The last decade has seen transcatheter aortic valve implantation （TAVI） emerge as the standard of care for patients with severe symptomatic aortic stenosis deemed to be either at excessiveor high-risk for surgical a...The last decade has seen transcatheter aortic valve implantation （TAVI） emerge as the standard of care for patients with severe symptomatic aortic stenosis deemed to be either at excessiveor high-risk for surgical aortic valve replacement （SAVR）. This position is supported by three important multicentre randomized trials comparing TAVI to the historical gold standard therapies： （1） The Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve （PARTNER） IB Trial compared TAVI （Edwards SAPIEN, Edwards Lifesciences Inc., Irvine, CA） to optimal medical therapy in patients at excessive surgical risk, and demonstrated an absolute mortality reduction of 〉 20% at 1-year, an effect that was maintained out to 5-year follow-up;Ill （2） The PARTNER 1A Trial compared TAVI （Edwards SAPIEN, Edwards Lifesciences Inc.,展开更多
Objective：We investigated whether disturbance of calcium and phosphate metabolism is associated with the presence and severity of calcific aortic valve disease （CAVD） in patients with normal or mildly impaired rena...Objective：We investigated whether disturbance of calcium and phosphate metabolism is associated with the presence and severity of calcific aortic valve disease （CAVD） in patients with normal or mildly impaired renal function. Methods：We measured serum levels of calcium, phosphate, alkaline phosphatase （AKP）, intact parathyroid hormone （iPTH）, 25-hydroxyvitamin D （25-OHD）, and biomarkers of bone turnover in 260 consecutive patients with normal or mildly impaired renal function and aortic valve sclerosis （AVSc） （n=164） or stenosis （AVS） （n=96） and in 164 age- and gender-matched controls. Logistic regression models were used to determine the association of mineral metabolism parameters with the presence and severity of CAVD. Results：Stepwise increases were observed in serum levels of calcium, phosphate, AKP, and iPTH from the control group to patients with AVS, and with reverse changes for 25-OHD levels （al P〈0.001）. Similarly, osteocalcin, procol agen I N-terminal peptide, andβ-isomerized type I col agen C-telopeptide breakdown products were significantly increased stepwise from the control group to patients with AVS （al P〈0.001）. In patients with AVS, serum levels of iPTH were positively, in contrast 25-OHD levels were negatively, related to trans-aortic peak flow velocity and mean pressure gradient. After adjusting for relevant confounding varia-bles, increased serum levels of calcium, phosphate, AKP, and iPTH and reduced serum levels of 25-OHD were in-dependently associated with the presence and severity of CAVD. Conclusions： This study suggests an association between mineral metabolism disturbance and the presence and severity of CAVD in patients with normal or mildly impaired renal function. Abnormal bone turnover may be a potential mechanism.展开更多
文摘The last decade has seen transcatheter aortic valve implantation （TAVI） emerge as the standard of care for patients with severe symptomatic aortic stenosis deemed to be either at excessiveor high-risk for surgical aortic valve replacement （SAVR）. This position is supported by three important multicentre randomized trials comparing TAVI to the historical gold standard therapies： （1） The Placement of AoRTic TraNscathetER Valve Trial Edwards SAPIEN Transcatheter Heart Valve （PARTNER） IB Trial compared TAVI （Edwards SAPIEN, Edwards Lifesciences Inc., Irvine, CA） to optimal medical therapy in patients at excessive surgical risk, and demonstrated an absolute mortality reduction of 〉 20% at 1-year, an effect that was maintained out to 5-year follow-up;Ill （2） The PARTNER 1A Trial compared TAVI （Edwards SAPIEN, Edwards Lifesciences Inc.,
基金Project supported by the Science and Technology Commission of Shanghai Municipality(No.114119a8800),China
文摘Objective：We investigated whether disturbance of calcium and phosphate metabolism is associated with the presence and severity of calcific aortic valve disease （CAVD） in patients with normal or mildly impaired renal function. Methods：We measured serum levels of calcium, phosphate, alkaline phosphatase （AKP）, intact parathyroid hormone （iPTH）, 25-hydroxyvitamin D （25-OHD）, and biomarkers of bone turnover in 260 consecutive patients with normal or mildly impaired renal function and aortic valve sclerosis （AVSc） （n=164） or stenosis （AVS） （n=96） and in 164 age- and gender-matched controls. Logistic regression models were used to determine the association of mineral metabolism parameters with the presence and severity of CAVD. Results：Stepwise increases were observed in serum levels of calcium, phosphate, AKP, and iPTH from the control group to patients with AVS, and with reverse changes for 25-OHD levels （al P〈0.001）. Similarly, osteocalcin, procol agen I N-terminal peptide, andβ-isomerized type I col agen C-telopeptide breakdown products were significantly increased stepwise from the control group to patients with AVS （al P〈0.001）. In patients with AVS, serum levels of iPTH were positively, in contrast 25-OHD levels were negatively, related to trans-aortic peak flow velocity and mean pressure gradient. After adjusting for relevant confounding varia-bles, increased serum levels of calcium, phosphate, AKP, and iPTH and reduced serum levels of 25-OHD were in-dependently associated with the presence and severity of CAVD. Conclusions： This study suggests an association between mineral metabolism disturbance and the presence and severity of CAVD in patients with normal or mildly impaired renal function. Abnormal bone turnover may be a potential mechanism.
