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Aortic stenosis guidelines

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https://www.readbyqxmd.com/read/28640443/pathophysiology-of-aortic-stenosis-and-mitral-regurgitation
#1
Gianluca L Perrucci, Marco Zanobini, Paola Gripari, Paola Songia, Bayan Alshaikh, Elena Tremoli, Paolo Poggio
The global impact of the spectrum of valve diseases is a crucial, fast-growing, and underrecognized health problem. The most prevalent valve diseases, requiring surgical intervention, are represented by calcific and degenerative processes occurring in heart valves, in particular, aortic and mitral valve. Due to the increasing elderly population, these pathologies will gain weight in the global health burden. The two most common valve diseases are aortic valve stenosis (AVS) and mitral valve regurgitation (MR)...
June 18, 2017: Comprehensive Physiology
https://www.readbyqxmd.com/read/28596467/-embolic-stroke-of-undetermined-source
#2
Teruyuki Hirano
A new clinical construct, embolic stroke of undetermined source (ESUS) was established as a therapeutically relevant entity, which are defined as a non-lacunar infarction without proximal arterial stenosis or cardioembolic sources, with a clear indication for anticoagulation, especially with direct oral anticoagulant (DOAC). The possible embolic sources include covert atrial fibrillation, arterial stenosis with <50%, low-risk emboligenic cardiac sources, aortic plaque, cancer-associated, and paradoxical embolism...
June 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28593422/treatment-of-asymptomatic-aortic-valve-stenosis-watchful-waiting-or-early-intervention
#3
J Ledwoch, H Thiele
There is ongoing debate about the optimal management of severe asymptomatic aortic stenosis (AS). Thus far, current guidelines recommend a watchful waiting strategy for the majority of asymptomatic patients. However, data on the prognosis of asymptomatic AS are inconsistent. Some reports claim an increased risk of complications and even mortality in this subset of patients when treated conservatively. Several factors are considered to contribute to the impaired outcome of asymptomatic patients, such as progressive myocardial damage or sudden cardiac death, during the watchful waiting period...
June 7, 2017: Herz
https://www.readbyqxmd.com/read/28572283/impact-of-mean-transaortic-pressure-gradient-on-long-term-outcome-in-patients-with-severe-aortic-stenosis-and-preserved-left-ventricular-ejection-fraction
#4
Yohann Bohbot, Cedric Kowalski, Dan Rusinaru, Anne Ringle, Sylvestre Marechaux, Christophe Tribouilloy
BACKGROUND: Mean transaortic pressure gradient (MTPG) has never been validated as a predictor of mortality in patients with severe aortic stenosis. We sought to determine the value of MTPG to predict mortality in a large prospective cohort of severe aortic stenosis patients with preserved left ventricular ejection fraction and to investigate the cutoff of 60 mm Hg, proposed in American guidelines. METHODS AND RESULTS: A total of 1143 patients with severe aortic stenosis defined by aortic valve area ≤1 cm(2) and MTPG ≥40 mm Hg were included...
June 1, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28560534/exercise-testing-and-stress-imaging-in-aortic-valve-disease
#5
REVIEW
Luc A Pierard, Raluca Dulgheru
Aortic valve disease and especially aortic stenosis (AS) is a growing cardiac pathology. Aortic valve replacement (AVR) is still the only treatment with proven benefit on survival in symptomatic patients and in patients with a left ventricular ejection fraction (LVEF) <50%. The benefit of prophylactic AVR in asymptomatic patients is still unproven. Once symptoms develop, the prognosis worsens. Exercise testing has emerged as a tool to unmask the "pseudo-asymptomatic" patients with AS (those without self-reporting symptoms), to link "exercise induced dyspnea" more confidently and more objectively to aortic valve disease and to allow for a safe "watchful waiting strategy" in "pseudo-symptomatic" patients (those with dyspnea unrelated to aortic valve disease)...
July 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28550588/value-of-ct-signs-and-measurements-as-a-predictor-of-pulmonary-hypertension-and-mortality-in-symptomatic-severe-aortic-valve-stenosis
#6
Matthias Eberhard, Monika Mastalerz, Jovana Pavicevic, Thomas Frauenfelder, Fabian Nietlispach, Francesco Maisano, Felix C Tanner, Thi Dan Linh Nguyen-Kim
To assess the value of computed tomography (CT) for non-invasive detection of pulmonary hypertension (PH) in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and to correlate CT measurements and signs with mortality after TAVI. 257 TAVI patients (median 84 years; 134 females) with both right heart catheterisation (RHC) and CT within 3 days were retrospectively analyzed. According to guidelines PH was defined as mean pulmonary artery pressure ≥25 mmHg in RHC. CT-signs for PH assessment were evaluated...
May 26, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28507251/stress-testing-in-asymptomatic-aortic-stenosis
#7
REVIEW
Björn Redfors, Philippe Pibarot, Linda D Gillam, Daniel Burkhoff, Jeroen J Bax, Brian R Lindman, Robert O Bonow, Patrick T O'Gara, Martin B Leon, Philippe Généreux
Aortic stenosis is 1 of the most common heart valve diseases among adults. When symptoms develop, prognosis is poor, and current guidelines recommend prompt aortic valve replacement. Depending of the severity of the aortic stenosis and the presence of concomitant heart disease and medical comorbidities, stress testing represents a reasonable strategy to help better risk stratify asymptomatic patients. The present report provides a comprehensive review of the current available data on stress testing in aortic stenosis and subsequently summarizes its potential for guiding the optimal timing of aortic valve replacement...
May 16, 2017: Circulation
https://www.readbyqxmd.com/read/28465975/review-in-translational-cardiology-micrornas-and-myocardial-fibrosis-in-aortic-valve-stenosis-a-deep-insight-on-left-ventricular-remodeling
#8
REVIEW
Fabiani Iacopo, Conte Lorenzo, Enrico Calogero, Passiatore Matteo, Pugliese Nicola Riccardo, Santini Veronica, Barletta Valentina, Liga Riccardo, Scatena Cristian, Mazzanti Chiara Maria, Di Bello Vitantonio
MicroRNAs (miRNAs) are a huge class of noncoding RNAs that regulate protein-encoding genes (degradation/inhibition of translation). miRNAs are nowadays recognized as regulators of biological processes underneath cardiovascular disorders including hypertrophy, ischemia, arrhythmias, and valvular disease. In particular, circulating miRNAs are promising biomarkers of pathology. This review gives an overview of studies in aortic valve stenosis (AS), exclusively considering myocardial remodeling processes. We searched through literature (till September 2016), all studies and reviews involving miRNAs and AS (myocardial compartment)...
October 2016: Journal of Cardiovascular Echography
https://www.readbyqxmd.com/read/28462903/long-term-outcomes-after-tavi-in-patients-with-different-types-of-aortic-stenosis-the-conundrum-of-low-flow-low-gradient-and-low-ejection-fraction
#9
Miriam Puls, Kerstin Pia Korte, Annalen Bleckmann, Mark Huenlich, Bernhard C Danner, Friedrich Schoendube, Gerd Hasenfuß, Claudius Jacobshagen, Wolfgang Schillinger
AIMS: We examined the impact of guidelines-defined subtypes of severe aortic stenosis (AS) on long-term outcomes after TAVI. METHODS AND RESULTS: 400 consecutive patients who underwent TAVI (203 transapical, 197 transfemoral) at our institution 8/2008-3/2013 were followed systematically (up to 7 years). 147 individuals suffered from NEF-HG AS (LV-EF ≥50%, high Pmean ≥40mmHg), 63 from LEF-HG AS (LV-EF <50%, high gradient), 77 from PLF-LG AS (LV-EF ≥50%, low gradient, stroke volume index (SVI) <35 ml/m²), and 81 from LEF-LG AS (LV-EF <50%, low gradient)...
May 2, 2017: EuroIntervention
https://www.readbyqxmd.com/read/28433490/evaluating-health-of-emerging-economies-through-the-eyes-of-heart-valve-disease-in%C3%A2-the%C3%A2-transcatheter-era
#10
REVIEW
Sameer Arora, Cassandra J Ramm, Amol A Bahekar, John P Vavalle
China and India are the 2 fastest growing major world economies. However, they suffer from great differences in health policies, demographics, and rates of population growth. Whereas China has seen a steep decline in rheumatic heart disease (RHD) and a rise in life expectancy, India continues to suffer from a significant burden of RHD due to insufficient distribution of economic prosperity to health care, denser population, and ineffective application of World Health Organization RHD prevention guidelines. As China faces the burden of the world's largest geriatric population, focus has shifted to calcific aortic stenosis for which it prepares by expansions in the field of transcatheter aortic valve replacement...
April 19, 2017: Global Heart
https://www.readbyqxmd.com/read/28396860/aortic-valve-replacement-for-moderate-aortic-stenosis-with-severe-calcification-and-left-ventricualr-dysfunction-a-case-report-and-review-of-the-literature
#11
Nikhil Narang, Roberto M Lang, Vladimir M Liarski, Valluvan Jeevanandam, Marion A Hofmann Bowman
A 55-year-old man with a history of erosive, seropositive rheumatoid arthritis (RA), and interstitial lung disease presented with shortness of breath. Echocardiography showed new-onset severe left ventricular (LV) dysfunction with an ejection fraction (EF) of 15% and moderately increased mean aortic valve gradient of 20 mmHg in a trileaflet aortic valve with severe sclero-calcific degeneration. Coronary angiography revealed no significant obstructive coronary disease. Invasive hemodynamic studies and dobutamine stress echocardiography were consistent with moderate aortic stenosis...
2017: Frontiers in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28391560/adjuvant-antithrombotic-therapy-in-tavr
#12
REVIEW
Ryan G O'Malley, Kenneth W Mahaffey, William F Fearon
PURPOSE OF REVIEW: Transcatheter aortic valve replacement (TAVR) has developed into an important alternative to surgical aortic valve replacement (SAVR) for patients with severe aortic stenosis (AS). Adjuvant antithrombotic therapies are commonly used during and after TAVR to decrease the risk of valve thrombosis and thromboembolic cerebrovascular events (CVEs) but consequently increase the risk of bleeding. This article reviews the past and current clinical data regarding adjuvant antithrombotic therapies in TAVR...
May 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28379981/improved-costs-and-outcomes-with-conscious-sedation-vs-general-anesthesia-in-tavr-patients-time-to-wake-up
#13
William Toppen, Daniel Johansen, Sohail Sareh, Josue Fernandez, Nancy Satou, Komal D Patel, Murray Kwon, William Suh, Olcay Aksoy, Richard J Shemin, Peyman Benharash
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has become a commonplace procedure for the treatment of aortic stenosis in higher risk surgical patients. With the high cost and steadily increasing number of patients receiving TAVR, emphasis has been placed on optimizing outcomes as well as resource utilization. Recently, studies have demonstrated the feasibility of conscious sedation in lieu of general anesthesia for TAVR. This study aimed to investigate the clinical as well as cost outcomes associated with conscious sedation in comparison to general anesthesia in TAVR...
2017: PloS One
https://www.readbyqxmd.com/read/28376985/a-clinical-review-of-surgical-vs-transcatheter-aortic-valve-replacement-in-geriatric-patients
#14
REVIEW
Laura V Tsu, Andrew J Berry, Neda Krunic, Sarah Penny, Sonny Le
OBJECTIVE: To provide an up-to-date review of the available evidence regarding management of elderly patients after transcatheter aortic valve replacement (TAVR). DATA SOURCES: A PubMed search of articles published (September 1969-December 2016) was done using a combination of the following words: aortic valve stenosis, geriatric, elderly, transcatheter aortic valve replacement, surgical aortic valve replacement, transcatheter aortic valve implantation (TAVI), and dual antiplatelet therapy...
April 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28370410/echocardiographic-assessment-of-pediatric-semilunar-valve-disease
#15
REVIEW
Massimiliano Cantinotti, Raffaele Giordano, Michele Emdin, Nadia Assanta, Maura Crocetti, Marco Marotta, Giorgio Iervasi, Leo Lopez, Shelby Kutty
We reviewed echocardiography literature for the assessment and management of semilunar valve disease in children. A search was performed within the National Library of Medicine using the keywords aortic stenosis (AS), aortic regurgitation, pulmonary stenosis (PS), and pulmonary regurgitation in children. The search was further refined adding the keywords-pediatric, neonates, echocardiographic definition, classification, evaluation. Thirty-eight studies were included. For stenotic lesions, there were sufficient consistencies between Doppler and invasive gradients (especially for PS), while other quantitative parameters used in adults showed significant limitations when applied to children...
March 31, 2017: Echocardiography
https://www.readbyqxmd.com/read/28351655/arterial-hypertension-and-aortic-valve-stenosis-shedding-light-on-a-common-liaison
#16
REVIEW
Charalampos I Liakos, Charalampos A Grassos, Dimitrios P Papadopoulos, Kyriakos S Dimitriadis, Constantinos P Tsioufis, Dimitrios Tousoulis
Arterial hypertension and aortic valve stenosis are common disorders and frequently present as concomitant diseases, especially in elderly patients. The impact of hypertension on heart haemodynamics is substantial, thus affecting the clinical presentation of any coexisting valvulopathy, especially of aortic stenosis. However, the interaction between these 2 entities is not thoroughly discussed in the European or/and American guidelines on the management of hypertension or/and valvular heart disease. The present review summarizes all available evidence on the potential interplay between hypertension and aortic valve stenosis, aiming to help physicians understand the pathophysiology and select the best diagnostic and therapeutic strategies (medical or/and interventional) for better management of these high-risk patients, taking into account the impact on outcome as well as the risk-benefit-ratio...
March 27, 2017: Hellenic Journal of Cardiology: HJC, Hellēnikē Kardiologikē Epitheōrēsē
https://www.readbyqxmd.com/read/28344612/the-polish-interventional-cardiology-tavi-survey-picts-adoption-and-practice-of-transcatheter-aortic-valve-implantation-in-poland
#17
Radosław Parma, Maciej Dąbrowski, Andrzej Ochała, Adam Witkowski, Dariusz Dudek, Zbigniew Siudak, Jacek Legutko
INTRODUCTION: Few studies have assessed the development of transcatheter aortic valve implantation (TAVI) in Poland since its introduction in 2008, and data on current TAVI activity or practice are missing. AIM: To assess the dynamics of TAVI adoption in Poland and to detect differences among Polish centres in TAVI practice and decision-making. MATERIAL AND METHODS: The Polish Interventional Cardiology TAVI Survey (PICTS) was approved by the Polish Association of Cardiovascular Interventions and presented to all 21 national TAVI centres...
2017: Postępy W Kardiologii Interwencyjnej, Advances in Interventional Cardiology
https://www.readbyqxmd.com/read/28336789/percutaneous-therapy-for-tricuspid-regurgitation-a-new-frontier-for-interventional-cardiology
#18
EDITORIAL
Samir Kapadia, Amar Krishnaswamy, E Murat Tuzcu
No abstract text is available yet for this article.
May 9, 2017: Circulation
https://www.readbyqxmd.com/read/28317478/homocysteine-and-non-cardiac-vascular-disease
#19
Niki Katsiki, Pablo Perez-Martinez, Dimitri P Mikhailidis
Elevated homocysteine (Hcy) levels are predictors of cardiovascular disease (CVD). Hyperhomocysteinemia has also been associated with total and CVD mortality. However, whether Hcy is just a marker or plays a causal role in CVD remains to be elucidated. In this narrative review, we discuss the associations between Hcy and non-cardiac vascular diseases, namely stroke, peripheral artery disease (PAD), carotid artery disease, chronic kidney disease (CKD), atherosclerotic renal artery stenosis (ARAS), abdominal aortic aneurysm (AAA) and erectile dysfunction (ED)...
March 17, 2017: Current Pharmaceutical Design
https://www.readbyqxmd.com/read/28262911/echocardiographic-predictors-of-outcome-in-acute-heart-failure-patients-in-sub-saharan-africa-insights-from-thesus-hf
#20
MULTICENTER STUDY
Mahmoud U Sani, Beth A Davison, Gad Cotter, Albertino Damasceno, Bongani M Mayosi, Okechukwu S Ogah, Charles Mondo, Anastase Dzudie, Dike B Ojji, Charles Kouam Kouam, Ahmed Suliman, Gerald Yonga, Sergine Abdou Ba, Fikru Maru, Bekele Alemayehu, Christopher Edwards, Karen Sliwa
BACKGROUND: The role of echocardiography in the risk stratification of acute heart failure (HF) is unknown. Some small studies and retrospective analyses have found little change in echocardiographic variables during admission for acute HF and some echocardiographic parameters were not found to be associated with outcomes. It is unknown which echocardiographic variables will predict outcomes in sub-Saharan African patients admitted with acute HF. Using echocardiograms, this study aimed to determine the predictors of death and re-admissions within 60 days and deaths up to 180 days in patients with acute heart failure...
January 2017: Cardiovascular Journal of Africa
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