Degenerative heart valve disease

Degenerativne bolesti srčanih zalistaka predstavljaju sve veći zdravstveni problem. Procjenjuje se da u industrijski razvijenim zemljama 2,5% populacije boluje od bolesti srčanih zalistaka. Degenerativne bolesti su vodeći uzrok i zbog toga prevalencija bolesti zalistaka raste s dobi. Degenerativne bolesti srčanih zalistaka su heterogena skupina bolesti s različitim patofiziološkim mehanizmima te makroskopskim i histološkim obilježjima. Na aortnom zalistku degenerativne se promjene očituju kao aortoskleroza koja može napredovati u degenerativnu kalcificiranu aortnu stenozu. To je aktivni proces koji uključuje oštećenje endotela, upalu, lipidnu infitraciju i kalcifikaciju. Prevalencija aortne stenoze je 0,4% u općoj populaciji, a 2,8% u populaciji starijih od 75 godina. Kad se razviju simptomi aortne stenoze, prognoza bolesti je loša, bez kirurškog liječenja je smrtnost 50% u godinu dana. TAVI je znatno poboljšao preživljenje i kvalitetu života neoperabilnih bolesnika. Mitralni zalistak zahvaćen degenerativnim promjenama je miksomatozno promijenjen. Dolazi do zadebljanja zalistka i korda zbog odlaganja glikozaminoglikana što rezultira produljenjem i pucanjem korda, širenjem mitralnog prstena te prolapsom mitralnog zalistka i posljedično mitralnom insuficijencijom. Razvojem teške mitralne insuficijencije 90% bolesnika će umrijeti ili biti podvrgnuto operaciji mitralnog zalistka tijekom 10 godina. U dijagnostici bolesti srčanih zalistaka važnu ulogu ima ehokardiografija. Iako su bolesti srčanih zalistaka sve veći zdravstveni problem, nema farmakološke terapije koja bi usporila napredak bolesti te je jedina terapija kirurški popravak ili zamjena zalistka.Degenerative heart valve disease is an emerging health problem with broad consequences. The prevalence of valvular heart disease is estimated at 2.5% in industrialized nations. The increased prevalence of valvular disease with age reflects the predominance of degenerative etiologies. Although widely used, the term “degenerative valve disease” encompasses heterogeneous lesions with regard to pathophysiological, macroscopic, and histological involvement of the valves. Calcific aortic valve disease is a form of degenerative valve disease. Its early stage is called aortic sclerosis and it may progress to the later stage – aortic stenosis. Calcific aortic valve disease is an active biological process marked by basement membrane disruption, inflammatory cell infiltration, lipid deposition, and calcification. The prevalence of aortic stenosis is estemated at 0.4% but it increases to 2.8% after 75 years of age. Symptomatic aortic stenosis has a poor outcome, inoperable patients have a mortality of 50% at 1 year. TAVI is associated with a significant reduction in symptoms and mortality in inoperable patients. Degenerative mitral valve disease is a pathologic condition in which the mitral valve leaflets and chordae are thickened due to abnormal accumulations of glycosaminoglycans. Degenerative lesions, such as chordal elongation, chordal rupture, leaflet tissue expansion, and annular dilation typically result in mitral regurgitation due to leaflet prolapse. At 10 years, 90% of patients with a severe mitral regurgitation had either died or undergone surgical repair. Echocardiography is the gold standard for diagnosis of degenerative valve disease. Despite the increasing prevalence of degenerative valve disease, there are no medical therapies to halt or delay disease progression, and the only available treatment is valve replacement or repair, to which not all patients are suited

Degenerative heart valve disease

Degenerativne bolesti srčanih zalistaka predstavljaju sve veći zdravstveni problem. Procjenjuje se da u industrijski razvijenim zemljama 2,5% populacije boluje od bolesti srčanih zalistaka. Degenerativne bolesti su vodeći uzrok i zbog toga prevalencija bolesti zalistaka raste s dobi. Degenerativne bolesti srčanih zalistaka su heterogena skupina bolesti s različitim patofiziološkim mehanizmima te makroskopskim i histološkim obilježjima. Na aortnom zalistku degenerativne se promjene očituju kao aortoskleroza koja može napredovati u degenerativnu kalcificiranu aortnu stenozu. To je aktivni proces koji uključuje oštećenje endotela, upalu, lipidnu infitraciju i kalcifikaciju. Prevalencija aortne stenoze je 0,4% u općoj populaciji, a 2,8% u populaciji starijih od 75 godina. Kad se razviju simptomi aortne stenoze, prognoza bolesti je loša, bez kirurškog liječenja je smrtnost 50% u godinu dana. TAVI je znatno poboljšao preživljenje i kvalitetu života neoperabilnih bolesnika. Mitralni zalistak zahvaćen degenerativnim promjenama je miksomatozno promijenjen. Dolazi do zadebljanja zalistka i korda zbog odlaganja glikozaminoglikana što rezultira produljenjem i pucanjem korda, širenjem mitralnog prstena te prolapsom mitralnog zalistka i posljedično mitralnom insuficijencijom. Razvojem teške mitralne insuficijencije 90% bolesnika će umrijeti ili biti podvrgnuto operaciji mitralnog zalistka tijekom 10 godina. U dijagnostici bolesti srčanih zalistaka važnu ulogu ima ehokardiografija. Iako su bolesti srčanih zalistaka sve veći zdravstveni problem, nema farmakološke terapije koja bi usporila napredak bolesti te je jedina terapija kirurški popravak ili zamjena zalistka.Degenerative heart valve disease is an emerging health problem with broad consequences. The prevalence of valvular heart disease is estimated at 2.5% in industrialized nations. The increased prevalence of valvular disease with age reflects the predominance of degenerative etiologies. Although widely used, the term “degenerative valve disease” encompasses heterogeneous lesions with regard to pathophysiological, macroscopic, and histological involvement of the valves. Calcific aortic valve disease is a form of degenerative valve disease. Its early stage is called aortic sclerosis and it may progress to the later stage – aortic stenosis. Calcific aortic valve disease is an active biological process marked by basement membrane disruption, inflammatory cell infiltration, lipid deposition, and calcification. The prevalence of aortic stenosis is estemated at 0.4% but it increases to 2.8% after 75 years of age. Symptomatic aortic stenosis has a poor outcome, inoperable patients have a mortality of 50% at 1 year. TAVI is associated with a significant reduction in symptoms and mortality in inoperable patients. Degenerative mitral valve disease is a pathologic condition in which the mitral valve leaflets and chordae are thickened due to abnormal accumulations of glycosaminoglycans. Degenerative lesions, such as chordal elongation, chordal rupture, leaflet tissue expansion, and annular dilation typically result in mitral regurgitation due to leaflet prolapse. At 10 years, 90% of patients with a severe mitral regurgitation had either died or undergone surgical repair. Echocardiography is the gold standard for diagnosis of degenerative valve disease. Despite the increasing prevalence of degenerative valve disease, there are no medical therapies to halt or delay disease progression, and the only available treatment is valve replacement or repair, to which not all patients are suited

Assessment of platelet function during transcatheter aortic valve implantation

Introduction: Recent studies described changes in platelet reactivity (PR) in days following transcatheter aortic valve implantation (TAVI).1 However, precise time course and duration of these changes have not been fully investigated. Aim of the study was to investigate PR changes during and after TAVI. Patients and Methods: Study included 40 consecutive patients with severe and symptomatic aortic stenosis undergoing transfemoral TAVI procedure. Patients’ clinical characteristics were collected from medical records. All patients who did not have chronic dual antiplatelet therapy received loading dose of aspirin and clopidogrel (300 mg) one day before the procedure followed by their standard maintenance doses. PR was measured in seven time points: before start of procedure (T1), after heparin administration (T2), 10 minutes after valve implantation (T3), at the end of procedure (T4), and on 3rd, 6th and 30th postoperative day (T5-7). PR was measured using impedance aggregometer in response to three platelet aggregation agonists using ASPI, ADP and TRAP test. Results: Mean patient age was 82.7 years with majority of patients being male 60% (N=25). All patients underwent successful transfemoral TAVI procedure using either self-expandable (N=25, 62.5 %) or balloon expandable valve. Mean postimplantation gradient was 9.97±4.44 mmHg. More than mild paravalvular regurgitation persisted in 2 (5%) patients. Values of PR in each tested time point are presented in Table 1. There was no significant difference in PR between T1 and T2. After the valve implantation significant reduction of PR in all 3 tests was observed. PR continued to decline on consecutive measurements, with lowest values reached on 3rd post-TAVI day (T5). On T6, value of ASPI test were not significantly different to the ones measured on T1, while values of ADP and TRAP test remained significantly lower. By 30th post TAVI day PR values reached levels not significantly different compared to T1. Conclusions: Presented results indicate that transfemoral TAVI induces transient decrease in PR regardless of the platelet activation pathway. Significant reduction of PR is observed 10 minutes after valve implantation with continuous decrease until 3rd day post-TAVI after which it is gradually increasing to pre-TAVI values

Long-term outcomes in patients with aortic regurgitation in the Zagreb University Hospital Centre

Introduction: Age and gender may influence the incidence of aortic regurgitation (AR) and its severity. Significant aortic regurgitation (sAR) is often treated surgically especially when symptomatic or when systolic function declines.1 The aim of this study was to evaluate the outcomes in patients with sAR according to treatment strategy, age and gender differences in our study population. Patients and Methods: In this retrospective descriptive single-centre study an overall of 107 patients (22 female, 85 male) with significant AR in the last 5 years were analyzed. Patients were treated according to valid recommendations, surgically (SUR) or conservatively (CON), except for 5 patients who refused surgery. Baseline and follow up (FU) data (AR severity, left ventricle ejection fraction (LVEF), ascending aorta diameter (AA), treatment, comorbidities and major adverse cardiovascular events (MACE) during FU), from documented medical history and digital imaging data were collected and analysed. Additional sub-analysis was performed according to sex and age differences (above vs. below the age of 50). For statistical analysis a Chi-Square test was used. Results: In the overall study population, during an average FU of 3.8 years, 16 patients (15%) developed MACE with no statistically significant difference between gender (p=0.846). Forty-six (43%) patients were surgically treated (87% male, 13% female) and 61 (54%) conservatively. LVEF did not worsen in FU period (54.1%, vs. 53.8%). In SUR, median age was 54 years, severe AR was present in 93%, incidence of MACE was 21.7%, 80.4% patients were symptomatic and 14.5% had dilatation of AA more than 50 mm. In CON, MACE was present in 9.8% during FU (p=0.87), median age was 64 years. Moderate AR (48% vs 6.5%) and AA from 40-49 mm (80 vs 35%) was present more frequently as well as arterial hypertension (82 vs 70%) and chronic renal disease (23.2 vs 16.6%). The incidence of MACE was not found to be agerelated (p=0.426). Conclusion: In patients with sAR treated by either surgery or medication therapy only, during 3.8 years of FU, LVEF remained unchanged, while incidence of MACE was not found to be related to treatment strategy nor gender. In surgically treated patients, as expected, AR was more severe and AA was more dilated, while neither age nor gender had an impact on the incidence of MACE