Seeking relationship between calcium metabolism and coronary artery disease associated with calcific aortic valve. The degree of endothelial dysfunction as a marker of significant coronary artery disease associated with calcific aortic valve.

Hledání vztahu mezi metabolismem kalcia a koronární nemocí spojenou s kalcifikací aortální chlopně. Stupeň endoteliální dysfunkce jako marker významné koronární nemoci spojené s kalcifikací aortální chlopně.

• MeSH
• Aortic Valve physiopathology   MeSH
• Biomarkers analysis   MeSH
• Calcification, Physiologic MeSH
• Coronary Artery Disease prevention & control   MeSH
• Calcium Metabolism Disorders MeSH
• Secondary Prevention MeSH

• Conspectus
• Patologie. Klinická medicína
• NML Fields
• kardiologie
• angiologie
• vnitřní lékařství
• NML Publication type
• závěrečné zprávy o řešení grantu IGA MZ ČR

• Publication type
• Comment MeSH

• MeSH
• Diagnostic Techniques, Cardiovascular classification   utilization   MeSH
• Echocardiography methods   utilization   MeSH
• Atrial Fibrillation diagnosis   etiology   surgery   MeSH
• Calcification, Physiologic physiology   drug effects   MeSH
• Cardiovascular Surgical Procedures methods   utilization   MeSH
• Comorbidity MeSH
• Humans MeSH
• Aged MeSH
• Carotid Stenosis diagnosis   surgery   therapy   MeSH
• Thyrotoxicosis diagnosis   etiology   surgery   MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

Souhrn: Doporučení odborných společností, běžněji nazývaná guidelines podle své anglické podoby, představují pomoc pro praktické i odborné lékaře. Jsou doporučením, nikoliv však zákonnou normou. Kardiologické společnosti vydaly v posledních letech 3 nová doporučení. Americká ACC/AHA v roce 2006, evropská ESC v roce 2007 a česká ČKS také v roce 2007. Doporučené postupy v diagnostice i terapii jsou uvedeny ve formě tříd I až III podle vhodnosti procedury a je určena také váha důkazů ve skupinách A až C. Je zdůrazněna snaha kardiologických společností o čistotu guidelines. Vyžadují totiž od autorů prohlášení, že nemají žádný vztah k organizaci, instituci nebo firmě, který by mohl být v současnosti nebo budoucnosti považován za střet zájmů. Je zmíněn rychlý rozvoj poznání, který nedovoluje uvedeným guidelines postihnout změny v katetrizační terapii obou nejčastějších chlopenních vad.

• MeSH
• Aortic Valve Stenosis diagnosis   therapy   MeSH
• Humans MeSH
• Mitral Valve Insufficiency diagnosis   therapy   MeSH
• Practice Guidelines as Topic MeSH
• Societies, Medical MeSH
• Check Tag
• Humans MeSH

Aortální stenóza spolu s mitrální regurgitací je nejčastější chlopenní vadou. Je také nejčastěji vadou operovanou. Obstrukce výtoku levé komory je lokalizována především na úrovni chlopenního ústí. Méně často se vyskytuje supravalvární i subvalvární stenóza.

• MeSH
• Aortic Valve Stenosis epidemiology   etiology   therapy   MeSH
• Atherosclerosis complications   MeSH
• Cardiac Surgical Procedures MeSH
• Humans MeSH
• Heart Valve Prosthesis MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH
• Introductory Journal Article MeSH

Na základe poznatku z patogeneze kalci&kované aortální stenózy byla formulována hypotéza medikamentózního zpomalení progrese vady hypolipidemickou lécbou statiny, kterou podporovaly i výsledky retrospektivních analýz. Studie SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) s 1 873 pacienty a dobou sledování více než ctyri roky, jejíž výsledky byly nedávno publikovány, však neprokázala vliv lécby simvastatinem a ezetimibem na výskyt závažných kardiovaskulárních príhod, vcetne potreby náhrady aortální chlopne, ani na progresi hemodynamické významnosti vady. Dosavadní výsledky naznacují, že statiny nedokáží „dekalci&kovat“ aortální chlopen, snižují však kardiovaskulární riziko pacientu s aortální stenózou, z nichž polovina má koronární nemoc.

Knowledge regarding the pathogenesis of calci&ed aortic stenosis provided the basis for a hypothesis of slowing aortic stenosis progression by lipid-lowering therapy with statins, a concept supported by results of retrospective analyses. However, the SEAS (Simvastatin and Ezetimibe in Aortic Stenosis) study with 1,873 patients and follow-up of more than four years, whose results were published recently, failed to demonstrate an e=ect of treatment with simvastatin and ezetimibe on the incidence of serious cardiovascular events including the need for aortic valve replacement, or on progression of the hemodynamic signi&cance of the stenosis. Current data suggest that, while unable to “decalcify” the aortic valve, statins do reduce the cardiovascular risk of aortic stenosis patients, half of whom have coronary artery disease.

• MeSH
• Aortic Valve Stenosis drug therapy   physiopathology   MeSH
• Azetidines pharmacology   MeSH
• Ezetimibe MeSH
• Financing, Organized MeSH
• Calcinosis drug therapy   prevention & control   MeSH
• Humans MeSH
• Longitudinal Studies MeSH
• Simvastatin pharmacology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

Řada nových informací posledních let přináší s sebou nové možnosti diagnostiky i terapie, ale také nové omyly a chyby. Zvyšuje se prevalence chlopenních vad a mění se jejich symptomatologie v důsledku stárnutí populace. Echokardiografické vyšetření zůstává základní diagnostickou procedurou, objevují se však nové možnosti v počítačové tomografii a magnetické rezonanci. Novinky jsou i v medikamentózním ovlivnění vad, zvláště pak rizikových faktorů, které se podílejí na jejich progresi. Operativa se přesouvá do časnějších stadií a preferují se záchovné operace. Přes tyto nové poznatky se v důsledku omylů a chyb diagnostiky i terapie stále ještě objevují nemocní, u nichž byla optimální doba k operaci promeškána, což je ve svém důsledku chybou největší.

The information boom of recent years brings the new diagnostic and treatment modalities as well as new mistakes and errors. The prevalence of valvular heart disease increases and their symptomatology changes in response to the aging population. Echocardiography remains the main diagnostic procedure while computer tomography and magnetic resonance represent new opportunities. There are innovations in pharmacological management of valvular heart disease, particularly in the management of the risk factors that facilitate their progression. Surgery moves to earlier stages and preservation surgery is preferred. Despite the advancing knowledge, we still have patients in whom, due to mistakes and errors in diagnosis and treatment, the ideal time for surgery have been missed and this is, in result, the most serious of all mistakes.

• MeSH
• Heart Valve Prosthesis Implantation methods   MeSH
• Medical Errors MeSH
• Diagnostic Techniques, Cardiovascular MeSH
• Diagnosis, Differential MeSH
• Financing, Organized MeSH
• Comorbidity MeSH
• Humans MeSH
• Heart Valve Diseases diagnosis   drug therapy   surgery   MeSH
• Postoperative Complications prevention & control   MeSH
• Prevalence MeSH
• Heart Valve Prosthesis utilization   MeSH
• Cardiac Catheterization MeSH
• Check Tag
• Humans MeSH

Calcific aortic stenosis (AS) is an atherosclerosis-related process and the most common cause of valve disease requiring surgery. OBJECTIVE:To assess the association of inflammatory markers with AS in advanced atherosclerosis. METHODS:Consecutive patients with coronary artery disease (CAD) associated with AS were prospectively identified (mean transvalvular aortic gradient of 30 mmHg or greater). Subjects with aortic sclerosis (mean transvalvular aortic gradient of 10 mmHg or less) served as controls. All patients underwent clinical evaluation, echocardiography and coronary angiography. RESULTS:One hundred twenty-two patients with AS (85 men) and 101 with aortic sclerosis (76 men) of similar CAD severity were enrolled. The AS patients were older (mean [+/- SD] 71+/-7 years versus 66+/-7 years; P<0.001), had higher soluble vascular adhesion molecule-1 (s-VCAM-1) levels (1533+/-650 mug/L versus 1157+/-507 mug/L; P<0.001), but lower soluble intercellular adhesion molecule-1 (s-ICAM-1) (254+/-81 mug/L versus 293+/-84 mug/L; P<0.01) and soluble E-selectin (53+/-28 mug/L versus 62+/-29 mug/L; P<0.05) levels. The two groups did not differ with respect to C-reactive protein level (3+/-2.9 mg/L versus 3.4+/-2.6 mg/L; P not significant). Higher s-VCAM-1 (OR 1.09, 95% CI 1.04 to 1.14; P<0.001) and lower s-ICAM-1 (OR 0.82, 95% CI 0.72 to 0.94; P<0.001) levels were associated with AS after adjustment for age. CONCLUSION:Increased s-VCAM-1 levels were associated with calcific AS in patients with significant CAD.

• MeSH
• Aortic Valve Stenosis MeSH
• Vascular Cell Adhesion Molecule-1 MeSH
• Calcinosis MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH

BACKGROUND: In calcific aortic valve disease, the early lesion is similar to atherosclerotic plaque, but later calcification prevails. Parathyroid hormone (PTH) and vitamin D are the principal calcium pool regulators, so the present study was designed to assess their association with aortic stenosis (AS) in patients with significant coronary artery disease (CAD), and preserved renal function. METHODS AND RESULTS: The 122 consecutive patients with AS (mean gradient > or =30 mmHg) plus CAD, and 101 patients with nonobstructive aortic sclerosis (mean gradient < or =10 mmHg) plus CAD, as controls, were prospectively enrolled. The AS patients were older (71+/-7 vs 66+/-7 years; p<0.001), had higher serum intact (i)PTH (51.4 [39-70] vs 37.4 [27-50] pg/ml; p<0.001), and lower plasma vitamin D (32.0 [25-40] vs 35.8 [27-55] nmol/L; p=0.003) levels than those with aortic sclerosis. The groups did not differ significantly in creatinine level (93 [82-105] vs 96 [85-107] micromol/L, p=0.19), calcium - phosphate product, occurrence of hypertension, smoking, diabetes, dyslipidemia, or body mass index. The iPTH (odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02-1.05; p<0.001) and vitamin D levels (OR 0.97, 95% CI 0.95-0.99; p=0.003) were independently associated with AS. CONCLUSION: Higher serum iPTH with lower vitamin D levels were independently associated with calcific AS in CAD patients.

• MeSH
• Aortic Valve Stenosis complications   blood   physiopathology   MeSH
• Financing, Organized MeSH
• Calcinosis complications   blood   physiopathology   MeSH
• Kidney physiopathology   MeSH
• Middle Aged MeSH
• Humans MeSH
• Multicenter Studies as Topic MeSH
• Coronary Artery Disease complications   blood   physiopathology   MeSH
• Parathyroid Hormone blood   MeSH
• Prospective Studies MeSH
• Aged MeSH
• Vitamin D blood   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH

PURPOSE: The aim of our study was to compare the calcium content measured by non-enhanced multidetector-row-computed tomography (MDCT) between patients with significant stenosis of bicuspid (BAV) and tricuspid aortic valve (TAV). Another aim of our study was to assess the accuracy of the non-enhanced MDCT to distinguish BAV and TAV based on the calcified plaque morphology, and to compare the results with the transesophageal echocardiography. SUBJECTS AND METHODS: A retrospective analysis of prospectively collected data was performed. Consecutive patients with symptomatic aortic stenosis (AS) admitted to hospital for evaluation before valve surgery underwent clinical evaluation, transthoracic and transesophageal echocardiography, and non-enhanced examination with the 64-detector-row CT using prospective ECG triggering with data acquisition in diastolic phase. The data acquisition started at 55% of the R-R interval. The patients were examined in the supine position in mild inspiration. Data were evaluated using dedicated software for calcium scoring, the volume of calcifications and calcium content were obtained. RESULTS: Thirty-seven patients (20 males, age 48-83 years) were enrolled. BAV was present in 13 patients, TAV in 24 patients. The calcium score in patients with severe AS (mean gradient >50 mmHg) was higher than in those with moderate AS (1123+/-616 mg versus 634+/-475, P=0.011). Significant correlation between the calcium scores and transaortic gradients was found (r=0.53, P=0.002). The patients with BAV did not differ significantly from those with TAV in the AS severity (58+/-13 versus 53+/-20 mmHg), nor in the valve calcium score (1168+/-717 versus 795+/-530 mg, P=0.093). The overall sensitivity to detect BAV in patients with calcified severe AS was 0.923 (12/13) and specificity 0.958 (23/24). The overall accuracy was 0.945 (35/37). CONCLUSION: We observed higher calcium score in patients with severe AS than with moderate AS. However, no difference in aortic valve calcium score between BAV and TAV was found. Thus, in our sample, the aortic valve calcium score correlated with AS severity, not with aortic valve morphology. Based on the calcified plaque space relationship, the aortic BAV and TAV could be distinguished in most cases.

• MeSH
• Aortic Valve Stenosis radiography   MeSH
• Aortography methods   MeSH
• Adult MeSH
• Electrocardiography methods   MeSH
• Calcinosis radiography   MeSH
• Contrast Media MeSH
• Middle Aged MeSH
• Humans MeSH
• Mitral Valve pathology   MeSH
• Tomography, X-Ray Computed methods   MeSH
• Reproducibility of Results MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Sensitivity and Specificity MeSH
• Cardiac-Gated Imaging Techniques methods   MeSH
• Tricuspid Valve radiography   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH
• Evaluation Study MeSH
• Research Support, Non-U.S. Gov't MeSH
• Comparative Study MeSH