Non-rheumatic Valvular Heart Disease Research Articles

Genetically Predicted Atrial Fibrillation and Valvular Heart Disease: A Two-Sample Mendelian Randomization Study.

BackgroundPrevious studies have found atrial fibrillation (AF) is associated with valvular heart disease (VHD). However, whether there is a causal relationship between these two diseases or it is just a result of bias caused by confounding factors is uncertain. This study aims to examine the potential causal association between AF and VHD by using Mendelian randomization.MethodsIn order to examine the causal relationship between AF and VHD, we performed a two-sample Mendelian randomization study by collecting exposure and outcome data from genome-wide association study (GWAS) datasets. We utilized data from FinnGen project (FinnGen, 11,258 cases for VHD including rheumatic fever, 3,108 cases for non-rheumatic VHD, and 75,137 cases for participants) and European Bio-informatics Institute database (EBI, 55,114 cases for AF and 482,295 cases for participants). Inverse-variance weighted (IVW), MR-Egger, and weighted median approaches were performed to estimate the causal effect.ResultsThe Mendelian randomization analysis indicated that AF increased the risk of VHD by all three MR methods [For VHD including rheumatic fever: IVW, odds ratio (OR) = 1.255; 95% confidence interval (CI), 1.191~1.322; p = 1.23 × 10−17; Weighted median, OR = 1.305, 95% CI, 1.216~1.400, p = 1.57 × 10−13; MR-Egger, OR = 1.250, 95% CI, 1.137~1.375, p = 1.69 × 10−5; For non-rheumatic VHD: IVW, OR = 1.267; 95% CI, 1.169~1.372; p = 6.73 × 10−9; Weighted median, OR = 1.400; 95% CI, 1.232~1.591; p = 2.40 × 10−7; MR-Egger, OR = 1.308; 95% CI, 1.131~1.513; p = 5.34 × 10−4]. After the one outlier SNP was removed by heterogeneity test, the results remained the same. No horizontal pleiotropic effects were observed between AF and VHD.ConclusionsOur study provides strong evidence of a causal relationship between AF and VHD. Early intervention for AF patients may reduce the risk of developing into VHD.

Evolution of non-fatal burden estimates for cardiovascular disease in Australia: a comparison of national and state-wide methodology of burden of disease.

Objective Burden of disease studies measure the impact of disease at the population level;however, methods and data sources for estimates of prevalence vary. Using a selection of cardiovascular diseases, we aimed to describe the implications of using different disease models and linked administrative data on prevalence estimation within three Australian burden of disease studies. Methods Three different methods (A = 2011 Australian Burden of Disease Study; B = 2015 Australian Burden of Disease Study; C = 2015 Western Australian Burden of Disease Study), which used linked data, were used to compare prevalence estimates of stroke, aortic aneurysm, rheumatic valvular heart disease (VHD) and non-rheumatic VHD. We applied these methods to 2015 Western Australian data, and calculated crude overall and age-specific prevalence for each condition. Results Overall, Method C produced estimates of cardiovascular prevalence that were lower than the other methods, excluding non-rheumatic VHD. Prevalence of acute and chronic stroke was up to one-third higher in Method A and B compared to Method C. Aortic aneurysms had the largest change in prevalence, with Method A producing an eight-fold higher estimate compared to Method C, but Method B was 10-20% lower. Estimates of VHD varied dramatically, with an up to six-fold change in prevalence in Method C due to substantial changes to disease models and the use of linked data. Conclusions Prevalence estimates require the best available data sources, updated disease models and constant review to inform government policy and health reform. Availability of nation-wide linked data will markedly improve future burden estimates.

Global, Regional and National Incidence, Mortality, and Disability-Adjusted Life-Years of Non-Rheumatic Valvular Heart Disease and Trend Analysis from 1990 to 2019: Results from the Global Burden of Disease Study 2019

Global, Regional and National Incidence, Mortality, and Disability-Adjusted Life-Years of Non-Rheumatic Valvular Heart Disease and Trend Analysis from 1990 to 2019: Results from the Global Burden of Disease Study 2019

Changes in the pattern of valvular heart disease following the epidemiological transition in Brazil from 1990 to 2019: data from the Global Burden of Disease 2019 study

Abstract Introduction Valvular heart disease is one of the leading causes of cardiovascular death in Brazil, with a great contribution of Rheumatic Heart Disease (RHD), the most socially driven etiology. However, as socioeconomic conditions improved, an increasing contribution of non-rheumatic valvular heart disease (NRVD) is being observed. Objectives We aimed to evaluate the changes in trends of prevalence, mortality and burden of RHD and non-rheumatic valvular heart disease in Brazil from 1990 to 2019, according to the Global Burden of Disease (GBD) 2019 study estimates. Methods We used available vital registration data, epidemiological survey data, and hospital claims data to estimate the cause-specific mortality rate, prevalence, and burden of RHD and NRVD using the GBD modelling framework. Burden estimates in Brazil were estimated for each sex, 5-year age group, federal unit, and year from 1990 to 2019. We also explored the correlation of disease burden and the sociodemographic index (SDI). Results From 1990 to 2019, age-standardized prevalence of RHD increased slightly (2.1% (95%UI 0.2–4.0)) in Brazil, from 899.6 (95%UI 699.8–1119.1) to 918.5 (95%UI 716–1142.5) per 100,000, remaining higher in women in the whole period. In contrast, age-standardized prevalence of NRVD had a marked 54.3% increase from 25.3 (95% UI 22.4–27.8) per 100,000 in 1990 to 39 (95% UI 33.9–44.6) per 100,000 in 2019. The percent change was considerably higher for men compared to women (105.9% vs. 20.9%). For mortality, age-standardized rates attributable to RHD significantly decreased 59.4%, from 2.8 (95%UI 2.7–3.0) to 1.2 (95%UI 1.1–1.2) per 100,000, whereas NRVD had a less pronounced 16.2% decrease in the period. However, crude NRVD mortality increased (51.9% (95%UI 39.8–62.7)), with a considerable contribution of older ages, noticeably over 70 years (17.2% (95%UI 5.4–27.4)), specifically driven by calcific aortic valve disease mortality, with a marked 17% (95%UI 2.0–38.5) increase in the elderly. RHD dropped from 12th to 10th in the mortality ranking, while aortic and mitral degenerative diseases rose in the period (Figure 1). There was a significant negative correlation between the percent change in age-standardized RHD mortality rates and SDI in 1990 (r=−0.41, p=0.03) and in 2019 (r=−0.44, p=0.02), and an opposite trend for NRVD, with positive correlations in 1990 (r=−0.55, p=0.003), and 2019 (r=−0.58, p=0.001), suggesting that SDI was a major driver for the observed trends. Conclusion Mortality and disease burden attributable to RHD decreased significantly in Brazil over the past decades, still with a stable prevalence trend. This contrasts with increasing prevalence and crude mortality estimates for NRVD, especially in older ages, and driven by degenerative conditions. Changes in mortality rates strongly correlated with SDI, depicting the effects of socioeconomic markers of the pattern of valve disease in Brazil. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study used data from the Institute of Health Metrics and Evaluation, funded by the Bill & Melinda Gates Foundation. This work was supported by the Brazilian Ministry of Health through resource transfer from the National Health Fund. Figure 1. Ranking of mortality rates.

Prevalence of Structural Heart Diseases Detected by Hand-Held Echocardiographic Device in School-Age Children in Iran: A Cross-Sectional Study

Background: Structural heart disease (SHD) has great impacts on healthcare systems, creating further public health concerns. Proper data are scant regarding the magnitude of the affected population by SHD. We aimed to determine the prevalence of SHD among children and adolescents. Methods: In this population-based study, multistage cluster-random sampling was used to choose schools from the Tehran urban area. All students were examined using a handheld Vscan device by echocardiographer, and the results were concurrently supervised and interpreted by cardiologists. All the major findings were reevaluated in hospital clinics. Findings: Of 15130 students (6-18 years, 52.2% boys) who were examined, the prevalence of individuals with congenital heart disease (CHD) and cardiomyopathy was 152 (10.04 per 1000 persons) and 9 (0.6 per 1000 persons), respectively. The prevalence of definite and borderline rheumatic heart disease (RHD) was 30 (2 per 1000 persons) and 113 (7.5 per 1000 persons), correspondingly. Non-rheumatic valvular heart disease (VHD) was also detected in 465 (30.7 per 1000 persons) students. Of all the pathologies, only 39 (25.6%) cases with CHD and 1 (0.007%) cases with RHD had already been diagnosed. Parental consanguinity was the strongest predictor of CHD and SHD (odds ratio [OR]: 1.907, 95% CI: 1.358 to 2.680; P < 0.001 and OR: 1.855, 95% CI: 1.334 to 2.579; P <0.001, respectively). The female sex (OR: 1.262, 95% CI: 1.013 to 1.573; P = 0.038) and fathers’ low literacy (OR: 1.872, 95% CI: 1.068 to 3.281; P = 0.029) were the strongest predictors of non-rheumatic VHD and RHD, correspondingly. Interpretation: The implementation of handheld echocardiographic screening for detecting SHD among young population is feasible and efficacious which detected SHD prevalence in our population comparable to previous reports. Further studies are required to delineate its economic aspects for community-based screening. Funding Information: National Institute for Medical Research Development. Declaration of Interests: SH reports grants from the National Institute for Medical Research Development (NIMAD), during the conduct of the study. All other authors have none to declare. Ethics Approval Statement: The study complies with the Declaration of Helsinki, and the 8 study protocol was evaluated and approved by the Ethics Committee of the National Committee for Ethics in Biomedical Research.

Understanding valvular heart disease in the dental setting.

Limited evidence is available regarding dentists' knowledge and interpretation of infective endocarditis (IE) prophylaxis guidelines. The aim of this study was to determine understanding and management of rheumatic and non-rheumatic valvular heart disease (VHD) in the dental setting in Western Australia (WA). A cross-sectional survey of dentists within Perth utilized an online Qualtrics questionnaire developed after consultation with stakeholders. A sampling frame was compiled from the Australian Health Practitioner Regulation Agency with contact details obtained from the White Pages (online), using five quintiles of Socio-Economic Indexes for Areas according to dentist's place of practice. Of 41 (13.7% of 300 approached) dentists completing the survey (95.1% general dentists, mean years of practice=15.6), 90.2% reported following the Australian Therapeutic Guidelines (ATG) regarding IE antibiotic prophylaxis in VHD. Most (92.7%) were unaware of the rheumatic heart disease (RHD) control program. Nearly all participants indicated prophylaxis for clearly invasive procedures such as tooth extraction (100.0%) and periodontal surgery (95.1%). Many dentists made the decision to prescribe antibiotics themselves (36.6%). The majority of dentists followed the ATG's IE prophylaxis recommendations for cardiac lesions and dental procedures. There was limited knowledge of the national RHD guidelines and the WA RHD control program.

Burden of valvular heart disease, 1990-2017: Results from the Global Burden of Disease Study 2017.

BackgroundValvular heart disease (VHD) is expected to cause an increase in public-health problems in the coming years, especially in elderly populations. We aim to estimate the incidence, mortality, and burden of VHD, by age, from 1990 to 2017 in 195 countries and territories.MethodsWe estimated the incidence, mortality, and burden of VHD based on the Global Burden of Disease Study 2017. All metrics are presented with their 95% uncertainty intervals (UIs). The Socio-demographic Index was used to identify whether developmental status correlates with health outcomes.ResultsThe global incidence of rheumatic heart disease (RHD) decreased by 8.67% between 1990 and 2017, while that of non-rheumatic VHD (NRVHD) increased by 45.10%. There was a 54.00% decrease in age-standardized death rate (ASDR) for RHD, but a small and non-significant decrease (-3.00%) in the ASDR for NRVHD. The global age-standardized disability-adjusted life years (DALY) rate of RHD decreased by 53.52%, while there was a 12.62% reduction in the age-standardized DALY rate of NRVHD.ConclusionsThe burden from different VHDs demonstrated a diverse change at a global level between 1990 and 2017. Although RHD burden has an obvious means of mitigation, a substantially high incidence of NRVHD was observed over this time period, especially in the elderly, which may lead to high health care costs and signify the potential for even higher costs in the future.

Nationwide incidence of patients hospitalized for a valvular heart disease according to etiology: Patient characteristics and temporal trends in France 2006–2016

The main etiologies of valvular heart disease (VHD) are rheumatic fever and age-related degeneration. In 2016, the prevalence of patients managed for a VHD was 0,6% of the French population (341,500 people). However, few recent incidence data are available in France. Estimate the annual incidence of patients hospitalized for VHD in France according to their etiology, describe their characteristics and the temporal trends. All patients hospitalized for VHD in France between 2006 and 2016 were identified using data from the national hospital discharge database (PMSI-MCO) integrated into the national health data system (SNDS). The first stay of the year in which the patient was hospitalized with a principal or related diagnosis of VHD was selected. Descriptive analyses of patients’demographic and medical characteristics and trends from 2006–2016 were stratified according to the origin of valvular heart disease. In 2016 38,875 patients were hospitalized for a VHD in France. Of these, 89% were hospitalized for non-rheumatic VHD (52.1/100,000 person-year (PY)) with an average age of 74 years; 5% for rheumatic VHD (3.1/100,000 PY) with an average age of 67 years; 3% for congenital VHD (1.1/100,000 PY) with an average age of 29 years; and 3% for unspecified origin. The incidence of patients hospitalized for non-rheumatic VHD increased by 43% between 2006 and 2016, particularly in older patients. It has decreased by 42% for rheumatic VHD. Departmental disparities were observed for these disorders, with a high incidence of hospitalization for rheumatic VHD in the Ile-de-France, the French overseas departments and territories and the south-east. The improvement in the management of streptococcal A angina, the increase in life expectancy and the expansion of indications for the management of aortic stenosis and mitral regurgitation by transcatheter valve replacement have reshaped the distribution of types of VHD hospitalized since 2006.

033 Age Discrepancy in Cardiometabolic Risk Factor Profiles in Indigenous and Non-Indigenous Australians With Atrial Fibrillation

Younger Indigenous Australians have higher rates of atrial fibrillation (AF) as compared to non-Indigenous Australians. This discrepancy becomes less apparent in older age groups, the reasons for which are not clear. Patient diagnosis data from Alice Springs Hospital in Central Australia from 2006-2016 was used to calculate comorbidity rate ratios for Indigenous compared to non-Indigenous patients with AF below and above 55 years of age. 1,210 patients (46% Indigenous) with AF were included. 53.7% of Indigenous patients and 20.6% of non-Indigenous patients were aged <55 years. There was a consistently worse cardiometabolic profile in Indigenous relative to non-Indigenous Australians in younger individuals <55 years compared to older individuals ≥55 years, including for hypertension (rate ratio {RR} 2.79 [1.99-3.90] vs 1.85 [1.64-2.08]), diabetes (RR 4.61 [3.01-7.05] vs 2.76 [2.34-3.25]), congestive heart failure (RR 3.30 [2.11-5.17] vs 1.63 [1.37-1.95]), stroke/TIA/thromboembolism (RR 3.80 [1.37-10.48] vs 1.49 [1.07-2.08]), ischaemic heart disease (RR 2.83 [1.80-4.45] vs 1.57 [1.28-1.92]), chronic kidney disease (RR 10.89 [5.53-21.43] vs 2.55 [2.17-2.98]), chronic pulmonary disease (RR 14.74 [3.66-59.29] vs 1.48 [1.16-1.90]) and valvular heart disease (RR 8.49 [3.17-22.72] vs 1.80 [1.17-2.75]). The discrepancy for valvular heart disease existed for rheumatic valvular heart disease (RR 30.37 [4.26-216.45] vs 2.88 [1.61-5.16]) but not for non-rheumatic valvular heart disease (RR 1.19 [0.32-4.42] vs 0.91 [0.44-1.89]). Younger Indigenous individuals with AF have a higher relative burden of cardiometabolic comorbidities compared to older individuals. These data may in-part explain the strikingly greater prevalence of AF in younger Indigenous individuals.

Diagnosis of infective endocarditis using echocardiography.

The aim of this study was to evaluate the application of transthoracic echocardiography for the diagnosis of infective endocarditis (IE) to provide a basis for the better treatment of IE. From October 2016 to October 2018, 87 consecutive patients with IE at our hospital were selected for this study. All the patients were subjected to transthoracic echocardiography. The morphology, structure, activity, and closure of the patients’ heart valves were observed for vegetation identification, and the size, number, location, morphology, and echo intensity of vegetation, as well as degree of valve involvement, were determined.The 87 patients investigated in this study included 38 cases of congenital heart disease, 27 cases of nonrheumatic valvular heart disease, 12 patients who underwent valve surgery, 5 cases of rheumatic valvular heart disease, and 5 patients with no obvious signs of heart disease. The most common clinical manifestations were heart murmur in 80 cases and fever in 60 cases. The most common complications were heart failure in 35 cases, followed by organ embolism in 12 cases. There were 36 cases of positive blood cultures, including 26 cases of Gram-positive cocci and 10 cases of Gram-negative bacilli. Echocardiography showed aortic valve involvement in 37 cases, mitral valve involvement in 34 cases, tricuspid valve involvement in 10 cases, pulmonary valve involvement in 2 cases, and the involvement of an artificial valve in 5 cases. Twenty-six of these cases showed multiple valve involvement, and 20 patients exhibited serious complications. No significant differences were found between echocardiography and actual surgical observations with respect to their accuracy in detecting the size, number, and location of vegetation in the 69 patients who underwent surgery (P > .05). Echocardiography could detect the occurrence of severe complications, namely, the rupture of chordae tendineae, valve prolapse, valve perforation, and paravalvular abscess, and no significant difference in diagnostic accuracy was found between echocardiography and surgical observations (P > .05).Transthoracic echocardiography can rapidly and accurately detect IE vegetation and its complications and has important clinical value for guiding clinical treatment and determining prognosis.

Prevalence and patterns of coronary artery disease in patients undergoing cardiac surgery for rheumatic and non- rheumatic valvular heart disease in a tertiary care center of Nepal

Background and Aims: Coronary artery disease (CAD) constitute a major cause of cardiovascular morbidity and mortality worldwide with an enormous burden on healthcare resources. Prevalence and pattern of CAD in patients of rheumatic and non-rhemuatic valvular heart diseases varies widely with limited data on optimal strategies for diagnosis and treatment.Methods: This study includes 97 patients with rheumatic and non-rheumatic valvular heart disease who underwent coronary angiogram (CAG) before cardiac surgery. Patients were divided into two groups based on rheumatic heart disease (RHD) &amp; non-rheumatic disease (Non-RHD) and correlate the patterns of CAD.Results: Out of 97 patients, 22 (22.6%) patients were found to have significant CAD. In patients with non-rheumatic origin CAD was common (15 patients, 68.1%) as compared to rheumatic origin (7 patients, 31. 8%). In rheumatic origin, the prevalence was 7(12.2%) out of 57 patients while in non-rheumatic origin, was 15(37.5%) out of 40 patients. In RHD group, all patients with CAD were found to have single vessel diease (SVD) while, in non-RHD group, 11 patients (73.3%) had SVD, 3 patients (16.7%) had double vessel disease (DVD) and one patient (5.6%) had triple vessel disease (TVD).Conclusions: Prevalence of CAD is higher in patients with non-RHD in comparison to those with RHD. We also found SVD to be the most common pattern of CAD in both rheumatic and non-rheumatic valvular heart disease.

RHEUMATIC HEART DISEASE PRESENTING AS PROGRESSIVE DYSPNEA AND PULMONARY INFILTRATES

SESSION TITLE: Cardiovascular Disease 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Acute rheumatic fever and subsequently rheumatic heart disease (RHD) has been significantly reduced in developed countries during the 20th century. Although uncommon, RHD remains present in undeveloped countries and immigrant populations. Knowledge of common presentations of this once ubiquitous disease thus remains clinically useful. CASE PRESENTATION: A 32-year-old African-American male presented for 7 days of progressive dyspnea, diaphoresis with exertion, and pleuritic chest pain. Prior evaluation was concerning for community acquired pneumonia treated with azithromycin and doxycycline without improvement. On admission, the patient reported subjective fever without recent travel or known sick contacts. He is a naturalized citizen who lived in Sierra Leone until age 16 and currently works with a predominantly immigrant population as a pig butcher. The patient’s past medical history was grossly unremarkable. Physical exam was significant for right lung crackles on inspiration and grade 3 holosystolic murmur with normal respiratory rate and oxygen saturation on room air. Chest x-ray at the time of presentation was notable for progressive worsening of a right upper lobe (RUL) infiltrate. Patient was started on Levaquin and admitted to the hospital for pneumonia versus tuberculosis. CT of the chest was completed for concern of non-resolving pulmonary symptoms and noted for RUL infiltrate and left ventricular hypertrophy (LVH). ECG also suggested LVH and transthoracic echocardiogram showed a dilated cardiomyopathy with severely reduced ejection fraction (20-25%), severe mitral regurgitation and severe aortic regurgitation. This presentation was highly suggestive of RHD with pulmonary infiltrate secondary to retrograde flow secondary to significant valvular disease, confirmed with transesophageal echocardiogram. The patient was transferred to a tertiary surgical center on hospital day 6 for valve replacement. DISCUSSION: This case represents classic findings of RHD with secondary mitral valve regurgitation and RUL pulmonary infiltrates. Per the REMEDY trial, the patient’s presentation of chronic rheumatic valvular disease leading to acute heart failure is the most common presentation of RHD. This exemplifies the need to suspect this disease in patients with the appropriate clinical history and in patients from countries where rheumatic fever and RHD are still common. CONCLUSIONS: RHD continues to be clinically relevant despite significant decrease in incidence among the US population. Presentation with signs of pulmonary infiltrate due to retrograde flow via the pulmonary veins is more than a theoretic presentation and supports maintenance of a broad differential especially in patients tied to the developing world. Reference #1: Essop MR, Nkomo VT. Rheumatic and nonrheumatic valvular heart disease: epidemiology, management, and prevention in Africa. Circ. 2005;112(23),3584-3591. Reference #2: Watkins DA., Johnson CO, Colquhoun SM, et al. Global, regional, and national burden of rheumatic heart disease, 1990-2015. N Engl J Med. 2017;377:713-722. Reference #3: Zuhlke L, Engel ME, Karthikeyan G, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J. 2015; 36(18),1115-1122. DISCLOSURES: no disclosure on file for Travis Bentz; No relevant relationships by Nathan Boyer, source=Web Response No relevant relationships by Aaron Farmer, source=Web Response No relevant relationships by Samone Franzese, source=Web Response No relevant relationships by John Lammie, source=Web Response No relevant relationships by Michael Phillips, source=Web Response

Heart Disease Mortality in the Life Span Study, 1950-2008.

Based on the findings from the Radiation Effects Research Foundation's studies of the cohort of Japanese atomic bomb survivors, it has been reported that total-body irradiation at 0.5-1.0 Gy could be responsible for increased rates of mortality from broad-based categories of cardiovascular disease (CVD), i.e., stroke and heart disease. However, CVD consists of various subtypes that have potentially different radiation dose responses, as well as subtype-specific risks that have not been fully evaluated. Potential problems with changes in the coding rules for the International Classification of Diseases (ICD) and the underlying causes and trends in CVD mortality in Japan also need to be considered. The goal of this study was to clarify the radiation risk of subtype-specific heart disease over different time periods. Radiation dose response was examined for mortality from several heart disease subtypes in 86,600 members of the Life Span Study (LSS) cohort during 1950-2008. These subtypes included ischemic heart disease (IHD), valvular heart disease (VHD), hypertensive organ damage (HOD) and heart failure (HF). Individual radiation doses ranged between 0 and 4 Gy. In addition to analyses for the total period, we examined specific periods, 1950-1968, 1969-1980, 1981-1994 and 1995-2008, corresponding to major developments in medical technologies and ICD code revisions. We observed significant positive associations between radiation dose and mortality from heart disease overall in 1950-2008 [excess relative risk or ERR/Gy (95% CI) = 0.14 (0.06, 0.22)]. Subtype-specific ERRs also positively increased with dose: 0.45 (0.13, 0.85) for VHD, 0.36 (0.10, 0.68) for HOD and 0.21 (0.07, 0.37) for HF, respectively. No significant departure from linearity was shown for the dose-response model. Although there was no evidence for a threshold in a model function, the lowest dose ranges with a statistically significant dose response were 0-0.7 Gy for heart disease overall and VHD, 0-1.5 Gy for HOD and 0-0.4 Gy for HF. No significant association between radiation exposure and IHD was observed in any model, although a quadratic model fit the best. The risk of HOD and rheumatic VHD increased significantly in the earliest periods [ERR/Gy = 0.59 (0.07, 1.32) and 1.34 (0.24, 3.16), respectively]. The risk of nonrheumatic VHD increased with calendar time and was significant in the latest period [ERR/Gy = 0.75 (0.02, 1.92)]. The risk of IHD, especially for myocardial infarction, tended to be elevated in the most recent period after 2001, where cautious interpretation is needed due to the uncertain validity of death diagnosis. Radiation risks of heart disease mortality in the LSS appeared to vary substantially among subtypes, indicating possible differences in radiation-induced pathogenesis. Trends in CVD rates in Japan during the long observation period may also impact risk analyses.

Success rates and prognosis of heart valvuloplasty and valve replacement performed for elderly patients.

Objective:To analyze the success rates and prognosis of heart valvuloplasty and valve replacement for elderly patients, and to provide clinical evidence.Methods:A total of 1240 patients who received heart valve surgeries in our hospital from June 2004 to October 2014 were selected and retrospectively analyzed. They were divided into two groups based on age (60), and those older than 60 (Group B) suffered from rheumatic valvular heart disease and nonrheumatic valvular heart disease including degenerative valve disease. Mitral valve replacement (MVR), tricuspid valve replacement (TVR), aortic valve replacement (AVR), double valve replacement (DVR), mitral valvuloplasty (MVP) and tricuspid valvuloplasty (TVP) were performed by using bioprosthetic and mechanical valves. Before surgery, coronary angiography, coronary artery bypass grafting (CABG), left atrial thrombectomy, left atrial wall folding and radiofrequency ablation were conducted. For the patients younger than 60 (Group A) who had congenital heart disease, rheumatic valvular heart disease and valvular heart disease, MVR, AVR, DVR, MVP, TVP and closed cuspid commissurotomy were performed with bioprosthetic and mechanical valves. The two groups were then monitored.Results:The mortality rates of Group A and Group B were 2.7% (16 cases) and 3.1% (20 cases) respectively. They died mainly of malignant ventricular arrhythmias, multiple organ failure, left ventricular rupture, low cardiac output syndrome, acute renal failure, respiratory failure, upper gastrointestinal bleeding, mechanical valve failure and cerebrovascular accident. The two groups had significantly different application rates of bioprosthetic valve, times of auxiliary ventilation and hospitalization stay lengths (P<0.05), but left ventricular ejection fractions, left ventricular end-diastolic diameters (LVEDDs), mortality rates as well as times of aortic cross-clamping and cardiopulmonary bypass were similar (P>0.05). LVEDD, complicated coronary artery disease, CABG and grade of the New York Heart Association Functional Classification were independent risk factors for postoperative death.Conclusion:When heart valvuloplasty and valve replacement were performed for elderly patients, the success rate and prognosis could only be improved by optimizing preoperative preparation, shortening the times of cardiopulmonary bypass and aortic cross-clamping, and paying particular attention to myocardial protection and postoperative treatment.

Prevalence of coronary artery disease in patients with rheumatic and non-rheumatic valvular heart disease treated at Asian heart hospital, Mumbai

Prevalence of coronary artery disease in patients with rheumatic and non-rheumatic valvular heart disease treated at Asian heart hospital, Mumbai

Changes in the etiology of valvular heart disease in the rapidly aging Korean population

BackgroundThe aim of this study is to assess the changes in the causes of valvular heart disease between 2006 and 2011 in Korea. MethodsData were collected from the Korean National Health Insurance Service from 2006 through 2011. These data consisted of primary diagnoses related to valvular heart disease regardless of other conditions. Valvular heart disease included non-rheumatic mitral valve disorders, non-rheumatic aortic valve disorders, rheumatic mitral valve disorders, and rheumatic aortic valve disorders. ResultsOverall, the age-standardized cumulative prevalence of non-rheumatic valvular heart disease was 70.6 per 100,000 persons in 2006 and 110.3 in 2011. This represented an increase from 42.2 to 65.2 in women and from 28.4 to 45.1 in men. In particular, there was a greater increase in prevalence in patients aged 65years or older compared with groups aged 20–44years or 45–64years for both genders. The age-standardized cumulative prevalence of rheumatic valve disease did not change dramatically between 2006 and 2011. ConclusionsThe overall age-standardized cumulative prevalence of non-rheumatic valvular heart diseases increased between 2006 and 2011, especially in individuals older than 65years. These changes should be considered in future designs of cardiovascular healthcare services in countries with a rapidly aging population.

Variations in Thebesian valve anatomy and coronary sinus ostium: implications for invasive electrophysiology procedures

The coronary sinus (CS) is a commonly cannulated structure in patients undergoing electrophysiology studies, catheter ablation of arrhythmias, implantation of resynchronization therapy devices and, more recently, percutaneous mitral valve repair. The advent of these procedures has led to a renewed interest in the anatomy of the coronary venous system including its various components. To improve our understanding of this structure, we studied the anatomy of the human CS, including the valve that guards its ostium, the Thebesian valve. In 75 randomly selected autopsied human hearts, we measured the transverse and craniocaudal dimensions of the CS ostium and characterized the shape, composition, per cent coverage, and attachment points of the Thebesian valve when present. Of the 75 hearts examined, 54 had organic heart disease including atherosclerotic coronary artery disease, left ventricular hypertrophy, dilated cardiomyopathy, rheumatic heart disease, infective endocarditis, and non-rheumatic valvular heart disease. A wide variety of Thebesian valve morphologies were seen, ranging from the absence of any valve to those where the valve was completely occluding the CS ostium. A Thebesian valve was present in the majority of the hearts examined (55/75 hearts-73%). The average transverse dimension of the CS ostium in hearts with Thebesian valves (7.3+/-2.8 mm) was significantly shorter than those without Thebesian valves (9.4+/-2.9 mm, P=0.005). Similarly, the average craniocaudal dimension of the CS ostium in hearts with Thebesian valves (7.9+/-2.7 mm) was also significantly shorter than those without Thebesian valves (9.3+/-2.9 mm, P=0.045). Our study shows that some form of Thebesian valve is present in the majority of hearts (>70%). Of these, a significant minority (16%) had a valve morphology (covering >75% of the ostium, a fibrous, fibromuscular, or muscular composition, and devoid of fenestrations) that makes them a 'potentially complicating' structure interfering with the cannulation of the CS.

Acquired immune‐related and inflammatory conditions and subsequent chronic lymphocytic leukaemia

Immune-mediated pathways have been recognized to be of importance in the pathogenesis of chronic lymphocytic leukaemia (CLL). We assessed a broad variety of immune-related and inflammatory conditions and subsequent CLL development among 4 million adult male veterans admitted to VA hospitals. We identified 3,680 CLL cases with up to 27 years of follow-up. Using Poisson regression analyses restricted to immune-related or inflammatory conditions that occurred more than one year before CLL, we estimated relative risk (RR) and 95% confidence intervals for CLL risk. Elevated CLL risk was found among individuals with prior chronic sinusitis (RR = 1.27, 1.01-1.61). Pneumonia had a borderline (RR = 1.13, 1.00-1.27) association with CLL; the risk was further elevated (RR = 1.35, 1.07-1.72) for latency <5 years. Conversely, chronic non-rheumatic valvular heart disease was associated with 0.76-fold (0.58-0.99) decreased risk. Herpes zoster and simplex were associated with increased (RR = 1.98, 1.40-2.79) and borderline increased (RR = 1.69, 0.96-2.98) CLL risk. There was no general association between autoimmunity and CLL; however, autoimmune haemolytic anaemia was associated with 3.86-fold (1.93-7.74) elevated CLL risk. Individuals with chronic osteoarthritis and prostatitis had 1.14-fold (1.03-1.25) and 1.64-fold (1.14-2.37) elevated CLL risk. These association patterns suggest primary focus on infectious agents rather than autoantigens for future aetiologic CLL studies.

Changing epidemiology of infective endocarditis: a retrospective survey of 108 cases, 1990-1999.

The aim of this study was to report the experience with infective endocarditis over the past decade, describe the changing clinical and epidemiological features of the disease, and attempt to determine the optimal number of blood culture sets required for diagnosis. All cases diagnosed during a 10-year period were reviewed clinically and microbiologically. In addition, a retrospective assessment of blood culture data was performed. From the period 1990-1999, 108 cases that met the von Reyn or Duke's criteria were recorded. The major underlying cardiac condition was the presence of a prosthetic valve ( n=33 patients, 31%). Among patients with native valves, nonrheumatic valvular heart disease of the elderly was the most common underlying factor ( n=19 patients, 25%). Overall, 13 patients (11%) died. Predictors on admission for increased mortality were shortness of breath, age >60 years, time to defervescence, erythrocyturia, hemoglobin level <10 g/dl, and leukocytosis >15,000 (all P<0.05). Analysis of blood culture data showed that the diagnostic yield among groups from whom either only one or more than six blood culture sets were drawn was reduced compared with that among groups from whom between two and five culture sets had been taken. The outcome of endocarditis in this series from a community hospital was much more favorable compared with that reported in surveys from large tertiary centers. Moreover, obtaining more than two or three blood cultures is neither helpful nor cost-effective in the initial assessment of patients with suspected endocarditis.

Right atrial ultrastructure in chronic rheumatic heart disease

We studied with ultrastructure techniques portions of right atrium resected at operation from 12 patients with chronic rheumatic heart disease and 6 patients with non-rheumatic valvular heart disease. The right atrial pressures, duration of symptoms and age of the patients were comparable in both groups. Ten of the 12 rheumatic and 4 of the 6 non-rheumatic patients had atrial fibrillation. In the 12 rheumatic patients we found severe interstitial fibrosis, extensive cellular degeneration (17% of cells studied) and marked cellular hypertrophy (average cell diameter 16 μm). The six non-rheumatic patients showed evidence of cellular hypertrophy (average cell diameter 15 μm) but minimal interstitial fibrosis or cellular degeneration. The degenerative changes in the rheumatic group did not correlate with the degree of hypertrophy or the extent of the hemodynamic alterations. Atrial fibrillation, present in both rheumatic and non-rheumatic patients, did not correlate with the presence of cellular degeneration. We conclude that the structural changes in atria of patients with chronic rheumatic heart disease may be part of the rheumatic process and are not entirely secondary to altered hemodynamics.