ACUTE CHANGES IN MITRAL ANNULAR DIMENSIONS ON 3D TRANSESOPHAGEAL ECHOCARDIOGRAPHY AFTER MITRACLIP TREATMENT OF MITRAL REGURGITATION: A PILOT STUDY
Richard RoStamatios LerakisKarthik SeetharamSahil KheraSamin K. SharmaAnnapoorna KiniGilbert H.L. Tang
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MitraClip
Functional mitral regurgitation
The aim of this study was to investigate long-term survival, clinical status, and echocardiographic findings of patients with severe functional mitral regurgitation (FMR) undergoing MitraClip (MC) treatment and to explore the role of baseline features on outcome. Methods and Results: Randomized and observational studies of FMR patients undergoing MC treatment were collected to evaluate the overall survival, New York Heart Association (NYHA) class and echocardiographic changes after MC treatment. Baseline parameters associated with mortality and echocardiographic changes were also investigated. Across 23 studies enrolling 3,253 patients, the inhospital death rate was 2.31%, whereas the mortality rate was 5.37% at 1 month, 11.87% at 6 months, 18.47% at 1 year and 31.08% at 2 years. Mitral regurgitation Grade <3+ was observed in 92.76% patients at discharge and in 83.36% patients at follow-up. At follow-up, 76.63% of patients NYHA Class I-II and there were significant improvements in left ventricular (LV) volume, ejection fraction, and pulmonary pressure. Atrial fibrillation (AF) had a significant negative effect on 1-year survival (β=0.18±0.06; P=0.0047) and on the reduction in LV end-diastolic and end-systolic volumes (β=-1.05±0.47 [P=0.0248] and β=-2.60±0.53 [P=0.0024], respectively).MC results in durable reductions in mitral regurgitation associated with significant clinical and echocardiographic improvements in heart failure patients. AF negatively affects LV reverse remodeling and 1-year survival after MC treatment.
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Objectives: MitraClip therapy has proved to be safe and effective for high-risk surgical patients with degenerative mitral regurgitation (MR), but data regarding functional MR (FMR) are sparse. We assessed echocardiographic parameters and outcome in FMR patients receiving MitraClip therapy.
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Vascular inflammation / Devices and multidisciplinary interventions in heart failure 809reversed the OxLDL effects on DCs and T cells.DC maturation was repressed and the production of TNF-α, IL-1β and IL-6 was limited, while TGF-β and IL-10 secretion were increased.Th1 and/or Th17 polarization was inhibited, while T regulatory cells were induced with IL-10 production.OxLDL induced miRNA let-7c, miR-27a, miR-27b, miR-185.Silencing PCSK9 repressed miR-27a and to a lesser extent let-7c.Further, PCSK9 silence enhanced the BLIMP1 and SOCS1 expression induced by OxLDL.Experiments on T cells from carotid atherosclerotic plaques or healthy individuals showed similar results.Conclusions: We demonstrate for the first time immunological effects of PCSK9 in relation to activation and maturation of DCs and plaque T cells by OxLDL, a central player in atherosclerosis.This may directly influence atherosclerosis and cardiovascular disease, independent of LDL-lowering.
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Novel determinants of aortic valve calcification / Structural cardiac interventions 1059purpose of this study was to compare the prognostic value of both parameters in patients with symptomatic severe aortic stenosis.Methods: Single-center retrospective study including all patients with symptomatic severe aortic stenosis who underwent cardiac CT to assess eligibility for transcatheter aortic valve implantation (TAVI).The primary endpoint was allcause mortality.Independent prognostic value of aortic valve calcium score and calcium density was analyzed through Cox regression.Results: 245 patients were included (139 women, mean age 82±8 years).The mean valvular area and transvalvular gradient were 0.42±0.12cm 2 /m 2 and 50±15 mmHg, respectively.The median calcium score was 2360 AU (IQR 1698-3480) and the median calcium density was 580 AU/cm 2 (IQR 413-806).The majority of patients underwent TAVI (n=133, 55%) or surgical aortic valve replacement (n=31, 13%), while 75 patients (30%) where refused for or await intervention.The remaining underwent palliative balloon valvuloplasty (n=6, 2%).During a median follow-up of 324 days (IQR 37-611) there were 47 deaths (24 under medical therapy and 23 after intervention).Classification of patients according to calcium score allowed better separation of survival curves when compared to calcium density (picture 1).After adjusting for Euroscore II and valvular intervention, calcium score independently predicted time to death (adjusted HR 1.16 for every 1000AU; 95% CI 1.03-1.32;p=0.017), whereas calcium density was not independently associated with prognostic (adjusted HR 1.02 for every 100 AU/cm 2 ; 95% CI 0.97-1.08;p=0.396).Picture 1 Conclusion:In patients with symptomatic severe aortic stenosis, aortic valve calcium score measured by CT independently predicted all-cause mortality.Indexing this value to LVOT does not seem to bring any additional advantage.
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S 28 EACTS Part II: Catheter based mitral interventions: The mitral going transcutaneous Tuesday, 14 October 2014
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