scholarly journals Diabetes Mellitus and Its Implications in Aortic Stenosis Patients

2021 ◽  
Vol 22 (12) ◽  
pp. 6212
Author(s):  
Laura Mourino-Alvarez ◽  
Nerea Corbacho-Alonso ◽  
Tamara Sastre-Oliva ◽  
Cecilia Corros-Vicente ◽  
Jorge Solis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Effective Treatment ◽  
Patient Management ◽  
Significant Morbidity ◽  
Therapeutic Approaches ◽  
The Relationship

Aortic stenosis (AS) and diabetes mellitus (DM) are both progressive diseases that if left untreated, result in significant morbidity and mortality. Several studies revealed that the prevalence of DM is substantially higher in patients with AS and, thus, the progression from mild to severe AS is greater in those patients with DM. DM and common comorbidities associated with both diseases, DM and AS, increase patient management complexity and make aortic valve replacement the only effective treatment. For that reason, a better understanding of the pathogenesis underlying both these diseases and the relationships between them is necessary to design more appropriate preventive and therapeutic approaches. In this review, we provided an overview of the main aspects of the relationship between AS and DM, including common comorbidities and risk factors. We also discuss the established treatments/therapies in patients with AS and DM.

scholarly journals Aortic stenosis and diabetes mellitus: An ominous combination

2019 ◽  
Vol 16 (4) ◽  
pp. 310-323 ◽  
Author(s):  
Marko Banovic ◽  
Lavanya Athithan ◽  
Gerry P McCann
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Aortic Stenosis ◽  
Therapeutic Approach ◽  
Severe Aortic Stenosis ◽  
Significant Morbidity ◽  
Therapeutic Approaches ◽  
The Relationship ◽  
Insight Into

Aortic stenosis and diabetes mellitus are both progressive diseases which, if left untreated, result in significant morbidity and mortality. There is evidence that the prevalence of diabetes is substantially increased in patients with aortic stenosis and those with diabetes have increased rates of progression from mild to severe aortic stenosis. There are good data supporting the hypothesis that aortic stenosis and diabetes mellitus are associated with diabetes mellitus being detrimental towards the quality of life and survival of patients. Thus, a thorough understanding of the pathogenesis of both of these disease processes and the relationship between them aids in designing appropriate preventive and therapeutic approaches. This review aims to give a comprehensive and up-to-date insight into the influence of diabetes mellitus on patients with degenerative aortic stenosis, as well as the prognosis and therapeutic approach to these patients.

scholarly journals Severe prosthesis-patient mismatch after aortic valve replacement for aortic stenosis: Analysis of risk factors for early and long-term mortality

2017 ◽  
Vol 69 (1) ◽  
pp. 333-339 ◽  
Author(s):  
Vito Mannacio ◽  
Luigi Mannacio ◽  
Emilo Mango ◽  
Anita Antignano ◽  
Michele Mottola ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Long Term Mortality

scholarly journals Aortic Valve Replacement for Patients with Severe Aortic Stenosis and Severe Left Ventricular Dysfunction - Mortality Risk Factors

2017 ◽  
Vol 4 (r) ◽  
Author(s):  
Abderrahmane BAKKALI ◽  
Dodji KOULEKEY ◽  
Rochde SAYAH ◽  
Imad JAABARI ◽  
Mahdi AIT HOUSSA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Hospital Mortality ◽  
Left Ventricular Dysfunction ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Severe Left Ventricular Dysfunction ◽  
The Mean

Severe left ventricular dysfunction increases the surgical risk of aortic valve replacement on aortic valvular stenosis. Several risk factors of hospital mortality have been reported in heterogeneous series. The aim of this study was to identify mortality risk factors of aortic valve replacement in patients with severe aortic stenosis and severe left ventricular dysfunction. To avoid biases of associated diseases, our study has been focused on isolated aortic stenosis. 46 patients, with AS and severe left ventricular dysfunction who underwent AVR were enrolled in this retrospective study. The mean age was 59 ± 12.70 years. 69.6% of patients were in class III or IV NYHA. The mean left ventricular ejection fraction (LVEF) was 32.3 ± 5.3%, and the mean EuroSCORE was 12.20 ± 8.70. The hospital mortality was 15.20%. The morbidity was marked mainly by low output syndrome in 30.4% of cases. A logistic regression in univariate analysis reveals functional class, renal failure, congestive heart failure and LVEF as factors related to the risk of hospital mortality. Multivariate logistic regression analysis found renal failure (OR = 11.94, CI [2.65 -72.22], p = 0.03) and congestive heart failure (OR = 25.33, CI [3 43 -194.74], p = 0.009) as independents risk of hospital mortality. The mean follow-up was 59.6 ± 21 months. Late mortality was 5%. Congestive heart failure and preoperative renal failure are the main independents hospital mortality’s risk factors of aortic valve replacement in patients with severe aortic stenosis and severe left ventricular dysfunction. Late mortality might be inversely related to the LV recovery.

Cardiac Remodeling and Disease Progression in Patients With Repaired Coarctation of Aorta and Aortic Stenosis

2021 ◽  
Vol 14 (12) ◽  
pp. 1091-1099
Author(s):  
Alexander C. Egbe ◽  
Jae K. Oh ◽  
Patricia A. Pellikka
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Cardiac Remodeling ◽  
Cardiovascular Events ◽  
Arterial Compliance ◽  
Coarctation Of Aorta ◽  
Lv Mass ◽  
The Relationship

Background: Valvulo-arterial impedance (Zva) is used for assessment of left ventricular (LV) global pressure load in patients with aortic stenosis (AS) and impaired arterial compliance. Because patients with repaired coarctation of aorta (COA) have impaired arterial compliance, we hypothesized that COA patients with greater than or equal to moderate AS (AS-COA group) will have higher Zva, symptomatic progression, and cardiovascular events, as compared to non-COA patients with similar AS severity (AS group). Methods: Propensity matching (1:1) of 71 AS-COA and 71 AS patients based on age, sex, body mass index, and aortic valve mean gradient (cohort 1). Of 172 patients, 117 patients (AS-COA [n=62]; AS [n=55]) underwent aortic valve replacement, cohort 2. Cohort 1 was used to assess the relationship between preoperative Zva, cardiac remodeling, and symptomatic progression, while cohort 2 was used to assess the relationship between postoperative Zva, LV mass index regression (reduction in LV mass index after aortic valve replacement), and cardiovascular events. Results: The AS-COA group had higher Zva (4.2±0.6 versus 3.5±0.4 mm Hg/mL·m 2 , P <0.001), more advanced cardiac remodeling, and higher 5-year incidence of symptomatic progression (85% versus 51%, P <0.001). Preoperative Zva was independently associated with cardiac remodeling (r=0.66, P <0.001) and symptomatic progression (hazard ratio, 1.06 [1.02–1.10], per mm Hg/mL·m 2 increase in Zva). The AS-COA group had higher postoperative Zva (3.3±0.5 versus 2.4±0.4 mm Hg/mL·m 2 , P <0.001), less robust LV mass index regression at 1-year post–aortic valve replacement, and higher 5-year incidence of cardiovascular events. Postoperative Zva was independently associated with LV mass index regression (r=−0.46, P <0.001) and cardiovascular events (hazard ratio, 1.06 [1.02–1.10], per mm Hg/mL·m 2 increase in Zva). Conclusions: Adults with AS-COA had higher LV global pressure load, cardiac remodeling, symptomatic progression, and cardiovascular events as compared to non-COA patients with similar severity of AS. Zva can identify patients at risk for adverse outcomes, and perhaps should be used for risk stratification with regards to timing of aortic valve replacement.

scholarly journals Cardiovascular Risk Factors and Hemodynamic Measures as Determinants of Increased Arterial Stiffness Following Surgical Aortic Valve Replacement

2021 ◽  
Vol 8 ◽  
Author(s):  
Oscar Plunde ◽  
Anders Franco-Cereceda ◽  
Magnus Bäck
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Aortic Valve ◽  
Arterial Stiffness ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Cardiovascular Risk Factors ◽  
Aortic Valve Disease ◽  
Valve Disease ◽  
Ejection Time

Valvular and arterial function are tightly intertwined, both in terms of structural changes and hemodynamics. While proximal valvulo-vascular coupling contributes to the cardiovascular consequences of aortic stenosis, less is known on how peripheral arterial stiffness relates to aortic valve disease. Previous studies have shown conflicting results regarding the impact of aortic valve replacement on arterial stiffness. The aim of the present study was therefore to determine predictors of arterial stiffness in patients with and without aortic valve disease undergoing cardiac surgery. Cardio ankle vascular index (CAVI) and carotid femoral pulse wave velocity (cfPWV) were measured to determine arterial stiffness the day before and 3 days after surgery for either ascending aortic or aortic valve disease. Stratification on indication for surgery revealed that CAVI was significantly lower in patients with aortic valve stenosis (n = 45) and aortic valve regurgitation (n=30) compared with those with isolated ascending aortic dilatation (n = 13). After surgery, a significant increased CAVI was observed in aortic stenosis (median 1.34, IQR 0.74–2.26, p &lt; 0.001) and regurgitation (median 1.04, IQR 0.01–1.49, p = 0.003) patients while cfPWV was not significantly changed. Age, diabetes, low body mass index, low pre-operative CAVI, as well as changes in ejection time were independently associated with increased CAVI after surgery. The results of the present study suggest aortic valve disease as cause of underestimation of arterial stiffness when including peripheral segments. We report cardiovascular risk factors and pinpoint the hemodynamic aspect ejection time to be associated with increased CAVI after aortic valve surgery.

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