MicroRNAs in Valvular Heart Diseases: Biological Regulators, Prognostic Markers and Therapeutical Targets

miRNAs have recently attracted investigators’ interest as regulators of valvular diseases pathogenesis, diagnostic biomarkers, and therapeutical targets. Evidence from in-vivo and in-vitro studies demonstrated stimulatory or inhibitory roles in mitral valve prolapse development, aortic leaflet fusion, and calcification pathways, specifically osteoblastic differentiation and transcription factors modulation. Tissue expression assessment and comparison between physiological and pathological phenotypes of different disease entities, including mitral valve prolapse and mitral chordae tendineae rupture, emerged as the best strategies to address miRNAs over or under-representation and thus, their impact on pathogeneses. In this review, we discuss the fundamental intra- and intercellular signals regulated by miRNAs leading to defects in mitral and aortic valves, congenital heart diseases, and the possible therapeutic strategies targeting them. These miRNAs inhibitors are comprised of antisense oligonucleotides and sponge vectors. The miRNA mimics, miRNA expression vectors, and small molecules are instead possible practical strategies to increase specific miRNA activity. Advantages and technical limitations of these new drugs, including instability and complex pharmacokinetics, are also presented. Novel delivery strategies, such as nanoparticles and liposomes, are described to improve knowledge on future personalized treatment directions.

MicroRNAs in Valvular Heart Diseases: Biological Regulators, Prognostic Markers and Therapeutical Targets

miRNAs have recently attracted investigators' interest as regulators of valvular diseases pathogenesis, diagnostic biomarkers, and therapeutical targets. Evidence from in-vivo and in-vitro studies demonstrated stimulatory or inhibitory roles in mitral valve prolapse development, aortic leaflet fusion, and calcification pathways, specifically osteoblastic differentiation and transcription factors modulation. Tissue expression assessment and comparison between physiological and pathological phenotypes of different disease entities, including mitral valve prolapse and mitral chordae tendineae rupture, emerged as the best strategies to address miRNAs over or under-representation and thus, their impact on pathogeneses. In this review, we discuss the fundamental intra- and intercellular signals regulated by miRNAs leading to defects in mitral and aortic valves, congenital heart diseases, and the possible therapeutic strategies targeting them. These miRNAs inhibitors comprise of antisense oligonucleotides and sponge vectors. The miRNA mimics, miRNA expression vectors, and small molecules are instead possible practical strategies to increase specific miRNA activity. Advantages and technical limitations of these new drugs, including instability and complex pharmacokinetics, are also presented. Novel delivery strategies, such as nanoparticles and liposomes, are described to improve knowledge on future personalized treatment directions.

Left Ventricular Hypertrophy (LVH) in Patients with Advanced Stages of Chronic Kidney Disease (CKD)

Objective: To determine the left ventricular hypertrophy (LVH) prevalence in patients admitted with advanced stage of Chronic kidney disease at Ziauddin hospital. Methodology: This was a cross-sectional study conducted in department of Nephrology of Ziauddin University Hospital, Karachi from January to July 2016. The inclusion criteria involved patients with CKD stages 3-5 undergoing two-dimensional M mode Doppler echocardiography. The sample size of the study was 147. LVH was considered as positive when Inter-ventricular-septal-wall-thickness in diastole (IVSd) >11 mm, Left-Ventricular-Septal-Wall-Thickness in diastole (LVPWd) >11 mm and Left-Ventricular-Mass-Index (LVMi) >131 g/m2 for men and > 100 g/m2 for women. The exclusion criteria included patients with terminal illness, on mechanical ventilator support, valvular heart diseases and congenital heart diseases, liver diseases and patients with acute kidney injury on chronic kidney disease. Results: 88 male and 59 female patients were included. The mean duration of CKD was 7.02±1.60 years. 94(63.9%) study subjects were observed with left ventricular hypertrophy. A significant association of LVH was observed with gender and CKD Stages. Conclusion: LVH can be easily diagnosed and assessed by M-mode or 2D echocardiography. The prevalence was high (60.5%) in stage 3–5 CKD patients.

SOME INNOVATIVE TECHNOLOGIES FOR THE CORRECTION OF VALVULAR HEART DISEASES. REVIEW

Valve defects or congenital/acquired heart defects are damage to the valve and/or subvalvular structures, which leads to impaired hemodynamics and the development of heart failure. Asymptomatic valvular heart disease is present in 2.5% of the population; with age, this figure rises to 13%. In the absence of permanent treatment, lesions of the heart valves significantly reduce the quality and duration of life. The European Society of Cardiology (ESC) and the American Heart Association (AHA) regularly review the effectiveness of new surgical treatments and reflect their findings in international guidelines. Today, minimally invasive surgery is the most effective and safe way to treat patients with valvular heart disease. The article presents two new methods for the treatment of valvular heart disease. Transapical mitral valve repair on a beating heart with neochord implantation (TOP-MINI) is a new MVP option that has been approved for patients with severe mitral regurgitation due to prolapse of the leaflet (s) or chord (grades 2-4). The new procedure with the NeoChord DS1000 device results in a significant reduction in mitral regurgitation and in reverse remodeling of the left ventricle and left atrium after 6 months of follow-up. Also reviewed is Minimally Invasive Aortic Valve Replacement (MAVR), which has been shown to be beneficial in improving patient satisfaction by minimizing pain and earlier recovery. Sutureless valves are preferred over traditional aortic valve replacement (AVR) due to the reduced operation time and the need for blood transfusion. The Perceval valve (Sorin, Sallugia, Italy) is a self-expanding bovine pericardial prosthesis placed in a nitinol stent designed to facilitate aortic valve implantation. A systematic review and meta-analysis demonstrated that the early clinical and hemodynamic characteristics of the Perceval valve are satisfactory and comparable to those of conventional AVRs. This literature review was carried out in accordance with the PRISM statement. The databases searched in this review included Pubmed, Web of Science, Scopus and Cochrane databases for systematic reviews

An Open-Access Database for the Evaluation of Cardio-Mechanical Signals From Patients With Valvular Heart Diseases

This paper describes an open-access database for seismo-cardiogram (SCG) and gyro-cardiogram (GCG) signals. The archive comprises SCG and GCG recordings sourced from and processed at multiple sites worldwide, including Columbia University Medical Center and Stevens Institute of Technology in the United States, as well as Southeast University, Nanjing Medical University, and the first affiliated hospital of Nanjing Medical University in China. It includes electrocardiogram (ECG), SCG, and GCG recordings collected from 100 patients with various conditions of valvular heart diseases such as aortic and mitral stenosis. The recordings were collected from clinical environments with the same types of wearable sensor patch. Besides the raw recordings of ECG, SCG, and GCG signals, a set of hand-corrected fiducial point annotations is provided by manually checking the results of the annotated algorithm. The database also includes relevant echocardiogram parameters associated with each subject such as ejection fraction, valve area, and mean gradient pressure.

Management of patients with acquired valvular heart disease in noncardiac surgery

Valvular heart disease is widespread among general population, mainly in older age groups, who often require noncardiac surgery. As the population ages, the significance of this problem will only increase. The basic principles of perioperative managing such patients by a multidisciplinary team, necessarily including a cardiologist, are systematized and set out in international clinical guidelines, which are regularly updated. Currently, the Russian Society of Cardiology guidelines on management of valvular heart diseases are being prepared for publication. However, specifics of assessment and management of patients when planning noncardiac surgery require more detailed presentation for a cardiology practitioner.