Ventricular Function in Valvular Heart Disease before and after Prosthetic Valve Surgery

1976 ◽  
pp. 125-128 ◽  
Author(s):  
H. Schmutzler ◽  
G. Grosse ◽  
W. Rutsch ◽  
H. Paeprer ◽  
U. Michel ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ventricular Function ◽  
Valvular Heart Disease ◽  
Prosthetic Valve ◽  
Valve Surgery ◽  
Before And After

scholarly journals Coronary risk of patients with valvular heart disease: prospective validation of CT-Valve Score

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001380
Author(s):  
Rasmus Bo Hasselbalch ◽  
Mia Marie Pries-Heje ◽  
Sarah Louise Kjølhede Holle ◽  
Thomas Engstrøm ◽  
Merete Heitmann ◽  
...  
Keyword(s):  
Heart Disease ◽  
Valvular Heart Disease ◽  
Primary Outcome ◽  
Multislice Ct ◽  
Cost Effective ◽  
University Hospital ◽  
Before And After ◽  
History Of ◽  
Artery Disease

ObjectiveTo prospectively validate the CT-Valve score, a new risk score designed to identify patients with valvular heart disease at a low risk of coronary artery disease (CAD) who could benefit from multislice CT (MSCT) first instead of coronary angiography (CAG).MethodsThis was a prospective cohort study of patients referred for valve surgery in the Capital Region of Denmark and Odense University Hospital from the 1 February 2015 to the 1 February 2017. MSCT was implemented for patients with a CT-Valve score ≤7 at the referring physician’s discretion. Patients with a history of CAD or chronic kidney disease were excluded. The primary outcome was the proportion of patients needing reevaluation with CAG after MSCT and risk of CAD among the patients determined to be low to intermediate risk.ResultsIn total, 1149 patients were included. The median score was 9 (IQR 3) and 339 (30%) had a score ≤7. MSCT was used for 117 patients. Of these 29 (25%) were reevaluated and 9 (7.7%) had CAD. Of the 222 patients with a score ≤7 that did not receive an MSCT, 14 (6%) had significant CAD. The estimated total cost of evaluation among patients with a score ≤7 before implementation was €132 093 compared with €79 073 after, a 40% reduction. Similarly, estimated total radiation before and after was 608 mSv and 362 mSv, a 41% reduction. Follow-up at a median of 32 months (18–48) showed no ischaemic events for patients receiving only MSCT.ConclusionThe CT-Valve score is a valid method for determining risk of CAD among patients with valvular heart disease. Using a score ≤7 as a cut-off for the use of MSCT is safe and cost-effective.

Abstract 223: Non-Cardiac Comorbidities in Predictive Models for Valvular Heart Disease Interventions

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Benjamin Wessler ◽  
Christine Lundquist ◽  
Gowri Raman ◽  
Jennifer Lutz ◽  
Jessica Paulus ◽  
...  
Keyword(s):  
Heart Disease ◽  
Predictive Models ◽  
Valvular Heart Disease ◽  
De Novo ◽  
Predictive Analytics ◽  
Model Performance ◽  
Median Number ◽  
Valve Surgery ◽  
Comorbid Condition ◽  
Comorbid Conditions

Background: Interventions for patients with valvular heart disease (VHD) now include both surgical and percutaneous procedures. As a result, treatments are being offered to increasingly complex patients with a significant burden of non-cardiac comorbid conditions. There is a major gap in our understanding of how various comorbidities relate to prognosis following interventions for VHD. Here we describe how comorbidities are handled in clinical predictive models for patients undergoing interventions for VHD. Methods: We queried the Tufts Predictive Analytics and Comparative Effectiveness (PACE) Clinical Prediction Model (CPM) Registry to identify de novo CPMs for patients undergoing VHD interventions. We systematically extracted information on the non-cardiac comorbidities contained in the CPMs and also measures of model performance. Results: From January 1990- May 2012 there were 12 CPMs predicting measures of morbidity or mortality for patients undergoing interventions for VHD. There were 2 CPMs predicting outcomes for isolated aortic valve replacement, 3 CPMs predicting outcomes for isolated mitral valve surgery, and 7 models predicting outcomes for a combination of valve surgery subtypes. Ten out of twelve (83%) of the CPMs for patients undergoing interventions for VHD predicted mortality. The median number of non-cardiac comorbidities included in the CPMs was 4 (range 0-7). All of the CPMs predicting mortality included at least 1 comorbid condition. The top 3 most common comorbidities included in these CPMs were, renal dysfunction (10/12, 83%), prior CVA (7/12, 58%) and measures of BMI/BSA (7/12, 58%). Diabetes was present in only 25% (3/12) of the models and chronic lung disease in only 17% (2/12). Conclusions: Non-cardiac comorbidities are frequently found in CPMs predicting morbidity and mortality following interventions for VHD. There is significant variation in the number and type of specific comorbid conditions included in these CPMs. More work is needed to understand the directionality, magnitude, and consistency of effect of these non-cardiac comorbid conditions for patients undergoing interventions for VHD.

scholarly journals Urinary Iron Excretion in Valvular Heart Disease and After Heart Valve Replacement

Blood ◽  
1970 ◽  
Vol 36 (6) ◽  
pp. 785-792 ◽  
Author(s):  
H. PETER ROESER ◽  
L. W. POWELL
Keyword(s):  
Heart Disease ◽  
Iron Deficiency ◽  
Valve Replacement ◽  
Valvular Heart Disease ◽  
Serum Iron ◽  
Normal Values ◽  
Iron Loss ◽  
Deficiency Anemia ◽  
Before And After ◽  
Iron Excretion

Abstract Urinary iron excretion and other aspects of iron metabolism were studied in patients with valvular heart disease before and after valve replacement with heterografts or Starr-Edwards prostheses. Eighty-one per cent of preoperative patients had increased daily urinary iron excretion (0.14-2.2 mg./24 hours) and 61 per cent had a reduced 51Cr survival time. Serum iron levels were low in two patients but iron-deficiency anemia was not observed. Fifty-three per cent of bone marrow aspirates had reduced or absent storage iron. Patients with normally functioning heterografts had no hemolysis and urinary iron excretion decreased exponentially with time until normal values were reached in 6-10 months after surgery. Calculated iron loss over a 6-month postoperative period varied from 11 to 360 mg. Serum iron levels and results of ferrokinetic studies returned towards normal, as did marrow iron stores. Seven patients (78%) with Starr-Edwards valves had evidence of hemolysis by the 51chromium survival method and six were anemic. Urinary iron loss was abnormal in all nine patients (0.8-10.8 mg./24 hours) and iron deficiency was a significant factor in the anemia noted. Iron therapy raised hemoglobin values in the two patients to whom it was administered. Urinary iron excretion was found to be a sensitive index of intravascular hemolysis, particularly in the presence of an intermittent hemolytic process.

P2753Anticoagulation control and all-cause death in patients with operated valvular heart disease with and without atrial fibrillation receiving vitamin K antagonists

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Zulkifly ◽  
D Pastori ◽  
G Y H Lip ◽  
D Lane
Keyword(s):  
Atrial Fibrillation ◽  
Heart Disease ◽  
Vitamin K ◽  
Therapeutic Range ◽  
Valvular Heart Disease ◽  
Prosthetic Valve ◽  
Factors Affecting ◽  
Anticoagulation Control ◽  
Bleeding History

Abstract Introduction Good quality of anticoagulation in patients with valvular heart disease (VHD) is needed to reduce ischaemic complications. There is limited evidence on factors affecting anticoagulation control in patients implanted with mechanical or tissue prosthetic valve(s). Objective To examine quality, factors affecting anticoagulation control and all-cause death in VHD patients with and without atrial fibrillation (AF) receiving a vitamin K antagonist (VKA) oral anticoagulant. The relationship between INR control with all-cause death and ≥1 adverse clinical events (ACE) [thromboembolism, bleeding, cardiovascular hospitalisation and all-cause death] were explored. Methods Anticoagulation control of 456 VHD patients [164 (36%) with AF and 290 (64%) without AF] referred to a hospital-based anticoagulation clinic were assessed retrospectively by time in therapeutic range (TTR) (Rosendaal) and percentage of INRs in range (PINRR) for a median of (IQR) 6.2 years (3.3–8.5). VHD was defined by the presence of mechanical or tissue prosthetic valve at either the mitral or aortic site or both. Results Mean (SD) age 51 (14.7), 64.5% male, mean (SD) CHA2DS2-VASc score 2.0 (1.4), 96.1% mechanical prosthesis and 64% aortic valve replacement. VHD patients with AF had lower mean TTR and PINRR, lower proportion of optimal TTR (i.e.≥70%) despite similar number of INR tests compared to VHD patients without AF [Table 1]. Predictors of poor TTR on multivariate logistic regression analysis were female sex, AF and anaemia/bleeding history. Significantly higher proportions of VHD patients with AF died [Table 1]. More deaths (13.1% vs. 4.1%; p=0.011) and ≥1 ACE (42.7% vs. 27.6%; p=0.006) were seen in VHD patients with TTR <70% vs. TTR≥70%, respectively. Table 1 N (%) Total (N=456) AF (N=164) No AF (N=290) p-value Mean (SD) TTR 58.5 (14.6) 55.7 (14.2) 60.1 (14.6) 0.002 TTR ≥70% 98 (21.5) 23 (14.0) 75 (25.7) 0.004 Mean (SD) PINRR 50.1 (13.8) 47.4 (13.5) 51.6 (13.7) 0.002 Mean (SD) INR tests 96.2 (55.3) 100.7 (58.8) 93.7 (53.1) 0.19 All-cause death 51 (11.2) 34 (20.7) 17 (5.8) <0.001 AF: Atrial fibrillation; IQR: interquartile range; PINRR: percentage of INRs in range; SD: standard deviation; TTR: Time in therapeutic range. Conclusion The quality of anticoagulation in VHD patients with AF was low. The presence of AF, anaemia/bleeding history and female sex independently predicted poor TTR. All-cause death was more common in VHD patients with AF and poor TTR. Closer INR monitoring is needed especially in VHD patients with AF to improve anticoagulation control and prevent adverse clinical outcomes. Acknowledgement/Funding Kementerian Pendidikan Malaysia and Universiti Teknologi MARA for PhD study but not directly for work under consideration

scholarly journals Exercise recommendations in patients with valvular heart disease

Heart ◽  
2018 ◽  
Vol 105 (2) ◽  
pp. 106-110 ◽  
Author(s):  
Sabiha Gati ◽  
Aneil Malhotra ◽  
Sanjay Sharma
Keyword(s):  
Physical Activity ◽  
Heart Disease ◽  
Ventricular Function ◽  
Functional Capacity ◽  
Valvular Heart Disease ◽  
Stress Test ◽  
Exercise Stress ◽  
Competitive Sport ◽  
Increased Risk ◽  
The Impact

Valvular heart disease affects 1%–2% of young individuals, many of whom aspire to partake in competitive sport or high intensity recreational exercise. There are limited reports on the impact of intensive physical activity on the progression of valvular heart disease; therefore, current recommendations are based on consensus opinion. The management of exercising individuals with valvular heart disease requires a structured approach that incorporates several key factors including symptomatic status, functional capacity, type and nature of the valvular lesion, impact on ventricular structure and function and effect on pulmonary artery pressure. Asymptomatic individuals with minor valvular abnormalities may engage in all forms of competitive sport, whereas those with lesions of moderate severity may exercise intensively if an exercise stress test tailored to the relevant physical activity reveals good functional capacity without myocardial ischaemia, haemodynamic disturbances or arrhythmia. Symptomatic athletes and those with severe valvular heart disease, impaired ventricular function, pulmonary hypertension and arrhythmias should refrain from most competitive sports. Athletes with a bicuspid aortic valve and aortic root diameter >40 mm should avoid sport with a strong isometric component even with minimal valvular dysfunction. There is an association between mitral valve prolapse and sudden cardiac death in the general population; however, there is limited evidence of increased risk with competitive sport. Athletes undergoing corrective surgery may return to exercise after 3 months if ventricular function and exercise capacity are preserved. Individuals anticoagulated for mechanical bioprosthetic valves should avoid contact or collision sport to minimise the risk of bleeding.

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