Incidence Of Valvular Heart Disease Research Articles

Comparative Morphological and Morphometrical Analysis of Atrio-Ventricular Valves of Human and Porcine

There is increased incidence of valvular heart diseases in recent years due to life style modifications. The mortality rates in valvular diseases are kept in pace using various modalities of treatments. One such lifesaving treatment is valve replacement surgeries. These are done by using mechanical valve prosthesis or tissue grafts. The tissue valves prosthesis, harvested from porcine heart are called as xenograft and are increasingly used in valve repair and replacement surgeries. In the present scenario, there is a smaller number of systematically analysed literatures available on the comparative anatomy of human and porcine heart valves. Hence this study was carried out to acquire knowledge and to put forth some points to future research works on heart valves. In this study, 20 formalin fixed porcine and human hearts were procured from slaughter house and cadavers respectively. The morphology and morphometry of tricuspid valve and mitral valve was observed and analysed using spss software 20 version. All the dependent variables were compared using student t test and independent sample test. The results were tabulated and compared. It was observed that the tricuspid and the mitral valve of the porcine resembles the corresponding human heart valves in morphology and morphometry and their values were coinciding to their maximum. The porcine valve resembles human heart valves in morphology and it can be used in designing valve substitutes in replacement surgeries. Porcine valve can also be used as bio-prosthesis by matching the morphometry and by reducing the geometrical difference to their minimum by using any interventional radiology. KEY WORDS: Tissue Graft, Porcine, Tricuspid Valve, Mitral Valve, Morphology And Morphometry.

Effect of bFGF gel nano-sustained-release technology on rehabilitation effect of adult heart valve replacement

the Due to the rapid improvement of economic level, aging and lifestyle changes, the incidence of valvular heart disease continues to increase, and the bFGF gel nano sustained-release technology plays an important role in the rehabilitation of adult heart valve replacement patients. The purpose of this article is to investigate the effect of bFGF gel nano-slow release technology on the rehabilitation effect of adult heart valve replacement patients. The research object was selected from all cases of valve replacement surgery from January 2019 to January 2020, and 216 patients were divided into experimental group and control group, the experimental group carried out the sustained release of bFGF gel nanospheres. The experimental group was 49.76±8.13 years old, including 94 cases of rheumatic heart disease, 13 cases of degenerative valvular disease, and 3 cases of congenital valvular disease, a total of 110 cases. Heart performance tests were performed respectively. The results showed that the incidence of atrial fibrillation, left ventricular hypertrophy and ST-segment depression of 0.1m V in the experimental group were 32.19%, 34.48%, and 19.84%, while the corresponding data in the control group were 62.78%, 52.07%, and 45.87%. It can be seen that bFGF gel nano sustained-release technology is of great significance for the rehabilitation of adult heart valve replacement patients.

Relation Between Matrix Gla Protein and Cardiac Vavular Calcifications in Haemodialysis Patients

Abstract Background Heart valve calcification was first described a century ago. Its pathologic features were first described by Dewitsky in 1910. Valvular heart disease is common in end-stage renal disease patients. The incidence of valvular heart disease is 5 times greater in dialysis patients than in the general population MGP plays a key role in the inhibition of tissue calcification, which was demonstrated in MGP-deficient mice Objective To detect the prevalence of cardiac valvular calcifications among end stage renal disease patients on prevalent haemodialysis and its relation to Matirx Gla protein. Patients and Methods Enrolled patients were recruited from Ain shams hospitals, divided into two groups according to the presence/absence of valvular calcifications on echocardiographic examination as follows: Group A: included patients with valvular calcifications. Group B: included patients without valvular calcifications. Results In current study, 19 (23.8%) patients showed mitral calcification, 30 (37.5%) showed aortic calcification and 44 (55.0%) had calcification in general as 5 patients had both mitral and aortic calcifications. In current study, the patient who had calcification were significantly older, heavier in weight and BMI and were had HD for longer than those who didn’t have calcification. Patient who had calcification had lower levels of both platelets and urea than those who didn’t have calcification. In current study, the mean ucMGP was 549.5 ± 160.1 and the patient who had calcification had higher levels of ucMGP than those who did not have calcification. There was a significant positive correlation between age, weight, BMI, duration of HD and ucMGP. And there was a significant negative correlation between platelet count, serum albumin and ucMGP. Conclusion In current study, MGP was able to significantly differentiate between patients with and without calcification at a cutoff point (>564 pg/mlv) with sensitivity 86.36%, specificity 97.22. Our study confirmed that older age, hypertension, diabetes mellitus low platelet, higher ucMGP and blood urea are the most predictive parameters of valvular calcifications in hemodialysis patients. Other markers were not associated with valvular calcifications. ucMGP serum levels can significantly differentiate between HD cases with valvular calcifications and those not and those who had findings in CXR.

Deep Learning Methods in Internet of Medical Things for Valvular Heart Disease Screening System

The heart is one of the most important organs of the human body. It circulates blood throughout the human body and delivers oxygen and nutrients to all the organs for metabolism. Cardiac muscle contraction results in blood circulation, which maintains the body temperature at approximately 37 °C. If the cardiac function is abnormal, then the body temperature will be affected. The cardiac function degenerates as the human body ages, and the degeneration can occasionally result in cardiovascular diseases. When the Internet of Medical Things is integrated into heart disease screening systems to detect heart diseases, people can perform self-examinations to evaluate whether their hearts exhibit irregularities for early heart disease detection. STM32 is used in this study as the main Internet-of-Medical Things controller and is combined with the Internet of Things devices—a sphygmomanometer cuff, temperature sensor, and pulse sensor—for instrument control and data acquisition. This assembly is used to develop a valvular heart disease screening system, whose structure incorporates deep learning for the development of fitting models and analysis. An experiment is performed where blood flow is blocked temporarily and released to observe changes in the surface temperature of the fingertip skin, and the blood supply capability of the heart is assessed indirectly based on the temperature change curve. Eighteen subjects were recruited in the experiment, where one subject exhibited cardiac valve insufficiency and arrhythmia. In the experiment, temperature curve variation data are successfully obtained from the healthy subjects, whereas the temperature curve irregularities of the patient with cardiac valve insufficiency are identified. This subject’s temperature range throughout three test steps is smaller by within 0.52 °C compared with those of most of the other subjects. In addition, during blood blocking and release, the overall temperature curve decreases, whereas some curves escalate first before plummeting slowly. The data analysis results show that the temperature curve variation and values of Subject 2 are similar to those of Subject 10, suggesting the incidence of valvular heart disease. This valvular heart disease screening system can successfully analyze and assess the characteristic signal values of patients with valvular heart disease.

Increased Risk of Valvular Heart Disease in Systemic Sclerosis: An Underrecognized Cardiac Complication.

Cardiac involvement is a poor prognostic marker in systemic sclerosis (SSc). While diastolic dysfunction, myocardial fibrosis, and arrhythmias are traditionally considered features of primary cardiac involvement in SSc, the incidence of valvular heart disease (VHD) is not well reported. Our objective was to examine the prevalence of VHD at the time of SSc diagnosis and incidence of VHD during follow-up compared to non-SSc subjects. Medical records of patients with suspicion of SSc were reviewed to identify incident cases. SSc subjects were matched 1:2 by age and sex to non-SSc subjects. The study included 78 incident SSc cases and 156 non-SSc comparators (56 yrs [± 15.7], 91% female). A nearly 4-fold increase in the prevalence of moderate/severe VHD prior to SSc diagnosis compared to non-SSc subjects (6% vs 0%; P = 0.004) was identified. During follow-up, 18 SSc and 12 non-SSc patients developed moderate/severe VHD. The cumulative incidence of VHD at 10 years after SSc incidence/index was 17.9% (95% CI 10.7-29.9) in patients with SSc compared with 2.3% (95% CI 0.7-7.0) in non-SSc subjects (HR 4.23, 95% CI 2.03-8.83). Coronary artery disease was the only significant risk factor for VHD. Patients with SSc have a 4-fold increase in the prevalence of moderate/severe VHD at diagnosis compared to non-SSc patients. They also have a 4-fold increased risk of developing moderate/severe VHD after diagnosis of SSc. Aortic stenosis and mitral regurgitation have a much higher prevalence in patients with SSc, besides secondary tricuspid regurgitation. Underlying mechanisms for this association require further elucidation.

Use of methylphenidate and risk for valvular heart disease: A case-control study nested in the BIFAP cohort.

To examine the association between use of methylphenidate and the risk for valvular heart disease (VHD) in the Spanish primary care database BIFAP. Case-control study nested in a cohort of patients aged 5 to 25 years between 2002 and 2014, based in a general practice research database. Cases were people with a validated diagnosis of VHD. Ten controls per case were matched on age, sex, and calendar year. Multivariable conditional logistic regression was used to estimate odds ratios (ORs) of VHD comparing patients ever treated with methylphenidate vs never users, as well as by time since last use, treatment duration, and variations in case inclusion criteria. From a cohort of 1 596 284 patients, we identified 262 valid cases of VHD. No difference in the incidence of VHD was observed when comparing "ever users" of methylphenidate with "never users" (adjusted OR 0.52, 95%CI 0.16-1.69). A similar result was found comparing current, recent, or past users of methylphenidate. Differences were not significant when both valid and probable cases were included as events of interest (adjusted OR 0.59, 95%CI 0.22-1.63). In this first-ever population-based study on this issue, association between methylphenidate and the incidence of VHD among persons in the 5 to 25 years age range was neither confirmed nor excluded. Additional studies may be required to clarify the presence or absence of this relationship.

Valvular Damage.

Valvular heart diseases (VHD) may be observed in patients with cancer for several reasons, including preexisting valve lesions, radiotherapy, infective endocarditis, and secondary to the left ventricle dysfunction. The incidence of VHD is especially in younger survivors treated with thoracic radiation therapy for certain malignancies, such as Hodgkin's lymphoma and breast cancer. The mechanism of radiation-induced damage to heart valves is not clear and includes diffuse fibrocalcific thickening of the valve. VHD is commonly diagnosed after a long latent period, in the context of clinical symptoms, or suspected on the basis of a new murmur. The evaluation includes identification of anatomical valve abnormalities, valve dysfunction, and assessing the functional consequences of valve dysfunction on the ventricles. Echocardiography is the optimal imaging technique for diagnostic and therapeutic management. Cardiovascular magnetic resonance and computed tomography (CT) may be used to assess the severity of VHD, but cardiac CT is mainly useful for detecting extensive calcifications of the ascending aorta. Patients exposed to mediastinal radiotherapy and minimal valve dysfunction require follow-up of 2–3 years, with moderate valve disease yearly, with severe, should be assessed for valve surgery.

P4668Risk of valvular heart disease in bromocriptine-treated women with hyperprolactinaemic disorders

Abstract Background Systematic echocardiographic screening is currently recommended for patients with hyperprolactinemic disorders treated with dopamine agonists, due to a perceived risk of cardiac valve regurgitation as observed in patients with Parkinson's disease. The dopamine agonist bromocriptine is used frequently in hyperprolactinemia patients, but its relation to cardiac valve disease remain uncertain. Purpose To determine the incidence of valvular heart disease in bromocriptine-treated women with hyperprolactinaemic disorders compared with matched controls from background population. Methods In nationwide Danish registries, we identified patients with hyperprolactinaemic disorders treated with bromocriptine between 1995–2017. Patients were matched 1:5 with population controls based on age and sex using incidence density sampling. We estimated the risk of valvular heart disease defined as admission and/or outpatient clinic visits. Incidence rates, cumulative incidence curve and adjusted cox-proportional hazard models were used to assess outcomes. Results A total of 23883 female bromocriptine users and 119415 controls were included. Median age was 29.9 years (Q1-Q3 26.4–33.8). Both groups had few comorbidities, 218 (0.9%) patients and 787 (0.7%) controls with hypertension, 160 (0.7%) patients and 629 (0.5%) controls with diabetes, 408 (1.7%) patients and 1305 (1.1%) controls were beta-blocker users. During a mean follow-up of 19 years 106 (0.44%) patients and 416 (0.35%) controls were diagnosed with valvular heart disease. Incidence rates were 0.254 per 1000 patient years (PY) in bromocriptine users (95% CI 0.21–0.31) and 0.198 per 1000 PY in the control cohort (95% CI 0.18–0.22). Overall, the cumulative incidence of valvular heart disease was 0.6% (95% CI 0.48–0.73) among patients and 0.5% (95% CI 0.4–0.51) among controls; P=0.03 (figure 1a). In adjusted analysis bromocriptine users still had a significant higher risk of valvular heart disease (hazard ratio=1.32, 95% CI 1.06–1.64, P=0.01). Incidence of valvular heart disease Conclusion The use of bromocriptine in younger and otherwise healthy women with hyperprolactinaemic disorders, were associated with a low absolute risk of cardiac valve disease. Still risk was approximately 30% higher compared with age- and sex matched controls. Our study suggests a low clinical yield of echocardiographic screening in this patient population. Acknowledgement/Funding Internal grant, Copenhagen University Hospital Rigshospitalet

Incidence of valvular heart disease after combination of dopamin agonists with statins

Incidence of valvular heart disease after combination of dopamin agonists with statins

THE INCIDENCE AND POSSIBLE CAUSES OF ATRIAL FIBRILLATION IN HOSPITALIZED PATIENTS DURING 1985–2010

Objective. To evaluate the incidence and causes of atrial fi brillation in hospitalized patients of therapeutic profi le and to compare the dynamics of these parameters over past 25 years.Design and methods.We analyzed 14595 medical histories of the faculty therapy clinic of Pavlov St Petersburg State Medical University for the periods from 1985 to 1990 years and from 2005 to 2010 years.Results.The incidence of atrial fi brillation increased by 1,7 times over the past 25 years. There is a signifi cant increase in the number of patients with atrial fi brillation in combination with co-morbidities: obesity — 1,9 times, essential hypertension — 1,8 times, and type 2 diabetes mellitus — 3-fold increase. The incidence of valvular heart diseases in patients with atrial fi brillation decreased by 1,9 times from 1985 to 2010 year. Statistical signifi cance of differences was assessed by Fisher’s exact test (p < 0,0001).Conclusion.The number of hospitalized patients with atrial fi brillation signifi cantly increased over the past 25 years. The number of patients with nonvalvular atrial fi brillation signifi cantly increased from 1985 to 2010 year and the number of patients with rheumatic valvular heart disease with atrial fi brillation decreased.

Improvement of cardiac parameters in patients with acromegaly treated with medical therapies

In acromegaly, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) excess results in a specific cardiomyopathy characterized by concentric cardiac hypertrophy primarily associated with diastolic dysfunction that can lead to impaired systolic function and eventually heart failure. This review of the literature evaluates the effect of therapeutic intervention on cardiac parameters. Clinical studies investigating the impact of treatments for acromegaly on cardiac function published between January 1980 and January 2009 were identified through electronic searches of Medline. Suppression of GH and IGF-1 following surgery or medical treatment with somatostatin analogue therapy is effective in decreasing left ventricular (LV) hypertrophy, with subsequent improvement in cardiac function. First-line treatment with somatostatin analogues resulted in improved cardiac outcome compared with first-line surgery, possibly due to somatostatin analogues acting directly through somatostatin receptors on cardiac cells. Additional cardiac improvement has been reported when somatostatin analogue treatment was combined with surgery. In patients where complete biochemical control was not achieved, an improved cardiac performance following treatment with somatostatin analogues has been reported. Treatment with pegvisomant has been demonstrated to reduce LV hypertrophy and improve diastolic and systolic performance. In contrast, reports have suggested that treatment with the dopamine agonist cabergoline increased the incidence of valvular heart disease. Although surgery and somatostatin analogues are effective in improving cardiomyopathy, a greater beneficial effect is observed with somatostatin analogue treatment. Selected patients with acromegaly should consider first-line therapy or pre-treatment with somatostatin analogues prior to surgery to achieve biochemical control and improve cardiac dysfunction.

Valve replacement in haemodialysis: bleeding risk in mechanical vs bioprosthetic valves

Valve replacement in haemodialysis: bleeding risk in mechanical vs bioprosthetic valves

Percutaneous Mitral Valve Repair: Potential in Heart Failure Management

As a large portion of the US demographic advances into the later decades of life, the incidence of valvular heart disease is expected to increase. Mitral regurgitation (MR) caused by primary valve abnormality (degenerative) or secondary to cardiomyopathy (functional) is an important cause of heart failure. Management of valvular heart disease is expected to account for a large segment of services provided to heart failure patients. Recent years have seen a transition from surgical therapy to minimally invasive techniques, specifically percutaneous approaches for the correction of heart valve disease. The double orifice technique of mitral valve repair using the MitraClip System (Abbott Vascular, Menlo Park, CA) is one of many percutaneous approaches to treat significant MR. This technique is effective in patients with both degenerative and functional MR, reducing MR severity and improving heart failure symptoms. Broad acceptance of this percutaneous technology requires collaboration among cardiologists and cardiac surgeons in centers with superior catheter experience and knowledge of echocardiography.

Percutaneous and Minimally Invasive Valve Procedures

The incidence of valvular heart disease is expected to increase over the next several decades as a large proportion of the US demographic advances into the later decades of life. At the same time, the next several years can be anticipated to bring a broad transition of surgical therapy to minimally invasive (minithoracotomy and small port) access and the more gradual introduction of percutaneous approaches for the correction of valvular heart disease. Broad acceptance of these technologies will require careful and sometimes perplexing comparisons of the outcomes of these new technologies with existing standards of care. The validation of percutaneous techniques, in particular, will require the collaboration of cardiologists and cardiac surgeons in centers with excellent surgical and catheter experience and a commitment to trial participation. For the near term, percutaneous techniques will likely remain investigational and will be limited in use to patients considered to be high risk or to inoperable surgical candidates. Although current-generation devices and techniques require significant modification before widespread clinical use can be adopted, it must be expected that less invasive and even percutaneous valve therapies will likely have a major impact on the management of patients with valvular heart disease over the next several years.

Dopamine agonists and valvular heart disease in Japanese patients with Parkinson's disease

A high incidence of valvular heart disease in Parkinson's disease (PD) patients treated with ergot-derived dopamine agonists, such as cabergoline and pergolide, has been reported. However, the frequency of valvulopathy, including “restrictive” valvulopathy, in Japanese PD patients remains unclear. We have evaluated the frequency of valvulopathy in PD patients treated with ergot-derived dopamine agonists. Patients treated with either pergolide or cabergoline were prone to higher grades of valvular regurgitation than control patients. Left-sided heart valves (aortic and mitral valves) were more affected than the tricuspid valve. However, “restrictive” valvulopathy was not observed in our patients. These results indicate that pergolide and cabergoline are risk factors for valvular regurgitation even in Japanese patients with PD.

CT of valvular heart disease

Although the incidence of valvular heart disease is significantly less than before the introduction of antibiotic therapy, chronic mitral and aortic valve disease continues to be found in the adult population. CT examination reveals characteristic chamber volume and myocardial mass changes expected in patients with valvular obstruction and regurgitation. Furthermore, CT provides sensitive visualization of annular and valve leaflet calcification, both of which are important findings for determining the presence of disease and estimating the significance of valvular dysfunction identified on examination. Although CT is by no means the first diagnostic modality to be employed in management of patients with valvular heart disease, it does reveal the sequelae of such disease, and may, in fact, provide insight into the significance of clinical or echocardiographic findings. Improved temporal resolution will increase the accuracy of CT diagnosis, and further expand its use for diagnosing and managing patients with cardiac disease in general, and valvular heart disease, in particular.

Clinical and hemodynamic characteristics of patients with inducible pulsus alternans

Pulsus alternans can be found in some patients with abnormal left ventricular function and also can develop after spontaneous premature beats. The purposes of this study were to: (1) determine the inducibility of pulsus alternans in a series of patients referred for routine cardiac catheterization and (2) define the clinical and hemodynamic characteristics of those who develop pulsus alternans. In 104 patients referred for right and left heart catheterization, atrial premature beats and rapid atrial pacing were used to try to provoke pulsus alternans. The 29 patients who developed pulsus alternans in response to these maneuvers were older (63 ± 6 vs 59 ± 10 years, p < 0.01) and had a greater incidence of valvular heart disease (45% vs 23%, p < 0.01) and congestive heart failure (38% vs 17%, p < 0.05). Aortic stenosis was the most prevalent valve lesion found. Those who developed pulsus alternans in response to pacing were further characterized by higher left ventricular systolic (143 ± 42 vs 121 ± 23 mm Hg, p < 0.02) and end-diastolic pressures (17 ± 9 vs 13 ± 6 mm Hg, p < 0.05), higher pulmonary artery systolic pressure (35 ± 14 vs 29 ± 11 mm Hg, p < 0.04), and lower left ventricular ejection fractions (0.42 ± 0.13 vs 0.53 ± 0.14, p < 0.001). Eight patients (28%) with inducibile pulsus alternans had a normal left ventricular ejection fraction (>0.50) and left ventricular end-diastolic pressure (<13 mm Hg). This study demonstrates that pulsus alternans can be induced in a substantial number of patients referred for routine cardiac catheterization and can occur in some patients who have normal left ventricular ejection fractions and end-diastolic pressures. The possibility that inducible pulsus alternans imparts prognostic information in selected patients may warrant further study.

Observations on 100 patients with continuous intraoperative monitoring of intramyocardial pH: The adverse effects of ventricular fibrillation and reperfusion

Intramyocardial pH and temperature data recorded in 100 patients undergoing cardiac operations were analyzed to elucidate the effects of ventricular fibrillation and reflow. All patients underwent a single period of aortic clamping. Systemic hypothermia (25 degrees C) and intermittent cold crystalloid K+ cardioplegia were employed for myocardial protection. Baseline myocardial pH was 6.88 +/- 0.03 at a temperature of 36.5 degrees +/- 0.2 degree C. During the period of hypothermic ventricular fibrillation prior to aortic clamping, ventricular fibrillation did not affect myocardial pH in 45 patients (Group 1). In 21 patients (Group 2), it caused a significant drop in intramyocardial pH despite cooling. Group 2 patients had a higher incidence of valvular heart disease and left ventricular hypertrophy. They also exhibited low intramyocardial pH values during the subsequent periods of aortic clamping and reflow, indicating inadequate myocardial protection. During the period of reflow, reperfusion acidosis (pH less than 6.8 at 32 degrees C) was encountered in 39 patients (Group B) as opposed to 37 patients (Group A) whose pH remained well above 6.8 during that period. Group B patients had a higher incidence of valvular heart disease and left ventricular hypertrophy, tended to have more ischemic anterior walls prior to cardiopulmonary bypass, sustained longer periods of aortic clamping, had intramyocardial pH evidence of suboptimal protection during aortic clamping, were affected more adversely by ventricular fibrillation during reflow, and tended to have a higher operative mortality. Thus: Depending on the underlying myocardial disease, the adequacy of protection during aortic clamping, and the conditions of reflow, intramyocardial pH in man can fall significantly during ventricular fibrillation and reflow. The metabolic correlate of injury with reflow is a reperfusion acidosis that can reach as low as pH 5.98. When encountered, reperfusion acidosis can be minimized by prompt defibrillation.

The effects of indomethacin on rheumatic fever

AbstractIndomethacin, a non‐steroid anti‐inflammatory drug, was given to 28 patients with acute rheumatic fever or chorea, and its effects compared to 23 similar patients given aspirin. No significant differences were observed either in effects on acute phase manifestations or the incidence of valvular heart disease one year later. Because of the incidence of side effects in other studies, indomethacin would appear to offer no advantage over aspirin in the therapy of rheumatic fever.

EPIDEMIOLOGIC STUDY OF SEVEN HUNDRED AND FIFTY-SEVEN CASES OF RHEUMATIC FEVER

DURING World War II rheumatic fever was one of the major causes of lost man days due to sickness in the Navy and Marine Corps. Coincident with large epidemics of hemolytic streptococcus infections which occurred in all the large naval training centers during the years 1942 to 1945 inclusive, the incidence of rheumatic fever rose to epidemic proportions by 1943 and the incidence of valvular heart disease increased accordingly. The number of cases of rheumatic fever in the Navy rose from 148 in 1940 to 7,668 in 1944. The rate per thousand persons increased during the same period from 0.73 to 2.29. The magnitude of the problem of rheumatic fever necessitated the establishment of two naval hospitals for the care of patients with this disease. Likewise, the Army experienced epidemics of hemolytic streptococcus infections as well as a sharp increase in the rate of rheumatic fever. However, the rate of