Aortic regurgitation management: a systematic review of clinical practice guidelines and recommendations.

Guidelines for the diagnosis and management of aortic regurgitation (AR) contain recommendations that do not always match. We systematically reviewed clinical practice guidelines and summarized similarities and differences in the recommendations as well as gaps in evidence on the management of AR. We searched MEDLINE and Embase (1 January 2011 to 1 September 2021), Google Scholar, and websites of relevant organizations for contemporary guidelines that were rigorously developed as assessed by the Appraisal of Guidelines for Research and Evaluation II tool. Three guidelines met our inclusion criteria. There was consensus on the definition of severe AR and use of echocardiography and of multimodality imaging for diagnosis, with emphasis on comprehensive assessment by the heart valve team to assess suitability and choice of intervention. Surgery is indicated in all symptomatic patients and aortic valve replacement is the cornerstone of treatment. There is consistency in the frequency of follow-up of patients, and safety of non-cardiac surgery in patients without indications for surgery. Discrepancies exist in recommendations for 3D imaging and the use of global longitudinal strain and biomarkers. Cut-offs for left ventricular ejection fraction and size for recommending surgery in severe asymptomatic AR also vary. There are no specific AR cut-offs for high-risk surgery and the role of percutaneous intervention is yet undefined. Recommendations on the treatment of mixed valvular disease are sparse and lack robust prospective data.

Association between mitral annular calcification and progression of mitral and aortic stenoses.

BACKGROUND: Mitral annular calcification (MAC) is a chronic degenerative process affecting the annular fibrosus of the mitral valve. We sought to examine the relationship between MAC and the progression of valve disease. METHODS: The echocardiography database was searched for patients with MAC who had undergone at least two studies more than 1 year apart. The degree of MAC was quantified according to both extent and thickness. The degree of aortic stenosis (AS) and mitral stenosis (MS) was classified according to valve area and mean gradient, respectively. RESULTS: Of 125 patients, moderate or greater AS was present in 8 of 86 (9.3%) patients with mild, 12 of 29 (41.4%) patients with moderate, and 4 of 10 (40%) patients with severe MAC extent, P = .0002. The rate of progression of AS was highest in those with greatest MAC extent (0.21 cm2 /y) or greatest MAC thickness (0.28 cm2 /y) compared with those with least MAC extent (0.09 cm2 /y) or thickness (0.07 cm2 /y), P = .04 and <.0001, respectively. The rate of progression of mean mitral gradient was highest in those with greatest MAC extent (0.71 mm Hg/y) or greatest MAC thickness (0.17 mm Hg/y) compared with those with least MAC extent (0.07 mm Hg/y) or thickness (0.07 mm Hg/y), P = .0003 and P < .0001, respectively. Patients with greatest MAC extent had lower survival than those with lower MAC extent, P = .03. However, there was no difference in survival between patients with different MAC thickness, P = .43. CONCLUSION: Both the degree of MAC extent and thickness are associated with the rate of progression of aortic and mitral stenosis and may serve as a risk marker for future progression.

Assessment of genetic diversity and phylogenetic relationship of Limousin herds in Hungary using microsatellite markers.

OBJECTIVE: This study was conducted to investigate basic information on genetic structure and characteristics of Limousin population in Hungary. Obtained results will be taken into consideration when adopting the new breeding strategy by the Association of Hungarian Limousin and Blonde d'Aquitaine Breeders (AHLBB). METHODS: Genetic diversity and phylogenetic relationship of 3,443 Limousin cattle from 16 different herds were investigated by performing genotyping using 18 microsatellite markers. Amplified DNA was genotyped using an automated genetic analyzer. RESULTS: Mean of effective alleles (ne) of the populations was 3.77. Population C had the lowest number of effective alleles (3.01) and the lowest inbreeding coefficient (FIS) value (-0.15). Principal component analysis of estimated genetic distance (FST) values (p<0.000) revealed two herds (C and E) distinct from the majority of other Limousin herds. The pairwise FST values of population C compared to the others (0.066 to 0.120) fell into the range of moderate genetic distance: 0.050 to 0.150, while population E displayed also moderate genetic distance (FST values in range 0.052 to 0.064) but only to six populations (G, H, J, L, N, and P). FST(C-E) was 0.148, all other pairs -excluding C and E herds- displayed low genetic distance (FST<0.049). Population D, F, I, J, K, L, N, O, and P carried private alleles, which alleles belonged to 1.1% of the individuals. Most probable number of clusters (K) were 2 and 7 determined by Structure and BAPS software. CONCLUSION: This study showed useful genetic diversity and phylogenetic relationship data that can be utilized for the development of a new breeding strategy by AHLBB. The results presented could also contribute to the proper selection of animals for further whole genome scan studies of Limousins.