ABSTRACT
INTRODUÇÃO: Troca transcateter de valva aórtica (TAVR) é cada vez mais utilizada no tratamento da estenose aórtica (EA) senil. EA é comumente associada a hipertensão pulmonar (HP) e insuficiência tricúspide (IT). Nosso OBJETIVO foi avaliar o impacto tardio no curso da HP e IT. MÉTODOS: Pacientes submetidos a TAVR foram acompanhados quanto aos dados ecocardiográficos da HP e da IT por 24 meses. Todos os ecocardiogramas foram realizados em centro único. Foram divididos em grupos de acordo com IT e HP após 24 meses (pressão sistólica da artéria pulmonar = or < 45 mmHg) com follow-up de até 96 meses. Resultados clínicos e mortalidade foram comparados. RESULTADOS: 156 e 151 pacientes foram selecionados para acompanhamento da HP e da IT respectivamente. Média de follow-up foi de 42,23±17,53 meses e 42,60±17,67 meses para grupos de HP e IT. HP se reduziu após o TAVR (32,7% pre-TAVR vs. 20,5% pos-TAVR, p<0,001), mas não foi encontrada mudança significativa na IT (11,9% pre-TAVR vs. 10,6% pos-TAVR). Aumento de átrio esquerdo (AE) foi associado a manutenção de HP (p=0,002). Além disso, o aumento do diâmetro do AE (p=0,015) e EuroSCORE II elevado (p=0,041) foram correlacionados ao surgimento de nova HP. Na análise multivariada, surgimento de nova HP (HR 6,17, 95% CI 1,7122,29,p=0,005), disfunção diastólica tipo II ou III (HR 1,06, 95% CI 1,06-1,11, p=0,036) e diâmetro de AE (HR 1,11, 95% CI 1,021,21, p=0,02) foram preditores independentes de mortalidade. CONCLUSÃO: TAVR foi capaz de reduzir a gravidade da HP, mas não da IT. Além disso, a sobrevida a longo prazo foi afetada pela HP, disfunção diastólica e tamanho do AE.
Subject(s)
Tricuspid Valve Insufficiency , Transcatheter Aortic Valve Replacement , Hypertension, PulmonaryABSTRACT
INTRODUCTION: transcatheter aortic valve replacement (TAVR) is increasingly utilized in treatment of aortic stenosis (AS). AS is commonly associated to pulmonary hypertension (PH) and tricuspid regurgitation (TR). We aimed to evaluate the long-term post-TAVR course of PH and TR. METHODS: Patients undergoing TAVR were screened for 24-month echocardiographic data on PH and TR. All echocardiograms were performed by a sing le team. Patients were divided in groups according to TR and PH (pulmonary systolic pressure ≥ or < 45 mmHg) grading at 24 months with follow-up of up to 96 months. Standardized clinical outcomes and survival were compared. RESULTS: 156 and 151 patients were se le cted for PH and TR follow-up, respectively. Mean follow-up was 42.23±17.53 months and 42.60±17.67 months for PH and TR groups. Maximum follow-up was 96 months. PH was reduced post-TAVR (32.7% pre-TAVR vs. 20.5% post-TAVR, p<0.001), but no significant difference in TR was found (11.9% pre-TAVR vs. 10.6% post-TAVR). Increased le ft atrial (LA) diameter (p = 0.002) was associated to maintenance PH. Moreover, increased LA diameter (p=0.015) and increased EuroSCORE II (p=0.041) were correlated to new onset PH. On a multivariab le Cox regression model, new onset PH (HR 6.17, 95% CI 1.7122.29, p=0.005), diastolic dysfunction type II or III (HR 1.06, 95% CI 1.06-1.11, p=0.036) and LA diameter (HR 1.11, 95% CI 1.021.21, p=0.02) were independent predictors of long-term mortality. CONCLUSIONS: TAVR was ab le to reduce the severity of PH, but not TR, in this cohort. Additionally, long-term survival was affected by PH, diastolic dysfunction and LA sizing.
Subject(s)
Humans , Tricuspid Valve Insufficiency/etiology , Transcatheter Aortic Valve Replacement/adverse effects , Hypertension, Pulmonary/etiology , Follow-Up StudiesABSTRACT
The aim of the work was to study the production of the exopolysaccharides by Agaricus brasiliensis and the isolation of exopolysaccharides (EPSs) with biological effects. A brasiliensis LPB03 was cultured in submerged fermentation in a medium containing glucose, yeast extract, hydrolyzed soybean protein, and salts (pH 6.1) at 29 degrees C and 120 rpm for 144 h. The maximum biomass and EPS yield was 7.80 +/- 0.01 and 1,430.70 +/- 26.75 mg/L, respectively. To isolate the produced EPSs, two methods were compared: (1) with alcohol precipitation and (2) treatment with tricloroacetic acid (TCA), followed by alcohol precipitation. The use of TCA facilitated the purification of the EPS, reducing the amount of the contaminant soy proteins. For monosaccharide identification, the EPSs were hydrolyzed, derivatized to alditol acetates, and analyzed by gas chromatography (GC) and GC-mass spectrometry, which showed the presence (in molar percentage) of mannose (58.7), galactose (21.4), and glucose (13.1) as major sugars, with lower amounts of rhamnose (3.9) and xylose (2.8). Scanning electron microscopy was used to observe the morphological structure of the EPS. The experiments in vivo including EPS in the mice diet during 8 weeks indicated the hipocholesteremic and hypoglycemic effects.
