The role of statin treatment in valvular heart disease: is the jury still out?

Valvular heart disease (VHD) represents a significant burden within the spectrum of cardiovascular diseases. In recent years, there has been a great interest in finding medical treatments able to slow the progression ofVHD. The negative results of several large randomized trials failing to demonstrate a benefit of such therapies, has led to a decrease of interest in this field. However, finding a medical treatment capable of preventing VHD progression is still a hot topic, due to the important clinical implications. We believe that the jury is still out on the debate about the role of statin therapy in VHD, considering also recently published studies providing new information with future implications for the treatment of this disease process. This article gives an overview of the published evidence about the role of hydroxymethylglutaryl coenzyme-A reductase inhibitors on delaying progressive valve dysfunction. A preventive therapy, which could influence not only the haemodynamic progression of valve disease, but also the cardiovascular outcome, is warranted. Large, prospective, randomized trials are needed to properly evaluate the role of statins in the early stages of valvular heart disease

Cardiac Structure and Function and Insulin Resistance in Morbidly Obese Patients: Does Superobesity Play an Additional Role?

Objective: To evaluate the impact of superobesity, defined as body mass index (BMI) ≥50, on cardiac structure and function. Methods: Using echocardiography, we studied 198 asymptomatic patients (mean age 48 ± 13 years, 29.3% were men) with a BMI ≥40. Insulin resistance was measured using the Homeostasis Model Assessment of insulin resistance (HOMA-IR). Patients were divided into 2 groups: morbidly obese (BMI ≥40 and <50; n = 160) and superobese (BMI ≥50; n = 38). Results: There were no significant differences in age, gender, hypertension and diabetes between groups. Superobese patients had higher LV mass (66.0 ± 14.7 vs. 59.9 ± 11.9 g/m2.7, p = 0.007), left ventricular (LV) end-diastolic (33.8 ± 7.7 vs. 31.5 ± 7.1 ml/m2.7, p = 0.041) and end-systolic (12.2 ± 3.6 vs. 10.9 ± 2.8 ml/m2.7, p = 0.016) volumes, left atrial volume (13.8 ± 4.5 vs. 12.2 ± 3.9 ml/m2.7, p = 0.029), peak velocity of transmitral flow in early diastole/early diastolic peak myocardial velocity ratio (9.1 ± 2.6 vs. 8.2 ± 2.2, p = 0.03) and HOMA-IR (9.7 ± 7.3 vs. 7.3 ± 6.5, p = 0.047). LV ejection fraction was similar. Conclusions: Superobesity is associated with insulin resistance and a worse impact on cardiac remodeling and LV diastolic function than morbid obesity. Prospective studies are needed to evaluate whether such further classification of morbid obesity could stratify the cardiovascular risk in these patients more accurately. © 2013 S. Karger AG, Basel

Impact of metabolic syndrome traits on cardiovascular function: Should the Adult Treatment Panel III definition be further stratified?

AIMS: The aims of the study were to evaluate whether a further classification of metabolic syndrome according to the number of traits (based on the Adult Treatment Panel III definition) could better explain the impact on cardiovascular remodeling and function, and to assess the role of single metabolic syndrome components in this regard. METHODS: We studied by echocardiography and carotid ultrasound 435 asymptomatic patients with metabolic syndrome. Patients with coronary artery disease or more than mild valvular heart disease were excluded. Carotid stiffness index (β) was measured using a high-resolution echo-tracking system. Patients with metabolic syndrome were divided into two groups: metabolic syndrome with three traits (Gr.1) and metabolic syndrome with four or five traits (Gr. 2). RESULTS: Patients in Gr. 2 had higher left ventricular mass index (P<0.001), left ventricular end-diastolic volume index (P=0.029), left atrial volume index (P=0.002), E/e' ratio (P=0.002), intima-media thickness (P=0.031), and prevalence of plaques (P=0.01) than patients in Gr. 1. Left ventricular ejection fraction was similar in both groups. The mean carotid β index tended to be higher in Gr. 2. Considering metabolic syndrome traits separately, in an age-corrected multivariate analysis, abdominal obesity was found to have the strongest association with cardiac structure and carotid artery atherosclerosis and stiffness. CONCLUSION: An increasing number of metabolic syndrome traits had a significantly worse impact on cardiac remodeling and function and carotid artery atherosclerosis. Abdominal obesity showed the strongest association with cardiac structure, carotid artery stiffness, and intima-media thickness. Prospective studies are needed to evaluate whether a new classification of metabolic syndrome using the number of traits could add prognostic information. © 2014 Italian Federation of Cardiology

Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study

Aims: The present Euro-Filling report aimed at comparing the diagnostic accuracy of the 2009 and 2016 echocardiographic grading algorithms for predicting invasively measured left ventricular filling pressure (LVFP). Method and results: A total of 159 patients who underwent simultaneous evaluation of echo estimates of LVFP and invasive measurements of LV end-diastolic pressure (LVEDP) were enrolled at nine EACVI centres. Thirty-nine (25%) patients had a reduced LV ejection fraction (<50%), 77 (64%) were in NYHA ≥ II, and 85 (53%) had coronary artery disease. Sixty-four (40%) patients had elevated LVEDP (≥15 mmHg). Taken individually, all echocardiographic Doppler estimates of LVFP (E/A, E/e', left atrial volume, tricuspid regurgitation jet velocity) were marginally correlated with LVEDP. By using the 2016 recommendations, 65% of patients with normal non-invasive estimate of LVFP had normal LVEDP, while 79% of those with elevated non-invasive LVFP had elevated invasive LVEDP. By using 2009 recommendations, 68% of the patients with normal non-invasive LVFP had normal LVEDP, while 55% of those with elevated non-invasive LVFP had elevated LVEDP. The 2016 recommendations (sensitivity 75%, specificity 74%, positive predictive value 39%, negative predictive value 93%, AUC 0.78) identified slightly better patients with elevated invasive LVEDP (≥ 15 mmHg) as compared with the 2009 recommendations (sensitivity 43%, specificity 75%, positive predictive value 49%, negative predictive value 71%, AUC 0.68). Conclusion: The present Euro-Filling study demonstrates that the new 2016 recommendations for assessing LVFP non-invasively are fairly reliable and clinically useful, as well as superior to the 2009 recommendations in estimating invasive LVEDP