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European Heart Journal Jan 2020The causal role of adiposity for several cardiovascular diseases (CVDs) is unclear. Our primary aim was to apply the Mendelian randomization design to investigate the...
AIMS
The causal role of adiposity for several cardiovascular diseases (CVDs) is unclear. Our primary aim was to apply the Mendelian randomization design to investigate the associations of body mass index (BMI) with 13 CVDs and arterial hypertension. We also assessed the roles of fat mass and fat-free mass on the same outcomes.
METHODS AND RESULTS
Single-nucleotide polymorphisms associated with BMI and fat mass and fat-free mass indices were used as instrumental variables to estimate the associations with the cardiovascular conditions among 367 703 UK Biobank participants. After correcting for multiple testing, genetically predicted BMI was significantly positively associated with eight outcomes, including and with decreasing magnitude of association: aortic valve stenosis, heart failure, deep vein thrombosis, arterial hypertension, peripheral artery disease, coronary artery disease, atrial fibrillation, and pulmonary embolism. The odds ratio (OR) per 1 kg/m2 increase in BMI ranged from 1.06 [95% confidence interval (CI) 1.02-1.11; P = 2.6 × 10-3] for pulmonary embolism to 1.13 (95% CI 1.05-1.21; P = 1.2 × 10-3) for aortic valve stenosis. There was suggestive evidence of positive associations of genetically predicted fat mass index with nine outcomes (P < 0.05). The strongest magnitude of association was with aortic valve stenosis (OR per 1 kg/m2 increase in fat mass index 1.46, 95% CI 1.13-1.88; P = 3.9 × 10-3). There was suggestive evidence of inverse associations of fat-free mass index with atrial fibrillation, ischaemic stroke, and abdominal aortic aneurysm.
CONCLUSION
This study provides evidence that higher BMI and particularly fat mass index are associated with increased risk of aortic valve stenosis and most other cardiovascular conditions.
Topics: Adult; Aged; Biological Specimen Banks; Body Mass Index; Cardiovascular Diseases; Female; Genome-Wide Association Study; Humans; Incidence; Male; Mendelian Randomization Analysis; Middle Aged; Obesity; Polymorphism, Single Nucleotide; Risk Assessment; Risk Factors; United Kingdom
PubMed: 31195408
DOI: 10.1093/eurheartj/ehz388 -
JACC. Cardiovascular Imaging Jan 2019Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of the prosthetic valve is too small in relation to a patient's body size, thus resulting... (Review)
Review
Prosthesis-patient mismatch (PPM) occurs when the effective orifice area (EOA) of the prosthetic valve is too small in relation to a patient's body size, thus resulting in high residual postoperative pressure gradients across the prosthesis. Severe PPM occurs in 2% to 20% of patients undergoing surgical aortic valve replacement (AVR) and is associated with 1.5- to 2.0-fold increase in the risk of mortality and heart failure rehospitalization. The purpose of this article is to present an overview of the role of multimodality imaging in the assessment, prediction, prevention, and management of PPM following AVR. The risk of PPM can be anticipated at the time of AVR by calculating the predicted indexed from the normal reference value of EOA of the selected prosthesis and patient's body surface area. The strategies to prevent PPM at the time of surgical AVR include: 1) implanting a newer generation of prosthetic valve with better hemodynamic; 2) enlarging the aortic root or annulus to accommodate a larger prosthetic valve; or 3) performing TAVR rather than surgical AVR. The identification and quantitation of PPM as well as its distinction versus prosthetic valve stenosis is primarily based on transthoracic echocardiography, but important information may be obtained from other imaging modalities such as transesophageal echocardiography and multidetector computed tomography. PPM is characterized by high transprosthetic velocity and gradients, normal EOA, small indexed EOA, and normal leaflet morphology and mobility. Transesophageal echocardiography and multidetector computed tomography are particularly helpful to assess prosthetic valve leaflet morphology and mobility, which is a cornerstone of the differential diagnosis between PPM and pathologic valve obstruction. Severe symptomatic PPM following AVR with a bioprosthetic valve may be treated by redo surgery or the transcatheter valve-in-valve procedure with fracturing of the surgical valve stent.
Topics: Aortic Valve; Aortic Valve Stenosis; Bioprosthesis; Echocardiography; Echocardiography, Doppler, Color; Echocardiography, Doppler, Pulsed; Echocardiography, Transesophageal; Heart Valve Prosthesis; Hemodynamics; Humans; Multidetector Computed Tomography; Multimodal Imaging; Postoperative Complications; Predictive Value of Tests; Prosthesis Design; Prosthesis Implantation; Risk Factors; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 30621987
DOI: 10.1016/j.jcmg.2018.10.020 -
Annals of Cardiothoracic Surgery Nov 2019The term "UFO" is not a medical term, but helps emphasize the extremely high degree of complexity of a surgical repair that is akin to someone observing an unidentified... (Review)
Review
The term "UFO" is not a medical term, but helps emphasize the extremely high degree of complexity of a surgical repair that is akin to someone observing an unidentified flying object. It involves replacement of the mitral and aortic valves with reconstruction of the intervalvular fibrous body (IVFB). Specific pathologies that render this operation necessary usually involve the IVFB, which is located between the aortic and mitral valves and constitutes a major portion of the fibrous skeleton of the heart. Patients that most often require such an operation are those with extensive aortic and mitral valve endocarditis with perivalvular extension into the IVFB. Other infrequent situations such as severe aortic and mitral annular calcification involving the IVFB, double valve replacement in patients with extremely small aortic and mitral annuli or double valve reoperations in which no IVFB is available following excision of both valves, necessitating the UFO procedure. The basic surgical principle has been first described as early as 1980. Depending on the extent of excised tissue due to the underlying disease, modifications and additional complex repair techniques have to be adopted. It is of utmost importance to have adequate visibility and exposure. There are certain important structures, which are at a risk of either injury or neglect, that can result in development of life-threatening complications during this operation, which a surgeon should be aware of. A step by step description of the "UFO" procedure can help guide the surgeon to perform this operation safely and efficiently. Although clinical complications are high, they are often related to the underlying disease and not specifically to the procedure itself, if performed perfectly.
PubMed: 31832364
DOI: 10.21037/acs.2019.11.05 -
Journal of Atherosclerosis and... Apr 2021Reports on an association between body mass index and aortic disease, which remains controversial. This study investigated the association between body mass index and...
AIMS
Reports on an association between body mass index and aortic disease, which remains controversial. This study investigated the association between body mass index and mortality from aortic disease.
METHODS
We conducted the Japan Collaborative Cohort Study, a prospective study of 103,972 Japanese men and women aged 40-79 years. Body mass index was calculated on the basis of self-reported height and weight, and the participants were followed up from 1988-89 through 2009. Sex-specific hazard ratios (95% confidence intervals) of mortality from aortic disease according to quintiles of body mass index were analyzed using the Cox proportional hazards model.
RESULTS
During the median 18.8 years of follow-up, we documented 139 deaths due to aortic aneurysm (including 51 thoracic and 74 abdominal aortic aneurysms) and 134 deaths due to aortic dissection. We observed positive associations of body mass index with mortality from aortic aneurysm among men: the multivariable hazard ratios (95% confidence intervals) for highest versus lowest quintiles of body mass index were 4.48 (2.10-9.58), P for trend <0.0001 for aortic aneurysm; 6.52 (1.33-32.02), P=0.005 for thoracic aortic aneurysm; 3.81 (1.39-10.49), P=0.01 for abdominal aortic aneurysm; and 2.71 (1.59-4.62), P=0.001 for total aortic disease. No association was found for aortic dissection. Among ever-smokers (men ≥ 90%) but not never-smokers (women ≥ 84%), an association between body mass index and aortic disease mortality was observed regardless of sex, which may explain the sex difference (P for sex-interaction=0.046).
CONCLUSIONS
We found a positive association between body mass index and mortality from aortic aneurysm among Japanese men and smokers.
Topics: Aged; Aortic Dissection; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Body Mass Index; Female; Follow-Up Studies; Humans; Japan; Male; Mass Screening; Middle Aged; Obesity; Preventive Health Services; Risk Factors; Risk Reduction Behavior; Sex Factors; Smoking; Ultrasonography
PubMed: 32727971
DOI: 10.5551/jat.57232 -
European Journal of Vascular and... Jan 2022
Topics: Aged, 80 and over; Aortic Aneurysm, Abdominal; Asymptomatic Diseases; Endovascular Procedures; Foreign-Body Migration; Humans; Male; Postoperative Complications; Radiography, Abdominal; Stents; Tomography, X-Ray Computed
PubMed: 34844832
DOI: 10.1016/j.ejvs.2021.10.028 -
Journal of Clinical Medicine Research Jun 2016Ankylosing spondylitis is one of the subgroup of diseases called "seronegative spondyloarthropathy". Frequently, it affects the vertebral colon and sacroiliac joint... (Review)
Review
Ankylosing spondylitis is one of the subgroup of diseases called "seronegative spondyloarthropathy". Frequently, it affects the vertebral colon and sacroiliac joint primarily and affects the peripheral joints less often. This chronic, inflammatory and rheumatic disease can also affect the extraarticular regions of the body. The extraarticular affections can be ophthalmologic, cardiac, pulmonary or neurologic. The cardiac affection can be 2-10% in all patients. Cardiac complications such as left ventricular dysfunction, aortitis, aortic regurgitation, pericarditis and cardiomegaly are reviewed.
PubMed: 27222669
DOI: 10.14740/jocmr2488w -
The Journal of Thoracic and... May 2018
Topics: Aortic Aneurysm; Body Surface Area; Humans
PubMed: 29395190
DOI: 10.1016/j.jtcvs.2017.10.156 -
Vascular Specialist International Mar 2021While rare, abdominal aortic infections remain one of the most technically and emotionally challenging cases that a vascular surgeon may face. Secondary infections of... (Review)
Review
While rare, abdominal aortic infections remain one of the most technically and emotionally challenging cases that a vascular surgeon may face. Secondary infections of either endovascular, or open aortic reconstructions range from 0.2% to 8%. Primary aortic infections are much more rare. Diagnosis can be elusive, depending upon the virulence of the causative microbes, and extent of the infection. Patients are often brittle, with immunocompromise and malnutrition prevalent in this patient population. The gold standard diagnostic test remains a computed tomographic angiogram. The mainstay of management requires vascular control, and wide debridement of all infected materials and revascularization. Multiple methods exist to reconstruct the vascular supply. The neo-aortoiliac system (NAIS) is attractive as it utilizes the patient's own femoral veins to reconstruct the vascular supply after the infection has been extirpated. The procedure is demanding upon the patient and surgeons alike. Also, the rarity of aortic infections limit experiences the literature to centers of excellence. However, the NAIS resists infection well, leaving the patient without any remaining foreign bodies. No further costs for conduit are incurred. Moreover, multiple experiences show excellent durability. While comparative effectiveness literature remains sparse, we believe the NAIS to be the optimal method of revascularization for select patients. In this article, we will review the use of NAIS for primary and secondary aortic infections. In particular, we will emphasize procedural details to help enable the reader to apply this procedure most effectively to their own patients.
PubMed: 33795548
DOI: 10.5758/vsi.210002 -
Frontiers in Cardiovascular Medicine 2021Abdominal aortic aneurysm (AAA) is a cardiovascular disease with a high risk of death, seriously threatening the life and health of people. The specific pathogenesis of... (Review)
Review
Abdominal aortic aneurysm (AAA) is a cardiovascular disease with a high risk of death, seriously threatening the life and health of people. The specific pathogenesis of AAA is still not fully understood. In recent years, researchers have found that amino acid, lipid, and carbohydrate metabolism disorders play important roles in the occurrence and development of AAA. This review is aimed to summarize the latest research progress of the relationship between AAA progression and body metabolism. The body metabolism is closely related to the occurrence and development of AAA. It is necessary to further investigate the pathogenesis of AAA from the perspective of metabolism to provide theoretical basis for AAA diagnosis and drug development.
PubMed: 33614752
DOI: 10.3389/fcvm.2021.630269 -
Journal of the American College of... Feb 2022High plasma lipoprotein(a) and high body mass index are both causal risk factors for calcific aortic valve disease.
BACKGROUND
High plasma lipoprotein(a) and high body mass index are both causal risk factors for calcific aortic valve disease.
OBJECTIVES
This study sought to test the hypothesis that risk of calcific aortic valve disease is the highest when both plasma lipoprotein(a) and body mass index are extremely high.
METHODS
From the Copenhagen General Population Study, we used information on 69,988 randomly selected individuals recruited from 2003 to 2015 (median follow-up 7.4 years) to evaluate the association between high lipoprotein(a) and high body mass index with risk of calcific aortic valve disease.
RESULTS
Compared with individuals in the 1st to 49th percentiles for both lipoprotein(a) and body mass index, the multivariable adjusted HRs for calcific aortic valve disease were 1.6 (95% CI: 1.3-1.9) for the 50th to 89th percentiles of both (16% of all individuals) and 3.5 (95% CI: 2.5-5.1) for the 90th to 100th percentiles of both (1.1%) (P for interaction = 0.92). The 10-year absolute risk of calcific aortic valve disease increased with higher lipoprotein(a), body mass index, and age, and was higher in men than in women. For women and men 70-79 years of age with body mass index ≥30.0 kg/m, 10-year absolute risks were 5% and 8% for lipoprotein(a) ≤42 mg/dL (88 nmol/L), 7% and 11% for 42-79 mg/dL (89-169 nmol/L), and 9% and 14% for lipoprotein(a) ≥80 mg/dL (170 nmol/L), respectively.
CONCLUSIONS
Extremely high lipoprotein(a) levels and extremely high body mass index together conferred a 3.5-fold risk of calcific aortic valve disease. Ten-year absolute risk of calcific aortic valve disease by categories of lipoprotein(a) levels, body mass index, age, and sex ranged from 0.4% to 14%.
Topics: Adult; Aged; Aged, 80 and over; Aortic Valve; Aortic Valve Stenosis; Biomarkers; Body Mass Index; Calcinosis; Denmark; Female; Follow-Up Studies; Forecasting; Humans; Incidence; Lipoprotein(a); Male; Middle Aged; Retrospective Studies; Risk Factors; Young Adult
PubMed: 35144746
DOI: 10.1016/j.jacc.2021.11.043