Diabetes mellitus as a risk factor for aortic stenosis: from new mechanisms to clinical implications

Natorska, Joanna

doi:10.33963/kp.a2021.0137

Cited by 11 publications

(11 citation statements)

References 76 publications

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“…Due to the aging population and increasing number of elderly patients with severe AS, the problem of their treatment is growing [2,6,7]. More importantly, concomitant CAD and diabetes mellitus are highly prevalent and may affect the outcomes for those patients [2][3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…As calcific aortic valve stenosis (AS) and coronary artery disease (CAD) share common risk factors, CAD is quite prevalent among patients with severe AS [1][2][3][4][5][6]. More importantly, CAD is associated with worse outcomes of transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in patients with severe AS [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Impact of diabetes mellitus on the diagnostic performance of fractional flow reserve in patients with severe aortic stenosis

et al. 2022

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Background:The validity of functional assessment of coronary artery disease with fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR) in patients with severe aortic stenosis (AS) might be affected by AS per se and other factors, including diabetes mellitus. Aims:We aimed to evaluate the impact of diabetic status on FFR performance in severe AS. Methods:The functional significance of 416 stenoses of intermediate angiographic severity in 221 patients with severe AS was assessed with iFR and FFR. Patients treated with insulin or oral hypoglycemic agents were classified as diabetic patients.Results: Of 221 enrolled patients, 68 (32.1%) patients were diabetic. A total of 128 (30.8%) lesions in patients with and 288 in patients without diabetes mellitus were assessed. The mean (SD) FFR was 0.85 (0.07), and iFR was 0.90 (0.04) with no difference between nondiabetic and diabetic patients. Good agreement between iFR and FFR was confirmed for non-diabetic (ICC, 0.83 [95% confidence interval, CI, 0.79-0.86]) and diabetic (ICC, 0.82 [95% CI, 0.76-0.87]) patients. Among patients without diabetes mellitus, the optimal cutoff value for FFR to detect iFR ≤0.89 was 0.81 with sensitivity and specificity of 96.6% and 100.0%. The optimal cutoff value for FFR to detect iFR ≤0.89 for diabetic patients was 0.83 with sensitivity and specificity of 98.0% and 100.0%. Conclusions:In patients with severe AS, FFR correlates well with iFR. However, the optimal threshold for FFR to identify significant ischemia (iFR ≤0.89) in those patients may differ from the standard threshold of FFR ≤0.80 and might be affected by the diabetic status.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of diabetes mellitus on the diagnostic performance of fractional flow reserve in patients with severe aortic stenosis

et al. 2022

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“…Its development is usually time-extended, attends to the graft (material, methods of preparation, viability, correctness of implantation, tissue fatigue), patient (age, actual and at operation, history of rheumatic disease, infections, presence of immunologic complexes, genetics, diabetes, arterial hypertension, atherosclerosis, metabolic and hormonal function, renal insufficiency, aortic root distension, diseases of connective tissue, the influence of drugs and their effectiveness), environmental factors, etc. [3,6,46,47,55,67,78,85,86]. An advanced phase of biologic valves degeneration is mineralization, interrelated with calcium phosphates It starts in the cytosol and extracellular matrix, where occur centers of mineralization, as "hole zones" in the structure of collagen, areas of damage of collagen and elastin fibers, apoptotic cells, fibrinogen debris; where may be bound ions and substances.…”

Section: Degeneration and Mineralizationmentioning

confidence: 99%

“…The visible mineralization contains calcium phosphates and calcium-cholesterol concretions, as grains, multiform accumulations, frequently massive, highly affecting the valve function [3,42,51,52,67,[85][86][87][88]. In contrary to the native valves, mineralization of AVA embraces mostly areas of sutures, aortic wall, while the distal rims of leaflets may remain free from visible lesions [6]; Figure 2.…”

Section: Degeneration and Mineralizationmentioning

confidence: 99%

Perspective Chapter: Role of Frozen Allografts in Aortic Valve Surgery

Pfitzner¹

2022

Aortic Stenosis - Recent Advances, New Perspectives and Applications

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Although, the mechanical and bioprosthetic valves, of good parameters, availability and easy of implantation, are universally applied as substitutes for failed aortic valve, the usefulness of aortic valve allografts (AVA); natural, viable, unstented human valves, is still considered. The essential technology for their preparation is cryopreservation, which allows for long-term storage. Hemodynamic functions of AVA are like of native valve, they do not produce hemolysis nor thromboembolism. Being markedly resistant for infection, AVA are recommended as the optimal grafts for severe endocarditis. Indeed, there exist some disadvantages, such as low availability, need for a specialized laboratories; implantation may be a challenge. Therefore, AVA are not recommended for routine use. Their important limitation is durability, affected with degenerative processes, characteristic of biological implants. Nevertheless, AVA presented satisfactory clinical results after 10, 20, and more years. This chapter have been discussed in detail the principal issues, connected with AVA, including preparation technologies, indications for use, surgical techniques, and first of all, clinical results.

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“…The average prevalence of severe aortic valve stenosis is estimated to be 0.2% in patients between 55 and 64 years of age. It increases with age, reaching approximately 3% at 75-80 years of age and even 10% after 80 years of age [1]. Severe, symptomatic aortic stenosis is associated with death of at least half of patients within 2 years after the onset of first symptoms.…”

Section: Introductionmentioning

confidence: 99%

Acute kidney injury as the most important predictor of poor prognosis after interventional treatment for aortic stenosis

et al. 2022

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Background: Aortic stenosis (AS) is the most common acquired valvular disease. There are two methods of interventional treatment: surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). The choice between SAVR and TAVI depends on the assessment of individual perioperative risk and long-term treatment outcomes. It is essential to identify factors that may influence the outcomes of the treatment to minimize their negative effects. Aims:The study aimed to identify the most important risk factor which affects treatment outcomes in patients with AS undergoing SAVR/TAVI. Methods:This study reviewed retrospectively patients with AS who underwent SAVR or TAVI. The primary outcomes included incidences of major adverse cardiovascular events (MACE) defined as cardiovascular death, stroke, and hospitalization for cardiovascular issues assessed over a one-year follow-up period. An occurrence of postprocedural AKI (acute kidney injury) was identified as an independent predictor of MACE. Results:The study included 78 patients, with the same number of subjects in each group (SAVR/TAVI [n = 39]). Twenty-nine patients developed AKI. It was similar in both groups (SAVR [n = 15]; TAVR [n = 14]). In the SAVR group, 13 (33%) patients developed at least one MACE compared to 5 (13%) patients in the TAVI group. AKI and the type of procedure (SAVR) were shown to be significantly and independently associated with the development of MACE (P = 0.01 and P = 0.03, respectively) as shown in the Cox multivariable regression model. Conclusions:Our study demonstrated that AKI is the strongest predictor of major adverse cardiovascular events after using both methods of aortic valve replacement (SAVR/TAVI).

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Diabetes mellitus as a risk factor for aortic stenosis: from new mechanisms to clinical implications

Cited by 11 publications

References 76 publications

Impact of diabetes mellitus on the diagnostic performance of fractional flow reserve in patients with severe aortic stenosis

Impact of diabetes mellitus on the diagnostic performance of fractional flow reserve in patients with severe aortic stenosis

Perspective Chapter: Role of Frozen Allografts in Aortic Valve Surgery

Acute kidney injury as the most important predictor of poor prognosis after interventional treatment for aortic stenosis

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