-
Journal of the American College of... Apr 2020
Topics: Aortic Valve; Aortic Valve Stenosis; Female; Humans; Male
PubMed: 32327101
DOI: 10.1016/j.jacc.2020.03.026 -
Journal of the American College of... Apr 2013
Topics: Aortic Valve Insufficiency; Aortic Valve Stenosis; Female; Heart Valve Prosthesis Implantation; Humans; Male
PubMed: 23500258
DOI: 10.1016/j.jacc.2013.01.029 -
Texas Heart Institute Journal Sep 2022
Topics: Aneurysm; Aortic Valve; Aortic Valve Stenosis; Heart Valve Prosthesis; Humans; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 36179106
DOI: 10.14503/THIJ-19-7117 -
Hellenic Journal of Cardiology : HJC =... 2009
Topics: Aortic Valve Stenosis; Humans; Hypertension
PubMed: 19196615
DOI: No ID Found -
Journal of the American Heart... May 2018
Review
Topics: Aortic Valve; Aortic Valve Stenosis; Clinical Decision-Making; Hemodynamics; Humans; Patient Selection; Risk Assessment; Risk Factors; Severity of Illness Index; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 29754127
DOI: 10.1161/JAHA.117.007147 -
ESC Heart Failure Aug 2023There is evidence to suggest that the subtype of aortic stenosis (AS), the degree of myocardial fibrosis (MF), and level of aortic valve calcification (AVC) are...
AIMS
There is evidence to suggest that the subtype of aortic stenosis (AS), the degree of myocardial fibrosis (MF), and level of aortic valve calcification (AVC) are associated with adverse cardiac outcome in AS. Because little is known about their respective contribution, we sought to investigate their relative importance and interplay as well as their association with adverse cardiac events following transcatheter aortic valve replacement (TAVR).
METHODS AND RESULTS
One hundred consecutive patients with severe AS and indication for TAVR were prospectively enrolled between January 2017 and October 2018. Patients underwent transthoracic echocardiography, multidetector computed tomography, and left ventricular endomyocardial biopsies at the time of TAVR. The final study cohort consisted of 92 patients with a completed study protocol, 39 (42.4%) of whom showed a normal ejection fraction (EF) high-gradient (NEFHG) AS, 13 (14.1%) a low EF high-gradient (LEFHG) AS, 25 (27.2%) a low EF low-gradient (LEFLG) AS, and 15 (16.3%) a paradoxical low-flow, low-gradient (PLFLG) AS. The high-gradient phenotypes (NEFHG and LEFHG) showed the largest amount of AVC (807 ± 421 and 813 ± 281 mm , respectively) as compared with the low-gradient phenotypes (LEFLG and PLFLG; 503 ± 326 and 555 ± 594 mm , respectively, P < 0.05). Conversely, MF was most prevalent in low-output phenotypes (LEFLG > LEFHG > PLFLG > NEFHG, P < 0.05). This was paralleled by a greater cardiovascular (CV) mortality within 600 days after TAVR (LEFLG 28% > PLFLG 26.7% > LEFHG 15.4% > NEFHG 2.5%; P = 0.023). In patients with a high MF burden, a higher AVC was associated with a lower mortality following TAVR (P = 0.045, hazard ratio 0.261, 95% confidence interval 0.07-0.97).
CONCLUSIONS
MF is associated with adverse CV outcome following TAVR, which is most prevalent in low EF situations. In the presence of large MF burden, patients with large AVC have better outcome following TAVR. Conversely, worse outcome in large MF and relatively little AVC may be explained by a relative prominence of an underlying cardiomyopathy. The better survival rates in large AVC patients following TAVR indicate TAVR induced relief of severe AS-associated pressure overload with subsequently improved outcome.
Topics: Humans; Aortic Valve; Transcatheter Aortic Valve Replacement; Treatment Outcome; Aortic Valve Stenosis; Fibrosis; Cardiomyopathies
PubMed: 37060191
DOI: 10.1002/ehf2.14307 -
Therapeutic Advances in Cardiovascular... 2019Over recent decades, the prevalence of aortic valve stenosis (AVS) has been constantly increasing possibly owing to the aging of general population. Severe AVS as... (Review)
Review
Over recent decades, the prevalence of aortic valve stenosis (AVS) has been constantly increasing possibly owing to the aging of general population. Severe AVS as determined by an aortic valve area (AVA) of <1 cm has been regarded as a serious clinical condition potentially associated with a variety of adverse outcomes, including sudden cardiac death (SCD). However, patients with severe AVS (in the absence of overt high-risk features) are usually evaluated and managed exclusively based on symptomatology or imperfect prognostic tools including exercise testing and biomarkers, with a potential risk of mismanagement, suggesting the need for further objective risk stratifiers in this setting. Within this context, copeptin (C-terminal pro-vasopressin), a novel neurohormone widely considered as the surrogate marker of the arginine-vasopressin (AVP) system, may potentially serve as a reliable prognostic and therapeutic guide (e.g. timing of aortic valvular intervention) in patients with severe AVS largely based on its hemodynamic, fibrogenic as well as autonomic implications in these patients. Accordingly, the present paper aims to discuss clinical and pathophysiological implications of copeptin in the setting of AVS along with a summary of biomarkers and other prognostic tools used in this setting.
Topics: Aortic Valve; Aortic Valve Stenosis; Biomarkers; Glycopeptides; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Prognosis; Severity of Illness Index
PubMed: 30803406
DOI: 10.1177/1753944719826420 -
Kardiologia Polska 2022
Topics: Humans; Constriction, Pathologic; Heart Valve Diseases; Aortic Valve; Aortic Valve Stenosis; Aortic Valve Insufficiency
PubMed: 35979642
DOI: 10.33963/KP.a2022.0195 -
Atherosclerosis May 2022We tested the hypotheses (i) that elevated lipoprotein(a) is causally associated with both mitral and aortic valve calcification and disease, and (ii) that aortic valve...
BACKGROUND AND AIMS
We tested the hypotheses (i) that elevated lipoprotein(a) is causally associated with both mitral and aortic valve calcification and disease, and (ii) that aortic valve calcification mediates the effect of elevated lipoprotein(a) on aortic valve stenosis.
METHODS
From the Copenhagen General Population study, we included 12,006 individuals who underwent cardiac computed tomography to measure mitral and aortic valve calcification and 85,884 to examine risk of heart valve disease. Participants had information on plasma lipoprotein(a) and genetic instruments associated with plasma lipoprotein(a) to investigate potential causality.
RESULTS
At age 70-79 years, 29% and 54% had mitral and aortic valve calcification, respectively. For 10-fold higher lipoprotein(a) levels, multifactorially adjusted odds ratios for mitral and aortic valve calcification were 1.26 (95% confidence interval: 1.13-1.41) and 1.62 (1.48-1.77). For mitral and aortic valve stenosis, corresponding hazard ratios were 0.93 (95%CI:0.40-2.15, 19 events) and 1.54 (1.38-1.71, 1158 events), respectively. For ≤23 versus ≥36 kringle IV type 2 number of repeats, the age and sex adjusted odds ratios for mitral and aortic valve calcification were 1.53 (1.18-1.99) and 2.23 (1.81-2.76). For carriers versus non-carriers of LPA rs10455872, odds ratios for mitral and aortic valve calcification were 1.33 (1.13-1.57) and 1.86 (1.64-2.13). For aortic valve stenosis, 31% (95%CI:16%-76%) of the effect of lipoprotein(a) was mediated through calcification.
CONCLUSIONS
Elevated lipoprotein(a) was genetically and observationally associated with mitral and aortic valve calcification and aortic valve stenosis. Aortic valve calcification mediated 31% of the effect of elevated lipoprotein(a) on aortic valve stenosis.
Topics: Aged; Aortic Valve; Aortic Valve Stenosis; Calcinosis; Humans; Lipoprotein(a); Risk Factors
PubMed: 34903381
DOI: 10.1016/j.atherosclerosis.2021.11.029 -
Polskie Archiwum Medycyny Wewnetrznej 2014Aortic stenosis (AS) represents the most common type of acquired valvular heart disease. Its incidence increases with age; therefore, from 3% to 9% of adults over 75... (Review)
Review
Aortic stenosis (AS) represents the most common type of acquired valvular heart disease. Its incidence increases with age; therefore, from 3% to 9% of adults over 75 years of age develop AS. The pathophysiological mechanisms and role of biomarkers in the prediction of AS have been extensively studied. Progression of AS is characterized by a number of abnormalities in calcification regulation, inflammation/adipokine dysregulation, prothrombic state, and altered von Willebrand factor function. The current understanding of the mechanisms of AS involves a complex role of the multiple cell types, in particular myofibroblasts and macrophages. The introduction of transcatheter aortic valve implantation provides invaluable opportunities for periprocedural and long-term monitoring of the changes in the biomarker profile. Effective pharmacological treatment, especially in the early stage of AS, is largely unknown. The current review discusses not only the pathophysiology of AS but also attempts at pharmacological treatment.
Topics: Adult; Aged; Aged, 80 and over; Aortic Valve Stenosis; Biomarkers; Coronary Artery Disease; Female; Humans; Male; Middle Aged; Treatment Outcome
PubMed: 25563623
DOI: 10.20452/pamw.2562