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Chen S, Redfors B, O’Neill BP, Clavel MA, Pibarot P, Elmariah S, Nazif T, Crowley A, Ben-Yehuda O, Finn MT, Alu MC, Vahl TP, Kodali S, Leon MB, Lindman BR. Low and elevated B-type natriuretic peptide levels are associated with increased mortality in patients with preserved ejection fraction undergoing transcatheter aortic valve replacement: an analysis of the PARTNER II trial and registry. Eur Heart J 2019; 41:958-969. [DOI: 10.1093/eurheartj/ehz892] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/08/2019] [Accepted: 11/30/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Aims
B-type natriuretic peptide (BNP) is a cardiac neurohormone that is secreted in response to ventricular volume expansion and pressure overload. There are conflicting data regarding the association between BNP levels and outcomes after transcatheter aortic valve replacement (TAVR). We therefore sought to assess the association between baseline BNP and adverse outcomes in patients with symptomatic, severe aortic stenosis (AS), and left ventricular ejection fraction (LVEF) ≥50%, undergoing TAVR in the PARTNER 2 Trial and Registry.
Methods and results
A total of 1782 patients were included in the analysis, and BNP was evaluated both as a continuous log-transformed value and by a priori categories: low (<50 pg/mL), normal (≥50 and <100 pg/mL), moderately elevated (≥100 and <400 pg/mL), or markedly elevated (≥400 pg/mL). Clinical outcomes from discharge to 2 years were compared between patients according to their baseline BNP level, using Kaplan–Meier event rates and multivariable Cox proportional hazards regression models. After adjustment, spline curves revealed a non-linear association between log-transformed BNP and all-cause and cardiovascular mortality in which both the lowest and highest values were associated with increased mortality. Two-year all-cause mortality rates for those with low (n = 86), normal (n = 202), moderately elevated (n = 885), and markedly elevated (n = 609) baseline BNP were 20.0%, 9.8%, 17.7%, and 26.1%, respectively. In adjusted models, compared to a normal baseline BNP, low [adjusted hazard ratio (HR) 2.6, 95% confidence interval (CI) 1.3–5.0, P-value 0.005], moderately elevated (adjusted HR 1.6, 95% CI 1.0–2.6, P-value 0.06), and markedly elevated (adjusted HR 2.1, 95% CI 1.3–3.5, P-value 0.003) BNP were associated with increased all-cause mortality, driven by cardiovascular mortality.
Conclusions
In a large cohort of patients with severe symptomatic AS and preserved LVEF undergoing TAVR, all-cause and cardiovascular mortality rates at 2 years were higher in patients with low and markedly elevated BNP levels.
Clinical Trial Registration
https://clinicaltrials.gov/ unique identifier #NCT01314313, #NCT02184442, #NCT03222128, and #NCT03222141.
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Rosenblum H, Narotsky DL, Hamid N, Hahn RT, Kodali S, Nazif T, Khalique OK, Bokhari S, Maurer MS, Castaño A. Beyond the Valve and into the Muscle: A Review of Coexisting Aortic Stenosis and Transthyretin Cardiac Amyloidosis. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2019.1678794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Dizon J, Nazif T, Crowley A, George I, Kodali S, Thourani V, Mack M, Leon M. TCT-73 The Relative Effects of New Pacemakers Versus Left Bundle Branch Block on Clinical and Echocardiographic Outcomes in the PARTNER Trials. J Am Coll Cardiol 2019. [DOI: 10.1016/j.jacc.2019.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Reisman AM, Robbins BT, Chou DE, Yugrakh MS, Gross GJ, Privitera L, Nazif T, Sommer RJ. Ticagrelor for Refractory Migraine/Patent Foramen Ovale (TRACTOR): An open-label pilot study. Neurology 2019; 91:1010-1017. [PMID: 30478067 DOI: 10.1212/wnl.0000000000006573] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/18/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE After finding that the thienopyridines clopidogrel and prasugrel reduced migraine headache (MHA) symptoms in some patients with patent foramen ovale (PFO), this small pilot study was undertaken to determine whether ticagrelor, a nonthienopyridine P2Y12 inhibitor, would have similar MHA effects and might be better suited for a future randomized trial. METHODS MHA patients were screened for PFO. Participants with documented right to left shunt (RLS) and ≥6 monthly MHA days received ticagrelor therapy for 28 days. Those with ≥50% reduction in monthly MHA days were deemed responders and completed 2 additional treatment months. RESULTS The 40 participants had a mean age of 36.2 years and mean MHA frequency of 17.4 d/mo. A total of 39/40 were female. A total of 14/40 met criteria for episodic MHA, 26/40 for chronic MHA, 14/40 had migraine with aura, and 22/40 had a moderate-large RLS (Spencer grade ≥4). Seventeen of 40 participants (43%) were responders. MHA reduction continued through 3 treatment months in all responders. MHA responder rates were not statistically different in participants with episodic or chronic MHA, with or without aura, or with small/larger RLS shunt magnitude. Thirteen (32%) patients had medication side effects, without serious adverse events. CONCLUSION P2Y12 inhibition with ticagrelor reduced MHA symptoms similarly to our previous thienopyridine experience, but participants seemed to have a less robust MHA benefit and more frequent side effects than with the thienopyridines, making it an inferior choice for a randomized trial. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that ticagrelor reduced MHA symptoms in patients with PFO.
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Sommer RJ, Nazif T, Privitera L, Robbins BT. Retrospective review of thienopyridine therapy in migraineurs with patent foramen ovale. Neurology 2019; 91:1002-1009. [PMID: 30478066 DOI: 10.1212/wnl.0000000000006572] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/12/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We retrospectively reviewed our clinical experience using off-label thienopyridine agents in patients with migraine headache (MHA) and patent foramen ovale (PFO). METHODS Between 2011 and 2017, MHA/PFO patients referred to our practice were clinically treated with clopidogrel specifically for MHA. Those with ≥50% reduction in monthly MHA days compared with baseline were deemed MHA responders. MHA nonresponders with inadequate platelet inhibition by PRU testing were offered prasugrel. Thienopyridine-responsive patients were then offered PFO closure. RESULTS Of 136 patients (86% female, mean age 37.9 years, mean MHA burden 14.7 days/month), 80 (59%) were MHA responders to clopidogrel. The clopidogrel responder rate was equivalent in episodic, chronic, aura, and nonaura subgroups. A total of 19/45 (40%) MHA nonresponders had inadequate platelet inhibition by PRU testing on clopidogrel. Sixteen of those patients received prasugrel, were adequately platelet inhibited by PRU, and 10/16 (62%) converted to MHA responders. A total of 56/90 thienopyridine-responsive patients underwent subsequent PFO closure with thienopyridine discontinuation after 3 months. Ninety-four percent had ongoing MHA relief. A total of 8/8 responders who stopped thienopyridine without PFO closure had resumption of MHA symptoms. CONCLUSION Successful P2Y12 platelet inhibition seemed to reduce MHA symptoms in some patients with PFO, suggesting a platelet-based mechanism/trigger. The nearly parallel response to PFO closure may mechanistically link venous platelet activation with the right-to-left shunt of PFO. Thienopyridine responsiveness could be used to enrich the study population for a new MHA/PFO trial. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that in patients with PFO, P2Y12 inhibition improved MHA symptoms.
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Tang D, Pianka M, Lifrieri A, Wang C, Armenta P, Guaman K, Alhau R, Vasireddi A, Agarwal V, Wolbinski M, Rubin J, Khera S, Ng V, Patel A, Vahl T, Khalique O, Bapat VN, Leon M, Hahn R, Nazif T, Kodali S, George I. PREDICTORS OF WORSENING OR PERSISTENT TRICUSPID REGURGITATION AFTER TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31701-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Cheng A, Deeconda A, Doshi D, Karmpaliotis D, Parikh M, Nazif T, Ali Z, Green P, Parikh S, Vahl TP, Kodali S, Collins M, Stone G, Leon M, Moses J, Kirtane A. ACHIEVEMENT OF GUIDELINE DIRECTED MEDICAL THERAPY GOALS IN COMPLEX HIGHER-RISK (AND INDICATED) PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Wood DA, Lauck SB, Cairns JA, Humphries KH, Cook R, Welsh R, Leipsic J, Genereux P, Moss R, Jue J, Blanke P, Cheung A, Ye J, Dvir D, Umedaly H, Klein R, Rondi K, Poulter R, Stub D, Barbanti M, Fahmy P, Htun N, Murdoch D, Prakash R, Barker M, Nickel K, Thakkar J, Sathananthan J, Tyrell B, Al-Qoofi F, Velianou JL, Natarajan MK, Wijeysundera HC, Radhakrishnan S, Horlick E, Osten M, Buller C, Peterson M, Asgar A, Palisaitis D, Masson JB, Kodali S, Nazif T, Thourani V, Babaliaros VC, Cohen DJ, Park JE, Leon MB, Webb JG. The Vancouver 3M (Multidisciplinary, Multimodality, But Minimalist) Clinical Pathway Facilitates Safe Next-Day Discharge Home at Low-, Medium-, and High-Volume Transfemoral Transcatheter Aortic Valve Replacement Centers. JACC Cardiovasc Interv 2019; 12:459-469. [DOI: 10.1016/j.jcin.2018.12.020] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
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Velagapudi P, Turagam MK, Kolte D, Khera S, Gupta T, Garg J, Abbott JD, George I, Khalique O, Vahl T, Nazif T, Lakkireddy D, Kodali S, Sommer R. Intracardiac vs transesophageal echocardiography for percutaneous left atrial appendage occlusion: A meta-analysis. J Cardiovasc Electrophysiol 2019; 30:461-467. [PMID: 30585678 DOI: 10.1111/jce.13820] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 10/28/2018] [Accepted: 11/21/2018] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Percutaneous left atrial appendage closure (LAAC) is typically performed utilizing transesophageal echocardiography (TEE) and fluoroscopy. Intracardiac echocardiography (ICE) can be a suitable alternative to guide implantation. Given the limited data, we performed a meta-analysis of all studies that compared ICE vs TEE for percutaneous LAAC. METHODS A comprehensive literature search was performed in PubMed, Embase, Scopus, Google Scholar, and major scientific conference sessions for published abstracts and manuscripts until 1 August 2018. Studies reporting clinical outcomes comparing TEE vs ICE for endocardial LAAC in human subjects aged greater than or equal to 18 years were included. Two investigators independently extracted the data and individual quality assessment was performed. The analysis was performed using Cochrane Collaboration software, RevMan 5.3. RESULTS Five eligible studies consisting of 1157 patients (ICE-391 patients and TEE-766 patients) were included. Four studies were retrospective and one was prospective, nonrandomized. Two studies included Watchman, two included the Amplatzer Cardiac Plug/Amulet device, and one included both devices. There was no significant difference in CHA2DS2VASC or HAS-BLED scores between both groups. There was no significant difference in acute procedural success between ICE vs TEE (risk ratio, 1.01; 95% CI, 0.99-1.04; P = 0.24). There was no significant difference in fluoroscopy time (mean difference [MD], 1.84 minutes; 95% CI, 0.59-4.27; P = 0.14) and total procedure time (MD, -5.06 minutes; 95% CI, -24.6-14.4; P = 0.61) between both groups. There was also no significant difference in complications including pericardial tamponade, device embolization, and stroke between both groups. CONCLUSION In our meta-analysis, ICE was as effective as TEE during percutaneous LAAC.
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Olds A, Eudailey K, Nazif T, Vahl T, Khalique O, Lewis C, Hahn R, Leon M, Bapat V, Ahmed M, Kodali S, George I. Suprasternal and Left Axillary Transcatheter Aortic Valve Replacement in Morbidly Obese Patients. Ann Thorac Surg 2018; 106:e325-e327. [DOI: 10.1016/j.athoracsur.2018.05.095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/24/2018] [Accepted: 05/29/2018] [Indexed: 10/27/2022]
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Ando T, Adegbala O, Villablanca PA, Briasoulis A, Takagi H, Grines CL, Schreiber T, Nazif T, Kodali S, Afonso L. In‐hospital outcomes of transcatheter versus surgical aortic valve replacement in non‐teaching hospitals. Catheter Cardiovasc Interv 2018; 93:954-962. [DOI: 10.1002/ccd.27968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 09/23/2018] [Accepted: 10/16/2018] [Indexed: 11/11/2022]
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Spina R, Khalique O, George I, Nazif T. Acute left main stem coronary occlusion following transcatheter aortic valve replacement in a patient without recognized coronary obstruction risk factors: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2018; 2:yty112. [PMID: 31020188 PMCID: PMC6426119 DOI: 10.1093/ehjcr/yty112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 09/04/2018] [Indexed: 11/16/2022]
Abstract
Background Acute coronary obstruction following transcatheter aortic valve replacement (TAVR) is an uncommon but life-threatening event. Case summary A 78-year-old man developed acute left main obstruction following transfemoral TAVR with a balloon-expandable valve. Cardiac arrest ensued, requiring emergent peripheral cardiopulmonary bypass. Percutaneous coronary intervention (PCI) to the left main coronary artery was performed with one drug-eluting stent. Intravascular ultrasound (IVUS) demonstrated focal underexpansion of the stent in its proximal segment which was not responsive to high-pressure non-compliant balloon dilatation, suggesting stent compression from either valve strut or calcific native leaflet. Therefore, to increase radial strength of the scaffolding at the site of compression, we deployed a second stent within the first stent, and further expanded that segment with high-pressure balloon inflations. Final IVUS demonstrated better expansion of the focally compressed segment. Following PCI, left ventricular function normalized completely. The patient was discharged from hospital on Day 3 post-procedure. At 12 weeks follow-up, his dyspnoea had improved significantly, and follow-up transthoracic echocardiography demonstrated normal left ventricular systolic function and normal aortic valve function. Discussion Established risk factors for coronary ostial occlusion include a short distance between the aortic annulus and the coronary ostia (<10 mm) and a narrow aortic root (<28 mm at the sinuses of Valsalva). These two factors increase the likelihood that the native valve leaflets are displaced over and obstruct the coronary ostia when the aortic bioprosthesis is deployed. Perplexingly, our patient did not present with any of the recognized risk factors for acute coronary occlusion, suggesting other factors might be at play. We suggest that a leaflet length to coronary sinus height ratio greater than 1 might be an additional useful predictor of coronary occlusion during TAVR. In addition, we suggest that if residual focal stent compression from either valve strut or calcific leaflet exists after stent deployment and the latter is resistant to balloon dilatation, deploying a second concentric layer of stent might improve the radial strength of the scaffolding and improve overall stent expansion.
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Sathananthan J, Webb J, Lauck S, Cairns J, Murdoch D, Cook R, Humphries K, Park J, Zhao Y, Welsh R, Leipsic J, Genereux P, Tyrrell B, Alqoofi F, Velianou J, Natarajan M, Wijeysundera H, Radhakrishnan S, Horlick E, Osten M, Asgar A, Kodali S, Nazif T, Thourani V, Babaliaros V, Cohen D, Masson J, Klein R, Rondi K, Umedaly H, Leon M, Wood D. IMPACT OF LEVEL OF ANAESTHESIA USING THE VANCOUVER CLINICAL PATHWAY FOR TRANSCATHETER AORTIC VALVE REPLACEMENT: INSIGHTS FROM THE 3M TAVR STUDY. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Sathananthan J, Lauck S, Cairns J, Humphries K, Murdoch D, Hensey M, Cook R, Guan M, Park J, Zhao Y, Welsh R, Leipsic J, Dvir D, Tyrrell B, Afilalo J, Alqoofi F, Velianou J, Natarajan M, Wijeysundera H, Radhakrishnan S, Horlick E, Asgar A, Masson JB, Kodali S, Nazif T, Thourani V, Babaliaros V, Cohen D, Leon M, Webb J, Wood D. TCT-225 Impact of frailty on a minimalist approach and early discharge following TAVR: insights from the 3M TAVR Study. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Gupta A, Finn M, Vahl T, Nazif T, Smyth E, Fidlow K, Leon M, Kodali S, Kirtane AJ. TCT-538 Bleeding Outcomes in Patients Undergoing Combined TAVR/PCI: Time for an Adjustment to the CathPCI Bleeding Model? J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Meduri C, Hahn R, Davidson C, Lim S, Nazif T, Ricciardi M, vivek rajagopal, Ailawadi G, Vannan M, Thomas J, Kodali S. TCT-74 SCOUT Study: Trialign results at 30 days from combined US and EU cohort for the treatment of functional TR. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lauck S, Wood D, Sathananthan J, suzanne baron, Humphries K, Park J, Zhao Y, Asgar A, Cook R, Murdoch D, Thourani V, Kodali S, Wijeysundera H, Welsh R, Natarajan M, Masson JB, Nazif T, Hawkey M, Keegan P, Dvir D, Cairns J, Leon M, Webb J, Cohen D. TCT-181 Early Changes in Quality of Life after Transcatheter Aortic Valve Replacement: Results from the 3M-TAVR Trial. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Olds A, Eudailey K, Brinkman M, Liao M, Pentyala S, Wang C, Guaman K, Ng V, Velagapudi P, Elias E, Patel A, Vahl T, Khalique O, Lewis C, Hahn R, Bapat V, Leon M, Ahmed M, Kodali S, Nazif T, George I. TCT-395 A Propensity-Matched Comparison of Suprasternal and Transfemoral Transcatheter Aortic Valve Replacement: Inominate versus Femoral. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Macedo LG, Kosmidou I, Alu M, Praz F, Nazif T, Kodali S, Thourani V, Szeto WY, Devireddy C, Kapadia S, Makkar R, Leon M. TCT-477 Prevalence and Clinical Impact of Baseline QRS Duration in Patients With Severe Aortic Stenosis Two Years After Aortic Valve Replacement in the PARTNER II Trial. J Am Coll Cardiol 2018. [DOI: 10.1016/j.jacc.2018.08.1650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chen S, Redfors B, Ben-Yehuda O, Crowley A, Greason KL, Alu MC, Finn MT, Vahl TP, Nazif T, Thourani VH, Suri RM, Svensson L, Webb JG, Kodali SK, Leon MB. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Prior Cardiac Surgery in the Randomized PARTNER 2A Trial. JACC Cardiovasc Interv 2018; 11:2207-2216. [PMID: 30409278 DOI: 10.1016/j.jcin.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to further evaluate clinical outcomes in patients with and without PCS. BACKGROUND Prior cardiac surgery (PCS) is associated with increased surgical risk and post-operative complications following surgical aortic valve replacement (SAVR), but whether this risk is similar in transcatheter aortic valve replacement (TAVR) is unclear. METHODS In the PARTNER 2A (Placement of Aortic Transcatheter Valve) trial, 2,032 patients with severe aortic stenosis at intermediate surgical risk were randomized to TAVR with the SAPIEN XT valve or SAVR. Adverse clinical outcomes at 30 days and 2 years were compared using Kaplan-Meier event rates and multivariate Cox proportional hazards regression models. The primary endpoint of the PARTNER 2 trial was all-cause death and disabling stroke. RESULTS Five hundred nine patients (25.1%) had PCS, mostly (98.2%) coronary artery bypass grafting. There were no significant differences between TAVR and SAVR in patients with or without PCS in the rates of the primary endpoint at 30 days or 2 years. Nevertheless, an interaction was observed between PCS and treatment arm; whereas no-PCS patients treated with TAVR had higher rates of 30-day major vascular complications than patients treated with SAVR (adjusted hazard ratio: 2.66; 95% confidence interval: 1.68 to 4.22), the opposite was true for patients with PCS (adjusted hazard ratio: 0.27; 95% confidence interval: 0.11 to 0.66) (pinteraction <0.0001). A similar interaction was observed for life-threatening or disabling bleeding. CONCLUSIONS In the PARTNER 2A trial of intermediate-risk patients with severe aortic stenosis undergoing SAVR versus TAVR, the relative risk for 2-year adverse clinical outcomes was similar between TAVR and SAVR in patients with or without PCS.
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Hahn RT, Pibarot P, Leipsic J, Blanke P, Douglas PS, Weissman NJ, Kapadia S, Thourani VH, Herrmann HC, Nazif T, McAndrew T, Webb JG, Leon MB, Kodali S. The Effect of Post-Dilatation on Outcomes in the PARTNER 2 SAPIEN 3 Registry. JACC Cardiovasc Interv 2018; 11:1710-1718. [PMID: 30121276 DOI: 10.1016/j.jcin.2018.05.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to understand the effects of balloon post-dilatation on outcomes following transcatheter aortic valve replacement with the SAPIEN 3 valve. BACKGROUND Hemodynamics and outcomes with balloon post-dilatation for the SAPIEN 3 valve have not been previously reported. METHODS The effects of balloon post-dilatation (BPD) in 1,661 intermediate (S3i cohort) and high surgical risk (S3HR cohort) patients with aortic stenosis enrolled in the PARTNER (Placement of Aortic Transcatheter Valves) 2, SAPIEN 3 observational study on outcomes, as well as procedural complications, were assessed. RESULTS 208 of 1,661 patients (12.5%) had BPD during the initial transcatheter aortic valve replacement. Baseline characteristics were similar except BPD had higher STS score (p < 0.001), significantly less % oversizing (p = 0.004), significantly more ≥moderate left ventricular outflow tract calcification (p = 0.005), and severe annular calcification (p = 0.006). BPD patients had no increase in permanent pacemaker, annular rupture, or valve embolization. Following transcatheter aortic valve replacement, BPD patients had significantly larger aortic valve area (1.72 ± 0.41 cm2 vs. 1.66 ± 0.37 cm2; p = 0.04) with no significant difference in prosthesis-patient mismatch (p = 0.08) or transvalvular aortic regurgitation (p = 0.65), but significantly more paravalvular regurgitation (p < 0.01). There was no significant difference in 30-day or 1-year outcomes of all-cause death (p = 0.65 to 0.76) or stroke (p = 0.28 to 0.72). However, at 1 year, there was a significantly higher incidence of minor stroke in BPD patients (p = 0.02). Adjusting for baseline differences, including calcium burden, minor strokes were no longer significantly different between the BPD and NoBPD groups (p = 0.21). CONCLUSIONS BPD is performed more frequently in patients with lower % oversizing and greater calcium burden. BPD is not associated with procedural complications or an increase in 1-year adverse events of death, rehospitalization, or stroke.
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Chen S, Redfors B, Ben-Yehuda O, Crowley A, Greason KL, Alu M, Finn MT, Vahl T, Nazif T, Thourani VH, Suri RM, Svensson L, Webb JG, Kodali S, Leon MB. 4994Transcatheter versus surgical aortic valve replacement in patients with prior cardiac surgery in the randomized PARTNER 2A Trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.4994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Codner P, Malick W, Kouz R, Patel A, Chen CH, Terre J, Landes U, Vahl TP, George I, Nazif T, Kirtane AJ, Khalique OK, Hahn RT, Leon MB, Kodali S. Mortality risk after transcatheter aortic valve implantation: analysis of the predictive accuracy of the Transcatheter Valve Therapy registry risk assessment model. EUROINTERVENTION 2018; 14:e405-e412. [DOI: 10.4244/eij-d-18-00032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Meduri C, Davidson C, Lim S, Nazif T, Ricciardi M, Rajagopal V, Ailawadi G, Vannan M, Thomas J, Fowler D, Rich S, Kodali SK, Hahn RT. 30 DAY RESULTS OF THE SCOUT I STUDY IN PATIENTS WITH SEVERE TRICUSPID REGURGITATION (TR). J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31545-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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75
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Dizon JM, Nazif T, Biviano A, Garan H, Kodali SK, Smith CR, Lowry A, Blackstone E, Thourani VH, Svensson L, Mack MJ, Leon MB. NEW PACEMAKER IMPLANTATION AFTER SURGICAL AORTIC VALVE REPLACEMENT IN THE PARTNER TRIALS: RATES, RISK FACTORS, AND CLINICAL OUTCOMES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30849-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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76
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Praz F, Khalique O, Macedo LDR, Jantz J, Pablo C, Patel A, Terre J, Vahl T, Bapat V, George I, Nazif T, Kodali SK, Leon MB, Hahn RT. COMPARISON BETWEEN THREE-DIMENSIONAL ECHOCARDIOGRAPHY AND COMPUTED TOMOGRAPHY FOR TRICUSPID ANNULUS SIZING: IMPLICATIONS FOR THE GRADING OF TRICUSPID REGURGITATION USING THE QUANTITATIVE DOPPLER METHOD. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32011-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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77
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Wolny R, Mintz G, Matsumura M, Ishida M, Parviz Y, Fall K, Nazif T, Parikh M, Rabbani L, Collins M, Green P, Ali Z, Karmpaliotis DI, Brogno D, Kodali SK, Vahl T, Parikh S, Privitera L, Leon MB, Stone G, Kirtane A, Moses J, Maehara A. INTRAVASCULAR ULTRASOUND MECHANISMS OF IN-STENT RESTENOSIS IN SAPHENOUS VEIN GRAFT LESIONS. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nazif T, George I, Dizon J, Hahn RT, Crowley A, Babaliaros V, Herrmann H, Brown D, Makkar R, Smalling R, Kapadia S, Webb J, Leon MB, Kodali SK. CLINICAL IMPACT OF NEW LEFT BUNDLE BRANCH BLOCK IN INTERMEDIATE RISK PATIENTS UNDERGOING TAVR: AN ANALYSIS OF THE PARTNER II TRIAL AND REGISTRIES. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31536-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lazar RM, Pavol MA, Bormann T, Dwyer MG, Kraemer C, White R, Zivadinov R, Wertheimer JC, Thöne-Otto A, Ravdin LD, Naugle R, Mechanic-Hamilton D, Garmoe WS, Stringer AY, Bender HA, Kapadia SR, Kodali S, Ghanem A, Linke A, Mehran R, Virmani R, Nazif T, Parhizgar A, Leon MB. Neurocognition and Cerebral Lesion Burden in High-Risk Patients Before Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:384-392. [DOI: 10.1016/j.jcin.2017.10.041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022]
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80
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Balter S, Brinkman M, Kalra S, Nazif T, Parikh M, Kirtane A, Moses J, Leon M, Feri A, Green P, Ali Z, Liao M, Karmpaliotis D. Novel radiation dose reduction fluoroscopic technology facilitates chronic total occlusion percutaneous coronary interventions. EUROINTERVENTION 2017; 13:e1468-e1474. [DOI: 10.4244/eij-d-16-00216] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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81
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Castaño A, Narotsky DL, Hamid N, Khalique OK, Morgenstern R, DeLuca A, Rubin J, Chiuzan C, Nazif T, Vahl T, George I, Kodali S, Leon MB, Hahn R, Bokhari S, Maurer MS. Unveiling transthyretin cardiac amyloidosis and its predictors among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Eur Heart J 2017; 38:2879-2887. [PMID: 29019612 PMCID: PMC5837725 DOI: 10.1093/eurheartj/ehx350] [Citation(s) in RCA: 440] [Impact Index Per Article: 62.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 04/25/2017] [Accepted: 06/05/2017] [Indexed: 12/21/2022] Open
Abstract
AIMS Transthyretin cardiac amyloidosis (ATTR-CA) has been reported in patients with aortic stenosis (AS) but its prevalence and phenotype are not known. We examine elderly patients with severe symptomatic AS undergoing transcatheter aortic valve replacement (TAVR) and determine the prevalence and phenotype of ATTR-CA non-invasively. METHODS AND RESULTS We performed technetium-99m pyrophosphate (99mTc-PYP) cardiac scintigraphy prospectively on patients who underwent TAVR, to screen for ATTR-CA. Transthoracic echocardiography and speckle-strain imaging were performed. We assessed the association of several parameters with ATTR-CA using multivariable logistic regression and constructed receiver operating curves to evaluate the best predictors of ATTR-CA. Among 151 patients (mean age 84 ± 6 years, 68% men), 16% (n = 24) screened positive for ATTR-CA with 99mTc-PYP scintigraphy. Compared with patients without ATTR-CA, ATTR-CA patients had a thicker interventricular septum (1.3 vs. 1.1 cm, P = 0.007), higher left ventricular (LV) mass index (130 vs. 98 g/m2, P = 0.002), and lower stroke volume index (30 vs. 36 mL/m2, P = 0.009). ATTR-CA patients had advanced diastolic dysfunction with higher E/A ratio (2.3 vs. 0.9, P = 0.001) and lower deceleration time (176 vs. 257 ms, P < 0.0001); impairment in systolic function with lower ejection fraction (48% vs. 56%, P = 0.011), myocardial contraction fraction (26 vs. 41, P < 0.0001), and average of lateral and septal mitral annular tissue Doppler S' (4.0 vs. 6.6 cm/s, P < 0.0001). While ATTR-CA patients had more impaired global longitudinal strain (-12 vs. -16%, P = 0.007), relative apical longitudinal strain was the same regardless of ATTR-CA diagnosis (0.98 vs. 0.98, P = 0.991). Average S' best predicted ATTR-CA in multivariable logistic regression (odds ratio 16.67 per 1 cm/s decrease with AUC 0.96, 95% confidence interval 0.90-0.99, P = 0.002) with a value ≤6 conferring 100% sensitivity for predicting a positive 99mTc-PYP amyloid scan. CONCLUSIONS Transthyretin cardiac amyloidosis is prevalent in 16% of patients with severe calcific AS undergoing TAVR and is associated with a severe AS phenotype of low-flow low-gradient with mildly reduced ejection fraction. Average tissue Doppler mitral annular S' of < 6 cm/s may be a sensitive measure that should prompt a confirmatory 99mTc-PYP scan and subsequent testing for ATTR-CA. Prospective assessment of outcomes after TAVR is needed in patients with and without ATTR-CA.
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Cleaman J, Finn M, Song L, Maehara A, Kalra S, Fried J, Moses J, Parikh M, Kirtane AJ, Collins M, Nazif T, Fall K, Green P, Batres C, Ali Z, Leon M, Mintz G. TCT-704 Intravascular Ultrasound Analysis of Intraplaque Versus Subintimal Tracking in Percutaneous Intervention for Coronary Chronic Total Occlusions: One Year Outcomes. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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83
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Lampert J, Finn M, Kantor A, Akkoc D, Liao M, Fidlow K, Codner P, Patel A, Khalique O, Hahn R, Vahl T, George I, Leon M, Kodali S, Nazif T. TCT-266 Complications of Indwelling Urinary Catheters In Patients Undergoing Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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84
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Taramasso M, Hahn R, Alessandrini H, Latib A, Attinger A, Braun D, Brochet E, Calen C, Connelly K, Denti P, Deuschl F, Fam N, Frerker C, Hausleiter J, Juliard JM, Kaple R, Kuck KH, Kuwata S, Ancona M, Mehr M, Nazif T, Nickenig G, Nietlispach F, Schofer J, Pozzoli A, Schäfer U, Schueler R, Tang G, Webb J, Yzeiraj E, Maisano F, Leon M. TCT-86 Which patients are undergoing transcatheter tricuspid repair today? An update from the International Multicenter Transcatheter Tricuspid Valve Therapies (TriValve) Registry. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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85
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Biviano A, Nazif T, Dizon J, Garan H, Crowley A, Malaisrie S, Makkar R, Thourani V, Mack M, Szeto WY, Fearon W, Leon M, Kodali S. TCT-106 Atrial Fibrillation is Associated with Increased Mortality in Intermediate-Risk Patients Undergoing TAVR or SAVR: Insights From the PARTNER 2A and PARTNER 2 S3i Trials. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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86
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Taramasso M, Hahn RT, Alessandrini H, Latib A, Attinger-Toller A, Braun D, Brochet E, Connelly KA, Denti P, Deuschl F, Englmaier A, Fam N, Frerker C, Hausleiter J, Juliard JM, Kaple R, Kreidel F, Kuck KH, Kuwata S, Ancona M, Malasa M, Nazif T, Nickenig G, Nietlispach F, Pozzoli A, Schäfer U, Schofer J, Schueler R, Tang G, Vahanian A, Webb JG, Yzeiraj E, Maisano F, Leon MB. The International Multicenter TriValve Registry. JACC Cardiovasc Interv 2017; 10:1982-1990. [DOI: 10.1016/j.jcin.2017.08.011] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/03/2017] [Accepted: 08/08/2017] [Indexed: 11/26/2022]
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87
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Bhatti N, Jhalani N, Galougahi KK, Parviz Y, Rathakrishnan B, Nazif T, Moses JW, Kodali S, Karmpaliotis D, Mintz G, Maehara A, Kirtane AJ, Akhund A, Ben-Yehuda O, Stone G, Crew R, Dube G, Hardy M, Mohan S, Radhakrishnan J, Cohen D, Ratner L, Leon M, Ali Z. TCT-474 Ultra-Low Contrast Coronary Angiography in Patients with Advanced Chronic Kidney Disease - Feasibility and Outcomes Compared to Standard Angiography. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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88
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Biviano AB, Nazif T, Dizon J, Garan H, Abrams M, Fleitman J, Hassan D, Kapadia S, Babaliaros V, Xu K, Rodes-Cabau J, Szeto WY, Fearon WF, Dvir D, Dewey T, Williams M, Kindsvater S, Mack MJ, Webb JG, Craig Miller D, Smith CR, Leon MB, Kodali S. Atrial Fibrillation is Associated with Increased Pacemaker Implantation Rates in the Placement of AoRTic Transcatheter Valve (PARTNER) Trial. J Atr Fibrillation 2017; 10:1494. [PMID: 29250217 DOI: 10.4022/jafib.1494] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 12/02/2016] [Accepted: 05/06/2017] [Indexed: 01/13/2023]
Abstract
Atrial fibrillation (AF) is associated with worse outcomes in many cardiovascular diseases. There are few data examining pacemaker implantation rates and indications in patients with AF who undergo transcatheter aortic valve replacement (TAVR). To examine the impact of AF on the incidence of and indications for pacemakers in patients undergoing TAVR, we evaluated data of 1723 patients without pre-existing pacemakers who underwent TAVR in the Placement of AoRTic TraNscathetER Valve (PARTNER) trial. Permanent pacemaker implantation rates and indications were compared in groups based on baseline and discharge heart rhythm: sinus rhythm (SR) vs. AF. 1211 patients manifested SR at baseline/SR at discharge (SR/SR), 105 SR baseline/AF discharge (SR/AF), and 407 AF baseline/AF discharge (AF/AF). Patients who developed and were discharged with AF (SR/AF) had the highest rates of pacemaker implantation at 30 days (13.7% SR/AF vs. 5.4% SR/SR, p=0.0008 and 5.9% AF/AF, p=0.008) and 1 year (17.7% SR/AF vs. 7.1% SR/SR, p=0.0002 and 8.1% AF/AF, p=0.0034). Conversion from SR to AF by discharge was an independent predictor of increased pacemaker implantation at 30 days (HR 2.19 vs. SR/SR, 95% CI 1.23-3.93, p=0.008) and 1 year (HR 1.91 vs. SR/SR, 95% CI 1.33-3.80). Pacemaker indications differed between groups, with relatively more implanted in the AF groups for sick sinus syndrome (SSS) versus AV block. In conclusion, conversion to AF is an independent predictor of permanent pacemaker implantation in TAVR patients. Indications differ depending on heart rhythm, with patients in AF manifesting clinically significant tachy-brady syndrome versus AV block.
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van Gils L, Clavel MA, Vollema EM, Hahn RT, Spitzer E, Delgado V, Nazif T, De Jaegere PP, Geleijnse ML, Ben-Yehuda O, Bax JJ, Leon MB, Pibarot P, Van Mieghem NM. Prognostic Implications of Moderate Aortic Stenosis in Patients With Left Ventricular Systolic Dysfunction. J Am Coll Cardiol 2017; 69:2383-2392. [DOI: 10.1016/j.jacc.2017.03.023] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 10/19/2022]
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90
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Brinkman M, Patel A, Chen CH, Nazif T, Khalique O, Liao M, Vahl T, George I, Codner P, Kouz R, Terre J, Jantz J, Leon M, Kodali S, Hahn R. REFINING THE CLASSIFICATION OF SEVERE, SYMPTOMATIC AORTIC STENOSIS USING FLOW AND GRADIENT MEASUREMENTS TO PREDICT OUTCOMES POST-TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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91
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Yin D, Maehara A, Mintz G, Hatem R, Song L, Amemiya K, Moses J, Parikh M, Kirtane A, Nazif T, Fall K, Liao M, Kim T, Green P, Ali Z, Leon M, Ochiai M. MORPHOLOGIC PATTERNS OF IN-STENT CHRONIC TOTAL OCCLUSIONS: AN INTRAVASCULAR ULTRASOUND STUDY. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34473-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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92
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Paradis JM, White JM, Généreux P, Urena M, Doshi D, Nazif T, Hahn R, George I, Khalique O, Harjai K, Lasalle L, Labbé BM, DeLarochellière R, Doyle D, Dumont É, Mohammadi S, Leon MB, Rodés-Cabau J, Kodali S. Impact of Coronary Artery Disease Severity Assessed With the SYNTAX Score on Outcomes Following Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2017; 6:JAHA.116.005070. [PMID: 28219920 PMCID: PMC5523783 DOI: 10.1161/jaha.116.005070] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The influence of coronary artery disease (CAD) on clinical and echocardiographic outcomes after transcatheter aortic valve replacement (TAVR) is still controversial. We sought to evaluate the impact of CAD severity as measured by the SYNTAX score (SS) on patients undergoing TAVR. Methods and Results A total of 377 patients who underwent TAVR in 2 high‐volume centers in North America were included in our retrospective analysis. A blinded angiographic core laboratory calculated the SS on all available coronary angiograms with the use of quantitative coronary analysis. Patients were stratified into 4 groups: (1) no CAD (SS=0); (2) low SS (SS between 1 and 22); (3) intermediate SS (SS between 23 and 32); and (4) high SS (SS ≥33). Patients who had undergone percutaneous coronary intervention within 6 months prior to TAVR were separated into 2 categories based on their residual SS (<8 and ≥8). Patients with previous coronary artery bypass grafting (CABG) were divided into 2 groups: (1) low CABG SS and (2) high CABG SS. The primary end point was a composite of all‐cause mortality, myocardial infarction, and stroke. At 30 days and 1 year, both the presence and the severity of CAD had no impact on the rate of the combined primary end point and on all‐cause mortality, cardiovascular mortality, and myocardial infarction. Patients with less complete revascularization (residual SS ≥8 versus residual SS <8 and low CABG SS versus high CABG SS, had similar rates of the combined primary end point, all‐cause mortality, cardiovascular mortality, MI, and stroke, at both 30 days and 1 year. Conclusions In our core laboratory–validated study, neither the severity of CAD nor completeness of revascularization after percutaneous coronary intervention or CABG were associated with clinical outcomes after TAVR, at both 30 days and 1 year.
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Patel A, Nazif T, Stone GW, Ali ZA. Intraluminal bioresorbable vascular scaffold dismantling with aneurysm formation leading to very late thrombosis. Catheter Cardiovasc Interv 2017; 89:876-879. [DOI: 10.1002/ccd.26913] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/07/2016] [Accepted: 12/11/2016] [Indexed: 11/08/2022]
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94
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Gaglia MA, Goodroe R, Mishkel G, Gharib W, Tabrizchi A, Nazif T, Wang J, Scott T, Lopez M, Steinberg D, Gai J, Torguson R, Waksman R. Promus Premier versus Xience V and Taxus Liberte in contemporary United States practice (REWARDS premier registry). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:16-21. [DOI: 10.1016/j.carrev.2016.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
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Kapadia SR, Kodali S, Makkar R, Mehran R, Lazar RM, Zivadinov R, Dwyer MG, Jilaihawi H, Virmani R, Anwaruddin S, Thourani VH, Nazif T, Mangner N, Woitek F, Krishnaswamy A, Mick S, Chakravarty T, Nakamura M, McCabe JM, Satler L, Zajarias A, Szeto WY, Svensson L, Alu MC, White RM, Kraemer C, Parhizgar A, Leon MB, Linke A, Makkar R, Al-Jilaihawi H, Kapadia S, Krishnaswamy A, Tuzcu EM, Mick S, Kodali S, Nazif T, Thourani V, Babaliaros V, Devireddy C, Mavromatis K, Waksman R, Satler L, Pichard A, Szeto W, Anwaruddin S, Vallabhajosyula P, Giri J, Herrmann H, Zajarias A, Lasala J, Greenbaum A, O’Neill W, Eng M, Rovin J, Lin L, Spriggs D, Wong SC, Bergman G, Salemi A, Smalling R, Kar B, Loyalka P, Lim DS, Ragosta M, Reisman M, McCabe J, Don C, Sharma S, Kini A, Dangas G, Mahoney P, Morse A, Stankewicz M, Rodriguez E, Linke A, Mangner N, Woitek F, Frerker C, Cohen D. Protection Against Cerebral Embolism During Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2017; 69:367-377. [DOI: 10.1016/j.jacc.2016.10.023] [Citation(s) in RCA: 265] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 10/21/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022]
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van Gils L, Clavel MA, Vollema M, Delgado V, Nazif T, Spitzer E, Hahn R, Bax J, Leon M, Pibarot P, Van Mieghem N. TCT-819 Clinical Outcome in Patients with Heart Failure and Moderate Aortic Stenosis. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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97
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Nombela-Franco L, Cerrato E, Nazif T, Eltchaninoff H, Sondergaard L, Ribeiro H, Barbanti M, Nietlispach F, Agostoni P, Trillo R, Jimenez P, D'Ascenzo F, Wendler O, Maluenda G, Chen M, Tamburino C, Macaya C, Leon M, Rodés-Cabau J. TCT-82 Evaluation of Current Practices in Transcatheter Aortic Valve Replacement: The WRITTEN (WoRldwIde TAVR ExperieNce) Survey. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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98
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Biviano AB, Nazif T, Dizon J, Garan H, Fleitman J, Hassan D, Kapadia S, Babaliaros V, Xu K, Parvataneni R, Rodes-Cabau J, Szeto WY, Fearon WF, Dvir D, Dewey T, Williams M, Mack MJ, Webb JG, Miller DC, Smith CR, Leon MB, Kodali S. Atrial Fibrillation Is Associated With Increased Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights From the Placement of Aortic Transcatheter Valve (PARTNER) Trial. Circ Cardiovasc Interv 2016; 9:e002766. [PMID: 26733582 DOI: 10.1161/circinterventions.115.002766] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study sought to evaluate the impact of atrial fibrillation (AF) on clinical outcomes in patients undergoing transcatheter aortic valve replacement. METHODS AND RESULTS Data were evaluated in 1879 patients with baseline and discharge ECGs who underwent transcatheter aortic valve replacement in the Placement of AoRTic TraNscathetER Valve (PARTNER) trial. A total of 1262 patients manifested sinus rhythm (SR) at baseline/SR at discharge, 113 SR baseline/AF discharge, and 470 AF baseline/AF discharge. Patients who converted from SR to AF by discharge had the highest rates of all-cause mortality at 30 days (P<0.0001 across all groups; 14.2% SR/AF versus 2.6% SR/SR; adjusted hazard ratio [HR]=3.41; P=0.0002) and over 2-fold difference at 1 year (P<0.0001 across all groups; 35.7% SR/AF versus 15.8% SR/SR; adjusted HR=2.14; P<0.0001). The presence of AF on baseline or discharge ECG was a predictor of 1-year mortality (adjusted HR=2.14 for SR/AF group and HR=1.88 for AF/AF groups; P<0.0001 for both groups versus SR/SR). For patients discharged in AF, those with lower ventricular response (ie, <90 bpm) experienced less 1-year all-cause mortality (HR=0.74; P=0.04). CONCLUSIONS After transcatheter aortic valve replacement, the presence of AF at discharge, and particularly, the conversion to AF by discharge and higher ventricular response are associated with increased mortality. These data underscore the deleterious impact of AF, as well as the need for targeted interventions to improve clinical outcomes, in patients undergoing transcatheter aortic valve replacement. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00530894.
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Bhatti NK, Karimi Galougahi K, Paz Y, Nazif T, Moses JW, Leon MB, Stone GW, Kirtane AJ, Karmpaliotis D, Bokhari S, Hardy MA, Dube G, Mohan S, Ratner LE, Cohen DJ, Ali ZA. Diagnosis and Management of Cardiovascular Disease in Advanced and End-Stage Renal Disease. J Am Heart Assoc 2016; 5:JAHA.116.003648. [PMID: 27491836 PMCID: PMC5015288 DOI: 10.1161/jaha.116.003648] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Castano A, Narotsky D, Kodali S, Nazif T, George I, Vahl T, Hamid N, Hahn R, Morgenstern R, Bokhari S, Maurer M. TRANSTHYRETIN CARDIAC AMYLOIDOSIS IS PREVALENT AMONG MEN WITH SEVERE AORTIC STENOSIS UNDERGOING TRANSCATHETER AORTIC VALVE REPLACEMENT. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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