The American journal of cardiology
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Multicenter Study Comparative Study
Ascending thoracic aorta dimension and outcomes in acute type B dissection (from the International Registry of Acute Aortic Dissection [IRAD]).
It is not well known if the size of the ascending thoracic aorta at presentation predicts features of presentation, management, and outcomes in patients with acute type B aortic dissection. The International Registry of Acute Aortic Dissection (IRAD) database was queried for all patients with acute type B dissection who had documentation of ascending thoracic aortic size at time of presentation. Patients were categorized according to ascending thoracic aortic diameters ≤4.0, 4.1 to 4.5, and ≥4.6 cm. ⋯ In conclusion, ascending thoracic aortic enlargement in patients with acute type B aortic dissection is common. Although its presence does not appear to predict an increased risk of mortality, it is associated with more frequent open surgical intervention that often involves replacement of the proximal aorta. Those with smaller proximal aortas are more likely to receive endovascular therapy.
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Comparative Study
Natural history of concentric left ventricular geometry in community-dwelling older adults without heart failure during seven years of follow-up.
Presence of concentric left ventricular (LV) geometry has important pathophysiologic and prognostic implications. However, little is known about its natural history in older adults. Of the 5,795 community-dwelling adults ≥65 years of age in the Cardiovascular Health Study, 1,871 without baseline heart failure had data on baseline and 7-year echocardiograms. ⋯ Incident eccentric hypertrophy occurred in 4% and 25% of those with baseline concentric remodeling and concentric hypertrophy, respectively, and was associated with increased LV end-diastolic volume and decreased LV ejection fraction at year 7. Previous myocardial infarction and baseline above-median LV mass (>39 g/m²·⁷) and RWT (>0.46) had significant unadjusted associations with incident eccentric LVH; however, only LV mass >39 g/m²·⁷ (odds ratio 17.52, 95% confidence interval 3.91 to 78.47, p <0.001) and previous myocardial infarction (odds ratio 4.73, 95% confidence interval 1.16 to 19.32, p = 0.031) had significant independent associations. In conclusion, in community-dwelling older adults with concentric LV geometry, transition to eccentric hypertrophy was uncommon but structurally maladaptive.
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Comparative Study
Different clinical outcome of paravalvular leakage after aortic or mitral valve replacement.
Although aortic valve replacement (AVR) and mitral valve replacement (MVR) are the most commonly performed prosthetic valve replacement operations, it is unclear whether clinical outcomes of paravalvular leakage (PVL) after MVR or AVR are different. It was hypothesized that clinical outcomes of PVL after AVR would be more favorable than after MVR because the pressure gradient is much larger in PVL occurring at the mitral position, which happens at the systolic phase, than at the aortic valve. Over a 12-year period, 82 patients with PVL were identified. ⋯ In conclusion, PVL after AVR demonstrated more favorable long-term clinical outcomes compared to that after MVR. In patients who develop PVL after AVR, repeat surgery may be deferred. However, in patients with PVL after MVR, more aggressive therapeutic approaches should be considered.
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Atherosclerotic lesions in the thoracic aorta detected by transesophageal echocardiography (TEE) have been correlated with coronary artery disease (CAD). We determined whether simple or complex aortic plaques seen on transesophageal echocardiogram correlated with extent, location, and severity of CAD. The study population consisted of 188 patients who underwent TEE and coronary angiography. ⋯ Multivariate logistic regression analysis showed that complex plaque in the descending aorta (odds ratio 5.4, 95% confidence interval 1.8 to 16.4, p = 0.003) was the strongest predictor of CAD. In conclusion, simple and complex thoracic atherosclerotic plaques detected by TEE are associated with increasing severity of CAD. Complex plaque in the descending aorta was the strongest association with presence of CAD.