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Myocardial Injury After Transaortic Versus Transapical Transcatheter Aortic Valve Replacement. Ann Thorac Surg 2015; 99:2001-9. [DOI: 10.1016/j.athoracsur.2015.01.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Revised: 12/21/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022]
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Fabbro M, Goldhammer J, Augoustides JGT, Patel PA, Frogel J, Ianchulev S, Cobey FC. CASE 1-2016 Problem-Solving in Transcatheter Aortic Valve Replacement: Cardiovascular Collapse, Myocardial Stunning, and Mitral Regurgitation. J Cardiothorac Vasc Anesth 2015; 30:229-36. [PMID: 26119409 DOI: 10.1053/j.jvca.2015.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Michael Fabbro
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jordan Goldhammer
- Cardiothoracic and Vascular Section, Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Prakash A Patel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jonathan Frogel
- Cardiovascular and Thoracic Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stefan Ianchulev
- Cardiac Section, Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
| | - Frederic C Cobey
- Cardiac Section, Department of Anesthesiology, Tufts Medical Center, Boston, Massachusetts
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Maadani M, Abdi S, Parchami-Ghazaee S, Alizadeh K, Fathi H, Musavi R. Relationship between Pre-Procedural Serum Lipid Profile and Post-Procedural Myocardial Injury in Patients Undergoing Elective Percutaneous Coronary Intervention. Res Cardiovasc Med 2014; 2:169-73. [PMID: 25478516 PMCID: PMC4253783 DOI: 10.5812/cardiovascmed.11542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 12/03/2022] Open
Abstract
Background: Along with technological progress in coronary intervention, periprocedural complications and adverse outcomes have markedly improved, yet perioperative myocardial injury is a frequent complication during percutaneous coronary intervention (PCI) and is strongly associated with post-procedural cardiovascular morbidity and mortality. Epidemiological researchers have defined lipid and lipoproteins abnormality as a risk factor for atherosclerotic cardiovascular diseases. Although several studies focus on identification the correlation between the changes of lipid profile levels and ischemic markers, there is a little information about the role of lipid profile disturbance as a predictor of periprocedural myocardial injuries. Objectives: This study aimed to observe the relationship between lipid profile levels and the post-procedural myocardial injury in patients undergoing elective PCI. Patients and Methods: This case-control study was conducted on 138 consecutive patients with a diagnosis of coronary artery disease who underwent PCI. Of a total 138, 35 patients had cardiac biomarker elevation, more than 3 × ULN, post-procedurally. The control group (n = 103), without cardiac enzyme rising after PCI were randomly chosen three times the number of patients with increased cardiac enzymes more than three times the ULN. Samples for serum lipid parameters [total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglyceride (TG), and very low-density lipoprotein cholesterol (VLDL)] were collected after 12-14 fasting hours immediately pre-procedurally. The samples for CPK-MB were collected at 8, 16, and 24 hours post procedurally. Results: Although the mean level of TC, LDL-C and TG was higher in patients with CPK-MB more than 3×ULN post procedurally, differences were insignificant. Among different lipid parameters, only the mean level of VLDL showed a considerable association with myocardial injury. Although, this subject had a near significant (P = 0.05) enhancement in group I, the changes were in normal ranges. Lipid abnormality (except for the VLDL values) was insignificantly more frequent in group I. Conclusions: Although the mean level of non-HDL-C was in normal ranges, it showed a higher value in patients with a diagnosis of myocardial injury post procedurally. However, according to multivariate analysis, left ventricular ejection fraction and diabetes remained as predictors of post-procedural CPK-MB elevation.
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Affiliation(s)
- Mohsen Maadani
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Seifollah Abdi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Sepideh Parchami-Ghazaee
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Keivan Alizadeh
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Hosein Fathi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
| | - Reza Musavi
- Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Reza Musavi, Cardiovascular Intervention Research Center, Rajaie Cardiovascular Medical and Research Center, Vali-Asr Ave, Niayesh Blvd, Tehran, IR Iran, Tel.: +98-9163431898, Fax: +98-21-22663335, E-mail:
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Giordana F, D'Ascenzo F, Nijhoff F, Moretti C, D'Amico M, Biondi Zoccai G, Sinning JM, Nickenig G, Van Mieghem NM, Chieffo A, Dumonteil N, Tchetche D, Barbash IM, Waksman R, D'Onofrio A, Lefevre T, Pilgrim T, Amabile N, Codner P, Kornowski R, Yong ZY, Baan J, Colombo A, Latib A, Salizzoni S, Omedè P, Conrotto F, La Torre M, Marra S, Rinaldi M, Gaita F. Meta-analysis of predictors of all-cause mortality after transcatheter aortic valve implantation. Am J Cardiol 2014; 114:1447-55. [PMID: 25217456 DOI: 10.1016/j.amjcard.2014.07.081] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 07/30/2014] [Accepted: 07/30/2014] [Indexed: 02/05/2023]
Abstract
The aim of this study was to identify predictors of 30-day and midterm mortality after transcatheter aortic valve implantation (TAVI) by means of a systemic review. TAVI was demonstrated to be safe and efficacious in patients with severe aortic stenosis. An accurate estimation of procedural risk of these patients represents an actual challenge. The PubMed and Cochrane Collaboration databases were systematically searched for studies reporting on the incidence and independent predictors of 30-day and midterm mortality. Adverse events were pooled with random effect, whereas independent predictors are reported as odds ratios (ORs) with 95% confidence intervals (CIs). A total of 25 studies with 8,874 patients were included (median age 82.5 ± 1.5 years, 54.6% women). At 30 days, 7.5% of patients (n = 663) died. At midterm follow-up (median 365 days, interquartile range 267 to 365 days), the cumulative mortality rate was 21.6% (n = 1,917). Acute kidney injury (AKI) stage ≥2 (OR 18.0, 95% CI 6.3 to 52), preprocedural hospitalization for heart failure (OR 9.4, 95% CI 2.6 to 35), periprocedural acute myocardial infarction (OR 8.5, 95% CI 2.6 to 33.5), and increased pro-brain natriuretic peptide (pro-BNP) levels (OR 5.4, 95% CI 1.7 to 16.5) were the most important independent predictors of 30-day mortality. Increased pro-BNP levels (OR 11, 95% CI 1.5 to 81), AKI stage 3 (OR 6.8, 95% CI 2.6 to 15.7), left ventricular ejection fraction <30% (OR 6.7, 95% CI 3.5 to 12.7), and periprocedural acute myocardial infarction (OR 6.5, 95% CI 2.3 to 18.1) represented the predictors of midterm mortality. In conclusion, in this large meta-analysis of patients undergoing TAVI, we found that high pro-BNP levels and postprocedural AKI were the strongest independent predictors of both 30-day and 1-year mortality. These findings may contribute to a better understanding of the risk assessment process of patients undergoing TAVI.
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Affiliation(s)
- Francesca Giordana
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy.
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Freek Nijhoff
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Claudio Moretti
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Maurizio D'Amico
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Jan Malte Sinning
- Medizinische Klinik und Poliklinik II, Innere Medizin, Universitätsklinikum, Bonn, Germany
| | - George Nickenig
- Medizinische Klinik und Poliklinik II, Innere Medizin, Universitätsklinikum, Bonn, Germany
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adelaide Chieffo
- Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific Institute, Milan, Italy
| | - Nicolas Dumonteil
- Pôle Cardiovasculaire et Métabolique, Hôpital Rangueil, Toulouse, France
| | - Didier Tchetche
- Department of General and Interventional Cardiology, Clinique Pasteur, Toulouse, France
| | - Israel M Barbash
- Interventional Cardiology, Division of Cardiology, Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Interventional Cardiology, Division of Cardiology, Washington Hospital Center, Washington, DC
| | | | - Thierry Lefevre
- Institut Cardiovasculaire Paris Sud, Institut Hospitalier Jacques Cartier, Massy, France
| | - Thomas Pilgrim
- Department of Cardiology, Swiss Cardiovascular Center, Bern University Hospital, Bern, Switzerland
| | - Nicolas Amabile
- Department of Cardiology, Centre Marie Lannelongue, Le Plessis-Robinson, France
| | - Pablo Codner
- Division of Cardiology, Beilinson Hospital, Rabin Medical Center, Petach-Tikva, Israel; Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Ran Kornowski
- Division of Cardiology, Beilinson Hospital, Rabin Medical Center, Petach-Tikva, Israel; Tel-Aviv University, Sackler Faculty of Medicine, Tel-Aviv, Israel
| | - Ze Yie Yong
- Department of Cardiology and Cardio-Thoracic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Jan Baan
- Department of Cardiology and Cardio-Thoracic Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - Antonio Colombo
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Azeem Latib
- Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, Milan, Italy
| | - Stefano Salizzoni
- Division of Cardio-Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Pierluigi Omedè
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Conrotto
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Michele La Torre
- Division of Cardio-Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Sebastiano Marra
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Division of Cardio-Surgery, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, University of Turin, Turin, Italy
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Sanz J, Dangas G. Myocardial damage after TAVR assessed with CMR: a new piece in a puzzle? J Am Coll Cardiol 2014; 64:358-60. [PMID: 25060369 DOI: 10.1016/j.jacc.2014.04.051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/15/2014] [Accepted: 04/20/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Javier Sanz
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, New York.
| | - George Dangas
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Mount Sinai School of Medicine, New York, New York
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56
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Development of a risk score for outcome after transcatheter aortic valve implantation. Clin Res Cardiol 2014; 103:631-40. [PMID: 24643728 DOI: 10.1007/s00392-014-0692-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 02/24/2014] [Indexed: 10/25/2022]
Abstract
AIMS Transcatheter aortic valve implantation (TAVI) is an increasingly common procedure in elderly and multimorbid patients with aortic stenosis. We aimed at developing a pre-procedural risk evaluation scheme beyond current surgical risk scores. METHODS We developed a risk algorithm for 1-year mortality in two cohorts consisting of 845 patients undergoing routine TAVI procedures by commercially available devices, mean age 80.9 ± 6.5, 51 % women. Clinical variables were determined at baseline. Multivariable Cox regression related clinical data to mortality (n = 207 deaths). RESULTS To account for variability related to age and sex and by enrolment site we forced age, sex, and cohort into the score model. Body mass index, estimated glomerular filtration rate, hemoglobin, pulmonary hypertension, mean transvalvular gradient and left ventricular ejection fraction at baseline were most strongly associated with mortality and entered the risk prediction algorithm [C-statistic 0.66, 95 % confidence interval (CI) 0.61-0.70, calibration χ (2)-statistic = 6.51; P = 0.69]. Net reclassification improvement compared to existing surgical risk predication schemes was positive. The score showed reasonable model fit and calibration in external validation in 333 patients, N = 55 deaths (C-statistic 0.60, 95 % CI 0.52-0.68; calibration χ (2)-statistic = 16.2; P = 0.06). Additional measurement of B-type natriuretic peptide and troponin I did not improve the C-statistic. Frailty increased the C-statistic to 0.71, 95 % CI 0.65-0.76. CONCLUSIONS We present a new risk evaluation tool derived and validated in routine TAVI cohorts that predicts 1-year mortality. Biomarkers only marginally improved risk prediction. Frailty increased the discriminatory ability of the score and needs to be considered. Risk algorithms specific for TAVI may help to guide decision-making when patients are evaluated for TAVI.
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Abstract
Transcatheter aortic valve replacement emerged ≈20 years ago and changed the landscape of structural interventional cardiology. The first experiments in animal models provided proofs of the concept and the substrate for the first percutaneous valve implantation in patients. The initial promising results in a clinical setting drew the attention of the industry and of the scientific community, and an effort was made for the past 12 years to address the limitations of the technology, facilitate the procedure, minimize the risk of complications, and broaden the applications of transcatheter aortic valve replacement. This article reviews the evolution of transcatheter aortic valve replacement, presents the first steps in this field, cites the evidence from registries and clinical trials, highlights the limitations of this treatment, and discusses the future perspectives and the developments proposed to address the current pitfalls.
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Affiliation(s)
- Christos V. Bourantas
- From the Department of Interventional Cardiology, ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B., P.W.S.); and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom (P.W.S.)
| | - Patrick W. Serruys
- From the Department of Interventional Cardiology, ThoraxCenter, Erasmus Medical Center, Rotterdam, The Netherlands (C.V.B., P.W.S.); and International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom (P.W.S.)
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58
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Grobben RB, Nathoe HM, Januzzi JL, van Kimmenade RRJ. Cardiac markers following cardiac surgery and percutaneous coronary intervention. Clin Lab Med 2014; 34:99-111, vii. [PMID: 24507790 DOI: 10.1016/j.cll.2013.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Differentiation between procedure-related necrosis and postprocedural myocardial infarction (MI) is challenging because of the inherent association of these procedures to varying levels of myocardial injury. To improve risk stratification of patients at risk of an acute MI, the universal definition of MI implemented cardiac biomarker thresholds. The cutoff points for these thresholds, however, are largely arbitrary and lack therapeutic implications. Measurement of cardiac marker concentrations after percutaneous coronary intervention and cardiac surgery should, therefore, be used as a marker of baseline risk, atherosclerosis burden, and procedural complexity rather than a conclusive marker to diagnose acute MI.
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Affiliation(s)
- Remco B Grobben
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - James L Januzzi
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
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Preprocedural high-sensitive troponin predicts survival after transcatheter aortic valve implantation (TAVI). Int J Cardiol 2013; 169:e38-9. [DOI: 10.1016/j.ijcard.2013.08.108] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/29/2013] [Indexed: 11/19/2022]
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Abstract
Patients with severe aortic stenosis who are at high surgical risk or not considered to be suitable candidates for surgical aortic valve replacement are increasingly being treated with transcatheter aortic valve replacement (TAVR). Although this novel treatment modality has been proven to be effective in this patient population, serious complications occur in approximately one-third of patients during the month after the procedure. Such events include myocardial infarction, cerebrovascular events, vascular complications, bleeding, acute kidney injury, valve regurgitation, valve malpositioning, coronary obstruction, and conduction disturbances and arrhythmias, which can all lead to death. Prevention of these complications should be based on patient screening and selection by a dedicated 'heart team' and the use of multimodality imaging. Anticipation and early recognition of these complications, followed by prompt management using a wide range of percutaneous or surgical rescue interventions, is vital to patient outcome. Continuous patient assessment and reporting of complications according to standardized definitions, in addition to growing operator experience and upcoming technological refinements, will hopefully reduce the future rate of complications related to this procedure.
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Chorianopoulos E, Krumsdorf U, Geis N, Pleger ST, Giannitsis E, Katus HA, Bekeredjian R. Preserved prognostic value of preinterventional troponin T levels despite successful TAVI in patients with severe aortic stenosis. Clin Res Cardiol 2013; 103:65-72. [PMID: 24096554 DOI: 10.1007/s00392-013-0624-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 09/25/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND Elevated concentrations of troponin T have prognostic impact in patients with various cardiovascular diseases including those with severe aortic stenosis. Transcatheter aortic valve implantation (TAVI) has improved prognosis for patients without a surgical option. Whether this affects the prognostic value of preinterventional troponin T remains unclear. METHODS We therefore conducted a prospective study in 198 consecutive patients with subsequent, successful transfemoral TAVI and analyzed cardiac troponin T (cTnT) levels with a new generation, high-sensitive troponin T assay before and after TAVI, as well as their prognostic value after 12 months. RESULTS Patients with severe aortic stenosis (AS) showed significant elevation of preinterventional cTnT levels. Postinterventional cTnT levels significantly rose further about sevenfold after transfemoral TAVI and peaked at day three until they steadily declined thereafter. Baseline renal function (P = 0.011), the duration of intraprocedural rapid pacing (P = 0.0012), and baseline cTnT (P = 0.0001) values predicted the magnitude of postinterventional cTnT elevations. Interestingly, Kaplan-Meier curve analysis revealed, that although cTnT levels were not predictive for short-term mortality, preinterventional as well as postinterventional peak cTnT showed prognostic value for 1-year mortality, regardless of successful TAVI. CONCLUSIONS Pre- and postinterventional hscTnT levels signal adverse 1-year mortality in patients with severe AS independent of successful aortic valve replacement.
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Affiliation(s)
- Emmanuel Chorianopoulos
- Department of Cardiology, Angiology and Pulmology, Heidelberg University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany,
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Zhao ZG, Liao YB, Peng Y, Chai H, Liu W, Li Q, Ren X, Wang XQ, Luo XL, Zhang C, Lu LH, Meng QT, Chen C, Chen M, Feng Y, Huang DJ. Sex-Related Differences in Outcomes After Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2013; 6:543-51. [PMID: 24065446 DOI: 10.1161/circinterventions.113.000529] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background—
There were considerable discrepancies with regard to sex-related differences in complications and prognosis after transcatheter aortic valve implantation.
Methods and Results—
The Cochrane library and PubMed online databases were searched. Articles reporting sex-specific post–transcatheter aortic valve implantation complications and mortality were identified. Two authors selected studies and extracted data independently. Random- and fixed-effects models were used depending on between-study heterogeneity. There were 27 articles, a total of 9118 patients, enrolled in our systematic review and meta-analysis, including 4176 men and 4942 women. Pooled analyses suggested considerable sex-related differences in complications and early as well as midterm outcomes after transcatheter aortic valve implantation. The difference in the risk for heart block requiring permanent pacemaker implantation was noted to be significant only in the subgroup of the CoreValve-dominating studies (pooled risk ratio [RR, men versus women], 1.29; 95% confidence interval [CI], 1.13–1.47). Although men had significantly lower risks for major/life-threatening bleeding (pooled RR, 0.81; 95% CI, 0.68–0.96) and major vascular complications (pooled RR, 0.49; 95% CI, 0.37–0.66), they had poorer prognosis. In fact, male sex was associated with significantly higher risks for deaths at both 30 days (RR, 1.37; 95% CI, 1.07–1.76) and 1 year (RR, 1.30; 95% CI, 1.14–1.49).
Conclusions—
Although men had lower risks for major/life-threatening bleeding and major vascular complications after transcatheter aortic valve implantation, they had less favorable short-term and midterm survival.
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Affiliation(s)
- Zhen-Gang Zhao
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yan-Biao Liao
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yong Peng
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Hua Chai
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Wei Liu
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Qiao Li
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xin Ren
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xue-Qin Wang
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiao-Lin Luo
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chen Zhang
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Li-Hui Lu
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Qing-Tao Meng
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Chi Chen
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Mao Chen
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yuan Feng
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
| | - De-Jia Huang
- From the Department of Cardiology, West China Hospital, Sichuan University, Chengdu, PR China
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Dixon SR, Safian RD. The Year in Interventional Cardiology. J Am Coll Cardiol 2013; 61:1637-52. [DOI: 10.1016/j.jacc.2013.01.040] [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] [Received: 01/07/2013] [Accepted: 01/16/2013] [Indexed: 02/07/2023]
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