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  1. Limited posterior left atrial linear radiofrequency ablation for patients with chronic atrial fibrillation undergoing rheumatic valvular heart surgery

    Institute of Scientific and Technical Information of China (English)

    王均志; 杜日映; 丁会霞; 柏本健; 王刚; 崔国方; 钟志欢

    2004-01-01

    @@ Since 1996, we have begun to successfully treat atrial fibrillation (AF) with the maze procedure, replacing surgical incisions with radiofrequency (RF) ablation.1,2 Recent data show that the posterior wall of the left atrium seems to be a critical area for the occurrence and the maintenance of AF in patients with valvular heart disease. The objective of this study was to evaluate whether limited surgical RF ablation of the posterior region of the left atrium is safe and effective in curing chronic AF in patients also suffering from valvular heart disease.

  2. [Atrial fibrillation concomitant with valvular heart disease].

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    Ishii, Yosuke

    2013-01-01

    Patients with valvular heart disease frequently have atrial fibrillation(AF) due to elevated pressure and dilatation of the left and right atria and pulmonary veins. Guidelines for valvular heart disease and AF recommend that surgical treatment for the valvular heart disease should be performed concomitantly with AF surgery. The Full-Maze procedure has evolved into the gold standard of treatment for medically refractory AF. In addition to the pulmonary vein isolation, the right and left atrial incisions of the Full-Maze procedure are designed to block potential macroreentrant pathways. According to the mechanisms of AF with valvular heart disease, the Full-Maze procedure is more effective for the patients than the pulmonary vein isolation alone.

  3. Effect of single intraoperative dose of amiodarone in patients with rheumatic valvular heart disease and atrial fibrillation undergoing valve replacement surgery

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    Selvaraj Thiruvenkadam

    2009-01-01

    Full Text Available Maintenance of sinus rhythm (SR is superior to rate control in atrial fibrillation (AF. In order to achieve SR, we administered single-dose intravenous amiodarone intraoperatively and evaluated its effect on conversion of rheumatic AF to SR in patients undergoing valvular heart surgery. Patients were randomly assigned to amiodarone ( n = 42 or control ( n = 40 group in a double blind manner. The amiodarone group received amiodarone (3 mg/kg intravenously prior to the institution of cardiopulmonary bypass and the control group received the same volume of normal saline. In the amiodarone group, the initial rhythm after the release of aortic cross clamp was noted to be AF in 14.3% ( n = 6 and remained so in 9.5% ( n = 4 of patients till the end of surgery. In the control group, the rhythm soon after the release of aortic cross clamp was AF in 37.5% ( n = 15 ( p = 0.035 and remained so in 32.5% ( n = 13 of patients till the end of surgery ( p = 0.01. At the end of first post-operative day 21.4% ( n = 9 of patients in amiodarone group and 55% ( n = 22 of patients in control group were in AF ( p = 0.002. The requirement of cardioversion/defibrillation was 1.5 (±0.54 in amiodarone group and 2.26 (±0.73 in the control group ( p = 0.014, and the energy needed was 22.5 (±8.86 joules in the amiodarone group and 40.53 (±16.5 in the control group ( p = 0.008. A single intraoperative dose of intravenous amiodarone increased the conversion rate of AF to normal sinus rhythm, reduced the need and energy required for cardioversion/defibrillation and reduced the recurrence of AF within one day.

  4. Predictors of left atrial appendage stunning after electrical cardioversion of non-valvular atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    杨沙宁; 黄从新; 胡晓军; 金立军; 李凤翥; 彭水先

    2003-01-01

    Objective To identify predictors of left atrial appendage stunning after the use of electrical cardioversion to restore sinus rhythm in patients with non-valvular atrial fibrillation.Methods A total of 68 consecutive patients (45 men, 23 women, 60.5±8.7 years of age) with non-valvular atrial fibrillation undergoing electrical cardioversion were enlisted in this study. Clinical and echocardiographic variables were analyzed by univariate regression and multivariate logistic regression to investigate the relationship between occurrences of left atrial appendage stunning and these factors. Results Univariate analysis revealed that, in comparing patients without and with left atrial appendage stunning, there were significant differences in the duration of atrial fibrillation > 8 weeks (32.3% vs 75.5%, P 50 mm (29.0% vs 54.1%, P 8 weeks (OR=7.249, 95%CI=1.998-26.304, P 50 mm (OR=3.896, 95%CI=1.105-13.734, P8 weeks, left atrial diameter >50 mm, left ventricular ejection fraction <50%, and cumulative energy of electrical cardioversion are independent predictors of left atrial appendage stunning. Anticoagulation treatment should be individualized for patients undergoing electrical cardioversion to reduce the risk of both cardioversion-related thromboembolic events and hemorrhagic complications caused by warfarin treatment.

  5. Stroke Prevention in Atrial Fibrillation and Valvular Heart Disease.

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    Ahmad, Saad; Wilt, Heath

    2016-01-01

    There is a clinically staggering burden of disease stemming from cerebrovascular events, of which a majority are ischemic in nature and many are precipitated by atrial fibrillation (AF). AF can occur in isolation or in association with myocardial or structural heart disease. In the latter case, and when considering health at an international level, congenital and acquired valve-related diseases are frequent contributors to the current pandemic of AF and its clinical impact. Guidelines crafted by the American Heart Association, American College of Cardiology, European Society of Cardiology and Heart Rhythm Society underscore the use of vitamin K antagonists (VKAs) among patients with valvular heart disease, particularly in the presence of concomitant AF, to reduce the risk of ischemic stroke of cardioembolic origin; however, the non-VKAs, also referred to as direct, target-specific or new oral anticoagulants (NOACs), have not been actively studied in this particular population. In fact, each of the new agents is approved in patients with AF not caused by a valve problem. The aim of our review is to carefully examine the available evidence from pivotal phase 3 clinical trials of NOACs and determine how they might perform in patients with AF and concomitant valvular heart disease.

  6. Impact of valvular heart disease on oral anticoagulant therapy in non-valvular atrial fibrillation: results from the RAMSES study.

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    Başaran, Özcan; Dogan, Volkan; Beton, Osman; Tekinalp, Mehmet; Aykan, Ahmet Çağrı; Kalaycıoğlu, Ezgi; Bolat, Ismail; Taşar, Onur; Şafak, Özgen; Kalçık, Macit; Yaman, Mehmet; İnci, Sinan; Altıntaş, Bernas; Kalkan, Sedat; Kırma, Cevat; Biteker, Murat

    2017-02-01

    The definition of non-valvular atrial fibrillation (NVAF) is controversial. We aimed to assess the impact of valvular heart disease on stroke prevention strategies in NVAF patients. The RAMSES study was a multicenter and cross-sectional study conducted on NVAF patients (ClinicalTrials.gov identifier NCT02344901). The study population was divided into patients with significant valvular disease (SVD) and non-significant valvular disease (NSVD), whether they had at least one moderate valvular disease or not. Patients with a mechanical prosthetic valve and mitral stenosis were excluded. Baseline characteristics and oral anticoagulant (OAC) therapies were compared. In 5987 patients with NVAF, there were 3929 (66%) NSVD and 2058 (34%) SVD patients. The predominant valvular disease was mitral regurgitation (58.1%), followed by aortic regurgitation (24.1%) and aortic stenosis (17.8%). Patients with SVD had higher CHA2DS2VASc [3.0 (2.0; 4.0) vs. 4.0 (2.0; 5.0), p valvular heart disease with the predominance of mitral regurgitation. Patients with SVD were at greater risk of stroke and bleeding compared to patients with NSVD. Although patients with mitral regurgitation should be given more aggressive anticoagulant therapy due to their higher risk of stroke, they are undertreated compared to patients with aortic valve diseases.

  7. New Procedure for Treatment of Atrial Fibrillation in Patients with Valvular Heart Disease

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    Naser Safaie

    2010-09-01

    Full Text Available "nPatients with valvular heart disease suffer from atrial fibrillation for more than 12 months after valve surgery and have a low probability of remaining in sinus rhythm. We performed an intra-operative procedure similar to surgical maze ІІІ procedure for conversion of this arrhythmia to sinus rhythm. We did this study to evaluate the efficacy of this procedure to restore the sinus rhythm in patients with valvular heart disease. 28 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant reduction of left and right atrial size and resection of both atrial auricles in Shahid Madani cardiothoracic center from September 2004 to October 2008. The procedure for atrial fibrillation treatment was performed with cardiopulmonary bypass and after mitral valve replacement. There was one in-hospital death postoperatively because of respiratory failure, but no other complication till 6 months after the operation. Out of 28 patients, 23 were in sinus rhythm one week after the operation, one patient had junctional rhythm after the operation that restored to sinus rhythm and 4 patients had persistent atrial fibrillation. During the 12-month follow up, atrial fibrillation was corrected in 82.14%. Doppler echocardiography in these patients with sinus rhythm demonstrated good atrial contractility. This procedure on both atria is effective and less invasive than the original maze procedure to eliminate the atrial fibrillation, and can be performed in patients with valvular heart disease without increasing the risk of operation.

  8. New Procedure for Treatment of Atrial Fibrillation in Patients with Valvular Heart Disease

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    Naser Safaie

    2010-10-01

    Full Text Available Patients with valvular heart disease suffer from atrial fibrillation for more than 12 months after valve surgery and have a low probability of remaining in sinus rhythm. We performed an intra-operative procedure similar to surgical maze ІІІ procedure for conversion of this arrhythmia to sinus rhythm. We did this study to evaluate the efficacy of this procedure to restore the sinus rhythm in patients with valvular heart disease. 28 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant reduction of left and right atrial size and resection of both atrial auricles in Shahid Madani cardiothoracic center from September 2004 to October 2008. The procedure for atrial fibrillation treatment was performed with cardiopulmonary bypass and after mitral valve replacement. There was one in-hospital death postoperatively because of respiratory failure, but no other complication till 6 months after the operation. Out of 28 patients, 23 were in sinus rhythm one week after the operation, one patient had junctional rhythm after the operation that restored to sinus rhythm and 4 patients had persistent atrial fibrillation. During the 12-month follow up, atrial fibrillation was corrected in 82.14%. Doppler echocardiography in these patients with sinus rhythm demonstrated good atrial contractility. This procedure on both atria is effective and less invasive than the original maze procedure to eliminate the atrial fibrillation, and can be performed in patients with valvular heart disease without increasing the risk of operation.

  9. New procedure for treatment of atrial fibrillation in patients with valvular heart disease.

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    Safaie, Naser; Maghamipour, Nasrollah; Jodati, Ahmad Reza; Mahmoodpoor, Ata; Dashtaki, Leila; Hakimzadeh, Masoud

    2010-01-01

    Patients with valvular heart disease suffer from atrial fibrillation for more than 12 months after valve surgery and have a low probability of remaining in sinus rhythm. We performed an intra-operative procedure similar to surgical maze ІІІ procedure for conversion of this arrhythmia to sinus rhythm. We did this study to evaluate the efficacy of this procedure to restore the sinus rhythm in patients with valvular heart disease. 28 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant reduction of left and right atrial size and resection of both atrial auricles in Shahid Madani cardiothoracic center from September 2004 to October 2008. The procedure for atrial fibrillation treatment was performed with cardiopulmonary bypass and after mitral valve replacement. There was one in-hospital death postoperatively because of respiratory failure, but no other complication till 6 months after the operation. Out of 28 patients, 23 were in sinus rhythm one week after the operation, one patient had junctional rhythm after the operation that restored to sinus rhythm and 4 patients had persistent atrial fibrillation. During the 12-month follow up, atrial fibrillation was corrected in 82.14%. Doppler echocardiography in these patients with sinus rhythm demonstrated good atrial contractility. This procedure on both atria is effective and less invasive than the original maze procedure to eliminate the atrial fibrillation, and can be performed in patients with valvular heart disease without increasing the risk of operation.

  10. Modified radial v/s biatrial maze for atrial fibrillation in rheumatic valvular heart surgery

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    Sayed, Sajid A.; Katewa, Ashish; Srivastava, Vivek; Jana, Sujit; Patwardhan, Anil M.

    2014-01-01

    Background Atrial fibrillation (AF) is commonest sustained atrial arrhythmia producing high morbidity. Although Cox's Maze III procedure cures AF in majority, reduced atrial transport function (ATF) is a concern. Radial approach with ablation lines radial from sinus node towards atrioventricular annulii and parallel to atrial coronary arteries, has shown better ATF. Methods Single blind open randomized prospective study of 80 patients was undertaken in two groups (40 each) of modified Cox's maze III and modified radial approach, to evaluate conversion to normal sinus rhythm (NSR) and ATF. Patients undergoing surgery for rheumatic valvular heart disease with continuous AF were prospectively randomized. Ablation lines were created with radiofrequency (RF) bipolar coagulation with cryoablation for the isthmal lesions and coronary sinus. Results were compared at 6 months and ATF was evaluated by atrial filling fraction (AFF) and A/E ratio on echocardiography. Results The rate of conversion to NSR in both groups was statistically insignificant by Fisher's exact test (p > 0.05). ATF was better in modified radial approach compared to modified Cox's Maze III (A/E compared by unpaired t test:0.52 ± 0.08 v/s 0.36 ± 0.10; p < 0.05. AFF compared using Mann Whitney U test: median AFF for radial group was 23 v/s 20 for biatrial group; p < 0.05). Discussion In patients with AF undergoing rheumatic valvular surgery, radiofrequency radial approach is as effective as modified Cox's maze III for conversion to NSR with better atrial transport function. PMID:25443604

  11. SECONDARY PREVENTION OF STROKE IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION: THE CLINICIANS’ VIEWPOINT

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    E. A. Drozdova

    2015-09-01

    Full Text Available Atrial fibrillation is one of the main risk factor of ischemic stroke. Current problems of the management of patients with stroke due to non-valvular atrial fibrillation and secondary stroke prevention in these patients are considered. Data of own author’s observation for patients of this type during 6 months after discharge from the hospital are presented. The problems which patients faced with are analyzed. Comparative assessment of warfarin and dabigatran therapies is given.

  12. Atrial fibrillation and rheumatic valvular heart disease: usefulness of very-low-dose amiodarone

    Institute of Scientific and Technical Information of China (English)

    Tsuyoshi Shiga

    2006-01-01

    @@ Atrial fibrillation (AF) is frequently associated with rheumatic valvular heart disease (RVHD). AF leads to systemic thromboembolic complications,reduced quality of life (QOL), impaired ventricular function and also increased mortality. Multivariate analysis of results from a population-based study has shown that valvular heart disease is one of risk factors for development of AF.1 The frequency of RVHD has decreased in developed countries in recent years, but RVHD now constitutes a significant population for the cardiology services in developing countries.2

  13. Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation

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    Scarsoglio, Stefania; Gaita, Fiorenzo; Ridolfi, Luca; Anselmino, Matteo

    2016-01-01

    Although atrial fibrillation (AF), a common arrhythmia, frequently presents in patients with underlying valvular disease, its hemodynamic contributions are not fully understood. The present work aimed to computationally study how physical conditions imposed by pathologic valvular anatomy act on AF hemodynamics. We simulated AF with different severity grades of left-sided valvular diseases and compared the cardiovascular effects that they exert during AF, compared to lone AF. The fluid dynamics model used here has been recently validated for lone AF and relies on a lumped parameterization of the four heart chambers, together with the systemic and pulmonary circulation. Three different grades of severity (mild, moderate, severe) were analyzed for each of the four valvulopathies (aortic stenosis, mitral stenosis, aortic regurgitation, mitral regurgitation). Regurgitation was hemodynamically more relevant than stenosis, as the latter led to inefficient cardiac flow, while the former introduced more drastic fluid ...

  14. INTRAOPERATIVE RADIOFREQUENCY AND CRYOABLATION FOR ATRIAL FIBRILLATION IN PATIENTS WITH VALVULAR HEART DISEASE

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    N. Maghamipour N. Safaie

    2007-05-01

    Full Text Available Patients with valvular heart disease and suffering atrial fibrillation of more than 12 months duration have a low probability of remaining in sinus rhythm after valve surgery alone. We performed intra-operative radiofrequency ablation or cryoablation as an alternative to surgical maze ІІІ procedure to create linear lesion lines for conversion of this arrhythmia to sinus rhythm. A total of 30 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant maze procedure with radiofrequency or cryo probes. These patients aged 48.10 ± 9.84 years in radiofrequency ablation group and 51.10 ± 13.93 years in cryoablation group. Both atrial ablation with radiofrequency probes, needed 26.15 ± 3.67 min extra ischemic time and ablation by mean of cryo-probes needed an extra ischemic time of 29.62 ± 4.27 min. There was one in hospital death postoperatively because of respiratory failure but no other complication. 6 months after the operation, among 30 patients with both atrial ablations, 25 patients were in sinus rhythm, no patient had junctional rhythm and 5 patients had persistent atrial fibrillation. At 12 months follow up, freedom from atrial fibrillation was 85% in radiofrequency group and 80% in cryo group. Doppler echocardiography in these patients demonstrated atrial contractility in 70% of the patients. Intraoperative radiofrequency or cryo-ablation of both atriums are effective and less invasive alternatives for the original maze procedure to eliminate the atrial fibrillation, and can be done in patients with valvular heart disease without increasing the risk of operation.

  15. Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation.

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    Scarsoglio, Stefania; Saglietto, Andrea; Gaita, Fiorenzo; Ridolfi, Luca; Anselmino, Matteo

    2016-01-01

    Although atrial fibrillation (AF), a common arrhythmia, frequently presents in patients with underlying valvular disease, its hemodynamic contributions are not fully understood. The present work aimed to computationally study how physical conditions imposed by pathologic valvular anatomy act on AF hemodynamics. We simulated AF with different severity grades of left-sided valvular diseases and compared the cardiovascular effects that they exert during AF, compared to lone AF. The fluid dynamics model used here has been recently validated for lone AF and relies on a lumped parameterization of the four heart chambers, together with the systemic and pulmonary circulation. The AF modelling involves: (i) irregular, uncorrelated and faster heart rate; (ii) atrial contractility dysfunction. Three different grades of severity (mild, moderate, severe) were analyzed for each of the four valvulopathies (AS, aortic stenosis, MS, mitral stenosis, AR, aortic regurgitation, MR, mitral regurgitation), by varying-through the valve opening angle-the valve area. Regurgitation was hemodynamically more relevant than stenosis, as the latter led to inefficient cardiac flow, while the former introduced more drastic fluid dynamics variation. Moreover, mitral valvulopathies were more significant than aortic ones. In case of aortic valve diseases, proper mitral functioning damps out changes at atrial and pulmonary levels. In the case of mitral valvulopathy, the mitral valve lost its regulating capability, thus hemodynamic variations almost equally affected regions upstream and downstream of the valve. In particular, the present study revealed that both mitral and aortic regurgitation strongly affect hemodynamics, followed by mitral stenosis, while aortic stenosis has the least impact among the analyzed valvular diseases. The proposed approach can provide new mechanistic insights as to which valvular pathologies merit more aggressive treatment of AF. Present findings, if clinically confirmed

  16. New oral anticoagulants in non-valvular atrial fibrillation.

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    Francia, Pietro; Adduci, Carmen; Santini, Daria; Musumeci, Beatrice; Tocci, Giuliano

    2013-06-01

    Atrial fibrillation (AF) is associated with an increased risk of embolic stroke. Dose-adjusted vitamin K antagonists (VKAs) to a target international normalized ratio (INR) range of 2.0-3.0 reduce the risk of ischemic stroke and are currently recommended in all patients with AF at moderate-high risk for stroke or systemic embolism. However, VKAs have several drawbacks, including unpredictable anticoagulant response, food and drug interactions, need for regular laboratory monitoring and dose adjustment. These limitations prompted the introduction of new oral anticoagulants (NOA) that target thrombin and factor Xa, key-enzymes in the coagulation pathway. NOA have predictable pharmacodynamics, allowing fixed dosing without the need of laboratory monitoring, and have few drug and food interactions. The present review focuses on pharmacological properties, safety, and appropriate clinical use of dabigatran, rivaroxaban and apixaban.

  17. [Low molecular weight heparin and non valvular atrial fibrillation].

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    Ederhy, S; Di Angelantonio, E; Meuleman, C; Janower, S; Boccara, F; Cohen, A

    2006-12-01

    Low molecular weight heparin (LMWH) are obtained through chemical or enzyme depolymerisation of unfractioned heparins (UFH). LMWHs present several advantages over UFH: they exhibit a smaller interindividual variability of the anticoagulant effect, they have a greater bioavailability, a longer plasma half-life and do not require monitoring of the anticoagulant effect. LMWH have restrictive indications in AF patients, cardioversion (II level C and TEE for ACC/AHA/ESC and 2C for ACCP guidelines) or use as a bridge therapy (IIB, level C for ACC/AHA/ESC). The ACE study (Anticoagulation for cardioversion using enoxaparin), showed a reduction, though not statistically significant, of 42% of the composite end point (embolic event, major bleeding and death) 2.8% under enoxaparin vs. 4.8 % under conventional treatment, relative risk 0.58, CI 95% 0.23-1.46). Other studies, using dalteparin, confirmed that an anticoagulant treatment using LMWH followed by warfarin was at least as good as conventional management. ACUTE II (Assessment of cardioversion using transesophageal echochardiography), a randomized multicenter trial, compared the efficacy and tolerance of enoxaparin (1 mg/kg every 12 hours) and UFH in 155 patients eligible for a TEE-guided cardioversion. These patients were administered LMWH or UFH for 24 hours before TEE or cardioversion. There were no significative differences regarding the incidence of the study end points, in particular stroke and bleeding, and no death occurred. HAEST (Heparin in acute embolic stroke trial), a randomized, placebo-controlled, double blind trial failed to show the LMWH superiority over aspirin in patients with acute ischemic stroke and atrial fibrillation. Finally, LMWH have been proposed as a bridge therapy in patients under chronic VKA prior to surgery or invasive procedures. This strategy resulted in a low rate of thromboembolic events and major bleedings.

  18. Direct oral anticoagulant use in nonvalvular atrial fibrillation with valvular heart disease: a systematic review.

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    Owens, Ryan E; Kabra, Rajesh; Oliphant, Carrie S

    2016-12-22

    Direct oral anticoagulants (DOACs) are indicated for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF), which, according to the American College of Cardiology/American Heart Association/Heart Rhythm Society atrial fibrillation (AF) guidelines, excludes patients with rheumatic mitral stenosis, a mechanical or bioprosthetic heart valve, or mitral valve repair. However, the data regarding use of DOACs in AF patients with other types of valvular heart disease (VHD) are unclear. We aimed to summarize and evaluate the literature regarding the safety and efficacy of DOAC use in NVAF patients with other types of VHD. After an extensive literature search, a total of 1 prospective controlled trial, 4 subanalyses, and 1 abstract were identified. Efficacy of the DOAC agents in NVAF patients with VHD mirrored the overall trial results. Bleeding risk was significantly increased in VHD patients treated with rivaroxaban, but not for dabigatran or apixaban. Of the bioprosthetic valve patients enrolled in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial, no safety or efficacy concerns were identified. In conclusion, subanalyses of DOAC landmark AF trials revealed that dabigatran, rivaroxaban, and apixaban may be safely used in AF patients with certain types of VHD: aortic stenosis, aortic regurgitation, and mitral regurgitation. More evidence is needed before routinely recommending these agents for patients with bioprosthetic valves or mild mitral stenosis. Patients with moderate to severe mitral stenosis or mechanical valves should continue to receive warfarin, as these patients were excluded from all landmark AF trials.

  19. Relationship between platelet indices and international normalized ratio in patients with non-valvular atrial fibrillation.

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    Arık, Osman Ziya; Ozkan, Buğra; Kutlu, Rasim; Karal, Hüseyin; Sahin, Durmuş Yıldıray; Kaypaklı, Onur; Ozel, Deniz; Cayli, Murat

    2014-01-01

    Atrial fibrillation (AF) is the most common sustained arrhythmia and associated with adverse outcomes and increased risk for thromboembolic events. Warfarin is still the most extensively prescribed oral anticoagulant in AF to prevent ischemic complications. We aimed to determine the differences at platelet indices with warfarin usage layered by International Normalized Ratio (INR). A total of 250 patients with permanent non-valvular AF (mean age 70.2 ± 9.1; 153 female) were divided into two groups. Group 1 included 125 patients whose INR is between 2.0 and 3.0 (called as "effective") and Group 2 included 125 patients whose INR is indices, even lower as the values of subjects in sinus rhythm. MPV, PDW and PCT are independent predictors of INR ineffectiveness and seem to be useful parameters for monitoring the effectiveness of warfarin treatment.

  20. Is There Association Between Changes in eGFR Value and the Risk of Permanent Type of Atrial Fibrillation? - Analysis of Valvular and Non-Valvular Atrial Fibrillation Population

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    Elzbieta Mlodawska

    2014-12-01

    Full Text Available Background/Aims: There are no data concerning renal function in population with valvular and non-valvular atrial fibrillation (AF. To assess renal function in patients with AF, the association between eGFR and AF perpetuation, in-hospital mortality. Methods: We studied 1523 patients with AF. Patients with chronic kidney disease (CKD were compared to population with preserved renal function. Results: CKD was more frequently observed in patients with valvular AF(p=0.009. In non-valvular AF patients eGFR 2 had more often permanent AF(p2DS2VASc score was 4.1±1.5 and HAS-BLED score was 2.1±1.2 and it was higher as compared to population with preserved renal function (p75 years old(OR=3.70,p=0.01,95%CI1.33-10.28, with CKD (OR=2.61,p=0.03,95%CI1.09-6.23. The type of AF had no significant influence on in-hospital mortality(OR=0.71,p=0.45,95%CI0.30-1.70. Conclusions: CKD is more often observed in patients with valvular AF. In population with non-valvular AF decreased eGFR is associated with permanent type of AF and with higher CHA2DS2VASc and HAS-BLED score. Among valvular AF patients there are no differences in type of AF between patients with and without CKD. There is the correlation between CKD and AF perpetuation but only in non-valvular population.

  1. Stroke prevention strategies in patients with atrial fibrillation and heart valve abnormalities: perceptions of 'valvular' atrial fibrillation: results of the European Heart Rhythm Association Survey.

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    Potpara, Tatjana S; Lip, Gregory Y H; Larsen, Torben B; Madrid, Antonio; Dobreanu, Dan; Jędrzejczyk-Patej, Ewa; Dagres, Nikolaos

    2016-10-01

    The purpose of this European Heart Rhythm Association (EHRA) Survey was to assess the perceptions of 'valvular' atrial fibrillation (AF) and management of AF patients with various heart valve abnormalities in daily clinical practice in European electrophysiology (EP) centres. Questionnaire survey was sent via the Internet to the EHRA-EP Research Network Centres. Of the 52 responding centres, 42 (80.8%) were university hospitals. Choosing the most comprehensive definition of valvular AF, a total of 49 centres (94.2%) encountered a mechanical prosthetic heart valve and significant rheumatic mitral stenosis, 35 centres (67.3%) also considered bioprosthetic valves, and 25 centres (48.1%) included any significant valvular heart disease, requiring surgical repair in the definition of valvular AF. Only three centres (5.8%) would define valvular AF as the presence of any (even mild) valvular abnormality. None of the centres would use non-vitamin K antagonist oral anticoagulants (NOACs) in AF patients with mechanical prosthetic valves, only 5 centres (9.8%) would use NOACs in patients with significant mitral stenosis, 17 centres (32.7%) would consider the use of NOACs in patients with bioprosthetic valves, and 21 centres (41.2%) would use NOACs in patients with a non-recent transcatheter valve replacement/implantation, while 13 centres (25.5%) would never consider the use of NOACs in AF patients with even mild native heart valve abnormality. Our survey showed marked heterogeneity in the definition of valvular AF and thromboprophylactic treatments, with the use of variable NOACs in patients with valvular heart disease other than prosthetic heart valves or significant mitral stenosis, indicating that this term may be misleading and should not be used.

  2. Left atrial appendage occlusion in high-risk patients with non-valvular atrial fibrillation.

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    Berti, Sergio; Pastormerlo, Luigi Emilio; Rezzaghi, Marco; Trianni, Giuseppe; Paradossi, Umberto; Cerone, Elisa; Ravani, Marcello; De Caterina, Alberto Ranieri; Rizza, Antonio; Palmieri, Cataldo

    2016-12-15

    Percutaneous left atrial appendage (LAA) occlusion has been developed as a viable option for stroke and thromboembolism prevention in patients with non-valvular atrial fibrillation (NVAF) and at high risk for cerebral cardioembolic events. Data on device implantation and long-term follow-up from large cohorts are limited. 110 consecutive patients with NVAF and contraindications to oral anticoagulants (OACs) underwent LAA occlusion procedures and achieved a longer than 1 year follow-up. All patients were enrolled in a prospective registry. Procedures were performed using the Amplatzer Cardiac Plug or Amulet guided by fluoroscopy and intracardiac echocardiography. Mean age of the population was 77±6 years old; 68 were men. Atrial fibrillation was paroxysmal in 20%, persistent in 15.5% and permanent in 64.5% of cases, respectively. Mean CHA2DS2-VASc and HAS-BLED scores were 4.3±1.3 and 3.4±1, respectively. Technical success (successful deployment and implantation of device) was achieved in 100% of procedures. Procedural success (technical success without major procedure-related complications) was achieved in 96.4%, with a 3.6% rate of major procedural complications (three cases of pericardial tamponade requiring drainage and one case of major bleeding). Mean follow-up was 30±12 months (264 patient-years). Annual rates for ischaemic stroke and for other thromboembolic events were respectively 2.2% and 0%, and annual rate for major bleeding was 1.1%. Our data suggest LAA occlusion in high-risk patients with NVAF not suitable for OACs is feasible and associated with low complication rates as well as low rates of stroke and major bleeding at long-term follow-up. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  3. [Economic evaluation of dabigatran for stroke prevention in patients with non-valvular atrial fibrillation].

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    Silva Miguel, Luís; Rocha, Evangelista; Ferreira, Jorge

    2013-01-01

    To estimate the cost-effectiveness and cost-utility of dabigatran in the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation in Portugal. A Markov model was used to simulate patients' clinical course, estimating the occurrence of ischemic and hemorrhagic stroke, transient ischemic attack, systemic embolism, myocardial infarction, and intra- and extracranial hemorrhage. The clinical parameters are based on the results of the RE-LY trial, which compared dabigatran with warfarin, and on a meta-analysis that estimated the risk of each event in patients treated with aspirin or with no antithrombotic therapy. Dabigatran provides an increase of 0.331 life years and 0.354 quality-adjusted life years for each patient. From a societal perspective, these clinical gains entail an additional expenditure of 2978 euros. Thus, the incremental cost is 9006 euros per life year gained and 8409 euros per quality-adjusted life year. The results show that dabigatran reduces the number of events, especially the most severe such as ischemic and hemorrhagic stroke, as well as their long-term sequelae. The expense of dabigatran is partially offset by lower event-related costs and by the fact that INR monitoring is unnecessary. It can thus be concluded that the use of dabigatran in clinical practice in Portugal is cost-effective. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  4. Adherence to medication and characteristics of Japanese patients with non-valvular atrial fibrillation.

    Science.gov (United States)

    Suzuki, Tsuyoshi; Shiga, Tsuyoshi; Omori, Hisako; Tatsumi, Fujio; Nishimura, Katsuji; Hagiwara, Nobuhisa

    2017-09-01

    Adherence to medication plays an important role in the prevention of morbidity and mortality in non-valvular atrial fibrillation (NVAF) patients. The aim of this study is to assess adherence to medication and risk factors for non-adherence in Japanese NVAF patients who are prescribed anticoagulants. A total of 378 outpatients with NVAF who completed self-reported questionnaires were analyzed in this prospective study (mean age 69±12 years; 26% female). Self-reported adherence to cardiovascular drugs including anticoagulants was measured with a modified Siegal scale. Depression was defined as a Patient Health Questionnaire-9 score of ≥10. Univariate and multivariate analyses were performed on several variables to analyze factors affecting non-adherence. In total, 291 (77%) of our patients received warfarin, and the remainder received direct oral anticoagulants. Fifty-two (14%) patients were defined as non-adherent. Univariate analyses showed that age non-adherence, 1.87 (95% CI: 1.01-3.42, p=0.04), 2.97 (95% CI: 1.64-5.49, pnon-adherence to medications was 14% in NVAF patients. Frequent daily dosing was an independent risk factor for non-adherence to medication (UMIN-CTR No. UMIN 000023514). Copyright © 2016 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  5. Direct oral anticoagulants for secondary prevention in patients with non-valvular atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Luca Masotti

    2013-12-01

    Full Text Available The patients with non-valvular atrial fibrillation (NVAF, both permanent and paroxysmal, and history of previous transient ischemic attack (TIA or stroke represent a category of patients at high risk of new embolic events, independently of the presence of other risk factors. In these patients, national and international guidelines recommend oral anticoagulants as first choice for antithrombotic prevention. Direct oral anticoagulants (DOACs have been demonstrated to be not inferior to warfarin for many end points in NVAF patients in terms of efficacy and safety. The post hoc analysis in selected subgroups of patients enrolled in the three mega trials of phase III comparing DOACs (RE-LY, ROCKET-AF and ARISTOTLE with warfarin help to evaluate whether superiority and non-inferiority persist in these subgroups. Here, patients with NVAF and history of previous TIA/stroke receiving DOACs as secondary prevention are compared with patients with the same characteristics receiving warfarin. An analysis of these patients has been recently published (separately for each of three DOACs. This analysis shows that DOACs maintain their non-inferiority when compared with warfarin in secondary prevention, representing a real alternative in this context of patients at high risk for ischemic and bleeding events.

  6. Cardio-vascular risk in patients with non-valvular persisting atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Kalashnykova O.S.

    2013-06-01

    Full Text Available Results of cardiovascular risk factors assessment of 133 patients with persisting non-valvular atrial fibrillation (AF (main group being admitted for electrical cardioversion performance and comparison of these risk factors with cardiovascular risk profile of 6535 AF patients from Cohort 1 of the international GARFIELD registry (group of comparison are revealed in the article. Patients in the main group were older than 65 years (33,8%, in European population of GARFIELD registry the majority of patients older than 65 years – 73,8%; p<0,001. There were more women in European population of GARFIELD registry in comparison with our patients (44,8% vs 28,6%; р<0,001. With regard to co-morbidity characteristics, patients in our study had higher BMI (31,9 ± 5,7 vs 28,5 ± 5,2; p<0,001, hypercholesterolaemia (72,9% vs 46,1%; p<0,001, moderate renal dysfunction (GFR 30-59 mL/min (36,8% vs 12,1%; p<0,001 and alcohol abuse (6,8% vs 1,1%. Number of patients with the risk of thromboembolism complications (TEC ≥ 2 score by CHA2DS2-VASc was higher in European population of GARFIELD registry (86,0% vs 68,4%, <0,001, that is explained by prevalence of elderly patients in this group. The use of oral anticoagulants for thromboembolism prevention in high risk patients was low in both groups (approximately 70,0%, a large majority of patients in both groups were not treated effectively (64,1% vs. 55%, p = 0,148. Prevalence of TEC in case-history was similar in both groups (11,4% vs 15,9%, p = 0,141. So in our study patients with persistent non-valvular AF are characterized by higher cardiovascular risk in younger age in comparison with European population of AF patients from GARFIELD registry. For identification of “truly low-risk” patients with TEC, further improvement of risk stratification is required.

  7. Early introduction of direct oral anticoagulants in cardioembolic stroke patients with non-valvular atrial fibrillation.

    Science.gov (United States)

    Cappellari, Manuel; Carletti, Monica; Danese, Alessandra; Bovi, Paolo

    2016-10-01

    Direct oral anticoagulants (DOACs) are superior to warfarin in reduction of the intracranial bleeding risk. The aim of the present study was to assess whether early DOAC introduction (1-3 days after onset) in stroke patients with non-valvular atrial fibrillation (nVAF) may be safe and effective, compared with DOAC introduction after 4-7 days. We conducted a prospective analysis based on data collected from 147 consecutive nVAF patients who started DOAC within 7 days after stroke onset. In all patients, we performed pre-DOAC CT scan 24-36 h after onset and follow-up CT scan at 7 days after DOAC introduction. Outcome measures were post-DOAC intracranial bleeding (new any intracerebral hemorrhage (ICH) in patients with pre-DOAC infarct without hemorrhagic transformation (HT) or expansion of ICH in patients with pre-DOAC infarct with asymptomatic HT) and post-DOAC recurrent ischemic stroke (any new ischemic infarct) on follow-up CT scan. 97 patients started DOAC after 1-3 days and 50 patients started DOAC after 4-7 days. On pre-DOAC CT scan, 132 patients had an infarct without HT and 15 an infarct with asymptomatic HT. On follow-up CT scan, new any ICH was noted in seven patients (asymptomatic in 6) and asymptomatic expansion of ICH in one patient. We found no association between early DOAC introduction and intracranial bleeding. Large infarct remained the only independent predictor of post-DOAC intracranial bleeding. No patients suffered recurrent ischemic stroke after DOAC introduction. Early DOAC introduction might be safe in carefully selected patients with nVAF who experience small- and medium-sized cardioembolic ischemic strokes. Further investigation will be needed.

  8. Native valve disease in patients with non-valvular atrial fibrillation on warfarin or rivaroxaban

    Science.gov (United States)

    Breithardt, Günter; Baumgartner, Helmut; Berkowitz, Scott D; Hellkamp, Anne S; Piccini, Jonathan P; Lokhnygina, Yuliya; Halperin, Jonathan L; Singer, Daniel E; Hankey, Graeme J; Hacke, Werner; Becker, Richard C; Nessel, Christopher C; Mahaffey, Kenneth W; Califf, Robert M; Fox, Keith A A; Patel, Manesh R

    2016-01-01

    Objective To compare the characteristics and outcomes of patients with atrial fibrillation (AF) and aortic stenosis (AS) with patients with AF with mitral regurgitation (MR) or aortic regurgitation (AR) and patients without significant valve disease (no SVD). Methods Using Rivaroxaban Once-Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) data, we analysed efficacy and safety outcomes, adjusting hazard ratios (HRs) for potential confounders using Cox regression analysis. Results Among 14 119 intention-to-treat ROCKET AF trial patients, a trial that excluded patients with mitral stenosis or artificial valve prosthesis, 214 had AS with or without other valve abnormalities, 1726 had MR or AR and 12 179 had no SVD. After adjusting for prognostic factors, the composite of stroke, systemic embolism or vascular death increased approximately twofold in patients with AS (AS 10.84, MR or AR 4.54 and no SVD 4.31 events per 100 patient-years, p=0.0001). All-cause death also significantly increased (AS 11.22, MR or AR 4.90 and no SVD 4.39 events per 100 patient-years, p=0.0003). Major bleeding occurred more frequently in AS (adjusted HR 1.61, confidence intervals (CI) 1.03 to 2.49, p<0.05) and MR or AR (HR 1.30, 1.07 to 1.57, p<0.01) than in no SVD, but there was no difference between AS and MR or AR (HR 1.24, 0.78 to 1.97). The relative efficacy of rivaroxaban versus warfarin was consistent among patients with and without valvular disease. Rivaroxaban was associated with higher rates of major bleeding than warfarin in patients with MR or AR (HR 1.63, 1.15 to 2.31). Conclusions We found that patients with AF and AS on oral anticoagulants may have distinctly different efficacy and safety outcomes than patients with MR or AR or no SVD. Trial registration number NCT00403767; Post-results. PMID:26888572

  9. Effect of Desmopressin on Platelet Aggregation and Blood Loss in Patients Undergoing Valvular Heart Surgery

    Institute of Scientific and Technical Information of China (English)

    Lei Jin; Hong-Wen Ji

    2015-01-01

    Background:Blood loss after cardiac surgery can be caused by impaired platelet (PLT) function after cardiopulmonary bypass.Desmopressin or 1-deamino-8-D-arginine vasopressin (DDAVP) is a synthetic analog of vasopressin.DDAVP can increase the level of von Willebrand factor and coagulation factor Ⅷ,thus it may enhance PLT function and improve coagulation.In this study,we assessed the effects of DDAVP on PLT aggregation and blood loss in patients undergoing cardiac surgery.Methods:A total of 102 patients undergoing valvular heart surgery (from October 2010 to June 2011) were divided into DDAVP group (n =52) and control group (n =50).A dose of DDAVP (0.3 μtg/kg) was administered to the patients intravenously when they were being re-warmed.At the same time,an equal volume of saline was given to the patients in the control group.PLT aggregation rate was measured with the AggRAM four-way PLT aggregation measurement instrument.The blood loss and transfusion,hemoglobin levels,PLT counts,and urine outputs at different time were recorded and compared.Results:The postoperative blood loss in the first 6 h was significantly reduced in DDAVP group (202 ± 119 ml vs.258 ± 143 ml,P =0.023).The incidence of fresh frozen plasma (FFP) transfusion was decreased postoperatively in DDAVP group (3.8% vs.12%,P =0.015).There was no significant difference in the PLT aggregation,urine volumes,red blood cell transfusions and blood loss after 24 h between two groups.Conclusions:A single dose of DDAVP can reduce the first 6 h blood loss and FFP transfusion postoperatively in patients undergoing valvular heart surgery,but has no effect on PLT aggregation.

  10. Effect of chronic kidney diseases on mortality among digoxin users treated for non-valvular atrial fibrillation

    DEFF Research Database (Denmark)

    Sessa, Maurizio; Mascolo, Annamaria; Andersen, Mikkel Porsborg;

    2016-01-01

    , 1997 to December 31, 2012 were identified in Danish nationwide administrative registries. Cox proportional hazard model was used to compare the adjusted risk of all-causes and cardiovascular mortality among patients with and without chronic kidney disease and among patients with different chronic......PURPOSE: This study investigated the impact of chronic kidney disease on all-causes and cardiovascular mortality in patients with atrial fibrillation treated with digoxin. METHODS: All patients with non-valvular atrial fibrillation and/or atrial flutter as hospitalization diagnosis from January 1...... kidney disease stages within 180 days and 2 years from the first digoxin prescription. RESULTS: We identified 37,981 patients receiving digoxin; 1884 patients had the diagnosis of chronic kidney disease. Cox regression analysis showed no statistically significant differences in all-causes (Hazard Ratio...

  11. Mean corpuscular volume and red cell distribution width as predictors of left atrial stasis in patients with non-valvular atrial fibrillation.

    Science.gov (United States)

    Providência, Rui; Ferreira, Maria João; Gonçalves, Lino; Faustino, Ana; Paiva, Luís; Fernandes, Andreia; Barra, Sérgio; Pimenta, Joana; Leitão-Marques, António M

    2013-01-01

    The role of erythrocyte indexes for the prediction of left atrial stasis, assessed by transesophageal echocardiography in patients with non-valvular atrial fibrillation, has not been previously clarified. Single center cross-sectional study comprising 247 consecutive patients admitted to the emergency department due to symptomatic atrial fibrillation and undergoing transesophageal echocardiogram evaluation for exclusion of left atrial appendage thrombus (LAAT) before cardioversion. All patients had a complete blood count performed up to 12 hours prior to the transesophageal echocardiogram. Markers of left atrial stasis were sought: LAAT, dense spontaneous echocardiographic contrast (DSEC) and low flow velocities (LFV) in the left atrial appendage. Erythrocyte indexes' accuracy for detecting transesophageal echocardiogram changes was evaluated through receiver operating curve analysis. Binary logistic multivariate analysis, using solely erythrocyte indexes and in combination with other variables (i.e. CHADS2, CHA2DS2VASc classifications and left ventricle ejection fraction), was used for transesophageal echocardiogram endpoints prediction. LAAT was found in 8.5%, DSEC in 26.1% and LFV in 12.1%. Mean corpuscular volume and red cell distribution width were independent predictors of LAAT and DSEC. Despite adding incremental predictive value to each other, when clinical risk factors from CHADS2 and CHA2DS2VASc classifications and left ventricle ejection fraction were added to the models, only mean corpuscular volume remained an independent predictor of LAAT and DSEC. These findings suggest that mean corpuscular volume and red cell distribution width may be linked to left atrial stasis markers.

  12. Coronary risk stratification of patients undergoing surgery for valvular heart disease

    DEFF Research Database (Denmark)

    Hasselbalch, Rasmus Bo; Engstrøm, Thomas; Pries-Heje, Mia

    2016-01-01

    BACKGROUND: Multislice computed tomography (MSCT) is a non-invasive, less expensive, low-radiation alternative to coronary angiography (CAG) prior to valvular heart surgery. MSCT has a high negative predictive value for coronary artery disease (CAD) but previous studies of patients with valvular ...

  13. Calpain-Calcineurin-Nuclear Factor Signaling and the Development of Atrial Fibrillation in Patients with Valvular Heart Disease and Diabetes

    Directory of Open Access Journals (Sweden)

    Yong Zhao

    2016-01-01

    Full Text Available Calpain, calcineurin (CaN, and nuclear factor of activated T cell (NFAT play a key role in the development of atrial fibrillation. Patients with valvular heart disease (VHD are prone to develop atrial fibrillation (AF. Thus, our current study was aimed at investigating whether activation of calpain-CaN-NFAT pathway is associated with the incidence of AF in the patients with VHD and diabetes. The expressions of calpain 2 and alpha- and beta-isoforms of CaN catalytic subunit (CnA as well as NFAT-c3 and NFAT-c4 were quantified by quantitative reverse transcription-polymerase chain reaction in atrial tissues from 77 hospitalized patients with VHD and diabetes. The relevant protein content was measured by Western blot and calpain 2 in human atrium was localized by immunohistochemistry. We found that the expressions of calpain 2, CnA alpha and CnA beta, and NFAT-c3 but not NFAT-c4 were significantly elevated in the samples from patients with AF compared to those with sinus rhythm (SR. Elevated protein levels of calpain 2 and CnA were observed in patients with AF, and so was the enhanced localization of calpain 2. We thereby concluded that CaN together with its upstream molecule, calpain 2, and its downstream effector, NFAT-c3, might contribute to the development of AF in patients with VHD and diabetes.

  14. Risk of major bleeding at different PT-INR ranges in elderly Japanese patients with non-valvular atrial fibrillation receiving warfarin: a nested case-control study

    OpenAIRE

    Ohgushi, Atsushi; Ohtani, Takayuki; Nakayama, Natsumi; Asai, Shigeo; Ishii, Yoshiyuki; Namiki, Atsuo; Akazawa, Manabu; Echizen, Hirotoshi

    2016-01-01

    Background Debate continues about the optimal anticoagulation level for elderly Japanese patients with non-valvular atrial fibrillation (NVAF) receiving warfarin. The Japanese Circulation Society guideline has recommended prothrombin time-international normalized ratios (PT-INR) of 1.6 – 2.6 for elderly patients and 2.0 – 3.0 for non-elderly patients, because previous observational studies indicated increased risk of bleeding when the ratio exceeded 2.6. We aimed to reappraise the relationshi...

  15. Nuevos anticoagulantes orales en fibrilación auricular no valvular New oral ant icoagulants in nonvalvular atrial fibrillation

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    Andrés F Buitrago

    2012-08-01

    Full Text Available La fibrilación auricular es la arritmia cardiaca sostenida más común y su prevalencia se duplica cada decenio por encima de los cincuenta años. Entretanto, las condiciones clínicas que más se asocian con ésta son la hipertensión arterial, la insuficiencia cardíaca, la enfermedad valvular cardíaca y la diabetes mellitus. Como complicaciones está la falla cardiaca, pero tal vez una de las peores son los eventos cardioembólicos, que ocurren aproximadamente en 4,5% de los pacientes no anticoagulados. El tratamiento antitrombótico con antagonistas de la vitamina K fue, durante más de cincuenta años, la única alternativa disponible, a pesar de sus múltiples limitaciones, las mismas que llevaron al desarrollo de nuevos fármacos anticoagulantes que disminuyen muchos de los problemas de los antagonistas de la vitamina K. Pueden agruparse en dos clases: inhibidores orales directos de la trombina e inhibidores orales del factor X activado. Tanto dabigatrán, rivaroxabán como apixabán, cuentan ya con estudios clínicos controlados aleatorizados que apoyan su uso en el tratamiento antitrombótico de la fibrilación auricular y recientemente se incluyeron en las guías basadas en la evidencia como alternativa (ACC e incluso con un grado de recomendación superior (CCS, CHEST al de los antagonistas de la vitamina K.Atrial fibrillation is the most common sustained cardiac arrhythmia and its prevalence doubles every decade for people older than fifty years. Meanwhile, the clinical conditions most associated with it are hypertension, heart failure, valvular heart disease and diabetes mellitus. Complications include heart failure, but perhaps one of the worst ones are the stroke events, which occur in approximately 4.5% of not anticoagulated patients. Antithrombotic therapy with vitamin K antagonists was for over fifty years the only alternative available, despite its many limitations. These limitations led to the development of new

  16. Anticoagulation therapy in Chinese patients with non-valvular atrial fibrillation: a prospective, multi-center, randomized,controlled study

    Institute of Scientific and Technical Information of China (English)

    CHEN Ke-ping; HUANG Cong-xin; HUANG De-jia; CAO Ke-jiang; MA Chang-sheng; WANG Fang-zheng; ZHANG Shu

    2012-01-01

    Background Non-valvular atrial fibrillation is associated with an increased risk of ischemic stroke; however,the appropriate intensity of anticoagulation therapy for Chinese patients has not been determined.The purpose of this study was to compare the safety and the efficacy of standard-intensity warfarin therapy,low-intensity warfarin therapy,and aspirin therapy for the prevention of ischemic events in Chinese patients with non-valvular atrial fibrillation (NVAF).Methods A total of 786 patients from 75 Chinese hospitals were enrolled in this study and randomized into three therapy groups:standard-intensity warfarin (international normalized ratio (INR) 2.1 to 2.5) group,low-intensity warfarin (INR 1.6 to 2.0) group and aspirin (200 mg per day) group.All patients were evaluated by physicians at 1,3,6,9,12,15,18,21 and 24 months after randomization to obtain a patient questionnaire,physical examination and related laboratory tests.Results The annual event rates of ischemic stroke,transient ischemic attack (TIA) or systemic thromboembolism were 2.6%,3.1% and 6.9% in the standard-intensity warfarin,low-intensity warfarin and aspirin groups,respectively (P=0.027).Thromboembolic event rates in both warfarin groups were significantly lower than that in the aspirin group (P=0.018,P=0.044),and there was no significant difference between the two warfarin groups.Severe hemorrhagic events occurred in 15 patients,7 (2.6%) in the standard-intensity warfarin group,7 (2.4%) in the low-intensity warfarin group and 1 (0.4%)in the aspirin group.The severe hemorrhagic event rates in the warfarin groups were higher than that in the aspirin group,but the difference did not reach statistical significance (P=0.101).The mild hemorrhagic and total hemorrhagic event rates in the warfarin groups (whether in the standard-intensity warfarin group or low-intensity warfarin group) were much higher than that in the aspirin group with the annual event rates of total hemorrhages of 10

  17. Relationship between Calcium-Phosphorus Product and Severity of Valvular Heart Insufficiency in Patients Undergoing Chronic Hemodialysis

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    Mehrdad Sheikhvatan

    2010-05-01

    Full Text Available Background: Recent interests have mainly focused on the roles of serum calcium and phosphorus and their product (Ca-P product in the development of valvular heart disease. The present study assessed the relationship between the Ca-P product and the severity of valvular heart disease in end-stage renal disease (ESRD patients undergoing chronic hemodialysis.Methods: This cross-sectional study reviewed the clinical course of 72 consecutive patients with the final diagnosis of ESRD candidated for chronic hemodialysis. The severity of valvular heart disease was determined using M-mode two-dimensional echocardiography. The serum calcium and phosphate values adopted were those values measured on the day between the two consecutive dialyses, and the Ca-P product was calculated.Results: The most common causes of ESRD were diabetic nephropathy, malignant hypertension, and chronic glomerulonephritis. The mean Ca-P product level in the dialysis patients was 50.44 ± 17.78 mg2/dL2. The receiver-operator characteristic (ROC curve illustrated that a Ca-P product level > 42 mg2/dL2 was the optimal value in terms of sensitivity and specificity for predicting the presence of valvular insufficiency. Aortic insufficiency was directly associated with a high Ca-P product value after adjustment for age, gender, serum albumin, diabetes, hypertension, hyperlipidemia, coronary artery disease, and serum creatinine (β = 0.412, SE = 158, p value= 0.011.Conclusion: A positive relationship between the Ca-P product value and the severity of aortic insufficiency is expected. Achieving an appropriate control of the Ca-P product level may decrease aortic valve calcification and improve the survival of patients on chronic hemodialysis.

  18. Long-Term Survival of Dialysis Patients with Bacterial Endocarditis Undergoing Valvular Replacement Surgery in the United States

    Science.gov (United States)

    Leither, Maxwell D.; Shroff, Gautam R.; Ding, Shu; Gilbertson, David T.; Herzog, Charles A.

    2013-01-01

    Background Bacterial endocarditis in dialysis patients is associated with high mortality rates. The literature is limited regarding long-term outcomes of valvular replacement surgery and choice of prosthesis in dialysis patients with bacterial endocarditis. Methods and Results Dialysis patients hospitalized for bacterial endocarditis, 2004-2007, were studied retrospectively using data from the US Renal Data System. Long-term survival of patients undergoing valve replacement surgery with tissue or non-tissue valves was compared using the Kaplan-Meier method. A Cox proportional hazards model was used to identify independent predictors of mortality in patients undergoing valvular replacement surgery. During the study period, 11,156 dialysis patients were hospitalized for bacterial endocarditis and 1267 (11.4%) underwent valvular replacement surgery (tissue valve 44.3%, non-tissue valve 55.7%). In the valve replacement cohort, 60% were men, 50% white, 54% aged 45-64 years, and 36% diabetic. Estimated survival with tissue and non-tissue valves, respectively, at 0.5, 1, 2, and 3 years was 59% and 60%, 48% and 50%, 35% and 37%, and 25% and 30% (log rank P = 0.42). Staphylococcus was the predominant organism (66% of identified organisms). Independent predictors of mortality in patients undergoing valve replacement surgery included older age, diabetes as cause of end-stage renal disease, surgery during index hospitalization, staphylococcus as the causative organism, and dysrhythmias as a comorbid condition. Conclusions Valve replacement surgery is appropriate for well-selected dialysis patients with bacterial endocarditis, but is associated with high mortality rates. Survival does not differ with tissue or non-tissue prosthesis. PMID:23785002

  19. Population pharmacokinetics and pharmacodynamics of rivaroxaban in patients with non-valvular atrial fibrillation: results from ROCKET AF.

    Science.gov (United States)

    Girgis, I G; Patel, M R; Peters, G R; Moore, K T; Mahaffey, K W; Nessel, C C; Halperin, J L; Califf, R M; Fox, K A A; Becker, R C

    2014-08-01

    Two once-daily rivaroxaban dosing regimens were compared with warfarin for stroke prevention in patients with non-valvular atrial fibrillation in ROCKET AF: 20 mg for patients with normal/mildly impaired renal function and 15 mg for patients with moderate renal impairment. Rivaroxaban population pharmacokinetic (PK)/pharmacodynamic (PD) modeling data from ROCKET AF patients (n = 161) are reported and are used to confirm established rivaroxaban PK and PK/PD models and to re-estimate values of the models' parameters for the current AF population. An oral one-compartment model with first-order absorption adequately described rivaroxaban PK. Age, renal function, and lean body mass influenced the PK model. Prothrombin time and prothrombinase-induced clotting time exhibited a near-linear relationship with rivaroxaban plasma concentration; inhibitory effects were observed through to 24 hours post-dose. Rivaroxaban plasma concentration and factor Xa activity had an inhibitory maximum-effect (Emax ) relationship. Renal function (on prothrombin time; prothrombinase-induced clotting time) and age (on factor Xa activity) had moderate effects on PK/PD models. PK and PK/PD models were shown to be adequate for describing the current dataset. These findings confirm the modeling and empirical results that led to the selection of doses tested against warfarin in ROCKET AF.

  20. [Oral anticogulation for non-valvular atrial fibrilation in the elderly].

    Science.gov (United States)

    Veiga Fernández, Fernando; Malfeito Jiménez, María del Rocío; Barros Cerviño, Sonia María; Magariños Losada, María del Mar

    2015-01-01

    Anticoagulation in elderly people with non-valvular atrial afibrillation (AF) is a challenge, due to the thromboembolic, as well as the haemorrhagic risks. The correct use of anticoagulants in these patients has shown a higher net clinical benefit when comparing it with a younger population. Non-vitamin K antagonist oral anticoagulants (NOACs) have been compared to oral vitamin K antagonists in several studies that included a sufficient number of elderly people. Favourable results for non-vitamin K antagonist oral anticoagulants were obtained in these studies, making them the preferred treatment for this group of patients. Basing the estimations on indirect comparisons, the ideal anticoagulant and the specific dose for each particular case has been determined. Finally, a new algorithm has been developed that relates these parameters. Geriatric assessment is the key to the indication for an anticoagulation, the type of anticoagulant needed, and also the best way to optimise all the factors for a safe anticoagulation. The arrival of non-vitamin K antagonist oral anticoagulants will enhance the efficient thromboembolic prophylaxis rate in elderly people with AF. This new treatment will remove different controversial prophylaxis, such as antiaggregants. Copyright © 2014 SEGG. Published by Elsevier Espana. All rights reserved.

  1. Galectin-3 in patients undergoing ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Nicolas Clementy

    2014-11-01

    Conclusions: Persistent type of atrial fibrillation is an independent predictor of higher Galectin-3 concentration. This biomarker of fibrosis may be implied in the mechanisms of atrial remodeling and maintenance of atrial fibrillation, and thus be helpful for the design of therapeutic strategy in patients with atrial fibrillation.

  2. Substantial differences in initiation of oral anticoagulant therapy and clinical outcome among non-valvular atrial fibrillation patients treated in inpatient and outpatient settings

    DEFF Research Database (Denmark)

    Mikkelsen, Anders Pretzmann; Hansen, Morten Lock; Olesen, Jonas Bjerring;

    2016-01-01

    AIMS: Patients with atrial fibrillation (AF) are encountered and treated in different healthcare settings, which may affect the quality of care. We investigated the use of oral anticoagulant (OAC) therapy and the risk of thrombo-embolism (TE) and bleeding, according to the healthcare setting....... METHODS AND RESULTS: Using national Danish registers, we categorized non-valvular AF patients (2002-11) according to the setting of their first-time AF contact: hospitalization (inpatients), ambulatory (outpatients), or emergency department (ED). Event rates and hazard ratios (HRs), calculated using Cox...... regression analysis, were estimated for outcomes of TE and bleeding. We included 116 051 non-valvular AF patients [mean age 71.9 years (standard deviation 14.1), 51.3% males], of whom 55.2% were inpatients, 41.9% outpatients, and 2.9% ED patients. OAC therapy 180 days after AF diagnosis among patients...

  3. Reducing the risk of stroke in elderly patients with non-valvular atrial fibrillation: a practical guide for clinicians

    Directory of Open Access Journals (Sweden)

    Foody JM

    2017-01-01

    Full Text Available Joanne M Foody Department of Medicine, Harvard Medical School, Boston, MA, USA Abstract: Non-valvular atrial fibrillation (NVAF significantly contributes to the burden of stroke, particularly in elderly patients. The challenge of optimizing anticoagulation therapy is balancing efficacy and bleeding risk, especially as the same patients at high risk of stroke also tend to be at high risk of bleeding. Treating the elderly patient with NVAF presents special challenges because of their heightened risk for both stroke and bleeding. Despite clinical trial data and evidence-based guidelines, surveys indicate that physicians underuse anticoagulation in older patients for reasons that include overemphasis of bleeding risk, particularly with the increased risk of falling, at the cost of thromboembolic risk. Clinical trial data are now available, and real-world data are emerging, to illustrate the relative merits of the non-vitamin K antagonist oral anticoagulants compared with conventional anticoagulation in the treatment of elderly patients with this condition, and to suggest some subgroups of older patients who may be more suitable candidates for particular agents. Care of elderly patients with NVAF is often complicated by factors including risk of falling, adherence, health literacy, cognitive function, adverse effects, and involvement of caregivers, as well as other factors including the patient–provider relationship and logistical barriers to obtaining medication. Thus, conversations between clinicians and patients, as well as shared decision making, are important. In addition, elderly patients often suffer from comorbidities including hypertension, coronary heart disease, diabetes mellitus, COPD, and/or heart failure, which necessitate the use of multiple concomitant medications, increasing the risk of drug/drug interactions. This review provides an overview of clinical trial data on the use of non-vitamin K anticoagulant agents in elderly

  4. Reducing the risk of stroke in elderly patients with non-valvular atrial fibrillation: a practical guide for clinicians

    Science.gov (United States)

    Foody, Joanne M

    2017-01-01

    Non-valvular atrial fibrillation (NVAF) significantly contributes to the burden of stroke, particularly in elderly patients. The challenge of optimizing anticoagulation therapy is balancing efficacy and bleeding risk, especially as the same patients at high risk of stroke also tend to be at high risk of bleeding. Treating the elderly patient with NVAF presents special challenges because of their heightened risk for both stroke and bleeding. Despite clinical trial data and evidence-based guidelines, surveys indicate that physicians underuse anticoagulation in older patients for reasons that include overemphasis of bleeding risk, particularly with the increased risk of falling, at the cost of thromboembolic risk. Clinical trial data are now available, and real-world data are emerging, to illustrate the relative merits of the non-vitamin K antagonist oral anticoagulants compared with conventional anticoagulation in the treatment of elderly patients with this condition, and to suggest some subgroups of older patients who may be more suitable candidates for particular agents. Care of elderly patients with NVAF is often complicated by factors including risk of falling, adherence, health literacy, cognitive function, adverse effects, and involvement of caregivers, as well as other factors including the patient–provider relationship and logistical barriers to obtaining medication. Thus, conversations between clinicians and patients, as well as shared decision making, are important. In addition, elderly patients often suffer from comorbidities including hypertension, coronary heart disease, diabetes mellitus, COPD, and/or heart failure, which necessitate the use of multiple concomitant medications, increasing the risk of drug/drug interactions. This review provides an overview of clinical trial data on the use of non-vitamin K anticoagulant agents in elderly populations, and serves as a practical resource for the management of NVAF in the elderly patient. PMID:28182166

  5. The frequency of cerebral microbleeds increases with CHADS(2) scores in stroke patients with non-valvular atrial fibrillation.

    Science.gov (United States)

    Song, T-J; Kim, J; Lee, H S; Nam, C M; Nam, H S; Heo, J H; Kim, Y D

    2013-03-01

    Cerebral microbleeds (CMBs) are extravasations of blood from lipohyalinized or amyloid angiopathic cerebral arterioles, and the presence and numbers of CMBs are significantly associated with the development of oral anticoagulation (OA)-related intracranial haemorrhage (ICH). The aim of this study was to investigate whether there is a difference in CMBs burden according to CHADS(2) scores or CHA(2) DS(2) -VASc scores in non-valvular atrial fibrillation (NVAF) patients. We included 550 ischaemic stroke patients who had NVAF and who had undergone brain magnetic resonance imaging (MRI) with gradient-recalled echo (GRE) T2 sequences from our prospective stroke registry between January 2005 and November 2011. We calculated CHADS(2) scores and CHA(2) DS(2) -VASc scores for all patients based on their underlying cardiovascular diseases. The presence, location and number of CMBs were assessed in each patient. We also investigated whether the CMBs were actually associated with the development of ICH during follow-up. The mean patient age was 70.4 ± 10.5 years, and 324 (58.9%) patients were men. One-hundred and seventy-three patients (31.5%) had CMBs detected on GRE MRI. Higher CHADS(2) scores or CHA(2) DS(2) -VASc scores were strongly associated with the presence and number of CMBs. During follow-up of median 3.1 ± 1.6 years, the presence of CMBs was independently associated with the development of ICH, whilst the CHADS(2) scores or CHA(2) DS(2) -VASc scores were not. Considering the positive association between the presence of CMBs and OA-related ICH, our results suggest that the increase in ICH in high-risk groups during OA may be related to an increased burden of CMBs. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  6. Comorbidities against quality control of VKA therapy in non-valvular atrial fibrillation: a French national cross-sectional study.

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    Agnes Rouaud

    Full Text Available Given the prevalence of non-valvular atrial fibrillation in the geriatric population, thromboembolic prevention by means of vitamin K antagonists (VKA is one of the most frequent daily concerns of practitioners. The effectiveness and safety of treatment with VKA correlates directly with maximizing the time in therapeutic range, with an International Normalized Ratio (INR of 2.0-3.0. The older population concentrates many of factors known to influence INR rate, particularly concomitant medications and concurrent medical conditions, also defined as comorbidities.Determine whether a high burden on comorbidities, defined by a Charlson Comorbidity Index (CCI of 3 or greater, is associated a lower quality of INR control.Cross-sectional study.French geriatric care units nationwide.2164 patients aged 80 and over and treated with vitamin K antagonists.Comorbidities were assessed using the Charlson Comorbidity Index (CCI. The recorded data included age, sex, falls, kidney failure, hemorrhagic event, VKA treatment duration, and the number and type of concomitant medications. Quality of INR control, defined as time in therapeutic range (TTR, was assessed using the Rosendaal method.487 patients were identified the low-quality control of INR group. On multivariate logistic regression analysis, low-quality control of INR was independently associated with a CCI ≥3 (OR = 1.487; 95% CI [1.15; 1.91]. The other variables associated with low-quality control of INR were: hemorrhagic event (OR = 3.151; 95% CI [1.64; 6.07], hospitalization (OR = 1.614, 95% CI [1.21; 2.14].An elevated CCI score (≥3 was associated with low-quality control of INR in elderly patients treated with VKA. Further research is needed to corroborate this finding.

  7. Comorbidities against Quality Control of VKA Therapy in Non-Valvular Atrial Fibrillation: A French National Cross-Sectional Study

    Science.gov (United States)

    Rouaud, Agnes; Hanon, Olivier; Boureau, Anne-Sophie; Chapelet, Guillaume Gilles; de Decker, Laure

    2015-01-01

    Background Given the prevalence of non-valvular atrial fibrillation in the geriatric population, thromboembolic prevention by means of vitamin K antagonists (VKA) is one of the most frequent daily concerns of practitioners. The effectiveness and safety of treatment with VKA correlates directly with maximizing the time in therapeutic range, with an International Normalized Ratio (INR) of 2.0-3.0. The older population concentrates many of factors known to influence INR rate, particularly concomitant medications and concurrent medical conditions, also defined as comorbidities. Objective Determine whether a high burden on comorbidities, defined by a Charlson Comorbidity Index (CCI) of 3 or greater, is associated a lower quality of INR control. Study-Design Cross-sectional study. Settings French geriatric care units nationwide. Participants 2164 patients aged 80 and over and treated with vitamin K antagonists. Measurements Comorbidities were assessed using the Charlson Comorbidity Index (CCI). The recorded data included age, sex, falls, kidney failure, hemorrhagic event, VKA treatment duration, and the number and type of concomitant medications. Quality of INR control, defined as time in therapeutic range (TTR), was assessed using the Rosendaal method. Results 487 patients were identified the low-quality control of INR group. On multivariate logistic regression analysis, low-quality control of INR was independently associated with a CCI ≥3 (OR = 1.487; 95% CI [1.15; 1.91]). The other variables associated with low-quality control of INR were: hemorrhagic event (OR = 3.151; 95% CI [1.64; 6.07]), hospitalization (OR = 1.614, 95% CI [1.21; 2.14]). Conclusion An elevated CCI score (≥3) was associated with low-quality control of INR in elderly patients treated with VKA. Further research is needed to corroborate this finding. PMID:25789771

  8. Implementing hospital guidelines improves warfarin use in non-valvular atrial fibrillation: a before-after study

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    Piobbici Marina

    2007-08-01

    Full Text Available Abstract Background The use of oral anticoagulant therapy (OAT to prevent non-valvular atrial fibrillation (NVAF related-strokes is often sub-optimal. We aimed to evaluate whether implementing guidelines on antithrombotic therapy (AT by a multifaceted strategy may improve appropriateness of its prescription in NVAF-patients discharged from a large tertiary-care hospital. Methods A survey was conducted on all consecutive NVAF patients discharged before (1st January–30th June 2000, n = 313 and after (1st January–30th June 2004, n = 388 guideline development and implementation. Results When strongly recommended, OAT use increased from 56.6% (60/106 in 2000 to 81.9% (86/105 in 2004, with an absolute difference of +25.3% (95%CI: 15% 35%. In patients for whom the choice OAT/acetylsalicylic acid should be individualised, those discharged without any AT were 33.7% (34/101 in 2000 and 16.9% (21/124 in 2004 (-16.7%;95%CI: -26.2% -7.2%. In a logistic regression model, OAT prescription in 2004 was increased by 2.11 times (95%CI: 1.47 3.04, after accounting for stroke risk, presence of contraindications (OR = 0.18; 0.13 0.27, older age (OR = 0.30; 0.21 0.45, prophylaxis at admission (OR = 3.03; 2.08 4.43. OAT was positively associated with the stroke risk in the 2004 sample only. Conclusion The guideline implementation has substantially improved the appropriateness of OAT at discharge, through a better evaluation at patient's individual level of the benefit-to-risk ratio.

  9. Fluvastatin therapy could not decrease progression of paroxysmal atrial fibrillation in non-valvular disease patients.

    Science.gov (United States)

    Tan, Qiang; Zhang, Shuangyue; Zou, Xiaoyi; Zhao, Jun; Hao, Jia; Sun, Qian

    2017-08-01

    This study aimed to evaluate whether fluvastatin therapy could decrease the probability of atrial fibrillation (AF) progression from paroxysmal AF to permanent AF and decrease the recurrence frequency of AF. Analyses were performed using two-tailed Student's t test or Mann-Whitney U tests. Categorical variables were compared with the χ2 statistics or Fisher's exact test. Patients with paroxysmal AF were randomized case-control, prospective into either the fluvastatin group (n=61) or control group (n=57). Patients were followed up for 24 months. The primary endpoint event was paroxysmal AF that progressed to permanent AF. Secondary endpoints were AF recurrence, cardiac dysfunction, stroke, or death. There were no differences in AF progression (fluvastatin group, 8.19% vs. control group, 12.51%; p>0.05) and stroke (fluvastatin group. 6.55% vs. 8.77%; p>0.05). Patients in the fluvastatin group had a lower rate of AF recurrence (fluvastatin group, 24.59% vs. control group, 49.12%; pdecrease AF progression. However, it could decrease the recurrence frequency of paroxysmal AF and cardiac dysfunction. This may occur because of depressing inflammation and improving circulating EPCs.

  10. [Anesthetic consideration in patients undergoing catheter ablation for atrial fibrillation].

    Science.gov (United States)

    Oda, Toshiyuki; Takahama, Yutaka

    2012-11-01

    This chapter describes anesthetic consideration in patients undergoing catheter ablation for atrial fibrillation (AF) based on electrophysiologic or pharmacological aspects. In the 2011 guidelines of the Japanese Circulation Society for non-pharmacotherapy of cardiac arrhythmias, catheter ablation is recommended as Class I therapeutic modality for the patients with drug-refractory paroxysmal AF. Catheter ablation of AF is an invasive and long-lasting procedure necessitating sedation during treatment. However, in the most of the patients, sedation or anesthesia is possibly performed by cardiologists using propofol, midazolam or dexmedetomidine. Deep sedation accompanies a high risk of ventilatory or circulatory derangement. Furthermore, life-threatening complications, such as cerebral infarction or cardiac tamponade, can occur during ablation. Patients with AF are increasing in number as a trend in the aging society, resulting in an increase in catheter ablation in high risk patients. To accomplish safe anesthetic management of the patients for catheter ablations, anesthesiologists are required to have fundamental knowledge and skill in the performance of the catheter ablation.

  11. Does novel oral anticoagulant improve anticoagulation for non-valvular atrial fibrillation associated stroke: An inpatient registration study in Shanghai

    Institute of Scientific and Technical Information of China (English)

    Feng-Di Liu; Rong Zhao; Xue-Mei Wang; Shuo Wang; Xiao-Lei Shen; Xiao-Xiao Tao; Bo Zheng

    2015-01-01

    Objective:To summarize the use rate,safety,efficacy of antithrombotics in stroke/transient ischemic attack (TIA) prevention,and reasons for not using dabigatran etexilate (DE) in Shanghai,China.Methods:Non-valvular atrial fibrillation (NVAF)-associated stroke patients were prospectively registered as an electronic database.Use rate of antithrombofics and reasons for not using DE were extracted during follow-up.Patients' baseline characteristics,recurrent ischemic stroke/TIA events and bleeding complications were analyzed.Patients:From April 2012 to August 2014,110 inpatients with NVAF-associated stroke were studied in our hospital.NVAF was diagnosed by 12-lead electrocardiogram,24 h Holter and echocardiography.Results:Before introduction of DE (April 2013),use rates of warfarin and antiplatelets were 28.9% (11/38) and 60.5% (23/38)respectively; after that,use rates of warfarin,DE,and antiplatelets were 20.8% (15/72),12.5% (9/72),and 43.1% (31/72).The DE did not improve use of anticoagulants (P =0.639).There were 19 (17.3%) recurrent ischemic stroke events up to October 2015; two (9.5%) in the non-user group,10 (18.5%) in the antiplatelet group,and seven (20.0%) in the anticoagulants group (P =0.570).Furthermore,recurrence rates were similar between the DE group (20.0%) and the Warfarin group (20.0%,P =1.000).The most common reason for not using DE was financial concerns (61.0%),followed by inconvenience to purchase (14.0%) and hemorrhage concerns (11.0%).Two patients using warfarin found fecal occult blood so they stopped warfarin and began to use antiplatelet drugs.No bleeding event occurred in the other groups.Only one patient had side effects (dyspepsia and gastroesophageal reflux)from DE.Conclusion:The use rate of either DE or warfarin in Shanghai was low; DE had not improved anticoagulation therapy for NVAF patients in Shanghai mainly because DE had not been covered by health insurance.

  12. Comparison of Approaches for Stroke Prophylaxis in Patients with Non-Valvular Atrial Fibrillation: Network Meta-Analyses of Randomized Controlled Trials

    Science.gov (United States)

    Patel, Nirav; Hashim, Taimoor; Godara, Hemant; Ather, Sameer; Arora, Garima; Pasala, Tilak; Whitfield, Thomas T.; McGiffin, David C.; Ahmed, Mustafa I.; Lloyd, Steven G.; Limdi, Nita A.

    2016-01-01

    Background Multiple novel oral anticoagulants and left atrial appendage closure devices (WATCHMAN) have been tested against dose-adjusted vitamin K antagonists in randomized controlled trials for stroke prophylaxis in non-valvular atrial fibrillation. No direct comparisons of these strategies are available from randomized controlled trials. We conducted the current analyses by combining efficacy and safety characteristics of all FDA approved stroke prophylaxis treatment strategies for patients with non-valvular atrial fibrillation. Materials and Methods We searched SCOPUS from 1945 till October 2015 for randomized controlled trials comparing these strategies and reporting efficacy and safety outcomes. Six randomized controlled trials were identified and included in the final analyses and review. We followed PRISMA guidelines for network meta-analyses while reporting the current analyses. We collected data on ischemic stroke, major bleeding, and the composite primary safety endpoint as defined by various randomized controlled trials. Network meta-analyses were conducted using consistency and inconsistency models for efficacy and safety outcomes. Surface under the cumulative ranking curve were then utilized to cluster rank these treatments for safety and efficacy. Results Six randomized controlled trials with 59,627 patients comparing six treatment strategies were eligible for the analyses. All prophylaxis strategies had comparable rates of ischemic stroke. Apixaban was associated with the least number of primary safety endpoint events as compared with all other treatments. In the cluster analyses assessing safety and efficacy, apixaban, edoxaban and dabigatran ranked best followed by vitamin K antagonists and rivaroxaban, whereas the WATCHMAN left atrial appendage closure device ranked last. Conclusions Dose-adjusted vitamin K antagonists, novel oral anticoagulants, and the WATCHMAN left atrial appendage closure devices are equally efficacious for ischemic stroke

  13. Propensity-matched analysis of association between preoperative anemia and in-hospital mortality in cardiac surgical patients undergoing valvular heart surgeries

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    Shreedhar S Joshi

    2015-01-01

    Full Text Available Introduction: Anaemia is associated with increased post-operative morbidity and mortality. We retrospectively assess the relationship between preoperative anaemia and in-hospital mortality in valvular cardiac surgical population. Materials and Methods: Data from consecutive adult patients who underwent valvular repair/ replacement at our institute from January 2010 to April 2014 were collected from hospital records. Anaemia was defined according to WHO criteria (hemoglobin <13g/dl for males and <12g/dl for females. 1:1 matching was done for anemic and non-anemic patients based on propensity for potentially confounding variables. Logistic regression was used to evaluate the relationship between anaemia and in-hospital mortality. MatchIt package for R software was used for propensity matching and SPSS 16.0.0 was used for statistical analysis. Results: 2449 patients undergoing valvular surgery with or without coronary artery grafting were included. Anaemia was present in 37.1% (33.91% among males & 40.88% among females. Unadjusted OR for mortality was 1.6 in anemic group (95% Confidence Interval [95% CI] - 1.041-2.570; p=0.033. 1:1 matching was done on the basis of propensity score for anaemia (866 pairs. Balancing was confirmed using standardized differences. Anaemia had an OR of 1.8 for mortality (95% CI- 1.042 to 3.094, P=0.035. Hematocrit of < 20 on bypass was associated with higher mortality. Conclusion: Preoperative anaemia is an independent risk factor associated with in-hospital mortality in patients undergoing valvular heart surgery.

  14. Effects of Smoking on Ischemic Stroke, Intracranial Hemorrhage, and Coronary Artery Events in Japanese Patients With Non-Valvular Atrial Fibrillation.

    Science.gov (United States)

    Suzuki, Shinya; Otsuka, Takayuki; Sagara, Koichi; Semba, Hiroaki; Kano, Hiroto; Matsuno, Shunsuke; Takai, Hideaki; Kato, Yuko; Uejima, Tokuhisa; Oikawa, Yuji; Nagashima, Kazuyuki; Kirigaya, Hajime; Yajima, Junji; Kunihara, Takashi; Sawada, Hitoshi; Aizawa, Tadanori; Yamashita, Takeshi

    2017-08-03

    The effects of smoking on the prognosis of non-valvular atrial fibrillation (NVAF) patients are unclear.The Shinken Database 2004-11 (n = 17,517) includes all new patients visiting the Cardiovascular Institute between June 2004 and March 2012. Among these cases, 2,102 NVAF patients were identified. The effects of smoking on ischemic stroke (IS), intracranial hemorrhage (ICH), and coronary artery events including percutaneous coronary intervention (PCI) and acute coronary syndrome (ACS) were analyzed. Smokers were younger and had lower risk profiles compared with non-smokers. A similar tendency was observed between current and former smokers. In contrast, patients with high tobacco consumption were older and had higher risk profiles, including uncontrolled hypertension, compared with those with low tobacco consumption. In 8,159 patient-years, IS, ICH, PCI, and ACS occurred at rates of 7.7, 2.7, 12.4, and 3.0 per 1000 patient-years. In multivariate Cox regression analysis, smoking was not significantly associated with any adverse event. However, different effects of smoking were observed when stratified by age. In patients ≥ 65 years old, current smokers were independently associated with PCI. Moreover, current smokers and smokers with a total tobacco amount ≥ 800 were marginally and independently associated with IS. In patients effects of smoking on cardiovascular events in our NVAF patients. In elderly patients who still smoke, smoking was associated with the promotion of atherosclerosis or thromboembolism, whereas in young patients it was associated with bleeding.

  15. ANALYSIS OF THE INFLUENCE OF THROMBOEMBOLIC COMPLICATIONS PREVENTION WITH ORAL ANTICOAGULANTS ON BUDGET IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

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    A. V. Rudakova

    2015-01-01

    Full Text Available Atrial fibrillation (AF is a risk factor for thromboembolic complications, requiring administration of vitamin K antagonists (warfarin or the new oral anticoagulants (apixaban, dabigatran and rivaroxaban.Aim. To assess the influence of apixaban use on the budget as an alternative to warfarin, dabigatran or rivaroxaban use in patients with non-valvular AF in the Russian Federation (RF.Material and methods. The analysis was performed with the perspective of the health care budget with 5 year horizon period and by the pharmacoeconomic model developed by Pharmerit International (Rotterdam, Netherlands and adapted for the RF. The cardiovascular complications rate in the model was in line with the results of comparative clinical trials: ARISTOTLE, AVERROES, RE-LY, ROCKET-AF. The analysis suggested that 100% of patients with atrial fibrillation were transferred on apixaban instead of warfarin, dabigatran or rivaroxaban. The analysis was based on the assumption that patients were fully committed to the therapy over the horizon of the study, ie, refusal of treatment was not considered. The possibility of episodes of ischemic and hemorrhagic strokes, the severity of which corresponded to previously published data for the Russian population, was considered in the study. The present study was performed based on two scenarios. In the first of them the cost of anticoagulation therapy was determined on the basis of the average weighted prices of public procurement for the period from 04.01.2014 to 01.04.2015. The alternative scenario purported to demonstrate potential savings of the budget of the health care system on the inclusion of apixaban in the list of essential drugs. This scenario took into account that the cost of dabigatran and rivaroxaban corresponded to registered maximum selling price including 10% VAT and 10% of the wholesale allowance and the cost of apixaban - presumed maximum selling price which the producer intends to register in case the

  16. ANALYSIS OF THE INFLUENCE OF THROMBOEMBOLIC COMPLICATIONS PREVENTION WITH ORAL ANTICOAGULANTS ON BUDGET IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-09-01

    Full Text Available Atrial fibrillation (AF is a risk factor for thromboembolic complications, requiring administration of vitamin K antagonists (warfarin or the new oral anticoagulants (apixaban, dabigatran and rivaroxaban.Aim. To assess the influence of apixaban use on the budget as an alternative to warfarin, dabigatran or rivaroxaban use in patients with non-valvular AF in the Russian Federation (RF.Material and methods. The analysis was performed with the perspective of the health care budget with 5 year horizon period and by the pharmacoeconomic model developed by Pharmerit International (Rotterdam, Netherlands and adapted for the RF. The cardiovascular complications rate in the model was in line with the results of comparative clinical trials: ARISTOTLE, AVERROES, RE-LY, ROCKET-AF. The analysis suggested that 100% of patients with atrial fibrillation were transferred on apixaban instead of warfarin, dabigatran or rivaroxaban. The analysis was based on the assumption that patients were fully committed to the therapy over the horizon of the study, ie, refusal of treatment was not considered. The possibility of episodes of ischemic and hemorrhagic strokes, the severity of which corresponded to previously published data for the Russian population, was considered in the study. The present study was performed based on two scenarios. In the first of them the cost of anticoagulation therapy was determined on the basis of the average weighted prices of public procurement for the period from 04.01.2014 to 01.04.2015. The alternative scenario purported to demonstrate potential savings of the budget of the health care system on the inclusion of apixaban in the list of essential drugs. This scenario took into account that the cost of dabigatran and rivaroxaban corresponded to registered maximum selling price including 10% VAT and 10% of the wholesale allowance and the cost of apixaban - presumed maximum selling price which the producer intends to register in case the

  17. Terapia antitrombótica en la fibrilación auricular no valvular, a la luz de la medicina basada en la evidencia Antithrombotic therapy in non-valvular atrial fibrillation

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    Juan Manuel Senior Sánchez

    2003-02-01

    Full Text Available La fibrilación auricular (FA afecta a más de dos millones de personas en Estados Unidos y se calcula que afectará a más de tres millones para el año 2020. Se caracteriza por la presencia en el electrocardiograma de ondas rápidas e irregulares sobre la línea de base, que varían de tamaño, morfología y tiempo. Es particularmente frecuente en los ancianos. Se produce por múltiples circuitos de microrreentrada que salen de la aurícula, colisionan, se extinguen y reaparecen; es necesaria una masa critica de tejido auricular para sostener un mínimo de circuitos que permitan perpetuar la arritmia. Dos estudios recientes permiten concluir que la terapia dirigida solamente al control de la respuesta ventricular es igualmente efectiva para el control del ritmo cardíaco, lo que desvirtúa la conducta de intentar restablecer el ritmo sinusal en todos los pacientes con FA. Una de las complicaciones más severas de la FA son los eventos tromboembólicos sistémicos que se presentan principalmente al sistema nervioso central; a la FA se le atribuye ser el factor causal en el 15% de todos los casos y en el 30% de los que ocurren en personas mayores de 80 años. Se revisan y analizan diferentes estudios de prevención tanto primaria como secundaria en pacientes con FA no valvular, los cuales sustentan las recomendaciones de consensos internacionales para su tratamiento basado en anticoagulación o antiagregación. The number of people with atrial fibrillation (AF in the United States has been projected to increase from the current 2.2 million to 3 million in 2020. It is characterized by the presence of rapid and irregular waves on the base line that vary in size, shape and timing. It is particularly frequent in the elderly. In AF multiple, small microreentrant circuits are constantly arising in the atria, colliding, being extinguished, and arising again; a critical mass of atrial tissue is required to sustain the minimal number of simultaneous

  18. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation

    DEFF Research Database (Denmark)

    Diener, Hans-Christoph; Aisenberg, James; Ansell, Jack;

    2016-01-01

    stroke risk factor (CHA2DS2VASc score of 1 in males, 2 in females); and (vi) patients with a single first episode of paroxysmal AF. Although there are no major differences in terms of efficacy and safety between the NOACs for some clinical scenarios, in others we are able to suggest that particular drugs......Patients with atrial fibrillation (AF) have a high risk of stroke and mortality, which can be considerably reduced by oral anticoagulants (OAC). Recently, four non-vitamin-K oral anticoagulants (NOACs) were compared with warfarin in large randomized trials for the prevention of stroke and systemic...... embolism. Today's clinician is faced with the difficult task of selecting a suitable OAC for a patient with a particular clinical profile or a particular pattern of risk factors and concomitant diseases. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. NOACs for stroke...

  19. Budget impact analysis of rivaroxaban vs warfarin anticoagulation strategy for direct current cardioversion in non-valvular atrial fibrillation patients: the MonaldiVert economic study.

    Science.gov (United States)

    Russo, Vincenzo; Rago, Anna; Papa, Andrea A; Bianchi, Valter; Tavoletta, Vincenzo; DE Vivo, Stefano; Cavallaro, Ciro; Nigro, Gerardo; D'Onofrio, Antonio

    2017-09-25

    Rivaroxaban is the first novel oral anticoagulant to receive regulatory approval for non-valvular atrial fibrillation (NVAF) patients who require cardioversion. The MonaldiVert real life experience showed positive benefit-risk profile of short term rivaroxaban administration for transesophageal echocardiogram guided cardioversion in patients who had not achieved adequate pre-procedural vitamin k antagonist (VKA) anticoagulation. Aim of our study was to perform a budget impact analysis of MonaldiVert anticoagulation strategy for direct current cardioversion in NVAF patients and to compare the following costs borne by the Regional Healthcare System (RHS) with those for a hypothetical cohort of identical patients underwent from the beginning to early rivaroxaban treatment before direct current cardioversion. The mean costs per each NVAF patient treated with VKA strategy and Rivaroxaban rescue strategy were 134.53€ and 189.83€, respectively. Considering a hypothetical scenario in which all population study would be treated from the beginning with rivaroxaban (Rivaroxaban early strategy), the mean cost per patient would have been 81.11€ (Table 3). The total cost borne by the RHS, including the cost of the cardioversion procedure, for the two therapeutic strategies carried out at Monaldi Hospital (VKA strategy and Rivaroxaban rescue strategy) was 88.458,53 €. The total cost would be borne by the RHS for Rivaroxaban early strategy, if applied to all population study, would have been 69.989,15 € with a saving of 18,469.38, respect to the actually applied strategy. Rivaroxaban rescue strategy for transoesophageal echocardiography guided direct current cardioversion in NVAF patients, who had not achieved adequate pre-procedural VKA anticoagulation, is an effective and safe strategy, which allows to not delay the procedure, reducing times and wastage of cardioversion slots, without substantial costs increase.

  20. Rivaroxaban in the Prevention of Stroke and Systemic Embolism in Patients with Non-Valvular Atrial Fibrillation: Clinical Implications of the ROCKET AF Trial and Its Subanalyses.

    Science.gov (United States)

    Spencer, Ryan J; Amerena, John V

    2015-12-01

    Atrial fibrillation (AF) is an increasingly common cause of stroke and systemic embolism. While warfarin has been the mainstay of stroke prevention in patients with AF, newer novel oral anticoagulant medications are now available. Rivaroxaban, a direct factor Xa inhibitor with a rapid onset and offset after oral administration, offers potential advantages over warfarin, predominantly due to its predictable pharmacokinetics across wide patient populations. It requires no coagulation monitoring, and only two different doses are needed (20 mg daily for patients with normal renal function and 15 mg daily in those with reduced renal function). A large randomized trial (ROCKET AF) has shown non-inferiority to warfarin for preventing stroke or systemic embolism in the per-protocol population and superiority to warfarin in the on-treatment safety population. Several subanalyses confirm that the treatment effect of rivaroxaban is consistent across different patient subgroups, including those with reduced renal function. The tolerability of rivaroxaban appears similar to that of warfarin, with comparable overall bleeding rates in clinical trials. In ROCKET AF, significantly lower rates of fatal and intracranial bleeding were seen with rivaroxaban, while lower rates of gastrointestinal bleeding were seen with warfarin. Important contraindications to rivaroxaban include valvular AF, the presence of a prosthetic valve (mechanical or bioprosthetic) or valve repair, the need for concurrent dual antiplatelet therapy, and creatinine clearance <30 ml/min. Once-daily dosing and the lack of coagulation monitoring may increase utilization and adherence compared with warfarin, potentially decreasing the large burden of care associated with stroke secondary to AF. Overall, rivaroxaban offers a useful alternative to warfarin for stroke prevention in patients with AF.

  1. COMPARISON OF DIRECT COSTS OF DABIGATRAN AND WARFARIN THERAPY IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION DURING PREPARATION FOR ELECTIVE CARDIOVERSION IN THE REAL CLINICAL PRACTICE

    Directory of Open Access Journals (Sweden)

    L. E. Kuvshinova

    2015-09-01

    Full Text Available Aim. To compare direct medical costs of dabigatran and warfarin therapy in patients with non-valvular atrial fibrillation (NVAF during preparation for elective cardioversion. Material and methods. An open non-randomized study was conducted to evaluate direct medical costs (cost of drug, cost of the international normalized ratio (INR adjust- ment in outpatient clinic, cost of visits to cardiologist. Patients (n=62 with persistent NVAF (AF paroxysm duration > 48 hours were enrolled. All of them requested medical as- sistance and were decided to perform an elective cardioversion. The patients received warfarin (n=32 or dabigatran (n=30. The patients of the both groups were similar in the main clinical characteristics and thromboembolic risk levels according to CHA2DS2-VASc scale.Results. Treatment duration before elective cardioversion was 21±2 and 30.5±4.5 days for dabigatran and warfarin groups, respectively (p<0.05. Average costs of visits to cardiologists were 3,720 and 744 RUB in warfarin and dabigatran groups, respectively (p<0.05, and drug costs were 53.63 and 1,172.01 RUB, respectively (p<0.05. The costs of laboratory INR monitoring were 3,058 RUB in warfarin group. Total costs per patient were 6,831.63 and 1,916.01 RUB in warfarin and dabigatran groups, respectively (p<0.05. Conclusion. In the real clinical practice in patients with NVAF dabigatran antithromboembolic therapy substantially reduces direct medical costs in comparison with warfarin ther- apy during preparation for elective cardioversion. Dabigatran therapy reduces time from the decision of elective cardioversion and antithromboembolic therapy start to car- dioversion performance.

  2. PHARMACOECONOMIC EVALUATION OF DABIGATRAN VS WARFARIN IN CARDIOVASCULAR EVENTS PREVENTION IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    Yu. B. Belousov

    2015-12-01

    Full Text Available According to recent guidelines, oral dabigatran etexilate is indicated for stroke and systemic embolism prevention in patients with atrial fibrillation (AF. Aim. Based on the RE-LY study to evaluate the cost-effectiveness of dabigatran etexilate versus warfarin prescribed in “real-world” settings from a Russian payer perspective. Material and methods. Markov model simulated AF patients at moderate to high risk of stroke while tracking clinical events and resulting functional disability. Acute event costs and resulting long-term follow-up costs incurred by disabled stroke survivors were calculated using general tariff agreement of Russian obligatory health insurance system and official national statistics. Clinical events, summarized as events per 100 patient-years, expected life years, total costs, and incremental cost effectiveness ratios (ICER were calculated. Results. Over a lifetime, dabigatran etexilate treated patients experienced fewer intracranial haemorrhages and fewer ischaemic strokes. ICER of dabigatran etexilate was 461,602 roubles per one additional life year versus “real-world” warfarin. Conclusion. This study demonstrates that dabigatran etexilate is a cost-effective alternative to current care for the prevention of stroke and systemic embolism among Russian patients with AF .

  3. PHARMACOECONOMIC EVALUATION OF DABIGATRAN VS WARFARIN IN CARDIOVASCULAR EVENTS PREVENTION IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    Yu. B. Belousov

    2012-01-01

    Full Text Available According to recent guidelines, oral dabigatran etexilate is indicated for stroke and systemic embolism prevention in patients with atrial fibrillation (AF. Aim. Based on the RE-LY study to evaluate the cost-effectiveness of dabigatran etexilate versus warfarin prescribed in “real-world” settings from a Russian payer perspective. Material and methods. Markov model simulated AF patients at moderate to high risk of stroke while tracking clinical events and resulting functional disability. Acute event costs and resulting long-term follow-up costs incurred by disabled stroke survivors were calculated using general tariff agreement of Russian obligatory health insurance system and official national statistics. Clinical events, summarized as events per 100 patient-years, expected life years, total costs, and incremental cost effectiveness ratios (ICER were calculated. Results. Over a lifetime, dabigatran etexilate treated patients experienced fewer intracranial haemorrhages and fewer ischaemic strokes. ICER of dabigatran etexilate was 461,602 roubles per one additional life year versus “real-world” warfarin. Conclusion. This study demonstrates that dabigatran etexilate is a cost-effective alternative to current care for the prevention of stroke and systemic embolism among Russian patients with AF .

  4. Coronary artery disease, left ventricular hypertrophy and diastolic dysfunction are associated with stroke in patients affected by persistent non-valvular atrial fibrillation: a case-control study

    Directory of Open Access Journals (Sweden)

    Andrea Passantino

    2009-04-01

    Full Text Available Persistent non-valvular atrial fibrillation (NVAF is associated with an increased risk of cardiovascular events such as stroke, and its rate is expected to rise because of the ageing population. The absolute rate of stroke depends on age and comorbidity. Risk stratification for stroke in patients with NVAF derives from populations enrolled in randomized clinical trials. However, participants in clinical trials are often not representative of the general population. Many stroke risk stratification scores have been used, but they do not include transthoracic echocardiogram (TTE, pulsate wave Doppler (PWD and tissue Doppler imaging (TDI, simple and non-invasive diagnostic tools. The role of TTE, PWD and TDI findings has not been previously determined. Our study goal was to determine the association between TTE and PWD findings and stroke prevalence in a population of NVAF prone outpatients. Patients were divided into two groups: P for stroke prone and F for stroke free. There were no statistically significant differences between the two groups concerning cardiovascular risk factors, age (p=0.2, sex (p=0.2, smoking (p=0.3, diabetes (p=0.1 and hypercholesterolemia (p=0.2; hypertension was statistically significant (p less than 0.001. There were statistically significant differences concerning coronary artery disease, previous acute myocardial infarction (AMI (p less than 0.05 and non- AMI coronaropathy (p less than 0.04, a higher rate being in the P group. Concerning echo-Doppler findings, a higher statistically significant rate of left ventricular hypertrophy (LVH (p less than  0.05 and left ventricular diastolic dysfunction (p less than 0.001 was found in the P group and dilated left atrium (p Impact of Triple Therapy in Elderly Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention.

    Directory of Open Access Journals (Sweden)

    Antonia Sambola

    Full Text Available Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplatelet therapy: aspirin plus clopidogrel in patients ≥75 years of age with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI.A prospective multicenter study was conducted from 2003 to 2012 at 6 Spanish teaching hospitals. A cohort study of consecutive patients with AF undergoing PCI and treated with TT or dual antiplatelet therapy (DAPT was analyzed. All outcomes were evaluated at 1-year of follow-up.Five hundred and eighty-five patients, 289 (49% of whom were ≥75 years of age (79.6±3.4 years; 33% women were identified. TT was prescribed in 55.9% of patients at discharge who had a higher thromboembolic risk (CHA2DS2VASc score: 4.23±1.51 vs 3.76±1.40, p = 0.007 and a higher bleeding risk (HAS-BLED ≥3: 88.6% vs 79.2%, p = 0.02 than those on DAPT. Therefore, patients on TT had a lower rate of thromboembolism than those on DAPT (0.6% vs 6.9%, p = 0.004; HR 0.08, 95% CI: 0.01-0.70, p = 0.004. Major bleeding events occurred more frequently in patients on TT than in those on DAPT (11.7% vs 2.4%, p = 0.002; HR 5.2, 95% CI: 1.53-17.57, p = 0.008. The overall mortality rate was similar in both treatment groups (11.9% vs 13.9%, p = 0.38; however, after adjustment for confounding variables, TT was associated with a reduced mortality rate (HR 0.33, 95% CI: 0.12-0.86, p = 0.02.In elderly patients with AF undergoing PCI, the use of TT compared to DAPT was associated with reduced thromboembolism and mortality rates, although a higher rate of major bleeding.

  5. Dynamics of Focal Fibrillation Waves during Persistent Atrial Fibrillation.

    Science.gov (United States)

    Lanters, Eva A H; Allessie, Maurits A; DE Groot, Natasja M S

    2016-04-01

    The incidence and appearance of focal fibrillation waves on the right and left atrial epicardial surface were visualized during 10 seconds of persistent atrial fibrillation in a 71-year-old woman with valvular heart disease. The frequent, nonrepetitive, widespread, and capricious distribution of focal waves suggests that transmural conduction of fibrillation waves is most likely the mechanism underlying focal fibrillation waves.

  6. Renal Impairment and Prognosis of Patients with Atrial Fibrillation Undergoing Coronary Intervention - The AFCAS Trial.

    Directory of Open Access Journals (Sweden)

    Heli M Lahtela

    Full Text Available Renal impairment is a well-known risk factor for cardiovascular complications, but the effect of different stages of renal impairment on thrombotic/thromboembolic and bleeding complications in patients with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI remains largely unknown. We sought to evaluate the incidence and clinical impact of four stages of renal impairment in patients with AF undergoing PCI.We assessed renal function by estimated glomerular filtration rate (eGFR and outcomes in 781 AF patients undergoing PCI by using the data from a prospective European multicenter registry. End-points included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE and bleeding events at 12 months.A total of 195 (25% patients had normal renal function (eGFR ≥90 mL/min, 290 (37% mild renal impairment (eGFR 60-89, 263 (34% moderate renal impairment (eGFR 30-59 and 33 (4% severe renal impairment (eGFR <30. Degree of renal impairment remained an independent predictor of mortality and MACCE in an adjusted a Cox regression model. Even patients with mild renal impairment had a higher risk of all-cause mortality (HR 2.25, 95%CI 1.02-4.98, p=0.04 and borderline risk for MACCE (HR 1.56, 95%CI 0.98- 2.50, p=0.06 compared to those with normal renal function.Renal impairment is common in patients with AF undergoing PCI and even mild renal impairment has an adverse prognostic effect in these patients requiring multiple antithrombotic medications.

  7. Icodextrin eliminates phosphate and ameliorates cardiac hypertrophy and valvular calcification in patients with end-stage renal disease and diabetes mellitus undergoing peritoneal dialysis.

    Science.gov (United States)

    Hiramatsu, Takeyuki; Hayasaki, Takahiro; Hobo, Akinori; Furuta, Shinji; Kabu, Koki; Tonozuka, Yukio; Iida, Yoshiyasu

    2013-01-01

    Among end-stage renal disease (ESRD) patients, cardiovascular disease is a common comorbidity and one of most important factors affecting clinical prognosis. Calcium deposition has been reported to correlate with plasma phosphate. Icodextrin (Ico)-based peritoneal dialysis (PD) has many advantages over glucose (Glu)-based PD. We aimed to identify factors that suppress arteriosclerosis and valvular disease in patients with ESRD and diabetes mellitus (DM) undergoing Ico-based PD. In this retrospective study, we evaluated the effects of Ico-based PD (n = 20) on phosphate elimination and cardiovascular disease progression in patients with ESRD andDM, and we compared the results with those for Glu-based PD (n = 20). Left ventricular mass index (LVMI) and aortic valve calcification (AVC) score were significantly decreased and daily phosphate elimination was significantly increased in the Ico group compared with the Glu group. Furthermore, mean daily phosphate elimination was significantly and negatively correlated with the amelioration in LVMI and AVC score. Our study suggests that, compared with glucose, icodextrin has the ability to eliminate more phosphate from the body, indicating that phosphate elimination might potentially be a means of controlling cardiovascular disease in PD patients with DM.

  8. COST-EFFECTIVENESS OF APIXABAN AS COMPARED WITH WARFARIN AND ACETYLSALICYLIC ACID IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION IN THE RUSSIAN FEDERATION

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-09-01

    Full Text Available Background. For prevention of thromboembolic events in patients with non-valvular atrial fibrillation (NVAF the following types of antithrombotic therapy are used: anticoagulant therapy with vitamin K antagonists (such as warfarin, antiplatelet therapy (such as acetylsalicylic acid and novel oral anticoagulants such as apixaban, rivaroxaban and dabigatran. Administration of vitamin K antagonists (VKA is complicated by the need for individual dose adjustment and frequent monitoring of international normalized ratio (INR. Both warfarin and acetylsalicylic acid are widely used for thrombosis prevention in patients with NVAF in the Russian Federation.Aim. To evaluate the cost-effectiveness ratio of apixaban compared with warfarin and acetylsalicylic acid in patients with NVAF from the Russian Federation national health care system perspective.Material and methods. This analysis used a Markov model that allowed estimation of the incremental cost-effectiveness ratio (ICER for apixaban as compared with warfarin and acetylsalicylic acid over lifetime horizon in VKA suitable and VKA unsuitable patients with NVAF respectively. The model enclosed cardiovascular event rates based on the results of the randomized clinical trials comparing clinical effectiveness and safety of apixaban with warfarin (ARISTOTLE and acetylsalicylic acid (AVERROES. The following cardiovascular events were taken into consideration: ischemic and hemorrhagic stroke, systemic embolism, intracranial hemorrhage, other major bleeds, clinically relevant non-major bleeds and myocardial infarction. Direct medical costs were determined based on the rates of the compulsory national medical insurance system. The price of the antithrombotic drugs was taken as a weighted average tender price for the year 2013. In the model both costs and benefits (quality-adjusted life years and life-years were discounted at 3.5%. Cost-effectiveness threshold was set at 1.4 million rubles per quality

  9. Early real-world evidence of persistence on oral anticoagulants for stroke prevention in non-valvular atrial fibrillation: a cohort study in UK primary care

    Science.gov (United States)

    Johnson, Michelle E; Lefèvre, Cinira; Collings, Shuk-Li; Evans, David; Kloss, Sebastian; Ridha, Essra; Maguire, Andrew

    2016-01-01

    Objectives To examine the characteristics and persistence in patients newly initiated with oral anticoagulants (OACs) for stroke prevention in non-valvular atrial fibrillation (NVAF). Design Cohort study in Clinical Practice Research Datalink. Setting UK primary care. Participants 15 242 patients with NVAF newly prescribed apixaban, rivaroxaban, dabigatran or vitamin K antagonists (VKAs) between 1 December 2012 and 31 October 2014. 13 089 patients were OAC naïve. Outcome measures Patient characteristics and risk of non-persistence compared to apixaban using Cox regression models over the entire follow-up and using a time-partitioned approach to handle non-proportional hazards. Results Among the OAC naïve patients, VKAs were most common (78.1%, n=10 218), followed by rivaroxaban (12.1%, n=1589), dabigatran (5.7%, n=741) and apixaban (4.1%, n=541). High baseline stroke risk (CHA2DS2VASc ≥2) ranged from 80.2% (dabigatran) to 88.4% (apixaban and rivaroxaban). History of stroke and bleeding was the highest among apixaban (23.7% and 31.6%) and lowest among VKA patients (15.9% and 27.5%). Across the entire follow-up period, adjusting for differences in characteristics, there was no evidence of a difference in non-persistence between VKA and apixaban (HR 0.92 (95% CI 0.68 to 1.23)). Non-persistence was higher with dabigatran (HR 1.67 (1.20 to 2.32)) and rivaroxaban (HR 1.41 (1.02 to 1.93)) than apixaban. Using the partitioned approach, non-persistence was lower with VKA (HR 0.33 (0.22 to 0.48)), and higher with dabigatran (HR 1.65 (1.08 to 2.52)) compared to apixaban in the first 2 months of follow-up. After 2 months, non-persistence was higher with VKA (HR 1.70 (1.08 to 2.66)) and dabigatran (HR 2.10 (1.30 to 3.41)). Pooling OAC naïve and experienced patients, non-persistence was also higher with rivaroxaban compared to apixaban after 2 months of follow-up (HR 1.69 (1.19 to 2.39)). Conclusions Observed differential prescribing of OACs can result in

  10. COST-EFFECTIVENESS OF APIXABAN AS COMPARED WITH WARFARIN AND ACETYLSALICYLIC ACID IN PATIENTS WITH NON-VALVULAR ATRIAL FIBRILLATION IN THE RUSSIAN FEDERATION

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2014-01-01

    Full Text Available Background. For prevention of thromboembolic events in patients with non-valvular atrial fibrillation (NVAF the following types of antithrombotic therapy are used: anticoagulant therapy with vitamin K antagonists (such as warfarin, antiplatelet therapy (such as acetylsalicylic acid and novel oral anticoagulants such as apixaban, rivaroxaban and dabigatran. Administration of vitamin K antagonists (VKA is complicated by the need for individual dose adjustment and frequent monitoring of international normalized ratio (INR. Both warfarin and acetylsalicylic acid are widely used for thrombosis prevention in patients with NVAF in the Russian Federation.Aim. To evaluate the cost-effectiveness ratio of apixaban compared with warfarin and acetylsalicylic acid in patients with NVAF from the Russian Federation national health care system perspective.Material and methods. This analysis used a Markov model that allowed estimation of the incremental cost-effectiveness ratio (ICER for apixaban as compared with warfarin and acetylsalicylic acid over lifetime horizon in VKA suitable and VKA unsuitable patients with NVAF respectively. The model enclosed cardiovascular event rates based on the results of the randomized clinical trials comparing clinical effectiveness and safety of apixaban with warfarin (ARISTOTLE and acetylsalicylic acid (AVERROES. The following cardiovascular events were taken into consideration: ischemic and hemorrhagic stroke, systemic embolism, intracranial hemorrhage, other major bleeds, clinically relevant non-major bleeds and myocardial infarction. Direct medical costs were determined based on the rates of the compulsory national medical insurance system. The price of the antithrombotic drugs was taken as a weighted average tender price for the year 2013. In the model both costs and benefits (quality-adjusted life years and life-years were discounted at 3.5%. Cost-effectiveness threshold was set at 1.4 million rubles per quality

  11. Endometrial Collagen Fibril Hyperplasia is Associated with Implantation Failure in Women Undergoing IVF-ET

    Institute of Scientific and Technical Information of China (English)

    Min-zhi GAO; Mei-zhen XIN; Xiao-ming ZHAO; Zhong ZHENG; Yan HONG; Yun SUN; Hui-qin ZHANG

    2009-01-01

    Objective To analyse the effects of controlled ovarian hyperstimulation(COH)on the endometrial expression of collagen fibril(CF)during the peri-implantation period in patients undergoing IVF,and its relation to endometrial receptivity(ER)in repeated implantation failure(RIF).Methods Peripheral blood and endometrial biopsies were obtained from 45 infertile women on days 5,7 or 9 after oocytes retrieval or ovulation in a stimulated cycle(SC)and natural cycle(NC)respectively.CF was assayed by transmission electron microscope and quantified by modified Masson dyeing.The outcome of subsequent embryo transfer(ET)was observed.Results Levels of both E2 and progesterone were higher in the peripheral blood in SC than in NC.Also the expression of CF in the stroma in each secretory phase was increased significantly in SC(P<0.05).After embryo transferring,expression levels of CF in the pregnancy group dropped between the mid-and late-secretory phase,but no change in the non-pregnancy group.In the same term,all patients undergone endometrial curettage had higher pregnancy rate than those without.Conclusion Imbalance of production and degradation of endometrial CF in the secretory phase resulting from COH may be the cause of defective ER and implantation failure in some RIF patients.Endometrial curettage may improve implantation rate by inducing appropriate CF hyperplasia and degradation.

  12. Complex fractionated electrogram distribution and temporal stability in patients undergoing atrial fibrillation ablation.

    Science.gov (United States)

    Roux, Jean-François; Gojraty, Sattar; Bala, Rupa; Liu, Christopher F; Hutchinson, Mathew D; Dixit, Sanjay; Callans, David J; Marchlinski, Francis; Gerstenfeld, Edward P

    2008-08-01

    Targeting of complex fractionated electrograms (CFEs) has been described as an approach for catheter ablation of atrial fibrillation (AF); however, the distribution and temporal stability of CFE regions remain poorly defined. In patients with persistent AF referred for ablation, we performed two consecutive left atrial (LA) CFE maps prior to AF ablation. Bipolar electrograms were acquired during AF, and the mean AF cycle length and electrogram voltage were automatically determined at each point. Sites with mean CL CFE positive. The two maps were then compared qualitatively and quantitatively. A total of 15 patients (93% male, age 56.1 +/- 9.0 years) undergoing AF ablation were studied. The two maps were separated in time by 31 +/- 10 minutes. There was no significant difference in the number of CFE-positive regions (12.3 +/- 5.2 vs 11.3 +/- 4.7; P = 0.06) between the maps. While CFEs were widely distributed within the LA, the PV/left atrial junction (73%) and left atrial appendage (77%) were most often CFE positive. The presence of CFEs at each region was concordant 78% of the time. There was a significant correlation between the two maps (r = 0.35 +/- 0.21, range 0.1-0.84; P CFE regions are found in the vicinity of the PVs. There is a significant correlation between two CFE maps constructed 31 minutes apart, with 78% concordance of CFE sites.

  13. Antithrombotic Therapy for Non-valvular Atrial Fibrillation Patients with Coronary Artery Disease after Percutaneous Coronary Intervention with Drug-eluting Stent%冠心病药物支架术后合并非瓣膜性心房颤动的抗栓治疗

    Institute of Scientific and Technical Information of China (English)

    王洁(综述); 苏立(审校)

    2015-01-01

    Patients with non-valvular atrial fibrillation undergoing percutaneous coronary intervention with drug-eluting stent implanta-tion need dual antiplatelet therapy as well as anticoagulation therapies.Dual antiplatelet therapy and anticoagulation therapy together can re-duce ischemic events, however, it can also increase bleeding events.More research is warranted to find an effective way to reduce ischemic events such as stent thrombosis and systemic embolism without increasing bleeding events through the combination of antiplatelet drugs with either vitamin K antagonist therapy or novel oral anticoagulants.%冠心病合并非瓣膜性心房颤动患者支架植入术后需要抗血小板及口服抗凝药物治疗。抗血小板及抗凝治疗在减少缺血事件的同时也增加了出血风险。抗血小板药物与传统口服抗凝药物维生素K拮抗剂或新型口服抗凝药物如何联合使用以最大程度减少支架内血栓、系统性栓塞等缺血事件,同时又不显著增加出血事件,有待更多研究。

  14. Temporal changes in patient characteristics and prior pharmacotherapy in patients undergoing radiofrequency ablation of atrial fibrillation

    DEFF Research Database (Denmark)

    Karasoy, Deniz; Gislason, Gunnar Hilmar; Hansen, Jim

    2013-01-01

    Trends in patient selection and pharmacotherapy before radiofrequency ablation (RFA) of atrial fibrillation are not well studied. We examined temporal trends in RFA utilization on a nationwide scale in Denmark.......Trends in patient selection and pharmacotherapy before radiofrequency ablation (RFA) of atrial fibrillation are not well studied. We examined temporal trends in RFA utilization on a nationwide scale in Denmark....

  15. Catheter ablation and surgical tneatment of atrial fibrillation with valvular heart disease%外科射频消融术与经导管消融术治疗瓣膜病性房颤的疗效对比

    Institute of Scientific and Technical Information of China (English)

    卢春山; 柳景华; 马长生; 孟旭; 罗毅; 刘旭; 董建增; 刘兴鹏

    2008-01-01

    Objective Catheter ablation of atrial fibrillation(AF) has became another nonpharmacologic therapeutic option for valvular heart divine with AF. The modified Cox maze procedure was the traditional treatment of AF during cardiac surgery. The purpose of this study wss to compare the clinical outcomes of the two approaches in patients with rheumatic valvular heart disease and AF. Methods From January 2004 to March 2006, patients with valvular heart disease with AF were inchuded. Catheter ablation(group 2) versus surgical treatment( group 1) for rheumatic heart disease with AF. Results Group 1 and 2 did not differ in terms of baseline characteristics. The perioperative mortality rate was not significantly different between the two groups. The maintenances of sinus rhythm were 90%, 82% respectively for group 2 in paroxysmal AF with LAd <50 mm, and case history < 1 year. The overall cumulative rate of sinus rhythm were75% in group 1 [(14±10) months] and 64% in group 2 [follow-up time, (14±10) months] , statistically significant. Conchusion The nsdiofrenquency (RF) ablation procedure during surgical treatment for valve heart disease with atrial fibrillation is a single, effective therapeutic option, allowing recovery of the sinus rhythm in the great majority of patients with atrial. fibrillation. While cstheter ablation is also a safe and effective means of curing atrial fibllation in paroxysmal AF with LAd <50 mm (<1 year).%目的 比较心内直视下射频迷宫术与介入导管消融术治疗合并心脏瓣膜病的心房颤动临床结果.方法 2004年1月到2006年3月因心脏瓣膜病合并心房颤动行瓣膜置换时加射频迷宫术60例,其中男34例,女26例;平均(57±11)岁.瓣膜置换术后在三维电解剖标测系统(CABTO)指导下进行经皮经导管环肺静脉消融治疗66例,其中男40例,女26例;平均(55±10)岁.结果 导管消融组随访(14±10)个月,窦性心律维持率64%.外科射频迷宫组随访(13±9)

  16. Thromboembolic risk in 16 274 atrial fibrillation patients undergoing direct current cardioversion with and without oral anticoagulant therapy

    DEFF Research Database (Denmark)

    Hansen, Morten Lock; Jepsen, Rikke Malene H G; Olesen, Jonas Bjerring;

    2015-01-01

    AIMS: To study the risk of thromboembolism in a nationwide cohort of atrial fibrillation patients undergoing direct current (DC) cardioversion with or without oral anticoagulant coverage. METHODS AND RESULTS: A retrospective study of 16 274 patients in Denmark discharged from hospital after a first......-time DC cardioversion for atrial fibrillation between 2000 and 2008. Use of oral anticoagulant therapy within 90 days prior and 360 days after DC cardioversion was obtained from the Danish Register of Medicinal Product Statistics. The risk of thromboembolism was estimated by calculating incidence rates...... and by multivariable adjusted Cox proportional-hazard models. During the initial 30 days following discharge, the thromboembolic incidence rate was 10.33 per 100 patient-years for the no prior oral anticoagulant therapy group [n = 5084 (31.2%)], as compared with 4.00 per 100 patient-years for the prior oral...

  17. Clinical characteristics and outcomes with rivaroxaban vs. warfarin in patients with non-valvular atrial fibrillation but underlying native mitral and aortic valve disease participating in the ROCKET AF trial

    Science.gov (United States)

    Breithardt, Günter; Baumgartner, Helmut; Berkowitz, Scott D.; Hellkamp, Anne S.; Piccini, Jonathan P.; Stevens, Susanna R.; Lokhnygina, Yuliya; Patel, Manesh R.; Halperin, Jonathan L.; Singer, Daniel E.; Hankey, Graeme J.; Hacke, Werner; Becker, Richard C.; Nessel, Christopher C.; Mahaffey, Kenneth W.; Fox, Keith A. A.; Califf, Robert M.

    2014-01-01

    Aims We investigated clinical characteristics and outcomes of patients with significant valvular disease (SVD) in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) trial. Methods and results ROCKET AF excluded patients with mitral stenosis or artificial valve prostheses. We used Cox regression to adjust comparisons for potential confounders. Among 14 171 patients, 2003 (14.1%) had SVD; they were older and had more comorbidities than patients without SVD. The rate of stroke or systemic embolism with rivaroxaban vs. warfarin was consistent among patients with SVD [2.01 vs. 2.43%; hazard ratio (HR) 0.83, 95% confidence interval (CI) 0.55–1.27] and without SVD (1.96 vs. 2.22%; HR 0.89, 95% CI 0.75–1.07; interaction P = 0.76). However, rates of major and non-major clinically relevant bleeding with rivaroxaban vs. warfarin were higher in patients with SVD (19.8% rivaroxaban vs. 16.8% warfarin; HR 1.25, 95% CI 1.05–1.49) vs. those without (14.2% rivaroxaban vs. 14.1% warfarin; HR 1.01, 95% CI 0.94–1.10; interaction P = 0.034), even when controlling for risk factors and potential confounders. In intracranial haemorrhage, there was no interaction between patients with and without SVD where the overall rate was lower among those randomized to rivaroxaban. Conclusions Many patients with ‘non-valvular atrial fibrillation’ have significant valve lesions. Their risk of stroke is similar to that of patients without SVD after controlling for stroke risk factors. Efficacy of rivaroxaban vs. warfarin was similar in patients with and without SVD; however, the observed risk of bleeding was higher with rivaroxaban in patients with SVD but was the same among those without SVD. Atrial fibrillation patients with and without SVD experience the same stroke-preventive benefit of oral anticoagulants. PMID:25148838

  18. Valvular heart disease

    OpenAIRE

    Gelson, E; Gatzoulis, M; Johnson, M.

    2007-01-01

    Valvular disease may be unmasked in pregnancy when physiological changes increase demands on the heart. Women with valvular heart disease require close follow-up during pregnancy, delivery, and postpartum

  19. Role of adenosine-guided pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a meta-analysis.

    Science.gov (United States)

    Chen, Yi-He; Lin, Hui; Xie, Cheng-Long; Hou, Jian-Wen; Li, Yi-Gang

    2017-04-01

    Adenosine had been reported to unmask dormant conduction and thus identify pulmonary vein at risk of reconnection. However, the role of adjunctive adenosine infusion after pulmonary vein isolation (PVI) on long-term arrhythmia-free survival was still contentious. The purpose of the present meta-analysis was to assess the association of adenosine testing with long-term ablation success in patients with atrial fibrillation (AF) (i.e. freedom from AF recurrence). We systematically searched the electronic databases and finally included 10 studies, with 1771 patients undergoing adenosine-guided PVI and 1787 patients undergoing conventional PVI. In comparison to conventional PVI alone, adenosine-guided PVI improved the arrhythmia-free survival by 17% during a median follow-up of 12 months [relative risk (RR): 1.17; 95% confidence interval (CI): 1.07 to 1.27; P = 0.014]. Patients undergoing adenosine-guided PVI had similar fluoroscopy time to those who undergoing conventional PVI [weighted mean difference (WMD): 1.76; 95% CI: -5.66 to 9.17; P = 0.64], despite longer procedure time (WMD: 20.6; 95% CI: 0.70 to 40.50; P = 0.042). From the available data of clinical studies, adenosine-guided PVI was associated with an increased arrhythmia-free survival when compared with conventional PVI in patients undergoing catheter ablation for AF.

  1. Expression and significance of TGF-β1 signal pathway in atrium of patients with valvular heart diseases complicated by atrial fibrillation

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    Jin-jin CHEN

    2011-11-01

    Full Text Available Objective To observe the expressions of transforming growth factor beta 1(TGF-β1 and mothers against decapentaplegic homolog 3(Smad3 in the right atrium of patients with rheumatic heart valve disease(RHVD and discuss the roles of the TGF-β1 signal pathway in the structural remodeling of atrial fibrillation(AF.Methods Up to 40 cases of rheumatic heart valve disease that underwent mitral valve replacements from Oct 2009 to May 2010 were selected in the present study.The patients were divided into 2 groups: sinus rhythm(SR group(n=12 and chronic atrial fibrillation(AF group(n=28 based on their history and electrocardiogram reports before surgery.Echocardiography was used to measure the cardiac cavity size,and analyze cardiac function.Right atrial specimens were obtained during the operation for Masson and Sirius red picric acid staining and to observe fibrosis and calculate the collagenous volumetric fraction(CVF.TGF-β1,Smad3 mRNA and protein expression were measured via real-time quantitative polymerase chain reaction and Western blot.Results Compared with the SR group,the AF group had a higher collagen in the right atrial myocardium.The expression levels of TGF-β1,Smad3 mRNA,and protein were significantly increased(P < 0.05.In the AF group,the TGF-β1 mRNA and protein expression levels in the right atrial myocardium were positively correlated with the CVF with a relationship index r=0.584 for(P=0.010and 0.671 for(P=0.024,respectively.The expression levels of TGF-β1 and Smad3 were positively correlated with the mRNA and protein levels(r=0.634,P=0.020;r=0.757,P=0.003.Conclusions An structural remodeling of the atria based mainly on the change of atrial fibrosis will occur during atrial fibrillation.TGF-β1/Smad3 may play a part in the atrial structural remodeling of AF patients,and it is related to the occurrence and maintenance of atrial fibrillation.

  2. Antithrombotic treatment in anticoagulated atrial fibrillation patients undergoing percutaneous coronary intervention.

    Science.gov (United States)

    Dézsi, Csaba András; Dézsi, Balázs Bence; Dézsi, Döme András

    2017-01-05

    Coronary artery disease coexists in a clinically relevant number of patients with atrial fibrillation and it often requires percutaneous coronary intervention. These patients represent a particular challenge for clinicians in terms of antithrombotic management. They require combined antiplatelet-anticoagulant therapy to reduce the risk of recurrent ischemic cardiac events and stroke; however, this antithrombotic strategy is associated with an increased risk of bleeding complications. In the absence of randomized, controlled clinical trials, the majority of current recommendations rely on the results of cohort studies, meta-analyses, post-hoc analyses and subgroup analyses of large, phase III studies. Based on the available evidence, the present review discusses the optimal antithrombotic strategy for patients receiving chronic anticoagulant therapy due to atrial fibrillation who require antiplatelet treatment after acute coronary syndrome and/or percutaneous coronary intervention, and discusses the issue of dental procedures. The correct planning of therapy significantly reduces the risk of bleeding complications and thromboembolic events.

  3. Safety and efficacy of non-vitamin K oral anticoagulant treatment compared with warfarin in patients with non-valvular atrial fibrillation who develop acute ischemic stroke or transient ischemic attack: a multicenter prospective cohort study (daVinci study).

    Science.gov (United States)

    Saji, Naoki; Kimura, Kazumi; Tateishi, Yohei; Fujimoto, Shigeru; Kaneko, Nobuyuki; Urabe, Takao; Tsujino, Akira; Iguchi, Yasuyuki

    2016-11-01

    The safety and efficacy of non-vitamin K oral anticoagulant (NOAC) compared with warfarin in treating patients with non-valvular atrial fibrillation (NVAF) who developed acute ischemic stroke or transient ischemic attack (AIS/TIA), particularly those receiving tissue-plasminogen activator (tPA) therapy, remains unclear. Between April 2012 and December 2014, we conducted a multicenter prospective cohort study to assess the current clinical practice for treating such patients. We divided the patients into two groups according to the administration of oral anticoagulants (warfarin or NOACs) and tPA therapy. The risk of any hemorrhagic or ischemic event was compared within 1 month after the onset of stroke. We analyzed 235 patients with AIS/TIA including 73 who received tPA therapy. Oral anticoagulants were initiated within 2-4 inpatient days. NOACs were administered to 49.8 % of patients, who were predominantly male, younger, had small infarcts, lower NIHSS scores, and had a lower all-cause mortality rate (0 vs. 4.2 %, P = 0.06) and a lower risk of any ischemic events (6.0 vs. 7.6 %, P = 0.797) compared with warfarin users. The prevalence of all hemorrhagic events was equivalent between the two groups. Early initiation of NOACs after tPA therapy appeared to lower the risk of hemorrhagic events, although there was no significant difference (0 vs. 5.6 %, P = 0.240). Although more clinicians are apt to prescribe NOACs in minor ischemic stroke, NOAC treatment may provide a potential benefit in such cases. Early initiation of NOACs after tPA therapy may reduce the risk of hemorrhagic events compared with warfarin.

  4. Spectral analysis-based risk score enables early prediction of mortality and cerebral performance in patients undergoing therapeutic hypothermia for ventricular fibrillation and comatose status

    OpenAIRE

    2015-01-01

    Background: Early prognosis in comatose survivors after cardiac arrest due to ventricular fibrillation (VF) is unreliable, especially in patients undergoing mild hypothermia. We aimed at developing a reliable risk-score to enable early prediction of cerebral performance and survival. Methods: Sixty-one out of 239 consecutive patients undergoing mild hypothermia after cardiac arrest, with eventual return of spontaneous circulation (ROSC), and comatose status on admission fulfilled the inclu...

  5. Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery

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    Charles André

    2015-08-01

    Full Text Available Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF. Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.

  6. Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery.

    Science.gov (United States)

    André, Charles

    2015-08-01

    Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF). Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.

  7. Rivaroxaban versus warfarin in Japanese patients with non-valvular atrial fibrillation in relation to hypertension: a subgroup analysis of the J-ROCKET AF trial.

    Science.gov (United States)

    Matsumoto, Masayasu; Hori, Masatsugu; Tanahashi, Norio; Momomura, Shin-Ichi; Uchiyama, Shinichiro; Goto, Shinya; Izumi, Tohru; Koretsune, Yukihiro; Kajikawa, Mariko; Kato, Masaharu; Ueda, Hitoshi; Iekushi, Kazuma; Yamanaka, Satoshi; Tajiri, Masahiro

    2014-05-01

    The majority of the patients enrolled in the rivaroxaban vs. warfarin in Japanese patients with atrial fibrillation (J-ROCKET AF) trial had hypertension. In this subgroup analysis, we investigated differences in the safety and efficacy of rivaroxaban and warfarin in subjects with and without hypertension. The baseline blood pressure (BP) measurements of patients with hypertension in the rivaroxaban and warfarin groups were 130/77 mm Hg and 131/77 mm Hg, respectively, whereas those of patients without hypertension were 123/74 mm Hg and 124/73 mm Hg, respectively. The incidence rates of the principal safety outcomes in the rivaroxaban and warfarin groups were 18.39% per year and 16.81% per year, respectively, among patients with baseline hypertension (hazard ratio (HR): 1.10; 95% confidence interval (CI): 0.84-1.45) and 16.71% per year and 15.00% per year, respectively, among patients without hypertension at baseline (HR: 1.14; 95% CI: 0.66-1.97), indicating no significant interaction (P=0.933). The incidence rates of the primary efficacy endpoints in the rivaroxaban group and the warfarin group were 0.54% per year and 2.24% per year, respectively, in patients without baseline hypertension (HR: 0.25; 95% CI: 0.03-2.25), and 1.45% per year and 2.71% per year, respectively, in patients with baseline hypertension (HR: 0.54; 95% CI: 0.25-1.16), indicating no significant interaction (P=0.509). In conclusion, the safety and efficacy profile of rivaroxaban was similar to that of warfarin, independent of baseline hypertensive status.

  8. Preoperative Antihypertensive Medication in Relation to Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis

    Science.gov (United States)

    Zhou, Ai-Guo; Chen, An-ji; Zhang, Xiong-fei; Deng, Hui-wei

    2017-01-01

    Background. We undertake a systematic review and meta-analysis to evaluate the effect of preoperative hypertension and preoperative antihypertensive medication to postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to March 2016) for eligible studies. The outcomes were the effects of preoperative hypertension, preoperative calcium antagonists regimen, preoperative ACE inhibitors regimen, and preoperative beta blocking agents regimen with POAF. We calculated pooled risk ratios (OR) and 95% CIs using random- or fixed-effects models. Results. Twenty-five trials involving 130087 patients were listed. Meta-analysis showed that the number of preoperative hypertension patients in POAF group was significantly higher (P < 0.05), while we found that there are no significant differences between two groups in Asia patients by subgroup analysis, which is in contrast to other outcomes. Compared with the Non-POAF group, the number of patients who used calcium antagonists and ACE inhibitors preoperatively in POAF group was significantly higher (P < 0.05). And we found that there were no significant differences between two groups of preoperative beta blocking agents used (P = 0.08). Conclusions. Preoperative hypertension and preoperative antihypertensive medication in patients undergoing cardiac operations seem to be associated with higher risk of POAF. PMID:28286753

  9. Effects of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting: a propensity score analysis

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    Ayşegül Kunt

    2015-08-01

    Full Text Available Aim To evaluate the effect of perioperative statin treatment on postoperative atrial fibrillation and cardiac mortality in patients undergoing coronary artery bypass grafting. Methods A total of 1890 patients who underwent isolated coronary artery bypass were analyzed retrospectively, of which 425 patients (22.4% older than 70 were included in the study. The demographic properties, preoperative, operative and postoperative data and other medications of these patients were recorded. Continuous preoperative and postoperative atorvastatin therapy were received by 124 (29.17% patients; 301 (70.82% patients were matched to a control group (no-statin group. The two groups were matched by propensity score analysis in terms of atrial fibrillation development and cardiac mortality. Results Medical history, medical treatment, cardiovascular history, and operative characteristics demonstrated significant heterogeneity in both groups. Postoperative atrial fibrillation was similar in both groups. Before propensity score matching, the percentages of patients in postoperative atrial fibrillation with respect to Atorvastain-group and No-statin-group were 13.71 and 10.3 respectively; however, those were 13.71 and 14.51 after matching. In a multivariate regression analysis, five-vessel bypass (odds ratio OR, 2.354; 95% confidence interval CI, 0.99 to 5.57 was an independent predictor of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting. In-hospital mortality was higher in the Atorvastatin-group compared with the No-statingroup: 124 (8.9% versus 301 (3.7%, respectively; p=0.027. Conclusion Perioperative atorvastatin treatment is not found to be associated with reduced postoperative atrial fibrillation and cardiac mortality in patients undergoing isolated coronary artery bypass grafting above the age of seventy years.

  10. Risk factors for early recurrence of atrial fibrillation after surgical radiofrequency ablation in patients with valvular heart disease combined with atrial fibrillation%瓣膜病合并房颤外科射频消融术后早期复发的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    陈从涛; 曹海龙; 武忠; 王东进

    2013-01-01

    Objective To explore the risk factors for early recurrence of atrial fibrillation (AF) after surgical radiofrequency ablation in patients with valvular heart disease combined with AF.Methods Data of 201 patients with valvular heart disease combined with AF in Nanjing Drum Tower Hospital from January 2010 to May 2012 were retrospectively analyzed.Multivariate logistic regression analysis was used to screen independent risk factors for predicting early recurrence of AF.Results 5 patients died after surgery and the data were excluded.Among the 196 patients who finished the heart rhythm monitor,98 patients maintained stable sinus rhythm (SR),whereas the other 98 cases developed AF recurrence during the postoperative hospital stay.Multivariate logistic regression analysis found that the duration of AF,hypertension and left atrial size were the independent risk factors for predicting AF early recurrence.Conclusion Long duration of AF,history of hypertension and enlargement of left atrium could influent the short-term outcome of surgical radiofrequency ablation in patients with valvular heart disease combined with AF.They could be used in clinical practice to choose more suitable patients with valvular heart disease combined with AF for surgical ablation.Thus,it can help to improve the exactness and success rate of terminating AF in this kind of patients,and reduce the waste of medical resources and the economic burden of patients.%目的:探讨心脏瓣膜病手术患者同期施行房颤外科射频消融术后房颤早期复发的危险因素.方法:回顾性分析2010年1月至2012年5月在南京市鼓楼医院心胸外科同期行房颤射频消融治疗的201例瓣膜病合并房颤患者,多元回归分析筛选影响房颤早期复发的独立危险因素.结果:排除5例术后死亡病例,根据术后住院期间的心律监测结果,98例维持稳定的窦性心律,其余98例出现房颤复发.多元逻辑回归分析发现,房颤病程、高血压病史、

  11. Periprocedural anticoagulation of patients undergoing pericardiocentesis for cardiac tamponade complicating catheter ablation of atrial fibrillation.

    Science.gov (United States)

    Lin, Tao; Bai, Rong; Chen, Ying-wei; Yu, Rong-hui; Tang, Ri-bo; Sang, Cai-hua; Li, Song-nan; Ma, Chang-sheng; Dong, Jian-zeng

    2015-01-01

    Anticoagulation of patients with cardiac tamponade (CT) complicating catheter ablation of atrial fibrillation (AF) is an ongoing problem. The aim of this study was to survey the clinical practice of periprocedural anticoagulation in such patients. This study analyzed the periprocedural anticoagulation of 17 patients with CT complicating AF ablation. Emergent pericardiocentesis was performed once CT was confirmed. The mean drained volume was 410.0 ± 194.1 mL. Protamine sulfate was administered to neutralize heparin (1 mg neutralizes 100 units heparin) in 11 patients with persistent pericardial bleeding and vitamin K1 (10 mg) was given to reverse warfarin in 3 patients with supratherapeutic INR (INR > 2.1). Drainage catheters were removed 12 hours after echocardiography confirmed absence of intrapericardial bleeding and anticoagulation therapy was restored 12 hours after removing the catheter. Fifteen patients took oral warfarin and 10 of them were given subcutaneous injection of LMWH (1 mg/kg, twice daily) as a bridge to resumption of systemic anticoagulation with warfarin. Two patients with a small amount of persistent pericardial effusion were given LMWH on days 5 and 13, and warfarin on days 6 and 24. The dosage of warfarin was adjusted to keep the INR within 2-3 in all patients. After 12 months of follow-up, all patients had no neurological events and no occurrence of delayed CT. The results showed that it was effective and safe to resume anticoagulation therapy 12 hours after removal of the drainage catheter. This may help to prevent thromboembolic events following catheter ablation of AF.

  12. The health care setting rather than medical speciality impacts on physicians adherence to guideline-conform anticoagulation in outpatients with non-valvular atrial fibrillation: a cross sectional survey

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    Gerber Bernhard

    2012-02-01

    Full Text Available Abstract Background In patients with non-valvular atrial fibrillation (NVAF at high risk for stroke guidelines consistently recommend long-term oral anticoagulation (OAC with a vitamin K antagonist. However recommendations remain ambiguous in respect to the precise OAC initiation regimens. Based on the clinical observation, that the initiation of OAC for NVAF varies considerably in daily practice, we aimed to assess the current practice in Switzerland. Methods Cross-sectional survey of randomly selected general practitioners, internists and cardiologists from different health care settings in an urban Swiss region that covers 1.4 million inhabitants. The main outcome measures were the preferred antithrombotic initiation regimen and long-term treatment in patients with newly diagnosed NVAF at high risk for stroke. Results We received 226 out of 388 (58.2% surveys. Compared to physicians working in a hospital setting (33.6% of respondents physicians in ambulatory care reported more years of experience and claimed lower-use (never or seldom of guidelines in general (47.6 vs. 12.2%. Regarding long-term thromboembolic prophylaxis 93.7% of all responders followed current recommendation by choosing an OAC. When focussing on guideline-consistent correct OAC initiation (either low-dose initial OAC or a combination of LMWH and OAC adherence dropped to 60.6% with hospital physicians demonstrating a significantly higher use of guideline-conform OAC regimens (79.7 vs. 51.0%. Medical speciality in non-hospital physicians was not related to correct guideline-use. Hospital setting remained independently associated with a guideline-conform OAC initiation regimen (OR 2.8, p = 0.023 when controlled for medical speciality, physicians' characteristics and clinical experience. Problems when starting an anticoagulation treatment were seldom reported (never or seldom accounting for 94.1% of all responses. Conclusions The guideline adherence with respect to OAC

  13. Alteration of Endothelin 1, MCP-1 and Chromogranin A in patients with atrial fibrillation undergoing pulmonary vein isolation.

    Science.gov (United States)

    Lackermair, K; Clauss, S; Voigt, T; Klier, I; Summo, C; Hildebrand, B; Nickel, T; Estner, H L; Kääb, S; Wakili, R; Wilbert-Lampen, U

    2017-01-01

    The relation between arrhythmias and stress is known. The aim of our current study was to elucidate whether plasma levels of previously described stress parameters are altered in highly symptomatic patients with atrial fibrillation (AF) per se and in patients undergoing ablation therapy by pulmonary vein isolation (PVI). 96 patients with AF undergoing PVI were recruited. Plasma levels of Endothelin-1 (ET-1), MCP-1 and Chromogranin-A (CGA) were measured before and three months after ablation completed with clinical follow-up with respect to AF recurrence. Additionally, we examined 40 healthy age- and sex-matched volunteers as a reference. Symptomatic AF patients showed increased levels of ET-1 compared to healthy controls (2.62pg/ml vs. 1.57pg/ml; pPVI (2.96pg/ml vs. 2.57pg/ml;p = 0.02). The temporal comparison revealed decreased ET-1 levels in patients without (2.57pg/ml vs. 2.33pg/ml; pPVI. Baseline MCP-1 was increased in AF patients vs. controls (268pg/ml vs. 227 pg/ml; p = 0.03). Both groups, with and without AF after PVI, showed an increase of MCP-1 compared to baseline (268pg/ml vs. 349pg/ml;pPVI showed an increase of CGA (14.2ng/ml vs. 20.7ng/ml;pPVI. Our study demonstrated dysregulated levels of ET-1, MCP-1 and CGA in symptomatic AF patients. We could demonstrate an association between ET-1 to presence or absence of AF. Furthermore, we could show that a decrease of ET-1 as well as an increase of CGA after PVI, representing a trend towards control cohort levels, were both associated with restoration of sinus rhythm. These results provide new insights into the role of stress-related biomarkers in AF and AF treatment by ablation therapy.

  14. The use of balloon atrial septostomy to facilitate difficult transseptal access in patients undergoing catheter ablation for atrial fibrillation.

    Science.gov (United States)

    Zadeh, Andrew A; Cannom, David S; Macrum, Bruce L; Ho, Ivan C

    2011-07-01

    With the increasing number of patients undergoing repeat catheter ablation procedures for atrial fibrillation, it is not uncommon to encounter a fibrotic interatrial septum that resists the conventional manual advancement of the transseptal sheath. Forceful advancement of the transseptal apparatus can reduce fine control and potentially lead to a higher rate of perforation. We report a case where adjunctive balloon atrial septostomy was used to facilitate transseptal access in a patient with fibrotic interatrial septum. Using a small-caliber angioplasty balloon and under direct fluoroscopic and transesophageal echocardiogram visualization, balloon septostomy was performed with hand inflation until a "waist" was seen. This technique provides a safe way to control the size of the transseptal access created, and allows the passage of a relatively soft-tipped transseptal sheath across a resistive septum. To our knowledge this is the first published use of balloon atrial septostomy during transseptal puncture for left atrium access in a catheter ablation procedure. Balloon atrial septostomy should be considered as an alternative technique for safe transseptal cannulation in select patients in the electrophysiology laboratory or other interventional procedures requiring left atrial access or delivery of large-caliber catheters or sheaths. © 2010 Wiley Periodicals, Inc.

  15. The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) : Exploring the changes in anticoagulant practice in patients with non-valvular atrial fibrillation in the Netherlands.

    Science.gov (United States)

    Ten Cate, V; Ten Cate, H; Verheugt, F W A

    2016-10-01

    There are over 385,000 cases of atrial fibrillation (AF) in the Netherlands, with over 45,000 new cases each year. Among other things, AF patients are at high risk of stroke. Patients are often prescribed oral anticoagulation, such as vitamin K antagonists (VKA), to mitigate these risks. A recently introduced class of oral anticoagulants, non-vitamin K antagonists (NOAC), is quickly gaining currency in global clinical practice. This study provides insight into the changes these new drugs will bring about in Dutch clinical practice.GARFIELD-AF is a large-scale observational AF patient registry initiated in 2009 to track the evolution of global anticoagulation practice, and to study the impact of NOAC therapy in AF in particular. The registry includes a wide array of baseline characteristics and has a particular focus on: (1) bleeding and thromboembolic events; (2) international normalised ratio fluctuations; and (3) therapy compliance and persistence patterns. The results in this paper provide the baseline characteristics of the first cohorts of Dutch participants in this registry and discuss some of the consequences of the changes in anticoagulation practice.Although VKA therapy remains overwhelmingly favoured by Dutch practitioners, NOACs are clearly gaining in popularity. Between 2011 and 2014, NOACs constituted an increasingly large proportion of prescriptions for oral anticoagulants.The insights provided by the GARFIELD-AF registry can be used by healthcare systems to inform better budgetary strategies, by practitioners to better tailor treatment pathways to patients, and finally to promote awareness of the various available treatment options and their associated risks and benefits for patients.

  16. Antithrombotic therapy in anticoagulated patients with atrial fibrillation presenting with acute coronary syndromes and/or undergoing percutaneous coronary intervention/stenting

    Directory of Open Access Journals (Sweden)

    Benjamin J. Wrigley

    2010-07-01

    Full Text Available The management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary inter vention/stenting cannot be done according to a regimented common protocol, and stroke and bleeding risk stratification schema should be employed to individualize treatment options. A delicate balance is needed between the prevention of thromboembolism, against recurrent cardiac ischemia or stent thrombosis, and bleeding risk. New guidance from a consensus document of the European Society of Cardiology Working Group on Thrombosis, endorsed by the European Heart Rhythm Association and the European Association ofPercutaneous Cardiovascular Interventions on the management of Antithrombotic Therapy in Atrial Fibrillation Patients Presenting with Acute Coronary Syndrome and/or Undergoing Percutaneous Coronary Intervention/Stenting has sought to clarify some of the major issues and problems surrounding this practice, and will allow clinicians to make much more informed decisions when faced with treating such patients.

  17. Prevalence, Patterns, and Clinical Predictors of Left Ventricular Late Gadolinium Enhancement in Patients Undergoing Cardiac Magnetic Resonance Prior to Pulmonary Vein Antral Isolation for Atrial Fibrillation: A Cross-Sectional Observational Study.

    Science.gov (United States)

    Nance, John W; Khurram, Irfan M; Nazarian, Saman; DeWire, Jane; Calkins, Hugh; Zimmerman, Stefan L

    2015-09-01

    Cardiac magnetic resonance (CMR) imaging is increasingly used to evaluate patients with atrial fibrillation (AF) before pulmonary vein antral isolation (PVAI). The purpose of this study was to assess the incidence and pattern of left ventricular (LV) late gadolinium enhancement (LGE) in patients undergoing CMR before PVAI and compare the clinical and demographic differences of patients with and without LV LGE. Clinical and demographic data on 62 patients (mean age 61 ± 7.9, 69% male) undergoing CMR before PVAI for AF were collected. Two observers, masked to clinical histories, independently recorded the prevalence, extent (number of myocardial segments), and pattern (subendocardial, midmyocardial, or subepicardial) of LV LGE in each patient. Clinical and demographic predictors of LV LGE were determined using logistic regression. Twenty-three patients (37%) demonstrated LV LGE affecting a mean of 3.0 ± 2.1 myocardial segments. There was no difference in LV ejection fraction between patients with and without LGE, and most (65%) patients with LGE had normal wall motion. Only age (P = 0.04) and a history of congestive heart failure (P = .03) were statistically significant independent predictors of LGE. The most common LGE pattern was midmyocardial, seen in 17 of 23 (74%) patients. Only 4 of 23 (17%) patients had LGE in an "expected" pattern based on clinical history. Of the remaining 19 patients, 4 had known congestive heart failure, 5 nonischemic cardiomyopathy, 4 known coronary artery disease, and 2 prior aortic valve replacement. Six of 23 (26%) patients had no known coronary artery, valvular, or myocardial disease. There is a high prevalence of unexpected LV scar in patients undergoing CMR before PVAI for AF, with most patients demonstrating a nonischemic pattern of LV LGE and no wall motion abnormalities (ie, subclinical disease). The high prevalence of unexpected LGE in these patients may argue for CMR as the modality of choice for imaging

  18. New risk factors for atrial fibrillation : causes of 'not-so-lone atrial fibrillation'

    NARCIS (Netherlands)

    Schoonderwoerd, Bas A.; Smit, Marcelle D.; Pen, Lucas; Van Gelder, Isabelle C.

    Atrial fibrillation (AF) is a prevalent arrhythmia in patients with cardiovascular disease. The classical risk factors for developing AF include hypertension, valvular disease, (ischaemic) cardiomyopathy, diabetes mellitus, and thyroid disease. In some patients with AF, no underlying

  19. New risk factors for atrial fibrillation : causes of 'not-so-lone atrial fibrillation'

    NARCIS (Netherlands)

    Schoonderwoerd, Bas A.; Smit, Marcelle D.; Pen, Lucas; Van Gelder, Isabelle C.

    2008-01-01

    Atrial fibrillation (AF) is a prevalent arrhythmia in patients with cardiovascular disease. The classical risk factors for developing AF include hypertension, valvular disease, (ischaemic) cardiomyopathy, diabetes mellitus, and thyroid disease. In some patients with AF, no underlying (cardiovascular

  20. THE STUDY OF PREVALENCE AND CLINICAL PROFILE OF VALVULAR HEART DISEASES IN A TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Radha Krishnan

    2015-04-01

    Full Text Available Valvular heart disease is still a common causes of mortality and morbidity in India and rheumatic heart disease is still far more frequent. AIMS AND OBJECTIVES: To study the prevalence and clinical profile of rheumatic and non - rheumatic valvular heart dise ase in patients attending to Government General Hospital, Kakinada. MATERIALS AND METHODS: 100 Adult patients with valvular abnormalities attending to the Medicine and Cardiology Units of Government General Hospital, Kakinada from Nov 2011 - May 2013 were studied. C linical history including various symptoms, past history of rheumatic fever, followed by systemic examination was done. A detailed cardiovascular examination with relevant investigations and evaluation was done. OBSERVATIONS AND RESULTS: The most common cause of acquired valvular heart disease is Rheumatic Heart Disease. Mitral valve involvement is the most common valve involvement with Mitral regurgitation as the most common valvular lesion. Mitral stenosis is the most common valvular lesion amon g rheumatic valvular heart disease. The most common complaint is breathlessness and the most common complication is Congestive heart failure. Multi valvular lesion is the most common valve involvement in patients presenting with congestive heart failure an d infective endocarditis. Patients having atrial fibrillation are noted to have mitral stenosis more commonly. Mitral stenosis is the valve abnormality commonly noted in patients presenting with haemoptysis, respiratory tract infection and chorea. Left sid ed hemiplegia is common in patients with acquired valvular heart disease. CONCLUSIONS: Though the incidencen of rheumatic valvular disease is decreased in modern era, still continuing in our country. The analysis of the present study gives us insight into the various types of presentation of acquired valvular heart disease and to increase awareness besides early detection of valvular diseases clinically. It also helps in planning of

  1. Analyze the effectiveness of modified maze procedure by irrigated radiofrequency ablation in the 144 patients with valvular heart disease and atrial fibrillation who underwent surgical operation%144例心脏瓣膜病合并心房颤动外科手术同期行单极冲洗射频消融改良迷宫术的疗效

    Institute of Scientific and Technical Information of China (English)

    王嬿; 胡大清

    2012-01-01

    目的 分析本院心脏瓣膜病伴发心房颤动(简称房颤)的患者外科手术同期行单极冲洗射频消融改良迷宫术MazeⅢ型手术疗效.方法 调查2007年11月至2010年8月收治的心脏瓣膜病合并房颤患者在心内直视手术下同期行单极冲洗射频消融改良迷宫术MazeⅢ型手术,观察随访6个月时的心律情况,根据节律分为窦性心律(简称窦律)组和非窦律组,分析影响术后转律的原因.结果 144例入选,2例安置永久起搏器,1例因瓣周漏而行二次手术.出院时窦律88例(61.11%),房颤39例(27.08%),随访6个月窦律88例(61.11%),房颤25例(17.36%).窦律组左房小于非窦律组,房颤时间短于非窦律组.左房内径≥6.5 cm者,可达龙的转复率高于非可达龙组(53.8% vs 28.6%,P<0.05).结论 心脏病伴发房颤的病人,在心脏外科手术中同期行单极冲洗射频消融改良迷宫术,对窦律的恢复仍不失为一种安全有效的方法.术前左房内径大小及房颤持续时间是房颤转复的主要危险因素,可达龙在一定程度上可提高大左房(≥6.5 cm)的转复成功率.%Objective To analyze the effectiveness of modified maze procedure by irrigated radiofrequeney ablation in the patients of valvular heart diseases with atriai fibrillation ( AF) who underwent open-heart surgery. Methods All the cases of valvular heart diseases with AF undergoing modified maze procedure by irrigated radioirequency ablation with concomitant open-heart surgery during November 2007 to August 2010 were investigated. All the patients were followed up for 6 months and divided into two groups:sinus-rhythm group and non-sinus-rhythm group according to the rhythm. Analyze the influencing factors of the rhythm. Results One hundred and forty-four cases were collected,2 cases were implanted permanent pacemakers,1 case was re-operated because of paravalvulur leak,88 cases were recorded sinus rhythm and 39 remained in AF when discharged from

  2. Anesthetic Considerations for a Patient With Hereditary Hemorrhagic Telangiectasia (Osler–Weber–Rendu Syndrome Undergoing a Five-Box Thoracoscopic Maze Procedure for Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Dominic Robinson DO

    2014-10-01

    Full Text Available Hereditary hemorrhagic telangiectasia (HHT is an autosomal dominant genetic disorder involving the abnormal communication of vascular structures. HHT typically presents with recurrent epistaxis and telangiectasis of the nasal and buccal mucosa, tongue, and lips. More serious manifestations of this disease include cerebral, pulmonary, gastrointestinal, and hepatic arteriovenous malformations. This case report details a 55-year-old male with HHT undergoing a five-box maze procedure for curative treatment of atrial fibrillation. Particular anesthetic considerations are described to reduce morbidity and mortality in this patient population.

  3. Cardiac Valvular Inflammatory Pseudotumor

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    Sathe Pragati A

    2008-09-01

    Full Text Available Abstract Inflammatory pseudotumors are quasineoplastic lesions that occur in the lungs as well as other extrapulmonary sites. The heart is an uncommon site of origin. We report a valvular pseudotumor that produced chronic mitral and aortic regurgitation in an elderly woman.

  4. Left atrial appendage occlusion with Amplatzer Cardio Plug is an acceptable therapeutic option for prevention of stroke recurrence in patients with non-valvular atrial fibrillation and contraindication or failure of oral anticoagulation with acenocumarol

    OpenAIRE

    Hawkes, Maximiliano A; Lucía Pertierra; Federico Rodriguez-Lucci; Virginia A. Pujol-Lereis; Sebastián F. Ameriso

    2016-01-01

    ABSTRACT Left atrial appendage occlusion (LAAO) appears as a therapeutic option for some atrial fibrillation patients not suitable for oral anticoagulation because an increased hemorrhagic risk or recurrent ischemic events despite anticoagulant treatment. Methods Report of consecutive atrial fibrillation patients treated with LAAO with Amplatzer Cardio Plug because contraindication or failure of oral anticoagulation with acenocumarol. CHA2DS2VASC, HAS-BLED, NIHSS, mRS, procedural complicati...

  5. Left atrial appendage occlusion with Amplatzer Cardio Plug is an acceptable therapeutic option for prevention of stroke recurrence in patients with non-valvular atrial fibrillation and contraindication or failure of oral anticoagulation with acenocumarol

    OpenAIRE

    Hawkes,Maximiliano A; Lucía Pertierra; Federico Rodriguez-Lucci; Pujol-Lereis,Virginia A.; Ameriso,Sebastián F

    2016-01-01

    ABSTRACT Left atrial appendage occlusion (LAAO) appears as a therapeutic option for some atrial fibrillation patients not suitable for oral anticoagulation because an increased hemorrhagic risk or recurrent ischemic events despite anticoagulant treatment. Methods Report of consecutive atrial fibrillation patients treated with LAAO with Amplatzer Cardio Plug because contraindication or failure of oral anticoagulation with acenocumarol. CHA2DS2VASC, HAS-BLED, NIHSS, mRS, procedural complicati...

  6. Analysis on risk factors of early postoperative death in patients undergoing valvular surgery%心脏瓣膜手术后早期住院死亡相关危险因素分析

    Institute of Scientific and Technical Information of China (English)

    孟毅; 董逸飞; 董书强; 曹文峰; 尹清; 闵凯

    2011-01-01

    目的 探讨影响心脏瓣膜手术后早期住院死亡相关危险因素.方法 2001年1月-2010年11月,618例心脏瓣膜疾病患者在我科行手术治疗,其中男339例,女279例,年龄10 -74(44.01±13.95)岁;风湿性心脏病387例,非风湿性心脏病231例;以手术后早期住院死亡为研究终点,采用单因素及多因素logistic回归方法 分析术后早期死亡的危险因素.结果 心脏瓣膜术后早期住院死亡率6.2% (38/618),死亡原因依次为低心排综合征,室性心律失常,多器官功能衰竭.单因素分析显示,年龄≥65岁(P=0.000)、心功能Ⅳ级(P=0.000)、肺动脉高压≥60 mmHg(P =0.024)、体外循环时间≥3 h(P=0.000)、主动脉阻断时间≥2 h(P =0.000)、术后出现并发症(P=0.011)、输血量≥2 000 ml(P =0.000)是瓣膜手术后早期死亡的危险因素.多因素Logistic回归分析示年龄≥65岁(P=0.042)、心功能Ⅳ级(P=0.019)、体外循环时间≥3 h(P=0.000)、术后出现并发症(P=0.000)、输血量≥2 000 ml(P =0.000)是瓣膜手术后早期死亡的独立危险因素.结论 重视心脏瓣膜术后早期死亡的独立危险因素处理,缩短体外循环时间,减少并发症,对降低瓣膜手术的死亡率具有重要的临床意义.%Objective To analyze risk factors associated with early postoperative death in patients with valvular surgery. Methods Form January 2001 to November 2010, clinical data of 618 patients, including 339 male, 279 famele, age 10 - 74 (44. 01 ± 13.95) undergoing valvular operations were investigated retrospectively. Its risk factors were evaluated by univariate and multivari-ate logistic regression analysis with SPSS software. Results The hospital mortality of valvular surgery was 6. 2% (38/618). The reason of death was in turn low cardiac output syndrome, ventricular arrhythmia and multiple organ dysfunction or failure. Univari-ate risk factor included age≥65y (P = 0.000) , NYHA functional class Ⅳ (P=0.000) , pulmonary

  7. 瓣膜病合并房颤患者射频消融术后复发的危险因素%Risk factors of recurrence of valvular atrial fibrillation after surgical radiofrequency ablation

    Institute of Scientific and Technical Information of China (English)

    于明港; 曹海龙; 李庆国; 周庆; 钱海荣; 王东进

    2014-01-01

    Objective The purpose of this study was to explore the risk factors of recurrence of atrial fibrillation (AF) after surgical radiofrequency ablation in patients undergoing cardiac valve surgery.Metbods Retrospective analysis was made in 255 cardiac valve patients undergoing concomitant radiofrequency modified Maze operation from April 2010 to December 2012 in Nanjing Drum Tower Hospital.Multivariate logistic regression analysis was used to screen independent risk factors for predicting recurrence of AF.Results Excluding 8 patients died after surgery,11 cases who were junctional rhythm after ablation or received pacemaker implantation and 60 lost case,176 patients were finished follow-up.107 cases maintained stable sinus rhythm (SR),whereas other 69 cases developed AF recurrence.Multivariate logistic regression analysis found larger left atrial size,higher B-type natriuretic peptide,lower preoperative heart rate and postoperative AF rhythm before discharge were independent risk factors for predicting AF recurrence.Conclusion Larger left atrial size,higher B-type natriuretic peptide and lower preoperative heart rate before surgery can impact outcome of surgical radiofrequency ablation in patients undergoing cardiac valve surgery after following 12(4-38)months.They can be used in clinical practice to choose more suitable cardiac valve patients with AF for surgical ablation.Postoperative appearance of AF rhythm before discharge indicated a poor prognosis,which should be interfered with drugs or electrical cardioversion.%目的 探讨心脏瓣膜病手术患者同期行房颤外科射频消融术后房颤复发的危险因素.方法 回顾性分析2010年4月至2012年12月施行瓣膜手术同期行房颤射频消融治疗的255例瓣膜病合并房颤患者,多元回归分析筛选影响房颤复发的独立危险因素.结果 术后死亡8例,交界性心律或安装起搏器11例,失访60例,完成随访176例.术后长期心律监测结果示107例患

  8. Prognostic value of strain and strain rate in the prediction of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting: a systematic literature review

    Directory of Open Access Journals (Sweden)

    Leila Bigdelu

    2016-03-01

    Full Text Available Introduction: Atrial fibrillation (AF is a common dysrhythmia postoperatively after coronary artery bypass grafting (CABG. Myocardial strain and strain-rate imaging is used for the assessment of postoperative atrial fibrillation (POAF as a new echocardiographic method. Methods: PubMed and Scopus were searched thoroughly using the following search terms: (strain and strain rate AND (atrial fibrillation OR AF on March 2015 to find English articles in which the strain and strain-rate echocardiographic imaging had been used for the evaluation of AF in patients undergone CABG. Full text of the relevant papers was fully reviewed for data extraction.Result: Of overall 6 articles found in PubMed, 10 records found in Scopus and 4 articles found through reference list search, only 6 papers fully met the inclusion criteria for further assessment and data extraction. The results of strain and strain-rate assessment showed that in total of 542 patients undergoing CABG, POAF occurred in 106 patients. Studies showed that the reduction of left atrial (LA strain rate is correlated with AF. Consistently, the results of present review showed that LA strain and strain-rate in patients who developed AF postoperatively after CABG are significantly reduced, suggesting that strain and strain-rate could be a predictor of POAF.Conclusion: Based on the obtained results, strain and strain-rate is a suitable and accurate echocardiographic technique in the assessment of left atrial function , and it might be helpful to detect the patients who are at high risk of POAF.

  9. Pulmonary vein orientation assessment: Is it necessary in patients undergoing contact force sensing guided radiofrequency catheter ablation of atrial fibrillation

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    Pim Gal

    2015-09-01

    Conclusions: This study shows that in patients undergoing PVI with the CFC ablation system, PV orientation does not affect CF and is not associated with AF free survival. PV orientation assessment does not appear to be necessary in patients undergoing CFC PVI.

  10. Safety and Efficacy of Underdosing Non-vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Catheter Ablation for Atrial Fibrillation

    Science.gov (United States)

    Murakami, Takashi; Hina, Kazuyoshi; Higashiya, Shunichi; Kawamura, Hiroshi; Murakami, Masaaki; Kamikawa, Shigeshi; Komatsubara, Issei; Kusachi, Shozo

    2017-01-01

    Background: Some patients with atrial fibrillation (AF) received underdoses of non-vitamin K antagonist oral anticoagulants (NOACs) in the real world. Underdosing is defined as administration of a dose lower than the manufacturer recommended dose. Objectives: To identify the efficacy and safety of underdosing NOACs as perioperative anticoagulation for atrial fibrillation ablation. Methods: We retrospectively analyzed patients who received rivaroxaban or dabigatran etexilate according to dosage: adjusted low dosage (reduced by disturbed renal function; n = 30), underdosage (n = 307), or standard dosage (n = 683). Non-vitamin K antagonist oral anticoagulants and dosing decisions were at the discretion of treating cardiologists. Results: Patients who received underdosed NOACs were older, more often female, and had lower body weight and lower renal function than those who received standard dosages. Activated clotting time at baseline in patients who received adjusted low dosage or underdosages was slightly longer than that in patients receiving standard dosages (156 ± 23, 151 ± 224, and 147 ± 24 seconds, respectively). Meaningful differences were not observed in other coagulation parameters. Adjusted low-, under-, and standard-dosing regimens did not differ in perioperative thromboembolic complications (0/30, 0.0%; 1/307, 0.3%; and 0/683, 0%, respectively) or major (0/30, 0.0%; 2/307, 0.6%; 3/683, 0.4%) and minor (1/30, 3.3%; 13/307, 4.2%; 25/683, 3.6%) bleeding episodes. When comparisons were performed for each NOAC, similar results were observed. Conclusions: With consideration of patient condition, age, sex, body weight, body mass index, and renal function, underdosing NOACs was effective and safe as a perioperative anticoagulation therapy for atrial fibrillation ablation. The therapeutic range of NOACs is potentially wider than manufacturer recommendations. PMID:28170360

  11. Impact of Wenxin Grannle Combined with Low - dose Amiodarone on Ventricular Remodeling of Valvular Heart Disease Patients Complicated with Paroxysmal Atrial Fibrillation%稳心颗粒联合小剂量胺碘酮对心脏瓣膜病并阵发性心房颤动患者心室重构的影响

    Institute of Scientific and Technical Information of China (English)

    刘国斌

    2016-01-01

    Objective To investigate the impact of wenxin grannle combined with low - dose amiodarone on ventricular remodeling of valvular heart disease patients complicated with paroxysmal atrial fibrillation. Methods From April 2013 to December 2015,a total of 106 valvular heart disease patients complicated with paroxysmal atrial fibrillation were selected in the Department of Cardiology,the Traditional Chinese Medicine Hospital of Neijiang,and they were divided into control group and treatment group according to random number table,each of 53 cases. Patients of both groups received mechanical heart valve replacement and radiofrequency ablation;patients of control group were given low - dose amiodarone after surgery,while patients of treatment group were given wenxin grannle combined with low - dose amiodarone. Clinical effect,index of ventricular remodeling(including LVEF,LVEDD and LVSV)before treatment and after 3 months of treatment were compared between the two groups,and incidence of adverse reactions during the treatment was observed. Results The clinical effect of treatment group was statistically significantly better than that of control group(P 0. 05);after 3 months of treatment,LVEF of treatment group was statistically significantly higher than that of control group,while LVEDD and LVSV of treatment group were statistically significantly lower than those of control group( P 0.05)。治疗后3个月,治疗组患者 LVEF 高于对照组,LVEDD 和 LVSV 低于对照组(P <0.05);且两组患者治疗后3个月 LVEF 高于治疗前,LVEDD 和 LVSV 低于治疗前(P <0.05)。治疗组患者治疗期间不良反应发生率低于对照组(P <0.05)。结论稳心颗粒联合小剂量胺碘酮治疗心脏瓣膜病并阵发性心房颤动的临床疗效确切,可有效逆转或延缓心室重构,且安全性较高。

  12. Research progress of warfarin in patients with atrial fibrillation undergoing dialysis%华法林在透析心房颤动患者中研究状况

    Institute of Scientific and Technical Information of China (English)

    缪达; 阳国平

    2016-01-01

    Kidney dysfunction can increase the incidence of atrial fibri-llation, the risk of stroke and bleeding increase significantly in patients with atrial fibrillation undergoing dialysis.Anticoagulantion treatment has been shown to reduce the risk of stroke.Warfarin is the most widely used anticoagulant in clinical practice, whether the use of warfarin in patients with atrial fibrillation undergoing dialysis can benefit is still in controver-sy.This review summarizes the recent researches on warfarin in patients with atrial fibrillation undergoing dialysis, analyzes the advice in guide-line for the management of patients with atrial fibrillation, and hopes to provide a reference for reasonable use of warfarin in patients with atrial fi-brillation undergoing dialysis.%肾功能异常可增加心房颤动发病率,透析的心房颤动患者卒中风险和出血风险显著升高。抗凝治疗可降低心房颤动患者卒中风险,华法林是临床常用口服抗凝药,在透析的心房颤动患者中使用华法林能否获益仍存在争议。本文汇总了近年来华法林在透析的心房颤动患者中的研究,分析了各国心房颤动抗凝指南的建议,旨在为华法林在透析的心房颤动患者中合理应用提供参考。

  13. Recurrent Hospitalization Among Patients With Atrial Fibrillation Undergoing Intracoronary Stenting Treated With 2 Treatment Strategies of Rivaroxaban or a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy

    Science.gov (United States)

    Pinto, Duane S.; Chi, Gerald; Arbetter, Douglas; Yee, Megan; Mehran, Roxana; Bode, Christoph; Halperin, Jonathan; Verheugt, Freek W.A.; Wildgoose, Peter; Burton, Paul; van Eickels, Martin; Korjian, Serge; Daaboul, Yazan; Jain, Purva; Lip, Gregory Y.H.; Cohen, Marc; Peterson, Eric D.; Fox, Keith A.A.

    2017-01-01

    Background: Patients with atrial fibrillation who undergo intracoronary stenting traditionally are treated with a vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT), yet this treatment leads to high risks of bleeding. We hypothesized that a regimen of rivaroxaban plus a P2Y12 inhibitor monotherapy or rivaroxaban plus DAPT could reduce bleeding and thereby have a favorable impact on all-cause mortality and the need for rehospitalization. Methods: Stented subjects with nonvalvular atrial fibrillation (n=2124) were randomized 1:1:1 to administration of reduced-dose rivaroxaban 15 mg daily plus a P2Y12 inhibitor for 12 months (group 1); rivaroxaban 2.5 mg twice daily with stratification to a prespecified duration of DAPT of 1, 6, or 12 months (group 2); or the reference arm of dose-adjusted VKA daily with a similar DAPT stratification (group 3). The present post hoc analysis assessed the end point of all-cause mortality or recurrent hospitalization for an adverse event, which was further classified as the result of bleeding, a cardiovascular cause, or another cause blinded to treatment assignment. Results: The risk of all-cause mortality or recurrent hospitalization was 34.9% in group 1 (hazard ratio=0.79; 95% confidence interval, 0.66–0.94; P=0.008 versus group 3; number needed to treat=15), 31.9% in group 2 (hazard ratio=0.75; 95% confidence interval, 0.62–0.90; P=0.002 versus group 3; number needed to treat=10), and 41.9% in group 3 (VKA+DAPT). Both all-cause death plus hospitalization potentially resulting from bleeding (group 1=8.6% [P=0.032 versus group 3], group 2=8.0% [P=0.012 versus group 3], and group 3=12.4%) and all-cause death plus rehospitalization potentially resulting from a cardiovascular cause (group 1=21.4% [P=0.001 versus group 3], group 2=21.7% [P=0.011 versus group 3], and group 3=29.3%) were reduced in the rivaroxaban arms compared with the VKA arm, but other forms of rehospitalization were not. Conclusions: Among patients with

  14. Left atrial appendage occlusion with Amplatzer Cardio Plug is an acceptable therapeutic option for prevention of stroke recurrence in patients with non-valvular atrial fibrillation and contraindication or failure of oral anticoagulation with acenocumarol

    Directory of Open Access Journals (Sweden)

    Maximiliano A. Hawkes

    2016-03-01

    Full Text Available ABSTRACT Left atrial appendage occlusion (LAAO appears as a therapeutic option for some atrial fibrillation patients not suitable for oral anticoagulation because an increased hemorrhagic risk or recurrent ischemic events despite anticoagulant treatment. Methods Report of consecutive atrial fibrillation patients treated with LAAO with Amplatzer Cardio Plug because contraindication or failure of oral anticoagulation with acenocumarol. CHA2DS2VASC, HAS-BLED, NIHSS, mRS, procedural complications and outcome were assessed. Seven patients (73 ± 6 year-old were treated after intracerebral (n = 5 and gastrointestinal (n = 1 hemorrhages or ischemic stroke recurrence while on acenocumarol (n = 1. Results Mean follow up was 18 months. Baseline CHA2DS2Vasc y HAS-BLED scores were 5.6 ± 0.7 and 4.1 ± 0.3 respectively. There were no strokes or deaths. There was only one non-serious adverse event. Conclusion LAAO with ACP appears as a feasible therapeutic option for stroke prevention in patients with atrial fibrillation and failure or contraindication to acenocumarol.

  15. Atrial fibrillation and bleeding complication - risk factors and risk marker

    NARCIS (Netherlands)

    Breithardt, G.; Ravens, U.; Kirchhof, P.; van Gelder, I. C.

    2012-01-01

    The development of atrial fibrillation (AF) is closely linked to risk factors like hypertension and heart failure, diabetes mellitus, myocardial infarction and valvular heart disease. These factors partly overlap with those which determine the progression of atrial fibrillation and the incidence of

  16. The Correlation analysis between the serum concentration of ang(1-7)in the patients with rheumatic valvular heart disease and the occurrence of atrial fibrillation%风湿性心脏瓣膜病患者血清 Ang(1-7)浓度与心房颤动的发生相关性分析∗

    Institute of Scientific and Technical Information of China (English)

    蒋永荣; 张殿新; 程功; 潘军强; 周鑫; 武金娥; 孙超峰

    2015-01-01

    Objective:By analysis of the correlation between the serum Ang (1-7 )in the patients with rheumatic valvular heart disease and the occurrence of atrial fibrillation,to reveal the function of the Ang(1-7)in the occurrence and maintaining of atrial fibrillation and to find new targets for the prevention and treatment of atrial fi-brillation.Methods:Collect the peripheral venous blood of the patients with rheumatic heart valve disease (total 46 patients,incude 24 with AF and 22 with SR).Use ELISA method to detect the Ang (1-7),AngⅡ concentrations in the serum samples.Then,analysis the difference and correlation between the two groups.Results:In the AF group,①the diameter of left atrium was significantly greater than the SR group(60.70±3.08&48.1 5±2.1 6mm,P<0.05);②the serum concentration of Ang (1-7)was significantly lower than that in the SR group(146.05 ± 1 7. 61&321.71±36.50 pg/ml,P <0.05);③the serum concentration of AngⅡ(45.88±2.87&35.78±1.08 pg/ml,P <0.05)were obviously higher than those in the SR group.Conclusion:For the patients with rheumatic valvular heart disease,the Ang (1-7)may weaken the function of AngⅡ,and by this way inhibits the atrial remodeling,and has a protective effect on the occurrence of atrial fibrillation.%目的::分析风湿性心脏瓣膜病患者血浆血管紧张素1-7(Ang1-7)的浓度与心房颤动发生之间的相关性,探讨 Ang(1-7)在风湿性心脏瓣膜病房颤发生与维持中的作用及房颤的预防及治疗新的靶点。方法:收取风湿性心脏瓣膜病患者(AF 组24例,SR 组22例)外周静脉血,用 ELISA法检测血清中 Ang(1-7)、血管紧张素Ⅱ(AngⅡ)的浓度,分析两组间的差别及相关性。结果:在AF 组,①左心房直径明显大于 SR 组(P <0.05);②血清 Ang(1-7)浓度显著低于 SR 组(P <0.05);③血清 AngⅡ浓度明显高于 SR 组(P <0.05)。结论:在风湿性心脏瓣膜病患者中,Ang(1-7)可能通过减弱 AngⅡ的作用,抑制心房的重

  17. 瓣膜置换同期行改良CoxⅢ迷宫手术治疗风湿性心脏瓣膜病伴房颤患者的护理%Nursing of patients with rheumatic valvular heart disease with atrial fibrillation treated with CoxⅢ labyrinth and simultaneous valve replacement operation

    Institute of Scientific and Technical Information of China (English)

    夏梅; 何萍; 吴蔚

    2008-01-01

    目的 总结瓣膜置换同期行改良CoxⅢ迷宫手术治疗风湿性心脏瓣膜病伴房颤的护理效果和经验.方法 回顾分析2006年4月-2008年7月收治的58例瓣膜置换同期行coxⅢ迷宫手术的风湿性心脏瓣膜病伴房颤患者的护理措施. 结果 本组病例中围手术期因肾功能衰竭死亡1例,低心排死亡1例,感染性心内膜炎死亡1例,死亡率5.2%,其余均康复出院.在术后住院期间及术后短期随访中存活患者均为窦性心律.在完成术后6个月随访的43例患者中,有3例(7.0%)出现房颤心律,其余均保持窦性心律. 结论 对于瓣膜置换同期行迷宫手术的患者,护理上要注意术前的心理护理及呼吸道准备,术后加强对患者心功能的监护,注意抗凝治疗的护理.%Objective To summarize the effect and experience of nursing of patients with rheumatic valvular heart disease with atrial fibrillation treated with Cox Ⅲ labyrinth and simultaneous valve replace-ment operation. Methods A retrospective analysis was carried out in the nursing of 58 patients with rheumatic valvular heart disease with atrial fibrillation treated with Cox Ⅲ labyrinth and simultaneous valve replacement operation in our hospital from April 2006 to July 2008. Results One patient died of periop-erative renal failure,one died of low cardiac output,one died of infectious endoearditis.Tbe mortality rate reached 5.2%.Other patients were discharged from hospital after completely cured.The survived patients maintained sinus rate during hospitalization days after operation and short-term follow-up after being dis-charged.Among 43 patients who completed follow-up of 6 months after operation,3 patients (7.0%) damon-strated atrial fibrillation,while others still kept sinus rate. Conclusions Attention should be paid to psy-chological nursing,respiratory tract preparation,cardiac function monitoring and nursing of anticoagulation treatment for patients treated with Cox Ⅲ labyrinth and

  18. QUest for the Arrhythmogenic Substrate of Atrial fibRillation in Patients Undergoing Cardiac Surgery (QUASAR Study): Rationale and Design.

    Science.gov (United States)

    van der Does, Lisette J M E; Yaksh, Ameeta; Kik, Charles; Knops, Paul; Lanters, Eva A H; Teuwen, Christophe P; Oei, Frans B S; van de Woestijne, Pieter C; Bekkers, Jos A; Bogers, Ad J J C; Allessie, Maurits A; de Groot, Natasja M S

    2016-06-01

    The heterogeneous presentation and progression of atrial fibrillation (AF) implicate the existence of different pathophysiological processes. Individualized diagnosis and therapy of the arrhythmogenic substrate underlying AF may be required to improve treatment outcomes. Therefore, this single-center study aims to identify the arrhythmogenic areas underlying AF by intra-operative, high-resolution, multi-site epicardial mapping in 600 patients with different heart diseases. Participants are divided into 12 groups according to the underlying heart diseases and presence of prior AF episodes. Mapping is performed with a 192-electrode array for 5-10 s during sinus rhythm and (induced) AF of the entire atrial surface. Local activation times are converted into activation and wave maps from which various electrophysiological parameters are derived. Postoperative cardiac rhythm registrations and a 5-year follow-up will show the incidence of postoperative and persistent AF. This project provides the first step in the development of a tool for individual AF diagnosis and treatment.

  19. Radiation-associated valvular disease

    Energy Technology Data Exchange (ETDEWEB)

    Carlson, R.G.; Mayfield, W.R.; Normann, S.; Alexander, J.A. (Univ. of Florida, Gainesville (USA))

    1991-03-01

    The prevalence of radiation-associated cardiac disease is increasing due to prolonged survival following mediastinal irradiation. Side effects of radiation include pericarditis, accelerated coronary artery disease, myocardial fibrosis and valvular injury. We evaluated the cases of three young patients with evidence of significant valvular disease following mediastinal irradiation. One patient underwent the first reported successful aortic and mitral valve replacement for radiation-associated valvular disease (RAVD) as well as concurrent coronary artery revascularization. A review of the literature revealed 35 reported cases of RAVD, with only one successful case of valve replacement that was limited to the aortic valve. Asymptomatic RAVD is diagnosed 11.5 years after mediastinal irradiation compared with 16.5 years for symptomatic patients, emphasizing that long-term follow-up is important for patients receiving mediastinal irradiation. This study defines a continuum of valvular disease following radiation that begins with mild asymptomatic valvular thickening and progresses to severe valvular fibrosis with hemodynamic compromise requiring surgical intervention. 32 refs.

  20. Genetics of Atrial Fibrillation and Possible Implications for Ischemic Stroke

    OpenAIRE

    Robin Lemmens; Sylvia Hermans; Dieter Nuyens; Vincent Thijs

    2011-01-01

    Atrial fibrillation is the most common cardiac arrhythmia mainly caused by valvular, ischemic, hypertensive, and myopathic heart disease. Atrial fibrillation can occur in families suggesting a genetic background especially in younger subjects. Additionally recent studies have identified common genetic variants to be associated with atrial fibrillation in the general population. This cardiac arrhythmia has important public health implications because of its main complications: congestive heart...

  1. 急性脑梗死伴非瓣膜性心房颤动患者肾功能不全的影响因素分析%Analysis of influencing factors of renal insufficiency in acute cerebral infarction patients with non-valvular atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    董恺; 张倩; 俞志鹏; 丁建平; 宋海庆; 黄小钦

    2016-01-01

    目的:观察急性脑梗死伴非瓣膜性心房颤动患者肾功能不全的发生率及其影响因素。方法回顾性连续纳入2013年1月至2015年1月首都医科大学宣武医院神经内科住院的急性脑梗死伴非瓣膜性心房颤动患者266例,以估算肾小球滤过率(eGFR)评价肾功能,eGFR <60 ml/(min·1.73 m2)为肾功能不全,并分为肾功能不全组(36例)和无肾功能不全组(230例)。观察伴非瓣膜性心房颤动的急性脑梗死患者肾功能不全发生率及其影响因素。结果(1)266例伴非瓣膜性心房颤动的急性脑梗死患者,肾功能不全发生率为13.5%(36例)。肾功能不全组年龄≥65岁患者比例高于无肾功能不全组,差异有统计学意义[94.4%(34/36)比70.0%(161/230),P =0.002],余一般资料差异均无统计学意义(均P >0.05)。(2)多因素Logistic 回归分析显示,年龄(≥65岁)是伴非瓣膜性心房颤动的急性脑梗死患者发生肾功能不全的独立危险因素(OR =1.147,95% CI:1.087~1.209,P <0.01),而高血压(OR =0.870,95% CI:0.362~2.089,P =0.755)、糖尿病(OR =1.078,95% CI:0.403~2.883,P =0.882)、高脂血症(OR =1.666,95% CI:0.645~4.302,P =0.292)病史与该类患者发生肾功能不全不相关。结论伴有非瓣膜性心房颤动的急性脑梗死患者肾功能不全发生率偏高,年龄(≥65岁)为该类患者发生肾功能不全的独立危险因素。%Objective To observe the incidence and the influencing factors of kidney insufficiency in acute cerebral infarction patients with non-valvular atrial fibrillation. Methods From January 2013 to January 2015,266 consecutive acute cerebral infarction patients with non-valvular atrial fibrillation admitted to the Department of Neurology,Xuanwu Hospital,Capital Medical University were enrolled

  2. Three steps to manage recurrent ventricular fibrillation during aortic valve replacement in patients with valvular aortic stenosis%三阶段法处理主动脉瓣狭窄患者瓣膜置换术中顽固性心室颤动

    Institute of Scientific and Technical Information of China (English)

    潘志浩; 郭建荣

    2010-01-01

    Objective To study rational method for managing recurrent ventricular fibrillation during aortic valve replacement in patients with valvular aortic stenosis.Methods One hundred consecutive patients with valvular aortic stenosis who scheduled to receive aortic valve replacement were enrolled into the study.Three steps method was applied when ventricular fibrillation occurred after aortic unclamping.The first step was to correct disturbance of internal environment,intravenous lidocaine (100mg) and defibrillation (20-30 W/s); the second step was to inject norepinephrine to maintain mean arterial pressure 70-90 mm Hg (1mm Hg =0.133 kPa),then repeated defibrillation; the third step was infusion of magenisum sulphate (1g) and/or amiodarone (150 mg),then repeated defibrillation.Preoperative left ventricular mass index,mean arterial pressure,nasopharyneal temperature,serum potassium level and hematocrit after aortic unclamping were collected and compared.ResultsAfter aortic unelamping,56 patients recovered spontaneous rhythm without defibrillation,after the first step,16 patients could be defibrillated successfully,other 10 patients recovered spontaneous rhythm after the second step,still other 18 patients remained unresponse untill the third step.Patients who recovered spontaneous rhythm without defibrillation or needed the first step management had significant lower left ventricular ragas index when comparing with patients who entered the second step and third step management respectively [(184±43),(178±51)g/m~2 vs(237±61),(242±46) g/m~2,P<0.05 ].Patients who needed the second step or third step management also had significant higher mean arterial pressure than the other patients.Conclusion Three steps method can be used to manage recurrent ventricular fibrillation during aortic valve replacement in patients with valvular aortic stenosis.%目的 研究主动脉瓣狭窄患者瓣膜置换术中顽周性心室颤动的处理.方法 100例因主动脉瓣狭窄行主

  3. Magnetic resonance imaging of valvular heart disease

    DEFF Research Database (Denmark)

    Søndergaard, Lise; Ståhlberg, F; Thomsen, C

    1999-01-01

    The optimum management of patients with valvular heart diseases requires accurate and reproducible assessment of the valvular lesion and its hemodynamic consequences. Magnetic resonance imaging (MRI) techniques, such as volume measurements, signal-void phenomena, and velocity mapping, can be used...... the optimal timing for valvular surgery. This paper reviews the validation of these MRI techniques in assessing valvular heart disease and discusses some typical pitfalls of the techniques, including suggestions for solutions.J. Magn. Reson. Imaging 1999;10:627-638....

  4. Valvular heart disease in pregnancy.

    Science.gov (United States)

    Windram, Jonathan D; Colman, Jack M; Wald, Rachel M; Udell, Jacob A; Siu, Samuel C; Silversides, Candice K

    2014-05-01

    In women with valvular heart disease, pregnancy-associated cardiovascular changes can contribute to maternal, foetal and neonatal complications. Ideally, a woman with valvular heart disease should receive preconception assessment and counselling from a cardiologist with expertise in pregnancy. For women with moderate- and high-risk valve lesions, appropriate risk stratification and management during pregnancy will optimise outcomes. Pregnancy in women with high-risk lesions, such as severe aortic stenosis, severe mitral stenosis and those with mechanical valves, requires careful planning and coordination of antenatal care by a multidisciplinary team. The purpose of this overview is to describe the expected haemodynamic changes in pregnancy, review pregnancy risks for women with valvular heart disease and discuss strategies for management.

  5. Influencing factors of compliance to anticoagulation therapy guideline recommendations in patients with non-valvular atrial fibrillation following discharge from hospital%非瓣膜病心房颤动患者出院处方依从抗凝治疗指南影响因素分析

    Institute of Scientific and Technical Information of China (English)

    余娟; 蒋捷; 盛琴慧; 周菁; 丁燕生

    2013-01-01

    Objective To investigate the influencing factors of compliance to anticoagulation therapy guideline recommendations in patients with non-valvular atrial fibrillation following discharge from hospitals. Methods The profiles of patients with atrial fibrillation admitted to The First Affiliated Hospital of Peking University between 2003 and 2008, including the procedures for assessment of the risk and risk factors of thromboembolism, were reviewed. The 2001 and 2006 American College of Cardiology (ACC)/American Heart Association (AHA)/European Society of Cardiology (ESC) clinical guidelines were employed to assess the compliance to anticoagulation therapy in patients discharged from the hospital, who were subsequently assigned to compliant and non-compliant group based on their compliance to the treatment. Results A total of 257 patients with non-valvular atrial fibrillation were recruited. Of the 25 (33. 3%) and 114 (67. 1%) cases with documented the procedure for assessment of the risk of thromboembolism in 2003 and 2008, 18 (20. 7%) and 96 (56. 5%) were compliant to the prescription following discharge from the hospital, respectively. Multivariate logistic regression analysis showed lower odds for prescribing anticoagulation medication based on the guideline recommendations to the elderly patients or those who had high CHADS2 score or missing documentation of risk assessment of thromboembolism. Conclusion Missing documentation of risk assessment procedures of thromboembolism, consistent with aging and history of thromboembolism, has become the major factors contributing to physicians' varying compliance for prescibing anticoagulation therapy based on guideline in patients with atrial fibrillation.%目的 分析非瓣膜病心房颤动住院患者出院是否依从指南根据血栓栓塞危险分层处方使用抗凝药物的影响因素.方法 收集北京大学第一医院2003年和2008年住院心房颤动患者的临床资料,包括心房颤动血栓栓塞相

  6. The impact of age on the atrial substrate: insights from patients with a low scar burden undergoing catheter ablation of persistent atrial fibrillation.

    Science.gov (United States)

    Yokokawa, Miki; Latchamsetty, Rakesh; Good, Eric; Crawford, Thomas; Jongnarangsin, Krit; Pelosi, Frank; Bogun, Frank; Oral, Hakan; Morady, Fred; Chugh, Aman

    2012-09-01

    Advancing age is a strong risk factor for the development of atrial fibrillation (AF). However, its impact on the left atrial (LA) substrate in patients is not well defined. Forty-seven patients underwent catheter ablation of persistent AF. Bipolar electrograms from the LA were recorded for voltage analysis. The AF cycle length was determined by averaging the cycle lengths of ten fibrillatory ("f") waves on lead V(1). The mean amplitude of the same ten "f" waves was also determined. The ablation strategy consisted of pulmonary vein isolation, electrogram guided, and linear ablation. There was an inverse relationship between the mean bipolar LA voltage and age (R = -0.58; P f" waves and age (R = -0.62; P < 0.0001). Areas of scar were found in 15 of the 47 patients (32%). AF cycle length was longer in patients with vs. those without scar (183 ± 20 vs. 151 ± 15 ms; P < 0.0001). Advancing age was the only predictor of LA scar (OR, 1.32; 95% CI, 1.11-1.58; P < 0.01). Forty patients (85%) remain arrhythmia-free without antiarrhythmic medications after a mean follow-up of 18 ± 10 months. Neither age nor LA scar was associated with outcome. In patients undergoing ablation of persistent AF, advancing age makes for a complex LA substrate that is characterized by areas of low voltage/scar, and yet is associated with a lower AF frequency. LA scar did not seem to impact outcome in this small study.

  7. The international normalized ratio (INR as seen in a population of patients with atrial fibrillation and cerebral infarction undergoing long-term treatment with vitamin K antagonists

    Directory of Open Access Journals (Sweden)

    Szczepańska-Szerej Anna

    2015-12-01

    Full Text Available It is estimated that nearly 20% of all cerebral infarctions in the total population are the result of a complication of atrial fibrillation (AF. While oral anticoagulation with vitamin K antagonists (AVKs substantially reduces this risk, this requires regular monitoring of the international normalized ratio (INR in order to achieve therapeutic levels (2,0-3,0. The aim of this study was to evaluate a group at high risk of cerebral infarction, among patients with AF undergoing long-term treatment with VKAs, taking into account the significance of therapeutic INR values. The analysed group consisted of 90 acute ischaemic stroke patients with paroxysmal or chronic “non-valvular” AF, receiving treatment with VKAs. As a result of the study, therapeutic INR values (≥ 2 were seen in thirty-five of these individuals (38,8%, while 55 (61,2% showed non-therapeutic INR values. Moreover, there were no differences in demographics, vascular risk factors, biochemical and morphological blood parameters, mean CHA2DS2-VASc score and TOAST classification between either of the two groups. Furthermore, no additional factor that would increase their risk of cerebral infarction during the adequate treatment with VKAs was found. However, patients with non-therapeutic INR values had a statistically significantly higher frequency of concomitant moderate pathology of the bicuspid valve, p<0.05. Hence, a lack of proper control of INR can proved to be particularly dangerous for this subgroup of patients. Hence, this is a group with an elevated risk of cerebral infarction and therefore requires special oversight of VKA treatment or NOA treatment.

  8. Progress of novel oral anticoagulants in non-valvular atrial fibrillation%新型口服抗凝药在非瓣膜性房颤中的应用进展

    Institute of Scientific and Technical Information of China (English)

    王鹏; 刘玉洁

    2016-01-01

    Objective:To review the recent progress of new oral anticoagulants in anticoagulation treatment for non-valve atrial ifbrillation.Methods: We collected the latest researches related to anticoagulation treatment with NOACs, and then gave the analysis and summary.Results and Conclusion:Atrial fibrillation is the most frequent arrhythmia in clinical practice. The use of anticoagulants is indicated if CHA2DS2-VASc score≥2 or in patients with previous transient ischemic attack or stroke. Recently, novel oral anticoagulants (NOACs) have been introduced, offering similar (or better) effectiveness, safety, and convenience than vitamin K antagonists. They display rapid onset of action, more predictable of pharmacological proifle, less interactions with other drugs, lack of signiifcant effects in the diet, and less risk of intracranial hemorrhage than warfarin.%目的:对新型口服抗凝药(NOACs)在非瓣膜性房颤抗凝治疗中的临床应用和发展进行探讨。方法:收集最新发表的相关文章,对新型口服抗凝药的药理学特性、临床试验结果和临床应用进行分析总结。结果与结论:房颤是临床中最常见的心律失常,对于CHA2DS2-VASc评分≥2或既往曾有一过性脑缺血发作(TIA)或有卒中史的患者,应该使用抗凝药物。新型口服抗凝药,与维生素K拮抗剂(VKA)相比,有相似甚至更好的抗凝效果、安全性和便利性。它们具有快速起效,更多可预测的药动学特征,与其他药物相互作用少,饮食对其无明显影响,比华法林导致颅内出血的风险更低。

  9. Primary Prevention of Sudden Death in Patients With Valvular Cardiomyopathy.

    Science.gov (United States)

    Rodríguez-Mañero, Moisés; Barrio-López, María Teresa; Assi, Emad Abu; Expósito-García, Víctor; Bertomeu-González, Vicente; Sánchez-Gómez, Juan Miguel; González-Torres, Luis; García-Bolao, Ignacio; Gaztañaga, Larraitz; Cabanas-Grandío, Pilar; Iglesias-Bravo, José Antonio; Arce-León, Álvaro; la Huerta, Ana Andrés; Fernández-Armenta, Juan; Peinado, Rafael; Arias, Miguel Angel; Díaz-Infante, Ernesto

    2016-03-01

    Few data exist on the outcomes of valvular cardiomyopathy patients referred for defibrillator implantation for primary prevention. The aim of the present study was to describe the outcomes of this cardiomyopathy subgroup. This multicenter retrospective study included consecutive patients referred for defibrillator implantation to 15 Spanish centers in 2010 and 2011, and to 3 centers after 1 January 2008. Of 1174 patients, 73 (6.2%) had valvular cardiomyopathy. These patients had worse functional class, wider QRS, and a history of atrial fibrillation vs patients with ischemic (n=659; 56.1%) or dilated (n=442; 37.6%) cardiomyopathy. During a follow-up of 38.1 ± 21.3 months, 197 patients (16.7%) died, without significant differences among the groups (19.2% in the valvular cardiomyopathy group, 15.8% in the ischemic cardiomyopathy group, and 17.9% in the dilated cardiomyopathy group; P=.2); 136 died of cardiovascular causes (11.6%), without significant differences among the groups (12.3%, 10.5%, and 13.1%, respectively; P=.1). Although there were no differences in the proportion of appropriate defibrillator interventions (13.7%, 17.9%, and 18.8%; P=.4), there was a difference in inappropriate interventions (8.2%, 7.1%, and 12.0%, respectively; P=.03). All-cause and cardiovascular mortality in patients with valvular cardiomyopathy were similar to those in other patients referred for defibrillator implantation. They also had similar rates of appropriate interventions. These data suggest that defibrillator implantation in this patient group confers a similar benefit to that obtained by patients with ischemic or dilated cardiomyopathy. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Predictive analysis of electrical cardioversion for recurrence of valvular atrial fibrillation after surgical radiofrequency ablation%心房颤动外科射频消融术后电复律治疗效果的预测因素分析

    Institute of Scientific and Technical Information of China (English)

    徐灿; 曹海龙; 周庆; 陈小芳; 王东进

    2015-01-01

    Objective The purpose of this study was to explore predictive factors of electrical cardioversion for recurrence of atrial fibrillation (AF) after surgical radiofrequency ablation.Methods Retrospective analysis was made in 69 valvular heart disease patients receiving electrical cardioversion for AF recurrence after concomitant radiofrequency modified Maze operation from February 2011 to May 2014 in Nanjing Drum Tower Hospital.Multivariate regression analysis was used to screen predictive factors for predicting failure of electrical cardioversion.Results Electrical cardioversion was successful in 55 cases,and failed in 14 cases.Multivariate regression analysis indicated that age was the significant risk factor and gender,larger left atrial size and heart rate were edge-significant risk factors for predicting failure of electrical cardioversion.Conclusion Female,elder age,left atrial enlargement and higher heart rate indicated a poor cardioversion possibility by electrical cardioversion for recurrence of AF after surgical radiofrequency ablation.%目的 探讨心脏瓣膜病手术同期实施心房颤动(房颤)外科射频消融的患者术后出现房颤复发或心房扑动时,行电复律治疗的效果影响因素.方法 回顾性分析2011年2月至2014年5月在南京鼓楼医院心胸外科行房颤术后电复律治疗的69例患者,多元回归分析筛选影响电复律治疗效果的临床因素.结果 电复律失败14例,电复律成功55例.多元回归分析发现,年龄是电复律失败的独立危险因素,而性别、电复律前左心房内径、电复律前心率是边缘显著的独立危险因素.结论 性别、年龄、电复律前左心房内径、电复律前心率可能影响电复律转复结果,对成功实施电复律治疗有指导价值.

  11. Radiofrequency ablation for treatment of atrial fibrillation.

    Science.gov (United States)

    Safaei, Nasser; Montazerghaem, Hossein; Azarfarin, Rasoul; Alizadehasl, Azin; Alikhah, Hossein

    2011-01-01

    Atrial Fibrillation (AF) is the most common cardiac arrhythmia which represents a major public health problem. The main purpose of this research is to evaluate the Radiofrequency (RF) ablation effects in the patients with chronic AF scheduled for cardiac surgery because of different heart diseases. The descriptive and prospective study was conducted on 60 patients with AF scheduled for surgery along with RF ablation. The data were collected by questionnaire and included: patients' age, sex, NYHA class, operation type, past medical history, type and cause of valvular heart disease, preoperative ECG (electrocardiogram), duration of surgery, clamping time, cardiopulmonary bypass, and RF ablation time. RF ablation was followed by the main operation. The follow up examination, ECG, and echocardiography were performed 3 and 6 months after operation. The mean age of patients was 48±10 years (18-71 years). Forty one patients had permanent AF and 19 had the persistent AF. The left ventricular ejection fraction was 48.27±9.75 percent before operation, and reached to 56.27±7.87 percent after the surgery (P<0.001). The mean NYHA class before the surgery was 2.83±0.68 which decreased to 1.34±0.46 6 months after the surgery with RF ablation (P<0.001). One patient (1.6%) died after surgery. Complete relief and freedom from AF recurrence was observed in 70% of patients in the mean follow up in 7 months after the surgery. The sinus rhythm with efficient atrial contraction was established in 100% of discharged patients. RF ablation is an effective procedure to cure atrial fibrillation in patients undergoing cardiac surgeries.

  12. Genetics of valvular heart disease.

    Science.gov (United States)

    LaHaye, Stephanie; Lincoln, Joy; Garg, Vidu

    2014-01-01

    Valvular heart disease is associated with significant morbidity and mortality and often the result of congenital malformations. However, the prevalence is increasing in adults not only because of the growing aging population, but also because of improvements in the medical and surgical care of children with congenital heart valve defects. The success of the Human Genome Project and major advances in genetic technologies, in combination with our increased understanding of heart valve development, has led to the discovery of numerous genetic contributors to heart valve disease. These have been uncovered using a variety of approaches including the examination of familial valve disease and genome-wide association studies to investigate sporadic cases. This review will discuss these findings and their implications in the treatment of valvular heart disease.

  13. Magnetic resonance imaging of valvular heart disease

    DEFF Research Database (Denmark)

    Søndergaard, Lise; Ståhlberg, F; Thomsen, C

    1999-01-01

    The optimum management of patients with valvular heart diseases requires accurate and reproducible assessment of the valvular lesion and its hemodynamic consequences. Magnetic resonance imaging (MRI) techniques, such as volume measurements, signal-void phenomena, and velocity mapping, can be used...... in an integrated approach to gain qualitative and quantitative information on valvular heart disease as well as ventricular dimensions and functions. Thus, MRI may be advantageous to the established diagnostic tools in assessing the severity of valvular heart disease as well as monitoring the lesion and predicting...... the optimal timing for valvular surgery. This paper reviews the validation of these MRI techniques in assessing valvular heart disease and discusses some typical pitfalls of the techniques, including suggestions for solutions.J. Magn. Reson. Imaging 1999;10:627-638....

  14. Predicting new-onset of postoperative atrial fibrillation in patients undergoing cardiac surgery using semi-automatic reading of perioperative electrocardiograms

    DEFF Research Database (Denmark)

    Gu, Jiwei; Graff, Claus; Melgaard, Jacob;

    2015-01-01

    P10 Predicting new-onset of postoperative atrial fibrillation in patients undergoingcardiac surgery using semi-automatic reading of perioperative electrocardiograms. Jiwei Gu, Claus Graff, Jacob Melgaard, Søren Lundbye-Christensen, Erik Berg Schmidt, Christian Torp-Pedersen, Kristinn Thorsteinsson......, Jan Jesper Andreasen. Aalborg, DenmarkBackground: Postoperative new onset atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery. The aim of this study was to evaluate if semi-automatic readings of perioperative electrocardiograms (ECGs) is of any value in predicting POAF after...

  15. Unique type of isolated cardiac valvular amyloidosis

    Directory of Open Access Journals (Sweden)

    Reehana Salma

    2006-10-01

    Full Text Available Abstract Background Amyloid deposition in heart is a common occurrence in systemic amyloidosis. But localised valvular amyloid deposits are very uncommon. It was only in 1922 that the cases of valvular amyloidosis were reported. Then in 1980, Goffin et al reported another type of valvular amyloidosis, which he called the dystrophic valvular amyloidosis. We report a case of aortic valve amyloidosis which is different from the yet described valvular amyloidosis. Case presentation A 72 years old gentleman underwent urgent aortic valve replacement. Intraoperatively, a lesion was found attached to the inferior surface of his bicuspid aortic valve. Histopathology examination of the valve revealed that the lesion contained amyloid deposits, identified as AL amyloidosis. The serum amyloid A protein (SAP scan was normal and showed no evidence of systemic amyloidosis. The ECG and echocardiogram were not consistent with cardiac amyloidosis. Conclusion Two major types of cardiac amyloidosis have been described in literature: primary-myelomatous type (occurs with systemic amyolidosis, and senile type(s. Recently, a localised cardiac dystrophic valvular amyloidosis has been described. In all previously reported cases, there was a strong association of localised valvular amyloidosis with calcific deposits. Ours is a unique case which differs from the previously reported cases of localised valvular amyloidosis. In this case, the lesion was not associated with any scar tissue. Also there was no calcific deposit found. This may well be a yet unknown type of isolated valvular amyloidosis.

  16. 心功能不同的风湿性心脏瓣膜病心房颤动患者超极化激活环核苷酸门控阳离子通道4的表达水平研究%Expression Level of Hyperpolarization-activated Cyclic Nucleotide-gated Channel 4 in Patients With Atrial Fibrillation Associated With Rheumatic Valvular Heart Disease of Different Cardiac Functions

    Institute of Scientific and Technical Information of China (English)

    张健; 李发鹏; 甘天翊; 许国军; 何卫; 周贤惠; 汤宝鹏; 李耀东; 郭霞

    2015-01-01

    目的:探讨超极化激活环核苷酸门控阳离子通道4(HCN4)基因在风湿性心脏瓣膜病心房颤动伴心力衰竭患者与心功能正常的风湿性心脏瓣膜病心房颤动患者心房肌中的表达水平。方法选取2008—2011年新疆医科大学第一附属医院因心脏瓣膜病需接受开胸换瓣手术患者45例,根据其心功能分级,将美国纽约心脏病协会( NYHA)分级为Ⅱ~Ⅲ级者27例作为试验组,将心功能正常者18例作为对照组。采用实时荧光定量PCR( Real-time PCR)和蛋白质免疫印迹法( Western-blotting)分别测定两组患者HCN4 mRNA及蛋白表达水平。结果对照组HCN4 mRNA表达水平为(1.12±0.69),低于试验组的(4.91±1.51)(t =0.021,P <0.05)。对照组 HCN4蛋白表达水平为(1.02±0.15),低于试验组的(2.01±0.92)(t=0.031,P<0.001)。结论 HCN4在心力衰竭与心功能正常的风湿性心脏瓣膜病心房颤动患者的心房肌中均有表达,且随着心功能不全的加重,HCN4表达水平上调。%Objective To investigate the expression level of hyperpolarization -activated cyclic nucleotide -gated channel 4(HCN4)in the atrial muscle of patients with atrial fibrillation associated with rheumatic valvular heart disease with heart failure or normal cardiac function. Methods We enrolled 45 patients with valvular heart disease who were going to receive thoracotomy for valve replacement in the First Affiliated Hospital of Xinjiang medical University from 2008 to 2011. According to cardiac functional grading,we assigned 27 patients who were at grade Ⅱ-Ⅲin NYHA grading into trial group and assigned 18 patients with normal cardiac function as control group. Real -time PCR and Western -blotting were employed to determine mRNA level and protein expression level of HCN4 of the two groups. Results The mRNA expression level of HCN4 in control group was(1. 12 ±0. 69),lower than that of trial group which was(4

  17. Pattern of atrial fibrillation and risk of outcomes

    DEFF Research Database (Denmark)

    Banerjee, Amitava; Taillandier, Sophie; Olesen, Jonas Bjerring;

    2012-01-01

    BACKGROUND: Risk of stroke and thromboembolism (TE) in patients with non-valvular atrial fibrillation (NVAF) is categorised in stroke risk stratification scores. The role of pattern of NVAF in risk prediction is unclear in contemporary 'real world' cohorts. METHODS AND RESULTS: Patients with NVAF...

  18. Atrial fibrillation

    African Journals Online (AJOL)

    ABEOLUGBENGAS

    patients with atrial fibrillation managed in a referral hospital in Port Harcourt, southern Nigeria. ... treatment despite all the patients having moderate to high risk of stroke ... Keywords: Atrial fibrillation, thrombosis, CHADS2 Score, stroke risk, ...

  19. Epidemiology of acquired valvular heart disease.

    Science.gov (United States)

    Iung, Bernard; Vahanian, Alec

    2014-09-01

    Population-based studies including systematic echocardiographic examinations are required to assess the prevalence of valvular heart disease. In industrialized countries, the prevalence of valvular heart disease is estimated at 2.5%. Because of the predominance of degenerative etiologies, the prevalence of valvular disease increases markedly after the age of 65 years, in particular with regard to aortic stenosis and mitral regurgitation, which accounts for 3 in 4 cases of valvular disease. Rheumatic heart disease still represents 22% of valvular heart disease in Europe. The prevalence of secondary mitral regurgitation cannot be assessed reliably but it seems to be a frequent disease. The incidence of infective endocarditis is approximately 30 cases per million individiuals per year. Its stability is associated with marked changes in its presentation. Patients are getting older and staphylococcus is now becoming the microorganism most frequently responsible. Heath care-associated infections are the most likely explanation of changes in the microbiology of infective endocarditis. In developing countries, rheumatic heart disease remains the leading cause of valvular heart disease. Its prevalence is high, between 20 and 30 cases per 1000 subjects when using systematic echocardiographic screening. In conclusion, the temporal and geographical heterogeneity illustrates the effect of socioeconomic status and changes in life expectancy on the frequency and presentation of valvular heart disease. A decreased burden of valvular disease would require the elaboration of preventive strategies in industrialized countries and an improvement in the socioeconomic environment in developing countries.

  20. Design and rationale of the PRAGUE-12 trial: a large, prospective, randomized, multicenter trial that compares cardiac surgery with left atrial surgical ablation with cardiac surgery without ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation.

    Science.gov (United States)

    Straka, Zbyněk; Budera, Petr; Osmančík, Pavel; Vaněk, Tomáš; Hulman, Michal; Smíd, Michal; Malý, Marek; Widimský, Petr

    2013-01-01

    Surgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on clinical outcomes. There is a need for a randomized trial with long-term follow-up to study the outcome of surgical ablation in patients with coronary and/or valve disease and AF. Patients are prospectively enrolled and randomized either to group A (cardiac surgery with left atrial ablation) or group B (cardiac surgery alone). The primary efficacy outcome is the SR presence (without any AF episode) during a 24-hour electrocardiogram after 1 year. The primary safety outcome is the combined end point of death, myocardial infarction, stroke, and renal failure at 30 days. Long-term outcomes are a composite of total mortality, stroke, bleeding, and heart failure at 1 and 5 years. We finished the enrollment with a total of 224 patients from 3 centers in 2 countries in December 2011. Currently, the incomplete 1-year data are available, and the patients who enrolled first will have their 5-year visits shortly. PRAGUE-12 is the largest study to be conducted so far comparing cardiac surgery with surgical ablation of AF to cardiac surgery without ablation in an unselected population of patients who are operated on for coronary and/or valve disease. Its long-term results will lead to a better recognition of ablation's potential clinical benefits.

  1. [Valvular heart disease in women].

    Science.gov (United States)

    Tornos, Pilar

    2006-08-01

    Very few studies of valvular heart disease have been specifically carried out in women. It is well known that the prevalence of some types of valve disease is influenced by sex: rheumatic mitral stenosis is very common in women but degenerative valve disease affects both sexes similarly. A number of sex differences in the physiopathology of degenerative aortic stenosis have been reported: the degree of calcification is less in women than men and women's ventricles respond to equivalent reductions in valve area with a greater increase in gradient and greater contractility. With regard to prognosis, it is generally accepted that mortality associated with heart surgery is higher in women than men, for both coronary artery and valve surgery. The underlying reasons for the increase in mortality are not clear. Pregnancy presents particular difficulties for women with valvular heart disease. In those with significant valve lesions, it is advisable to correct the valve disease before pregnancy is considered. Anticoagulant treatment involves serious problems for pregnant women with a mechanical prosthesis. They suffer increased risks of prosthetic valve thrombosis and of fetal embryopathy if they take oral anticoagulants during the first trimester.

  2. Genetic basis of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Oscar Campuzano

    2016-12-01

    Full Text Available Atrial fibrillation is the most common sustained arrhythmia and remains as one of main challenges in current clinical practice. The disease may be induced secondary to other diseases such as hypertension, valvular heart disease, and heart failure, conferring an increased risk of stroke and sudden death. Epidemiological studies have provided evidence that genetic factors play an important role and up to 30% of clinically diagnosed patients may have a family history of atrial fibrillation. To date, several rare variants have been identified in a wide range of genes associated with ionic channels, calcium handling protein, fibrosis, conduction and inflammation. Important advances in clinical, genetic and molecular basis have been performed over the last decade, improving diagnosis and treatment. However, the genetics of atrial fibrillation is complex and pathophysiological data remains still unraveling. A better understanding of the genetic basis will induce accurate risk stratification and personalized clinical treatment. In this review, we have focused on current genetics basis of atrial fibrillation.

  3. Cardiac imaging in valvular heart disease.

    Science.gov (United States)

    Choo, W S; Steeds, R P

    2011-12-01

    The aim of this article is to provide a perspective on the relative importance and contribution of different imaging modalities in patients with valvular heart disease. Valvular heart disease is increasing in prevalence across Europe, at a time when the clinical ability of physicians to diagnose and assess severity is declining. Increasing reliance is placed on echocardiography, which is the mainstay of cardiac imaging in valvular heart disease. This article outlines the techniques used in this context and their limitations, identifying areas in which dynamic imaging with cardiovascular magnetic resonance and multislice CT are expanding.

  4. Fluid dynamics of heart valves during atrial fibrillation: a lumped parameter-based approach

    CERN Document Server

    Scarsoglio, Stefania; Guala, Andrea; Ridolfi, Luca

    2015-01-01

    Atrial fibrillation (AF) consequences on the heart valve dynamics are usually studied along with a valvular disfunction or disease, since in medical monitoring the two pathologies are often concomitant. Aim of the present work is to study, through a stochastic lumped-parameter approach, the basic fluid dynamics variations of heart valves, when only paroxysmal AF is present with respect to the normal sinus rhythm (NSR) in absence of any valvular pathology. Among the most common parameters interpreting the valvular function, the most useful turns out to be the regurgitant volume. During AF both atrial valves do not seem to worsen their performance, while the ventricular efficiency is remarkably reduced.

  5. Fluid dynamics of heart valves during atrial fibrillation: a lumped parameter-based approach.

    Science.gov (United States)

    Scarsoglio, S; Camporeale, C; Guala, A; Ridolfi, L

    2016-01-01

    Atrial fibrillation (AF) consequences on the heart valve dynamics are usually studied along with a valvular disfunction or disease, since in medical monitoring, the two pathologies are often concomitant. Aim of the present work is to study, through a stochastic lumped-parameter approach, the basic fluid dynamics variations of heart valves, when only paroxysmal AF is present with respect to the normal sinus rhythm in absence of any valvular pathology. Among the most common parameters interpreting the valvular function, the most useful turns out to be the regurgitant volume. During AF, both atrial valves do not seem to worsen their performance, while the ventricular efficiency is remarkably reduced.

  6. Pathophysiology of valvular heart disease.

    Science.gov (United States)

    Zeng, Y I; Sun, Rongrong; Li, Xianchi; Liu, Min; Chen, Shuang; Zhang, Peiying

    2016-04-01

    Valvular heart disease (VHD) is caused by either damage or defect in one of the four heart valves, aortic, mitral, tricuspid or pulmonary. Defects in these valves can be congenital or acquired. Age, gender, tobacco use, hypercholesterolemia, hypertension, and type II diabetes contribute to the risk of disease. VHD is an escalating health issue with a prevalence of 2.5% in the United States alone. Considering the likely increase of the aging population worldwide, the incidence of acquired VHD is expected to increase. Technological advances are instrumental in identifying congenital heart defects in infants, thereby adding to the growing VHD population. Almost one-third of elderly individuals have echocardiographic or radiological evidence of calcific aortic valve (CAV) sclerosis, an early and subclinical form of CAV disease (CAVD). Of individuals ages >60, ~2% suffer from disease progression to its most severe form, calcific aortic stenosis. Surgical intervention is therefore required in these patients as no effective pharmacotherapies exist. Valvular calcium load and valve biomineralization are orchestrated by the concerted action of diverse cell-dependent mechanisms. Signaling pathways important in skeletal morphogenesis are also involved in the regulation of cardiac valve morphogenesis, CAVD and the pathobiology of cardiovascular calcification. CAVD usually occurs without any obvious symptoms in early stages over a long period of time and symptoms are identified at advanced stages of the disease, leading to a high rate of mortality. Aortic valve replacement is the only primary treatment of choice. Biomarkers such as asymmetric dimethylarginine, fetuin-A, calcium phosphate product, natriuretic peptides and osteopontin have been useful in improving outcomes among various disease states. This review, highlights the current understanding of the biology of VHD, with particular reference to molecular and cellular aspects of its regulation. Current clinical questions

  7. The preventive effect of statin therapy on new-onset and recurrent atrial fibrillation in patients not undergoing invasive cardiac interventions

    DEFF Research Database (Denmark)

    Bang, Casper N; Greve, Anders M; Abdulla, Jawdat;

    2013-01-01

    BACKGROUND: Previous meta-analyses suggest that pre-procedural use of statin therapy may reduce atrial fibrillation (AF) following invasive cardiac interventions (coronary artery by-pass grafting and percutaneous coronary intervention). However, the current evidence on the benefit of statins......-onset and recurrent AF. In the statin versus control group the mean age was 60.7±8.3 versus 68.6±6.2years and females comprised 8.4% versus 10.3%. Statin therapy was associated with significant reduction of AF (Risk ratio (RR): 0.81 [95% confidence interval (CI): 0.80-0.83], p0.05. Assessing exclusively observational...

  8. Ejection fraction and outcomes in patients with atrial fibrillation and heart failure

    DEFF Research Database (Denmark)

    Banerjee, Amitava; Taillandier, Sophie; Olesen, Jonas Bjerring;

    2012-01-01

    Heart failure (HF) increases the risk of stroke and thrombo-embolism (TE) in non-valvular atrial fibrillation (NVAF), and is incorporated in stroke risk stratification scores. We aimed to establish the role of ejection fraction (EF) in risk prediction in patients with NVAF and HF.......Heart failure (HF) increases the risk of stroke and thrombo-embolism (TE) in non-valvular atrial fibrillation (NVAF), and is incorporated in stroke risk stratification scores. We aimed to establish the role of ejection fraction (EF) in risk prediction in patients with NVAF and HF....

  9. Genetics of Atrial Fibrillation and Possible Implications for Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Robin Lemmens

    2011-01-01

    Full Text Available Atrial fibrillation is the most common cardiac arrhythmia mainly caused by valvular, ischemic, hypertensive, and myopathic heart disease. Atrial fibrillation can occur in families suggesting a genetic background especially in younger subjects. Additionally recent studies have identified common genetic variants to be associated with atrial fibrillation in the general population. This cardiac arrhythmia has important public health implications because of its main complications: congestive heart failure and ischemic stroke. Since atrial fibrillation can result in ischemic stroke, one might assume that genetic determinants of this cardiac arrhythmia are also implicated in cerebrovascular disease. Ischemic stroke is a multifactorial, complex disease where multiple environmental and genetic factors interact. Whether genetic variants associated with a risk factor for ischemic stroke also increase the risk of a particular vascular endpoint still needs to be confirmed in many cases. Here we review the current knowledge on the genetic background of atrial fibrillation and the consequences for cerebrovascular disease.

  10. Atrial fibrillation.

    Science.gov (United States)

    Bang, Casper N

    2013-10-01

    Atrial fibrillation (AF) is a common complication after myocardial infarction (MI) and new-onset AF has been demonstrated to be associated with adverse outcome and a large excess risk of death in both MI and aortic stenosis (AS) patients. Prevention of new-onset AF is therefore a potential therapeutic target in AS and MI patients. Lipid-lowering drugs, particularly statins, have anti-inflammatory and antioxidant properties that may prevent AF. Accordingly, statins are recommended as a class IIa recommendation for prevention of new-onset AF after coronary artery bypass grafting (CABG). However, this preventive effect has not been investigated on new-onset AF in asymptomatic patients with AS or a large scale first-time MI patient sample and data in patients not undergoing invasive cardiac interventions are limited. This PhD thesis was conducted at the Heart Centre, Rigshospitalet, Denmark, with the aim to investigate the three aforementioned questions and to add to the existing evidence of AF prevention with statins. This was done using three different settings: 1) a randomized patients sample of 1,873 from the Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study, 2) a register patient sample of 97,499 with first-time MI, and 3) all published studies until beginning of June 2011 examining statin treatment on new-onset and recurrent AF in patients not undergoing cardiac surgery. This thesis revealed that statins did not lower the incidence or the time to new-onset AF in patients with asymptomatic AS. However, statin treatment showed an independently preventive effect on new-onset AF, including type-dependent effect and a trend to dosage-dependent effect. In addition, this thesis showed that good compliance to statin treatment was important to prevent new-onset AF. Finally, the meta-analysis in this PhD thesis showed a preventive effect in the observational studies although this effect was absent in the randomized controlled trials. Based on this PhD thesis

  11. Radiation-associated valvular heart disease.

    Science.gov (United States)

    Ong, Daniel S; Aertker, Robert A; Clark, Alexandra N; Kiefer, Todd; Hughes, G Chad; Harrison, J Kevin; Bashore, Thomas M

    2013-11-01

    Therapeutic ionizing radiation, such as that used in the treatment of Hodgkin's lymphoma, can cause cardiac valvular damage that may take several years to manifest as radiation-associated valvular heart disease. Treatment can be complicated by comorbid radiation injury to other cardiac and mediastinal structures that lead to traditional surgical valve replacement or repair becoming high-risk. A representative case is presented that demonstrates the complexity of radiation-associated valvular heart disease and its successful treatment with percutaneous transcatheter valve replacement. The prevalence and pathophysiologic mechanism of radiation-associated valvular injury are reviewed. Anthracycline adjuvant therapy appears to increase the risk of valvular fibrosis. Left-sided heart valves are more commonly affected than right-sided heart valves. A particular pattern of calcification has been noted in some patients, and experimental data suggest that radiation induction of an osteogenic phenotype may be responsible. A renewed appreciation of the cardiac valvular effects of therapeutic ionizing radiation for mediastinal malignancies is important, and the treatment of such patients may be assisted by the development of novel, less-invasive approaches.

  12. 非瓣膜性心房颤动患者内皮和血小板功能及β受体阻滞剂干预的临床意义%Endothelial function and platelet activation in patients with non-valvular atrial fibrillation and the influence of beta-blocker on them

    Institute of Scientific and Technical Information of China (English)

    种甲; 杨杰孚

    2011-01-01

    目的 探讨非瓣膜性心房颤动(房颤)与内皮细胞功能及血小板功能的关系,观察β受体阻滞剂治疗对房颤患者内皮功能及血小板功能的影响.方法 非瓣膜性持续性房颤患者(房颤组)25例,窦性心律组(窦律组)35例,通过竞争性酶联免疫(ELASA)分析定量测定两组血清血管性血友病因子(von Willebrand Factor,vWF)和可溶性P选择素水平,及房颤组β受体阻滞剂治疗后上述指标的变化.结果 房颤组血清vWF水平(1945.2±111.3)g/L高于窦律组(1862.3±101.6)g/L,差异有统计学意义(P<0.05).房颤组患者服用β受体阻滞剂(阿替洛尔)后,血清vWF水平下降至(1758.3±152.4)g/L,与服药前比较差异有统计学意义(P<0.01).血清可溶性P选择素水平房颤组与窦律组[分别为(24.32±9.21)g/L与(24.68±11.70)g/L]比较,差异无统计学意义(P>0.05),服用β受体阻滞剂后血清可溶性P选择素水平下降至(21.05±8.94)g/L,但与服药前相比差异无统计学意义(P>0.05).vWF与可溶性P选择素无相关性(Pearson相关系数为-0.008,P>0.05).结论 房颤患者血清vWF水平较窦性心律者升高,提示存在心血管内皮损伤.服用阿替洛尔后,房颤患者血清vWF水平下降,提示阿替洛尔用于房颤患者除能有效控制心室率外,还可能具有内皮保护功能.%Objective To examine the serum von Willebrand factor (vWF) and soluble Pselectin levels in patients with non-valvular atrial fibrillation (NVAF), and to observe the influence of beta-blocker treatment on endothelial function and platelet activation in NVAF patients. Methods The 25 subjects, 17 males and 8 females, with persistent NVAF and left ventricular ejection fraction (LVEF)≥50%, were enrolled in NVAF group. Those with myocardial infarction, cardiomyopathy or hyperthyroidism were excluded. Another 35 subjects with sinus rhythm were as control (age,gender and LVEF matched with NVAF group, and with similar cardiovascular diseases). Serum

  13. MicroRNA-21 and matrix metalloprotease-2 in patients with rheumatic valvular heart disease and atrial fibrillation%心房颤动患者心房组织中微小RNA-21和金属基质蛋白酶-2表达水平改变及意义

    Institute of Scientific and Technical Information of China (English)

    朱瓦力; 伍伟锋

    2011-01-01

    Objective To investigate changes of micmRNA-21 expressions in right auricle in patients with rheumatic heart disease and atrial fibrillation(AF).Methods Right atrial appendages were obtained from 12 rheumatic valvular heart disease patients with sinus rhythm(SR)and 14 patients with chronic AF.Quantitative real time polymerase chain reaction(qRT-PCR)was applied to assess expressions of microRNA-21.Proteins were quantified from immunoblots.Immunohistochemistry was applied to localize MMP-2 and Masson staining was used to estimate collagen deposition.Results Expressions of microRNA-21 was increased(relative expression:2.23±0.31 vs.0.94±0.24;P<0.01)in AF patients.There was a corresponding increased MMP-2 procollagen volume fraction CVF:14.1%±0.01%vs.8.3%±0.01%;P<0.01).Expression of MicroRNA-21 was positively correlated to left atrium dimension(r=0.429;P<0.05).Expression of MMP-2 was positively correlated to collagen content(r=0.456,P<0.05)and left atrium dimension(r=0.471;P<0.05).Conclusion Expression of microRNA-21 level was significantly up-regulated in human patients with AF,possibly contributing to up-regulation of MMP-2 leading to increased collagen content in the atrium.These results provide potential new insights into molecular mechanisms of AF.%目的 检测微小RNA(microRNA)-21及其调控的金属基质蛋白酶-2(MMP-2)在心房颤动(房颤)患者心房组织中的表达变化,探讨房颤患者心房结构重构的分子机制.方法 26例风湿性心脏瓣膜病接受瓣膜置换术患者分为两组,其中窦性心律组12例,慢陛房颤组14例.于术中获取右心耳组织,采用荧光定量聚合酶链反应(PCR)检测心肌组织中micmRNA-21的相对表达量,用免疫印迹法及免疫组织化学染色法检测MMP-2蛋白水平及分布.用Masson染色检测心肌胶原容积.结果 房颤组心房肌组织microRNA-21及MMP-2表达水平明显增加[microRNA-21:房颤组(2.23±0.31)与窦性心律组(0.94±0.24),P<0.01;MMP-2:房颤组(0.93

  14. 利伐沙班在心房颤动导管消融围手术期的应用进展%Research Progress of Periprocedural Management of Rivaroxaban in Patients Undergoing Atrial Fibrillation Ablation

    Institute of Scientific and Technical Information of China (English)

    余香(综述); 肖骅(审校)

    2015-01-01

    新型抗凝药利伐沙班在非瓣膜性心房颤动患者预防脑卒中或全身性栓塞已有充分的临床应用证据,但其在心房颤动导管消融围手术期的用药策略尚无统一意见。通过对相关临床研究进行分类分析,以期为利伐沙班在心房颤动导管消融围手术期的临床合理应用策略提供参考。%Rivaroxaban was approved for the prevention of stroke or embolism in patients with nonvalvular atrial fibrillation ( AF ) . However, There is no unified opinion of periprocedural anticoagulation strategies for the patients undergoing AF ablation.This article reviews the studies of periprocedural management of rivaroxaban in patients undergoing AF ablation,to provide evidence for clinical reasonable appli-cation strategy of rivaroxaban.

  15. Prognosis of patients with carcinoid heart disease after valvular surgery.

    Science.gov (United States)

    Manoly, Imthiaz; McAnelly, Sarah-Louise; Sriskandarajah, Sanjeevan; McLaughlin, Kenneth Edward

    2014-08-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. We addressed the following question: in patients who are diagnosed with carcinoid heart disease (CHD), do valvular surgeries improve their prognosis? Fifty percent of the patients with clinically diagnosed carcinoid syndrome had cardiac involvement which was present either as valvular dysfunction or as cardiac metastases. These patients often require surgery due to their heightened risk of cardiac disease. Altogether 217 relevant papers were identified as a result of the below-mentioned search, of which 10 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Of the patients who were identified to have carcinoid heart disease in different studies, 193 patients had valve procedure, mainly replacements at tricuspid, mitral and aortic valve positions and either valvuloplasty or replacement at pulmonary valve. Tricuspid and pulmonary valves represented the majority of the excised valves among patients undergoing valvular surgery for CHD. The pathology of carcinoid valve was attributed to the presence of plaque, causing thickening and retraction. Pure regurgitation was the most common finding in all the valves except pulmonary valve which had both stenosis and insufficiency. Thirty-day mortality was 17% (range 1-63%) and long-term survivors were reported to be alive at an average of 58 months (28-80 months) after the valve surgery. The evidence demonstrates that surgical intervention can lead to improved prognosis and reduce the symptoms of heart failure. Postoperative mortality was mainly due to the carcinoid disease itself and not as a complication of the surgery. Therefore, surgery could be considered for symptomatic palliation in carefully selected individuals.

  16. Triple antithrombotic therapy in patients with atrial fibrillation undergoing coronary artery stenting: hovering among bleeding risk, thromboembolic events, and stent thrombosis

    Directory of Open Access Journals (Sweden)

    Menozzi Mila

    2012-10-01

    Full Text Available Abstract Dual antiplatelet treatment with aspirin and clopidogrel is the antithrombotic treatment recommended after an acute coronary syndrome and/or coronary artery stenting. The evidence for optimal antiplatelet therapy for patients, in whom long-term treatment oral anticoagulation is mandatory, is however scarce. To evaluate the safety and efficacy of the various antithrombotic strategies adopted in this population, we reviewed the available evidence on the management of patients receiving oral anticoagulation, such as a vitamin-k-antagonists, referred for coronary artery stenting. Atrial fibrillation is the most frequent indication for oral anticoagulation. The need of starting antiplatelet therapy in this clinical scenario raises concerns about the combination to choose: triple therapy with warfarin, aspirin, and a thienopyridine being the most frequent and advised. The safety of this regimen appeared suboptimal because of an increased risk in hemorrhagic complications. On the other hand, the combination of oral anticoagulation and an antiplatelet agent is suboptimal in preventing thromboembolic events and stent thrombosis; dual antiplatelet therapy may be considered only when a high hemorrhagic risk and low thromboembolic risk are perceived. Indeed, the need for prolonged multiple-drug antithrombotic therapy increases the bleeding risks when drug eluting stents are used. Since current evidence derives mainly from small, single-center and retrospective studies, large-scale prospective multicenter studies are urgently needed.

  17. Primary prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with end-stage renal disease undergoing dialysis.

    Science.gov (United States)

    Lin, Ting-Tse; Yang, Yao-Hsu; Liao, Min-Tsun; Tsai, Chia-Ti; Hwang, Juey J; Chiang, Fu-Tien; Chen, Pau-Chung; Lin, Jiunn-Lee; Lin, Lian-Yu

    2015-08-01

    Current evidence suggests that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce the incidence of new atrial fibrillation (AF) in a variety of clinical conditions, including the treatment of left ventricular dysfunction or hypertension. Here we assessed whether ACEIs and ARBs could decrease incidence of new-onset AF in patients with end-stage renal disease (ESRD). We identified patients from the Registry for Catastrophic Illness, a nation-wide database encompassing almost all of the patients receiving dialysis therapy in Taiwan from 1995 to 2008. Propensity score matching and Cox proportional hazards regression models were used to estimate hazard ratios for new-onset AF. Among 113,186 patients, 13% received ACEIs, 14% received ARBs therapy, and 9% received ACEIs or ARBs alternatively. After a median follow-up of 1524 days, the incidence of new-onset AF significantly decreased in patients treated with ACEIs (hazard ratio 0.587, 95% confidence interval 0.519-0.663), ARBs (0.542, 0.461-0.637), or ACEIs/ARBs (0.793, 0.657-0.958). The prevention of new-onset AF was significantly better in patients taking longer duration of ACEI or ARB therapy. The effect remained robust in subgroup analyses. Thus both ACEIs and ARBs appear to be effective in the primary prevention of AF in patients with ESRD. Hence, renin-angiotensin system inhibition may be an emerging treatment target for the primary prevention of AF.

  18. Enfermedad valvular y embarazo Valvular disease and pregnancy

    Directory of Open Access Journals (Sweden)

    Jorge E Velásquez

    2008-10-01

    Full Text Available La situación de la mujer en nuestra sociedad, cambió en forma dramática y ocasionó un desplazamiento en el tiempo y en la prioridad del deseo gestacional, lo cual la ubica en situaciones de mayor riesgo para ella y el futuro infante. De igual manera, los avances en cardiología y cirugía cardiovascular pediátrica, permitieron modificar la historia natural de las cardiopatías congénitas y la vida diaria de las pacientes con estas condiciones. Esto hace que puedan ser más cercanas a lo normal e implica encontrar pacientes con estas condiciones que consultan por gestaciones que han puesto de manifiesto su reserva cardiaca y que las clasifica en alto riesgo. Así mismo, la cardiopatía reumática, aún es una condición frecuente en nuestro medio y es responsable de cambios valvulares mitral y aórtico o ambos, que obligarán, en algunos casos, al uso de anticoagulación oral crónica, los cual es un nuevo reto para la gestante, su bebé y su médico tratante. Por ende, para el personal médico en general, es fundamental estar al tanto de los riesgos que implican estas situaciones para las futuras gestantes y la necesidad de realizar una adecuada consejería pre-concepcional y un seguimiento multidisciplinario riguroso que permita tener embarazos seguros, que lleguen a feliz término.Women status in our society has changed dramatically and has caused a displacement in the timing and priority of pregnancy desire, leading to situations of higher risks for both mother and future infant. Likewise, advances in pediatric cardiology and cardiovascular surgery have allowed the modification of the natural history of congenital heart diseases and the daily life of patients under these conditions. Being nearer to normality, patients in this situation consult for pregnancies that have shown their cardiac reserve and place them at high risk. Rheumatic cardiopathy is still a frequent condition in our community, being responsible for mitral and/or aortic

  19. Analysis the Curative Effect of Valve Replacement Simultaneous Coordinate Ablation Therapy in Treatment of Valvular Heart Disease%行瓣膜置换术同期配合射频消融治疗瓣膜性心脏病的疗效分析

    Institute of Scientific and Technical Information of China (English)

    赵勇鹏; 陈兴澎

    2016-01-01

    Objective To explore the practical value of radiofrequency catheter ablation in patients with valvular heart disease undergoing valve replacement.Methods Selected 80 cases of valvular heart disease, which were divided into the observation group and the control group. The control group was treated with valve replacement, the control group basis on the observation group was treated with radiofrequency ablation.Results There were significant differences in the rate of atrial fibrillation, left atrial diameter, left ventricular ejection fraction, and the difference was statistically signiifcant (P<0.05).Conclusion Patients with valvular heart disease undergoing valve replacement combined with radiofrequency ablation of the actual value of the actual value is signiifcant.%目的:系统地探究对瓣膜性心脏病患者行瓣膜置换术同期配合射频消融手术治疗的实际价值。方法选取80例瓣膜性心脏病患者,结合临床随机表法将其平均地列入观察组与对照组。对照组应用瓣膜置换术,在对照组基础上,观察组同期行射频消融手术治疗。结果两组房颤转复率、左心房内径、左室射血分数比较,差异有统计学意义(P<0.05)。结论对瓣膜性心脏病患者行瓣膜置换术同期配合射频消融手术治疗的实际价值显著。

  20. Ganglionated plexus ablation vs linear ablation in patients undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation: a randomized comparison.

    Science.gov (United States)

    Pokushalov, Evgeny; Romanov, Alexandr; Katritsis, Demosthenes G; Artyomenko, Sergey; Shirokova, Natalya; Karaskov, Alexandr; Mittal, Suneet; Steinberg, Jonathan S

    2013-09-01

    The optimal ablation technique for persistent and long-standing persistent atrial fibrillation (AF) is unclear. Both linear lesion (LL) and ganglionated plexus (GP) ablation have been used in addition to pulmonary vein isolation (PVI), but no direct comparison of the 2 methods exists. The aim of this study is to assess the comparative safety and efficacy of 2 different ablation strategies-PVI+LL vs PVI+GP ablation -in patients with persistent or long-standing persistent AF. Two hundred sixty-four consecutive patients with persistent/long-standing persistent AF were randomly assigned to 2 different ablation schemes: PVI+LL (n = 132) and PVI+GP (n = 132) ablation. Consistent sinus rhythm (SR) off antiarrhythmic drug was assessed after follow-up of at least 3 years with the use of an implanted monitoring device. All procedural end points were acutely achieved. At 12 months after a single procedure, 47% of the patients treated with PVI+LL were in SR compared to 54% of the patients treated with PVI+GP (P = .29). At 3 years, 34% of the patients with PVI+LL and 49% of the patients with PVI+GP maintained SR (P = .035). Atrial flutter was more frequent in the PVI+LL group than in PVI+GP group (18% vs 6%; P = .002). After a second procedure in 78 patients of the PVI+LL group and 55 patients of the PVI+GP group, the long-term overall success rate was 52% and 68%, respectively (P = .006). PVI+GP ablation confers superior clinical results with less ablation-related left atrial flutter and reduced AF recurrence compared to PVI+LL ablation at 3 years of follow-up. © 2013 Heart Rhythm Society. All rights reserved.

  1. Genetic associations with valvular calcification and aortic stenosis

    DEFF Research Database (Denmark)

    Thanassoulis, George; Campbell, Catherine Y; Owens, David S

    2013-01-01

    Limited information is available regarding genetic contributions to valvular calcification, which is an important precursor of clinical valve disease.......Limited information is available regarding genetic contributions to valvular calcification, which is an important precursor of clinical valve disease....

  2. Comparative study of calcified changes in aortic valvular diseases.

    Science.gov (United States)

    Togashi, Mayuko; Tamura, Koichi; Masuda, Yukinari; Fukuda, Yuh

    2008-06-01

    Calcification of the aortic valve leads to stenosis or regurgitation or both. To clarify the mechanism of heart valve calcification, comparative studies using histological and ultrastructural examinations were performed of calcified aortic valves. These valves were obtained at valve replacement surgery from 11 patients with rheumatic aortic valvular disease (RAVD), 10 patients with degenerative aortic valve disease (DAVD), and 10 patients with congenitally bicuspid aortic valves (CBAV). For electron microscopic study, 5 cases were selected from each group. In RAVD, histological examination revealed calcification in a degenerated amorphous area at the center of fibrous thickened regions and in laminar fibrous thickened areas near the valve surface. In DAVD, calcification was observed mainly in the fibrosa near the valve ring. In CBAV, basic pathological changes were similar to those in DAVD; however, additional severe calcification of the raphe was observed, if the raphe was present. Ultrastructural examinations showed deposition of electron-dense materials in two patterns in all three groups; one pattern was observed in the interfibrillar spaces of collagen fibrils, and the other pattern was widespread macular deposition unrelated to the preexisting structure. In RAVD, microfibril-like fibrillar structures were found in the areas of deposition of electron-dense materials. These findings suggest that newly formed connective tissue degraded and became necrotic because of nutritional deprivation, especially in the thickened central area, causing calcium deposition. In DAVD and CBAV, numerous lipid vacuoles were found in the electron-dense deposition areas similar to lipid deposition in aortic atherosclerosis. Localized calcium deposition in the fibrosa suggests that the stress of valvular motion and pressure load induces sclerotic changes with the degeneration of collagen fibers, providing a core for calcification. In CBAV, the raphe was the main location of

  3. [Indications for surgery for valvular heart disease].

    Science.gov (United States)

    Halbach, Marcel; Wahlers, Thorsten; Baldus, Stephan; Rudolph, Volker

    2015-11-01

    Due to the demographic change, chronic valvular heart disease becomes increasingly important - especially age-related primary diseases of the aortic and mitral valve as well as secondary diseases of the mitral and tricuspid valve caused by other age-related cardiac disorders. Medical treatment is limited to symptom relief by use of diuretics. Specific drugs or drugs with a prognostic benefit are not available. Thus, valve repair or replacement are the key options for treatment of relevant valvular heart disease. While open heart surgery was the only approach for a long time, interventional, catheter-based therapies have evolved in the last decade. This article describes up-to-date recommendations on indications for surgery for the most prevalent valvular heart diseases in adults - aortic stenosis, and aortic, mitral and tricuspid regurgitation).

  4. Relationship between vitamin D level and left atrial fibrosis in patients with lone paroxysmal atrial fibrillation undergoing cryoballoon-based catheter ablation.

    Science.gov (United States)

    Canpolat, Uğur; Aytemir, Kudret; Hazirolan, Tuncay; Özer, Necla; Oto, Ali

    2017-01-01

    Left atrial (LA) fibrosis is known as the hallmark for arrhythmogenic substrate in atrial fibrillation (AF). Quantification of LA fibrosis by using delayed-enhanced magnetic resonance imaging (DE-MRI) in AF patients is a pioneering noninvasive technique. Vitamin D (vitD) negatively regulates the renin-angiotensin system, binds to vitD receptors on cardiac myocytes, and has antioxidant properties that may ameliorate the inflammation and proarrhythmic substrate formation. However, its role in LA fibrosis is unclear. We aimed to investigate the association of serum 25(OH)D level with the extent of LA fibrosis by using DE-MRI and also predictors for AF recurrence after cryoablation was assessed in patients with paroxysmal AF. A total of 48 patients with lone paroxysmal AF (41.7% female; age: 48.5±8.4 years) who underwent DE-MRI at 1.5T and initial cryoballoon-based catheter ablation along with 48 healthy control subjects were enrolled. Fibrosis degree was categorized according to Utah class defined in the DECAAF study. Serum 25(OH)D levels were significantly lower in AF group compared to control group (25.8±7.6ng/ml vs. 31.0±9.5ng/ml, p=0.004). Serum 25(OH)D levels were associated with moderate-severe LA fibrosis independent of other measures (OR: 0.72, 95% CI: 0.54-0.97, p=0.028). At a mean 16.5±2.6 months follow-up, late recurrence was observed in 10 (20.8%) patients. In multivariable Cox regression analysis, LA volume index (HR: 1.42, 95% CI: 1.01-2.01, p=0.045) and the extent of LA fibrosis (HR: 1.14, 95% CI: 1.01-1.28, p=0.034) were found as independently associated with late AF recurrence during follow-up. Lower levels of serum 25(OH)D are significantly associated with more extensive LA fibrosis in patients with lone paroxysmal AF and may be implicated in the pathophysiology of AF recurrence after cryoablation. Further large-scale studies are needed to elucidate the exact role of vitD deficiency and replacement on LA fibrosis. Copyright © 2016 Japanese

  5. Eumelanin fibrils

    Science.gov (United States)

    McQueenie, Ross; Sutter, Jens; Karolin, Jan; Birch, David J. S.

    2012-07-01

    We describe the auto-oxidation of 3, 4-dihydroxy-L-phenylalanine (L-DOPA) in the synthesis of eumelanin to spontaneously produce fibrils upon drying. The self-assembled fibrils are of characteristic diameter ~1 to 2 μm, composed of filaments, and are unidirectional, apart from branches that are formed at typically an angle of 20 to 22 deg. The fibrils are characterized using fluorescence spectroscopy, fluorescence decay times, scanning electron microscopy, atomic force microscopy, and fluorescence lifetime imaging microscopy. The fibrils mimic natural melanin in consisting of core eumelanin with efficient nonradiative properties, but they also display pockets of electronically isolated species with higher radiative rates on the nanosecond timescale. Eumelanin fibrils formed occasionally in solution are tentatively attributed to a scaffold of bacteria or fungus. Fabricating and characterizing novel synthetic eumelanin structures such as fibrils are of interest in helping to reveal a functional structure for eumelanin, in understanding its photophysics, in learning more about L-DOPA as it is used in the treatment of Parkinson's disease, and in producing novel materials which might embody some of the diverse properties of eumelanin.

  6. Voltage mapping for delineating inexcitable dense scar in patients undergoing atrial fibrillation ablation: a new end point for enhancing pulmonary vein isolation.

    Science.gov (United States)

    Squara, Fabien; Frankel, David S; Schaller, Robert; Kapa, Suraj; Chik, William W; Callans, David J; Marchlinski, Francis E; Dixit, Sanjay

    2014-11-01

    Characterization of left atrial scar using bipolar voltage (BiV) mapping is not well defined. We have previously shown that the BiV range of 0.2-0.45 mV can identify chronic scar from prior pulmonary vein isolation (PVI). This study sought to determine a BiV range that can identify atrial inexcitable dense scar (IDS) in patients acutely and chronically after PVI. Thirty consecutive patients undergoing first time (n = 15) or redo (n = 15) PVI were included. A left atrial shell was created using electroanatomic mapping, and IDS was defined by inability to capture at an output of 10 mA and a pulse width of 2 ms in sinus rhythm, circumferentially at the edge of PVI-related scar (≤5 mm). At each pacing site, BiV amplitude and atrial capture were recorded. Overall, 837 pacing sites were assessed. BiV predicted IDS (receiver operating characteristic curve area 0.93 for first time PVI and 0.90 for redo PVI). In first time PVI, the best BiV value to predict IDS was 0.45 mV for the left pulmonary vein-left atrial appendage (LAA-LPV) ridge (sensitivity 0.98; specificity 1.0) and 0.2 mV for other localizations (sensitivity 0.91; specificity 0.86). In redo PVI, the best BiV value to predict IDS was 0.2 mV for the LAA-LPV ridge (sensitivity 0.77; specificity 1.0) and 0.15 mV for other localizations (sensitivity 0.81; specificity 0.82). BiV reproducibly identifies acute and chronic IDS using a cutoff value of 0.2 mV (0.45 mV for the LAA-LPV ridge) in patients undergoing first time PVI and 0.15 mV (0.2 mV for the LAA-LPV ridge) in patients undergoing redo PVI. IDS thus identified may be a rigorous tool for validating PVI. Published by Elsevier Inc.

  7. Clinical and epidemiological profile of patients with valvular heart disease admitted to the emergency department

    Energy Technology Data Exchange (ETDEWEB)

    Moraes, Ricardo Casalino Sanches de [Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil); Katz, Marcelo [Hospital Israelita Albert Einstein, São Paulo, SP (Brazil); Tarasoutchi, Flávio [Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP (Brazil)

    2014-07-01

    To evaluate the clinical and epidemiological profile of patients with valvular heart disease who arrived decompensated at the emergency department of a university hospital in Brazil. A descriptive analysis of clinical and echocardiographic data of 174 patients with severe valvular disease, who were clinically decompensated and went to the emergency department of a tertiary cardiology hospital, in the State of São Paulo, in 2009. The mean age of participants was 56±17 years and 54% were female. The main cause of valve disease was rheumatic in 60%, followed by 15% of degenerative aortic disease and mitral valve prolapse in 13%. Mitral regurgitation (27.5%) was the most common isolated valve disease, followed by aortic stenosis (23%), aortic regurgitation (13%) and mitral stenosis (11%). In echocardiographic data, the mean left atrial diameter was 48±12mm, 38±12mm for the left ventricular systolic diameter, and 54±12mm for the diastolic diameter; the mean ejection fraction was 56±13%, and the mean pulmonary artery pressure was 53±16mmHg. Approximately half of patients (44%) presented atrial fibrillation, and over one third of them (37%) had already undergone another cardiac surgery. Despite increased comorbidities and age-dependent risk factors commonly described in patients with valvular heart disease, the clinical profile of patients arriving at the emergency department represented a cohort of rheumatic patients in more advanced stages of disease. These patients require priority care in high complexity specialized hospitals.

  8. Oral anticoagulants for stroke prevention in atrial fibrillation: current status, special situations, and unmet needs

    NARCIS (Netherlands)

    Verheugt, F.W.A.; Granger, C.B.

    2015-01-01

    In patients with non-valvular atrial fibrillation, oral anticoagulation with vitamin K antagonists reduces the risk of stroke by more than 60%. But vitamin K antagonists have limitations, including causing serious bleeding such as intracranial haemorrhage and the need for anticoagulation monitoring.

  9. Surgical intervention for advanced valvular heart disease in 227 cases

    Institute of Scientific and Technical Information of China (English)

    ZHANG Xi; ZHONG Fo-tian; XU Zhe; XU Ying-qi; WANG Zhi-ping; WU Zhong-kai; TANG Bai-yun; XIONG Mai; YAO Jian-ping; SUN Pei-wu

    2005-01-01

    Background Although the results of surgical treatment in cardiac valve disease continue to improve, the postoperative mortality rate and the rate of complications in patients with advanced valvular heart disease (AVHD) are still very high. We did this retrospective study to summarize the surgical experience of heart valve replacement for patients with AVHD and discuss effective ways to improve the surgical outcome.Results The operative mortality rate was 13.2% (30/227). The main causes of death included multiple organ dysfunction syndrome (MODS), low cardiac output syndrome and ventricular fibrillation. From the results of the binary noncounterpart multivariate logistic regression, the following statistically significant factors were found to influence the operative mortality rate: redo operation, age ≥55 years, preoperative NYHA cardiac function grading, extracorporeal circulation time ≥120 minutes and postoperative usage of GIK (glucose, insulin and potassium) solution. All factors were risk ones except postoperative application of GIK. The Hosmer-Lemeshow goodness of fit coefficient of this model was 0.976.Conclusions The risk factors associated with postoperative mortality rate in the patients with AVHD were redo operation, age ≥55 years, preoperative NYHA cardiac function grading and extracorporeal circulation time ≥120 minutes. Postoperative usage of GIK acted as a kind of metabolic therapy and will improve the recovery for patients with AVHD. Active perioperative management and care will play a very important role in reducing the operative risk and improving the short term outcome of surgical treatment for the patients with AVHD.

  10. Efficacy and Safety of Non-Vitamin K Antagonist Oral Anticoagulants versus Vitamin K Antagonist Oral Anticoagulants in Patients Undergoing Radiofrequency Catheter Ablation of Atrial Fibrillation: A Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Giuseppe Santarpia

    Full Text Available Use of the non-vitamin K antagonist oral anticoagulants (NOACs is endorsed by current guidelines for stroke prevention in patients with atrial fibrillation (AF. However efficacy and safety of NOACs in patients undergoing catheter ablation (RFCA of AF has not been well established yet.To perform a meta-analysis of all studies comparing NOACs and vitamin K antagonist oral anticoagulants (VKAs in patients undergoing RFCA.Studies were searched for in PubMed and Google Scholar databases.Studies were considered eligible if: they evaluated the clinical impact of NOACs versus VKAs; they specifically analyzed the use of anticoagulants during periprocedural phase of RFCA; they reported clinical outcome data.25 studies were selected, including 9881 cases. The summary measure used was the risk ratio (RR with 95% confidence interval (CI. The random-effects or the fixed effect model were used to synthesize results from the selected studies.There was no significant difference in thromboembolic complications (RR 1.39; p=0.13. Bleeding complications were significantly lower in the NOACs-treated arm as compared to VKAs (RR=0.67, p<0.001. Interestingly, a larger number of thromboembolic events was found in the VKAs-treated arm in those studies where VKAs had been interrupted during the periprocedural phase (RR=0.68; p=ns. In this same subgroup a significantly higher incidence of both minor (RR=0.54; p=0.002 and major bleeding (RR=0.41; p=0.01 events was recorded. Conversely, the incidence of thromboembolic events in the VKAs-treated arm was significantly lower in those studies with uninterrupted periprocedural anticoagulation treatment (RR=1.89; p=0.02.As with every meta-analysis, no patients-level data were available.The use of NOACs in patients undergoing RFCA is safe, given the lower incidence of bleedings observed with NOACs. On the other side, periprocedural interruption of VKAs and bridging with heparin is associated with a higher bleeding rate with no

  11. Atrial fibrillation

    DEFF Research Database (Denmark)

    Lip, Gregory Y H; Fauchier, Laurent; Freedman, Saul B;

    2016-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, and increases in prevalence with increasing age and the number of cardiovascular comorbidities. AF is characterized by a rapid and irregular heartbeat that can be asymptomatic or lead to symptoms such as palpitations...

  12. Atrial fibrillation

    DEFF Research Database (Denmark)

    Olesen, Morten S; Nielsen, Morten W; Haunsø, Stig;

    2014-01-01

    Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting 1-2% of the general population. A number of studies have demonstrated that AF, and in particular lone AF, has a substantial genetic component. Monogenic mutations in lone and familial AF, although rare, have been recognized...

  13. Dual antiplatelet therapy versus oral anticoagulation plus dual antiplatelet therapy in patients with atrial fibrillation and low-to-moderate thromboembolic risk undergoing coronary stenting: design of the MUSICA-2 randomized trial.

    Science.gov (United States)

    Sambola, Antonia; Montoro, J Bruno; Del Blanco, Bruno García; Llavero, Nadia; Barrabés, José A; Alfonso, Fernando; Bueno, Héctor; Cequier, Angel; Serra, Antonio; Zueco, Javier; Sabaté, Manel; Rodríguez-Leor, Oriol; García-Dorado, David

    2013-10-01

    Oral anticoagulation (OAC) is the recommended therapy for patients with atrial fibrillation (AF) because it reduces the risk of stroke and other thromboembolic events. Dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention and stenting (PCI-S). In patients with AF requiring PCI-S, the association of DAPT and OAC carries an increased risk of bleeding, whereas OAC therapy or DAPT alone may not protect against the risk of developing new ischemic or thromboembolic events. The MUSICA-2 study will test the hypothesis that DAPT compared with triple therapy (TT) in patients with nonvalvular AF at low-to-moderate risk of stroke (CHADS2 score ≤2) after PCI-S reduces the risk of bleeding and is not inferior to TT for preventing thromboembolic complications. The MUSICA-2 is a multicenter, open-label randomized trial that will compare TT with DAPT in patients with AF and CHADS2 score ≤2 undergoing PCI-S. The primary end point is the incidence of stroke or any systemic embolism or major adverse cardiac events: death, myocardial infarction, stent thrombosis, or target vessel revascularization at 1 year of PCI-S. The secondary end point is the combination of any cardiovascular event with major or minor bleeding at 1 year of PCI-S. The calculated sample size is 304 patients. The MUSICA-2 will attempt to determine the most effective and safe treatment in patients with nonvalvular AF and CHADS2 score ≤2 after PCI-S. Restricting TT for AF patients at high risk for stroke may reduce the incidence of bleeding without increasing the risk of thromboembolic complications. © 2013.

  14. Valvular and aortic diseases in osteogenesis imperfecta.

    Science.gov (United States)

    Lamanna, Arvin; Fayers, Trevor; Clarke, Sophie; Parsonage, William

    2013-10-01

    Osteogenesis imperfecta (OI) is an inheritable connective tissue disorder caused by defective collagen synthesis with the principal manifestations of bone fragility. OI has been associated with left sided valvular regurgitation and aortic dilation. Valve and aortic surgery are technically feasible in patients with OI but are inherently high risk due to the underlying connective tissue defect. This report reviews the valvular and aortic pathology associated with OI and their management. We describe two cases of patients with OI who have significant aortic and mitral valve regurgitation, one of whom has been managed conservatively and the other who has undergone successful mitral valve repair and aortic valve replacement. The latter case represents the fifth case of mitral valve repair in a patient with OI reported in the medical literature.

  15. Neurologic complications of valvular heart disease.

    Science.gov (United States)

    Cruz-Flores, Salvador

    2014-01-01

    Valvular heart disease (VHD) is frequently associated with neurologic complications; cerebral embolism is the most common of these since thrombus formation results from the abnormalities in the valvular surfaces or from the anatomic and physiologic changes associated with valve dysfunction, such as atrial or ventricular enlargement, intracardiac thrombi, and cardiac dysrhythmias. Prosthetic heart valves, particularly mechanical valves, are very thrombogenic, which explains the high risk of thromboembolism and the need for anticoagulation for the prevention of embolism. Infective endocarditis is a disease process with protean manifestations that include not only cerebral embolism but also intracranial hemorrhage, mycotic aneurysms, and systemic manifestations such as fever and encephalopathy. Other neurologic complications include nonbacterial thrombotic endocarditis, a process associated with systemic diseases such as cancer and systemic lupus erythematosus. For many of these conditions, anticoagulation is the mainstay of treatment to prevent cerebral embolism, therefore it is the potential complications of anticoagulation that can explain other neurologic complications in patients with VHD. The prevention and management of these complications requires an understanding of their natural history in order to balance the risks posed by valvular disease itself against the risks and benefits associated with treatment.

  16. Atrial Fibrillation.

    Science.gov (United States)

    Zimetbaum, Peter

    2017-03-07

    This issue provides a clinical overview of atrial fibrillation, focusing on diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  17. The atrial fibrillation ablation pilot study

    DEFF Research Database (Denmark)

    Arbelo, Elena; Brugada, Josep; Hindricks, Gerhard

    2014-01-01

    AIMS: The Atrial Fibrillation Ablation Pilot Study is a prospective registry designed to describe the clinical epidemiology of patients undergoing an atrial fibrillation (AFib) ablation, and the diagnostic/therapeutic processes applied across Europe. The aims of the 1-year follow-up were to analyse...... tachycardia, and 4 patients died (1 haemorrhagic stroke, 1 ventricular fibrillation in a patient with ischaemic heart disease, 1 cancer, and 1 of unknown cause). CONCLUSION: The AFib Ablation Pilot Study provided crucial information on the epidemiology, management, and outcomes of catheter ablation of AFib...

  18. Electrophysiological properties and the results of catheter ablation of symptomatic atrial tachyarrhythmia after surgical ablation of atrial fibrillation

    OpenAIRE

    Bockeria L.A.; Bockeria O.L.; Sergeev A.V.; Melikulov A.Kh.; Klimchuk I.Ya.; Temirbulatov I.A.; Fatulaev Z.F.

    2016-01-01

    Objective. To characterize electrophysiological properties of postablational arrhythmia and to assess shortand long-term efficacy of catheter radiofrequency ablation of these arrhythmias. Material and methods. We analyzed retrospectively 20 consecutive patients with highly symptomatic postsurgical atrial arrhythmia operated on valvular heart disease in conjunction with paroxysmal, persistent, longstanding persistent and permanent forms of atrial fibrillation during 2010–2013. Medi...

  19. Left atrial appendage occlusion with the Amplatzer Amulet for stroke prevention in atrial fibrillation: the first case in Greece.

    Science.gov (United States)

    Tzikas, Apostolos; Karagounis, Lambros; Bouktsi, Maria; Drevelegas, Antonios; Parcharidou, Despina; Ioannidis, Stathis; Krasopoulos, George; Giannakoulas, George

    2013-01-01

    Left atrial appendage (LAA) occlusion has been introduced into clinical practice as a valuable alternative to oral anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation. In this case presentation we describe the first LAA occlusion in Greece using the Amplatzer Amulet device. We also briefly discuss issues related to procedural safety and multimodality imaging for LAA occlusion.

  20. Demographics, treatment and outcomes of atrial fibrillation in a developing country: the population-based TuRkish Atrial Fibrillation (TRAF) cohort.

    Science.gov (United States)

    Yavuz, Bünyamin; Ata, Naim; Oto, Emre; Katircioglu-Öztürk, Deniz; Aytemir, Kudret; Evranos, Banu; Koselerli, Rasim; Ertugay, Emre; Burkan, Abdulkadir; Ertugay, Emrah; Gale, Christ P; Camm, A John; Oto, Ali

    2017-05-01

    Although atrial fibrillation (AF) is increasingly common in developed countries, there is limited information regarding its demographics, co-morbidities, treatments and outcomes in the developing countries. We present the profile of the TuRkish Atrial Fibrillation (TRAF) cohort which provides real-life data about prevalence, incidence, co-morbidities, treatment, healthcare utilization and outcomes associated with AF. The TRAF cohort was extracted from MEDULA, a health insurance database linking hospitals, general practitioners, pharmacies and outpatient clinics for almost 100% of the inhabitants of the country. The cohort includes 507 136 individuals with AF between 2008 and 2012 aged >18 years who survived the first 30 days following diagnosis. Of 507 136 subjects, there were 423 109 (83.4%) with non-valvular AF and 84 027 (16.6%) with valvular AF. The prevalence was 0.80% in non-valvular AF and 0.28% in valvular AF; in 2012 the incidence of non-valvular AF (0.17%) was higher than valvular AF (0.04%). All-cause mortality was 19.19% (97 368) and 11.47% (58 161) at 1-year after diagnosis of AF. There were 35 707 (7.04%) ischaemic stroke/TIA/thromboembolism at baseline and 34 871 (6.87%) during follow-up; 11 472 (2.26%) major haemorrhages at baseline and 10 183 (2.01%) during follow-up, and 44 116 (8.69%) hospitalizations during the follow-up. The TRAF cohort is the first population-based, whole-country cohort of AF epidemiology, quality of care and outcomes. It provides a unique opportunity to study the patterns, causes and impact of treatments on the incidence and outcomes of AF in a developing country.

  1. STRATEGIES OF PROPHYLAXIS AND MANAGEMENT OF POSTOPERATIVE ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    Dembele, A.

    2016-07-01

    Full Text Available This article analyses different strategies of prophylaxis and management of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting (CABG at different periods after acute myocardial infarction (AMI. It examines the efficacy of early administration of beta-adrenergic blocking agents (metoprolol and amiodarone (in prophylactic doses in the diminution of the risk of postoperative atrial fibrillation in different groups of patients. The article also discerns the effectiveness of digoxin in the management of episodes of postoperative atrial fibrillation.

  2. Cine MR imaging in valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, Tsunehiko; Yamada, Naoaki; Itoh, Akira; Miyatake, Kunio

    1989-01-01

    Cine MR Imaging was carried out using FLASH (fast low angle shot) which employes TE of 16 msec and TR of 30/similar to/40 msec. Regurgitant jet was visible as discrete area of low signal intensity extending from the incompetent valve into the respective cardiac chamber. In 20 patients with mitral regurgitation, the correlation of the length and area of mitral jet by cine MR and color doppler mapping was 0.74 and 0.71, respectively. Cine MR imaging is a promising modality for detection and quantification of valvular heart disease.

  3. Degeneración Valvular Mixomatosa

    Directory of Open Access Journals (Sweden)

    Carlos J. Mucha

    2007-07-01

    Full Text Available La degeneración valvular mixomatosa de la válvula mitral se trata de la cardiopatía adquirida mas frecuente en el perro, caracterizada por un proceso degenerativo no infeccioso de la válvula, cuyo signo patognomónico es la presencia de un soplo de regurgitación mitral. Nuestro objetivo en este trabajo es mostrar las características de esta enfermedad, su diagnostico y terapéutica,

  4. Recent advances in echocardiography for valvular heart disease.

    Science.gov (United States)

    Hahn, Rebecca

    2015-01-01

    Echocardiography is the imaging modality of choice for the assessment of patients with valvular heart disease. Echocardiographic advancements may have particular impact on the assessment and management of patients with valvular heart disease. This review will summarize the current literature on advancements, such as three-dimensional echocardiography, strain imaging, intracardiac echocardiography, and fusion imaging, in this patient population.

  5. Stress echo for evaluation of valvular heart disease

    OpenAIRE

    2014-01-01

    Resting echocardiography is the most important tool for diagnosing valvular heart disease. However, treatment planning in valvular heart diseases may require additional information in some patients, particularly asymptomatic patients with severe valve disease or symptomatic patients with moderate disease. Stress echocardiography provides invaluable information in these situations and aids decision making. Stress echocardiography is performed using either physical stress or dobutamine stress a...

  6. The role of cardiac magnetic resonance in valvular heart disease.

    Science.gov (United States)

    Lopez-Mattei, Juan C; Shah, Dipan J

    2013-01-01

    The prevalence of valvular heart disease is increasing as the population ages. In diagnosing individuals with valve disease, echocardiography is the primary imaging modality used by clinicians both for initial assessment and for longitudinal evaluation. However, in some cases cardiovascular magnetic resonance has become a viable alternative in that it can obtain imaging data in any plane prescribed by the scan operator, which makes it ideal for accurate investigation of all cardiac valves: aortic, mitral, pulmonic, and tricuspid. In addition, CMR for valve assessment is noninvasive, free of ionizing radiation, and in most instances does not require contrast administration. The objectives of a comprehensive CMR study for evaluating valvular heart disease are threefold: (1) to provide insight into the mechanism of the valvular lesion (via anatomic assessment), (2) to quantify the severity of the valvular lesion, and (3) to discern the consequences of the valvular lesion.

  7. Persistent reduction in left ventricular strain using two-dimensional speckle-tracking echocardiography after balloon valvuloplasty in children with congenital valvular aortic stenosis.

    NARCIS (Netherlands)

    Marcus, K.A.; Korte, C.L. de; Feuth, T.; Thijssen, J.M.; Oort, A.M. van; Tanke, R.B.; Kapusta, L.

    2012-01-01

    BACKGROUND: The aim of this study was to investige serial changes of myocardial deformation using two-dimensional speckle-tracking echocardiographic (2DSTE) imaging in children undergoing balloon valvuloplasty for congenital valvular aortic stenosis (VAS). METHODS: Thirty-seven children with isolate

  8. Double-valve Libman-Sacks endocarditis causing ventricular fibrillation cardiac arrest.

    Science.gov (United States)

    Tanawuttiwat, Tanyanan; Dia, Muhyaldeen; Hanif, Tabassum; Mihailescu, Mihaela

    2011-01-01

    Libman-Sacks endocarditis is a well-known and rather common cardiac manifestation of systemic lupus erythematosus. Transesophageal and transthoracic echocardiography are the definitive imaging methods used to evaluate cardiac valvular involvement in this disease. Valvular masses (vegetations) and valvular thickening are 2 common morphologic echocardiographic patterns. Libman-Sacks lesions are typically characterized by single-valve involvement and their small size of 1 to 4 mm.Herein, we present the unusual case of a 22-year-old woman with newly diagnosed systemic lupus erythematosus who had large, sterile vegetations of Libman-Sacks endocarditis that involved the mitral and aortic valves. This compromised coronary blood flow and resulted in ventricular fibrillation cardiac arrest. The vegetations were surgically excised, and the patient's cardiac function recovered. We discuss the treatment of the patient and that of Libman-Sacks endocarditis.

  9. Atrial fibrillation and survival in colorectal cancer

    Directory of Open Access Journals (Sweden)

    Justin Timothy A

    2004-11-01

    Full Text Available Abstract Background Survival in colorectal cancer may correlate with the degree of systemic inflammatory response to the tumour. Atrial fibrillation may be regarded as an inflammatory complication. We aimed to determine if atrial fibrillation is a prognostic factor in colorectal cancer. Patients and methods A prospective colorectal cancer patient database was cross-referenced with the hospital clinical-coding database to identify patients who had underwent colorectal cancer surgery and were in atrial fibrillation pre- or postoperatively. Results A total of 175 patients underwent surgery for colorectal cancer over a two-year period. Of these, 13 patients had atrial fibrillation pre- or postoperatively. Atrial fibrillation correlated with worse two-year survival (p = 0.04; log-rank test. However, in a Cox regression analysis, atrial fibrillation was not significantly associated with survival. Conclusion The presence or development of atrial fibrillation in patients undergoing surgery for colorectal cancer is associated with worse overall survival, however it was not found to be an independent factor in multivariate analysis.

  10. Left ventricular diastolic dysfunction and N-terminal probrain sodium-uretic peptid level in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Dzyak G.V.

    2013-06-01

    Full Text Available In our study 100 consecutive non-valvular permanent atrial fibrillation patients with NYHA I – III heart failure, 43 - 86 years old (65 men and 35 women were examined. Control group consisted of 30 patients with arterial hypertension and coronary artery disease matched by age, sex with basic group. Relationship of NT-proBNP with echocardiographic parameters of left heart were studied. Transthoracic echocardiography with tissue doppler measurements were performed on echocardiograph “SONOS 7500”. For left ventricular filling pressure assessment ratio Em/Ea was used due to its diagnostic value in atrial fibrillation (regardless of left ventricular ejection fraction. Mean left ventricular filling pressure was increased in patients with heart failure: in atrial fibrillation group and controls as well. In comparison with controls atrial fibrillation group was more likely to have higher both systolic and diastolic left atrial square and volume. According to Em/Ea in 95% of patients with non-valvular atrial fibrillation high left ventricular filling pressure was observed, this testifies to diastolic dysfunction. This parameter correlated well with left atrial square and volume during systole and diastole. Correlation between NT pro-BNP level and NYHA class of heart failure, left ventricular filling pressure was determined in patients with atrial fibrillation. Tissue doppler echocardiography makes it possible to diagnose left ventricular diastolic dysfunction in atrial fibrillation patients.

  11. Three-dimensional Echocardiography in Valvular Heart Disease.

    Science.gov (United States)

    Kurklinsky, Andrew; Mankad, Sunil

    2012-01-01

    Recent technologic advances in 3-dimensional (3D) echocardiography, using parallel processing to scan a pyramidal volume, have allowed for a superior ability to describe valvular anatomy using both transthoracic and transesophageal echocardiography. Although still in evolution and at an early phase of adaptation with respect to its clinical application, 3D echocardiography has emerged as an important clinical tool in the assessment of valvular heart disease. Three-dimensional echocardiography provides unique perspectives of valvular structures by presenting "en face" views of valvular structures, allowing for a better understanding of the topographical aspects of pathology, and a refined definition of the spatial relationships of intracardiac structures. Three-dimensional echocardiography makes available indices not described by 2D echocardiography and has been demonstrated to be superior to 2D echocardiography in a variety of valvular disease scenarios. The information gained from 3D echocardiography has especially made an impact in guiding clinical decisions in the evaluation of mitral valve (MV) disease. The decision of early surgery in degenerative MV disease is based on the suitability of repair, and the suitability of repair is generally based on echocardiography. The superior understanding of MV anatomy afforded by 3D echocardiography has been shown to be quite valuable in this setting. This review will describe the contemporary use of 3D echocardiography in the assessment of valvular heart disease, including MV, aortic, tricuspid, and prosthetic valve abnormalities. This article illustrates how 3D echocardiography can complement current echocardiography techniques in the management of valvular heart disease.

  12. Enfermedad valvular degenerativa canina: reporte de caso

    Directory of Open Access Journals (Sweden)

    Carmenza Janneth Benavides Melo

    2014-07-01

    Full Text Available En caninos, la enfermedad valvular degenerativa o endocardiosis es la patología cardiovascular con mayor prevalencia. Se caracteriza por regurgitación de la sangre hacia las aurículas, con disminución del gasto cardiaco, lo que lleva a sobrecarga de volumen con hipertrofia excéntrica e insuficiencia cardiaca congestiva. Este reporte tiene como objetivo describir los hallazgos clínicos y de necropsia de un canino, sugestivos de una endocardiosis valvular. El paciente ingresó por consulta externa a la Clínica Veterinaria Carlos Martínez Hoyos, de la Universidad de Nariño (Pasto, Colombia. Su propietario lo reportó enfermo desde hacía dos meses, con signos de enfermedad respiratoria, pérdida de peso y decaimiento. En el examen clínico se encontraron membranas mucosas muy pálidas, disnea inspiratoria, estertores, desdoblamiento de S2, soplo de regurgitación mesosistólico grado 4 y dilatación abdominal con signo de choque de onda positivo. En la necropsia se evidenció abundante cantidad de material de aspecto acuoso traslúcido en cavidad abdominal, torácica y pericárdica, corazón severamente aumentado de tamaño, redondeado, con engrosamiento de válvulas atrioventriculares, hígado con moderada disminución de tamaño y evidencia de lobulillación, riñones severamente disminuidos de tamaño y pálidos de superficie irregular con presencia de múltiples áreas quísticas en región corticomedular. Se tomaron muestras de estos tejidos y se fijaron en formol bufferado al 10 %, para después ser procesadas para análisis histopatólogico en el Laboratorio de Patología de la Universidad de Nariño, mediante la técnica de hematoxilina y eosina de rutina. De esta manera se diagnostica como enfermedad valvular degenerativa.

  13. Acute peritonitis as the first presentation of valvular cardiomyopathy.

    LENUS (Irish Health Repository)

    Higgins, Nikki

    2012-02-01

    Valvular cardiomyopathy can present a diagnostic challenge in the absence of overt cardiac symptoms. This report describes the case of a 46-year-old woman who presented with acute peritonitis associated with vomiting and abdominal distension. Subsequent abdominal computed tomography and ultrasound revealed bibasal pleural effusions, ascites, and normal ovaries. An echocardiogram revealed that all cardiac chambers were dilated with a global decrease in contractility and severe mitral, tricuspid, and aortic regurgitation. A diagnosis of cardiomyopathy with acute heart failure, secondary to valvular heart disease, was secured. Acute peritonitis as the presenting feature of valvular cardiomyopathy is a rare clinical entity.

  14. Antithrombotic Treatment Regimens in Atrial Fibrillation Patients after Percutaneous Coronary Intervention%置入冠状动脉支架的心房颤动患者抗栓治疗方案的研究进展

    Institute of Scientific and Technical Information of China (English)

    张博阳; 王楠楠; 刘鹏飞(综述); 李田昌(审校)

    2016-01-01

    Clinical guidelines recommended the long-term use of vitamin K antagonists for non-valvular atrial fibrillation patients whose CHA 2 DS-VAS C scores greater than 1.When these patients undergo percutaneous coronary intervention with stenting ,treatment with as-pirin and a P 2 Y 12 receptor inhibitor also becomes indicated .However the methods of ,how to balance the antithrombotic therapy and prevent the risk of bleeding in non-valvular atrial fibrillation patients with coronary heart disease after coronary intervention is still lack of uniform standards and recommendationsed .The aim of this article is to reviews the current new clinical research and provides the basis for the next study.%指南推荐CHA 2 DS-VAS C 评分>1分的非瓣膜性心房颤动患者长期使用抗凝药物,冠心病进行冠状动脉介入术治疗后,联合使用阿司匹林和P2Y12受体拮抗剂抗血小板至少1年。非瓣膜性心房颤动伴冠心病并接受冠状动脉介入术治疗后如何兼顾抗栓治疗与预防出血风险尚缺乏统一的规范和推荐。现就目前的相关研究做一综述,对进一步的研究提供依据。

  15. Analysis of risk factors in male patients with intraoperative ventricular fibrillation undergoing off-pump coronary artery bypass grafting%男性患者非体外循环冠状动脉旁路移植术中心室颤动危险因素分析

    Institute of Scientific and Technical Information of China (English)

    金沐; 李书闻; 卢家凯; 程卫平

    2013-01-01

    目的 分析1516例施行非体外循环冠状动脉旁路移植术(OPCABG)的男性患者术中心室颤动发生的危险因素.方法 回顾性分析麻醉科2007年11月至2009年2月1516例记录齐全的男性患者OPCABG围术期资料.以术中发生心室颤动为因变量,将有统计学意义的单因素进行Logistic回归分析,并用Logistic回归分析模型评价各影响因素的作用大小.结果 全组患者术中发生心室颤动24例(1.6%),无一例死亡.术前左心室射血分数(LVEF)< 40%(P<0.01,OR=17.182)、搭桥数>3支(P <0.05,OR=3.233)和术中发生心房颤动(P<0.01,OR=24.979)为术中发生心室颤动的独立危险因素.结论 患者术前左心室功能差(LVEF <40%)、冠状动脉搭桥支数大于3支和术中发生心房颤动与OPCABG手术中发生心室颤动密切相关.%Objective To analyze the risk factors of intraoperative ventricular fibrillation in male patients undergoing off-pump coronary artery bypass grafting (OPCABG).Methods The perioperative data of 1516 male patients undergoing OPCABG were investigated based on the perioperative OPCABG database from Nov.2007 to Feb.2009.The risk factors were identified by multiple logistic regression.Results 24 patients (1.6%) were suffered from intraoperative ventricular fibrillation and no patient died during OPCABG.Multivariate analysis demonstrated that preoperative ejection fraction (LVEF) less than 40% (P < 0.01,OR =17.182),more than 3 grafts (P < 0.05,OR =3.233) and intraoperative atrial fibrillation (P < 0.01,OR =24.979) were the independent risk factors of intraoperative ventricular fibrillation in male patients undergoing off-pump coronary artery bypass grafting.Conclusion This study shows LVEF less than 40%,more than 3 grafts and intraoperative atrial fibrillation are predominant factors of intraoperative ventricular fibrillation during OPCABG.

  16. [Prevalence of atrial fibrillation among patients under observation by an outpatient clinic].

    Science.gov (United States)

    Bulanova, N A; Stazhadze, L L; Alekseeva, L A; Dubrovina, E V; Dorofeeva, E V

    2011-01-01

    Prevalence of atrial fibrillation among patients attending our policlinic (2.44 and 3.78% in 2002 and 2009, respectively) was higher among men than among women and progressively increased with age achieving maximum in the group of patients aged more or equal 85 years. Paroxysmal and persistent forms were more frequent than permanent AF. Thromboembolic complications, heart failure and valvular heart disease were to a greater degree characteristic of permanent AF.

  17. [Spontaneous return of sinus rhythm in mitralic fibrillation of long duration (author's transl)].

    Science.gov (United States)

    Vincenzi, M; Cappelletti, F; Maiolino, P; Morlino, T; Ometto, R

    1976-01-01

    A case of mitral valvular disease in which spontaneous return of sinus rhythm occurred after 12 years of atrial fibrillation is reported. The course of the disease, complicated by A.V. and intraventricular conduction disturbances which made the insertion of a pacemaker necessary, suggests that return to sinus rhythm should not be considered necessarily an improvement in the clinical picture and in the prognosis in such patients.

  18. Aspirin versus warfarin in atrial fibrillation: decision analysis may help patients' choice.

    LENUS (Irish Health Repository)

    Romero-Ortuno, Roman

    2012-03-01

    the primary prevention of ischaemic stroke in chronic non-valvular atrial fibrillation (AF) typically involves consideration of aspirin or warfarin. CHA(2)DS(2)-VASc estimates annual stroke rates for untreated AF patients, which are reduced by 60% with warfarin and by 20% with aspirin. HAS-BLED estimates annual rates of major bleeding on warfarin. The latter risk with aspirin is 0.5-1.2% per year.

  19. Intrathecal Fentanyl for Labour Analgesia in a Patient with Severe Mitral Stenosis and Atrial Fibrillation in Advanced Stage of Labour-Case Report

    Directory of Open Access Journals (Sweden)

    Vaijayanti Nitin Gadre

    2013-12-01

    Full Text Available Labour is an intensely painful experience and puts considerable physiological stress on the circulation. A case of rheumatic valvular heart disease with severe mitral stenosis in atrial fibrillation is discussed here in which analgesia with intrathecal fentanyl proved beneficial given during the advanced first stage of labour.

  20. Ischaemic and haemorrhagic stroke associated with non-vitamin K antagonist oral anticoagulants and warfarin use in patients with atrial fibrillation

    DEFF Research Database (Denmark)

    Staerk, Laila; Fosbøl, Emil Loldrup; Lip, Gregory Y H;

    2017-01-01

    BACKGROUND: Non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) are widely used as stroke prophylaxis in non-valvular atrial fibrillation (AF), but comparative data are sparse. PURPOSE: To compare dabigatran, rivaroxaban, and apixaban vs. VKA and the risk of stroke/thromboembolism (TE...

  1. Intrathecal Fentanyl for Labour Analgesia in a Patient with Severe Mitral Stenosis and Atrial Fibrillation in Advanced Stage of Labour-Case Report

    OpenAIRE

    Vaijayanti Nitin Gadre

    2013-01-01

    Labour is an intensely painful experience and puts considerable physiological stress on the circulation. A case of rheumatic valvular heart disease with severe mitral stenosis in atrial fibrillation is discussed here in which analgesia with intrathecal fentanyl proved beneficial given during the advanced first stage of labour.

  2. Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation: A net clinical benefit analysis using a 'real world' nationwide cohort study

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Lip, Gregory Y H; Lindhardsen, Jesper

    2011-01-01

    It was the aim of this study to determine the efficacy and safety of vitamin K antagonists (VKAs) and acetylsalicylic acid (ASA) in patients with non-valvular atrial fibrillation (AF), with separate analyses according to predicted thromboembolic and bleeding risk. By individual level...

  3. Genetics Home Reference: X-linked cardiac valvular dysplasia

    Science.gov (United States)

    ... my area? Other Names for This Condition congenital valvular heart disease CVD1 filamin-A-associated myxomatous mitral valve disease ... Valves (image) Encyclopedia: Mitral Valve Prolapse Health Topic: Heart Valve Diseases Health Topic: Mitral Valve Prolapse Genetic and Rare ...

  4. Amyloid Fibril Solubility

    CERN Document Server

    Rizzi, L G

    2015-01-01

    It is well established that amyloid fibril solubility is protein specific, but how solubility depends on the interactions between the fibril building blocks is not clear. Here we use a simple protein model and perform Monte Carlo simulations to directly measure the solubility of amyloid fibrils as a function of the interaction between the fibril building blocks. Our simulations confirms that the fibril solubility depends on the fibril thickness and that the relationship between the interactions and the solubility can be described by a simple analytical formula. The results presented in this study reveal general rules how side-chain side-chain interactions, backbone hydrogen bonding and temperature affect amyloid fibril solubility, which might prove a powerful tool to design protein fibrils with desired solubility and aggregation properties in general.

  5. Exercise Testing and Stress Imaging in Valvular Heart Disease.

    OpenAIRE

    Henri, Christine; Pierard, Luc; Lancellotti, Patrizio; Mongeon, Francois-Pierre; Pibarot, Philippe; Basmadjian, Arsene J.

    2014-01-01

    The role of exercise testing and stress imaging in the management of patients with valvular heart disease (VHD) is reviewed in this article. The American College of Cardiology/American Heart Association and the European Society of Cardiology/European Association of Cardiothoracic Surgery have recently put emphasis on the role of exercise testing to clarify symptom status and the use of stress imaging to assess the dynamic component of valvular abnormalities and unmask subclinical myocardial d...

  6. [Prevention of brain infarction in patients with atrial fibrillation].

    Science.gov (United States)

    Ogata, Toshiyasu; Yasaka, Masahiro

    2007-01-01

    The patients with cardioembolic stroke sometimes suffer from severe neurological deficit and from recurrent strokes. Since atrial fibrillation, especially non-valvular atrial fibrillation (NVAF) is associated with over half of the cardioembolic strokes, the prevention of cardioembolic stroke in patients with NVAF is important. There have been some reports about how to prevent stroke. They have indicated that the best medication for preventing from stroke was anticoagulation by warfarin. Therefore, the guidelines recommended the patients with NVAF to take warfarin. In case with the older patients under 70 years, prothrombin international normalized ratio (PT-INR) should be kept from 2.0 to 3.0. On the other hand, if the patients with NVAF are over 70 years, PT-INR has to be controlled from 1.6 to 2.6. Before extraction of a tooth, anticoagulation should not be call off.

  7. [Prevention of brain infarction in patients with atrial fibrillation].

    Science.gov (United States)

    Ogata, Toshiyasu; Yasaka, Masahiro

    2007-01-01

    The patients with cardioembolic stroke sometimes suffer from severe neurological deficit and from recurrent strokes. Since atrial fibrillation, especially non-valvular atrial fibrillation (NVAF) is associated with over half of the cardioembolic strokes, the prevention of cardioembolic stroke in patients with NVAF is important. There have been some reports about how to prevent stroke. They have indicated that the best medication for preventing from stroke was anticoagulation by warfarin. Therefore, the guidelines recommended the patients with NVAF to take warfarin. In case with the older patients under 70 years, prothrombin international normalized ratio (PT-INR) should be kept from 2.0 to 3.0. On the other hand, if the patients with NVAF are over 70 years, PT-INR has to be controlled from 1.6 to 2.6. Before extraction of a tooth, anticoagulation should not be call off.

  8. [Obesity as a risk factor for atrial fibrillation].

    Science.gov (United States)

    Duraj, Iwona; Broncel, Marlena

    2016-01-01

    Atrial fibrillation (AF) and obesity is a growing problem of public health both in Poland and in the whole world. AF risk factors may be summarized as elderliness, male sex, smoking, hypertension, diabetes, obesity, coronary heart disease, heart failure, valvular heart disease, cardiac surgery. Once obesity is an independent, potentially modifiable risk factor for AF. The connection between obesity and atrial fibrillation is very up-to-date because of incremental prevalence, almost epidemic of obesity in the whole world. The probability of AF among obese patients increases with concomitant obstructive sleep apnea. Regardless many researches it hasn't been assessed yet how obesity itself predisposes to AF. It could be an effect of change in the atrial anatomy, the rise of atrial pressure, mechanical stretch, interstitial atrial fibrosis and disruption of atrial electric integrity. A great role is ascribed to inflammation, especially proinflammatory cytokines increased by adipocites of left atrial epicardial adiposity.

  9. Effect of prophylactic amiodarone in patients with rheumatic valve disease undergoing valve replacement surgery

    Directory of Open Access Journals (Sweden)

    Kar Sandeep

    2011-01-01

    Full Text Available The study was carried out to evaluate the effect of prophylactic single-dose intravenous amiodarone in patients undergoing valve replacement surgery. Maintenance of sinus rhythm is better than maintenance of fixed ventricular rate in atrial fibrillation (AF especially in the presence of irritable left or right atrium because of enlargement. Fifty-six patients with valvular heart disease with or without AF were randomly divided into two groups. Group I or the amiodarone group (n=28 received amiodarone (3 mg/kg in 100 ml normal saline and group II or the control group received same volume of normal saline. The standardized protocol for cardiopulmonary bypass was maintained for all the patients. AF occurred in 7.14% patients in group I, and in group II, 28.57% (P=0.035; ventricular tachycardia/fibrillation was observed in 21.43% patients in group I and 46.43% patients in group II (P=0.089 after release of aortic clamp. Most of the patients in group I (92.86% maintained sinus rhythm without cardioversion or defibrillation after release of aortic cross clamp (P=0.002. Defibrillation or cardio version was needed in 7.14% patients in group I and 28.57% patients in group II (P=0.078. A single prophylactic intraoperative dose of intravenous amiodarone decreased post bypass arrhythmia in this study in comparison to the control group. Single dose of intraoperative amiodarone may be used to decrease postoperative arrhythmia in open heart surgery.

  10. Advanced imaging in valvular heart disease.

    Science.gov (United States)

    Bax, Jeroen J; Delgado, Victoria

    2017-04-01

    Although echocardiography remains the mainstay imaging technique for the evaluation of patients with valvular heart disease (VHD), innovations in noninvasive imaging in the past few years have provided new insights into the pathophysiology and quantification of VHD, early detection of left ventricular (LV) dysfunction, and advanced prognostic assessment. The severity grading of valve dysfunction has been refined with the use of Doppler echocardiography, cardiac magnetic resonance (CMR), and CT imaging. LV ejection fraction remains an important criterion when deciding whether patients should be referred for surgery. However, echocardiographic strain imaging can now detect impaired LV systolic function before LV ejection fraction reduces, thus provoking the debate on whether patients with severe VHD should be referred for surgery at an earlier stage (before symptom onset). Impaired LV strain correlates with the amount of myocardial fibrosis detected with CMR techniques. Furthermore, accumulating data show that the extent of fibrosis associated with severe VHD has important prognostic implications. The present Review focuses on using these novel imaging modalities to assess pathophysiology, early LV dysfunction, and prognosis of major VHDs, including aortic stenosis, mitral regurgitation, and aortic regurgitation.

  11. High sensitivity troponin and valvular heart disease.

    Science.gov (United States)

    McCarthy, Cian P; Donnellan, Eoin; Phelan, Dermot; Griffin, Brian P; Sarano, Maurice Enriquez-; McEvoy, John W

    2017-01-16

    Blood-based biomarkers have been extensively studied in a range of cardiovascular diseases and have established utility in routine clinical care, most notably in the diagnosis of acute coronary syndrome (e.g., troponin) and the management of heart failure (e.g., brain-natriuretic peptide). The role of biomarkers is less well established in the management of valvular heart disease (VHD), in which the optimal timing of surgical intervention is often challenging. One promising biomarker that has been the subject of a number of recent VHD research studies is high sensitivity troponin (hs-cTn). Novel high-sensitivity assays can detect subclinical myocardial damage in asymptomatic individuals. Thus, hs-cTn may have utility in the assessment of asymptomatic patients with severe VHD who do not have a clear traditional indication for surgical intervention. In this state-of-the-art review, we examine the current evidence for hs-cTn as a potential biomarker in the most commonly encountered VHD conditions, aortic stenosis and mitral regurgitation. This review provides a synopsis of early evidence indicating that hs-cTn has promise as a biomarker in VHD. However, the impact of its measurement on clinical practice and VHD outcomes needs to be further assessed in prospective studies before routine clinical use becomes a reality.

  12. European Association of Echocardiography recommendations for the assessment of valvular regurgitation. Part 1: Aortic and pulmonary regurgitation (native valve disease)

    NARCIS (Netherlands)

    P. Lancellotti (Patrizio); C. Tribouilloy (Christophe); A. Hagendorff (Andreas); L. Moura (Luis); B.A. Popescu (Bogdan); E. Agricola (Eustachio); J.L. Monin; L. Pié rard (Luc); L. Badano (Luigi); J.L. Zamorano (Jose); R. Sicari (Rosa); A. Vahanian (Alec); J.R.T.C. Roelandt (Jos)

    2010-01-01

    textabstractValvular regurgitation represents an important cause of cardiovascular morbidity and mortality. Echocardiography has become the primary non-invasive imaging method for the evaluation of valvular regurgitation. The echocardiographic assessment of valvular regurgitation should integrate qu

  13. Association Between Valvular Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Heart Failure

    Science.gov (United States)

    Kiefer, Todd; Park, Lawrence; Tribouilloy, Christophe; Cortes, Claudia; Casillo, Roberta; Chu, Vivian; Delahaye, Francois; Durante-Mangoni, Emanuele; Edathodu, Jameela; Falces, Carlos; Logar, Mateja; Miró, José M.; Naber, Christophe; Tripodi, Marie Françoise; Murdoch, David R.; Moreillon, Philippe; Utili, Riccardo; Wang, Andrew

    2016-01-01

    Context Heart failure (HF) is the most common complication of infective endocarditis. However, clinical characteristics of HF in patients with infective endocarditis, use of surgical therapy, and their associations with patient outcome are not well described. Objectives To determine the clinical, echocardiographic, and microbiological variables associated with HF in patients with definite infective endocarditis and to examine variables independently associated with in-hospital and 1-year mortality for patients with infective endocarditis and HF, including the use and association of surgery with outcome. Design, Setting, and Patients The International Collaboration on Endocarditis–Prospective Cohort Study, a prospective, multicenter study enrolling 4166 patients with definite native- or prosthetic-valve infective endocarditis from 61 centers in 28 countries between June 2000 and December 2006. Main Outcome Measures In-hospital and 1-year mortality. Results Of 4075 patients with infective endocarditis and known HF status enrolled, 1359 (33.4% [95% CI, 31.9%–34.8%]) had HF, and 906 (66.7% [95% CI, 64.2%–69.2%]) were classified as having New York Heart Association class III or IV symptom status. Within the subset with HF, 839 (61.7% [95% CI, 59.2%–64.3%]) underwent valvular surgery during the index hospitalization. In-hospital mortality was 29.7% (95% CI, 27.2%–32.1%) for the entire HF cohort, with lower mortality observed in patients undergoing valvular surgery compared with medical therapy alone (20.6% [95% CI, 17.9%–23.4%] vs 44.8% [95% CI, 40.4%–49.0%], respectively; Pendocarditis complicated by HF, severity of HF was strongly associated with surgical therapy and subsequent mortality, whereas valvular surgery was associated with lower in-hospital and 1-year mortality. PMID:22110106

  14. Atrial Ectopics Precipitating Atrial Fibrillation

    OpenAIRE

    Johnson Francis

    2015-01-01

    Holter monitor tracing showing blocked atrial ectopics and atrial ectopic precipitating atrial fibrillation is being demonstrated. Initially it was coarse atrial fibrillation, which rapidly degenerated into fine atrial fibrillation.

  15. Valvular heart disease: classic teaching and emerging paradigms.

    Science.gov (United States)

    Brinkley, D Marshall; Gelfand, Eli V

    2013-12-01

    Valvular heart disease is both prevalent and increases with age. The final pathway of valvular disease is heart failure and sometimes sudden death, so clinicians must identify and treat it before these endpoints occur. Noninvasive diagnostic modalities such as echocardiography, exercise tolerance testing, and cardiac magnetic resonance provide additional quantitative, qualitative, and prognostic data. Studies have elucidated predictors of disease progression and potential medical therapies, but the niche of valvular disease has benefited relatively less from randomized controlled clinical trials than other cardiovascular disease fields. New invasive techniques like transcatheter valve replacement offer hope for high-risk operative candidates. We review classic teaching with current guidelines and emphasize recent advances in disease management.

  16. Gated blood pool scintigraphy in patients with valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Breuel, H.P.; Heusinger, J.H.; Hanisch, K.

    1984-10-01

    In 58 patients suffering from either stenosis or insufficiency of a single heart valve, gated blood pool scintigraphy was performed to determine the ejection fraction as well as the peak filling and peak ejection rates. It could be demonstrated that in patients with valvular disorders the ejection fraction was only moderately decreased, generally remaining in the lower reference range. The peak filling and ejection rates showed no pathologic changes with the exception of patients with aortic regurgitation where these rates were significantly decreased. Thus, the estimation of left ventricular peak filling and ejection rates may permit diagnosis of myocardial impairment in patients with valvular disease even under resting conditions.

  17. [Valvular heart disease: preoperative assessment and postoperative care].

    Science.gov (United States)

    Nägele, Reto; Kaufmann, Beat A

    2013-10-30

    Patients with valvular heart disease or with a prosthetic heart valve replacement are seen with increasing frequency in clinical practice. The medical care and evaluation of patients with valvular heart disease before valve surgery, but also the post-operative treatment is complex and managed by general practitioners, cardiologists and cardiac surgeons. In this mini-review we will first discuss the preoperative assessment of the two most common valvulopathies, aortic stenosis and mitral regurgitation. Then we will discuss the post-operative care, which includes the management of anticoagulation, serial follow up and as well as the diagnostic assessment of complications such as thromboembolism, hemolysis, endocarditis and valve dysfunction.

  18. Stress echocardiography in valvular heart disease: a current appraisal.

    Science.gov (United States)

    Naji, Peyman; Patel, Krishna; Griffin, Brian P; Desai, Milind Y

    2015-03-01

    Stress echocardiography is increasingly used in the management of patients with valvular heart disease and can aid in evaluation, risk stratification and clinical decision making in these patients. Evaluation of symptoms, exercise capacity and changes in blood pressure can be done during the exercise portion of the test, whereas echocardiographic portion can reveal changes in severity of disease, pulmonary artery pressure and left ventricular function in response to exercise. These parameters, which are not available at rest, can have diagnostic and prognostic importance. In this article, we will review the indications and diagnostic implications, prognostic implications, and clinical impact of stress echocardiography in decision making and management of patients with valvular heart disease.

  19. [Valvular heart disease in patients with anti-phospholipid syndrome].

    Science.gov (United States)

    Muñoz-Rodríguez, F J; Reverter Calatayud, J C; Font Franco, J; Espinosa Garriga, G; Tàssies Penella, D; Ingelmo Morin, M

    2002-10-01

    Anti-phospholipid antibodies (APA) may involve heart and valvular heart disease seems to be the most common clinical manifestation. To study the prevalence and characteristics of valvular heart disease in a large patient population with anti-phospholipid syndrome (APS) and also to analyze the clinical and immunological profile of patients with valvular involvement compared with those without involvement. Patients and methods. Retrospective analysis of 113 patients diagnosed of APS. Eighty-one percent were females and the mean age was 39 years (SD:14). Sixty-two percent of patients were diagnosed of primary APS (70 patients) and the remaining 38% (43 patients) corresponded to patients with APS associated with systemic lupus erythematosus (SLE). The median follow-up of patients was 55 months (range: 7-144 months). The cardiologic assessment was performed by means of transthoracic echocardiogram. The study of anti-lupus anticoagulant (AL) was performed by means of coagulometric assays and measurement of anticardiolipin antibodies (aCL), anti-beta2 glycoprotein I (abeta2-PGI) and anti-prothrombin (aPT) by ELISA. The prevalence of valvular heart disease was 19%. The mitral valve was mostly involved (91%) and the most common structural abnormality corresponded to mitral insufficiency. Valvular replacement was required in 24% of patients. In the subgroup of patients with valvular heart disease, a significantly higher prevalence was observed in the following parameters: total thrombosis (71% versus 49%; p = 0.05), arterial thrombosis (57% versus 23%; p = 0.002), stroke (38% versus 13%; p = 0.01), trombocitopenia (71% versus 45%; p = 0.02), hemolytic anemia (29% versus 9%; p = 0.02), and livedo reticularis (48% versus 3%; p < 0.0001). As for immunological differences, only a higher prevalence of LA was found (81% versus 59%; p= 0.04) and abeta2-GPI (IgG isotype) (43% versus 22%; p = 0.05) in patients with valvular heart disease. Valvular heart disease is more frequent in pa

  20. Fish oil and postoperative atrial fibrillation: the Omega-3 Fatty Acids for Prevention of Post-operative Atrial Fibrillation (OPERA) randomized trial.

    Science.gov (United States)

    Mozaffarian, Dariush; Marchioli, Roberto; Macchia, Alejandro; Silletta, Maria G; Ferrazzi, Paolo; Gardner, Timothy J; Latini, Roberto; Libby, Peter; Lombardi, Federico; O'Gara, Patrick T; Page, Richard L; Tavazzi, Luigi; Tognoni, Gianni

    2012-11-21

    Postoperative atrial fibrillation or flutter (AF) is one of the most common complications of cardiac surgery and significantly increases morbidity and health care utilization. A few small trials have evaluated whether long-chain n-3-polyunsaturated fatty acids (PUFAs) reduce postoperative AF, with mixed results. To determine whether perioperative n-3-PUFA supplementation reduces postoperative AF. The Omega-3 Fatty Acids for Prevention of Post-operative Atrial Fibrillation (OPERA) double-blind, placebo-controlled, randomized clinical trial. A total of 1516 patients scheduled for cardiac surgery in 28 centers in the United States, Italy, and Argentina were enrolled between August 2010 and June 2012. Inclusion criteria were broad; the main exclusions were regular use of fish oil or absence of sinus rhythm at enrollment. Patients were randomized to receive fish oil (1-g capsules containing ≥840 mg n-3-PUFAs as ethyl esters) or placebo, with preoperative loading of 10 g over 3 to 5 days (or 8 g over 2 days) followed postoperatively by 2 g/d until hospital discharge or postoperative day 10, whichever came first. Occurrence of postoperative AF lasting longer than 30 seconds. Secondary end points were postoperative AF lasting longer than 1 hour, resulting in symptoms, or treated with cardioversion; postoperative AF excluding atrial flutter; time to first postoperative AF; number of AF episodes per patient; hospital utilization; and major adverse cardiovascular events, 30-day mortality, bleeding, and other adverse events. At enrollment, mean age was 64 (SD, 13) years; 72.2% of patients were men, and 51.8% had planned valvular surgery. The primary end point occurred in 233 (30.7%) patients assigned to placebo and 227 (30.0%) assigned to n-3-PUFAs (odds ratio, 0.96 [95% CI, 0.77-1.20]; P = .74). None of the secondary end points were significantly different between the placebo and fish oil groups, including postoperative AF that was sustained, symptomatic, or treated (231

  1. Aortic stenosis and mitral regurgitation as predictors of atrial fibrillation during 11 years of follow-up

    Directory of Open Access Journals (Sweden)

    Widgren Veronica

    2012-10-01

    Full Text Available Abstract Background There is limited information about any association between the onset of atrial fibrillation (AF and the presence of valvular disease. Methods We retrospectively examined 940 patients in sinus rhythm, examined by echocardiography in 1996. During 11 years of follow-up, we assessed the incidence of AF and outcome defined as valvular surgery or death, in relation to baseline valvular function. AS (aortic stenosis severity at baseline examination was assessed using peak transaortic valve pressure gradient. Results In univariate analysis, the risk of developing AF was related to AS (significant AS versus no significant AS; hazard ratio (HR 3.73, 95% confidence interval (CI 2.39-5.61, p Conclusions AS, but not MR, was independently predictive of development of AF and combined valvular surgery or death. In patients with combined AS and MR, the grade of AS, more than the grade of MR, determined the risk of AF and combination of valvular surgery or death. Further studies using contemporary echocardiographic quantification of aortic stenosis are warranted to confirm these retrospective data based on peak transaortic valve pressure gradient.

  2. Fibrilación auricular en el postoperatorio de cirugía cardíaca: Prevalencia y tiempo de internación Atrial fibrillation in postoperative cardiac surgery: Prevalence and hospitalized period

    Directory of Open Access Journals (Sweden)

    Alejandro E. Contreras

    2010-08-01

    Full Text Available La fibrilación auricular es el trastorno del ritmo más frecuente luego de la cirugía cardíaca. En estudios previos se ha asociado a prolongación de la internación, aumento en los costos e incremento en la mortalidad. El objetivo de este estudio fue conocer la prevalencia de fibrilación auricular en el postoperatorio de cirugía cardíaca y determinar el efecto en el tiempo de estadía hospitalaria. Se analizaron retrospectivamente las historias clínicas de pacientes sometidos a cirugía cardíaca consecutivamente (de revascularización miocárdica, valvulares o ambas entre enero 2006 y noviembre 2008. El punto final evaluado en el postoperatorio fue la presencia de fibrilación auricular. Se dividió a la muestra en dos grupos según tuvieran o no fibrilación auricular, y se compararon las variables clínicas y el tiempo de estadía hospitalaria. Ciento setenta y dos pacientes fueron operados en este período. Se excluyeron del análisis siete pacientes por falta de datos. La edad media fue 64.2 ± 9.5 años, con predominio del sexo masculino. La fibrilación auricular fue la complicación más frecuente (23.6%. El tiempo promedio de internación fue 6.7 ± 4.6 días. No hubo diferencias relevantes al comparar la estadía hospitalaria entre los grupos con o sin fibrilación auricular, 7.5 ± 4.1 días vs. 6.5 ± 4.7 días respectivamente, p = 0.21. La presencia de fibrilación auricular no prolongó la hospitalización. Probablemente una estrategia de prevención indiscriminada no sería costo-efectiva.Atrial fibrillation is the most common heart rhythm disorder after cardiac surgery. In previous studies it has been associated with prolonged hospitalization, increased costs and mortality. This study aimed to determine the prevalence of postoperative atrial fibrillation in cardiac surgery and its impact on the hospitalization period. Medical records of consecutive patients undergoing cardiac surgery (coronary artery bypass graft

  3. Safety and efficacy of oral anticoagulation therapy in Chinese patients with concomitant atrial fibrillation and hypertension.

    Science.gov (United States)

    Ho, L Y; Siu, C W; Yue, W S; Lau, C P; Lip, G Y; Tse, H F

    2011-05-01

    Limited evidence is available on the safety and efficacy of anticoagulants in non-valvular atrial fibrillation (AF) patients with concomitant hypertension. We investigated the safety and efficacy of 476 consecutive anticoagulated Chinese outpatients with non-valvular AF and hypertension. Occurrence of ischaemic stroke and major bleeding, and international normalized ratio (INR) values during these events were recorded. There was no significant difference in anticoagulation control between patients with or without hypertension. INR-specific incidence rates of the events were calculated, which showed no excessive risk for ischaemic stroke (2.5 vs 1.6% per year, P=0.22) or major bleeding (3.9 vs 3.2% per year, P=0.29) in non-valvular AF patients with or without hypertension. In multivariate analysis, congestive heart failure, smoking and high CHADS2 score were independent predictors for ischaemic stroke, whereas use of antiplatelet agents was an independent predictor for bleeding. It can be noted that hypertension was not associated with ischaemic stroke or major bleeding. Hypertensive patients who achieved target blood pressure control (risk compared with those not achieving target blood pressure. Our findings demonstrate the effects of hypertension on the outcomes of warfarin therapy; further investigation is needed to clarify whether more aggressive antihypertensive therapy could result in better outcomes in hypertensive patients with non-valvular AF.

  4. 风湿性心脏瓣膜置换术同期射频消融迷宫术治疗房颤%Intraoperative modified maze procedure by radiofrequency ablation to treat atrial fibrillation during concomitant valve replacement of rheumatic heart disease

    Institute of Scientific and Technical Information of China (English)

    雷虹; 严中亚; 严宇; 朱正艳

    2012-01-01

    Objective To analyze the effectiveness of modified maze procedure by radiofrequency ablation in the patients of valvular heart diseases with atrial fibrillation ( AF ) who underwent heart valve replacement surgery. Methods 11 cases of valvular heart diseases with AF undergoing modified maze procedure by radiofrequency ablation with concomitant Valve Replacement during March 2010 to November 2011 were investigated. Including 1 case of double valvular replacement ,10 cases of mitral valvular replacement, four of them with tricuspid valve annuloplasty. Results 11 cases resumed sinus rhythm immediately after the surgery. 1 cf them is sinus bradycardia, another case is ventricular tachycardia Ⅲ0 atrial - ventricular block and atrial muscle perforation did not occurr. 1 patient occurred death. With 3 ~ 12 months follow - up. 10 patients remained in sinus rhythm. One patient had atrial fibrillation recurrence after 6 months. And the left atriums of the remaining 10 patients were significantly reduced. Conclusion Valve replace operation combined with radiofrequency modified maze procedure in the treatment of atrial fibrillation with valvular heart disease is safe and worth popularizing.%目的 对合并房颤的心脏瓣膜病患者行瓣膜置换手术的同时进行射频改良迷宫Ⅲ手术,评价风湿性心脏瓣膜置换术同期射频消融迷宫术治疗房颤的临床效果.方法 2010 年3 月至2011 年11 月,采用Medtronic公司的射频消融系统对11例合并房颤的心脏瓣膜病患者行瓣膜置换手术的同时进行射频改良迷宫Ⅲ手术,其中包括双瓣置换术1例、二尖瓣置换术10例同时三尖瓣成形术4例.结果 术毕转为窦性心律11 例,1例窦性心动过缓,1例室速,无Ⅲ°房室传导阻滞,无心房穿孔出血,1例术后低心排死亡,随访3~12个月,10例均为窦性心律,1例术后6个月出现房颤复发,余10例患者超声心动图检查左房明显缩小.结论 射频消融改良迷宫Ⅲ手术在

  5. Vulnerability to ventricular fibrillation

    Science.gov (United States)

    Janse, Michiel J.

    1998-03-01

    One of the factors that favors the development of ventricular fibrillation is an increase in the dispersion of refractoriness. Experiments will be described in which an increase in dispersion in the recovery of excitability was determined during brief episodes of enhanced sympathetic nerve activity, known to increase the risk of fibrillation. Whereas in the normal heart ventricular fibrillation can be induced by a strong electrical shock, a premature stimulus of moderate intensity only induces fibrillation in the presence of regional ischemia, which greatly increases the dispersion of refractoriness. One factor that is of importance for the transition of reentrant ventricular tachycardia to ventricular fibrillation during acute regional ischemia is the subendocardial Purkinje system. After selective destruction of the Purkinje network by lugol, reentrant tachycardias still develop in the ischemic region, but they do not degenerate into fibrillation. Finally, attempts were made to determine the minimal mass of thin ventricular myocardium required to sustain fibrillation induced by burst pacing. This was done by freezing of subendocardial and midmural layers. The rim of surviving epicardial muscle had to be larger than 20 g. Extracellular electrograms during fibrillation in both the intact and the "frozen" left ventricle were indistinguishable, but activation patterns were markedly different. In the intact ventricle epicardial activation was compatible with multiple wavelet reentry, in the "frozen" heart a single, or at most two wandering reentrant waves were seen.

  6. Amyloid Fibrils from Hemoglobin

    Directory of Open Access Journals (Sweden)

    Nadishka Jayawardena

    2017-04-01

    Full Text Available Amyloid fibrils are a class of insoluble protein nanofibers that are formed via the self-assembly of a wide range of peptides and proteins. They are increasingly exploited for a broad range of applications in bionanotechnology, such as biosensing and drug delivery, as nanowires, hydrogels, and thin films. Amyloid fibrils have been prepared from many proteins, but there has been no definitive characterization of amyloid fibrils from hemoglobin to date. Here, nanofiber formation was carried out under denaturing conditions using solutions of apo-hemoglobin extracted from bovine waste blood. A characteristic amyloid fibril morphology was confirmed by transmission electron microscopy (TEM and atomic force microscopy (AFM, with mean fibril dimensions of approximately 5 nm diameter and up to several microns in length. The thioflavin T assay confirmed the presence of β-sheet structures in apo-hemoglobin fibrils, and X-ray fiber diffraction showed the characteristic amyloid cross-β quaternary structure. Apo-hemoglobin nanofibers demonstrated high stability over a range of temperatures (−20 to 80 °C and pHs (2–10, and were stable in the presence of organic solvents and trypsin, confirming their potential as nanomaterials with versatile applications. This study conclusively demonstrates the formation of amyloid fibrils from hemoglobin for the first time, and also introduces a cost-effective method for amyloid fibril manufacture using meat industry by-products.

  7. Risk for valvular heart disease after treatment for hodgkin lymphoma

    NARCIS (Netherlands)

    D.J. Cutter (David J.); M. Schaapveld (Michael); S. Darby (S.); M. Hauptmann; F.A. Van Nimwegen (Frederika A.); A.D.G. Krol (Augustinus); C.P.M. Janus (Cécile P.M.); F.E. van Leeuwen (F.); B.M.P. Aleman (Berthe)

    2015-01-01

    textabstractBackground: Hodgkin lymphoma (HL) survivors are at increased risk for developing valvular heart disease (VHD). We evaluated the determinants of the risk and the radiation dose-response. Methods: A case-control study was nested in a cohort of 1852 five-year HL survivors diagnosed at ages

  8. Cine-MR imaging of valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jae Hyung; Han, Man Chung; Kim, Chu Wan [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, Dae Jin; Kim, Woo Sung; Park, Hyun Wuk; Cho, Zang Hee [Korea Advanced Institute of Science and Technology, Daejeon (Korea, Republic of)

    1989-04-15

    Cine-MR imaging was done in 2 normal persons and 9 patients of valvular heart disease with 2.0 T superconducting MR system (Spectro-2000; GoldStar, Korea). The MRI was undertaken using gradient echo technique with small flip angle. Repetition time (TR) was 34 msec, and echo time (TE), 18 msec. In most cases, 20 to 30 frames could be obtained during one cardiac cycle. With normal heart, high signal intensity was identified in the blood filled cardiac chambers. Transient signal void was observed near tricuspid, mitral and aortic valves due to the turbulences induced by valve opening or closure. In 6 cases of mitral valvular disease, mitral valve was identified in all cases. The valvular motion was limited revealing doming toward cardiac apex during diastole. Signal void was evident in pansystolic phase of left ventricle in all cases. Evidence of combined aortic or tricuspid valve disease were also demonstrated, revealing signal void in the corresponding cardiac chambers. Cine-MRI seemed to be not only a good non-invasive diagnostic modality for the valvular heart disease, but also an accurate modality for cardiac functional evaluation.

  9. Effect of remote ischemic preconditioning on renal dysfunction after complex valvular heart surgery: a randomized controlled trial.

    Science.gov (United States)

    Choi, Yong Seon; Shim, Jae Kwang; Kim, Jong Chan; Kang, Kyu-Sik; Seo, Yong Han; Ahn, Ki-Ryang; Kwak, Young Lan

    2011-07-01

    Acute kidney injury after cardiac surgery with cardiopulmonary bypass is closely related to systemic inflammatory reactions and oxidative stresses. Remote ischemic preconditioning is a systemic protective strategy whereby brief limb ischemia confers systemic protection against prolonged ischemia and inflammatory reactions in distant organs. This study investigated whether remote ischemic preconditioning provides systemic protective effect on kidneys that are not directly exposed to ischemia-reperfusion injury during complex valvular heart surgery. Seventy-six adult patients undergoing complex valvular heart surgery were randomly assigned to either remote ischemic preconditioning group (n = 38) or control group (n = 38). Remote ischemic preconditioning consisted of 3 10-minute cycles of lower limb ischemia and reperfusion with an automated cuff inflator. Primary end points were comparisons of biomarkers of renal injury including serum creatinine, cystatin C and neutrophil gelatinase-associated lipocalin, and incidence of acute kidney injury. Secondary end points were comparisons of myocardial enzyme release and pulmonary parameters. There were no significant differences in serum levels of biomarkers of renal injury between groups throughout the study period. The incidence of acute kidney injury did not differ between groups. Creatine kinase isoenzyme MB at 24 hours after surgery was lower, and intensive care unit stay was shorter in the remote ischemic preconditioning group than in the control group. In patients undergoing complex valvular heart surgery, remote ischemic preconditioning did not reduce degree of renal injury or incidence of acute kidney injury whereas it did reduce myocardial injury and intensive care unit stay. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  10. Utilization Pattern of Antiplatelet and Anticoagulant Medicines Among the Patients Suffering From Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Sandip Jadav

    2016-07-01

    Full Text Available Background: Antithrombotic therapy is recommended in atrial fibrillation (AF patients due to high risk of stroke. However, antithrombotic therapy is often underutilized due to adverse effects and limited data available in Indian population. Aims: Primary objective was to study usage pattern of antiplatelet and anticoagulant drugs in AF patients. Secondary objective was to assess the risk of stroke and compare usage pattern of antithrombotic drugs in non-valvular atrial fibrillation (NVAF patients with application of CHADS2 and CHA2DS2-VASc score. Materials and Methods: A prospective and observational study was conducted in outpatient department for period of one year in patients > 35 years of either gender diagnosed with AF due to any established cause. CHADS2 and CHA2DS2-VASc score were used to assess risk of stroke among NVAF patients. Results: 111 patients diagnosed with AF (mean age 54 years; 54.96% female were analyzed and out of these, 78 patients were valvular AF patients and 33 were NVAF patients. Anticoagulants were predominantly prescribed in 60 valvular AF patients. Out of 33 NVAF patients, 19 (57.57% patients had CHADS2 score 1 while as per CHA2DS2-VASc score 28 (84.84% patients had score ≥ 2. Out of 33 NVAF patients, 15 (45.45% patients were prescribed warfarin, aspirin in 12 (36.36% patients and no antithrombotic therapy in 6 (18.18% patients. Conclusion: Oral anticoagulant drugs are most commonly prescribed antithrombotic drugs in valvular AF and NVAF patients for stroke prevention. CHADS2 and CHA2DS2-VASc score are easy, simple schemes to assess stroke risk in NVAF patients and helps physicians and patients to choose most suitable antithrombotic therapy.

  11. Surgery for atrial fibrillation.

    Science.gov (United States)

    Lawrance, Christopher P; Henn, Matthew C; Damiano, Ralph J

    2014-11-01

    Atrial fibrillation is the most common cardiac arrhythmia, and its treatment options include drug therapy or catheter-based or surgical interventions. The surgical treatment of atrial fibrillation has undergone multiple evolutions over the last several decades. The Cox-Maze procedure went on to become the gold standard for the surgical treatment of atrial fibrillation and is currently in its fourth iteration (Cox-Maze IV). This article reviews the indications and preoperative planning for performing a Cox-Maze IV procedure. This article also reviews the literature describing the surgical results for both approaches including comparisons of the Cox-Maze IV to the previous cut-and-sew method.

  12. Clinical efficacy and safety of catheter ablation for atrial fibrillation in elderly patients

    Institute of Scientific and Technical Information of China (English)

    董静

    2013-01-01

    Objective To evaluate the clinical efficacy and safty of catheter ablation for atrial fibrillation in elderly patients.Methods From September 2008 to October 2011,a total of 420 consecutive patients undergoing cathete rablation

  13. Sequence dependent aggregation of peptides and fibril formation

    Science.gov (United States)

    Hung, Nguyen Ba; Le, Duy-Manh; Hoang, Trinh X.

    2017-09-01

    Deciphering the links between amino acid sequence and amyloid fibril formation is key for understanding protein misfolding diseases. Here we use Monte Carlo simulations to study the aggregation of short peptides in a coarse-grained model with hydrophobic-polar (HP) amino acid sequences and correlated side chain orientations for hydrophobic contacts. A significant heterogeneity is observed in the aggregate structures and in the thermodynamics of aggregation for systems of different HP sequences and different numbers of peptides. Fibril-like ordered aggregates are found for several sequences that contain the common HPH pattern, while other sequences may form helix bundles or disordered aggregates. A wide variation of the aggregation transition temperatures among sequences, even among those of the same hydrophobic fraction, indicates that not all sequences undergo aggregation at a presumable physiological temperature. The transition is found to be the most cooperative for sequences forming fibril-like structures. For a fibril-prone sequence, it is shown that fibril formation follows the nucleation and growth mechanism. Interestingly, a binary mixture of peptides of an aggregation-prone and a non-aggregation-prone sequence shows the association and conversion of the latter to the fibrillar structure. Our study highlights the role of a sequence in selecting fibril-like aggregates and also the impact of a structural template on fibril formation by peptides of unrelated sequences.

  14. What Is Atrial Fibrillation?

    Science.gov (United States)

    ... regular beat. Certain cells in your heart make electric signals that cause the heart to contract and pump ... read your ECG to find out if the electric signals are normal. In atrial fibrillation (AFib), the heart’s ...

  15. Valvular and perivalvular involvement in patients with chronic kidney disease

    Institute of Scientific and Technical Information of China (English)

    Neelavathi Senkottaiyan; Saad Hafidh; Farrin A. Manian; Martin A. Alpert

    2005-01-01

    Abstract Mitral annular calcification (MAC) and aortic valve alcification (AVC) are the most common valvular and perivalvular bnormalities in patients with chronic kidney disease (CKD). Both MAC and AVC occur at a younger age in CKD patients than in the general population. AVC progresses to aortic stenosis and mild aortic stenosis progresses to severe aortic stenosis at a more rapid rate in patients with CKD than in the general population. The use of calcium-free phosphate binders in such patients may reduce the calcium burden in valvular and perivalvular tructures and retard the rate of progression of aortic stenosis. Despite high rates of morbidity and mortality, the prognosis associated with valve surgery in patients with CKD is better than without valve surgery. Infective endocarditis remains an important complication of CKD, particularly in those treated with hemodialysis.

  16. Prevalence of valvular regurgitation in adolescent idiopathic scoliosis patients.

    Science.gov (United States)

    Zhu, Xiao-Dong; Wang, Jia-Lin; Li, Ming

    2011-01-01

    Sixty-seven adolescent scoliosis patients with thoracic curve (Lenke type 1, 3, and 6) and 16 nonthoracic curve patients (Lenke type 5) were evaluated with color Doppler echocardiography to identify and compare the prevalence and frequency of valvular regurgitation. Regurgitation of one or more valves was detected in 36 thoracic curve patients (53.73%) and seven nonthoracic curve patients (43.75%). Regurgitation with tricuspid valve involvement was statistically significant in patients with thoracic curve (P=0.0216). Frequency of tricuspid valve involvement was statistically significant (28.57 vs. 83.33%, P=0.0076) in patients with thoracic curve. Those without cardiac disease had a higher incidence of valvular regurgitation.

  17. Minimally invasive surgical treatment of valvular heart disease.

    Science.gov (United States)

    Goldstone, Andrew B; Joseph Woo, Y

    2014-01-01

    Cardiac surgery is in the midst of a practice revolution. Traditionally, surgery for valvular heart disease consisted of valve replacement via conventional sternotomy using cardiopulmonary bypass. However, over the past 20 years, the increasing popularity of less-invasive procedures, accompanied by advancements in imaging, surgical instrumentation, and robotic technology, has motivated and enabled surgeons to develop and perform complex cardiac surgical procedures through small incisions, often eliminating the need for sternotomy or cardiopulmonary bypass. In addition to the benefits of improved cosmesis, minimally invasive mitral valve surgery was pioneered with the intent of reducing morbidity, postoperative pain, blood loss, hospital length of stay, and time to return to normal activity. This article reviews the current state-of-the-art of minimally invasive approaches to the surgical treatment of valvular heart disease.

  18. The role of valvular endothelial cell paracrine signaling and matrix elasticity on valvular interstitial cell activation.

    Science.gov (United States)

    Gould, Sarah T; Matherly, Emily E; Smith, Jennifer N; Heistad, Donald D; Anseth, Kristi S

    2014-04-01

    The effects of valvular endothelial cell (VlvEC) paracrine signaling on VIC phenotype and nodule formation were tested using a co-culture platform with physiologically relevant matrix elasticities and diffusion distance. 100 μm thin poly(ethylene glycol) (PEG) hydrogels of 3-27 kPa Young's moduli were fabricated in transwell inserts. VICs were cultured on the gels, as VIC phenotype is known to change significantly within this range, while VlvECs lined the underside of the membrane. Co-culture with VlvECs significantly reduced VIC activation to the myofibroblast phenotype on all gels with the largest percent decrease on the 3 kPa gels (~70%), while stiffer gels resulted in approximately 20-30% decrease. Additionally, VlvECs significantly reduced αSMA protein expression (~2 fold lower) on both 3 and 27 kPa gels, as well as the number (~2 fold lower) of nodules formed on the 27 kPa gels. Effects of VlvECs were prevented when nitric oxide (NO) release was inhibited with l-NAME, suggesting that VlvEC produced NO inhibits VIC activation. Withdrawal of l-NAME after 3, 5, and 7 days with restoration of VlvEC NO production for 2 additional days led to a partial reversal of VIC activation (~25% decrease). A potential mechanism by which VlvEC produced NO reduced VIC activation was studied by inhibiting initial and mid-stage cGMP pathway molecules. Inhibition of soluble guanylyl cyclase (sGC) with ODQ or protein kinase G (PKG) with RBrcGMP or stimulation of Rho kinase (ROCK) with LPA, abolished VlvEC effects on VIC activation. This work contributes substantially to the understanding of the valve endothelium's role in preventing VIC functions associated with aortic valve stenosis initiation and progression.

  19. Pulmonary hemosiderosis due to mitral valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eung Yeop; Kim, Tae Sung; Han, Joung Ho; Lee, Kyung Soo [Sungkyunkwan Univ. College of Medicine, Seoul (Korea, Republic of)

    1999-01-01

    We report a case of biopsy-proven secondary hemosiderosis of the lung in a 58-year-old patient with mitral valvular heart disease. Both chest radiography and high-resolution CT demonstrated patchy areas of ground-glass opacity ; the former indicated that it was in both lungs, while the latter showed inter-and intralobular septal thickening. These findings were reversible when pulmonary venous hypertension was corrected.

  20. Pregnancy and non-valvular heart disease - Anesthetic considerations

    Directory of Open Access Journals (Sweden)

    Maitra Gaurab

    2010-01-01

    Full Text Available Non-valvular heart disease is an important cause of cardiac disease in pregnancy and presents a unique challenge to the anesthesiologist during labor and delivery. A keen understanding of the underlying pathophysiology, in addition to the altered physiology of pregnancy, is the key to managing such patients. Disease-specific goals of management may help preserve the hemodynamic and ventilatory parameters within an acceptable limit and a successful conduct of labor and postpartum period

  1. Actinobacillus equuli subsp. equuli associated with equine valvular endocarditis

    DEFF Research Database (Denmark)

    Aalbæk, Bent; Østergaard, Stine; Buhl, Rikke;

    2007-01-01

    Microbiological and pathological data from a case of equine valvular endocarditis are reported. Limited information is available on the pathogenic potential of equine Actinobacillus species as several strains originate from apparently healthy horses. After the establishment of two subspecies within...... this species, this seems to be the first report of an etiological association between A. equuli subsp. equuli and equine endocarditis. Furthermore, new information on some phenotypical characteristics of this subspecies are reported, compared to previous findings...

  2. Reemplazo valvular mitral en edad pediátrica

    Directory of Open Access Journals (Sweden)

    H S Diliz-Nava

    2017-01-01

    Full Text Available ANTECEDENTES: el reemplazo valvular mitral en pediatría es un procedimiento raro asociado con dificultades técnicas y clínicas únicas. Estudios recientes reportan mejores resultados, a corto y largo plazo, posteriores al procedimiento.   OBJETIVO: analizar la experiencia del reemplazo valvular mitral en el Instituto Nacional de Pediatría.   MATERIALES Y MÉTODOS: se revisaron los expedientes de los pacientes con reemplazo valvular mitral, en el Instituto Nacional de Pediatría, entre agosto del 2002 y agosto del 2012. Las variables de evaluación primaria fueron mortalidad, complicaciones de la anticoagulación y resultados a largo plazo. Se incluyó a doce pacientes, con mediana de edad de 12.5 años (tres pacientes menores de 5 años. RESULTADOS: en 11 casos la anomalía mitral fue considerada congénita. La manifestación clínica más frecuente fue insuficiencia mitral. La mediana de la fracción de eyección del ventrículo izquierdo fue de 62% antes de la cirugía. Se colocó prótesis mecánica en 11 casos. Dos pacientes fallecieron en el postoperatorio inmediato, con supervivencia a 30 días de 83%, sin reporte de ninguna muerte en el periodo de seguimiento. Un paciente presentó sangrado de  tubo digestivo leve y dos arritmia auricular. No se reportaron eventos tromboembólicos ni necesidad de nueva intervención. La mediana del tiempo de seguimiento fue de 16.6 meses.   CONCLUSIÓN: en nuestras condiciones el reemplazo valvular mitral parece ser una buena opción para los pacientes que no pueden beneficiarse de la reparación, con resultados aceptables a corto y mediano plazos.

  3. LEFT ATRIUM THROMBOSIS IN PATIENTS WITH RHEUMATIC MITRAL VALVULAR DISEASE

    Directory of Open Access Journals (Sweden)

    N. D. Kaverin

    2012-01-01

    Full Text Available Systemic thromboembolism — fairly common complication of mitral valvular disease, often leading to disability or fatal consequences for the patient. The source of emboli in most cases, are blood clots localized in the left atrium. The survey reflected basic views on the pathogenesis, diagnosis, treatment and prevention of intraatrial thrombosis according to new scientific advances. Articles (reviews, meta-analyzes and original researchs from Pub Med database, as well as domestic literature were used.

  4. LEFT ATRIUM THROMBOSIS IN PATIENTS WITH RHEUMATIC MITRAL VALVULAR DISEASE

    Directory of Open Access Journals (Sweden)

    N. D. Kaverin

    2014-07-01

    Full Text Available Systemic thromboembolism — fairly common complication of mitral valvular disease, often leading to disability or fatal consequences for the patient. The source of emboli in most cases, are blood clots localized in the left atrium. The survey reflected basic views on the pathogenesis, diagnosis, treatment and prevention of intraatrial thrombosis according to new scientific advances. Articles (reviews, meta-analyzes and original researchs from Pub Med database, as well as domestic literature were used.

  5. Study of Coronary Artery Disease in Single Aortic Valvular Disease

    Institute of Scientific and Technical Information of China (English)

    张斌; 杨伟民; 占亚平

    2003-01-01

    Objectives To analyze the results of coronary angiographies (GAG) in patients with single aortic valvular heart disease; To study the relationship between aortic valve diseases and coronary artery disease (CAD). Methods 105 patients with single aortic valvular heart disease before surgery underwent angiography. The data of clinical characteristics and angiographies were analyzed. Results 51 patients had symptoms of angina pectoris among 105 patients with single aortic valvular heart disease. Seven of them were confirmed coronary artery disease by angiographies. Although the incidence of angina in aortic valve stenosis group was significantly higher than that in aortic valve regurgitation, the probability of combination of CAD in aortic valve stenosis group was similar to the later. However, the probability of combination of CAD in degenerative aortic valve group was significantly higher than the groups of rheumatic, congenitally bicuspid aortic valves, and other causes (p <0.01).Conclusions Angina pectoris is not sensitive for diagnosis of CAD in single aortic valve heart disease.The probability of combination of CAD in degenerative aortic valve disease is higher than that in aortic valve disease with other causes. Coronary angiography is strongly suggested for these patients.

  6. [Value and indications of transesophageal echocardiography before cardioversion of atrial fibrillation].

    Science.gov (United States)

    Lesbre, J P

    2003-09-01

    Transoesophageal echocardiography is essential for the diagnosis of left atrial thrombosis and its precursors (dense spontaneous contrast--reduced auricular emptying velocities) and for the diagnosis of complex aortic atheroma. The sensitivity and specificity of transoesophageal echocardiography for the diagnosis of left atrial thrombus are about 100% and about 90% for that of aortic atheroma. The formal indications for transoesophageal echocardiography before cardioversion are: atrial fibrillation complicated by stroke or a recent systemic embolism: atrial fibrillation complicated by mitral valve disease as the thrombo-embolic risk is major in this context: atrial fibrillation with a high thromboembolic risk: a history of stroke, presence of cardiac failure, diabetes, permanent hypertension, a very dilated left atrium (> or = 50 mm): apparently isolated atrial fibrillation for which long term anticoagulant therapy is hoped to be avoided. On the other hand, in recent, uncomplicated, non-valvular atrial fibrillation, a common fallacy should be corrected: transoesophageal echocardiography does not improve the safety of electrical cardioversion. With similar durations of prior anticoagulant therapy. Over a 3 week period, the frequency of thromboembolic complications is the same whether or not transoesophageal echocardiography is performed before cardioversion (0.8% in both groups of the SEIDL study). With short periods of anticoagulant therapy before cardioversion, there is a higher thromboembolic complication and mortality rate (ACUTE study). The safety of cardioversion is not related to the practice of prior transoesophageal echocardiography but to strict and efficacious anticoagulation for a period of 3 weeks before cardioversion.

  7. [Atrial fibrillation ablation: application of nurse methodology].

    Science.gov (United States)

    Ramos-González-Serna, Amelia; Mateos-García, M Dolores

    2011-01-01

    Ablation of pulmonary veins for treatment of atrial fibrillation involves applying radiofrequency energy wave by a catheter that causes a circumferential lesion to achieve electrical isolation and voltage drop in the interior. It is mainly applied when there is resistance to treatment and recurrence of symptoms affecting the quality of life of patients. The nurse is an important part of the multidisciplinary team who care for patients who undergo this procedure. The provision of comprehensive nursing care should include nursing procedures prior to, during, and after treatment to ensure the careful and systematic quality required. The aims of this article are: to provide specialised knowledge on the procedure of atrial fibrillation ablation, to describe the preparation of the electrophysiology laboratory, analyse nursing care and develop a standardized care plan for patients on whom this procedure is performed using the NANDA (North American Nursing Association) taxonomy and NIC (Nursing Intervention Classification).

  8. MicroRNAs in Valvular Heart Diseases: Potential Role as Markers and Actors of Valvular and Cardiac Remodeling

    Directory of Open Access Journals (Sweden)

    Cécile Oury

    2016-07-01

    Full Text Available miRNAs are a class of over 5000 noncoding RNAs that regulate more than half of the protein-encoding genes by provoking their degradation or preventing their translation. miRNAs are key regulators of complex biological processes underlying several cardiovascular disorders, including left ventricular hypertrophy, ischemic heart disease, heart failure, hypertension and arrhythmias. Moreover, circulating miRNAs herald promise as biomarkers in acute myocardial infarction and heart failure. In this context, this review gives an overview of studies that suggest that miRNAs could also play a role in valvular heart diseases. This area of research is still at its infancy, and further investigations in large patient cohorts and cellular or animal models are needed to provide strong data. Most studies focused on aortic stenosis, one of the most common valvular diseases in developed countries. Profiling and functional analyses indicate that miRNAs could contribute to activation of aortic valve interstitial cells to a myofibroblast phenotype, leading to valvular fibrosis and calcification, and to pressure overload-induced myocardial remodeling and hypertrophy. Data also indicate that specific miRNA signatures, in combination with clinical and functional imaging parameters, could represent useful biomarkers of disease progression or recovery after aortic valve replacement.

  9. [A Case of Mitral Valvular Re-repair in a Patient with Hemolytic Anemia after Mitral Valvular Repair].

    Science.gov (United States)

    Tomino, Mikiko; Miyata, Kazuto; Takeshita, Yuji; Kaneko, Koki; Kanazawa, Hiroko; Uchino, Hiroyuki

    2015-07-01

    A 54-year-old woman was admitted for mitral valvular repair. After folding plasty to A3, a 30 mm Cosgrove-Edwards ring was placed. There was no mitral regurgitation jet observed by transesophageal echocardiography (TEE) during the operation. However, high blood pressure was monitored and treated in the intensive care unit, hemolytic anemia developed, and the serum lactate dehydrogenase level was elevated. Two weeks after the operation, serum lactate dehydrogenase was again elevated. TEE showed mild mitral regurgitation and the regurgitation jet colliding with the annuloplasty ring. Multiple transfusions of red blood cells were required. Repeat surgery was therefore undertaken. Lam and associates previously studying patients on hemolysis after mitral valvular repair noted high grade mitral regurgitation jets fragmented or accelerated. In the present case, mitral regurgitation was mild, but the high velocity and manner of regurgitation (collision with the annuloplasty ring) could cause hemolytic anemia. In the present case, high blood pressure might have caused chordae rupture. Furthermore, a flexible ring, such as the Cosgrove-Edwards ring, is likely to cause hemolytic anemia. As contributing factors to hemolysis after mitral valvular repair, perioperative blood pressure management and type of ring are significant.

  10. Structural Organization of Insulin Fibrils Based on Polarized Raman Spectroscopy: Evaluation of Existing Models.

    Science.gov (United States)

    Sereda, Valentin; Sawaya, Michael R; Lednev, Igor K

    2015-09-01

    Many different proteins undergo misfolding and self-assemble into amyloid fibrils, resulting in a range of neurodegenerative diseases. The limitations of conventional methods of structural biology for fibril characterization have led to the use of polarized Raman spectroscopy for obtaining quantitative structural information regarding the organization of amyloid fibrils. Herein, we report the orientation of selected chemical groups and secondary structure elements in aligned insulin fibrils, including β-sheets, which possess a high level of orientation in the cross-β core, and α-helices in the disordered portions of the fibrils. Strong orientation of disulfide bonds in amyloid fibrils was also revealed, indicating their association with the fibril core. The determined orientation of chemical groups provides strong constraints for modeling the overall structure of amyloid fibrils, including the core and disordered parts. The developed methodology allows for the validation of structural models proposed in the literature for amyloid fibrils. Specifically, the polarized Raman data obtained herein strongly agreed with two insulin fibril models (Jiménez et al., Proc. Natl. Acad. Sci. U. S. A. 2002, 99, 9196-9201 and Ivanova et al., Proc. Natl. Acad. Sci. U. S. A. 2009, 106, 18990-18995) yet revealed significant qualitative and quantitative differences. This work demonstrates the great potential of polarized Raman spectroscopy for structural characterization of anisotropic biological species.

  11. Anaesthetic Management of Parturient with Acute Atrial Fibrillation for Emergency Caesarean Section

    Directory of Open Access Journals (Sweden)

    Madhu Gupta

    2013-01-01

    Full Text Available A 31-year-antenatal lady with critical mitral stenosis presented for emergency caesarean section with fetal distress. She had acute onset atrial fibrillation. She was given a combined spinal epidural (CSE anaesthesia and her arrhythmia was successfully managed after delivery of the baby with intravenous calcium channel blocker. Mitral stenosis is the most common valvular heart disease complicating pregnancy in developing countries. The physiological changes during pregnancy may exacerbate their cardiac symptoms. They may present with complications like congestive cardiac failure, atrial fibrillation, or pulmonary thromboembolism during the antenatal, intrapartum, or postpartum period. Here we discuss the management of parturient woman with high maternal and fetal risk presenting for emergency caesarean. The merits of regional anaesthesia and the importance of invasive monitoring are also discussed.

  12. Stroke prevention in atrial fibrillation

    DEFF Research Database (Denmark)

    Freedman, Ben; Potpara, Tatjana S; Lip, Gregory Y H

    2016-01-01

    Atrial fibrillation is found in a third of all ischaemic strokes, even more after post-stroke atrial fibrillation monitoring. Data from stroke registries show that both unknown and untreated or under treated atrial fibrillation is responsible for most of these strokes, which are often fatal...... or debilitating. Most could be prevented if efforts were directed towards detection of atrial fibrillation before stroke occurs, through screening or case finding, and treatment of all patients with atrial fibrillation at increased risk of stroke with well-controlled vitamin K antagonists or non-vitamin K...

  13. Risk profiles and antithrombotic treatment of patients newly diagnosed with atrial fibrillation at risk of stroke: perspectives from the international, observational, prospective GARFIELD registry.

    Directory of Open Access Journals (Sweden)

    Ajay K Kakkar

    Full Text Available Limited data are available on the characteristics, clinical management, and outcomes of patients with atrial fibrillation at risk of stroke, from a worldwide perspective. The aim of this study was to describe the baseline characteristics and initial therapeutic management of patients with non-valvular atrial fibrillation across the spectrum of sites at which these patients are treated.The Global Anticoagulant Registry in the FIELD (GARFIELD is an observational study of patients newly diagnosed with non-valvular atrial fibrillation. Enrollment into Cohort 1 (of 5 took place between December 2009 and October 2011 at 540 sites in 19 countries in Europe, Asia-Pacific, Central/South America, and Canada. Investigator sites are representative of the distribution of atrial fibrillation care settings in each country. Cohort 1 comprised 10,614 adults (≥18 years diagnosed with non-valvular atrial fibrillation within the previous 6 weeks, with ≥1 investigator-defined stroke risk factor (not limited to those in existing risk-stratification schemes, and regardless of therapy. Data collected at baseline included demographics, medical history, care setting, nature of atrial fibrillation, and treatments initiated at diagnosis. The mean (SD age of the population was 70.2 (11.2 years; 43.2% were women. Mean±SD CHADS2 score was 1.9±1.2, and 57.2% had a score ≥2. Mean CHA2DS2-VASc score was 3.2±1.6, and 8,957 (84.4% had a score ≥2. Overall, 38.0% of patients with a CHADS2 score ≥2 did not receive anticoagulant therapy, whereas 42.5% of those at low risk (score 0 received anticoagulant therapy.These contemporary observational worldwide data on non-valvular atrial fibrillation, collected at the end of the vitamin K antagonist-only era, indicate that these drugs are frequently not being used according to stroke risk scores and guidelines, with overuse in patients at low risk and underuse in those at high risk of stroke.ClinicalTrials.gov TRI08888.

  14. Preoperative CT scanning of 70 cases of rheumatic valvular disease

    Energy Technology Data Exchange (ETDEWEB)

    Take, Akira; Matuzaki, Shigeru; Oki, Shinichi (Jichi Medical School, Minamikawachi, Tochigi (Japan)) (and others)

    1992-05-01

    Seventy patients with rheumatic valvular disease were evaluated with preoperative CT scanning. The correlation of the obtained CT images to the operative findings were examined. Left atrial thrombi were found in 24 cases at the operation. CT scan had detected thrombi in 19 cases (79.2%) and echocardiography in 15 (62.5%). CT failed to find them in 5 cases in which the left atrial thrombi were less than 3 g. Echocardiogram, however, failed to detect thrombi in 9 cases, the largest being 14 g. There were 15 cases with left atrial calcification, in which 10 cases had left atrial thrombi. Nine cases out of these 10 cases had rough left atrial surface after thrombectomy. Early postoperative CT of 10 with left atrial calcification showed recurrent left atrial thrombi in 4 (40%) cases. Mitral valve calcification was found in 42 cases during operation. CT scan was able to detect it in 40 (95.2%), while echocardiogram detected in 34 cases (81.0%) (p<0.05). All mitral valves with calcification required replacement. Out of 30 cases with non calcified mitral valves, 9 underwent OMC, and the other 21 underwent mitral valve replacement. Aortic valve calcification was found in 9 out of 11 cases of aortic stenosis. All has been diagnosed by CT scan. In conclusion, 1. in detecting the left atrial thrombi, CT scan was superior to echo-cardiography, and provided useful information for planning the operative procedure including atrial approach and valvular manipulation, 2. CT scan could detect calcification of left atrial wall which had high incidence of thrombus formation and rough left atrial surface, 3. CT scan could detect calcification of both mitral and aortic valve, and showed the severity of valvular structural changes. (author).

  15. Direct myocardial perfusion imaging in valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Soto, R.C.; Durante, M.L.; Villacorta, E.V.; Torres, J.F.; Monzon, O.P.

    1981-02-01

    Twenty two patients with rheumatic valvular heart disease - 21 having a history of heart failure - were studied using direct coronary injection of /sup 99m/Tc labelled MAA particles during the course of hemodynamic and arteriographic studies. Myocardial perfusion deficit patterns have been shown to be consistent or indicative of either patchy, regional or gross ischemia. In patients with history of documented heart failure 90% (18 cases) had ischemic perfusion deficit in the involved ventricle. We conclude that diminished myocardial blood flow is an important mechanism contributing to the development of heart failure.

  16. Current status of radionuclide imaging in valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Boucher, C.A.; Okada, R.D.; Pohost, G.M.

    1980-12-18

    The current state-of-the-art in radionuclide imaging of valvular heart disease is based on different angiographic patterns in three left-sided valve abnormalities: pressure overload, volume overload, and inflow obstruction. In pressure overload, the left ventricle has normal dimensions or is minimally dilated the volume overload involves a left ventricular dilatation with a normal or reduced ejection fraction at rest the left ventricular function in inflow obstruction is normal, but in some cases may be depressed. Radionuclide angiography evaluates the effect of a valve abnormality on cardiac chamber and function thallium-201 imaging diagnoses regional myocardial blood flow and cell integrity and can evaluate the associated coronary artery disease.

  17. Cineangiographic findings and balloon catheter angioplasty of pulmonic valvular stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Yeon, Kyung Mo; Yoon, Yong Soo; Kim, In One; Han, Man Chung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1987-08-15

    Transluminal balloon valvuloplasty was performed in the treatment of congenital pulmonic valvular stenosis in 55 children, aged 4 months to 15 years. The right ventricular outflow tract pressure gradient decreased significantly immediately after the procedure from 87.18 {+-} 56mmHg to 29.62 {+-} 26.48mmHg ({rho} < 0.001). Technical success rate was 98% (54/55 patients) and failed case (1 patient) was due to severe fibrous thickening of valve. Complication occurred in one case, that is tricuspid regurgitation (Grade II) due to suspected rupture of chordae tendinae. The degree of pulmonary conus dilatation was closely related with age than the pressure gradient.

  18. Vitamin C in prevention of atrial fibrillation after coronary artery bypass graft: double blind randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Mahmoodreza Sarzaeem

    2014-03-01

    Conclusion: Vitamin C is relatively safe, inexpensive, well tolerated and has a low complication. According to the 44% reduction in the incidence of atrial fibrillation in vitamin C patients undergoing coronary artery bypass grafting surgery, this drug can be prescribed as a prophylaxis for prevention of post-CABG atrial fibrillation.

  19. Analysis of maternal-fetal outcomes of valvular heart surgeries in

    Directory of Open Access Journals (Sweden)

    Alireza Yaghoubi

    2010-03-01

    Full Text Available Valvular heart surgery (VHS in pregnancy has its specific complexity and problems.Between years 1983-2007 11 women who underwent VHS during pregnancy were found and analyzed. Valvular heart surgery in pregnancy is associated with the least maternal-fetal side effects. Intensive evaluations before and during pregnancy with a specialized medical team is essential

  20. Modulation of atrial fibrillation

    NARCIS (Netherlands)

    Geuzebroek, G.S.C.

    2013-01-01

    In this thesis we investigate the results of various surgical procedures for atrial fibrillation which have been performed in the last 2 decades in the Sint Antonius Hospital, Nieuwegein, The Netherlands. In the 1990s the classical Maze III procedure was the main surgical technique for drug-refracto

  1. Lesson Five Atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    鲁端; 吴文烈

    2003-01-01

    @@ Atrial fibrillation(AF) may occur in paroxysmaland persistent forms. It may be seen in normal subjects,particularly during emotional stress or follow-ing surgery,exercise, or acute alcoholic intoxication.It also may occur in patients with heart or lungdisease who develop acute hypoxia, hypercapnia,ormetabolic or hemodynamic derangements.

  2. Estimation of the cost-effectiveness of apixaban versus vitamin K antagonists in the management of atrial fibrillation in Argentina.

    Science.gov (United States)

    Giorgi, Mariano Anibal; Caroli, Christian; Giglio, Norberto Damian; Micone, Paula; Aiello, Eleonora; Vulcano, Cristina; Blanco, Julia; Donato, Bonnie; Quevedo, Joaquin Mould

    2015-12-01

    Apixaban, a novel oral anticoagulant which has been approved for the prevention of stroke and systemic embolism in non-valvular atrial fibrillation, reduces both ischemic and haemorrhagic stroke and produces fewer bleedings than vitamin K antagonist warfarin. These clinical results lead to a decrease in health care resource utilization and, therefore, have a positive impact on health economics of atrial fibrillation. The cost-effectiveness of apixaban has been assessed in a variety of clinical settings and countries. However, data from emergent markets, as is the case of Argentina, are still scarce.We performed a cost-effectiveness analysis of apixaban versus warfarin in non-valvular atrial fibrillation (NVAF) in patients suitable for oral anticoagulation in Argentina. A Markov-based model including both costs and effects were used to simulate a cohort of patients with NVAF. Local epidemiological, resource utilization and cost data were used and all inputs were validated by a Delphi Panel of local experts. We adopted the payer's perspective with costs expressed in 2012 US Dollars.The study revealed that apixaban is cost-effective compared with warfarin using a willingness to pay threshold ranging from 1 to 3 per capita Gross Domestic Product (11558 - 34664 USD) with an incremental cost-effectiveness ratio of 786.08 USD per QALY gained. The benefit is primarily a result of the reduction in stroke and bleeding events.The study demonstrates that apixaban is a cost-effective alternative to warfarin in Argentina.

  3. Bleeding after initiation of multiple antithrombotic drugs, including triple therapy, in atrial fibrillation patients following myocardial infarction and coronary intervention

    DEFF Research Database (Denmark)

    Lamberts, Morten; Olesen, Jonas Bjerring; Ruwald, Martin Huth;

    2012-01-01

    Uncertainty remains over optimal antithrombotic treatment of patients with atrial fibrillation presenting with myocardial infarction and/or undergoing percutaneous coronary intervention. We investigated the risk and time frame for bleeding following myocardial infarction/percutaneous coronary int...

  4. Exercise testing and stress imaging in valvular heart disease.

    Science.gov (United States)

    Henri, Christine; Piérard, Luc A; Lancellotti, Patrizio; Mongeon, François-Pierre; Pibarot, Philippe; Basmadjian, Arsène J

    2014-09-01

    The role of exercise testing and stress imaging in the management of patients with valvular heart disease (VHD) is reviewed in this article. The American College of Cardiology/American Heart Association and the European Society of Cardiology/European Association of Cardiothoracic Surgery have recently put emphasis on the role of exercise testing to clarify symptom status and the use of stress imaging to assess the dynamic component of valvular abnormalities and unmask subclinical myocardial dysfunction that could be missed at rest. Recent studies have demonstrated the incremental prognostic value of exercise echocardiography for asymptomatic patients with severe aortic stenosis, moderate-severe mitral stenosis, and severe primary mitral regurgitation. In patients with low-flow, low-gradient aortic stenosis, dobutamine stress echocardiography is recommended to differentiate true severe from pseudosevere aortic stenosis. Data on the prognostic value of stress echocardiography in aortic regurgitation and functional mitral regurgitation are less robust. Data are sparse on the use of stress imaging in right-sided VHD, however recent studies using stress cardiovascular magnetic resonance imaging offer some prognostic information. Although the strongest recommendations for surgical treatment continue to be based on symptom status and resting left ventricular repercussions, stress imaging can be useful to optimize risk stratification and timing of surgery in VHD. Randomized clinical trials are required to confirm that clinical decision-making based on stress imaging can lead to improved outcomes.

  5. Etiology of valvular heart disease-genetic and developmental origins.

    Science.gov (United States)

    Lincoln, Joy; Garg, Vidu

    2014-01-01

    Valvular heart disease occurs as either a congenital or acquired condition and advances in medical care have resulted in valve disease becoming increasingly prevalent. Unfortunately, treatments remain inadequate because of our limited understanding of the genetic and molecular etiology of diseases affecting the heart valves. Therefore, surgical repair or replacement remains the most effective option, which comes with additional complications and no guarantee of life-long success. Over the past decade, there have been significant advances in our understanding of cardiac valve development and, not surprisingly, mutations in these developmental genes have been identified in humans with congenital valve malformations. Concurrently, there has been a greater realization that acquired valve disease is not simply a degenerative process. Molecular investigation of acquired valve disease has identified that numerous signaling pathways critical for normal valve development are re-expressed in diseased valves. This review will discuss recent advances in our understanding of the development of the heart valves, as well as the implications of these findings on the genetics of congenital and acquired valvular heart disease.

  6. Aortic calcified particles modulate valvular endothelial and interstitial cells.

    Science.gov (United States)

    van Engeland, Nicole C A; Bertazzo, Sergio; Sarathchandra, Padmini; McCormack, Ann; Bouten, Carlijn V C; Yacoub, Magdi H; Chester, Adrian H; Latif, Najma

    Normal and calcified human valve cusps, coronary arteries, and aortae harbor spherical calcium phosphate microparticles of identical composition and crystallinity, and their role remains unknown. The objective was to examine the direct effects of isolated calcified particles on human valvular cells. Calcified particles were isolated from healthy and diseased aortae, characterized, quantitated, and applied to valvular endothelial cells (VECs) and interstitial cells (VICs). Cell differentiation, viability, and proliferation were analyzed. Particles were heterogeneous, differing in size and shape, and were crystallized as calcium phosphate. Diseased donors had significantly more calcified particles compared to healthy donors (Pparticles from healthy and diseased donors. VECs treated with calcified particles showed a significant decrease in CD31 and VE-cadherin and an increase in von Willebrand factor expression, Pparticles. Isolated calcified particles from human aortae are not innocent bystanders but induce a phenotypical and pathological change of VECs and VICs characteristic of activated and pathological cells. Therapy tailored to reduce these calcified particles should be investigated. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. [Factors facilitating development of degenerative aortic valvular stenosis].

    Science.gov (United States)

    Andropova, O V; Polubentseva, E I; Anokhin, V N

    2005-01-01

    The aim of the study was to determine factors of risk and progress of aortal valvular calcinosis (AVC) and aortic ostium stenosis (AOS). The subjects were 85 patients with AVC (42--with aortic valvular stenosis (AVS), and 43--without AOS). The study, which included analysis of the lipid and mineral metabolism, and immunological tests, shows that potential factors of AVC are: age (p dislipidemia (high serum level of total cholesterol, cholesterol of low density lipoproteins, and apoB, atherogenic shift of apoB/apoA-1 ratio, low level of cholesterol of high density lipoproteins (CHDLP)), disbalance between intecellular matrix synthesis and destruction (high concentration of alkaline phosphatase and its bone fraction, and accelerated deoxypyridinoline excretion), inflammation (high concentration of C-reactive protein (CRP), fibrinogen, and interleukin-6 (IL-6)). The factors of AOS were: age (p dislipidemia (high levels of cholesterol of low density and very low density lipoproteins, low concentrations of CHDLP, and apoA-1), degradation of extracellular matrix, and inflammation (high concentrations of CRP, fibrinogen, IL-6, and IL-8). Thus, atherogenic dislipidemia and mineral dysmetabolism disorder facilitate AVC. The revealed immune status changes imply the role of inflammation in the development and progress of AVS.

  8. Postoperative atrial fibrillation in patients on statins undergoing ...

    African Journals Online (AJOL)

    LW Drummond

    2013-04-02

    Apr 2, 2013 ... The Newcastle-Ottawa Scale (NOS16) for cohort studies was used to assess ... a 25% relative risk reduction (RRR) in AF in the statin group compared to ..... isolated heart valve operations: a propensity score analysis of 3,217.

  9. HYPERTHYROIDISM AND ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    I. M. Marusenko

    2017-01-01

    Full Text Available Review on a problem of the development of atrial fibrillation in patients with thyrotoxicosis is presented. Thyrotoxicosis is one of the most frequent endocrine diseases, conceding only to a diabetes mellitus. The most frequent reasons of hyperthyroidism are Graves’ disease and functional thyroid autonomy. The authors give an analysis of data on the cardiac effects of thyrotoxicosis, features of heart remodeling under the influence of thyroid hyperfunction, prevalence of atrial fibrillation in thyrotoxicosis, depending on age, as well as the possibility of restoring sinus rhythm in the combination of these diseases. Particular attention is paid to the effect on the heart of subclinical thyrotoxicosis, which is defined as a dysfunction of the thyroid gland, characterized by low serum concentration of thyrotropin, normal values of free thyroxine and free triiodothyronine. Subclinical hyperthyroidism is also capable of causing heart remodeling and diastolic dysfunction.Prevalence of thyrotoxicosis in elderly people is higher in areas of iodine deficiency; it is relevant for our country due to the large territory of iodine deficiency. In elderly patients, the cardiac effects of thyrotoxicosis prevail in the clinical picture, that makes it difficult to diagnose endocrine disorders, and correction of thyrotoxicosis is critically important for the successful control of the heart rhythm. The article also discusses the problem of thyrotoxic cardiomyopathy, caused by the toxic effect of excess thyroid hormones: features of this heart disorder, factors affecting its formation, clinical significance and contribution to the development of rhythm disturbances. The greatest significance is the development of atrial fibrillation as a result of thyrotox-icosis in older patients who already have various cardiovascular diseases.Atrial fibrillation is the most frequent heart rhythm disorder in thyrotoxicosis. The main cause of arrhythmia in hyperthyroidism is the

  10. Cardiopatía valvular en un paciente con granulomatosis de Wegener Valvular cardiopathy in a patient with Wegener's granulomatosis

    Directory of Open Access Journals (Sweden)

    Luis E Silva

    2012-01-01

    Full Text Available La granulomatosis de Wegener es una vasculitis necrotizante autoinmune cuya prevalencia reportada es de 3/100.000 habitantes. Tiene compromiso multisistémico, principalmente el tracto respiratorio superior e inferior, y el sistema nervioso central y renal. La frecuencia del compromiso cardiaco varía según las series estudiadas, pero oscila alrededor de 6%; sin embargo, las manifestaciones clínicas son poco frecuentes. El compromiso valvular se reporta como insuficiencia aórtica o mitral, secundaria a infiltración de las valvas o dilatación de la raíz aórtica. El tratamiento se basa en el control de la enfermedad, el manejo de la falla cardiaca y la intervención quirúrgica de la válvula comprometida según la indicación.Wegener's granulomatosis is an autoimmune necrotizing vasculitis with a reported prevalence of 3/100.000 inhabitants. It is a multisystemic disease, involving mainly the upper and lower respiratory tract, the central nervous system and the kidneys. The frequency of cardiac involvement varies depending on the series studied, but oscillates around 6%; however, the clinical manifestations are rare. The valvular involvement is reported as aortic or mitral insufficiency secondary to infiltration of the leaflets, or as aortic root dilatation. Treatment is based on the control of the disease, the management of heart failure and surgical intervention of the involved valve, as directed.

  11. CARDIAC SURGERY FOR VALVULAR HEART DISEASE AT A REFERRAL HOSPITAL IN ETHIOPIA: A REVIEW OF CASES OPERATED IN THE LAST 30 YEARS.

    Science.gov (United States)

    Guteta, Senbeta; Yadeta, Dejuma; Azazh, Aklilu; Mekonnen, Dufera

    2016-04-01

    Valvular heart disease has been a significant cause of heart disease worldwide. In Ethiopia, it particularly affects young individuals and constitutes the major cause of cardiovascular disease. Factors associated with choice of treatment for advanced valvular heart disease are variable. The objective of this study is to review surgery done for Ethiopian patients with valvular heart disease. We analyzed data on patients who had valve surgery and follow-up at the Tikur Anbessa Specialized Hospital cardiology unit. We collected data on sociodemographic characteristics, the pre-operative status of effected valves and co-morbidities, and assessed their associations with patient management options. A total of 157 valve surgeries were done from 1983 to 2013. Mean age at time of surgery was 26.7 years and females constituted 66% of the cases. Patients with rheumatic heart disease were younger, more likely to be female and have atrial fibrillation, but less likely to have impaired left ventricular systolic function when compared to patients with non-rheumatic heart disease. More than 75% of the surgical procedures done were mechanical valve replacement. Mechanical valves, compared with bioprosthetic valves, were more likely to be used in patients with rheumatic heart disease. The median age of those receiving mechanical valves, 24 (IQR 22-28) years, was lower than those receiving bioprosthetic valves, 31.5 (IQR 29.9-37.9) years. Mechanical valve replacement was significantly higher in those under the age of 20 years (Adjusted Odds Ratio 41.0, 95% CI: 3.0-557.2) and in those between 20 and 29 years of age (Adjusted Odds Ratio 14.3, 95% CI: 2.3-88.6). Valve surgery for valvular heart diseases has been more common performed for young and female patients. A great majority of the replacements done have been with mechanical valves. As many of the patients have been younger and female, the choice of valve surgery and the need for anticoagulation impacts subsequent management of

  12. Quantitative cardiac-cineangiography in acquired valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Han, M. C.; Lim, T. M [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1980-12-15

    For the determination of the prognosis of the acquired valvular heart disease, many diagnostic tools such as, echocardiogram, computerized RI cardiac scan, cardiac catheterization and cardiac angiography are now widely used. Among these, the cineangiography offers the most accurate and objective values in quantitation of the left ventricular performance, which is thought to be an essential prognostic factor of the valvular heart disease. Although many authors differ their opinions, increased end diastolic volume is generally understood in two ways: The one as an indicator of compensatory mechanism for the changed hemodynamics of the heart and the other as a parameter of deteriorated left ventricular performance. Authors analyzed EDV, ESV, EF, EDP and angiographic grade of regurgitation in 97 cases of the acquired valvular heart disease and results are as follows. 1. Mean EDVs are 226.2 ml/m{sup 2} in AI + MI, 167.2 ml/m{sup 2} in AI, 155.6 ml/m{sup 2} in MI and 98.3 ml/m{sup 2} in MS respectively. 2. Mean ESVs are 101.1 ml/m{sup 2} in AI + MI, 84.1 ml/m{sup 2} in AI, 66.5 ml/m{sup 2} in MI and 46.4 ml/m{sup 2} in MS respectively. 3. Mean EFs are 0.56 in AI + MI, 0.55 in AI, 0.57 in MI and 0.54 in MS respectively. 4. There are higher correlations between ESV and EF than between EDV and EF. 5. There are no significant correlation between EDP and EDV in all disease entities except AI, in which large EDV relatively correlates with high EDP. 6. In AI, EDV, ESV, EF and angiographic grade of regurgitation show close correlations between each other. 7. In MI with higher grade of regurgitation, ESV seems to be more sensitive indicator of left ventricular performance than EF. In MI with lower grade of regurgitation, EF seems to be more sensitive indicator of left ventricular performance than ESV. 8. In AI + MI, EDV, ESV and EDP show higher values than in any other disease involving single valve alone, but there are no correlations between ventricular volumes and grades of

  13. Apixaban versus Antiplatelet drugs or no antithrombotic drugs after anticoagulation-associated intraCerebral HaEmorrhage in patients with Atrial Fibrillation (APACHE-AF): study protocol for a randomised controlled trial

    OpenAIRE

    van Nieuwenhuizen, Koen M.; van der Worp, H. Bart; Algra, Ale; Kappelle, L. Jaap; Rinkel, Gabriel J E; Van Gelder, Isabelle C; Schutgens, Roger E.G.; Klijn, Catharina J. M.

    2015-01-01

    BACKGROUND: There is a marked lack of evidence on the optimal prevention of ischaemic stroke and other thromboembolic events in patients with non-valvular atrial fibrillation and a recent intracerebral haemorrhage during treatment with oral anticoagulation. These patients are currently treated with oral anticoagulants, antiplatelet drugs, or no antithrombotic treatment, depending on personal and institutional preferences. Compared with warfarin, the direct oral anticoagulant apixaban reduces ...

  14. Ochronosis as an unusual cause of valvular defect: a case report

    Directory of Open Access Journals (Sweden)

    Steverding Dietmar

    2009-11-01

    Full Text Available Abstract Introduction Alkaptonuria (also known as ochronosis is a genetic disorder characterised by the accumulation of homogentisic acid deposits in connective tissue. In rare cases, ochronosis can cause valvular heart disease. Case presentation We present the case of a 68-year-old Caucasian man with alkaptonuria-associated degenerative valvular defects with aortic, mitral and tricuspid valve insufficiency. The patient did not have any cardiac complaints and was referred to our clinic for evaluation of a conspicuous new heart murmur. Conclusion This case report shows that early diagnosis of cardiovascular ochronosis gives us the opportunity to use conservative treatment to slow down the progression of valvular dysfunction.

  15. [Offer early attention and intervention to patients with valvular heart disease].

    Science.gov (United States)

    Jiang, Shengli; Ren, Chonglei

    2015-02-01

    As a key feature of the updates, early intervention of valvular heart disease is highlighted in the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. This article reviewed the new guideline in regards to the issue of early intervention of diseases such as aortic stenosis, aortic insufficiency, mitral stenosis, mitral insufficiency, tricuspid insufficiency, and infective endocarditis, with discussion on the related topics according to the authors' understanding and practical experience in China. We conclude that valvular heart disease should receive early intervention and attention should also be paid on the progress of disease.

  16. Clinical Applications of Natriuretic Peptides in Assessment of Valvular Heart Disease.

    Science.gov (United States)

    Sharma, Abhishek; Ahmed, Vaseem; Garg, Aakash; Aggarwal, Chirag

    2015-01-01

    Biomarkers such as natriuretic peptides (NPs) have evolving clinical utility beyond the scope of heart failure. The role of NPs in the management of valvular heart disease is a growing area of investigation. NPs have much potential in the assessment of asymptomatic patients with hemodynamically significant valvular lesions who have traditionally been excluded from consideration of surgical intervention. NPs also have a role in the risk stratification of these patients as well as in routine surveillance and monitoring. Together with echocardiographic data and functional status, NPs are being incorporated into the management of valvular heart disease. In this review we examine the evidence for the role of natriuretic peptides in assessment of VHD.

  17. Substrate properties influence calcification in valvular interstitial cell culture.

    Science.gov (United States)

    Benton, Julie A; Kern, Hanna B; Anseth, Kristi S

    2008-11-01

    Valvular calcification is an active, cell-mediated process that results in significant morbidity and mortality. In standard culture, valvular interstitial cells (VICs) elicit significant calcification as a result of myofibroblast activation, and this limits their use in characterization studies. The study aim was to identify culturing substrates that would suppress atypical VIC calcification, and to investigate culture substrates representing a more physiological system. Several culture platforms were selected to compare and contrast the influence of biochemical and mechanical properties on VIC calcification. Substrates investigated included: tissue culture polystyrene (TCPS), TCPS coated with either fibronectin or fibrin, and an elastic poly(ethylene glycol) (PEG) hydrogel, also with fibronectin or fibrin coupled to the surface. Experiments were repeated with profibrotic growth factor transforming growth factor-beta 1 (TGF-beta1). VIC calcification was characterized by calcific nodule formation, alkaline phosphatase activity and calcium accumulation. Gene and protein expression of alpha smooth muscle actin (aSMA) and core binding factor-1 (CBFa-1) were analyzed with qRT-PCR and immunostaining. Unmodified TCPS substrates had an innate ability to promote the markers of calcification studied. The addition of TGF-beta1 enhanced levels of all osteoblastic markers studied. When TCPS surfaces were modified with fibronectin, all markers for calcification were repressed, but alphaSMA - a marker for myofibroblastic activity was unchanged. Meanwhile, fibrin-modified TCPS surfaces enhanced calcification over unmodified TCPS substrates. On soft PEG hydrogels, all markers for calcification were repressed, regardless of the surface chemistry, while alphaSMA expression remained unaffected. Collectively, VIC properties are highly linked to the culture microenvironment. Both, the biochemical and mechanical environment of tissue culture has an effect on the spontaneous calcification

  18. Fibril Formation and Phase Separation in Aqueous Cellulose Ethers

    Science.gov (United States)

    Maxwell, Amanda; Schmidt, Peter; McAllister, John; Lott, Joseph; Bates, Frank; Lodge, Timothy

    Aqueous solutions of many cellulose ethers are known to undergo thermoreversible gelation and phase separation upon heating to form turbid hydrogels, but the mechanism and resulting structures have not been well understood. Turbidity, light scattering and small-angle neutron scattering (SANS) are used to show that hydroxypropyl methylcellulose (HPMC) chains are dissolved in water below 50 °C and undergo phase separation at higher temperatures. At 70 °C, at sufficiently high concentrations in water, HPMC orders into fibrillar structures with a well-defined radius of 18 +/- 2 nm, as characterized by cryogenic transmission electron microscopy and SANS. The HPMC fibril structure is independent of concentration and heating rate. However, HPMC fibrils do not form a percolating network as readily as is seen in methylcellulose, resulting in a lower hot-gel modulus, as demonstrated by rheology.

  19. Management of refractory atrial fibrillation post surgical ablation

    OpenAIRE

    Altman, Robert K.; PROIETTI, RICCARDO; Barrett, Conor D.; Paoletti Perini, Alessandro; Santangeli, Pasquale; Danik, Stephan B.; Di Biase, Luigi; Natale, Andrea

    2014-01-01

    Over the past two decades, invasive techniques to treat atrial fibrillation (AF) including catheter-based and surgical procedures have evolved along with our understanding of the pathophysiology of this arrhythmia. Surgical treatment of AF may be performed on patients undergoing cardiac surgery for other reasons (concomitant surgical ablation) or as a stand-alone procedure. Advances in technology and technique have made surgical intervention for AF more widespread. Despite improvements in out...

  20. Actinobacillus equuli subsp. equuli associated with equine valvular endocarditis

    DEFF Research Database (Denmark)

    Aalbæk, Bent; Østergaard, Stine; Buhl, Rikke

    2007-01-01

    Microbiological and pathological data from a case of equine valvular endocarditis are reported. Limited information is available on the pathogenic potential of equine Actinobacillus species as several strains originate from apparently healthy horses. After the establishment of two subspecies within...

  1. 337. Reparación valvular mitral: experiencia en nuestro centro

    Directory of Open Access Journals (Sweden)

    A.M. Bel Mínguez

    2012-04-01

    Conclusiones: Gracias a la curva de aprendizaje no solo realizamos reparación valvular sencilla sino que hemos aumentado los casos de reparación valvular compleja, obteniendo excelentes resultados con mínima morbimortalidad. La mayor reducción de volúmenes ventriculares, cuando éstos son menores preoperatoriamente, indican que la cirugía debe ser precoz.

  2. Epidemiology and prevention of valvular heart diseases and infective endocarditis in Africa

    OpenAIRE

    2007-01-01

    Valvular heart diseases in Africa affect mainly children and young adults and are a result of rheumatic fever. Rheumatic fever is a preventable disease, but in Africa the combination of a lack of resources, lack of infrastructure, political, social and economic instability, poverty, overcrowding, malnutrition and lack of political will contributes to the persistence of a high burden of rheumatic fever, rheumatic valvular heart diseases and infective endocarditis. Combating and eradicating rhe...

  3. Chronic atrial fibrillation and stroke in paced patients with sick sinus syndrome. Relevance of clinical characteristics and pacing modalities.

    Science.gov (United States)

    Sgarbossa, E B; Pinski, S L; Maloney, J D; Simmons, T W; Wilkoff, B L; Castle, L W; Trohman, R G

    1993-09-01

    The goal of the report was to study the long-term incidence and the independent predictors for chronic atrial fibrillation and stroke in 507 paced patients with sick sinus syndrome, adjusting for differences in baseline clinical variables with multivariate analysis. From 1980 to 1989, we implanted 376 dual-chamber, 19 atrial, and 112 ventricular pacemakers to treat patients with sick sinus syndrome. After a maximum follow-up of 134 months (mean: 59 +/- 38 months for chronic atrial fibrillation, 65 +/- 37 months for stroke), actuarial incidence of chronic atrial fibrillation was 7% at 1 year, 16% at 5 years, and 28% at 10 years. Independent predictors for this event, from Cox's proportional hazards model, were history of paroxysmal atrial fibrillation (P < .001; hazard ratio [HR] = 16.84), use of antiarrhythmic drugs before pacemaker implant (P < .001; HR = 2.25), ventricular pacing mode (P = .003; HR = 1.98), age (P = .005; HR = 1.03), and valvular heart disease (P = .008; HR = 2.05). For patients with preimplant history of paroxysmal atrial fibrillation, independent predictors were prolonged episodes of paroxysmal atrial fibrillation (P < .001; HR = 2.56), long history of paroxysmal atrial fibrillation (P = .004; HR = 2.05), ventricular pacing mode (P = .025; HR = 1.69), use of antiarrhythmic drugs before pacemaker implant (P = .024; HR = 1.71), and age (P = .04; HR = 1.02). Actuarial incidence of stroke was 3% at 1 year, 5% at 5 years, and 13% at 10 years. Independent predictors for stroke were history of cerebrovascular disease (P < .001; HR = 5.22), ventricular pacing mode (P = .008; HR = 2.61), and history of paroxysmal atrial fibrillation (P = .037; HR = 2.81). Development of chronic atrial fibrillation and stroke in paced patients with sick sinus syndrome are strongly determined by clinical variables and secondarily by the pacing modality. Ventricular pacing mode predicts chronic atrial fibrillation in patients with preimplant paroxysmal atrial fibrillation

  4. Efficacy of serial electrical cardioversion therapy in patients with chronic atrial fibrillation after valve replacement and implications for surgery to cure atrial fibrillation

    NARCIS (Netherlands)

    Crijns, HJGM; VanGelder, IC; VanderWoude, HJ; Grandjean, JG; Tieleman, RG; Brugemann, J; DeKam, PJ; Ebels, T

    1996-01-01

    Chronic atrial fibrillation (AF) occurs often in the setting of mitral and aortic valve disease. Eventually, these patients undergo valve replacement which improves cardiac function but does not prevent AF. This study investigates which patient may benefit from additional surgery for the cure of AF

  5. Atrial fibrillation in the elderly

    Institute of Scientific and Technical Information of China (English)

    Roberto A.Franken; Ronaldo F.Rosa; Silvio CM Santos

    2012-01-01

    This review discusses atrial fibrillation according to the guidelines of Brazilian Society of Cardiac Arrhythmias and the Brazilian Cardiogeriatrics Guidelines. We stress the thromboembolic burden of atrial fibrillation and discuss how to prevent it as well as the best way to conduct cases of atrial fibrillatios in the elderly, reverting the arrhythmia to sinus rhythm, or the option of heart rate control. The new methods to treat atrial fibrillation, such as radiofrequency ablation, new oral direct thrombin inhibitors and Xa factor inhibitors, as well as new antiarrhythmic drugs, are depicted.

  6. Electrostatic effects in collagen fibrillization

    Science.gov (United States)

    Morozova, Svetlana; Muthukumar, Murugappan

    2014-03-01

    Using light scattering and AFM techniques, we have measured the kinetics of fibrillization of collagen (pertinent to the vitreous of human eye) as a function of pH and ionic strength. At higher and lower pH, collagen triple-peptides remain stable in solution without fibrillization. At neutral pH, the fibrillization occurs and its growth kinetics is slowed upon either an increase in ionic strength or a decrease in temperature. We present a model, based on polymer crystallization theory, to describe the observed electrostatic nature of collagen assembly.

  7. Application of rivaroxaban in clinical practice: results of a prospective observational study XANTUS in patients with atrial fibrillation

    Directory of Open Access Journals (Sweden)

    S. G. Kanorskii

    2016-01-01

    Full Text Available In XANTUS study the safety and efficacy of factor Xa inhibitor rivaroxaban were evaluated in routine clinical practice in patients with non-valvular atrial fibrillation. In consecutive patients who started treatment with rivaroxaban, all adverse events were recorded every 3 months for 1 year. Conclusions of major bleeding, symptomatic thromboembolic complications (stroke, systemic embolism, transient ischemic attack, and myocardial infarction and death from all causes were centrally adjudicated. In total 6784 patients were treated with rivaroxaban at 311 centers in Europe, Israel, and Canada, on average, 329 days. The mean CHADS2 and CHA2DS2-VASc scores were 2.0 and 3.4, respectively. Treatmentemergent major bleeding occurred in 128 patients (2.1 events per 100 patient-years, 118 (1.9 events per 100 patient-years died, and 43 (0.7 events per 100 patient-years suffered a stroke. XANTUS is the first international, prospective, observational study to describe the use of rivaroxaban in a broad non-valvular atrial fibrillation patient population. Rates of stroke and major bleeding were low in patients receiving rivaroxaban in routine clinical practice.

  8. Valvular heart disease: what does cardiovascular MRI add?

    Energy Technology Data Exchange (ETDEWEB)

    Masci, Pier G.; Dymarkowski, Steven; Bogaert, Jan [Gasthuisberg University Hospital, Department of Radiology, Leuven (Belgium)

    2008-02-15

    Although ischemic heart disease remains the leading cause of cardiac-related morbidity and mortality in the industrialized countries, a growing number of mainly elderly patients will experience a problem of valvular heart disease (VHD), often requiring surgical intervention at some stage. Doppler-echocardiography is the most popular imaging modality used in the evaluation of this disease entity. It encompasses, however, some non-negligible constraints which may hamper the quality and thus the interpretation of the exam. Cardiac catheterization has been considered for a long time the reference technique in this field, however, this technique is invasive and considered far from optimal. Cardiovascular magnetic resonance imaging (MRI) is already considered an established diagnostic method for studying ventricular dimensions, function and mass. With improvement of MRI soft- and hardware, the assessment of cardiac valve function has also turned out to be fast, accurate and reproducible. This review focuses on the usefulness of MRI in the diagnosis and management of VHD, pointing out its added value in comparison with more conventional diagnostic means. (orig.)

  9. Exercise stress echocardiography in patients with valvular heart disease.

    Science.gov (United States)

    Sharma, Vishal; Newby, David E; Stewart, Ralph A H; Lee, Mildred; Gabriel, Ruvin; Van Pelt, Niels; Kerr, Andrew J

    2015-09-01

    Stress echocardiography is recommended for the assessment of asymptomatic patients with severe valvular heart disease (VHD) when there is discrepancy between symptoms and resting markers of severity. The aim of this study is to determine the prognostic value of exercise stress echocardiography in patients with common valve lesions. One hundred and fifteen patients with VHD (aortic stenosis (n=28); aortic regurgitation (n=35); mitral regurgitation, (n=26); mitral stenosis (n=26)), and age- and sex-matched controls (n=39) with normal ejection fraction underwent exercise stress echocardiography. The primary endpoint was a composite of death or hospitalization for heart failure. Asymptomatic VHD patients had lower exercise capacity than controls and 37% of patients achieved 60 mmHg) was associated with an increased risk of death or hospital admission (14% vs 1%, P<0.0001). The assessment of contractile reserve did not offer additional predictive value. In conclusion, an abnormal stress echocardiogram is associated with death and hospitalization with heart failure at 2 years. Stress echocardiography should be considered as part of the routine follow-up of all asymptomatic patients with VHD.

  10. Palliative care in end-stage valvular heart disease.

    Science.gov (United States)

    Steiner, Jill M; Cooper, Stephanie; Kirkpatrick, James N

    2017-08-01

    Valvular heart disease (VHD), particularly aortic valve disease, is prevalent with increasing incidence. When surgery is not possible, or when risks outweigh benefits, percutaneous treatment options may offer effective alternatives. However, procedures may not always go as planned, and frail patients or those whose symptoms are caused by other comorbidities may not benefit from valve intervention at all. Significant effort should be made to assess frailty, comorbidities and patient goals prior to intervention. Palliative care (PC) should play a critical role in the care of patients with severe valve disease. PC is specialised medical care that aims to optimise health-related quality of life by managing symptoms and clarifying patient values and goals of care. It should be implemented at the time of diagnosis and continue throughout the disease course. Because of the paucity of studies dedicated to the provision of PC to patients with advanced VHD, further research is needed. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  11. Valvular heart disease in the community: a European experience.

    Science.gov (United States)

    Iung, Bernard; Baron, Gabriel; Tornos, Pilar; Gohlke-Bärwolf, Christa; Butchart, Eric G; Vahanian, Alec

    2007-11-01

    The Euro Heart Survey on valvular heart disease included 5001 patients from 92 centers in 25 European countries in 2001: 71.9% had native valve disease and 28.1% had previously undergone valve surgery. Aortic stenosis (AS) and mitral regurgitation (MR) accounted for 43.1 and 33.6%, respectively, of single-valve diseases and were mostly caused by degenerative diseases. Mean age was 69 and 65 years, respectively, and at least one comorbidity was present in 36.3% of patients with AS and 41.7% with MR. Analysis of the therapeutic decision in patients with severe valve diseases showed that symptomatic patients were frequently denied surgery (32.3% in AS after the age of 75 and 51.3% in MR), more on the basis of age and left ventricular function than comorbidities. There was a better concordance between practice and guidelines concerning interventions in asymptomatic patients. These findings underline the need for better implementation of guidelines.

  12. Hypertension and Atrial Fibrillation

    DEFF Research Database (Denmark)

    Dzeshka, Mikhail S.; Shahid, Farhan; Shantsila, Alena

    2017-01-01

    Atrial fibrillation (AF) is the most prevalent sustained arrhythmia found in clinical practice. AF rarely exists as a single entity but rather as part of a diverse clinical spectrum of cardiovascular diseases, related to structural and electrical remodeling within the left atrium, leading to AF o...... of complications as the first clinical manifestation of the disease. Antithrombotic prevention in AF combined with strict blood pressure control is of primary importance, since stroke risk and bleeding risk are both greater with underlying hypertension....... onset, perpetuation, and progression. Due to the high overall prevalence within the AF population arterial hypertension plays a significant role in the pathogenesis of AF and its complications. Fibroblast proliferation, apoptosis of cardiomyocytes, gap junction remodeling, accumulation of collagen both...... in atrial and ventricular myocardium all accompany ageing-related structural remodeling with impact on electrical activity. The presence of hypertension also stimulates oxidative stress, systemic inflammation, rennin-angiotensin-aldosterone and sympathetic activation, which further drives the remodeling...

  13. Observational study of the effects of dabigatran on gastrointestinal symptoms in patients with non-valvular atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Takeshi Yamashita, FJCC, MD, PhD

    2014-12-01

    Conclusions: The reported symptoms of dyspepsia were generally mild, but were moderate in approximately 10% of patients. Proton pump inhibitors, H2-receptor antagonists, and rebamipide seemed to be equally effective in relieving dabigatran-related dyspepsia (umin-CTR UMIN000007579.

  14. Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation

    DEFF Research Database (Denmark)

    Diener, Hans-Christoph; Aisenberg, James; Ansell, Jack

    2017-01-01

    in the following subgroups of patients with AF: (vii) secondary stroke prevention in patients after stroke or transient ischaemic attack (TIA), (viii) patients with acute stroke requiring thrombolysis or thrombectomy, (ix) those initiating or restarting OAC treatment after stroke or TIA, (x) those with renal...

  15. Novel Pharmacotherapies for the Prevention of Stroke or Systemic Embolism in Adults with Non-valvular Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Christos Dresios

    2014-06-01

    Full Text Available Over the last decade, a paradigm shift is apparent in the eld of stroke prevention in atrial brillation (AF. For more than 6 decades, warfarin has represented the mainstay of anticoagulation therapy when used in AF patients. However, warfarin has important disadvantages, which limit its use in clinical practice. The recent emergence of novel oral anticoagulant drugs (NOACs that overcome many of limitations of warfarin has allowed the provision of e ective stroke prevention for many more patients with AF, as these drugs have a favorable e cacy–safety pro le but also certain pharmacokinetic and pharmacodynamic properties that render periodic anticoagulant monitoring and dose adjustments unnecessary. The NOACs fall into 2 broad categories, the oral direct thrombin inhibitors (dabigatran and the oral factor Xa inhibitors (rivaroxaban, apixaban.The scope of this manuscript is to review currently available data regarding NOACs and to address practical issues relating to the safe and e ective use of NOACs in clinical practice.

  16. Effectiveness and safety of apixaban versus warfarin in non-valvular atrial fibrillation patients in "real-world" clinical practice

    DEFF Research Database (Denmark)

    Li, Xiaoyan; Deitelzweig, Steve; Keshishian, Allison

    2017-01-01

    ) of NVAF patients newly initiating apixaban or warfarin from January 1, 2013 to September 30, 2015. After 1:1 warfarin-apixaban propensity score matching (PSM) within each database, the resulting patient records were pooled. Kaplan-Meier curves and Cox proportional hazards models were used to estimate...... to warfarin treatment. This is the largest "real-world" study on apixaban effectiveness and safety to date, showing that apixaban initiation was associated with significant risk reductions in stroke/SE and major bleeding compared to warfarin initiation after PSM. These benefits were consistent across various...

  17. PREVALENCE OF CORONARY ARTERY DISEASE IN PATIENTS WITH VALVULAR HEART DISEASE

    Directory of Open Access Journals (Sweden)

    Hiranya Kumar Saharia

    2016-07-01

    Full Text Available BACKGROUND Heart disease is a growing problem, particularly in developing countries. India has quoted to have 12.2% and 12% prevalence of coronary artery disease and rheumatic valvular heart disease respectively. Some older reports suggest that rheumatic fever, in addition to producing specific injuries to small coronary arterial branches may accelerate the development of coronary atherosclerosis. AIM To assess the prevalence of Coronary Artery disease in patients with Valvular Heart disease in some selected hospitals of Guwahati, Assam. SETTING AND DESIGN It was conducted in Gauhati Medical College and Hospital and Hayat Hospital, Guwahati. Explorative approach, survey design was selected for the study. MATERIALS AND METHODS Purposive sampling technique was used to select 126 patients who were diagnosed with valvular heart disease. Data was collected through a self-structured interview scheduled on prevalence of coronary artery disease. RESULTS Of the total 126 patients of valvular heart disease, 108 (85.71% cases were rheumatic valvular heart disease and 18 (14.29% were non-rheumatic valvular heart disease. Majority (56.34% of cases with CAD and RHD were in the range of 45 to 54 years. The prevalence of typical angina was significantly high among men (41.18%. Most of the rheumatic patients (72.22% did not complain about angina. Diabetes mellitus, hypertension and dyslipidaemia are significantly high among non-rheumatic group and Coronary artery disease group. In our study, the overall prevalence of significant coronary artery disease in patients with valvular heart disease was 14.28%. CONCLUSION Coronary artery disease prevalence is very high in this part of the country. Health professionals should actively participate in health promotion activities, apply the findings of the study to identify high risk individuals and prevent the occurrence of coronary artery disease.

  18. Comparison of rate assessment between resting heart rate and 24-hour Holter monitoring in patients with chronic atrial fibrillation.

    Science.gov (United States)

    Srisukwattana, Akanis; Krittayaphong, Rungroj

    2012-02-01

    Target heart rate in rate control strategy has been proposed by the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study. There is limited data on the correlation of measured heart rate at rest and during Holter monitoring. To evaluate the proportion of achieved target heart rate between resting heart rate measuring and 24-hour Holter monitoring in patients with chronic atrial fibrillation who receive rate control strategy. Patients with chronic atrial fibrillation who archived target resting heart rate under rate control strategy at Siriraj Hospital and who underwent 24-hour Holter monitoring were studied to evaluate the correlation between two methods of heart rate control. 47 patients were enrolled. Underlying cardiac conditions were as follows: hypertensive heart disease 44.7%, valvular heart disease 25%, coronary artery disease 17% and dilated cardiomyopathy 12.8%. There were 10 patients (21.3%) whose achieving target resting heart rate was not correlated with 24-hour Holter monitoring. Three patients (6.4%) underwent permanent pacemaker implantation due to sick sinus syndrome (SSS) or tachycardia-bradycardia syndrome. In chronic atrial fibrillation patients that receive rate control strategy, evaluation of only resting heart rate might not be enough for long-term evaluation and treatment and 24-hour monitoring may be an additional helpful test in order to more precisely adjust medication for long-term treatment and detection of SSS.

  19. Amyloid fibril systems reduce, stabilize and deliver bioavailable nanosized iron

    Science.gov (United States)

    Shen, Yi; Posavec, Lidija; Bolisetty, Sreenath; Hilty, Florentine M.; Nyström, Gustav; Kohlbrecher, Joachim; Hilbe, Monika; Rossi, Antonella; Baumgartner, Jeannine; Zimmermann, Michael B.; Mezzenga, Raffaele

    2017-07-01

    Iron-deficiency anaemia (IDA) is a major global public health problem. A sustainable and cost-effective strategy to reduce IDA is iron fortification of foods, but the most bioavailable fortificants cause adverse organoleptic changes in foods. Iron nanoparticles are a promising solution in food matrices, although their tendency to oxidize and rapidly aggregate in solution severely limits their use in fortification. Amyloid fibrils are protein aggregates initially known for their association with neurodegenerative disorders, but recently described in the context of biological functions in living organisms and emerging as unique biomaterial building blocks. Here, we show an original application for these protein fibrils as efficient carriers for iron fortification. We use biodegradable amyloid fibrils from β-lactoglobulin, an inexpensive milk protein with natural reducing effects, as anti-oxidizing nanocarriers and colloidal stabilizers for iron nanoparticles. The resulting hybrid material forms a stable protein-iron colloidal dispersion that undergoes rapid dissolution and releases iron ions during acidic and enzymatic in vitro digestion. Importantly, this hybrid shows high in vivo iron bioavailability, equivalent to ferrous sulfate in haemoglobin-repletion and stable-isotope studies in rats, but with reduced organoleptic changes in foods. Feeding the rats with these hybrid materials did not result in abnormal iron accumulation in any organs, or changes in whole blood glutathione concentrations, inferring their primary safety. Therefore, these iron-amyloid fibril hybrids emerge as novel, highly effective delivery systems for iron in both solid and liquid matrices.

  20. 药物洗脱支架植入术后心房颤动患者抗栓治疗方案疗效对比%Comparison of different antithrombotic regime in patients with atrial fibrillation undergoing Drug-Eluting Stent imolantation

    Institute of Scientific and Technical Information of China (English)

    冯仕勇; 许勇

    2011-01-01

    Objective To compare the prognosis of different antithrombotic regimen in patients with atrial fibrillation(AF) undergoing drug-eluting stent implantation.Methods We enrolled 549 consecutive patients who had a history of AF or newly diaguosed AF undergoing drug-eluting stent implantation.Among them, 115 patients ( TF group) continued triple antithrombotic therapy including aspirin, clopidogrel and warfarin after discharge ;347 patients( DT group) prescribed dual antiplatelet therapy ;87 patients( WS group) discharged with warfarin and single antiplatelet agent.In patients with warfarin target INR value was set as 1.8 to 2.5 before discharge and ordered regular INR monitoring after discharge.Results Patients with triple antithrombotic therapy had a significant reduction in stroke and major adverse cardiac and cerebral events(MACCE) (7.1% vs 21.5% vs 17.3% ,P <0.01 ) as compared with either DT or WS group.In Cox regression analysis,non-administration with warfarin( hazard ratio[HR]=2.27;95% confidence interval[CI]1.39 to 3.70; P < 0.01 ) and baseline CHADS2 score ≥2 ( HR = 2.49;95% CI: 1.51 to 4.11; P < 0.01 ) were independent predictors of MACCE.Importantly, the incidence of major bleeding was comparable among three groups( 3.6% vs 1.8% vs 2.5% , P > 0.05 ), although there was an increased risk of overall bleeding in TT group.Kaplan-Meier analysis indicated the TT group was associated with the best net clinical outcome.Conclusion Our study confirmed the cardiovascular benefits of triple antithrombotic therapy by reducing MACCE rate,and suggested the major bleeding rate was comparable with other treatment options despite an increased minor bleeding risk.%目的 对比不同抗栓治疗方案在接受药物洗脱支架(DES)植入的冠心病伴心房颤动患者中的作用.方法 连续入选接受介入治疗置入DES,合并房颤病史或新诊断的房颤患者549名,根据患者出院后不同抗栓治疗方案分为三组:三联抗栓

  1. Mechanical properties of collagen fibrils

    OpenAIRE

    Wenger, M. P. E.; Bozec, L.; Horton, M. A.; Mesquida, P

    2007-01-01

    The formation of collagen fibers from staggered subfibrils still lacks a universally accepted model. Determining the mechanical properties of single collagen fibrils ( diameter 50 - 200 nm) provides new insights into collagen structure. In this work, the reduced modulus of collagen was measured by nanoindentation using atomic force microscopy. For individual type 1 collagen fibrils from rat tail, the modulus was found to be in the range from 5 GPa to 11.5 GPa ( in air and at room temperature)...

  2. Renal function assessment in atrial fibrillation: Usefulness of chronic kidney disease epidemiology collaboration vs reexpressed 4 variable modification of diet in renal disease

    Institute of Scientific and Technical Information of China (English)

    Rami; Riziq-Yousef; Abumuaileq; Emad; Abu-Assi; Andrea; López-López; Sergio; Raposeiras-Roubin; Moisés; RodríguezMa?ero; Luis; Martínez-Sande; Francisco; Javier; García-Seara; Xesus; Alberte; Fernandez-López; Jose; Ramón; GonzálezJuanatey

    2015-01-01

    AIM: To compare the performance of the re-expressed Modification of Diet in Renal Disease equation vs the new Chronic Kidney Disease Epidemiology Collaboration equation in patients with non-valvular atrial fibrillation.METHODS: We studied 911 consecutive patients with non-valvular atrial fibrillation on vitamin-K antagonist. The performance of the re-expressed Modification of Diet in Renal Disease equation vs the new Chronic Kidney Disease Epidemiology Collaboration equation in patients with non-valvular atrial fibrillation with respect to either a composite endpoint of major bleeding, thromboembolic events and all-cause mortality or each individual component of the composite endpoint was assessed using continuous and categorical ≥ 60, 59-30, and < 30 m L/min per 1.73 m2 estimated glomerular filtration rate.RESULTS: During 10 ± 3 mo, the composite endpoint occurred in 98(10.8%) patients: 30 patients developed major bleeding, 18 had thromboembolic events, and 60 died. The new equation provided lower prevalence of renal dysfunction < 60 m L/min per 1.73 m2(32.9%),compared with the re-expressed equation(34.1%). Estimated glomerular filtration rate from both equations was independent predictor of composite endpoint(HR = 0.98 and 0.97 for the re-expressed and the new equation, respectively; P < 0.0001) and all-cause mortality(HR = 0.98 for both equations, P < 0.01). Strong association with thromboembolic events was observed only when estimated glomerular filtration rate was < 30 m L/min per 1.73 m2: HR is 5.1 for the re-expressed equation, and HR = 5.0 for the new equation. No significant association with major bleeding was observed for both equations.CONCLUSION: The new equation reduced the prevalence of renal dysfunction. Both equations performed similarly in predicting major adverse outcomes.

  3. New technologies in treatment of atrial fibrillation in cardiosurgical patients

    Science.gov (United States)

    Evtushenko, A. V.; Evtushenko, V. V.; Bykov, A. N.; Sergeev, V. S.; Syryamkin, V. I.; Kistenev, Yu. V.; Anfinogenova, Ya. D.; Smyshlyaev, K. A.; Kurlov, I. O.

    2015-11-01

    The article is devoted to the evaluation of the results of clinical application of penetrating radiofrequency ablation techniques on atrial myocardium. Total operated on 241 patients with valvular heart disease and coronary heart disease complicated with atrial fibrillation. All operations were performed under cardiopulmonary bypass and cardioplegia. The main group consists of 141 patients which were operated using penetrating technique radiofrequency exposure. The control group consisted of 100 patients who underwent surgery with the use of "classical" monopolar RF-ablation technique. Both groups were not significantly different on all counts before surgery. Patients with previous heart surgery were excluded during the selection of candidates for the procedure, due to the presence of adhesions in the pericardium, that do not allow good visualization of left atrium, sufficient to perform this procedure. Penetrating technique has significantly higher efficiency compared to the "classic" technique in the early and long-term postoperative periods. In the early postoperative period, its efficiency is 93%, and in the long term is 88%. The efficacy of "classical" monopolar procedure is below: 86% and 68% respectively.

  4. Relation between epicardial fat tissue and atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Enbiya Aksakal

    2012-03-01

    Full Text Available Objectives: The objective of the study was to evaluatethe relationship of epicardial fat thickness (EFT assessedby echocardiography with atrial fibrillation (AF ina clinical setting.Materials and methods: The study consisted of 58 AFpatients who underwent echocardiography and a controlgroup of 22 participants. The EFT thickness was measuredon the free wall of the right ventricle from the parasternallong-axis view. The association between EFT andAF was studied by adjusting the risk factors for AF, includingstructural valvular diseases and multiple risk factors.Results: EFT was significantly increased in patients withAF as compared to participants in the control group (6.5 ±1.2 mm vs. 5.8 ± 1.0 mm, p=0.01. In subgroup analysisof different types of AF, EFT was significantly increasedin permanent AF in relation to paroxysmal and persistentAF (6.8 ± 0.9 mm vs. 6,0 ± 1.2 mm and 5.8±1.2 respectively.In addition, EFT measurements were comparablebetween sinus rhythm, paroxysmal and persistent AF.Conclusions: Epicardial fat thickness measured byechocardiography seems to be associated with the chronicityof AF. J Clin Exp Invest 2012; 3(1: 13-17

  5. Evaluation of the Severity of Mitral Valvular Regurgitation with Doppler Echocardiography Using Proximal Flow Convergence Method

    Directory of Open Access Journals (Sweden)

    Pinjari A. Khayum

    2009-01-01

    Full Text Available Problem statement: Valvular regurgitation is recognized as the central cause of morbidity and mortality. Even though the clinician can detect the presence of regurgitation by mere physical examination; diagnostic methods become inevitable while estimating the severity of valvular regurgitation and in the transformation of cardiac chambers as in reaction to the volume overload condition. Lately, a promising new technology, the Echocardiography with Doppler is found to facilitate the non-invasive recognition and assessment of the severity and etiology of valvular regurgitation. Accurate measurements of regurgitant volume in patients is of utmost importance since it aids in the estimation of the progression of the disease which in turn is vital for determining the optimal time for surgical repair or replacement. Approach: Color space conversion and anisotropic diffusion segmentation techniques are utilized in this study for the pre-processing stage of the quantification of mitral regurgitation. Flow field measurements are carried out with the aid of proximal flow convergence method. Results: A calculated value of flow rate, regurgitant orifice area, regurgitant fraction and the regurgitant volume for a regurgitant orifice in the cardiovascular system are obtained from the potential Color Doppler visualization of the flow convergence region. Conclusion: The research proposed provides a significant assessment of the echocardiographic and Doppler techniques employed in the evaluation of mitral valvular regurgitation in the patients. Additionally it also proffers the estimation of mildness, severity and eccentricity of mitral valvular regurgitation on basis of the scientific literature and a consensus of a panel of experts.

  6. Fatal postoperative systemic pulmonary hypertension in benfluorex-induced valvular heart disease surgery

    Science.gov (United States)

    Baufreton, Christophe; Bruneval, Patrick; Rousselet, Marie-Christine; Ennezat, Pierre-Vladimir; Fouquet, Olivier; Giraud, Raphael; Banfi, Carlo

    2017-01-01

    Abstract Rationale: Drug-induced valvular heart disease (DI-VHD) remains an under-recognized entity. Patient concerns: This report describes a heart valve replacement which was complicated by intractable systemic pulmonary arterial hypertension in a 61-year-old female with severe restrictive mitral and aortic disease. The diagnosis of valvular disease was preceded by a history of unexplained respiratory distress. The patient had been exposed to benfluorex for 6.5 years. Diagnoses: The diagnostic procedure documented specific drug-induced valvular fibrosis. Interventions: Surgical mitral and aortic valve replacement was performed. Outcomes: Heart valve replacement was postoperatively complicated by unanticipated disproportionate pulmonary hypertension. This issue was fatal despite intensive care including prolonged extracorporeal life support. Lessons: Benfluorex is a fenfluramine derivative which has been marketed between 1976 and 2009. Although norfenfluramine is the common active and toxic metabolite of all fenfluramine derivatives, the valvular and pulmonary arterial toxicity of benfluorex was much less known than that of fenfluramine and dexfenfluramine. The vast majority of benfluorex-induced valvular heart disease remains misdiagnosed as hypothetical rheumatic fever due to similarities between both etiologies. Better recognition of DI-VHD is likely to improve patient outcome. PMID:28079786

  7. Modifiable Risk Factors in Atrial Fibrillation: The Role of Alcohol, Obesity, and Sleep Apnea.

    Science.gov (United States)

    Sidhu, Kiran; Tang, Anthony

    2017-07-01

    Atrial fibrillation (AF) is a common arrhythmia affecting a growing number of Canadians. Traditional risk factors, such as hypertension, diabetes, and valvular disease, are often present in older patients with AF. Modifiable risk factors should also be sought in patients presenting with new-onset AF. Obesity is a rapidly growing epidemic in Canada. Emerging evidence is linking obesity and the often coexistent obstructive sleep apnea with an increased incidence of AF. Alcohol intake can also predispose to the development of AF. The purpose of this article is to review recent evidence looking at these modifiable risk factors and how intervention can mitigate these increased risks. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  8. [Newly developed atrial fibrillation among patients under active observation by an outpatient clinic].

    Science.gov (United States)

    Bulanova, N A; Stazhadze, L L; Alekseeva, L A; Dubrovina, E V; Dorofeeva, E V; Sidorenko, B A

    2012-01-01

    We carried out prospective cohort study of incidence of new cases of atrial fibrillation (AF) in a sample of Moscow population (patients under observation in our policlinic). Total incidence of AF between 2003 and 2009 was 7.7 per 1000 patient/years, it was higher among men than among women. Incidence of AF progressively increased with age reaching maximum in age group more or equal 85 years. Most frequent baseline disease in patients with first appearance of AF was hypertensive disease (71%). Ischemic heart disease diagnosed according to strict criteria (postinfarction cardiosclerosis, revascularization procedures) was registered in 20.1%, diabetes - in 15.7%, chronic heart failure - in 13%, valvular heart disease - in 5.6%, and history of acute ischemic stroke - in 2.5% of patients.

  9. CHADS2评分对心房颤动患者二尖瓣置换术围手术期脑卒中风险的预测作用%Predictive role of CHADS2 score for perioperative stroke risk in atrial fibrillation patients undergoing mitral valve replacement surgery

    Institute of Scientific and Technical Information of China (English)

    龚志云; 任崇雷; 姜胜利; 王明岩; 肖苍松; 高长青

    2016-01-01

    住院期间脑卒中的独立危险因素。 CHADS2评分对于预测房颤患者二尖瓣置换术围手术期脑卒中风险有一定价值,值得进一步研究。%Objective Ischemic stroke is a severe complication following cardiac surgery , but its risk factors remain unclear and need further study .This study assessed the predictive value of CHADS 2 scores for perioperative ischemic stroke among atrial fibrillation ( AF) patients undergoing mitral valve replacement surgery .Methods A total of 805 AF patients , with females accounting for 52.4%and at a mean age of (53.7 ±10.5) years, undergoing mitral valve replacement in our hospital from January 2005 to December 2014 were recruited in this study .Their CHADS2 scores were used to stratify the risk for perioperative stroke .The incidence of stroke during hospitalization was observed and compared between those with the score ≥2 and the score0.05).Multivariate logistic regres-sion analysis showed that the CHADS 2 score≥2 (OR=4.164, 95%CI:1.388-12.495;P=0.011) and application of recombinant human coagulation factor Ⅶa (OR=11.757, 95%CI:2.909-47.520; P=0.001) were independent risk factors for stroke during hospitalization .Conclusion There is an increased risk for stroke in the AF patients with higher CHADS 2 score after mitral valve replacement.CHADS2 score ≥2 is an independent risk factor for stroke during hospitalization .The score is of significant value in the prediction of perioperative ischemic stroke in the AF patients undergoing mitral valve replacement surgery and worth further study .

  10. Risk of valvular heart disease after treatment for Hodgkin lymphoma.

    Science.gov (United States)

    Cutter, David J; Schaapveld, Michael; Darby, Sarah C; Hauptmann, Michael; van Nimwegen, Frederika A; Krol, Augustinus D G; Janus, Cecile P M; van Leeuwen, Flora E; Aleman, Berthe M P

    2015-04-01

    Hodgkin lymphoma (HL) survivors are at increased risk of developing valvular heart disease (VHD). We evaluated the determinants of the risk and the radiation dose-response. A case-control study was nested in a cohort of 1852 five-year HL survivors diagnosed at ages 15 to 41 years and treated between 1965 and 1995. Case patients had VHD of at least moderate severity as their first cardiovascular diagnosis following HL treatment. Control patients were matched to case patients for age, gender, and HL diagnosis date. Treatment and follow-up data were abstracted from medical records. Radiation doses to heart valves were estimated by reconstruction of individual treatments on representative computed tomography datasets. All statistical tests were two-sided. Eighty-nine case patients with VHD were identified (66 severe or life-threatening) and 200 control patients. Aortic (n = 63) and mitral valves (n = 42) were most frequently affected. Risks increased more than linearly with radiation dose. For doses to the affected valve(s) of less than or equal to 30, 31-35, 36-40, and more than 40 Gy, VHD rates increased by factors of 1.4, 3.1, 5.4, and 11.8, respectively (P trend < .001). Approximate 30-year cumulative risks were 3.0%, 6.4%, 9.3%, and 12.4% for the same dose categories. VHD rate increased with splenectomy by a factor of 2.3 (P = .02). Radiation dose to the heart valves can increase the risk of clinically significant VHD, especially at doses above 30 Gy. However, for patients with mediastinal involvement treated today with 20 or 30 Gy, the 30-year risk will be increased by only about 1.4%. These findings may be useful for patients and doctors both before treatment and during follow-up. © The Author 2015. Published by Oxford University Press.

  11. Atrial fibrillation and heart failure: is atrial fibrillation a disease?

    Science.gov (United States)

    Tilman, V

    2014-09-01

    Atrial fibrillation in heart failure often occur together. The relationship between atrial fibrillation and heart failure has remained a subject of research. The main manifestation of the violation of hydrodynamics in heart failure is the increased end-diastolic pressure, which is transmitted through the intercommunicated system (left ventricle-left atrium-pulmonary veins-alveolar capillaries) causing increased pulmonary wedge pressure with the danger for pulmonary edema. End-diastolic pressure is the sum of left ventricle diastolic pressure and left atrial systolic pressure. Stopping the mechanical systole of the left atrium can reduce the pressure in the system in heart failure. Atrial fibrillation stops the mechanical systole of the left atrium and decreases the intercommunicating pressure and pulmonary wedge pressure. It is possible that atrial fibrillation is a mechanism for protection from increasing end-diastolic pressure and pulmonary wedge pressure, and prevents the danger of pulmonary edema. This hypothesis may explain the relationship between heart failure and atrial fibrillation and their frequent association.

  12. What can we learn about valvular heart disease from PET/CT?

    Science.gov (United States)

    Jenkins, William S A; Chin, Calvin; Rudd, James H F; Newby, David E; Dweck, Marc R

    2013-09-01

    Valvular heart disease is a major cause of morbidity and mortality, and with an aging population, its prevalence is increasing. Here, we review the evolving use of positron emission tomography/computed tomography in valvular heart disease, with particular focus on calcific aortic stenosis and infective endocarditis. In principle, the activity of any pathological process can be studied, as long as an appropriate radiotracer can be developed. We will review some of the early data using established tracers in the above and other conditions, providing discussion as to the future research and clinical roles of these techniques. Furthermore, we will discuss the potential impact of novel tracers that are currently under development or testing in preclinical models. It is hoped that such advanced imaging might improve the diagnosis, treatment and outlook for patients with valvular heart disease.

  13. Clinical Applications of Natriuretic Peptides in Assessment of Valvular Heart Disease

    Directory of Open Access Journals (Sweden)

    Abhishek Sharma

    2015-01-01

    Full Text Available Biomarkers such as natriuretic peptides (NPs have evolving clinical utility beyond the scope of heart failure. The role of NPs in the management of valvular heart disease is a growing area of investigation. NPs have much potential in the assessment of asymptomatic patients with hemodynamically significant valvular lesions who have traditionally been excluded from consideration of surgical intervention. NPs also have a role in the risk stratification of these patients as well as in routine surveillance and monitoring. Together with echocardiographic data and functional status, NPs are being incorporated into the management of valvular heart disease. In this review we examine the evidence for the role of natriuretic peptides in assessment of VHD.

  14. [Management of aortic valvular heart disease according to the 2012 guidelines].

    Science.gov (United States)

    Dayal, N B; Müller, H

    2014-05-28

    In 2012, the European Society of Cardiology (ESC) published an updated version of its guidelines on the management of valvular heart disease. Novelties include the use of advanced techniques for risk stratification and prognostic evaluation, such as stress and 3D echocardiography as well as measurement of left ventricular strain by speckle tracking. Equally important is the inclusion of percutaneous valve replacement or repair procedures, reflecting their ever-increasing use in clinical practice. Finally, the importance of a multidisciplinary approach to valvular heart disease, with collaboration of multiple specialities in a heart team has been put forward. We discuss practical aspects of the diagnostic and therapeutic approach to aortic valvular disease, including an outline of the surgical indications according to the ESC guidelines.

  15. Rest and exercise radionuclide ventriculography in the ambulatory monitoring of patients with valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Raichlen, J.S.; Brest, A.N.

    1988-01-01

    Radionuclide angiography serves as a valuable adjunct in the noninvasive evaluation and monitoring of patients with valvular heart disease. Although estimations of regurgitant fractions and the differences between left and right ventricular stroke volumes can be made, the limitations of the techniques do not enable adequate quantitation of the severity of valvular insufficiency to warrant routine use in ambulatory management. The importance of radionuclide ventriculography, however, lies in its ability to examine global ventricular function both at rest and with exercise, thus enabling assessment of the functional reserve of the left and right ventricles. Such data are of considerable value in determining the need for invasive evaluation and the timing of valve replacement in patients with valvular heart disease. 41 references.

  16. Association Between Echocardiography Laboratory Accreditation and the Quality of Imaging and Reporting for Valvular Heart Disease.

    Science.gov (United States)

    Thaden, Jeremy J; Tsang, Michael Y; Ayoub, Chadi; Padang, Ratnasari; Nkomo, Vuyisile T; Tucker, Stephen F; Cassidy, Cynthia S; Bremer, Merri; Kane, Garvan C; Pellikka, Patricia A

    2017-08-01

    It is presumed that echocardiographic laboratory accreditation leads to improved quality, but there are few data. We sought to compare the quality of echocardiographic examinations performed at accredited versus nonaccredited laboratories for the evaluation of valvular heart disease. We enrolled 335 consecutive valvular heart disease subjects who underwent echocardiography at our institution and an external accredited or nonaccredited institution within 6 months. Completeness and quality of echocardiographic reports and images were assessed by investigators blinded to the external laboratory accreditation status and echocardiographic results. Compared with nonaccredited laboratories, accredited sites more frequently reported patient sex (94% versus 78%; Pheart disease. Future quality improvement initiatives should highlight the importance of high-quality color Doppler imaging and echocardiographic quantification to improve the accuracy, reproducibility, and quality of echocardiographic studies for valvular heart disease. © 2017 American Heart Association, Inc.

  17. Reparación valvular mitral en un caso de endocarditis de Libman-Sacks

    Directory of Open Access Journals (Sweden)

    Eduardo Bernabeu

    2012-07-01

    Full Text Available La endocarditis de Libman-Sacks es una forma de endocarditis no bacteriana asociada a los pacientes con lupus eritematoso sistémico (LES. Aunque con frecuencia cursa de forma asintomática, en ocasiones es causa de insuficiencia cardíaca grave. Presentamos un caso de reparación valvular mitral en una paciente aquejada de esta infrecuente entidad, que debutó clínicamente con un edema agudo de pulmón secundario a insuficiencia mitral masiva. La reparación valvular mitral puede ser un procedimiento eficaz y seguro, que permite evitar el riesgo adicional asociado al uso de prótesis valvulares en estos pacientes con riesgo trombótico elevado.

  18. Risk of thromboembolism and bleeding after general surgery in patients with atrial fibrillation

    NARCIS (Netherlands)

    Vink, R; Rienstra, Michel; van Dongen, CJJ; Levi, M; Buller, HR; Crijns, HJ; van Gelder, IC

    2005-01-01

    We provide insight into the risk of perioperative thromboembolism and bleeding in patients who have atrial fibrillation, use anticoagulants, and undergo a surgical procedure. Ninety-four patients underwent 121 noncardiac operations during a mean follow-up of 29 months. There was a 3.6-fold increased

  19. Cryoballoon ablation for paroxysmal atrial fibrillation in septuagenarians: a prospective study.

    NARCIS (Netherlands)

    Chierchia, G.B.; Capulzini, L.; Asmundis, C. de; Sarkozy, A.; Sorgente, A.; Yazaki, Y.; Muller-Burri, S.A.; Paparella, G.; Lameir, M.; Bayrak, F.; Ponti, R. De; Brugada, P.

    2010-01-01

    AIMS: To evaluate the effects of pulmonary vein isolation (PVI) in terms of feasibility, safety and success rate on a midterm follow-up period in septuagenarians undergoing ablation with the Arctic Front Cryoballoon for atrial fibrillation (AF). METHODS AND RESULTS: We prospectively enrolled 21 pati

  20. Four patients with Sillence type I osteogenesis imperfecta and mild bone fragility, complicated by left ventricular cardiac valvular disease and cardiac tissue fragility caused by type I collagen mutations.

    Science.gov (United States)

    Vandersteen, Anthony M; Lund, Allan M; Ferguson, David J P; Sawle, Philip; Pollitt, Rebecca C; Holder, Susan E; Wakeling, Emma; Moat, Neil; Pope, F Michael

    2014-02-01

    Osteogenesis imperfecta (OI) type I is a hereditary disorder of connective tissue (HDCT) characterized by blue or gray sclerae, variable short stature, dentinogenesis imperfecta, hearing loss, and recurrent fractures from infancy. We present four examples of OI type I complicated by valvular heart disease and associated with tissue fragility. The diagnosis of a type I collagen disorder was confirmed by abnormal COL1A1 or COL1A2 gene sequencing. One patient was investigated with electrophoresis of collagens from cultured skin fibroblasts, showing structurally abnormal collagen type I, skin biopsy showed unusual histology and abnormal collagen fibril ultra-structure at electron microscopy. The combined clinical, surgical, histological, ultra-structural, and molecular genetic data suggest the type I collagen defect as contributory to cardiac valvular disease. The degree of tissue fragility experienced at cardiac surgery in these individuals, also reported in a small number of similar case reports, suggests that patients with OI type I need careful pre-operative assessment and consideration of the risks and benefits of cardiac surgery.

  1. Detection of herpes simplex virus type 1 in rheumatic valvular tissue

    Institute of Scientific and Technical Information of China (English)

    PAN Zhi-gang; WANG Xiu-nan; LI Yan-wen; ZHANG Hong-yi; Leonard C. Archard

    2005-01-01

    Background Rheumatic heart disease (RHD) is the most important sequela of rheumatic fever (RF): evidence that streptococcal infection is aetiological is prominent, but sometimes contradictory. Acute HSV-1 infection in mouse leads to carditis and valvulitis whereas recurrent infection results in inflammatory granulomatous lesions that resemble Aschoff bodies. Cells containing HSV-1 inclusions or virus infected giant cells appear similar to Anitschkow cells or Aschoff cells respectively. We hypothesized that HSV-1 infection also may be involved in RHD. Methods Formalin-fixed, paraffin-embedded valvular tissue samples from 32 patients with RHD were investigated for evidence of HSV-1 infection. HSV-1 antigen was detected by immunohistochemistry, using HSV-1-specific monoclonal and polyclonal antibodies. HSV-1 glycoprotein D gene sequences were amplified by nPCR, using β-globin gene amplification in the same samples as internal control. Valvular tissue from 5 cases of sudden death and 3 cases died of neisseria meningitis without a history of valvular disease was used for comparison. HSV-1-infected lung tissue was used as positive control. Results HSV-1 antigens were detected in valvular tissues from 21 of 32 (65.6%) patients. Fifteen of these 21 (46.9% of cases), but no antigen-negative sample, were positive also for HSV DNA. Nucleotide sequence of PCR products was homologous to the targeted region of the HSV-1 glycoprotein D gene. HSV-1 antigen was present also in one case of sudden death but viral DNA was not found in any tissue sample from the comparison group. Results from reagent and positive controls were as anticipated.Conclusions This is the first study to show the presence of HSV-1 antigen and genomic DNA in valvular tissues from patients with RHD and provides evidence for an association of HSV-1 infection with some cases of rheumatic valvular disease.

  2. Current status of valvular heart diseases in Xinjiang: an epidemiological study on Han, Uygur and Kazkh ethnic populations%新疆不同民族心脏瓣膜病流行病学调查

    Institute of Scientific and Technical Information of China (English)

    安勇; 马翔; 黄莺; 马依彤; 杨毅宁; 刘芬; 王宝珠

    2011-01-01

    ),coronary heart disease (7.50%) and fibrillation atrial (3.20%).Conclusion The prevalence of valvular heart diseases had a substantial increase,parallel with age.Differences were seen on the prevelance rates of VHD among ethnic populations.

  3. Impact of anesthesia on valvular function in normal rats during echocardiography.

    Science.gov (United States)

    Droogmans, Steven; Lauwers, Rinaldo; Cosyns, Bernard; Roosens, Bram; Franken, Philippe R; Weytjens, Caroline; Bossuyt, Axel; Lahoutte, Tony; Schoors, Danny; Van Camp, Guy

    2008-10-01

    Anesthetic agents have different effects on hemodynamic and cardiac functional parameters. The influence of these changes on valvular function has not been studied in small animals. For this purpose, 48 male Wistar rats were divided into three equal groups. An echocardiogram was performed under inhaled isoflurane 2% gas (group I) or under intraperitoneal pentobarbital 50 mg/kg (group II) or ketamine/xylazine (group III) 40/8 mg/kg. Aortic regurgitation was only found in group III (80%, p anesthesia causes hemodynamic changes that may result in functional valvular regurgitations in normal rats.

  4. Aortic valvular disease and right coronary artery stenosis induced by mediastinal irradiation; Report of a case

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Makoto; Hamada, Mareomi; Matsumoto, Yuji; Hiwada, Kunio; Osuka, Yo (Ehime Univ., Shigenobu (Japan). School of Medicine)

    1993-05-01

    This report presents a case of aortic valvular dysfunction and right coronary artery disease following radiation therapy on the mediastinum. A 61-year-old woman had received mediastinal radiation for the treatment of right mammary cancer 20 years previously. She developed symptoms of congestive heart failure 6 months ago. The patient was found to have aortic valvular dysfunction and proximal stenosis of the right coronary artery. Surgical aortic valve replacement improved cardiac status, and vasodilator treatment reduced ischemia due to right coronary artery stenosis (author).

  5. Molecular recycling within amyloid fibrils.

    Science.gov (United States)

    Carulla, Natàlia; Caddy, Gemma L; Hall, Damien R; Zurdo, Jesús; Gairí, Margarida; Feliz, Miguel; Giralt, Ernest; Robinson, Carol V; Dobson, Christopher M

    2005-07-28

    Amyloid fibrils are thread-like protein aggregates with a core region formed from repetitive arrays of beta-sheets oriented parallel to the fibril axis. Such structures were first recognized in clinical disorders, but more recently have also been linked to a variety of non-pathogenic phenomena ranging from the transfer of genetic information to synaptic changes associated with memory. The observation that many proteins can convert into similar structures in vitro has suggested that this ability is a generic feature of polypeptide chains. Here we have probed the nature of the amyloid structure by monitoring hydrogen/deuterium exchange in fibrils formed from an SH3 domain using a combination of nuclear magnetic resonance spectroscopy and electrospray ionization mass spectrometry. The results reveal that under the conditions used in this study, exchange is dominated by a mechanism of dissociation and re-association that results in the recycling of molecules within the fibril population. This insight into the dynamic nature of amyloid fibrils, and the ability to determine the parameters that define this behaviour, have important implications for the design of therapeutic strategies directed against amyloid disease.

  6. Mapping out the multistage fibrillation of glucagon

    DEFF Research Database (Denmark)

    Ghodke, Shirin; Nielsen, Søren B.; Christiansen, Gunna

    2012-01-01

    unusual far‐UV CD spectra to tertiary‐level structural changes during the formation and maturation of fibrils. The fibrillation model for the whole process involves the formation of three oligomeric species and two different morphologies of fibrils in the same solution. The visualization of annular pore...... fibrillar state and identifies the importance of fibril twisting for its thermodynamic stabilization. Structured digital abstract and by () and by () and by ()...

  7. Fish Oil and Post-Operative Atrial Fibrillation – Results of the Omega-3 Fatty Acids for Prevention of Post-Operative Atrial Fibrillation (OPERA) Trial

    Science.gov (United States)

    Mozaffarian, Dariush; Marchioli, Roberto; Macchia, Alejandro; Silletta, Maria G.; Ferrazzi, Paolo; Gardner, Timothy J.; Latini, Roberto; Libby, Peter; Lombardi, Federico; O’Gara, Patrick T.; Page, Richard L.; Tavazzi, Luigi; Tognoni, Gianni

    2013-01-01

    Context Post-operative atrial fibrillation/flutter (AF) is one of the most common complications of cardiac surgery and significantly increases morbidity and healthcare utilization. A few small trials have evaluated whether long-chain n-3-polyunsaturated fatty acids (PUFA) reduce post-op AF, with mixed results. Objective To determine whether peri-operative n-3-PUFA supplementation reduces post-op AF. Design Randomized, double-blind, placebo-controlled, multinational, clinical trial. Patients A total of 1,516 patients scheduled for cardiac surgery across 28 centers in the US, Italy, and Argentina, enrolled between Aug 2010 and Jun 2012. Inclusion criteria were broad; the main exclusions were regular use of fish oil or absence of sinus rhythm at enrollment. Forty-eight percent of screened patients and 94% of eligible patients were enrolled. Intervention Patients were randomized to receive fish oil (1 g capsules containing ≥840 mg n-3-PUFA as ethyl esters) or placebo, with pre-operative loading of 10g over 3-5 days (or 8g over 2 days) followed post-operatively by 2g/d until hospital discharge or post-op day10, whichever first. Main Outcome Measures The primary endpoint was occurrence of post-op AF >30 sec. We also evaluated post-op AF lasting >1hr, resulting in symptoms, or treated with cardioversion; other secondary post-op AF endpoints; other tachyarrhythmias; hospital utilization; and major adverse cardiovascular events, 30-day mortality, bleeding, and other adverse events. All endpoints and analyses plans were prespecified. Results At enrollment, mean±SD age was 64±13 years, 72.2% were male, and 51.8% had planned valvular surgery. The primary endpoint occurred in 233 (30.7%) and 227 (30.0%) patients assigned to placebo and n-3-PUFA, respectively (OR=0.96, 95%CI=0.77-1.20; P=0.74). None of the secondary endpoints were significantly different, including post-op AF that was sustained, symptomatic, or treated (n=231 [30.5%] vs. n=224 [29.6%], P=0.70) or number of

  8. Risk factors analysis for stroke in patients with non-valvular atrial fibir llation%非瓣膜性心房颤动患者的卒中危险因素分析

    Institute of Scientific and Technical Information of China (English)

    刘立阳; 陈新; 陈晓虹

    2014-01-01

    Stroke is non-valvular atrial fibrillation major complication .Heart failure,advanced age, hypertension , diabetes , history of stroke or transient ischemic attack and stroke in patients with atrial fibrillation associated risks , in addition, the clinical risk factors for other causes of ischemic stroke is also associated with the risk of stroke in patients with atrial fibrillation .Screening patients with atrial fibrillation stroke risk factors,and to take effective way to assess their risks of stroke ,both for anticoagulant therapy to prevent stroke event , or to reduce the risk of bleeding caused by anticoagulant therapy , are of great significance .%卒中是非瓣膜性心房颤动(以下简称为房颤)的主要并发症。心力衰竭、高龄、高血压、糖尿病及卒中或短暂性脑缺血发作史与房颤患者卒中的风险相关,此外,临床上其他原因所致的缺血性卒中的危险因素也与房颤患者的卒中风险相关。筛选房颤患者并发卒中的危险因素,并采取有效方法评估其卒中的危险性,无论是对于抗凝治疗预防卒中事件,还是对于减少抗凝治疗引起的出血风险,都具有十分重要的意义。

  9. Valvular repair or replacement for mitral endocarditis: 7-year cohort study.

    Science.gov (United States)

    Wang, Tom Kai Ming; Oh, Timothy; Voss, Jamie; Gamble, Greg; Kang, Nicholas; Pemberton, James

    2014-10-01

    A few studies have compared mitral valve repair and replacement in the setting of infective endocarditis, with varying results. We compared the characteristics and outcomes of mitral repair and replacement in endocarditis patients. All patients undergoing mitral valve repair or replacement for active mitral endocarditis during 2005-2011 were included. Operative and follow-up mortality, composite morbidity, recurrent endocarditis, and redo operations were prespecified endpoints for analyses. There were 25 and 35 patients undergoing mitral valve repair and replacement, respectively. They were followed-up for 3.9 ± 2.5 years. Valve replacement patients were older (p = 0.029), had a higher prevalence of intracardiac abscess (p = 0.035), previous endocarditis (p = 0.036), atrial fibrillation (p = 0.001), worse renal function (p = 0.013), higher risk scores (p = 0.004-0.020), and longer operation times (p endocarditis (p = 0.081), and redo operations (p = 0.813). Independent predictors of operative mortality were preoperative inotropic or intraaortic balloon pump support. The independent predictor of mortality during follow-up was dialysis. Independent predictors of composite morbidity were intracardiac abscess and hypercholesterolemia. The independent predictor of recurrent endocarditis was previous endocarditis, and the independent predictor of redo operation was previous stroke. Mitral valve replacement candidates had more baseline risk factors and higher raw rates of postoperative mortality and morbidity, which did not reach statistical significance. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  10. Registro Español de Reparación Valvular 2014

    Directory of Open Access Journals (Sweden)

    Yolanda Carrascal

    2016-03-01

    Conclusiones: La actividad reparadora valvular mitral está actualmente consolidada en España, siendo especialmente infrecuente cuando la etiología de la valvulopatía es reumática. La cirugía reparadora aórtica difiere mucho entre grupos y parece encontrarse estabilizada.

  11. A case of valvular pulmonic stenosis and an aberrant coronary artery in a Brittany spaniel.

    Science.gov (United States)

    Estey, Chelsie

    2011-05-01

    Valvular pulmonic stenosis and aberrancy of the right coronary artery with subsequent subvalvular stenosis was found on echocardiographic evaluation of a 9-month-old Brittany spaniel. Previous echocardiography at 4 mo of age revealed the pulmonic stenosis; however, the aberrant coronary artery only became apparent during the second evaluation.

  12. The Maze procedure: surgical therapy for refractory atrial fibrillation.

    Science.gov (United States)

    McCarthy, P M; Castle, L W; Trohman, R G; Simmons, T W; Maloney, J D; Klein, A L; White, R D; Cox, J L

    1993-01-01

    Although atrial fibrillation is well tolerated by most patients, in some patients the consequences may be severe. The Maze procedure is a new open-heart operation that creates a carefully designed maze of incisions in the atrial myocardium; this maze then acts as an electrical conduit to channel atrial impulses from the sinoatrial node to the atrioventricular node. The Maze procedure has been shown to restore sinus rhythm and atrial systole (thus reducing the risk of thromboembolism), improve hemodynamics, alleviate palpitations, and eliminate the need for antiarrhythmic and anticoagulant drugs. We describe our first patient to undergo this operation.

  13. Ventricular fibrillation following autologous intramyocardial cell therapy for inherited cardiomyopathy.

    Science.gov (United States)

    Pytel, Peter; Husain, Aliya; Moskowitz, Ivan; Raman, Jai; MacLeod, Heather; Anderson, Allen S; Burke, Martin; McNally, Elizabeth M

    2010-01-01

    A 41-year-old male with cardiomyopathy from an inherited beta myosin heavy-chain mutation underwent treatment for heart failure with intramyocardial cell transplantation. He received direct injections into his heart of autologous precursor cells isolated from his blood. He immediately suffered ventricular fibrillation. Although he was resuscitated, he experienced a prolonged downward course that prohibited his undergoing transplantation. His autopsy revealed marked fibrosis throughout the myocardium with areas of mononuclear cell infiltrate. This case highlights the potential adverse effects associated with intramyocardial therapy in the cardiomyopathic heart.

  14. Ventricular fibrillation following autologous intramyocardial cell therapy for inherited cardiomyopathy

    Science.gov (United States)

    Pytel, Peter; Husain, Aliya; Moskowitz, Ivan; Raman, Jai; MacLeod, Heather; Anderson, Allen S.; Burke, Martin; McNally, Elizabeth M.

    2010-01-01

    A 41 year old male with cardiomyopathy from an inherited β myosin heavy chain mutation underwent treatment for heart failure with intramyocardial cell transplantation. He received direct injections into his heart of autologous precursor cells isolated from his blood. He immediately suffered ventricular fibrillation. Although he was resuscitated, he experienced a prolonged downward course that prohibited his undergoing transplantation. His autopsy revealed marked fibrosis throughout the myocardium with areas of mononuclear cell infiltrate. This case highlights the potential adverse effects associated with intramyocardial therapy in the cardiomyopathic heart. PMID:19026577

  15. Management Options in Atrial Fibrillation – The Role of Vernakalant

    Directory of Open Access Journals (Sweden)

    Stefan H. Hohnloser

    2012-01-01

    Full Text Available Atrial Fibrillation (AF is the most common cardiac arrhythmia encountered in clinical practice and is associated with significant mortality and morbidity mainly due to thromboembolic complications and heart failure. Furthermore, it is an important contributor to the increasing costs of healthcare. This article provides a short summary of our current knowledge related to some important aspects of AF. Particular emphasis is given to chemical restoration of sinus rhythm by means of intravenous administration of vernakalant (Brinavess®, Merck Sharp & Dohme Ltd, UK, a novel antiarrhythmic agent that has been approved in the EU and is undergoing marketing approval in the USA.

  16. Atrial fibrillation and delayed gastric emptying.

    Directory of Open Access Journals (Sweden)

    Isadora C Botwinick

    Full Text Available BACKGROUND: Atrial fibrillation and delayed gastric emptying (DGE are common after pancreaticoduodenectomy. Our aim was to investigate a potential relationship between atrial fibrillation and DGE, which we defined as failure to tolerate a regular diet by the 7(th postoperative day. METHODS: We performed a retrospective chart review of 249 patients who underwent pancreaticoduodenectomy at our institution between 2000 and 2009. Data was analyzed with Fisher exact test for categorical variables and Mann-Whitney U or unpaired T-test for continuous variables. RESULTS: Approximately 5% of the 249 patients included in the analysis experienced at least one episode of postoperative atrial fibrillation. Median age of patients with atrial fibrillation was 74 years, compared with 66 years in patients without atrial fibrillation (p = 0.0005. Patients with atrial fibrillation were more likely to have a history of atrial fibrillation (p = 0.03. 92% of the patients with atrial fibrillation suffered from DGE, compared to 46% of patients without atrial fibrillation (p = 0.0007. This association held true when controlling for age. CONCLUSION: Patients with postoperative atrial fibrillation are more likely to experience delayed gastric emptying. Interventions to manage delayed gastric function might be prudent in patients at high risk for postoperative atrial fibrillation.

  17. Dynamics of Fibril Growth and Feedback Motifs

    DEFF Research Database (Denmark)

    Cordsen, Pia

    in the literature were found, such as length distribution and apparant persistence lengths. It is found that at all concentrations, fibril growth is characterized by Poissonian stop-go dynamics where the fibril either grows (``go'') or does not grow (``stop''). A monomer-trimer model is proposed in which monomers...... and trimers exist in equilibrium with monomers dominating at low concentrations and trimers dominating at high concentrations. In the model, fibrils consist either of monomers or of trimers and fibril growth is inhibited when the other species binds reversibly to the fibril. Growth probability is derived from...... chemical reaction rates of the model, and the theoretical and experimental growth probabilities are found to be in good agreement. Speed distributions of fibrils are also analysed and found to be in good agreement with the predictions of the model. Fibrils of the protein alpha-synuclein which are involved...

  18. [New antithrombotics for atrial fibrillation].

    NARCIS (Netherlands)

    Verheugt, F.W.A.

    2011-01-01

    Cerebral infarction is the most serious complication of atrial fibrillation. Coumarin derivatives (vitamin K antagonists) counteract systemic thromboembolism and reduce the risk of stroke by more than 60%, but carry a risk of serious bleeding. Antiplatelet therapy and subcutaneous low-molecular-weig

  19. Radiofrequency ablation of atrial fibrillation

    NARCIS (Netherlands)

    Wiesfeld, ACP; Tan, ES; Van Veldhuisen, DJ; Crijns, HJGM; Van Gelder, IC

    2004-01-01

    Twenty-five patients (16 males, mean age 46 years.) underwent radiofrequency ablation because of either paroxysmal (13 patients) or persistent atrial fibrillation (12 patients). Ablation aimed at earliest activation of spontaneous and catheter-induced repetitive ectopy in left and right atria and ap

  20. Nonlinear Dynamical Analysis of Fibrillation

    Science.gov (United States)

    Kerin, John A.; Sporrer, Justin M.; Egolf, David A.

    2013-03-01

    The development of spatiotemporal chaotic behavior in heart tissue, termed fibrillation, is a devastating, life-threatening condition. The chaotic behavior of electrochemical signals, in the form of spiral waves, causes the muscles of the heart to contract in an incoherent manner, hindering the heart's ability to pump blood. We have applied the mathematical tools of nonlinear dynamics to large-scale simulations of a model of fibrillating heart tissue to uncover the dynamical modes driving this chaos. By studying the evolution of Lyapunov vectors and exponents over short times, we have found that the fibrillating tissue is sensitive to electrical perturbations only in narrow regions immediately in front of the leading edges of spiral waves, especially when these waves collide, break apart, or hit the edges of the tissue sample. Using this knowledge, we have applied small stimuli to areas of varying sensitivity. By studying the evolution of the effects of these perturbations, we have made progress toward controlling the electrochemical patterns associated with heart fibrillation. This work was supported by the U.S. National Science Foundation (DMR-0094178) and Research Corporation.

  1. Fracture mechanics of collagen fibrils

    DEFF Research Database (Denmark)

    Svensson, Rene B; Mulder, Hindrik; Kovanen, Vuokko

    2013-01-01

    Tendons are important load-bearing structures, which are frequently injured in both sports and work. Type I collagen fibrils are the primary components of tendons and carry most of the mechanical loads experienced by the tissue, however, knowledge of how load is transmitted between and within...

  2. Personalized management of atrial fibrillation

    DEFF Research Database (Denmark)

    Kirchhof, Paulus; Breithardt, Günter; Aliot, Etienne

    2013-01-01

    The management of atrial fibrillation (AF) has seen marked changes in past years, with the introduction of new oral anticoagulants, new antiarrhythmic drugs, and the emergence of catheter ablation as a common intervention for rhythm control. Furthermore, new technologies enhance our ability to de...

  3. Estimation of pulmonary hypertension in lung and valvular heart diseases by perfusion lung scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Fujii, Tadashige [Shinshu Univ., Matsumoto, Nagano (Japan). School of Allied Medical Sciences; Tanaka, Masao; Yazaki, Yoshikazu; Kitabayashi, Hirosi; Koizumi, Tomonori; Kubo, Keisi; Sekiguchi, Morie; Yano, Kesato

    1999-06-01

    To estimate pulmonary hypertension, we measured postural differences in pulmonary blood flow for the lateral decubitus positions on perfusion lung scintigrams with Tc-99 m macro-aggregated albumin, applying the method devised by Tanaka et al (Eur J Nucl Med 17: 320-326, 1990). Utilizing a scintillation camera coupled to a minicomputer system, changes in the distribution of pulmonary blood flow caused by gravitational effects, namely, changes in the total count ratios for the right lung versus the left lung in the right and left lateral decubitus positions (R/L), were obtained for 44 patients with lung disease, 95 patients with valvular heart disease, and 23 normal subjects. Mean standard deviation in the R/L ratios was 3.09{+-}1.28 for the normal subjects, 1.97{+-}0.89 for the patients with lung disease, and 1.59{+-}0.59 for the patients with valvular heart disease. The R/L ratios correlated with mean pulmonary arterial pressure and cardio-thoracic ratios in the lung disease and valvular heart disease groups, with pulmonary arteriolar resistance in the former, and with pulmonary capillary wedge pressure in the latter. Defining pulmonary hypertension (>20 mmHg) as an R/L ratio of less than 1.81, which is the mean-1 standard deviation for normal subjects, the sensitivity and the specificity of the R/L ratio for the diagnosis of pulmonary hypertension were 62.9% and 76.2%, respectively, for the lung disease patients, and 80.3% and 61.8%, respectively, for the valvular heart disease patients. This method seems to be useful for the pathophysiologic evaluation of pulmonary perfusion in cases of lung disease and valvular heart disease. (author)

  4. Role of echocardiography for catheter-based management of valvular heart disease.

    Science.gov (United States)

    Shiota, Takahiro

    2017-01-01

    Catheter-based treatment of valvular heart disease, such as transvalvular aortic valve replacement (TAVR) or mitral clip procedure, has been increasingly accepted as a treatment choice for the past several years. Such new treatment options have been changing the management of patients with valvular heart disease drastically while socio-economic factors regarding their application need to be taken into consideration. The use of echocardiography, including transesophageal echocardiography (TEE), for such catheter-based treatments is essential for the success of the procedures. Severe hypotension after TAVR is a life-threatening emergency. Rapid assessment and diagnosis in the catheterization or hybrid laboratory is essential for safety and a positive outcome. Possible diagnoses in this critical situation would include severe left ventricular dysfunction due to coronary obstruction, cardiac tamponade, aortic rupture, acute severe aortic and/or mitral valve regurgitation, and hypovolemia due to bleeding. Although new types of TAVR valves reduce para-valvular aortic regurgitation (AR) significantly, it is still important to judge the severity of para-valvular AR correctly in the laboratory. As for mitral clip procedure, TEE is vital for guiding and monitoring the entire process. Accurate identification of the location and the geometry of the regurgitant orifice is necessary for proper placement of the clip. Real-time 3D TEE provides helpful en face view of the mitral valve and clip together to this end. Residual mitral regurgitation (MR) after the first clip is not uncommon. Quick and precise imaging of the residual MR (location and severity) with TEE is extremely important for the interventionist to place the second clip and possibly third clip properly. After the completion of the clip procedure, mitral valve stenosis and also iatrogenic atrial septal defect need to be checked by TEE. Echocardiography, especially TEE, is also vital for the success of other newer trans

  5. Valvular heart diseases and its impact: An assessment among patients attending a tertiary hospital in Kolkata

    Directory of Open Access Journals (Sweden)

    Dey Indira, Das Bhaskar, Dey Subrata

    2014-07-01

    Full Text Available Background: Valvular heart diseases (VHD are an important cause of morbidity and mortality worldwide and rheumatic fever still continues to be a contributing factor to VHD in the developing nations like India. This enormous disease burden often translates into huge economic and social losses. Aims: This study was undertaken to identify the sociodemographic characteristics of the patients with VHD, to find the frequency of different types of valvular diseases and their etiologies and the effect of such diseases on daily living. Materials and Methods: A hospital based observational study was carried out among the patients with VHD attending Cardiothoracic and Vascular Surgery OPD from April,2013 to Dec,2013.Data collection was done using a predesigned and pretested schedule after taking informed consent. Result; Out of the 108 patient’s majority were males and resided in rural areas. Their mean age was 36.39 ± 13.88. Mitral stenosis was found to be the commonest single valve lesion and most of the VHDs were of rheumatic origin. In 32.4% of the cases outdoor activities were completely restricted. Out of the 62 patients working outside, 40.2% were mostly absent from their workplace. Conclusion: Mitral stenosis of rheumatic origin was found to be the commonest type of valvular heart disease in this part. This study reveals that valvular heart disease of rheumatic origin still exists in our society. So preventive measures, diagnosis and management of valvular diseases should not be neglected and we need to provide preventive services in cases of rheumatic fever to reduce the development of VHD.

  6. Chronic mitral regurgitation detected on cardiac MDCT: differentiation between functional and valvular aetiologies.

    LENUS (Irish Health Repository)

    Killeen, Ronan P

    2012-02-01

    OBJECTIVE: To determine whether cardiac computed tomography (MDCT) can differentiate between functional and valvular aetiologies of chronic mitral regurgitation (MR) compared with echocardiography (TTE). METHODS: Twenty-seven patients with functional or valvular MR diagnosed by TTE and 19 controls prospectively underwent cardiac MDCT. The morphological appearance of the mitral valve (MV) leaflets, MV geometry, MV leaflet angle, left ventricular (LV) sphericity and global\\/regional wall motion were analysed. The coronary arteries were evaluated for obstructive atherosclerosis. RESULTS: All control and MR cases were correctly identified by MDCT. Significant differences were detected between valvular and control groups for anterior leaflet length (30 +\\/- 7 mm vs. 22 +\\/- 4 mm, P < 0.02) and thickness (3.0 +\\/- 1 mm vs. 2.2 +\\/- 1 mm, P < 0.01). High-grade coronary stenosis was detected in all patients with functional MR compared with no controls (P < 0.001). Significant differences in those with\\/without MV prolapse were detected in MV tent area (-1.0 +\\/- 0.6 mm vs. 1.3 +\\/- 0.9 mm, P < 0.0001) and MV tent height (-0.7 +\\/- 0.3 mm vs. 0.8 +\\/- 0.8 mm, P < 0.0001). Posterior leaflet angle was significantly greater for functional MR (37.9 +\\/- 19.1 degrees vs. 22.9 +\\/- 14 degrees , P < 0.018) and less for valvular MR (0.6 +\\/- 35.5 degrees vs. 22.9 +\\/- 14 degrees, P < 0.017). Sensitivity, specificity, and positive and negative predictive values of MDCT were 100%, 95%, 96% and 100%. CONCLUSION: Cardiac MDCT allows the differentiation between functional and valvular causes of MR.

  7. The Mid-Term Results of Patients who Underwent Radiofrequency Atrial Fibrillation Ablation Together with Mitral Valve Surgery

    Directory of Open Access Journals (Sweden)

    Abdurrahim Çolak

    Full Text Available Abstract Objetive: Saline-irrigated radiofrequency ablation, which has been widely used for surgical treatment of atrial fibrillation in recent years, is 80-90% successful in achieving sinus rhythm. In our study, our surgical experience and mid-term results in patients who underwent mitral valve surgery and left atrial radiofrequency ablation were analyzed. Methods: Forty patients (15 males, 25 females; mean age 52.05±9.9 years; range 32-74 underwent surgery for atrial fibrillation associated with mitral valvular disease. All patients manifested atrial fibrillation, which started at least six months before the surgical intervention. The majority of patients (36 patients, 90% were in NYHA class III; 34 (85% patients had rheumatic heart disease. In addition to mitral valve surgery and radiofrequency ablation, coronary artery bypass, DeVega tricuspid annuloplasty, left ventricular aneurysm repair, and left atrial thrombus excision were performed. Following discharge from the hospital, patients' follow-up was performed as outpatient clinic examinations and the average follow-up period of patients was 18±3 months. Results: While the incidence of sinus rhythm was 85.3% on the first postoperative day, it was 80% during discharge and 71% in the 1st year follow-up examination. Conclusion: Radiofrequency ablation is an effective method when it is performed by appropriate surgical technique. Its rate for returning to sinus rhythm is as high as the rate of conventional surgical procedure.

  8. Overtreatment and undertreatment with anticoagulation in relation to cardioversion of atrial fibrillation (the RHYTHM-AF study).

    Science.gov (United States)

    Lip, Gregory Y H; Gitt, Anselm K; Le Heuzey, Jean-Yves; Bash, Lori D; Morabito, Christopher J; Bernhardt, Alexandra A; Sisk, Christine McCrary; Chazelle, François; Crijns, Harry J

    2014-02-01

    Antithrombotic therapy is central to the management of atrial fibrillation. This analysis from the RHYTHM-atrial fibrillation (RHYTHM-AF) registry explored the appropriateness of antithrombotic therapy in relation to stroke risk and atrial fibrillation duration in patients with atrial fibrillation. RHYTHM-AF, a prospective multinational registry, enrolled consecutive adult patients with atrial fibrillation considered for cardioversion. We compared the type of antithrombotic therapy administered at the time of cardioversion and at discharge with stroke risk ("high stroke risk" defined by CHA2DS2-VASc >1) and duration of atrial fibrillation (≤48 vs >48 hours or unknown duration). Of 2,972 patients who were cardioverted (34.5% through pharmacologic cardioversion [PCV] and 65.5% through electrical cardioversion [ECV]), 65% were at high risk of stroke and 30% presented with atrial fibrillation of >48-hour or unknown duration. At the time of PCV and ECV, 36% (n = 242) and 84% (n = 1,075) of high-risk patients, respectively, were taking vitamin K antagonists or heparin. At discharge, these rates increased to 62% (n = 414) and 93% (n = 1,191), respectively. Of all low-stroke risk patients with short-duration atrial fibrillation undergoing PCV (n = 260) and ECV (n = 111), 7% (n = 17) and 30% (n = 33), respectively, were taking vitamin K antagonists or heparin at the time of cardioversion. At discharge, these rates increased to 19% (n = 50) and 40% (n = 44), respectively. In conclusion, ECV was frequently performed under appropriate antithrombotic therapy for most high-risk patients with atrial fibrillation, whereas PCV was frequently performed without appropriate antithrombotic therapy. To enhance pericardioversion stroke prevention, cardioversion algorithms should focus less on the type of conversion and more on stroke risk factors and atrial fibrillation duration.

  9. [Atrial fibrillation and cognitive function].

    Science.gov (United States)

    Duron, Emmanuelle; Hanon, Olivier

    2010-09-01

    Atrial fibrillation (AF), which prevalence increases with age, is a growing public health problem and a well known risk factor for stroke. On the other hand, dementia is one of the most important neurological disorders in the elderly, and with aging of the population in developed countries, the number of demented patients will increase in absence of prevention. In the past decade, several vascular risk factors (hypertension, obesity and metabolic syndrome, hypercholesterolemia) have been found, with various degree of evidence, to be associated with vascular dementia but also, surprisingly, with Alzheimer's disease. This review is devoted to the links between atrial fibrillation, cognitive decline and dementia. Globally, transversal studies showed a significant association between atrial fibrillation, cognitive decline and dementia. However, these studies are particularly sensitive to various biases. In this context, recent longitudinal studies of higher level of evidence have been conducted to assess the link between AF and dementia. One study disclosed a high incidence of dementia among patients suffering from atrial fibrillation during a 4.6 years follow-up. Similarly another study showed that atrial fibrillation was significantly associated with conversion from mild cognitive impairment to dementia during a 3 years follow-up. Nevertheless two other longitudinal studies did not find any significant association between AF and dementia, but this discrepancy should be interpreted taking into account that the comparability of all these studies is moderate because they were using different methodologies (population, cognitive testing, and mean follow-up). Possible explanatory mechanisms for the association between AF and the risk of dementia are proposed, such as thrombo-embolic ischemic damage and cerebral hypo perfusion due to fluctuations in the cardiac output. Thus, there is some evidence that FA could be associated with cognitive decline and dementia but this

  10. Combined aspirin and anticoagulant therapy in patients with atrial fibrillation.

    Science.gov (United States)

    So, Charlotte H; Eckman, Mark H

    2017-01-01

    The combined use of aspirin and oral anticoagulant therapy in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) has been questioned due to an increased risk of major bleeding with little to no benefit in preventing ischemic events. (1) To better understand patterns and indications for combined antiplatelet and anticoagulant therapy and identify patients who might reasonably be treated with oral anticoagulant (OAC) therapy alone. (2) To perform an updated literature review regarding the use of combined antiplatelet and OAC therapy in patients with AF and stable CAD. Retrospective review. Patients within the University of Cincinnati Health System with a diagnosis of non-valvular AF, excluding those with acute coronary syndrome or revascularization within the last 12 months. Numbers and indications for combined antiplatelet and anticoagulant therapy and sequence of events leading to the initiation of each. Of 948 patients receiving OAC, 430 (45 %) were receiving concomitant OAC and aspirin. Among patients receiving combined antiplatelet and anticoagulant therapy, 49 and 42 % of patients respectively, had CAD or DM. In a more detailed analysis including chart review of 219 patients receiving combined OAC and aspirin, 27 % had a diagnosis of CAD and 14 % had a diagnosis of DM prior to the development of AF. These patients were initially treated with aspirin. Warfarin was added when they subsequently developed AF but aspirin wasn't discontinued. A surprisingly large proportion of patients (22.8 %) had no obvious indication for dual therapy. Prior myocardial infarction, CAD, vascular disease and DM (among others) increase the likelihood of receiving combined antiplatelet and anticoagulant therapy among patients with AF. A literature review suggests this may lead to increased major bleeding with little benefit in decreasing either AF-related stroke or cardiovascular events.

  11. Amiodarone cost effectiveness in preventing atrial fibrillation after coronary artery bypass graft surgery

    DEFF Research Database (Denmark)

    Zebis, Lars R; Christensen, Thomas D; Hjortdal, Vibeke E

    2008-01-01

    BACKGROUND: The purpose of this study was to estimate the costs and health benefits of routinely administered postoperative amiodarone as prevention of atrial fibrillation for patients undergoing coronary artery bypass grafting (CABG) for stable angina. METHODS: This cost-effectiveness study...... was based on a randomized, controlled, double-blind trial (the RASCABG study) using avoidance of atrial fibrillation as the measure of benefit at the Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark. Two hundred and fifty eligible consecutively enrolled CABG...... of atrial fibrillation compared with 32 in the control group (p cost per patient was 7,639 euros in the amiodarone group and 7,814 euros in the placebo group (p

  12. Structural Transformation and Aggregation of cc-beta Peptides Into Amyloid Proto-fibrils

    Science.gov (United States)

    Bhandari, Yuba; Steckmann, Timothy; Chapagain, Prem; Gerstman, Bernard

    2013-03-01

    The study of amyloid fibrils has important implications in understanding and treatment of various neurodegenerative diseases such as Alzheimer's and Parkinson's. During the formation of amyloid fibrils, peptide polymers manifest fascinating physical behavior by undergoing complicated structural transformations. We examine the behavior of a small engineered peptide called cc-beta, that was designed to mimic the structural changes of the much larger, naturally occurring amyloid beta proteins. Molecular dynamics (MD) simulations are performed to uncover the underlying physics that is responsible for the large scale structural transformations. By using implicit solvent replica exchange MD simulations, we examined the behavior of 12 peptides, initially arranged in four different cc-beta alpha helix trimers. We observed various intermediate stages of aggregation, as well as an organized proto-fibril beta aggregate. We discuss the time evolution and the various interactions involved in the structural transformation.

  13. Pharmacological approaches in the treatment of atrial fibrillation.

    Science.gov (United States)

    Tamargo, Juan; Caballero, Ricardo; Delpón, Eva

    2004-01-01

    Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with substantial cardiovascular morbidity and mortality. The arrhythmia can be initiated and/or maintained by rapidly firing foci, single- and multiple-circuit reentry. Once initiated, AF alters atrial electrical and structural properties (atrial remodeling) in a way that promotes its own maintenance and recurrence and may alter the response to antiarrhythmic drugs. Thus, initial episodes of paroxysmal (self-terminating) AF lengthens to the point where the arrhythmia becomes persistent (requires cardioversion to restore sinus rhythm) and permanent. AF usually requires a trigger for initiation and a favorable electrophysiological and/or anatomical substrate for maintenance. The substrate includes both cardiovascular (coronary artery disease, valvular heart disease, heart failure, hypertension, dilated cardiomyopathy) and non cardiovascular diseases (thyrotoxicosis, pulmonary diseases). Accordingly, the initial step in patients with AF requires a careful assessment of symptoms and identification of underlying reversible triggers and potentially modifiable underlying structural substrate and treat them aggressively. In contrast to other cardiac arrhythmias, antiarrhythmic drugs (ADs) are the mainstay of therapy. Long-term treatment of AF is directed to restore and maintain the sinus rhythm with class I and III ADs (rhythm-control) or to allow AF to persist and ensure that the ventricular rate is controlled (rate-control) with atrioventricular nodal blocking drugs (digoxin, beta-blockers, verapamil, diltiazem) and prevent thromboembolic complications with anticoagulants. However, the long-term efficacy of ADs for preventing AF recurrence is far from ideal, because of limited efficacy (AF recurs in at least one-half of the patients) and potential side effects, particularly proarrhythmia. Thus, the choice of the appropriate AD will depend on the temporal pattern of the arrhythmia

  14. Risk of atrial fibrillation in diabetes mellitus

    DEFF Research Database (Denmark)

    Pallisgaard, Jannik L.; Schjerning, Anne-Marie; Lindhardt, Tommi B.

    2016-01-01

    AIM: Diabetes has been associated with atrial fibrillation but the current evidence is conflicting. In particular knowledge regarding young diabetes patients and the risk of developing atrial fibrillation is sparse. The aim of our study was to investigate the risk of atrial fibrillation in patients...... with diabetes compared to the background population in Denmark. METHODS AND RESULTS: Through Danish nationwide registries we included persons above 18 years of age and without prior atrial fibrillation and/or diabetes from 1996 to 2012. The study cohort was divided into a background population without diabetes...... and a diabetes group. The absolute risk of developing atrial fibrillation was calculated and Poisson regression models adjusted for sex, age and comorbidities were used to calculate incidence rate ratios of atrial fibrillation. The total study cohort included 5,081,087 persons, 4,827,713 (95%) in the background...

  15. Amiodarone is a cost-neutral way of preventing atrial fibrillation after surgery for lung cancer

    DEFF Research Database (Denmark)

    Riber, Lars P; Christensen, Thomas D; Pilegaard, Hans K

    2013-01-01

    OBJECTIVES: Our aim was to estimate the costs and health benefits of routinely administered postoperative amiodarone as a prophylactic agent in reducing the risk of atrial fibrillation in patients undergoing surgery for lung cancer. METHODS: This was a cost-effectiveness study, based on the rando......OBJECTIVES: Our aim was to estimate the costs and health benefits of routinely administered postoperative amiodarone as a prophylactic agent in reducing the risk of atrial fibrillation in patients undergoing surgery for lung cancer. METHODS: This was a cost-effectiveness study, based...... on the randomized, controlled, double-blinded PASCART study, using avoidance of atrial fibrillation as the measure of benefit. Two hundred and fifty-four eligible, consecutively enrolled patients, undergoing surgery for lung cancer at the department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital.......23). There were no signs of adverse developments referable to amiodarone in this prophylactic regime. CONCLUSIONS: For patients undergoing surgery for lung cancer, routine use of postoperative prophylactic intravenous bolus and five subsequent days of oral amiodarone therapy reduces the risk of atrial...

  16. The Relation Between Collagen Fibril Kinematics and Mechanical Properties in the Mitral Valve Anterior Leaflet

    Energy Technology Data Exchange (ETDEWEB)

    Liao,J.; Yang, L.; Grashow, J.; Sacks, M.

    2007-01-01

    fibril strain was 8.3 min, which was smaller than the tissue-level stress relaxation time constants of 22.0 and 16.9 min in the circumferential and radial directions, respectively. Moreover, there was no change in the fibril angular distribution under both creep and stress relaxation over the test period. Our results suggest that (1) the MVAL collagen fibrils do not exhibit intrinsic viscoelastic behavior, (2) tissue relaxation results from the removal of stress from the fibrils, possibly by a slipping mechanism modulated by noncollagenous components (e.g. proteoglycans), and (3) the lack of creep but the occurrence of stress relaxation suggests a 'load-locking' behavior under maintained loading conditions. These unique mechanical characteristics are likely necessary for normal valvular function.

  17. Almanac 2011: Valvular heart disease. The national society journals present selected research that has driven recent advances in clinical cardiology

    Directory of Open Access Journals (Sweden)

    Raphael Rosenhek

    2012-03-01

    Full Text Available With an ageing population and improved diagnostic modalities, the number of patients with valvular heart disease is dramatically increasing. We are faced with more complex decisions in patients with advanced age and increasing comorbidities. Advances in percutaneous valve interventions – like percutaneous aortic valve replacement and mitral valve repair – have revolutionised the way we manage such diseases. This overview highlights recent advances in the decision making – process and the management of patients with valvular heart disease.

  18. Cardiac embolism after implantable cardiac defibrillator shock in non-anticoagulated atrial fibrillation: The role of left atrial appendage occlusion.

    Science.gov (United States)

    Freixa, Xavier; Andrea, Rut; Martín-Yuste, Victoria; Fernández-Rodríguez, Diego; Brugaletta, Salvatore; Masotti, Mónica; Sabaté, Manel

    2014-04-26

    Cardioembolic events are one of the most feared complications in patients with non-valvular atrial fibrillation (NVAF) and a formal contraindication to oral anticoagulation (OAC). The present case report describes a case of massive peripheral embolism after an implantable cardiac defibrillator (ICD) shock in a patient with NVAF and a formal contraindication to OAC due to previous intracranial hemorrhage. In order to reduce the risk of future cardioembolic events, the patient underwent percutaneous left atrial appendage (LAA) occlusion. A 25 mm Amplatzer™ Amulet was implanted and the patient was discharged the following day without complications. The potential risk of thrombus dislodgement after an electrical shock in patients with NVAF and no anticoagulation constitutes a particular scenario that might be associated with an additional cardioembolic risk. Although LAA occlusion is a relatively new technique, its usage is rapidly expanding worldwide and constitutes a very valid alternative for patients with NVAF and a formal contraindication to OAC.

  19. Chronic Atrial Fibrillation Ablation with Harmonic Scalpel during Mitral Valve Surgery

    Science.gov (United States)

    Brick, Alexandre Visconti; Braile, Domingo M.

    2017-01-01

    Objective To evaluate surgical treatment of chronic atrial fibrillation with ultrasound in patients with mitral valve disease, considering preoperative clinical characteristics of patients undergoing surgical procedure and follow-up in the immediate postoperative period, in hospital and up to 60 months after discharge. Methods We studied 100 patients with chronic atrial fibrillation and mitral valve disease who underwent surgical treatment using ultrasound ablation. Patient data were reviewed by consulting the control reports, including signs and symptoms, underlying disease, functional class, hospital stay, surgical procedure time, ablation time, immediate complications, and complications at discharged and up to 60 months later. Actuarial curve (Kaplan-Meier) was used for the study of permanence without recurrence after 12, 24, 36, 48 and 60 months. Results 86% of the patients had rheumatic mitral valve disease, 14% had degeneration of the mitral valve, 40% had mitral regurgitation, and 36% had mitral stenosis. Main symptoms included palpitations related to tachycardia by chronic atrial fibrillation (70%), congestive heart failure (70%), and previous episodes of acute pulmonary edema (27%). Early results showed that 94% of the patients undergoing ultrasound ablation reversed the rate of chronic atrial fibrillation, 86% being in sinus rhythm and 8% in atrioventricular block. At hospital discharge, maintenance of sinus rhythm was observed in 86% of patients and there was recurrence of chronic atrial fibrillation in 8% of patients. At follow-up after 60 months, 83.8% of patients maintained the sinus rhythm. Conclusion Surgical treatment of chronic atrial fibrillation with ultrasound concomitant with mitral valve surgery is feasible and satisfactory, with maintenance of sinus rhythm in most patients (83.8%) after 60 months of follow-up.

  20. Atrial fibrillation in the elderly

    Institute of Scientific and Technical Information of China (English)

    Roger Kerzner; Michael W. Rich

    2005-01-01

    Atrial fibrillation (AF) is an extremely common condition in the elderly, with increasing prevalence around the world as the population ages. AF may be associated with serious health consequences, including stroke, heart failure, and decreased quality of life, so that careful management of AF by geriatric health care providers is required. With careful attention to anticoagulation therapy, and prudent use of medications and invasive procedures to minimize symptoms, many of the adverse health consequences of AF can be prevented.

  1. Alginate-Collagen Fibril Composite Hydrogel.

    Science.gov (United States)

    Baniasadi, Mahmoud; Minary-Jolandan, Majid

    2015-02-16

    We report on the synthesis and the mechanical characterization of an alginate-collagen fibril composite hydrogel. Native type I collagen fibrils were used to synthesize the fibrous composite hydrogel. We characterized the mechanical properties of the fabricated fibrous hydrogel using tensile testing; rheometry and atomic force microscope (AFM)-based nanoindentation experiments. The results show that addition of type I collagen fibrils improves the rheological and indentation properties of the hydrogel.

  2. Alginate-Collagen Fibril Composite Hydrogel

    Directory of Open Access Journals (Sweden)

    Mahmoud Baniasadi

    2015-02-01

    Full Text Available We report on the synthesis and the mechanical characterization of an alginate-collagen fibril composite hydrogel. Native type I collagen fibrils were used to synthesize the fibrous composite hydrogel. We characterized the mechanical properties of the fabricated fibrous hydrogel using tensile testing; rheometry and atomic force microscope (AFM-based nanoindentation experiments. The results show that addition of type I collagen fibrils improves the rheological and indentation properties of the hydrogel.

  3. Quenched Hydrogen Exchange NMR of Amyloid Fibrils.

    Science.gov (United States)

    Alexandrescu, Andrei T

    2016-01-01

    Amyloid fibrils are associated with a number of human diseases. These aggregatively misfolded intermolecular β-sheet assemblies constitute some of the most challenging targets in structural biology because to their complexity, size, and insolubility. Here, protocols and controls are described for experiments designed to study hydrogen-bonding in amyloid fibrils indirectly, by transferring information about amide proton occupancy in the fibrils to the dimethyl sulfoxide-denatured state. Since the denatured state is amenable to solution NMR spectroscopy, the method can provide residue-level-resolution data on hydrogen exchange for the monomers that make up the fibrils.

  4. The role of protonation in protein fibrillation

    DEFF Research Database (Denmark)

    Jeppesen, Martin D; Westh, Peter; Otzen, Daniel E

    2010-01-01

    Many proteins fibrillate at low pH despite a high population of charged side chains. Therefore exchange of protons between the fibrillating peptide and its surroundings may play an important role in fibrillation. Here, we use isothermal titration calorimetry to measure exchange of protons between...... buffer and the peptide hormone glucagon during fibrillation. Glucagon absorbs or releases protons to an extent which allows it to attain a net charge of zero in the fibrillar state, both at acidic and basic pH. Similar results are obtained for lysozyme. This suggests that side chain pKa values change...

  5. Collagen fibril diameter and leather strength.

    Science.gov (United States)

    Wells, Hannah C; Edmonds, Richard L; Kirby, Nigel; Hawley, Adrian; Mudie, Stephen T; Haverkamp, Richard G

    2013-11-27

    The main structural component of leather and skin is type I collagen in the form of strong fibrils. Strength is an important property of leather, and the way in which collagen contributes to the strength is not fully understood. Synchrotron-based small angle X-ray scattering (SAXS) is used to measure the collagen fibril diameter of leather from a range of animals, including sheep and cattle, that had a range of tear strengths. SAXS data were fit to a cylinder model. The collagen fibril diameter and tear strength were found to be correlated in bovine leather (r(2) = 0.59; P = 0.009), with stronger leather having thicker fibrils. There was no correlation between orientation index, i.e., fibril alignment, and fibril diameter for this data set. Ovine leather showed no correlation between tear strength and fibril diameter, nor was there a correlation across a selection of other animal leathers. The findings presented here suggest that there may be a different structural motif in skin compared with tendon, particularly ovine skin or leather, in which the diameter of the individual fibrils contributes less to strength than fibril alignment does.

  6. Operationalizing the 2014 ACC/AHA Guidelines for Valvular Heart Disease: A Guide for Clinicians.

    Science.gov (United States)

    Nishimura, Rick A; Carabello, Blase

    2016-05-17

    The 2014 American College of Cardiology/American Heart Association guidelines for valvular heart disease were released to help guide the clinician in caring for patients with this ever more prevalent and complex group of diseases and have been instrumental in providing a foundation of knowledge for the management of patients with valvular heart disease. However, there are many caveats in applying the guidelines to individual patients. As clinicians, we wish to outline important aspects to be considered by other clinicians, including the integration of the echocardiogram with the history and physical examination, recognition of discordant data within an echocardiographic examination, and proper interpretation of the cutoff measurements applied to timing of intervention. Decisions regarding management should be individualized to the institution, particularly when recommending early operation for an asymptomatic patient. Finally, all decisions should be individualized to each patient by not only recognizing specific comorbidities, but also understanding the patient's needs and preferences.

  7. Cardiovascular Magnetic Resonance Imaging for Structural and Valvular Heart Disease Interventions.

    Science.gov (United States)

    Cavalcante, João L; Lalude, Omosalewa O; Schoenhagen, Paul; Lerakis, Stamatios

    2016-03-14

    The field of percutaneous interventions for the treatment of structural and valvular heart diseases has been expanding rapidly in the last 5 years. Noninvasive cardiac imaging has been a critical part of the planning, procedural guidance, and follow-up of these procedures. Although echocardiography and cardiovascular computed tomography are the most commonly used and studied imaging techniques in this field today, advances in cardiovascular magnetic resonance imaging continue to provide important contributions in the comprehensive assessment and management of these patients. In this comprehensive paper, we will review and demonstrate how cardiovascular magnetic resonance imaging can be used to assist in diagnosis, treatment planning, and follow-up of patients who are being considered for and/or who have undergone interventions for structural and valvular heart diseases.

  8. Estimation of turbulent shear stress in free jets: application to valvular regurgitation.

    Science.gov (United States)

    Winoto, S H; Shah, D A; Liu, H

    1996-01-01

    In an attempt to better assess the severity of valvular regurgitation, an in-vitro experiment has been conducted to estimate turbulent shear stress levels within free jets issuing from different orifice shapes and sizes by means of hot-wire anemometry. On the basis of the measured mean velocities and the jet profiles, the distributions of the normalized kinematic turbulent shear stress (uv/Um2) were estimated for different jets by using an equation available for self-preserving circular jet. The results indicate that the equation can estimate the distributions of uv/Um2 independent of the orifice shape and Reynolds number of the jet. For the range of Reynolds numbers considered, the estimation of maximum turbulent shear stress inferred from these distributions suggests that the critical shear stress level of approximately 200 N/m2, corresponding to destruction of blood cells, is exceeded for typical blood flow velocity of 5 m/s at the valvular lesion.

  9. A case of left main pulmonary artery aneurysm associated with valvular pulmonary stenosis in a child.

    Science.gov (United States)

    Lee, Ran; Son, Jae Sung; Park, Yong Mean

    2011-10-01

    Aneurysm of the main pulmonary artery is a rare clinical entity that can be congenital or acquired. Most cases occur in association with other congenital malformations, severe pulmonary hypertension, vasculitides, infectious agents, or collagen vascular disorders. We report here a pediatric case of left pulmonary artery aneurysm associated with valvular pulmonary stenosis and a hypoplastic right pulmonary artery, which we confirmed via multidetector computed tomography angiography.

  10. A time course investigation of the statin paradox among valvular interstitial cell phenotypes

    OpenAIRE

    Monzack, Elyssa L.; Masters, Kristyn S.

    2012-01-01

    Statin drugs are prescribed primarily for their ability to lower cholesterol, but may also exert beneficial side effects unrelated to cholesterol metabolism. Previous work has described a “statin paradox,” where statin treatment decreased osteoblastic markers in valve myofibroblasts while increasing those same markers in preosteoblasts. However, valvular interstitial cells (VICs) themselves are a multipotent cell type, capable of differentiating into activated, myofibroblastic VICs (aVICs) an...

  11. [Optimization of postoperative medical therapy of infective endocarditis in patients with congenital valvular heart disease].

    Science.gov (United States)

    Chistyakov, I S; Medvedev, A P; Pichugin, V V

    2016-01-01

    The purpose of this study was to evaluate the effectiveness of combined surgical and medical treatment of infective endocarditis in patients with congenital valvular heart disease when included in a regimen of the drug Reamberin. In this regard, the analysis of the effectiveness of a combination regimen of 74 patients with valvular congenital heart diseases complicated with infective endocarditis. Given the indications for surgical correction operative technique features and possible technical difficulties in carrying out such operations, due to the inflammatory changes and tissue destruction, and ways to overcome them. For the correction of metabolic disorders in the postoperative period, 47 patients (main group) was appointed Reamberin: once, intravenous drip 400 ml/day during the first 5 days after surgery. 27 patients (control group) was conducted infusion therapy depending on the severity of the condition according to the classical scheme. In addition to standard clinical and laboratory examination, to assess the effectiveness of Reamberin was investigated catalase activity of CPK in blood serum in the dynamics of observation (1, 3 and 5 days after surgery). It is revealed that surgical approach, used in complex treatment of patients with valvular congenital heart diseases, including reorganization of the cavities of the heart, increasing the frequency of joints and the use of reinforcing strips of synthetic material that prevents the cutting of sutures through the inflamed tissue has achieved good short-and long-term results. Infective endocarditis and destruction of the valvular annulus fibrosus the use of a frame of strips of polytetrafluoroethylene allows you to restore its integrity and to implant a mechanical prosthesis. The inclusion in the regimen of patients with infective endocarditis complicated by cardiac insufficiency in the early postoperative period the drug Reamberin improves the efficiency of treatment by a more rapid restoration of the normal

  12. Residue-specific Fluorescent Probes of α-Synuclein: Detection of Early Events at the N- and C-termini during Fibril Assembly†

    Science.gov (United States)

    Yap, Thai Leong; Pfefferkorn, Candace M.; Lee, Jennifer C.

    2011-01-01

    In the Parkinson’s disease-associated state, α-synuclein (α-syn) undergoes large conformational changes forming ordered, β-sheet containing fibrils. To unravel the role of specific residues during the fibril assembly process, we prepared single-Cys mutants in the disordered (G7C and Y136C) and proximal (V26C and L100C) fibril core sites and derivatized them with environment sensitive dansyl (Dns) fluorophores. Dns fluorescence exhibits residue-specificity in spectroscopic properties as well as kinetic behavior; early kinetic events were revealed by probes located at positions 7 and 136 compared to those positioned at 26 and 100. PMID:21338068

  13. Fibrosis and electrophysiological characteristics of the atrial appendage in patients with atrial fibrillation and structural heart disease

    NARCIS (Netherlands)

    Brakel, T.J. van; Krieken, T. van der; Westra, S.W.; Laak, J.A.W.M. van der; Smeets, J.L.R.M.; Swieten, H.A. van

    2013-01-01

    PURPOSE: This study was conducted to investigate the degree of fibrosis in atrial appendages of patients with and without atrial fibrillation (AF) undergoing cardiac surgery. In addition, we hypothesized that areas of atrial fibrosis can be identified by electrogram fractionation and low voltage for

  14. Elevated transaortic valvular gradients after combined aortic valve and mitral valve replacement: an intraoperative dilemma.

    Science.gov (United States)

    Essandoh, Michael; Portillo, Juan; Zuleta-Alarcon, Alix; Castellon-Larios, Karina; Otey, Andrew; Sai-Sudhakar, Chittoor B

    2015-03-01

    High transaortic valvular gradients, after combined aortic valve and mitral valve replacement, require prompt intraoperative diagnosis and appropriate management. The presence of high transaortic valvular gradients after cardiopulmonary bypass, in this setting, can be secondary to the following conditions: prosthesis dysfunction, left ventricular outflow tract obstruction, supravalvular obstruction, prosthesis-patient mismatch, hyperkinetic left ventricle from administration of inotropes, left ventricular intracavitary gradients, pressure recovery phenomenon, and increased transvalvular blood flow resulting from hyperdynamic circulation or anemia. Transesophageal echocardiography is an extremely useful tool for timely diagnosis and treatment of this complication. We describe a case of a critically ill patient with endocarditis and acute lung injury, who presented for combined aortic valve and mitral valve replacement. Transesophageal echocardiographic assessment, post-cardiopulmonary bypass, revealed high transaortic valvular gradients due to encroachment of the mitral prosthesis strut on the left ventricular outflow tract, which was compounded by a small, hypertrophied, and hyperkinetic left ventricle. Discontinuation of inotropic support, administration of fluids, phenylephrine, and esmolol led to resolution of the high gradients and prevented further surgery.

  15. Quantitative assessment of left-sided valvular regurgitation by multi-gated equilibrium scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Kosuda, Shigeru; Kunieda, Etsuo; Takagi, Yaeko (Keio Univ., Tokyo (Japan). School of Medicine)

    1983-04-01

    In order to evaluate quantitatively left-sided valvular regurgitation by multi-gated equilibrium scintigraphy, regurgitant fraction (RF) was defined as following, RF = (LVCO - RVCO)/RVCO = SVR - 1. LVCO; left ventricular count output. RVCO; right ventricular count output. SVR; stroke volume ratio. RF values in 70 subjects were calculated after multigated equilibrium scintigraphies were performed. In 85% of 54 subjects without regurgitation, RF was less than 0.5 (MEAN +- S.D. 0.29 +- 0.28). In all of 16 patients with mitral and/or aortic regurgitation, RF was more than 0.5 (MEAN +- S.D. 1.68 +- 0.99) (P<0.001). Furthermore, the value of RF indicated the severity of regurgitation based on Sellers' criteria determined by contrast angiography. After successful valve replacement, post-operative RF reduced and were within normal values. We conclude that RF by multi-gated equilibrium scintigraphy permits noninvasive, quantitative assessment of left-sided valvular regurgitation, and RF is highly reproducible and useful for post-operative assessment in patients with valvular regurgitation.

  16. Radiographic Evaluation of Valvular Heart Disease With Computed Tomography and Magnetic Resonance Correlation.

    Science.gov (United States)

    Lempel, Jason K; Bolen, Michael A; Renapurkar, Rahul D; Azok, Joseph T; White, Charles S

    2016-09-01

    Valvular heart disease is a group of complex entities with varying etiologies and clinical presentations. There are a number of imaging tools available to supplement clinical evaluation of suspected valvular heart disease, with echocardiography being the most common and clinically established, and more recent emergence of computed tomography and magnetic resonance imaging as additional supportive techniques. Yet even with these newer and more sophisticated modalities, chest radiography remains one of the earliest and most common diagnostic examinations performed during the triage of patients with suspected cardiac dysfunction. Recognizing the anatomic and pathologic features of cardiac radiography including the heart's adaptation to varying hemodynamic changes can provide clues to the radiologist regarding the underlying etiology. In this article, we will elucidate several principles relating to chamber modifications in response to pressure and volume overload as well as radiographic appearances associated with pulmonary fluid status and cardiac dysfunction. We will also present a pattern approach to optimize analysis of the chest radiograph for valvular heart disease, which will help guide the radiologist down a differential diagnostic pathway and create a more meaningful clinical report.

  17. The Role of Interleukin-13 in Patients with Rheumatic Valvular Fibrosis: A Clinical and Histological Study.

    Science.gov (United States)

    Liu, Qi; Qiao, Wei-Hua; Li, Fei-fei; Deng, Peg; Hu, Zhi-Wei

    2015-07-01

    Interleukin (IL)-13 is a major inducer of fibrosis in many chronic infectious diseases, yet few studies have reported its role in valvular fibrosis in patients with rheumatic heart disease (RHD). The study aim was to investigate the role of IL-13 in mitral valvular fibrosis in patients with RHD. Peripheral blood samples were collected from surgical patients with RHD (n = 18) and from healthy controls (n = 9). Serum levels of IL-13 and interferon (IFN)-gamma were analyzed using ELISA. Rheumatic mitral valves removed from surgical patients with RHD, and normal mitral valves, were obtained at autopsy. The expression and distribution of collagen I, collagen III, and IL-13Ralpha1 were examined by immunohistochemical staining, the degree of which was measured using computed imaging analysis. Higher IL-13 levels were observed in RHD patients (15.16 +/- 9.62 pg/ml; p valves, rheumatic mitral valves expressed high levels of collagen I (0.01931 +/- 0.00159 versus 0.01183 +/- 0.00207; p heart interstitial cells, while IL-13Ralpha1 was expressed in the endothelial cells and smooth muscle cells of the blood vessels, and in interstitial cells. Patients with RHD showed increased serum levels of IL-13 compared to healthy controls. IFN-gamma levels were clearly different among RHD patients and healthy controls. The expression of collagens I and III and IL-13Ralpha1 was higher in rheumatic mitral valves compared to normal mitral valves. IL-13 may induce mitral valvular fibrosis in RHD.

  18. Anti-fibrin antibody binding in valvular vegetations and kidney lesions during experimental endocarditis.

    Science.gov (United States)

    Yokota, M; Basi, D L; Herzberg, M C; Meyer, M W

    2001-01-01

    In Streptococcus sanguinis (sanguis) induced experimental endocarditis, we sought evidence that the development of aortic valvular vegetation depends on the availability of fibrin. Endocarditis was induced in New Zealand white rabbits by catheter placement into the left ventricle and inoculation of the bacteria. Fibrin was localized in the developing vegetation with 99mTechnetium (Tc)-labeled anti-fibrin antibody one or three days later. When rabbit anti-fibrin antibody was given intravenously on day 1, the mass of aortic valvular vegetation was significantly reduced at day 3; infusion of non-specific rabbit IgG showed no effect. The 99mTc-labeled anti-fibrin antibody also labeled kidneys that showed macroscopic subcapsular hemorrhage. To learn if the deposition of fibrin in the kidneys was a consequence of endocarditis required a comparison of farm-bred and specific pathogen-free rabbits before and after the induction of endocarditis. Before induction, the kidneys of farm-bred rabbits were labeled, but specific pathogen-free rabbits were free of labeling and signs of macroscopic hemorrhage. After 3 days of endocarditis, kidneys of 10 of 14 specific pathogen-free rabbits labeled with 99mTc-labeled anti-fibrin antibody and showed hemorrhage. Kidney lesions were suggested to be a frequent sequellae of S. sanguinis infective endocarditis. For the first time, fibrin was shown to be required for the continued development of aortic valvular vegetations.

  19. Predictors and prognosis of paroxysmal atrial fibrillation in general practice in the UK

    Directory of Open Access Journals (Sweden)

    Wallander Mari-Ann

    2005-07-01

    Full Text Available Abstract Background Natural history of paroxysmal atrial fibrillation (AF is not very well documented. Clinical experience suggests that paroxysmal AF could progress to chronic AF with estimates ranging between 15 and 30% over a period of 1–3 years. We performed an epidemiologic study to elucidate the natural history of paroxysmal AF, this study estimated its incidence in a general practice setting, identified associated factors and analyzed the progression into chronic AF as well as the mortality rate. Methods Using the UK General Practice Research Database (GPRD, we identified patients aged 40–89 years with a first-recorded episode of paroxysmal AF during 1996. Risk factors were assessed using 525 incident paroxysmal AF cases confirmed by the general practitioner (GP and a random sample of controls. We follow-up paroxysmal AF patients and estimated their mortality rate and progression to chronic AF. Results The incidence of paroxysmal AF was 1.0 per 1,000 person-years. Major risk factors for paroxysmal AF were age and prior valvular heart disease, ischaemic heart disease, heart failure and hyperthyroidism. During a mean follow-up of 2.7 years, 70 of 418 paroxysmal AF patients with complete information progressed to chronic AF. Risk factors associated with progression were valvular heart disease (OR 2.7, 95% CI 1.2–6.0 and moderate to high alcohol consumption (OR 3.0, 95% CI 1.1–8.0. Paroxysmal AF patients did not carry an increased risk of mortality, compared to an age and sex matched sample of the general population. There was a suggestion of a small increased risk among patients progressing to chronic AF (RR 1.5, 96% CI 0.8–2.9. Conclusion Paroxysmal AF is a common arrhythmia in the general practice setting, increasing with age and commonly associated with other heart diseases. It sometimes is the initial presentation and then progress to chronic AF. A history of valvular heart disease and alcohol consumption are associated with

  20. 重症心脏瓣膜病外科治疗%Analysis of surgical treatment of severe valvular heart disease

    Institute of Scientific and Technical Information of China (English)

    吴颖猛

    2011-01-01

    目的 探讨危重心脏瓣膜病外科治疗效果,以期提高存活率。方法 对危重心脏瓣膜病患者100例给予手术治疗。术前心功能Ⅲ级60例,Ⅳ级40例。结果 共死亡4例(4%),死于术后低心排综合征1例,突发室颤抢救无效死亡3例,其96例顺利出院;心功能恢复至Ⅰ级10例、Ⅱ级29例、Ⅲ级14例。术后心胸比率有不同程度缩小;瓣膜病变超声心动图检出情况:主动脉瓣钙化或硬化12例(40.0%),二尖瓣硬化与钙化13例(26%);术后20个月左室舒张末期内径(LVEDD) (53.0±7.0) mm低于出院时(64.0±6.2)mm(t=3.789,P<0.05);术后20个月左室射血分数(LVEF)为(42.5±11.0)%,高于出院时(37.5±6.2)%,(t =3.799,P<0.05)。结论 对重症心脏瓣膜病患者,注重改善术前心功能,尽量保留瓣下组织,加强术后并发症的防治,可提高术后存活率。%Objective To investigate the effects of surgical treatment of severe valvular heart disease to improve early survival. Methods 100 cases with severe heart valve surgery were opercted,The mitralvalve replacement (MVR) in 50 cases, aortic valve replacement (AVR) in 30 cases, MVR + AVR in 20 cases;tricuspid valvuloplasty (TVP) in 50 cases,dissection of left atrial thrombus in 25 cases,left atrial plication in 12 cases,coronary artery bypass grafting(CABG) in 20 patients; The Ⅲ grade of heart function( n = 60), Ⅳ grade( n = 40). Results A total of 4 cases died(4% )died of postoperative low cardiac output syndrome in 1 case, sudden ventricular fibrillation in 3 cases died,the other 96 cases discharged;heart function recovered to 10 cases of grade Ⅰ, Ⅱ Grade 29 cases, Ⅲ grade 14 cases. Postoperative cardiothoracic ratio reduced to varying degrees;The 12 cases(40% ) with aortic valve calcification or hardening,13 cases(26% ) with mitral valve sclerosis or calcification in patients with severe valvular heart disease by echocardiography; The left

  1. Formation and properties of whey protein fibrils

    NARCIS (Netherlands)

    Kroes-Nijboer, A.

    2011-01-01

    Protein fibrils are threadlike aggregates that are about one molecule thick and more than thousand molecules long. Due to their threadlike structure they could potentially be used to form meat-like structures. Protein fibrils can be produced from milk protein and plant protein, opening opportunities

  2. Viscoelastic behavior of discrete human collagen fibrils

    DEFF Research Database (Denmark)

    2010-01-01

    on the strain. The slope of the viscous response showed a strain rate dependence corresponding to a power function of powers 0.242 and 0.168 for the two patellar tendon fibrils, respectively. In conclusion, the present work provides direct evidence of viscoelastic behavior at the single fibril level, which has...

  3. PAROXYSMAL ATRIAL FIBRILLATION: CHOICE OF CARDIOVERSION THERAPY

    Directory of Open Access Journals (Sweden)

    B. A. Tatarskii

    2007-01-01

    Full Text Available Characteristics and classification of different patterns of paroxysmal atrial fibrillation are presented. Main indications to restoration of sinus rhythm are discussed. The features of main medications used to terminate of atrial fibrillation are given. The choice of antiarrhythmic drug is considerate. Necessity of individual approach to therapy tactics is proved.

  4. Viscoelastic behavior of discrete human collagen fibrils

    DEFF Research Database (Denmark)

    Svensson, René; Hassenkam, Tue; Hansen, Philip

    2010-01-01

    Whole tendon and fibril bundles display viscoelastic behavior, but to the best of our knowledge this property has not been directly measured in single human tendon fibrils. In the present work an atomic force microscopy (AFM) approach was used for tensile testing of two human patellar tendon fibr...

  5. Graphene oxide strongly inhibits amyloid beta fibrillation

    NARCIS (Netherlands)

    Mahmoudi, Morteza; Akhavan, Omid; Ghavami, Mahdi; Rezaee, Farhad; Ghiasi, Seyyed Mohammad Amin

    2012-01-01

    Since amyloid beta fibrillation (AbF) plays an important role in the development of neurodegenerative diseases, we investigated the effect of graphene oxide (GO) and their protein-coated surfaces on the kinetics of Ab fibrillation in the aqueous solution. We showed that GO and their protein-covered

  6. Fibril assembly in whey protein mixtures

    NARCIS (Netherlands)

    Bolder, S.G.

    2007-01-01

    The objective of this thesis was to study fibril assembly in mixtures of whey proteins. The effect of the composition of the protein mixture on the structures and the resulting phase behaviour was investigated. The current work has shown that beta-lactoglobulin is responsible for the fibril assembly

  7. The risk factors associated with intraoperative acute cardiac decompensation in patients undergoing off-pump coronary artery bypass grafting%非体外循环冠状动脉旁路移植术患者术中急性心功能失代偿的危险因素

    Institute of Scientific and Technical Information of China (English)

    董秀华; 卢家凯; 卿恩明; 王义军; 王学勇

    2010-01-01

    目的 筛选非体外循环冠状动脉旁路移植术(OPCABG)患者术中发生急性心功能失代偿的危险因素.方法 选择本院2007年11月至2009年2月行OPCABG的患者2379例,记录术前、术中与急性心功能失代偿可能有关的因素.根据是否发生急性心功能失代偿,分为2组:急性心功能失代偿组和非急性心功能失代偿组.采用1ogistic多元回归分析,筛选发生急性心功能失代偿的危险因素.结果 术中发生急性心功能失代偿368例(发生率15.5%),无一例患者死亡.logistic多元回归分析显示,室壁瘤、术中房颤、术中频发性室性期前收缩、术前射血分数<40%、术前室性期前收缩、合并瓣膜病、心肌梗死史、入室心动过速、急诊手术、左主干病变为术中发生急性心功能失代偿的危险因素.结论 术前合并室壁瘤、瓣膜病变、左主干病变、心肌梗死史、术前室性期前收缩、射血分数<40%,术中房颤、频发性室性期前收缩、入室心动过速和急诊手术为OPCABG患者术中发生急性心功能失代偿的危险因素.%Objective To identify the risk factors associated with intraoperative acute cardiac decompensation in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Methods From November 2007 to February 2009, 2379 OPCABGs were performed in our hospital. The possible risk factors associated with intraoperative cardiac decompensation were retrospectively analyzed. The preoperative patient demographics and intraoperative characteristics were correlated with intraoperative acute cardiac decompensation.The possible risk factors included sex, age, body weight, cardiac function (NYHA classification), the associated diseases (hypertension, diabetes mellitus, liver-kidney dysfunction), history of myocardial infarct, ventricular aneurysm, preoperative treatment with β-blocker and/or calcium channel blocking agent, ventricular extrasystole,atrial fibrillation, duration of

  8. Modeling generic aspects of ideal fibril formation

    CERN Document Server

    Michel, Denis

    2016-01-01

    Many different proteins self-aggregate into insoluble fibrils growing apically by reversible addition of elementary building blocks. But beyond this common principle, the modalities of fibril formation are very disparate, with various intermediate forms which can be reshuffled by minor modifications of physico-chemical conditions or amino-acid sequences. To bypass this complexity, the multifaceted phenomenon of fibril formation is reduced here to its most elementary principles defined for a linear prototype of fibril. Selected generic features, including nucleation, elongation and conformational recruitment, are modeled using minimalist hypotheses and tools, by separating equilibrium from kinetic aspects and in vitro from in vivo conditions. These reductionist approaches allow to bring out known and new rudiments, including the kinetic and equilibrium effects of nucleation, the dual influence of elongation on nucleation, the kinetic limitations on nucleation and fibril numbers and the accumulation of complexe...

  9. Atrial fibrillation in patients with ischemic stroke

    DEFF Research Database (Denmark)

    Thygesen, Sandra Kruchov; Frost, Lars; Eagle, Kim A;

    2009-01-01

    BACKGROUND: Atrial fibrillation is a major risk factor for ischemic stroke. However, the prognostic impact of atrial fibrillation among patients with stroke is not fully clarified. We compared patient characteristics, including severity of stroke and comorbidity, quality of in-hospital care...... and outcomes in a cohort of first-time ischemic stroke patients with and without atrial fibrillation. METHODS: Based on linkage of public medical databases, we did a population-based follow-up study among 3,849 stroke patients from the County of Aarhus, Denmark admitted in the period of 2003......-2007 and prospectively registered in the Danish National Indicator Project. RESULTS: Atrial fibrillation was associated with an adverse prognostic profile but not with an overall poorer quality of in-hospital care. Patients with atrial fibrillation had a longer total length of stay (median: 15 vs 9 days), and were...

  10. Molecular basis for insulin fibril assembly

    Energy Technology Data Exchange (ETDEWEB)

    Ivanova, Magdalena I.; Sievers, Stuart A.; Sawaya, Michael R.; Wall, Joseph S.; Eisenberg, David; (HHMI); (BNL)

    2009-12-01

    In the rare medical condition termed injection amyloidosis, extracellular fibrils of insulin are observed. We found that the segment of the insulin B-chain with sequence LVEALYL is the smallest segment that both nucleates and inhibits the fibrillation of full-length insulin in a molar ratio-dependent manner, suggesting that this segment is central to the cross-{beta} spine of the insulin fibril. In isolation from the rest of the protein, LVEALYL forms microcrystalline aggregates with fibrillar morphology, the structure of which we determined to 1 {angstrom} resolution. The LVEALYL segments are stacked into pairs of tightly interdigitated {beta}-sheets, each pair displaying the dry steric zipper interface typical of amyloid-like fibrils. This structure leads to a model for fibrils of human insulin consistent with electron microscopic, x-ray fiber diffraction, and biochemical studies.

  11. Nanoscale scraping and dissection of collagen fibrils.

    Science.gov (United States)

    Wenger, M P E; Horton, M A; Mesquida, P

    2008-09-24

    The main function of collagen is mechanical, hence there is a fundamental scientific interest in experimentally investigating the mechanical and structural properties of collagen fibrils on the nanometre scale. Here, we present a novel atomic force microscopy (AFM) based scraping technique that can dissect the outer layer of a biological specimen. Applied to individual collagen fibrils, the technique was successfully used to expose the fibril core and reveal the presence of a D-banding-like structure. AFM nanoindentation measurements of fibril shell and core indicated no significant differences in mechanical properties such as stiffness (reduced modulus), hardness, adhesion and adhesion work. This suggests that collagen fibrils are mechanically homogeneous structures. The scraping technique can be applied to other biological specimens, as demonstrated on the example of bacteria.

  12. Chondroitin Sulfate Perlecan Enhances Collagen Fibril Formation

    DEFF Research Database (Denmark)

    Kvist, A. J.; Johnson, A. E.; Mörgelin, M.

    2006-01-01

    produced in the presence of perlecan. Interestingly, the enhancement of collagen fibril formation is independent on the core protein and is mimicked by chondroitin sulfate E but neither by chondroitin sulfate D nor dextran sulfate. Furthermore, perlecan chondroitin sulfate contains the 4,6-disulfated......Inactivation of the perlecan gene leads to perinatal lethal chondrodysplasia. The similarity to the phenotypes of the Col2A1 knock-out and the disproportionate micromelia mutation suggests perlecan involvement in cartilage collagen matrix assembly. We now present a mechanism for the defect...... in collagen type II fibril assembly by perlecan-null chondrocytes. Cartilage perlecan is a heparin sulfate or a mixed heparan sulfate/chondroitin sulfate proteoglycan. The latter form binds collagen and accelerates fibril formation in vitro, with more defined fibril morphology and increased fibril diameters...

  13. 人工瓣膜置换治疗重症心脏瓣膜病的临床分析%Clinical Analysis of Artificial Valve Replacement in Treatment of Severe Valvular Heart Disease

    Institute of Scientific and Technical Information of China (English)

    范永峰; 张大国; 向道康; 刘秀伦

    2015-01-01

    Objective To discuss the clinical effect of bipolar radiofrequency ablation for atrial fibrillation combined with artificial valve replacement in the treatment of severe valvular heart disease. Methods 80 patients with severe valvular heart disease treated in our hospital during April 2013 and April 2014 were selected as the research object and randomly divided into control group and observation group with 40 in each. The patients in the control group were treated with artificial valve replacement, while those in the observation group underwent simultaneous surgical treatment of artificial valve replacement and bipolar radiofrequency ablation for atrial fibrillation. Patient's situation during operation and color doppler ultrasound examination one year later were compared between the two groups. Results Immediate recovery rate of sinus rhythm of the patients in the control group was obviously lower than that in the observation group, 17.50%vs 90.00%. Color doppler ultrasound examination one year later showed that left atrial dimension, pulmonary artery systolic pressure and left ventricular ejection fraction were (39.64±5.07)mm、(35.17±4.97)mmHg、(57.09±5.87)%in the observation group, while those were(48.71±6.36)mm、(40.19±5.38)mmHg、(50.28±6.31)%, and the differ-ences were statistically significant,P<0.05. Conclusion Simultaneous surgical treatment of artificial valve replacement and bipolar radiofrequency ablation for atrial fibrillation is worthy of clinical application in the treatment of severe valvular heart disease due to its good effect.%目的:探究在人工瓣膜置换中行房颤双极射频消融术治疗重症心脏瓣膜病的临床效果。方法随机选取2013年4月-2014年4月在该院接受治疗的80例重症心脏瓣膜病患者作为研究对象,并随机分为对照组和观察组,每组40例。给予对照组患者进行人工瓣膜置换术,对观察组实施人工瓣膜置换术的同时行房颤双极射频消融术

  14. Fibril-forming motifs are essential and sufficient for the fibrillization of human Tau.

    Science.gov (United States)

    Meng, Sheng-Rong; Zhu, Ying-Zhu; Guo, Tong; Liu, Xiao-Ling; Chen, Jie; Liang, Yi

    2012-01-01

    The misfolding of amyloidogenic proteins including human Tau protein, human prion protein, and human α-synuclein is involved in neurodegenerative diseases such as Alzheimer disease, prion disease, and Parkinson disease. Although a lot of research on such amyloidogenic proteins has been done, we do not know the determinants that drive these proteins to form fibrils and thereby induce neurodegenerative diseases. In this study, we want to know the role of fibril-forming motifs from such amyloidogenic proteins in the fibrillization of human Tau protein. As evidenced by thioflavin T binding and turbidity assays, transmission electron microscopy, and circular dichroism, fibril-forming motifs are essential and sufficient for the fibrillization of microtubule-associated protein Tau: only when both of its fibril-forming motifs, PHF6 and PHF6*, are deleted can recombinant human Tau fragment Tau(244-372) lose its ability to form fibrils, and the insertion of unrelated fibril-forming motifs from other amyloidogenic proteins, such as human prion protein, yeast prion protein, human α-synuclein, and human amyloid β, into the disabled Tau protein can retrieve its ability to form fibrils. Furthermore, this retrieval is independent of the insertion location on Tau(244-372). We demonstrate for the first time that insertion of fibril-forming motifs can replace PHF6/PHF6* motifs, driving human Tau protein to form fibrils with different morphologies and different kinetic parameters. Our results suggest that fibril-forming motifs play a key role in the fibrillization of human Tau protein and could be the determinants of amyloidogenic proteins tending to misfold, thereby causing the initiation and development of neurodegenerative diseases. Our study also touches on the importance of amyloid "strains": changes to the amyloidgenic driver region results in altered structural morphologies at the macromolecular level.

  15. Fibril-forming motifs are essential and sufficient for the fibrillization of human Tau.

    Directory of Open Access Journals (Sweden)

    Sheng-Rong Meng

    Full Text Available BACKGROUND: The misfolding of amyloidogenic proteins including human Tau protein, human prion protein, and human α-synuclein is involved in neurodegenerative diseases such as Alzheimer disease, prion disease, and Parkinson disease. Although a lot of research on such amyloidogenic proteins has been done, we do not know the determinants that drive these proteins to form fibrils and thereby induce neurodegenerative diseases. In this study, we want to know the role of fibril-forming motifs from such amyloidogenic proteins in the fibrillization of human Tau protein. METHODOLOGY/PRINCIPAL FINDINGS: As evidenced by thioflavin T binding and turbidity assays, transmission electron microscopy, and circular dichroism, fibril-forming motifs are essential and sufficient for the fibrillization of microtubule-associated protein Tau: only when both of its fibril-forming motifs, PHF6 and PHF6*, are deleted can recombinant human Tau fragment Tau(244-372 lose its ability to form fibrils, and the insertion of unrelated fibril-forming motifs from other amyloidogenic proteins, such as human prion protein, yeast prion protein, human α-synuclein, and human amyloid β, into the disabled Tau protein can retrieve its ability to form fibrils. Furthermore, this retrieval is independent of the insertion location on Tau(244-372. CONCLUSIONS/SIGNIFICANCE: We demonstrate for the first time that insertion of fibril-forming motifs can replace PHF6/PHF6* motifs, driving human Tau protein to form fibrils with different morphologies and different kinetic parameters. Our results suggest that fibril-forming motifs play a key role in the fibrillization of human Tau protein and could be the determinants of amyloidogenic proteins tending to misfold, thereby causing the initiation and development of neurodegenerative diseases. Our study also touches on the importance of amyloid "strains": changes to the amyloidgenic driver region results in altered structural morphologies at the

  16. Molecular insights into the reversible formation of tau protein fibrils.

    Science.gov (United States)

    Luo, Yin; Dinkel, Paul; Yu, Xiang; Margittai, Martin; Zheng, Jie; Nussinov, Ruth; Wei, Guanghong; Ma, Buyong

    2013-05-04

    We computationally and experimentally showed that tau protein fibrils can be formed at high temperature. When cooled, the fibrils dissociate back to monomers. Heparin promotes tau fibril formation and prevents its reversion. Our results revealed the physicochemical mechanism of reversible formation of tau fibrils.

  17. Anticoagulation therapy for atrial fibrillation.

    Science.gov (United States)

    Hylek, Elaine M

    2013-03-01

    Atrial fibrillation (AF) is the most common significant cardiac rhythm disorder, and its prevalence is increasing worldwide. Atrial fibrillation confers a fivefold increased risk of stroke, and these strokes are associated with significant mortality and disability. The vitamin K antagonist, warfarin, has been the mainstay of anticoagulant therapy for patients with AF, reducing the risk of stroke by 65%. Despite its efficacy, warfarin remains underused in clinical practice because of its variable dose response, diet and medication interactions, and need for frequent monitoring. Stroke prevention in AF has entered an exciting therapeutic era with new classes of targeted anticoagulants that avoid the many pitfalls of the vitamin K antagonists. Dabigatran, an oral thrombin inhibitor, and the factor Xa inhibitors, rivaroxaban and apixaban, have demonstrated efficacy for stroke prevention and a reduced risk of intracranial hemorrhage relative to warfarin. Translating the efficacy of clinical trials into effective use of these novel agents in clinical practice will require an understanding of their pharmacokinetic profiles, dose selection, and management in select clinical situations.

  18. Neuronal Classification of Atria Fibrillation

    Directory of Open Access Journals (Sweden)

    Mohamed BEN MESSAOUD

    2008-06-01

    Full Text Available Motivation. In medical field, particularly the cardiology, the diagnosis systems constitute the essential domain of research. In some applications, the traditional methods of classification present some limitations. The neuronal technique is considered as one of the promising algorithms to resolve such problem.Method. In this paper, two approaches of the Artificial Neuronal Network (ANN technique are investigated to classify the heart beats which are Multi Layer Perception (MLP and Radial Basis Function (RBF. A calculation algorithm of the RBF centers is proposed. For the Atria Fibrillation anomalies, an artificial neural network was used as a pattern classifier to distinguish three classes of the cardiac arrhythmias. The different classes consist of the normal beats (N, the Arrhythmia (AFA and Tachycardia (TFA Atria Fibrillation cases. The global and the partition classifier are performed. The arrhythmias of MIT-BIH database are analyzed. The ANN inputs are the temporal and morphological parameters deduced from the electrocardiograph.Results. The simulation results illustrate the performances of the studied versions of the neural network and give the fault detection rate of the tested data, a rate of classification reaching the 3.7%.Conclusion. This system can constitute a mesh in a chain of automated diagnosis and can be a tool for assistance for the classification of the cardiac anomalies in the services of urgencies before the arrival of a qualified personal person.

  19. 'Real-world' antithrombotic treatment in atrial fibrillation: The EORP-AF pilot survey.

    Science.gov (United States)

    Lip, Gregory Y H; Laroche, Cécile; Dan, Gheorghe-Andrei; Santini, Massimo; Kalarus, Zbigniew; Rasmussen, Lars Hvilsted; Ioachim, Popescu Mircea; Tica, Otilia; Boriani, Giuseppe; Cimaglia, Paolo; Diemberger, Igor; Hellum, Camilla Fragtrup; Mortensen, Bettina; Maggioni, Aldo P

    2014-06-01

    Current guidelines strongly recommend that oral anticoagulation should be offered to patients with atrial fibrillation and ≥1 stroke risk factors. The guidelines also recommend that oral anticoagulation still should be used in the presence of stroke risk factors irrespective of rate or rhythm control. In an analysis from the dataset of the EURObservational Research Programme on Atrial Fibrillation Pilot Survey (n = 3119), we examined antithrombotic therapy prescribing, with particular focus on the risk factors determining oral anticoagulation or antiplatelet therapy use. When oral anticoagulation was used among admitted patients in whom no pharmacologic cardioversion, electrical cardioversion, or catheter ablation was performed or planned, vitamin K antagonist therapy was prescribed in the majority (72.2%), whereas novel oral anticoagulants were used in the minority (7.7%). There was no significant difference in bleeding risk factors among the patients treated with the different types of antithrombotic therapies, except for those with chronic kidney disease, in whom oral anticoagulation was less commonly used (P = .0318). Antiplatelet therapy was more commonly used in patients with a high Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly score (≥2) (P < .0001). More oral anticoagulation use was associated with female gender (P = .0245). Less novel oral anticoagulant use was associated with valvular heart disease (P < .0001), chronic heart failure (P = .0010), coronary artery disease (P < .0001), and peripheral artery disease (P = .0092). Coronary artery disease was the strongest reason for combination therapy with oral anticoagulation plus antiplatelet drug (odds ratio, 8.54; P < .0001). When the Congestive heart failure, Hypertension, Age ≥75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [female

  20. Effect of stirring and seeding on whey protein fibril formation.

    Science.gov (United States)

    Bolder, Suzanne G; Sagis, Leonard M C; Venema, Paul; van der Linden, Erik

    2007-07-11

    The effect of stirring and seeding on the formation of fibrils in whey protein isolate (WPI) solutions was studied. More fibrils of a similar length are formed when WPI is stirred during heating at pH 2 and 80 degrees C compared to samples that were heated at rest. Addition of seeds did not show an additional effect compared to samples that were stirred. We propose a model for fibril formation, including an activation, nucleation, growth, and termination step. The activation and nucleation steps are the rate-determining steps. Fibril growth is relatively fast but terminates after prolonged heating. Two processes that possibly induce termination of fibril growth are hydrolysis of nonassembled monomers and inactivation of the growth ends of the fibrils. Stirring may break up immature fibrils, thus producing more active fibrils. Stirring also seems to accelerate the kinetics of fibril formation, resulting in an increase of the number of fibrils formed.

  1. Magnetite nanoparticle interactions with insulin amyloid fibrils

    Science.gov (United States)

    Chen, Yun-Wen; Chang, Chiung-Wen; Hung, Huey-Shan; Kung, Mei-Lang; Yeh, Bi-Wen; Hsieh, Shuchen

    2016-10-01

    Accumulation of amyloid fibrils is one of the likely key factors leading to the development of Alzheimer’s disease and other amyloidosis associated diseases. Magnetic nanoparticles (NPs) have been developed as promising medical materials for many medical applications. In this study, we have explored the effects of Fe3O4 NPs on the fibrillogenesis process of insulin fibrils. When Fe3O4 NPs were co-incubated with insulin, Fe3O4 NPs had no effect on the structural transformation into amyloid-like fibrils but had higher affinity toward insulin fibrils. We demonstrated that the zeta potential of insulin fibrils and Fe3O4 NPs were both positive, suggesting the binding forces between Fe3O4 NPs and insulin fibrils were van der Waals forces but not surface charge. Moreover, a different amount of Fe3O4 NPs added had no effect on secondary structural changes of insulin fibrils. These results propose the potential use of Fe3O4 NPs as therapeutic agents against diseases related to protein aggregation or contrast agents for magnetic resonance imaging.

  2. Characterization of tau fibrillization in vitro.

    Science.gov (United States)

    Xu, Shaohua; Brunden, Kurt R; Trojanowski, John Q; Lee, Virginia M-Y

    2010-03-01

    The assembly of tau proteins into paired helical filaments, the building blocks of neurofibrillary tangles, is linked to neurodegeneration in Alzheimer's disease and related tauopathies. A greater understanding of this assembly process could identify targets for the discovery of drugs to treat Alzheimer's disease and related disorders. By using recombinant human tau, we have delineated events leading to the conversion of normal soluble tau into tau fibrils. Atomic force microscopy and transmission electron microscopy methodologies were used to determine the structure of tau assemblies that formed when soluble tau was incubated with heparin for increasing lengths of time. Tau initially oligomerizes into spherical nucleation units of 18- to 21-nm diameter that appear to assemble linearly into nascent fibrils. Among the earliest tau fibrils are species that resemble a string of beads formed by linearly aligned spheres that with time seem to coalesce to form straight and twisted ribbon-like filaments, as well as paired helical filaments similar to those found in human tauopathies. An analysis of fibril cross sections at later incubation times revealed three fundamental axial structural features. By monitoring tau fibrillization, we showed that different tau filament morphologies coexist. Temporal changes in the predominant tau structural species suggest that tau fibrillization involves the generation of structural intermediates, resulting in the formation of tau fibrils with verisimilitude to their authentic human counterparts. 2010 The Alzheimer's Association. All rights reserved.

  3. Valvular heart disease: assessment of valve morphology and quantification using MR

    Energy Technology Data Exchange (ETDEWEB)

    Schwitter, J. [Div. of Cardiology and Cardiovascular, MR Center, Univ. Hospital Zurich (Switzerland)

    2000-06-01

    For clinical evaluation and decision-making in patients with valvular heart disease, the diagnostic armamentarium expands steadily. This evolution makes it difficult to choose the most appropriate approach for a specific valvular lesion. It may also reflect our uncertainty of what are the findings that best predict clinical outcome of patients, e. g. after surgery. Accordingly, for each type of valvular lesion, some pathophysiological considerations are stated in order to derive the most important measures that would allow optimal guidance of patients. Based on these considerations the value of an MR study is discussed for each valvular lesion. Newest advances in MR technology allow for highly accurate measurements of regurgitant volumes and hence, MR may be the method of choice for a quantitative evaluation of regurgitant valves. For assessment of stenosis severity, measurement of transvalvular pressure gradient is an appropriate measure and MR may not confer benefits over echocardiography, provided the ultrasound window is adequate (and stroke volume is in the normal range). With respect to surgical treatment, valvular morphology is of pivotal importance, particularly for the mitral valve, and echocardiography still appears to be the first line method. Little data relate lesion severity and/or morphology to clinical outcome. Conversely, the extent of cardiac adaptation to pressure- and/or volume-overload, i. e. ventricular remodeling, is a strong predictor of outcome, and is therefore most important for final judgement of the patient. For assessment of left and right ventricular remodeling, echocardiography typically provides all the necessary information. However, in special cases with discrepant findings, with inadequate ultrasound window, or in the preoperative work-up, MR may provide important information regarding cardiac adaptation to valvular lesion. (orig.) [German] Das diagnostische Repertoire zur Evaluation von Klappenvitien ist in den letzten Jahren

  4. [ESC guidelines on the management of valvular heart disease. What has changed and what is new?].

    Science.gov (United States)

    Mangner, N; Schuler, G

    2013-12-01

    In 2012 the new and collaborative "Guidelines on the management of valvular heart disease (version 2012)" were published by the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). These guidelines emphasize that decision-making in patients with valvular heart disease should ideally be carried out by a"heart team" with particular expertise in valvular heart disease. In aortic regurgitation pathologies of the aortic root are frequent and in patients with Marfan syndrome, surgery is indicated when the maximal ascending aortic diameter is ≥50 mm, while the threshold for intervention should be lower in patients with risk factors for progression. Regarding aortic stenosis, transcatheter aortic valve implantation (TAVI) should be performed only in hospitals with on-site cardiac surgery and with a"heart team" available to assess patient risks. The TAVI procedure is indicated in patients with severe symptomatic aortic stenosis who are judged by the"heart team" to be unsuitable for surgery but have sufficient life expectancy. It should be considered for high-risk patients with severe symptomatic aortic stenosis based on the individual risk profile assessed by the"heart team". Furthermore, low flow - low gradient aortic stenosis with normal ejection fraction and the difficult topic of asymptomatic severe aortic stenosis and the indications for aortic valve replacement are discussed. With respect to mitral regurgitation, valve repair should be the preferred technique when it is expected to be durable. The topics of asymptomatic mitral regurgitation as well as percutaneous mitral valve repair using the edge to edge technique as an alternative for high risk patients are discussed. Tricuspid disease should not be forgotten and during left-sided valve surgery, tricuspid valve surgery should be considered in the presence of mild to moderate secondary regurgitation if there is significant annular dilatation. Last but not least

  5. Redirecting valvular myofibroblasts into dormant fibroblasts through light-mediated reduction in substrate modulus.

    Science.gov (United States)

    Wang, Huan; Haeger, Sarah M; Kloxin, April M; Leinwand, Leslie A; Anseth, Kristi S

    2012-01-01

    Fibroblasts residing in connective tissues throughout the body are responsible for extracellular matrix (ECM) homeostasis and repair. In response to tissue damage, they activate to become myofibroblasts, which have organized contractile cytoskeletons and produce a myriad of proteins for ECM remodeling. However, persistence of myofibroblasts can lead to fibrosis with excessive collagen deposition and tissue stiffening. Thus, understanding which signals regulate de-activation of myofibroblasts during normal tissue repair is critical. Substrate modulus has recently been shown to regulate fibrogenic properties, proliferation and apoptosis of fibroblasts isolated from different organs. However, few studies track the cellular responses of fibroblasts to dynamic changes in the microenvironmental modulus. Here, we utilized a light-responsive hydrogel system to probe the fate of valvular myofibroblasts when the Young's modulus of the substrate was reduced from ~32 kPa, mimicking pre-calcified diseased tissue, to ~7 kPa, mimicking healthy cardiac valve fibrosa. After softening the substrata, valvular myofibroblasts de-activated with decreases in α-smooth muscle actin (α-SMA) stress fibers and proliferation, indicating a dormant fibroblast state. Gene signatures of myofibroblasts (including α-SMA and connective tissue growth factor (CTGF)) were significantly down-regulated to fibroblast levels within 6 hours of in situ substrate elasticity reduction while a general fibroblast gene vimentin was not changed. Additionally, the de-activated fibroblasts were in a reversible state and could be re-activated to enter cell cycle by growth stimulation and to express fibrogenic genes, such as CTGF, collagen 1A1 and fibronectin 1, in response to TGF-β1. Our data suggest that lowering substrate modulus can serve as a cue to down-regulate the valvular myofibroblast phenotype resulting in a predominantly quiescent fibroblast population. These results provide insight in designing

  6. Redirecting valvular myofibroblasts into dormant fibroblasts through light-mediated reduction in substrate modulus.

    Directory of Open Access Journals (Sweden)

    Huan Wang

    Full Text Available Fibroblasts residing in connective tissues throughout the body are responsible for extracellular matrix (ECM homeostasis and repair. In response to tissue damage, they activate to become myofibroblasts, which have organized contractile cytoskeletons and produce a myriad of proteins for ECM remodeling. However, persistence of myofibroblasts can lead to fibrosis with excessive collagen deposition and tissue stiffening. Thus, understanding which signals regulate de-activation of myofibroblasts during normal tissue repair is critical. Substrate modulus has recently been shown to regulate fibrogenic properties, proliferation and apoptosis of fibroblasts isolated from different organs. However, few studies track the cellular responses of fibroblasts to dynamic changes in the microenvironmental modulus. Here, we utilized a light-responsive hydrogel system to probe the fate of valvular myofibroblasts when the Young's modulus of the substrate was reduced from ~32 kPa, mimicking pre-calcified diseased tissue, to ~7 kPa, mimicking healthy cardiac valve fibrosa. After softening the substrata, valvular myofibroblasts de-activated with decreases in α-smooth muscle actin (α-SMA stress fibers and proliferation, indicating a dormant fibroblast state. Gene signatures of myofibroblasts (including α-SMA and connective tissue growth factor (CTGF were significantly down-regulated to fibroblast levels within 6 hours of in situ substrate elasticity reduction while a general fibroblast gene vimentin was not changed. Additionally, the de-activated fibroblasts were in a reversible state and could be re-activated to enter cell cycle by growth stimulation and to express fibrogenic genes, such as CTGF, collagen 1A1 and fibronectin 1, in response to TGF-β1. Our data suggest that lowering substrate modulus can serve as a cue to down-regulate the valvular myofibroblast phenotype resulting in a predominantly quiescent fibroblast population. These results provide insight in

  7. Association of Streptococcus pluranimalium with valvular endocarditis and septicaemia in adult broiler parents.

    Science.gov (United States)

    Hedegaard, L; Christensen, H; Chadfield, M S; Christensen, J P; Bisgaard, M

    2009-04-01

    The genus Streptococcus consists of more than 60 species, but only Streptococcus equi subspecies zooepidemicus, Streptococcus gallolyticus ssp. gallolyticus, Streptococcus gallinaceus, Streptococcus dysgalactiae, Streptococcus mutans and Streptococcus suis have been isolated from poultry. During investigations of the aetiology of increased mortality in broiler parent stock at the end of production, pure cultures of streptococcal-like organisms that could not be classified among these six species were obtained from 24 cases of septicaemia or valvular endocarditis and septicaemia. Phenotypic characterization using the API20 STREP kit identified the isolates as Aerococcus viridans (10), Aerococcus urinae (2), Leuconostoc species (4), Streptococcus salivarius (2), Streptococcus bovis II 3 (1), Enterococcus avium (3), Enterococcus faecium (1) or Gemella morbillorum (1). However, this identification was misleading as subsequent genetic investigations using pulse field gel electrophoresis and sequencing of 16S rRNA genes showed that 19 isolates were classified as Streptococcus pluranimalium, while the remaining isolates were E. avium (3), E. faecium (1) or Lactobacillus species (1). Misidentification by API20 STREP was related to the database provided by the manufacturer, as the phenotypic characteristics could identify these organisms as S. pluranimalium. The isolates of S. pluranimalium belonged to at least three different clones as determined by pulsed field gel electrophoresis of SmaI-digested genomic DNA. The capacity that these isolates had to colonize the valvular endothelium was suggested by the occurrence of valvular endocarditis in 12 of 19 cases. Demonstration of the same clone in all four houses on a farm suggested the pathogenic potential of this organism.

  8. The Year in Cardiology 2013: valvular heart disease (focus on catheter-based interventions).

    Science.gov (United States)

    Grube, Eberhard; Sinning, Jan-Malte; Vahanian, Alec

    2014-02-01

    2013 was the year of transcatheter heart valve interventions. Not least because of the 2012 European guidelines on the management of valvular heart disease (VHD), the multidisciplinary heart team approach became an established concept. Decision-making, when a patient is too 'sick' for surgery and too 'healthy' for catheter-based interventions, is complex, since VHD is often seen at an older age and, as a consequence, there is a higher frequency of co-morbidity and frailty. However, before TAVI and other transcatheter heart valve interventions can be expanded to intermediate-risk patients, evidence in favour of this less invasive treatment has to be provided by upcoming randomized clinical trials.

  9. Valvular pulmonary stenosis. Fonocardiográfico Study. Morphology of the curve right ventricle

    OpenAIRE

    Bocanegra, José; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú; Peralta, Aurelio; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú; Alzamora F., Rafael; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú; Roitman, Marcos; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú; Bendezú, Jesús; Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú

    2014-01-01

    We studied 24 cases of Congenital Valvular Pulmonary Stenosis, the characters of the second pulmonary sound. - In 16 cases splitting is registered with the pulmonary component of lower intensity than the aortic, and interval between the onset of both components from 0.06 to 0.08 second, in 5 cases it was found weak but pure and in the remaining three bullrings, was pure and normal intensity. Nature of the second pulmonary noise is related to the duration of systole and right ventricular systo...

  10. ¿Están correctamente anticoagulados nuestros pacientes con fibrilación auricular no valvular?

    Directory of Open Access Journals (Sweden)

    Joaquín Juan-Ortega

    2016-09-01

    Conclusiones: La fibrilación auricular no valvular es una de las principales causas del accidente vascular cerebral en nuestros pacientes. Se demuestra que el tratamiento anticoagulante en aquellos pacientes con alto riesgo embolígeno reduce los eventos cerebrovasculares en un 64% y la mortalidad en un 26%. En nuestro medio la mayoría de los pacientes diagnosticados con fibrilación auricular no valvular presentan ese riesgo, pero tenemos un 33% no anticoagulado y un 25% mal controlado con el acenocumarol (un total del 46% de los pacientes. Todo esto implica que casi el 50% de nuestros pacientes con fibrilación auricular no valvular presenten alto riesgo tromboembólico por falta de tratamiento o ineficacia de este.

  11. Echocardiographic evaluation of changes in left ventricular size and valvular regurgitation associated with physical training during and after maturity in standardbred trotters

    DEFF Research Database (Denmark)

    Buhl, Rikke; Ersbøll, Annette Kjær

    2012-01-01

    To assess whether physical training induces cardiac hypertrophy and valvular regurgitation in maturing Standardbred trotters and to establish a prediction model for the size of the left ventricle.......To assess whether physical training induces cardiac hypertrophy and valvular regurgitation in maturing Standardbred trotters and to establish a prediction model for the size of the left ventricle....

  12. Reparación valvular mitral con cuerdas artificiales. ¿Qué aporta respecto a la técnica clásica?

    Directory of Open Access Journals (Sweden)

    Rafael García-Fuster

    2013-07-01

    Conclusiones: El empleo de neocuerdas ha mostrado excelentes resultados a medio plazo y un aumento de la reparabilidad valvular. Su uso exclusivo como técnica de reconstrucción valvular permite reparar lesiones más complejas y extensas.

  13. Valvular interstitial cell seeded poly(glycerol sebacate) scaffolds: toward a biomimetic in vitro model for heart valve tissue engineering.

    Science.gov (United States)

    Masoumi, Nafiseh; Johnson, Katherine L; Howell, M Christian; Engelmayr, George C

    2013-04-01

    Tissue engineered replacement heart valves may be capable of overcoming the lack of growth potential intrinsic to current non-viable prosthetics, and thus could potentially serve as permanent replacements in the surgical repair of pediatric valvular lesions. However, the evaluation of candidate combinations of cells and scaffolds lacks a biomimetic in vitro model with broadly tunable, anisotropic and elastomeric structural-mechanical properties. Toward establishing such an in vitro model, in the current study, porcine aortic and pulmonary valvular interstitial cells (i.e. biomimetic cells) were cultivated on anisotropic, micromolded poly(glycerol sebacate) scaffolds (i.e. biomimetic scaffolds). Following 14 and 28 days of static culture, cell-seeded scaffolds and unseeded controls were assessed for their mechanical properties, and cell-seeded scaffolds were further characterized by confocal fluorescence and scanning electron microscopy, and by collagen and DNA assays. Poly(glycerol sebacate) micromolding yielded scaffolds with anisotropic stiffnesses resembling those of native valvular tissues in the low stress-strain ranges characteristic of physiologic valvular function. Scaffold anisotropy was largely retained upon cultivation with valvular interstitial cells; while the mechanical properties of unseeded scaffolds progressively diminished, cell-seeded scaffolds either retained or exceeded initial mechanical properties. Retention of mechanical properties in cell-seeded scaffolds paralleled the accretion of collagen, which increased significantly from 14 to 28 days. This study demonstrates that valvular interstitial cells can be cultivated on anisotropic poly(glycerol sebacate) scaffolds to yield biomimetic in vitro models with which clinically relevant cells and future scaffold designs can be evaluated.

  14. ECHOCARDIOGRAPHIC PROFILE OF VALVULAR LESIONS IN CHILDREN WITH ACUTE RHEUMATIC FEVER / RHEUMATIC HEART DISEASE IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Ramu

    2015-03-01

    Full Text Available CONTEXT (B ACKGROUND: Rheumatic Heart disease is still a leading cause of valvular disease in developing countries like India and constitutes 10 to 50% of the cardiac patients in Indian hospitals. Echocardiography is a very sensitive investigation for the diagnosis of Rheumatic Carditis and its sequalae like Mitral, Aortic and Tricuspid valve disease as well as sub clinical Carditis. AIMS & OBJECTIVES: To study the profile, severity and gender based differences of valvular lesions on the Trans Thoracic Echocardiographic records of children diagnosed as Acute Rheumatic fever/ Rheumatic Heart disease. MATERIALS & METHODS: This study was conducted during D ecember’2014 by reviewing the records of trans thoracic Echocardiographic reports of our 36 cases (childhood Acute Rheumatic fever/ Rheumatic Heart disease cases for type and degree of valvular involvement according to AHA guidelines. RESULTS: Mitral valv e was involved most often (23 cases – 63.89%. Severe Mitral regurgitation is the common type of valvular lesions both in Boys and Girls (19.44% and 25% respectively. Isolated Aortic valve/ Tricuspid valve involvement was not found in our study. Mixed les ions were seen most often than pure isolated valvular lesions. CONCLUSION: Mitral valve was most commonly affected, while Regurgitant lesions were more common than Stenotic lesions and most severe in children less than 15 years age group. Aortic Regurgitat ion (AR was found more commonly in Girls than Boys in our study. But all these cases of AR had some other valvular involvement as Mixed lesions. Therefore Echocardiography should be done routinely for patients with Rheumatic Heart Disease, focusing on you nger population to facilitate diagnosis and definitive treatment before complications set in.

  15. On fibrils and field lines: The nature of H$\\alpha$ fibrils in the solar chromosphere

    CERN Document Server

    Leenaarts, Jorrit; van der Voort, Luc Rouppe

    2015-01-01

    Observations of the solar chromosphere in the line-core of the \\Halpha\\ line show dark elongated structures called fibrils that show swaying motion. We performed a 3D radiation-MHD simulation of a network region, and computed synthetic \\Halpha\\ images from this simulation to investigate the relation between fibrils and the magnetic field lines in the chromosphere. The periods, amplitudes and phase-speeds of the synthetic fibrils are consistent with those observed. We analyse the relation between the synthetic fibrils and the field lines threading through them, and find that some fibrils trace out the same field line along the fibril's length, but there are also fibrils that sample different field lines at different locations along their length. Fibrils sample the same field lines on a time scale of $\\sim200$~s. This is shorter than their own lifetime. We analysed the evolution of the atmosphere along a number of field lines that thread through fibrils and find that they carry slow-mode waves that load mass in...

  16. Atrial fibrillation management in older heart failure patients: a complex clinical problem

    Directory of Open Access Journals (Sweden)

    Stefano Tolone

    2016-09-01

    Full Text Available Background Atrial fibrillation (AF and heart failure (HF, two problems of growing prevalence as a consequence of the ageing population, are associated with high morbidity, mortality, and healthcare costs. AF and HF also share common risk factors and pathophysiologic processes such as hypertension, diabetes mellitus, ischemic heart disease, and valvular heart disease often occur together. Although elderly patients with both HF and AF are affected by worse symptoms and poorer prognosis, there is a paucity of data on appropriate management of these patients. Methods PubMed was searched for studies on AF and older patients using the terms atrial fibrillation, elderly, heart failure, cognitive impairment, frailty, stroke, and anticoagulants. Results The clinical picture of HF patients with AF is complex and heterogeneous with a higher prevalence of frailty, cognitive impairment, and disability. Because of the association of mental and physical impairment to non-administration of oral anticoagulants (OACs, screening for these simple variables in clinical practice may allow better strategies for intervention in this high-risk population. Since novel direct OACs (NOACs have a more favorable risk-benefit profile, they may be preferable to vitamin K antagonists (VKAs in many frail elderly patients, especially those at higher risk of falls. Moreover, NOACs are simple to administer and monitor and may be associated with better adherence and safety in patients with cognitive deficits and mobility impairments. Conclusions Large multicenter longitudinal studies are needed to examine the effects of VKAs and NOACs on long-term cognitive function and frailty; future studies should include geriatric conditions.

  17. Changes of IK,ATP current density and allosteric modulation during chronic atrial fibrillation

    Institute of Scientific and Technical Information of China (English)

    WU Gang; HUANG Cong-xin; TANG Yan-hong; JIANG Hong; WAN Jun; CHEN Hui; XIE Qiang; HUANG Zheng-rong

    2005-01-01

    Background Atrial fibrillation (AF) is the most common supraventricular arrhythmia in clinical practice. Chronic atrial fibrillation (CAF) is associated with ionic remodeling. However, little is known about the activity of ATP-sensitive potassium current (IK,ATP) during CAF. So we studied the changes of IK,ATP density and allosteric modulation of ATP-sensitivity by intracellular pH during CAF.Methods Myocardium samples were obtained from the right auricular appendage of patients with rheumatic heart disease complicated with valvular disease in sinus rhythm (SR) or CAF. There were 14 patients in SR group and 9 patients in CAF group. Single atrial cells were isolated using an enzyme dispersion technique. IK,ATP was recorded using the whole-cell and inside-out configuration of voltage-clamp techniques. In whole-cell model, myocytes of SR and CAF groups were perfused with simulated ischemic solution to elicit IK,ATP. In inside-out configuration, the internal patch membranes were exposed to different ATP concentrations in pH 7.4 and 6.8.Results Under simulated ischemia, IK,ATP current density of CAF group was significantly higher than in SR group [(83.5±10.8) vs. (58.7±8.4) pA/pF, P<0.01]. IK,ATP of the two groups showed ATP concentration-dependent inhibition. The ATP concentration for 50% current inhibition (IC50) for the SR group was significantly different in pH 7.4 and pH 6.8 (24 vs. 74 μmol/L, P<0.01). The IC50 did not change significantly in CAF group when the pH decreased from 7.4 to 6.8.Conclusions During CAF, IK,ATP current density was increased and its allosteric modulation of ATP-sensitivity by intracellular pH was diminished.

  18. Atrial Fibrillation During an Exploration Class Mission

    Science.gov (United States)

    Lipsett, Mark; Hamilton, Douglas; Lemery, Jay; Polk, James

    2011-01-01

    This slide presentation reviews a possible scenario of an astronaut having Atrial Fibrillation during a Mars Mission. In the case review the presentation asks several questions about the alternatives for treatment, medications and the ramifications of the decisions.

  19. Aggregate geometry in amyloid fibril nucleation

    CERN Document Server

    Irbäck, A; Linnemann, N; Linse, B; Wallin, S; 10.1103/PhysRevLett.110.058101

    2013-01-01

    We present and study a minimal structure-based model for the self-assembly of peptides into ordered beta-sheet-rich fibrils. The peptides are represented by unit-length sticks on a cubic lattice and interact by hydrogen bonding and hydrophobicity forces. By Monte Carlo simulations with >100,000 peptides, we show that fibril formation occurs with sigmoidal kinetics in the model. To determine the mechanism of fibril nucleation, we compute the joint distribution in length and width of the aggregates at equilibrium, using an efficient cluster move and flat-histogram techniques. This analysis, based on simulations with 256 peptides in which aggregates form and dissolve reversibly, shows that the main free-energy barriers that a nascent fibril has to overcome are associated with changes in width.

  20. Atrial Fibrillation and Stroke in Elderly Patients

    Directory of Open Access Journals (Sweden)

    Geetanjali Dang

    2016-11-01

    Full Text Available The increasing prevalence of stroke, with an estimated annual cost of $71.5 billion, has made it a major health problem that increases disability and death, particularly in patients with atrial fibrillation. Although advanced age and atrial fibrillation are recognized as strong risk factors for stroke, the basis for this susceptibility are not well defined. Aging or associated diseases are accompanied by changes in rheostatic, humoral, metabolic and hemodynamic factors that may contribute more to stroke predisposition than rhythm abnormality alone. Several thromboembolism-predisposing clinical characteristics and serum biomarkers with prognostic significance have been identified in patients with atrial fibrillation. Although anticoagulation decreases the risk of thromboembolism, management in the elderly remains complex due to major concerns about bleeding. New anticoagulants and nonpharmacologic strategies are helpful to reduce the risk of bleeding, particularly in older-elderly patients. Herein, we review the pathogenesis and management of select issues of thromboembolism in the elderly with atrial fibrillation.

  1. Amyloid fibrils compared to peptide nanotubes.

    Science.gov (United States)

    Zganec, Matjaž; Zerovnik, Eva

    2014-09-01

    Prefibrillar oligomeric states and amyloid fibrils of amyloid-forming proteins qualify as nanoparticles. We aim to predict what biophysical and biochemical properties they could share in common with better researched peptide nanotubes. We first describe what is known of amyloid fibrils and prefibrillar aggregates (oligomers and protofibrils): their structure, mechanisms of formation and putative mechanism of cytotoxicity. In distinction from other neuronal fibrillar constituents, amyloid fibrils are believed to cause pathology, however, some can also be functional. Second, we give a review of known biophysical properties of peptide nanotubes. Finally, we compare properties of these two macromolecular states side by side and discuss which measurements that have already been done with peptide nanotubes could be done with amyloid fibrils as well.

  2. [Cardiac rehabilitation in patients with atrial fibrillation].

    Science.gov (United States)

    Schlitt, Axel; Kamke, Wolfram; Guha, Manju; Haberecht, Olaf; Völler, Heinz

    2015-06-01

    The course of cardiac rehabilitation is often altered due to episodes of paroxysmal, predominantly postoperative atrial fibrillation. In symptomatic patients, a TEE-guided cardioversion - preferential DC shock - is indicated. In patients with persistent / permanent atrial fibrillation, a heart rate up to 110 / min and 170 / min at rest and during physical activity should, respectively, be tolerated. Therefore, training should not be quitted by heart rate but rather by load. The antithrombotic management is in addition a great task in treating patients with atrial fibrillation. With the exception of patients with a CHA2DS2-VASc-Score < 1, oral anticoagulation is indicated. Atrial fibrillation has little impact on social aspects, whereas the underlying heart disease and drug treatment (oral anticoagulation) has an important impact.

  3. Alcohol consumption and risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Tolstrup, Janne Schurmann; Wium-Andersen, Marie Kim; Ørsted, David Dynnes

    2016-01-01

    BACKGROUND: The aim of this study was to test the hypothesis that alcohol consumption, both observational (self-reported) and estimated by genetic instruments, is associated with a risk of atrial fibrillation and to determine whether people with high cardiovascular risk are more sensitive towards...... register. As a measure of alcohol exposure, both self-reported consumption and genetic variations in alcohol metabolizing genes (ADH1B/ADH1C) were used as instrumental variables. The endpoint was admission to hospital for atrial fibrillation as recorded in a validated hospital register. RESULTS: A total...... of 3493 cases of atrial fibrillation occurred during follow-up. High alcohol consumption was associated with a risk of atrial fibrillation among men, but not among women. Among the men who drank 28-35 and 35+ drinks/week, the hazards ratios were 1.40 (95% confidence interval 1.09-1.80) and 1.62 (95...

  4. [Anticoagulation in atrial fibrillation - an update].

    Science.gov (United States)

    Antz, Matthias; Hullmann, Bettina; Neufert, Christian; Vocke, Wolfgang

    2008-12-01

    The correct anticoagulation regimen for prevention of thromboembolic events is essential in patients with atrial fibrillation. However, only a minority of patients receives anticoagulation according to the guidelines. The current guidelines are intended to make the indication for anticoagulation more simple and are summarized in the present article. This includes recommendations for chronic anticoagulation, prevention of thromboembolic events after cardioversion and in ablation of atrial fibrillation.

  5. Evaluation of the left ventricular reserve by dynamic exercise echocardiography after surgery for valvular heart diseases.

    Directory of Open Access Journals (Sweden)

    Sano,shunji

    1989-08-01

    Full Text Available Dynamic ergometer exercise in a supine position was applied to 64 patients more than 1 year after valvular heart surgery, and the left ventricular reserve was evaluated echocardiographically. The left ventricular reserve declined in the mitral stenosis-mitral valve replacement group, while it was better maintained in the mitral stenosis-mitral commissurotomy, aortic regurgitation and aortic stenosis groups. The patients were divided into 3 groups depending on whether the percentage increase during exercise of stroke index, an index of left ventricular pump function, increased, unchanged, or decreased. The percentage increase of mean velocity of circumferential fibre shortening (y and that of left ventricular end-diastolic diameter (x during exercise were plotted for each group. The increased group was isolated from the unchanged group by the line of y = -5.02x + 30.1; the unchanged group was isolated from the decreased group by that of y = -5.68x-10.0, and the increased and unchanged groups were clearly isolated from the decreased group by that of y = -6.86x-4.76. We conclude that dynamic ergometer exercise echocardiography is useful for evaluating the left ventricular reserve of postoperative patients with valvular heart disease. It was also thought that the subclinical state of cardiac failure can be effectively detected by the present method.

  6. Platelet function and activation in Cavalier King Charles Spaniels with subclinical chronic valvular heart disease.

    Science.gov (United States)

    Tong, Linda J; Hosgood, Giselle L; French, Anne T; Irwin, Peter J; Shiel, Robert E

    2016-08-01

    OBJECTIVE To assess platelet closure time (CT), mean platelet component (MPC) concentration, and platelet component distribution width (PCDW) in dogs with subclinical chronic valvular heart disease. ANIMALS 89 Cavalier King Charles Spaniels (CKCSs) and 39 control dogs (not CKCSs). PROCEDURES Platelet count, MPC concentration, PCDW, and Hct were measured by use of a hematology analyzer, and CT was measured by use of a platelet function analyzer. Murmur grade and echocardiographic variables (mitral valve regurgitant jet size relative to left atrial area, left atrial-to-aortic diameter ratio, and left ventricular internal dimensions) were recorded. Associations between explanatory variables (sex, age, murmur grade, echocardiographic variables, platelet count, and Hct) and outcomes (CT, MPC concentration, and PCDW) were examined by use of multivariate regression models. RESULTS A model with 5 variables best explained variation in CT (R(2), 0.74), with > 60% of the variance of CT explained by mitral valve regurgitant jet size. The model of best fit to explain variation in MPC concentration included only platelet count (R(2), 0.24). The model of best fit to explain variation in PCDW included platelet count and sex (R(2), 0.25). CONCLUSIONS AND CLINICAL RELEVANCE In this study, a significant effect of mitral valve regurgitant jet size on CT was consistent with platelet dysfunction. However, platelet activation, as assessed on the basis of the MPC concentration and PCDW, was not a feature of subclinical chronic valvular heart disease in CKCSs.

  7. The Role of Stress Echocardiography in Valvular Heart Disease: A Current Appraisal.

    Science.gov (United States)

    Gentry Iii, James L; Phelan, Dermot; Desai, Milind Y; Griffin, Brian P

    2017-04-11

    Stress echocardiography is a widely available, safe, low-cost, versatile imaging modality which is becoming increasingly recognized as a valuable tool in the assessment of patients with native and prosthetic left-sided valvular heart disease. It provides a quantitative assessment to help guide clinical decision-making when discordance exists between symptoms and severity of valve disease. Exercise (treadmill or bicycle) remains the preferred stress modality, but pharmacological augmentation with dobutamine can be used if needed. Low-dose dobutamine stress echocardiography is specifically valuable in patients with low-flow, low-gradient aortic stenosis when attempting to differentiate true severe aortic stenosis from pseudo-severe aortic stenosis. Stress echocardiography not only identifies high-risk features that indicate need for earlier surgery, it also provides useful information for the peri- and postoperative period, including long-term outcome, risk stratification to guide monitoring frequency, and offers guidance for eligibility in competitive sports participation. As research continues to expand the utility of stress echocardiography in the management of patients with valvular heart disease, future research should focus on the recognition of newer parameters identifying high-risk features including subsequent validation in a large population.

  8. Cohort profile: prevalence of valvular heart disease in community patients with suspected heart failure in UK

    Science.gov (United States)

    Marciniak, Anna; Glover, Keli; Sharma, Rajan

    2017-01-01

    Purpose The aim of this study was to evaluate the proportion of suspected heart failure patients with significant valvular heart disease. Early diagnosis of valve disease is essential as delay can limit treatment and negatively affect prognosis for undiagnosed patients. The prevalence of unsuspected valve disease in the community is uncertain. Participants We prospectively evaluated 79 043 patients, between 2001 and 2011, who were referred to a community open access echocardiography service for suspected heart failure. All patients underwent a standard transthoracic echocardiogram according to British Society of Echocardiography guidelines. Findings to date Of the total number, 29 682 patients (37.5%) were diagnosed with mild valve disease, 8983 patients (11.3%) had moderate valve disease and 2134 (2.7%) had severe valve disease. Of the total number of patients scanned, the prevalence of aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation was 10%, 8.4%, 1%, and 12.5% respectively. 18% had tricuspid regurgitation. 5% had disease involving one or more valves. Conclusions Of patients with suspected heart failure in the primary care setting, a significant proportion have important valvular heart disease. These patients are at high risk of future cardiac events and will require onward referral for further evaluation. We recommend that readily available community echocardiography services should be provided for general practitioners as this will result in early detection of valve disease. PMID:28131996

  9. Metabolic regulation of collagen gel contraction by porcine aortic valvular interstitial cells.

    Science.gov (United States)

    Kamel, Peter I; Qu, Xin; Geiszler, Andrew M; Nagrath, Deepak; Harmancey, Romain; Taegtmeyer, Heinrich; Grande-Allen, K Jane

    2014-12-06

    Despite a high incidence of calcific aortic valve disease in metabolic syndrome, there is little information about the fundamental metabolism of heart valves. Cell metabolism is a first responder to chemical and mechanical stimuli, but it is unknown how such signals employed in valve tissue engineering impact valvular interstitial cell (VIC) biology and valvular disease pathogenesis. In this study porcine aortic VICs were seeded into three-dimensional collagen gels and analysed for gel contraction, lactate production and glucose consumption in response to manipulation of metabolic substrates, including glucose, galactose, pyruvate and glutamine. Cell viability was also assessed in two-dimensional culture. We found that gel contraction was sensitive to metabolic manipulation, particularly in nutrient-depleted medium. Contraction was optimal at an intermediate glucose concentration (2 g l(-1)) with less contraction with excess (4.5 g l(-1)) or reduced glucose (1 g l(-1)). Substitution with galactose delayed contraction and decreased lactate production. In low sugar concentrations, pyruvate depletion reduced contraction. Glutamine depletion reduced cell metabolism and viability. Our results suggest that nutrient depletion and manipulation of metabolic substrates impacts the viability, metabolism and contractile behaviour of VICs. Particularly, hyperglycaemic conditions can reduce VIC interaction with and remodelling of the extracellular matrix. These results begin to link VIC metabolism and macroscopic behaviour such as cell-matrix interaction.

  10. SDS-Induced Fibrillation of α-Synuclein

    DEFF Research Database (Denmark)

    Giehm, L.; Oliveira, Cristiano Luis Pinto De; Pedersen, J.S.;

    2010-01-01

    -stabilized micelles. Thus, fibrillation in this case occurs by a process of continuous accretion rather than by the rate-limiting accumulation of a distinct nucleus. The morphology of the SDS-induced fibrils does not exhibit the classical rod-like structures formed by αSN when aggregated by agitation in the absence......, and transmission electron microscopy to elucidate a fibrillation pathway that is remarkably different from the fibrillation pathway in the absence of SDS. Fibrillation occurs most extensively and most rapidly (starting within 45 min) under conditions where 12 SDS molecules are bound per αSN molecule, which is also...... of SDS. The SDS-induced fibrils have a flexible worm-like appearance, which can be converted into classical straight fibrils by continuous agitation. SDS-induced fibrillation represents an alternative and highly reproducible mechanism for fibrillation where protein association is driven by the formation...

  11. Laser-induced propagation and destruction of amyloid beta fibrils.

    Science.gov (United States)

    Yagi, Hisashi; Ozawa, Daisaku; Sakurai, Kazumasa; Kawakami, Toru; Kuyama, Hiroki; Nishimura, Osamu; Shimanouchi, Toshinori; Kuboi, Ryoichi; Naiki, Hironobu; Goto, Yuji

    2010-06-18

    The amyloid deposition of amyloid beta (Abeta) peptides is a critical pathological event in Alzheimer disease (AD). Preventing the formation of amyloid deposits and removing preformed fibrils in tissues are important therapeutic strategies against AD. Previously, we reported the destruction of amyloid fibrils of beta(2)-microglobulin K3 fragments by laser irradiation coupled with the binding of amyloid-specific thioflavin T. Here, we studied the effects of a laser beam on Abeta fibrils. As was the case for K3 fibrils, extensive irradiation destroyed the preformed Abeta fibrils. However, irradiation during spontaneous fibril formation resulted in only the partial destruction of growing fibrils and a subsequent explosive propagation of fibrils. The explosive propagation was caused by an increase in the number of active ends due to breakage. The results not only reveal a case of fragmentation-induced propagation of fibrils but also provide insights into therapeutic strategies for AD.

  12. Early results of first versus second generation Amplatzer occluders for left atrial appendage closure in patients with atrial fibrillation.

    Science.gov (United States)

    Gloekler, Steffen; Shakir, Samera; Doblies, Janosch; Khattab, Ahmed A; Praz, Fabien; Guerios, Ênio; Koermendy, Dezsoe; Stortecky, Stefan; Pilgrim, Thomas; Buellesfeld, Lutz; Wenaweser, Peter; Windecker, Stephan; Moschovitis, Aris; Jaguszewski, Milosz; Landmesser, Ulf; Nietlispach, Fabian; Meier, Bernhard

    2015-08-01

    Transcatheter left atrial appendage (LAA) occlusion has been proven to be an effective treatment for stroke prophylaxis in patients with atrial fibrillation. For this purpose, the Amplatzer cardiac plug (ACP) was introduced. Its second generation, the Amulet, was developed for easier delivery, better coverage, and reduction of complications. To investigate the safety and efficacy of first generation versus second generation Amplatzer occluders for LAA occlusion. Retrospective analysis of prospectively collected data from the LAA occlusion registries of the Bern and Zurich university hospitals. Comparison of the last consecutive 50 ACP cases versus the first consecutive 50 Amulet cases in patients with non-valvular atrial fibrillation. For safety, a periprocedural combined endpoint, which is composed of death, stroke, cardiac tamponade, and bailout by surgery was predefined. For efficacy, the endpoint was procedural success. There were no differences between the two groups in baseline characteristics. The percentage of associated interventions during LAA occlusion was high in (78% with ACP vs. 70% with Amulet p = ns). Procedural success was similar in both groups (98 vs. 94%, p = 0.61). The combined safety endpoint for severe adverse events was reached by a similar rate of patients in both groups (6 vs. 8%, p = 0.7). Overall complication rate was insignificantly higher in the ACP group, which was mainly driven by clinically irrelevant pericardial effusions (24 vs. 14%, p = 0.31). Death, stroke, or tamponade were similar between the groups (0 vs. 2%, 0 vs. 0%, or 6 vs. 6%, p = ns). Transcatheter LAA occlusion for stroke prophylaxis in patients with atrial fibrillation can be performed with similarly high success rates with first and second generations of Amplatzer occluders. According to this early experience, the Amulet has failed to improve results of LAA occlusion. The risk for major procedural adverse events is acceptable but has to be taken into account when

  13. Chirality and chiroptical properties of amyloid fibrils.

    Science.gov (United States)

    Dzwolak, Wojciech

    2014-09-01

    Chirality of amyloid fibrils-linear beta-sheet-rich aggregates of misfolded protein chains-often manifests in morphological traits such as helical twist visible in atomic force microscopy and in chiroptical properties accessible to vibrational circular dichroism (VCD). According to recent studies the relationship between molecular chirality of polypeptide building blocks and superstructural chirality of amyloid fibrils may be more intricate and less deterministic than previously assumed. Several puzzling experimental findings have put into question earlier intuitive ideas on: 1) the bottom-up chirality transfer upon amyloidogenic self-assembly, and 2) the structural origins of chiroptical properties of protein aggregates. For example, removal of a single amino acid residue from an amyloidogenic all-L peptide was shown to reverse handedness of fibrils. On the other hand, certain types of amyloid aggregates revealed surprisingly strong VCD spectra with the sign and shape dependent on the conditions of fibrillation. Hence, microscopic and chiroptical studies have highlighted chirality as one more aspect of polymorphism of amyloid fibrils. This brief review is intended to outline the current state of research on amyloid-like fibrils from the perspective of their structural and superstructural chirality and chiroptical properties.

  14. Phospholipids as inhibitors of amyloid fibril formation

    Directory of Open Access Journals (Sweden)

    K. O. Vus

    2016-11-01

    Full Text Available Amyloid fibrils are the protein aggregates, whose formation is involved in the pathogenesis of Alzheimer’s disease, systemic amyloidosis, etc. Since there is no effective ways to treat these diseases, developing the new anti-amyloid drugs is of great importance. In this study a series of phospholipids have been tested for their ability to inhibit lysozyme and insulin amyloid fibril formation at acidic or neutral pH and elevated temperature.  The lag time, elongation rate and fibrillization extent were estimated using Thioflavin T fluorescence assay. It is found that the oxidized and charged phospholipids, included into the liposomes, were the most effective inhibitors of the protein fibrillization. By comparing the magnitude and direction of the lipid effect in different lipid-protein systems it was concluded that the reduction of the amyloid fibril formation is governed by hydrophobic and specific liposome-protein interactions. It is hypothesized that the presence of the surface formed by the lipid polar heads is critical for reducing the protein fibrillization extent.

  15. Modeling generic aspects of ideal fibril formation

    Energy Technology Data Exchange (ETDEWEB)

    Michel, D., E-mail: denis.michel@live.fr [Universite de Rennes1-IRSET, Campus de Beaulieu Bat. 13, 35042 Rennes (France)

    2016-01-21

    Many different proteins self-aggregate into insoluble fibrils growing apically by reversible addition of elementary building blocks. But beyond this common principle, the modalities of fibril formation are very disparate, with various intermediate forms which can be reshuffled by minor modifications of physico-chemical conditions or amino-acid sequences. To bypass this complexity, the multifaceted phenomenon of fibril formation is reduced here to its most elementary principles defined for a linear prototype of fibril. Selected generic features, including nucleation, elongation, and conformational recruitment, are modeled using minimalist hypotheses and tools, by separating equilibrium from kinetic aspects and in vitro from in vivo conditions. These reductionist approaches allow to bring out known and new rudiments, including the kinetic and equilibrium effects of nucleation, the dual influence of elongation on nucleation, the kinetic limitations on nucleation and fibril numbers, and the accumulation of complexes in vivo by rescue from degradation. Overlooked aspects of these processes are also pointed: the exponential distribution of fibril lengths can be recovered using various models because it is attributable to randomness only. It is also suggested that the same term “critical concentration” is used for different things, involved in either nucleation or elongation.

  16. Non-Vitamin K Oral Anticoagulants for Stroke Prevention in Special Populations with Atrial Fibrillation.

    Science.gov (United States)

    Bisson, Arnaud; Angoulvant, Denis; Philippart, Raphael; Clementy, Nicolas; Babuty, Dominique; Fauchier, Laurent

    2017-06-01

    Atrial fibrillation (AF) is associated with an increased risk of ischemic stroke or systemic embolism compared with normal sinus rhythm. These strokes may efficiently be prevented in patients with risk factors using oral anticoagulant therapy, with either vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) (i.e., direct thrombin inhibitors or direct factor Xa inhibitors). Owing to their specific risk profiles, some AF populations may have increased risks of both thromboembolic and bleeding events. These AF patients may be denied oral anticoagulants, whilst evidence shows that the absolute benefits of oral anticoagulants are greatest in patients at highest risk. NOACs are an alternative to VKAs to prevent stroke in patients with "non-valvular AF", and NOACs may offer a greater net clinical benefit compared with VKAs, particularly in these high-risk patients. Physicians have to learn how to use these drugs optimally in specific settings. We review concrete clinical scenarios for which practical answers are currently proposed for use of NOACs based on available evidence for patients with kidney disease, elderly patients, women, patients with diabetes, patients with low or high body weight, and those with valve disease.

  17. The use of oral anticoagulants in patients with atrial fibrillation: cohort study data

    Directory of Open Access Journals (Sweden)

    O. V. Gaisenok

    2016-01-01

    Full Text Available Aim. To study the rate of prescription of oral anticoagulants (OAC in patients with atrial fibrillation (AF depending AF type and the reasons for their not-prescribing according to cohort study data.Material and methods. Patients (n=58 with AF were included into the study. The rate of OAC, including new OAC (NOAC, prescription depending type AF and the reasons for their not-prescribing were studied.Results. The rate of OAC use was 46.5% (warfarin – 22.4%, NOAC – 20.7%, antiplatelet agents use – 60.3%. The reasons for the lack of OAC use were: contraindications (high risk of hemorrhage or bleeding history – 5.2%; patient’s inability to comply with the recommendations and the valvular AF, which does not allow to recommend NOAC – 25.8%; preference for a doctor based on the patient's refusal or preference – 22.4%. OAC use in patients with persistent AF was recorded significantly more frequently than in paroxysmal AF (85.71% vs 24.32%; χ2=17.9; p<0.0001.Conclusions. A large part of patients with AF remains without OAC prescribing. More active use of NOAC will allow to correct current situation

  18. Cardiac Plug I and Amulet Devices: Left Atrial Appendage Closure for Stroke Prophylaxis in Atrial Fibrillation.

    Science.gov (United States)

    Parashar, Akhil; Tuzcu, E Murat; Kapadia, Samir R

    2015-01-01

    Percutaneous left atrial appendage (LAA) occlusion has emerged as an exciting and effective modality for stroke prophylaxis in patients with non-valvular atrial fibrillation who are deemed too high risk for anticoagulation with warfarin or newer anticoagulants. The Amplatzer devices have been used in LAA occlusion for more than a decade, starting with off label use of an atrial septal occluder device for LAA occlusion. This was followed by introduction of a dedicated Amplatzer cardiac plug (ACP) 1 for LAA occlusion, and more recently, the second generation Amulet device, with reported better stability enhancing features, has been introduced. Both these devices are widely used outside the United States, however in the US only the WATCHMAN device has been FDA approved. Unlike the WATCHMAN device, where the evidence is continuously building as the data from two pivotal randomized controlled trials are emerging, most of the evidence for ACP devices is from pooled multicenter registry data. In this article, we review the device design, implantation techniques and the most recently published evidence for both the Amplatzer cardiac plug 1 and the newer Amulet device. Our goal is to summarize the most recent literature and discuss the current role of the Amplatzer devices in the exciting and rapidly growing field of percutaneous LAA occlusion.

  19. Trasplante de homoinjertos valvulares cardiacos y vasculares Cardiac and vascular homograft valves transplant

    Directory of Open Access Journals (Sweden)

    J. M. Herreros

    2006-08-01

    Full Text Available Los progresos en la manipulación de los tejidos humanos, el desarrollo de la criobiología, la cirugía cardiaca pediátrica, la imposibilidad de conseguir una prótesis valvular cardiaca ideal y el tratamiento quirúrgico de las infecciones cardiovasculares, han reintroducido el interés para utilizar los homoinjertos. Los donantes de estos homoinjertos pueden ser: a Donantes vivos: válvula aórtica y pulmonar del receptor de trasplante cardiaco; b Donantes multiorgánicos con el diagnóstico de muerte según criterios neurológicos, cuyo corazón es rechazado para trasplante cq ardiaco; c Donantes cadáveres con asistolia inferior a 8 horas. Los homoinjertos valvulares cardiacos son el sustituto de elección en las endocarditis valvulares aórticas, pacientes con contraindicación para la anticoagulación, reconstrucción del tracto de salida de ventrículo derecho, sustitución valvular aórtica en niños o adultos jóvenes mediante la operación de Ross y es una indicación opcional la sustitución valvular aórtica y/o la aorta ascendente en los pacientes con edad superior a 60 años. Aunque no hay series suficientemente amplias de homoinjertos como sustitutos arteriales, en cuanto a número de pacientes y tiempo de evolución, los resultados sugieren que se pueden beneficiar los pacientes con infección vascular, inmunodeprimidos o los pacientes complejos cuya técnica durante la intervención puede requerir la necesidad de un homoinjerto.The advances in the manipulation of human tissues, the development of cryobiology, paediatric cardiac surgery, the impossibility of obtaining an ideal prosthetic cardiac valve and the surgical treatment of cardiovascular infections have revived interest in the use of homografts. The donors of these homografts can be: a Live donors: aortic and pulmonary valve of the recipient of a heart transplant; b Multiorgan donors with a diagnosis of death according to neurological criteria, whose heart is rejected

  20. Curcumin Protects β-Lactoglobulin Fibril Formation and Fibril-Induced Neurotoxicity in PC12 Cells.

    Directory of Open Access Journals (Sweden)

    Mansooreh Mazaheri

    Full Text Available In this study the β-lactoglobulin fibrillation, in the presence or absence of lead ions, aflatoxin M1 and curcumin, was evaluated using ThT fluorescence, Circular dichroism spectroscopy and atomic force microscopy. To investigate the toxicity of the different form of β-Lg fibrils, in the presence or absence of above toxins and curcumin, we monitored changes in the level of reactive oxygen species and morphology of the differentiated neuron-like PC12 cells. The cell viability, cell body area, average neurite length, neurite width, number of primary neurites, percent of bipolar cells and node/primary neurite ratios were used to assess the growth and complexity of PC12 cells exposed to different form of β-Lg fibrils. Incubation of β-Lg with curcumin resulted in a significant decrease in ROS levels even in the presence of lead ions and aflatoxin M1. The β-Lg fibrils formed in the presence of lead ions and aflatoxin M1 attenuated the growth and complexity of PC12 cells compared with other form of β-Lg fibrils. However, the adverse effects of these toxins and protein fibrils were negated in the presence of curcumin. Furthermore, the antioxidant and inhibitory effects of curcumin protected PC12 cells against fibril neurotoxicity and enhanced their survival. Thus, curcumin may provide a protective effect toward β-Lg, and perhaps other protein, fibrils mediated neurotoxicity.

  1. Effect of age on stroke prevention therapy in patients with atrial fibrillation: the atrial fibrillation investigators

    DEFF Research Database (Denmark)

    van Walraven, Carl; Hart, Robert G; Connolly, Stuart

    2009-01-01

    on the relative efficacy of oral anticoagulants (OAC) and antiplatelet (AP) therapy (including acetylsalicylic acid and triflusal) on ischemic stroke, serious bleeding, and vascular events in patients with atrial fibrillation. METHODS: This is an analysis of the Atrial Fibrillation Investigators database, which...

  2. RR-Interval variance of electrocardiogram for atrial fibrillation detection

    Science.gov (United States)

    Nuryani, N.; Solikhah, M.; Nugoho, A. S.; Afdala, A.; Anzihory, E.

    2016-11-01

    Atrial fibrillation is a serious heart problem originated from the upper chamber of the heart. The common indication of atrial fibrillation is irregularity of R peak-to-R-peak time interval, which is shortly called RR interval. The irregularity could be represented using variance or spread of RR interval. This article presents a system to detect atrial fibrillation using variances. Using clinical data of patients with atrial fibrillation attack, it is shown that the variance of electrocardiographic RR interval are higher during atrial fibrillation, compared to the normal one. Utilizing a simple detection technique and variances of RR intervals, we find a good performance of atrial fibrillation detection.

  3. Valvular endocarditis and septic thrombosis associated with a radial fracture in a red-tailed hawk (Buteo jamaicensis).

    Science.gov (United States)

    Lemon, Matthew J; Pack, LeeAnn; Forzán, María J

    2012-01-01

    A free-ranging adult female red-tailed hawk died suddenly after 3 weeks in rehabilitation for a radial fracture. Cause of death was septic thrombosis from a chronic bacterial valvular endocarditis, probably associated with injury at the fracture site. The challenge of clinical diagnosis of sepsis in wild birds is emphasized.

  4. Valvular endocarditis and septic thrombosis associated with a radial fracture in a red-tailed hawk (Buteo jamaicensis)

    OpenAIRE

    2012-01-01

    A free-ranging adult female red-tailed hawk died suddenly after 3 weeks in rehabilitation for a radial fracture. Cause of death was septic thrombosis from a chronic bacterial valvular endocarditis, probably associated with injury at the fracture site. The challenge of clinical diagnosis of sepsis in wild birds is emphasized.

  5. First case of Streptococcus oligofermentans endocarditis determined based on sodA gene sequences after amplification directly from valvular samples.

    Science.gov (United States)

    Matta, Matta; Gousseff, Marie; Monsel, Fabien; Poyart, Claire; Diebold, Benoît; Podglajen, Isabelle; Mainardi, Jean-Luc

    2009-03-01

    We report the first case of infection due to Streptococcus oligofermentans, which is a recently described oral Streptococcus species. It was responsible for the endocarditis and left forearm abscess of a 43-year-old woman. Identification was made using molecular techniques performed directly from valvular and surgical samples.

  6. 103. Reparación valvular mitral en un caso de endocarditis trombótica no bacteriana

    Directory of Open Access Journals (Sweden)

    R. Manrique

    2012-04-01

    Conclusiones: La reparación valvular mitral es un procedimiento eficaz y seguro en la insuficiencia mitral aguda en pacientes con endocarditis trombótica no bacteriana. Permite evitar un riesgo adicional asociado al uso de prótesis mecánicas en pacientes con riesgo tromboembólico elevado.

  7. Valvular Excrescences

    DEFF Research Database (Denmark)

    Marstrand, Peter; Jensen, Maiken Brit; Ihlemann, Nikolaj

    2015-01-01

    The thrombogenic potential of Lambl excrescences (LE) is minimal unlike the benign tumour fibroelastoma wherefrom thrombi often originate. We present a patient with multiple strokes within a six-year period. A possible locus on the aortic valve was found and diagnosed as fibroelastoma. Before aor...... aortic valve substitution prior finding could not be visualized and surgery was aborted. Due to review of earlier Transesophageal Echocardiography (TEE) and the transient component, LE was accepted as the most plausible diagnosis. This illustrates the need for TEE just before surgery....

  8. Nonequilibrium all-atom molecular dynamics simulation of the bubble cavitation and application to dissociate amyloid fibrils.

    Science.gov (United States)

    Hoang Viet, Man; Derreumaux, Philippe; Nguyen, Phuong H

    2016-11-07

    The cavitation of gas bubbles in liquids has been applied to different disciplines in life and natural sciences, and in technologies. To obtain an appropriate theoretical description of effects induced by the bubble cavitation, we develop an all-atom nonequilibrium molecular-dynamics simulation method to simulate bubbles undergoing harmonic oscillation in size. This allows us to understand the mechanism of the bubble cavitation-induced liquid shear stress on surrounding objects. The method is then employed to simulate an Aβ fibril model in the presence of bubbles, and the results show that the bubble expansion and contraction exert water pressure on the fibril. This yields to the deceleration and acceleration of the fibril kinetic energy, facilitating the conformational transition between local free energy minima, and leading to the dissociation of the fibril. Our work, which is a proof-of-concept, may open a new, efficient way to dissociate amyloid fibrils using the bubble cavitation technique, and new venues to investigate the complex phenomena associated with amyloidogenesis.

  9. Use of a small peptide fragment as an inhibitor of insulin fibrillation process: a study by high and low resolution spectroscopy.

    Directory of Open Access Journals (Sweden)

    Victor Banerjee

    Full Text Available A non-toxic, nine residue peptide, NIVNVSLVK is shown to interfere with insulin fibrillation by various biophysical methods. Insulin undergoes conformational changes under certain stress conditions leading to amyloid fibrils. Fibrillation of insulin poses a problem in its long-term storage, reducing its efficacy in treating type II diabetes. The dissociation of insulin oligomer to monomer is the key step for the onset of fibrillation. The time course of insulin fibrillation at 62°C using Thioflavin T fluorescence shows an increase in the lag time from 120 min without peptide to 236 min with peptide. Transmission electron micrographs show branched insulin fibrils in its absence and less inter-fibril association in its presence. Upon incubation at 62°C and pH 2.6, insulin lost some α-helical structure as seen by Fourier transformed infra-red spectroscopy (FT-IR, but if the peptide is added, secondary structure is almost fully maintained for 3 h, though lost partially at 4 h. FT-IR spectroscopy also shows that insulin forms the cross beta structure indicative of fibrils beyond 2 h, but in the presence of the peptide, α-helix retention is seen till 4 h. Both size exclusion chromatography and dynamic light scattering show that insulin primarily exists as trimer, whose conversion to a monomer is resisted by the peptide. Saturation transfer difference nuclear magnetic resonance confirms that the hydrophobic residues in the peptide are in close contact with an insulin hydrophobic groove. Molecular dynamics simulations in conjunction with principal component analyses reveal how the peptide interrupts insulin fibrillation. In vitro hemolytic activity of the peptide showed insignificant cytotoxicity against HT1080 cells. The insulin aggregation is probed due to the inter play of two key residues, Phe(B24 and Tyr(B26 monitored from molecular dynamics simulations studies. Further new peptide based leads may be developed from this nine residue peptide.

  10. Valvular Abnormalities Detected by Echocardiography in 5-Year Survivors of Childhood Cancer: A Long-Term Follow-Up Study

    Energy Technology Data Exchange (ETDEWEB)

    Pal, Helena J. van der, E-mail: h.j.vanderpal@amc.uva.nl [Department of Medical Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Department of Pediatric Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Dijk, Irma W. van [Department of Radiation Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Geskus, Ronald B. [Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Kok, Wouter E. [Department of Cardiology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Koolen, Marianne; Sieswerda, Elske [Department of Pediatric Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Oldenburger, Foppe; Koning, Caro C. [Department of Radiation Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands); Leeuwen, Flora E. van [Department of Epidemiology, Netherlands Cancer Institute, Amsterdam (Netherlands); Caron, Huib N.; Kremer, Leontien C.; Dalen, Elvira C. van [Department of Pediatric Oncology, Emma Children' s Hospital/Academic Medical Center, Amsterdam (Netherlands)

    2015-01-01

    Purpose: To determine the prevalence of valvular abnormalities after radiation therapy involving the heart region and/or treatment with anthracyclines and to identify associated risk factors in a large cohort of 5-year childhood cancer survivors (CCS). Methods and Materials: The study cohort consisted of all 626 eligible 5-year CCS diagnosed with childhood cancer in the Emma Children's Hospital/Academic Medical Center between 1966 and 1996 and treated with radiation therapy involving the heart region and/or anthracyclines. We determined the presence of valvular abnormalities according to echocardiograms. Physical radiation dose was converted into the equivalent dose in 2-Gy fractions (EQD{sub 2}). Using multivariable logistic regression analyses, we examined the associations between cancer treatment and valvular abnormalities. Results: We identified 225 mainly mild echocardiographic valvular abnormalities in 169 of 545 CCS (31%) with a cardiac assessment (median follow-up time, 14.9 years [range, 5.1-36.8 years]; median attained age 22.0 years [range, 7.0-49.7 years]). Twenty-four CCS (4.4%) had 31 moderate or higher-graded abnormalities. Most common abnormalities were tricuspid valve disorders (n=119; 21.8%) and mitral valve disorders (n=73; 13.4%). The risk of valvular abnormalities was associated with increasing radiation dose (using EQD{sub 2}) involving the heart region (odds ratio 1.33 per 10 Gy) and the presence of congenital heart disease (odds ratio 3.43). We found no statistically significant evidence that anthracyclines increase the risk. Conclusions: Almost one-third of CCS treated with potentially cardiotoxic therapy had 1 or more asymptomatic, mostly mild valvular abnormalities after a median follow-up of nearly 15 years. The most important risk factors are higher EQD{sub 2} to the heart region and congenital heart disease. Studies with longer follow-up are necessary to investigate the clinical course of asymptomatic valvular abnormalities

  11. Mechanical deformation mechanisms and properties of amyloid fibrils.

    Science.gov (United States)

    Choi, Bumjoon; Yoon, Gwonchan; Lee, Sang Woo; Eom, Kilho

    2015-01-14

    Amyloid fibrils have recently received attention due to their remarkable mechanical properties, which are highly correlated with their biological functions. We have studied the mechanical deformation mechanisms and properties of amyloid fibrils as a function of their length scales by using atomistic simulations. It is shown that the length of amyloid fibrils plays a role in their deformation and fracture mechanisms in such a way that the competition between shear and bending deformations is highly dependent on the fibril length, and that as the fibril length increases, so does the bending strength of the fibril while its shear strength decreases. The dependence of rupture force for amyloid fibrils on their length is elucidated using the Bell model, which suggests that the rupture force of the fibril is determined from the hydrogen bond rupture mechanism that critically depends on the fibril length. We have measured the toughness of amyloid fibrils, which is shown to depend on the fibril length. In particular, the toughness of the fibril with its length of ∼3 nm is estimated to be ∼30 kcal mol(-1) nm(-3), comparable to that of a spider silk crystal with its length of ∼2 nm. Moreover, we have shown the important effect of the pulling rate on the mechanical deformation mechanisms and properties of amyloid fibril. It is found that as the pulling rate increases, so does the contribution of the shear effect to the elastic deformation of the amyloid fibril with its length of deformation mechanism of the amyloid fibril with its length of >15 nm is almost independent of the pulling rate. Our study sheds light on the role of the length scale of amyloid fibrils and the pulling rate in their mechanical behaviors and properties, which may provide insights into how the excellent mechanical properties of protein fibrils can be determined.

  12. Compressive deformation of ultralong amyloid fibrils

    Science.gov (United States)

    Paparcone, Raffaella; Cranford, Steven; Buehler, Markus J.

    2010-12-01

    Involved in various neurodegenerative diseases, amyloid fibrils and plaques feature a hierarchical structure, ranging from the atomistic to the micrometer scale. At the atomistic level, a dense and organized hydrogen bond network is resembled in a beta-sheet rich secondary structure, which drives a remarkable stiffness in the range of 10-20GPa, larger than many other biological nanofibrils, a result confirmed by both experiment and theory. However, the understanding of how these exceptional mechanical properties transfer from the atomistic to the nanoscale remains unknown. Here we report a multiscale analysis that, from the atomistic-level structure of a single fibril, extends to the mesoscale level, reaching size scales of hundreds of nanometers. We use parameters directly derived from full atomistic simulations of A β (1-40) amyloid fibrils to parameterize a mesoscopic coarse-grained model, which is used to reproduce the elastic properties of amyloid fibrils. We then apply our mesoscopic model in an analysis of the buckling behavior of amyloid fibrils with different lengths and report a comparison with predictions from continuum beam theory. An important implication of our results is a severe reduction of the effective modulus due to buckling, an effect that could be important to interpret experimental results of ultra-long amyloid fibrils. Our model represents a powerful tool to mechanically characterize molecular structures on the order of hundreds of nanometers to micrometers on the basis of the underlying atomistic behavior. The work provides insight into structural and mechanical properties of amyloid fibrils and may enable further analysis of larger-scale assemblies such as amyloidogenic bundles or plaques as found in disease states.

  13. Isoproterenol infusion increases level of consciousness during catheter ablation of atrial fibrillation.

    Science.gov (United States)

    O'Neill, Daniel K; Aizer, Anthony; Linton, Patrick; Bloom, Marc; Rose, Emily; Chinitz, Larry

    2012-08-01

    The objective of this study was to determine the effects of isoproterenol infusion on level of consciousness during ablation using total intravenous anesthesia. Seven patients undergoing total intravenous anesthesia for atrial fibrillation ablation were monitored for level of consciousness using bispectral EEG levels (BIS). Isoproterenol infusion was performed after the ablation during anesthesia. BIS levels prior to, during, and post-isoproterenol infusion were recorded and correlated to isoproterenol infusion doses. In all patients, BIS levels significantly increased during isoproterenol infusion (median BIS prior to infusion, 46; during infusion, 64 (p levels could again be reduced. Isoproterenol infusion alters consciousness level during total intravenous anesthesia for atrial fibrillation ablation. BIS monitoring is a novel way to modulate anesthesia during ablation to potentially optimize patient comfort and ablation success.

  14. Visualisation during ablation of atrial fibrillation - stimulating the patient's own resources

    DEFF Research Database (Denmark)

    Nørgaard, Marianne W; Pedersen, Preben U; Bjerrum, Merete

    2014-01-01

    BACKGROUND: Going through ablation of atrial fibrillation can be accompanied by pain and discomfort when a light, conscious sedation is used. Visualisation has been shown to reduce the patients' perception of pain and anxiety during invasive procedures, when it is used together with the usual pain...... management. PURPOSE: The purpose of this study was to investigate patients' experiences with visualisation in relation to pain and anxiety during an intervention consisting of visualisation, when undergoing ablation of atrial fibrillation. METHODS: Qualitative interviews were conducted with 14 patients from...... a study population of a clinical controlled study with 147 patients. The transcribed interviews were analysed according to qualitative methodology of inductive content analysis. FINDINGS: Four categories emerged from the interviews: 'approach to visualisation'; 'strategies of managing pain'; 'strategies...

  15. GENETIC PREDICTORS OF ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    A. V. Kuskaeva

    2016-01-01

    Full Text Available Atrial fibrillation (AF is the most common heart rhythm disturbance. It is believed that the primary form of AF is genetically determined in most cases, but the genetic component cannot be excluded in the secondary form of AF. AF is a heterogeneous disease and many authors proved its relationship with other genetic heart disease. In most cases, certain combinations of polymorphisms of different genes promote the development of AF. The study of genes of renin-angiotensin-aldosterone system (RAAS is especially important, because the role of this system in AF pathogenesis is currently studding most intensively. These studies are of great practical interest, as associative effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists in the prevention of AF is revealed. RAAS blockers are able not only to reduce the risk of new-onset AF in hypertensive and normotensive patients but also prevent recurrence of AF. Furthermore, experimental studies showed that RAAS blockers prevent not only the remodeling of the left ventricle, and also the left atrium, pointing to the pathogenesis of AF. So, screening for susceptibility genes and the study of their polymorphism is currently an important focus in the study of AF.

  16. Platelet expression of stromal cell-derived factor-1 is associated with the degree of valvular aortic stenosis.

    Directory of Open Access Journals (Sweden)

    Thomas Wurster

    Full Text Available BACKGROUND AND PURPOSE: Platelet surface expression of stromal-cell-derived factor-1 (SDF-1 is increased during platelet activation and constitutes an important factor in hematopoetic progenitor cell trafficking at sites of vascular injury and ischemia. Enhanced platelet SDF-1 expression has been reported previously in patients suffering from acute coronary syndrome (ACS. We hypothesized that expression of platelet associated SDF-1 may also be influenced by calcified valvular aortic stenosis (AS. METHODS: We consecutively evaluated 941 patients, who were admitted to the emergency department with dyspnea and chest pain. Platelet surface expression of SDF-1 was determined by flow cytometry, AS was assessed using echocardiography and hemodynamic assessment by heart catheterization. A 1∶1 propensity score matching was implemented to match 218 cases with 109 pairs adjusting for age, sex, cardiovascular risk factors, and medication including ACE inhibitors, angiotensin receptor blockers, beta blockers, statins, aspirin, clopidogrel, GPIIb/IIIa antagonists, and vitamin K antagonists. RESULTS: Patients with valvular AS showed enhanced platelet SDF-1 expression compared to patients without AS (non-valvular disease, NV independent of ACS and stable coronary artery disease (SAP [mean fluorescence intensity (MFI for ACS (AS vs. NV: 75±40.4 vs. 39.5±23.3; P = 0.002; for SAP (AS vs. NV: 54.9±44.6 vs. 24.3±11.2; P = 0.008]. Moreover, the degree of AS significantly correlated with SDF-1 platelet surface expression (r = 0.462; P = 0.002. CONCLUSIONS: Valvular AS is associated with enhanced platelet-SDF-1 expression; moreover the degree of valvular AS correlates with SDF-1 platelet surface expression. These findings may have clinical implications in the future.

  17. Doppler echocardiography imaging in detecting multi-valvular lesions: a clinical evaluation in children with acute rheumatic fever.

    Directory of Open Access Journals (Sweden)

    Pushpa Shivaram

    Full Text Available RATIONALE: Doppler echocardiography has been demonstrated to be accurate in diagnosing valvular lesions in rheumatic heart disease (RHD when compared to clinical evaluation alone. OBJECTIVE: To perform Doppler echocardiography in children clinically diagnosed by the Jones criteria to have acute rheumatic fever (ARF, and to then compare the effectiveness of echo in detecting single/multi-valvular lesions with that of the initial clinical evaluation. METHODS AND RESULTS: We enrolled 93 children who were previously diagnosed with ARF by clinical examination. Presence of valvular lesions were enlisted, first by clinical auscultation, and then by performing Doppler echocardiography. We found that Doppler echocardiography was a sensitive technique, capable of detecting valvular lesions that were missed by clinical auscultation alone. Echocardiography of patients with carditis revealed mitral regurgitation to be the most common lesion present (53 patients, 56.98%, followed by aortic regurgitation in 21 patients (22.6%. The difference between clinical and echocardiographic diagnosis in ARF children with carditis was statistically significant for mitral regurgitation, aortic regurgitation and tricuspid regurgitation. Clinical auscultation alone revealed 4 cases of mitral stenosis, 39 mitral regurgitation, 14 aortic regurgitation, 9 tricuspid regurgitation; in contrast, echo revealed 5 cases of mitral stenosis, 53 mitral regurgitation, 21 aortic regurgitation, 18 tricuspid regurgitation. CONCLUSION: Doppler echocardiography is a more sensitive technique for detecting valvular lesions. In the setting of ARF, echo enables a 46.9% higher detection level of carditis, as compared to the clinical examination alone. Echo was very significant in detecting regurgitation lesions, especially for cases of tricuspid regurgitation in the setting of multivalvular involvement. The results of our study are in accordance with previous clinical studies, all of which clearly

  18. Fibrilación atrial en los adultos mayores Atrial Fibrillation in the Elderly

    Directory of Open Access Journals (Sweden)

    Jorge Brizuela-Torres

    2009-09-01

    Full Text Available La fibrilación atrial es la taquiarritmia más prevalente en los adultos mayores. La frecuencia de dicha arritmia aumenta con la edad, presentándose en un 1.5% de los 50 a 59 años a 10% de los 80 a 89 años. La fibrilación atrial no valvular incrementa el riesgo de sufrir un evento cerebrovascular isquémico cardioembólico en 5 veces y causa el 15% de todos los accidentes cerebrovasculares isquémicos en Estados Unidos de América. El manejo de la fibrilación atrial se enfoca, principalmente, en la prevención de los fenómenos tromboembólicos y en el control de la frecuencia y ritmo cardiaco. La anticoagulación, cuando está indicada, ha demostrado ser la principal herramienta en la prevención de dichos eventos. Sin embargo, aunque las complicaciones hemorrágicas son más frecuentes, en esta población, y aumentan con la edad, sobrepasa por mucho, el beneficio al riesgo. El control de la frecuencia cardiaca ha demostrado ser igual o mejor que el control del ritmo en cuanto a prevención de eventos cerebrovasculares y mortalidad en estos pacientes. La edad cronológica por sí sola, no es contraindicación alguna para ofrecer una terapia óptima. Debe tomarse en cuenta el estado funcional, cognitivo y social, así como aspectos fisiológicos del envejecimiento con respecto a la prescripción de medicamentos. Cuando, a pesar del tratamiento adecuado, la sintomatología persiste, las estrategias invasivas han demostrado ser beneficiosas, pero faltan estudios que involucren a individuos mayores.Atrial fibrillation is the most prevalent arrhythmia in the elderly. Its frequency increases with age, being 1.5% from 50 to 59 years old and 10% from 80 to 89 years old. Non valvular atrial fibrillation increases 5 fold the risk of suffering an stroke and causes 15% of strokes in the USA. Atrial fibrillation management focuses in the prevention of thromboembolic phenomena and heart rate and rhythm control. Anticoagulation, when indicated, has

  19. Percutaneous closure of the left atrial appendage for prevention of thromboembolism in atrial fibrillation for patients with contraindication to or failure of oral anticoagulation: a single-center experience.

    Science.gov (United States)

    Faustino, Ana; Paiva, Luís; Providência, Rui; Trigo, Joana; Botelho, Ana; Costa, Marco; Leitão-Marques, António

    2013-06-01

    In non-valvular atrial fibrillation 90% of thrombi originate in the left atrial appendage (LAA). Percutaneous LAA closure has been shown to be non-inferior to warfarin for prevention of thromboembolism. To evaluate the initial experience of a single center in percutaneous LAA closure in patients with high thromboembolic risk and in whom oral anticoagulation was impractical or contraindicated or had failed. Patients with non-valvular atrial fibrillation and CHADS2 score ≥2 in whom oral anticoagulation was impractical or contraindicated or had failed underwent percutaneous LAA closure according to the standard technique. After the procedure, dual antiplatelet therapy was maintained for one month, followed by single antiplatelet therapy indefinitely. Patients were followed by clinical assessment and transthoracic and transesophageal echocardiography. The procedure was performed in 22 of the 23 selected patients (95.7%), mean age 70±9 years, CHADS2 score 3.2±0.9 and CHA2DS2-VASC score 4.7±1.4. Intraprocedural device replacement was necessary only in the first patient, due to oversizing. The following periprocedural complications were observed: one femoral pseudoaneurysm, three femoral hematomas and two minor oropharyngeal bleeds, resolved by local hemostatic measures. During a 12±8 month follow-up a mild peri-device flow and a thrombus adhering to the device, resolved under with enoxaparin therapy, were identified. The rate of transient ischemic attack (TIA)/stroke was lower than expected according to the CHADS2 score (0 vs. 6.7±2.2%). In our initial experience, this procedure proved to be a feasible, safe and effective alternative for atrial fibrillation patients in whom oral anticoagulation is not an option. Only relatively minor complications were observed, with a lower than expected TIA/stroke rate. Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  20. Amyloid-like fibril elongation follows michaelis-menten kinetics

    National Research Council Canada - National Science Library

    Milto, Katazyna; Botyriute, Akvile; Smirnovas, Vytautas

    2013-01-01

    ... are. We obtained experimental data on insulin amyloid-like fibril elongation at the conditions where other processes which may impact kinetics of fibril formation are minor and fitted it using Michaelis-Menten equation...

  1. Risk of atrial fibrillation and stroke in rheumatoid arthritis

    DEFF Research Database (Denmark)

    Lindhardsen, Jesper; Ahlehoff, Ole; Gislason, Gunnar Hilmar;

    2012-01-01

    To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke.......To determine if patients with rheumatoid arthritis have increased risk of atrial fibrillation and stroke....

  2. Management and prognosis of atrial fibrillation in the diabetic patient

    DEFF Research Database (Denmark)

    Pallisgaard, Jannik Langtved; Lindhardt, Tommi Bo; Olesen, Jonas Bjerring

    2015-01-01

    The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation. I...... and outcomes of heart failure and the success rates of both ablation and cardioversion in atrial fibrillation patients with diabetes. Finally, this article describes the association of HbA1c levels with the management and prognosis of atrial fibrillation patients.......The global burden of atrial fibrillation and diabetes mellitus (diabetes) is considerable, and prevalence rates are increasing. Diabetes is associated with an increased risk of developing atrial fibrillation; however, diabetes also influences the management and prognosis of atrial fibrillation...

  3. Surgical Treatment of Atrial Fibrillation: A Review

    Directory of Open Access Journals (Sweden)

    Nadine Hiari

    2011-01-01

    Full Text Available Atrial fibrillation is the most commonly sustained arrhythmia in man. While it affects millions of patients worldwide, its incidence will markedly increase with an aging population. Primary goals of AF therapy are to (1 reduce embolic complications, particularly stroke, (2 alleviate symptoms, and (3 prevent long-term heart remodelling. These have been proven to be a challenge as there are major limitations in our knowledge of the pathological and electrophysiological mechanisms underlying AF. Although advances continue to be made in the medical management of this condition, pharmacotherapy is often unsuccessful. Because of the high recurrence rate of AF despite antiarrhythmic drug therapy for maintenance of sinus rhythm and the adverse effects of these drugs, there has been growing interest in nonpharmacological strategies. Surgery for treatment of AF has been around for some time. The Cox-Maze procedure is the gold standard for the surgical treatment of atrial fibrillation and has more than 90% success in eliminating atrial fibrillation. Although the cut and sew maze is very effective, it has been superseded by newer operations that rely on alternate energy sources to create lines of conduction block. In addition, the evolution of improved ablation technology and instrumentation has facilitated the development of minimally invasive approaches. In this paper, the rationale for surgical ablation for atrial fibrillation and the different surgical techniques that were developed will be explored. In addition, it will detail the new approaches to surgical ablation of atrial fibrillation that employ alternate energy sources.

  4. A resorcinarene for inhibition of Aβ fibrillation.

    Science.gov (United States)

    Han, Xu; Park, Jiyong; Wu, Wei; Malagon, Andres; Wang, Lingyu; Vargas, Edgar; Wikramanayake, Athula; Houk, K N; Leblanc, Roger M

    2017-03-01

    Amyloid-β peptides (Aβ) fibrillation is the hallmark of Alzheimer's disease (AD). However, it has been challenging to discover potent agents in order to inhibit Aβ fibrillation. Herein, we demonstrated the effect of resorcinarene on inhibiting Aβ fibrillation in vitro via experimental and computational methods. Aβ were incubated with different concentrations of resorcinarene so as to monitor the kinetics by using thioflavin T binding assay. The results, which were further confirmed by far-UV CD spectroscopy and atomic force microscopy, strongly indicated that the higher concentration of resorcinarene, the more effective the inhibition of Aβ fibrillation. A cytotoxicity study showed that when sea urchin embryos were exposed to the resorcinarene, the majority survived due to the resorcinarene low toxicity. In addition, when the resorcinarene was added, the formation of toxic Aβ 42 species was delayed. Computational studies of Aβ fibrillation, including docking simulations and MD simulations, illustrated that the interaction between inhibitor resorcinarene and Aβ is driven by the non-polar interactions. These studies display a novel strategy for the exploration of promising antiamyloiddogenic agents for AD treatments.

  5. Redux valvular surgery with coronary artery bypass graft in familial hypercholesterolemia

    Directory of Open Access Journals (Sweden)

    Ziadi Jalel

    2014-01-01

    Full Text Available Familial hypercholesterolemia (FH is a dominantly inherited disorder caused by mutation at the locus for the low-density lipoprotein (LDL receptor and is frequently associated with premature coronary artery disease and aortic valve involvement. The surgical treatment of these complications is accompanied by a high degree of risk, even in skillful hands. An intensive cholesterol-lowering therapy and LDL aphaeresis in association with surgery may be useful. The case of a 12-year-old girl, with a medical history of familial hypercholesterolemia is reported here, operated two years previously for valvular aortic stenosis; Ross intervention was done. She was readmitted for acute coronary syndrome. Three coronary artery bypass grafting was performed with saphenous veins with positive results.

  6. Progressive systemic sclerosis (scleroderma, carcinoma breast and valvular heart disease: an unusual combination.

    Directory of Open Access Journals (Sweden)

    Dewani M

    2000-07-01

    Full Text Available Systemic sclerosis is a multi system disorder characterised by fibrosis of skin and internal organs. There are reports of relation between cancer and polymyositis/dermatomyositis, but no overall association with systemic sclerosis. Reports of the coexistence of cancer and systemic sclerosis, however, emphasise a close temporal relation in their occurrence. Cardiac involvement in the form of myocardial fibrosis and pericarditis occurs frequently in systemic sclerosis, while valvular involvement has been reported only sporadically. We report a patient, admitted for adenocarcinoma of left breast who was found to have features of systemic sclerosis, pulmonary hypertension, gangrene of toes, and stenotic mitral valve disease. The possible mechanisms of the coincidence of the three disorders are discussed.

  7. Gene expression profiling of valvular interstitial cells in Rapacz familial hypercholesterolemic swine

    Directory of Open Access Journals (Sweden)

    Ana M. Porras

    2014-12-01

    Full Text Available Rapacz familial hypercholesterolemic (RFH swine is a well-established model of human FH, a highly prevalent hereditary disease associated with increased risk of coronary artery disease and calcific aortic valve disease (CAVD. However, while these animals have been used extensively for the study of atherosclerosis, the heart valves from RFH swine have not previously been examined. We report the analysis of valvular interstitial cell gene expression in adult (two year old and juvenile (three months old RFH and WT swine by microarray analysis via the Affymetrix Porcine Genome Array (GEO #: GSE53997. Principal component and hierarchical clustering analysis revealed grouping and almost no variability between the RFH juvenile and WT juvenile groups. Additionally, only 21 genes were found differentially expressed between these two experimental groups whereas over 900 genes were differentially expressed when comparing either RFH or WT juvenile swine to RFH adults.

  8. Cardiopatía valvular en un paciente con granulomatosis de Wegener

    Directory of Open Access Journals (Sweden)

    Luis E. Silva, MD

    2012-01-01

    Full Text Available La granulomatosis de Wegener es una vasculitis necrotizante autoinmune cuya prevalencia reportada es de 3/100.000 habitantes. Tiene compromiso multisistémico, principalmente el tracto respiratorio superior e inferior, y el sistema nervioso central y renal. La frecuencia del compromiso cardiaco varía según las series estudiadas, pero oscila alrededor de 6%; sin embargo, las manifestaciones clínicas son poco frecuentes. El compromiso valvular se reporta como insuficiencia aórtica o mitral, secundaria a infiltración de las valvas o dilatación de la raíz aórtica. El tratamiento se basa en el control de la enfermedad, el manejo de la falla cardiaca y la intervención quirúrgica de la válvula comprometida según la indicación.

  9. Tissue engineering of vascular/valvular equivalents on the base of the xenogeneic decellularized matrix

    Directory of Open Access Journals (Sweden)

    Savchuk M. V.

    2014-07-01

    Full Text Available According to the WHO, in 2008 cardiovascular diseases claimed the lives of 17.5 million people (30 % of all diseases. Often the only option to save a patient’s life is a replacing the injured part of an organ by the prosthesis. Aim. This research was aimed to produce biomodificated cardiovascular graft by decellularisation of porcine heart valve. Methods. Our method of decellularization permits to make morphologically and physically non-modified decellularised extracellular matrix. Results. The analysis of matrix shows a decrease of the total number of cells, preservation of the collagen and elastin fibers structure, and safety of physiological adhesion. Conclusions. The matrix can be used as a framework for the vessel-valvular tissue-engineering prosthesis after its recellularization by the recipient’s autologous cells.

  10. Contribution of Long Fibrils and Peptides to Surface and Foaming Behavior of Soy Protein Fibril System.

    Science.gov (United States)

    Wan, Zhili; Yang, Xiaoquan; Sagis, Leonard M C

    2016-08-16

    When soy glycinin (11S) is heated for a prolonged time at pH 2 (20 h at 85 °C), a mixture is formed consisting of long semiflexible 11S fibrils and small peptides. The surface and foaming properties of this mixture were investigated at different pHs, and compared to the behavior of pure fibrils and pure peptides, to determine the individual contributions of these two factions to the behavior of the mixture. The adsorption of these three systems at air-water interfaces and the resulting surface rheological properties were studied by combining drop shape analysis tensiometry, ellipsometry, and surface large amplitude oscillatory dilatational (LAOD) rheology. Lissajous plots of surface pressure versus deformation were used to analyze the surface rheological response in terms of interfacial microstructure. Our results show that the adsorption kinetics, dilatational rheological properties, and the foaming behavior of the mixture were mainly dominated by the small peptides in the fibril system. Compared to pH 2, the fibril mixture at pH 5 and 7 provides much better foam stability and appears to be a very promising protein material to make stable foams, even at low protein concentration (0.1 wt %). The presence of fibril clusters and peptide aggregates at pH 5 and 7 contributed to foam stability of the mixture. In contrast, pure fibril formed an interface with a highly pH-responsive adsorption and rheological behavior, and the foamability and foam stability of the pure fibrils were very poor.

  11. Assessment of left ventricular function using dobutamine stress echocardiography and myocardial scintigraphy in valvular heart disease

    Energy Technology Data Exchange (ETDEWEB)

    Ozaki, Nobuchika; Sugimoto, Takaki; Okada, Masayoshi [Kobe Univ. (Japan). School of Medicine

    1999-02-01

    To assess the left ventricular (LV) function in valvular heart disease, we employed the preoperative dobutamine stress echocardiography and the myocardial scintigraphy. During the past 13 years, 37 of 324 the patients showed LV dysfunction with the % fractional shortening (%FS) of 25% or less in the preoperative echocardiogram. These patients were retrospectively divided into two groups; Group A (n=21): %FS has improved late after operation; Group B (n=16): %FS has deteriorated or LV failure occurred. The mean follow-up period was 84{+-}54 months after valve surgery. No significant differences were observed in the preoperative characteristics and operative variables between these two groups. The dobutamine stress test had been performed in 8 patients in Group A and 9 patients in Group B preoperatively, and the maximum increase ratio of %FS ({delta}%FS) was used for assessment. Seven patients in Group A had showed {delta}%FS of more than 9%, while all patients in Group B had showed {delta}%FS of less than 9%. Myocardial scintigraphy was performed in 11 patients of them, and another 22 patients with %FS of above 25% acted as the control group. The Defect Score, which was defined as the sum of defect scales in 25 LV segments, showed a significant difference between 11 patients with LV dysfunction and control group. The distribution of the Defect Score in each myocardial segment, showed significantly higher in the posterior and inferior LV segments. In addition, the perfusion defect on myocardial imaging was initiated in the junction between the septal and LV free wall, and extended from the posterior to the lateral wall along with deterioration of LV function. In conclusion, preoperative dobutamine stress echocardiography proved to be very useful for prediction of the postoperative LV function, and myocardial scintigraphy might be indicative of LV function even in valvular heart disease. (author)

  12. Factors influencing the quantification of valvular regurgitation by gated equilibrium radionuclide angiography

    Energy Technology Data Exchange (ETDEWEB)

    Berthout, P.; Faivre, R.; Bassand, J.P.; Maurat, J.P.; Cardot, J.C.; Baud, M.; Verdenet, J.; Bidet, A.C.; Bidet, R.

    1984-03-01

    To test the clinical validity of the stroke volume ratio (SVR) and the factors influencing its value we determined it in a population of 41 patients free of valvular regurgitation. The SVR was estimated from multigated blood pool scans in left anterior oblique position by two methods. The first method followed the classical formula of the left to right ventricular stroke count ratio. The second method used the same formula except that the right atrial activity emanating from the area of right atriventricular overlap as traced at right ventricular end-systole, was subtracted from the right ventricular stroke count. The SVR average 1.25+-0.18 (range 0.97-1.80) by the first technique and 1.05+-0.12 (range 0.82-1.36) by the second (P<0.001). In our results the SVR is not correlated to either ejection fraction or angiographically determined left ventricular volumes. Conversely the SVR is correlated with the left to right end-diastolic volume ratio evaluated from radionuclide counts measured at right and left ventricular end-diastole (r=0.48, P<0.01). This may be due to variations in the area of right atriventricular overlap, depending on the size of the ventricular chamber. It is postulated that the accuracy of SVR determination could be enhanced by subtraction of the right atrial activity from the right ventricular activity at end-systole. In patients free of valvular regurgitation the LV/RV stroke volume ratio approaches unity and the variability of the results is smaller. Interobserver and intraobserver variability is reduced using the Fourier phase approach.

  13. Type A aortic dissection: Are there CT signs suggestive of valvular involvement?

    Science.gov (United States)

    Platon, Alexandra; Bernard, Stephane; Perrin, Nils; Murith, Nicolas; John, Gregor; Perneger, Thomas; Rutschmann, Olivier T; Poletti, Pierre-Alexandre

    2016-11-01

    To identify the predictive signs of aortic valve involvement on the non-electrocardiogram (ECG)-gated admission computed tomography (CT) of patients with Type A aortic dissection (AD) according to the Stanford classification. We retrospectively analyzed the non-ECG-gated CT examinations of patients admitted to the emergency department who underwent surgery for Type A AD over a period of 4 years. The diameter of the following structures was calculated as the mean of the smallest and largest diameters (mm) measured in two different planes: aortic annulus, sinus of Valsalva, sinotubular junction, and proximal ascending aorta. These parameters were compared against operative reports in order to determine whether they were predictive of aortic valve involvement. In total, 20 patients (13 men and 7 women) of a mean age of 59.5 years (29-80) were included, 55% of patients (11/20) having surgically proven valvular involvement. The mean diameters (inmm) of the aortic annulus, sinus of Valsalva, sinotubular junction and proximal ascending aorta in the group with (and without, respectively) valvular involvement was 27.7 (26.7), 44.3 (38.1), 42.6 (36.6), and 47.8 (45.9). Only the measurement of the mean diameter of the sinuses of Valsalva was significantly predictive (p=0.02) of aortic valve involvement. Our findings suggest that measuring the diameter of the sinuses of Valsalva on non-ECG-gated admission CT examinations allows for predicting aortic valve involvement in Type A AD patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Técnicas de reparación valvular aórtica

    Directory of Open Access Journals (Sweden)

    Diana Aicher

    2014-07-01

    Full Text Available La reparación de la válvula aórtica ha experimentado una evolución constante en las 2 últimas décadas y se ha beneficiado notablemente de una mejor comprensión de la geometría de la válvula y de la raíz aórtica normal. Actualmente, las investigaciones se centran en algunos aspectos especiales, tales como la técnica óptima para la reparación o sustitución de los velos, la estabilización del anillo basal y el material ideal a emplear. El prolapso de los velos en las válvulas aórticas bicúspides y tricúspides es la causa más frecuente de insuficiencia aórtica en los países industrializados. Con base en la más reciente literatura, así como en nuestra propia experiencia, ofrecemos una serie de recomendaciones para un adecuado manejo quirúrgico de los pacientes con insuficiencia aórtica por patología valvular. Detallamos el diagnóstico y el análisis sistemático intraoperatorio que debe seguirse, así como las distintas técnicas quirúrgicas que se deben emplear. Presentamos los resultados obtenidos en 1.808 pacientes sometidos a distintas técnicas de reparación valvular aórtica en nuestra institución.

  15. The management of non-valvular atrial fibrillation (NVAF in Australian general practice: bridging the evidence-practice gap. A national, representative postal survey

    Directory of Open Access Journals (Sweden)

    Middleton Sandy

    2008-11-01

    Full Text Available Abstract Background General practitioners (GPs are ideally placed to bridge the widely noted evidence-practice gap between current management of NVAF and the need to increase anticoagulant use to reduce the risk of fatal and disabling stroke in NVAF. We aimed to identify gaps in current care, and asked GPs to identify potentially useful strategies to overcome barriers to best practice. Methods We obtained contact details for a random sample of 1000 GPs from a national commercial data-base. Randomly selected GPs were mailed a questionnaire after an advance letter. Standardised reminders were administered to enhance response rates. As part of a larger survey assessing GP management of NVAF, we included questions to explore GPs' risk assessment, estimates of stroke risk and GPs' perceptions of the risks and benefits of anticoagulation with warfarin. In addition, we explored GPs' perceived barriers to the wider uptake of anticoagulation, quality control of anticoagulation and their assessment of strategies to assist in managing NVAF. Results 596 out of 924 eligible GPs responded (64.4% response rate. The majority of GPs recognised that the benefits of warfarin outweighed the risks for three case scenarios in which warfarin is recommended according to Australian guidelines. In response to a hypothetical case scenario describing a patient with a supratherapeutic INR level of 5, 41.4% of the 596 GPs (n = 247 and 22.0% (n = 131 would be "highly likely" or "likely", respectively, to cease warfarin therapy and resume at a lower dose when INR levels are within therapeutic range. Only 27.9% (n = 166/596 would reassess the patient's INR levels within one day of recording the supratherapeutic INR. Patient contraindications to warfarin was reported to "usually" or "always" apply to the patients of 40.6% (n = 242/596 of GPs when considering whether or not to prescribe warfarin. Patient refusal to take warfarin "usually" or "always" applied to the patients of 22.3% (n = 133/596 of GPs. When asked to indicate the usefulness of strategies to assist in managing NVAF, the majority of GPs (89.1%, n = 531/596 reported that they would find patient educational resources outlining the benefits and risks of available treatments "quite useful" or "very useful". Just under two-thirds (65.2%; n = 389/596 reported that they would find point of care INR testing "quite" or "very" useful. An outreach specialist service and training to enable GPs to practice stroke medicine as a special interest were also considered to be "quite" or "very useful" by 61.9% (n = 369/596 GPs. Conclusion This survey identified gaps, based on GP self-report, in the current care of NVAF. GPs themselves have provided guidance on the selection of implementation strategies to bridge these gaps. These results may inform future initiatives designed to reduce the risk of fatal and disabling stroke in NVAF.

  16. Clinical implication of monitoring rivaroxaban and apixaban by using anti-factor Xa assay in patients with non-valvular atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Kozue Ikeda, MD

    2016-02-01

    Conclusions: Measurement of AXA might be useful to assess the pharmacodynamics of high-risk patients, such as high age, low body weight, and/or low renal function, and to assess the intensity of anticoagulation by using different methods of administration, such as crushed tablet via the nasogastric tube.

  17. Fracture of Protein Fibrils As Induced by Elongational Flow

    NARCIS (Netherlands)

    Kroes-Nijboer, A.; Venema, P.; Baptist, H.G.M.; Linden, van der E.

    2010-01-01

    The length distribution of whey protein fibrils is important for application purposes. However, it is hard to influence the length distribution of whey protein fibrils during production. One way of influencing the length distribution of the mature fibrils is exposing them to an external field, like

  18. Artificial atrial fibrillation in the dog. An artifact?

    NARCIS (Netherlands)

    Strackee, J.; Hoelen, A.J.; Zimmerman, A.N.E.; Meijler, F.L.

    1971-01-01

    R-R interval sequences during artificial atrial fibrillation in dogs were studied in the same way as in patients in a previous study and compared with results obtained in dogs with spontaneous atrial fibrillation. Artificial atrial fibrillation was effected by right atrial stimulation in three close

  19. Autonomic and surgical substrate modulation of atrial fibrillation

    NARCIS (Netherlands)

    Krul, S.P.J.

    2016-01-01

    This thesis focuses on the effects of fibrosis and the autonomic nervous system on conduction in patients with atrial fibrillation and the surgical ablation of the atria and autonomic nervous system as treatment of atrial fibrillation. Atrial fibrillation is the most common arrhythmia and results fr

  20. Universal Behavior in the Mesoscale Properties of Amyloid Fibrils

    Science.gov (United States)

    Assenza, Salvatore; Adamcik, Jozef; Mezzenga, Raffaele; De Los Rios, Paolo

    2014-12-01

    Amyloid fibrils are ubiquitous proteinaceous aggregates occurring in vivo and in vitro, with an invariant structural fingerprint at the molecular length scale. However, interpretation of their mesoscopic architectures is complicated by diverse observable polymorphic states. We here present a constitutive model for amyloid fibrils based on the minimization of the total energy per fibril. The model is benchmarked on real amyloid fibrils studied by atomic force microscopy. We use multistranded β -lactoglobulin amyloid fibrils as a model system exhibiting a rich polymorphism. The constitutive model quantitatively recapitulates the main mesoscopic topological features of amyloid fibrils, that is, the evolution of fibril periodicity as a function of the ionic strength of the solution and of the fibril width. A universal mesoscopic structural signature of the fibrils emerges from this picture, predicting a general, parameter-free law for the periodicity of the fibrils, that depends solely on the number of protofilaments per fibril. These predictions are validated experimentally and conclusively highlight the role of competing electrostatic and elastic contributions as the main players in the establishment of amyloid fibrils structure.

  1. POSTOPERATIVE ATRIAL FIBRILLATION – AN UPDATE

    Directory of Open Access Journals (Sweden)

    Johnson Francis

    2015-12-01

    Full Text Available Atrial fibrillation is the most common perioperative cardiac arrhythmia. Sympathetic overactivity, inflammatory state and oxidative stress are important contributors to the genesis of postoperative atrial fibrillation. Advancing age and mitral valve disease along with left atrial size are important parameters in noted in multivariate prediction model. Genetic predisposition has also been noted. Preventive strategies tried include beta blockers, statins, posterior pericardiotomy, carperitide infusion and thoracic epidural analgesia. Treatment options include rate and rhythm control along with anticoagulation if it persists more than 48 hours with high CHADS2 score. Some of the therapeutic modalities which have been found to be NOT useful in preventing post operative atrial fibrillation are dexamethasone, magnesium infusion and concomitant pulmonary vein isolation.

  2. Antihypertensive treatment and risk of atrial fibrillation

    DEFF Research Database (Denmark)

    Marott, Sarah C W; Nielsen, Sune F; Benn, Marianne

    2014-01-01

    AIMS: To examine the associations between antihypertensive treatment with angiotensin-converting enzyme inhibitors (ACEis) or angiotensin receptor blockers (ARBs), β-blockers, diuretics, or calcium-antagonists, and risk of atrial fibrillation. We examined these associations using the entire Danish...... population from 1995 through 2010. METHODS AND RESULTS: Excluding medication used in atrial fibrillation, we matched individuals on ACEi monotherapy 1:1 with individuals on β-blocker (n = 48 658), diuretic (n = 69 630), calcium-antagonist (n = 57 646), and ARB monotherapy (n = 20 158). Likewise, individuals...... on ARB monotherapy were matched 1:1 with individuals on β-blocker (n = 20 566), diuretic (n = 20 832), calcium-antagonist (n = 20 232), and ACEi monotherapy (n = 20 158). All were free of atrial fibrillation and of predisposing diseases like heart failure, ischaemic heart disease, diabetes mellitus...

  3. Incidencia y caracterización de las regurgitaciones valvulares fisiológicas en el caballo Incidence and characterization of the physiological valvular regurgitations in the horse

    Directory of Open Access Journals (Sweden)

    G Pidal

    2007-12-01

    Full Text Available El mapeo de flujo color es la técnica de elección para evaluar los flujos sanguíneos, particularmente a nivel de las distintas válvulas cardiacas, dado que las variaciones en tonalidad, sentido, y morfología del "jet", dan un clara idea de su dirección, velocidad y tipo (laminar o turbulento. El objetivo de este estudio fue establecer las características que definen a las regurgitaciones valvulares fisiológicas sin correlato clínico identificadas mediante mapeo del flujo en color y establecer su incidencia en el caballo. Se estudiaron 326 caballos, de ambos sexos y edades entre 2 y 14 años, discriminados de la siguiente manera: 138 mestizos, 89 sangre pura de carrera, 51 Árabes y 48 tipo salto. Se determinó que las regurgitaciones fisiológicas sin correlato clínico se caracterizaron por: presentar bajo grado de ambigüedad (aliasing, que el área color generada por los flujos "anómalos" no se extendió más allá de 40 mm dentro de la cámara receptora, adoptaron morfología fusiforme, su diámetro mayor no excedió los 10 mm, se produjeron temprano en diástole en el caso de la válvulas sigmoideas y temprano en sístole en el caso de la válvulas atrioventriculares y en ambos casos se observan durante un lapso breve. De los 326 caballos estudiados, 137 (42,1% presentaron regurgitaciones inocentes. En todas las razas estudiadas, la válvula que presentó más flujos regurgitantes inocentes fue la aórtica.The color flow map is the most sensitive technique to evaluate the blood flows, particularly at level of the cardiac valves, since by the variations in tonality and morphology of the "jet" give a clear idea of its direction, speed and flow type (laminar or turbulent. The objective of this study was to establish the characteristics that define the physiological valvular regurgitations without clinical manifestations, identified by means of color flow map and establish its incidence in horses. Three hundred twenty six horses both

  4. Composite risk scores and composite endpoints in the risk prediction of outcomes in anticoagulated patients with atrial fibrillation. The Loire Valley Atrial Fibrillation Project.

    Science.gov (United States)

    Banerjee, A; Fauchier, L; Bernard-Brunet, A; Clementy, N; Lip, G Y H

    2014-03-01

    Several validated risk stratification schemes for prediction of ischaemic stroke (IS)/thromboembolism (TE) and major bleeding are available for patients with non-valvular atrial fibrillation (NVAF). On the basis for multiple common risk factors for IS/TE and bleeding, it has been suggested that composite risk prediction scores may be more practical and user-friendly than separate scores for bleeding and IS/TE. In a long-term prospective hospital registry of anticoagulated patients with newly diagnosed AF, we compared the predictive value of existing risk prediction scores as well as composite risk scores, and also compared these risk scoring systems using composite endpoints. Endpoint 1 was the simple composite of IS and major bleeds. Endpoint 2 was based on a composite of IS plus intracerebral haemorrhage (ICH). Endpoint 3 was based on weighted coefficients for IS/TE and ICH. Endpoint 4 was a composite of stroke, cardiovascular death, TE and major bleeding. The incremental predictive value of these scores over CHADS2 (as reference) for composite endpoints was assessed using c-statistic, net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Of 8,962 eligible individuals, 3,607 (40.2%) had NVAF and were on OAC at baseline. There were no statistically significant differences between the c-statistics of the various risk scores, compared with the CHADS2 score, regardless of the endpoint. For the various risk scores and various endpoints, NRI and IDI did not show significant improvement (≥1%), compared with the CHADS2 score. In conclusion, composite risk scores did not significantly improve risk prediction of endpoints in patients with NVAF, regardless of how endpoints were defined. This would support individualised prediction of IS/TE and bleeding separately using different separate risk prediction tools, and not the use of composite scores or endpoints for everyday 'real world' clinical practice, to guide decisions on

  5. Cryoballoon Catheter Ablation in Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Cevher Ozcan

    2011-01-01

    Full Text Available Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.

  6. Elastic model for crimped collagen fibrils

    Science.gov (United States)

    Freed, Alan D.; Doehring, Todd C.

    2005-01-01

    A physiologic constitutive expression is presented in algorithmic format for the nonlinear elastic response of wavy collagen fibrils found in soft connective tissues. The model is based on the observation that crimped fibrils in a fascicle have a three-dimensional structure at the micron scale that we approximate as a helical spring. The symmetry of this wave form allows the force/displacement relationship derived from Castigliano's theorem to be solved in closed form: all integrals become analytic. Model predictions are in good agreement with experimental observations for mitral-valve chordae tendinece.

  7. Elastic Response of Crimped Collagen Fibrils

    Science.gov (United States)

    Freed, Alan D.; Doehring, Todd C.

    2005-01-01

    A physiologic constitutive expression is presented in algorithmic format for the elastic response of wavy collagen fibrils found in soft connective tissues. The model is based on the observation that crimped fibrils have a three-dimensional structure at the micrometer scale that we approximate as a helical spring. The symmetry of this waveform allows the force/displacement relationship derived from Castigliano's theorem to be solved in closed form. Model predictions are in good agreement with experimental observations for mitral-valve chordae tendineae

  8. Atrial natriuretic peptide in patients with heart failure and chronic atrial fibrillation : Role of duration of at atrial fibrillation

    NARCIS (Netherlands)

    Van Den Berg, MP; Crijns, HJGM; Van Veldhuisen, DJ; Van Gelder, IC; De Kam, PJ; Lie, KI

    1998-01-01

    The purpose of this study was to analyze the determinants of atrial natriuretic peptide level in patients with congestive heart failure and atrial fibrillation. In particular, the duration of atrial fibrillation was analyzed because atrial fibrillation per se might have a specific effect on atrial n

  9. Uniform spatial distribution of collagen fibril radii within tendon implies local activation of pC-collagen at individual fibrils

    Science.gov (United States)

    Rutenberg, Andrew D.; Brown, Aidan I.; Kreplak, Laurent

    2016-08-01

    Collagen fibril cross-sectional radii show no systematic variation between the interior and the periphery of fibril bundles, indicating an effectively constant rate of collagen incorporation into fibrils throughout the bundle. Such spatially homogeneous incorporation constrains the extracellular diffusion of collagen precursors from sources at the bundle boundary to sinks at the growing fibrils. With a coarse-grained diffusion equation we determine stringent bounds, using parameters extracted from published experimental measurements of tendon development. From the lack of new fibril formation after birth, we further require that the concentration of diffusing precursors stays below the critical concentration for fibril nucleation. We find that the combination of the diffusive bound, which requires larger concentrations to ensure homogeneous fibril radii, and lack of nucleation, which requires lower concentrations, is only marginally consistent with fully processed collagen using conservative bounds. More realistic bounds may leave no consistent concentrations. Therefore, we propose that unprocessed pC-collagen diffuses from the bundle periphery followed by local C-proteinase activity and subsequent collagen incorporation at each fibril. We suggest that C-proteinase is localized within bundles, at fibril surfaces, during radial fibrillar growth. The much greater critical concentration of pC-collagen, as compared to fully processed collagen, then provides broad consistency between homogeneous fibril radii and the lack of fibril nucleation during fibril growth.

  10. A long-term echocardiographic study of the course of valvular dysfunctions following discontinuation of ergot-derived dopamine agonists in patients with Parkinson's disease

    Directory of Open Access Journals (Sweden)

    Walter Serra

    2015-03-01

    Conclusions: This long-term study confirms an improvement of the restrictive VHD after withdrawal of EDA in PD patients. However, only a partial reversibility of cardiac valvular abnormalities was observed.

  11. THE VALUE OF 99mTc-MIBI MYOCARDIAL PERFUSION SPECT IMAGING IN DETECTING CORONARY ARTERY DISEASE IN PATIENTS WITH VALVULAR DISEASE BEFORE OPERATION

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective. The aim of this study was to detect coronary artery disease using99m Tc-MIBI myocardial perfusion imaging in patients with valvular disease.Methods. Thirty patients with valvular disease confirmed by echocardiography underwent 99mTc-MIBI myocardial perfusion imaging using multiSPECT 1h after stress test (exercise, dipyridamole or dobutamine test) and were performed coronary angiography within 1 month before valvular operation.Results.For 29 out of the 30 patients, the results of 99mTc-MIBI myocardial perfusion imaging were similar with those of coronary angiography, the concordance rate was 96.7% and the negative predictability was 100%.Conclusion.99m Tc-MIBI myocardial perfusion imaging is a reliable non-invasive method for detecting coronary artery disease in patients with valvular disease and so as to draw up suitable operation programs for them.

  12. Stop-and-go kinetics in amyloid fibrillation

    DEFF Research Database (Denmark)

    Ferkinghoff-Borg, Jesper; Fonslet, Jesper; Andersen, Christian Beyschau

    2010-01-01

    in an intermittent fashion, with periods of growth followed by long pauses. The observed exponential distributions of stop and growth times support a Markovian model, in which fibrils shift between the two states with specific rates. Even if the individual rates vary considerably, we observe that the probability......Many human diseases are associated with protein aggregation and fibrillation. We present experiments on in vitro glucagon fibrillation using total internal reflection fluorescence microscopy, providing real-time measurements of single-fibril growth. We find that amyloid fibrils grow...

  13. Bi-focal atrial tachycardia mimicking atrial fibrillation: fusion and interference between two distinct tachycardias.

    Science.gov (United States)

    Ejima, Koichiro; Shoda, Morio; Tanizaki, Kohei; Kasanuki, Hiroshi

    2007-11-01

    Irregular tachycardias mimicking atrial fibrillation (AF) have previously been described. We report a case of a 60-year-old man with an antiarrhythmic drug-resistant atrial tachycardia (AT) mimicking AF. The tachycardia consisted of two distinct ATs with interference of one repetitive AT with another sustained AT. Radiofrequency (RF) ablation of two distinct right atrial foci eliminated the irregular tachycardia. Although catheter-based pulmonary vein isolation has become a popular therapeutic approach for patients with symptomatic AF, careful evaluation of the intracardiac recordings in the patients undergoing RF ablation for AF is important.

  14. Risk of thromboembolism and bleeding after general surgery in patients with atrial fibrillation.

    Science.gov (United States)

    Vink, Roel; Rienstra, Michiel; van Dongen, Carlo J J; Levi, Marcel; Büller, Harry R; Crijns, Harry J; van Gelder, Isabelle C

    2005-09-15

    We provide insight into the risk of perioperative thromboembolism and bleeding in patients who have atrial fibrillation, use anticoagulants, and undergo a surgical procedure. Ninety-four patients underwent 121 noncardiac operations during a mean follow-up of 29 months. There was a 3.6-fold increased risk for all bleeding complications within 1 month after surgery compared with the control period (95% confidence interval 1.05 to 12.0). No thromboembolic event occurred in the first month after surgery compared with 11 events in the remaining period (0.4% per month).

  15. Evidence of structurally continuous collagen fibrils in tendon

    DEFF Research Database (Denmark)

    Svensson, Rene B; Herchenhan, Andreas; Starborg, Tobias

    2017-01-01

    in this structure-function relationship is the collagen fibril length. During embryogenesis short fibrils are produced but they grow rapidly with maturation. There is some controversy regarding fibril length in adult tendon, with mechanical data generally supporting discontinuity while structural investigations......Tendons transmit muscle-generated force through an extracellular matrix of aligned collagen fibrils. The force applied by the muscle at one end of a microscopic fibril has to be transmitted through the macroscopic length of the tendon by mechanisms that are poorly understood. A key element...... fibrils was confirmed. In light of these results, possible mechanisms that could reconcile the opposing findings on fibril continuity are discussed. STATEMENT OF SIGNIFICANCE: Connective tissues hold all parts of the body together and are mostly constructed from thin threads of the protein collagen...

  16. Amyloid-like fibril elongation follows michaelis-menten kinetics.

    Science.gov (United States)

    Milto, Katazyna; Botyriute, Akvile; Smirnovas, Vytautas

    2013-01-01

    A number of proteins can aggregate into amyloid-like fibrils. It was noted that fibril elongation has similarities to an enzymatic reaction, where monomers or oligomers would play a role of substrate and nuclei/fibrils would play a role of enzyme. The question is how similar these processes really are. We obtained experimental data on insulin amyloid-like fibril elongation at the conditions where other processes which may impact kinetics of fibril formation are minor and fitted it using Michaelis-Menten equation. The correlation of the fit is very good and repeatable. It speaks in favour of enzyme-like model of fibril elongation. In addition, obtained [Formula: see text] and [Formula: see text] values at different conditions may help in better understanding influence of environmental factors on the process of fibril elongation.

  17. Evidence of structurally continuous collagen fibrils in tendon

    DEFF Research Database (Denmark)

    Svensson, Rene B; Herchenhan, Andreas; Starborg, Tobias

    2017-01-01

    fibrils was confirmed. In light of these results, possible mechanisms that could reconcile the opposing findings on fibril continuity are discussed. STATEMENT OF SIGNIFICANCE: Connective tissues hold all parts of the body together and are mostly constructed from thin threads of the protein collagen......Tendons transmit muscle-generated force through an extracellular matrix of aligned collagen fibrils. The force applied by the muscle at one end of a microscopic fibril has to be transmitted through the macroscopic length of the tendon by mechanisms that are poorly understood. A key element...... in this structure-function relationship is the collagen fibril length. During embryogenesis short fibrils are produced but they grow rapidly with maturation. There is some controversy regarding fibril length in adult tendon, with mechanical data generally supporting discontinuity while structural investigations...

  18. Cardiac involvement in patients with systemic lupus erythematosus and correlation of valvular lesions with anti-Ro/SS-A and anti-La/SS-B antibody levels.

    Science.gov (United States)

    Shahin, Amira A; Shahin, Hesham A; Hamid, Magdy A; Amin, Mona A

    2004-01-01

    The aim of this study was to evaluate the incidence of morphologic and functional cardiac abnormalities in patients with systemic lupus erythematosus (SLE) and to correlate the findings with levels of anti-Ro/SS-A, anti-La/SS-B, and anti-cardiolipin antibody (aCL). Sixty-two patients with SLE were enrolled in this study. All patients underwent complete history taking, clinical assessment, and standard two-dimensional and Doppler echocardiography. Anti-Ro/SS-A, anti-La/SS-B, and aCL levels were measured using a standardized ELISA test. The patients were subdivided into two subgroups based on the presence or absence of valvular involvement. The two subgroups were then compared. Valvular involvement was present in 19 patients (30.6%), pericardial effusion in 12 patients (19.4%), impaired left ventricular relaxation abnormalities in 2 patients (3.2%), and pulmonary hypertension in 3 patients (4.8%). More patients in the valvular involvement group had positive anti-Ro/SS-A antibodies than in the valvular noninvolvement group (7/19 vs. 4/43). The difference was significant, with P anti-Ro/SS-A levels were significantly higher in the valvular involvement group (33.7 +/- 36.0 vs. 13.7 +/- 25.1; P anti-Ro/SS-A and anti-La/SS-B antibodies and the pathogenesis of the valvular lesions in SLE patients.

  19. Peptide p5 binds both heparinase-sensitive glycosaminoglycans and fibrils in patient-derived AL amyloid extracts

    Energy Technology Data Exchange (ETDEWEB)

    Martin, Emily B.; Williams, Angela [Department of Medicine, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN 37922 (United States); Heidel, Eric [Department of Surgery, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN 37922 (United States); Macy, Sallie [Department of Medicine, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN 37922 (United States); Kennel, Stephen J. [Department of Medicine, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN 37922 (United States); Department of Radiology, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN 37922 (United States); Wall, Jonathan S., E-mail: jwall@utmck.edu [Department of Medicine, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN 37922 (United States); Department of Radiology, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Knoxville, TN 37922 (United States)

    2013-06-21

    Highlights: •Polybasic peptide p5 binds human light chain amyloid extracts. •The binding of p5 with amyloid involves both glycosaminoglycans and fibrils. •Heparinase treatment led to a correlation between p5 binding and fibril content. •p5 binding to AL amyloid requires electrostatic interactions. -- Abstract: In previously published work, we have described heparin-binding synthetic peptides that preferentially recognize amyloid deposits in a mouse model of reactive systemic (AA) amyloidosis and can be imaged by using positron and single photon emission tomographic imaging. We wanted to extend these findings to the most common form of visceral amyloidosis, namely light chain (AL); however, there are no robust experimental animal models of AL amyloidosis. To further define the binding of the lead peptide, p5, to AL amyloid, we characterized the reactivity in vitro of p5 with in situ and patient-derived AL amyloid extracts which contain both hypersulfated heparan sulfate proteoglycans as well as amyloid fibrils. Histochemical staining demonstrated that the peptide specifically localized with tissue-associated AL amyloid deposits. Although we anticipated that p5 would undergo electrostatic interactions with the amyloid-associated glycosaminoglycans expressing heparin-like side chains, no significant correlation between peptide binding and glycosaminoglycan content within amyloid extracts was observed. In contrast, following heparinase I treatment, although overall binding was reduced, a positive correlation between peptide binding and amyloid fibril content became evident. This interaction was further confirmed using synthetic light chain fibrils that contain no carbohydrates. These data suggest that p5 can bind to both the sulfated glycosaminoglycans and protein fibril components of AL amyloid. Understanding these complex electrostatic interactions will aid in the optimization of synthetic peptides for use as amyloid imaging agents and potentially as

  20. AFM study of glucagon fibrillation via oligomeric structures resulting in interwoven fibrils

    Energy Technology Data Exchange (ETDEWEB)

    Dong Mingdong [Interdisciplinary Nanoscience Center (iNANO), University of Aarhus, DK-8000 Aarhus C (Denmark); Hovgaard, Mads Bruun [Interdisciplinary Nanoscience Center (iNANO), University of Aarhus, DK-8000 Aarhus C (Denmark); Xu Sailong [Interdisciplinary Nanoscience Center (iNANO), University of Aarhus, DK-8000 Aarhus C (Denmark); Otzen, Daniel Erik [Interdisciplinary Nanoscience Center (iNANO), University of Aarhus, DK-8000 Aarhus C (Denmark); Besenbacher, Flemming [Interdisciplinary Nanoscience Center (iNANO), University of Aarhus, DK-8000 Aarhus C (Denmark)

    2006-08-28

    Glucagon is a 29-residue amphiphatic hormone involved in the regulation of blood glucose levels in conjunction with insulin. In concentrated aqueous solutions, glucagon spontaneously aggregates to form amyloid fibrils, destroying its biological activity. In this study we utilize the atomic force microscope (AFM) to elucidate the fibrillation mechanism of glucagon at the nanoscale under acidic conditions (pH 2.0) by visualizing the nanostructures of fibrils formed at different stages of the incubation. Hollow disc-shaped oligomers form at an early stage in the process and subsequently rearrange to more solid oligomers. These oligomers co-exist with, and most likely act as precursors for, protofibrils, which subsequently associate to form at least three different classes of higher-order fibrils of different heights. A repeat unit of around 50 nm along the main fibril axis suggests a helical arrangement of interwoven protofibrils. The diversity of oligomeric and fibrillar arrangements formed at pH 2.0 complements previous spectroscopic analyses that revealed that fibrils formed under different conditions can differ substantially in stability and secondary structure.