Initially developed to predict stroke probability in patientswith atrial fibrillation （AF）,t1~1 CHADS2 and CHA2DS2VASCscores are used to predict different outcomes in cardiac pa-tients in both acute and chronic cond...Initially developed to predict stroke probability in patientswith atrial fibrillation （AF）,t1~1 CHADS2 and CHA2DS2VASCscores are used to predict different outcomes in cardiac pa-tients in both acute and chronic conditions. Thescores were also demonstrated to correlate with mortal-ity. AF also has been associated with mortality indifferent groups of patients, including elderly.展开更多
BackgroundCalcific aortic stenosis （AS） is an active process sharing similarities with atherosclerosis and chronic inflammation. The pathophysiology of AS is notable for three cardinal components： inflammation, fib...BackgroundCalcific aortic stenosis （AS） is an active process sharing similarities with atherosclerosis and chronic inflammation. The pathophysiology of AS is notable for three cardinal components： inflammation, fibrosis and calcification. Monocytes play a role in each of these processes. The role of circulating monocytes in AS is not clear. The aim of the present study was to study an association between cir-culating apoptotic and non apoptotic CD14＋ monocytes and AS features.MethodsWe assessed the number of CD14＋ monocytes and apoptotic monocytes in 54 patients with significant AS （aortic valve area 0.74 ± 0.27 cm2） and compared them to 33 patients with similar risk factors and no valvular disease. The level of CD14＋ monocytes and apoptotic monocytes was assessed by flow cytometry.ResultsThere was no difference in the risk factor profile and known coronary or peripheral vascular diseases between patients with AS and controls.Pa-tients with AS exhibited increased numbers of CD14＋ monocytes as compared to controls （9.9% ± 4.9%vs. 7.7% ± 3.9%,P= 0.03）. CD14＋ monocyte number was related to age and the presence and severity of AS. In patients with AS, both CD14＋ monocytes and apoptotic mono-cytes were inversely related to aortic valve area.ConclusionsPatients with significant AS have increased number of circulating CD14＋ monocytes and there is an inverse correlation between monocyte count and aortic valve area. These findings may suggest that inflammation is operative not only in early valve injury phase, but also at later developed stages such as calcification when AS is severe.展开更多
BACKGROUND Transcatheter aortic valve replacement(TAVR)provokes an early injury response,partially represented by dynamic changes in inflammatory markers.TAVR greatly benefits the elderly and we aimed to determine whe...BACKGROUND Transcatheter aortic valve replacement(TAVR)provokes an early injury response,partially represented by dynamic changes in inflammatory markers.TAVR greatly benefits the elderly and we aimed to determine whether increased inflammatory markers post-TAVR in octagenerians were different than their younger counterparts and whether it was associated with adverse clinical outcomes.METHODS Patients with severe symptomatic aortic stenosis who underwent transfemoral TAVR from January 2010 to December 2021 were enrolled.Total white blood cells(WBC)count and subpopulation dynamics were evaluated.RESULTS Five-hundred and seven patients were finally included in the study,65%of these patients were 80 or more years old(54%female,median age 84[82-87])years,with severe symptomatic aortic stenosis.In patients aged above 80 years(patients≥80),we noticed significant kinetic changes in the WBC and their differential cellular subpopulations(P<0.0001)between admission and early days post-procedure.This was evident by a significant increase in total WBC(median 7.1 to 9.4)and absolute neutrophil count(median 4.7 to 7.4),neutrophil-lymphocyte(NL)ratio(median 2.82 to 7.21),and a meaningful decrease in absolute lymphocyte count(median 1.5 to 1.0).Implantation of self-expandable valves(SEVs)was associated with a more pronounced inflammatory response than balloon-expandable valves(BEVs).Higher WBC and neutrophil counts were associated with higher mortality and major vascular complications at 30 days,in addition,higher neutrophil counts and NL ratios were found to be correlated to arrhythmia at 30 days with P values of 0.04 and 0.028,respectively.CONCLUSION This is the first description of a differential age-related inflammatory response in patients after TAVR,which shows an association between inflammatory markers post procedure and clinical outcome.Nevertheless,survival rates were similar in the elderly population and in younger patients,despite the presence of comorbid conditions.展开更多
文摘Initially developed to predict stroke probability in patientswith atrial fibrillation （AF）,t1~1 CHADS2 and CHA2DS2VASCscores are used to predict different outcomes in cardiac pa-tients in both acute and chronic conditions. Thescores were also demonstrated to correlate with mortal-ity. AF also has been associated with mortality indifferent groups of patients, including elderly.
文摘BackgroundCalcific aortic stenosis （AS） is an active process sharing similarities with atherosclerosis and chronic inflammation. The pathophysiology of AS is notable for three cardinal components： inflammation, fibrosis and calcification. Monocytes play a role in each of these processes. The role of circulating monocytes in AS is not clear. The aim of the present study was to study an association between cir-culating apoptotic and non apoptotic CD14＋ monocytes and AS features.MethodsWe assessed the number of CD14＋ monocytes and apoptotic monocytes in 54 patients with significant AS （aortic valve area 0.74 ± 0.27 cm2） and compared them to 33 patients with similar risk factors and no valvular disease. The level of CD14＋ monocytes and apoptotic monocytes was assessed by flow cytometry.ResultsThere was no difference in the risk factor profile and known coronary or peripheral vascular diseases between patients with AS and controls.Pa-tients with AS exhibited increased numbers of CD14＋ monocytes as compared to controls （9.9% ± 4.9%vs. 7.7% ± 3.9%,P= 0.03）. CD14＋ monocyte number was related to age and the presence and severity of AS. In patients with AS, both CD14＋ monocytes and apoptotic mono-cytes were inversely related to aortic valve area.ConclusionsPatients with significant AS have increased number of circulating CD14＋ monocytes and there is an inverse correlation between monocyte count and aortic valve area. These findings may suggest that inflammation is operative not only in early valve injury phase, but also at later developed stages such as calcification when AS is severe.
文摘BACKGROUND Transcatheter aortic valve replacement(TAVR)provokes an early injury response,partially represented by dynamic changes in inflammatory markers.TAVR greatly benefits the elderly and we aimed to determine whether increased inflammatory markers post-TAVR in octagenerians were different than their younger counterparts and whether it was associated with adverse clinical outcomes.METHODS Patients with severe symptomatic aortic stenosis who underwent transfemoral TAVR from January 2010 to December 2021 were enrolled.Total white blood cells(WBC)count and subpopulation dynamics were evaluated.RESULTS Five-hundred and seven patients were finally included in the study,65%of these patients were 80 or more years old(54%female,median age 84[82-87])years,with severe symptomatic aortic stenosis.In patients aged above 80 years(patients≥80),we noticed significant kinetic changes in the WBC and their differential cellular subpopulations(P<0.0001)between admission and early days post-procedure.This was evident by a significant increase in total WBC(median 7.1 to 9.4)and absolute neutrophil count(median 4.7 to 7.4),neutrophil-lymphocyte(NL)ratio(median 2.82 to 7.21),and a meaningful decrease in absolute lymphocyte count(median 1.5 to 1.0).Implantation of self-expandable valves(SEVs)was associated with a more pronounced inflammatory response than balloon-expandable valves(BEVs).Higher WBC and neutrophil counts were associated with higher mortality and major vascular complications at 30 days,in addition,higher neutrophil counts and NL ratios were found to be correlated to arrhythmia at 30 days with P values of 0.04 and 0.028,respectively.CONCLUSION This is the first description of a differential age-related inflammatory response in patients after TAVR,which shows an association between inflammatory markers post procedure and clinical outcome.Nevertheless,survival rates were similar in the elderly population and in younger patients,despite the presence of comorbid conditions.
