Acute advanced aortic stenosis

Avvedimento, Marisa; Angellotti, Domenico; Ilardi, Federica; Leone, Attilio; Scalamogna, Maria; Catiello, Domenico Simone; Manzo, Rachele; Mariani, Andrea; Molaro, Maddalena Immobile; Simonetti, Fiorenzo; Spaccarotella, Carmen; Piccolo, Raffaele; Esposito, Giovanni; Franzone, Anna

doi:10.1007/s10741-023-10312-7

Cited by 2 publications

(1 citation statement)

References 69 publications

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“…The main aim of drug therapy in this scenario is to stabilize the haemodynamic profile of the patient. 128 Whilst loop diuretics are the mainstay treatment in HF for haemodynamic stabilization, their benefit in the setting of AS is limited by low intravascular volume and reflex vasoconstriction response, causing hypoperfusion. Tolvaptan, an oral selective V2 receptor antagonist, has been proved safe and efficacious in causing net volume depletion in cases of acute HF and severe AS.…”

Section: Management Of Amyloidosis and Underlying Aortic Stenosismentioning

confidence: 99%

Cardiac amyloidosis and aortic stenosis: a state-of-the-art review

Jaiswal,

Agrawal,

Khulbe

et al. 2023

European Heart Journal Open

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Cardiac amyloidosis is caused by the extracellular deposition of amyloid fibrils in the heart, involving not only the myocardium but any cardiovascular structure. Indeed, this progressive infiltrative disease also involves the cardiac valves and, specifically, shows a high prevalence with aortic stenosis. Misfolded proteins infiltration in the aortic valve leads to tissue damage resulting in the onset or worsening of valve stenosis. Transthyretin-cardiac amyloidosis and aortic stenosis coexist in patients > 65 years in about 4 to 16% of cases, especially in those undergoing transcatheter aortic valve replacement. Diagnostic work-up for cardiac amyloidosis in patients with aortic stenosis is based on a multiparametric approach considering clinical assessment, electrocardiogram, haematologic tests, basic and advanced echocardiography, cardiac magnetic resonance, technetium labeled cardiac scintigraphy like 99mTc-pyrophosphate, 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid, and 99mTc-hydroxymethylenediphosphonate. However, a biopsy is the traditional gold standard for diagnosis. The prognosis of patients with coexisting cardiac amyloidosis and aortic stenosis is still under evaluation. The combination of these two pathologies worsens the prognosis. Regarding treatment, mortality is reduced in patients with cardiac amyloidosis and severe aortic stenosis after undergoing transcatheter aortic valve replacement. Further studies are needed to confirm these findings and to understand whether the diagnosis of cardiac amyloidosis could affect therapeutic strategies. The aim of this review is to critically expose the current state-of-art regarding the association of cardiac amyloidosis with aortic stenosis, from pathophysiology to treatment.

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Section: Management Of Amyloidosis and Underlying Aortic Stenosismentioning

confidence: 99%

Cardiac amyloidosis and aortic stenosis: a state-of-the-art review

Jaiswal,

Agrawal,

Khulbe

et al. 2023

European Heart Journal Open

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Ex vivo model of pathological calcification of human aortic valve

Kachanova,

Boyarskaya,

Docshin

et al. 2024

Front. Cardiovasc. Med.

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The development of drug therapy for the pathological calcification of the aortic valve is still an open issue due to the lack of effective treatment strategies. Currently, the only option for treating this condition is surgical correction and symptom management. The search for models to study the safety and efficacy of anti-calcifying drugs requires them to not only be as close as possible to in vivo conditions, but also to be flexible with regard to the molecular studies that can be applied to them. The ex vivo model has several advantages, including the ability to study the effect of a drug on human cells while preserving the original structure of the valve. This allows for a better understanding of how different cell types interact within the valve, including non-dividing cells. The aim of this study was to develop a reproducible ex vivo calcification model based on valves from patients with calcific aortic stenosis. We aimed to induce spontaneous calcification in valve tissue fragments under osteogenic conditions, and to demonstrate the possibility of significantly suppressing it using a calcification inhibitor. To validate the model, we tested a Notch inhibitor Crenigacestat (LY3039478), which has been previously shown to have an anti-calcifying effect on interstitial cell of the aortic valve. We demonstrate here an approach to testing calcification inhibitors using an ex vivo model of cultured human aortic valve tissue fragments. Thus, we propose that ex vivo models may warrant further investigation for their utility in studying aortic valve disease and performing pre-clinical assessment of drug efficacy.

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Acute advanced aortic stenosis

Cited by 2 publications

References 69 publications

Cardiac amyloidosis and aortic stenosis: a state-of-the-art review

Cardiac amyloidosis and aortic stenosis: a state-of-the-art review

Ex vivo model of pathological calcification of human aortic valve

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