Quantitative analysis of mitral annulus morphology in aortic stenosis using real time 3-dimentional transesophageal echocardiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Suzuki ◽  
Y Nakano ◽  
H Ohashi ◽  
H Ando ◽  
K Waseda ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Aortic Stenosis ◽  
Transesophageal Echocardiography ◽  
Real Time ◽  
Mitral Annulus ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
The Impact ◽  
The Relationship ◽  
Saddle Shape

Abstract Background Normal mitral annulus morphology is known to be saddle shape. There are a few reports regarding the relationship between flattening of the mitral annular saddle shape and mitral regurgitation. However, the relationship between aortic stenosis (AS) and mitral annulus morphology is unknown. Purpose To assess the impact of AS on mitral annular saddle shape using 3-dimentional transesophageal echocardiography. Methods A total of consecutive 83 subjects including 44 patients with severe AS (AS group) and 39 patients without AS (control group), who underwent real-time 3-dimentional transesophageal echocardiography of the mitral valve, were enrolled. The 3-dimentional geometry of the mitral annulus apparatus was evaluated by the parameters analyzed using dedicated quantification software such as anteroposterior diameter (APD), commissural width (CW), annular height (AH), mitral annulus (MA) area and annular height to commissural width ratio (AHCWR) as shown in Figure. We assessed the impact of severe AS on AHCWR, which is the key parameter showing flattening of the mitral annular saddle shape. These parameters were adjusted by body surface area (BSA). Exclusion criteria included left ventricular ejection fraction <50%, the presence of aortic regurgitation, mitral valve disease, pericardial or congenital diseases, endocarditis, cardiomyopathy, prior myocardial infarction, and paroxysmal or persistent atrial fibrillation. Results Comparisons of mitral valve geometry between AS group and control group are summarized in Table. AH/BSA and AHCWR were significantly lower in AS group compared with control group. Multiple linear regression analysis revealed severe AS to be a significant and independent predictor of lowering AHCWR (β=−0.39, t=−4.04, p<0.001) (adjusted with MA area, selected by stepwise analysis). Conclusions Severe AS might contribute to flattening of the mitral annular saddle shape, lead to the mitral annular structural remodeling. Assessment of the mitral annulus morphology might help evaluating severe AS. Mitral annulus 3-dimensional geometry Funding Acknowledgement Type of funding source: None

scholarly journals Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Benito Gonzalez ◽  
X Freixa ◽  
C Godino ◽  
M Taramasso ◽  
R Estevez-Loureiro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
One Year ◽  
The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

scholarly journals Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001716
Author(s):  
Luke Byrne ◽  
Roisin Gardiner ◽  
Patrick Devitt ◽  
Caleb Powell ◽  
Richard Armstrong ◽  
...  
Keyword(s):  
Public Health ◽  
Public Perception ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
St Elevation ◽  
The Impact ◽  
Transfer Times

IntroductionThe COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection control procedures on ST elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.MethodsPatients meeting ST elevation criteria and undergoing primary percutaneous coronary intervention from 27 March 2020, the day initial national lockdown measures were announced in Ireland, were included in the study. Patients presenting after the lockdown period, from 18 May to 31 June 2020, were also examined. Time from symptom onset to first medical contact (FMC), transfer time and time of wire cross was noted. Additionally, patient characteristics, left ventricular ejection fraction, mortality and biochemical parameters were documented. Outcomes and characteristics were compared against a control group of patients meeting ST elevation criteria during the month of January.ResultsA total of 42 patients presented with STEMI during the lockdown period. A significant increase in total ischaemic time (TIT) was noted versus controls (8.81 hours (±16.4) vs 2.99 hours (±1.39), p=0.03), with increases driven largely by delays in seeking FMC (7.13 hours (±16.4) vs 1.98 hours (±1.46), p=0.049). TIT remained significantly elevated during the postlockdown period (6.1 hours (±5.3), p=0.05), however, an improvement in patient delays was seen versus the control group (3.99 hours (±4.5), p=0.06). There was no difference seen in transfer times and door to wire cross time during lockdown, however, a significant increase in transfer times was seen postlockdown versus controls (1.81 hours (±1.0) vs 1.1 hours (±0.87), p=0.004).ConclusionA significant increase in TIT was seen during the lockdown period driven mainly by patient factors highlighting the significance of public health messages on public perception. Additionally, a significant delay in transfer times to our centre was seen postlockdown.

scholarly journals IMPULSE: the impact of gender on the presentation and management of aortic stenosis across Europe

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001443
Author(s):  
Richard Paul Steeds ◽  
David Messika-Zeitoun ◽  
Jeetendra Thambyrajah ◽  
Antonio Serra ◽  
Eberhard Schulz ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Surgical Aortic Valve Replacement ◽  
Ventricular Ejection Fraction ◽  
Patient Profile ◽  
Transcatheter Aortic Valve ◽  
The Impact

AimsThere is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI).MethodsData from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age.ResultsOverall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001).ConclusionsThe present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.

Comparison of Real Time Two-Dimensional with Live/Real Time Three-Dimensional Transesophageal Echocardiography in the Evaluation of Mitral Valve Prolapse and Chordae Rupture

2008 ◽  
Vol 25 (10) ◽  
pp. 1131-1137 ◽  
Author(s):  
Jayaprakash Manda ◽  
Saritha Kumari Kesanolla ◽  
Ming Chon Hsuing ◽  
Navin C. Nanda ◽  
Elsayed Abo-Salem ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Transesophageal Echocardiography ◽  
Real Time ◽  
Mitral Valve Prolapse ◽  
Three Dimensional ◽  
Two Dimensional

scholarly journals Metabolomics Analysis Reveals Potential Mechanisms in Bupleurum L. (Apiaceae) Induced by Three Levels of Nitrogen Fertilization

Agronomy ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 2291
Author(s):  
Jialin Sun ◽  
Weinan Li ◽  
Ye Zhang ◽  
Yun Guo ◽  
Zejia Duan ◽  
...  
Keyword(s):  
Nitrogen Fertilization ◽  
Total Content ◽  
Nitrogen Level ◽  
Gas Chromatography Mass Spectrometry ◽  
Control Group ◽  
High Nitrogen ◽  
Yield And Quality ◽  
High Nitrogen Level ◽  
The Impact ◽  
The Relationship

Bupleurum (Apiaceae) is widely used in traditional Chinese medicine to treat inflammatory and infectious diseases. Although roots are the only used parts in China, other countries use the whole plant. The yield and quality of Bupleurum depend mainly on fertilizers, especially nitrogen. The current study aimed to assess the relationship between the nitrogen fertilization level and the quality and metabolomic response of different parts (flowers, main shoots, lateral shoots and roots) of Bupleurum to three nitrogen fertilization levels (control group: 0 kg·ha−1; low-nitrogen group: 55 kg·ha−1; high-nitrogen group: 110 kg·ha−1). The results showed that a high nitrogen level increases Bupleurum yield and quality parameters only in aerial parts, especially flowers, but has no significant effect on roots. The HPLC method was exploited for simultaneous quantification of three saikosaponins (A, C and D), which are the main bioactive components in the plant. It was found that the total content of saikosaponins decreased with high nitrogen fertilization in roots but significantly increased in flowers. Moreover, nitrogen fertilizer promoted the content of saikosaponin A but inhibited saikosaponins C and saikosaponins D in most parts of the plant. To study the response of primary metabolites, we adopted gas chromatography–mass spectrometry (GC−MS) analysis; 84 metabolites were identified that were mostly up-regulated with a high nitrogen level in flowers but down-regulated in roots. Four differential metabolites—D-fructose, lactose, ether and glycerol—were recognized as key metabolites in Bupleurum under nitrogen fertilization. Meanwhile, The Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment results explained that the impact of nitrogen fertilization on Bupleurum was attributed to the C-metabolism, N-metabolism, and lipids metabolism. This research put forward new insights into potential mechanisms and the relationship between the quality and yield of Bupleurum and nitrogen fertilization.

scholarly journals From Dependence to Independence

2021 ◽  
Author(s):  
Intan Azura Mokhtar ◽  
Shaheen Majid ◽  
Schubert Foo
Keyword(s):  
Control Group ◽  
Mediated Learning ◽  
Control Group Design ◽  
Student Responses ◽  
Quasi Experimental ◽  
Information Skills ◽  
Group Interviews ◽  
Library Skills ◽  
The Impact ◽  
The Relationship

Although it is widely believed that information literacy (IL) competencies are useful in helping students perform better in their schoolwork and beyond, limited empirical evidence is available showing the relationship between IL competencies and IL education. While a lot of research has been done worldwide and most of the findings have proven that IL is a much-needed skill by students, little research has been conducted on IL teaching approaches or what is termed IL pedagogy. To date, studies on IL have mainly focused only on students’ information skills per se, on library skills or on ICT education. None of these studies has assessed the different approaches to IL education. This paper provides an overview of a research study that investigates the impact of an IL teaching approach in the form of personalised coaching, which is grounded in the pedagogy known as mediated learning, on students’ level and applicability of IL competencies. Through the application of a quasi-experimental pretest-posttest control-group design, as well as student responses in the post-experiment semi-structured group interviews, it was found that personalised coaching (or mediated learning) helps students perform better in the learning and application of IL competencies.

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