Coronary artery disease (CAD) is highly prevalent in patients with severe aortic stenosis (AS). The management of CAD is a central aspect of the work-up of patients undergoing transcatheter aortic valve implantation (TAVI), but few data are available on this field and the best percutaneous coronary intervention (PCI) practice is yet to be determined. A major challenge is the ability to elucidate the severity of bystander coronary stenosis independently of the severity of aortic valve stenosis and subsequent impact on blood flow. The prognostic role of CAD in patients undergoing TAVI is being still debated and the benefits and the best timing of PCI in this context are currently under evaluation. Additionally, PCI in the setting of advanced AS poses some technical challenges, due to the complex anatomy, risk of hemodynamic instability, and the increased risk of bleeding complications. This review aims to provide a comprehensive synthesis of the available literature on myocardial revascularization in patients with severe AS undergoing TAVI. This work can assist the Heart Team in individualizing decisions about myocardial revascularization, taking into account available diagnostic tools as well as the risks and benefits.
Purpose/Background/Objectives: Acute kidney injury (AKI) is a serious postoperative complication. Increased arterial stiffness has been shown to be an independent risk factor for cardiovascular events. Our aim was to investigate whether arterial stiffness is a predictor of AKI in patients following surgical aortic valve replacement (SAVR). Methods: Eighty-four patients (mean age 72 ± 8 years, 34 females) with moderate to severe aortic stenosis undergoing SAVR were included. As indicators of arterial stiffness aortic hemodynamics, carotid-femoral pulse wave velocity (cfPWV) and brachial-ankle pulse wave velocity (baPWV) were assessed prior to surgery. Renal dysfunction was defined when eGFR was below 60 ml/min (n = 28, 33%). AKI was defined using KDIQO criteria. Results: Twelve patients (14%) developed AKI. There was no significant difference in aortic hemodynamics and cfPWV between the two groups. baPWV significantly correlated with AKI (r = 0.313, p = 0.004). In logistic regression analysis, increase of baPWV per 1 Standard Deviation (Odds Ratio [OR] = 2.76, 95% Confidence intervals [CI]: 1.25-6.11, p = 0.012) and presence of renal dysfunction (OR = 14.93, 95% CI: 2.55-87.32, p = 0.003) were associated with higher risk for AKI even after adjustment for age, gender, systolic blood pressure and diabetes. baPWV was a stronger predictor of AKI than baseline creatinine (Area under the curve [AUC] 0.68, 95% CI: 0.52-0.84, p = 0.05 vs AUC 0.61, 95% CI: 0.46-0.77, p = 0.21; p < 0.05). Conclusion: baPWV could be considered as a useful predictive biomarker for AKI after SAVR, especially in patients with renal dysfunction prior to surgery.
AimArterial involvement has been implicated in the coronavirus disease of 2019 (COVID-19). 18F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging is a valuable tool for the assessment of disease severity in different types of vasculitis and is a predictor of outcome. We sought to prospectively assess the presence of aortic inflammation and its time-dependent trend by measuring the 18-FDG uptake in PET/CT in patients with severe or critical COVID-19.Methods In this pilot case control study, we recruited 20 patients, who were admitted with severe or critical COVID-19 illness. Patients underwent imaging between 20 to 120 days after hospital admission. Ten age- and sex-matched individuals with prior history of malignancy but free of active disease served as the control group. Arterial inflammation was assessed by measuring 18-FDG uptake in PET/CT and calculating aortic target to blood ratio (TBR).ResultsThere was a significant correlation between aortic TBR values and time distance from diagnosis to 18F-FDG PET/CT scan (-rho- =0.547, p=0.015) even after adjustment for confounders (p=0.002). Patients who were scanned less than 60 days (median) from diagnosis had significantly higher TBR values compared to patients examined more than 60 days post-diagnosis (1.55 [1.47-1.61] vs 1.40 [1.33-1.45], respectively, p=0.013).ConclusionThis is the first study suggesting that 18 FDG PET/CT imaging could be used for assessment of arterial inflammation in patients with severe/critical COVID-19. These findings may have important implications for the understanding of the pathophysiology and the course of the disease and for improving our preventive and therapeutic strategies.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.