Background
Transcatheter aortic valve replacement (TAVR) is increasingly utilized for most patients with symptomatic severe aortic stenosis. TAVR is linked to enhanced long-term cardiac hemodynamics, reversal of left ventricle (LV) hypertrophy, and improved aortic valve gradients. We present a retrospective observational study assessing cardiac remodeling and valvular flow patterns post-TAVR.
Methods
Retrospective echocardiographic data were collected, evaluating cardiac function and valvular flow patterns before and after TAVR at a single institution. Data was compiled and statistically analyzed using a paired t-test evaluating variations at approximately 30 days and one-year post-TAVR.
Results
On echocardiogram 30 days and one-year post-TAVR, there was a reduction in LV mass index from 132 g/m² to 110 g/m² (95%CI: 98-122; p=0.01) and 118 g/m² (95%CI: 102-133; p=0.03), and a reduction in relative wall thickness from 0.54 to 0.49 (95%CI: 0.46-0.52; p=0.05) and 0.44 (95%CI: 0.38-0.49; p=0.03), respectively. Doppler velocity indices (DVI) increased from 0.24 to 0.61 (95%CI: 0.49-0.73; p<0.001) and 0.57 (95%CI: 0.48-0.65; p<0.001). Expected improvement in aortic valve velocities and gradients were observed post-TAVR.
Conclusions
Following TAVR, LV remodeling can be observed as early as 30 days. This is demonstrated by a reduction in LV mass index and relative wall thickness in conjugation with an anticipated improvement in valvular flow patterns and flow across the aortic valve.
Stress-induced cardiomyopathy (SIC) is associated with varying etiologies. We present a case of a 65-yearold female with recurrent SIC secondary to seizures who presented in cardiogenic shock requiring mechanical circulatory support using an Impella CP via the right axillary approach.
Introduction: EDKA poses a diagnostic challenge in the setting of normal glucose.Case :79-year old Caucasian male with a past medical history of CAD, diabetes mellitus and ischemic cardiomyopathy presented after a cardiac arrest. The patient had been experiencing intermittent chest pain for two weeks prior to admission. He experienced sudden loss of consciousness while watching TV. Upon EMS arrival, he was found to be in ventricular fibrillation for which 1 shock was delivered, followed by asystole. Return of spontaneous circulation was achieved after 2 rounds of CPR and epinephrine. Patient was then intubated and brought to the hospital. Labs on admission were significant for anion gap metabolic acidosis with a pH of 7.15,pCO2 37, HCO3 12, anion gap 21. elevated beta-hydroxybutyrate of 6.7, and a blood glucose of 134. Urinalysis was significant for 3+ glucose and 3+ ketones. Patient's home diabetic regimen included Sitagliptin 100 mg daily, Dapagliflozin 10 mg daily and Metformin 1000 mg twice a day. Endocrinology was consulted for euglycemic diabetic ketoacidosis (EDKA) in the setting of Dapagliflozin use. The patient was treated with intravenous fluids and insulin drip with subsequent resolution in acidosis. Discussion:Diabetic ketoacidosis (DKA) is defined as a combination of hyperglycemia (glucose > 250 mg/dL), acidosis (pH < 7.3, bicarbonate < 15 mEq/L) and ketosis. Euglycemic DKA (EDKA) is a form of DKA that presents with the same clinical picture but in the setting of normal serum glucose. Common causes of EDKA include low caloric intake, fasting, pregnancy, pancreatitis, cocaine use, diarrhea, emesis, insulin pump use and recently, SGLT2 inhibitors, as seen in this case. SLGT2 inhibitors work by inhibiting the resorption of glucose in the proximal tubules and thereby increase glucose excretion. The link between EDKA and SGLT2 is thought to be the lowering of insulin production and increase in glucagon secretion which promotes a shift of glucose to fat metabolism and stimulation of ketogenesis. The treatment of EDKA is the same for DKA which includes aggressive fluid hydration, insulin and electrolyte repletion and monitoring labs to assess for resolution of acidosis.
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