Risultati per: Diagnosi e gestione dell’aneurisma aorta addominale (AAA)

Circulation, Volume 148, Issue Suppl_1, Page A11913-A11913, November 6, 2023. Introduction:Right ventricular (RV) systolic dysfunction and pulmonary hypertension is present in 20% of adults with repaired coarctation of aorta (COA). However, the prognostic value of RV to pulmonary artery (RV-PA) coupling in this population is unknown.Objective:The purpose of this study was to assess the relationship between RV-PA coupling and clinical outcomes (heart failure hospitalization and all-cause mortality) in this population.Methods:Retrospective cohort study of adults with repaired COA and normal RV systolic function defined as RV-free wall strain ≥-24%. RV-PA coupling was assessed using tricuspid annular plane systolic excursion/ RV systolic pressure (TAPSE/RVSP) ratio.Results:Of 509 patients (median age 32 [20-45] years; men 290 [57%]), the average TAPSE and RVSP were 22±5 mm and 33±9 mmHg, respectively, and TAPSE/RVSP ratio was 0.78 (0.56-0.96) mm/mmHg. Of 509 patients, 51 (10%) died and 43 (8%) were hospitalized for heart failure. TAPSE/RVSP was associated with all-cause mortality (hazard ratio 0.82, 95% confidence interval 0.78-0.86, per 0.1 mm/mmHg), and heart failure hospitalization (hazard ratio 0.86, 95% confidence interval 0.79-0.83, per 0.1 mm/mmHg) after adjustment for anatomic lesions, cardiovascular interventions, comorbidities, and echocardiographic indices. The inclusion of TAPSE/RVSP ratio in the risk models improved the prognostic power of the models to predict all-cause mortality (C-statistics difference 0.046, p

Circulation, Volume 148, Issue Suppl_1, Page A11914-A11914, November 6, 2023. Introduction:The relative diagnostic and prognostic performance of left ventricular global longitudinal strain (LVGLS) as compared to LV ejection fraction (LVEF), and the role of LVGLS for detecting early stages of LV systolic dysfunction in adults with repaired coarctation of aorta (COA) is unknown.Objective:The purpose of this study was to address these knowledge gaps.Methods:Retrospective cohort study of adults with repaired COA that underwent transthoracic echocardiogram (2003-2020). LV systolic function was assessed using LVEF (derived from volumetric analysis) and LVGLS (derived from speckle-tracking echocardiography).Results:Of the 795 patients (age 36±14 years), mean LVEF and LVGLS were 62±11%, and 21±4%, respectively. The prevalence of LV systolic dysfunction was higher when assessed using LVGLS as compared to LVEF (20% versus 6%, p

Circulation, Volume 148, Issue Suppl_1, Page A18373-A18373, November 6, 2023. Introduction:The serum and glucocorticoid inducible kinase-1 (SGK-1) can contribute to matrix remodeling in murine models of hypertension (HTN) and abdominal aortic aneurysm (AAA), a potential biomechanical link between these aortopathies. Utilizing aortic stiffness as a marker of pathologic remodeling.Hypothesis:We hypothesize that HTN causes an SGK-1 dependent increase in aortic stiffness to amplify AAA growth.Methods:AngiotensinII (AngII) infusion induced HTN in C57Bl/6 mice (WT;1.46mg/kg/day) with subset groups treated + periadventitial CaCl2 to induce AAA and + infusion of the specific SGK-1 inhibitor EMD638683 (2.5mg/kg/day;n=2-4 each). Abdominal aortic ultrasound was conducted on Day 0 and Day 21 to measure stiffness parameters (radial strain(RS), distensibility(D), pulse propagation velocity(PPV)). Aortic diameter (AoD) was obtained by ultrasound and systolic blood pressures (SBP) were measured by Coda tail cuff.Results:This HTN model has consistently resulted in >30% increase in SBP and AAA induction did not effect SBP. Although the WT+AngII+AAA mice had 66+8% increase in AoD, dilation was not amplified beyond that of the WT+AAA mice (72+7%, p=NS). Treatment with EMD had no impact on SBP, but did significantly reduce AAA growth (WT+AAA+EMD=29+5%; WT+AngII+AAA+EMD= 24+3%), therefore despite ongoing mechanical tension, SGK-1 inhibition abrogated a pathway necessary for degenerative remodeling. Accordingly, aortic stiffness was differentially altered in HTN versus AAA. As indictors of increased stiffness, D decreased with HTN (p

Circulation, Volume 148, Issue Suppl_1, Page A200-A200, November 6, 2023. Background:The use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for hemorrhagic shock (HS) has grown in popularity. However, REBOA has a risk of complications related to blocking the blood flow downstream to the visceral organs. Several drugs have been reported so far to mitigate ischemia, including hydrogen gas (H2); however, they could not reach the downstream of REBOA as they are distributed through the bloodstream. This study aimed to develop a system to deliver drugs to the ischemic organs where REBOA blocks the bloodstream.Methods:Herein, a female 40-kg swine volume-regulated HS model was used. In addition to the REBOA in zone 1, a catheter was inserted for drug delivery retrograde into the right femoral artery. The top tip of the catheter was positioned distal to the REBOA balloon. After HS induction (20% of the total blood volume), drug delivery capability was evaluated in three REBOA use patterns, such as controlled HS in normal time of full inflation , uncontrolled HS with liver injury in extended time of full inflation, and partial inflation. Simultaneously with the REBOA inflation, the intra-aortic irrigation of a drug-containing solution, H2-dissolved saline, was initiated.Results:The occlusion by the REBOA was achieved in all cases after shock induction (approximately 40 mmHg). In all patterns, the concentration of H2in the portal vein, which represents the concentration of outflow from the intestine and inflow to the liver, increased immediately after the irrigation. A full inflation setting required 30 mL/min of irrigation speed to obtain the minimum effective concentration of H2(1%), whereas a partial inflation setting required 2 mL/min.Conclusion:A drug delivery system combined with the REBOA was developed, which enabled the drugs to be administered downstream of REBOA. The newly developed system can potentially overcome the major limitations of REBOA.

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