Incidence of prosthesis-patient mismatch in patients receiving mitral Biocor® porcine prosthetic valves

Background: The aim was to assess the incidence of prosthesis-patient mismatch (PPM) after mitral valve replacement (MVR) in patients receiving Biocor® porcine or mechanical valves, and to evaluate the effect of PPM on long-term survival. Methods: All patients undergoing MVR between 2009 and 2013 received either mechanical or bioprosthetic valves (Biocor® porcine). PPM was defined as severe when the indexed effective ori­fice area was < 0.9 cm2/m2, moderate between 0.9 cm2/m2 and 1.2 cm2/m2 or absent > 1.2 cm2/m2. The primary endpoint was all-cause long-term mortality. Results: Among a total of 136 MVR, PPM was severe in 27%, moderate in 44% and absent in 29% of patients. Implanted valves were 57% mechanical and 43% bioprosthetic. Only 3% of patients with mechanical valves had severe PPM vs. 59% with bioprostheses (p < 0.0001). Sixty-month survival with severe mismatch was 0.559 (SE 0.149) and with no mismatch 0.895 (SE 0.058) (p = 0.043). Survival of patients suffering from severe mismatch, or moderate mismatch with pulmonary hypertension (PH) was 0.749 (SE 0.101); while for patients with no mismatch or with moderate mismatch without PH, survival was 0.951 (SE 0.028) (p = 0.016). Conclusions: About one-fourth of patients had severe PPM and almost all of them had received a bioprosthesis. Sixty-month survival was significantly lower in patients with severe mismatch, or moderate mismatch with PH. Specifically, when a bioprothesis is chosen and while further evidence on the impact of PPM on clinical outcomes appears, surgeons are recommended to follow a preoperative strategy to implant a mitral prosthesis of adequate size in order to prevent PP

Left ventricular filling patterns in patients with previous myocardial infarction measured by conventional cine cardiac magnetic resonance

To explore left ventricular filling patterns in patients with a history of previous myocardial infarction (MI) using time-volume curves obtained from conventional cine-cardiac magnetic resonance (CMR) examinations. Consecutive patients with a history of previous MI who were referred for CMR evaluation constituted the study population, and a consecutive cohort of sex and age-matched patients with a normal CMR constituted the control group. The following CMR diastolic parameters were evaluated: peak filling rate (PFR), time to PFR (tPFR), normalised PFR adjusted for diastolic volume at PFR (nPFR), and percent RR interval between end systole and PFR. Fifty patients were included, 25 with a history of previous MI and 25 control. The mean age was 59.6 ± 13.9 years and 27 (54%) were male. Within the control group, age was significantly related to PFR (r = -0.53, p = 0.007), whereas among patients with previous MI age was not related to PFR (r = -0.16, p = 0.44). PFR (252.4 ± 96.7 ml/s vs. 316.0 ± 126.4 ml/s, p = 0.05) and nPFR (1.6 ± 1.2 vs. 3.3 ± 1.5, p<0.001) were significantly lower in patients with previous MI, whereas no significant differences were detected regarding tPFR (143.0 ± 67.5 ms vs. 176.2 ± 83.9 ms, p = 0.13) and % RR to PFR (18.1 ± 9.7% vs. 20.6 ± 12.2%, p = 0.44). MI size was related to LV ejection fraction (r = -0.76, p<0.001), PFR (r = -0.40, p = 0.004), nPFR (r = -0.52, p<0.001) and left atrium area (r = 0.40, p = 0.004). Patients at the lowest PFR quartile (<200 ml/s) showed a larger MI size (Q1 26.5 ± 25.5%, Q2 15.5 ± 20.9%, Q3 6.3 ± 12.4%, Q4 8.8 ± 14.1%, p = 0.04). At multivariate analysis, MI size was the only independent predictor of the lowestPFR (p = 0.017). Infarct size has an impact on LV filling profiles, as assessed by conventional cine CMR without additional specific pulse sequences.Fil: Rodriguez Granillo, Gaston Alfredo. Sanatorio "Otamendi y Miroli S.A.". Servicio de Diagnóstico por Imágenes. Departamento de Imágenes en Cardiología. Centro de Investigaciones Cardiovasculares; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mejía Campillo, Marlon. No especifíca;Fil: Rosales, Miguel A.. Sanatorio "Otamendi y Miroli S.A.". Servicio de Diagnóstico por Imágenes. Departamento de Imágenes en Cardiología. Centro de Investigaciones Cardiovasculares; ArgentinaFil: Bolzán, Gabriel. No especifíca;Fil: Ingino, Carlos. No especifíca;Fil: López, Federico. No especifíca;Fil: Degrossi, Elina. Sanatorio "Otamendi y Miroli S. A."; ArgentinaFil: Lylyk, Pedro. Sanatorio "Otamendi y Miroli S. A."; Argentin

Common variants in Alzheimer’s disease and risk stratification by polygenic risk scores

Funder: Funder: Fundación bancaria ‘La Caixa’ Number: LCF/PR/PR16/51110003 Funder: Grifols SA Number: LCF/PR/PR16/51110003 Funder: European Union/EFPIA Innovative Medicines Initiative Joint Number: 115975 Funder: JPco-fuND FP-829-029 Number: 733051061Genetic discoveries of Alzheimer's disease are the drivers of our understanding, and together with polygenetic risk stratification can contribute towards planning of feasible and efficient preventive and curative clinical trials. We first perform a large genetic association study by merging all available case-control datasets and by-proxy study results (discovery n = 409,435 and validation size n = 58,190). Here, we add six variants associated with Alzheimer's disease risk (near APP, CHRNE, PRKD3/NDUFAF7, PLCG2 and two exonic variants in the SHARPIN gene). Assessment of the polygenic risk score and stratifying by APOE reveal a 4 to 5.5 years difference in median age at onset of Alzheimer's disease patients in APOE ɛ4 carriers. Because of this study, the underlying mechanisms of APP can be studied to refine the amyloid cascade and the polygenic risk score provides a tool to select individuals at high risk of Alzheimer's disease

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Myocardial perfusion imaging and infarct characterization using multidetector cardiac computed tomography

Until recently, computed tomography coronary angiography was restricted to the anatomical assessment of coronary stenosis, whereas the functional significance of coronary lesions remained outside of its scope. Nevertheless, the kinetics of iodinated contrast is similar to gadolinium-diethylenetriamine pentaacetic acid used in contrast-enhanced magnetic resonance imaging, allowing assessment of myocardial perfusion and viability by cardiac computed tomography

Transseptal Approach for Mitral Valve Replacement

Background Although the access to the mitral valve through transseptal approach is technically more demanding, it allows a better exposure of its leaflets and subvalvular apparatus, specially, in small atria, in reoperations or when it is combined with tricuspid valve treatment.ObjectiveTo evaluate technical difficulties and complications associated with the transseptal approach for mitral valve replacement.Material and MethodsBetween 2006 and 2009, 62 consecutive patients who underwent mitral valve replacement alone or associated with myocardial revascularization through a transseptal approach extended to the left atrial roof were included. Technical difficulties and morbimortality of the procedure were evaluated.ResultsIn all patients, the transseptal approach could be done with no technical difficulties with an appropriate exposure of the mitral valve. The rate of conduction disorders in the postoperative period was 9.7% and the need of a permanent pacemaker implantation was 4.8%. From patients who had previous atrial fibrillation (n = 18), 83.3% recovered high sinus or junctional rhythm during the postoperative period.ConclusionsThe transseptal approach extended to the left atrial roof constituted an access alternative to the mitral valve, with an exposure better than the traditional approach, at the expense of a more demanding technique. Surgical times, mortality and complications were similar to those which belong to the conventional technique, except for a probable greater incidence of junctional rhythm and AV block. Possibly, there is certain benefit in the recovery of sinus rhythm in patients with previous chronic atrial fibrillation.REV ARGENT CARDIOL 2010;78:400-404.    Introducción A pesar de que es técnicamente más demandante, el acceso a la válvula mitral por vía transeptal permite una exposición mayor de sus valvas y del aparato subvalvular, en especial en aurículas pequeñas, en reoperaciones o cuando se combina con el tratamiento de la válvula tricuspídea. Objetivos Evaluar las dificultades técnicas y las complicaciones asociadas con el abordaje transeptal para el reemplazo valvular mitral.Material y métodos Entre 2006 y 2009 se incluyeron 62 pacientes consecutivos a los que se les realizó reemplazo valvular mitral solo o asociado con revascularización miocárdica a través de un abordaje transeptal extendido al techo de la aurícula izquierda. Se evaluaron las dificultades técnicas y la morbimortalidad del procedimiento

Endovascular Treatment of Aortic Aneurysm Rupture

Introduction: Endovascular repair of aortic aneurysm emerges as a less invasive option for patients with high operative risk, constituting a feasible and safe treatment due to technical advances. For this reason, our institution considers endovascular treatment as the “first line therapy” in patients with very high operative risk, as those with ruptured abdominal aortic aneurysm.Objective: The goal of this study is to report the experience with our surgical treatment protocol of patients with ruptured abdominal aortic aneurysm.Methods: Seventeen patients were treated based on the protocol “endovascular approach first”. The population was classified according to systolic blood pressure (SBP) at admission in: hemodynamically stable (SBP ≥ 80 mm Hg) or hemodynamically unstable (SBP 10 minutes). The outcomes included mortality at 30 days and during follow-up and complications after the procedure. The statistical analysis was performed using Fisher’s test.Results: Mortality at 30 days was 23.5%. Technical success was achieved in 94.1% of patients. Despite both groups had similar comorbidities, mortality in stable patients, operated on under local anesthesia, was 7.7% (p 10 minutos). Los resultados incluyeron mortalidad a 30 días, en el seguimiento y complicaciones post-procedimiento. El análisis estadístico se realizó mediante test de Fisher. Resultados: Los mortalidad a 30 días fue 23,5%. El éxito técnico se logró en 94,1%. Si bien, ambos grupos tuvieron comorbilidades similares, los pacientes estables, operados bajo anestesia local, presentaron una tasa de mortalidad del 7,7% (p<0.02). Conclusión: El tratamiento endovascular del AAA-r, siguiendo un estricto manejo clínico quirúrgico, es factible y seguro, especialmente en pacientes estables bajo anestesia local.

In-hospital Outcomes of Surgical Aortic Valve Replacement: the Benchmark for Transcatheter Valve Implant

Objective: The aim of this study was to analyze the current in-hospital outcomes of aortic valve replacement (AVR) surgery in order to serve as a benchmark for comparing the local results of transcatheter aortic valve implantation (TAVI). Methods: We retrospectively analyzed the in-hospital outcomes of 422 patients undergoing isolated AVR between 2012 and 2017 in our institutions associated with the University of Buenos Aires. Results: Overall in-hospital mortality was 3.6%, and 3.8% at 30 days; while the in-hospital and 30-days, mortality rate of 71 patients older than 80 years was 4.2%. In the whole series, in-hospital mortality in the low-risk group (EuroSCORE II <4%) was 2.2%, and in the moderate risk group (EuroSCORE II between 4% and 7%) it was 5.0%. Conclusions: This updated information on the local outcomes of AVR surgery stratified by risk could serve as a standard for comparing TAVI results.Objetivo: El objetivo de este estudio fue analizar los resultados hospitalarios actuales de la cirugía del reemplazo valvular aórtico (RVA) a fin de que sirvan como patrón estandarizado para comparar los resultados locales del implante valvular aórtico transcatéter (TAVI). Material y métodos: Se analizaron en forma retrospectiva los resultados hospitalarios de 422 pacientes sometidos a RVA aislado entre 2012 y 2017 en las instituciones asociadas a la Universidad de Buenos Aires. Resultados: La mortalidad hospitalaria global fue 3,6%, y 3,8% a los 30 días, mientras que la mortalidad hospitalaria y a 30 días de 71 pacientes mayores de 80 años, fue 4,2%. En toda la serie la mortalidad hospitalaria en el grupo de bajo riesgo (EuroSCORE II < 4%) fue 2,2%, y en el de riesgo moderado (EuroSCORE II entre 4% y 7%) fue 5,0%. Conclusiones: Esta información actualizada sobre los resultados locales de la cirugía de RVA en todos los estratos de riesgo podría servir como punto de referencia para comparar el TAVI