Degenerative Aortic Valve Research Articles

How to perform a late explantation of a Sapien XT transcatheter aortic prosthesis

Starting as a therapeutically option for high-risk surgical patients with degenerative aortic valve stenosis, the transcatheter aortic valve implantation method is probably going to become the method of choice for this pathology also in younger and low-risk patients. As bioprosthesis are prone to degeneration, requiring a redo procedure, whenever a valve in valve procedure is contraindicated, a surgical valve replacement will become necessary. We describe a simple surgical method for explantation of a Sapien XT prosthesis that was implanted 7 years previously in a calcified aortic valve.

Thrombosis of Prosthetic Cardiac Valve: Difficulties of Diagnostics on the Example of a Clinical Case with Lethal Outcome

The article describes the clinical observation of thrombosis of prosthetic cardiac valve in a 51-year-old female patient, 9 years after surgical intervention for a degenerative aortic valve disease with the installation of mechanical prosthesis into the aortal position and further warfarin medication, with absence of international normalized ratio (INR) control over the past six months. The patient's condition worsened under the “mask” of decompensation of left ventricular circulatory failure; pulmonary embolism and acute coronary syndrome were also excluded. At the same time, the negative dynamics of the cardiac ultrasound data were underestimated: the appearance of prosthetic dysfunction, an increase in the degree of valve regurgitation, severe pulmonary hypertension, as well as anamnestic data (double acute cerebrovascular accident and lack of INR control for a long time, lability of its values during index hospitalization).This case can be important in terms of clarifying the reasons for the decompensation of chronic cardiac failure in patients with valvular defects and mechanical valve prosthetics, especially in cases of irregular INR monitoring or not being it in the target range, and progressive negative dynamics of the cardiac ultrasound data.

Identifying diagnosis evidence of cardiogenic stroke from Chinese echocardiograph reports

BackgroundCardiogenic stroke has increasing morbidity in China and brought economic burden to patient families. In cardiogenic stroke diagnosis, echocardiograph examination is one of the most important examinations. Sonographers will investigate patients’ heart via echocardiograph, and describe them in the echocardiograph reports. In this study, we developed a machine learning model to automatically identify diagnosis evidences of cardiogenic stroke providing to neurologist for clinical decision making.MethodsWe collected 4188 Chinese echocardiograph reports of 4018 patients, with average length 177 Chinese characters in free-text style. Collaborating with neurologists and sonographers, we summarized 149 phrases on diagnosis evidence of cardiogenic stroke such as “二尖瓣重度狭窄” (severe mitral stenosis), “主动脉瓣退行性变” (aortic valve degeneration) and so on. Furthermore, we developed an annotated corpus via mapping 149 phrases to the 4188 reports. We selected 11 most frequent diagnosis evidence types such as “二尖瓣狭窄” (mitral stenosis) for further identifying. The generated corpus is divided into training set and testing set in the ratio of 8:2, which is used to train and validate a machine learning model to identify the evidence of cardiogenic stroke using BiLSTM-CRF algorithm.ResultsOur machine learning method achieved the average performance on the diagnosis evidence identification is 98.03, 90.17 and 93.94% respectively. In addition, our method is capable to identify the novel diagnosis evidence of cardiogenic stroke description such as “二尖瓣中-重度狭窄” (mitral stenosis), “主动脉瓣退行性病变” (aortic valve calcification) et al.ConclusionsIn this study, we analyze the structure of the echocardiograph reports and summarized 149 phrases on diagnosis evidence of cardiogenic stroke. We use the phrases to generate an annotated corpus automatically, which greatly reduces the cost of manual annotation. The model trained based on the corpus also has a good performance on the testing set. The method of automatically identifying diagnosis evidence of cardiogenic stroke proposed in this study will be further refined in the practice.

Etiology and distribution of isolated aortic stenosis in Indian patients – A study from a large tertiary care hospital in north India

BackgroundIsolated aortic valve disease (IAVD) has traditionally been a disease of elderly, etiology being either senile degeneration of a tricuspid aortic valve or calcification of a bicuspid aortic valve. However, there is scarcity of Indian data regarding demographic distribution and etiological patterns of IAVD in context of emerging therapies like transcatheter aortic valve implantation (TAVR). Methods & resultsA retrospective observational analysis of 60,560 echocardiograms over three years revealed 3728 newly diagnosed cases of valvular heart disease (VHD). Isolated mitral valve disease (IMVD) constituted 48.7% (n = 1815) of all VHD, including 1104 (29.6%) cases of pure mitral stenosis (MS) which was the commonest single lesion followed by combined mitral and aortic valve disease (CMAVD) (n = 1320, 34.5%), mixed aortic valve disease (MAVD) (n = 349, 9.4%), isolated aortic stenosis (IAS) (n = 179, 4.8%) and isolated aortic regurgitation (IAR) (n = 75, 2.0%). IAS patients had bimodal age distribution with peaks in first and sixth decade, contributed by congenital and acquired IAS respectively. Acquired IAS comprised of degenerative tricuspid aortic valve (n = 79, 58.1%; mean age: 63.2 ± 8.8 years), bicuspid aortic valve (BAV) (n = 34, 25.0%; mean age: 36.0 ± 8.3 years), rheumatic (n = 4, 2.9%; mean age: 55.3 ± 3.4 years) and non-rheumatic IAS with unclear morphology (n = 19, 14%; mean age: 48.5 ± 9.3 years). 65.6% patients with acquired non-rheumatic isolated aortic stenosis were less than 60 years of age. ConclusionIn Indian population, senile valvular degeneration is the commonest cause of acquired IAS with majority of them presenting before 60 years of age, thereby bereaving them with the option of TAVR as a treatment modality.

Case report: early aortic valve degeneration associated with interstitial deletion of chromosome 2\u201346,XX,del (2)(q31.3; q32.2)

BackgroundInterstitial deletions within the long arm of chromosome 2, involving the 2q31q33 region, are rare but are known to be associated with delays in development, behavioral problems, facial dysmorphism and various hand/foot anomalies.Case presentationHere, we describe a case with an interstitial 2q31.3.q32.2 deletion, presenting the previously described phenotype, exhibiting fibromyxoid degeneration of the aortic valve in addition to previously described clinical features.ConclusionInterstitial deletion in chromosome 2q31.2q32.3 might be associated to a fibromyxoid degeneration of valvular leaflets generating regurgitation. Patients diagnosed with this mutation may require investigation to rule out a valvular disease.

Recursive multiresolution convolutional neural networks for 3D aortic valve annulus planimetry.

Transcatheter aortic valve replacement (TAVR) is the standard of care in a large population of patients with severe symptomatic aortic valve stenosis. The sizing of TAVR devices is done from ECG-gated CT angiographic image volumes. The most crucial step of the analysis is the determination of the aortic valve annular plane. In this paper, we present a fully tridimensional recursive multiresolution convolutional neural network (CNN) to infer the location and orientation of the aortic valve annular plane. We manually labeled 1007 ECG-gated CT volumes from 94 patients with severe degenerative aortic valve stenosis. The algorithm was implemented and trained using the TensorFlow framework (Google LLC, USA). We performed K-fold cross-validation with K = 9 groups such that CT volumes from a given patient are assigned to only one group. We achieved an average out-of-plane localization error of (0.7 ± 0.6) mm for the training dataset and of (0.9 ± 0.8) mm for the evaluation dataset, which is on par with other published methods and clinically insignificant. The angular orientation error was (3.9 ± 2.3)° for the training dataset and (6.4 ± 4.0)° for the evaluation dataset. For the evaluation dataset, 84.6% of evaluation image volumes had a better than 10° angular error, which is similar to expert-level accuracy. When measured in the inferred annular plane, the relative measurement error was (4.73±5.32)% for the annular area and (2.46±2.94)% for the annular perimeter. The proposed algorithm is the first application of CNN to aortic valve planimetry and achieves an accuracy on par with proposed automated methods for localization and approaches an expert-level accuracy for orientation. The method relies on no heuristic specific to the aortic valve and may be generalizable to other anatomical features.

Successful Treatment of Aortic Sutureless Valve Degeneration Using the Self-expandable Acurate Neo Percutaneous Prosthesis

Successful Treatment of Aortic Sutureless Valve Degeneration Using the Self-expandable Acurate Neo Percutaneous Prosthesis

On the cause and consequences of IgE to galactose-α-1,3-galactose: A report from the National Institute of Allergy and Infectious Diseases Workshop on Understanding IgE-Mediated Mammalian Meat Allergy

The mammalian meat allergy known as the "α-Gal syndrome" relates to IgE specific for galactose-α-1,3-galactose (α-Gal), an oligosaccharide that is present in cells and tissues of nonprimate mammals. The recognition of delayed reactions to food derived from mammals in patients with IgE to α-Gal and also the association with tick bites have been increasing worldwide. In 2018, the National Institute of Allergy and Infectious Diseases, Division of Allergy, Immunology and Transplantation, sponsored a workshop on this emerging tick-related disease. International experts from the fields of tick biology, allergy, immunology, infectious disease, and dermatology discussed the current state of our understanding of this emerging medical condition. The participants provided suggestions for specific research priorities and for the development of resources to advance our knowledge of the mechanisms, diagnosis, management, and prevention of this allergic disease. This publication is a summary of the workshop and the panel's recommendations are presented herein.

The Prognostic Value of C-reactive Protein to Albumin Ratio in Patients with Isolated Degenerative Aortic Valve Stenosis Undergoing Surgical Aortic Valve Replacement.

ObjectiveTo evaluate the prognostic value of C-reactive protein to albumin ratio (CAR) in patients with severe aortic valve stenosis undergoing surgical aortic valve replacement (AVR).MethodsFour hundred seventy-six patients with severe degenerative aortic stenosis who underwent successful isolated surgical AVR were enrolled. Hospitalization due to heart failure, surgical aortic reoperation, paravalvular leakage rates, and long-term mortality were evaluated in the whole study group. The participants were divided into two groups, as 443 patients without mortality (group 1) and 33 patients with mortality (group 2) during the follow-up time.ResultsCAR was lower in patients without mortality than in those with mortality during the follow-up time (0.84 [0.03-23.43] vs. 2.50 [0.22-26.55], respectively, P<0.001). Age (odds ratio [OR]: 1.062, confidence interval [CI]: 1.012-1.114, P=0.014), CAR (OR: 1.221, CI: 1.125-1.325, P<0.001), ejection fraction (OR: 0.956, CI: 0.916-0.998, P=0.042), and valve type (OR: 2.634, CI: 1.045-6.638, P=0.040) were also found to be independent predictors of long-term mortality. Additionally, rehospitalization (0.86 [0.03-26.55] vs. 1.6 [0.17-24.05], P=0.006), aortic reoperation (0.87 [0.03-26.55] vs. 1.6 [0.20-23.43], P=0.016), and moderate to severe aortic paravalvular leakage (0.86 [0.03-26.55] vs. 1.86 [0.21-19.50], P=0.023) ratios were associated with higher CAR.ConclusionIt was firstly described that CAR was strongly related with increased mortality rates in patients with isolated severe aortic stenosis after surgical AVR. Additionally, rehospitalization, risk of paravalvular leakage, and aortic reoperation rates were higher in patients with increased CAR than in those without it.

892 TAVI in TAVI- A Single Centre Experience

The use of transcatheter aortic valve implantation (TAVI) for severe aortic stenosis is well established in clinical practice. However, there is a paucity in the literature of the procedural feasibility of repeat TAVI for late valve degeneration. Here we discuss three cases of patients who underwent TAVI in TAVI procedures. A 81 year old female who had a transapical balloon-expandable TAVI inserted 9 years prior presented with NYHA class 3 symptoms and recurrent admissions with decompensated heart failure. Echocardiography showed severe mixed aortic valve degeneration, and she subsequently underwent successful transfemoral valve in valve (ViV) TAVI. On 6 month follow-up she has NYHA class 1-2 symptoms with normal aortic valve hemodynamics. A 85 year old male with a self-expanding TAVI three years prior presented with recurrent decompensated heart failure. Echocardiography revealed severe transvalvular aortic regurgitation. He underwent a BASILICA (bioprosthetic or native aortic scallop to prevent iatrogenic coronary artery obstruction) and successful ViV-TAVI with a balloon expandable prosthesis, with favourable echocardiographic and symptomatic outcomes at 6 month follow-up. A 76 year old female with a previous TAVI procedure 8 years prior presented with NYHA class III symptoms and declining exercise tolerance, with echocardiography demonstrating severe aortic stenosis (mean gradient 87mmHg). Anticoagulation with warfarin was trialled for 3 months with no improvement, and she subsequently underwent ViV-TAVI with improvement in symptoms and favourable post implantation valve hemodynamics. These cases demonstrates procedural safety with improvement in patient symptoms and favourable post implantation hemodynamics, suggesting repeat TAVI is a feasible treatment option.

TAVI chez les femmes, des résultats très encourageants

The population of elderly patients comprises a high percentage of women. This population is more vulnerable due to the presence of numerous comorbidities and is, therefore, particularly exposed to the risk of aortic valve degeneration, resulting in aortic valve stenosis whose symptoms are predictors of poor short-term outcomes. In the presence of symptomatic aortic stenosis, the recommended therapeutic option in this vulnerable population is the implementation of transcatheter aortic valve implantation, preferably via the femoral route. The outcomes of this procedure are better in women than in men despite a more frequent occurrence of vascular, bleeding and cerebral complications. Several hypotheses have been reported in the literature regarding the reasons for such differences. Among other reasons, it is likely that in female patients, the myocardium adjusts better to the occurrence of aortic stenosis and that recovery after valve treatment is also more optimal. Another explanation is the higher frequency of coronary artery disease in this older population. This has a considerable impact on the outcome even when coronary lesions are treated prior to valve implantation. There is still room for improvement and progress can be achieved by further reducing the size of the equipment used in order to decrease the diameter of the vascular access, and by continuing to simplify TAVI procedures. Less invasive techniques should result in decreased complication rates. In addition, dedicated studies should allow us to further improve our practice in this growing population of vulnerable patients.

Highlights From the Circulation Family of Journals.

Highlights From the Circulation Family of Journals.

P3358Cardiovascular risk, aortic valve microcalcification and vascular microcalcification: is there a link?

Abstract 18F-sodium fluoride (18F-NaF) has been used to evaluate aortic stenosis. It is know that its uptake is related with microcalcification. The purpose of this study is to assess the relationship between 18F-NaF uptake by the aortic valve and by the main arterial vessels and cardiovascular risk. Twenty-five hypertensive patients without known cardiovascular disease or aortic stenosis underwent PET-CT with 18F-NaF. Cardiovascular risk was assessed through the ASCVD risk calculator. The patients had a mean age of 64.0±8.6 years and 56% were males. The mean ASCVD risk was of 28.8±19.0 (IQR: 10–48.5). The uptake of 18F-NaF assessed through the corrected uptake per lesion (CUL = max SUV – mean blood-pool SUV) was of 0.49±0.14 (IQR: 0.44–0.57) and the mean uptake in the aortic, coronary and carotid territories was of 0.66±0.21 (IQR: 0.53 - 0.76).The patients were classified according to the ASCVD: Group A: patients with a risk above the 50thpercentile of the ASCVD risk distribution (50thpercentile=25), 12 patients) and Group B: patients with a risk under or equal to the 50thpercentile of the ASCVD risk distribution, 13 patients. The uptake of 18F-NaF in the aortic valve (AoV)and in the main vascular territories (VT) were evaluated in both groups: A vs B: AoV CUL = 0.57±0.09 vs 0. 42±0.14, p=0.005; VT= 0.78±0.16 vs 0.54±0.20, p=0.003. We also evaluate the relation between AoV uptake and VT uptake and they were significantly related (r=0.69, p=0.0001). In conclusion on this study microcalcification of the aortic valve and in the main vessels, evaluated through 18F-NaF uptake, were related between them and with cardiovascular risk reinforcing the importance of cardiovascular risk prevention in aortic valve degeneration and vascular atherosclerosis.

P184511 years of transcatheter aortic valve implantation in a single centre and outcomes for all 1004 patient cases completed

Abstract Background Long-term outcome data after TAVI is of key importance as indications have extended from high risk patients to intermediate risk alongside contemporary study of low risk patients. Purpose We report our complete 11 y experience of TAVI. Methods All patients (n=1004) treated with TAVI in our institution between Feb 2008 &amp; Nov 2018 were included. Data was collected prospectively and all death certificates were reviewed. Independent predictors of mortality were determined by multivariable cox proportional hazard modelling. Annular sizing was performed via echocardiography +/or angiography until Aug 2012 after which time cardiac CT was used. Results Patients were 53% female &amp; had mean age 81.9±6.6 y, logistic EuroScore 18.5%. 89% were NYHA &gt;2, and 26.7% had a left ventricular ejection fraction (LVEF) of &lt;50%. TAVI was performed for severe degenerative aortic valve disease (93.5%), while valve-in-valve (2.4%) bicuspid (2.1%) &amp; rheumatic (2%) made up the remainder. Self-expanding valves were implanted in 73% cases. 98% cases were performed under local anaesthesia. A percutaneous transfemoral approach was used in 92% cases. For the first 6 y 19% procedures were performed for urgent inpatients, rising to 42% over the last 5 y. The mean time to discharge was 5.5 d, overall, &amp; 60% cases were discharged within 72 h in the last 5 y. Mortality, for those at risk, was 3.2%, 12.8%, 53% &amp; 88% at 30 d, 1 y, 5 y &amp; 10 y. The median time to death was 2.6 y. Non-cardiac death accounted for 62% deaths, with sepsis being the main cause (55%). The main cause of cardiac death was heart failure (HF (53%)). Independent clinical predictors of death were increased age, atrial fibrillation, pulmonary disease &amp; LVEF &lt;50%. Use of a 2nd generation valve was associated with better survival at 5 y (p&lt;0.001). 30 d new permanent pacemaker and stroke incidence were 13.7% and 2% respectively. 30 d readmission occurred in 13% patients. Independent clinical predictors of 1 y HF (7%) readmission were NYHA Class &gt;2 and LVEF &lt;50%. Endocarditis was seen in 1.6% during a mean follow-up 2,593 patient y. Mean aortic gradients at 1 y, 5 y &amp; 10 y were 9.7mmHg, 8.4mmHg &amp; 10.53mmHg. One patient had severe trans-aortic regurgitation during the follow-up. A 2nd TAVI procedure was performed in 5 patients with clinically significant paravalvular regurgitation, all within 30 d. Figure 1. A. Survival. B. Predictors death Conclusion This comprehensive evaluation of all patients treated with this innovative technology provides reassurance regarding the long-term clinical efficacy of TAVI &amp; gives insight into the evolution of our programme with time.

Pregnancy and transcatheter aortic valve replacement in a severely stenotic Freestyle full aortic root stentless bioprosthesis

Symptomatic degenerative prosthetic aortic valve stenosis during pregnancy represents a significant risk to both mother and fetus, and until recently, surgical aortic valve replacement (SAVR) during pregnancy was often the only choice for women opting to continue pregnancy. However, symptomatic severe stenosis in a pregnant woman with a degenerated full aortic root Freestyle stentless bioprosthesis (FSB) and reimplanted coronary arteries presents additional complexities that require an alternative surgical approach. In this case report, we describe the first successful transcatheter aortic valve replacement (TAVR) in SAVR for a severely stenotic degenerative FSB in a pregnant woman and subsequent delivery of a healthy infant several months later. TAVR in SAVR of a severely stenotic aortic FSB should be considered as a surgical option in symptomatic pregnant women. Short-term and long-term implications for future pregnancy should be discussed by a multidisciplinary team and with the patient.

Clonal haematopoiesis in patients with degenerative aortic valve stenosis undergoing transcatheter aortic valve implantation.

AimsClonal haematopoiesis of indeterminate potential (CHIP), defined as the presence of an expanded somatic blood cell clone without other haematological abnormalities, was recently shown to increase with age and is associated with coronary artery disease and calcification. The most commonly mutated CHIP genes, DNMT3A and TET2, were shown to regulate inflammatory potential of circulating leucocytes. The incidence of degenerative calcified aortic valve (AV) stenosis increases with age and correlates with chronic inflammation. We assessed the incidence of CHIP and its association with inflammatory blood cell phenotypes in patients with AV stenosis undergoing transfemoral aortic valve implantation (TAVI).Methods and resultsTargeted amplicon sequencing for DNMT3A and TET2 was performed in 279 patients with severe AV stenosis undergoing TAVI. Somatic DNMT3A- or TET2-CHIP-driver mutations with a VAF ≥ 2% were detected in 93 out of 279 patients (33.3%), with an age-dependent increase in the incidence from 25% (55–69 years) to 52.9% (90–100 years). Patients with DNMT3A- or TET2-CHIP-driver mutations did not differ from patients without such mutations in clinical parameters, concomitant atherosclerotic disease, blood cell counts, inflammatory markers, or procedural characteristics. However, patients with DNMT3A- or TET2-CHIP-driver mutations had a profoundly increased medium-term all-cause mortality following successful TAVI. Differential myeloid and T-cell distributions revealed pro-inflammatory T-cell polarization in DNMT3A-mutation carriers and increased pro-inflammatory non-classical monocytes in TET2-mutation carriers.ConclusionThis is the first study to show that acquired somatic mutations in the most commonly mutated CHIP-driver genes occur frequently in patients with severe degenerative AV stenosis, are associated with increased pro-inflammatory leucocyte subsets, and confer a profound increase in mortality following successful TAVI.

Outcomes of Guideline-Directed Concomitant Annuloplasty for Functional Tricuspid Regurgitation

Despite guideline recommendations, rates of concomitant tricuspid valve repair are suboptimal, possibly due to fear of complications. We reviewed morbidity, mortality, recurrent tricuspid regurgitation, and right ventricular remodeling after guideline-directed concomitant tricuspid valve repair. We performed guideline-directed concomitant tricuspid valve repair on 171 consecutive patients who underwent left-sided valve surgery (degenerative mitral surgery or aortic valve replacement) between May 2012 and March 2016. Exclusion criteria included functional mitral regurgitation, rheumatic disease, active endocarditis, and concomitant coronary artery bypass grafting or complex aortic surgery. Mean age was 68 ± 12 years, and 47% (81 of 171) were women. Preoperative atrial fibrillation was present in 57% (98 of 171), and preoperative tricuspid regurgitation was moderate or higher in 64% (108 of 171). The rate of de novo pacemaker placement was 4.1% (7 of 171), and the 30-day mortality rate was 0.6% (1 of 171). Estimated survival was 95% ± 4% at 1 year and 92% ± 5% at 5 years. Freedom from moderate or worse residual/recurrent tricuspid regurgitation was 93% ± 6% at 6 months and 89% ± 8% at 3 years. Quantitative echocardiography found no significant increase in right ventricular dimensions or area at 1 year in subgroup analysis. Mean echocardiographic follow-up was 14.1 months, and mean clinical follow-up was 33.9 months. Guideline-directed concomitant tricuspid valve repair resulted in excellent safety end points andsurvival. At 14 months, freedom from moderate or worse tricuspid regurgitation was high, right ventricular performance did not worsen, and the pacemaker rate wascomparable to rates after isolated mitral repair. Given these findings, adherence to current guidelines regarding functional tricuspid regurgitation should be encouraged.

Arrhythmic Risk in Elderly Patients Candidates to Transcatheter Aortic Valve Replacement: Predictive Role of Repolarization Temporal Dispersion.

Background/AimDegenerative aortic valve stenosis (AS) is associated to ventricular arrhythmias and sudden cardiac death, as well as mental stress in specific patients. In such a context, substrate, autonomic imbalance as well as repolarization dispersion abnormalities play an undoubted role. Aim of the study was to evaluate the increase of premature ventricular contractions (PVC) and complex ventricular arrhythmias during mental stress in elderly patients candidate to the transcatheter aortic valve replacement (TAVR).MethodsIn eighty-one elderly patients with AS we calculated several short-period RR- and QT-derived variables at rest, during controlled breathing and during mild mental stress, the latter being represented by a mini-mental state evaluation (MMSE).ResultsAll the myocardial repolarization dispersion markers worsened during mental stress (p < 0.05). Furthermore, during MMSE, low frequency component of the RR variability increased significantly both as absolute power (LFRR) and normalized units (LFRRNU) (p < 0.05) as well as the low-high frequency ratio (LFRR/HFRR) (p < 0.05). Eventually, twenty-four (30%) and twelve (15%) patients increased significantly PVC and, respectively, complex ventricular arrhythmias during the MMSE administration. At multivariate logistic regression analysis, the standard deviation of QTend (QTesd), obtained at rest, was predictive of increased PVC (odd ratio: 1.54, 95% CI 1.14–2.08; p = 0.005) and complex ventricular arrhythmias (odd ratio: 2.31, 95% CI 1.40–3.83; p = 0.001) during MMSE. The QTesd showed the widest sensitive-specificity area under the curve for the increase of PVC (AUC: 0.699, 95% CI: 0.576–0.822, p < 0.05) and complex ventricular arrhythmias (AUC: 0.801, 95% CI: 0.648–0.954, p < 0.05).ConclusionIn elderly with AS ventricular arrhythmias worsened during a simple cognitive assessment, this events being a possible further burden on the outcome of TAVR. QTesd might be useful to identify those patients with the highest risk of ventricular arrhythmias. Whether the TAVR could led to a QTesd reduction and, hence, to a reduction of the arrhythmic burden in this setting of patients is worthy to be investigated.

Impact of Cumulative Smoking Exposure on Subclinical Degenerative Aortic Valve Disease in Apparently Healthy Male Workers.

Little is known regarding the impact of cumulative smoking exposure and smoking cessation on subclinical degenerative aortic valve (DAV) disease. We examined associations of smoking status, cigarette-years of smoking, and years since quitting smoking with subclinical DAV disease defined by echocardiography. Of 756 apparently healthy male workers, 154 had DAV including 63 with DAV with ≥2 leaflets calcification (DAV ≥2 cal). Compared with never smokers, ever smokers had higher risk of DAV and DAV ≥2 cal; odds ratios (95% CI) were 2.883 (1.800-4.618) (p<0.001) and 5.281 (2.297-12.138) (p<0.001), respectively. Both current and former smokers had dose-dependent relationships of cigarette-years on DAV and DAV ≥2 cal (P for trend, <0.001 for both DAV, in both smokers). In current smokers with >400-≤800 and with >800 cigarette-years, odds ratios (95%CIs) were 3.201 (1.690-6.063) (p<0.001) and 5.326 (2.800-10.053) (p<0.001) for DAV, 7.460 (2.828-19.680) (p<0.001) and 8.397 (3.146-22.414) (p<0.001) for DAV ≥2 cal, respectively. In former smokers with >800 cigarette-years, odds ratios (95%CI) were 3.780 (1.970-7.254) (p<0.001) for DAV, 10.035 (3.801-26.496) (p<0.001) for DAV ≥2 cal. Compared with current smokers, former smokers with quitting smoking >10 years had significantly lower risk of DAV and DAV ≥2 cal. In apparently healthy male workers, DAV disease was strongly associated with smoking. Cumulative smoking exposure was associated with dose-dependent relationship on subclinical DAV disease both in current smokers and former smokers.

Pro-Calcific Differentiation Of Aortic Interstitial Valve Cells Is Prevented By Treatment With L-Arginine: Results Of A Proteomic Study

Background and Aims: Oxidative stress and reduced bioavailability of nitric oxide (NO) are potentially involved in the calcific degeneration of aortic valve. Aim of the study was to investigate the effects of L-Arginine (L-Arg), main precursor of NO, on the osteogenic differentiation of aortic interstitial valve cells (VIC).