Prevalence Of Valvular Disease Research Articles

Associated factor analysis of early repolarization syndrome in patients with growth hormone-secreting pituitary adenomas

Objective To study the incidence rate and risk factors of early repolarization syndrome (ERS) in patients with growth hormone-secreting pituitary adenomas. Methods A total of 103 patients with pituitary growth hormone (GH) adenomas (GH adenoma group) and 99 patients with pituitary nonfunctional adenomas (nonfunctional adenoma group) admitted to Department of Neurosurgery, Pituitary Tumor Center, the First Affiliated Hospital, Sun Yat-sen University, from August 2014 to August 2016 were prospectively enrolled. Comparison was conducted about the difference of left ventricular mass index (LVMI), prevalence of valvular disease, incidence of myocardial ischemia and incidence of ERS between the two groups. The risk factors of ERS in patients with growth hormone-secreting pituitary adenomas were investigated by Logistic regression analysis. Results Compared with pituitary nonfunctional adenomas, the growth hormone (GH), insulin-like growth factor-1 (IGF-1), LVMI and ERS were significantly increased in pituitary growth hormone adenomas (all P<0.05), and the incidences of ERS were 35.0% (36/103) and 13.1% (13/99) in pituitary growth hormone adenomas and pituitary nonfunctional adenomas, respectively. The results of Logistic regression analysis showed that LVMI was an independent risk factor for ERS (OR=1.012, 95%CI: 1.003-1.021, P=0.012). The results of the bivariate correlation analysis showed that the duration of disease (r=0.287, P<0.01), serum GH (r=0.310, P<0.01), IGF-1 (r=0.282, P<0.01) and diabetes mellitus (r=0.247, P<0.01) were associated with LVMI. The results of multivariate linear regression analysis demonstrated that the duration of disease and IGF-1 were positive risk factors of LVMI (all P<0.05). Conclusions Compared with that in pituitary nonfunctional adenomas, the incidence of ERS is significantly higher in pituitary growth hormone adenomas. Serum GH, IGF-1 and blood glucose demonstrate continuous increase which lead to myocardial hypertrophy and elevated LVMI and may be one of the reasons for increased incidence of ERS. Key words: Growth hormone-secreting pituitary adenoma; Insulin-like growth factors; Left ventricular mass index; Early repolarization syndrome

Assessment of Valvular Disorders in Survivors of Hodgkin's Lymphoma Treated by Mediastinal Radiotherapy ± Chemotherapy

As the number of Hodgkin's lymphoma (HL) survivors grows, understanding long-term complications becomes more important. Mediastinal radiotherapy (MRT) seems to cause valvular disease, and the prevalence might increase during follow-up. In this cross-sectional study 82 HL survivors participated (52% men, mean age 47.8 years, 50 treated with MRT). Valvular disease was diagnosed by transthoracic echocardiography and compared between HL survivors treated with and without MRT. Univariate and multivariate logistic regression analysis was used to identify predictors for valvular disease. During a median follow-up of 13.4 years (range 2 to 39 years), ≥ mild valvular disease was present in 61.2% of HL survivors with MRT (n = 30), compared with 31.0% of HL survivors without MRT (n = 9; odds ratio [OR] 3.51, 95% CI 1.32 to 9.30, p = 0.01). In multivariate analysis, only current age remained predictive for ≥ mild valvular disease (OR 1.08 per year, 95% CI 1.01 to 1.14, p = 0.023). Aortic regurgitation (AR) was most prevalent and irradiated patients had significantly more ≥ mild AR (38.2% vs 6.8%, p = 0.007). Within the MRT subgroup, time after radiation of >15 years was associated with AR (OR 4.70, 95% CI 1.05 to 21.03, p = 0.043), after adjusting for current age and hypertension. Severe valvular disease was present in 24.5% of HL survivors with MRT compared with 3.4% without MRT (p = 0.016). Valvular surgery was performed in 9 HL survivors (18.0%) with MRT and in none without MRT. In conclusion, the prevalence of valvular disease in HL survivors treated with MRT is high and increases with time after irradiation. Long-time screening for valvular disease by transthoracic echocardiography might be worthwhile.

Effect of fenfluramine-derivative diet pills on cardiac valves: A meta-analysis of observational studies

Background Fenfluramine-derivative diet pills were withdrawn from the market in 1997 because of an association with valvular regurgitation, but subsequent estimates of the prevalence of this condition have varied widely. We systematically reviewed evidence regarding the prevalence of valvular disease after fenfluramine exposure. Methods We searched multiple databases with multiple search terms. Conference proceedings from 1997 onward were searched by index. Authors of eligible studies were contacted to identify unpublished works. Selection criteria were liberally determined. Ten of the identified 11 articles met these criteria. Reviewers assessed the studies' methodologic quality by use of a standard form to evaluate selection, attrition, performance, and detection bias. The studies were analyzed in 2 groups on the basis of length of exposure (<90 days or >90 days). The Mantel-Haenszel method was used to summarize data. Quantitative and qualitative tests for heterogeneity were performed. Tests for publication bias were also done. Results Tests for heterogeneity were nonsignificant after removing 1 outlier trial. The pooled prevalence of valvular regurgitation meeting Food and Drug Administration criteria (at least mild aortic regurgitation or at least moderate mitral regurgitation) among patients treated for >90 days was 12.0% compared with 5.9% for the unexposed group (prevalence odds ratio 2.2, 95% CI 1.7-2.7). The combined analyses also identified a small but statistically significant increase in mitral regurgitation not previously identified by individual studies (exposed 3.5%, unexposed 1.8%, prevalence odds ratio 1.6, 95% CI 1.05-2.3). Among patients exposed for <90 days, a trend toward more regurgitation was not statistically significant by either combined Food and Drug Administration criteria (exposed 6.8%, unexposed 5.8%, prevalence odds ratio 1.4, 95% CI 0.8-2.4) or by individual valve. Conclusions These data indicate that fenfluramine-associated valvular regurgitation is less common than initially reported, but still present in 1 of 8 patients treated for >90 days. (Am Heart J 2002;144:1065-73.)

Valvular Lesions in Fenfluramine Users Less Common Than Previously Thought

Recent studies have yielded widely varying estimates of the prevalence of valvular heart disease in users of fenfluramine and dexfenfluramine. To more

Chronic valvular disease in the cavalier King Charles spaniel in Sweden.

The prevalence of chronic valvular disease was studied in 494 cavalier King Charles spaniels with a mean (+/- sd) age of 3.0 +/- 2.7 years. Cardiac murmurs were detected in 65 (13.2 per cent) of the dogs. Among 61 cavalier King Charles spaniels with a mean age of 6.4 +/- 2.8 years, cardiac murmurs were detected in 32 (52 per cent). In both groups of dogs the prevalence of cardiac murmurs was low among dogs younger than three years (1.9 per cent) but increased with age (P < 0.001). The estimated ages at which 50 per cent of the dogs had developed murmurs were 7.5 and 6.2 years, respectively. When 39 of the 61 dogs were re-examined three years later, cardiac murmurs were detected in 28 (72 per cent), and the intensities of the murmurs had generally increased (P < 0.05). Nine (28 per cent) of the dogs which had previously had murmurs had been euthanased for signs of congestive heart failure whereas none of the dogs which had been free of murmurs had died from congestive heart failure. Animal insurance statistics from 1982 to 1990 (1983 excluded) for dogs less than 10 years old showed that claims for veterinary care or death or euthanasia were five times more common in the cavalier King Charles spaniel than in dachshunds (P < 0.001) and eight times more common than the mean for all other insured breeds (P < 0.001).

Fibrinolytic and thromboplastic activity of normal human heart valves

Human atrioventricular valves, with their chordae tendineae, and semilunar valves were assayed for their content of tissue thromboplastin and plasminogen activator. Concentrations of tissue thromboplastin as well as of plasminogen activator were low in all samples. Localization of fibrinolytic sites was studied by the histochemical fibrin slide technique. Fibrinolytic activity could be related to vascular structures present primarily in the proximal parts of the atrioventricular valves and the parts of the chordae tendineae close to the attachments to the papillary muscles. In the distal parts of the atrioventricular valves and the semilunar valves there were few sites of ribrinolytic activity, all related lated to the endocardial lining. The relation of these observations to the vascularization of the valves and the chordae tendineae is discussed. The absence of any significant differences between the left and right side of the heart precludes that the prevalence of valvular disease on the left side is caused solely by a local, hemostatic difference.