Impact of Preoperative Measurement of Right Heart Chambers in the Evaluation of Pulmonary Hypertension Following Aortic Valve Replacement

Effects of staged rehabilitation training on inflammatory factor levels and red blood cell distribution width followingcardiac valve replacement

BACKGROUND

The current study was conducted aimed atexploring the effects of staged rehabilitation training on the levels of inflammatory factors and red blood cell distribution in patients who underwent cardiac valve replacement.

METHODS

A total of 140 patients who underwent cardiac valve replacement at The First Hospital of Hebei Medical University between April 2021 and November 2022 were included in this study. During the postoperative rehabilitation phase, the patients were randomly assigned to either the control group or the experimental group. The experimental group received staged rehabilitation training (n = 70), while the control group received conventional care and rehabilitation suggestions without specialized staged rehabilitation training (n = 70). Informed consent was obtained from all patients prior to theirinclusion in the study. Clinical data of the patients were collected andanalyzed. RDW was measured using an automated blood cell analyzer on postoperative day 1, 14, and 28. Levels ofTNF-α, IL-6 and CRP were measured using ELISA. Quality of life was evaluated usingthe WHOQOL-BREF questionnaire. The effects of postoperative rehabilitation were assessed using the 6MWD test. The occurrence of adverse events in the postoperative periodwas alsoanalyzed.

RESULTS

There were no significant differences in the general characteristics of the two groups of patients (P > 0.05). On the first day after surgery, no significant differences were seen in RDW between the two groups (P > 0.05). However, on the 14th and 28th day after surgery, the experimental group exhibited a significant reduction in RDW compared to the control group (P < 0.05). On the first day after surgery, the levels of serum TNF-α, IL-6 and CRP were comparable between the two groups (P > 0.05). However, on the 14th and the 28th after surgery, the experimental group showed evidently lower levels of TNF-α, IL-6 and CRP compared to the control group (P < 0.05). The experimental group demonstrated higher scores in the domains of physical health, psychological state, social relationships, and environment in the WHOQOL-BREF questionnaire compared to the control group (P < 0.05). Furthermore, the experimental group exhibited increased average,minimum,maximum walking distances in the6-minute walking test compared to the control group (P < 0.05). There were no significant differences in the incidence of postoperative adverse events between the two groups of patients (P > 0.05).

CONCLUSION

Staged rehabilitation training exerteda positive effect on the levels of inflammatory factors and red blood cell distribution in patients following cardiac valve replacement. This type of rehabilitation training facilitated the patient's recovery process by reducing the inflammatory response and improving the condition of red blood cells. Additionally, it enhanced the quality of life and rehabilitation outcomes for patients.

Severe Aortic Valve Stenosis and Pulmonary Hypertension: A Systematic Review of Non-Invasive Ways of Risk Stratification, Especially in Patients Undergoing Transcatheter Aortic Valve Replacement

Patients with severe aortic valve stenosis and concomitant pulmonary hypertension show a significantly reduced survival prognosis. Right heart catheterization as a preoperative diagnostic tool to determine pulmonary hypertension has been largely abandoned in recent years in favor of echocardiographic criteria. Clinically, determination of echocardiographically estimated systolic pulmonary artery pressure falls far short of invasive right heart catheterization data in terms of accuracy. The aim of the present systematic review was to highlight noninvasive possibilities for the detection of pulmonary hypertension in patients with severe aortic valve stenosis, with a special focus on cardiovascular biomarkers. A total of 525 publications regarding echocardiography, cardiovascular imaging and biomarkers related to severe aortic valve stenosis and pulmonary hypertension were analyzed in a systematic database analysis using PubMed Central®. Finally, 39 publications were included in the following review. It was shown that the current scientific data situation, especially regarding cardiovascular biomarkers as non-invasive diagnostic tools for the determination of pulmonary hypertension in severe aortic valve stenosis patients, is poor. Thus, there is a great scientific potential to combine different biomarkers (biomarker scores) in a non-invasive way to determine the presence or absence of PH.

Importance of Tricuspid Regurgitation Velocity Threshold in Risk Assessment of Pulmonary Hypertension-Long-Term Outcome of Patients Submitted to Aortic Valve Replacement

Background: The upper physiological threshold for tricuspid regurgitation velocity (TRV) of 2.8 m/s proposed by the Pulmonary Hypertension (PH) guidelines had been questioned. The aim of this study was to evaluate the prognostic significance of preoperative PH in patients with aortic stenosis, long-term after valve replacement, using two different TRV thresholds (2.55 and 2.8 m/s). Methods: Four hundred and forty four patients were included (mean age 73 ± 9 years; 55% male), with a median follow-up of 5.8 years (98% completed). Patients were divided into three PH probability groups according to guidelines (low, intermediate and high) for both thresholds (TRV ≤ 2.8 m/s and TRV ≤ 2.55 m/s), using right atrial area>18 cm² and right ventricle/left ventricle ratio>1 as additional echocardiographic variables. Results: In patients with measurable TRV (n = 304), the low group mortality rate was 25% and 30%, respectively for 2.55 and 2.8 m/s TRV thresholds. The intermediate group with TRV > 2.55 m/s was an independent mortality risk factor (HR 2.04; 95% CI: 1.91 to 3.48, p = 0.01), in contrast to the intermediate group with TRV>2.8 m/s (HR 1.44; 95% CI: 0.89 to 2.32, p = 0.14). Both high probability groups were associated with an increased mortality risk, as compared to their respective low groups. When including all patients (with measurable and non-measurable TRV), both intermediate groups remained independently associated with an increased mortality risk: HR 1.62 (95% CI 1.11 to 2.35 p = 0.01) for the new cut-off point; and HR 1.43 (95% CI: 0.96 to 2.13, p = 0.07) for guidelines threshold. Conclusion: A TRV threshold of 2.55 m/s, together with right cavities measures, allowed a better risk assessment of patients with PH secondary to severe aortic stenosis, with or without tricuspid regurgitation.