This document discusses the management of mitral regurgitation (MR) in heart failure patients. It explores the differences between primary and functional (secondary) MR, and notes that correcting primary MR may improve outcomes but the benefits are less clear for functional MR which is primarily a ventricular problem. The document reviews potential management options for MR in heart failure including optimal medical therapy, cardiac resynchronization therapy, surgery, and percutaneous techniques such as the MitraClip system. It presents evidence from studies on the acute effects of CRT and the impact of CRT on functional MR severity. It also discusses guidelines on indications for mitral valve surgery in chronic secondary MR and barriers to surgery.
SOLACI Chile Congress 2011. Dr.Ajay Kirtane. Drug-Eluting Stents for Multivessel PCI: Indications and Outcomes. Find more presentations on the web site: www.solaci.org/
Coronary angioplasty has revolutionized the management of coronary artery disease. It has not ceased to develop to become the reference method of myocardial revascularization. The aim of our study is to evaluate the ultrasound parameters of left ventricular function after coronary angioplasty. This is a prospective analytical study including patients with stable coronary artery disease with a known coronary artery anatomy programmed for coronary angioplasty. Transthoracic echocardiography was performed four hours before and seven days after myocardial revascularization.
SOLACI Chile Congress 2011. Dr.Ajay Kirtane. Drug-Eluting Stents for Multivessel PCI: Indications and Outcomes. Find more presentations on the web site: www.solaci.org/
Coronary angioplasty has revolutionized the management of coronary artery disease. It has not ceased to develop to become the reference method of myocardial revascularization. The aim of our study is to evaluate the ultrasound parameters of left ventricular function after coronary angioplasty. This is a prospective analytical study including patients with stable coronary artery disease with a known coronary artery anatomy programmed for coronary angioplasty. Transthoracic echocardiography was performed four hours before and seven days after myocardial revascularization.
Results:Infarct size was significantly reduced by RIPerC in NG, but not in the AHG group (NG + Isch: 46.27 ± 5.31 % vs. NG + RIPerC: 24.65 ± 7.45 %, p < 0.05; AHG + Isch: 54.19 ± 4.07 % vs. 52.76 ±
3.80 %). Acute hyperglycemia per se did not influence infarct size, but significantly increased the incidence and duration of arrhythmias. Acute hyperglycemia activated mechanistic target of rapamycine (mTOR) pathway, as it significantly increased the phosphorylation of mTOR and S6 proteins and the phosphorylation of AKT. In spite of a decreased LC3II/LC3I ratio, other markers of autophagy, such as
ATG7, ULK1 phopsphorylation, Beclin 1 and SQSTM1/p62, were not modulated by acute hyperglycemia. Furthermore, acute hyperglycemia significantly elevated nitrative stress in the heart (0.87 ± 0.01 vs. 0.50 ± 0.04 μg 3-nitrotyrosine/mg protein, p < 0.05).This is the first demonstration that acute hypreglycemia deteriorates cardioprotection by RIPerC. The mechanism of this phenomenon may involve an acute hyperglycemia-induced increase in nitrative stress and activation of the mTOR pathway.
Lipids are a heterogenous group of
water –insoluble ( hydrophobic ) organic
molecules. Presentation on how they affect the body and what to do to prevent their effects.
XIII Reunión anual de la sección de Insuficiencia Cardiaca de la SEC
OVIEDO, 16-18 JUNIO 2016 HOSPITAL UNIVERSITARIO CENTRAL DE ASTURIAS (HUCA)
http://secardiologia.es/insuficiencia/cientifico/ic-oviedo-2016
Simposio: Abordaje integral y multidisciplinar de la Insuficiencia Mitral
VIERNES, 17 DE JUNIO 12:45-14:00 SALA A
Posibilidades del tratamiento percutáneo
Xavi Freixa Rofastes, Barcelona
Terapi Endovaskuler, Standar Baru Manajemen Stroke Iskemik Akut? Ersifa Fatimah
Konon, plenary pertama International Stroke Conference (ISC) 2015 yang digelar di Nashville, Tennessee bulan Februari lalu merupakan sesi ISC terseru selama beberapa tahun terakhir. Sebagaimana diberitakan dalam Medscape (Hughes, 2015), para presenter terpaksa memberi jeda beberapa saat untuk menyambut applause dari audiens. Suatu kejadian langka dalam partemuan saintifik. Adalah MR CLEAN, ESCAPE, EXTEND-IA, dan SWIFT PRIME yang menjadi topik hangat lantaran keempat studi ini dirilis dengan hasil yang positif dramatis hingga diprediksi bakal menjadikan terapi endovascular sebagai standar baru dalam manajemen stroke iskemik akut. Sehebat apakah 4 studi yang “menyejarah” dalam tatalaksana stroke iskemik akut ini? Bagaimana bila studi-studi ini diadopsi dan diaplikasikan dalam praktik sehari-hari di sentra kita?
Note: Esai ini ditulis saat SWIFT PRIME fulltext belum published (akhir Maret-awal April 2015). Update & beberapa revisi dibuat menjelang presentasi tanggal 18 Mei 2015.
Linee guida e timing chirurgico insufficienza aorticaICARDIOLOGI
Linee guida e timing chirurgico dell’insufficienza valvolare aortica: che cosa attende migliore definizione. Dr. Antonio Federico - Villa Maria Cecilia Hospital - Maggio 2009
Coronary artery bypass grafting with adjunctive
endarterectomy: A mandatory procedure in complex
revascularizations. current results and postoperative
considerations
Percutaneous Transvenous Mitral Commissurotomy in 71 Years Old Woman with Mit...M A Hasnat
AAS Majumder, MA Hasnat, AKMM Islam, M Ullah, MZ Rahman, S Zaman, MM Rahman, MH Alamgir.
Department of Cardiology, NICVD, Dhaka.
(Cardiovasc. j. 2013; 6(1): 68-70)
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Under Pressure : Kenneth Kruk's StrategyKenneth Kruk
Kenneth Kruk's story of transforming challenges into opportunities by leading successful medical record transitions and bridging scientific knowledge gaps during COVID-19.
Chandrima Spa Ajman is one of the leading Massage Center in Ajman, which is open 24 hours exclusively for men. Being one of the most affordable Spa in Ajman, we offer Body to Body massage, Kerala Massage, Malayali Massage, Indian Massage, Pakistani Massage Russian massage, Thai massage, Swedish massage, Hot Stone Massage, Deep Tissue Massage, and many more. Indulge in the ultimate massage experience and book your appointment today. We are confident that you will leave our Massage spa feeling refreshed, rejuvenated, and ready to take on the world.
Visit : https://massagespaajman.com/
Call : 052 987 1315
Cold Sores: Causes, Treatments, and Prevention Strategies | The Lifesciences ...The Lifesciences Magazine
Cold Sores, medically known as herpes labialis, are caused by the herpes simplex virus (HSV). HSV-1 is primarily responsible for cold sores, although HSV-2 can also contribute in some cases.
Stem Cell Solutions: Dr. David Greene's Path to Non-Surgical Cardiac CareDr. David Greene Arizona
Explore the groundbreaking work of Dr. David Greene, a pioneer in regenerative medicine, who is revolutionizing the field of cardiology through stem cell therapy in Arizona. This ppt delves into how Dr. Greene's innovative approach is providing non-surgical, effective treatments for heart disease, using the body's own cells to repair heart damage and improve patient outcomes. Learn about the science behind stem cell therapy, its benefits over traditional cardiac surgeries, and the promising future it holds for modern medicine. Join us as we uncover how Dr. Greene's commitment to stem cell research and therapy is setting new standards in healthcare and offering new hope to cardiac patients.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Rate Controlled Drug Delivery Systems, Activation Modulated Drug Delivery Systems, Mechanically activated, pH activated, Enzyme activated, Osmotic activated Drug Delivery Systems, Feedback regulated Drug Delivery Systems systems are discussed here.
INFECTION OF THE BRAIN -ENCEPHALITIS ( PPT)blessyjannu21
Neurological system includes brain and spinal cord. It plays an important role in functioning of our body. Encephalitis is the inflammation of the brain. Causes include viral infections, infections from insect bites or an autoimmune reaction that affects the brain. It can be life-threatening or cause long-term complications. Treatment varies, but most people require hospitalization so they can receive intensive treatment, including life support.
KEY Points of Leicester travel clinic In London doc.docxNX Healthcare
In order to protect visitors' safety and wellbeing, Travel Clinic Leicester offers a wide range of travel-related health treatments, including individualized counseling and vaccines. Our team of medical experts specializes in getting people ready for international travel, with a particular emphasis on vaccines and health consultations to prevent travel-related illnesses. We provide a range of travel-related services, such as health concerns unique to a trip, prevention of malaria, and travel-related medical supplies. Our clinic is dedicated to providing top-notch care, keeping abreast of the most recent recommendations for vaccinations and travel health precautions. The goal of Travel Clinic Leicester is to keep you safe and well-rested no matter what kind of travel you choose—business, pleasure, or adventure.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
LGBTQ+ Adults: Unique Opportunities and Inclusive Approaches to CareVITASAuthor
This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
This document is designed as an introductory to medical students,nursing students,midwives or other healthcare trainees to improve their understanding about how health system in Sri Lanka cares children health.
1. The conundrum of mitral regurgitation
in heart failure
Piotr Ponikowski, MD, PhD, FESC
Medical University, Centre for Heart Disease
Clinical Military Hospital
Wroclaw, Poland
The road ahead
3. Primary vs functional MR:
key question for the current management
n Primary MR
MR→LV volume overload→remodeling with subsequent consequences
„correction of primary MR in a timely fashion reverses these
consequences”
n Functional MR – damaged LV causes MR
„primarily a ventricular problem it is less obvious that correcting
the MR by itself will be curative or even beneficial”
Carabello BA, JACC 2008;52:319-26
• Secondary MR
„because MR is only 1 component of the disease (severe LV dysfunction, CAD
or idiopathic myocardial disease are the others), restoration of mitral valve
competence is not by itself curative;
2014 AHA/ACC Valvular Heart Disease Guideline
4. Primary vs functional MR:
key question for the current management
Marwick TH, Zoghbi WA, Narula J. JACC CV Imaging 2014
Potential confounders in the causal pathway linking FMR and adverse events
5. MR in Heart Failure
Management options: how / when to intervene ?
• Optimal medical therapy
• CRT
• Surgery
MV surgery
Surgical treatment of LV
• Percutaneous techniques
6. Functional Mitral Regurgitation –
management options
Acute effect of CRT on FMR in HF patients (EF<30%) with LBBB
Breithardt OA et al. JACC 2003;41,765-770
…increase in TMP mediated by a rise in maximal rate of LV systolic pressure rise due to
more coordinated LV contraction, may facilitate effective MV closure…
7. Functional Mitral Regurgitation –
management options
Impact of CRT on the severity of FMR
Di Biase L et al. Europace 2011;13, 829–838
The distribution of MR in CRT population
9. MR in Heart Failure
Management options: how / when to intervene ?
• Optimal medical therapy
• CRT
• Surgery
MV surgery
Surgical treatment of LV
• Percutaneous techniques
10. ESC Guidelines on the Management of VHD 2012
Indications for mitral valve surgery
in chronic secondary MR
11. Euro Heart Survey:
why surgery is denied in clinical practice ?
Mirabel et al., Eur Heart J 2007;28:1358-65
12. Cardiac
surgeon
Cardiologist
Anaesthetists
Other specialists:
geriatrician, GP, etc Imaging specialist (ECHO, CT, MRI)
Decision-making
in VHD patient
HEART TEAM
‘heart team’ approach is particularly advisable in the management of high-risk patients and is
also important for other subsets, such as asymptomatic patients, where the evaluation of valve
repairability is a key component in decision-making…
ESC Guidelines on the Management of VHD 2012
13. MR in Heart Failure
Management options: how / when to intervene ?
• Optimal medical therapy
• CRT
• Surgery
MV surgery
Surgical treatment of LV
• Percutaneous techniques
15. WHY to recommend „new procedure”
for HF patient ?
Therapy
footprint
Economic
impact
Patient
Durability
Procedural
success
Safety
profile
Survival
& QoL
16. MitraClip therapy
“The most established PMVR therapy”
n More than 20000 patients treated worldwide
n Used in more than 420 centers and 35 countries
n More than 560 clinical papers published to date*
n Included in:
– 2012 ESC/HFA/EACTS Guidelines²
– 2014 ACC/AHA Guidelines3
– 2012/2013 German Guidelines4,5
– 2014 Italian Guidelines6
• H. Hermann & F. Maisano – Transcatheter therapy of Mitral Regurgitation – Circulation 2014; 130:1712-1722
• ESC/EACTS 2012 Guidelines on the management of valvular heart disease. Eur Heart J (2012) 33, 2451–2496.
• Nishimura RA, et al. - 2014 ACC/AHA valve guidelines: earlier intervention for chronic mitral regurgitation - Heart June 2014 Vol 100 No 12
• Boekstegers P. et.al. Percutaneous interventional mitral regurgitation treatment using the Mitra-Clip system Clin. Res. Cardiol. 2013
• Nickenig G. et al. - Consensus of the German Cardiac Society and the German Society for Thoracic and Cardiovascular Surgery on treatment of mitral valve insufficiency -
Kardiologe 2013 · 7:76–90
• Maisano et al. - Transcatheter treatment of chronic mitral regurgitation with the MitraClip system: an Italian consensus statement - J Cardiovasc Med 2014, 15:173–188
Therapy
footprint
17. EVEREST II: 279 patients with moderately severe or severe (grade 3+ or 4+) MR
randomized in a 2:1 ratio to percutaneous repair or conventional surgery
LVEF – 60%, functional MR – 27%
12 months
Surgery better Percutaneous repair better
Feldman T et al., N Engl J Med 2011
MitraClip therapy
“The most established PMVR therapy”
Therapy
footprint
18. MitraClip therapy
Safety profile
• T. Feldman, et al., The New England journal of medicine 364, 1395 (2011)/ 2. P. L. Whitlow, et al., Journal of the American College of Cardiology 59, 130 (2012)/ 3. F.
Maisano, et al., Journal of the American College of Cardiology 62, 1052 (2013)/ 4. S. Kar, Presented at TCT, 2013, San Francisco, CA (2013)/ 5. W. Schillinger, et al.,
EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 9, 84 (2013)/4. C.
Grasso, et al., The American journal of cardiology 111, 1482 (2013)
Safety
profile
• Low Major Adverse Events (MAEs) • Low post-procedural mortality
Low Major Adverse Events (MAEs) Low post-procedural mortality
S
MC
19. MitraClip as therapeutic option for MR
first (and strong) evidence
EVEREST II: 4-year results
Sustained clinical benefits comparable to those after surgery
Improvement in MR durable through 4 years
Mauri et al., JACC 2013
Survival &
QoL
20. MitraClip as therapeutic option for MR
first (and strong) evidence
EVEREST II: 4-year results
Mauri et al., JACC 2013
Differences in rates of the efficacy endpoints:
freedom from death, MV surgery and from +3/+4 MR
Survival &
QoL
21. MitraClip as therapeutic option for MR
Real World Experience
ACCESS-EU: 567 pts with significant MR who underwent MitraClip therapy
at 14 European sites; 69% functional MR, 85% NYHA III-IV, 53% LVEF <40%
Implant rate – 99.6%; mortality: 30-day – 3.4%,1-year – 81.8%
Maisano F et al., JACC 2013;62:1052–61
Severity of MR at baseline and during follow-up Changes in 6MWT in patients with MitraClip
Survival &
QoL
22. MitraClip as therapeutic option for MR
Real World Experience
TCVT – ESC : 628 consecutive pts with significant MR who underwent MitraClip
therapy at 25 European sites;
72% functional MR: 88% NYHA III-IV, 42% LVEF <30%, EuroScore - 22
Nickenig G al., JACC 2014;64:875–84
Survival &
QoL
Composite of death and HF rehospitalisation
23. MitraClip as therapeutic option for MR
Real World Experience
139 consecutive pts with MitraClip
therapy vs 53 treated surgically vs
59 treated conservatively
MitraClip: EuroScore: 24±16%
NYHA II-III: 77%; LVEF: 37±15%
FMR: 77%
Swaans et al., JACC Interv 2014;7:875-81
Conclusion: high-surgical-risk
patients treated with TMVR displayed
survival benefit vs those treated
conservatively.
Survival &
QoL
24. Grades A & B
At risk of MR → Progressive MR
•Primary myocardial disease with LV
dilation and systolic dysfunction
•Symptoms due to CAD/HF
•OMT/devices/revascularization
Grade C
Asymptomatic severe MR
•Abnormal valve hemodynamics – ERO, RF
•Symptoms due to CAD/HF
•OMT/devices/revascularization
Grade D
Symptomatic severe MR
•Abnormal valve hemodynamics – ERO, RF
•Symptoms due to MR, persist even after
OMT/devices/revascularizationModified from 2014 AHA/ACC
Valvular Heart Disease Guideline
strategy:
1.Treat HF optimally
2.MR - watch and see
strategy:
1.Treat HF optimally
2.MR – consider intervention
Ready to challenge this paradigm ?
Is there enough evidence ?
FMR in Heart Failure
how / when / WHY to intervene ?