首页 > 最新文献

Structural Heart最新文献

英文 中文
Coaptation Length as Predictor of Recurrent Mitral Regurgitation After Surgical Repair for Degenerative Mitral Valve Disease: Meta-Analysis of Reconstructed Time-to-Event Data 适应长度作为退行性二尖瓣疾病手术修复后二尖瓣返流复发的预测因子:重建时间-事件数据的荟萃分析
Q4 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2022.100152
Michel Pompeu Sá MD, MSc, MHBA, PhD , Xander Jacquemyn BSc , Jef Van den Eynde BSc , Ozgun Erten MD , Tulio Caldonazo MD , Torsten Doenst MD , Mateo Marin-Cuartas MD , Michael A. Borger MD, PhD , Marie-Annick Clavel DVM, PhD , Philippe Pibarot DVM, PhD , Roberto Rodriguez MD , Basel Ramlawi MD , Scott Goldman MD
{"title":"Coaptation Length as Predictor of Recurrent Mitral Regurgitation After Surgical Repair for Degenerative Mitral Valve Disease: Meta-Analysis of Reconstructed Time-to-Event Data","authors":"Michel Pompeu Sá MD, MSc, MHBA, PhD , Xander Jacquemyn BSc , Jef Van den Eynde BSc , Ozgun Erten MD , Tulio Caldonazo MD , Torsten Doenst MD , Mateo Marin-Cuartas MD , Michael A. Borger MD, PhD , Marie-Annick Clavel DVM, PhD , Philippe Pibarot DVM, PhD , Roberto Rodriguez MD , Basel Ramlawi MD , Scott Goldman MD","doi":"10.1016/j.shj.2022.100152","DOIUrl":"10.1016/j.shj.2022.100152","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9933947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Transcatheter Aortic Valve Replacement Outcomes in End-Stage Renal Disease Patients on Hemodialysis Requiring Midodrine 经导管主动脉瓣置换术治疗需要米多定血液透析的终末期肾病患者的预后
Q4 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2023.100163
Ethan C. Korngold MD , Ruyun Jin MD , Kateri J. Spinelli PhD , Vishesh Kumar MD , Brydan Curtis DO , Sameer Gafoor MD , Derek Phan MD , Daniel Spoon MD , Aidan Raney MD , Lisa McCabe ARNP , Brandon Jones MD

Background

Patients with dialysis-dependent end-stage renal disease (ESRD) taking midodrine may be at high risk for poor outcomes following transcatheter aortic valve replacement (TAVR). We evaluated dialysis-dependent ESRD patients taking midodrine.

Methods

We conducted a retrospective analysis of non-clinical trial TAVR patients from February 2012 to December 2020 from 11 facilities in a Western US health system. Patient groups included ESRD patients on midodrine before TAVR (ESRD [+M]), ESRD patients without midodrine (ESRD [−M]), and non-ESRD patients. The endpoints of 30-day and 1-year mortality were represented by Kaplan–Meier survival estimator and compared by log-rank test.

Results

Forty-five ESRD (+M), 216 ESRD (−M), and 6898 non-ESRD patients were included. ESRD patients had more comorbid conditions, despite no significant difference in predicted Society of Thoracic Surgeons mortality risk between ESRD (+M) and ESRD (−M) (8.7% vs. 9.2%, p = 0.491). Thirty-day mortality was significantly higher for ESRD (+M) patients vs. ESRD (−M) patients (20.1% vs. 5.6%, p = 0.001) and for ESRD (+M) vs. non-ESRD patients (2.5%, p < 0.001). One-year mortality trended higher for ESRD (+M) vs. ESRD (−M) patients (41.9% vs. 29.8%, p = 0.07), and was significantly higher for ESRD (+M) vs. non-ESRD patients (10.7%, p < 0.001). Compared to ESRD (−M), ESRD (+M) patients had a higher incidence of 30-day stroke (6.7% vs. 1.4%, p = 0.033), 30-day vascular complications (6.7% vs. 0.9%, p = 0.011), and a lower rate of discharge to home (62.2% vs. 84.7%, p < 0.001). In contrast, ESRD (−M) patients had no significant differences from non-ESRD patients for these outcomes.

Conclusions

Our experience suggests ESRD patients on midodrine are a higher acuity population with worse survival after TAVR, compared to ESRD patients not on midodrine. These findings may help with risk stratification for ESRD patients undergoing TAVR.

背景透析依赖性终末期肾病(ESRD)患者服用米多林可能是经导管主动脉瓣置换术(TAVR)后不良结果的高危人群。我们评估了服用米多林的透析依赖性ESRD患者。方法我们对2012年2月至2020年12月来自美国西部卫生系统11个机构的非临床试验TAVR患者进行了回顾性分析。患者组包括TAVR前服用米多林的ESRD患者(ESRD[+M])、未服用米多琳的ESRD(ESRD[-M])和非ESRD患者。30天和1年死亡率的终点由Kaplan–Meier生存估计量表示,并通过对数秩检验进行比较。结果纳入45例ESRD(+M)、216例ESRD患者和6898例非ESRD患者。ESRD患者有更多的合并症,尽管ESRD(+M)和ESRD(−M)之间预测的胸科医生学会死亡率风险没有显著差异(8.7%vs.9.2%,p=0.491)。ESRD(−M)患者(20.1%对5.6%,p=0.001),ESRD(+M)与非ESRD患者(2.5%,p<;0.001)。ESRD(+M)与ESRD(–M)患者的一年死亡率趋势更高(41.9%对29.8%,p=0.07),ESRD(+M,ESRD(+M)患者的30天中风发生率较高(6.7%对1.4%,p=0.033),30天血管并发症发生率较高,出院率较低(62.2%对84.7%,p<0.001)。相反,ESRD(−M)患者与非ESRD患者在这些结果上没有显著差异。结论我们的经验表明,与未服用米多林的ESRD患者相比,服用米多丁的ESRD病人是TAVR后视力更高、生存率更差的人群。这些发现可能有助于对接受TAVR的ESRD患者进行风险分层。
{"title":"Transcatheter Aortic Valve Replacement Outcomes in End-Stage Renal Disease Patients on Hemodialysis Requiring Midodrine","authors":"Ethan C. Korngold MD ,&nbsp;Ruyun Jin MD ,&nbsp;Kateri J. Spinelli PhD ,&nbsp;Vishesh Kumar MD ,&nbsp;Brydan Curtis DO ,&nbsp;Sameer Gafoor MD ,&nbsp;Derek Phan MD ,&nbsp;Daniel Spoon MD ,&nbsp;Aidan Raney MD ,&nbsp;Lisa McCabe ARNP ,&nbsp;Brandon Jones MD","doi":"10.1016/j.shj.2023.100163","DOIUrl":"10.1016/j.shj.2023.100163","url":null,"abstract":"<div><h3>Background</h3><p>Patients with dialysis-dependent end-stage renal disease (ESRD) taking midodrine may be at high risk for poor outcomes following transcatheter aortic valve replacement (TAVR). We evaluated dialysis-dependent ESRD patients taking midodrine.</p></div><div><h3>Methods</h3><p>We conducted a retrospective analysis of non-clinical trial TAVR patients from February 2012 to December 2020 from 11 facilities in a Western US health system. Patient groups included ESRD patients on midodrine before TAVR (ESRD [+M]), ESRD patients without midodrine (ESRD [−M]), and non-ESRD patients. The endpoints of 30-day and 1-year mortality were represented by Kaplan–Meier survival estimator and compared by log-rank test.</p></div><div><h3>Results</h3><p>Forty-five ESRD (+M), 216 ESRD (−M), and 6898 non-ESRD patients were included. ESRD patients had more comorbid conditions, despite no significant difference in predicted Society of Thoracic Surgeons mortality risk between ESRD (+M) and ESRD (−M) (8.7% vs. 9.2%, <em>p</em> = 0.491). Thirty-day mortality was significantly higher for ESRD (+M) patients vs. ESRD (−M) patients (20.1% vs. 5.6%, <em>p</em> = 0.001) and for ESRD (+M) vs. non-ESRD patients (2.5%, <em>p</em> &lt; 0.001). One-year mortality trended higher for ESRD (+M) vs. ESRD (−M) patients (41.9% vs. 29.8%, <em>p</em> = 0.07), and was significantly higher for ESRD (+M) vs. non-ESRD patients (10.7%, <em>p</em> &lt; 0.001). Compared to ESRD (−M), ESRD (+M) patients had a higher incidence of 30-day stroke (6.7% vs. 1.4%, <em>p</em> = 0.033), 30-day vascular complications (6.7% vs. 0.9%, <em>p</em> = 0.011), and a lower rate of discharge to home (62.2% vs. 84.7%, <em>p</em> &lt; 0.001). In contrast, ESRD (−M) patients had no significant differences from non-ESRD patients for these outcomes.</p></div><div><h3>Conclusions</h3><p>Our experience suggests ESRD patients on midodrine are a higher acuity population with worse survival after TAVR, compared to ESRD patients not on midodrine. These findings may help with risk stratification for ESRD patients undergoing TAVR.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9579161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Cardiac Computed Tomography Angiography Anatomical Characterization of Patients Screened for a Dedicated Transfemoral Transcatheter Valve System for Primary Aortic Regurgitation 针对原发性主动脉反流筛选专用经股导管瓣膜系统的患者的心脏计算机断层血管造影解剖特征
Q4 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2023.100164
Shawnbir Gogia MD , Torsten P. Vahl MD , Vinod H. Thourani MD , Pradeep K. Yadav MD , Isaac George MD , Susheel K. Kodali MD , Nadira Hamid MD , Lauren Ranard MD , Tiffany Chen MD , Mitsuaki Matsumura BS , Akiko Maehara MD , Hendrik Treede MD, PhD , Stephan Baldus MD , David Daniels MD , Brett C. Sheridan MD , Firas Zahr MD , Mark J. Russo MD, MS , James M. McCabe MD , Stanley J. Chetcuti MD , Martin B. Leon MD , Omar K. Khalique MD

Background

Cardiac computed tomography angiography was used to identify anatomical characteristics of the aortic root in patients with severe aortic regurgitation (AR) as compared to those with aortic stenosis (AS) to judge feasibility of transcatheter aortic valve replacement (TAVR) with the JenaValve Trilogy system.

Methods

Cardiac computed tomography angiography was performed prior to planned TAVR for 107 patients with severe AR and 92 patients with severe AS. Measurements related to aortic root and coronary artery anatomy were obtained and compared between groups. Perimeter >90 mm and aortic annulus angle ​>70 degrees were defined as the theoretical exclusion criteria for TAVR. A combination of sinus of Valsalva diameter <30 mm and coronary height <12 mm was defined as high risk for coronary occlusion.

Results

The mean age of patients in the AR group was 74.9 ± 11.2 years, 46% were women, and the mean Society of Thoracic Surgeons risk score for mortality was 3.6 ± 2.1. Comparatively, the mean age of patients in the AS group was 82.3 ± 5.53 years, 65% were women, and the mean Society of Thoracic Surgeonsrisk score was 5.5 ± 3.3. Annulus area, perimeter, diameter, and angle were larger in patients with severe AR. Sinus of Valsalva diameters and heights were larger in patients with severe AR. More AR patients were excluded based on perimeter (14 vs. 2%) and annulus angle (6 vs. 1%). More AS patients exhibited high-risk anatomy for left main coronary occlusion (21 vs. 7%) and right coronary occlusion (14 vs. 3%). The maximum dimension of the ascending aorta was larger in patients with severe AR (39 vs. 35 mm). The percentage of referred AR patients with significant aortopathy requiring surgical intervention was very low (only 1 AR patient with ascending aorta diameter >5.5 cm).

Conclusions

A significantly larger proportion of patients with severe AR are excluded from TAVR as compared to AS due to large aortic annulus size and steep annulus angulation. By far the most prevalent excluding factor is aortic annulus size, with fewer patients excluded due to angulation. AR patients have lower-risk anatomy for coronary occlusion. Larger transcatheter valve sizes and further delivery system modifications are required to treat a larger proportion of AR patients.

背景心脏计算机断层扫描血管造影术用于识别严重主动脉瓣反流(AR)患者与主动脉狭窄(as)患者主动脉根部的解剖特征,以判断JenaValve Trilogy系统经导管主动脉瓣置换术(TAVR)的可行性。方法对107例严重AR患者和92例严重AS患者在计划的TAVR前进行心脏计算机断层造影,获得与主动脉根和冠状动脉解剖相关的测量值,并在各组之间进行比较。周长>;90mm和主动脉瓣环角度​>;70度被定义为TAVR的理论排除标准。Valsalva直径<;30mm和冠状动脉高度<;12mm被定义为冠状动脉闭塞的高风险。结果AR组患者的平均年龄为74.9±11.2岁,46%为女性,胸科医生协会的平均死亡率风险评分为3.6±2.1。相比之下,AS组患者的平均年龄为82.3±5.53岁,65%为女性,胸科医生协会的平均风险评分为5.5±3.3。严重AR患者的瓣环面积、周长、直径和角度较大。严重AR患者瓦尔萨尔瓦窦的直径和高度较大。根据周长(14vs.2%)和瓣环角度(6vs.1%),排除了更多的AR患者。更多的AS患者表现出左主冠状动脉闭塞(21%对7%)和右冠状动脉闭塞的高危解剖结构(14%对3%)。严重AR患者的升主动脉最大尺寸较大(39 mm对35 mm)。需要手术干预的具有显著主动脉病变的AR患者的转诊百分比非常低(只有1名AR患者的升主动脉直径>5.5cm)。结论与as相比,严重AR患者被排除在TAVR之外的比例明显更大,这是由于主动脉瓣环大小大和瓣环角度陡峭。到目前为止,最普遍的排除因素是主动脉瓣环大小,由于成角而排除的患者较少。AR患者冠状动脉闭塞的解剖结构风险较低。需要更大的经导管瓣膜尺寸和进一步的输送系统改造来治疗更大比例的AR患者。
{"title":"Cardiac Computed Tomography Angiography Anatomical Characterization of Patients Screened for a Dedicated Transfemoral Transcatheter Valve System for Primary Aortic Regurgitation","authors":"Shawnbir Gogia MD ,&nbsp;Torsten P. Vahl MD ,&nbsp;Vinod H. Thourani MD ,&nbsp;Pradeep K. Yadav MD ,&nbsp;Isaac George MD ,&nbsp;Susheel K. Kodali MD ,&nbsp;Nadira Hamid MD ,&nbsp;Lauren Ranard MD ,&nbsp;Tiffany Chen MD ,&nbsp;Mitsuaki Matsumura BS ,&nbsp;Akiko Maehara MD ,&nbsp;Hendrik Treede MD, PhD ,&nbsp;Stephan Baldus MD ,&nbsp;David Daniels MD ,&nbsp;Brett C. Sheridan MD ,&nbsp;Firas Zahr MD ,&nbsp;Mark J. Russo MD, MS ,&nbsp;James M. McCabe MD ,&nbsp;Stanley J. Chetcuti MD ,&nbsp;Martin B. Leon MD ,&nbsp;Omar K. Khalique MD","doi":"10.1016/j.shj.2023.100164","DOIUrl":"10.1016/j.shj.2023.100164","url":null,"abstract":"<div><h3>Background</h3><p>Cardiac computed tomography angiography was used to identify anatomical characteristics of the aortic root in patients with severe aortic regurgitation (AR) as compared to those with aortic stenosis (AS) to judge feasibility of transcatheter aortic valve replacement (TAVR) with the JenaValve Trilogy system.</p></div><div><h3>Methods</h3><p>Cardiac computed tomography angiography was performed prior to planned TAVR for 107 patients with severe AR and 92 patients with severe AS. Measurements related to aortic root and coronary artery anatomy were obtained and compared between groups. Perimeter &gt;90 mm and aortic annulus angle ​&gt;70 degrees were defined as the theoretical exclusion criteria for TAVR. A combination of sinus of Valsalva diameter &lt;30 mm and coronary height &lt;12 mm was defined as high risk for coronary occlusion.</p></div><div><h3>Results</h3><p>The mean age of patients in the AR group was 74.9 ± 11.2 years, 46% were women, and the mean Society of Thoracic Surgeons risk score for mortality was 3.6 ± 2.1. Comparatively, the mean age of patients in the AS group was 82.3 ± 5.53 years, 65% were women, and the mean Society of Thoracic Surgeonsrisk score was 5.5 ± 3.3. Annulus area, perimeter, diameter, and angle were larger in patients with severe AR. Sinus of Valsalva diameters and heights were larger in patients with severe AR. More AR patients were excluded based on perimeter (14 vs. 2%) and annulus angle (6 vs. 1%). More AS patients exhibited high-risk anatomy for left main coronary occlusion (21 vs. 7%) and right coronary occlusion (14 vs. 3%). The maximum dimension of the ascending aorta was larger in patients with severe AR (39 vs. 35 mm). The percentage of referred AR patients with significant aortopathy requiring surgical intervention was very low (only 1 AR patient with ascending aorta diameter &gt;5.5 cm).</p></div><div><h3>Conclusions</h3><p>A significantly larger proportion of patients with severe AR are excluded from TAVR as compared to AS due to large aortic annulus size and steep annulus angulation. By far the most prevalent excluding factor is aortic annulus size, with fewer patients excluded due to angulation. AR patients have lower-risk anatomy for coronary occlusion. Larger transcatheter valve sizes and further delivery system modifications are required to treat a larger proportion of AR patients.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9579167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Early Effect of Transcatheter Mitral Valve Repair on Cardiac Sympathetic Nerve Activity 经导管二尖瓣修复术对心脏交感神经活动的早期影响
Q4 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2022.100153
Hiroaki Yokoyama MD, Koki Shishido MD, Shingo Mizuno MD, Futoshi Yamanaka MD, Shigeru Saito MD

Background

Cardiac sympathetic nerve activity (SNA) is overactivated in heart failure patients and associated with clinical outcomes. The aim of this study is to investigate the early effect of MitraClip repair on cardiac SNA.

Methods

We evaluated the change of cardiac SNA by 123I- meta-iodobenzylguanidine (MIBG) scintigraphy in patients who underwent MitraClip repair from March 2019 to June 2020 in our hospital. Patients without acute procedural success were excluded, including patients who died or underwent mitral valve surgery before discharge. MIBG scintigraphy was performed at baseline and 1 ​month after MitraClip repair.

Results

We analyzed 48 patients (mean age 78.6 ± 10 years; 52.1% male; 37 secondary mitral regurgitation [SMR]/11 primary mitral regurgitation [PMR]). MR severity and New York Heart Association functional class significantly improved from baseline to 1 ​month after MitraClip repair (both p < 0.001). Overall, delay heart-mediastinum ratio (H/M) had no significant change, and washout rate (WR) showed a decreasing trend (delay H/M; pre 2.07 ± 0.46, post 2.05 ± 0.49, paired p = 0.348, WR; pre 36.1 ± 11.6%, post 33.6 ± 11.7%, paired p = 0.061). In PMR patients, WR was significantly decreased, however, delay H/M was not (delay H/M; pre 2.15 ± 0.50, post 2.10 ± 0.57, paired p = 0.019, WR; pre 34.6 ± 10.5%, post 26.7 ± 13.8%, paired p = 0.568). In contrast, in SMR patients, neither delay H/M nor WR were significantly changed (delay H/M; pre 2.05 ± 0.45, post 2.03 ± 0.47, paired p = 0.474, WR; pre 36.6 ± 11.9%, post 35.7 ± 10.4%, paired p = 0.523).

Conclusions

Our study demonstrates that MitraClip repair could significantly decrease cardiac SNA of WR in PMR patients during 1-month follow-up, however, in SMR patients, the significant change of MIBG parameters was not observed.

心脏交感神经活动(SNA)在心力衰竭患者中被过度激活,并与临床结果相关。本研究的目的是研究MitraClip修复对心脏SNA的早期影响。方法我们通过123I-间碘苄基胍(MIBG)闪烁扫描评估了2019年3月至2020年6月在我院接受MitraClib修复的患者的心脏SNA变化。没有急性手术成功的患者被排除在外,包括出院前死亡或接受二尖瓣手术的患者。MIBG闪烁扫描在基线和1​MitraClip修复后一个月。结果我们分析了48例患者(平均年龄78.6±10岁;52.1%为男性;37例为继发性二尖瓣反流[SMR]/11例为原发性二尖瓣返流[PMR])。MR严重程度和纽约心脏协会功能分级从基线显著改善到1​MitraClip修复后一个月(均p<0.001)。总体而言,延迟性心脏纵隔比(H/M)没有显著变化,冲洗率(WR)呈下降趋势(延迟性H/M;2.07±0.46前,2.05±0.49后,配对p=0.348,WR;36.1±11.6%前,33.6±11.7%后,配对p=0.061)。然而,在PMR患者中,WR显著降低,延迟H/M没有(延迟H/M;前2.15±0.50,后2.10±0.57,配对p=0.019,WR;前34.6±10.5%,后26.7±13.8%,配对p=0.068)。相反,在SMR患者中,延迟H/M和WR均无显著变化(延迟H/M;2.05±0.45前,2.03±0.47后,配对p=0.474,WR;36.6±11.9%,35.7±10.4%,配对p=0.523),未观察到MIBG参数的显著变化。
{"title":"Early Effect of Transcatheter Mitral Valve Repair on Cardiac Sympathetic Nerve Activity","authors":"Hiroaki Yokoyama MD,&nbsp;Koki Shishido MD,&nbsp;Shingo Mizuno MD,&nbsp;Futoshi Yamanaka MD,&nbsp;Shigeru Saito MD","doi":"10.1016/j.shj.2022.100153","DOIUrl":"10.1016/j.shj.2022.100153","url":null,"abstract":"<div><h3>Background</h3><p>Cardiac sympathetic nerve activity (SNA) is overactivated in heart failure patients and associated with clinical outcomes. The aim of this study is to investigate the early effect of MitraClip repair on cardiac SNA.</p></div><div><h3>Methods</h3><p>We evaluated the change of cardiac SNA by <sup>123</sup>I- meta-iodobenzylguanidine (MIBG) scintigraphy in patients who underwent MitraClip repair from March 2019 to June 2020 in our hospital. Patients without acute procedural success were excluded, including patients who died or underwent mitral valve surgery before discharge. MIBG scintigraphy was performed at baseline and 1 ​month after MitraClip repair.</p></div><div><h3>Results</h3><p>We analyzed 48 patients (mean age 78.6 ± 10 years; 52.1% male; 37 secondary mitral regurgitation [SMR]/11 primary mitral regurgitation [PMR]). MR severity and New York Heart Association functional class significantly improved from baseline to 1 ​month after MitraClip repair (both <em>p</em> &lt; 0.001). Overall, delay heart-mediastinum ratio (H/M) had no significant change, and washout rate (WR) showed a decreasing trend (delay H/M; pre 2.07 ± 0.46, post 2.05 ± 0.49, paired <em>p</em> = 0.348, WR; pre 36.1 ± 11.6%, post 33.6 ± 11.7%, paired <em>p</em> = 0.061). In PMR patients, WR was significantly decreased, however, delay H/M was not (delay H/M; pre 2.15 ± 0.50, post 2.10 ± 0.57, paired <em>p</em> = 0.019, WR; pre 34.6 ± 10.5%, post 26.7 ± 13.8%, paired <em>p</em> = 0.568). In contrast, in SMR patients, neither delay H/M nor WR were significantly changed (delay H/M; pre 2.05 ± 0.45, post 2.03 ± 0.47, paired <em>p</em> = 0.474, WR; pre 36.6 ± 11.9%, post 35.7 ± 10.4%, paired <em>p</em> = 0.523).</p></div><div><h3>Conclusions</h3><p>Our study demonstrates that MitraClip repair could significantly decrease cardiac SNA of WR in PMR patients during 1-month follow-up, however, in SMR patients, the significant change of MIBG parameters was not observed.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9933943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Integrating Structural Heart Disease Trainees within the Dynamics of the Heart Team: The Case for Multimodality Training 将结构性心脏病受训者纳入心脏团队的动态:多模式培训的案例
Q4 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2023.100167
Homam Ibrahim MD , Angela Lowenstern MD , Andrew M. Goldsweig MD, MS , Sunil V. Rao MD

Structural heart disease is a rapidly evolving field. However, training in structural heart disease is still widely variable and has not been standardized. Furthermore, integration of trainees within the heart team has not been fully defined. In this review, we discuss the components and function of the heart team, the challenges of current structural heart disease models, and possible solutions and suggestions for integrating trainees within the heart team.

结构性心脏病是一个快速发展的领域。然而,结构性心脏病的训练仍然存在很大的变数,尚未标准化。此外,核心团队中受训人员的整合还没有完全确定。在这篇综述中,我们讨论了心脏团队的组成部分和功能,当前结构性心脏病模型的挑战,以及将受训人员整合到心脏团队中的可能解决方案和建议。
{"title":"Integrating Structural Heart Disease Trainees within the Dynamics of the Heart Team: The Case for Multimodality Training","authors":"Homam Ibrahim MD ,&nbsp;Angela Lowenstern MD ,&nbsp;Andrew M. Goldsweig MD, MS ,&nbsp;Sunil V. Rao MD","doi":"10.1016/j.shj.2023.100167","DOIUrl":"10.1016/j.shj.2023.100167","url":null,"abstract":"<div><p>Structural heart disease is a rapidly evolving field. However, training in structural heart disease is still widely variable and has not been standardized. Furthermore, integration of trainees within the heart team has not been fully defined. In this review, we discuss the components and function of the heart team, the challenges of current structural heart disease models, and possible solutions and suggestions for integrating trainees within the heart team.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9579165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The World of Structural Heart Disease Expands 结构性心脏病的世界在扩大
Q4 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2023.100186
Anthony DeMaria MD
{"title":"The World of Structural Heart Disease Expands","authors":"Anthony DeMaria MD","doi":"10.1016/j.shj.2023.100186","DOIUrl":"10.1016/j.shj.2023.100186","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9579162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Structural Valve Deterioration in Transcatheter Aortic Bioprostheses: Diagnosis, Pathogenesis, and Treatment 经导管主动脉生物假体的结构性瓣膜恶化:诊断、发病机制和治疗
Q4 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2022.100155
Sankalp P. Patel DO , Santiago Garcia MD , Janarthanan Sathananthan MBChB, MPH , Gilbert H.L. Tang MD, MSc, MBA , Mazen S. Albaghdadi MD, MSc , Philippe Pibarot DVM, PhD , Robert J. Cubeddu MD

Transcatheter aortic valve replacement has emerged as the preferred treatment modality in most patients with severe aortic stenosis. With its global adoption and broader application in younger and healthier patients, the issue of transcatheter bioprosthetic valve degeneration and its impact on valve durability continues to earn clinical relevance. Differences in the pathophysiologic processes that separate native from transcatheter heart valve deterioration remain poorly understood. When compared to surgical aortic bioprostheses, the mechanisms of valve degeneration are similar in transcatheter heart valves, with meaningful differences most noticeably found between the individual constructs of their design. Recognizing the clinical and hemodynamic presentation of structural valve degeneration remains paramount. The recently revised consensus guidelines that incorporate the integration of advanced multimodality imaging with invasive hemodynamics represent a major step forward in our ability to accurately diagnose bioprosthetic valve degeneration, and to identify differences in durability patterns, and to establish treatment recommendations for the lifetime management of patients with aortic stenosis. Parallel efforts to unmask the biomolecular differences in atherosclerotic plaque burden, valve calcification, and thrombotic diathesis, including host immunocompetence, between the different available bioprostheses, will further advance the role of emerging valve tissue technologies to improve durability. As with surgical heart valves, the optimal treatment options for redo-transcatheter aortic valve replacement and surgical explant remain poorly understood. Ongoing translational research in bench testing coupled with prospectively designed core lab-adjudicated clinical trials are much needed. This report provides a contemporary overview of transcatheter structural valve degeneration, including evolving concepts in its pathogenesis, diagnosis, and treatment.

经导管主动脉瓣置换术已成为大多数严重主动脉狭窄患者的首选治疗方式。随着其在全球的采用和在更年轻、更健康的患者中的广泛应用,经导管生物瓣膜退化及其对瓣膜耐久性的影响继续具有临床意义。将天然心脏瓣膜恶化与经导管心脏瓣膜恶化区分开来的病理生理过程的差异仍知之甚少。与外科主动脉生物瓣膜相比,经导管心脏瓣膜的瓣膜退化机制相似,在其设计的单个结构之间发现了最显著的有意义的差异。认识结构性瓣膜变性的临床和血液动力学表现仍然至关重要。最近修订的共识指南将先进的多模态成像与有创血流动力学相结合,这标志着我们在准确诊断生物瓣膜退化、识别耐久性模式差异以及为主动脉瓣狭窄患者的终身管理制定治疗建议方面迈出了重要一步。同时努力揭示不同可用生物瓣膜在动脉粥样硬化斑块负荷、瓣膜钙化和血栓形成素质(包括宿主免疫能力)方面的生物分子差异,将进一步推进新兴瓣膜组织技术在提高耐用性方面的作用。与外科心脏瓣膜一样,对再次经导管主动脉瓣置换术和外科移植物的最佳治疗方案仍知之甚少。非常需要在台架测试中进行持续的转化研究,再加上前瞻性设计的核心实验室裁决的临床试验。本报告提供了经导管结构瓣膜变性的当代综述,包括其发病机制、诊断和治疗方面的概念演变。
{"title":"Structural Valve Deterioration in Transcatheter Aortic Bioprostheses: Diagnosis, Pathogenesis, and Treatment","authors":"Sankalp P. Patel DO ,&nbsp;Santiago Garcia MD ,&nbsp;Janarthanan Sathananthan MBChB, MPH ,&nbsp;Gilbert H.L. Tang MD, MSc, MBA ,&nbsp;Mazen S. Albaghdadi MD, MSc ,&nbsp;Philippe Pibarot DVM, PhD ,&nbsp;Robert J. Cubeddu MD","doi":"10.1016/j.shj.2022.100155","DOIUrl":"10.1016/j.shj.2022.100155","url":null,"abstract":"<div><p>Transcatheter aortic valve replacement has emerged as the preferred treatment modality in most patients with severe aortic stenosis. With its global adoption and broader application in younger and healthier patients, the issue of transcatheter bioprosthetic valve degeneration and its impact on valve durability continues to earn clinical relevance. Differences in the pathophysiologic processes that separate native from transcatheter heart valve deterioration remain poorly understood. When compared to surgical aortic bioprostheses, the mechanisms of valve degeneration are similar in transcatheter heart valves, with meaningful differences most noticeably found between the individual constructs of their design. Recognizing the clinical and hemodynamic presentation of structural valve degeneration remains paramount. The recently revised consensus guidelines that incorporate the integration of advanced multimodality imaging with invasive hemodynamics represent a major step forward in our ability to accurately diagnose bioprosthetic valve degeneration, and to identify differences in durability patterns, and to establish treatment recommendations for the lifetime management of patients with aortic stenosis. Parallel efforts to unmask the biomolecular differences in atherosclerotic plaque burden, valve calcification, and thrombotic diathesis, including host immunocompetence, between the different available bioprostheses, will further advance the role of emerging valve tissue technologies to improve durability. As with surgical heart valves, the optimal treatment options for redo-transcatheter aortic valve replacement and surgical explant remain poorly understood. Ongoing translational research in bench testing coupled with prospectively designed core lab-adjudicated clinical trials are much needed. This report provides a contemporary overview of transcatheter structural valve degeneration, including evolving concepts in its pathogenesis, diagnosis, and treatment.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236800/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9933944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Computed Tomography-Guided Computational Modeling to Guide Treatment in Aortic Stenosis With Extremely Large Aortic Annulus 计算机断层扫描引导下的计算模型指导特大主动脉环狭窄的治疗
Q4 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2023.100168
Abdul Rahman Ihdayhid MBBS, PhD , Breandan Yeats BS , Michael Vernon BEng , Janarthanan Sathananthan MD , John Webb MD , Jonathon Leipsic MD , Sharad Shetty MBBS , Vinod H. Thourani MD , Gerald Yong MBBS , Elena De-Juan-Pardo BEng, PhD , Lakshmi P. Dasi PhD
{"title":"Computed Tomography-Guided Computational Modeling to Guide Treatment in Aortic Stenosis With Extremely Large Aortic Annulus","authors":"Abdul Rahman Ihdayhid MBBS, PhD ,&nbsp;Breandan Yeats BS ,&nbsp;Michael Vernon BEng ,&nbsp;Janarthanan Sathananthan MD ,&nbsp;John Webb MD ,&nbsp;Jonathon Leipsic MD ,&nbsp;Sharad Shetty MBBS ,&nbsp;Vinod H. Thourani MD ,&nbsp;Gerald Yong MBBS ,&nbsp;Elena De-Juan-Pardo BEng, PhD ,&nbsp;Lakshmi P. Dasi PhD","doi":"10.1016/j.shj.2023.100168","DOIUrl":"10.1016/j.shj.2023.100168","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9579168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Secondary Mitral Regurgitation: Cardiac Remodeling, Diagnosis, and Management 继发性二尖瓣返流:心脏重塑、诊断和处理
Q4 Medicine Pub Date : 2023-05-01 DOI: 10.1016/j.shj.2022.100129
Alex L. Huang MBChB, PhD, Jacob P. Dal-Bianco MD, Robert A. Levine MD, Judy W. Hung MD

Secondary mitral regurgitation (MR) refers to MR resulting from left ventricular or left atrial remodeling. In ischemic or nonischemic cardiomyopathy, left ventricular dilation (regional or global) leads to papillary muscle displacement, tethering, and leaflet malcoaptation. In atrial functional MR, MR occurs in patients with left atrial dilation and altered mitral annular geometry due to atrial fibrillation. In addition to cardiac remodeling, leaflet remodeling is increasingly recognized. Mitral leaflet tissue actively adapts through leaflet growth to ensure adequate coaptation. Leaflets, however, can also undergo maladaptive thickening and fibrosis, leading to increased stiffness. The balance of cardiac and leaflet remodeling is a key determinant in the development of secondary MR. Clinical management starts with detection, severity grading, and identification of the underlying mechanism, which relies heavily on echocardiography. Treatment of secondary MR consists of guideline-directed medical therapy, surgical repair or replacement, and transcatheter edge-to-edge repair. Based on a better understanding of pathophysiology, novel percutaneous mitral repair and replacement devices have been developed and clinical trials are underway.

继发性二尖瓣反流(MR)是指由左心室或左心房重构引起的MR。在缺血性或非缺血性心肌病中,左心室扩张(局部或全局)会导致乳头肌移位、束缚和小叶接合不良。在心房功能性MR中,MR发生在左心房扩张和因心房颤动而改变二尖瓣环几何形状的患者中。除了心脏重塑外,小叶重塑也越来越受到重视。二尖瓣小叶组织通过小叶生长主动适应,以确保充分的接合。然而,小叶也会发生不适应的增厚和纤维化,导致硬度增加。心脏和小叶重塑的平衡是继发性MR发展的关键决定因素。临床管理从检测、严重程度分级和识别潜在机制开始,这在很大程度上依赖于超声心动图。继发性MR的治疗包括指南指导的药物治疗、手术修复或置换以及经导管边缘到边缘修复。基于对病理生理学的更好理解,已经开发出新型经皮二尖瓣修复和置换装置,临床试验正在进行中。
{"title":"Secondary Mitral Regurgitation: Cardiac Remodeling, Diagnosis, and Management","authors":"Alex L. Huang MBChB, PhD,&nbsp;Jacob P. Dal-Bianco MD,&nbsp;Robert A. Levine MD,&nbsp;Judy W. Hung MD","doi":"10.1016/j.shj.2022.100129","DOIUrl":"10.1016/j.shj.2022.100129","url":null,"abstract":"<div><p>Secondary mitral regurgitation (MR) refers to MR resulting from left ventricular or left atrial remodeling. In ischemic or nonischemic cardiomyopathy, left ventricular dilation (regional or global) leads to papillary muscle displacement, tethering, and leaflet malcoaptation. In atrial functional MR, MR occurs in patients with left atrial dilation and altered mitral annular geometry due to atrial fibrillation. In addition to cardiac remodeling, leaflet remodeling is increasingly recognized. Mitral leaflet tissue actively adapts through leaflet growth to ensure adequate coaptation. Leaflets, however, can also undergo maladaptive thickening and fibrosis, leading to increased stiffness. The balance of cardiac and leaflet remodeling is a key determinant in the development of secondary MR. Clinical management starts with detection, severity grading, and identification of the underlying mechanism, which relies heavily on echocardiography. Treatment of secondary MR consists of guideline-directed medical therapy, surgical repair or replacement, and transcatheter edge-to-edge repair. Based on a better understanding of pathophysiology, novel percutaneous mitral repair and replacement devices have been developed and clinical trials are underway.</p></div>","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10236886/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9933945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Aims & Scope 目标和范围
Q4 Medicine Pub Date : 2023-05-01 DOI: 10.1016/S2474-8706(23)00074-X
{"title":"Aims & Scope","authors":"","doi":"10.1016/S2474-8706(23)00074-X","DOIUrl":"https://doi.org/10.1016/S2474-8706(23)00074-X","url":null,"abstract":"","PeriodicalId":36053,"journal":{"name":"Structural Heart","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49698970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Structural Heart
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1