Mitral Annular Calcification as a Challenging Concomitant Factor for Patients Underwent TAVI

INTRODUCTION: Mitral annular calcification (MAC) is commonly observed in patients with cardiovascular diseases and has been associated with adverse clinical outcomes. This study aims to clarify the prevelance and impact of MAC on peri-procedural, in-hospital, and long-term outcomes in high-surgical-risk patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). METHODS: 403 patients underwent TAVI for severe AS was retrospectively evaluated. MAC was identified on transthoracic-echocardiography and confirmed on computed-tomography in 45.4% of patients. Clinical outcomes, including in-hospital mortality and two-year follow-up mortality, were evaluated, and potential predictors of MAC and mortality were analyzed using logistic and Cox regression models. RESULTS: MAC was more prevalent in older, female patients with atrial fibrillation. Although the presence of MAC did not correlate with increased in-hospital (unadjOR: 1.77, 95% CI (0.88-3.54), p=0.106) or long-term mortality (unadjOR: 0.73, 95% CI (0.40-1.33), p=0.311), it was associated with a higher requirement for post-TAVI permanent pacemaker implantation (PPI) and moderate-to-severe paravalvular aortic regurgitation (PVAR). Multivariate analysis revealed left ventricular ejection fraction (adjHR: 0.97, 95% CI (0.94-0.99),p=0.015), mean transvalvular gradient, (adjHR: 1.02, 95% CI (1.00-1.04), p=0.0.25) systolic pulmonary artery pressure (adjHR: 1.04, 95% CI (1.01-1.0.6), p=0.001) and severe PVAR (adjHR: 3.16, 95% CI (1.25-7.96), p=0.015) as independent predictors of long-term mortality. DISCUSSION AND CONCLUSION: In patients with severe AS undergoing TAVI, MAC is a marker of complex cardiac pathology but does not independently predict mortality. However, its presence may increase the need for PPI and the incidence of PVAR, which warrants attention in postoperative management and follow-up

May High Serum Triglyceride Levels be a Predictor of New Silent Ischemic Lesions Detected with DW-MRI After Carotid Stenting?

INTRODUCTION: Silent ischemic lesions(CIL) frequently occur after carotid artery stenting(CAS) and are associated with poor long-term prognosis. The effect of blood triglyceride (TG) level on CIL after CAS is yet clear. We investigated the effect of serum TG level on post-procedure CIL in patients undergoing CAS. METHODS: 57 patients who underwent CAS were included in the study, and diffusion-weighted magnetic resonance imaging was conducted before and after CAS. The primary endpoint was new CILs after CAS. The effects of pre-procedural TG, total cholesterol, HDL, and LDL levels on the primary endpoint were investigated. RESULTS: Of the patients 46 (80.7%) were male, median age was 69(60-73) years, and 27 (47.3%) were symptomatic. After the procedure, ipsilateral new CILs were detected in 28 (49.1%) patients. NASCET stenosis %, being symptomatic and using aspirin before the procedure were associated with the presence of new ipsilateral CILs. In multivariate logistic regression analysis, pre-procedural TG level was the only independent predictor of ipsilateral new CILs after the procedure. DISCUSSION AND CONCLUSION: Our study reveals that high TG level is an independent risk factor for new CILs after CAS. Since CILs increase the risk for future ischemic events, TG as a simple, inexpensive, effective, and modifiable marker, can provide information for intense medical treatment, early intervention, and the prognosis

Kardiyovasküler İşlemlerde Görüntüleme

Doğum sırasındaki fizyolojik değişimlerle kapanması öngörülen foramen ovale erişkin populasyonun yaklaşık %75’inde tamamen kapanmış olarak izlenirken, %25’inde ise kapanmaz ve patent foramen ovale (PFO) olarak varlığını sürdürür.1 PFO, serebrovasküler olay dahil birçok patoloji (auralı migren, dalgıçlarda dekompresyon hastalığı vs.) ile ilişkilendirilmiştir. İskemik inmelerin %25’inde standart tanısal değerlendirmeye rağmen bir neden bulunamaz ve bu grup kriptojenik inme olarak adlandırılır. PFO ve kriptojenik inme arasındaki patofizyolojik ilişki paradoksal embolizm, PFO içerisinde meydana gelen trombüs, sol atriyal disfonksiyon ve atriyal aritmiler gibi nedenlere bağlı olabilir. Epidemiyolik veriler ve klinik gözlemsel çalışmalar, PFO kapatılmasıyla inme rekürrenslerinin azaldığını gösteren randomize kontrollü çalışmalar tarafından kuvvetle desteklenmektedir.2 PFO’nun tanısında ve perkütan tedavisinde çoklu görüntüleme yöntemleri önem arz etmektedir