The morbidity of coronary heart disease (CHD) is high, and the prognosis is unfavorable. Fibrinogen is both coagulation and inflammation factor, which has important influence on the occurrence and development of CHD. Previous studies reported that fibrinogen had relevance with traditional risk factors of CHD such as hypertension, diabetes and subclinical diseases such as left ventricular hypertrophy. The incidence of CHD increases with the fibrinogen level increasing. The fibrinogen level is higher in patients with CHD than that in healthy people. The coronary stenosis degree is heavier and the lesion is wider in patients with hyperfibrinogenemia. But the effects of fibrinogen on the secondary prevention of CHD is controversial. This paper summarized research progress based on the new understanding to fibrinogen on CHD recently.
Objective To search and review the best clinical evidence to compare the clinical therapeutic effects and safety between TAVR and SAVR, thereby guiding its clinical use and providing references of treatments for such patients. Methods EMbase (1974～2016), MEDLINE (1996～2016) and The Cochrane Library (Issue 5, 2016) were systematically retrieved to collect randomized control trials, case-control studies and meta-analyses. Then, we assessed the quality of all the evidences to develop treatments based on those evidences and the situations of such patients. Results We identified 21 articles, including 2 articles of meta-analysis. With regard to the mortality and incidence of cardiovascular events, TAVR was not worse than SAVR. In addition, TAVR was more dominant than SAVR for patients who combined more basic diseases. Conclusion TAVR is one of the effective treatments for most patients with severe AS after sufficient assessment.
Aortic valve calcification (AVC) is one of the major causes of aortic stenosis (AS), and its pathogenesis is related to inflammation infiltration, lipid deposition, endothelial damage, calcification osteogenesis and angiogenesis. Previous studies have shown that AVC is associated with the severity of AS, the incidence of cardiovascular events, mortality, and surgical outcomes. The quantitative analysis of AVC using imaging methods not only has diagnostic value for AS, but also has guiding significance for the selection of surgical timing, assessment of surgical risk, and prognosis prediction. This article comprehensively elaborates on the methods and values of evaluating AVC using echocardiography, CT, and positron emission tomography.
Transcatheter aortic valve replacement (TAVR) has become a well-established treatment for patients with severe aortic stenosis. At present, TAVR has already shown noninferiority and even superiority to surgical aortic valve replacement (SAVR) in patients deemed at high or intermediate risk for SAVR. However, the long-term follow-up results of the randomized controlled trials comparing the efficacy and safety between TAVR and SAVR are still lacking in those patients who are at low risk for SAVR. This paper gives an overview and reviews results of the Evolut Low Risk trial and interprets its implications for transcatheter therapy in aortic valve diseases.
According to new clinical evidence, the European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) updated and published 2021 ESC/EACTS guidelines for the management of valvular heart disease. This new guideline gives recommendation for clinical assessment, internal treatment and intervention for patients with valvular heart disease with/without comorbidities, which is a globally approbatory reference for clinical practice. This article summarized the updated contents of the new guideline in terms of transcatheter therapy for valvular heart disease.
Objective To investigate the role and mechanism of peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α) in the activation of aortic valve interstitial cells (AVICs) in aortic stenosis. Methods Isolating primary AVICs and stimulating their activation with transforming growth factor β1 (TGF-β1, 30 ng/mL), the expression of PGC-1α was detected. The activation of AVICs induced by TGF-β1 was observed after overexpression of PGC-1α by adenovirus or inhibition of PGC-1α function by GW9662. The possible downstream molecular mechanism of PGC-1α in AVICs activation was screened. Finally, the phenotype was further verified in primary human AVICs. Results The expression of PGC-1α decreased after the activation of AVICs induced by TGF-β1 (control group: 1.00±0.18; 24 h: 0.31±0.10; 48 h: 0.32±0.06; 72 h: 0.20±0.07; P<0.05). Specific overexpression of PGC-1α by adenovirus inhibited the activation of AVICs induced by TGF-β1 stimulation (periostin: 3.17±0.64 vs. 1.45±0.54, P<0.05; α-smooth muscle actin: 0.77±0.11 vs. 0.28±0.06, P<0.05). On the contrary, inhibition of PGC-1α function by GW9662 promoted the activation of AVICs (periostin: 2.20±0.68 vs. 7.99±2.50, P<0.05). Subsequently, it was found that PGC-1α might inhibit the activation of AVICs through downregulating the expression of calcium/calmodulin-dependent protein kinase (CAMK1δ) (0.97±0.04 vs. 0.74±0.11, P<0.05), and downregulating the expression of CAMK1δ alleviated the activation of AVICs (periostin: 1.76±0.11 vs. 0.99±0.20, P<0.05). The possible mechanism was that the activation of mammalian target of rapamycin (mTOR) signaling pathway was inhibited by reducing the accumulation of reactive oxygen species (ROS) (778.3±139.4 vs. 159.3±43.2, P<0.05). Finally, the protective effect of PGC-1α overexpression was verified in the activated phenotype of human AVICs (periostin: 2.73±0.53 vs. 1.63±0.14, P<0.05; connective tissue growth factor: 1.27±0.04 vs. 0.48±0.09, P<0.05). Conclusions The expression of PGC-1α significantly decreases during the activation of AVICs induced by TGF-β1. The overexpression of PGC-1α significantly inhibites the activation of AVICs, suggesting that PGC-1α plays a protective role in the activation of AVICs. The possible mechanism is that PGC-1α can inhibit the activation of CAMK1δ-ROS-mTOR pathway. In conclusion, interventions based on PGC-1α expression levels are new potential therapeutic targets for aortic stenosis.
Transcatheter aortic valve replacement (TAVR) for aortic stenosis has been confirmed to be safe and efficient, and its status has gradually increased with the continuous updating of guidelines. But for severe pure aortic valve regurgitation, it has long been considered a relative contraindication to TAVR. However, many elderly, high-risk patients with pure aortic regurgitation have also been treated with TAVR and prognosis was improved through off-label use of transcatheter heart valves due to contraindications to surgery or intolerance. But because of the complexity and challenging anatomic features, high technical requirements, limited device success rate, high rate of complications, and lack of randomized controlled studies to confirm its safety and efficacy, TAVR treatment of pure aortic regurgitation has been evolving in a debate. In recent years, with the application of new-generation valves and an increasing number of studies, some new insights have been gained regarding TAVR for severe aortic regurgitation, and this article will review the progress of research on TAVR for severe pure aortic regurgitation.
At present, transeatheter aortic valve replacement is an effective treatment for elderly patients with severe aortic valve stenosis. Cardiac rehabilitation after transeatheter aortic valve replacement can effectively improve cardiopulmonary endurance and exercise capacity, and improve the quality of life. In order to better carry out cardiac rehabilitation for patients undergoing transeatheter aortic valve replacement, the Structural Heart Disease Professional Committee of Chinese College of Cardiovascular Physicians has drawn up Expert Consensus on Motor Rehabilitation after Transeatheter Aortic Valve Replacement. This consensus mainly elaborates the specific implementation process and methods of cardiac rehabilitation from three time periods of perioperative rehabilitation, outpatient rehabilitation and home rehabilitation. This article will interpret the main content of the consensus.
At present, interventional therapy for structural heart disease is in a period of vigorous development. Among them, transcatheter aortic valve replacement, as a representative of the interventional treatment of heart valve disease, has made rapid progress, which is a bright spot in the field of cardiovascular disease. The future development of transcatheter tricuspid valve repair/replacement is also promising. With the availability of important clinical evidence, the indications of transcatheter aortic valve replacement have been extended to the full risk range of severe aortic stenosis. More and more data showed that transcatheter mitral and tricuspid valve interventions could effectively alleviate patients’ symptoms and improve their prognosis. Transcatheter valve interventions have developed rapidly and have made tremendous progress in China. This article will review and interpret the important progress in the field of transcatheter valve interventions.
Transcatheter aortic valve replacement (TAVR) developed rapidly since firstly introduced to clinical practice in 2002. In 2015, Experts Consensus for Transeatheter Aortic Valve Replacement (abbreviated as the Consensus) helped TAVR develop normatively and safely in China. This article interpreted the Consensus in combination of new evolutions of TAVR field: first, the indications of TAVR expand from inoperative and high risk patients to the intermediate risk patients; second, although the Consensus recommended pre-dilation with balloon of modest size, the necessity of pre-dilation is under debate; third, the Consensus pointed out main complications of TAVR, and the main strategies to avoid complications are careful pre-procedural analysis and development of new device; fourth, our experts had made outstanding contribution to TAVR in the treatment of patients with bicuspid aortic valve, which still has many problems to be solved urgently.