BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Pote...BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Potential novel predictors of post-TAVR PPM,like QRS duration,QTc prolongation,and supraventricular arrhythmias,have been poorly studied.AIM To evaluate the effects of baseline nonspecific interventricular conduction delay and supraventricular arrhythmia on post-TAVR PPM requirement and determine the impact of PPM implantation on clinical outcomes.METHODS RESULTS Out of the 357 patients that met inclusion criteria,the mean age was 80 years,188(52.7%)were male,and 57(16%)had a PPM implantation.Baseline demographics,valve type,and cardiovascular risk factors were similar except for type II diabetes mellitus(DM),which was more prevalent in the PPM cohort(59.6%vs 40.7%;P=0.009).The PPM cohort had a significantly higher rate of pre-procedure right bundle branch block,prolonged QRS>120 ms,prolonged QTc>470 ms,and supraventricular arrhythmias.There was a consistently significant increase in the odds ratio(OR)of PPM implantation for every 20 ms increase in the QRS duration above 100 ms:QRS 101-120[OR:2.44;confidence intervals(CI):1.14-5.25;P=0.022],QRS 121-140(OR:3.25;CI:1.32-7.98;P=0.010),QRS 141-160(OR:6.98;CI:3.10-15.61;P<0.001).After model adjustment for baseline risk factors,the OR remained significant for type II DM(aOR:2.16;CI:1.18-3.94;P=0.012),QRS>120(aOR:2.18;CI:1.02-4.66;P=0.045)and marginally significant for supraventricular arrhythmias(aOR:1.82;CI:0.97-3.42;P=0.062).The PPM cohort had a higher adjusted OR of heart failure(HF)hospitalization(aOR:2.2;CI:1.1-4.3;P=0.022)and nonfatal myocardial infarction(MI)(aOR:3.9;CI:1.1-14;P=0.031)without any difference in mortality(aOR:1.1;CI:0.5-2.7;P=0.796)at one year.CONCLUSION Pre-TAVR type II DM and QRS duration>120,regardless of the presence of bundle branch blocks,are predictors of post-TAVR PPM.At 1-year post-TAVR,patients with PPM have higher odds of HF ho展开更多
Background： Mitral valve （MV） repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for dege...Background： Mitral valve （MV） repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for degenerative mitral regurgitation （MR）. However, there has been limited infomlation regarding tile echocardiographic follow-up of these patients. The present study was therefore to evaluate the echocardiographic follow-up outcomes after robotic MV repair in patients with MR due to degenerative disease of the MV. Methods： A retrospective analysis was undertaken using data from the echocardiographic database of our department. Between March 2007 and February 2015, 84 patients with degenerative MR underwent robotic MV repair. The repair techniques included leaflet resection in 67 patients （79.8%）, artificial chordae in 20 （23.8%）, and ring annuloplasty in 79 （94.1%）. Eighty-one （96.4%） of the 84 patients were eligible for echocardiographic follow-up assessment, and no patients were lost to follow-up. Results： At a median echocardiographic follow-up of 36.0 months （interquartile range 14.3-59.4 months）, lbur patients （4.9%） developed recurrent mild MR, and no patients had more than mild MR. Mean MR grade, leli atrial diameter （LAD）, left ventricular end-diastolic diameter （LVEDD）, and let1 ventricular ejection fraction （LVEF） were significantly decreased when compared with preoperative values. Mean MR grade decreased from 3.96 ± 0.13 to 0.17 ± 0.49 （Z- -8.456, P 〈 0.001 ）, LAD from 43.8 ± 5.9 to 35.5 ± 3.8 mm （I - 15.131, P 〈 0.001 ）, LVEDD fiom 51.0 ± 5.0 to 43.3 ± 2.2 mm （t = 14.481, P 〈 0.001 ）, and LV EF l＇rom 67.3 ± 7.0% to 63.9 ± 5.1% （t = 4.585, P 〈 0.001 ）. Conclusion： Robotic MV repair for MR due to degenerative disease is associated with a low rate of recurrent MR, and a significant improvement in MR grade, LAD, and LVEDD, but a significant decrease in LVEF at echocardiographic follow-up.展开更多
Background Understanding the interaction between the mitral valve(MV)and the left ventricle(LV)is very important in assessing cardiac pump function,especially when the MV is dysfunctional.Such dysfunction is a major m...Background Understanding the interaction between the mitral valve(MV)and the left ventricle(LV)is very important in assessing cardiac pump function,especially when the MV is dysfunctional.Such dysfunction is a major medical problem owing to the essential role of the MV in cardiac pump function.Computational modelling can provide new approaches to gain insight into the functions of the MV and LV.Methods In this study,a previously developed LV-MV model was used to study cardiac dynamics of MV leaflets under normal and pathological conditions,including hypertrophic cardiomyopathy(HOCM)and calcification of the valve.The coupled LV-MV model was implemented using a hybrid immersed boundary/finite element method to enable assessment of MV haemodynamic performance.Constitutive parameters of the HOCM and calcified valves were inversely determined from published experimental data.The LV compensation mechanism was further studied in the case of the calcified MV.Results Our results showed that MV dynamics and LV pump function could be greatly affected by MV pathology.For example,the HOCM case showed bulged MV leaflets at the systole owing to low stiffness,and the calcified MV was associated with impaired diastolic filling and much-reduced stroke volume.We further demonstrated that either increasing the LV filling pressure or increasing myocardial contractility could enable a calcified valve to achieve near-normal pump function.Conclusion The modelling approach developed in this study may deepen our understanding of the interactions between the MV and the LV and help in risk stratification of heart valve disease and in silico treatment planning by exploring intrinsic compensation mechanisms.展开更多
文摘BACKGROUND Conduction and rhythm abnormalities requiring permanent pacemakers(PPM)are short-term complications following transcatheter aortic valve replacement(TAVR),and their clinical outcomes remain conflicting.Potential novel predictors of post-TAVR PPM,like QRS duration,QTc prolongation,and supraventricular arrhythmias,have been poorly studied.AIM To evaluate the effects of baseline nonspecific interventricular conduction delay and supraventricular arrhythmia on post-TAVR PPM requirement and determine the impact of PPM implantation on clinical outcomes.METHODS RESULTS Out of the 357 patients that met inclusion criteria,the mean age was 80 years,188(52.7%)were male,and 57(16%)had a PPM implantation.Baseline demographics,valve type,and cardiovascular risk factors were similar except for type II diabetes mellitus(DM),which was more prevalent in the PPM cohort(59.6%vs 40.7%;P=0.009).The PPM cohort had a significantly higher rate of pre-procedure right bundle branch block,prolonged QRS>120 ms,prolonged QTc>470 ms,and supraventricular arrhythmias.There was a consistently significant increase in the odds ratio(OR)of PPM implantation for every 20 ms increase in the QRS duration above 100 ms:QRS 101-120[OR:2.44;confidence intervals(CI):1.14-5.25;P=0.022],QRS 121-140(OR:3.25;CI:1.32-7.98;P=0.010),QRS 141-160(OR:6.98;CI:3.10-15.61;P<0.001).After model adjustment for baseline risk factors,the OR remained significant for type II DM(aOR:2.16;CI:1.18-3.94;P=0.012),QRS>120(aOR:2.18;CI:1.02-4.66;P=0.045)and marginally significant for supraventricular arrhythmias(aOR:1.82;CI:0.97-3.42;P=0.062).The PPM cohort had a higher adjusted OR of heart failure(HF)hospitalization(aOR:2.2;CI:1.1-4.3;P=0.022)and nonfatal myocardial infarction(MI)(aOR:3.9;CI:1.1-14;P=0.031)without any difference in mortality(aOR:1.1;CI:0.5-2.7;P=0.796)at one year.CONCLUSION Pre-TAVR type II DM and QRS duration>120,regardless of the presence of bundle branch blocks,are predictors of post-TAVR PPM.At 1-year post-TAVR,patients with PPM have higher odds of HF ho
文摘Background： Mitral valve （MV） repair can now be carried out through small incisions with the use of robotic assistance. Previous reports have demonstrated the excellent clinical result of robotic MV repair for degenerative mitral regurgitation （MR）. However, there has been limited infomlation regarding tile echocardiographic follow-up of these patients. The present study was therefore to evaluate the echocardiographic follow-up outcomes after robotic MV repair in patients with MR due to degenerative disease of the MV. Methods： A retrospective analysis was undertaken using data from the echocardiographic database of our department. Between March 2007 and February 2015, 84 patients with degenerative MR underwent robotic MV repair. The repair techniques included leaflet resection in 67 patients （79.8%）, artificial chordae in 20 （23.8%）, and ring annuloplasty in 79 （94.1%）. Eighty-one （96.4%） of the 84 patients were eligible for echocardiographic follow-up assessment, and no patients were lost to follow-up. Results： At a median echocardiographic follow-up of 36.0 months （interquartile range 14.3-59.4 months）, lbur patients （4.9%） developed recurrent mild MR, and no patients had more than mild MR. Mean MR grade, leli atrial diameter （LAD）, left ventricular end-diastolic diameter （LVEDD）, and let1 ventricular ejection fraction （LVEF） were significantly decreased when compared with preoperative values. Mean MR grade decreased from 3.96 ± 0.13 to 0.17 ± 0.49 （Z- -8.456, P 〈 0.001 ）, LAD from 43.8 ± 5.9 to 35.5 ± 3.8 mm （I - 15.131, P 〈 0.001 ）, LVEDD fiom 51.0 ± 5.0 to 43.3 ± 2.2 mm （t = 14.481, P 〈 0.001 ）, and LV EF l＇rom 67.3 ± 7.0% to 63.9 ± 5.1% （t = 4.585, P 〈 0.001 ）. Conclusion： Robotic MV repair for MR due to degenerative disease is associated with a low rate of recurrent MR, and a significant improvement in MR grade, LAD, and LVEDD, but a significant decrease in LVEF at echocardiographic follow-up.
基金This work was supported by the National Natural Science Foundation of China(Grant Nos.11871399,12271440)the UK EPSRC(Grant Nos.EP/S030875,EP/S014284/1,EP/S020950/1,EP/R511705/1,and EP/T017899/1).
文摘Background Understanding the interaction between the mitral valve(MV)and the left ventricle(LV)is very important in assessing cardiac pump function,especially when the MV is dysfunctional.Such dysfunction is a major medical problem owing to the essential role of the MV in cardiac pump function.Computational modelling can provide new approaches to gain insight into the functions of the MV and LV.Methods In this study,a previously developed LV-MV model was used to study cardiac dynamics of MV leaflets under normal and pathological conditions,including hypertrophic cardiomyopathy(HOCM)and calcification of the valve.The coupled LV-MV model was implemented using a hybrid immersed boundary/finite element method to enable assessment of MV haemodynamic performance.Constitutive parameters of the HOCM and calcified valves were inversely determined from published experimental data.The LV compensation mechanism was further studied in the case of the calcified MV.Results Our results showed that MV dynamics and LV pump function could be greatly affected by MV pathology.For example,the HOCM case showed bulged MV leaflets at the systole owing to low stiffness,and the calcified MV was associated with impaired diastolic filling and much-reduced stroke volume.We further demonstrated that either increasing the LV filling pressure or increasing myocardial contractility could enable a calcified valve to achieve near-normal pump function.Conclusion The modelling approach developed in this study may deepen our understanding of the interactions between the MV and the LV and help in risk stratification of heart valve disease and in silico treatment planning by exploring intrinsic compensation mechanisms.
