Effect of TAVI on Epicardial Functional Indices and Their Relationship to Coronary Microvascular Function

Circulation Cardiovascular Interventions, Journal Year: 2025, Volume and Issue: unknown

Published: April 11, 2025

BACKGROUND: The anatomic and physiological changes associated with severe aortic stenosis may influence the functional evaluation of coronary stenoses. In this study, we aimed to assess in resting hyperemic indices before immediately after transcatheter valve implantation (TAVI) their relationship microvascular resistance. METHODS: pooled analysis 3 prospective observational studies, fractional flow reserve (FFR), full-cycle ratio (RFR), Pd/Pa were measured patients TAVI left anterior descending artery. Coronary microcirculation was also assessed using thermodilution-based methods, resistance (cutoff ≤3) used identify dysfunction. RESULTS: A total 126 included. Baseline Pd/Pa, RFR, FFR measurements 0.93±0.04, 0.90±0.07, 0.89±0.07, respectively. Immediately post-TAVI, a small but significant decrease observed for both RFR (RFR, 0.88±0.08; FFR, P <0.05 all). remained unchanged. Applying established cutoff values, 16 (12.7%) vessels had positive while higher proportion (35.7% 43.7%, respectively; <0.001). concordance between pre- post-TAVI (92.8%) compared (75.4%) (73.8%) ( <0.001 both). rate disagreement unchanged, regardless presence CONCLUSIONS: is reduction post-procedure. Overall, agreement values indices.

Language: Английский

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A Tale of Two Diseases: Decoding Aortic Stenosis and Cardiac Amyloidosis

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(8), P. 2652 - 2652

Published: April 12, 2025

Background/Objectives: Transthyretin cardiac amyloidosis (ATTR-CA) is an infiltrative cardiomyopathy caused by transthyretin (TTR) amyloid deposition in the myocardium, increasingly recognized patients with aortic stenosis (AS). This study aims to investigate diagnostic challenges and therapeutic strategies for both conditions, focusing on shared pathophysiological mechanisms key indicators. Methods: A multimodal approach was applied, utilizing magnetic resonance (CMR) bone scintigraphy technetium-99m-labeled tracers assess AS suspected ATTR-CA. Clinical signs, such as disproportionate heart failure symptoms, conduction abnormalities, low-flow, low-gradient AS, were evaluated. Electrocardiographic findings, including low-voltage QRS complexes pseudo-infarction patterns, also assessed. Treatment options, transcatheter valve replacement (TAVR) emerging pharmacotherapies ATTR-CA, analyzed. Results: The found that ATTR-CA prevalent patients, like oxidative stress amyloid-induced tissue remodeling. Key signs include specific electrocardiographic patterns. TAVR effective isolated although conditions had a higher risk of hospitalization persistent symptoms. Emerging pharmacotherapies, TTR stabilizers gene-silencing agents, showed promise slowing disease progression. Conclusions: essential early detection patients. Combining may improve long-term outcomes this high-risk group, enhancing patient care those conditions.

Language: Английский

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Cardiovascular therapeutic targets of sodium-glucose co-transporter 2 (SGLT2) inhibitors beyond heart failure

Pharmacology & Therapeutics, Journal Year: 2025, Volume and Issue: 270, P. 108861 - 108861

Published: April 15, 2025

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are oral antidiabetic agents that have shown significant improvements in cardiovascular and renal outcomes among patients with heart failure (HF), regardless of diabetic status, establishing them as a cornerstone therapy. In addition to glycemic control the osmotic diuretic effect, inhibition SGLT2 improves endothelial function vasodilation, optimizing myocardial energy metabolism preserving cardiac contractility. Moreover, may exhibit anti-inflammatory properties attenuate acute ischemia/reperfusion injury, thereby reducing infarct size, enhancing left ventricular function, mitigating arrhythmias. These pleiotropic effects demonstrated efficacy across various conditions, ranging from chronic coronary syndromes extending arrhythmias, valvular disease, cardiomyopathies, cardio-oncology, cerebrovascular disease. This review provides an overview current literature on potential mechanisms underlying effectiveness wide range diseases beyond HF.

Language: Английский

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Expanding the Use of SGLT2 Inhibitors in T2D Patients Across Clinical Settings

Cells, Journal Year: 2025, Volume and Issue: 14(9), P. 668 - 668

Published: May 2, 2025

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are currently recommended in patients with type 2 diabetes (T2D) to reduce serum glucose levels. Moreover, robust evidence has clearly demonstrated their beneficial cardiovascular and renal effects, making this class of drugs pivotal for the treatment T2D, especially when complicated by diabetic kidney disease or heart failure. However, several other comorbidities frequently encountered T2D beyond these long-term complications, internal medicine setting. For some comorbidities, such as MAFLD cognitive impairment, association is increasingly recognized, hypothesis a common pathophysiologic background, whereas, others, coincident epidemiology linked ageing populations, including that subjects, may be advocated. In effort personalizing treatment, on potential effects SGLT2i different clinical conditions accumulating. The purpose narrative review update current literature settings glycaemic control, elucidate molecular mechanisms which they exert effects.

Language: Английский

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Aortic valve replacement in uncontrolled diabetes: a matter of causes – effect

IJC Heart & Vasculature, Journal Year: 2025, Volume and Issue: 56, P. 101616 - 101616

Published: Jan. 21, 2025

Language: Английский

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Common Risk Factors for Atrial Fibrillation After Transcatheter Aortic Valve Implantation: A Systematic Review from 2009 to 2024

Journal of Cardiovascular Development and Disease, Journal Year: 2025, Volume and Issue: 12(3), P. 90 - 90

Published: Feb. 28, 2025

Transcatheter Aortic Valve Implantation (TAVI) is an effective treatment for severe aortic stenosis in high-risk patients; however, atrial fibrillation (AF) a common complication associated with the procedure. New-Onset Atrial Fibrillation (NOAF) after TAVI linked to increased mortality and additional complications. This study aimed evaluate incidence of NOAF following identify risk factors development thromboembolic events. A systematic review 18 studies was conducted using databases such as MEDLINE/PubMed, EMBASE, Web Science, Scopus, Cochrane Library, Google Scholar, Wiley Online SciELO, Redalyc. No language restrictions were applied, search covered from 2009 2024. The follow-up period ranged 48 h 730 days, mean 180 days. Early monitoring management AF are essential patients undergoing TAVI. up 29.04%, meaning about 29 out every 100 affected. rates varied between 7.2% 37%, average around 20. Standardizing anticoagulation strategies important reduce Randomized needed relationship post-TAVI determine whether marker higher or independent factor these patients.

Language: Английский

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Impact of Sarcopenia on Mortality in Patients Undergoing TAVI: A Follow-Up Study

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(9), P. 3182 - 3182

Published: May 4, 2025

Objective: The use of transcatheter aortic valve implantation (TAVI) has expanded in patients with severe stenosis who are deemed inoperable. However, sarcopenia may be a determining factor their survival. aim our study is to assess the impact sarcopenia, evaluated by computed tomography (CT), on mortality this patient population. Methods: Patients undergoing follow-up after TAVI at Hospital Universitario de la Princesa were recruited. Body composition was analyzed using routine CT scans and open-source software. Survival analysis performed, correlations between body parameters T12 L3 vertebral levels assessed. Results: Our sample comprised 97 subjects. Time associated diabetes mellitus (p = 0.050), atrial fibrillation 0.02), respiratory disease 0.03). Interestingly, 0.039) normal-density muscle area 0.025) also time mortality, association becoming stronger adjusting for covariates < 0.001). correlation different substantial statistically significant. Conclusions: highly valuable can predict mortality. Sarcopenia should considered as relevant parameter comprehensive evaluation these patients.

Language: Английский

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Coronary Artery Disease and Severe Aortic Stenosis: Contemporary Treatment Options for Patients Undergoing Transcatheter Aortic Valve Implantation

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(24), P. 7625 - 7625

Published: Dec. 14, 2024

Approximately 50% of individuals eligible for transcatheter aortic valve implantation (TAVI) have coronary artery disease (CAD). The influence CAD, both its prevalence and severity, on post-TAVI clinical results has yielded conflicting findings. Recent research shown positive the use computed tomography angiography functional percutaneous evaluation lesions in pre-TAVI assessment, besides classic angiography. As we anticipate outcomes current randomized studies, it become common practice to perform invasive revascularization TAVI patients with obstructive CAD. Furthermore, there is a lack comprehensive data about occurrence, features, treatment incidents after TAVI. There also growing concern possible difficulties accessing arteries who need or without intervention This review presents analysis contemporary options CAD undergoing In this context, examines incidence candidates; significance; assessment management before, concomitant, procedure, including patients’ unresolved concerns; future aspects.

Language: Английский

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Contemporary Management of the Aortic Valve—Narrative Review of an Evolving Landscape

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 14(1), P. 134 - 134

Published: Dec. 29, 2024

Background: Aortic valve replacement has undergone novel changes in recent decades, providing not only a multitude of procedural options but expanding the treatable patient population. Specifically, number minimally invasive and interventional treatment have allowed for high prohibitive risk surgical patients. Further, technology is allowing development innovative transcatheter models, which will advance aortic disease future. Objective: Here, we choose to describe modern techniques available valves designs.

Language: Английский

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