ABSTRACT
AIMS: Despite aortic stenosis (AS) relief, patients undergoing transcatheter aortic valve implantation (TAVI) are at increased risk of developing heart failure (HF) within first months of intervention. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors have been shown to reduce the risk of HF hospitalization in individuals with diabetes mellitus, reduced left ventricular ejection fraction and chronic kidney disease. However, the effect of SGLT-2 inhibitors on outcomes after TAVI is unknown. The Dapagliflozin after Transcatheter Aortic Valve Implantation (DapaTAVI) trial is designed to assess the clinical benefit and safety of the SGLT-2 inhibitor dapagliflozin in patients undergoing TAVI. METHODS: DapaTAVI is an independent pragmatic, controlled, prospective, randomized, open-label blinded endpoint, multicentre trial conducted in Spain, evaluating the effect of dapagliflozin 10 mg/day on the risk of death and worsening HF in patients with severe AS undergoing TAVI. Candidate patients should have prior history of HF admission plus ≥1 of the following criteria: (i) diabetes mellitus, (ii) left ventricular ejection fraction ≤40%, or (iii) estimated glomerular filtration rate between 25 and 75 ml/min/1.73 m2 . A total of 1020 patients will be randomized (1:1) to dapagliflozin vs. no dapagliflozin. Key secondary outcomes include: (i) incidence rate of individual components of the primary outcome; (ii) cardiovascular mortality; (iii) the composite of HF hospitalization or cardiovascular death; and (iv) total number of HF rehospitalizations. CONCLUSION: DapaTAVI will determine the efficacy and safety of dapagliflozin in a broad spectrum of frail patients after AS relief by TAVI.
Subject(s)
Aortic Valve Stenosis , Heart Failure , Transcatheter Aortic Valve Replacement , Aortic Valve , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/surgery , Benzhydryl Compounds , Glucosides , Humans , Prospective Studies , Stroke Volume , Treatment Outcome , Ventricular Function, LeftABSTRACT
The right coronary artery involvement occurs in 1-2% of aortic dissection and may cause atrioventricular (AV) block due to obstruction of blood supply to the AV node. A 59-year-old man with a history of hypertension presented to the emergency department with chest pain and complete AV block. After the diagnostic approach, aortic dissection Stanford A was diagnosed. Aortic dissection must be suspected in hypertensive patients who present with AV block and chest pain.
La obstrucción de la coronaria derecha debida a extensión de disección aórtica ocurre en el 1 a 2% de los casos y puede ocasionar bloqueo auriculoventricular. En este caso se presenta a un paciente de 59 años con antecedente de hipertensión que acudió al servicio de urgencias por dolor precordial y bloqueo auriculoventricular completo. Tras el abordaje inicial se diagnosticó disección aórtica (Stanford A). Se debe sospechar la presencia de disección aórtica en pacientes con descontrol hipertensivo, bloqueo auriculoventricular completo y dolor torácico.
Subject(s)
Aortic Aneurysm/complications , Aortic Dissection/complications , Atrioventricular Block/etiology , Aortic Dissection/diagnostic imaging , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm, Abdominal/diagnostic imaging , Aortic Aneurysm, Thoracic/diagnostic imaging , Atrioventricular Block/diagnostic imaging , Electrocardiography , Humans , Hypertension/complications , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The cost of performing a percutaneous coronary intervention is considerably high for the patient as well as for health systems, which have promoted the development of local technology to help meet the need for these devices. METHODS: The INC-01 bare-metal stent was developed at the National Institute of Cardiology in Mexico City and was first implanted on porcine models with technical success in 100% of the evaluated parameters. PRESENTATION OF CASES: We present the first three cases of patients with ischemic heart disease, to whom the INC-01 bare-metal stent was implanted. Intracoronary ultrasonography was performed post-stent implantation, showing all the characteristics of implant success during evaluation and clinical follow-up. CONCLUSIONS: Angiography and intracoronary ultrasound were carried out demonstrating that the INC-01 bare-metal stent has physical, biological, and histological characteristics similar to those found in commercial metallic stents.
Subject(s)
Myocardial Ischemia/surgery , Prosthesis Design , Stents , Adult , Aged , Follow-Up Studies , Humans , Male , Mexico , Middle Aged , Myocardial Ischemia/diagnostic imaging , Myocardial Ischemia/physiopathology , Pilot Projects , Treatment Outcome , UltrasonographyABSTRACT
ABSTRACT Background: The cost of performing a percutaneous coronary intervention is considerably high for the patient as well as for health systems, which have promoted the development of local technology to help meet the need for these devices. Methods: The INC-01 bare-metal stent was developed at the National Institute of Cardiology in Mexico City and was first implanted on porcine models with technical success in 100% of the evaluated parameters. Presentation of Cases: We present the first three cases of patients with ischemic heart disease, to whom the INC-01 bare-metal stent was implanted. Intracoronary ultrasonography was performed post-stent implantation, showing all the characteristics of implant success during evaluation and clinical follow-up. Conclusions: Angiography and intracoronary ultrasound were carried out demonstrating that the INC-01 bare-metal stent has physical, biological, and histological characteristics similar to those found in commercial metallic stents.
