Acta cardiologica最新文献

Objective: Elevated systolic blood pressure and increased pulse pressure are closely associated with renal damage; however, the exact mechanism remains unclear. Therefore, we investigated the effects of increased pulse pressure on tubulointerstitial fibrosis and renal damage in elderly rats with isolated systolic hypertension (ISH). Additionally, the role of renal tubular epithelial-mesenchymal transition (EMT) and its upstream signalling pathways were elucidated.

Methods: Ten-month-old male rats were randomly divided into control and ISH groups, with seven rats in each group administered warfarin and vitamin K1 for 6 weeks. Blood pressure, renal function, mean blood flow in the common iliac artery, and diastolic vessel diameter were assessed, and the rat kidney medulla was collected for histological, genetic, and protein level analysis.

Results: Increased pulse pressure, abnormal renal function, and increased shear stress were detected in rats with ISH. Histology assessments revealed fibrosis in the interstitium of ISH rats. Epithelial marker E-cadherin protein expression was decreased, while the protein expression of interstitial markers α-SMA and Vimentin was increased, and transforming growth factor (TGF)-β1/Smad3 signalling was upregulated in the kidney tissue of ISH rats.

Conclusions: Increased pulse pressure in elderly rats with ISH caused an increase in shear stress. These effects led to the development of EMT and the activation of its upstream TGF-β1/Smad3 signalling pathway, ultimately leading to renal tubular interstitial fibrosis causing renal injury.

Background: The implantable cardioverter-defibrillator (ICD) remains the cornerstone in the prevention of sudden cardiac death. Cost-effectiveness depends on survival after implantation. In Belgium there are unexplained major differences in 3-year mortality after ICD implantation. Centre volume and socio-economic differences might affect survival after implantation.

Methods: In total, 9647 patients underwent a first ICD implantation between February 2010 and 2016 in Belgium and were retrospectively compared for demographics, 30-day and 3-year mortality. Chi-squared and Mann-Whitney U tests were used to determine differences across centre volume.

Results: Low-volume centres treated patients with different characteristics and implanted more patients with ischaemic heart disease (50.2 vs 47.9%, p = 0.002), in primary prevention (66.7 vs 62.0%, p < 0.001) and with overall more comorbidities. Kaplan-Meier survival analysis showed a significant higher 3-year mortality in low-volume centres (16.3 vs 11.4%, p < 0.001). After adjudication with a multivariable Cox model, centre volume remained an independent predictor of 3-year mortality (low volume HR 1.300 [95% CI 1.124-1.504]. However similar 30-day mortality (0.6% in low vs 0.5% in high volume centres, p = 0.393) suggests that implantation related determinants alone are insufficient to explain the long-term survival difference. Socio-economic factors like regional average income (wealth) and overall survival (health) also were associated with the survival difference between low- and high-volume centres.

Conclusions: There exist large survival differences after ICD implantation between implanting centres in Belgium that cannot only be explained by a volume-outcome effect. Centres size and characteristics are inhomogeneous and vary according to different socio-economic variables. Some of these variables are also significantly associated with survival and warrant further investigation.

Objectives: Edge-to-edge mitral valve repair with MitraClip leads to a differed flow pattern and a decreased flow velocity at the left ventricle apex. This combination may lead to initiation of thrombus formation, especially in patients with severely reduced ejection fraction. The prevalence and mechanism of left ventricular thrombus formation after MitraClip implantation is still unknown.

Methods: We describe a case of a 74 year old women with a non-ischaemic cardiomyopathy and chronic heart failure with a severely reduced ejection fraction who was treated with a MitraClip for a severe secondary mitral valve insufficiency. One and a half year later she suffered from an ischaemic stroke due to a large thrombus at the ventricular side of the posterior mitral leaflet. Oral anticoagulation was started with complete resolution of the thrombus. We performed a literature review.

Results: There are just a few case reports of this complication and two single centre observational retrospective studies on the prevalence of thrombus formation after MitraClip. They reported a divergent prevalence of 4.4% and 21%. Multiple hypotheses have been described such as the correction of the regurgitating blood that might be leading to more stasis of blood in the left ventricle. Another hypothesis states that the 2 divergent jets after the MitraClip can lead to an increase of shear stress, which might initiate thrombus formation.

Conclusion: Thrombus formation in the left ventricle after MitraClip implantation in patients with severely reduced ejection fraction is a rare complication. This case reports shows that it may occur even more than one year after the intervention. Permanent vigilance is warranted, especially in patients who are not chronically treated with oral anticoagulation.

Introduction: Determining the normal diameter of the abdominal aorta in different populations and its relationship with other demographic factors is crucial for diagnosing and managing abdominal aortic diseases. This study aimed to assess the size of the abdominal aorta in a healthy Iranian population.

Methods: This cross-sectional study included healthy individuals. Various variables including age, sex, height, and weight were measured as part of this study. We performed an echocardiographic evaluation to assess the aortic sections.

Results: The study encompassed 167 participants, predominantly women (67.7%). Notable differences in sizes of the ascending aorta, aortic arch, sinus of Valsalva, and abdominal aorta were observed across the four age groups. Men exhibited greater sizes in multiple aortic sections within the 45-64 age group. Correlation and regression analyses demonstrated significant positive relationships between abdominal aorta size and various aortic dimensions, with a one-millimeter increase in ascending or descending aorta diameter corresponding to a 0.23 and 0.35 mm increase, respectively, in abdominal aorta diameter. The relationship between abdominal aorta size and demographic factors such as gender, age, weight, BSA, and SBP was explored, revealing age as a significant predictor.

Conclusions: We observed significant differences in the sizes of distinct aortic sections across different age groups, underscoring the importance of considering age-related changes when evaluating aortic characteristics. These findings contribute to our understanding of the structural changes that occur in the aorta over time. Echocardiographic screening of the abdominal aorta would enable echocardiologists to diagnose the aneurysmal aorta.