorizada por Raios X
6.
Am J Cardiol ; 132: 87-92, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32753267

RESUMO

Valvular heart disease is common among left ventricular assist device (LVAD) recipients. However, its management at the time of LVAD implantation remains controversial. Patients who underwent LVAD implantation and concomitant aortic (AVR), mitral (MVR), or tricuspid valve (TVR) repair or replacement from 2010 to 2017 were identified using the national inpatient sample. End points were in-hospital outcomes, length of stay, and cost. Procedure-related complications were identified via ICD-9 and ICD-10 coding and analysis was performed via mixed effect models. A total of 25,171 weighted adults underwent LVAD implantation without valvular surgery, 1,329 had isolated TVR, 1,021 AVR, 377 MVR, and 615 had combined valvular surgery (411 had TVR + AVR, 115 TVR + MVR, 62 AVR + MVR, 25 AVR + MVR + TVR). During the study period, rates of AVR decreased and combined valvular surgeries increased. Patients who underwent TVR or combined valvular surgery had overall higher burden of co-morbidities than LVAD recipients with or without other valvular procedures. Postoperative bleeding was higher with AVR whereas acute kidney injury requiring dialysis was higher with TVR or combined valvular surgery. In-hospital mortality was higher with AVR, MVR, or combined surgery without differences in the rates of stroke. Length of stay did not differ significantly among groups but cost of hospitalization and nonroutine discharge rates were higher for cases of TVR and combined surgery. Approximately 1 in 9 LVAD recipients underwent concomitant valvular surgery and TVR was the most frequently performed procedure. In-hospital mortality and cost were lower among those who did not undergo valvular surgery.


Assuntos
Insuficiência Cardíaca/terapia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Coração Auxiliar , Comorbidade , Feminino , Seguimentos , Insuficiência Cardíaca/epidemiologia , Doenças das Valvas Cardíacas/epidemiologia , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
7.
J Stroke Cerebrovasc Dis ; 29(9): 105002, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807420

RESUMO

BACKGROUND: Retinal artery occlusion (RAO) can cause acute, painless, and irreversible loss of vision. Using a large sample population database, we investigated the possible impact of RAO and numerous other clinical and non-clinical factors on the risk of developing a subsequent cerebrovascular accident. METHODS: Cases of RAO were obtained from the National Inpatient Sample (NIS) database between 2002 and 2013 using ICD-9 codes. Associated morbidities and procedures were assessed in these cases with a primary hospital admitting diagnosis of stroke. Univariate and multivariate logistic regression analyses were carried out in RAO cases to determine risk factors for stroke. The Bonferroni correction method was applied. RESULTS: The RAO group consisted of 19,809 cases that were separated into stroke (n=1,157, 55% male, mean age: 69±0.4 years) and non-stroke (n=18,652, 55% male, mean age: 68±0.1) cohorts. Age groups associated with reduced risk of stroke with respect to were 20-39 (OR: 0.391), 40-59 (OR: 0.842), and 60-79 (OR: 0.837). No cases of stroke were present for ages < 20. Other factors associated with a reduced stroke risk were carotid stenosis (OR: 0.187), transient ischemic attack (OR: 0.064), coronary artery disease (OR: 0.788), cardiac catheterization (OR: 0.481), and septicemia (OR: 0.333). Factors associated with an increased risk of stroke included hypertension (OR: 1.418), tobacco use (OR: 1.568), valvular disease (OR: 1.359), hyperlipidemia (OR: 1.298), and non-stroke cerebrovascular disease (OR: 2.985). CONCLUSIONS: A large patient population was used to determine that RAO patients with a history of hypertension, hyperlipidemia, tobacco usage, valvular disease, or non-stroke cerebrovascular disease had an increased risk of stroke. Patients below the age of 40 had significantly reduced the odds of stroke. Carotid stenosis, coronary artery disease, transient ischemic attacks, cardiac catheterization, and septicemia were all independently associated with a decreased risk of stroke development in RAO patients.


Assuntos
Oclusão da Artéria Retiniana/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Lactente , Recém-Nascido , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Prognóstico , Oclusão da Artéria Retiniana/diagnóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
8.
Eur J Endocrinol ; 183(4): 463-470, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32822316

RESUMO

Objective: Turner syndrome (TS) is a rare disorder affecting 1/2500 female newborn. Aortic dilatation (AD) and aortic dissection represent a major concern in TS. The aims of our study were to describe the aortic root growth, potential aortic dilatation (AD) risk factors and cardiovascular outcomes in a cohort of patients with TS. Methods: Among 204 adult patients included, 197 were studied using a standardized 1.5 Tesla MRI protocol. AD was defined as an aortic diameter ≥20 mm/m2 at the Valsalva sinuses and/or at the ascending aorta, when indexed to body surface area. Results: At baseline, AD was present in 81/197 (41.1%) and 32/197 (16.2%) of patients, at the levels of Valsalva and ascending aorta, respectively. The aortic Valsalva diameter was larger in patients treated for thyroiditis (P < 0.001). Potential risk factors of AD were aging (P < 0.001) and the presence of bicuspid aortic valve (BAV) (P = 0.002). The hazard ratio (HR) of AD occurrence in the presence of BAV was 2.2 (95% CI: 1.33-3.71). After a median follow-up period of 5.1 years (n = 143), AD was present in 58/143 (40.6%) and 25/143 (17.5%) of patients at the levels of Valsalva and ascending aorta, respectively. The median aortic growth of the Valsalva sinuses remained stable. At the ascending aorta, it increased by 0.14 ± 0.61 mm/year. Only one aortic-related death was observed. Conclusion: AD is common in adult patients with TS. However, our results are rather reassuring, as the median aortic diameters remained stable after 5.1 years and few aortic events were observed.


Assuntos
Doenças da Aorta/epidemiologia , Síndrome de Turner/epidemiologia , Adulto , Aorta/diagnóstico por imagem , Aorta/patologia , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico , Valva Aórtica/anormalidades , Valva Aórtica/patologia , Estudos de Coortes , Dilatação Patológica/complicações , Dilatação Patológica/diagnóstico , Dilatação Patológica/epidemiologia , Progressão da Doença , Feminino , França/epidemiologia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/patologia , Humanos , Masculino , Prevalência , Síndrome de Turner/complicações , Adulto Jovem
9.
Cardiovasc Drugs Ther ; 34(5): 689-696, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32710129

RESUMO

PURPOSE: To date, clinical data on real-world treatment practices in Japanese patients with atrial fibrillation (AF) after bioprosthetic valve (BPV) replacement are needed. We conducted a large-scale, prospective, multicenter study to understand the actual usage of antithrombotic therapy and the incidence of thromboembolic and bleeding events in these patients, and to eliminate the clinical data gap between Japan and Western countries. METHODS: This was an observational study, in patients who had undergone BPV replacement and had a confirmed diagnosis of AF, with no mandated interventions. We report the baseline demographic and clinical data for the 899 evaluable patients at the end of the enrollment period. RESULTS: Overall, 45.7% of patients were male; the mean age was 80.3 years; AF was paroxysmal, persistent, or permanent in 36.9%, 34.6%, and 28.5% of patients, respectively. Mean risk scores for stroke and bleeding were 2.5 (CHADS2), 4.1 (CHA2DS2-VASc), and 2.5 (HAS-BLED). Many patients (76.2%) had comorbid hypertension and 54.8% had heart failure. Most BPVs (65.5%) were positioned in the aortic valve. Warfarin-based therapy, direct oral anticoagulant (DOAC)-based therapy, and antiplatelet therapy (without warfarin and DOAC) were administered to 55.0%, 29.3%, and 9.7% of patients, respectively. CONCLUSION: Patients enrolled into this study are typical of the wider Japanese AF/BPV population in terms of age and clinical history. Future data accruing from the observational period will contribute to future treatment recommendations and guide therapeutic decisions in patients with BPV and AF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: UMIN000034485.


Assuntos
Fibrilação Atrial/tratamento farmacológico , Bioprótese , Fibrinolíticos/uso terapêutico , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Tromboembolia/prevenção & controle , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/epidemiologia , Feminino , Fibrinolíticos/efeitos adversos , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/epidemiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hemorragia/induzido quimicamente , Hemorragia/epidemiologia , Humanos , Incidência , Japão/epidemiologia , Masculino , Estudos Prospectivos , Desenho de Prótese , Sistema de Registros , Projetos de Pesquisa , Fatores de Risco , Tromboembolia/diagnóstico , Tromboembolia/epidemiologia , Fatores de Tempo , Resultado do Tratamento
10.
Am J Cardiol ; 128: 210-215, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32534732

RESUMO

The clinical and imaging differences between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with medically managed asymptomatic moderate-to-severe aortic stenosis (AS) have not been studied previously. We aim to characterize these differences and their clinical outcomes in this study. A retrospective observational study was conducted on 836 consecutive cases of isolated asymptomatic moderate-to-severe AS, with median follow-up of 3.4 years. Clinical and echocardiographic characteristics were compared between BAV and TAV patients. Subgroup analysis stratified by AS severity were performed. Survival analysis of all-cause mortality was performed using Kaplan-Meier curves and Cox proportional hazards model. Compared to BAV patients, TAV patients were older (76 ± 11 vs 55 ± 16 years, p <0.001) and had more co-morbidities including hypertension (78% vs 56%; p <0.001), diabetes (41% vs 24%; p <0.001), and chronic kidney disease (20% vs 3%; p = 0.001). TAV patients had less severe aortic valve disease than BAV patients, with a higher aortic valve area index (0.71 ± 0.20 cm2/m2 vs 0.61 ± 0.18 cm2/m2, p <0.001) and less aortic dilation (sinotubular junction: 23.7 ± 4.0 mm vs 26.9 ± 4.8 mm, p <0.001; mid-ascending aorta: 31.4 ± 4.7 mm vs 36.3 ± 6.3 mm, p <0.001). TAV patients were more likely to have eccentric left ventricular hypertrophy and less likely to have a normal geometry (p = 0.003). Competing risk analysis identified increased age (hazard ratio 1.03, 95% confidence interval 1.02 to 1.05, p <0.001) and LVEF (hazard ratio 0.98, 95% confidence interval 0.97 to 0.99, p <0.001) as independent risk factors of all-cause mortality. Valve morphology was not a significant independent risk factor for aortic valve replacement or mortality. In conclusion, asymptomatic TAV patients had more cardiovascular risk factors, less severe aortic valve disease, less sinotubular and mid-ascending aortic dilation, more severe LV remodeling.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/anormalidades , Doenças Assintomáticas , Doenças das Valvas Cardíacas/diagnóstico por imagem , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/epidemiologia , Doenças da Aorta/fisiopatologia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/fisiopatologia , Estudos de Casos e Controles , Causas de Morte , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/epidemiologia , Dilatação Patológica/fisiopatologia , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/epidemiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mortalidade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Volume Sistólico
12.
J Ayub Med Coll Abbottabad ; 32(2): 179-183, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32583990

RESUMO

BACKGROUND: Mitral Annular Calcification (MAC) is a degenerative process involving the mitral valve and is a marker of advanced cardiovascular disease. Prevalence in the general population is upto 10% and increases in advanced age, diabetes mellitus, chronic kidney disease (CKD), end stage renal disease (upto 40%) and mitral valve prolapse.The aims of this study were to assess the prevalence of MAC in CKD5D patients and correlate with patients' characteristics. METHODS: Echocardiograms were obtained in 84 hemodialysis patients. Association of MAC with various patient characteristics was studied. Data was analysed using SPSS-22. RESULTS: The mean age of the patients was 63.38±12.3 years and 48 (57%) were males. Sixty-eight patients (81%) had DM and 79 (94%) had hypertension. MAC was present in 37 out of 84 (44%) patients. Sixty-four (72%) had IHD. The presence of MAC correlated significantly with IHD (Odds Ratio 6.42, p=0.006). Mean follow up of the patients was 30.30±29.22 months and 37 (44%) suffered mortality during this period. Patients on dialysis for longer than 36 months had an elevated risk of developing MAC (OR=3.32, p=0.019). Patients with the following risk factors: serum PO4 greater than 5.5 (OR=2.03), DM (OR=1.95), HTN (OR=3.35), Age >60 (OR=1.83), AFIB (OR=1.28); had an observable increase in incidence of MAC with time but they weren't statistically significant. CONCLUSIONS: Mitral Annular Calcification is common in hemodialysis patients and correlates significantly with IHD. Our findings support the recommendation by KDIGO 2017 guidelines on Mineral and Bone Disease on the use of echocardiography for the detection of valvular calcification.


Assuntos
Calcinose , Doenças das Valvas Cardíacas , Valva Mitral/fisiopatologia , Diálise Renal , Insuficiência Renal Crônica , Idoso , Calcinose/complicações , Calcinose/epidemiologia , Calcinose/fisiopatologia , Cardiomiopatias/complicações , Cardiomiopatias/fisiopatologia , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/mortalidade , Insuficiência Renal Crônica/terapia
13.
Prog Cardiovasc Dis ; 63(4): 452-456, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32599025

RESUMO

Bicuspid aortic valve (BAV), the most frequent congenital heart disease, is characterized by an uneven distribution between sexes. BAV is three to four times more frequent in men than in women which could be associated with a reduced dosage of X chromosome genes. In addition, BAV has a multifactorial inheritance, low penetrance and variable phenotypes that may lead to different form of valve degeneration and dysfunction over time as well as different incidence of aortic valve and vascular complications between men and women. Definition of the phenotype is the first step in the evaluation of patients with BAV. Among the various phenotypes, BAV with a fusion raphe between the left and the right coronary cusp is the most frequent phenotype observed in men and women. It has been hypothesized that the valve and vascular related complications vary according to the BAV phenotype and this could explain differences in the clinical outcomes of men versus women. However, the evidence on the distribution of the various BAV phenotypes between sexes in not consistent and while some series have described differences between male and female, others have not confirmed those findings. In terms of valvular complications, women present more frequently with aortic stenosis while aortic regurgitation is more frequently diagnosed in men. Furthermore, endocarditis is more frequently reported in men as compared to women. In terms of vascular complications, men show larger diameters of the various parts of the aortic root and ascending aorta and more frequently present complications in terms of aortic aneurysm and dissection as compared to women. Although there are no survival differences between men and women with BAV, compared to the general population some large series have shown that women have worse prognosis. The present review article summarizes the differences between men and women in terms of BAV phenotype, type and incidence of aortic valve and vascular complications that will determine the differences in clinical outcomes.


Assuntos
Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/epidemiologia , Feminino , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Masculino , Fatores Sexuais
14.
J Cardiothorac Surg ; 15(1): 74, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32381038

RESUMO

BACKGROUND: Hypo-attenuated leaflet thickening (HALT) in bioprosthetic aortic valve has been studied, but its equivalent in bioprosthetic mitral valve (bMV) remains uncharacterized. We sought to identify the prevalence, hemodynamic characteristics, and significance of anticoagulation therapy in bMV HALT. METHODS: A single-center cross-sectional study of 53 consecutive patients who underwent mitral valve replacement (MVR) with bMV between 2007 and 2017 was conducted. Cardiac-gated contrasted CT scans were obtained. Anticoagulant and antiplatelet therapy use were ascertained at the time of hospital discharge and CT scanning. Patient characteristics, postoperative stroke, and hemodynamic profile by echocardiogram were obtained to descriptively characterize the prevalence and characteristics associated with bMV HALT. RESULTS: Three patients (5.7%) were found to have a HALT on bMV. The mean time from index MVR to CT scan was 3.4 ± 0.8 years in HALT cohort and 3.4 ± 2.7 years in non-HALT cohort. Fifty patients (94.3%) were discharged on warfarin, and 37 patients (69.8%) were on warfarin at the time of CT scans. One patient with HALT was on therapeutic warfarin at the time of the CT scan that identified HALT. All three patients were asymptomatic at the time of CT scan. In patients with HALT, mean transmitral pressure gradient were 8, 5, and 2.7 mmHg, all with trivial or mild mitral regurgitation. CONCLUSIONS: In this study, the prevalence of HALT was low at 5.7%, all presenting without symptoms. One patient presented with HALT while on therapeutic oral anticoagulation, which may suggest thrombotic etiology may not adequately explain HALT.


Assuntos
Bioprótese , Doenças das Valvas Cardíacas/epidemiologia , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Complicações Pós-Operatórias/epidemiologia , Trombose/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Estudos Transversais , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/epidemiologia , Inibidores da Agregação de Plaquetas/uso terapêutico , Complicações Pós-Operatórias/diagnóstico por imagem , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Varfarina/uso terapêutico
15.
Am J Cardiol ; 125(11): 1673-1677, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32291092

RESUMO

Our study was to apply the 2015 American Heart Association/American College of Cardiology Athletic Participation Guidelines to a group of otherwise healthy school age children and young adults with bicuspid aortic valve (BAV) and describe the potential competitive sports restriction as they age. We performed a retrospective chart review of children and young adults aged 5 to 22 years with isolated BAV with at least two echocardiograms between 2000 and 2013. Using task force guidelines, exercise restriction was recommended for any of the following: (1) any dilation of the aortic root, (2) any dilation of the ascending aorta, (3) moderate aortic stenosis, (4) severe aortic regurgitation; (5) left ventricular dilation or (6) reduced shortening fraction. Of the 345 patients with isolated BAV, 202 were considered restricted at study entry. The final cohort included 123 children and young adults. Over the course of follow up, 36% (44 of 123) met restriction criteria. The most likely cause for restriction was aortic dilation (34%). Progression of aortic valve disease occurred in a minority of patients (3%). There were no reports of death, dissection or catheter or surgical based intervention. In conclusion, we found that strict adherence to current guidelines would result in restriction of more than 1/3 of school age children and young adults with BAV from some form of competitive athletics during school age years. Strict application of the current guidelines in this age group may lead to over-restriction of youths from competitive sports.


Assuntos
Doenças da Aorta/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/anormalidades , Exercício Físico , Doenças das Valvas Cardíacas/diagnóstico por imagem , Esportes , Adolescente , Doenças da Aorta/epidemiologia , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/epidemiologia , Criança , Pré-Escolar , Dilatação Patológica , Gerenciamento Clínico , Progressão da Doença , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Adulto Jovem
16.
Am J Cardiol ; 125(12): 1879-1883, 2020 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-32303339

RESUMO

Tricuspid valve disease (TVD), particularly tricuspid regurgitation, is a common valvular pathology that is associated with increased morbidity and mortality. The prevalence of TVD in hospitalized patients has not been well characterized. We used the National Inpatient Sample to determine the overall and age- and sex-specific prevalence and temporal trends in prevalence of TVD in hospitalized patients in the US. All-cause and heart failure (HF) hospitalizations in patients ≥50 years of age from January 2006 to September 2015 in the US were identified. Temporal trends in the prevalence of TVD were studied using Poisson regression. Of 194,184,433 all-cause and 38,083,773 HF hospitalizations in patients ≥50 years of age, 3,235,292 (1.7%) and 1,787,548 (4.7%) had a diagnosis of TVD, respectively. From 2006 to 2015, the prevalence of TVD in all hospitalizations and in HF hospitalizations increased from 1.7% to 2.0% and from 3.9% to 5.7%, respectively (ptrend <0.001 for both), particularly in those ≥85 years of age and in women. In patients with TVD, primary reasons for hospitalizations were HF (20.8%), infections (10.1%), arrhythmias (9.8%), respiratory conditions (8.4%), and coronary artery disease/acute myocardial infarction (8.2%). In-hospital mortality and length of stay in patients with TVD remained unchanged, whereas costs of hospitalization increased during the study period. In conclusion, the prevalence of TVD in all hospitalized patients and in those hospitalized with HF has increased over the past several years, particularly in those ≥85 years of age and in women. Approximately 1 in 5 hospitalizations with a diagnosis of TVD is due to HF.


Assuntos
Doenças das Valvas Cardíacas/epidemiologia , Hospitalização , Valva Tricúspide , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia
17.
Am J Cardiol ; 125(11): 1718-1724, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32284176

RESUMO

To analyze pregnancy outcomes of patients with heart disease in a single center and to explore the risk factors of adverse outcomes. One thousand thirty-three pregnant women with heart disease were retrospectively included from 2010 to 2017. We collected data of maternal, obstetric, and fetal outcomes. Among 1,086 pregnancies, 295 (27.1%) with congenital heart disease, 244 (22.5%) with rheumatic heart disease, 387 (35.6%) with arrhythmia, and 55 (5.1%) with cardiomyopathy. There were 8 (0.7%) maternal deaths. Risk factors of mortality were New York Heart Association (NYHA) classification IV (p <0.001), cardiac surgery during pregnancy (p <0.001), and general anesthesia (p <0.001). Maternal cardiac complications occurred in 6.7% of women, with most in the cardiomyopathy (26.0%) and rheumatic heart disease (32.9%) groups. Multivariate logistic regression modeling was used to analyze the potential risk factors. NYHA classification III and IV independently predicted worse maternal outcomes. Peripartum intensive care unit admission rate was 10.2%. Admission to intensive care unit was associated with NYHA classification II/III/IV, modified World Health Organization (mWHO) classification II-III/III/IV, and cardiac surgery during pregnancy. In conclusion, pregnancy with heart disease is at higher risk of complications for both women and neonates. In our findings, maternal morbidity is associated with NYHA classification and mWHO classification.


Assuntos
Arritmias Cardíacas/epidemiologia , Cardiomiopatias/epidemiologia , Cardiopatias Congênitas/epidemiologia , Mortalidade Materna , Mortalidade Perinatal , Complicações Cardiovasculares na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Cardiopatia Reumática/epidemiologia , Aborto Induzido , Aborto Espontâneo , Adulto , Procedimentos Cirúrgicos Cardíacos , China/epidemiologia , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Modelos Logísticos , Análise Multivariada , Hemorragia Pós-Parto/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/cirurgia , Estudos Retrospectivos , Índice de Gravidade de Doença , Tromboembolia Venosa/epidemiologia , Adulto Jovem
18.
Int Heart J ; 61(2): 273-280, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32173708

RESUMO

For its high occurrence and elevated risks for aortic valve dysfunction and vascular complications, bicuspid aortic valve (BAV) represents a great health challenge. However, the prevalence and clinical features of BAV in the Chinese population are inadequately illustrated.From January 2011 to December 2015, 3,673 BAV patients with 69.1% male predominance were identified among 325,910 recipients of transthoracic echocardiography in our institution, demonstrating 58.4% overt aortic valve dysfunction, 52.5% ascending aortic dilatation, and 19.2% aortic root dilatation. The prevalence of pure aortic stenosis and mixed aortic valve dysfunction rose strikingly with age (both P < 0.0001), while pure aortic regurgitation showed significant decrease with age (P < 0.0001). Males showed elevated prevalence of pure aortic regurgitation (OR 3.16, 95% CI 2.55-3.91, P < 0.0001) and mixed aortic valve dysfunction than females (OR 1.63, 95% CI 1.23-2.17, P = 0.0008), but lower prevalence of pure aortic stenosis (OR 0.51, 95% CI 0.43-0.60, P < 0.0001). Aortic root dilatation was associated with male gender (OR 5.02, 95% CI 3.74-6.74, P < 0.0001), pure aortic regurgitation (OR 2.61, 95% CI 2.15-3.17, P < 0.0001), and right-left (RL) cusp fusion type (OR 1.98, 95% CI 1.64-2.40, P < 0.0001). Ascending aortic dilatation was associated with an elder age (OR 1.04, 95% CI 1.04-1.05, P < 0.0001), pure aortic stenosis (OR 1.37, 95% CI 1.16-1.61 P = 0.0002), and mixed aortic valve dysfunction (OR 2.51, 95% CI 1.89-3.33, P < 0.0001).Bicuspid aortic stenosis and ascending aortic dilatation demonstrate a similar pattern of age escalation, while aortic regurgitation is more prevalent in younger BAV patients. Aortic root dilatation intervenes closely with a unique phenotypic subgroup of male BAV patients with pure aortic regurgitation and RL fusion type.


Assuntos
Doenças da Aorta/etiologia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/complicações , Adolescente , Adulto , Idoso , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/epidemiologia , Valva Aórtica/diagnóstico por imagem , China/epidemiologia , Ecocardiografia , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
19.
BMC Endocr Disord ; 20(1): 25, 2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-32075620

RESUMO

BACKGROUND: Whether lower dose cabergoline therapy for hyperprolactinemia increases risk of valvular dysfunction remains controversial. We examined valvular abnormalities among asymptomatic adults with hyperprolactinemia treated with dopamine agonists. METHODS: This cross-sectional study was conducted among adults receiving cabergoline or bromocriptine for > 12 months for hyperprolactinemia and had no cardiac-related symptoms. Cardiac valve morphology and function were assessed from transthoracic echocardiograms at the study visit (except for two participants) with evaluation performed blinded to type and duration of dopamine agonist received. RESULTS: Among 174 participants (mean age 49 ± 13 years, 63% women) without known structural heart disease before starting therapy, 62 received only cabergoline, 63 received only bromocriptine, and 49 received both. Median cabergoline use was 2.8 years in cabergoline only users and 3.2 years for those exposed to both cabergoline and bromocriptine; median bromocriptine use was 5.5 years in bromocriptine only users and 1.1 years for those exposed to both cabergoline and bromocriptine. Compared with bromocriptine only users (17.5%), regurgitation of ≥1 valve was more common for cabergoline only (37.1%, P = 0.02) but not for combined exposure (26.5%, P = 0.26). Compared with bromocriptine only exposure (1.6%), regurgitation of ≥2 valves was more common for cabergoline only (11.3%, P = 0.03) and combined exposure (12.2%, P = 0.04). Cabergoline only users had higher age-sex-adjusted odds for ≥1 valve with grade 2+ regurgitation compared to bromocriptine only users (adjusted odds ratio [aOR] 3.2, 95% confidence interval [CI]:1.3-7.5, P = 0.008), but the association for combined exposure to cabergoline and bromocriptine was not significant (aOR 1.7, 95%CI:0.7-4.3, P = 0.26). Compared to bromocriptine only, age-sex-adjusted odds of ≥2 valves with grade 2+ regurgitation were higher for both cabergoline only (aOR 8.4, 95% CI:1.0-72.2, P = 0.05) and combined exposure (aOR 8.8, 95% CI:1.0-75.8, P = 0.05). Cumulative cabergoline exposure > 115 mg was associated with a higher age-sex adjusted odds of ≥2 valves with grade 2+ regurgitation (aOR 9.6, 95%CI:1.1-81.3, P = 0.04) compared to bromocriptine only. CONCLUSIONS: Among community-based adults treated for hyperprolactinemia, cabergoline use and greater cumulative cabergoline exposure were associated with a higher prevalence of primarily mild valvular regurgitation compared with bromocriptine. Research is needed to clarify which patients treated with dopamine agonists may benefit from echocardiographic screening and surveillance.


Assuntos
Cabergolina/efeitos adversos , Agonistas de Dopamina/efeitos adversos , Doenças das Valvas Cardíacas/patologia , Hiperprolactinemia/tratamento farmacológico , Adulto , California/epidemiologia , Estudos Transversais , Feminino , Seguimentos , Doenças das Valvas Cardíacas/induzido quimicamente , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Hiperprolactinemia/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
20.
Heart ; 106(7): 512-519, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32054673

RESUMO

OBJECTIVE: To perform a systematic review and meta-analysis of maternal/fetal outcomes in pregnant women with moderate/severe native valvular heart disease (VHD) from medium/higher Human Development Index (HDI) countries. METHODS: OvidSP platform databases were searched (1985-January 2019) to identify studies reporting pregnancy outcomes in women with moderate/severe VHD. The primary maternal outcome was maternal mortality. The primary fetal/neonatal outcome was stillbirth and neonatal death. Pooled incidences and 95% confidence intervals (CI) of maternal/fetal outcomes could only be calculated from studies involving mitral stenosis (MS) or aortic stenosis (AS). RESULTS: Twelve studies on 646 pregnancies were included. Pregnant women with severe MS had mortality rates of 3% (95% CI, 0% to 6%), pulmonary oedema 37% (23%-51%) and new/recurrent arrhythmias 16% (1%-25%). Their stillbirth, neonatal death and preterm birth rates were 4% (1%-7%), 2% (0%-4%), and 18% (7%-29%), respectively. Women with moderate MS had mortality rates of 1%(0%-2%), pulmonary oedema 18% (2%-33%), new/recurrent arrhythmias 5% (1%-9%), stillbirth 2% (1%-4%) and preterm birth 10%(2%-17%).Pregnant women with severe AS had a risk of mortality of 2% (0%-5%), pulmonary oedema 9% (2%-15%), and new/recurrent arrhythmias 4% (0%-7%). Their stillbirth, neonatal death and preterm birth rates were 2% (0%-5%), 3% (0%-6%) and 14%(4%-24%), respectively. No maternal/neonatal deaths were reported in moderate AS, however women experienced pulmonary oedema (8%; 0%-20%), new/recurrent arrhythmias (2%; 0%-5%), and preterm birth (13%; 6%-20%). CONCLUSIONS: Women with moderate/severe MS and AS are at risk for adverse maternal and fetal/neonatal outcomes. They should receive preconception counseling and pregnancy care by teams with pregnancy and heart disease experience.


Assuntos
Doenças das Valvas Cardíacas/epidemiologia , Complicações Cardiovasculares na Gravidez/epidemiologia , Resultado da Gravidez , Feminino , Humanos , Morte Perinatal , Gravidez , Índice de Gravidade de Doença , Natimorto/epidemiologia
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