Development Of Severe Stenosis Research Articles

The impact of resting heart rate on adverse outcomes and haemodynamic progression of aortic stenosis

Abstract Introduction A high resting heart rate (RHR) is an established risk factor for cardiovascular disease, adverse cardiac events, accelerated calcification in coronary artery disease and carotid stenosis, and increased aortic valve calcification in patients with and without a confirmed diagnosis of aortic stenosis (AS). Aortic valve calcification is the most common precursor to AS and is associated with significantly faster disease progression. There are few studies exploring the effects of RHR on the progression of AS, the development of severe stenosis, and the risk of complications and death. Purpose We hypothesised that an elevated RHR would be associated with poorer outcomes and more rapid haemodynamic disease progression in patients with AS and tested this in a large cohort of patients without severe disease. Methods Using the National Echocardiography Database of Australia (NEDA) we undertook a retrospective observational study on patients without severe AS, a bicuspid aortic valve or prior aortic valve replacement. The association between baseline RHR and time to the composite primary endpoint of severe AS, aortic valve replacement or cardiovascular death was tested using Cox proportional hazards regression. In addition, the relationship between baseline RHR and the components of this composite was investigated. Subsequently, the relationship between annualised AS progression rate, defined as change in standard indices of AS severity (maximal jet velocity [Vmax], mean pressure gradient [MPG], and aortic valve area [AVA]), and RHR were analysed using general linear models. Results The initial study cohort comprised 55 585 individuals: 54% male, mean age 63 years and median baseline RHR 70 bpm. The composite primary endpoint, reached by 7 434 patients, was independently associated with RHR (hazard ratio [per 10bpm increase], 1.04; 95% CI, 1.02-1.05; p < 0.001). RHR was also independently associated with time to developing severe AS (hazard ratio [per 10bpm increase], 1.06; 95% CI, 1.01-1.12; p = 0.017) and cardiovascular death (hazard ratio [per 10bpm increase], 1.04; 95% CI, 1.02-1.06; p < 0.001). The event rate was significantly higher in patients with a RHR of at least 70 bpm (the median RHR) compared to those with an RHR less than 70 bpm. In addition, RHR was independently associated with rate of change of each individual measurement index of AS severity including Vmax (β = 0.65 cm/s/year [per 10 bpm increase]; p < 0.001), MPG (β = 0.05 mmHg/ year [per 10 bpm increase]; p<0.001), and AVA (β = -0.01 cm2/year [per 10 bpm increase]; p < 0.001). Conclusions RHR is independently associated with adverse clinical outcomes and haemodynamic progression of AS in patients without severe disease. Future randomised controlled trials should investigate the effect of lowering RHR on clinical endpoints and progression of AS.

Virus persistence in atherosclerotic plaques in patients after carotid endarterectomy

Objective ‒ to mark the quantity of herpes and flu infection detection of the none-stabil and stabil atherosclerotic (AS) plaques in patients with ischemic stroke (IS)/TIA and with the progressing AS and in the anamnesis after carotid endarterectomy.Materials and methods. 103 patients with IS/TIA after carotid endarterectomy were examined: 67 males 42‒82 years old (average age ‒ 66,1±1,4 years), 36 females 44‒81 years old (average age ‒ 63,0±1,3 years). Average age ‒ 65,1± 0,9 year. We examined the width of intima-media complex, presence of AS plaques, their constitution.Results. Among all viruses investigated with transfection and polymerase chain reaction in AS plaques and blood after carotid endarterectomy (HSV1,2, ЕВV, CMV, HHV6), the most prefer are with CMV and associated CMV + HSV1, CMV + HSV2, where patients, hwo have HHV6 and associated HSV1 + HHV6, HHV6 + HSV1 + HSV2.Conclusions. Presentation of CMV and associated CMV + HSV1, CMV + HSV2 increases the risk of development of the hypoechoic none-stabil AS plaques of internal carotid artery (ICA). Presentation of HHV6 and associated HSV1 + HHV6, HSV1 + HSV2 + HHV6 in AS plaques of ICA increases the relative risk of development of severe stenosis in the patients with symptomatic stenosis. The investigation confirms the necessary of periodical administration at exclusion of the stenosis of ICA.

E-072 Post-coital MCA Dissection Presenting with SAH: A Case Report and Review of the Literature

BackgroundPost-coital dissections are uncommon and have been reported rarely in the aorta and coronary arteries. Intracranial arterial dissections are rare and data regarding this disease process is scant. We present...

OP-034 The Relationship Between the Degree of Collateral Circulation and Atrial Electromechanical Delay and P Wave Dispersion in Patients with Coronary Collateral Circulation

Coronary collateral circulation (CCC) consists of vascular channels which are activated to maintain perfusion in major epicardial coronary arteries in the development of severe stenosis. The presence of well developed CCC may prevent myocardium from ischemic damage and may improve the prognosis of coronary artery disease. It is known that myocardial ischemia may cause cardiac electrical instability. In this study, it was aimed to assess P wave dispertion (PWD), minimum and maximum P wave duration, intra-atrial and inter-atrial electromechanic delay (AEMD); which are predictors of atrial fibrilation in patients with CCC and evaluate the relation between these parameters and Rentrop classification which shows the degree of collateral development.

Aetiological factors and imaging program for severe radiation-induced extracranial carotid stenosis in nasopharyngeal carcinoma

Over a period of 3 years, we have collected the carotid ultrasound findings of 189 post-radiotherapy (RT) nasopharyngeal carcinoma patients. The patients had duplex ultrasound examination for assessment of extracranial carotid stenosis. Factors including age, sex, hyperlipidaemia, diabetes mellitus, smoking history, time lapsed after RT, symptoms of cerebrovascular disease were recorded. Association of individual factor with development of severe stenosis was assessed.Eighty-two (43%) patients developed moderate to severe stenosis of the common carotid and/or internal carotid artery. Age and time lapsed after RT were the only factors found to be associated with development of severe stenosis. When age >57 years and >12 years post-RT were used as rules to identify patients with severe stenosis, the sensitivity was 46.7%, specificity 98.2%, PPV 77.8% and NPV 95.6%.Radiation-induced carotid stenosis is a common event. If available resources do not allow routine surveillance, age and time lapsed after RT help to identify high-risk patients.

Development of severe stenosis in a previously purely regurgitant, congenitally bicuspid aortic valve

Acongenitally bicuspid aortic valve may function normally, it may be stenotic with or without associated regurgitation or it may be purely regurgitant (no associated stenosis). 1,2 Such a valve may function normally for many years and then it may become stenotic (as calcific deposits build up) or it may become purely regurgitant (because of superimposed infective endocarditis or because of reasons unclear). Once a bicuspid valve develops some degree of stenosis, its course thereafter is one of gradually worsening stenosis; once a bicuspid valve develops some degree of pure regurgitation (without associated stenosis), its course thereafter is one of gradually worsening regurgitation. Recently, we encountered a man who 8 years earlier had evidence of severe pure aortic regurgitation (no element of stenosis) and thereafter he went on to develop severe aortic valve stenosis with virtual loss of the regurgitation. To our knowledge, conversion from pure aortic regurgitation to severe aortic stenosis has not been reported. This report records such an occurrence.