Biomedical subjects

Christian N Gring

Publications and source records attributed to Christian N Gring.

3 recordsLinked to original sources

PubMed2006

Preoperative cholesterol levels do not predict explant for structural valve deterioration in patients undergoing bioprosthetic aortic valve replacement.

BACKGROUND AND AIM OF THE STUDY: Structural valve deterioration (SVD) is the most common cause of bioprosthetic valve failure. Coronary disease risk factors, including hypercholesterolemia, might predict SVD. Here, the relationship was examined between preoperative cholesterol levels and SVD in patients undergoing bioprosthetic aortic valve replacement (AVR). METHODS: A total of 7,150 patients (mean age 68 +/- 12 years) was identified who underwent bioprosthetic AVR at the Cleveland Clinic Foundation, between January 1975 and December 2002. Preoperative and postoperative variables were retrieved from a prospective, computerized database. A parametric method was used to estimate the distribution of valve explants; a multivariable risk factor model was then developed to include patient demographics, cardiac and non-cardiac comorbidities, valve type and interactions. The primary end-point was explant for SVD. All explants were examined, and observations were censored at the time of any explant or death. Bootstrap analysis was used to validate the model. RESULTS: Among 7,150 patients, 208 had explants for SVD. Mean preoperative total cholesterol (TC) was 203 +/- 48 mg/dl, HDL-cholesterol 45 +/- 15 mg/dl, and LDL-cholesterol 121 +/- 41 mg/dl. The average follow up was 3.7 years, and 1,169 patients (16%) were followed for more than eight years. In multivariable analysis, only younger age (p < 0.0001), greater body weight (p < 0.0001), elevated serum creatinine level (p = 0.0004) and use of a pericardial valve (p = 0.04) predicted SVD. Neither preoperative cholesterol nor its fractions predicted valve explant for SVD (log-rank p = 0.19) Moreover, no cardiovascular risk factors were predictive of SVD. CONCLUSION: Preoperative cholesterol levels do not predict SVD in patients undergoing bioprosthetic AVR. Whether long-term hypercholesterolemia or statin therapy impacts SVD requires further investigation.

Aged↗

PubMed2004

A hard look at angiotensin receptor blockers in heart failure.

Multiple trials over the past several years have examined indications for angiotensin receptor blockers (ARBs) in the treatment of left ventricular dysfunction, both acutely after myocardial infarction and in chronic heart failure. Yet despite these data, there is still confusion regarding the efficacy of ARBs as monotherapy in these patient populations, as well as the specific indications for combination ARB/angiotensin-converting enzyme (ACE) inhibitor therapy. We examine the key differences among the trials-including the ACE inhibitor dose, the ARB and its dose, blood pressure reduction, and patient populations-to present our perspective on ARB use, alone or in combination with ACE inhibitors, in patients with chronic heart failure and post-myocardial infarction left ventricular dysfunction. We conclude that ACE inhibitors remain the first-line therapy for left ventricular dysfunction. Angiotensin receptor blockers should be reserved for monotherapy in ACE intolerant patients and for combination therapy in symptomatic class II/III patients with chronic heart failure.

Angiotensin Receptor Antagonists↗

PubMedDate not supplied

Mitral valve prolapse.

Mitral valve prolapse is a common valvular abnormality that is the most common cause of severe non-ischaemic mitral regurgitation in the USA. The overall prognosis of patients with mitral valve prolapse is excellent, but a small subset will develop serious complications, including infective endocarditis, sudden cardiac death, and severe mitral regurgitation. We present a comprehensive review of mitral valve prolapse, examining normal mitral anatomy, the clinical and echocardiographic features of mitral valve prolapse, and the pathophysiology and genetics of the disorder. We discuss the contemporary management of both asymptomatic and symptomatic prolapse, with particular attention to the timing and technique of surgical repair. We conclude that echocardiography is the method of choice for diagnosing mitral valve prolapse, that clinical and echocardiographic features can predict which patients with prolapse are at highest risk for complications, and that mitral valve repair is the treatment of choice for symptomatic prolapse.

Echocardiography↗