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Sousa Nunes F, Coelho C, Vilela E, Fontes-Carvalho R, Neves F. A Starr-Edwards Prothesis can Last Forever (but its sutures may not). Hellenic J Cardiol 2024:S1109-9666(24)00072-1. [PMID: 38554833 DOI: 10.1016/j.hjc.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/13/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- F Sousa Nunes
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal.
| | - C Coelho
- Cardiology Department, Hospital Distrital de Santarém, Portugal
| | - E Vilela
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
| | - R Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
| | - F Neves
- Cardiac Surgery Department, Centro Hospitalar de Vila Nova de Gaia / Espinho, Portugal
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Teixeira R, Ribeiro D, Sousa Nunes F, Leite M, Neves A, Santos D, Silva M, Silva G, Diaz S, Saraiva F, Sampaio F, Fontes-Carvalho R. Modeling aortic stenosis progression: impact on follow-up, treatment and survival. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) is one of the main valvular heart diseases in developed countries. Degenerative fibrocalcific aortic stenosis is a progressive disease of the valve and ultimately of the myocardium, which can be fatal when symptomatic. There is no medical treatment that can halt or delay its progression. AS does not evolve linearly over time, and not every patient has the same progression rate.
Aims
The aim of this study is to 1) compare different mathematical models of aortic stenosis progression, 2) cluster patients into rapid and slow progressors and explore possible predictors, 4) evaluate the impact of different progression rates on cardiac structure and function, and 5) evaluate survival and optimal timing for follow-up and treatment.
Methods
We retrospectively studied consecutive patients with aortic peak velocities from 2012 to 2020. Follow-up echocardiograms, seriated biomarker assessment, and clinical records were consulted, providing a multiparametric data frame for longitudinal and dynamic modeling of aortic stenosis progression and its consequences.
Results
This study included 9583 studies from 752 patients with a median total follow-up of 4.26 years (interquartile range: 1.28 to 7.24 years). A logistic model was selected with the best accuracy to predict the rate of AS progression. Patients were categorized into slow and rapid progressors in a ratio of 5:1. Multiparametric analysis showed no association between these profiles and clinical variables. However, anti-hypertensive drugs before and after adjustment for blood pressure control (Calcium Channel Blockers, p=0.013, OR 0.50) were associated with slower progression. Meanwhile, elevated inflammatory markers (erythrocyte sedimentation rate, p=0.01) were associated with faster AS progression. Despite no survival difference between these groups, higher rates of valvular intervention were registered in rapid progressors (p<0.001). Moreover, faster progressors were associated with earlier cardiac damage (as demonstrated by early onset of moderate mitral and tricuspid valve regurgitation, left auricle dilation, and left ventricle hypertrophy, p<0.05).
Conclusions
These results can potentially modify follow-up times and deliver more personalized and individualized health care to different AS patients, thereby optimizing resources.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Teixeira
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - D Ribeiro
- Faculty of Medicine University of Porto , Porto , Portugal
| | - F Sousa Nunes
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - M Leite
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - A Neves
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - D Santos
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - M Silva
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - G Silva
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - S Diaz
- Faculty of Medicine University of Porto , Porto , Portugal
| | - F Saraiva
- Faculty of Medicine University of Porto , Porto , Portugal
| | - F Sampaio
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
| | - R Fontes-Carvalho
- Hospital Center of Vila Nova de Gaia/Espinho , Vila Nova de Gaia , Portugal
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