Valvular Heart Disease in Patients with Chronic Kidney Disease

Valvular heart disease (VHD) is highly prevalent in patients with chronic kidney disease (CKD) from the early stages to end-stage renal disease (ESRD). Aortic and mitral valves are the most frequently affected, leading to aortic valve and/or mitral annular calcification, which, in turn, causes either valve stenosis or regurgitation at an accelerated rate compared with the general population. Tricuspid regurgitation is also prevalent in CKD and ESRD, and haemodialysis patients are at an increasingly high risk of infective endocarditis. As for pathophysiology, several mechanisms causing VHD in CKD have been proposed, highlighting the complexity of the process. Echocardiography constitutes the gold standard for the assessment of VHD in CKD/ESRD patients, despite the progress of other imaging modalities. With regard to treatment, the existing 2017 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on the management of VHD addressing patients with normal kidney function are also applied to patients with CKD/ESRD

Risk of atrial fibrillation in athletes: a systematic review and meta-analysis.

A systematic review, meta-analysis and meta-regression were performed on selected studies to investigate the incidence of atrial fibrillation (AF) among athletes compared with non-athlete controls. Meta-analysis with heterogeneity analysis and subsequent meta-regression to model covariates were performed. The mode of exercise (endurance and mixed sports) and age were the a priori determined covariates. PubMed, MEDLINE, Science Direct, SPORTDiscus and the Cochrane library were searched. Research articles published after 1990 and before 2 December 2020 were included if they reported the number of AF cases in athletes with non-athlete (physically active or inactive) control groups, were case-control or cohort studies and if data allowed calculation of OR. The risk of developing AF was significantly higher in athletes than in non-athlete controls (OR: 2.46; 95% CI 1.73 to 3.51; p<0.001, Z=4.97). Mode of exercise and risk of AF were moderately correlated (B=0.1259, p=0.0193), with mixed sport conferring a greater risk of AF than endurance sport (B=-0.5476, p=0.0204). Younger (<55 years) athletes were significantly more likely to develop AF compared with older (≥55 years) athletes (B=-0.02293, p<0.001). Athletes have a significantly greater likelihood of developing AF compared with non-athlete controls, with those participating in mixed sport and younger athletes at the greatest risk. Future studies of AF prevalence in athletes according to specific exercise dose parameters, including training and competition history, may aid further in delineating those at risk. [Abstract copyright: © Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.

Έκβαση ασθενών υποβληθέντων σε διακαθετηριακή εμφύτευση αορτικής βαλβίδας σε σχέση με δημογραφικά και κλινικά χαρακτηριστικά

Η στένωση της αορτικής βαλβίδας αποτελεί τη δεύτερη συχνότερη βαλβιδοπάθεια μετά την ανεπάρκεια μιτροειδούς και συγχρόνως τη συχνότερη βαλβιδοπάθεια σε άτομα μεγαλύτερης ηλικίας των 70 ετών. Τα άτομα αυτά λόγω των πολλαπλών συννοσηροτήτων απαιτούν συχνότερα λιγότερων χειρουργικών παρεμβάσεων όπως είναι και η εφαρμογή της διακαθετηριακής εμφύτευσης αορτικής βαλβίδας (TAVI). Σκοπός: Σκοπός της παρούσας εργασίας ήταν η μελέτη της έκβασης ασθενών υποβληθέντων σε διακαθετηριακή εμφύτευση αορτικής βαλβίδας (transcatheter aortic valve implantation-TAVI) σε σχέση με δημογραφικά και κλινικά χαρακτηριστικά. Υλικό και Μέθοδος: Το δείγμα της μελέτης αποτέλεσαν 246 ασθενείς με σοβαρού βαθμού στένωση της αορτικής βαλβίδας που υποβλήθηκαν σε διακαθετηριακή αντικατάσταση αορτικής βαλβίδας στο Γ.Ν.Α. «ΙΠΠΟΚΡΑΤΕΙΟ» από το 2008 μέχρι το 2017 και παρακολουθήθηκαν από 2-40 μήνες. Αποτελέσματα: Το 52,8% των ασθενών ήταν γυναίκες και η μέση ηλικία των ασθενών ήταν 79,9±7,7 έτη. Μετά TAVI, ΑΕΕ παρατηρήθηκε στο 2,8%, παραβαλβιδική ανεπάρκεια (PVL) στο 8,1%, εμφύτευση μόνιμου βηματοδότη έγινε στο 38,6%, μείζονα αιμορραγία είχε το 7,7% και ελάσσονα το 6,5%. Το 10,2% των ασθενών απεβίωσα από καρδιαγγειακά αίτια και το ποσοστό ολικής θνητότητας ήταν 17,9%. Μεγαλύτερη θνησιμότητα παρατηρήθηκε στους ασθενείς με καρδιακή ανεπάρκεια σταδίου IV κατά NYHA (p=0,006), με ιστορικό εμφράγματος του μυοκαρδίου (p=0,049), με τοποθέτηση stent (p=0,011), με μέτρια προς σοβαρή ανεπάρκεια τριγλώχινας (pπαχυσαρκία (p 0,047). Συμπεράσματα: Παράγοντες που συνεισφέρουν αρνητικά στην έκβαση των ασθενών μετά TAVI είναι η ανεπάρκεια μιτροειδούς και τριγλώχινας βαλβίδας, η μικρότερη μέγιστη ταχύτητα αίματος διαμέσου της αορτικής βαλβίδας μετά TAVI, καθώς και η μικρότερη μέση κλίση πίεσης μεταξύ αριστερής κοιλίας και αορτής, επίσης η παχυσαρκία, το υψηλό EuroSCORE, ο βαθμός της καρδιακής ανεπάρκειας, το προηγηθέν έμφραγμα και άλλα.In our days, in developed countries, aortic valve stenosis constitutes the second most common valvular heart disease following mitral valve regurgitation and simultaneously it constitutes the most common valvular heart disease in older patients (over 70 years old). Particularly in the latter population due to the multiple comorbidities the need for less invasive therapeutic approaches such as the TAVI-procedure implementation is growing. Aim: The aim of this study is to identify the outcomes of patients undergoing transcatheter aortic valve implantation (TAVI) in relation to demographics and clinical characteristics. Material and method: It involved 246 patients suffering from severe aortic valve stenosis who underwent TAVI at &gt; General Hospital of Athens during the period 2008-2017. The follow-up duration ranged from 2 to 40 months. Results: 52,8% accounted for women. The average age of patients was 79,9±7,7 years old. As for the complications post TAVI, the prevalence of stroke was 2,8%, the prevalence of paravalvular leak was 8,1%, the prevalence of permanent pacemaker implantation was 38,6%, the prevalence of major bleeding was 7,7% and the prevalence of minor bleeding was 6,5%. Cardiovascular mortality accounted for 10,2% and all-cause mortality for 17.9%. Regarding the risk factors from the history of patients prior to TAVI which correlated to higher mortality post TAVI, it was shown that heart failure stage IV in the NYHA classification (p=0,006), prior myocardial infarction (p=0,049), prior PCI with stent (p=0,011), moderate to severe tricuspid valve regurgitation (psignificant higher mortality post TAVI. Conclusion: Coexistent mitral valve regurgitation, tricuspid valve regurgitation, low peak velocity across the aortic valve post-TAVI, low mean pressure gradient across the aortic valve post-TAVI, obesity, high EuroSCORE, severe heart failure (NYHA Class IV) preoperatively, history of myocardial infarction prior to TAVI constitute factors that are associated with adverse outcomes of patients undergoing TAVI

Valvular heart disease in patients with chronic kidney disease

Valvular heart disease (VHD) is highly prevalent in patients with chronic kidney disease (CKD) from the early stages to end-stage renal disease (ESRD). Aortic and mitral valves are the most frequently affected, leading to aortic valve and/or mitral annular calcification, which, in turn, causes either valve stenosis or regurgitation at an accelerated rate compared with the general population. Tricuspid regurgitation is also prevalent in CKD and ESRD, and haemodialysis patients are at an increasingly high risk of infective endocarditis. As for pathophysiology, several mechanisms causing VHD in CKD have been proposed, highlighting the complexity of the process. Echocardiography constitutes the gold standard for the assessment of VHD in CKD/ESRD patients, despite the progress of other imaging modalities. With regard to treatment, the existing 2017 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on the management of VHD addressing patients with normal kidney function are also applied to patients with CKD/ESRD. [Abstract copyright: Copyright © 2021, Radcliffe Cardiology.

Undiagnosed chronic obstructive pulmonary disease is highly prevalent in patients referred for dobutamine stress echocardiography with shortness of breath

Shortness of breath (SOB) is a common symptom referral for dobutamine stress echocardiography (DSE). Patients with SOB and a normal DSE have worse long-term outcome than the general population. This suggests multiple aetiologies are involved. The purpose of this study was to assess the prevalence and clinical significance of undiagnosed COPD amongst patients referred for a DSE with SOB. We prospectively studied 114 patients referred for DSE with SOB without prior evidence of lung disease (mean age 64.9 ± 18.5 years, 60 male). Respiratory function testing using spirometry was performed on all patients on the day of their DSE. The study end-points were cardiac events and total mortality. Respiratory function testing and DSE was performed in all patients and COPD was highly prevalent (n = 93). Multivariate Cox regression analysis was used to estimate the effect of dyspnoea on non-fatal cardiac events (NFCE) and all-cause mortality. Over a mean follow-up of 4.5 ± 2.6 years, the composite end-point of NFCE and all-cause mortality occurred in 62.7% and 16.7% patients, respectively. COPD (HR 1.27; 95% CI 1.17-1.93), previous myocardial infarction (HR 1.84; 95% CI 1.06-3.2), myocardial ischaemia (HR 2.56; 95% CI 1.48-4.43), peak wall motion score index (HR 4.66; 95% CI 2.26-9.6), and mitral E/E' (HR 1.21; 95% CI 1.1-1.33) were significantly associated with a NFCE. Myocardial ischaemia (HR 4.43; 95% CI 1.24-15.81) was the only independent predictor of all-cause mortality. Undiagnosed COPD is highly prevalent and independently associated with worse outcome amongst patients with SOB referred for DSE. Symptom presentation is therefore an important consideration when interpreting DSE results. [Abstract copyright: © 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.