In its advanced stages, NAFLD may progress to cirrhosis and its complications, including HCC. This heterogeneous continuum ranges from simple, isolated steatosis (non-alcoholic fatty liver (NAFL)) to steatohepatitis with evidence of hepatocyte injury and necroinflammation (non-alcoholic steatohepatitis (NASH)) with or without hepatic fibrosis. Regarded as the hepatic manifestation of the metabolic syndrome in view of its intimate association with insulin resistance, obesity, hypertension and dyslipidaemia, NAFLD is a multi-system disease encompassing a histopathological spectrum of severity. NAFLD is defined as the accumulation of liver fat (exceeding 5% of hepatocytes) without evidence for coexisting hepatic insults, namely viral or autoimmune hepatitis, use of steatogenic medication, or significant alcohol intake ( 2). Non-alcoholic fatty liver disease (NAFLD) is recognised as the most common aetiology of chronic liver disease, with an estimated global prevalence of 25.2%, and as a major cause of cirrhosis and hepatocellular carcinoma (HCC), projected to become the leading indication for liver transplantation during this decade ( 1). This review summarises the current concepts in diagnosis and disease progression of non-alcoholic liver disease, focusing on pragmatic approaches to risk assessment and management in both primary and secondary care settings. Despite the current lack of licensed, liver-targeted pharmacotherapy, several promising agents are undergoing late-phase clinical trials to complement standard management in patients with advanced disease. A multidisciplinary approach to treatment is advised, centred on amelioration of cardiometabolic risk through lifestyle and pharmacological interventions. This necessitates risk stratification of patients by fibrosis stage using combinations of non-invasive methods, such as composite scoring systems and/or transient elastography. The presence and severity of fibrosis are the most important prognostic factors in non-alcoholic fatty liver disease. Patients with non-alcoholic fatty liver disease show variable rates of disease progression through a histological spectrum ranging from steatosis to steatohepatitis with or without fibrosis. Its high clinical burden results from the growing prevalence, inherent cardiometabolic risk and potential of progressing to cirrhosis. Prospective studies are needed to elucidate the causes of excess mortality among TAVI recipients.Non-alcoholic fatty liver disease is a chronic liver disease which is closely associated with components of the metabolic syndrome. Repeat aortic valve procedures were uncommon in both groups. 1.4% HR 1.43, 95%CI 0.61-3.34 P=0.41).Ĭonclusions: In this comparative, propensity-matched cohort study, 1-year mortality after an episode of IE was higher among TAVI recipients vs. Aortic valve reoperation was uncommon in both groups, with 13 and 10 events in the TAVI and SAVR groups, respectively (1.8% vs. The Kaplan-Meier 1-year mortality between 7 days and 1 year (as deaths before 7 days were excluded) was 18.4% in the TAVI cohort (131 events) vs. The baseline characteristics were well balanced, as indicated by standardized mean differences <0.1, Table 1. Results: We identified 713 patients with post-TAVI IE and 713 matched patients with post-SAVR IE. We matched the cohorts for demographics and clinically relevant background characteristics. Both cohorts were required to have at least 1 week follow-up, i.e., deaths within 7 days of IE were excluded. Methods: Using data from the TriNetX Research Network, we identified (1) a cohort of patients who underwent TAVI between and (CPT procedure code 1021150) and developed IE (captured with ICD-10 codes I33, I38, or I39) after the procedure and (2) a propensity score-matched cohort of patients who underwent SAVR (CPT procedure codes 1006141, excluding any associated transcatheter procedures) and developed IE. Data on post-TAVI IE in comparison to post-SAVR IE outcomes are limited. As a result, post-TAVI infective endocarditis (IE) is increasingly common. Customer Service and Ordering Informationīackground: With improving technology and experience, indications for transcatheter aortic valve implantation (TAVI) have expanded to include younger patients and those at moderate surgical risk, leading to increasing use of TAVI as an alternative to surgical aortic valve replacement (SAVR).Stroke: Vascular and Interventional Neurology.Journal of the American Heart Association (JAHA).Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |