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Wal P, Rathore S, Aziz N, Singh YK, Gupta A. Aortic stenosis: a review on acquired pathogenesis and ominous combination with diabetes mellitus. Egypt Heart J 2023; 75:26. [PMID: 37027109 PMCID: PMC10082141 DOI: 10.1186/s43044-023-00345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/08/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Aortic stenosis (AS) is a progressive disease, with no pharmacological treatment. The prevalence of diabetes mellitus (DM) among AS patients is higher than in the general population. DM significantly increases the risk of AS development and progression from mild to severe. The interplay between AS and DM's mechanism is not entirely known yet. MAIN BODY The increased accumulation of advanced glycation end products (AGEs) was linked to increased valvular oxidative stress, inflammation, expression of coagulation factors, and signs of calcification, according to an analysis of aortic stenotic valves. It is interesting to note that in diabetic AS patients, valvular inflammation did not correlate with serum glucose levels but rather only with long-term glycemic management markers like glycated haemoglobin and fructosamine. Transcatheter aortic valve replacement, which has been shown to be safer than surgical aortic valve replacement, is advantageous for AS patients who also have concurrent diabetes. Additionally, novel anti-diabetic medications have been proposed to lower the risk of AS development in DM patients, including sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonist that target reduction of AGEs-mediated oxidative stress. CONCLUSIONS There are little data on the effects of hyperglycemia on valvular calcification, but understanding the interactions between them is essential to develop a successful treatment strategy to stop or at least slow the progression of AS in DM patients. There is a link among AS and DM and that DM negatively impacts the quality of life and longevity of AS patients. The sole successful treatment, despite ongoing efforts to find new therapeutic modalities, involves aortic valve replacement. More research is required to find methods that can slow the advancement of these conditions, enhancing the prognosis and course of people with AS and DM.
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Affiliation(s)
- Pranay Wal
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India.
| | - Shruti Rathore
- LCIT School of Pharmacy, Bilaspur, Chhattisgarh, 495220, India
| | - Namra Aziz
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India
| | - Yash Kumar Singh
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India
| | - Arpit Gupta
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India
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Lee HJ, Park CS, Lee S, Park JB, Kim HK, Park SJ, Kim YJ, Lee SP. Systemic proinflammatory-profibrotic response in aortic stenosis patients with diabetes and its relationship with myocardial remodeling and clinical outcome. Cardiovasc Diabetol 2023; 22:30. [PMID: 36765354 PMCID: PMC9921197 DOI: 10.1186/s12933-023-01763-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Previous studies have mainly focused more on how diabetes affects the valve than the myocardium in aortic stenosis (AS). In the pressure-overloaded heart, myocardial fibrosis is an important driver of the progression from compensated hypertrophy to heart failure. Using comprehensive noninvasive imaging and plasma proteomics, we investigated whether and how diabetes aggravates the remodeling of the myocardium and its relation with prognosis in AS patients. METHODS Severe AS patients were enrolled in two prospective cohorts for imaging and biomarker analysis. The imaging cohort (n = 253) underwent echocardiography and cardiac magnetic resonance, and the biomarker cohort (n = 100) blood sampling with multiplex proximity extension assay for 92 proteomic biomarkers. The composite outcome of hospitalization for heart failure admissions and death was assessed in the imaging cohort. RESULTS Diabetic patients were older (70.4 ± 6.8 versus 66.7 ± 10.1 years) with more advanced ventricular diastolic dysfunction and increased replacement and diffuse interstitial fibrosis (late gadolinium enhancement % 0.3 [0.0-1.6] versus 0.0 [0.0-0.5], p = 0.009; extracellular volume fraction % 27.9 [25.7-30.1] versus 26.7 [24.9-28.5], p = 0.025) in the imaging cohort. Plasma proteomics analysis of the biomarker cohort revealed that 9 proteins (E-selectin, interleukin-1 receptor type 1, interleukin-1 receptor type 2, galectin-4, intercellular adhesion molecule 2, integrin beta-2, galectin-3, growth differentiation factor 15, and cathepsin D) were significantly elevated and that pathways related to inflammatory response and extracellular matrix components were enriched in diabetic AS patients. During follow-up (median 6.3 years), there were 53 unexpected heart failure admissions or death in the imaging cohort. Diabetes was a significant predictor of heart failure and death, independent of clinical covariates and aortic valve replacement (HR 1.88, 95% CI 1.06-3.31, p = 0.030). CONCLUSIONS Plasma proteomic analyses indicate that diabetes potentiates the systemic proinflammatory-profibrotic milieu in AS patients. These systemic biological changes underlie the increase of myocardial fibrosis, diastolic dysfunction, and worse clinical outcomes in severe AS patients with concomitant diabetes.
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Affiliation(s)
- Hyun-Jung Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Chan Soon Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Sahmin Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea. .,Center for Precision Medicine, Seoul National University Hospital, Seoul, South Korea.
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Mourino-Alvarez L, Corbacho-Alonso N, Sastre-Oliva T, Corros-Vicente C, Solis J, Tejerina T, Padial LR, Barderas MG. Diabetes Mellitus and Its Implications in Aortic Stenosis Patients. Int J Mol Sci 2021; 22:ijms22126212. [PMID: 34207517 PMCID: PMC8227301 DOI: 10.3390/ijms22126212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/18/2022] Open
Abstract
Aortic stenosis (AS) and diabetes mellitus (DM) are both progressive diseases that if left untreated, result in significant morbidity and mortality. Several studies revealed that the prevalence of DM is substantially higher in patients with AS and, thus, the progression from mild to severe AS is greater in those patients with DM. DM and common comorbidities associated with both diseases, DM and AS, increase patient management complexity and make aortic valve replacement the only effective treatment. For that reason, a better understanding of the pathogenesis underlying both these diseases and the relationships between them is necessary to design more appropriate preventive and therapeutic approaches. In this review, we provided an overview of the main aspects of the relationship between AS and DM, including common comorbidities and risk factors. We also discuss the established treatments/therapies in patients with AS and DM.
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Affiliation(s)
- Laura Mourino-Alvarez
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, 45071 Toledo, Spain; (L.M.-A.); (N.C.-A.); (T.S.-O.); (C.C.-V.)
| | - Nerea Corbacho-Alonso
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, 45071 Toledo, Spain; (L.M.-A.); (N.C.-A.); (T.S.-O.); (C.C.-V.)
| | - Tamara Sastre-Oliva
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, 45071 Toledo, Spain; (L.M.-A.); (N.C.-A.); (T.S.-O.); (C.C.-V.)
| | - Cecilia Corros-Vicente
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, 45071 Toledo, Spain; (L.M.-A.); (N.C.-A.); (T.S.-O.); (C.C.-V.)
| | - Jorge Solis
- Department of Cardiology, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Atria Clinic, 28009 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (J.S.); or (M.G.B.); Fax: +34-925247745 (M.G.B.)
| | - Teresa Tejerina
- Department of Pharmacology, School of Medicine, Universidad Complutense, 28040 Madrid, Spain;
| | - Luis R. Padial
- Department of Cardiology, Hospital Virgen de la Salud, SESCAM, 45004 Toledo, Spain;
| | - Maria G. Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, 45071 Toledo, Spain; (L.M.-A.); (N.C.-A.); (T.S.-O.); (C.C.-V.)
- Correspondence: (J.S.); or (M.G.B.); Fax: +34-925247745 (M.G.B.)
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Abecasis J, Gomes Pinto D, Ramos S, Masci PG, Cardim N, Gil V, Félix A. Left Ventricular Remodeling in Degenerative Aortic Valve Stenosis. Curr Probl Cardiol 2021; 46:100801. [PMID: 33588124 DOI: 10.1016/j.cpcardiol.2021.100801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 01/14/2021] [Indexed: 01/15/2023]
Abstract
Aortic stenosis was once considered a pure isolated valve obstacle challenging left ventricle driving force of contraction and flow generation. Left ventricular (LV) adaptation was merely interpreted as a uniform hypertrophic response to increased afterload. However, in these last 2 decades cardiac imaging research and some histopathology correlation studies brought insight towards the complex interaction between the vasculature, the valve and the myocardium. Verily, LV remodeling in this setting is a complex multidetermined process that goes further beyond myocardial hypertrophy. Ultrastructural changes involving both diffuse and replacement fibrosis of the myocardium take part and might explain the transition of clinical phenotypes with distinct prognosis, from compensated hypertrophy to LV maladaptive dysfunction and heart failure. Presently, the combined appropriate use of echocardiography and cardiac magnetic resonance may better assess the global LV afterload, hypertrophy and geometric remodeling, global and regional LV function, beyond ejection fraction, and structural changes that include the fibrotic burden of the myocardium. As a whole these may not only better stratify individual risk of disease progression but also identify patients benefiting from earlier valve intervention. In this paper, we review the maladaptive response of the LV to chronic pressure overload, describing the different signaling pathways and mechanisms that underly both hypertrophy and remodeling. Histomorphology changes in this setting are described and we try to make sense of the use of new imaging tools for LV characterization.
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Affiliation(s)
- João Abecasis
- Nova Medical School, Lisboa, Portugal; Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Cardiology Department, Hospital dos Lusíadas, Lisboa, Portugal.
| | - Daniel Gomes Pinto
- Nova Medical School, Lisboa, Portugal; Pathology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | - Sância Ramos
- Pathology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; Faculdade Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | | | - Nuno Cardim
- Nova Medical School, Lisboa, Portugal; Hospital da Luz, Lisboa, Portugal
| | - Victor Gil
- Cardiology Department, Hospital dos Lusíadas, Lisboa, Portugal; Faculdade de Medicina de Lisboa, Portugal
| | - Ana Félix
- Nova Medical School, Lisboa, Portugal; Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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The Impact of Valvuloarterial Impedance on Left Ventricular Geometrical Change after Transcatheter Aortic Valve Replacement: A Comparison between Valvuloarterial Impedance and Mean Pressure Gradient. J Clin Med 2020; 9:jcm9103143. [PMID: 33003289 PMCID: PMC7600915 DOI: 10.3390/jcm9103143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022] Open
Abstract
Increase in left ventricular (LV) mass develops as a compensatory mechanism against pressure overload in aortic valve stenosis. However, long-standing LV geometrical changes are related to poor prognosis. The LV geometrical change occurs after transcatheter aortic valve replacement (TAVR). The present study aimed to investigate the relationship between improvement in valvuloarterial impedance (Zva) and change in LV mass index (LVMI) and the ratio of LVMI to LV end-diastolic volume index (LVMI/LVEDVI). We compared these relationships to that between Zva and mean pressure gradient (MPG). Baseline and follow-up transthoracic echocardiograms of 301 patients who underwent TAVR from November 2011 to December 2015 were reviewed. Spearman correlation coefficient (ρ) was used to compare ΔLVMI and ΔLVMI/LVEDVI with Zva or MPG. The correlation between ΔZva and ΔLVMI (ρ = 0.47, p < 0.001) was superior to that between ΔMPG and ΔLVMI (ρ = 0.15, p = 0.009) (p for comparison < 0.001). The correlation between ΔZva and ΔLVMI/LVEDVI was statistically significant (ρ = 0.54, p < 0.001); in contrast, that of ΔMPG and ΔLVMI/LVEDVI was not. The improvement in Zva after TAVR was more closely related to LVMI and LVMI/LVEDVI reduction than MPG reduction.
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Elbadawi A, Mohamed AH, Elgendy IY, Ogunbayo GO, Megaly M, Shahin HI, Mahmoud K, Omer MA, Abuzaid A, Fujise K, Gilani S. Comparative Outcomes of Transapical Versus Transfemoral Access for Transcatheter Aortic Valve Replacement in Diabetics. Cardiol Ther 2020; 9:107-118. [PMID: 31713066 PMCID: PMC7237629 DOI: 10.1007/s40119-019-00155-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION The outcomes of transfemoral (TF) compared with transapical (TA) access for transcatheter aortic valve replacement (TAVR) in diabetics are unknown. METHODS We queried the NIS database (2011-2014) to identify diabetics who underwent TAVR. We performed a propensity matching analysis comparing TF-TAVR versus TA-TAVR. RESULTS The analysis included 14.555 diabetics who underwent TAVR. After matching, in-hospital mortality was not different between TF-TAVR and TA-TAVR. (3.5 vs. 4.4%, p = 0.11). TF-TAVR was associated with lower rates of cardiogenic shock (2.7 vs. 4.7%, p = 0.02), use of mechanical circulatory support (2.0 vs. 2.9%, p = 0.03), acute renal failure (17.8 vs. 26.5%, p < 0.001), major bleeding (35.8 vs. 40.7%, p < 0.001) and respiratory complications (1.1 vs. 4.4%, p < 0.001) compared with TA-TAVR. However, TF-TAVR was associated with a higher rate of vascular complications (2.9 vs. 0.9%, p < 0.001), cardiac tamponade (0.5 vs. 0.0%, p < 0.001), complete heart block (10.8 vs. 7.7%, p < 0.001) and pacemaker insertion (11.8 vs. 8.3%, p < 0.001). There was no difference between both groups in acute stroke (1.8 vs. 2.2%, p = 0.39), hemodialysis (2.0 vs. 2.2%, p = 0.71), and ventricular arrhythmias (4.9 vs. 4.2%, p = 0.19). Notably, TF-TAVR was associated with higher mortality, acute stroke, AKI, hemodialysis, PCI, and respiratory complications in complicated diabetics compared with non-complicated diabetics. CONCLUSIONS This observational analysis showed no difference in-hospital mortality between TF-TAVR and TA-TAVR among diabetic patients. Studies exploring the optimal access for TAVR among diabetics are recommended.
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Affiliation(s)
- Ayman Elbadawi
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Ahmed H Mohamed
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Islam Y Elgendy
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY, USA
| | - Michael Megaly
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Hend I Shahin
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, USA
| | - Karim Mahmoud
- Department of Internal Medicine, Houston Medical Center, Warner Robbins, GA, USA
| | - Mohamed A Omer
- Department of Cardiology, Minneapolis Heart Institute, Minneapolis, MN, USA
| | - Ahmed Abuzaid
- Alaska Heart and Vascular Institute Anchorage, Alaska, US
| | - Ken Fujise
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Syed Gilani
- Department of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX, USA
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Abstract
Aortic stenosis and diabetes mellitus are both progressive diseases which, if left untreated, result in significant morbidity and mortality. There is evidence that the prevalence of diabetes is substantially increased in patients with aortic stenosis and those with diabetes have increased rates of progression from mild to severe aortic stenosis. There are good data supporting the hypothesis that aortic stenosis and diabetes mellitus are associated with diabetes mellitus being detrimental towards the quality of life and survival of patients. Thus, a thorough understanding of the pathogenesis of both of these disease processes and the relationship between them aids in designing appropriate preventive and therapeutic approaches. This review aims to give a comprehensive and up-to-date insight into the influence of diabetes mellitus on patients with degenerative aortic stenosis, as well as the prognosis and therapeutic approach to these patients.
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Affiliation(s)
- Marko Banovic
- 1 Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- 2 Belgrade Medical School, University of Belgrade, Belgrade, Serbia
| | - Lavanya Athithan
- 3 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- 4 The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- 3 Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- 4 The NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
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Bell DSH, Goncalves E. Heart failure in the patient with diabetes: Epidemiology, aetiology, prognosis, therapy and the effect of glucose-lowering medications. Diabetes Obes Metab 2019; 21:1277-1290. [PMID: 30724013 DOI: 10.1111/dom.13652] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Revised: 01/29/2019] [Accepted: 02/03/2019] [Indexed: 12/24/2022]
Abstract
In people with type 2 diabetes the frequency of heart failure (HF) is increased and mortality from HF is higher than with non-diabetic HF. The increased frequency of HF is attributable to the cardiotoxic tetrad of ischaemic heart disease, left ventricular hypertrophy, diabetic cardiomyopathy and an extracellular volume expansion resistant to atrial natriuretic peptides. Activation of the renin-angiotensin-aldosterone system and sympathetic nervous systems results in cardiac remodelling, which worsens cardiac function. Reversal of remodelling can be achieved, and cardiac function improved in people with HF with reduced ejection fraction (HFrEF) by treatment with angiotensin-converting enzyme inhibitors and β-blockers. However, with HF with preserved ejection fraction (HFpEF), only therapy for the underlying risk factors helps. Blockers of mineralocorticoid receptors may be beneficial in both HFrEF and HFpEF. Glucose-lowering drugs can have a negative effect (insulin, sulphonylureas, dipeptidyl peptidase-4 inhibitors and thiazolidinediones), a neutral effect (α-glucosidase inhibitors and glucagon-like peptide-1 receptor agonists) or a positive effect (sodium-glucose co-transporter-2 inhibitors and metformin).
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9
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Guzzetti E, Annabi MS, Ong G, Zenses AS, Dagenais F, Tastet L, Salaun E, Shen M, Piché ME, Poirier P, Voisine P, Pibarot P, Clavel MA. Impact of Metabolic Syndrome and/or Diabetes Mellitus on Left Ventricular Mass and Remodeling in Patients With Aortic Stenosis Before and After Aortic Valve Replacement. Am J Cardiol 2019; 123:123-131. [PMID: 30385031 DOI: 10.1016/j.amjcard.2018.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/07/2018] [Accepted: 09/17/2018] [Indexed: 01/17/2023]
Abstract
In aortic stenosis (AS), metabolic syndrome (MetS), and diabetes mellitus (DM) are associated with more pronounced left ventricular (LV) hypertrophy and more concentric remodeling. We aimed to assess the impact of MetS and DM on LV mass, remodeling, and LV mass regression after aortic valve replacement (AVR) in patients with severe AS. We included 177 patients with severe AS and preserved LV ejection fraction (>50%). All patients underwent a complete echocardiogram before and 1 year after AVR. Forty-seven (27%) patients had MetS, 37 (21%) DM, and 93 (52%) neither MetS nor DM (No MetS-DM). Before AVR, indexed LV mass was higher in MetS and DM groups compared with No MetS-DM group (56.1 ± 14.2, 56.2 ± 18.2 vs 49.2 ± 14.1 g/m2.7, respectively; p <0.01). Prevalence of LV hypertrophy was higher in MetS and DM than in No MetS-DM patients (66%, 65% vs 44%, p <0.01) as well as LV mass to end-diastolic volume ratio (2.10 ± 0.44 and 2.21 ± 0.63 vs 1.96 ± 0.41 g/ml, respectively, p = 0.03). After multivariate analysis, DM and MetS were independently associated with higher baseline LV mass (p <0.05). One year after AVR, decrease in LV mass was significant (p <0.001) in all 3 groups. MetS was independently associated with less LV mass regression and higher LV mass 1 year after AVR. Therefore, MetS and DM patients showed more residual LV hypertrophy than those with No MetS-DM (57%, 38%, and 17%, p <0.01). In conclusion, MetS and DM were associated with higher preoperative LV mass, more LV hypertrophy, and more concentric remodeling. One year after AVR, MetS showed less significant LV mass regression and both DM and MetS persisted with more residual LV hypertrophy.
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10
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Abstract
Transcatheter aortic valve replacement (TAVR) is a safe and effective therapy for aortic valve replacement in patients ineligible for or at high risk for surgery. However, outcomes after TAVR based on an individual's sex remain to be fully elucidated. We searched PUBMED and EMBASE using the keywords: "transcatheter aortic valve replacement," "transcatheter aortic valve implantation," "sex differences," "gender," "sex characteristics" and collected information on baseline features, procedural characteristics, and postprocedural outcomes in women. Inclusion/exclusion resulted in 23 publications. Women had less preexisting comorbidities than men. Most studies reported better survival in women (range of hazard ratio [95% CI] = 0.27 [0.09-0.84] to 0.91 [0.75-1.10]). At 30 days, women also had more vascular complications (6-20% vs 2-14%) and higher bleeding rates (10-44% vs 8-25%). Stroke rates were similar at 30 days (women, 1-7%; men, 1-5%). This literature review showed better survival in women than men after TAVR. However, women had more vascular complications and bleeding; stroke rates were similar. These findings may partly be explained by fewer baseline comorbidities in women. These results should be interpreted with caution as most measures only include unadjusted percentages.
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Abramowitz Y, Vemulapalli S, Chakravarty T, Li Z, Kapadia S, Holmes D, Matsouaka RA, Wang A, Cheng W, Forrester JS, Smalling R, Thourani V, Mack M, Leon M, Makkar RR. Clinical Impact of Diabetes Mellitus on Outcomes After Transcatheter Aortic Valve Replacement: Insights From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005417. [PMID: 29138245 DOI: 10.1161/circinterventions.117.005417] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/09/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Diabetes mellitus (DM) adversely affects morbidity and mortality for cardiovascular diseases and procedures. Data evaluating the outcomes of transcatheter aortic valve replacement (TAVR) in diabetic patients are limited by small sample size and contradictory results. We aimed to establish the magnitude of risk and the incremental influence of insulin dependency by examining short- and long-term adverse outcomes according to DM status and therapy in the world's largest TAVR registry. METHODS AND RESULTS We analyzed data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. In-hospital mortality, 30-day mortality, and 1-year mortality after TAVR in patients with and without DM were evaluated using multivariate modeling. Among 47 643 patients treated with TAVR from November 2011 through September 2015 at 394 US hospitals, there were 17 849 (37.5%) patients with DM. Overall, 6600 of the diabetic patients were insulin treated (IT). Thirty-day mortality was 5.0% in patients with DM (6.1% in IT DM and 4.4% in non-IT DM; P<0.001) versus 5.9% in patients without DM (P<0.001). Overall, 1-year mortality was 21.8% in patients with DM (24.8% in IT DM and 20.1% in non-IT DM; P<0.001) versus 21.2% in patients without DM (P=0.274). In a multivariable model, DM was associated with increased 1-year mortality (hazard ratio, 1.30; 95% confidence interval, 1.13-1.49; P<0.001). Subgroup multivariable analysis showed stronger mortality association in IT diabetics (hazard ratio, 1.57; 95% confidence interval, 1.28-1.91; P<0.001) than in non-IT diabetics (hazard ratio, 1.17; 95% confidence interval, 1.00-1.38; P=0.052). CONCLUSIONS Our data establish the magnitude of short- and long-term risk conferred by DM and the incremental risk conferred by insulin dependency in the performance of TAVR. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01737528.
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Affiliation(s)
- Yigal Abramowitz
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Sreekanth Vemulapalli
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Tarun Chakravarty
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Zhuokai Li
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Samir Kapadia
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - David Holmes
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Roland A Matsouaka
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Alice Wang
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Wen Cheng
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - James S Forrester
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Richard Smalling
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Vinod Thourani
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Michael Mack
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Martin Leon
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.)
| | - Raj R Makkar
- From the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA (Y.A., T.C., W.C., J.S.F., R.R.M.); Department of Medicine, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC (S.V., Z.L.); Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Durham, NC (R.A.M.); Department of Surgery, Duke University Medical Center, Durham, NC (A.W.); Heart and Vascular Institute, Cleveland Clinic, OH (S.K.); Division of Cardiology, Mayo Clinic, Rochester, MN (D.H.); University of Texas Memorial Hermann Heart and Vascular Institute, Houston (R.S.); Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (V.T.); Heart Hospital Baylor Plano, Baylor Healthcare System, TX (M.M.); and Division of Cardiology, Columbia University Medical Center, New York, NY (M.L.).
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12
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Bagai J, Brilakis ES. Patients with diabetes also deserve TAVR! Hellenic J Cardiol 2018; 59:108-109. [PMID: 29733911 DOI: 10.1016/j.hjc.2018.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022] Open
Affiliation(s)
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
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13
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Does diabetes mellitus impact prognosis after transcatheter aortic valve implantation? Insights from a meta-analysis. J Cardiol 2017; 70:484-490. [DOI: 10.1016/j.jjcc.2017.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/15/2017] [Accepted: 01/28/2017] [Indexed: 01/13/2023]
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Defining the Association between Diabetes and Plastic Surgery Outcomes: An Analysis of Nearly 40,000 Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1461. [PMID: 28894673 PMCID: PMC5585446 DOI: 10.1097/gox.0000000000001461] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/06/2017] [Indexed: 12/17/2022]
Abstract
Background: Diabetes is an increasingly prevalent comorbidity in patients presenting for surgery, impacting nearly 14% of adults in the United States. Although it is known that diabetic patients are at an increased risk for postoperative complications, there is a paucity of literature on the specific ramifications of diabetes on different surgical procedures. Methods: Using the American College of Surgeons National Surgical Quality Improvement Program dataset, demographics, outcomes, and length of in-patient hospitalization were examined for patients who underwent plastic surgery between 2007 and 2012. Adjusted multivariable logistic regression models were used to assess the relationship between diabetes status and a spectrum of medical and surgical postoperative outcomes. Results: Thirty-nine thousand four hundred seventy-five plastic surgery patients were identified, including 1,222 (3.10%) with insulin-dependent diabetes mellitus (IDDM) and 1,915 (4.75%) with non–insulin-dependent diabetes mellitus (NIDDM), who had undergone breast, hand/upper and lower extremity, abdominal, or craniofacial procedures. Logistic regression analyses showed that only insulin-dependent diabetics had a higher likelihood of surgical complications (IDDM: P value < 0.0001; NIDDM: P value < 0.103), whereas patients with both IDDM and NIDDM had increased likelihoods of medical complications (IDDM: P value < 0.001; NIDDM: P value = 0.0093) compared with nondiabetics. Average hospital stay for diabetics was also longer than for nondiabetics. Conclusions: Diabetes is associated with an increase in a multitude of postoperative complications and in hospital length of stay, in patients undergoing plastic surgery. Diabetes status should thus be evaluated and addressed when counseling patients preoperatively. Risks may be further stratified based on IDDM versus NIDDM status.
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15
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Tokarek T, Dziewierz A, Wiktorowicz A, Bagienski M, Rzeszutko L, Sorysz D, Kleczynski P, Dudek D. Effect of diabetes mellitus on clinical outcomes and quality of life after transcatheter aortic valve implantation for severe aortic valve stenosis. Hellenic J Cardiol 2017; 59:100-107. [PMID: 28807801 DOI: 10.1016/j.hjc.2017.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/03/2017] [Accepted: 08/07/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is considered a marker of poor prognosis after cardiac surgery. We sought to investigate the effect of DM on clinical outcomes and quality of life (QoL) after transcatheter aortic valve implantation (TAVI). METHODS A total of 148 consecutive patients with symptomatic, severe aortic stenosis who underwent TAVI were included. Baseline characteristics, procedural and long-term clinical outcomes, and the results of frailty and QoL assessment with EQ-5D-3L questionnaire were compared between patients with and without DM. RESULTS DM was present in 48 of 148 (32.4%) patients. No differences in periprocedural risk (Logistic Euroscore and Society of Thoracic Surgeons (STS) scale) between groups were observed. There were no differences in 30-day and 12-month all-cause mortality between groups [DM(-) vs. DM(+): 7 (7.0%) vs. 5 (10.4%), p = 0.53 and 12 (12.0%) vs. 10 (20.8%), p = 0.16, respectively]. No influence of DM presence on the risk of death was confirmed after adjustment for age and gender (for 30-day mortality, age/gender-adjusted OR 1.55, 95%CI 0.47-5.17; for 12-month mortality, age/gender-adjusted OR 2.05, 95%CI 0.79-5.32). Similarly, at the longest available follow-up, mortality did not differ between groups [14 (29.2%) vs. 19 (19.0%), p = 0.16; age/gender-adjusted OR 1.81, 95%CI 0.80-4.08]. Similar rates of other complications after TAVI were noted. Frailty measured with the 5-meter walking test was more frequently reported in patients with DM [11 (22.9%) vs. 10 (10.0%), p = 0.035]. No differences in QoL parameters at baseline and 12 months were noted. CONCLUSIONS Patients with DM undergoing TAVI demonstrated similar mortality, complication rates, and QoL outcomes compared to patients without DM.
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Affiliation(s)
- Tomasz Tokarek
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Agata Wiktorowicz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Maciej Bagienski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Lukasz Rzeszutko
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Danuta Sorysz
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland
| | - Pawel Kleczynski
- 2nd Department of Cardiology, Institute of Cardiology, Jagiellonian University, Medical College, 17 Kopernika St., 31-501 Krakow, Poland.
| | - Dariusz Dudek
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, 17 Kopernika St., 31-501 Krakow, Poland
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16
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Minamino-Muta E, Kato T, Morimoto T, Taniguchi T, Inoko M, Haruna T, Izumi T, Miyamoto S, Nakane E, Sasaki K, Funasako M, Ueyama K, Shirai S, Kitai T, Izumi C, Nagao K, Inada T, Tada E, Komasa A, Ishii K, Saito N, Sakata R, Minatoya K, Kimura T. Impact of the left ventricular mass index on the outcomes of severe aortic stenosis. Heart 2017; 103:1992-1999. [PMID: 28684442 PMCID: PMC5749367 DOI: 10.1136/heartjnl-2016-311022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/07/2017] [Accepted: 05/26/2017] [Indexed: 12/16/2022] Open
Abstract
Objective To elucidate the factors associated with high left ventricular mass index (LVMI) and to test the hypothesis that high LVMI is associated with worse outcome in severe aortic stenosis (AS). Methods We analysed 3282 patients with LVMI data in a retrospective multicentre registry enrolling consecutive patients with severe AS in Japan. The management strategy, conservative or initial aortic valve replacement (AVR), was decided by the attending physician. High LVMI was defined as LVMI >115 g/m2 for males and >95 g/m2 for females. We compared the risk between normal and high LVMI in the primary outcome measures compromising aortic valve-related death and heart failure hospitalisation. Results Age was mean 77 (SD 9.6) years and peak aortic jet velocity (Vmax) was 4.1 (0.9) m/s. The factors associated with high LVMI (n=2374) included female, body mass index ≥22, absence of dyslipidemia, left ventricular ejection fraction <50%, Vmax ≥4 m/s, regurgitant valvular disease, hypertension, anaemia and end-stage renal disease. In the conservative management cohort (normal LVMI: n=691, high LVMI: n=1480), the excess adjusted 5-year risk of high LVMI was significant (HR: 1.53, 95% CI 1.26 to 1.85, p<0.001). In the initial AVR cohort (normal LVMI: n=217, high LVMI: n=894), the risk did not differ significantly between the two groups (HR: 0.96, 95% CI 0.60 to 1.55, p=0.88). There was a significant interaction between the initial treatment strategy and the risk of high LVMI (p=0.016). Conclusions The deleterious impact of high LVMI on outcome was observed in patients managed conservatively, but not observed in patients managed with initial AVR. Trial registration number UMIN000012140; Post-results.
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Affiliation(s)
- Eri Minamino-Muta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Tetsuya Haruna
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Toshiaki Izumi
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Shoichi Miyamoto
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Eisaku Nakane
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Kenichi Sasaki
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Moritoshi Funasako
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Koji Ueyama
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Chisato Izumi
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Kazuya Nagao
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Tsukasa Inada
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Eiji Tada
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Akihiro Komasa
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Naritatsu Saito
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryuzo Sakata
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Franzone A, O’Sullivan C, Stortecky S, Heg D, Lanz J, Vollenbroich R, Praz F, Piccolo R, Asami M, Roost E, Räber L, Valgimigli M, Windecker S, Pilgrim T. Prognostic impact of invasive haemodynamic measurements in combination with clinical and echocardiographic characteristics on two-year clinical outcomes of patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2017; 12:e2186-e2193. [DOI: 10.4244/eij-d-16-00790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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The impact of age on the postoperative response of the diastolic function and left ventricular mass regression after surgical or transcatheter aortic valve replacement for severe aortic stenosis. Surg Today 2016; 47:770-776. [DOI: 10.1007/s00595-016-1458-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 09/29/2016] [Indexed: 11/30/2022]
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