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Emami Meybodi M, Bamarinejad A, Bamarinejad F, Abhari AP, Fakhrolmobasheri M, Khosravi Larijani F, Nasiri S, Shafie D. Prognostic Implication of Preprocedural Pulmonary Hypertension in Patients with Severe Aortic Valve Stenosis Undergoing Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-analysis. Cardiol Rev 2024:00045415-990000000-00200. [PMID: 38285645 DOI: 10.1097/crd.0000000000000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Pulmonary hypertension (PH) is a common comorbidity in patients with aortic stenosis (AS) who are candidates for transcatheter aortic valve implantation (TAVI). Herein, we sought to elucidate the prognostic value of preprocedural PH on the early and late mortality after TAVI. The Cochrane Library, Scopus, PubMed, Web of Science, Embase, and ProQuest were screened using a predefined search query. We considered odds ratios (ORs) as the measure of effect. Meta-regression analysis was applied to investigate the potential impact of baseline characteristics on the outcomes. Egger's and Begg's tests were used to assess the publication bias. Thirty-three studies comprising 34 datasets representing 68,435 patients were included in the analysis. Regardless of the definition and severity of PH, pooled data analysis indicated that preprocedural PH was associated with higher cardiac and overall 30-day [OR, 1.45 (1.15-1.82) and OR, 1.75 (1.42-2.17), respectively], and 1-year mortality [OR, 1.63 (1.35-1.96) and OR, 1.59 (1.38-1.82), respectively]. Meta-regression analysis demonstrated that older age, higher New York Heart Association function class, history of hypertension, diabetes, and lower left ventricular ejection fraction were predictors of higher mortality rate following TAVI. Moreover, we found that preprocedural PH is significantly associated with higher in-hospital mortality and 30-day acute kidney injury. Our results demonstrated that preprocedural PH is associated with higher early and late cardiac and overall mortality following TAVI; however, this finding is limited regarding the considerable inconsistency in the definition of PH and PH severity among studies.
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Affiliation(s)
- Mahmood Emami Meybodi
- From the Department of Cardiology, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Atefe Bamarinejad
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fateme Bamarinejad
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Parsa Abhari
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Fakhrolmobasheri
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Shidrokh Nasiri
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Davood Shafie
- Heart Failure Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
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Shamekhi J, Hasse C, Veulemans V, Al-Kassou B, Piayda K, Maier O, Zeus T, Weber M, Sedaghat A, Zimmer S, Kelm M, Nickenig G, Sinning JM. A simplified cardiac damage staging predicts the outcome of patients undergoing TAVR-A multicenter analysis. Catheter Cardiovasc Interv 2022; 100:850-859. [PMID: 35989489 DOI: 10.1002/ccd.30368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/24/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND A significant number of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) suffer from extra-aortic cardiac damage. Few studies have investigated strategies to quantify cardiac damage and stratify patients accordingly in different risk groups. The aim of this retrospective multicenter study was to provide a user-friendly simplified staging system based on the proposed classification system of Généreux et al. as a tool to evaluate the prognosis of patients undergoing TAVR more easily. Moreover, we analyzed changes in cardiac damage after TAVR. METHODS We assessed cardiac damage in patients, who underwent TAVR at the Heart Center Bonn or Düsseldorf, using pre- and postprocedural transthoracic echocardiography. Patients were assigned to the staging system proposed by Généreux et al. according to the severity of their baseline cardiac damage. Based on the established system, we created a simplified staging system to facilitate improved applicability. Finally, we compared clinical outcomes between the groups and evaluated changes in cardiac damage after TAVR. RESULTS A total of 933 TAVR patients were included in the study. We found a significant association between cardiac damage and 1-year all-cause mortality (stage 0: 0% vs. stage 1: 3% vs. stage 2: 6.6%; p < 0.009). In multivariate analysis, cardiac damage was an independent predictor of 1-year all-cause mortality (hazard ratio: 2.0, 95% confidence interval: 1.1-3.8; p = 0.03). CONCLUSIONS In patients undergoing TAVR, cardiac damage is associated with enhanced mortality. A simplified staging system can help identify patients at high risk for an adverse outcome.
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Affiliation(s)
- Jasmin Shamekhi
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Caroline Hasse
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Kerstin Piayda
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Oliver Maier
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marcel Weber
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, St. Vinzenz-Hospital Cologne, Cologne, Germany
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Graziani F, Cialdella P, Lillo R, Locorotondo G, Genuardi L, Ingrasciotta G, Cangemi S, Nesta M, Bruno P, Aurigemma C, Romagnoli E, Calabrese M, Giambusso N, Lombardo A, Burzotta F, Trani C. Acute haemodynamic impact of transcatheter aortic valve implantation in patients with severe aortic stenosis. ESC Heart Fail 2022; 9:1721-1730. [PMID: 35348288 PMCID: PMC9065843 DOI: 10.1002/ehf2.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/26/2021] [Accepted: 02/04/2022] [Indexed: 11/21/2022] Open
Abstract
Aims There are limited data about the intraprocedural haemodynamic study performed immediately before and after transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS). We aimed to evaluate the acute haemodynamic impact of TAVI in patients with severe AS and to investigate invasive and non‐invasive parameters predicting all‐cause mortality. Methods and results A total of 245 consecutive AS patients (43% male, mean age 80.3 ± 7.3 years) undergoing TAVI were enrolled. Intraprocedural left heart catheterization (LHC) and echocardiogram before and after TAVI were performed. The clinical endpoint was the death for any cause. LHC after TAVI revealed significant changes in aortic and left ventricular (LV) pressures, including indexes of intrinsic myocardial contractility and diastolic function such as positive dP/dT (1128.9 ± 398.7 vs. 806.3 ± 247.2 mmHg/s, P ˂ 0.001) and negative dP/dT (1310.7 ± 431.1 vs. 1075.1 ± 440.8 mmHg/s, P ˂ 0.001). Post‐TAVI echo showed a significant reduction in LV end‐diastolic (P = 0.036) and end‐systolic (P ˂ 0.001) diameters, improvement in LV ejection fraction (from 55 ± 12% to 57.2 ± 10.5%, P ˂ 0.001), and pulmonary artery systolic pressure (42.1 ± 14.2 vs. 33.1 ± 10.7 mmHg, P < 0.001). After a mean follow‐up time interval of 24 months, 47 patients died. Post‐TAVI significant aortic regurgitation at echocardiography was the only independent predictor of mortality (hazard ratio 5.592, confidence interval 1.932–16.184, P = 0.002). Conclusions Left heart catheterization performed immediately before and after prosthesis release offers a unique insight in the assessment of LV adaptation to severe AS and the impact of TAVI on LV, catching changes in indexes of intrinsic contractility and myocardial relaxation. Aortic regurgitation assessed by echocardiography was the only independent predictor of mortality in patients undergoing TAVI.
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Affiliation(s)
- Francesca Graziani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Rosa Lillo
- Department of Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Locorotondo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Genuardi
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gessica Ingrasciotta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Cangemi
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Michele Calabrese
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Nicole Giambusso
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
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Strachinaru M, Ren B, van Dalen BM, Van Mieghem N, De Jaegere PPT, van Gils L, Galema TW, Geleijnse ML. Determinants of changes in pulmonary artery pressure in patients with severe aortic stenosis treated by transcatheter aortic valve implantation. Acta Cardiol 2021; 76:185-193. [PMID: 31920151 DOI: 10.1080/00015385.2019.1708599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Elevated pulmonary artery pressure (PAP) in patients with severe aortic stenosis (AS) is a strong predictor of adverse prognosis. This study sought to assess the relation between PAP and clinical and echocardiographic parameters in elderly patients with severe AS, as well as to identify the determinants of the change in PAP after transcatheter aortic valve implantation (TAVI). METHODS The study included 170 subjects (age 81 ± 7 years, 45% men) with symptomatic severe AS who were treated by TAVI. They underwent a clinical evaluation and a transthoracic echocardiography before the TAVI procedure and 6 months after. RESULTS In a multivariable analysis, the independent predictors for baseline PAP were the body mass index (BMI) (β = 0.21, p = .006), COPD GOLD class (β = 0.20; p = .009), the E/e' ratio (β = 0.20; p = .02) and the degree of aortic regurgitation (β = 0.20; p = .01). After TAVI, there was significantly less (51% vs. 29%, p<.0001) pulmonary hypertension, defined as a tricuspid regurgitation velocity ≥2.8 m/s. The baseline variables related to an improvement in PAP were the tricuspid regurgitation velocity (p = .0001) and the E/e' (p = .005). From the parameters potentially modified with TAVI, the only independent predictor of PAP variation was the change in the E/e' ratio (β = 0.23; p = .01). CONCLUSIONS Independent predictors for baseline PAP in elderly patients with symptomatic AS were the BMI, GOLD class, the aortic regurgitation and the E/e' ratio. The baseline predictors for a change in PAP 6 months after TAVI were the baseline PAP and E/e', with only the change in the E/e' ratio being correlated to the change in PAP.
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Affiliation(s)
- Mihai Strachinaru
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Ben Ren
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Bas M. van Dalen
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Nicolas Van Mieghem
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | | | - Lennart van Gils
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Tjebbe W. Galema
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
| | - Marcel L. Geleijnse
- Department of Cardiology, Thorax Center, Erasmus MC, Rotterdam, The Netherlands
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Twelve-month outcomes of transapical transcatheter aortic valve implantation in patients with severe aortic valve stenosis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:68-74. [PMID: 33868420 PMCID: PMC8039915 DOI: 10.5114/aic.2021.104771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/13/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Transapical access (TA) transcatheter aortic valve implantation (TAVI) (TA-TAVI) represents one of the possible routes in patients with severe aortic stenosis (AS) who are not suitable for transfemoral access. Aim To assess early- and mid-term clinical outcomes after TA-TAVI. Material and methods Patients with severe symptomatic AS undergoing TA-TAVI from November 2008 to December 2019 were enrolled. Clinical and procedural characteristics as well as clinical outcomes including all-cause mortality during 12-month follow-up were assessed. Results Sixty-one consecutive patients underwent TA-TAVI for native AS. Patients were elderly with median age of 80.0 (76.0-84.0) years; 55.7% were males. Median baseline EuroSCORE I and STS scores were 18.2% (11.6-27.7) and 4.8% (3.3-8.2), respectively. The procedural success rate was 96.7%. In-hospital, 30-day and 12-month mortality rates were 9.8%; 18.0% and 24.6%, respectively. The main periprocedural and in-hospital complications were bleeding complications (14.8%). The following factors were associated with 12-month mortality: previous cerebrovascular event (CVE), glomerular filtration rate (GFR), aortic valve area (AVA), right ventricular systolic pressure (RVSP) and serum level of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (RR for CVE 3.17, 95% confidence interval (CI): 1.15-8.76: p = 0.026; RR for AVA per 0.1 cm2 1.28, 95% CI: 1.03-1.55: p = 0.024; RR for GFR per 1 ml/min 0.96: 95% CI: 0.94-0.99: p = 0.007; RR for NT-proBNP per 1000 pg/ml 1.07: 95% CI: 1.01-1.17: p = 0.033; RR for RVSP per 1 mm Hg 1.07: 95% CI 1.02-1.16: p = 0.011). Conclusions Transapical TAVI in high-risk patients provides good hemodynamic results with acceptable outcomes.
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6
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Pulmonary hypertension in aortic valve stenosis. Trends Cardiovasc Med 2020; 32:73-81. [DOI: 10.1016/j.tcm.2020.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/26/2020] [Accepted: 12/12/2020] [Indexed: 01/09/2023]
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Keymel S, Papadopoulos G, Minol JP, Blehm A, Krüger S, Afzal S, Jung C, Westenfeld R, Lichtenberg A, Kelm M, Zeus T, Veulemans V. Patients with severe aortic stenosis and coexisting pulmonary hypertension treated by transapical transcatheter aortic valve replacement-Is there a need for increased attention? Catheter Cardiovasc Interv 2020; 95:1001-1008. [PMID: 31165581 DOI: 10.1002/ccd.28358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/25/2019] [Accepted: 05/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Aim of this study is to elucidate the impact of pulmonary hypertension on patients treated with a transapical aortic valve replacement. BACKGROUND In patients with aortic stenosis (AS) the coexistence of pulmonary hypertension (PH) is associated with increased peri-operative risk for surgical aortic valve replacement. For transcatheter aortic valve replacement (TAVR), it is unknown whether transapical TAVR (TA-TAVR) is associated with increased peri-interventional risk in PH patients. METHODS We performed a single center analysis in 189 patients with severe AS with (AS + PH) or without PH (AS - PH) undergoing TA-TAVR. PH was defined by mean pulmonary artery pressure ≥25 mmHg assessed by right heart catheterization (exclusion of 64 patients due to missing results). As the primary endpoint a combination of 30-day mortality or cardiopulmonary resuscitation (CPR) was analyzed. RESULTS Seventy three patients (58.4%) had PH. Increased peri-interventional risk in AS + PH patients was reflected by an increased rate of the primary endpoint in comparison to AS - PH patients (24.7 vs. 3.8%; p = .002). A higher proportion of acute kidney injury (34.2 vs. 15.7%; p = .025) was found in AS + PH patients while AS - PH patients showed a higher rate of bleeding in comparison AS + PH patients (18.5 vs. 6.8% p = .050). CONCLUSION Patients with AS + PH treated by TA-TAVR are at increased peri-interventional risk for severe complications in comparison to AS - PH patients. Therefore, the identification of preventive therapeutic strategies is needed. CLASSIFICATIONS TAVR, transapical, pulmonary hypertension, aortic stenosis.
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Affiliation(s)
- Stefanie Keymel
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Georgios Papadopoulos
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Jan P Minol
- Department of Cardiovascular Surgery, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Alexander Blehm
- Department of Cardiovascular Surgery, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Stefan Krüger
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Shazia Afzal
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Artur Lichtenberg
- Department of Cardiovascular Surgery, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany.,Cardiovascular Research Institute Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
| | - Verena Veulemans
- Department of Cardiology, Pneumology and Angiology, Medical Faculty, University Hospital Dusseldorf, Dusseldorf, Germany
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Schueler R, Öztürk C, Laser JV, Wirth F, Werner N, Welz A, Nickenig G, Sinning J, Hammerstingl C. Right ventricular assessment in patients undergoing transcatheter or surgical aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:E711-E722. [DOI: 10.1002/ccd.28861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/22/2020] [Accepted: 03/15/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Robert Schueler
- Contilia Heart and Vessel Centrum, Department of Cardiology and Angiology Elisabeth Hospital Essen Germany
| | - Can Öztürk
- Heart Centre Bonn, Department of Internal Medicine, Cardiology, Pulmonology and Angiology University of Bonn Bonn Germany
| | - Jasmin Viktoria Laser
- Heart Centre Bonn, Department of Internal Medicine, Cardiology, Pulmonology and Angiology University of Bonn Bonn Germany
| | - Fabian Wirth
- Heart Centre Bonn, Department of Internal Medicine, Cardiology, Pulmonology and Angiology University of Bonn Bonn Germany
| | - Nikos Werner
- Heart Centre Bonn, Department of Internal Medicine, Cardiology, Pulmonology and Angiology University of Bonn Bonn Germany
| | - Armin Welz
- Heart Centre Bonn, Department of Cardiovascular Surgery University Hospital Bonn Bonn Germany
| | - Georg Nickenig
- Heart Centre Bonn, Department of Internal Medicine, Cardiology, Pulmonology and Angiology University of Bonn Bonn Germany
| | - Jan‐Malte Sinning
- Heart Centre Bonn, Department of Internal Medicine, Cardiology, Pulmonology and Angiology University of Bonn Bonn Germany
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Schewel J, Schlüter M, Schmidt T, Kuck K, Frerker C, Schewel D. Correlation between Doppler echocardiography and right heart catheterization assessment of systolic pulmonary artery pressure in patients with severe aortic stenosis. Echocardiography 2020; 37:380-387. [DOI: 10.1111/echo.14611] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/12/2020] [Accepted: 01/21/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jury Schewel
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | | | - Tobias Schmidt
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | - Karl‐Heinz Kuck
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
| | | | - Dimitry Schewel
- Department of Cardiology Asklepios Klinik St. Georg Hamburg Germany
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10
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Schewel J, Schmidt T, Kuck KH, Frerker C, Schewel D. Impact of Pulmonary Hypertension Hemodynamic Status on Long-Term Outcome After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2155-2168. [DOI: 10.1016/j.jcin.2019.08.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/15/2019] [Accepted: 08/27/2019] [Indexed: 01/04/2023]
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11
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Usefulness of High Estimated Pulmonary Artery Systolic Pressure to Predict Acute Kidney Injury After Cardiac Valve Operations. Am J Cardiol 2019; 123:440-445. [PMID: 30473326 DOI: 10.1016/j.amjcard.2018.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/27/2018] [Accepted: 10/31/2018] [Indexed: 11/21/2022]
Abstract
High estimated pulmonary artery systolic pressure (ePASP) has been established as a detrimental predictor for adverse outcomes in patients with chronic kidney disease. However, the relation between preoperative high ePASP and the development of cardiac surgery associated acute kidney injury (CSA-AKI) has not been validated. We performed a retrospective cohort study of adult patients who underwent valve surgery in 2015 at Zhongshan Hospital, Fudan University. Right ventricular systolic pressure, a surrogate for pulmonary systolic pressure, was estimated in the study group of 1056 patients by preoperative echocardiography. CSA-AKI was defined based on the Kidney Disease Improving Global Outcomes criteria. The relation between preoperative ePASP and CSA-AKI was demonstrated with the use of multivariate analysis after adjusting for potential risk factors for CSA-AKI. Of these patients, preoperative ePASP was 44.5 ± 14.9 mm Hg. 401 (38%) patients developed CSA-AKI in which 73 patients (6.9%) suffered from severe AKI (stage II and III). Multivariate analysis showed that preoperative ePASP was independently associated with CSA-AKI (odds ratio per 10 mm Hg increment, 1.099; 95% confidence interval, 1.003 to 1.204; p = 0.042). Preoperative ePASP more than 60 mm Hg was found to be linked with the increasing incidence of AKI by 62% and in-hospital mortality by over 300%, but not linked with severe AKI or renal replacement therapy. In conclusion, an increase in preoperative ePASP was independently and significantly associated with the development of CSA-AKI in patients who underwent valve surgery. Such relation between preoperative ePASP and CSA-AKI could provide a novel therapeutic target against prevention of AKI.
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Kokkinidis DG, Papanastasiou CA, Jonnalagadda AK, Oikonomou EK, Theochari CA, Palaiodimos L, Karvounis HI, Armstrong EJ, Faillace RT, Giannakoulas G. The predictive value of baseline pulmonary hypertension in early and long term cardiac and all-cause mortality after transcatheter aortic valve implantation for patients with severe aortic valve stenosis: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:859-867. [DOI: 10.1016/j.carrev.2018.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/17/2018] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
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Maeder MT, Weber L, Buser M, Gerhard M, Haager PK, Maisano F, Rickli H. Pulmonary Hypertension in Aortic and Mitral Valve Disease. Front Cardiovasc Med 2018; 5:40. [PMID: 29876357 PMCID: PMC5974123 DOI: 10.3389/fcvm.2018.00040] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/13/2018] [Indexed: 12/30/2022] Open
Abstract
In patients with aortic and/or mitral valve disease the presence of pulmonary hypertension (PH) indicates a decompensated state of the disease with left ventricular and left atrial dysfunction and exhausted compensatory mechanism, i.e., a state of heart failure. Pulmonary hypertension in this context is the consequence of the backwards transmission of elevated left atrial pressure. In this form of PH, pulmonary vascular resistance is initially normal (isolated post-capillary PH). Depending on the extent and chronicity of left atrial pressure elevation additional pulmonary vascular remodeling may occur (combined pre- and post-capillary PH). Mechanical interventions for the correction of valve disease often but not always reduce pulmonary pressures. However, the reduction in pulmonary pressures is often modest, and persistent PH in these patients is common and a marker of poor prognosis. In the present review we discuss the pathophysiology and clinical impact of PH in patients with aortic and mitral valve disease, the comprehensive non-invasive and invasive diagnostic approach required to define treatment of PH, and recent insights from mechanistic studies, registries and randomized studies, and we provide an outlook regarding gaps in evidence, future clinical challenges, and research opportunities in this setting.
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Affiliation(s)
| | - Lukas Weber
- Cardiology Division, Kantonsspital, St. Gallen, Switzerland
- Department of Internal Medicine, Spital Rorschach, Rorschach, Switzerland
| | - Marc Buser
- Cardiology Division, Kantonsspital, St. Gallen, Switzerland
| | - Marc Gerhard
- Cardiology Division, Kantonsspital, St. Gallen, Switzerland
| | | | - Francesco Maisano
- Department of Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland
| | - Hans Rickli
- Cardiology Division, Kantonsspital, St. Gallen, Switzerland
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14
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Kleczynski P, Dziewierz A, Wiktorowicz A, Bagienski M, Rzeszutko L, Sorysz D, Trebacz J, Sobczynski R, Tomala M, Dudek D. Prognostic value of tricuspid regurgitation velocity and probability of pulmonary hypertension in patients undergoing transcatheter aortic valve implantation. Int J Cardiovasc Imaging 2017; 33:1931-1938. [PMID: 28668978 PMCID: PMC5698373 DOI: 10.1007/s10554-017-1210-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/28/2017] [Indexed: 11/26/2022]
Abstract
Pulmonary hypertension (PH) is associated with adverse clinical outcomes after transcatheter aortic valve implantation (TAVI). We sought to investigate the effects of tricuspid regurgitant velocity (TRV) and echocardiographic probability of PH on clinical outcomes of patients undergoing TAVI. A total of 148 consecutive patients undergoing TAVI were included and stratified as having "low" (TRV ≤2.8 m/s), "intermediate" (TRV 2.9-3.4 m/s), and "high" (TRV >3.4 m/s) probability of PH. Only the patients from the "high" probability group were considered as patients with PH. All-cause mortality, complications rate and quality of life (QoL) were assessed according to VARC-2 recommendations. Of 148 patients, 65 (43.9%) were considered as patients with PH. These presented with higher NYHA class at baseline (p = 0.027) and had more frequently a history of previous stroke/transient ischemic attack (p = 0.019). A difference in all-cause mortality was noted at 12 months [PH (-) vs. PH (+): 9.6 vs. 21.5%; p = 0.043]; however, it was no longer significant after adjustment for age and gender (OR 2.39, 95% CI 0.91-6.24; p = 0.08). Unadjusted and adjusted rates of all-cause death at maximal follow-up of 13.3 (6.0-31.1) months were higher in patients with PH. However, the presence of PH was not identified as an independent predictor of all-cause mortality at follow-up. No difference in other complications rates and QoL were noted. The presence of TRV >3.4 m/s indicating "high" probability of PH may predict impaired clinical outcomes after TAVI. No impact of PH on QoL outcomes was confirmed.
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Affiliation(s)
- Pawel Kleczynski
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland.
| | - Artur Dziewierz
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Agata Wiktorowicz
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Maciej Bagienski
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Lukasz Rzeszutko
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Danuta Sorysz
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Jaroslaw Trebacz
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Robert Sobczynski
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Marek Tomala
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University, Kopernika 17 Street, 31-501, Krakow, Poland
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15
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Eberhard M, Mastalerz M, Pavicevic J, Frauenfelder T, Nietlispach F, Maisano F, Tanner FC, Nguyen-Kim TDL. Value of CT signs and measurements as a predictor of pulmonary hypertension and mortality in symptomatic severe aortic valve stenosis. Int J Cardiovasc Imaging 2017; 33:1637-1651. [DOI: 10.1007/s10554-017-1180-5] [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: 02/07/2017] [Accepted: 05/24/2017] [Indexed: 01/10/2023]
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16
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Schewel D, Zavareh M, Schewel J, Thielsen T, Schmidt T, Schäfer U, Kuck KH, Frerker C. Impact of interaction of diabetes mellitus and impaired renal function on prognosis and the incidence of acute kidney injury in patients undergoing transcatheter aortic valve replacement (TAVR). Int J Cardiol 2017; 232:147-154. [PMID: 28089458 DOI: 10.1016/j.ijcard.2017.01.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/17/2016] [Accepted: 01/04/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND In high-risk patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR) diabetes mellitus (DM) is a common comorbidity. It is known to increase the risk of arteriosclerosis and adversely affect morbidity, mortality for all types of cardiovascular disease, and post-procedural outcome after percutaneous and surgical procedures. Moreover, DM is known to facilitate the genesis of renal failure (RF). Pre-existing RF seems to increase the rate of acute kidney injury (AKI), which is a powerful short- and midterm predictor of mortality in patients undergoing TAVR. Therefore, the aim of the present study was to investigate the impact of DM on AKI, short- and midterm prognosis after TAVR, especially in patients with pre-existing RF. METHODS AND RESULTS In 337(30%) of 1109 patients DM was documented. The incidence of RF at baseline (GFR <60mL/min) was statistically similar in both patient groups (no DM vs. DM: 54% vs. 61%; p=0.057). Also, the incidence of AKI stage 3 was similar in all patients (no DM vs. DM: 1.6% vs. 1.8%; p=0.799). There were no significant differences regarding the procedure-related complications according to VARC-2 and mortality between patients neither with nor without DM. Even after differentiating patients according to baseline renal function, similar incidence of AKI and midterm mortality were documented. CONCLUSION In patients undergoing TAVR, neither in case of preserved nor impaired renal function, we couldn't find any evidence for influence of DM on overall acute and midterm prognosis nor the incidence of AKI.
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Affiliation(s)
- Dimitry Schewel
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany.
| | - Milad Zavareh
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Jury Schewel
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Thomas Thielsen
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Tobias Schmidt
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
| | - Christian Frerker
- Department of General and Interventional Cardiology, Asklepios Clinic St. Georg Hospital, Hamburg, Germany
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17
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Sokalskis V, Muraru D, Fraccaro C, Napodano M, D'Onofrio A, Tarantini G, Badano LP. Echocardiographic follow-up after transcatheter aortic valve replacement. Echocardiography 2017; 34:267-278. [PMID: 28052455 DOI: 10.1111/echo.13443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The use of transcatheter aortic valve replacement (TAVR) for high-risk patients with aortic stenosis has rapidly increased during the past years. Accordingly, more and more patients are referred for a follow-up echocardiographic study after TAVR. However, the echocardiographic evaluation of patients who underwent TAVR places specific demands on echocardiographers. Furthermore, TAVR may be associated with new types of complications, which are frequently unrecognized or underestimated due to lack of familiarity with the normal and pathological appearance of TAVR. Therefore, this review summarizes the echocardiographic parameters describing the structural and functional status of bioprostheses used in TAVR, procedures taking into account their peculiar hemodynamics. We also describe the strengths and the limitations of echocardiography and of other imaging modalities in detecting long-term complications of TAVR (eg, infective endocarditis, thrombosis). The aim of this review was to serve as a guide for a structured echocardiographic follow-up of TAVR patients, as well as for the echocardiographic diagnosis of the procedure-associated complications.
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Affiliation(s)
- Vladislavs Sokalskis
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy.,University Heart Center Hamburg, Hamburg, Germany
| | - Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Massimo Napodano
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Augusto D'Onofrio
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
| | - Luigi Paolo Badano
- Department of Cardiac, Thoracic and Vascular Sciences, School of Medicine, University of Padova, Padova, Italy
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18
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Tang M, Liu X, Lin C, He Y, Cai X, Xu Q, Hu P, Gao F, Jiang J, Lin X, Zhu Q, Wang L, Kong H, Yu Y, Wang J. Meta-Analysis of Outcomes and Evolution of Pulmonary Hypertension Before and After Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 119:91-99. [PMID: 27788934 DOI: 10.1016/j.amjcard.2016.09.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 09/19/2016] [Accepted: 09/19/2016] [Indexed: 01/06/2023]
Abstract
Pulmonary hypertension (PH) is a common entity in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI), but its role on clinical outcomes remains undetermined. We evaluated the impact of baseline and postprocedural PH on clinical outcomes and changes in pulmonary artery systolic pressure after TAVI by performing a meta-analysis of 16 studies enrolling 9,204 patients with AS who underwent TAVI. In patients with baseline PH, all-cause mortality was significantly increased, as shown by pooled odds ratio (ORs) for overall 30-day (OR 1.52, 95% confidence interval [CI] 1.28 to 1.80), 1-year (OR 1.39, 95% CI 1.27 to 1.51), and 2-year all-cause mortality (OR 2.00, 95% CI 1.49 to 2.69), compared with those without PH, independent of different methods of PH assessment. The presence of post-TAVI PH was associated with a significant increase in 2-year all-cause mortality (OR 2.32, 95% CI 1.43 to 3.74). Nevertheless, pulmonary artery systolic pressure decreased at 3-month to 1-year follow-up (standardized mean difference -1.12, 95% CI -1.46 to -0.78). Baseline PH was associated with higher 30-day and 1-year cardiovascular mortality. Patients with baseline PH had higher risk of stroke at 1 year and acute kidney injury at 30 days. But the risk of major vascular complications was significantly lower in patients with baseline PH. In conclusion, the presence of PH is associated with increased short- and long-term mortality, also higher risk of stroke and acute kidney injury after TAVI. A significant decrease in PSAP is detected in patients with AS in midterm follow-up after TAVI.
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19
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Transcatheter Aortic Valve Implantation in a Patient with Severe, Precapillary Pulmonary Arterial Hypertension. Ann Am Thorac Soc 2016; 14:147-149. [PMID: 28035872 DOI: 10.1513/annalsats.201609-743le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Nijenhuis VJ, Huitema MP, Vorselaars VMM, Swaans MJ, de Kroon T, van der Heyden JAS, Rensing BJWM, Heijmen R, Ten Berg JM, Post MC. Echocardiographic pulmonary hypertension probability is associated with clinical outcomes after transcatheter aortic valve implantation. Int J Cardiol 2016; 225:218-225. [PMID: 27732925 DOI: 10.1016/j.ijcard.2016.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 10/01/2016] [Accepted: 10/04/2016] [Indexed: 11/17/2022]
Abstract
AIMS Pulmonary hypertension (PH) is associated with mortality after transcatheter aortic valve implantation (TAVI). However, diagnosis based on tricuspid regurgitant velocity (TRV) is often inaccurate and unreliable. The updated PH guidelines introduced a PH probability grading implementing additional PH signs on transthoracic echocardiography (TTE), from which we aimed to analyse its effects on clinical outcomes in patients undergoing TAVI. METHODS AND RESULTS We included 591 consecutive patients (mean age 80.2±8.4years, 58.0% female, mean STS risk score 6.2±3.8%) undergoing TAVI. Patients were divided into "low" (n=270; TRV ≤2.8m/s without additional PH signs), "intermediate" (n=131; TRV ≤2.8m/s with additional PH signs, or TRV 2.9-3.4m/s without additional PH signs), and "high" PH probability (n=190; TRV 2.9-3.4m/s with additional PH signs, or TRV >3.4m/s). The overall 30-day and 2-year mortality rates were 10.2% and 33.8%, respectively. "High" PH probability was an independent predictor of mortality at 30days (HR 3.68, 95% CI 2.03 to 6.67, p<0.01) and 2years (HR 2.19, 95% CI 1.57 to 3.04, p<0.01), compared to "low" PH probability. The "intermediate" group did not show an increased risk. The presence of additional PH signs resulted in a significantly higher mortality at 30days (19.6% vs. 5.1%, p<0.01) and two years (54.2% vs. 22.5%, p<0.01). CONCLUSIONS The updated echocardiographic PH probability model incorporating additional PH signs independently predicts early and late mortality after TAVI. Additional PH signs are of great value in assessing one's risks since its presence is strongly associated with early and late mortality.
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Affiliation(s)
- V J Nijenhuis
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - M P Huitema
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - V M M Vorselaars
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - T de Kroon
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | - B J W M Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - R Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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21
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Lindsay AC, Harron K, Jabbour RJ, Kanyal R, Snow TM, Sawhney P, Alpendurada F, Roughton M, Pennell DJ, Duncan A, Di Mario C, Davies SW, Mohiaddin RH, Moat NE. Prevalence and Prognostic Significance of Right Ventricular Systolic Dysfunction in Patients Undergoing Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2016; 9:CIRCINTERVENTIONS.115.003486. [DOI: 10.1161/circinterventions.115.003486] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 06/09/2016] [Indexed: 01/19/2023]
Abstract
Background—
Cardiovascular magnetic resonance (CMR) can provide important structural information in patients undergoing transcatheter aortic valve implantation. Although CMR is considered the standard of reference for measuring ventricular volumes and mass, the relationship between CMR findings of right ventricular (RV) function and outcomes after transcatheter aortic valve implantation has not previously been reported.
Methods and Results—
A total of 190 patients underwent 1.5 Tesla CMR before transcatheter aortic valve implantation. Steady-state free precession sequences were used for aortic valve planimetry and to assess ventricular volumes and mass. Semiautomated image analysis was performed by 2 specialist reviewers blinded to patient treatment. Patient follow-up was obtained from the Office of National Statistics mortality database. The median age was 81.0 (interquartile range, 74.9–85.5) years; 50.0% were women. Impaired RV function (RV ejection fraction ≤50%) was present in 45 (23.7%) patients. Patients with RV dysfunction had poorer left ventricular ejection fractions (42% versus 69%), higher indexed left ventricular end-systolic volumes (96 versus 40 mL), and greater indexed left ventricular mass (101 versus 85 g/m
2
;
P
<0.01 for all) than those with normal RV function. Median follow-up was 850 days; 21 of 45 (46.7%) patients with RV dysfunction died, compared with 43 of 145 (29.7%) patients with normal RV function (
P
=0.035). After adjustment for significant baseline variables, both RV ejection fraction ≤50% (hazard ratio, 2.12;
P
=0.017) and indexed aortic valve area (hazard ratio, 4.16;
P
=0.025) were independently associated with survival.
Conclusions—
RV function, measured on preprocedural CMR, is an independent predictor of mortality after transcatheter aortic valve implantation. CMR assessment of RV function may be important in the risk stratification of patients undergoing transcatheter aortic valve implantation.
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Affiliation(s)
- Alistair C. Lindsay
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Katie Harron
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Richard J. Jabbour
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Ritesh Kanyal
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Thomas M. Snow
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Paramvir Sawhney
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Francisco Alpendurada
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Michael Roughton
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Dudley J. Pennell
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Alison Duncan
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Carlo Di Mario
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Simon W. Davies
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Raad H. Mohiaddin
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
| | - Neil E. Moat
- From the Department of Cardiology (A.C.L., R.J.J., R.K., T.M.S., P.S., M.R., A.D., C.D.M., S.W.D.), Department of Cardiovascular Magnetic Resonance (F.A., D.J.P., R.H.M.), and Department of Surgery (N.E.M.), Royal Brompton and Harefield NHS Trust, London, United Kingdom; Department of Statistics, London School of Hygiene and Tropical Medicine, University College London, United Kingdom (K.H.); and Department of Cardiovascular Medicine, Imperial College, London, United Kingdom (D.J.P., R.H.M.)
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Toutouzas K, Latsios G, Stathogiannis K, Drakopoulou M, Synetos A, Sanidas E, Mastrokostopoulos A, Trantalis G, Kaitozis O, Lazaros G, Yuecel S, Gerckens U, Grube E, Tousoulis D. One-year outcomes after direct transcatheter aortic valve implantation with a self-expanding bioprosthesis. A two-center international experience. Int J Cardiol 2016; 202:631-5. [DOI: 10.1016/j.ijcard.2015.09.075] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 08/24/2015] [Accepted: 09/21/2015] [Indexed: 11/16/2022]
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