Abstract Background Valve-in-valve (ViV) transcatheter aortic implantation (TAVI) is an alternative to redo surgery for patients with a failing aortic bioprosthesis. A lack of anatomic markers may ...complicate the procedure. This study reports procedural and midterm outcomes of patients undergoing ViV-TAVI for failing stentless bioprostheses, at a single institution. Methods A total of 22 consecutive patients with failing homograft (n = 17), stented porcine valve (n = 3), aortic root bioprosthesis (n = 1), or native resuspended aortic valve (n = 1) (aged 74 ± 12 years; Society of Thoracic Surgeons 30-day predicted risk of mortality score: 14% ± 8%) were treated with ViV-TAVI, between 2007 and 2014. All had severe aortic regurgitation and were highly symptomatic before TAVI: 41% had chronic kidney disease; 32% had undergone previous coronary bypass grafts; 27% had previous percutaneous coronary intervention; 14% had severe pulmonary disease; 14% had had a stroke. All underwent TAVI with a self-expanding device. Results The 30-day mortality was 0%. No cases occurred of myocardial infarction, tamponade, stroke, severe bleeding, acute kidney injury, or major vascular complications. Three instances of device migration, and 1 of device embolization, occurred. Permanent pacing was required in 14%. Paravalvular aortic regurgitation was absent or mild in 19, and mild to moderate in 3. Average hospital stay was 8 ± 3 days; all patients were discharged home. Six-month and 1-year mortality was 4.8% and 14.3%, respectively. Aortic valve area and paravalvular aortic regurgitation were unchanged at 1 year. Conclusions The ViV-TAVI procedure may be performed in high-risk patients with a degenerate stentless bioprosthesis with low 30-day mortality, and 1-year mortality of 14.3%. Although technically challenging, owing to a lack of anatomic markers, satisfactory positioning is possible in most cases, with excellent clinical and echocardiographic outcomes.
Reward processing is influenced by reward magnitude, as previous EEG studies showed changes in amplitude of the feedback‐related negativity (FRN) and reward positivity (RewP), or power of ...fronto‐medial theta (FMθ). However, it remains unclear whether these changes are driven by increased reward sensitivity, altered reward predictions, enhanced cognitive control, or a combination of these effects. To address this question, we asked 36 participants to perform a simple gambling task where feedback valence (reward vs. no‐reward), its magnitude (small vs. large reward), and expectancy (expected vs. unexpected) were manipulated in a factorial design, while 64‐channel EEG was recorded concurrently. We performed standard ERP analyses (FRN and RewP) as well as time‐frequency decompositions (FMθ) of feedback‐locked EEG data. Subjective reports showed that large rewards were more liked and expected than small ones. At the EEG level, increasing magnitude led to a larger RewP irrespective of expectancy, whereas the FRN was not influenced by this manipulation. In comparison, FMθ power was overall increased when reward magnitude was large, except if it was unexpected. These results show dissociable effects of reward magnitude on the RewP and FMθ power. Further, they suggest, that although large reward magnitude boosts reward processing (RewP), it can nonetheless undermine the need for enhanced cognitive control (FMθ) in case reward is unexpected. We discuss these new results in terms of optimistic bias or positive mood resulting from an increased reward magnitude.
While reward magnitude substantially influences reward processing, it remains unclear if these changes interact with reward expectations or cognitive control. By manipulating reward magnitude and expectancy during a simple gambling task, we found dissociable effects for ERPs and time‐frequency spectra. Increasing reward magnitude led to a boost in reward processing (RewP), occurring irrespective of expectancy and selectively for rewards. Intriguingly, this boost was accompanied by a transient decrease in cognitive control (FMθ), as though magnitude blurred the processing of expectancy during reward processing.
Use of biomarkers to diagnose and manage cardiac amyloidosis Castiglione, Vincenzo; Franzini, Maria; Aimo, Alberto ...
European journal of heart failure,
February 2021, 2021-Feb, 2021-02-00, 20210201, Letnik:
23, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Amyloidoses are characterized by the tissue accumulation of misfolded proteins into insoluble fibrils. The two most common types of systemic amyloidosis result from the deposition of immunoglobulin ...light chains (AL) and wild‐type or variant transthyretin (ATTRwt/ATTRv). Cardiac involvement is the main determinant of outcome in both AL and ATTR, and cardiac amyloidosis (CA) is increasingly recognized as a cause of heart failure. In CA, circulating biomarkers are important diagnostic tools, allow to refine risk stratification at baseline and during follow‐up, help to tailor the therapeutic strategy and monitor the response to treatment. Among amyloid precursors, free light chains are established biomarkers in AL amyloidosis, while the plasma transthyretin assay is currently being investigated as a tool for supporting the diagnosis of ATTRv amyloidosis, predicting outcome and monitor response to novel tetramer stabilizers or small interfering RNA drugs in ATTR CA. Natriuretic peptides (NPs) and troponins are consistently elevated in patients with AL and ATTR CA. Plasma NPs, troponins and free light chains hold prognostic significance in AL amyloidosis, and are evaluated for therapy decision‐making and follow‐up, while the value of NPs and troponins in ATTR is less well established. Biomarkers can be usefully integrated with clinical and imaging variables at all levels of the clinical algorithm of systemic amyloidosis, from screening to diagnosis and prognosis, and treatment tailoring.
99mTc-HMDP scintigraphy has proved its efficacy in non-invasive diagnosis of cardiac amyloidosis (CA) and is currently interpreted according to the Perugini qualitative assessment. Several ...semi-quantitative indices have been proposed to overcome inherent possible limitations of visual grading. Our aim was to comparatively evaluate six different indices and their diagnostic performance.
We retrospectively reviewed scintigraphy of 76 patients (53 ATTR, 12 AL, 11 LVH) who underwent diagnostic evaluation at our centre. ROC-curve analysis was performed to identify optimal cut-off and relative diagnostic accuracy of six different indices (of which one was proposed for the first time), both in identifying CA patients and in discriminating patients according to their Perugini score.
Heart/Whole-body ratios proved to be the most accurate (100%) in identifying CA patients. Heart/Pelvis ratio (with soft tissue background correction) offered acceptable accuracy (98%), with the largest area under the curve (AUC) (0.98) in discriminating patients with Perugini ≥ 2. Heart/Contralateral Lung ratio confirmed to be exposed to confounding background noise in case of simultaneous lung uptake. Heart/Skull ratio had the worst performance, with six false-negative patients in ATTR identification.
Heart/Whole-body ratios may be robust and effective semi-quantitative indices for the evaluation of CA by means of scintigraphy
Summary Background Coronary stents improve immediate and late results of balloon angioplasty by tacking up dissections and preventing wall recoil. These goals are achieved within weeks after ...angioplasty, but with current technology stents permanently remain in the artery, with many limitations including the need for long-term antiplatelet treatment to avoid thrombosis. We report a prospective multicentre clinical trial of coronary implantations of absorbable magnesium stents. Methods We enrolled 63 patients (44 men; mean age 61·3 SD 9·5 years) in eight centres with single de novo lesions in a native coronary artery in a multicentre, non-randomised prospective study. Follow-up included coronary angiography and intravascular ultrasound at 4 months and clinical assessment at 6 months and 12 months. The primary endpoint was cardiac death, non-fatal myocardial infarction, or clinically driven target lesion revascularisation at 4 months Findings 71 stents, 10–15 mm in length and 3·0–3·5 mm in diameter, were successfully implanted after pre-dilatation in 63 patients. Diameter stenosis was reduced from 61·5 (SD 13·1%) to 12·6 (5·6%) with an acute gain of 1·41 mm (0·46 mm) and in-stent late loss of 1·08 mm (0·49 mm). The ischaemia-driven target lesion revascularisation rate was 23·8% after 4 months, and the overall target lesion revascularisation rate was 45% after 1 year. No myocardial infarction, subacute or late thrombosis, or death occurred. Angiography at 4 months showed an increased diameter stenosis of 48·4 (17·0%). After serial intravascular ultrasound examinations, only small remnants of the original struts were visible, well embedded into the intima. Neointimal growth and negative remodelling were the main operating mechanisms of restenosis. Interpretation This study shows that biodegradable magnesium stents can achieve an immediate angiographic result similar to the result of other metal stents and can be safely degraded after 4 months. Modifications of stent characteristics with prolonged degradation and drug elution are currently in development.
Key Points
Historically percutaneous coronary interventions (PCI) of severely calcified lesions is associated with high rate of periprocedural complications and poor long‐term outcomes.
Available ...data from controlled prospective registries reported promising safety and efficacy results of intravascular lithotripsy (IVL) but were limited to restricted inclusion criteria.
This multicenter IVL registry in all‐comer patients including very long lesions, S‐T segment elevation myoìcardial infarction, chronic total occlsusion and left main PCI confirmed high procedural success, low rate of periprocedural complications and good long‐term outcome.
Key Points
Women are less frequently referred to CTO recanalizations according to their ambiguous presentation
Gender has a great impact on technical procedural success and also on procedural ...complication rate
It is important to adopt tricks to avoid the most common complications in women such as cardiac tamponade, access problems, and contrast nephropathy
Although SARS-CoV-2 was first reported in China and neighbouring countries, the pandemic quickly spread around the globe. This paper explores national drivers of the pandemic and the radically ...different epidemiology and response in the West and in the East. We studied coronavirus disease (COVID-19) mortality until 31st December 2020, using an ecological study design, considering baseline characteristics and responses that might account for the uneven impact of the pandemic. A multivariable regression model was developed to explore key determinants. Key variables in the West were contrasted with those in the East, and speed of response was examined. Worldwide, 2.24 million COVID-19 deaths were documented in 2020. Western countries reported a median mortality 114 times that of the East (684 vs. 6.0 per million). Significant correlates of mortality in countries with at least 1 million population were median age, obesity prevalence, and democracy index; political stability and experience of SARS in 2002-2003 were protective; health system variables and income inequality were not associated. Outputs of the model were consistent when adjusted for stringency index, timeliness of stay-at-home requirements, and geographical autocorrelation. The West experiences a much higher COVID-19 mortality than the East. Despite structural advantages in the West, delays in national responses early on resulted in a loss of control over the spread of SARS-CoV-2. Although the early success of the East was sustained in the second half of 2020, the region remains extremely vulnerable to COVID-19 until enough people are immunized.
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