The predictive role of fully revascularized coronary artery disease in patients undergoing transaortic valve implantation

Понастоящем, в ерата на бързото развитие на високотехнологичната медицина, въвеждането на иновативни инвазивни методи за лечение постепенно измества традиционната конвенционална хирургия. През 2002 г. е извършена първата транскатетърна имплантация на аортна клапа (ТАVI). През следващите 10 години, с усъвършенстването и с напредването на технологиите и натрупването на опит от клиничните центрове, ТАVI се утвърди като стандарт при възрастни и високорискови пациенти с високостепенна аортна (Ао) стеноза. При голям процент от пациентите, включени по протокол за транскатетърна аортна клапа се открива или е известна съпътстваща исхемична болест на сърцето (ИБС). В световен мащаб не се установява сигнификантна разлика в общата смъртност на 30-ия ден след ТАVI при пациенти с ИБС. Значимо по-висока обаче е общата смъртност при едногодишно проследяване на пациенти след ТАVI с подлежаща коронарна патология. Проведохме проучване, което сравнява процента на късните и ранните неблагоприятни събития при пациенти със съпътстваща и напълно реваскуларизирана ИБС и такива с несигнификантна коронарна атеросклероза. На базата на данните – събрани, анализирани и обобщени в нашия клиничен център, напълно реваскуларизираната ИБС не увеличава процента на големи нежелани събития след транскатетърна имплантация на аортна клапа. Все пак ИБС трябва да се вземе предвид при оценка на риска при транскатетърна аортна имплантация, като част от индивидуалния подход за всеки пациент. In the modern days and the era of the rapid development of medical technology, the introduction of innovative invasive methods of treatment is gradually displacing traditional conventional surgery. In 2002 was performed the fi rst transcatheter implantation of an aortic valve. Over the next twenty years, with the advancement of technology and the accumulation of experience in clinical centers, transcatheter aortic valve implantation has become the standard in adult and high-risk patients with high-grade Ao stenosis. In a large percentage of cases enrolled under the transcatheter aortic valve protocol a concomitant ischemic heart disease is detected or known. Globally, there is no signifi cant difference in overall mortality on the thirtieth day after TAVI in patients with ischemic heart disease. However, the overall mortality was signifi cantly higher in one – year follow - up of patients after transcatheter aortic valve implantation with underlying coronary pathology. We conducted a study comparing the number of late and early adverse events in patients with concomitant fully revascularized ischemic heart disease and those with insignifi cant coronary atherosclerosis. Based on the data collected, analyzed and summarized in our clinical center, fully revascularized ischemic heart disease does not increase the percentage of major adverse events after transcatheter aortic valve implantation. It can be considered when assessing the risk of transcatheter aortic implantation, as part of the individual approach for each case

Hafnium and neodymium isotopes and REY distribution in the truly dissolved, nanoparticulate/colloidal and suspended loads of rivers in the Amazon Basin, Brazil

Radiogenic isotopes in river sediments and river waters have been widely used in provenance studies, as these samples naturally integrate the geology/chemistry of the entire catchment. While the Hf and Nd isotope systems are coupled during igneous processes, they are decoupled during supergene processes at the Earth's surface, which is reflected by the isotope composition of riverine sediments. We present the first data for both Hf and Nd isotope compositions of the dissolved (0.2 mu m-filtrates rich in nanoparticles and colloids, NPCs) and the truly dissolved (1 kDa-ultrafiltrates) load of rivers. Hafnium and Nd isotope compositions and concentrations of the Rare Earths and Yttrium (REY) and Hf were determined for suspended particles (>0.2 mu m) as well as for the dissolved and the truly dissolved load of the Rio Solimoes, the Amazon's largest tributary draining the Andes, and of the Rio Negro, an organic NPC- and particle-rich river draining the rainforest of northern Amazonia. We also analyzed the Nd isotope compositions of suspended sediments and 0.2 mu m-filtered water samples from the Amazon River and its tributaries Rio Tapajos, Rio Xingu and Rio Jari. Our novel results clearly show that the decoupling of the Hf and Nd isotope systems is related to incongruent weathering processes on the continent, as this decoupling can already be observed in the different Hf and Nd pools, i.e. in the particulate, the NPC-dominated dissolved and the truly dissolved load of rivers. In the Rio Negro and Rio Solimoes, a strong particle size-dependent difference in Hf isotope composition is observed. Values of epsilon(Hf) become more radiogenic as filter poresize decreases, which can be related to the density- and size-dependent distribution of Hf-rich minerals, e.g. zircons, and their absence from the truly dissolved pool. In contrast, the Nd isotope composition of Amazonian river waters reflects that of their catchment geology. Tributaries draining the Precambrian Brazilian and Guyana shields show very unradiogenic epsilon(Nd) values of -19 to -25 in their dissolved load, whereas the Rio Solimoes draining the Andes yields a more radiogenic eNd signal of only -7. The dissolved Nd isotope composition of the Amazon is dominated by its Andean tributaries and averages at -8. Although Nd isotope compositions are thought to not being fractionated by Earth surface processes, significant differences of 1.3-1.9 epsilon-units can be observed between the dissolved and suspended loads in the Amazon River and its main tributary, the Rio Solimoes. In these rivers, the dissolved load is more radiogenic than the suspended sediment, which is likely due to incongruent weathering and related mineral sorting in the Andean headwaters. In contrast, the organic-rich and mineral-poor shield rivers do not show a difference between the truly dissolved, dissolved and suspended load, as the Nd in all these pools is controlled by surface- and solution-complexation and hence isotopically homogenized by continuous exchange and reequilibration. (C) 2017 Elsevier Ltd. All rights reserved