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Journal of the American College of... Aug 2022
Topics: Aortic Valve; Aortic Valve Stenosis; Humans; Severity of Illness Index; Stroke Volume; Ventricular Function, Left
PubMed: 35953134
DOI: 10.1016/j.jacc.2022.05.037 -
Circulation Research Apr 2021Aortic stenosis (AS) remains one of the most common forms of valve disease, with significant impact on patient survival. The disease is characterized by left ventricular... (Review)
Review
Aortic stenosis (AS) remains one of the most common forms of valve disease, with significant impact on patient survival. The disease is characterized by left ventricular outflow obstruction and encompasses a series of stenotic lesions starting from the left ventricular outflow tract to the descending aorta. Obstructions may be subvalvar, valvar, or supravalvar and can be present at birth (congenital) or acquired later in life. Bicuspid aortic valve, whereby the aortic valve forms with two instead of three cusps, is the most common cause of AS in younger patients due to primary anatomic narrowing of the valve. In addition, the secondary onset of premature calcification, likely induced by altered hemodynamics, further obstructs left ventricular outflow in bicuspid aortic valve patients. In adults, degenerative AS involves progressive calcification of an anatomically normal, tricuspid aortic valve and is attributed to lifelong exposure to multifactoral risk factors and physiological wear-and-tear that negatively impacts valve structure-function relationships. AS continues to be the most frequent valvular disease that requires intervention, and aortic valve replacement is the standard treatment for patients with severe or symptomatic AS. While the positive impacts of surgical interventions are well documented, the financial burden, the potential need for repeated procedures, and operative risks are substantial. In addition, the clinical management of asymptomatic patients remains controversial. Therefore, there is a critical need to develop alternative approaches to prevent the progression of left ventricular outflow obstruction, especially in valvar lesions. This review summarizes our current understandings of AS cause; beginning with developmental origins of congenital valve disease, and leading into the multifactorial nature of AS in the adult population.
Topics: Age Factors; Animals; Aortic Valve; Aortic Valve Stenosis; Calcinosis; Disease Progression; Humans; Medical Illustration; Mice; Risk Factors; Ventricular Outflow Obstruction
PubMed: 33914609
DOI: 10.1161/CIRCRESAHA.120.317978 -
Journal of the American College of... Dec 2020
Topics: Aortic Valve Stenosis; Crime; Diastole; Humans; Registries; Transcatheter Aortic Valve Replacement
PubMed: 33334423
DOI: 10.1016/j.jacc.2020.10.034 -
The International Journal of... Feb 2024At the present time, right ventricular function in patients with aortic stenosis is insufficiently taken into account in the decision-making process of aortic valve...
At the present time, right ventricular function in patients with aortic stenosis is insufficiently taken into account in the decision-making process of aortic valve replacement. The aim of our study was to evaluate significance of right ventricular dysfunction in patients with severe aortic stenosis by modern 3D echocardiographic methods. This is prospective analysis of 68 patients with severe high and low-gradient aortic stenosis. We evaluated function of left and right ventricle on the basis of 3D reconstruction. Enddiastolic, endsystolic volumes, ejection fraction and stroke volumes of both chambers were assessed. There were more patients with right ventricular dysfunction in low-gradient group (RVEF < 45%) than in the high-gradient group (63.6% vs 39%, p = 0.02). Low-gradient patients had worse right ventricular function than high-gradient patients (RVEF 36% vs 46%, p = 0.02). There wasn't any significant correlation between the right ventricular dysfunction and pulmonary hypertension (r = - 0.25, p = 0.036). There was significant correlation between left and right ejection fraction (r = 0.78, p < 0.0001). Multiple regression analysis revealed that the only predictor of right ventricular function is the left ventricular function. According to our results we can state that right ventricular dysfunction is more common in patients with low-gradient than in high-gradient aortic stenosis and the only predictor of right ventricular dysfunction is left ventricular dysfunction, probably based on ventriculo-ventricular interaction. Pulmonary hypertension in patients with severe AS does not predict right ventricular dysfunction.
Topics: Humans; Hypertension, Pulmonary; Ventricular Dysfunction, Right; Predictive Value of Tests; Aortic Valve Stenosis; Ventricular Function, Left; Stroke Volume; Aortic Valve; Severity of Illness Index; Treatment Outcome
PubMed: 37950827
DOI: 10.1007/s10554-023-02986-9 -
JACC. Cardiovascular Imaging Jul 2021
Topics: Aortic Valve Disease; Aortic Valve Stenosis; Humans; Myocardium; Predictive Value of Tests
PubMed: 33865765
DOI: 10.1016/j.jcmg.2021.02.007 -
International Journal of Molecular... Jul 2020Calcific aortic stenosis is a disorder that impacts the physiology of heart valves. Fibrocalcific events progress in conjunction with thickening of the valve leaflets.... (Review)
Review
Calcific aortic stenosis is a disorder that impacts the physiology of heart valves. Fibrocalcific events progress in conjunction with thickening of the valve leaflets. Over the years, these events promote stenosis and obstruction of blood flow. Known and common risk factors are congenital defects, aging and metabolic syndromes linked to high plasma levels of lipoproteins. Inflammation and oxidative stress are the main molecular mediators of the evolution of aortic stenosis in patients and these mediators regulate both the degradation and remodeling processes. Mitochondrial dysfunction and dysregulation of autophagy also contribute to the disease. A better understanding of these cellular impairments might help to develop new ways to treat patients since, at the moment, there is no effective medical treatment to diminish neither the advancement of valve stenosis nor the left ventricular function impairments, and the current approaches are surgical treatment or transcatheter aortic valve replacement with prosthesis.
Topics: Animals; Aortic Valve; Aortic Valve Stenosis; Autophagy; Basement Membrane; Calcinosis; Disease Progression; Endothelial Cells; Humans; Inflammation; Lipids; Mitochondria, Heart; Nitric Oxide Synthase Type III; Oxidative Stress; Therapies, Investigational; Unfolded Protein Response
PubMed: 32664529
DOI: 10.3390/ijms21144899 -
Diabetes & Vascular Disease Research Jul 2019Aortic stenosis and diabetes mellitus are both progressive diseases which, if left untreated, result in significant morbidity and mortality. There is evidence that the... (Review)
Review
Aortic stenosis and diabetes mellitus are both progressive diseases which, if left untreated, result in significant morbidity and mortality. There is evidence that the prevalence of diabetes is substantially increased in patients with aortic stenosis and those with diabetes have increased rates of progression from mild to severe aortic stenosis. There are good data supporting the hypothesis that aortic stenosis and diabetes mellitus are associated with diabetes mellitus being detrimental towards the quality of life and survival of patients. Thus, a thorough understanding of the pathogenesis of both of these disease processes and the relationship between them aids in designing appropriate preventive and therapeutic approaches. This review aims to give a comprehensive and up-to-date insight into the influence of diabetes mellitus on patients with degenerative aortic stenosis, as well as the prognosis and therapeutic approach to these patients.
Topics: Aortic Valve Stenosis; Atherosclerosis; Diabetes Mellitus; Disease Progression; Humans; Prevalence; Prognosis; Risk Factors; Severity of Illness Index
PubMed: 30623669
DOI: 10.1177/1479164118820657 -
JACC. Cardiovascular Interventions Jun 2021
Topics: Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34112457
DOI: 10.1016/j.jcin.2021.03.063 -
JACC. Cardiovascular Interventions Nov 2021
Topics: Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 34794657
DOI: 10.1016/j.jcin.2021.09.030 -
Aging Feb 2020
Topics: Aortic Valve Stenosis; Cognition; Humans; Quality of Life; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 32081837
DOI: 10.18632/aging.102851