scholarly journals Mitral valve dysfunction among sudden death victims

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Gupta ◽  
S Keen ◽  
S Thota ◽  
H Jiang ◽  
H Jones ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Sudden Death ◽  
Population Based ◽  
Control Group ◽  
Mitral Insufficiency ◽  
Funding Sources ◽  
Bivariate Logistic Regression ◽  
Artery Disease ◽  
Wake County ◽  
Demographic Covariates

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Mitral dysfunction is a commonly found valvular abnormality in the US. The association between mitral dysfunction with sudden death is both complex and controversial. Purpose To assess mitral dysfunction as a potential risk factor for sudden death using medical and autopsy records in a population-based registry of sudden deaths. Methods From 2013-2015, out-of-hospital deaths aged 18-64 reported by Emergency Medical Services in Wake County, North Carolina were screened to adjudicate 399 sudden death victims. Medical records were available in 270 victims, echocardiograms in 53, and autopsies in 64. Echocardiogram reports of none/trace/trivial mitral insufficiency were compared to patients with mild, moderate, or severe insufficiency. Autopsy reports for thickened mitral leaflets, calcification, and redundancy were reviewed. Additionally, available echocardiograms from a control group of 1101 patients were reviewed for mitral insufficiency. Demographics and clinical comorbidities were assessed from medical and death records. Mean, t-tests, and a bivariate logistic regression were estimated, as appropriate. Results Of the 53 victims with echocardiograms, mean age was 53 years, 36 (65.5%) were male, and 21 (39.6%) were African-American. Victims with available echocardiograms were more likely to have congestive heart failure (41.8%), coronary artery disease (50.9%), and diabetes (47.3%) compared to victims without echocardiograms. None/trivial/trace insufficiency was present in 27 victims (50.9%), mild insufficiency in 18 (34.0%), and moderate-severe insufficiency in 8 (15.1%). There was no association between severity of mitral insufficiency with demographic covariates or comorbid conditions. The presence of structural mitral valve abnormalities, including thickened leaflets, calcification, and redundancy of the mitral valve, were present in only 8 (12.5%) of 64 victims with autopsies. In a control group of 1101 date-matched patients from the same county, 57 (4.8%) patients had an echocardiogram available. 14 (24.6%) of these patients had mild-moderate mitral insufficiency. Conclusion Mitral insufficiency and structural abnormalities of the mitral valve are often identified in echocardiograms or autopsies of sudden death victims. Living controls had approximately half the prevalence of mitral insufficiency, suggesting that mitral dysfunction and its associated comorbidities are associated with sudden death.

scholarly journals Indicators of adrenergic reactivity of erythrocyte membranes in patients with myocardial infarction and nonobstructive atherosclerosis of the coronary arteries after 1 year

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
D Vorobyeva ◽  
TYU Rebrova ◽  
SA Afanasyev ◽  
VV Ryabov
Keyword(s):  
Cell Membranes ◽  
Acute Myocarditis ◽  
The Body ◽  
Erythrocyte Membranes ◽  
Control Group ◽  
Index Hospitalization ◽  
Funding Sources ◽  
Artery Disease ◽  
Time Of Admission ◽  
And Control

Abstract Funding Acknowledgements Type of funding sources: None. Background We hypothesized that MINOCA patients have distinctive features of sympatho-adrenal system (SAS) activation in comparison with patients with stenosis atherosclerosis which can play a significant role in the development of ischemic events at the time of the index hospitalization and after 1 year. Aim To study the parameters of β-adrenoreception of cell membranes in patients with MINOCA compared with patients with AMI and single-vessel coronary artery disease after 1 year. Material and methods: The study is non-randomized open controlled. Adrenergic reactivity of the body was assessed by the method for assessing the β-adrenergic reactivity of erythrocyte membranes (β-ARM) for studying the parameters of adrenergic reception of cell membranes. This parameter (β-ARM) was studied upon admission, at days 2, 4 and 7 and 1 year after AMI. The normal level of β- ARM <20 rel.units. Results The study included 40 patients with AMI (19 patients in the main group and 21 patients in the control group). Three patients (15.7%) with diagnosed acute myocarditis were excluded from the analysis. The median age in the main and control groups was 66 (54; 70) years and 59 (55; 65) years, respectively. These groups were different at the admission in such parameters: in smoking frequency (31,3% vs 52.3%), history of angina pectoris (62,5% vs 28,5%), time of admission to the hospital (390 min. vs 180 min.) and thrombolytic therapy at the prehospital phase (3% vs 11%), p < 0,05.  The median β-ARM in MINOCA patients upon admission was 41.7 (29.0; 61.5) rel. units, 1 day - 48.6 (38.5; 57.3) rel. units, 4 days - 49, 4 (39.0; 63.3) rel. units, 7 days - 53.5 (35.2; 67.7) rel. units, after 1 year - 35.7 (25.5; 42.6) rel. units. In the control group, the median β-ARM upon admission was 52.5 (25.4; 64.5) rel. units, 1 day –51.6 (28.3; 56.9) rel. units, 4 days - 48, 5 (34.9; 61.2) rel. units, 7 days - 45.1 (32.2; 68.9) rel. units, after 1 year - 20.8 (14.8; 29.3). In MINOCA patients β-ARM indices in the early postinfarction period statistically higher than the 1 year:  at  1, 2, 4 days, p <0.05, on day 7 no differences were found (p = 0.34). A dynamic comparison of β-ARM indicators in the control group at the time of the index hospitalization and through 1 year revealed differences  at all days early postinfarction period, p <0.05. In the control group, the β-ARM indicator reached normal values by 1-year follow-up period. In MINOCA patients, β-ARM indices after 1 year were statistically higher than in the control group, p = 0.008. Conclusions: The β - ARM indices in MINOCA patients after 1 year from the ischemic event are higher than in the control group. In dynamics, the β - ARM indices statistically decreased in the control group, but did’n change in MINOCA patients. Despite the use of a beta-blocker in MINOCA patients, increased SAS activity persists; therefore, β-APM values did’n change significantly after 1 year.

Fatty Acid Metabolism in Symptomatic Patients with Mitral Valve Prolapse but without Coronary Artery Disease - Comparison with 201 Tl Myocardial Perfusion Scintigraphy

1987 ◽  
Vol 26 (04) ◽  
pp. 172-176 ◽  
Author(s):  
H. Schicha ◽  
U. Tebbei ◽  
P. Neumann ◽  
D. Emrich ◽  
E. Voth
Keyword(s):  
Coronary Artery Disease ◽  
Fatty Acid ◽  
Coronary Artery ◽  
Mitral Valve ◽  
Acid Metabolism ◽  
Myocardial Perfusion Scintigraphy ◽  
Control Group ◽  
Perfusion Scintigraphy ◽  
Elimination Half ◽  
Artery Disease

Using 123l-ω-heptadecanoic acid (HDA) and 201TI, respectively, myocardial fatty acid metabolism and perfusion were studied in 51 symptomatic patients with mitral valve prolapse (MVP) as diagnosed by ventriculography, and no evidence of coronary artery disease. Twelve subjects with normal coronary arteries and normal ventriculogram served as a control group for the evaluation of elimination kinetics of HDA. In the control group, the mean elimination halflife was 26.1 ± 3.6 min, whereas the patients with MVP had a mean value of ± 6.4 min. In patients with MVP, a high incidence concerning abnormalities of accumulation and/or elimination of HDA occurred, namely accumulation defects in 31 % and both prolonged and shortened elimination half-lives in 16% and 29%, respectively. Myocardial perfusion scintigraphy using 201TI showed abnormalities in 76%. Correlations were found between decreased uptake of HDA and prolonged elimination half-life as well as defects by 201TI, presumably due to ischemia based on small-vessel disease or abnormalities of cellular metabolism.

scholarly journals Risk of Mitral Valve Prolapse in Patients with Keratoconus in Taiwan: A Population-Based Cohort Study

2020 ◽  
Vol 17 (17) ◽  
pp. 6049
Author(s):  
Yuh-Shin Chang ◽  
Ming-Cheng Tai ◽  
Shih-Feng Weng ◽  
Jhi-Joung Wang ◽  
Sung-Huei Tseng ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health Insurance ◽  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Population Based ◽  
Control Group ◽  
Study Cohort ◽  
Research Database ◽  
Taiwan National Health Insurance ◽  
Cox Proportional Hazard Regression

This retrospective, nationwide, matched-cohort study included 4488 new-onset keratoconus (KCN) patients, ≥12 years old, recruited between 2004 and 2011 from the Taiwan National Health Insurance Research Database. The control group included 26,928 non-KCN patients selected from the Taiwan Longitudinal Health Insurance Database 2000. Information for each patient was collected and tracked from the index date until December 2013. The incidence rate of mitral valve prolapse (MVP) was 1.77 times (95% confidence interval (CI) = 1.09–2.88; p = 0.0206) higher in KCN patients ≥40 years old and 1.49 times (95% CI = 1.12–1.98; p = 0.0060) higher in female KCN patients than in controls. After using the Cox proportional hazard regression analysis to adjust for potential confounders, including hypertension, hyperlipidemia, and congestive heart failure, KCN maintained an independent risk factor, MVP being 1.77 times (adjusted hazard ratio (HR) = 1.77, 95% CI = 1.09–2.88) and 1.48 times (adjusted HR = 1.48, 95% CI = 1.11–1.97) more likely to develop in patients ≥40 years old and female patients in the study cohort, respectively. We found that KCN patients ≥40 years of age and female KCN patients have increased risks of MVP. Therefore, it is recommended that KCN patients should be alerted to MVP.

scholarly journals Is this atherosclerosis in patients with HIV? Data received by OCT

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
N M Efendieva ◽  
O P Shevchenko ◽  
A V Sozykine ◽  
A E Nikitin ◽  
A O Shevchenko ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Layer Structure ◽  
Antiretroviral Drugs ◽  
Public Institution ◽  
Control Group ◽  
Funding Sources ◽  
Coronary Wall ◽  
Artery Disease ◽  
Medical University

Abstract Background Chronic infection by HIV evolves with a vascular inflammatory action causing endothelial dysfunction. The action of the virus as well as the side effects of antiretroviral drugs contributes to the progression of cardiovascular diseases. The study aimed to characterise the changes of the structure of the coronary wall and the thickening of the intima by Optical Coherence Tomography in HIV-infected patients with or without symptoms of coronary heart disease. Methods Fifty-two HIV-infected individuals had a mean age of 49.8±11.4 years. There were 75% men, diabetes 30,8%, hypertension 30,8%, smokers 34,62% and 7,7% with cholesterol levels ≥99 mg/dl. Control group included 120 non-HIV-infected controls with coronary heart disease. All the participants from HIV-group receive ART, 100% of participants had plasma HIV RNA <20 copies/mL and 78,85% of them have symptoms of coronary artery disease. Results The average diffuse homogeneous thickening of the intima in patients with HIV was 0.67±0.24 mm, and 0.34±0.18 mm in control group, with normal values not exceeding 0.05 mm. There was impaired three-layer structure of coronary wall in 90,4% (47 of 52) HIV-infected participants and in 60% of control group, atherosclerotic plaque had only 34,62% of HIV group. All HIV-infected patients receive ART more than 5 years. Conclusion The coronary angiography and OCT demonstratedthat the inflammatory process resulting from HIV-infection or HAART may be relevant in the changes of coronary arteries in HIV-positive patients. The changes are predominantly represented by thickening of the intima, impaired three-layer structure of arterial wall and accelerating atherosclerosis. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Russian National Research Medical University named after N.I. PirogovCentral Clinical Hospital of Russian Academy of Science, Moscow, Russia

Surgical Strategy for Moderate Ischemic Mitral Valve Regurgitation: Repair or Ignore?

2014 ◽  
Vol 17 (4) ◽  
pp. 201 ◽  
Author(s):  
Adem İ Diken ◽  
Garip Altıntaş ◽  
Adnan Yalçınkaya ◽  
Gökhan Lafçı ◽  
Onur Hanedan ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Intervention Group ◽  
Control Group ◽  
Artery Pressure ◽  
Artery Disease

<p><strong>Background:</strong> Ischemic heart disease is a significant complication of atherosclerosis. Myocardial infarction after the development of coronary artery disease can lead to a number of serious complications, including ischemic mitral regurgitation (IMR). Currently there is no consensus regarding the preferred therapeutic modality for moderately severe IMR. In this study, the postoperative outcome of concomitant coronary artery bypass (CABG) and mitral valve repair was compared with that of CABG alone in two groups of patients with moderately severe IMR.</p><p><strong>Methods:</strong> A total of 84 patients who underwent operations for coronary artery disease and moderately severe IMR were included in the study. Preoperative demographic and clinical characteristics were recorded at the time of admission. The severity of mitral regurgitation was graded using transthoracic echocardiography and left ventriculography.</p><p><strong>Results:</strong> Significant postoperative improvements were observed in ejection fraction and systolic diameter compared to preoperative values (<em>P</em> = .006 and <em>P</em> = .020 respectively, in the intervention group, <em>P</em> = .001 and <em>P</em> = .001 respectively, in the control group). The decrease in pulmonary artery pressure (PAP) was significant only in the intervention group (<em>P</em> = .001). There was a significantly marked reduction in the severity of IMR in the intervention group compared to control.</p><p><strong>Conclusion:</strong> Surgical repair of the mitral valve in conjunction with CABG for moderately severe IMR appears to be more effective than isolated CABG for certain outcome parameters, including decreased severity of mitral regurgitation and decreased pulmonary artery pressure.</p>

scholarly journals Myocardial extracellular volume by T1 mapping: a new marker of arrhythmia in mitral valve prolapse

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
A Pavon ◽  
D Arangalage ◽  
S Hugelshofer ◽  
T Rutz ◽  
AP Porretta ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Prolapse ◽  
Interstitial Fibrosis ◽  
Extracellular Volume ◽  
Holter Monitoring ◽  
Left Ventricular ◽  
Control Group ◽  
Funding Sources ◽  
Replacement Fibrosis ◽  
Additional Value

Abstract Funding Acknowledgements Type of funding sources: None. Background In MVP, MAD has been associated with myocardial replacement fibrosis and arrhythmia, but the importance of interstitial fibrosis remains unknown. We aimed to evaluate the relationship between mitral annular disjunction (MAD) severity and myocardial interstitial fibrosis at the left ventricular (LV) base in patients with mitral valve prolapse (MVP), and to assess the association between severity of interstitial fibrosis and the occurrence of ventricular arrhythmic events Methods Thirty patients with MVP and MAD (MVP-MAD) underwent Cardiac Magnetic Resonance (CMR) with assessment of MAD length, late gadolinium enhancement (LGE), and basal segments myocardial extracellular volume (ECV). The control group included 14 patients with mitral regurgitation but no MAD (MR-NoMAD) and 10 patients with normal CMR (NoMR-NoMAD). Fifteen MVP-MAD patients underwent 24h-Holter monitoring. Results LGE was observed in 47% of MVP-MAD patients and absent in controls. ECV was higher in MVP-MAD (30 ± 3% vs 24 ± 3% MR-NoMAD, p &lt; 0.0001 and vs 24 ± 2% NoMR-NoMAD, p &lt; 0.0001), even in MVP-MAD patients without LGE (29 ± 3% vs 24 ± 3%, p &lt; 0.0001 and vs 24 ± 2%, p &lt; 0.0001, respectively), Fig.1. MAD length was correlated with ECV (rho = 0.61, p = 0.0003), but not with LGE extent. Four patients had history of OHCA; LGE and ECV were equally performant to identify those high-risk patients (area under the ROC curve 0.81 vs 0.83, p = 0.84). Among patients with Holter, 87% had complex ventricular arrhythmia. ECV was above the cut-off value in all while only 53% had LGE. Conclusion Increase in ECV, a marker of interstitial fibrosis, occurs in MVP-MAD even in the absence of LGE, and was correlated with MAD length and OHCA. ECV should be part of the CMR examination of MVP patients in an effort to better assess fibrous remodelling as it may provide additional value beyond the assessment of LGE in the arrhythmic risk stratification.

scholarly journals Coronary Artery Disease and Atherosclerotic Risk Factors in a Population-Based Study of Sudden Death

2019 ◽  
Vol 35 (2) ◽  
pp. 531-537 ◽  
Author(s):  
Golsa Joodi ◽  
Joan A. Maradey ◽  
Brittany Bogle ◽  
Mojtaba Mirzaei ◽  
Murrium I. Sadaf ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Sudden Death ◽  
Population Based ◽  
Population Based Study ◽  
Artery Disease ◽  
Atherosclerotic Risk Factors

scholarly journals Optimizing diagnosis of obstructive coronary artery disease by CT angiography: RCT's final results and 12-months follow-up

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P Dias Ferreira Reis ◽  
R Ramos ◽  
P Modas Daniel ◽  
S Aguiar Rosa ◽  
L Almeida Morais ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Functional Test ◽  
Control Group ◽  
Diagnostic Strategy ◽  
Coronary Syndrome ◽  
Tertiary Center ◽  
Safety Endpoint ◽  
Artery Disease ◽  
Primary Safety Endpoint

Abstract Aim In patients (pts) with suspected coronary artery disease (CAD), computed tomographic angiography (CTA) may improve pt selection for invasive coronary angiography (ICA) as alternative to functional testing. However. the role of CTA in symptomatic pts after abnormal functional test (FT) is incompletely defined. Methods and results This randomized clinical trial conducted in single academic tertiary center selected 218 symptomatic pts with mild to moderately abnormal FT referred to ICA to receive either the originally intended ICA (n=103) or CTA (n=115). CTA interpretation and subsequent care decisions were made by the clinical team. Pts with high risk features on FT, previous acute coronary syndrome, previously documented CAD, chronic kidney disease (GFR&lt;60ml/min/1.73m2) or persistent atrial fibrillation were excluded. The primary endpoint was the percentage of ICA with no significant obstructive CAD (no stenosis ≥50%) in each group. Diagnostic (DY) and revascularization (RY) yields of ICA in either group were also assessed. Pts were followed up for at least 1 year for the primary safety endpoint of all cause death/ nonfatal myocardial infarction/ stroke. Unplanned revascularization (UP) and symptomatic status (SS) were also evaluated. Pts averaged 68±9 years of age, 60% were male, 29% were diabetic. Nuclear perfusion stress test was used in 33.9% in CTA group and 31.1% in control group (p=0.655). Mean post (functional) test probability of obstructive CAD was 34%. Overall prevalence of obstructive CAD was 32.1%. In the CTA group, ICA was cancelled by referring physicians in 83 of the pts (72.2%) after receiving CTA results. For those undergoing ICA, non-obstructive CAD was found in 5 pts (15.6%) in the CTA-guided arm and 60 (58.3%) in the usual care arm (p&lt;0.001 Mean cumulative radiation exposure related to diagnostic work up was similar in both groups (6±14 vs 5±14mSv, p=0.152). Both DY (84.4% vs 41.7, p&lt;0.001) and RY (71.9% vs 38.8%, p=0.001) yields were significantly higher for CTA-guided ICA as compared to standard FT-guided ICA. The rate of the primary safety endpoint was similar between both groups (1.9% vs 0%, p=0.244), as well as the rates of UP (0.9% vs 0.9%, p=1.000) and SS (persistent angina: 29.6% vs 24.8%, p=0.425). Conclusions In pts with suspected CAD and mild to moderately abnormal ischemia test, a diagnostic strategy including CTA as gatekeeper is safe, effective and significantly improves diagnostic and revascularization yields of ICA. Funding Acknowledgement Type of funding source: None

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