Valvular Heart Disease Research Articles

Spanish cardiac catheterization and coronary intervention registry. 33rd official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2023)

Introduction and objectivesThis article presents the 2023 activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC). MethodsAll interventional cardiology laboratories in Spain were invited to participate in an online survey. Data analysis was carried out by an external company and subsequently reviewed and presented by the members of the ACI-SEC board. ResultsA total of 119 hospitals participated. The number of diagnostic studies decreased by 1.8%, while the number of percutaneous coronary interventions (PCI) showed a slight increase. There was a reduction in the number of stents used and an increase in the use of drug-coated balloons. The use of intracoronary diagnostic techniques remained stable. For the first time, data on PCI guided by intracoronary imaging was reported, showing a 10% usage rate in Spain. Techniques for plaque modification continued to grow. Primary PCI increased, becoming the predominant treatment for myocardial infarction (97%). Noncoronary structural procedures continued their upward trend. Notably, the number of left atrial appendage closures, patent foramen ovale closures, and tricuspid valve interventions grew in 2023. There was also a significant increase in interventions for acute pulmonary embolism. ConclusionsThe 2023 Spanish cardiac catheterization and coronary intervention registry indicates a stabilization in coronary interventions, together with an increase in complexity. There was consistent growth in procedures for both valvular and nonvalvular structural heart diseases.

FOXC1 and FOXC2 Ablation Causes Abnormal Valvular Endothelial Cell Junctions and Lymphatic Vessel Formation in Myxomatous Mitral Valve Degeneration.

Mitral valve (MV) disease including myxomatous degeneration is the most common form of valvular heart disease with an age-dependent frequency. Genetic evidence indicates that mutations of the human transcription factor FOXC1 are associated with MV defects, including MV regurgitation. In this study, we sought to determine whether murine Foxc1 and its closely related factor, Foxc2, are required in valvular endothelial cells (VECs) for the maintenance of MV leaflets, including VEC junctions and the stratified trilaminar ECM (extracellular matrix). Adult mice carrying tamoxifen-inducible, vascular endothelial cell (EC), and lymphatic EC-specific, compound Foxc1;Foxc2 mutations (ie, EC-Foxc-DKO and lymphatic EC-Foxc-DKO mice, respectively) were used to study the function of Foxc1 and Foxc2 in the maintenance of MVs. The EC and lymphatic EC mutations of Foxc1/c2 were induced at 7 to 8 weeks of age by tamoxifen treatment, and abnormalities in the MVs of these mutant mice were assessed via whole-mount immunostaining, immunohistochemistry/RNAscope, Movat pentachrome/Masson Trichrome staining, and Evans blue injection. EC deletions of Foxc1 and Foxc2 in mice resulted in abnormally extended and thicker MVs by causing defects in the regulation of ECM organization with increased proteoglycan and decreased collagen. Notably, reticular adherens junctions were found in VECs of control MV leaflets, and these reticular structures were severely disrupted in EC-Foxc-DKO mice. PROX1 (prospero homeobox protein 1), a key regulator in a subset of VECs on the fibrosa side of MVs, was downregulated in EC-Foxc1/c2 mutant VECs. Furthermore, we determined the precise location of lymphatic vessels in murine MVs, and these lymphatic vessels were aberrantly expanded and dysfunctional in EC-Foxc1/c2 mutant MVs. Lymphatic EC deletion of Foxc1/c2 also resulted in similar structural/ECM abnormalities as seen in EC-Foxc1/c2 mutant MVs. Our results indicate that Foxc1 and Foxc2 are required for maintaining the integrity of the MV, including VEC junctions, ECM organization, and lymphatic vessel formation/function to prevent myxomatous MV degeneration.

A cross-sectional study of the spectrum, aetiology and clinical characteristics of adult mitral valve disease at Chris Hani Baragwanath Academic Hospital.

Valvular heart disease constitutes a considerable amount of cardiovascular morbidity and mortality worldwide. There is a scarcity of data from Africa. In this descriptive, cross-sectional study, we documented the demographic, clinical and echocardiographic features of current patients with adult mitral valve disease (MVD) at Chris Hani Baragwanath Academic Hospital from December 2018 to March 2019. The study included 134 patients (mean age 50 ± 13.3 years) and 77% were female. The majority were of African ethnicity (96%). Mitral regurgitation (39%), followed by mixed MVD (38%) were the dominant lesions. Mitral stenosis was found in 23% of the patients. The main aetiologies were rheumatic heart disease (80%), mitral valve prolapse (11%), myxomatous degeneration (6%) and infective endocarditis (3%). Hypertension (30%) and HIV (12%) were the main co-morbidities. Heart failure was present in 78% of the patients at index hospitalisation. The main complications were pulmonary hypertension (28%) and atrial fibrillation (14%). The patients with MVD tended to be older African females with co-morbidities who had predominant rheumatic mitral regurgitation.

O59 INFLUENCE OF CIRCADIAN BLOOD PRESSURE PATTERN ON RIGHT VENTRICULAR STRUCTURE AND FUNCTION IN PATIENTS WITH ARTERIAL HYPERTENSIION

Background and Objective: It is well proven, that arterial hypertension affects left side of the heart and causes its remodeling and functional changes. Since heart works as a unit and has ventricular interdependence, aim of the study was to assess influence of hypertension and circadian blood pressure (BP) profile on a right ventricular structure and function. Methods: 75 hypertensive patients (57.13±7.27 y/o) and 25 normotensive control subjects (57.56±7.55 y/o) were involved in a study. All of them were males without history of coronary artery disease, cerebrovascular or peripheral artery disease, obstructive lung disease, significant valvular heart disease or heart failure. All of them were either lifetime nonsmokers, or stopped smoking more than 5 years. All the patients underwent to 24-hour ambulatory BP monitoring and heart ultrasound with tissue doppler imaging. Results: Hypertensive patients with dipper circadian BP profile had higher TAPSE (19±1.586 vs 17.708±2.857; P<0.05), higher right ventricular ejection fraction (55.103±4.597 vs 47.829±14.605; P<0,005) and lower right ventricular outflow tract diameter (29.985±3.932 vs 32.639±3.510; P<0/05). None of the echo parameters were different between normotensive subjects with different circadian BP pattern. Trans tricuspid valve early diastolic (E) and late diastolic (A) peak velocities were significantly lower in hypertensive patients (1.416±0.130 vs 0.897±1.49; P<0.005). Hence, non-dipper hypertensives had significantly lower tricuspid E/A ratio in comparison with dippers (0.812±0.094 vs 1.048±0.101; P<0.00001). Interventricular septum and posterior wall diameters were higher in non-dipper hypertensives (1.134±0.131 vs. 1.322±0.138; P<0.00001 and 1.072±0.175 vs. 1.254±0.135; P<0.001; respectively). Conclusion: Study data show increased interdependence between two ventricles. Patients with arterial hypertension have systole-diastolic dysfunction, which especially well is present in patients with non-dipper circadian BP profile.

Pregnancy complications and long-term risk of cardiovascular events in women with structural heart disease

BackgroundTo determine the frequency of pregnancy complications and their association with the risk of cardiovascular outcomes in women with structural heart disease (SHD).MethodsThis nationwide registry-based cohort study included women in...

441.2: Impact of de novo or worsening of pre-existing valvular heart disease in patients referred to the kidney transplant waitlist – a single centre retrospective cohort study.

441.2: Impact of de novo or worsening of pre-existing valvular heart disease in patients referred to the kidney transplant waitlist – a single centre retrospective cohort study.

Cardiac Magnetic Resonance for Structural Aortic Valve Stenosis Procedures.

The number of structural aortic valve procedures has increased significantly in recent years. Pre-procedural planning and follow-up with noninvasive testing are essential. Although cardiac magnetic resonance (CMR) is the gold standard for assessing left ventricular mass, volume, and function, it is not performed routinely in patients undergoing structural interventions. CMR can provide useful information for pre- and post-procedural assessment, including quantification of cardiac function, myocardial assessment, grading of the severity of valvular heart disease, and evaluation of extracardiac anatomy while avoiding the limitations of other non-invasive modalities. Here, we review the use cases, future perspectives, and limitations of CMR for patients undergoing structural aortic valve procedures.

P195 CARDIOVASCULAR OUTCOMES IN PATIENTS WITH AORTIC STENOSIS AND HYPERTENSION UNDERGOING AORTIC VALVE REPLACEMENT

Background and Objective: Aortic valve stenosis (AS) is most common valvular heart disease and in its severe form requires aortic valve replacement (AVR). The prevalence of both AS and arterial hypertension (HTN) increases with age and the conditions therefore often co-exist. Co-existence of AS and HTN is associated with higher global left ventricular (LV) pressure overload, more abnormal LV geometry and function, and more adverse cardiovascular outcome. Management of HTN in AS has historically been associated with prudence and concerns, mainly related to drug-induced potential adverse consequences. We evaluated the cardiovascular outcomes of patients with AS and HTN undergoing to AVR Methods: A retrospective cohort study where all the patients who underwent AVR between 2019- 2024, in a 4-level center in Bogotá, Colombia. A descriptive analysis was performed. Continuous variables were expressed as mean or median with their respective measure of dispersion, standard deviation or interquartile range (ICR), the categorical variables were expressed in proportions and absolute numbers. Results: We analyzed 1043 Patients with moderate/severe AS undergoing AVR, 64.3% (671 with HTN), median age for all of 69.8 years ICR (61.7-77.4) Hypertensive patient being older (72 years p<0.0001). In the HTN group 57.8% were men, and more frequently they had diabetes and dyslipidemia comorbidities (p<0.001) as well as greater baseline renal involvement (p<0.001) comparatively with NO-HTN. In addition, hypertensive patient had better LVEF and were treated with ARA II/IECA (55,6% vs 19.4% p<0.001), beta blockers (60.4% vs 47.3% p< 0.001) and anti-calcium medication (13,1% vs 19,5% p<0.001).Table 1. Cardiovascular outcomes showed greater tendency towards worsening of renal function. There were no statistically significant differences in mortality. Conclusions: AVR is presented as a safe procedure in patients with AS and HTN in developing countries. The institutional results show a safe technique, associated with low mortality rates. Hypertensive patients had more acute kidney injury in the post-surgical period, which leads us to propose kidney protection strategies in this group.

On-demand mitral valve morphometrics during surgical repair

Abstract Mitral valve regurgitation is one of the most common heart valve diseases that can occur when the structural composition of the mitral valve is affected. Mitral valve repair, typically performed in a minimally invasive setting, is a complex surgery that aims to reinstate the structural integrity of the valve and thereby restore normal valve function. The current practice lacks quantification of geometrical changes and interactive 3D visualization that could enhance the understanding of pathomorphological changes and impact of surgical correction. This work presents functionalities from smartMVR, a quantitative tool to measure, compare, and analyse changes in mitral valve geometry from data captured on-demand using an RGB-D camera. The feasibility of the approach is demonstrated on a silicone replica of a pathological mitral valve that is iteratively corrected using common surgical techniques.

Genetic causal association between lipidomic profiles, inflammatory proteomics, and aortic stenosis: a Mendelian randomization investigation

BackgroundAortic stenosis (AS) is a prevalent and serious valvular heart disease with a complex etiology involving genetic predispositions, lipid dysregulation, and inflammation. The specific roles of lipid and protein biomarkers in AS development are not fully elucidated. This study aimed to elucidate the causal relationships between lipidome, inflammatory proteins, and AS using Mendelian randomization (MR), identifying potential therapeutic targets.MethodsUtilizing data from large-scale genome-wide association studies (GWAS) and genome-wide protein quantitative trait loci (pQTL) studies, we conducted MR analyses on 179 plasma lipidome and 91 inflammatory proteins to assess their causal associations with AS. Our approach included Inverse Variance Weighting (IVW), Wald ratio, and robust adjusted profile score (RAPS) analyses to refine these associations. MR-Egger regression was used to address directional horizontal pleiotropy.ResultsOur MR analysis showed that genetically predicted 50 lipids were associated with AS, including 38 as risk factors [(9 Sterol ester, 18 Phosphatidylcholine, 4 Phosphatidylethanolamine, 1 Phosphatidylinositol and 6 Triacylglycerol)] and 12 as protective. Sterol ester (27:1/17:1) emerged as the most significant risk factor with an odds ratio (OR) of 3.11. Additionally, two inflammatory proteins, fibroblast growth factor 19 (FGF19) (OR = 0.830, P = 0.015), and interleukin 6 (IL-6) (OR = 0.729, P = 1.79E-04) were significantly associated with reduced AS risk. However, a two-step MR analysis showed no significant mediated correlations between these proteins and the lipid–AS pathway.ConclusionThis study reveals complex lipid and protein interactions in AS, identifying potential molecular targets for therapy. These results go beyond traditional lipid profiling and significantly advance our genetic and molecular understanding of AS, highlighting potential pathways for intervention and prevention.

Percutaneous Valvular and Structural Heart Disease Interventions. 2024 Core Curriculum of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC.

The percutaneous treatment of structural, valvular, and non-valvular heart disease (SHD) is rapidly evolving. The Core Curriculum (CC) proposed by the EAPCI describes the knowledge, skills, and attitudes that define competency levels required by newly trained SHD interventional cardiologists (IC) and provides guidance for training centres. SHD ICs are cardiologists who have received complete interventional cardiology training. They are multidisciplinary team specialists who manage adult SHD patients from diagnosis to follow-up and perform percutaneous procedures in this area. They are competent in interpreting advanced imaging techniques and master planning software. The SHD ICs are expected to be proficient in the aortic, mitral, and tricuspid areas. They may have selective skills in either the aortic area or mitral/tricuspid areas. In this case, they must still have common transversal competencies in the aortic, mitral, and tricuspid areas. Additional SHD domain competencies are optional. Completing dedicated SHD training, aiming for full aortic, mitral, and tricuspid competencies, requires at least 18 months. For full training in the aortic area, with basic competencies in mitral/tricuspid areas, the training can be reduced to 1 year. The same is true for training in the mitral/tricuspid area, with competencies in the aortic area. The SHD IC CC promotes excellence and homogeneous training across Europe and is the cornerstone of future certifications and patient protection. It may be a reference for future CC for national associations and other SHD specialities, including imaging and cardiac surgery.

Facile engineering of interactive double network hydrogels for heart valve regeneration

Regenerative heart valve prostheses are essential for treating valvular heart disease, which requested interactive materials that can adapt to the tissue remodeling process. Such materials typically involves intricate designs with multiple active components, limiting their translational potential. This study introduces a facile method to engineer interactive materials for heart valve regeneration using 1,1’-thiocarbonyldiimidazole (TCDI) chemistry. TCDI crosslinking forms cleavable thiourea and thiocarbamate linkages which could gradually release H2S during degradation, therefore regulates the immune microenvironment and accelerates tissue remodeling. By employing this approach, a double network hydrogel was formed on decellularized heart valves (DHVs), showcasing robust anti-calcification and anti-thrombosis properties post fatigue testing. Post-implantation, the DHVs could adaptively degrade during recellularization, releasing H2S to further support tissue regeneration. Therefore, the comprehensive endothelial cell coverage and notable extracellular matrix remodeling could be clearly observed. This accessible and integrated strategy effectively overcomes various limitations of bioprosthetic valves, showing promise as an attractive approach for immune modulation of biomaterials.

Veins in the Lateral Fascial Compartment of the Calf

Venous insufficiency mostly arises from valvular incompetence in the great saphenous vein (GSV) and small saphenous vein (SSV). However, non-saphenous reflux (NSR) remains relatively unexplored in clinical practice and ultrasound investigations. This study reports an uncommon anatomical finding and the associated venous reflux, which is believed to involve the peripheral nerve. A systematic database search was conducted to identify patients from our clinic previously diagnosed with an interfascial vein in the lateral calf compartment during duplex ultrasound examination. Subsequently, a questionnaire was distributed to those who volunteered to participate, collecting further demographic details and clinical information related to peripheral neuropathy of the calf. Ultrasound findings, including venous competency and diameter measurements, were included for data analysis. In total, 20 legs with an interfascial vein were identified from 19 patients between 2008 and 2022. Of the 6 patients who returned the questionnaire and provided consent for inclusion, 2 reported lateral calf pain in the lower calf. Calf numbness was noted in 2 patients, primarily affecting the upper and mid portions with 2 further patients reporting foot drop. Reflux flow in the interfascial vein was detected in 5 patients. Sonographic findings revealed interfascial vein diameters range from 1.1 to 4.0 mm, with a mean of 2.4 mm. The distance between the interfascial vein and SSV varied, with a mean of 36.3 mm. Based on topographic anatomy and reflux flow originating from sciatic nerve varices, we hypothesize that the interfascial vein identified in our patients likely represents the superficial peroneal nerve vein. This study sheds light on the existence of an interfascial vein in the lateral calf compartment and its role in producing lateral calf neuropathy.

Should routine pulmonary function tests be performed in patients with left ventricular dysfunction and/or congestive heart failure undergoing cardiac surgery?

BackgroundIt is controversial whether pulmonary function testing should be performed routinely in cardiac surgery patients. The aim of our study was to focus on patients who have congestive heart failure, caused by left ventricular dysfunction or left-sided heart valve disease, and study the prognostic value of performing preoperative pulmonary function testing on their postoperative outcomes.MethodsThis is a retrospective propensity score matched study that included 366 patients with congestive heart failure who underwent cardiac surgery and had preoperative pulmonary function test. The patients were divided into two groups: Group 1 who had a normal or mild reduction in pulmonary function tests and group 2 who had moderate to severe reduction in pulmonary function tests. The postoperative outcomes, including pulmonary complications, were compared between the two groups.ResultsPulmonary function tests were normal or mildly reduced in 190 patients (group 1) and moderately to severely reduced in 176 patients (group 2). Propensity matching identified 111 matched pairs in each group with balanced preoperative and operative characteristics. Compared to group 1, Group 2 had longer duration of mechanical ventilation [12 (7.5–16) vs. 9 (6.5–13) hours, p < 0.001], higher postoperative Creatinine [111 (90–142) vs. 105 (81–128) µmol/dl, p = 0.02] and higher hospital mortality (6.31% vs. 0%, p = 0.02).ConclusionRoutine Pulmonary Function Testing should be performed in patients with Left ventricular dysfunction and/or congestive heart failure undergoing cardiac surgery since moderate to severe reduction in those patients was associated with longer duration of mechanical ventilation and higher hospital mortality.

The clinical relevance of the new criteria for cirrhotic cardiomyopathy and future directions.

Cardiac dysfunction in patients with liver disease has been recognized since the 1950s. Initially attributed to shared risk factors, it is now evident that cardiac dysfunction in patients with cirrhosis can occur in the absence of known cardiac, i.e., coronary artery and valvular heart disease, and across all etiologies for cirrhosis. In 1996 this myocardial dysfunction was termed cirrhotic cardiomyopathy (CCM). The pathophysiologic mechanisms underlying CCM include impaired beta-adrenergic membrane function and circulating proinflammatory and cardiotoxic substances. In 2005, the first diagnostic criteria for CCM were introduced enabling greater sensitivity and accuracy of diagnosis. Since 2005, advancements in echocardiographic methods and better understanding of the pathophysiology of cardiac dysfunction in patients with cirrhosis necessitated revision of CCM criteria. Changes in CCM criteria included removal of blunted contractile or heart rate response on stress testing and addition of global longitudinal systolic strain. Refinement of criteria for diastolic dysfunction were also incorporated into the new diagnostic approach. Since 2020, the prevalence of the disorder and clinical considerations for pre-transplant, peritransplant, and post-transplant patients with cirrhosis have been further evaluated and CCM was found to adversely impact clinical outcomes during all three phases of care. Future research considerations should address the timing of universal echocardiographic screening for patients with cirrhosis, utility of biomarkers in aiding CCM diagnosis, impact of CCM on right heart function, and role of anti-remodeling agents post-liver transplant (post-LT).

Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case-Control Study.

Objective: We analyzed the obstetric and cardiac characteristics and results of pregnant women with heart disease (HD) and compared their results with those of healthy controls. Methods: In this retrospective single-center case-control study, women with HD attended between 2010 and 2018 were matched at a 1:2 ratio (according to date of delivery, parity, and singleton or twin pregnancy) with controls without heart disease treated in the same referral center. Results: We identified 141 pregnant women with HD, of whom 132 reached 22 weeks of gestation and were paired with 264 healthy controls, for a total of 396 participants and 408 newborns. Most common HDs were congenital HD (53 women), arrhythmia (46), valvular HD (35), and cardiomyopathy (16), having women with more than one coexisting HD. During pregnancy or the puerperium, 19.9% of mothers experienced a major adverse cardiac event (MACE), with 5% requiring intensive care unit (ICU) admission. The rates of cesarean section were 37.1% in the case group and 18.2% in the control group, with an odds ratio (OR) of 2.66 (95% CI = 1.66-4.26, p < 0.001). We also found a higher use of general anesthesia, with an OR of 10.73 (95% CI = 2.32-49.75, p = 0.002); more prolonged hospitalizations, with an OR of 2.91 (95% CI 1.02-8.35, p = 0.023); and a higher incidence of low neonatal weight, with an OR of 1.96 (95% CI 1.09-3.52, p = 0.012). There were no differences between groups in terms of gestational age at delivery; however, we observed greater prematurity in women with HD, without reaching statistical significance. The rate of congenital heart disease among the newborns of mothers with HD was 13.2%. Conclusions: HD increases maternal morbidity during pregnancy and it is associated with higher rates of cesarean section and low birth weight.

Risk factors analysis and prediction model construction of major adverse cardiovascular events in pregnant women with valvular heart disease

Objective: To analysis the risk factors for major adverse cardiovascular event (MACE) in pregnant women with valvular heart disease (VHD) and to construct a risk prediction model. Methods: The clinical data of 245 pregnant women with VHD who were hospitalized in Beijing Anzhen Hospital from January 1, 2012, to June 1, 2023 were retrospectively analyzed, including general information, pre-pregnancy and pregnancy-associated cardiac conditions, and MACE. Univariate analysis and logistic regression models were employed to identify risk factors for MACE during pregnancy among pregnant women with VHD. Furthermore, a predictive model was constructed and internal validation was conducted using bootstrap techniques. Results: (1) Among 245 pregnant women with VHD, the incidence of MACE was 18.0% (44/245), and the most common MACE was heart failure (61.4%, 27/44). The mitral valve was the most frequently affected valve (64.9%, 159/245). Prior to pregnancy, the most common type of valve surgery undertaken was mechanical valve replacement, representing 31.4% (77/245) of surgeries. In contrast, among those pregnant women who did not undergo valve surgery before pregnancy, the most common lesion type was mitral regurgitation (17.6%, 43/245). (2) Comparing the maternal and infant outcomes of warfarin, low molecular weight heparin (LMWH) and LMWH sequential with warfarin, the fetal loss rate (36%, 15/42) and malformation rate (7%, 3/42) were the highest, but the MACE rate (12%, 5/42) was the lowest in warfarin group. The fetal loss rate (1/19), malformation rate (1/19) and artificial valve thrombosis rate (0) of LMWH sequential with warfarin were the lowest, and the fetal loss rate and artificial valve thrombosis rate of the three anticoagulation methods were statistically significant (all P<0.05). (3) There were no significant differences in gestational age, age of diagnosis of heart disease, weight at delivery, pre-pregnancy body mass index, proportion of multiparous women and chronic medical history between women with MACE and those without MACE (all P>0.05). (4) Binary logistic regression analysis identified the following as risk factors for MACE during the second trimester of pregnancy among pregnant women with VHD: pre-pregnancy cardiac symptoms, history of corrective surgery for congenital heart disease, pregnancy risk grade Ⅴ, anticoagulation with LMWH during pregnancy, and arrhythmia (all P<0.05). Based on the results of multivariate analysis, a receiver operating characteristic curve was constructed, with an area under the curve of 0.837, indicating good discriminative ability. The calibration plot demonstrated a close alignment between the standard curve and the calibration prediction curve, suggesting excellent calibration of the model. Conclusions: Pregnant women with VHD are at a high risk of experiencing MACE during gestation. Five risk factors, including pre-pregnancy cardiac symptoms, history of corrective surgery for congenital heart disease, pregnancy risk grade Ⅴ, anticoagulation with LMWH, and arrhythmia, could aid in identifying high-risk pregnant women.

The Significance of von Willebrand Factor Antigen Levels in Predicting the Severity of Coronary Artery Disease in Patients with ST-Segment Elevation Myocardial Infarction

Background When the endothelium of the coronary artery is damaged, it exposes the underlying structure to a series of events that can cause complete blockage and a myocardial infarction with ST-segment elevation (STEMI). One of the key factors in this process is a protein called von Willebrand factor (vWF) that helps platelets adhere to the damaged area. Our objective was to investigate the importance of measuring vWF levels in patients with STEMI to determine the severity of their coronary artery disease (CAD) on angiography. Methods The study included 30 patients who experienced their first STEMI. Patients with a history of CAD, cardiomyopathies, valvular heart disease, atrial fibrillation, anticoagulants, coagulation disorders, and pregnancy were not included in the study. After informed consent, all patients were subjected to routine blood investigations, electrocardiography, echocardiography, and coronary angiography. Blood samples were collected for vWF Ag within 24 hours of the patients’ arrival at the hospital. After the angiography, the coronary arteries were evaluated for stenosis and quantified using the modified Gensini score (mGS). The score was then correlated with vWF Ag levels using the Spearman rank correlation. Additionally, the receiver operating characteristic (ROC) curve was plotted for the value of vWF Ag levels to detect significant CAD. Results The average age of the group was (49.77 ± 10.79) years. The average levels of vWF Ag were (204.17% ± 51.99%). Patients with an mGS score of over 150 had higher levels of vWF Ag than those with a score of under 100 ( P &lt; .001). There was a positive correlation ( r2: 0.67) between the parameters. On the ROC curve, vWF Ag levels higher than 186% predicted the presence of CAD, with an area under curve indicating sensitivity and specificity. Conclusion: In patients with STEMI, higher levels of vWF Ag were found to be associated with a greater severity of CAD.

Management of carcinoid heart disease

Carcinoid Heart Disease (CaHD) is defined as the constellation of all cardiac manifestations that occur in patients with carcinoid tumors. Cardiac manifestations are generally due to the paraneoplastic effects of vasoactive substances secreted by carcinoid tumors. These primarily cause cardiac valve dysfunction and resultant heart failure. Successful management of patients with CaHD requires a multidisciplinary team to address both the classical manifestations of carcinoid syndrome, as well as the additional manifestations of cardiac dysfunction. While the cornerstone of medical management for carcinoid syndrome are somatostatin analogs (SSAs), there is no evidence to suggest that the usage of SSAs influences the development or progression of CaHD. Additionally, while liver-directed therapies provide a survival benefit to symptomatic carcinoid syndrome patients with resectable disease, there are conflicting data on the survival benefit of hepatic resection among patients with CaHD. Cardiac surgery in patients with CaHD is a complex undertaking, and is the only definitive treatment for symptom management in CaHD with significant survival benefit for patients in advanced disease states. Two crucial surgical decisions to be made are determining which valve(s) should be replaced, and what prosthetic should be utilized. While challenging in this often medically frail population, cardiac surgery confers a survival benefit and should be pursued in cases of symptomatic CaHD or progressive right ventricular dysfunction.

CARDIAC VALVE DISEASE IN DIABETIC PREGNANT WOMEN: FETAL COMPROMISE AND MATERNAL RISK

Introduction: Cardiac valve diseases represent a significant concern in the management of pregnant women, particularly those with diabetes mellitus, a condition that alters the hemodynamic profile and can exacerbate pre-existing cardiac issues. During pregnancy, a woman's body undergoes physiological changes that can affect the function of the cardiac valves. Diabetes mellitus can accelerate the progression of valvulopathies, leading to complications affecting both the mother and the fetus. Fetal compromise often results from maternal hemodynamic instability and changes in blood flow, while maternal risk includes worsening cardiac symptoms and an increased likelihood of adverse events during pregnancy. Objective: The objective of this systematic review was to analyze the available evidence on the impact of cardiac valve diseases in diabetic pregnant women, focusing on the consequences for the fetus and the risks for the mother. Methodology: To conduct the systematic review, the PRISMA checklist criteria were followed. The search was performed in electronic databases, including PubMed, Scielo, and Web of Science, using five main descriptors: "cardiac valve disease," "diabetic pregnant women," "fetal compromise," "maternal risk," and "diabetes mellitus." Studies published in the last 10 years were included, prioritizing peer-reviewed articles and original research. Inclusion criteria comprised: (1) studies specifically addressing valvulopathies in pregnant women with diabetes mellitus, (2) articles providing data on fetal and maternal outcomes, and (3) research published in peer-reviewed journals. Exclusion criteria included: (1) studies not directly focusing on diabetic pregnant women, (2) research with non-rigorous methodologies or lack of relevant data, and (3) articles published more than 10 years ago. Results: The results indicated that pregnant women with valvulopathies and diabetes mellitus face a heightened risk of complications. Key findings included increased neonatal mortality and maternal cardiovascular complications, such as heart failure and worsening valvular symptoms. Fetal compromise often involved intrauterine growth problems and a higher incidence of prematurity. Conclusion: The review highlighted that the combination of diabetes mellitus and cardiac valve diseases presents a significant challenge in managing pregnant women, with important implications for both maternal and fetal health. Early identification and appropriate management of valvulopathies are crucial to reducing associated risks and improving outcomes for both mother and baby. Future studies should focus on treatment strategies and monitoring approaches that can mitigate these complications and promote better outcomes.