140 Impact of TAVI with the Edwards-SAPIEN endoprosthesis on mitral regurgitation: results of a serial echocardiography assessment

PurposeThe impact of transcatheter aortic valve implantation (TAVI) on mitral regurgitation (MR) is controversial. Two recent publications have reported improvement in MR grades following implantation of the Edwards-SAPIEN endoprosthesis. These findings were not replicated with the Core-Valve. The time course of improvement in MR grades with the Edwards-SAPIEN valve has not been described on an individual patient basis and the potential mechanisms of benefit are unclear. The aim of this study was to assess the acute and intermediate changes in MR severity after TAVI with the Edwards-SAPIEN endoprosthesis.MethodsEchocardiography was performed in 22 consecutive patients before and after treatment, and at 1 month follow-up. MR was assessed by color flow mapping and was graded as none, mild, moderate, or severe. MR was defined as organic or functional.ResultsThe aortic valve area increased from pretreatment 0.72cm2 to post-treatment 1.87cm2 and postdischarge 1.81cm2 (P<0.0001). Before intervention MR was present in 73% of the patients. It was mild, moderate, or severe in 36% (n=8), 32% (n=7), and 4% (n=1) respectively. MR was defined as organic in 6 patients (27%) and functional in 10 patients (45%). Compared to baseline, MR grades improved by 1 month (p for trend=0.01). This benefit was secondary to a reduction in regurgitation grades in 50% of patients with an MR at baseline (n=6), while no worsening was observed in the other patients with an MR (n=6) and no occurrence of MR was observed in patients without MR (n=6). A trend for a greater improvement in MR grade was observed in patients with functional MR (n=7, − 1.00) compared to those with an organic MR (n=5, − 0.294; p=0.10).ConclusionIn consecutive patients with a successful implantation of an Edwards-SAPIEN valve a significant improvement in MR was observed. This benefit was secondary to an improvement in 50% of patients with an MR and no worsening in the others

Aldosterone, atherosclerosis and vascular events in patients with stable coronary artery disease

AbstractBackground and aimsPlasma aldosterone has been associated with all-cause and cardiovascular mortality in high-risk cardiovascular populations, including patients with heart failure, myocardial infarction and high-risk coronary artery disease (CAD) patients. In the present study, we evaluated the association of plasma aldosterone levels with vascular events in a large prospective cohort of stable CAD patients recruited in an outpatient setting. Moreover, we investigated the relationship between aldosterone and atherosclerotic burden.Methods and resultsBaseline plasma aldosterone levels were measured in 2699 subjects with CAD (mean age 60±10years, 82% male). During a median follow-up of 4.7years, 308 (11%) patients died, of which 203 were from a vascular cause. Vascular endpoints of myocardial infarction, ischemic stroke or vascular death occurred in 355 (13%) patients. Multivariable Cox regression analysis was performed, adjusting for multiple confounders. Aldosterone (median 96pg/mL, interquartile range 70–138pg/mL, normal range 58–362pg/mL) was independently associated with major vascular events (hazard ratio (HR) 1.56, 95% confidence interval (CI) 1.13–2.15) and vascular mortality (HR 1.95, 95% CI 1.27–3.00). By multivariable regression analysis, aldosterone was also associated with the presence of atherosclerosis in additional vascular territories (cerebrovascular disease and/or peripheral artery disease) (p=0.026).ConclusionsIn patients with stable coronary artery disease, plasma aldosterone is independently associated with the risk of major vascular events and vascular mortality and with atherosclerotic burden

Atherosclerotic cardiovascular disease - the renin angiotensin aldosterone system and inflammatory cells as potential sources of biomarkers

Even with the greatly improved treatment options, cardiovascular disease is still an important cause of death and causes a huge disease burden worldwide. Many patients survive their first atherosclerotic disease manifestation and are subsequently at increased risk for complications or secondary events. To be able to identify those patients particularly at risk among apparently stable patients, could further optimize cardiovascular treatment. Biomarkers could be useful in this process. In this thesis we investigated the role of the renin angiotensin aldosterone system in the progression of atherosclerosis and the potential of measuring blood levels of these hormones as possible biomarker for cardiovascular disease prediction. Furthermore, we related the reactivity of circulating (white) blood cells, crucial for the activation and continuation of atherosclerosis, to characteristics of coronary artery disease patients

Atherosclerotic cardiovascular disease - the renin angiotensin aldosterone system and inflammatory cells as potential sources of biomarkers

Even with the greatly improved treatment options, cardiovascular disease is still an important cause of death and causes a huge disease burden worldwide. Many patients survive their first atherosclerotic disease manifestation and are subsequently at increased risk for complications or secondary events. To be able to identify those patients particularly at risk among apparently stable patients, could further optimize cardiovascular treatment. Biomarkers could be useful in this process. In this thesis we investigated the role of the renin angiotensin aldosterone system in the progression of atherosclerosis and the potential of measuring blood levels of these hormones as possible biomarker for cardiovascular disease prediction. Furthermore, we related the reactivity of circulating (white) blood cells, crucial for the activation and continuation of atherosclerosis, to characteristics of coronary artery disease patients

Early math learning with tablet pc's: the role of action

In the present study an experiment was conducted in which small groups of 4-6 year old children played with a simple numerical board game on a tablet computer for four 15-minute sessions. Children’s hand and finger movements were manipulated during instruction in three different conditions. In the first condition, children could freely jump between numbers on the number line. In a second group, children could only point to where a particular number had to be located; jumping with hands and fingers was not encouraged. Finally, a third group played non-mathematical games, such as puzzling and drawing. Results revealed that the linearity of number line estimations and the knowledge of numerical magnitude in a pretest and a posttest significantly increased in both groups that received a math intervention. However, only children who used maximal action showed the highest accuracy in their estimations. These results indicate that for early math learning, the way action properties are represented in digital tools play a causal role in learning. Results were discussed in the context of embodied cognition and action.status: publishe

The relationship between fractional flow reserve, platelet reactivity and platelet leukocyte complexes in stable coronary artery disease.

BACKGROUND: The presence of stenoses that significantly impair blood flow and cause myocardial ischemia negatively affects prognosis of patients with stable coronary artery disease. Altered platelet reactivity has been associated with impaired prognosis of stable coronary artery disease. Platelets are activated and form complexes with leukocytes in response to microshear gradients caused by friction forces on the arterial wall or flow separation. We hypothesized that the presence of significantly flow-limiting stenoses is associated with altered platelet reactivity and formation of platelet-leukocyte complexes. METHODS: One hundred patients with stable angina were studied. Hemodynamic significance of all coronary stenoses was assessed with Fractional Flow Reserve (FFR). Patients were classified FFR-positive (at least one lesion with FFR≤0.75) or FFR-negative (all lesions FFR>0.80). Whole blood samples were stimulated with increasing concentrations of ADP, TRAP, CRP and Iloprost with substimulatory ADP. Expression of P-selectin as platelet activation marker and platelet-leukocyte complexes were measured by flowcytometry. Patients were stratified on clopidogrel use. FFR positive and negative patient groups were compared on platelet reactivity and platelet-leukocyte complexes. RESULTS: Platelet reactivity between FFR-positive patients and FFR-negative patients did not differ. A significantly lower percentage of circulating platelet-neutrophil complexes in FFR-positive patients and a similar non-significant decrease in percentage of circulating platelet-monocyte complexes in FFR-positive patients was observed. CONCLUSION: The presence of hemodynamically significant coronary stenoses does not alter platelet reactivity but is associated with reduced platelet-neutrophil complexes in peripheral blood of patients with stable coronary artery disease

Measuring and targeting aldosterone and renin in atherosclerosis: A review of clinical data

Our understanding of the development and progression of atherosclerosis has increased substantially over the past decades. A significant role for the renin-angiotensin-aldosterone system (RAAS) in this process has gained appreciation in recent years. Preclinical and clinical studies have associated components of the RAAS with various cardiovascular disease conditions. Classically known for its contribution to hypertension, dysregulation of the system is now also believed to promote vascular inflammation, fibrosis, remodeling, and endothelial dysfunction, all intimately related to atherosclerosis. The reduction in cardiovascular mortality and morbidity, as seen with the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, supports the concept that RAAS is involved in the pathogenesis of atherosclerotic disease. However, the underlying molecular mechanisms of the pathophysiology remain to be completely understood. Evidence points toward additional benefit from therapeutic approaches aiming at more complete inhibition of the system and the possible utility of renin or aldosterone in the prediction of cardiovascular outcome. This review will summarize the current knowledge from clinical studies regarding the presumptive role of renin and aldosterone in the prediction and management of patients with atherosclerosis. For this purpose, a literature search was performed, focusing on available clinical data regarding renin or aldosterone and cardiovascular outcome. (Am Heart J 2011;162:585-96.

Maximal expression of P-selectin after stimulation with ADP (A), TRAP (B), CRP (C) and Iloprost with substimulatory ADP (D). Lines indicate median values with interquartile range.

<p>Maximal expression of P-selectin after stimulation with ADP (A), TRAP (B), CRP (C) and Iloprost with substimulatory ADP (D). Lines indicate median values with interquartile range.</p