5 research outputs found
Sequential Activation of Vulnerable Plaques Endorsing the Inflammatory Hypothesis of Atherosclerosis
A case of sequential activation of vulnerable plaques in two different coronary vessels over the course of 2 days is being presented probably related to inflammation inciting these acute coronary events. Rhythmos 2017;12(4): 69-70
Meningitis-Retention Syndrome
Meningitis-retention syndrome (MRS) is a clinical entity that has recently appeared in the literature. We present the case of a 22-year-old man with fever and headache who, in the course of his hospitalization with a diagnosis of aseptic meningitis, developed acute urinary retention. Fewer than 30 such cases have been described and in several of them, no clear associations with other disorders have been made. In some cases, direct association with viral infection has been proved, and in others, there are indications of an underlying demyelinating condition. To further complicate the issue, various conditions such as Elsberg syndrome and acute disseminated encephalomyelitis, which not only have some similarities but also have some distinct differences, have been placed under the umbrella definition of MRS. In our review, we attempt to address these conditions and better define MRS by establishing diagnostic criteria based on what has thus far been described in the literature
Meningitis-Retention Syndrome
Meningitis-retention syndrome (MRS) is a clinical entity that has
recently appeared in the literature. We present the case of a
22-year-old man with fever and headache who, in the course of his
hospitalization with a diagnosis of aseptic meningitis, developed acute
urinary retention. Fewer than 30 such cases have been described and in
several of them, no clear associations with other disorders have been
made. In some cases, direct association with viral infection has been
proved, and in others, there are indications of an underlying
demyelinating condition. To further complicate the issue, various
conditions such as Elsberg syndrome and acute disseminated
encephalomyelitis, which not only have some similarities but also have
some distinct differences, have been placed under the umbrella
definition of MRS. In our review, we attempt to address these conditions
and better define MRS by establishing diagnostic criteria based on what
has thus far been described in the literature
Long-Term Outcomes of Aortic Stenosis Patients with Different Flow/Gradient Patterns Undergoing Transcatheter Aortic Valve Implantation
Background: Few data exist on the comparative long-term outcomes of severe aortic stenosis (AS) patients with different flow-gradient patterns undergoing transcatheter aortic valve implantation (TAVI). This study sought to evaluate the impact of the pre-TAVI flow-gradient pattern on long-term clinical outcomes after TAVI and assess changes in the left ventricular ejection fraction (LVEF) of different subtypes of AS patients following TAVI. Methods: Consecutive patients with severe AS undergoing TAVI in our institution were screened and prospectively enrolled. Patients were divided into four subgroups according to pre-TAVI flow/gradient pattern: (i) low flow—low gradient (LF-LG): stroke volume indexed (SVi) ≤ 35 mL/m2 and mean gradient (MG) 35 mL/m2 and MG 2 and MG ≥ 40 mmHg and (iv) normal flow—high gradient (NF-HG): SVi > 35 mL/m2 and MG ≥ 40 mmHg. Transthoracic echocardiography was repeated at 1-year follow-up. Clinical follow-up was obtained at 12 months, and yearly thereafter until 5-year follow-up was complete for all patients. Results: A total of 272 patients with complete echocardiographic and clinical follow-up were included in our analysis. Their mean age was 80 ± 7 years and the majority of patients (N = 138, 50.8%) were women. 62 patients (22.8% of the study population) were distributed in the LF-LG group, 98 patients (36%) were LF-HG patients, 95 patients (34.9%) were NF-HG, and 17 patients (6.3%) were NF-LG. There was a greater prevalence of comorbidities among LF-LG AS patients. One-year all-cause mortality differed significantly between the four subgroups of AS patients (log-rank p: 0.022) and was more prevalent among LF-LG patients (25.8%) compared to LF-HG (11.3%), NF-HG (6.3%) and NF-LG patients (18.8%). At 5-year follow-up, global mortality remained persistently higher among LF-LG patients (64.5%) compared to LF-HG (47.9%), NF-HG (42.9%), and NF-LG patients (58.8%) (log-rank p: 0.029). At multivariable Cox hazard regression analysis, baseline SVi (HR: 0.951, 95% C.I.; 0.918–0.984), the presence of at least moderate tricuspid regurgitation at baseline (HR: 3.091, 95% C.I: 1.645–5.809) and at least moderate paravalvular leak (PVL) post-TAVI (HR: 1.456, 95% C.I.: 1.106–1.792) were significant independent predictors of late global mortality. LF-LG patients and LF-HG patients exhibited a significant increase in LVEF at 1-year follow-up. A lower LVEF (p p Conclusions: Patients with LF-LG AS have acceptable 1-year outcomes with significant improvement in LVEF at 1-year follow-up, but exhibit exceedingly high 5-year mortality following TAVI. The presence of low transvalvular flow and at least moderate tricuspid regurgitation at baseline and significant paravalvular leak post-TAVI were associated with poorer long-term outcomes in the entire cohort of AS patients. The presence of a low LVEF or a low SVi predicts LVEF improvement at 1-year
Long-Term Outcomes and Valve Performance in Patients Undergoing Transcatheter Aortic Valve Implantation
Transcatheter aortic valve implantation (TAVI) is an established method
for treating patients with aortic valve stenosis. We sought to determine
the long-term clinical outcomes and performance of a self-expanding
bioprosthesis beyond 5 years. Consecutive patients scheduled for TAVI
were included in the analysis. Primary end points were all-cause and
cardiovascular mortality, structural valve deterioration (SVD) and
bioprosthetic valve failure (BVF), based on the VARC-2 criteria and
consensus statement by ESC/EAPCI. The study prospectively evaluated 273
patients (80.61 +/- 7.00 years old, 47% females) who underwent TAVI
with CoreValve/Evolut-R (Medtronic Inc.). The median follow-up duration
was 5 years (interquartile range: 2.9 to 6; longest: 8 years). At 1, 5,
and 8 years, estimated survival rates were 89.0%, 61.1%, and 56.0%,
respectively, while cardiovascular mortality was 8% at the end of
follow-up. Regarding valve performance, 5% of patients had early BVF
and 1% had late BVF. Concerning SVD, 16 patients (6% of the total
population) had moderate SVD (91% had an increase in mean gradient),
with no severe SVD cases. Five patients with SVD died during follow-up.
Actual analysis of the 8-year cumulative incidence of function of
moderate SVD was 5.9% (2.5% to 16.2%). At multivariate analysis, the
factor that emerged as an independent predictor for future SVD, was
smaller bioprosthetic valve size (HR 0.58, 95% CI 0.41 to 0.82, p =
0.002). Long-term evaluation beyond 5 years after TAVI with a
self-expanding bioprosthesis demonstrated low rates of cardiovascular
mortality and structural valve deterioration. Valve size was an
independent predictor for SVD. (C) 2021 Elsevier Inc. All rights
reserved