Circulation journal : official journal of the Japanese Circulation Society
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Multicenter Study Clinical Trial
Prognostic value of global longitudinal strain in paradoxical low-flow, low-gradient severe aortic stenosis with preserved ejection fraction.
To assess whether global longitudinal strain (GLS) can discriminate high-risk patients with adverse outcome in paradoxical low-flow, low-gradient (LFLPG) severe aortic stenosis (AS). METHODS AND RESULTS: We enrolled 204 patients with severe AS (indexed aortic valve area [iAVA] <0.6 cm(2)/m(2)) and preserved left ventricular ejection fraction (LVEF >50%). Patients were divided into 4 groups according to flow state (stroke volume index < or > 35 ml/m(2)) and mean pressure gradient (< or > 40 mmHg). LV GLS was measured by 2-dimensional speckle-tracking analysis. The primary endpoint consisted of major cardiovascular events, including aortic valve replacement. During a mean 399-day follow-up, 51 (25%) patients met the primary endpoint. Among the 98 LFLPG AS patients, GLS was significantly reduced in patients with any event (-15.6±4.5% vs. -19.4±3.6%, P=0.002). Using receiver-operating characteristic analysis, we classified LFLPG AS patients as impaired GLS (GLS ≥-17%, n=24) or preserved GLS (GLS <-17%, n=74). The impaired GLS group had smaller iAVA, higher LV mass index, higher E/E', and lower overall 2-year event-free survival (57% vs. 97%; P<0.001) than the preserved GLS group. ⋯ Longitudinal function was severely impaired in patients with LFLPG AS and they had poor prognosis. GLS could stratify the high-risk group for future adverse outcomes. Patients with paradoxical LFLPG AS comprised a mixed group with different LV mechanical properties associated with different prognoses.
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Comparative Study Observational Study
Propensity score-matched analysis of minimally invasive aortic valve replacement.
Right mini-thoracotomy and partial sternotomy are widely recognized as effective approaches in minimally invasive aortic valve replacement (AVR). The aim of this study was to evaluate the objective benefits of the respective approaches compared to the conventional approach. METHODS AND RESULTS: A retrospective analysis was performed in 282 consecutive patients who underwent isolated and initial AVR at a single cardiovascular institute between May 2007 and December 2012. Mini-thoracotomy and partial sternotomy were performed in 62 (22%) and in 26 patients (9%), respectively. Propensity score matching produced 36 (mini-thoracotomy vs. full sternotomy) and 24 (partial sternotomy vs. full sternotomy) well-matched pairs. Compared to the conventional approach, mini-thoracotomy was associated with significantly shorter operative time (235±35 min vs. 272±73 min; P=0.009), lower prevalence of blood transfusion (42%, 15/36 vs. 67%, 24/36; P=0.025), and significantly shorter intensive care unit and postoperative hospital stay (1.4±0.8 days vs. 2.2±1.1 days, P=0.001; and 13.3±6.5 days vs. 21.5±10.3 days, P=0.001; respectively). There were no significant differences in operative and postoperative data between the partial sternotomy and full sternotomy groups. ⋯ The objective benefits of right mini-thoracotomy included early rehabilitation and lower prevalence of blood transfusion. Significant advantages of partial sternotomy were not found.
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Clinical Trial
Reconstruction of bicuspid aortic valve with autologous pericardium--usefulness of tricuspidization.
This study describes the surgical treatment of bicuspid aortic valve with original aortic valve reconstruction. ⋯ Medium-term results were excellent. Tricuspidization gave good opening and closure of aortic valve with excellent hemodynamics.
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Some potential biomarkers have been reported recently in patients with pulmonary arterial hypertension (PAH), but the most clinically useful among these potential biomarkers, especially in childhood PAH, has not been identified. Therefore, this study investigated which biomarker is useful in assessing severity of and patient prognosis in childhood idiopathic PAH (IPAH)/heritable PAH (HPAH). ⋯ The sST2 and NT-proBNP combination is a useful biomarker to predict clinical condition and outcome in patients with childhood IPAH/HPAH.
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Perioperative complication of end-organ injury including acute kidney injury (AKI) is a frequent and severe problem for patients undergoing left ventricular assist device (LVAD) implantation. This study evaluated an emerging AKI biomarker, plasma neutrophil gelatinase-associated lipocalin (NGAL), in a LVAD implantation cohort. ⋯ Measurement of perioperative plasma NGAL is useful for predicting severe AKI requiring RRT and renal recovery in patients who have had LVAD implantation surgery. Further investigation is necessary to confirm these findings because this study examined a low number of patients.