ABSTRACT
Purpose@#Cardiac power (CP) index is a product of mean arterial pressure (MAP) and cardiac output (CO). In aortic stenosis, however, MAP is not reflective of true left ventricular (LV) afterload. We evaluated the utility of a gradient-adjusted CP (GCP) index in predicting survival after transcatheter aortic valve replacement (TAVR), compared to CP alone. @*Materials and Methods@#We included 975 patients who underwent TAVR with 1 year of follow-up. CP was calculated as (CO× MAP)/[451×body surface area (BSA)] (W/m2). GCP was calculated using augmented MAP by adding aortic valve mean gradient (AVMG) to systolic blood pressure (CP1), adding aortic valve maximal instantaneous gradient to systolic blood pressure (CP2), and adding AVMG to MAP (CP3). A multivariate Cox regression analysis was performed adjusting for baseline covariates. Receiver operator curves (ROC) for CP and GCP were calculated to predict survival after TAVR. @*Results@#The mortality rate at 1 year was 16%. The mean age and AVMG of the survivors were 81±9 years and 43±4 mm Hg versus 80±9 years and 42±13 mm Hg in the deceased group. The proportions of female patients were similar in both groups (p=0.7). Both CP and GCP were independently associated with survival at 1 year. The area under ROCs for CP, CP1, CP2, and CP3 were 0.67 [95% confidence interval (CI), 0.62–0.72], 0.65 (95% CI, 0.60–0.70), 0.66 (95% CI, 0.61–0.71), and 0.63 (95% CI 0.58–0.68), respectively. @*Conclusion@#GCP did not improve the accuracy of predicting survival post TAVR at 1 year, compared to CP alone.
ABSTRACT
Venous thromboembolism includes 2 inter-related conditions: Deep venous thrombosis and pulmonary embolism. Heparin and low-molecular-weight heparin followed by oral anticoagulation with vitamin K agonists is the first line and current accepted standard therapy with good efficacy. However, this therapeutic strategy has many limitations including the significant risk of bleeding and drug, food and disease interactions that require frequent monitoring. Dabigatran, rivaroxaban, apixaban, and edoxaban are the novel oral anticoagulants that are available for use in stroke prevention in atrial fibrillation and for the treatment and prevention of venous thromboembolism (HYPERLINK\l "1). Recent prospective randomized trials comparing the NOACs with warfarin have shown similar efficacy between the treatment strategies but fewer bleeding episodes with the NOACs. This paper presents an evidence-based review describing the efficacy and safety of the new anticoagulants compared to warfarin.
ABSTRACT
Double-chambered right ventricle (DCRV) is an uncommon congenital anomaly in which anomalous muscle bands divide the right ventricle into two chambers; a proximal high-pressure and distal low-pressure chamber. It may be associated with mid right ventricular obstruction. It is commonly associated with other congenital anomalies, most frequently perimembranous ventricular septal defect (PM-VSD). We herein present 5 adult patients with concomitant DCRV and PM-VSD who varied in their symptomatic presentations and the ways of management.
Subject(s)
Adult , Humans , Echocardiography , Heart Septal Defects, Ventricular , Heart VentriclesABSTRACT
BACKGROUND: To quantify changes of left ventricular (LV) torsion in patients' pre and post kidney transplantation. METHODS: A prospective study was conducted on 48 patients who received kidney transplantation for end stage renal disease and without myocardial infarction. The rotation, twist and torsion of LV were studied pre and post kidney transplantation (6 months post transplantation) using velocity vector imaging by echocardiography. The data is expressed as mean +/- standard deviation and compared by paired t-test at the p < 0.05 significance level. RESULTS: Six months post kidney transplantation, left ventricular ejection fraction (from 40.33 +/- 11.42 to 61.00 +/- 13.68%), ratio of mitral early and late diastolic filling velocity (from 1.04 +/- 0.57 to 1.21 +/- 0.52), rotation of basal LV (from 4.48 +/- 2.66 to 5.65 +/- 2.64 degree), rotation of apical LV (from 4.27 +/- 3.08 to 5.50 +/- 4.25 degree), LV twist (8.75 +/- 4.45 to 11.14 +/- 5.25 degree) and torsion (from 1.06 +/- 0.54 to 1.33 +/- 0.61 degree/cm) were increased significantly (p < 0.05). Interventricular septum thickness (from 11.67 +/- 2.39 to 9.67 +/- 0.48 mm), left ventricular mass index (from 104.00 +/- 16.47 to 95.50 +/- 21.44 g/m2), systolic blood pressure (from 143.50 +/- 34.99 to 121.50 +/- 7.09 mmHg), serum blood urea nitrogen (from 42.40 +/- 7.98 to 30.43 +/- 13.85 mg/dL) and creatinine (from 4.53 +/- 1.96 to 2.73 +/- 2.57 mg/dL) were decreased significantly (p < 0.05). CONCLUSION: Kidney transplantation in end stage renal disease without myocardial infarction results in improvement in left ventricular structure, function and myocardial mechanics as detected by echocardiography and velocity vector imaging. Velocity vector imaging provided valuable information for detection and follow-up of cardiac abnormalities in patients with end stage renal disease.
Subject(s)
Humans , Blood Pressure , Blood Urea Nitrogen , Creatinine , Echocardiography , Kidney Failure, Chronic , Kidney Transplantation , Kidney , Mechanics , Myocardial Infarction , Prospective Studies , Stroke VolumeABSTRACT
The association between visceral obesity and cardiovascular risk has been well described. Some studies show a proportional relationship between the presence of visceral obesity and epicardial fat. Measuring the amount of epicardial adipose tissue [EAT] can be a novel parameter that is inexpensive and easy to obtain and may be helpful in cardiovascular risk stratification. However, the relationship between epicardial fat and cardiac function and that between epicardial fat and cardiac risk factors is less well described. To evaluate the association between echocardiographic epicardial fat and the morphologic and physiologic changes observed at echocardiography and to evaluate the association between epicardial fat and cardiac risk factors. Across-sectional study of 97 echocardiographic studies [females, n = 42] was conducted. Two groups were identified: epicardial fat >/= 5 mm [group I] and <5 mm [group II]. Epicardial fat >5 mm was associated with LA enlargement, with lower ejection fraction, increased left ventricular mass, and abnormal diastolic function. On a multivariable regression analysis, all these parameters also correlated individually with EAT thickness independent of age. Hyperglycemia [DM], systolic hypertension, and lipid parameters for metabolic syndrome showed a trend for positive association, but this was not statistically significant. The association was not significant even for higher cutoff limits of EAT thickness. Epicardial fat >5 mm is associated with cardiac abnormalities on echocardiography. This is a sensitive assessment of body fat distribution, is easily available at echocardiography, and is simple to acquire at no added cost. Further studies looking at the appropriate cut-off thickness of EAT and the sites of measurement to be used are needed. Comparison of this simple and inexpensive measure with other measures of obesity, such as waist-hip ratio, body mass index, Dexa scan of visceral fat, and magnetic resonance imaging of visceral, are needed