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2.
Int J Cardiovasc Imaging ; 35(9): 1701-1707, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30953252

RESUMO

We assessed CT-derived left ventricular strain in a cohort of patients referred for transcatheter aortic valve implantation (TAVI) and validated it against 2 dimensional speckle tracking echocardiography as the gold standard. 65 consecutive patients with symptomatic aortic valve stenosis referred for CT imaging prior to TAVI were included in this analysis. For all patients, retrospectively ECG-gated multi-phase functional CT data sets acquired with identical reconstruction parameters were available. All data sets were acquired using a third generation dual source system. In all patients, multiphase reconstructions in increments of 10% of the cardiac cycle were rendered (slice thickness 0.75, increment 0.5 mm, medium smooth reconstruction kernel) and transferred to a dedicated workstation (Ziostation2, Ziosoft Inc., Tokyo, Japan). Additional functional reconstructions for dynamic assessment and quantification of strain were processed. Multiplanar reconstructions (MPR) of the left ventricle similar to standard echocardiographic 4, 2 and apical 3 chamber views were rendered in CT. Similar to echocardiographic longitudinal strain, the perimeter of the left ventricle was manually traced within the myocardium and peak maximal shortening as a parameter representing longitudinal strain was calculated for each view and averaged to obtain a marker for global longitudinal strain (CT perimeter-derived strain). Furthermore, for quantification of 3-dimensional strain, endocardial and epicardial borders of myocardium were marked in six short axis views and peak maximum 3- dimensional strain of the myocardium was calculated in standard six basal, six mid and four apical segments. 3-dimensional strain values of the 16 standard segments as well as perimeter-derived strain values in the three standard windows were averaged to obtain global strain. Echocardiography was performed in all patients before CT data acquisition. Digital loops were acquired from three apical views (four-, two-, and three chamber views). For assessment of 2 dimensional global longitudinal strain (GLS), recordings were processed with acoustic-tracking software allowing offline semiautomated speckle-based strain analyses. The mean age of all 65 patients was 81 ± 5 years. The mean echocardiographic ejection fraction and mean echocardiographic GLS were 50 ± 12% and -13.6 ± 4.5%, respectively. The mean CT-derived peak 3-dimensional global strain and mean peak strain derived by perimeter was 43.2 ± 13.5% and -11.2 ± 3.5%, respectively. Both CTderived global 3D-strain and perimeter derived strain showed a significant correlation to GLS derived by echocardiography (r = -0.8, p < 0.0001 for 3D strain and r = 0.71, p < 0.0001 for perimeter-derived strain). Bland-Altman analysis showed a systematic underestimation (i. e. worse strain values) of CT perimeter-derived strain compared to GLS by echocardiography (mean difference -2.4% with 95% limits of agreement between 4% to -9%). ROC Curve analysis assuming a normal GLS when less than -18% showed that a CT-derived peak 3-dimensional global strain cut-off-value of 45% has a sensitivity of 91% and a specificity of 60% for detecting normal left ventricular strain (AUC 0.81, p = 0.001). For CT perimeter-derived strain, a cut-off value of -12%-assuming a normal echocardiographic GLS when less than -18%-achieved a sensitivity of 82% and a specificity of 61% (AUC of 0.82, p = 0.001) for detecting abnormal left ventricular strain. Using dedicated software, assessment of CT-derived left ventricular strain is feasible and comparable to strain derived by echocardiographic 2 dimensional speckle tracking.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Ecocardiografia/métodos , Ventrículos do Coração/diagnóstico por imagem , Contração Miocárdica , Volume Sistólico , Tomografia Computadorizada por Raios X/métodos , Função Ventricular Esquerda , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Fenômenos Biomecânicos , Técnicas de Imagem de Sincronização Cardíaca , Eletrocardiografia , Estudos de Viabilidade , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença , Software
4.
Arch Cardiovasc Dis ; 112(5): 354-362, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31014990

RESUMO

Within the past decade, transcatheter aortic valve implantation (TAVI) has become established as the optimal treatment option for elderly, inoperable and high-risk patients with severe aortic stenosis, and is now recommended by international guidelines. Randomized controlled trials have demonstrated the non-inferiority of TAVI to open surgery in intermediate-risk patients and, most recently, in low-risk patients. Further randomized controlled trials are underway, but existing studies have already provided reassuring data in this cohort, and TAVI is offered routinely to younger and lower-risk patients in numerous centers. Improvements in the design of devices and delivery systems, accompanied by increased operator experience, have dramatically improved the safety of the procedure, and further expansion into low-risk groups seems inevitable once concerns about valve durability and device cost have been addressed. In this article, we provide a review of the existing literature, and estimate the clinical impact of TAVI in low-risk patients. Abbreviated title: Why should we extend TAVI to low-risk patients?


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Tomada de Decisão Clínica , Humanos , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
5.
Innovations (Phila) ; 14(1): 27-36, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30848711

RESUMO

OBJECTIVES: Aortic valve replacement (AVR) in patients with small aortic annulus (diameter ≤21 mm) is considered a challenging scenario because of technical aspects and the high risk of patient-prosthesis mismatch (PPM). The choice of the appropriate prosthesis is crucial, and at the moment, an ideal device has yet to be identified. We compare clinical and hemodynamic results after AVR with three bioprostheses with different design and characteristics. METHODS: We retrospectively evaluated 76 consecutive patients from two cardiac surgery centers who underwent AVR (Trifecta = 24; Edwards INTUITY Elite valve system = 26, and Perceval = 26) for severe aortic stenosis between 2013 and 2017. Patients selected were older than 75 years and with an annulus diameter ≤21 mm at preoperative echocardiogram. Reinterventions and combined procedures were excluded. Minimally invasive AVR was performed in 44 (57.8%) patients. Telephonic interview was obtained at 2.9 ± 0.5 years and echocardiographic follow-up at 2.2 ± 0.8 years. RESULTS: Clinical outcome was similar in the three groups. At follow-up, Trifecta patients presented significantly higher peak and mean transprosthetic pressure gradients ( P = 0.04 and 0.01). Effective orifice area and left ventricular mass regression were comparable, although an advantage was observed in Perceval patients without reaching the statistical significance. Incidence of moderate ( P = 0.2) and severe PPM ( P = 0.7) was comparable. CONCLUSIONS: Despite higher postoperative pressure gradients observed with the Trifecta valve, all three prostheses (Trifecta, Edwards INTUITY Elite, and Perceval) have proven to be reliable when implanted in small aortic annuli, with good clinical outcome and favorable left ventricular mass regression.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas/tendências , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/patologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/patologia , Ecocardiografia/métodos , Feminino , Seguimentos , Hemodinâmica/fisiologia , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento
6.
Int J Cardiovasc Imaging ; 35(7): 1347-1355, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30838504

RESUMO

Myocardial crypts can be recognized in patients with hypertrophic cardiomyopathy (HCM) using magnetic resonance imaging, but similar studies using computed tomography (CT) are sparse. The aim of the present study was to evaluate the prevalence and morphology of myocardial crypts in patients with HCM, arterial hypertension, and aortic valve stenosis using contrast-enhanced CT. We also investigated the added value of a finding of myocardial crypts on CT scan to the diagnosis of HCM. The study cohort included 73 patients with HCM, 100 patients with arterial hypertension, 120 patients with aortic valve stenosis, and 100 subjects without cardiovascular disease (normal control group). All underwent evaluation for the presence and dimensions of myocardial crypts using 256-slice CT. Crypts were identified in 18 patients (24.7%) with HCM, 7 patients (7%) with hypertension, 8 patients (6.7%) with aortic valve stenosis, and 4 (4%) normal subjects (P < 0.001). Values of crypt length, width, area, and penetration into myocardium were highest in the HCM group. Crypt area differentiated patients with HCM from patients with arterial hypertension and aortic valve stenosis, and from normal control subjects. Crypt area was an accurate predictor of HCM, with an area under the receiver-operator characteristic curve of 0.88 (95% CI 0.80-0.96). Myocardial crypts identified by CT are more prevalent and larger in area in HCM than in arterial hypertension and aortic valve stenosis. Crypt area could potentially help to improve the diagnosis of HCM by CT beyond the assessment of left ventricular thickness or mass.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Ventrículos do Coração/diagnóstico por imagem , Hipertensão/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Miocárdio/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/patologia , Técnicas de Imagem de Sincronização Cardíaca , Cardiomiopatia Hipertrófica/epidemiologia , Cardiomiopatia Hipertrófica/patologia , Diagnóstico Diferencial , Eletrocardiografia , Feminino , Ventrículos do Coração/patologia , Humanos , Hipertensão/epidemiologia , Hipertensão/patologia , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos
7.
Cardiovasc Diabetol ; 18(1): 31, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30876424

RESUMO

BACKGROUND: Diabetes mellitus (DM) adversely affects morbidity and mortality for major atherosclerosis-related cardiovascular diseases and is associated with increased risk for the development of aortic stenosis. Clinical data regarding the impact of DM on outcomes of patients undergoing aortic valve replacement (AVR) have revealed inconsistent results. The aim of the current study was to investigate and compare the impact of type 2 DM on short-, intermediate- and long-term mortality between DM and non-DM patients who undergo isolated AVR. METHODS: We performed an observational study in a large tertiary medical center over a 14-year period (2004-2018), which included all patients who had undergone isolated AVR surgery for the first time. Of the 1053 study patients, 346 patients (33%) had type 2 DM (DM group) and were compared with non-DM (non-DM group) patients (67%). Short-term (in-hospital), intermediate (1- and 3-years), and late (5- and 10-years) mortality were evaluated. Mean follow-up of was 69 ± 43 months. RESULTS: Short-term (in-hospital) mortality was similar between the DM compared with the non-DM group: 3.5% and 2.5% (p = 0.517). Intermediate-term mortality (1- and 3-year) was higher in the DM group compared with the non-DM group, but did not reach statistical significance: 8.1% vs. 5.7% (p = 0.169) and 12.1% vs. 8.3% (p = 0.064) respectively. Long-term (5- and 10-year) mortality was significantly higher in the DM group, compared to the non-DM group: 19.4% vs. 12.9% (p = 0.007) and 30.3% vs. 23.5% (p = 0.020) respectively. Among the 346 DM patients, 55 (16%) were treated with insulin and 291 (84%) with oral antiglycemic medication only. Overall in-hospital mortality among insulin-treated DM patients was 7.3% compared with 2.7% among non insulin-treated DM patients (p = 0.201). Long-term mortality was higher in the subgroup of insulin-treated DM patients compared with the subgroup of non-insulin treated DM patients with an overall mortality rate of 36.4% vs. 29.2% (p = 0.039). Furthermore, predictors for late mortality included DM (HR 1.39 CI 1.03-1.86, p = 0.031) and insulin treatment (HR 1.76 CI 1.05-2.94, p = 0.033), as demonstrated after adjustment for confounders by multivariable analysis. CONCLUSIONS: Type 2 DM is an independent predictor for long-term mortality after isolated AVR surgery.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Diabetes Mellitus Tipo 2/mortalidade , Implante de Prótese de Valva Cardíaca/mortalidade , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Mortalidade Hospitalar , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento
8.
J Cardiovasc Med (Hagerstown) ; 20(4): 226-236, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30829877

RESUMO

AIMS: To compare transcatheter aortic valve replacement TAVR with self-expandable first-generation Medtronic CoreValve with new-generation Evolut R devices in patients with aortic stenosis. METHODS: Multiple databases were screened for all available reports directly or indirectly comparing CoreValve vs Evolut R. Primary endpoint was device success. Procedural, functional and clinical outcomes were assessed as well. RESULTS: Ten retrospective series including 12 294 pts. were found. Overall device success rate was 95.5% and was statistically higher in the Evolut R treated patients as compared with CoreValve: 96.6 vs. 94.8%, respectively; RR (risk ratio) 95%CIs (confidence intervals): 1.02 (1.00-1.04); P = 0.01. There were no statistical differences with regard to postoperative mean aortic gradients 8.5 +/- 5.3 vs 7.9 +/- 4.6 with Evolut R and CoreValve. Evolut R valve demonstrated nearly 50% reduction of the risk for moderate-to-severe paravalvilar leak 0.55 (0.39-0.79); P = 0.001; 60% statistically significant lower risk of developing myocardial injury 0.40 (0.22-0.72); P = 0.002 and numerical reductions in the risk of acute kidney injury, vascular complications and bleeding. Together with significantly reduced risk of permanent pacemaker implantation (0.80 [0.67-0.96]; P = 0.02) the above benefits were associated with 40% reduction in the risk of 30-day all-cause mortality with Evolut R as compared to CoreValve: 0.60 (0.37-1.00); P = 0.05. CONCLUSIONS: The use of new-generation Evolut R was associated with improved procedural, functional and clinical outcomes compared with the CoreValve device.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
9.
Int J Cardiovasc Imaging ; 35(6): 1141-1147, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30915667

RESUMO

Measures of sarcopenia, such as low muscle mass measured from the readily available preoperative computed tomography (CT) images, have been recently suggested as a predictor of outcomes in patients undergoing transcatheter aortic valve replacement (TAVR). However, results of these studies are variable and, therefore, we performed a systematic review of current literature to evaluate sarcopenia as a predictor of outcome post TAVR. The search was carried out in electronic databases between 2008 and 2018. We identified studies that reported CT-derived skeletal muscle area (SMA) and survival outcomes post TAVR. Studies were evaluated for the incidence of early (≤ 30 days) and late all-cause mortality (> 30 days) post TAVR. Eight studies with 1881 patients were included (mean age of 81.8 years ± 12, 55.9% men). Mean body mass index was (28.2 kg/m2 ± 1.1), mean Society of Thoracic Surgeons risk score (7.0 ± 0.6), and mean albumin level was (3.8 g/dL ± 0.1). Higher SMA was associated with lower long-term mortality [odds ratio (OR) 0.49, 95% confidence interval (CI) 0.28-0.83, p = 0.049], compared with low SMA. Also, higher SMA was associated with lower early mortality but was not statistically significant (OR 0.72; 95% CI 0.44-1.18; p = 0.285). CT-derived SMA provides value in predicting post-TAVR long-term outcomes for patients undergoing TAVR. This is a simple risk assessment tool that may help in making treatment decisions and help identifying and targeting high-risk patients with interventions to improve muscle mass prior to and following the procedures.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Avaliação Geriátrica/métodos , Músculo Esquelético/diagnóstico por imagem , Sarcopenia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Substituição da Valva Aórtica Transcateter/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Medição de Risco , Fatores de Risco , Sarcopenia/mortalidade , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
10.
Int J Cardiovasc Imaging ; 35(6): 1089-1100, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30825136

RESUMO

Surgical therapies in aortic valve stenosis (AVS) and hypertrophic obstructive cardiomyopathy (HOCM) aim to relief intraventricular pressure overload and improve clinical outcome. It is currently unknown to what extent myocardial adaptation concurs with restoration of intraventricular pressures, and whether this is similar in both patient groups. The aim of this study was to investigate changes in myocardial adaptation after surgical therapies for AVS and HOCM. Ten AVS and ten HOCM patients were enrolled and underwent cardiac magnetic resonance cine imaging and myocardial tagging prior to, and 4 months after aortic valve replacement (AVR) and septal myectomy, respectively. Global left ventricular (LV) analyses were derived from cine images. Circumferential strain was assessed from myocardial tagging images at the septal and lateral wall of the mid ventricle. Pressure gradients significantly decreased in both AVS and HOCM after surgery (p < 0.01), with a concomitant decrease in left atrial volume (p < 0.05) suggesting lower diastolic filling pressures. Also, LV volumes, mass and septal wall thickness decreased in both, but to a larger extent in AVS than in HOCM patients. AVR improved wall thickening (p < 0.05) and did not change systolic strain rate. Myectomy did not affect wall thickening and reduced septal systolic strain rate (p = 0.03). Both AVR and myectomy induced positive structural remodeling in line with a reduction of pressure overload. A concomitant recovery in systolic function however was found in AVR only. The systolic functional deterioration in HOCM patients seems to be inherent to myectomy and the ongoing and irreversible disease.


Assuntos
Estenose da Valva Aórtica/cirurgia , Cardiomiopatia Hipertrófica/cirurgia , Implante de Prótese de Valva Cardíaca , Função Ventricular Esquerda , Pressão Ventricular , Remodelação Ventricular , Adaptação Fisiológica , Adulto , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Cardiomiopatia Hipertrófica/fisiopatologia , Feminino , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Sístole , Fatores de Tempo , Resultado do Tratamento
11.
Echocardiography ; 36(3): 469-477, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30726555

RESUMO

OBJECTIVE: To test the relationship between left atrial (LA) distensibility (LAD), LA strain (LAS), and left ventricular (LV) dysfunction and prognosis in aortic stenosis (AS). METHODS: Transthoracic Doppler echocardiography was performed prospectively in 102 consecutive patients with AS (77 with severe, 25 with moderate, mean age 77 years). LA volume was calculated by the area-length method in apical four- and two-chamber views, immediately before mitral valve opening (Volmax ) and at mitral valve closure (Volmin ). LAD was defined as (Volmax   - Volmin ) × 100%/Volmin . LAS (mean of maximal strain from the 4-2 chamber views) was conducted using a dedicated software package. The endpoint was hospitalization for heart failure and death from any cause. RESULTS: Left atrial strain, LAD, and LA vol/m² were significantly correlated with LV diastolic parameters, and PASP (all, P < 0.05). However, LAD and LAS but not LA vol/m² were significantly correlated with Charlson score, LV global longitudinal strain, and to transaortic mean gradient (all, P < 0.05). At a median follow-up of 25 months, 53 patients had an event. LAS, LAD, LA vol/m², and Charlson index were associated with events (all, P < 0.05). In multivariate analysis, LAD, LAS, and Charlson index (all, P < 0.01) remained independently associated with events. Using a ROC curve analysis, LAD ≤ 69% and LAS ≤ 17% were the best cutoffs associated with an event. CONCLUSION: In patients with moderate to severe AS, LAD and LAS are associated with LV dysfunction, AS severity, and are independently linked to events.


Assuntos
Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/fisiopatologia , Ecocardiografia , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Disfunção Ventricular Esquerda/diagnóstico por imagem
12.
Lupus ; 28(3): 275-282, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30739545

RESUMO

OBJECTIVE: Artery calcification, as subclinical atherosclerosis, is attracting attention. The aim of this study was to determine the prevalence and risk factors of artery calcification in patients with systemic lupus erythematosus. METHODS: 641 patients with systemic lupus erythematosus were enrolled in the study. Demographic, clinical, and laboratory characteristics were collected. Calcification score was quantified from the multi-detector computed tomography scan image using the Agatston Score method. RESULTS: The total incidence of artery calcification was 25.9% (166/641), of which the percentages of aorta calcium and coronary artery calcification were 23.1% (148/641) and 8.4% (54/641), respectively. In multivariate models, systemic lupus erythematosus patients with artery calcification had longer disease duration than patients without artery calcification ( p < 0.05). Presence of serositis (OR 2.559, 95%CI 1.414-4.632), pneumonia (OR 2.022, 95%CI 1.102-3.711) and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score (OR 1.049, 95%CI 1.004-1.095) were independently associated with increased risk of aorta calcium, while the duration of corticosteroids use (OR 1.039, 95%CI 1.002-1.078) and cyclophosphamide therapy (OR 8.251, 95%CI 2.496-27.279) were independently associated with increased risk of coronary artery calcification in systemic lupus erythematosus patients. In systemic lupus erythematosus patients, aorta calcium was prone to occur at a younger age compared to coronary artery calcification, and aorta calcium score was positively correlated with age. CONCLUSIONS: Systemic lupus erythematosus patients had a much earlier onset and higher incidences of aorta calcium than coronary artery calcification. Presence of serositis, pneumonia, and higher SLEDAI score may predict increased risk of aorta calcium.


Assuntos
Estenose da Valva Aórtica/epidemiologia , Valva Aórtica/patologia , Calcinose/epidemiologia , Lúpus Eritematoso Sistêmico/complicações , Adulto , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/etiologia , Calcinose/diagnóstico por imagem , Calcinose/etiologia , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/epidemiologia , Fatores de Risco , Serosite/complicações , Serosite/epidemiologia , Tomografia Computadorizada por Raios X
13.
Angiology ; 70(4): 332-336, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30700108

RESUMO

Lipoprotein(a) [Lp(a)] is a genetically determined risk factor for calcific aortic valve stenosis (CAVS) for which transcatheter aortic valve replacement (TAVR) is increasingly utilized as treatment. We evaluated the effect of a program to increase testing of and define the prevalence of elevated Lp(a) among patients undergoing TAVR. Educational efforts and incorporation of a "check-box" Lp(a) order to the preoperative TAVR order set were instituted. Retrospective chart review was performed in 229 patients requiring TAVR between May 2013 and September 2018. Of these patients, 57% had an Lp(a) level measured; testing rates increased from 0% in 2013 to 96% in 2018. Lipoprotein(a) testing occurred in 11% of patients before and in 80% of patients after the "check-box" order set ( P < .001). The prevalence of elevated Lp(a) (≥30 mg/dL) was 35%; these patients had a higher incidence of coronary artery disease requiring revascularization compared with patients with normal Lp(a) (65% vs 47%; P = .047). Patients with Lp(a) ≥30 mg/dL also had higher incidence of paravalvular leak compared with those with normal Lp(a) (13% vs 4%; P = .04). This study defines the prevalence of elevated Lp(a) in advanced stages of CAVS and provides a practice pathway to assess procedural complications and long-term outcomes of TAVR in patients with elevated Lp(a) levels.


Assuntos
Estenose da Valva Aórtica/sangue , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Análise Química do Sangue/tendências , Calcinose/sangue , Calcinose/cirurgia , Hiperlipoproteinemias/sangue , Lipoproteína(a)/sangue , Padrões de Prática Médica/tendências , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/epidemiologia , Biomarcadores/sangue , Calcinose/diagnóstico por imagem , Calcinose/epidemiologia , California/epidemiologia , Lista de Checagem/tendências , Tomada de Decisão Clínica , Comorbidade , Educação Médica Continuada/tendências , Feminino , Nível de Saúde , Humanos , Hiperlipoproteinemias/diagnóstico , Hiperlipoproteinemias/epidemiologia , Capacitação em Serviço/tendências , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima
14.
Int J Cardiovasc Imaging ; 35(5): 881-895, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30701439

RESUMO

The assessment of aortic valve (AV) morphology is paramount for planning transcatheter AV implantation (TAVI). Nowadays, pre-TAVI sizing is routinely performed at one cardiac phase only, usually at mid-systole. Nonetheless, the AV is a dynamic structure that undergoes changes in size and shape throughout the cardiac cycle, which may be relevant for prosthesis selection. Thus, the aim of this study was to present and evaluate a novel software tool enabling the automatic sizing of the AV dynamically in three-dimensional (3D) transesophageal echocardiography (TEE) images. Forty-two patients who underwent preoperative 3D-TEE images were retrospectively analyzed using the software. Dynamic measurements were automatically extracted at four levels, including the aortic annulus. These measures were used to assess the software's ability to accurately and reproducibly quantify the conformational changes of the aortic root and were validated against automated sizing measurements independently extracted at distinct time points. The software extracted physiological dynamic measurements in less than 2 min, that were shown to be accurate (error 2.2 ± 26.3 mm2 and 0.0 ± 2.53 mm for annular area and perimeter, respectively) and highly reproducible (0.85 ± 6.18 and 0.65 ± 7.90 mm2 of intra- and interobserver variability, respectively, in annular area). Using the maximum or minimum measured values rather than mid-systolic ones for device sizing resulted in a potential change of recommended size in 7% and 60% of the cases, respectively. The presented software tool allows a fast, automatic and reproducible dynamic assessment of the AV morphology from 3D-TEE images, with the extracted measures influencing the device selection depending on the cardiac moment used to perform its sizing. This novel tool may thus ease and potentially increase the observer's confidence during prosthesis' size selection at the preoperative TAVI planning.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Ecocardiografia Tridimensional/métodos , Ecocardiografia Transesofagiana/métodos , Hemodinâmica , Interpretação de Imagem Assistida por Computador/métodos , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/cirurgia , Automação , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Desenho de Prótese , Reprodutibilidade dos Testes , Estudos Retrospectivos , Desenho de Programas de Computador , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/instrumentação
15.
Ann Biomed Eng ; 47(4): 1116-1128, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30710186

RESUMO

Several studies have shown the variation of aortic sinus structures' hemodynamics with different flow and geometric characteristics. They have also correlated aortic sinus hemodynamics with the progression and evolution of calcific aortic valve disease (CAVD). This study aims at visualizing aortic sinus fluid structure variations as functions of different leaflet calcification degrees and assessing their potential relationship with CAVD. A degenerated 23 mm Carpentier-Edwards Perimount Magna valve extracted from a redo-surgery patient was implanted in an aortic root model and tested in a pulse duplicator left heart simulator. The valve has 3 leaflets with 3 different levels of calcium distribution: mild, moderate and severe. High-speed imaging and particle image velocimetry were performed to assess sinus vortices, leaflet tip position and velocity along with shear stress. Results have shown that (a) aortic sinus vortices initiation, entrapment and evolution varied with different calcified leaflet exposure; (b) higher velocities in the sinus were calculated with the mildly calcified leaflet compared to the moderately and severely calcified ones; (c) during systole, the mildly calcified leaflet sinus case shows the most spread-out and higher ranges of shear stress probabilities and highest magnitudes going from (- 1.5 to + 1.8 Pa) compared with (- 1.0 to + 1.0 Pa) for moderately and severely calcified leaflets. The higher the calcification degree the lower the shear stress range and likelihoods of having higher shear stress. This holds in diastole as well. This study shows the impact of calcification on the aortic sinus flow structures.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Valva Aórtica/patologia , Calcinose/fisiopatologia , Simulação por Computador , Modelos Cardiovasculares , Seio Aórtico/fisiopatologia , Estresse Mecânico , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Humanos , Seio Aórtico/diagnóstico por imagem
16.
J Cardiovasc Comput Tomogr ; 13(2): 92-98, 2019 Mar - Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30665879

RESUMO

BACKGROUND: To investigate whether aortic valve calcification (AVC) scoring performed with different workstation platforms generates comparable and thus software-independent results. METHODS: In this IRB-approved retrospective study, we included 100 consecutive patients with symptomatic aortic stenosis undergoing CT prior to transcatheter aortic valve implantation. Two independent observers performed AVC scoring on non-enhanced images with commercially available software platforms of four vendors (GE, Philips, Siemens, 3mensio). Gender-specific Agatston score cut-off values were applied according to current recommendations to assign patients to different likelihood categories of aortic stenosis (unlikely to very likely). Comparative analysis of Agatston scores between the four platforms were performed by using Kruskal-Wallis analysis, Spearman rank correlation, linear regression analysis, and Bland-Altman analysis. Differences in category assignment were compared using Fisher's exact test and Cohen's kappa. RESULTS: For both observers, each workstation platform produced slightly different numeric AVC Agatston scores, however, without statistical significance (p = 0.96 and p = 0.98). Excellent correlation was found between platforms, with r = 0.991-0.996 (Spearman) and r2 = 0.981-0.992 (regression analysis) for both observers. Bland-Altman analyses revealed small mean differences with narrow limits of agreement between platforms (mean differences: 6 ±â€¯128 to 100 ±â€¯179), for inter-observer (mean differences: 1 ±â€¯43 to 12 ±â€¯70), and intra-observer variability (mean differences: 9 ±â€¯42 to 20 ±â€¯96). Observer 1 assigned 11 (kappa: 0.85-0.97) and observer 2 assigned 10 patients (kappa: 0.88-0.95) to different likelihood groups of severe aortic stenosis with at least one platform. Overall, there was no significant difference of likelihood assignment between platforms (p = 0.98 and p = 1.0, respectively). CONCLUSION: While absolute values differ slightly, common commercially available software platforms produce comparable results for AVC scoring, which indicates software-independence of the method.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Calcinose/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Software , Tomografia Computadorizada por Raios X , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
17.
BMC Med Imaging ; 19(1): 12, 2019 01 25.
Artigo em Inglês | MEDLINE | ID: mdl-30683072

RESUMO

BACKGROUND: Fetal deformity is a disease caused by abnormal chromosome structure, which may be influenced by genetic factors as well as the maternal and external environment. Magnetic resonance imaging (MRI) may be used to effectively diagnose fetus deformities. However it has been reported that gene analysis is a more accurate diagnostic method. The aim of the present study was to investigate the effectiveness of MRI in combination with gene analysis for the diagnosis of fetal congenital heart disease, a form of fetus deformity. METHODS: MRI, array comparative genome hybridization analysis and fluorescence in situ hybridization were used to analyze the effectiveness of the two methods in a total of 78 pregnant women with suspected fetal congenital heart disease. RESULTS: Our findings demonstrated that the combination of MRI and gene analysis resulted in significantly improved diagnostic accuracy, sensitivity and specificity for fetal congenital heart disease compared with either method alone. MRI combined with gene analysis confirmed 42 fetuses with pulmonary stenosis, 24 with aortic stenosis and 12 healthy fetuses, which was significantly improved compared with MRI or gene analysis alone. It was also observed that gene analysis was a more efficient method of diagnosis compared with MRI; however, the combination of the two methods was the most effective. CONCLUSION: In conclusion, the results of the present study suggest that MRI combined with gene analysis may be a more effective diagnostic method for fetal congenital heart disease compared with the current protocol.


Assuntos
Hibridização Genômica Comparativa/métodos , Cardiopatias Congênitas/diagnóstico , Hibridização in Situ Fluorescente/métodos , Imagem por Ressonância Magnética/métodos , Adulto , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/genética , Estudos de Casos e Controles , Diagnóstico Precoce , Feminino , Cardiopatias Congênitas/genética , Humanos , Idade Materna , Gravidez , Estenose da Valva Pulmonar/congênito , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/genética , Sensibilidade e Especificidade , Adulto Jovem
18.
Arch Cardiovasc Dis ; 112(3): 162-170, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30655226

RESUMO

BACKGROUND: Immediate improvement in kidney function has been reported after surgical aortic valve replacement or transcatheter aortic valve implantation. Long-term data, however, are not available. AIM: To assess the evolution of kidney function in chronic kidney disease stage 3b-5, 1 year after surgical aortic valve replacement or transcatheter aortic valve implantation. METHODS: All patients with chronic kidney disease stage 3b-5 undergoing surgical aortic valve replacement or transcatheter aortic valve implantation for aortic stenosis in a single centre were included. Kidney function was assessed 1 year postprocedure. Improvement or deterioration in estimated glomerular filtration rate was defined by an increase or decrease of 5mL/min/1.73 m2, respectively. RESULTS: Overall, 127 procedures were analysed (54 surgical aortic valve replacements and 73 transcatheter aortic valve implantations). Kidney function improved in 51% of patients at 1 year (45% of the surgical aortic valve replacement group versus 57% of the transcatheter aortic valve implantation group; P=0.21), and deteriorated in only 14% of patients at 1 year (18% of the surgical aortic valve replacement group versus 10% of the transcatheter aortic valve implantation group; P=0.22). Almost a quarter of patients (23%) had an improvement in estimated glomerular filtration rate of>15mL/min/1.73 m2, and this was consistent at later follow-up. Few patients went onto chronic dialysis at 1 year (three after surgical aortic valve replacement and one after transcatheter aortic valve implantation). Acute kidney injury was an independent prognostic factor for long-term deterioration in kidney function (odds ratio 2.1, 95% confidence interval 1.4-3.6; P=0.006). CONCLUSION: Aortic valve replacement, whether by surgical aortic valve replacement or transcatheter aortic valve implantation, improved estimated glomerular filtration rate at 1 year in more than half of patients with chronic kidney disease stage 3b-5.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Taxa de Filtração Glomerular , Implante de Prótese de Valva Cardíaca , Rim/fisiopatologia , Insuficiência Renal Crônica/fisiopatologia , Substituição da Valva Aórtica Transcateter , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Recuperação de Função Fisiológica , Sistema de Registros , Insuficiência Renal Crônica/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
19.
BMJ Case Rep ; 12(1)2019 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-30674490

RESUMO

Radiation-induced cardiac injury entails a wide spectrum of cardiovascular complications such as cardiomyopathy and valvular diseases among others. We present the internist's perspective and the challenges faced in managing these patients. There are guidelines addressing radiation-induced valvular disease (RIVD) including screening and treatment, but are often unrecognised by most internist's practice. A thorough cardiovascular examination and screening echocardiography may detect RIVD at an earlier stage. Early screening with transthoracic echocardiogram should be considered in asymptomatic or low-risk patients and more frequently in symptomatic and high-risk patients. The internists should educate their patients with prior chest irradiation, regarding the possible radiation related adverse cardiovascular effects and recommended screening. Lifestyle changes and aggressive cardiovascular risk modification should be emphasised, as concomitant hypertension, coronary artery disease and cardiomyopathy can have unfavourable effects in these patients.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Cardiopatias/etiologia , Coração/efeitos da radiação , Lesões por Radiação/complicações , Radioterapia/efeitos adversos , Antagonistas Adrenérgicos beta/uso terapêutico , Estenose da Valva Aórtica/tratamento farmacológico , Estenose da Valva Aórtica/etiologia , Diagnóstico Diferencial , Ecocardiografia/métodos , Feminino , Cardiopatias/diagnóstico por imagem , Doença de Hodgkin/radioterapia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
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