Viscoelastic parameters were evaluated in 169 consecutive male patients with clinical signs of coronary heart disease. The patients were classified according to the extent of coronary artery stenosis. Levels of blood viscosity, erythrocyte aggregation, and plasma viscosity were elevated in patients with extensive coronary vessel disease. However, the differences between the several groups were not statistically significant. The increase of hemorheologic parameters was mainly due to high hematocrit, fibrinogen, and cholesterol concentrations. There was a significant correlation between plasma fibrinogen values and plasma viscosity levels. Blood viscosity and erythrocyte aggregation can be described by multiple linear regression as a function of the sum of log hematocrit, fibrinogen, cholesterol, and alpha 2-macroglobulin.
Evaluation of prosthesis-patient mismatch (P-PM) after transcatheter aortic valve replacement (TAVR) by transthoracic echocardiography (TTE) has provided conflicting results regarding its impact on outcomes. Whether post-TAVR computed tomography angiography (CTA) evaluation of P-PM can improve our understanding is unknown. We aimed to evaluate the inter-modality (TTE vs. CTA) agreement, inter-valve platform (balloon-expanding valve [BEV] vs. self-expandable valve [SEV]) differences in P-PM severity, and outcomes related to P-PM after TAVR. Methods: We analyzed patients with both CTA and TTE before and after TAVR. Indexed effective orifice area was calculated using two methods: TTE-derived left ventricular outflow tract (LVOT) area from measured diameter and post-TAVR CTA-measured area. Body size specific cut-offs for P-PM severity were used: for body mass index (BMI) < 30 kg/m 2 , moderate ¼ 0.66-0.85 cm 2 /m 2 and severe 0.65 cm 2 /m 2 ; for BMI !30 kg/m 2 , moderate ¼ 0.56-0.70 cm 2 /m 2 and severe 0.55 cm 2 /m 2 . Results: A total of 447 patients were included (median age, 83 years; 54% male). The prevalence of P-PM (moderate or severe) was lower with CTA vs. TTE (3.5% vs. 19.5%, p < 0.001). The prevalence of P-PM measured by TTE was more common in BEV compared to SEV (p ¼ 0.002), while CTA assessment showed no difference in P-PM incidence and severity between TAVR platforms (p ¼ 0.40). In multivariable analysis, CTA-defined but not TTE-defined P-PM was associated with mortality after TAVR (HR:3.97; 95%CI,1.55-10.2; p ¼ 0.004). Both CTAdefined and TTE-defined P-PM were associated with the composite of death and heart failure rehospitalization. Conclusion: Although post-TAVR CTA substantially downgraded the prevalence of P-PM compared to TTE, it identified a subset of patients with clinically relevant P-PM which associated with outcomes.
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