127 research outputs found
Doppler gradient estimations across tunnel obstructions: An in vitro study including flow visualization
Expert Consensus on Sizing and Positioning of SAPIEN 3/Ultra in Bicuspid Aortic Valves
VĂ lvula aĂČrtica bicĂșspide; Talla del bicĂșspide; SAPIEN 3/UltraVĂĄlvula aĂłrtica bicĂșspide; Talla del bicĂșspide; SAPIEN 3/UltraBicuspid aortic valve; Bicuspid sizing; SAPIEN 3/UltraSevere aortic stenosis patients with bicuspid anatomy have been excluded from the major transcatheter aortic valve replacement (TAVI) randomized clinical trials. As a result, there is no official recommendation on bicuspid TAVI. A panel of bicuspid experts was created to fill this gap. In this consensus statement, an algorithm is proposed to guide the choice of surgery or TAVI within this complex patient population, depending on aortic dilatation, age, surgical risk score, and anatomy. A step-by-step guide for sizing and positioning of the SAPIEN 3/Ultra TAVI bioprostheses is presented. Annular sizing remains the primary strategy in most bicuspid patients. However, some anatomies may require sizing at the supra-annular level, for which patients the panel recommends the circle method, a dedicated sizing and positioning approach for SAPIEN 3/Ultra. The consensus provides valuable pre-operative insights on the interactions between SAPIEN 3/Ultra and the bicuspid anatomy; understanding the valveâanatomy relationship is critical to avoid complications and to optimize outcomes for patients.The journalâs Rapid Service Fee was supported by Edwards Lifesciences
Prevalence and prognostic significance of right ventricular systolic dysfunction in heart failure with preserved ejection fraction. Insights from a cardiac magnetic resonance imaging study
Expert Consensus on Sizing and Positioning of SAPIEN 3/Ultra in Bicuspid Aortic Valves
Severe aortic stenosis patients with bicuspid anatomy have been excluded from the major transcatheter aortic valve replacement (TAVI) randomized clinical trials. As a result, there is no official recommendation on bicuspid TAVI. A panel of bicuspid experts was created to fill this gap. In this consensus statement, an algorithm is proposed to guide the choice of surgery or TAVI within this complex patient population, depending on aortic dilatation, age, surgical risk score, and anatomy. A step-by-step guide for sizing and positioning of the SAPIEN 3/Ultra TAVI bioprostheses is presented. Annular sizing remains the primary strategy in most bicuspid patients. However, some anatomies may require sizing at the supra-annular level, for which patients the panel recommends the circle method, a dedicated sizing and positioning approach for SAPIEN 3/Ultra. The consensus provides valuable pre-operative insights on the interactions between SAPIEN 3/Ultra and the bicuspid anatomy; understanding the valve-anatomy relationship is critical to avoid complications and to optimize outcomes for patients.Peer reviewe
PRE-INTERVENTIONAL LEFT VENTRICULAR 2D STRAIN PREDICTS THE RECOVERY OF MYOCARDIAL DYSFUNCTION AND IMPROVEMENT IN FUNCTIONAL CAPACITY AFTER TRANSCATHETER AORTIC VALVE IMPLANTATION
International audienceAn extended literature analyzes the accumulation foreign exchange holding observed in many developing and emerging countries since the 2000s. Empirical studies on the self-insurance motive suggest that high-reserves economies are more resilient to financial crises and to international capital inflows volatility. They show also that pre-crisis foreign reserve accumulation explains post-crisis growth. However, some papers suggest that the relationship between international reserves holding and reduced vulnerability is nonlinear, meaning that reserve holding is subject to diminishing returns. This paper devotes more attention to the potential nonlinear relationship between the foreign reserves holding and macroeconomic resilience to shocks. For a sample of 9 emerging economies, we assess to what extent the accumulation of international reserves allows to mitigate negative impacts of external shocks on the output gap. While a major part of the literature focuses on the global financial crisis, we investigate this question by considering two sub-periods: 1995-2003 and 2004-2013. We implement threshold VAR (TVAR) model in which the structure is allow to change if the threshold variable crosses a certain estimated threshold. We find that the effectiveness of reserve holding to improve the resilience of domestic economies to shocks has increased over time. Hence, the diminishing returns of foreign reserve holding stressed in the previous literature must be qualified
Epicardial fat volume is inversely correlated with the degree of diastolic dysfunction and outcome in patients with heart failure with preserved ejection fraction
TRANSCATHETER AORTIC VALVE IMPLANTATION IS NOT ASSOCIATED WITH A DETRIMENTAL EFFECT ON RIGHT VENTRICULAR FUNCTION AS OBSERVED AFTER SURGICAL AORTIC VALVE REPLACEMENT
Quantitative fluid overload in severe aortic stenosis refines cardiac damage and associates with worse outcomes
Aims: Cardiac decompensation in aortic stenosis (AS) involves extra-valvular cardiac damage and progressive fluid overload (FO). FO can be objectively quantified using bioimpedance spectroscopy. We aimed to assess the prognostic value of FO beyond established damage markers to guide risk stratification. Methods and results: Consecutive patients with severe AS scheduled for transcatheter aortic valve implantation (TAVI) underwent prospective risk assessment with bioimpedance spectroscopy (BIS) and echocardiography. FO by BIS was defined as â„1.0 L (0.0 L = euvolaemia). The extent of cardiac damage was assessed by echocardiography according to an established staging classification. Right-sided cardiac damage (rCD) was defined as pulmonary vasculature/tricuspid/right ventricular damage. Hospitalization for heart failure (HHF) and/or death served as primary endpoint. In total, 880 patients (81 ± 7 years, 47% female) undergoing TAVI were included and 360 (41%) had FO. Clinical examination in patients with FO was unremarkable for congestion signs in >50%. A quarter had FO but no rCD (FO+/rCDâ). FO+/rCD+ had the highest damage markers, including N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. After 2.4 ± 1.0 years of follow-up, 236 patients (27%) had reached the primary endpoint (29 HHF, 194 deaths, 13 both). Quantitatively, every 1.0 L increase in bioimpedance was associated with a 13% increase in event hazard (adjusted hazard ratio 1.13, 95% confidence interval 1.06â1.22, p < 0.001). FO provided incremental prognostic value to traditional risk markers (NT-proBNP, EuroSCORE II, damage on echocardiography). Stratification according to FO and rCD yielded worse outcomes for FO+/rCD+ and FO+/rCDâ, but not FOâ/rCD+, compared to FOâ/rCDâ. Conclusion: Quantitative FO in patients with severe AS improves risk prediction of worse post-interventional outcomes compared to traditional risk assessment
A consensus statement by the Society for Cardiovascular Magnetic Resonance (SCMR) endorsed by the European Association for Cardiovascular Imaging (EACVI)
Parametric mapping techniques provide a non-invasive tool for quantifying
tissue alterations in myocardial disease in those eligible for cardiovascular
magnetic resonance (CMR). Parametric mapping with CMR now permits the routine
spatial visualization and quantification of changes in myocardial composition
based on changes in T1, T2, and T2*(star) relaxation times and extracellular
volume (ECV). These changes include specific disease pathways related to
mainly intracellular disturbances of the cardiomyocyte (e.g., iron overload,
or glycosphingolipid accumulation in Anderson-Fabry disease); extracellular
disturbances in the myocardial interstitium (e.g., myocardial fibrosis or
cardiac amyloidosis from accumulation of collagen or amyloid proteins,
respectively); or both (myocardial edema with increased intracellular and/or
extracellular water). Parametric mapping promises improvements in patient care
through advances in quantitative diagnostics, inter- and intra-patient
comparability, and relatedly improvements in treatment. There is a multitude
of technical approaches and potential applications. This document provides a
summary of the existing evidence for the clinical value of parametric mapping
in the heart as of mid 2017, and gives recommendations for practical use in
different clinical scenarios for scientists, clinicians, and CMR
manufacturers
Heart Failure with Preserved and Reduced Ejection Fraction in Hemodialysis Patients: Prevalence, Disease Prediction and Prognosis
- âŠ