1
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Subramani K, Bander J, Chen S, Suárez-Fariñas M, Venkatesan T, Subrahmanian S, Varshney R, Kini A, Sharma S, Rifkin DB, Cho J, Coller BS, Ahamed J. Evidence That Anemia Accelerates AS Progression Via Shear-Induced TGF-β1 Activation: Heyde's Syndrome Comes Full Circle. JACC Basic Transl Sci 2024; 9:185-199. [PMID: 38510715 PMCID: PMC10950403 DOI: 10.1016/j.jacbts.2023.09.007] [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: 05/03/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 03/22/2024]
Abstract
The severity of aortic stenosis (AS) is associated with acquired von Willebrand syndrome (AVWS) and gastrointestinal bleeding, leading to anemia (Heyde's syndrome). We investigated how anemia is linked with AS and AVWS using the LA100 mouse model and patients with AS. Induction of anemia in LA100 mice increased transforming growth factor (TGF)-β1 activation, AVWS, and AS progression. Patients age >75 years with severe AS had higher plasma TGF-β1 levels and more severe anemia than AS patients age <75 years, and there was a correlation between TGF-β1 and anemia. These data are compatible with the hypothesis that the blood loss anemia of Heyde's syndrome contributes to AS progression via WSS-induced activation of platelet TGF-β1 and additional gastrointestinal bleeding via WSS-induced AVWS.
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Affiliation(s)
- Kumar Subramani
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Jeffrey Bander
- Icahn School of Medicine at Mount Sinai New York, New York, USA
| | - Sixia Chen
- University of Oklahoma Health Sciences Centers, Oklahoma City, Oklahoma, USA
| | | | - Thamizhiniyan Venkatesan
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Sandeep Subrahmanian
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Rohan Varshney
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Annapoorna Kini
- Icahn School of Medicine at Mount Sinai New York, New York, USA
| | - Samin Sharma
- Icahn School of Medicine at Mount Sinai New York, New York, USA
| | - Daniel B. Rifkin
- Departments of Cell Biology and Medicine, New York University, New York, New York, USA
| | - Jaehyung Cho
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Barry S. Coller
- Laboratory of Blood and Vascular Biology, Rockefeller University, New York, New York, USA
| | - Jasimuddin Ahamed
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- University of Oklahoma Health Sciences Centers, Oklahoma City, Oklahoma, USA
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2
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Banovic M, Iung B, Wojakowski W, Van Mieghem N, Bartunek J. Asymptomatic Severe and Moderate Aortic Stenosis: Time for Appraisal of Treatment Indications. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100201. [PMID: 37745683 PMCID: PMC10512009 DOI: 10.1016/j.shj.2023.100201] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 09/26/2023]
Abstract
Over the last decades, we have witnessed considerable improvements in diagnostics and risk stratification of patients with significant aortic stenosis (AS), paralleled by advances in operative and anesthetic techniques. In addition, accumulating evidence points to the potential benefit of early valve replacement in such patients prior to the onset of symptoms. In parallel, interventional randomized trials have proven the benefit of transcatheter aortic valve replacement in comparison to a surgical approach to valve replacement over a broad risk spectrum in symptomatic patients with AS. This article reviews contemporary management approaches and scrutinizes open questions regarding timing and mode of intervention in asymptomatic patients with severe AS. We also discuss the challenges surrounding the management of symptomatic patients with moderate AS as well as emerging dilemmas related to the concept of a life-long treatment strategy for patients with AS.
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Affiliation(s)
- Marko Banovic
- Belgrade Medical Faculty, University of Belgrade, Belgrade, Serbia
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Bernard Iung
- University of Paris, Paris, France
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, Paris, France
| | - Wojtek Wojakowski
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | | | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
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3
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Prosperi-Porta G, Willner N, Messika-Zeitoun D. Aortic stenosis progression: Still a long way to go. Arch Cardiovasc Dis 2023; 116:113-116. [PMID: 36774270 DOI: 10.1016/j.acvd.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/18/2023] [Indexed: 02/02/2023]
Affiliation(s)
- Graeme Prosperi-Porta
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7 Ontario, Canada
| | - Nadav Willner
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7 Ontario, Canada
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7 Ontario, Canada.
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4
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Stassen J, Ewe SH, Pio SM, Pibarot P, Redfors B, Leipsic J, Genereux P, Van Mieghem NM, Kuneman JH, Makkar R, Hahn RT, Playford D, Marsan NA, Delgado V, Ben-Yehuda O, Leon MB, Bax JJ. Managing Patients With Moderate Aortic Stenosis. JACC Cardiovasc Imaging 2023:S1936-878X(22)00741-0. [PMID: 36881428 DOI: 10.1016/j.jcmg.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/02/2022] [Accepted: 12/02/2022] [Indexed: 02/10/2023]
Abstract
Current guidelines recommend that clinical surveillance for patients with moderate aortic stenosis (AS) and aortic valve replacement (AVR) may be considered if there is an indication for coronary revascularization. Recent observational studies, however, have shown that moderate AS is associated with an increased risk of cardiovascular events and mortality. Whether the increased risk of adverse events is caused by associated comorbidities, or to the underlying moderate AS itself, is incompletely understood. Similarly, which patients with moderate AS need close follow-up or could potentially benefit from early AVR is also unknown. In this review, the authors provide a comprehensive overview of the current literature on moderate AS. They first provide an algorithm that helps to diagnose moderate AS correctly, especially when discordant grading is observed. Although the traditional focus of AS assessment has been on the valve, it is increasingly acknowledged that AS is not only a disease of the aortic valve but also of the ventricle. The authors therefore discuss how multimodality imaging can help to evaluate the left ventricular remodeling response and improve risk stratification in patients with moderate AS. Finally, they summarize current evidence on the management of moderate AS and highlight ongoing trials on AVR in moderate AS.
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Affiliation(s)
- Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Université Laval, Québec City, Québec, Canada
| | - Bjorn Redfors
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonathon Leipsic
- Departments of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philippe Genereux
- Department of Cardiology, Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jurrien H Kuneman
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Raj Makkar
- Department of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California, USA
| | - Rebecca T Hahn
- Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - David Playford
- Department of Cardiology, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ori Ben-Yehuda
- Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Martin B Leon
- Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
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5
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Amanullah MR, Pio SM, Sin KYK, Marsan NA, Ding ZP, Stassen J, Leon MB, Genereux P, Delgado V, Ewe SH, Bax JJ. Factors Affecting Rate of Progression of Aortic Stenosis and Its Impact on Outcomes. Am J Cardiol 2022; 185:53-62. [PMID: 36241571 DOI: 10.1016/j.amjcard.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 08/13/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022]
Abstract
The rate of aortic stenosis (AS) progression in patients with moderate AS is unclear. This study examined the risk factors of progression from moderate to severe AS and its impact on clinical outcomes. A total of 954 patients with moderate AS (valve area >1.0 and ≤1.5 cm²) and follow-up echocardiograms were included. AS progressed to severe (valve area <1.0 cm1) in 589 patients (61.7%) over a median follow-up of 2.46 (interquartile range [IQR] 1.29 to 3.91) years. Of those who progressed to severe AS, patients were subdivided into Slow (n = 294, over 3.91 [IQR 3.11 to 5.10] years) versus Fast (n = 295, over 1.29 [IQR 0.85 to 1.85] years) Progressors, according to the median time between the 2 echocardiograms. The correlates of fast AS progression and its impact on cumulative survival and freedom from valve intervention were evaluated. On multivariate analysis, age, thickened left ventricle posterior wall, severe renal impairment, and aortic valve area were significantly associated with fast AS progression. Over a median follow-up of 6.34 (IQR 4.05 to 9.55) years, 228 patients (38.7%) died. Despite similar aortic valve intervention rates, Fast Progressors had worse 5-year survival (61.2% vs 81.9%, log-rank p <0.001) and event-free (valve intervention and all-cause mortality) survival rates (16.2% vs 55.9%, log-rank p <0.001). On multivariable Cox analysis, shorter progression to severe AS (in years) was independently associated with increased risk of all-cause mortality (hazard ratio 1.26, 95% confidence interval 1.16 to 1.37, p <0.001), or combined aortic valve intervention and death (hazard ratio 1.46, 95% confidence interval 1.38 to 1.55, p <0.001). In conclusion, fast progression from moderate to severe AS is associated with worse outcomes.
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Affiliation(s)
| | - Stephen M Pio
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kenny Y K Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Zee Pin Ding
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin B Leon
- Department of Cardiology, Columbia University Medical Center, New York, United States
| | - Philippe Genereux
- Gagnon Cardiovascular Institute, Morristown Medical Center, New Jersey, United States
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, Singapore.
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Physiology, Nuclear Medicine and Positron Emission Tomography, Turku University Hospital and Turku Positron Emission Tomography Center, University of Turku, Turku, Finland
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6
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Pinto G, Fragasso G. Aortic valve stenosis: drivers of disease progression and drug targets for therapeutic opportunities. Expert Opin Ther Targets 2022; 26:633-644. [DOI: 10.1080/14728222.2022.2118576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Giuseppe Pinto
- Departmen of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Gabriele Fragasso
- Department of Clinical Cardiology, Heart Failure Clinic, IRCCS San Raffaele Scientific Institute, Milano
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7
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Shen M, Tastet L, Capoulade R, Bédard É, Arsenault M, Clavel MA, Pibarot P. Determinants of Aortic Stenosis Progression in Bicuspid and Tricuspid Aortic Valves. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:184-192. [PMID: 37969929 PMCID: PMC10642113 DOI: 10.1016/j.cjcpc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/19/2022] [Indexed: 11/17/2023]
Abstract
Background Bicuspid aortic valve (BAV) is associated with a faster progression of aortic stenosis (AS). Whether the determinants of AS progression are the same or different in patients with BAV vs tricuspid aortic valve (TAV) is unknown. The aim of this study was to identify the factors associated with the progression of AS in patients with BAV vs patients with TAV. Methods Patients with AS were prospectively recruited in the Metabolic Determinants of the Progression of Aortic Stenosis (PROGRESSA) study (ClinicalTrials.gov Identifier: NCT01679431). The haemodynamic progression rate of AS was assessed by the annualized progression rate of peak aortic jet velocity (Vpeak). Univariable and multivariable linear regression analyses were used to identify the factors associated with a faster progression of AS in patients with BAV vs patients with TAV. Results There were 79 patients with BAV and 208 patients with TAV. The baseline severity of AS was similar between the 2 groups of patients as well as the annualized progression rate of AS. In patients with BAV, obesity (β = 0.25, P = 0.04), diabetes (β = 0.26, P = 0.02), and BAV with right-noncoronary cusp fusion (β = 0.29, P = 0.01) were found to be independently associated with a faster progression of AS, whereas in patients with TAV, AS baseline severity (baseline Vpeak, β = 0.14, P = 0.04) and chronic kidney disease (β = 0.16, P = 0.02) were significantly associated with AS progression. Conclusion Factors associated with progression rate of AS are different in BAV and TAV. The main factors associated with a faster progression of AS appear to be obesity, diabetes, right-noncoronary cusp fusion in patients with BAV vs chronic kidney disease in patients with TAV.
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Affiliation(s)
- Mylène Shen
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec City, Québec, Canada
| | - Lionel Tastet
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec City, Québec, Canada
| | - Romain Capoulade
- CHU Nantes, CNRS, INSERM, l’institut du thorax, Université de Nantes, Nantes, France
| | - Élisabeth Bédard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec City, Québec, Canada
| | - Marie Arsenault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec City, Québec, Canada
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec City, Québec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec City, Québec, Canada
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8
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Pankayatselvan V, Raber I, Playford D, Stewart S, Strange G, Strom JB. Moderate aortic stenosis: culprit or bystander? Open Heart 2022; 9:openhrt-2021-001743. [PMID: 35074936 PMCID: PMC8788328 DOI: 10.1136/openhrt-2021-001743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/04/2022] [Indexed: 11/18/2022] Open
Abstract
Non-rheumatic aortic stenosis (AS) is among the most common valvular diseases in the developed world. Current guidelines support aortic valve replacement (AVR) for severe symptomatic AS, which carries high morbidity and mortality when left untreated. In contrast, moderate AS has historically been thought to be a benign diagnosis for which the potential benefits of AVR are outweighed by the procedural risks. However, emerging data demonstrating the substantial mortality risk in untreated moderate AS and substantial improvements in periprocedural and perioperative mortality with AVR have challenged the traditional risk/benefit paradigm. As such, an appraisal of the contemporary data on morbidity and mortality associated with moderate AS and appropriate timing of valvular intervention in AS is warranted. In this review, we discuss the current understanding of moderate AS, including the epidemiology, current surveillance and management guidelines, clinical outcomes, and future studies.
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Affiliation(s)
- Varayini Pankayatselvan
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Inbar Raber
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Playford
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia
| | - Simon Stewart
- School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia.,Torrens University Australia, Adelaide, South Australia, Australia
| | - Geoff Strange
- Torrens University Australia, Adelaide, South Australia, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Heart Research Institute, Sydney, New South Wales, Australia
| | - Jordan B Strom
- Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA .,Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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9
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Badiani S, Bhattacharyya S, Aziminia N, Treibel TA, Lloyd G. Moderate Aortic Stenosis: What is it and When Should We Intervene? ACTA ACUST UNITED AC 2021; 16:e09. [PMID: 34188693 PMCID: PMC8201468 DOI: 10.15420/icr.2021.04] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/29/2021] [Indexed: 12/15/2022]
Abstract
Current guidelines recommend aortic valve replacement in patients with severe aortic stenosis in the presence of symptoms or a left ventricular ejection fraction <50%. However, patients with less than severe aortic stenosis may also experience symptoms and recent literature suggests that the prognosis is not as benign as previously reported. There are no recommendations for patients with moderate aortic stenosis and left ventricular dysfunction, despite the high associated morbidity and mortality. There is also some evidence that these patients may benefit from early aortic valve intervention. It is recognised that aortic stenosis not only affects the valve but also has a complex myocardial response. This review discusses the natural history of moderate aortic stenosis along with the role of multimodality imaging in risk stratification in these patients.
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Affiliation(s)
- Sveeta Badiani
- Heart Valve Clinic and Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital London, UK.,William Harvey Research Institute, Queen Mary University of London UK
| | - Sanjeev Bhattacharyya
- Heart Valve Clinic and Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital London, UK.,William Harvey Research Institute, Queen Mary University of London UK.,Institute of Cardiovascular Sciences, University College London London, UK
| | - Nikoo Aziminia
- Heart Valve Clinic and Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Thomas A Treibel
- Heart Valve Clinic and Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital London, UK.,Institute of Cardiovascular Sciences, University College London London, UK
| | - Guy Lloyd
- Heart Valve Clinic and Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital London, UK.,William Harvey Research Institute, Queen Mary University of London UK.,Institute of Cardiovascular Sciences, University College London London, UK
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10
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Sá MPBO, Simonato M, Van den Eynde J, Cavalcanti LRP, Roever L, Bisleri G, Dokollari A, Dvir D, Zhigalov K, Ruhparwar A, Weymann A. Asymptomatic severe aortic stenosis, bicuspid aortic valves and moderate aortic stenosis in heart failure: New indications for transcatheter aortic valve implantation. Trends Cardiovasc Med 2020; 31:435-445. [PMID: 33065313 DOI: 10.1016/j.tcm.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 11/15/2022]
Abstract
Aortic stenosis (AS) remains one of the most common valvular heart diseases, with enormous impact on patient survival. Over the past years, transcatheter aortic valve implantation (TAVI) has become a reality worldwide, offering a less invasive method to treat AS. Apart from the classical indications for aortic valve disease, recent studies tried to address unanswered questions for TAVI - asymptomatic severe AS, bicuspid aortic valves and moderate AS in patients with heart failure. This review discusses the rationale of those possible indications, pitfalls and current evidence in the medical literature.
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Affiliation(s)
- Michel Pompeu B O Sá
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, University of Pernambuco, Pernambuco, Brazil
| | - Matheus Simonato
- Division of Cardiac Surgery, Escola Paulista de Medicina - UNIFESP, São Paulo, Brazil
| | - Jef Van den Eynde
- Department of Cardiovascular Diseases, Research Unit of Cardiac Surgery, University Hospitals Leuven, and Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, University of Pernambuco, Pernambuco, Brazil
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlândia, Minas Gerais, Brazil
| | | | | | - Danny Dvir
- Division of Cardiology, University of Washington, Washington, United States of America
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, Essen, Germany
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11
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Choi YJ, Park JB, Hwang IC, Lee SP, Kim HK, Kim YJ, Sohn DW. Proteinuria is an independent predictor of rapid progression of mild to moderate aortic stenosis in patients with preserved renal function. Int J Cardiovasc Imaging 2018; 35:481-489. [PMID: 30343402 DOI: 10.1007/s10554-018-1473-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/12/2018] [Indexed: 11/28/2022]
Abstract
Although proteinuria is a well-known risk factor for cardiovascular disease, its relationship with the progression of aortic stenosis (AS) has not been established. Our aim was to investigate the relationship between proteinuria (detected by urine dipstick test) and AS progression (assessed by the annualized reduction rate of aortic valve area [AVA]). A total of 460 patients with mild to moderate AS (defined by a peak velocity of 2.0-4.0 m/s) without end-stage renal disease who underwent two echocardiograms at least 3 months apart were included. The progression of AS was significantly faster in patients with proteinuria than those without (108 patients vs. 352 patients; annualized reduction rate of AVA, - 7.7 ± 13.5% vs. - 4.5 ± 11.6%; p = 0.017). The relationship between the presence of proteinuria and the accelerated progression of AS was significant among patients with estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m2 (- 11.0 ± 17.5% vs. - 4.2 ± 10.0%; p < 0.001), but not among those with eGFR 15-60 mL/min/1.73 m2 (- 5.8 ± 10.3 vs. - 5.3 ± 14.8%; p = 0.822). When stratified by the presence of diabetes, the association of proteinuria with AS progression was only significant in patients without diabetes (- 8.1 ± 12.0% vs. - 8.1 ± 15.7%; p = 0.018). Multivariable logistic regression analysis identified that the presence of proteinuria was an independent predictor of AS progression. The progression of AS was accelerated in patients with mild to moderate AS and proteinuria, particularly among those with preserved renal function and no diabetes.
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Affiliation(s)
- You-Jung Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea. .,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea. .,Division of Cardiology, Department of Internal Medicine, Office of Medical Education, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
| | - In-Chang Hwang
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dae-Won Sohn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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12
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Kiso S, Naito R, Fukao K, Hiki M, Miyazaki T, Takagi A, Miyauchi K, Daida H. Rapidly progressed aortic stenosis in a patient with previous diagnosis of polycythemia vera and post‐polycythemia vera myelofibrosis. Clin Case Rep 2016; 4:589-92. [PMID: 27398203 PMCID: PMC4891485 DOI: 10.1002/ccr3.568] [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: 09/14/2015] [Revised: 03/14/2016] [Accepted: 04/03/2016] [Indexed: 11/27/2022] Open
Abstract
Polycythemia vera (PV) is a chronic myeloproliferative disease that is often complicated with thromboembolism. However, aortic stenosis (AS) could be a manifestation of the cardiovascular complications of PV possibly through shear stress and atherosclerosis. We report a rare case of rapidly progressed AS in a patient with PV.
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Affiliation(s)
- Shohei Kiso
- Department of Cardiovascular MedicineJuntendo University Graduate School of Medicine2‐1‐1 Hongo Bunkyo‐kuTokyo113‐8421Japan
| | - Ryo Naito
- Department of Cardiovascular MedicineJuntendo University Graduate School of Medicine2‐1‐1 Hongo Bunkyo‐kuTokyo113‐8421Japan
| | - Kosuke Fukao
- Department of Cardiovascular MedicineJuntendo University Graduate School of Medicine2‐1‐1 Hongo Bunkyo‐kuTokyo113‐8421Japan
| | - Makoto Hiki
- Department of Cardiovascular MedicineJuntendo University Graduate School of Medicine2‐1‐1 Hongo Bunkyo‐kuTokyo113‐8421Japan
| | - Tetsuro Miyazaki
- Department of Cardiovascular MedicineJuntendo University Graduate School of Medicine2‐1‐1 Hongo Bunkyo‐kuTokyo113‐8421Japan
| | - Atsutoshi Takagi
- Department of Cardiovascular MedicineJuntendo University Graduate School of Medicine2‐1‐1 Hongo Bunkyo‐kuTokyo113‐8421Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular MedicineJuntendo University Graduate School of Medicine2‐1‐1 Hongo Bunkyo‐kuTokyo113‐8421Japan
| | - Hiroyuki Daida
- Department of Cardiovascular MedicineJuntendo University Graduate School of Medicine2‐1‐1 Hongo Bunkyo‐kuTokyo113‐8421Japan
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Mrak M, Ambrožič J, Mušič Š, Terseglav S, Kontestabile B, Lakič N, Bunc M. Transcatheter aortic valve implantation in a cancer patient denied for surgical aortic valve replacement—a case report. Wien Klin Wochenschr 2016; 128:516-20. [DOI: 10.1007/s00508-016-0990-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/29/2016] [Indexed: 01/06/2023]
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Galas A, Hryniewiecki T, Michałowska I, Kępka C, Abramczuk E, Orłowska-Baranowska E, Rużyłło W. Aortic valve calcification in 499 consecutive patients referred for computed tomography. Arch Med Sci 2015; 11:952-7. [PMID: 26528335 PMCID: PMC4624733 DOI: 10.5114/aoms.2015.47874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 12/05/2013] [Accepted: 12/10/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Aortic valve calcification (AVC) is the most common cause of aortic stenosis. The aim of the study was to assess the prevalence of aortic valve, coronary artery and aortic calcifications and to evaluate the correlation between calcification of the aortic valve, coronary arteries and aorta. MATERIAL AND METHODS The study included 499 patients aged 60 years and over who underwent coronary computed tomography because of chest pain. Beside coronary artery calcium score (CAC), we evaluated AVC and ascending aorta calcifications (AAC). RESULTS Aortic valve calcification was found in 144 subjects (28.9% of the whole study population). Prevalence of CAC and AAC was higher than AVC and amounted to 73.8% and 54.0%. Prevalence of AVC, CAC and AAC was significantly lower in the group of patients ≤ 70 years than in the group of patients > 70 years of age (p = 0.0002, p < 0.0001, p < 0.0001). Aortic valve calcification was more often observed in men than women (34.7% vs. 25.4%, p = 0.02). Degree of aortic valve calcification was also significantly higher among men than women (median score 4 vs. 0, p = 0.01). Similar observations were true for CAC and AAC, where both prevalence and degree of calcification was higher among men than women. In the whole study population no correlation was noted between AVC and CAC or AAC (p = 0.34, p = 0.85). There was a significant correlation between AAC and CAC (p < 0.0001). CONCLUSIONS Despite some similarities in pathological mechanism and risk factors, a degenerative defect of the aortic valve could be independent of atheromatous lesions in the coronary arteries and aorta.
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Affiliation(s)
- Anna Galas
- Department of Valvular Heart Disease, Institute of Cardiology, Warsaw, Poland
| | - Tomasz Hryniewiecki
- Department of Valvular Heart Disease, Institute of Cardiology, Warsaw, Poland
| | | | - Cezary Kępka
- Department of Coronary and Structural Heart Diseases, Institute of Cardiology, Warsaw, Poland
| | - Elżbieta Abramczuk
- Department of Valvular Heart Disease, Institute of Cardiology, Warsaw, Poland
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Gómez M, Ble M, Cladellas M, Molina L, Comín-Colet J, Enjuanes C, Roqueta C, Soler C, Bruguera J. Effect of correction of anemia on echocardiographic and clinical parameters in patients with aortic stenosis involving a three-cuspid aortic valve and normal left ventricular ejection fraction. Am J Cardiol 2015; 116:270-4. [PMID: 25983280 DOI: 10.1016/j.amjcard.2015.04.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 11/29/2022]
Abstract
The objective of the study is to investigate the impact of anemia (defined as hemoglobin concentration of <12 g/dl in women and 13 g/dl in men) on prognosis and to study the effect of recovery from anemia on echocardiographic and clinical parameters in patients with aortic stenosis (AS). This was a prospective study in 315 patients with moderate or severe AS. Patients with anemia received oral iron (ferrous sulfate with mucoproteose, 160 mg iron/day) and erythropoietin, if needed, or intravenous iron, if necessary. The following tests were performed before and after normalization of hemoglobin values: echocardiogram, 6-minute walk test, N-terminal B-type natriuretic peptide, and measures of depression, cognitive impairment, and dependence. Patient mean age was 74 years (SD 9). Mean follow-up was 25 months (SD 8). Anemia prevalence in the overall group was 22% (n = 70). Patients who are anemic had a higher rate of complications at follow-up (mortality, hospital admission, or need for valve procedure; 80% vs 62%, p = 0.009). In total, 89% of patients recovered from anemia, with a mean time to recovery of 4.6 weeks (SD 1.4). Improvements were observed on echocardiographic parameters of peak velocity (4.1 to 3.7 m/s, p = 0.02) and mean gradient (44 to 35 mm Hg, p = 0.02). Performance on the 6-minute walk test improved from 235 to 303 m (p <0.001). Median N-terminal B-type natriuretic peptide value decreased from 612 to 189 pg/dl (p <0.001). In conclusion, patients with AS and anemia have a worse prognosis than those without anemia. Resolution of anemia is associated with improvements in echocardiographic parameters and functional status, suggesting that treatment of iron deficiency is a relevant option in the management of patients with AS, particularly in nonoperable cases.
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Affiliation(s)
- Miquel Gómez
- Cardiology Department, Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Mireia Ble
- Cardiology Department, Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mercedes Cladellas
- Cardiology Department, Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Luis Molina
- Cardiology Department, Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Josep Comín-Colet
- Cardiology Department, Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Cristina Enjuanes
- Cardiology Department, Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Cristina Roqueta
- Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain; Geriatrics Department, Centre Forum-Parc de Salut Mar, Barcelona, Spain
| | - Cristina Soler
- Cardiology Department, Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jordi Bruguera
- Cardiology Department, Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain
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Douglas PS, Hahn RT, Pibarot P, Weissman NJ, Stewart WJ, Xu K, Wang Z, Lerakis S, Siegel R, Thompson C, Gopal D, Keane MG, Svensson LG, Tuzcu EM, Smith CR, Leon MB. Hemodynamic Outcomes of Transcatheter Aortic Valve Replacement and Medical Management in Severe, Inoperable Aortic Stenosis: A Longitudinal Echocardiographic Study of Cohort B of the PARTNER Trial. J Am Soc Echocardiogr 2015; 28:210-7.e1-9. [DOI: 10.1016/j.echo.2014.10.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Indexed: 10/24/2022]
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Abstract
Degenerative, calcific valvular aortic stenosis (AS), caused by an active process of atherosclerosis, calcification and ossification, is the most common cause of AS in industrialized nations. The prevalence of calcific AS is age-dependent, and thus is expected to increase due to demographic aging of the global population. It is well recognized that severe AS carries a poor prognosis if left untreated. Despite this recognition, many patients are inappropriately denied surgery because of perceived risk. This article will examine the etiology, prevalence, and current trends in the treatment of degenerative AS focusing on indications for surgical aortic valve replacement.
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Affiliation(s)
- Jeremy J Thaden
- Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, Rochester, MN
| | - Vuyisile T Nkomo
- Division of Cardiovascular Disease and Internal Medicine, Mayo Clinic, Rochester, MN.
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