Accelerated Progression and Morbidity in Patients With Aortic Stenosis on Chronic Dialysis

lead to a high rate of cardiovascular mortality. In particular, multiple pathways including calcium and phosphorus metabolic abnormalities caused by secondary hyperparathyroidism, inflammation and cardiac overload accelerate the process of valvular calcification, and the consequent P atients with end-stage renal disease (ESRD) on chronic hemodialysis (HD) often have a high prevalence of structural abnormalities of the heart including calcified valvular sclerosis, 1,2 left ventricular (LV) remodeling 3,4 and LV diastolic dysfunction, 5 which may

Section: Echocardiographymentioning

confidence: 99%

Section: Echocardiographymentioning

confidence: 99%

Echocardiographic Assessment of Cardiac Structural and Functional Abnormalities in Patients With End-Stage Renal Disease Receiving Chronic Hemodialysis

Matsuo

Dohi

Makino³

et al. 2018

“…[1][2][3][4] In particular, recent studies have shown that any stage of renal dysfunction (mild to severe) is an independent risk factor for short-and long-term mortality among patients with myocardial infarction (MI), even after administration of fibrinolytics. [5][6][7][8] Moreover, it has been demonstrated that impaired renal function is associated with poorer clinical outcome after either percutaneous coronary intervention or coronary artery bypass graft surgery.…”

mentioning

confidence: 99%

Association of Creatinine Clearance and In-Hospital Mortality in Patients With Acute Coronary Syndromes

Pitsavos

Kurlaba

Panagiotakos

et al. 2007

revious studies have demonstrated that renal insufficiency is an independent risk factor for cardiovascular morbidity and for all-cause as well as cardiovascular death in both the general population and patients with cardiovascular disease. [1][2][3][4] In particular, recent studies have shown that any stage of renal dysfunction (mild to severe) is an independent risk factor for short-and long-term mortality among patients with myocardial infarction (MI), even after administration of fibrinolytics. [5][6][7][8] Moreover, it has been demonstrated that impaired renal function is associated with poorer clinical outcome after either percutaneous coronary intervention or coronary artery bypass graft surgery. [9][10][11][12] Several recently published studies have shown that renal insufficiency is common among patients with a broad spectrum of acute coronary syndromes (ACS) at admission and is associated with higher risk of death as well as major bleeding. [13][14][15][16][17][18][19] However, the effect of renal insufficiency in patients with non-ST-segment elevation MI (NSTEMI) and unstable angina (UA) has been less extensively investigated.The primary objective of this study was to evaluate the characteristics of patients with varying degrees of renal dysfunction among those hospitalized with all clinical presentations of ACS and the impact of renal dysfunction on in-hospital cardiovascular mortality of those patients. Secondarily, we sought to investigate the aforementioned for those with ST-segment elevation MI (STEMI) and those with NSTEMI and UA, separately and to compare the predictive value of these 2 final models in order to conclude in which of these 2 subgroups creatinine clearance is the better predictor. Methods DesignThe design and rationale of this study have been described in detail previously. 20 Briefly, from October 2003 to September 2004 (12 months) we enrolled almost all consecutive patients (participation rate =98%) that entered cardiology clinics or emergency units of 6 major general hospitals in Greece. Finally, the study included only those patients with a discharge diagnosis of ACS; that is, patients STEMI or NSTEMI and UA. The criteria for the diagnosis of STEMI, NSTEMI and UA took into account clinical presentation, ECG findings and the results of serum biochemical markers of necrosis. In particular, acute MI was defined by a typical rise and gradual fall of troponin or a more rapid rise and fall of creatine kinase (CK)-MB, with at least 1 of the following: (a) ischemic symptoms, (b) development of Background The relationship between renal dysfunction and mortality in patients with myocardial infarction (MI) has been extensively investigated, but there are limited data about this relationship in patients presenting with non-ST-segment-elevation MI and unstable angina. Therefore, the aim of the present study was to investigate whether renal insufficiency is an independent predictor for in-hospital mortality among such patients. Methods and ResultsTwo thousand a hundred and seventy-two patie...

“…[17][18][19] Several studies have suggested that several risk factors associated with atherosclerotic disease have been associated with degenerative AV, including age, gender, smoking, hyperlipidemia, hypertension and diabetes. [20][21][22][23] Risk factors in patients with degenerative AS were similar to those of CAD in the elderly population. A large number of patients with AS have concomitant CAD.…”

Section: Discussionmentioning

confidence: 70%

The Simultaneous Assessment of Aortic Valve Area and Coronary Artery Stenosis Using 16-Slice Multidetector-Row Computed Tomography in Patients With Aortic StenosisComparison With Echocardiography

Tanaka

Shimada

Yoshida

et al. 2007

he method of 16-slice multidetector-row computed tomography (16-slice MDCT) has recently been introduced for the non-invasive visualization of arteriosclerotic coronary arteries, abnormal cardiac structures and myocardial properties. [1][2][3][4][5][6][7] Single-center studies have reported sensitivities between 72% and 95% and specificities between 86% and 97% for the detection of obstructive coronary lesions using 16-slice MDCT. 1-4 Multidetector-row computed tomography (MDCT) is a promising non-invasive technique for the detection of obstructive epicardial coronary artery disease (CAD).In industrialized countries the most frequent cause of aortic stenosis (AS) is degenerative changes of valve leaflets, such as the congenital bicuspid aortic valve (AV) 8 and atherosclerotic valves. These changes frequently occur in elderly patients, who are also at high risk for CAD. Severe AS (an AV area (AVA) of less than 1.0 cm 2 ) accompanied by CAD presents problems for surgical decision-making in Circulation Journal Vol.71, October 2007 whether AV replacement (AVR) should be performed with coronary artery bypass graft (CABG) surgery. 9 Transthoracic echocardiography (TTE) is an important and non-invasive method for assessing the significance of cardiac murmurs, which are derived from diseased heart valves. For diagnosing and evaluating the AVA by 2-dimensional echocardiography (DE) in patients with AS, the planimetric method without disturbed visualizations and the Doppler approach using an adequate angle of ultrasound beam are highly sensitive. [10][11][12][13] The high spatial and temporal resolution of 16-slice MDCT might allow for detailed images of the AV orifice and measurements of the AVA.The purpose of the present study is to investigate whether the AVA in patients with AS assessed by 16-slice MDCT corresponds to that by echocardiographic assessment and to evaluate simultaneously the clinical accuracy in detecting CAD with 16-slice MDCT. Methods SubjectsThe study population consisted of 29 consecutive patients (15 male, 14 female; mean age 71.0±10.6 years) who underwent TTE for the evaluation of AS. All subjects were examined by 16-slice MDCT for calculating AVA within a 1-week period following 2-DE. No change in the patients' provide for non-invasive assessment of not only coronary artery disease (CAD), but also myocardial properties and the anatomy of the whole heart. The purpose of the present study was to investigate whether the aortic valve area (AVA) in patients with aortic stenosis (AS) assessed by 16-slice MDCT corresponds to echocardiographic assessment and to evaluate simultaneously the clinical accuracy in detecting CAD with 16-slice MDCT. Methods and ResultsThe AVA of 29 consecutive AS patients with transthoracic echocardiography (TTE) and 16-slice MDCT were analyzed. The AVA was estimated by means of the continuity equation method in 2-dimensional echocardiography (DE) and the quantitative planimetric method after multi-planar reformation in 16-slice MDCT. Concomitantly, the severity of the corona...