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Hioki H, Watanabe Y, Kozuma K, Nara Y, Kawashima H, Nagura F, Nakashima M, Kataoka A, Yamamoto M, Naganuma T, Araki M, Tada N, Shirai S, Yamanaka F, Hayashida K. Timing of Susceptibility to Mortality and Heart Failure in Patients With Preexisting Atrial Fibrillation After Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 120:1618-1625. [PMID: 28842144 DOI: 10.1016/j.amjcard.2017.07.061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/07/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
The relationship between cardiac rhythm and adverse events after transcatheter aortic valve implantation (TAVI) remains unclear. To compare the prognostic impact of preexisting atrial fibrillation (AF) and new-onset AF (NOAF) after TAVI, we assessed 1,124 patients (846 with sinus rhythm [SR], 49 with NOAF, and 229 with preexisting AF) who underwent TAVI with a balloon-expandable valve from October 2013 to April 2016. The incidences of all-cause death and rehospitalization for heart failure (HF) were retrospectively evaluated. The median follow-up period was 370 days (range 188 to 613). In the Kaplan-Meier analysis, the incidences of all-cause death and rehospitalization for HF were significantly higher in patients with preexisting AF than those in patients with NOAF and SR. The multivariable analysis showed that preexisting AF was significantly associated with increased all-cause death (hazard ratio [HR] 1.54; 95% confidence interval [CI] 1.02 to 2.34) and rehospitalization for HF (HR 2.94; 95% CI 1.75 to 4.93). The landmark analysis demonstrated that patients with preexisting AF had a significantly higher incidence of rehospitalization for HF within the first 6 months after TAVI (HR 4.04; 95% CI 2.23 to 7.32), and a higher incidence of all-cause death from 6 months to 2 years after TAVI (HR 2.12; 95% CI 1.15 to 3.90). Our study demonstrated that preexisting AF increased the risk of all-cause death and rehospitalization for HF after TAVI in comparison with NOAF or SR. Moreover, there was a specific timing of susceptibility to all-cause death and rehospitalization for HF after TAVI.
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102
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Hosoba S, Yamamoto M, Shioda K, Sago M, Koyama Y, Shimura T, Kagase A, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Watanabe Y, Hayashida K. Safety and efficacy of minimalist approach in transfemoral transcatheter aortic valve replacement: insights from the Optimized transCathEter vAlvular interventioN–Transcatheter Aortic Valve Implantation (OCEAN-TAVI) registry†. Interact Cardiovasc Thorac Surg 2017; 26:420-424. [DOI: 10.1093/icvts/ivx355] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/03/2017] [Indexed: 11/13/2022] Open
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103
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Yoon SH, Ahn JM, Hayashida K, Watanabe Y, Shirai S, Kao HL, Yin WH, Lee MKY, Tay E, Araki M, Yamanaka F, Arai T, Lin MS, Park JB, Park DW, Kang SJ, Lee SW, Kim YH, Lee CW, Park SW, Muramatsu T, Hanyu M, Kozuma K, Kim HS, Saito S, Park SJ. Clinical Outcomes Following Transcatheter Aortic Valve Replacement in Asian Population. JACC Cardiovasc Interv 2017; 9:926-33. [PMID: 27151607 DOI: 10.1016/j.jcin.2016.01.047] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/26/2016] [Accepted: 01/26/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study describes the characteristics of a real-world Asian patient population treated with transcatheter aortic valve replacement (TAVR) and evaluates their clinical outcomes. BACKGROUND No previously reported randomized or observational studies adequately assess the safety and efficacy of TAVR in an Asian population. METHODS The Asian TAVR registry is an international multicenter study that enrolled patients with aortic stenosis who underwent TAVR in Asian countries. RESULTS In total, 848 patients with mean STS score of 5.2 ± 3.8% were enrolled between March 2010 and September 2014 at 11 centers in 5 countries. The Edwards Sapien or Medtronic CoreValve was implanted in 64.7% and 35.3% of patients, respectively. The procedural success rate was 97.5%. The 30-day and 1-year mortality rates were 2.5% and 10.8%, respectively. There was no difference in 1-year mortality between devices (Sapien: 9.4%; CoreValve: 12.2%; log-rank p = 0.40). The rates of stroke, life-threatening bleeding, major vascular complications and acute kidney injury (stage 2 to 3) were 3.8%, 6.4%, 5.0% and 3.3%, respectively. Moderate or severe paravalvular leakage was significantly more common with the CoreValve than Sapien (14.4% vs. 7.3%; p = 0.001). According to the multivariate model, a higher STS score, lower body mass index, New York Heart Association functional class III-IV symptoms, diabetes mellitus, prior cerebrovascular accident, low mean gradient at baseline, and moderate or severe paravalvular leakage were significantly associated with reduced survival. CONCLUSIONS Despite anatomical features of concern, the clinical outcomes of TAVR in our Asian population were favorable in comparison with those of previously published trials and observational studies. (The Asian Transcatheter Aortic Valve Replacement Registry [Asian TAVR]; NCT02308150).
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Ochiai T, Saito S, Yamanaka F, Shishido K, Tanaka Y, Yamabe T, Shirai S, Tada N, Araki M, Naganuma T, Watanabe Y, Yamamoto M, Hayashida K. Renin–angiotensin system blockade therapy after transcatheter aortic valve implantation. Heart 2017; 104:644-651. [DOI: 10.1136/heartjnl-2017-311738] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 01/29/2023] Open
Abstract
ObjectiveThe persistence of left ventricular (LV) hypertrophy is associated with poor clinical outcomes after transcatheter aortic valve implantation (TAVI) for aortic stenosis. However, the optimal medical therapy after TAVI remains unknown. We investigated the effect of renin−angiotensin system (RAS) blockade therapy on LV hypertrophy and mortality in patients undergoing TAVI.MethodsBetween October 2013 and April 2016, 1215 patients undergoing TAVI were prospectively enrolled in the Optimized CathEter vAlvular iNtervention (OCEAN)-TAVI registry. This cohort was stratified according to the postoperative usage of RAS blockade therapy with angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs). Patients with at least two prescriptions dispensed 180 days apart after TAVI and at least a 6-month follow-up constituted the RAS blockade group (n=371), while those not prescribed any ACE inhibitors or ARBs after TAVI were included in the no RAS blockade group (n=189).ResultsAt 6 months postoperatively, the RAS blockade group had significantly greater LV mass index regression than the no RAS blockade group (−9±24% vs −2±25%, p=0.024). Kaplan-Meier analysis revealed a significantly lower cumulative 2-year mortality in the RAS blockade than that in the no RAS blockade group (7.5% vs 12.5%; log-rank test, p=0.031). After adjusting for confounding factors, RAS blockade therapy was associated with significantly lower all-cause mortality (HR, 0.45; 95% CI 0.22 to 0.91; p=0.025).ConclusionsPostoperative RAS blockade therapy is associated with greater LV mass index regression and reduced all-cause mortality. These data need to be confirmed by a prospective randomised controlled outcome trial.
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Mukai T, Okamoto T, Taminato T, Lin Y, Araki M, Sato W, Yamamura T, Takahashi Y. Neurological adverse events after fingolimod administration in patients with multiple sclerosis. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Odo T, Araki M, Lin Y, Takahashi Y, Yamamura T. Potential benefit of continuous immunotherapies for secondary progressive multiple sclerosis. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Araki M, Nakamura M, Sato W, Takahashi Y, Yamamura T. Potential benefits of the anti-IL-6 receptor antibody tocilizumab in multiple sclerosis patients with high plasmablast frequency. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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108
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Okamoto T, Lin Y, Araki M, Sato W, Kawazoe T, Wakasugi N, Takewaki D, Takahashi Y, Yamamura T. Clinical course of multiple sclerosis in Japanese patients treated with glatiramer acetate. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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109
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Kano S, Yamamoto M, Shimura T, Kagase A, Tsuzuki M, Kodama A, Koyama Y, Kobayashi T, Shibata K, Tada N, Naganuma T, Araki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Otsuka T, Watanabe Y, Hayashida K. Gait Speed Can Predict Advanced Clinical Outcomes in Patients Who Undergo Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2017; 10:CIRCINTERVENTIONS.117.005088. [DOI: 10.1161/circinterventions.117.005088] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 07/10/2017] [Indexed: 11/16/2022]
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110
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Shimura T, Yamamoto M, Kano S, Kagase A, Kodama A, Koyama Y, Otsuka T, Kohsaka S, Tada N, Yamanaka F, Naganuma T, Araki M, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Higashimori A, Watanabe Y, Hayashida K. Impact of frailty markers on outcomes after transcatheter aortic valve replacement: insights from a Japanese multicenter registry. Ann Cardiothorac Surg 2017; 6:532-537. [PMID: 29062750 DOI: 10.21037/acs.2017.09.06] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There are no standardized criteria for measuring patients' frailty. We examined prognosis based on four frailty markers [serum albumin level, grip strength, gait speed, and clinical frailty scale (CFS)] in patients who underwent transcatheter aortic valve replacement (TAVR) between October 2013 and April 2016 and were recorded in the Optimized CathEter vAlvular iNtervention (OCEAN) Japanese multicenter registry. Serum albumin level was assessed by dividing patients into two groups: hypoalbuminemia or non-hypoalbuminemia according to their serum albumin level. Clinical outcomes including all-cause, cardiovascular and non-cardiovascular mortality rates after TAVR were compared. During the follow-up period cumulative all-cause, cardiovascular and non-cardiovascular mortality rates were significantly higher in the hypoalbuminemia group than in the non-hypoalbuminemia group. This result remained unchanged even after a propensity-matched model was used in terms of cumulative all-cause and non-cardiovascular mortality; however, differences in cardiovascular mortality rates were attenuated. To consider the impact of grip strength patients were divided into a low or high peak grip strength group based on classification and regression tree (CART) survival analysis. The clinical outcomes for each sex were compared between the two groups. In both sexes the cumulative 1-year mortality rates were significantly different between the two groups. To investigate gait speed patients were classified into two gait speed groups (low or high gait speed group) based on CART survival analysis. Clinical outcomes were compared between the two groups. The cumulative 1-year mortality rate was significantly different between the two gait speed groups. The effect of CFS on prognosis after TAVR was assessed. Patients were categorized into five groups based on the following CFS scores: CFS1-3, CFS4, CFS5, CFS6, and CFS ≥7. We evaluated the relationship between the CFS score and other indicators of frailty markers. We also assessed the mid-term mortality among the five groups. The CFS score had a significant correlation with other frailty markers. The cumulative 1-year mortality increased with an increasing CFS score. In the Cox regression multivariable analysis, the CFS score was an independent predictive factor of an increased late cumulative mortality risk. In conclusion, the results suggest that serum albumin level, grip strength, gait speed, and CFS score are all useful indicators when considering the optimal indications and risk stratification for TAVR.
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111
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Kobayashi N, Hirano K, Yamawaki M, Araki M, Sakai T, Sakamoto Y, Mori S, Tsutsumi M, Honda Y, Tokuda T, Makino K, Shirai S, Ito Y. Characteristics and clinical outcomes of repeat endovascular therapy after infrapopliteal balloon angioplasty in patients with critical limb ischemia. Catheter Cardiovasc Interv 2017; 91:505-514. [DOI: 10.1002/ccd.27238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/22/2017] [Indexed: 11/05/2022]
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112
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Sanuki Y, Shinjo S, Shimizu A, Takami H, Anai R, Muraoka Y, Tsuda Y, Araki M, Otsuji Y. P517Contribution of post-stent irregular protrusion to in-stent neoatheroscrelosis after second-generation drug-eluting stent implantation. - Optical coherence tomography study-. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p517] [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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113
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Tsutsumi M, Ito Y, Hirano K, Yamawaki M, Araki M, Kobayashi N, Sakamoto Y, Mori S, Takama T, Honda Y, Tokuda T, Makino K, Shirai S. P5188Long-term clinical outcomes after polymer-free paclitaxel-coated stent implantation for femoropopliteal disease in comparison with bare metal stent. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5188] [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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114
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Makino K, Hirano K, Yamawaki M, Araki M, Kobayashi N, Mori S, Sakamoto Y, Tsutsumi M, Takama T, Honda Y, Takahiro T, Shirai S, Ito Y. P5202The effectiveness of ultrasound-guided tibial artery endovascular interventions for chronic total occlusion lesions in critical limb ischemia. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5202] [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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115
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Kobayashi N, Hirano K, Yamawaki M, Araki M, Sakamoto Y, Mori S, Tsutsumi M, Honda Y, Tokuda T, Makino K, Shirai S, Ito Y. P5215Severity of angiographic dissection and future restenosis after balloon angioplasty for femoropopliteal disease. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5215] [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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116
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Shimizu A, Sonoda S, Takami H, Anai R, Muraoka Y, Sanuki Y, Tsuda Y, Araki M, Otsuji Y. P1661Impact of hemorrhagic events during dual antiplatelet therapy after drug-eluting stent implantation in patients with hemodialysis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1661] [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: 11/12/2022] Open
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117
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Takami H, Sonoda S, Shimizu A, Anai R, Muraoka Y, Sanuki Y, Tsuda Y, Araki M, Otsuji Y. P1801Comparison between minimum lumen area and integrated backscatter intravascular ultrasound derived intraluminal ultrasonic intensity for detecting functionally significant coronary artery stenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1801] [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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118
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Muraoka Y, Sonoda S, Shimizu A, Takami H, Anai R, Sanuki Y, Tsuda Y, Araki M, Otsuji Y. P666Efficacy of optical coherence tomography based vulnerable plaque assessment at the index PCI to predict remote plaque progression in non-culprit lesions. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p666] [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: 11/12/2022] Open
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119
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Tokuda T, Hirano K, Yamawaki M, Araki M, Kobayashi N, Mori S, Sakamoto Y, Takimura H, Tsutsumi M, Ito Y. Efficacy and safety of a coagulated thrombus injection for peripheral artery perforation: The coagulated thrombus hemostasis method. Catheter Cardiovasc Interv 2017; 91:302-307. [DOI: 10.1002/ccd.27163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/22/2016] [Accepted: 06/05/2017] [Indexed: 11/11/2022]
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120
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Mizutani K, Hara M, Iwata S, Murakami T, Shibata T, Yoshiyama M, Naganuma T, Yamanaka F, Higashimori A, Tada N, Takagi K, Araki M, Ueno H, Tabata M, Shirai S, Watanabe Y, Yamamoto M, Hayashida K. Elevation of B-Type Natriuretic Peptide at Discharge is Associated With 2-Year Mortality After Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Stenosis: Insights From a Multicenter Prospective OCEAN-TAVI (Optimized Transcatheter Valvular Intervention-Transcatheter Aortic Valve Implantation) Registry. J Am Heart Assoc 2017; 6:JAHA.117.006112. [PMID: 28710182 PMCID: PMC5586312 DOI: 10.1161/jaha.117.006112] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background In this study, we sought to investigate the 2‐year prognostic impact of B‐type natriuretic peptide (BNP) levels at discharge, following transcatheter aortic valve replacement. Methods and Results We enrolled 1094 consecutive patients who underwent transcatheter aortic valve replacement between 2013 and 2016. Study patients were stratified into 2 groups according to survival classification and regression tree analysis (high versus low BNP groups). We evaluated the impact of high BNP on 2‐year mortality compared with that of low BNP using a multivariable Cox model, and assessed whether this stratification would improve predictive accuracy for determining 2‐year mortality by assessing time‐dependent net reclassification improvement and integrated discrimination improvement. The median age of patients was 85 years (quartile 82–88), and 29.2% of the study population were men. The median Society of Thoracic Surgeons score was 6.8 (4.7–9.5), and BNP at discharge was 186 (93–378) pg/mL. All‐cause mortality following discharge was 7.9% (95% CI, 5.8–9.9%) at 1 year and 15.4% (95% CI, 11.6–19.0%) at 2 years. The survival classification and regression tree analysis revealed that the discriminating BNP level to discern 2‐year mortality was 202 pg/mL, and that elevated BNP had a statistically significant impact on outcomes, with an adjusted hazard ratio of 2.28 (1.36–3.82, P=0.002). The time‐dependent net reclassification improvement (P=0.047) and integrated discrimination improvement (P=0.029) analysis revealed that the incorporation of BNP stratification with other clinical variables significantly improved predictive accuracy for 2‐year mortality. Conclusions Elevation of BNP at discharge is associated with 2‐year mortality after transcatheter aortic valve replacement.
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121
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Naganuma T, Kawamoto H, Takagi K, Yabushita H, Mitomo S, Watanabe Y, Shirai S, Araki M, Tada N, Yamanaka F, Yamamoto M, Onishi H, Nakamura S, Higashimori A, Tabata M, Mizutani K, Ueno H, Hayashida K. Can we perform rotational atherectomy in patients with severe aortic stenosis? Substudy from the OCEAN TAVI Registry. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:356-360. [DOI: 10.1016/j.carrev.2017.02.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/17/2017] [Accepted: 02/23/2017] [Indexed: 10/20/2022]
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122
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Shimura T, Yamamoto M, Kano S, Kagase A, Kodama A, Koyama Y, Tsuchikane E, Suzuki T, Otsuka T, Kohsaka S, Tada N, Yamanaka F, Naganuma T, Araki M, Shirai S, Watanabe Y, Hayashida K, Yashima F, Inohara T, Kakefuda Y, Arai T, Yanagisawa R, Tanaka M, Kawakami T, Maekawa Y, Takashi K, Yoshitake A, Iida Y, Yamazaki M, Shimizu H, Yamada Y, Jinzaki M, Tsuruta H, Itabashi Y, Murata M, Kawakami M, Fukui S, Sano M, Fukuda K, Hosoba S, Sato H, Teramoto T, Kimura M, Sago M, Tsunaki T, Watarai S, Tsuzuki M, Irokawa K, Shimizu K, Kobayashi T, Okawa Y, Miyasaka M, Enta Y, Shishido K, Ochiai T, Yamabe T, Noguchi K, Saito S, Kawamoto H, Onishi H, Yabushita H, Mitomo S, Nakamura S, Yamawaki M, Akatsu Y, Honda Y, Takama T, Isotani A, Hayashi M, Kamioka N, Miura M, Morinaga T, Kawaguchi T, Yano M, Hanyu M, Arai Y, Tsubota H, Kudo M, Kuroda Y, Kataoka A, Hioki H, Nara Y, Kawashima H, Nagura F, Nakashima M, Sasaki K, Nishikawa J, Shimokawa T, Harada T, Kozuma K. Impact of the Clinical Frailty Scale on Outcomes After Transcatheter Aortic Valve Replacement. Circulation 2017; 135:2013-2024. [DOI: 10.1161/circulationaha.116.025630] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 03/01/2017] [Indexed: 12/14/2022]
Abstract
Background:
The semiquantitative Clinical Frailty Scale (CFS) is a simple tool to assess patients’ frailty and has been shown to correlate with mortality in elderly patients even when evaluated by nongeriatricians. The aim of the current study was to determine the prognostic value of CFS in patients who underwent transcatheter aortic valve replacement.
Methods:
We utilized the OCEAN (Optimized Catheter Valvular Intervention) Japanese multicenter registry to review data of 1215 patients who underwent transcatheter aortic valve replacement. Patients were categorized into 5 groups based on the CFS stages: CFS 1-3, CFS 4, CFS 5, CFS 6, and CFS ≥7. We subsequently evaluated the relationship between CFS grading and other indicators of frailty, including body mass index, serum albumin, gait speed, and mean hand grip. We also assessed differences in baseline characteristics, procedural outcomes, and early and midterm mortality among the 5 groups.
Results:
Patient distribution into the 5 CFS groups was as follows: 38.0% (CFS 1-3), 32.9% (CFS4), 15.1% (CFS 5), 10.0% (CFS 6), and 4.0% (CFS ≥7). The CFS grade showed significant correlation with body mass index (Spearman’s ρ=−0.077,
P
=0.007), albumin (ρ=−0.22,
P
<0.001), gait speed (ρ=−0.28,
P
<0.001), and grip strength (ρ=−0.26,
P
<0.001). Cumulative 1-year mortality increased with increasing CFS stage (7.2%, 8.6%. 15.7%, 16.9%, 44.1%,
P
<0.001). In a Cox regression multivariate analysis, the CFS (per 1 category increase) was an independent predictive factor of increased late cumulative mortality risk (hazard ratio, 1.28; 95% confidence interval, 1.10–1.49;
P
<0.001).
Conclusions:
In addition to reflecting the degree of frailty, the CFS was a useful marker for predicting late mortality in an elderly transcatheter aortic valve replacement cohort.
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Yashima F, Yamamoto M, Tanaka M, Yanagisawa R, Arai T, Fukuda K, Watanabe Y, Naganuma T, Shirai S, Araki M, Tada N, Yamanaka F, Hayashida K. TRANSCATHETER AORTIC VALVE IMPLANTATION IN PATIENTS WITH AN EXTREMELY SMALL ANNULUS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34730-7] [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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Nara Y, Watanabe Y, Kozuma K, Kataoka A, Nakashima M, Hioki H, Kawashima H, Nagura F, Shirai S, Tada N, Araki M, Naganuma T, Yamanaka F, Yamamoto M, Hayashida K. Incidence, Predictors, and Mid-Term Outcomes of Percutaneous Closure Failure After Transfemoral Aortic Valve Implantation Using an Expandable Sheath (from the Optimized Transcatheter Valvular Intervention [OCEAN-TAVI] Registry). Am J Cardiol 2017; 119:611-617. [PMID: 27939382 DOI: 10.1016/j.amjcard.2016.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 12/14/2022]
Abstract
The aim of this study was to evaluate the incidence, predictors, and outcomes of percutaneous closure device (PCD) failure during transfemoral transcatheter aortic valve implantation (TAVI) with an Edwards Sapien-XT prosthesis using an expandable sheath (eSheath). From October 2013 to April 2016, 1,215 patients who underwent TAVI were prospectively enrolled in the Optimized Transcatheter Valvular Intervention (OCEAN-TAVI) registry. Of these, 478 patients underwent transfemoral TAVI with Sapien-XT prosthesis using an eSheath and percutaneous closure with a Perclose ProGlide system. We evaluated the predictors of PCD failure and whether it affected the clinical outcomes. Patients were aged 85 years (interquartile range 82 to 88 years). PCD failure occurred in 36 patients (8%). Sheath-to-femoral artery ratio (SFAR) (per 1 increase) (odds ratio 5.40, 95% confidence interval 1.28 to 22.92, p = 0.022) predicted PCD failure in a multivariate model. The sensitivity-specificity curves identified an SFAR threshold of 1.03; the area under the curve for SFAR as a predictor of PCD failure was 0.629. The PCD failure group did not have a higher rate of 30-day mortality (0% vs 1%, p = 0.52) or mid-term (365-day) mortality (log-rank test p = 0.85) compared with the PCD success group in the Kaplan-Meier analysis. In conclusion, PCD failures occurred in 8% of the patients and were not associated with 30-day or mid-term mortality rates after percutaneous transfemoral TAVI. The SFAR threshold of 1.03 was useful for predicting PCD failures.
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Arai T, Yashima F, Yanagisawa R, Tanaka M, Shimizu H, Fukuda K, Watanabe Y, Naganuma T, Araki M, Tada N, Yamanaka F, Shirai S, Yamamoto M, Hayashida K. Prognostic value of liver dysfunction assessed by MELD-XI scoring system in patients undergoing transcatheter aortic valve implantation. Int J Cardiol 2017; 228:648-653. [DOI: 10.1016/j.ijcard.2016.11.096] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 11/06/2016] [Indexed: 11/27/2022]
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