Valve Disorders Research Articles

ASSESSMENT OF ADVERSE DRUG REACTIONS ON CARDIOVASCULAR DRUGS IN HOSPITALIZED PATIENTS OF A TERTIARY CARE HOSPITAL – A PROSPECTIVE ANALYSIS

Objective: The present study was taken up to assess the adverse drug reactions (ADRs) based on the spontaneous reactions among the inpatients who were hospitalized for the treatment of cardiac ailments. Methods: A prospective and observational study was done in the department of cardiology for a period of 6 months. Patients on cardiac drug therapy were evaluated to detect unwanted effects and were given treatment for the developed complications. The ADRs were identified, followed up, and documented. Results: In the present study, 255 inpatients were assessed to pinpoint the negative effects and about 80 (n=80) sufferers were recognized with 28 types of ADRs. The highest percentage of ADRs was in adults of age group 60–70 years. Type A accounted for most of the reports which was based on severity. The number of ADRs in heart muscle disorders was found to be 44% (n=35) followed by coronary artery disease 40% (n=32), then heart valve disorders and patients underwent surgery were affiliated to 8% (n=6) each. The highest number of ADRs was reported in patients suffered from disorders pertained to heart muscle. Majority of ADRs were rated as possible, preventable, and moderate according to causality, preventability, and severity parameters, respectively. The data were tabulated, analyzed, and subjected to statistics using Graph Pad Prism 8. Conclusion: It was concluded that proper management and monitoring of drug therapy are the key to prevent ADRs.

Counting the cost of progressive aortic valve stenosis: an international observational clinical cohort study

Abstract Background We sought, for the first time, to quantify the societal to healthcare burden associated with the entire spectrum of aortic stenosis (AS) - the most common cardiac valve disorder requiring clinical management. Methods In this observational clinical cohort study with individual data linkage to all-cause mortality, we examined the distribution of progressive stenosis in the native aortic valves of 98,565 men and 99,357 women aged ≥65 years within a multicentre cohort across 24 sites internationally. Individuals were grouped according to their peak aortic valve velocity on last electrocardiogram investigation: 1.0–1.99 m/s (no AS/reference groups) and then 0.5 m/s increments up to ≥4.0 m/s (severe AS). Sex-specific premature mortality and years of life-lost (YLL) during 5-year follow-up were calculated, along with willingness-to-pay (WTP) to regain quality-adjusted life-years (QALYs) and healthcare costs associated with concurrent heart failure (HF). Results Overall, 20,701 men (21.0%; 95% CI 20.8–21.3) and 18,576 women (18.7%; 95% CI 18.5–18.9) had AS at baseline. Five-year mortality in men and women with no AS was 38.6% and 36.8%, respectively. In both sexes, mortality rose from 46.8–49.0% to 59.5–65.7% in the least- to most-severe cases of AS. Premature mortality (53.5–59.1% in the no AS group) declined from 42.4–50.9% to 34.8–35.2% of all deaths. Per 1,000 individuals, AS in men and women was associated with 8 and 13 more premature deaths resulting in 36 and 62 more QALYs (societal cost of $AU1.54 and $AU2.68 million respectively) when compared to no AS. The additional 5-year cost of healthcare utilisation for the 25 and 35 more men and women with concurrent HF and AS was estimated to be $AU1.27 and $AU1.91 million, respectively. Conclusions The presence of any degree of aortic valve stenosis is associated with higher levels of premature mortality coupled with excess healthcare costs that impose a heavy societal burden. These findings indicate the need for proactive and cost-effective strategies to promptly detect this common condition. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Edwards LifeSciences: Investigator-initiated grant

Prognostic significance of mean transmitral pressure gradient in degenerative non-rheumatic mitral valve: insights from a vast echocardiographic database

Abstract Background The incidence and prevalence of senile, non-rheumatic mitral valve disease are increasing and there is a renewed interest in new transcatheter structural cardiac interventions intended to treat that valvular disorder. While the severity of rheumatic mitral valve disease can be accurately assessed by echocardiography using various parameters, including mean transmitral pressure gradient, these methods have been questioned for quantifying senile mitral valve disorder and their prognostic significance is still unknown. Aims The current study aims to document the natural history of patients with elevated senile mean transmitral pressure gradient (MG) and assess its prognostic significance. Methods A vast institutional echocardiography database was retrospectively analyzed from 2009 to 2020 for all patients aged over 60 years with a detailed echocardiography report with valid measurement of transmitral gradients. Patients with rheumatic valvular disease or who underwent surgical or transcatheter valvular replacement/repair were excluded. All-cause mortality was set to be the primary outcome, and survival models utilizing univariable and adjusted multivariable analysis for various clinical and echocardiographic variables were applied. Results A total of 5524 patients consisted of the final cohort. They were stratified by the MG into three groups: MG <3 (2914 patients, 53%), 3≤MG<6 (2079 patients, 37.6%) and MG ≥6 mmHg (531 patients,9.6%). The mean age of the total cohort was 77.2±7.9 years; 60.5% were female, 33.3% with diabetes mellitus, 15.1% with chronic kidney disease, and 14.1% with ischemic heart disease. An Adjusted Cox proportional hazard regression model demonstrated that MG is independently associated with all-cause mortality (adjusted HR 1.04 per 1 mmHg increase, 95% CI 1.02–1.05, p<0.001). Moreover, an elevated MG was associated with a rise in all-cause mortality (HR of 1.15 and 1.4 for patients with 3≤MG<6 and MG ≥6 mmHg, respectively (Fig. 1). Conclusion The elevated mean transmitral gradient in senile non-rheumatic valves is an independent predictor for all-cause mortality. Interventions and prospective trials intended to mitigate that risk should be needed. Funding Acknowledgement Type of funding sources: None.

Identification of MMP9 as a Novel Biomarker to Mitochondrial Metabolism Disorder and Oxidative Stress in Calcific Aortic Valve Stenosis.

Calcific aortic valve stenosis (CAVS) is the most common heart valve disorder among humans. To date, no effective method has been identified to prevent this disease. Herein, we aimed to identify novel diagnostic and mitochondria-related biomarkers of CAVS, based on two machine learning algorithms. We further explored their association with infiltrating immune cells and studied their potential function in CAVS. The GSE12644, GSE51472, and GSE83453 expression profiles were downloaded from the Gene Expression Omnibus (GEO) repository. The GSE12644 and GSE51472 datasets were integrated to identify differentially expressed genes (DEGs). GSE12644 contains 10 normal and 10 CAVS samples, whereas GSE51472 contains 5 normal and 10 CAVS samples. GO and KEGG assays of DEGs were conducted, and the correlation between matrix metalloproteinase 9 (MMP9) expression and immune cell infiltration was explored, using CIBERSORT. The LASSO regression model and SVM-RFE analysis were used to identify diagnostic genes. The expression of MMP9 in CAVS and non-CAVS samples was measured using RT-PCR, western blotting and immunohistochemistry. A series of functional experiments were performed to explore the potential role of MMP9 in mitochondrial metabolism and oxidative stress during CAVS progression. Twenty-two DEGs were identified, of which six genes (SCG2, PPBP, TREM1, CCL19, WIF1, and MMP9) were ultimately distinguished as diagnostic genes in CAVS. Of these, MMP9 was indicated as a mitochondria-related gene, the expression and diagnostic value of which were further confirmed in the GSE83453 dataset. Correlation analysis revealed a positive correlation between MMP9 and infiltrating immune cells. In our cohort, MMP9 expression was distinctly increased in CAVS samples, and its inhibition attenuated the calcification of valve interstitial cells (VICs) by suppressing mitochondrial damage and oxidative stress. Taken together, our findings suggest MMP9 as a novel mitochondrial dysfunction biomarker and therapeutic target for CAVS.

An Investigation of Left Ventricular Valve Disorders and the Mechano-Electric Feedback Using a Synergistic Lumped Parameter Cardiovascular Numerical Model.

Cardiac diseases and failure make up one of largest contributions to global mortality and significantly detriment the quality of life for millions of others. Disorders in the valves of the left ventricle are a prominent example of heart disease, with prolapse, regurgitation, and stenoses—the three main valve disorders. It is widely known that mitral valve prolapse increases the susceptibility to cardiac arrhythmia. Here, we investigate stenoses and regurgitation of the mitral and aortic valves in the left ventricle using a synergistic low-order numerical model. The model synergy derives from the incorporation of the mechanical, chemical, and electrical elements. As an alternative framework to the time-varying elastance (TVE) method, it allows feedback mechanisms at work in the heart to be considered. The TVE model imposes the ventricular pressure–volume relationship using a periodic function rather than calculating it consistently. Using our synergistic approach, the effects of valve disorders on the mechano-electric-feedback (MEF) are investigated. The MEF is the influence of cellular mechanics on the electrical activity, and significantly contributes to the generation of arrhythmia. We further investigate stenoses and regurgitation of the mitral and aortic valves and their relationship with the MEF and generation of arrhythmia. Mitral valve stenosis is found to increase the sensitivity to arrhythmia-stimulating systolic stretch, and reduces the sensitivity to diastolic stretch. Aortic valve stenosis does not change the sensitivity to arrhythmia-stimulating stretch, and regurgitation reduces it. A key result is found when valve regurgitation is accompanied by diastolic stretch. In the presence of MEF disorder, ectopic beats become far more frequent when accompanied by valve regurgitation. Therefore, arrhythmia resulting from a disorder in the MEF will be more severe when valve regurgitation is present.

Counting the cost of premature mortality with progressively worse aortic stenosis in Australia: a clinical cohort study

SummaryBackgroundAortic stenosis is the most common cardiac valve disorder requiring clinical management. However, there is little evidence on the societal cost of progressive aortic stenosis. We sought to quantify the societal burden of premature mortality associated with progressively worse aortic stenosis.MethodsIn this observational clinical cohort study, we examined echocardiograms on native aortic valves of 98 565 men and 99 357 women aged 65 years or older across 23 sites in Australia, from Jan 1, 2003, to Dec 31, 2017. Individuals were grouped according to their peak aortic valve velocity in 0·50 m/s increments up to 4·00 m/s or more (severe aortic stenosis), using 1·00–1·99 m/s (no aortic stenosis) as the reference group. Sex-specific premature mortality and years of life lost during a 5-year follow-up were calculated, along with willingness-to-pay to regain quality-adjusted life years (QALYs).FindingsOverall, 20 701 (21·0%) men and 18 576 (18·7%) women had evidence of mild-to-severe aortic stenosis. The actual 5-year mortality in men with normal aortic valves was 32·1% and in women was 26·1%, increasing to 40·9% (mild aortic stenosis) and 52·2% (severe aortic stenosis) in men and to 35·9% (mild aortic stenosis) and 55·3% (severe aortic stenosis) in women. Overall, the estimated societal cost of premature mortality associated with aortic stenosis was AU$629 million in men and $735 million in women. Per 1000 men and women investigated, aortic stenosis was associated with eight more premature deaths in men resulting in 32·5 more QALYs lost (societal cost of $1·40 million) and 12 more premature deaths in women resulting in 57·5 more QALYs lost (societal cost of $2·48 million) when compared with those without aortic stenosis.InterpretationAny degree of aortic stenosis in older individuals is associated with premature mortality and QALYs. In this context, there is a crucial need for cost-effective strategies to promptly detect and optimally manage this common condition within our ageing populations.FundingEdwards LifeSciences, National Health and Medical Research Council of Australia, and the National Heart, Lung, and Blood Institute.

Clinical and Echocardiographic Predictor of Atrial Fibrillation in Patient with Rheumatic Mitral Valve Disease

Background: Rheumatic fever principally influences kids in developing states, particularly where deficiency is common. Atrial fibrosis is a mutual characteristic of clinical atrial fibrillation (AF) and is accompanying with AF in a diversity of experiment sittings,
 Aim and Objectives: The current work aimed to assess whether there are any clinical or echo-cardiographic parameters that expect the existence of AF among cases with rheumatic mitral valve disorder (RMVD),
 Subjects and Methods: The current study was a comparative cross-sectional was conducted on 100 RMVD cases at cardio-vascular medicine department Tanta university hospitals within 6-mths starting from September 2019. Cases have been allocated into 2 groups: Group-I: 50 cases with sinus rhythm. Group-II: 50 cases with AF,
 Results: A significant change was found among study groups regarding Fibrosis characteristics, There is a highly significant difference between the three different types regarding mitral valve area (MVA), LA-diameter, LA volume, LA-diameter/BSA and LA volume index, Age, area of mitral valve, LA-diameter and LA volume were found to be significant predictors for AF,
 Conclusion: Echo-cardiography factors could recognize cases at higher danger of advancing AF among RMVD cases who may benefit from preventive measures.

Epidemiological study of calcified aortic valve stenosis in a Chinese community population

Background and aimsDue to the ageing global population, calcified aortic valve disease is currently the most common cardiac valve disorder. This study aimed to investigate the prevalence and the risk...

Measurement of ANP, BNP and endothelin‐1 concentrations in jumping horses with heart valvular regurgitation and their correlation with the dimensions of heart structures

SummaryBackgroundNatriuretic peptides and endothelin‐1 are used as biochemical biomarkers for the diagnosis and prognosis of heart diseases.ObjectivesThis study aimed to investigate plasma ANP, BNP and endothelin‐1 in jumping horses with various manifestations of heart valve regurgitation and their association with echocardiographic variables.Study designClinical evaluations including cardiac auscultation were performed in 198 jumping horses, and 30 horses were chosen.MethodsSixteen jumping horses with murmurs of grade 3/6 to 5/6 having various degrees of heart valve regurgitation with the severity of insignificant to moderate on colour Doppler echocardiography were considered as the valvular regurgitation group (average age 9.75 ± 3.28 years and weight 427.43 ± 82.22 kg, and consisting of 10 mares, three stallions and three castrated male horses with breeds of 12 Thoroughbred and four crossbred). Fourteen healthy horses were chosen as the healthy group (average age 8.64 ± 2.44 years and weight 462.14 ± 77.42 kg, and consisting of nine mares, three stallions and two castrated males with breeds of 12 Thoroughbreds, and two crossbred). Blood samples were collected from the jugular vein, and plasma concentration of ANP, BNP and endothelin‐1 was determined using Sandwich ELISA by a horse‐specific kit. Then, the plasma concentration of mentioned peptides and echocardiographic variables were compared between the two groups.ResultsB‐type natriuretic peptide was significantly increased in horses with valve regurgitation compared to healthy horses, but increases in ANP and endothelin‐1 were insignificant. Also, in the valvular regurgitation group, horses with a pulmonic valve disorder had a significantly higher concentration of BNP and endothelin‐1 than healthy horses. Assessment of the relation between ANP, BNP and endothelin‐1 with echocardiographic variables showed a significant correlation between ANP and right ventricle length (RVL) and left ventricle width (LVW) in systole and endothelin‐1 with right ventricle width (RVW) and left ventricle width in systole, but BNP had no significant correlation.Conclusion and clinical importanceAccording to the study results, it can be assumed that the measurement of these cardiac biomarkers can be helpful in the diagnosis of the jumping horse with cardiac valvular disorders (especially pulmonic valve regurgitation) and changes in the dimensions of the heart ventricle.

Classification of heart sounds associated with murmur for diagnosis of cardiac valve disorders

Background: Nowadays, cardiovascular diseases have been a major cause of death in the world. The heart sound is still used as a primary tool for screening and diagnosing many pathological conditions of the human heart. The abnormality in the heart sounds starts appearing much earlier than the symptoms of the disease.

Automated detection of heart valve disorders with time-frequency and deep features on PCG signals

Heart valve diseases (HVDs) can cause cardiac arrhythmias, heart attacks, and sudden cardiac death if not diagnosed early. Therefore, the detection of HVDs is critical in order to avoid heart-related mortality. The focus of this research is to establish an efficient computer-aided diagnosis approach that detects HVDs using phonocardiogram (PCG) signals. The proposed approach uses traditional time–frequency and deep features with machine learning models. The time–frequency features are extracted from non-linear measurements using discrete wavelet transform (DWT), wavelet packet transform (WPT), perceptual wavelet packet transform (PWPT) and empirical mode decomposition (EMD) methods. Deep features are extracted from VGG16, ResNet50 and MobileNetV2 pre-trained CNN models, and multilayer extreme learning machine (ML-ELM) model using scalogram images of PCG signals. Recursive feature elimination (RFE) algorithm is applied to all features and the most distinctive features are selected. Experimental results show that the PWPT + EMD features selected by RFE and the random forest (RF) classification model achieve the highest performance with accuracy of 99.4%, Matthews correlation coefficient (MCC) and G-mean of 99.3%. In another proposed approach, ML-ELM deep features selected by RFE algorithm and RF classification model provide accuracy and G-mean of 98.9%, and MCC values of 98.6%. It was observed that the time–frequency features have outperformed compared to deep features for the detection of HVDs. The proposed approach is compared with the existing studies and it has obtained higher performance values ​​than the approaches using the same database. The proposed approach can be considered as an easily integrated system on the embedded platform.

Atrial Mitral and Tricuspid Regurgitation: Sex Matters. A Call for Action to Unravel the Differences Between Women and Men.

Atrial functional regurgitation is caused by atrioventricular annulus dilation, with normal leaflets and ventricular dimensions and function within the normal range. Its occurrence, in both mitral and tricuspid valves, implies a worse prognosis due to the hemodynamic derangement they produce, but also constitutes a marker of greater comorbidity and more advanced disease. Predisposing conditions for these heart valve dysfunctions are mainly atrial fibrillation and heart failure with preserved ejection fraction. However, other factors like female sex also may be involved and influence their incidence, especially for atrial tricuspid regurgitation. In the present review, we analyze sex differences in the reported prevalence of atrial mitral and tricuspid regurgitation, and suggest possible mechanisms involved. Finally, we underline potential therapeutic and preventive strategies to reduce the burden of these heart valve disorders and discuss research gaps.

Measures of high-density lipoprotein function in men and women with severe aortic stenosis

BackgroundCalcification of the aortic valve is a common heart valve disorder, in some cases leading to clinically impactful severe aortic stenosis (AS). Sex-specific differences in aortic valve calcification (ACV) exist, with women having a lower burden of calcification than men as measured by computed tomography; however, the pathophysiological mechanism that leads to these differences remains unclear.MethodsUsing cultured human Tamm-Horsfall protein 1 (THP-1) macrophages and human aortic valve interstitial cells, the effects of high-density lipoprotein (HDL) particles isolated from the plasma of men and women with severe AS were studied for cholesterol efflux capacity (CEC).ResultsHDL-CEC was assessed in 46 patients with severe AS, n = 30 men, n = 16 women. ATP-Binding Cassette A1 (ABCA1)-mediated HDL-CEC was measured from human cultured THP-1 macrophages to plasma HDL samples. Women with severe AS had more ABCA1-mediated HDL-CEC, as compared to men (8.50 ± 3.90% cpm vs. 6.80 ± 1.50% cpm, P = 0.04). HDL pre-β1 and α-particles were higher in woman than in men by spectral density, (pre-β1 HDL, 20298.29 ± 1076.15 vs. 15,661.74 ± 789.00, P = 0.002, and α-HDL, 63006.35 ± 756.81 vs. 50,447.00 ± 546.52, P = 0.03). Lecithin-cholesterol acyltransferase conversion of free cholesterol into cholesteryl esters was higher in women than men (16.44 ± 9.11%/h vs. 12.00 ± 8.07%/h, P = 0.03).ConclusionsSex-specific changes in various parameters of HDL-CEC were found in patients with severe AS. Sex-based modifications in HDL functionality by HDL-CEC might account for the reduced burden of calcification in women vs. men with severe AS. Therefore, future studies should target sex-related pathways in AS to help to improve understanding and treatment of AS.Graphical abstractSex specifc differences in AVC and differences associated with HDL function in men and women with severe AS. When compared to men, women had higher preβ-HDL and α-HDL migrating particles, higher cholesterol efflux to HDL, and higher lecithin cholesterol acyl transferase (LCAT) activity, possibly indicating that improved reverse cholesterol transport may be protective against worsened calcification.

Liquid Spreader Grafts: Internal Nasal Valve Opening with Hyaluronic Acid.

Nasal valve disorders frequently give rise to nasal obstruction. Dermal fillers could be used in the internal valve area to generate valve widening. The goal of this study was to report our "liquid spreader" procedure consisting in the injection of hyaluronic acid (HA) at the internal nasal valve in patients complaining of nasal obstruction. The procedure described in this paper is suitable for patients with unilateral or bilateral nasal obstruction related to architectural features resulting in narrowing of the internal nasal valve. HA is injected along the internal valve from a single entry point located at the anterior part of the internal valve, thus creating a volume which will induce nasal valve widening. Rhinomanometries and visual analog scales (VAS) regarding nasal obstruction were collected before and after the procedure. Sixteen patients were enrolled (7 females). Mean age was 44years (min=24 y-o, max=65 y-o). Thirteen presented nasal valve narrowing without septal deviation while 3 patients had high septal deviation. Before injection, mean nasal resistances were 3.4±5.6sPa/mL (min=0.55, max=19.8). One month after injection, mean nasal resistances were 0.38±0.26sPa/mL (min = 0.20, max = 0.85). The difference was statistically significant (p=0.049). VAS scores were improved with a trend back to baseline after 12 months. The liquid spreader is a useful procedure that can be combined with non-surgical esthetic rhinoplasties. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

ROSS procedure versus mechanical valve replacement in young and middle-aged adults with aortic valve disease

Background: Aortic valve replacement (AVR) remains the only treatment that was revealed to advance the natural history in the cases with severe symptomatic aortic valve disorder. However, aortic valve diseases were challenging in young and adults in middle age persons. The aim of our study: was to compare the mid-term outcomes, quality of life and adverse valve- related events among patients undergoing the Ross procedure and those receiving a mechanical aortic valve . Patients and Methods: This study included patients with aortic valve disease divided into Fifty patients were candidates for ROSS procedure and the other Fifty were for mechanically aortic valve replacement after obtaining the approval of the local ethical committee. Results: Ross patients show statistically significant lower MLHFQ scores compared to Mechanical valve patients; however, a nonsignificant change was found among the study groups in terms of major cardiovascular events or mortality. Conclusion: Mechanical AVR is accompanied by low morbidities and mortalities in both the short and long term. Our data suggest that The Ross operation may be accomplished securely and reproducibly in properly particular cases with lower morbidity and mortality and better quality of life.

The scaffold protein Shoc2 controls ERK1/2‐driven neural crest development by balancing the expression of extracellular matrix components

Dysregulation of the extracellular‐signal‐regulated kinase 1/2 (ERK1/2) pathway results in common developmental syndromes – RASopathies. Our lab studies a RASopathy called Noonan syndrome with loose anagen hair (NSLAH). This RASopathy is caused by mutations in a critical regulator of the ERK1/2 pathway, Shoc2. Patients harboring shoc2mutations have structural deficiencies common among RASopathies (e.g., altered pigmentation, craniofacial defects, valve disorders). Many NSLAH features could involve defects in the development of neural crest (NC).Zebrafish provide an excellent system for studying neural crest development because of their transparency and highly conserved molecular pathways. Therefore, we utilized the zebrafish model to study the role of Shoc2‐mediated signals in NC development. We found that the loss of Shoc2 affects the expression of the transcription factors prdm1a, pax7, and foxd3‐ all required for the neural plate border formation in zebrafish. The loss of Shoc2 also led to the irregular expression of sox10, the global regulator of NC formation. Moreover, embryos depleted of Shoc2 displayed altered expression of dlx2a, a key transcription factor for the maintenance of cranial NCCs and their migration. We observed that loss of Shoc2 impaired the expression of the transcription factor inducing commitment to cartilage fate, promoting the activation of cartilage‐specific genes in the forebrain and the pharyngeal arch regions, and regulating chondrocyte stacking, sox9a. Moreover, the loss of the Shoc2‐ERK1/2 axis hindered the terminal differentiation of NCCs and resulted in the reduced number of NCC‐derived Schwann cells and pigment cells, including iridophores. Finally, our global assessment of the transcription programs affected by the loss of the Shoc2‐ERK1/2 signals revealed striking differences in the expression of a significant number of extracellular matrix proteins and proteoglycans, including collagen2aI, and aggrecans a and b ‐ all of which are critical for chondrocyte differentiation and maturation.Together, our data suggest that the Shoc2‐ERK1/2 signaling axis is critical for the development, specification/differentiation, and morphogenesis of the NC‐derived tissues. Our study is the first to define that Shoc2‐mediated ERK1/2 signals regulate NC development. Future inquiries into the mechanisms by which Shoc2 controls embryogenesis will significantly advance our understanding of the mechanisms underlying pathological causes of NSLAH and, ultimately, other RASopathies.

Automatic detection of heart valve disorders using Teager–Kaiser energy operator, rational-dilation wavelet transform and convolutional neural networks with PCG signals

Automatic detection of heart valve disorders using Teager–Kaiser energy operator, rational-dilation wavelet transform and convolutional neural networks with PCG signals

Assessment of Postoperative Outcomes of Spine Fusion Patients With History of Cardiac Disease

There is paucity on the effect of different cardiac diagnoses on outcomes in elective spine fusion patients. Patients undergoing elective spine fusion surgery were isolated in the PearlDiver database. Patients were stratified by having a previous history of coronary artery disease (CAD), congestive heart failure (CHF), valve disorder (valve), dysrhythmia, and no heart disease (control). Means comparison tests (chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, comorbidities, procedural characteristics, length of stay, complication outcomes, and total hospital charges among the cohort. In total, 537,252 elective spine fusion patients were stratified into five groups: CAD, CHF, valve, dysrhythmia, and control. Among the cohort, patients with CHF had significantly higher rates of morbid obesity, peripheral vascular disease, and chronic kidney disease (P < 0.001 for all). Patients with CAD had significantly higher rates of chronic obstructive pulmonary disease, diabetes, hypertension, and hyperlipidemia (all P < 0.001). Comparing postoperative outcomes for CAD and control subjects, CAD was associated with higher odds of myocardial infarction (odds ratio [OR]: 1.64 [1.27 to 2.11]) (P < 0.05). Assessing postoperative outcomes for CHF versus control subjects, patients with CHF had higher rates of pneumonia, cerebrovascular accident (CVA), myocardial infarction, sepsis, and death (P < 0.001). Compared with control subjects, CHF was a significant predictor of death in spine fusion patients (OR: 2.0 [1.1 to 3.5], P = 0.022). Patients with valve disorder compared with control displayed significantly higher rates of 30-day readmission (P < 0.05) and 1.38× greater odds of CVA by 90 days postoperatively (OR: 1.4 [1.1 to 1.7], P = 0.007). Patients with dysrhythmia were associated with significantly higher odds of CVA (OR: 1.8 [1.4 to 2.3], P < 0.001) by 30 days postoperatively. Heart disease presents an additional challenge to spine fusion patients who are undergoing a challenging and risky procedure. Before surgical intervention, a proper understanding of cardiac diagnoses could give insight into the potential risks for each patient based on their heart condition and preventive measures showing benefit in minimizing perioperative complications after elective spine fusion.

Autologous Pericardial Band for Tricuspid Valve Annuloplasty: Midterm Results

Background: Even though tricuspid regurgitation (TR) is a frequent cardiac valve disorder, and tricuspid valve annuloplasty (TVA) has been evolved to manage TR for more than 50 years, there is still a substantial controversy regarding the best durable method for TVA. We reported our midterm (3 years) outcomes of TVA using autologous pericardial (AP) band comparing it with DeVega annuloplasty for the management of functional TR.&#x0D; Methods: Between January 2017 and November 2018, about 175 cases with moderate or more TR underwent TVA as a part of primary left-sided valve replacement surgery. Autologous pericardial (AP) TVA was performed in 100 patients, and DeVega TVA in 75 patients.&#x0D; Results: Both groups are comparable as regards preoperative characteristics. Immediate postoperatively, regarding NYHA class, degree of TR, ejection fraction, and pulmonary artery systolic pressure, there was a marked improvement within the 2 groups compared to the preoperative values, without a significant difference between both groups. 94% of patients completed the follow-up period. In hospital death was 2% in the AP group, and 1% in the DeVega group. The AP group showed a marked improvement in the mean degree of TR at the same follow-up period compared to the DeVega group, 12% patients of the AP group and 21% patients of the De Vega group had 3+ or 4+ TR at 3 years postoperative follow up. There was a marked improvement in the Diastolic tricuspid annuloplasty diameter in the AP group compared to the DeVega group. There were 6.3% late deaths in our study.&#x0D; Conclusion: TVA with an AP was more durable than the DeVega in avoiding postoperative TR progression on the midterm results.

Sex-Specific Cell Types and Molecular Pathways Indicate Fibro-Calcific Aortic Valve Stenosis.

BackgroundAortic stenosis (AS) is the most common valve disorder characterized by fibro-calcific remodeling of leaflets. Recent evidence indicated that there is a sex-related difference in AS development and progression. Fibrotic remodeling is peculiar in women’s aortic valves, while men’s leaflets are more calcified. Our study aimed to assess aortic valve fibrosis (AVF) in a severe AS cohort using non-invasive diagnostic tools and determine whether sex-specific pathological pathways and cell types are associated with severe AS.Materials and MethodsWe have included 28 men and 28 women matched for age with severe AS who underwent echocardiography and cardiac contrast-enhanced computed tomography (CT) before intervention. The calcium and fibrosis volumes were assessed and quantified using the ImageJ thresholding method, indexed calcium and fibrosis volume were calculated by dividing the volume by the aortic annular area. For a deeper understanding of molecular mechanisms characterizing AS disorder, differentially expressed genes and functional inferences between women and men’s aortic valves were carried out on a publicly available microarray-based gene expression dataset (GSE102249). Cell types enrichment analysis in stenotic aortic valve tissues was used to reconstruct the sex-specific cellular composition of stenotic aortic valves.ResultsIn agreement with the literature, our CT quantifications showed that women had significantly lower aortic valve calcium content compared to men, while fibrotic tissue composition was significantly higher in women than men. The expression profiles of human stenotic aortic valves confirm sex-dependent processes. Pro-fibrotic processes were prevalent in women, while pro-inflammatory ones, linked to the immune response system, were enhanced in men. Cell-type enrichment analysis showed that mesenchymal cells were over-represented in AS valves of women, whereas signatures for monocytes, macrophages, T and B cells were enriched men ones.ConclusionsOur data provide the basis that the fibro-calcific process of the aortic valve is sex-specific, both at gene expression and cell type level. The quantification of aortic valve fibrosis by CT could make it possible to perform population-based studies and non-invasive assessment of novel therapies to reduce or halt sex-related calcific aortic valve stenosis (CAVS) progression, acting in an optimal window of opportunity early in the course of the disease.