-
1.
Detecting native and bioprosthetic aortic valve disease using 18F-sodium fluoride: Clinical implications.
Fletcher, AJ, Dweck, MR
Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology. 2021;(2):481-491
-
-
Free full text
-
Abstract
Calcific aortic valve disease is the most common valvular disease and confers significant morbidity and mortality. There are currently no medical therapies that successfully halt or reverse the disease progression, making surgical replacement the only treatment currently available. The majority of patients will receive a bioprosthetic valve, which themselves are prone to degeneration and may also need replaced, adding to the already substantial healthcare burden of aortic stenosis. Echocardiography and computed tomography can identify late-stage manifestations of the disease process affecting native and bioprosthetic aortic valves but cannot detect or quantify early molecular changes. 18F-fluoride positron emission tomography, on the other hand, can non-invasively and sensitively assess disease activity in the valves. The current review outlines the pivotal role this novel molecular imaging technique has played in improving our understanding of native and bioprosthetic aortic valve disease, as well as providing insights into its feasibility as an important future research and clinical tool.
-
2.
Effect of prognostic nutritional index on short-term survival after transcatheter aortic valve implantation.
Panç, C, Yılmaz, E, Gürbak, İ, Uzun, F, Ertürk, M
Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir. 2020;(6):585-593
Abstract
OBJECTIVE Transcatheter aortic valve implantation (TAVI) is a good alternative to surgical aortic valve replacement (SAVR) in severe aortic stenosis patients who are at intermediate or high risk, or other cases that are considered unsuitable for SAVR. TAVI is most often performed on elderly patients, and although conventional risk scores include a number of comorbidities, they do not take into account functional decline specific to elderly patients. The prognostic nutritional index (PNI), which is a simple and effective parameter for both nutritional and inflammatory status, reflects functional decline in the elderly. The aim of this study was to determine the effect of the PNI on short-term survival after TAVI. METHODS The PNI values of 302 patients who underwent TAVI were analyzed. The study population was divided into 2 groups according to a PNI cut-off value: PNI >43.37 (n=213; 70%) and PNI <43.37 (n=89; 30%). RESULTS Patients with a lower PNI score had a significantly higher mortality rate in the initial 30-day period following the procedure than patients with a higher PNI score (3.3% vs. 31.5%; p<0.001). Major vascular complications and cardiac tamponade were significantly more frequent in the lower PNI group. The cut-off value of the PNI for 30-day survival was 43.37, with 94.3% specificity and 73.4% sensitivity and the negative predictive value of the PNI was 96.7%. The PNI score was found to be an independent risk factor for 30-day mortality after TAVI. CONCLUSION A higher PNI score was associated with short-term survival and fewer post-TAVI complications.
-
3.
Effects of Isolated Impaired Fasting Glucose on Brain Injury During Cardiac Surgery Under Cardiopulmonary Bypass.
Zhou, T, Li, S, Xiang, D, Gao, L
Journal of investigative surgery : the official journal of the Academy of Surgical Research. 2020;(4):350-358
Abstract
Objective: To evaluate the effects of isolated impaired fasting glucose (IIFG) on brain injury in patients undergoing cardiopulmonary bypass (CPB) surgery. Methods: Patients with rheumatic heart valve disease who underwent elective mitral valve replacement were included and divided into control and IIFG groups. Pre-, intra-, and postoperative blood glucose levels, serum insulin levels, insulin resistance index (HOMA-IR), lactic acid levels, and neuron-specific enolase (NSE) and S100B levels were measured. The cerebral oxygen extraction ratio (OER) was calculated. Cognitive function was assessed via the Mini-Mental State Examination (MMSE). Results: HOMA-IR levels were higher in the IIFG group than the control group 30 min after the beginning of CPB, at the termination of CPB, and 2 h after the termination of CPB. Cerebral OER and lactic acid increased intraoperatively in both groups, especially in the IIFG group. NSE and S100B levels were higher in the IIFG group than in the control group at the termination of CPB, 2 h after the termination of CPB, and at 24 h postoperatively. The MMSE scores did not significantly differ between the two groups. Delirium occurred in two patients in the IIFG group, and one in the control group. No other signs and symptoms of brain injuries were detected in either group. Conclusions: The increased postoperative NSE and S100B levels in the IIFG group compared with controls may be associated with severe insulin resistance and stress hyperglycemia. However, the IIFG group did not have clinical manifestations of brain injuries, including cognitive impairment.
-
4.
Intravenous Iron Versus Placebo in the Management of Postoperative Functional Iron Deficiency Anemia in Patients Undergoing Cardiac Valvular Surgery: A Prospective, Single-Blinded, Randomized Controlled Trial.
Xu, H, Duan, Y, Yuan, X, Wu, H, Sun, H, Ji, H
Journal of cardiothoracic and vascular anesthesia. 2019;(11):2941-2948
Abstract
OBJECTIVE To compare the efficacy of intravenous iron versus placebo to correct postoperative functional iron deficiency anemia in patients undergoing cardiac valvular surgery. DESIGN A prospective, single-blinded, randomized controlled study. SETTING National Center for Cardiovascular Diseases and a university hospital. PARTICIPANTS The study comprised 150 patients with postoperative functional iron deficiency anemia after cardiac valvular surgery. INTERVENTIONS The patients were randomly assigned (1:1) to either the treatment (intravenous iron) group or the control (placebo) group. MEASUREMENTS AND MAIN RESULTS The hemoglobin and ferritin concentrations and postoperative adverse events were collected and compared between the 2 groups. The hemoglobin concentration and the proportion of patients who had their anemia corrected or achieved hemoglobin increments of >20 g/L in the intravenous iron group were significantly higher than that in the placebo group at postoperative day 14 (p = 0.023, p = 0.037, and p = 0.001), whereas there was no statistical difference at postoperative day 7. The ferritin concentration was substantially higher at postoperative day 7 and postoperative day 14 in the intravenous iron group compared with the placebo group (both p < 0.001). There were no significant differences in rates of death, blood tranfusion, antibiotic upgrade, ventilator time >24 hours, postoperative hospital stay >10 days, poor wound healing, and perivalvular leakage between the 2 groups. CONCLUSIONS Intravenous iron could significantly increase the hemoglobin level in patients with postoperative functional iron deficiency anemia at postoperative day 14. However, there is no difference in blood transfusion requirements or postoperative adverse outcomes between the 2 groups.
-
5.
Forced diuresis with matched hydration during transcatheter aortic valve implantation for Reducing Acute Kidney Injury: a randomized, sham-controlled study (REDUCE-AKI).
Arbel, Y, Ben-Assa, E, Puzhevsky, D, Litmanowicz, B, Galli, N, Chorin, E, Halkin, A, Sadeh, B, Konigstein, M, Bassat, OK, et al
European heart journal. 2019;(38):3169-3178
Abstract
AIMS: Acute kidney injury (AKI) is a common complication following transcatheter aortic valve implantation (TAVI) and is associated with increased risk for short- and long-term mortality. In patients undergoing percutaneous coronary intervention (PCI), forced diuresis with matched hydration has been shown to reduce the incidence of AKI by ∼50%. The aim of the present study was to evaluate whether forced diuresis with matched intravenous hydration reduces AKI in patients undergoing TAVI. METHODS AND RESULTS Reducing Acute Kidney Injury (REDUCE-AKI) was a single-centre, prospective, randomized, double-blind sham-controlled clinical trial, designed to examine the effect of an automated matched saline infusion with urine output for the prevention of AKI in patients undergoing TAVI. A total of 136 TAVI patients were randomized, 68 in each group. Mean age was 83.9 ± 5 years and 41.2% were males. There were no differences in baseline characteristics between the two groups. The rate of AKI was not statistically different between the groups (25% in the active group vs. 19.1% in the sham group, P = 0.408). There was a significant increase in long-term mortality in the active group (27.9% vs. 13. 2% HR 3.744, 95% CI 1.51-9.28; P = 0.004). The study was terminated prematurely by the Data Safety Monitoring Board for futility and a possible signal of harm. CONCLUSIONS Unlike in PCI, forced diuresis with matched hydration does not prevent AKI in patients undergoing TAVI, and might be associated with increased long-term mortality. Future studies should focus on understanding the mechanisms behind these findings. CLINICALTRIALS.GOV REGISTRATION NCT01866800, 30 April 2013.
-
6.
How Did We Get Here?: A Historical Review and Critical Analysis of Anticoagulation Therapy Following Mechanical Valve Replacement.
MacIsaac, S, Jaffer, IH, Belley-Côté, EP, McClure, GR, Eikelboom, JW, Whitlock, RP
Circulation. 2019;(23):1933-1942
Abstract
Managing severe valvular heart disease with mechanical valve replacement necessitates lifelong anticoagulation with a vitamin K antagonist. Optimal anticoagulation intensity for patients with mechanical valves remains uncertain; current recommendations are inconsistent across guideline bodies and largely based on expert opinion. In this review, we outline the history of anticoagulation therapy in patients with mechanical heart valves and critically evaluate current antithrombotic guidelines for these patients. We conclude that randomized trials evaluating optimal anticoagulation intensity in patients with mechanical valves are needed, and that future guidelines must better justify antithrombotic treatment recommendations.
-
7.
Glucose-insulin-potassium improves left ventricular performances after aortic valve replacement: a secondary analysis of a randomized controlled trial.
Licker, M, Diaper, J, Sologashvili, T, Ellenberger, C
BMC anesthesiology. 2019;(1):175
Abstract
BACKGROUND Patients with left ventricular (LV) hypertrophy may suffer ischemia-reperfusion injuries at the time of cardiac surgery with impairment in left ventricular function. Using transesophageal echocardiography (TEE), we evaluated the impact of glucose-insulin potassium (GIK) on LV performances in patients undergoing valve replacement for aortic stenosis. METHODS In this secondary analysis of a double-blind randomized trial, moderate-to-high risk patients were assigned to receive GIK (20 IU insulin with 10 mEq KCL in 50 ml glucose 40%) or saline over 60 min upon anesthetic induction. The primary outcomes were the early changes in 2-and 3-dimensional left ventricular ejection fraction (2D and 3D-LVEF), peak global longitudinal strain (PGLS) and transmitral flow propagation velocity (Vp). RESULTS At the end of GIK infusion, LV-FAC and 2D- and 3D-LVEF were unchanged whereas Vp (mean difference [MD + 7.9%, 95% confidence interval [CI] 3.2 to 12.5%; P < 0.001) increased compared with baseline values. After Placebo infusion, there was a decrease in LV-FAC (MD -2.9%, 95%CI - 4.8 to - 1.0%), 2D-LVEF (MD -2.0%, 95%CI - 2.8 to - 1.3%, 3D-LVEF (MD -3.0%, 95%CI - 4.0 to - 2.0%) and Vp (MD - 4.5 cm/s, 95%CI - 5.6 to - 3.3 cm/s). After cardiopulmonary bypass, GIK pretreatment was associated with preserved 2D and 3D-LVEF (+ 0.4%, 95% 95%CI - 0.8 to 1.7% and + 0.4%, 95%CI - 1.3 to 2.0%), and PGLS (- 0.9, 95%CI - 1.6 to - 0.2) as well as higher Vp (+ 5.1 cm/s, 95%CI 2.9 to 7.3), compared with baseline. In contrast, in the Placebo group, 2D-LVEF (- 2.2%, 95%CI - 3.4 to - 1.0), 3D-LVEF (- 6.0%, 95%CI - 7.8 to - 4.2), and Vp (- 7.6 cm/s, 95%CI - 9.4 to - 5.9), all decreased after bypass. CONCLUSIONS Administration of GIK before aortic cross-clamping resulted in better preservation of systolic and diastolic ventricular function in patients with LV hypertrophy undergoing aortic valve replacement. TRIAL REGISTRATION ClinicalTrials.gov: NCT00788242 , registered on November 10, 2008.
-
8.
D-Dimer to Predict the Clinical Outcomes in Patients with Mechanical Heart Valve Replacement During Oral Anticoagulation Therapy.
Zhang, L, Long, Y, Xiao, H, Yang, J, Liu, X, Zhang, Z
International heart journal. 2019;(3):631-636
Abstract
Mechanical heart valve replacement (MHVR) entails lifetime oral anticoagulation to eliminate thrombosis. However, adverse events may still occur despite proper anticoagulation therapy. In this study, we investigated whether D-dimer can predict the clinical events in post-MHVR patients during oral anticoagulation therapy.This was a single-center, prospective study. In all, 772 patients who underwent MHVR in the Wuhan Asia Heart Hospital from January 2013 to May 2014 were screened. Patients were assigned to the abnormal D-dimer group and the normal D-dimer group according to the D-dimer levels measured 3 months after the beginning of the oral anticoagulation therapy regime. All patients were followed up for 24 months or until the observation of the endpoints, which included thrombotic events, bleeding events, and all-cause deaths.A total of 718 patients were included in the analysis: 91 had abnormal D-dimer levels, and 627 had normal D-dimer levels. In all, 53 events were observed during 24 months. Compared with the normal D-dimer group, patients with abnormal D-dimer levels had a higher incidence of thrombotic events (10 versus 14; hazard ratio (HR): 5.36; 95% confidence interval (CI): 2.38-12.1; P < 0.001), all-cause mortality (8 versus 13; HR: 4.65; 95% CI: 1.93-11.2; P < 0.001), and a higher incidence of total events (16 versus 37; HR: 3.26; 95% CI: 1.81-5.86; P < 0.001). No significant difference was observed in bleeding events (2 versus 21; HR: 0.72; 95% CI: 0.17-3.07; P = 0.66).D-dimer may be a useful marker to predict thrombotic events and all-cause deaths in post-MHVR patients during oral anticoagulation therapy (ClinicalTrials.gov; NCT01996657).
-
9.
Myocardial contrast echocardiography in the diagnosis of postoperative takotsubo myocardiopathy: case report and literature review.
Zeng, JH, Li, W, Yao, FJ, Liu, DH, Li, CL, Liu, YQ, Fan, R, Ye, M, Lin, H
BMC cardiovascular disorders. 2019;(1):9
Abstract
BACKGROUND Takotsubo cardiomyopathy (TCM) is a brief ventricular dysfunction that usually occurs after emotional or physical stress. Here, we report a patient who underwent cardiac surgery and then developed TCM during the postoperative period. CASE PRESENTATION A 51-year-old woman was admitted to our hospital complaining of chest tightness, palpitations and dyspnoea after activity. An echocardiogram performed by our hospital showed rheumatic heart disease (severe mitral stenosis and regurgitation) with normal cardiac function and wall motion. After mitral valve replacement, this patient developed heart failure with low blood pressure and tachycardia. Urgent bedside echocardiography demonstrated akinesis in the middle and apical segments of the left ventricle and a depressed ejection fraction (EF) of 36%. Myocardial contrast echocardiography (MCE) showed similar enhancement intensity in the basal, middle and apical segments. Quantitative analysis showed approximately equivalent maximum intensity in these regions. The diagnosis was considered TCM instead of myocardial infarction. Then, an intra-aortic balloon pump was inserted to maintain effective circulation and reduce the postcardiac load. Given ventilation therapy, postoperative anticoagulation therapy and anti-infection treatment, the patient recovered quickly. In the follow-up examination, the patient remained asymptomatic and showed normalization of ventricular wall motion in the apical segment. CONCLUSION This report presents a case of TCM in which MCE was used to demonstrate intact microvascular perfusion despite apical akinesis. This report might support the use of MCE as a substitute for invasive coronary angiography.
-
10.
Short-Term Effects of Tolvaptan in Tricuspid Insufficiency Combined with Left Heart Valve Replacement-Caused Volume-Overload Patients: Results of a Prospective Pilot Study.
Yuan, F, Wu, Z, Jiang, L, Zhou, J, Xu, L, Liu, H, Ma, L, Zhai, Z, Zhang, J
American journal of cardiovascular drugs : drugs, devices, and other interventions. 2019;(2):211-218
Abstract
OBJECTIVES Our objective was to explore the effects of tolvaptan as a new therapeutic approach in patients with right heart failure with tricuspid insufficiency (TI). METHODS This prospective, multicenter, non-randomized controlled pilot study enrolled patients (N = 40) with TI from the Shanghai Chest Hospital and Shanghai Tongren Hospital who fulfilled inclusion criteria between March 2015 and June 2016. Participants were assigned to receive either tolvaptan combined with torasemide (n = 20) or torasemide monotherapy (n = 20; control group). The primary endpoints were changes in patient weight and in tricuspid annular plane systolic excursion (TAPSE) after 10 days of treatment. The secondary endpoints included net fluid balance and cardiac functions before and after medication from the first to the tenth day of treatment. Safety was evaluated by monitoring adverse and serious adverse events. RESULTS TAPSE significantly increased in the tolvaptan group compared with the control group after 10 days of medication (P = 0.029). Daily weight losses in the tolvaptan group significantly increased as the time of treatment increased (time × group, P = 0.022). Recovery to New York Heart Association (NYHA) grade I occurred 4 days earlier in the tolvaptan group. In addition, the net fluid balance and median net fluid balance were significantly higher in the tolvaptan group. Eight adverse events and one serious adverse event were recorded in the tolvaptan group and 15 adverse events were recorded in the control group. CONCLUSIONS Our results indicate that tolvaptan might be a useful and safe drug to improve heart function in patients with right heart failure with TI after left heart valve replacement. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier no. NCT02644616.