Rheumatic Heart Valve Disease Research Articles

Robotic mitral surgery: recent advances and outcomes.

This review explores recent advancements in robotic cardiac surgery, specifically focusing on its application in diverse mitral valve surgeries. The aim is to provide an overview of current clinical practices and supporting evidence in this evolving field. A literature review indicates a 30% surge in robotic mitral valve repair from 2015 to 2021, paralleled by a decline in sternotomy-based repair per the STS database. Robotic mitral valve repair consistently shows effective and safe outcomes, with comparable mortality but lower morbidity risks than sternotomy and thoracotomy. The robotic approach exhibits lower conversion to valve replacement, shorter ICU stays, and reduced 30-day readmissions. For experienced programs, robotic techniques prove versatile in various pathologies, including rheumatic heart valve disease, infective endocarditis, ischemic cardiomyopathy, and mitral annular calcification necessitating valve replacement. Literature supports their selective use in high-risk scenarios, including redo surgeries and elderly patients. Recent evidence supports the growing use of robotic approaches in mitral valve surgery, highlighting their efficacy with comparable mortality rates but lower morbidity risks. Robotic techniques consistently yield positive outcomes across various pathologies and patient profiles, signaling a potential paradigm shift in mitral valve interventions.

A case of anaphylactic shock to human fibrinogen infusion during cardiac surgery

Human fibrinogen (FIB) has been clinically proven to be considerably effective for the treatment of postoperative bleeding, with reported cases of allergic reactions to human FIB being rare. Here, we report a case of an anaphylactic shock in 27-year-old patients with rheumatic heart valve disease who received a human FIB infusion during mitral valve replacement, aortic valve replacement, and tricuspid valve-shaping surgery. The patients showed generalised profuse sweating, a barely noticeable skin rash, faint pulse, systolic pressure < 50 mmHg, and a heart rate of 71 beats/min. We share insights from a case of severe allergy to human FIB infusion during cardiac surgery, through which we have gained experience in the processes of diagnosing and treating. This report aims to provide a preliminary summary of the characteristics of this case to serve as a reference for fellow clinicians.

Acute postpartale hypoxemie: een diagnose van reumatisch mitraliskleplijden

Acute postpartum hypoxemia: diagnosis of rheumatic mitral valve disease Among various causes for peri- and postpartum respiratory insufficiency, rheumatic mitral valve disease is a less common, yet potentially dangerous condition. In Europe, the incidence of rheumatic fever is low, making rheumatic heart valve disease rare. However, as a result of modern migration of patients from endemic regions, one must be aware of possible associated underlying valvular disease in young patients. A 42-year-old patient of North African ethnicity undergoing an elective C-section develops acute hypoxemia during the procedure, persisting postpartum despite the administration of oxygen. Initially, more obvious causes, such as a high spinal block and an allergic reaction, are excluded. A CT scan formally excludes a pulmonary embolism, but is suggestive of heart failure. A consecutive transthoracic echocardiography confirms acute decompensated heart failure with pathognomonic characteristics of rheumatic mitral valve disease. The patient is admitted to the cardiac intensive care unit, where the administration of oxygen and an intravenous treatment with diuretics have a favorable result. A low-dose beta blocker is initiated prior to discharge 5 days postpartum. Although rheumatic mitral stenosis is less common in Europe, one should consider this disease entity in the differential diagnosis when confronted with sudden (cardio)respiratory insufficiency in the parturient. Through this case, the authors highlight the implications of rheumatic mitral valve stenosis during pregnancy and the possible triggers for peripartum cardiac decompensation.

Preventative effects of the albumin nano tissue-type plasminogen activator gene plasmid ultrasound microbubble carrier system on thrombosis after cardiac valve replacement

Mechanical valve replacement is a new method for treating rheumatic heart valve disease. However, patients require long-term anticoagulation therapy after surgery, thus reducing their use of anticoagulants, making the prevention of postoperative thrombosis of great research interest. We examined the potential preventative effects of the albumin nano tissue plasminogen activator (tPA) gene plasmid ultrasound microbubble carrier system on thrombosis. The average particle size of the nano tPA gene plasmid was 131.8 nm, the surface zeta potential was 30.65±40.34 mV, and the encapsulation efficiency was 76.56%, all meeting experimental requirements. One month after gene integration, the tPA content of group B had increased beyond pre-integration levels and above post-integration levels of group A. After valve replacement operations, the venous blood D-Dimer (D-D) content of group B increased significantly, whereas the venous blood D-D content of group A decreased. In addition, at 1, 2, and 4 weeks after operation, the venous blood D-D content of group B was greater than that of group A. These results suggest that the prepared albumin nano tPA gene plasmid ultrasound microbubble vector system can prevent thrombosis after heart valve replacement.

Curcumin Involve the Myofibrosis Process of Rabbit Valve Interstitial Cells based on Expression Alpha- Smooth Muscle Actin: Experimental Posttest-only Control Group Design

Introduction: Following an acute rheumatic fever infection brought on by an inflammatory reaction to streptococcal bacteria, rheumatic heart valve disease results in valve degeneration. Elements of the immune system play an important role, in facilitating myofibroblast transdifferentiation and clearing damaged tissue of apoptotic cells. Myelofibrosis arising in valve components is the main cause of valve dysfunction. Valve myelofibrosis showed a significantly increased collagen, proteoglycan, and elastin content in myofibrotic valves compared to healthy valves. Objective: To establish curcumin’s capacity to prevent rabbit valve interstitial cells (VIC) from differentiating into myofibroblasts after being stimulated by TGF-1 by comparing the results to controls. Method: This study uses a posttest-only control group design for an in-vitro laboratory experiment. Heart VIC of a New Zealand rabbit were isolated (Oryctolagus cuniculus), and induced fibrosis by administration of TGF-β1 5 ng/mL. VIC pretreated with TGF-β1 were treated with low-dose curcumin (20 nanoM/L) and high-dose curcumin (50 nanoM/L). The immunocytochemical method based on SMA expression observed the inhibition of myofibroblastic differentiation. Statistical significance was analyzed by Kruskal-Wallis statistical test with a p-value &lt; 0.05 as the limit of significance. Result: Administration of curcumin with low doses (20 nanoM/L) and high doses (50 nanoM/L), significantly decreased TGF-β1-induced myofibroblastic differentiation of VIC, which was characterized by decreased SMA expression in all low-dose curcumin treatment groups (20 nanoM/L) (1.40 ± 6.30) and high-dose curcumin (50 nanoM/L) (1.40 ± 8.30). Conclusion: Curcumin potentially prevent the development of SMA-expressing VIC into myofibroblasts.

New insight into the role of lipid metabolism-related proteins in rheumatic heart valve disease

PurposeThe aim of this study was to determine the expression of lipid metabolism-related proteins in rheumatic heart valve disease (RHVD).MethodsThis retrospective study involved a total of 20 cases of moderate or severe rheumatic mitral valve stenosis and 4 cases of mitral regurgitation due to secondary causes from September 2018 to September 2021. The patients enrolled included 12 males and 12 females who underwent surgical excision of the mitral valve at the cardiac surgery department of Hainan General Hospital. The samples of mitral valve were collected during surgery treatment as the study group, and mitral valves collected from patients with ischemic heart disease were allocated into the control group. Hematoxylin–eosin (HE), oil red staining and immunohistochemical (IHC) staining were conducted to compare the expression of lipid metabolism-related proteins (ATP-binding cassette transporter A1 and acyl-coenzyme A: cholesterol acyltransferase-1), and real-time polymerase chain reaction (RT–PCR) was applied to compare the mRNA levels of ABCA1, ACAT1, and the inflammatory cytokines TNF-α, IL-10, and MCP-1.ResultsIn general, the rheumatic mitral valve showed leaflet thickening along with border adhesions and visible yellow fats. Oil red O staining also revealed the abovementioned results as well as fat cells. Both ABCA1 and ACAT1 were expressed in the rheumatic mitral valve via IHC, whereas only ACAT1 showed a faint level of expression in the ischemic mitral valve with no expression of ABCA1. In addition, compared with the ischemic mitral valve, RT-PCT showed increased mRNA expression levels of ABCA1, ACAT1, and the inflammatory cytokines TNF-α, IL-10, and MCP-1 (P < 0.05). After dividing the RMs into two groups for RT–PCR, we found that the higher the expression of ABCA1 and ACAT1 was, the lower the relative expression of inflammatory factors.ConclusionThis study showed that adipose tissue, adipose cells, and lipid transport-related proteins were expressed strongly in the rheumatic mitral valve, suggesting that adipose tissue formation might be one of the important pathways in the pathology of rheumatic heart disease. In addition, adipose tissue and adipocytes were also involved in the inflammatory process. These data provide new insight into pathological mechanisms in rheumatic heart disease.

Coronary Artery Embolism: a Rare Cause of ST Segment Elevation Myocardial Infarction

Acute myocardial infarction (AMI) is a fatal clinical disease, and is often caused by thrombotic occlusion, secondary to coronary artery atherosclerotic plaque erosion or rupture [1]. But about 1-14% of AMI is caused by myocardial infarction with non-obstructive coronary atherosclerosis (MINOCA [2], which is characterized by evidence of myocardial infarction, normal coronary angiography or coronary artery stenosis of &lt;50&gt;]. The causes of MINOCA vary from person to person [4], such as coronary artery spasm [5], Stress cardiomyopathy [6], Thrombophilia [7], coronary artery embolism(CE) [8,9]. CE is a rare cause of AMI in clinical practice. We had presented a female patient who had left anterior descending artery embolism, with dilated cardiomyopathy and paroxysmal atrial flutter [10]. CE, while rare, is now recognized as an important non-atherosclerotic cause of AMI. In the past, the description of clinical features about CE was little or just case reports [8-9]. A recent study involving 1776 patients evaluated the clinical features of CE-related myocardial infarction. It is pointed out that the prevalence rate is 2.9% in the initial AMI. and atrial fibrillation is the most important cause of CE (73%). Other causes include cardiomyopathy and valvular heart disease. And proposed CE diagnostic criteria [11]. In recent years, thrombus aspiration devices have been widely used in AMI patients with angiographically confirmed thrombosis and have proved to be a viable and effective strategy for the treatment of thrombotically burdened AMI, including CE-related infarction. Moreover, histological examination of aspiration thrombus provides additional information for the diagnosis of CE. Although thrombus aspiration is an effective method for treating patients with CE, Stoel et al [12] reported that the diameter of the lumen of the aspiration catheter is small and useless for aspirating large thrombi. In addition, it is challenging to access to the distal lumen through the suction device. In fact, 42% of existing patients are treated conservatively because of distal occlusion or small vessel with a criminal lesion. The treatment of CE-related risk factors is also very important. Including atrial fibrillation, cardiomyopathy, rheumatic heart valve disease, prosthetic heart valve, patent foramen ovale, atrial septal defect, history of cardiac surgery, infective endocarditis or hypercoagulable state. The patient in this case was dilated cardiomyopathy with paroxysmal atrial flutter, both of which were high risk for CE. She had chest pain, typical changes in the ECG, coronary angiography revealed coronary embolization of the LAD. that are consistent with acute myocardial infarction. Intravascular ultrasound (IVUS) or optical coherence Tomography (OCT) is an effective method to detect the atherosclerotic plaque erosion or rupture of coronary artery. This patient was proved to be CE by IVUS. It is very important to given sufficient anticoagulant therapy to prevent CE in clinical practice.

Can we diagnose acute rheumatic fever early to maximize the success of secondary prophylaxis in rheumatic heart valve disease?

Can we diagnose acute rheumatic fever early to maximize the success of secondary prophylaxis in rheumatic heart valve disease?

Quantitative proteomics profiling of lysine 2‐hydroxyisobutyrylation in right atrial appendage from rheumatic heart valve disease patients

ObjectivesLysine 2‐hydroxyisobutyrylation (Khib) is a novel acylation that regulates glycolysis. Little has been done in human diseases regarding the role of Khib. The present study was designed to reveal the role of Khib in the development of atrial fibrillation (AF) associated with heart valve disease.MethodsDiscarded right atrial appendage tissues during the cannulation procedure were collected from AF and sinus rhythm (SR) patients with rheumatic heart valve disease. The protein profiles and Khib sites were identified and qualified by Tandem Mass Tag labeling and liquid chromatography‐tandem mass spectrometry (LC‐MS/MS) technology. Bioinformatic tools, including Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, and protein‐protein interaction, were also used to explore the biological function between AF and SR.ResultsA total of 6,523 matched spectrum, 3,234 peptides, 2,867 modified peptides, corresponding to 579 proteins and 2,900 sites from LC‐MS/MS analysis were identified. Of these identified proteins and sites, 480 proteins and 2,275 sites were quantifiable. The length of most peptides distributed between 7 and 22, which was consistent with the length of tryptic peptides. Differentially expressed Khib sites analysis showed that there were 35 and 48 Khib sites related to 124 and 67 proteins exhibited upregulation and downregulation in AF compared to SR. Subcellular location analysis of Khib ‐related proteins revealed that cytoplasm, nucleus, and extracellular accounted for the most proportion. Bioinformatic analysis demonstrated that proteins with Khib were significantly enriched in different biological approach, such as cysteine and methionine metabolism, cGMP‐PKG signaling pathway, and glucose‐responsive energy metabolism.ConclusionsThe present study for the first time revealed larger number of differentially expressed Khib sites between AF and SR in patients with rheumatic valve disease. The proteins related to these sites are involved in diverse cellular processes including energy metabolism. These results indicate that Khib modification might be a key factor in occurrence of AF in patients with rheumatic heart valve disease.

Atypical Expression of Smooth Muscle Markers and Co-activators and Their Regulation in Rheumatic Aortic and Calcified Bicuspid Valves

ObjectiveWe have previously reported that human calcified aortic cusps have abundant expression of smooth muscle (SM) markers and co-activators. We hypothesised that cells in bicuspid aortic valve (BAV) cusps and those affected by rheumatic heart valve (RHV) disease may follow a similar phenotypic transition into smooth muscle cells, a process that could be regulated by transforming growth factors (TGFs).AimsCusps from eight patients with BAV and seven patients with RHV were analysed for early and late SM markers and regulators of SM gene expression by immunocytochemistry and compared to healthy aortic valves from 12 unused heart valve donors. The ability of TGFs to induce these markers in valve endothelial cells (VECs) on two substrates was assessed.ResultsIn total, 7 out of 8 BAVs and all the RHVs showed an increased and atypical expression of early and late SM markers α-SMA, calponin, SM22 and SM-myosin. The SM marker co-activators were aberrantly expressed in six of the BAV and six of the RHV, in a similar regional pattern to the expression of SM markers. Additionally, regions of VECs, and endothelial cells lining the vessels within the cusps were found to be positive for SM markers and co-activators in three BAV and six RHV. Both BAVs and RHVs were significantly thickened and HIF1α expression was prominent in four BAVs and one RHV. The ability of TGFβs to induce the expression of SM markers and myocardin was greater in VECs cultured on fibronectin than on gelatin. Fibronectin was shown to be upregulated in BAVs and RHVs, within the cusps as well as in the basement membrane.ConclusionBicuspid aortic valves and RHVs expressed increased numbers of SM marker-positive VICs and VECs. Concomittantly, these cells expressed MRTF-A and myocardin, key regulators of SM gene expression. TGFβ1 was able to preferentially upregulate SM markers and myocardin in VECs on fibronectin, and fibronectin was found to be upregulated in BAVs and RHVs. These findings suggest a role of VEC as a source of cells that express SM cell markers in BAVs and RHVs. The similarity between SM marker expression in BAVs and RHVs with our previous study with cusps from patients with aortic stenosis suggests the existance of a common pathological pathway between these different pathologies.

Prothymosin Alpha: A Novel Contributor to Estradiol Receptor Alpha-Mediated CD8+ T-Cell Pathogenic Responses and Recognition of Type 1 Collagen in Rheumatic Heart Valve Disease.

Rheumatic heart valve disease (RHVD) is a leading cause of cardiovascular death in low- and middle-income countries and affects predominantly women. The underlying mechanisms of chronic valvular damage remain unexplored and regulators of sex predisposition are unknown. Proteomics analysis of human heart valves (nondiseased aortic valves, nondiseased mitral valves [NDMVs], valves from patients with rheumatic aortic valve disease, and valves from patients with rheumatic mitral valve disease; n=30) followed by system biology analysis identified ProTα (prothymosin alpha) as a protein associated with RHVD. Histology, multiparameter flow cytometry, and enzyme-linked immunosorbent assay confirmed the expression of ProTα. In vitro experiments using peripheral mononuclear cells and valvular interstitial cells were performed using multiparameter flow cytometry and quantitative polymerase chain reaction. In silico analysis of the RHVD and Streptococcuspyogenes proteomes were used to identify mimic epitopes. A comparison of NDMV and nondiseased aortic valve proteomes established the baseline differences between nondiseased aortic and mitral valves. Thirteen unique proteins were enriched in NDMVs. Comparison of NDMVs versus valves from patients with rheumatic mitral valve disease and nondiseased aortic valves versus valves from patients with rheumatic aortic valve disease identified 213 proteins enriched in rheumatic valves. The expression of the 13 NDMV-enriched proteins was evaluated across the 213 proteins enriched in diseased valves, resulting in the discovery of ProTα common to valves from patients with rheumatic mitral valve disease and valves from patients with rheumatic aortic valve disease. ProTα plasma levels were significantly higher in patients with RHVD than in healthy individuals. Immunoreactive ProTα colocalized with CD8+ T cells in RHVD. Expression of ProTα and estrogen receptor alpha correlated strongly in circulating CD8+ T cells from patients with RHVD. Recombinant ProTα induced expression of the lytic proteins perforin and granzyme B by CD8+ T cells as well as higher estrogen receptor alpha expression. In addition, recombinant ProTα increased human leukocyte antigen class I levels in valvular interstitial cells. Treatment of CD8+ T cells with specific estrogen receptor alpha antagonist reduced the cytotoxic potential promoted by ProTα. In silico analysis of RHVD and Spyogenes proteomes revealed molecular mimicry between human type 1 collagen epitope and bacterial collagen-like protein, which induced CD8+ T-cell activation in vitro. ProTα-dependent CD8+ T-cell cytotoxicity was associated with estrogen receptor alpha activity, implicating ProTα as a potential regulator of sex predisposition in RHVD. ProTα facilitated recognition of type 1 collagen mimic epitopes by CD8+ T cells, suggesting mechanisms provoking autoimmunity.

Effect of Combined Etomidate-Ketamine Anesthesia on Perioperative Electrocardiogram and Postoperative Cognitive Dysfunction of Elderly Patients with Rheumatic Heart Valve Disease Undergoing Heart Valve Replacement.

Objective To explore the effect of combined etomidate-ketamine anesthesia on perioperative electrocardiogram (ECG) and postoperative cognitive dysfunction (POCD) of elderly patients with rheumatic heart valve disease (RHVD) undergoing heart valve replacement. Methods The data of 100 elderly RHVD patients treated in our hospital from May 2019 to May 2020 were selected for the retrospective analysis, and by adopting the double-blind method, the patients were divided into the ketamine group (n = 50) and the combined group (n = 50) according to the anesthesia methods. During the induction of anesthesia, the patients of the two groups were given a small dose of ketamine (0.5 mg/kg) at 5 μg/kg/min continuously via pump injection until the end of surgery, and on this basis, with the same anesthesia measures, those in the combined group were given etomidate (0.3 mg/kg) additionally. The patients' perioperative ECG indicators, POCD scores, and Numeric Rating Scale (NRS) scores were compared between the two groups. Results Compared with the ketamine group, the combined group presented significantly lower incidence of ST-T wave changes after anesthesia induction and at the time of intubation and skin incision (P < 0.05), significantly lower average magnitude of ST-segment depression after anesthesia induction (P < 0.001), significantly lower average magnitude of ST-segment elevation after anesthesia induction and extubation (P < 0.001), significantly lower POCD incidence (6.%, P < 0.05), and significantly better NRS score after surgery (P < 0.001). Conclusion Combined etomidate-ketamine anesthesia can stabilize the perioperative ECG indicators of elderly RHVD patients undergoing heart valve replacement, improve their postoperative cognitive function, and reduce their pain sensation, which should be promoted and applied in practice.

Rheumatic Heart Valve Disease Pathophysiology and Underlying Mechanisms.

Rheumatic heart valve disease (RHVD) is a post-infectious sequel of acute rheumatic fever resulting from an abnormal immune response to a streptococcal pharyngitis that triggers valvular damage. RHVD is the leading cause of cardiovascular death in children and young adults, mainly in women from low and middle-income countries. It is known that long-term inflammation and high degree of fibrosis leads to valve dysfunction due to anatomic disruption of the valve apparatus. However, since public and private investments in RHVD studies are practically inexistent the number of publications is scarce. This disease shows different natural history and clinical presentations as compared to other degenerative heart valve diseases. Although more than five decades passed after the pioneering studies on the pathogenesis of RHVD, it is still unclear how self-tolerance mechanisms fail in this disease, and how humoral and cellular inflammatory responses are interconnected. Despite that pathological mechanisms have been already proposed for RHVD, none of them are able to explain the preferential involvement of the mitral valve. This review focuses on pathophysiology and underlying mechanisms of RHVD.

Bovine pericardial versus porcine stented replacement mitral valves: early hemodynamic performance and clinical results of a randomized comparison of the Perimount and the Mosaic valves.

BackgroundTo compare the hemodynamic and clinical outcomes following mitral valve replacement with the Perimount valve with those of the Mosaic valve.MethodsA total of 145 consecutive patients with rheumatic heart valve disease who underwent single bioprosthetic mitral valve replacement were randomized to receive either the Perimount (n=72) valve or the Mosaic bioprosthesis (n=73). The mean age of patients was 72.1 years (range, 58–89 years) with a sex distribution of 55.2% female and 44.8% male. Patients underwent follow up transthoracic echocardiography at 3 months and 1 year postoperatively. We compared demographics, preoperative clinical data, operative data, hemodynamic profiles, and clinical outcomes.ResultsThe cross-clamp time was similar, with 50.7±15.3 minutes for the Perimount and 50.7±21.8 minutes for the Mosaic bioprosthesis. The total bypass time was also similar, with 91.3±25.7 minutes for the Perimount and 87.8±25.6 minutes for the Mosaic valve. The peak and mean pressure gradients were lower in the Perimount group for all valve sizes and the difference was statistically significant at 1 year. The effective orifice area (EOA) was slightly larger in the Perimount valve (1.98±0.21 vs. 1.89±0.71 cm2, P=0.538) postoperatively, but there was no significant difference at 1 year. There were no differences in preoperative or postoperative left atrium diameter (LAD), left ventricular diastolic diameter (LVDD), left ventricular systolic diameter (LVSD), left ventricular ejection fraction (LVEF), pulmonary artery pressure (PAP). The mortality and major complications rate were similar between the two groups.ConclusionsThe Perimount prostheses is superior to the Mosaic prostheses after mitral valve replacement, achieving statistically significant lower gradients and larger EOA when compared on the basis of manufacturer-labeled valve sizes. Both valves appear to provide satisfactory clinical results.

Abstract 13401: Prothymosin Alpha (Protα) Associates With Pathogenesis and Sex Predisposition in Rheumatic Heart Valve Disease

Introduction: Acute rheumatic fever (ARF) results from autoimmune responses to group A streptococcus. ARF can cause chronic rheumatic heart valve disease (RHVD), a major public health burden in low- and middle-income countries. Although ARF affects both sexes equally, females have a higher prevalence of RHVD. We identified a target protein, ProTα, that may contribute to pathophysiology of and gender predisposition in RHVD. Estradiol regulates ProTα, which influences transcriptional activity of the estrogen receptor (ER). Methods: Human heart valves (n=120) obtained from heart transplantation and valve replacement surgeries, including non-diseased mitral and aortic valves (NDMV and NDAV, n=17/group), rheumatic mitral and aortic valves (RMVD, n=45; RAVD, n=8) and calcifying valves from patients with calcific aortic valve disease (CAVD, n=33) underwent proteomic and network analyses, and immunohistochemical assessment of CD68, CD4, CD8 and ProTα. ProTα levels were measured in plasma and peripheral mononuclear cells (PBMCs) from RHVD patients and healthy donors (n=14/group) by ELISA and flow cytometry. Results: A comparison of proteomes from NDMV and NDAV established the baseline differences between valve types. 12 proteins were enriched (q&lt;0.05) in NDMV that may indicate the mitral valve predisposition to RVHD. Proteome analysis of non-diseased and diseased valves (NDMV vs RMVD, NDAV vs RAVD) identified a total of 213 proteins enriched in RHVD (q&lt;0.05). The expression of the 12 NDMV-enriched proteins were evaluated across the 213 proteins enriched in diseased valves, resulting in the identification of ProTα common to both the RMVD and RAVD proteomes, but absent in CAVD. Additional KEGG pathway enrichment analyses linked 6 among 213 proteins with the estrogen signaling pathway (p&lt;0.05). Immunoreactive ProTα colocalized with T CD8 cells in RHVD. ProTα and ERα also correlated strongly in circulating T CD8 cells in RHVD (p&lt;0.05). ProTα plasma levels were higher in RHVD patients than healthy individuals (2 fold, p&lt;0.05). Conclusion: We propose that ProTα is a novel contributor to the immunopathogenesis of RHVD and may regulate sex predisposition in this disease.

Effect of periodontitis on oxidative stress parameters in patients with rheumatic heart valve disease

ObjectiveThe aim of this study was to evaluate the effects of periodontitis on oxidative stress parameters by investigating serum and gingival crevicular fluid (GCF) total antioxidant capacity (TAOC), total oxidant status (TOS), and oxidative stress index (OSI) values in patients with rheumatic heart valve disease (RHVD). Materials and methodsThe study population comprised 76 patients, who were divided into four groups: chronic periodontitis with RVHD (RV-CP), periodontally healthy with RVHD (RV-C), systemically healthy with chronic periodontitis (CP), and systemically and periodontally healthy (C). Demographic, periodontal, and echocardiographic parameters were measured. Serum and GCF oxidative stress parameters were evaluated based on the OSI. ResultsSimilar serum oxidative stress parameters were found in all study groups (P ≥ 0.05). The GCF TAOC values of the C group were significantly higher than those of the other groups (P = 0.001). The GCF OSI values of the C group were significantly lower than those of the other groups (P = 0.001). The GCF TOS and OSI values of the RV-CP group were significantly higher than those of the CP and C groups (P = 0.001). The GCF TOS value of the RV-C group was significantly higher than those of the CP and C groups (P = 0.001). ConclusionsAltered local oxidative stress profile was associated with the presence of periodontitis. Rheumatic heart valve disease may increase oxidative stress in individuals with chronic periodontitis.

Nötrofil-lenfosit Oranının Hamile Kadınlarda Romatizmal Kalp Kapağı Hastalığını Öngörme Yeteneği

Objective There is a role of inflammatory processes on the pathophysiology of rheumatic heart valve disease (RHVD). The neutrophil-lymphocyte ratio (NLR) as an inflammatory marker is associated with some clinical situations in pregnancy. In this study, we aimed to investigate the predictive role of NLR in pregnant women with NLR. Materials and Methods First-trimester pregnant women, who were referred to cardiology outpatient clinic and diagnosed with RHVD (n=24) were enrolled in this study and age-matched healthy pregnant women (n=24) were taken as control groups. The two groups were compared in terms of clinical characteristics, echocardiographic findings, and NLR. The role of NLO in predicting RKKH has been examined. Results Groups were similar in terms of demographic features. NLR was higher in pregnant women with RHVD than the control group (3.68 ±1.74 vs. 2.68±1.14, p=0.00239). NLR (OR: 0,597, p= 0,037, 95% CI: 0,343-0,921) and neutrophil count (OR: 0,609, p= 0.013, 95% CI: 0,390-0,863) were possible independent predictors of RHVD. Conclusion NLR was significantly higher among pregnant women with RHVD. As it is not possible to provide routine cardiac check-up to all pregnant women; markers for specific risk groups need to be defined to reduce the risks associated with heart diseases during pregnancy. According to these findings, pregnant women with high NLR may need extra attention in terms of CVD like RHVD. Further studies with large patient groups are needed to define the predictive value of NLR.

Patterns of cardiovascular risk and disease in HIV-positive adults on anti-retroviral therapy in Mozambique.

With improved access to anti-retroviral therapy (ART) the focus of HIV treatment is changing to reducing chronic co-morbidities and their effects, but guidelines for HIV care in many African countries do not include screening for cardiac disease. Our study aimed to determine the pattern of cardiac abnormalities in HIV-positive patients on ART. We implemented a prospective, observational study for 24 months on a random sample of adult patients seen at a dedicated HIV clinic in Mozambique. Demographic, clinical and full cardiovascular evaluations were performed on all participants. We enrolled 264 HIVvpositive patients (mean age 39.3 years; 186 female, 70.5%). The mean time on ART was 46 (SD 36) months and most had low viral load (174, 65%). Obesity (45, 17%), overweight (65, 24.6%), hypertension (54, 20.5%) and severe anaemia (21, 8.3%) were frequent. Diabetes was present in four patients (1.5%). The most important conditions in 252 patients submitted to echocardiography (88, 34.9% had cardiac abnormalities) were: severe rheumatic heart valve disease (six), severe dilated cardiomyopathy (five), aortic degenerative disease and congenital heart disease (in three patients each). At 24-month follow up, six of the 252 patients had died; of the 196 reviewed on echocardiography 29 had progressed and two had improved ventricular systolic function. This young cohort of HIV-positive patients on ART showed lower occurrence of tuberculous pericarditis and dilated cardiomyopathy but high cardiovascular risk, as assessed by the presence of obesity, hypertension and anaemia. Cardiac abnormalities needing multidisciplinary care were also found. There is a need for tailored cardiovascular risk stratification and screening for cardiovascular disease in HIV-positive patients on ART in Africa.

Rheumatic heart disease: current status of diagnosis and therapy.

Rheumatic heart disease (RHD) is the only preventable cardiovascular disease which causes significant morbidity and mortality particularly in low- and middle-income countries. Early clinical diagnosis is key, the updated Jones criteria increases the likelihood of diagnosis in endemic settings, including the echo diagnosis of sub-clinical carditis, polyarthralgia and monoarthritis as well as amended thresholds of minor criteria. The mainstay of rheumatic heart valve disease (RHVD) is a thorough clinical and echocardiographic investigation while severe disease is managed with medical, interventional and surgical treatment. In this report we detail some of the more recent epidemiological findings and focus on the diagnostic and interventional elements of the specific valve lesions. Finally, we discuss some of the recent efforts to improve medical and surgical management for this disease. As we are already more than a year from the historic 2018 World Heart Organization Resolution against Rheumatic Fever and Rheumatic Heart Disease, we advocate strongly for renewed efforts to prioritize this disease across the endemic regions of the world.

Epidemiological Approach to Understand Rheumatic Heart Valve Disease: Case of Thoracic Cardiovascular Clinic of Fann Hospital (Dakar)

Objective: Rheumatic heart disease is the major cause of heart valve disease in developing countries. In Senegal, cardiac pathology is dominated by rheumatic pathology whose hospital prevalence was estimated at 0.15% [1]. Epidemiological data on rheumatic heart valve disease (RHVD) are unfortunately imprecise due to the lack of good quality data collection in a large number of countries, especially in sub-Saharan areas and in Central Asia. The objective of this epidemiological study is to collect data about rheumatic heart valve disease in our clinic which is the only surgical center of Senegal. Patients and Methods: Our study conducted between 2014 and 2017 involved a population of one hundred and eighty-three patients with complete medical records, all followed at the Thoracic and Cardiovascular Surgery Clinic at Fann Hospital for rheumatic valve disease. This population was the subject of an epidemiological survey based on a questionnaire covering clinical parameters as consanguinity, clinical signs, diagnosis and surgical intervention. Results: Our work is an epidemiological study involving one hundred and eighty-three (183) patients with various types of rheumatic valve disease, followed at the Thoracic and Cardiovascular Surgery Clinic at Fann Hospital, and who responded to a questionnaire about clinical aspects of this disease. Our results showed 5.46% of family cases, of which 2.18% came from consanguineous marriages. Mean age at onset of clinical signs was 14 ± 9 years with 14.20% before 6 years of age, 65.91% between 6 and 21 years and 19.89% in adulthood. Average age of diagnosis was 21 ± 11 years with an average delay between diagnosis and intervention of 10 years ± 14. Mitral stricture (22.5%) was the most common diagnosis, followed by mitral disease (17.9%) and mitral regurgitation (6.9%). Surgical procedures involved 31.8% of mitral valve, 8.79% of aortic valve, 12.09% of mitral and aortic valves, 13.74% of mitral and tricuspid valves, 2.75% of 3 valves mitral, aortic and tricuspid. 27.49% of patients were awaiting surgery. Conclusion: It appears that a considerable effort should be made to prevent the pathology, to make population aware of the clinical signs and to improve the accessibility of patients to surgical procedure. These different actions would reduce the incidence and prevalence of the disease in Senegal.