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Seo J, Kharawala A, Borkowski P, Singh N, Akunor H, Nagraj S, Avgerinos DV, Kokkinidis DG. Obesity and Transcatheter Aortic Valve Replacement. J Cardiovasc Dev Dis 2024; 11:169. [PMID: 38921670 PMCID: PMC11203863 DOI: 10.3390/jcdd11060169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/20/2024] [Accepted: 05/24/2024] [Indexed: 06/27/2024] Open
Abstract
Amidst an aging population and escalating obesity prevalence, elucidating the impact of obesity on transcatheter aortic valve replacement (TAVR) outcomes becomes paramount. The so-called "obesity paradox"-a term denoting the counterintuitive association of obesity, typically a risk factor for cardiovascular diseases, with improved survival outcomes in TAVR patients relative to their leaner or normal-weight counterparts-merits rigorous examination. This review comprehensively investigates the complex relationship between obesity and the clinical outcomes associated with TAVR, with a specific focus on mortality and periprocedural complications. This study aims to deepen our understanding of obesity's role in TAVR and the underlying mechanisms of the obesity paradox, thereby optimizing management strategies for this patient demographic, tailored to their unique physiological and metabolic profiles.
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Affiliation(s)
- Jiyoung Seo
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.)
| | - Amrin Kharawala
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.)
| | - Pawel Borkowski
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.)
| | - Nikita Singh
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.)
| | - Harriet Akunor
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY 10461, USA (P.B.)
| | - Sanjana Nagraj
- Department of Cardiology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, Bronx, NY 10467, USA
| | | | - Damianos G. Kokkinidis
- Section of Cardiovascular Medicine, Lawrence Memorial Hospital & Northeast Medical Group, Yale New Haven Heath, New London, CT 06614, USA
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Mohammadyari P, Vieceli Dalla Sega F, Fortini F, Minghini G, Rizzo P, Cimaglia P, Mikus E, Tremoli E, Campo G, Calore E, Schifano SF, Zambelli C. Deep-learning survival analysis for patients with calcific aortic valve disease undergoing valve replacement. Sci Rep 2024; 14:10902. [PMID: 38740898 DOI: 10.1038/s41598-024-61685-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
Calcification of the aortic valve (CAVDS) is a major cause of aortic stenosis (AS) leading to loss of valve function which requires the substitution by surgical aortic valve replacement (SAVR) or transcatheter aortic valve intervention (TAVI). These procedures are associated with high post-intervention mortality, then the corresponding risk assessment is relevant from a clinical standpoint. This study compares the traditional Cox Proportional Hazard (CPH) against Machine Learning (ML) based methods, such as Deep Learning Survival (DeepSurv) and Random Survival Forest (RSF), to identify variables able to estimate the risk of death one year after the intervention, in patients undergoing either to SAVR or TAVI. We found that with all three approaches the combination of six variables, named albumin, age, BMI, glucose, hypertension, and clonal hemopoiesis of indeterminate potential (CHIP), allows for predicting mortality with a c-index of approximately 80 % . Importantly, we found that the ML models have a better prediction capability, making them as effective for statistical analysis in medicine as most state-of-the-art approaches, with the additional advantage that they may expose non-linear relationships. This study aims to improve the early identification of patients at higher risk of death, who could then benefit from a more appropriate therapeutic intervention.
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Affiliation(s)
| | | | | | - Giada Minghini
- Department of Environmental and Prevention Sciences, Università di Ferrara, Ferrara, Italy
| | - Paola Rizzo
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy.
- Department of Translational Medicine, Università di Ferrara, Ferrara, Italy.
- Laboratory for Technologies of Advanced Therapies (LTTA), Ferrara, Italy.
| | - Paolo Cimaglia
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Elisa Mikus
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Elena Tremoli
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Italy
| | - Gianluca Campo
- Department of Translational Medicine, Università di Ferrara, Ferrara, Italy
- Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Enrico Calore
- Istituto Nazionale di Fisica Nucleare (INFN), Ferrara, Italy
| | - Sebastiano Fabio Schifano
- Istituto Nazionale di Fisica Nucleare (INFN), Ferrara, Italy.
- Department of Environmental and Prevention Sciences, Università di Ferrara, Ferrara, Italy.
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Alharbi A, Shah M, Mhanna M, Rejent K, Safi M, Alsughayer A, Patel N, Assaly R. Body Mass Index and Outcomes of Transcatheter Aortic Valve Replacement: A Retrospective Observational Study. Curr Probl Cardiol 2023; 48:101879. [PMID: 37343774 DOI: 10.1016/j.cpcardiol.2023.101879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
The influence of body mass index (BMI) on Transcatheter Aortic Valve Replacement (TAVR) outcomes has been the focus of several previous studies. In this study, we examined the relationship between BMI and various clinical outcomes following TAVR procedures. A comprehensive analysis was conducted using a large cohort of patients who underwent TAVR. In this study, we identified patients who underwent Transcatheter aortic valve replacement (TAVR) in the year 2020. Procedure Classification System (ICD-10-PCS) codes were used to identify TAVR cases. The weighted final study sample included 77319 TAVR hospitalizations. Patients were categorized into 5 groups based on their Body Mass Index (BMI. Our findings revealed that there was no significant difference in in-hospital mortality among different BMI groups when compared to patients with a normal BMI (20 to 24.9). patients with a BMI of 25 or higher demonstrated a statistically significant shorter duration of hospitalization compared to those with a normal BMI. patients with a BMI ranging between 30 and 39.9 exhibited decreased hospitalization costs when compared to patients with a normal BMI. Moreover, our study revealed a decrease in atrial fibrillation, acute heart failure and acute kidney injury complications following TAVR in patients with above-normal BMI. Despite similar in-hospital mortality across BMI groups, having a BMI of 25 or greater is associated with improved immediate outcomes following TAVR. These benefits in overweight and obese patients are consistent with findings described in recent literature. Further studies are warranted to explore the underlying mechanisms and potential implications of these associations, as well as to optimize patient selection and management strategies for TAVR procedures.
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Affiliation(s)
| | - Momin Shah
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Mohammed Mhanna
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, IA
| | - Kassidy Rejent
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Mohammad Safi
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Anas Alsughayer
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Neha Patel
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Ragheb Assaly
- Department of Internal Medicine, University of Toledo, Toledo, OH; Department of Internal Medicine, Pulmonary and Critical Care Medicine, University of Toledo, Toledo, OH
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Patel E, Varghese JJ, Garg M, Yacob O, Sánchez JS, Garcia-Garcia HM. Comparison of Body Mass Index (Four Categories) to In-Hospital Outcomes in Patients Who Underwent Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 192:190-195. [PMID: 36812703 DOI: 10.1016/j.amjcard.2023.01.032] [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] [Received: 05/13/2022] [Revised: 12/16/2022] [Accepted: 01/15/2023] [Indexed: 02/23/2023]
Abstract
Although obesity is often associated with adverse outcomes in cardiovascular diseases, studies have demonstrated a beneficial effect on patients who underwent transcatheter aortic valve implantation (TAVI), coining the term "obesity paradox." We sought to determine if the obesity paradox is valid when patients are studied in body mass index (BMI) groups versus simplified classification of obese and nonobese. We examined the National Inpatient Sample database from 2016 to 2019 for all patients who underwent TAVI >18 years of age using the International Classification of Diseases, 10th edition procedure codes. Patients were grouped by BMI categories of underweight, overweight, obese, and morbidly obese. They were compared with normal-weight patients to assess the relative risk of in-hospital mortality, cardiogenic shock, ST-elevation myocardial infarction, bleeding complications requiring transfusions, and complete heart blocks requiring permanent pacemaker. A logistic regression model was constructed to account for potential confounders. Of the 221,000 patients who underwent TAVI, 42,315 patients with appropriate BMI designation were stratified into BMI groups. Compared to the normal-weight group, overweight, obese, and morbid-obese TAVI patients were associated with a lower risk of in-hospital mortality (relative risk [RR] 0.48, confidence interval [CI] 0.29 to 0.77, p <0.001), (RR 0.42, CI 0.28 to 0.63, p <0.001), (RR 0.49, CI 0.33 to 0.71, p <0.001 respectively), cardiogenic shock (RR 0.27, CI 0.20 to 0.38, p <0.001), (RR 0.21, CI 0.16 to 0.27, p <0.001), (RR 0.21, CI 0.16 to 0.26, p <0.001), and blood transfusions (RR 0.63, CI 0.50 to 0.79, p <0.001), (RR 0.47, CI 0.39 to 0.58, p <0.001), (RR 0.61, CI 0.51 to 0.74, p <0.001). This study indicated that obese patients were at a significantly lower risk of in-hospital mortality, cardiogenic shock, and bleeding complications requiring transfusions. In conclusion, our study supported the existence of the obesity paradox in TAVI patients.
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Affiliation(s)
- Etee Patel
- Department of Medicine, HCA Florida Oak Hill Hospital, Brooksville, Florida
| | - Jobin Joseph Varghese
- Departments of Medicine, Medstar Cardiovascular Research Network, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Mohil Garg
- Departments of Medicine, Medstar Cardiovascular Research Network, Medstar Washington Hospital Center, Washington, District of Columbia
| | - Omar Yacob
- Department of Cardiology, MercyOne Heart and Vascular Institute, Mason City, Iowa
| | - Jorge Sanz Sánchez
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain
| | - Hector M Garcia-Garcia
- Departments of Cardiology, Medstar Cardiovascular Research Network, Medstar Washington Hospital Center, Washington, District of Columbia.
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Gupta R, Mahmoudi E, Behnoush AH, Khalaji A, Malik AH, Sood A, Bandyopadhyay D, Zaid S, Goel A, Sreenivasan J, Patel C, Vyas AV, Lavie CJ, Patel NC. Effect of BMI on patients undergoing transcatheter aortic valve implantation: A systematic review and meta-analysis. Prog Cardiovasc Dis 2023:S0033-0620(22)00158-X. [PMID: 36657654 DOI: 10.1016/j.pcad.2022.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 12/26/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND The relationship of body mass index (BMI) and an "obesity paradox" with cardiovascular risk prediction is controversial. This systematic review and meta-analysis aims to compare the associations of different BMI ranges on transcatheter aortic valve implantation (TAVI) outcomes. METHODS International databases, including PubMed, the Web of Science, and the Cochrane Library, were systematically searched for observational and randomized controlled trial studies investigating TAVI outcomes in any of the four BMI categories: underweight, normal weight, overweight, and obese with one of the predefined outcomes. Primary outcomes were in-hospital, 30-day, and long-term all-cause mortality. Random-effects meta-analysis was performed to calculate the odds ratio (OR) or standardized mean differences (SMD) with 95% confidence interval (CI) for each paired comparison between two of the BMI categories. RESULTS A total of 38 studies were included in our analysis, investigating 99,829 patients undergoing TAVI. There was a trend toward higher comorbidities such as hypertension, diabetes, and dyslipidemia in overweight patients and individuals with obesity. Compared with normal-weight, patients with obesity had a lower rate of 30-day mortality (OR 0.42, 95% CI 0.25-0.72, p < 0.01), paravalvular aortic regurgitation (OR 0.63, 95% CI 0.44-0.91, p = 0.01), 1-year mortality (OR 0.48, 95% CI 0.24-0.96, p = 0.04), and long-term mortality (OR 0.69, 95% CI 0.51-0.94, p = 0.02). However, acute kidney injury (OR 1.16, 95% CI 1.04-1.30, p = 0.01) and permanent pacemaker implantation (OR 1.25, 95% CI 1.05-1.50, p = 0.01) odds were higher in patients with obesity. Noteworthy, major vascular complications were significantly higher in underweight patients in comparison with normal weight cases (OR 1.62, 95% CI 1.07-2.46, p = 0.02). In terms of left ventricular ejection fraction (LVEF), patients with obesity had higher post-operative LVEF compared to normal-weight individuals (SMD 0.12, 95% CI 0.02-0.22, p = 0.02). CONCLUSION Our results suggest the presence of the "obesity paradox" in TAVI outcomes with higher BMI ranges being associated with lower short- and long-term mortality. BMI can be utilized for risk prediction of patients undergoing TAVI.
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Affiliation(s)
- Rahul Gupta
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Elham Mahmoudi
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Behnoush
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Khalaji
- Universal Scientific Education and Research Network, Tehran University of Medical Sciences, Tehran, Iran
| | - Aaqib H Malik
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Aayushi Sood
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, Scranton, PA, USA
| | - Dhrubajyoti Bandyopadhyay
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Syed Zaid
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Akshay Goel
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Institute, Houston, TX, USA
| | - Jayakumar Sreenivasan
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Chirdeep Patel
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Apurva V Vyas
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Nainesh C Patel
- Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA
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Elevated Fasting Glucose and C-Reactive Protein Levels Predict Increased All-Cause Mortality after Elective Transcatheter Aortic Valve Implantation. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010054. [PMID: 36676003 PMCID: PMC9864580 DOI: 10.3390/life13010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022]
Abstract
Surgical aortic valve replacement in the elderly is now being supplanted by transcatheter aortic valve implantation (TAVI). Scoring systems to predict survival after catheter-based procedures are understudied. Both diabetes (DM) and underlying inflammatory conditions are common in patients undergoing TAVI, but their impact remains understudied in this patient group. We examined 560 consecutive TAVI procedures and identified eight pre-procedural factors: age, body mass index (BMI), DM, fasting blood glucose (BG), left-ventricular ejection fraction (EF), aortic valve (AV) mean gradient, C-reactive protein levels, and serum creatinine levels and studied their impact on survival. The overall mortality rate at 30 days, 1 year and 2 years were 5.2%, 16.6%, and 34.3%, respectively. All-cause mortality was higher in patients with DM (at 30 days: 8.9% vs. 3.1%, p = 0.008; at 1 year: 19.7% vs. 14.9%, p = 0.323; at 2 years: 37.9% vs. 32.2%, p = 0.304). The presence of DM was independently associated with increased 30-day mortality (hazard ratio [HR] 5.38, 95% confidence interval [CI], 1.24-23.25, p = 0.024). BG levels within 7-11, 1 mmol/L portended an increased risk for 30-day and 2-year mortality compared to normal BG (p = 0.001 and p = 0.027). For each 1 mmol/L increase in BG 30-day mortality increased (HR 1.21, 95% CI, 1.04-1.41, p = 0.015). Reduced EF and elevated CRP were each associated with increased 2-year mortality (p = 0.042 and p = 0.003). DM, elevated BG, reduced EF, and elevated baseline CRP levels each are independent predictors of short- and long-term mortality following TAVI. These easily accessible screening parameters should be integrated into risk-assessment tools for catheter-based aortic valve replacement candidates.
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Seo J, Li W, Safiriyu I, Kharawala A, Nagraj S, Tahir A, Doundoulakis I, Koliastasis L, Rios S, Palaiodimos L, Kokkinidis DG. A Meta-Analysis on the Impact of High BMI in Patients Undergoing Transcatheter Aortic Valve Replacement. J Cardiovasc Dev Dis 2022; 9:386. [PMID: 36354785 PMCID: PMC9695436 DOI: 10.3390/jcdd9110386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 11/01/2022] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND A paradoxical association of obesity with lower risk of transcatheter aortic valve replacement (TAVR) outcomes has been reported. We aimed to systematically review the literature and compare TAVR-related morbidity and mortality among individuals with overweight or obesity and their peers with normal body mass index (BMI). METHODS PubMed and Embase databases were systematically searched for studies reporting TAVR outcomes in different BMI groups. Separate meta-analyses were conducted for studies reporting hazard ratios (HR) and odds ratios/relative risks. Short- and mid-/long-term outcomes were examined. RESULTS 26 studies with a total of 74,163 patients were included in our study. Overweight was associated with lower risk of short-term mortality (HR: 0.77; 95% CI: 0.60-0.98) and mid-/long-term mortality (HR: 0.79; 95% CI: 0.70-0.89). Obesity was associated with lower risk for mid-/long-term mortality (HR: 0.79; 95% CI: 0.73-0.86), but no difference was observed in short-term mortality, although a trend was noted (HR: 0.87l 95% CI: 0.74-1.01). Individuals with obesity demonstrated an association with higher odds of major vascular complications (OR: 1.33; 95% CI: 1.05-1.68). Both overweight (OR: 1.16; 95% CI: 1.03-1.30) and obesity (OR: 1.26; 95% CI: 1.06-1.50) were associated with higher likelihood for receiving permanent pacemakers after TAVR. CONCLUSION Individuals with overweight and obesity were associated with lower mortality risk compared to those with normal BMI but with higher likelihood of major vascular complications and permanent pacemaker implantation after TAVR.
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Affiliation(s)
- Jiyoung Seo
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Weijia Li
- AdventHealth Orlando, Orlando, FL 32803, USA
| | - Israel Safiriyu
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Amrin Kharawala
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Sanjana Nagraj
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Arooj Tahir
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Ioannis Doundoulakis
- Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Leonidas Koliastasis
- Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, 10679 Athens, Greece
| | - Saul Rios
- Montefiore Einstein Center for Heart & Vascular Care, Albert Einstein College of Medicine, Montefiore Medical Center, The Bronx, NY 10467, USA
| | - Leonidas Palaiodimos
- Department of Internal Medicine, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, NY 10461, USA
| | - Damianos G. Kokkinidis
- Section of Cardiovascular Medicine, Yale New Haven Hospital, Yale University School of Medicine, New Haven, CT 06510, USA
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Luo ZR, Chen LW, Qiu HF. Does the "obesity paradox" exist after transcatheter aortic valve implantation? J Cardiothorac Surg 2022; 17:156. [PMID: 35698230 PMCID: PMC9195232 DOI: 10.1186/s13019-022-01910-x] [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: 05/29/2021] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Transcatheter aortic valve implantation (TAVI) for symptomatic aortic stenosis is considered a minimally invasive procedure. Body mass index (BMI) has been rarely evaluated for pulmonary complications after TAVI. This study aimed to assess the influence of BMI on pulmonary complications and other related outcomes after TAVI. Methods The clinical data of 109 patients who underwent TAVI in our hospital from May 2018 to April 2021 were retrospectively analyzed. Patients were divided into three groups according to BMI: low weight (BMI < 21.9 kg/m2, n = 27), middle weight (BMI 21.9–27.0 kg/m2, n = 55), and high weight (BMI > 27.0 kg/m2, n = 27); and two groups according to vascular access: through the femoral artery (TF-TAVI, n = 94) and through the transapical route (TA-TAVI, n = 15). Procedure endpoints, procedure success, and adverse outcomes were evaluated according to the Valve Academic Research Consortium (VARC)-2 definitions. Results High-weight patients had a higher proportion of older (p < 0.001) and previous percutaneous coronary interventions (p = 0.026), a higher percentage of diabetes mellitus (p = 0.026) and frailty (p = 0.032), and lower glomerular filtration rate (p = 0.024). Procedure success was similar among the three groups. The 30-day all-cause mortality of patients with low-, middle-, and high weights was 3.7% (1/27), 5.5% (3/55), and 3.7% (1/27), respectively. In the multivariable analysis, middle- and high-weight patients exhibited similar overall mortality (middle weight vs. low weight, p = 0.500; high weight vs. low weight, p = 0.738) and similar intubation time compared with low-weight patients (9.1 ± 7.3 h vs. 8.9 ± 6.0 h vs. 8.7 ± 4.2 h in high-, middle-, and low-weight patients, respectively, p = 0.872). Although high-weight patients had a lower PaO2/FiO2 ratio than low-weight patients at baseline, transitional extubation, and post extubation 12th hour (p = 0.038, 0.030, 0.043, respectively), there were no differences for post extubation 24th hour, post extubation 48th hour, and post extubation 72nd hour (p = 0.856, 0.896, 0.873, respectively). Chronic lung disease [odds ratio (OR) 8.038, p = 0.001] rather than high weight (OR 2.768, p = 0.235) or middle weight (OR 2.226, p = 0.157) affected postoperative PaO2/FiO2 after TAVI. Conclusions We did not find the existence of an obesity paradox after TAVI. BMI had no effect on postoperative intubation time. Patients with a higher BMI should be treated similarly without the need to deliberately extend the intubation time for TAVI. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01910-x.
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Affiliation(s)
- Zeng-Rong Luo
- Key Laboratory of Cardio-Thoracic Surgery, Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fujian Province University, Fuzhou, 350001, People's Republic of China
| | - Liang-Wan Chen
- Key Laboratory of Cardio-Thoracic Surgery, Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fujian Province University, Fuzhou, 350001, People's Republic of China
| | - Han-Fan Qiu
- Key Laboratory of Cardio-Thoracic Surgery, Department of Cardiovascular Surgery and Cardiac Disease Center, Union Hospital, Fujian Medical University, Fujian Province University, Fuzhou, 350001, People's Republic of China.
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Alperi A, McInerney A, Modine T, Chamandi C, Tafur-Soto JD, Barbanti M, Lopez D, Campelo-Parada F, Cheema AN, Toggweiler S, Saia F, Amat-Santos I, Oteo JF, Serra V, Dabrowski M, Abi-Akar R, Echavarria NG, Valvo R, Lopez-Pais J, Matta A, Arif M, Moccetti F, Compagnone M, Mohammadi S, Nombela-Franco L, Rodés-Cabau J. Transcatheter aortic valve replacement in obese patients: procedural vascular complications with the trans-femoral and trans-carotid access routes. Interact Cardiovasc Thorac Surg 2021; 34:982-989. [PMID: 34942005 PMCID: PMC9159419 DOI: 10.1093/icvts/ivab354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/12/2021] [Accepted: 11/20/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Alberto Alperi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | - Angela McInerney
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Thomas Modine
- Centre Hospitalier Universitaire de Lille, Lille, France
| | | | - Jose D Tafur-Soto
- The Ochsner Clinical School, Ochsner Medical Center, New Orleans, LA, USA
| | - Marco Barbanti
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Diego Lopez
- CIVERCV, Instituto de investigación de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Asim N Cheema
- Division of Cardiology, St Michaels Hospital, Toronto, Canada
| | | | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Ignacio Amat-Santos
- CIBERCV, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Juan F Oteo
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Viçent Serra
- Hospital General Universitari Vall d'Hebron, Barcelona, Spain
| | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | | | | | - Roberto Valvo
- Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Javier Lopez-Pais
- CIVERCV, Instituto de investigación de Santiago (IDIS), Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Anthony Matta
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - Mobeena Arif
- Division of Cardiology, St Michaels Hospital, Toronto, Canada
| | | | - Miriam Compagnone
- Cardiology Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada
| | | | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Canada.,Hospital Clínic Barcelona, Barcelona, Spain
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10
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Boukhris M, Forcillo J, Potvin J, Noiseux N, Stevens LM, Badreddine M, Gobeil JF, Masson JB. Does "obesity paradox" apply for patients undergoing transcatheter aortic valve replacement? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 38:1-8. [PMID: 34412992 DOI: 10.1016/j.carrev.2021.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 08/06/2021] [Accepted: 08/09/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Data is controversial regarding the existence of an "obesity paradox" in patients undergoing Transcatheter Aortic Valve Replacement (TAVR). We sought to investigate the prognostic value of the body mass index (BMI) on outcomes following TAVR. METHODS This is an observational, single-center study involving all patients who underwent TAVR from 2009 to 2019. BMI was calculated in all patients before TAVR. The cohort was subdivided into four groups: underweight (<20 kg/m2), normal weight (≥20 to <25 kg/m2), overweight (≥25 to <30 kg/m2) and obese (≥30 kg/m2). The main endpoint was all-cause 30-day and one-year mortality. RESULTS A total of 412 patients (mean age 79.6 ± 7.8 years, mean STS score 5.3 ± 3.6) were included. Patients were grouped as follows: underweight (n = 35, 8.5%), normal weight (n = 121, 29.4%), overweight (n = 140, 34%) and obese (n = 116, 28.1%). Obese patients were younger, included more females and had lower STS score than the rest of the cohort whereas underweight patients were older, had higher STS score, more chronic kidney disease, more left ventricular dysfunction and more often underwent non-transfemoral TAVR. BMI predicted 30-day survival (AUC:0.692 [95%CI 0.522-0.862]; p = 0.030) with an optimal cut-off of 24.4 (sensitivity = 66.6%, specificity = 63.6%). On multivariate analysis, higher BMI trended toward lower 30-day mortality (HR = 0.87 [95%CI 0.75-1.01]; p = 0.071). Thirty-day mortality was higher in the underweight group (8.3%) in comparison with other BMI subgroups (normal weight 2.5%, overweight 1.4%, obese 0.9%; p = 0.045). However, no significant difference was found after adjustment of confounders (all p = NS). BMI did not predict one-year mortality. No significant difference in one-year survival was observed between the four BMI subgroups (log rank p = 0.925). CONCLUSION BMI could represent an interesting prognostic tool for short-term mortality in patients undergoing TAVR. BMI < 20 kg/m2 was associated with higher 30-day mortality. Symptoms improved similarly in obese patients compared to lower BMI patients. For 30-day survivors, no evidence of the existence of an obesity paradox was observed in this cohort.
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Affiliation(s)
- Marouane Boukhris
- Division of Cardiology and Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Department of Cardiology, Dupuytren University Hospital, Limoges, France
| | - Jessica Forcillo
- Division of Cardiology and Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Jeannot Potvin
- Division of Cardiology and Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Nicolas Noiseux
- Division of Cardiology and Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Louis-Mathieu Stevens
- Division of Cardiology and Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Malek Badreddine
- Division of Cardiology and Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Jean-François Gobeil
- Division of Cardiology and Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Bernard Masson
- Division of Cardiology and Cardiac Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.
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11
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McInerney A, Tirado-Conte G, Rodes-Cabau J, Campelo-Parada F, Tafur Soto JD, Barbanti M, Muñoz-Garcia E, Arif M, Lopez D, Toggweiler S, Veiga G, Pylko A, Sevilla T, Compagnone M, Regueiro A, Serra V, Carnero M, Oteo JF, Rivero F, Barbosa Ribeiro H, Guimaraes L, Matta A, Giraldo Echavarria N, Valvo R, Moccetti F, Muñoz-Garcia AJ, Lopez-Pais J, Garcia Del Blanco B, Campanha Borges DC, Dumont E, Gonzalo N, Criscione E, Dabrowski M, Alfonso F, de la Torre Hernández JM, Cheema AN, Amat-Santos IJ, Saia F, Escaned J, Nombela-Franco L. Impact of Morbid Obesity and Obesity Phenotype on Outcomes After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e019051. [PMID: 34056919 PMCID: PMC8477858 DOI: 10.1161/jaha.120.019051] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is a paucity of outcome data on patients who are morbidly obese (MO) undergoing transcatheter aortic valve replacement. We aimed to determine their periprocedural and midterm outcomes and investigate the impact of obesity phenotype. Methods and Results Consecutive patients who are MO (body mass index, ≥40 kg/m2, or ≥35 kg/m2 with obesity-related comorbidities; n=910) with severe aortic stenosis who underwent transcatheter aortic valve replacement in 18 tertiary hospitals were compared with a nonobese cohort (body mass index, 18.5-29.9 kg/m2, n=2264). Propensity-score matching resulted in 770 pairs. Pre-transcatheter aortic valve replacement computed tomography scans were centrally analyzed to assess adipose tissue distribution; epicardial, abdominal visceral and subcutaneous fat. Major vascular complications were more common (6.6% versus 4.3%; P=0.043) and device success was less frequent (84.4% versus 88.1%; P=0.038) in the MO group. Freedom from all-cause and cardiovascular mortality were similar at 2 years (79.4 versus 80.6%, P=0.731; and 88.7 versus 87.4%, P=0.699; MO and nonobese, respectively). Multivariable analysis identified baseline glomerular filtration rate and nontransfemoral access as independent predictors of 2-year mortality in the MO group. An adverse MO phenotype with an abdominal visceral adipose tissue:subcutaneous adipose tissue ratio ≥1 (VAT:SAT) was associated with increased 2-year all-cause (hazard ratio [HR], 3.06; 95% CI, 1.20-7.77; P=0.019) and cardiovascular (hazard ratio, 4.11; 95% CI, 1.06-15.90; P=0.041) mortality, and readmissions (HR, 1.81; 95% CI, 1.07-3.07; P=0.027). After multivariable analysis, a (VAT:SAT) ratio ≥1 remained a strong predictor of 2-year mortality (hazard ratio, 2.78; P=0.035). Conclusions Transcatheter aortic valve replacement in patients who are MO has similar short- and midterm outcomes to nonobese patients, despite higher major vascular complications and lower device success. An abdominal VAT:SAT ratio ≥1 identifies an obesity phenotype at higher risk of adverse clinical outcomes.
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Affiliation(s)
- Angela McInerney
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
| | - Gabriela Tirado-Conte
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
| | - Josep Rodes-Cabau
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | | | | | | | - Erika Muñoz-Garcia
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares Cardiology Department Hospital Universitario Virgen de la Victoria Málaga Spain
| | - Mobeena Arif
- Division of Cardiology St. Michael's HospitalToronto University Toronto Ontario Canada
| | - Diego Lopez
- Hospital Clínico Universitario de SantiagoCIBERCV Santiago Spain
| | | | - Gabriela Veiga
- Hospital Universitario Marques de Valdecilla IDIVAL Santander Spain
| | - Anna Pylko
- Department of Interventional Cardiology and Angiology National Institute of Cardiology Warsaw Poland
| | - Teresa Sevilla
- CIBERCVInstituto de Ciencias del CorazónHospital Clínico Universitario de Valladolid Valladolid Spain
| | - Miriam Compagnone
- Cardiology Unit Cardio-Thoracic-Vascular Department University Hospital of BolognaPoliclinico S, Orsola-Malpighi Bologna Italy
| | - Ander Regueiro
- Cardiology Department Cardiovascular Institute, Hospital ClínicUniversidad de BarcelonaInstitut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| | - Viçent Serra
- Hospital General Universitari Vall d'Hebron Barcelona Spain
| | - Manuel Carnero
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
| | - Juan F Oteo
- Department of Cardiology Hospital Universitario Puerta de Hierro Majadahonda Spain
| | - Fernando Rivero
- Cardiology Department Hospital Universitario de la PrincesaInstituto de Investigación Sanitaria Princesa (IIS-IP)Universidad Autónoma de Madrid, CIBER-CV Madrid Spain
| | | | - Leonardo Guimaraes
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - Anthony Matta
- Cardiology Department Rangueil University Hospital Toulouse France
| | | | - Roberto Valvo
- Ferrarotto Hospital University of Catania Catania Italy
| | | | - Antonio J Muñoz-Garcia
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares Cardiology Department Hospital Universitario Virgen de la Victoria Málaga Spain
| | | | | | | | - Eric Dumont
- Quebec Heart and Lung InstituteLaval University Quebec City Quebec Canada
| | - Nieves Gonzalo
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
| | | | - Maciej Dabrowski
- Department of Interventional Cardiology and Angiology National Institute of Cardiology Warsaw Poland
| | - Fernando Alfonso
- Cardiology Department Hospital Universitario de la PrincesaInstituto de Investigación Sanitaria Princesa (IIS-IP)Universidad Autónoma de Madrid, CIBER-CV Madrid Spain
| | | | - Asim N Cheema
- Division of Cardiology St. Michael's HospitalToronto University Toronto Ontario Canada
| | - Ignacio J Amat-Santos
- CIBERCVInstituto de Ciencias del CorazónHospital Clínico Universitario de Valladolid Valladolid Spain
| | - Francesco Saia
- Cardiology Unit Cardio-Thoracic-Vascular Department University Hospital of BolognaPoliclinico S, Orsola-Malpighi Bologna Italy
| | - Javier Escaned
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
| | - Luis Nombela-Franco
- Cardiovascular InstituteHospital Clínico San CarlosInstituto de Investigación Sanitaria San Carlos Madrid Spain
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12
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Ogunbiyi MO, Ahmad M. To the Editor-Effect of permanent pacemakers on survival after transcatheter aortic valve replacement. Heart Rhythm 2020; 18:332-333. [PMID: 33207250 DOI: 10.1016/j.hrthm.2020.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/19/2022]
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13
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Eftychiou C, Eteocleous N, Zittis I, Simamonian K, Ioannou A, Loukaidou P, Ntaka A, Hadjigregoriou A, Vasiliades V, Adamou M, Constantinou E, Avraamides P. Outcomes of transfemoral transcatheter aortic valve implantation (TAVI) and predictors of thirty-day major adverse cardiovascular events (MACE) and one-year mortality. Hellenic J Cardiol 2020; 62:57-64. [PMID: 33007466 DOI: 10.1016/j.hjc.2020.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 09/05/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE TAVI is more frequently used to treat aortic stenosis with the mandate to have a low as possible rate of adverse events. We present our 30-day outcomes and one-year mortality and examine the factors associated with them. METHODS A prospective evaluation was performed of all patients who underwent transfemoral TAVI in Nicosia General Hospital from January 2015 until March 2020. MACE were defined as cardiac death, disabling stroke, and/or major vascular complications (VC). Multiple logistic and Cox regression analyses were used to identify the factors associated with 30-day MACE and one-year mortality, respectively. RESULTS A total of 235 TAVI procedures were performed (178 balloon-expandable, 57 self-expandable). Thirty-day outcomes were MACE: 4.3%, cardiovascular death: 2.1%, disabling stroke: 1.3%, major VC: 1.7%, and contrast induced nephropathy (CIN): 4.3%. There was a rate of 6.2% new pacemaker implantations and 0.9% of more than mild aortic valve regurgitation (AR) at 30 days. Mortality at one year was 15.1%. The balloon-expandable valves appear to have less new pacemakers, less mild AR, lower contrast volume used, and less days of hospitalization, while the self-expandable valves have lower post-procedural gradients. Low hemoglobulin, history of atrial fibrillation (AF), and lower BMI were predictors of 30-day MACE. Serum creatinine >2 mg/dL, history of AF, RVSP >60 mmHg and major VC are predictors of one-year mortality. CONCLUSION We have shown excellent 30-day results with low incidence of adverse events for both the balloon-expandable and self-expandable valves. Clinical factors are the main predictors of both 30-day MACE and one-year mortality; major VC is a strong predictor of one-year mortality.
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Affiliation(s)
| | | | - Ioannis Zittis
- Cardiology Department of Nicosia General Hospital, Cyprus
| | | | | | | | - Aliki Ntaka
- Anesthesiology Department of Nicosia General Hospital, Cyprus
| | | | | | - Maria Adamou
- Blood Bank Department of Nicosia General Hospital, Cyprus
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14
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Kandathil A, Mills RA, Hanna M, Merchant AM, Wehrmann LE, Minhajuddin A, Abbara S, Fox AA. Abdominal adiposity assessed using CT angiography associates with acute kidney injury after trans-catheter aortic valve replacement. Clin Radiol 2020; 75:921-926. [PMID: 32782129 DOI: 10.1016/j.crad.2020.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/02/2020] [Indexed: 12/29/2022]
Abstract
AIM To determine if there is an association between area-based visceral abdominal adipose tissue (VAT), subcutaneous abdominal adipose tissue (SAT), and abdominal circumference measured on computed tomography (CT) angiography before trans-catheter aortic valve replacement (TAVR) and post-TAVR acute kidney injury (AKI). MATERIALS AND METHODS In this retrospective cohort study of 106 TAVR patients, SAT and VAT areas and abdominal circumference was measured on a single CT section at L4 vertebral level. Univariate comparisons between patients who did and did not develop AKI were undertaken for radiological measurements. Multivariable logistic regression was used to assess association between CT measurements and the development of post-TAVR AKI. RESULTS Post-TAVR AKI occurred in 20 of 106 patients (19%). In univariate comparisons, body mass index (BMI) did not differ significantly between patients who did and did not develop AKI (p=0.14); however, VAT+SAT (443.2±163.7 versus 351±168.7 cm2; p=0.03), VAT (213.9±110.6 versus 153.9±96.1 cm2; p=0.03), and outer abdominal circumference (100.2±14.4 cm versus 91.8±13.3 cm; p=0.02) were significantly higher in the patients who did not develop post-TAVR AKI. These three measures on pre-TAVR CT angiogram remained significantly associated with reduced post-TAVR AKI with a lower incidence of post-TAVR AKI after multivariable adjustment for pre-TAVR estimated glomerular filtration rate and patient height (p<0.05). CONCLUSION This study found that increased abdominal obesity as assessed by measures on pre-TAVR CT angiogram is associated with a significantly lower incidence of AKI.
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Affiliation(s)
- A Kandathil
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA.
| | - R A Mills
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - M Hanna
- Department of Radiology, UT Health Science Center, Houston, TX, 77030, USA
| | - A M Merchant
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - L E Wehrmann
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - A Minhajuddin
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - S Abbara
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - A A Fox
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA; McDermott Center for Human Growth and Development, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
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15
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Ruge H, Burri M, Erlebach M, Lange R. Access site related vascular complications with third generation transcatheter heart valve systems. Catheter Cardiovasc Interv 2020; 97:325-332. [PMID: 32588968 DOI: 10.1002/ccd.29095] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/05/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study examines the impact of anatomical and procedural factors on Valve Academic Research Consortium-2-defined vascular complications at the femoral access site in transcatheter aortic valve replacement (TAVR) with third generation transcatheter heart valve (THV)-systems. BACKGROUND Randomized clinical trials reported on vascular complications with current THV-systems. However, clinical presentation and consequences of these events are not well studied. METHODS All patients who underwent a transfemoral TAVR using an Edwards Sapien3®/Sapien3ultra® or a Medtronic Evolut-R®/Evolut-PRO® have been identified from our institutional database. Only procedures utilizing the PerClose-ProGlide® vascular closure device were included. Risk factors for vascular complications were analyzed with a logistic regression model. Preoperative and procedural data were collected. The postoperative course of patients with and without vascular complications was compared. RESULTS A total of 878 patients met the inclusion criteria. Of these, 152 patients (17.3%) had an access-site related vascular complication (87 major complications, 9.9%). Sheath-to-femoral-artery-ratio (SFAR) (OR per 0.1 increase = 1.35, p < .001) and more than 2 vessel entries with large bore sheaths (OR = 1.76, p = .029) were independent risk factors for vascular complications. Female gender (OR = 1.44, p = .07) and two vessel entries with large bore sheaths (OR = 1.2, p = .53) increased the risk, although no statistical significance was shown. Age (OR = 1.07, p = .62), body mass index (OR = 1.1 per 5 points, p = .32) and vessel wall calcification at puncture site (OR = 0.93, p = .7) had no influence on vascular complications. Patients with vascular complications had a higher need for blood transfusion (p < .001) and a higher in-hospital mortality (2.6 vs. 0.4%, p = .019). CONCLUSIONS Procedural risk assessment should include SFAR calculation and consider the need for large bore sheath exchange. This might reduce the vascular trauma, lower vascular complication rates and improve the clinical outcome after TAVR.
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Affiliation(s)
- Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Center, TUM, INSURE (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, TUM, Munich, Germany
| | - Melchior Burri
- Department of Cardiovascular Surgery, German Heart Center, TUM, INSURE (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, TUM, Munich, Germany
| | - Magdalena Erlebach
- Department of Cardiovascular Surgery, German Heart Center, TUM, INSURE (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, TUM, Munich, Germany
| | - Ruediger Lange
- Department of Cardiovascular Surgery, German Heart Center, TUM, INSURE (Institute for Translational Cardiac Surgery), Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, TUM, Munich, Germany
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16
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Ahmad M, Patel JN, Loc BL, Vipparthy SC, Divecha C, Barzallo PX, Kim M, Baman T, Barzallo M, Mungee S. Association Between Body Mass Index and Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement (TAVR) with Edwards SAPIEN™ 3 TAVR Valves: A Single-Center Experience. Cureus 2019; 11:e5142. [PMID: 31328076 PMCID: PMC6634273 DOI: 10.7759/cureus.5142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) can be complicated with a high-degree atrioventricular block requiring a permanent pacemaker (PPM) in 5% - 25% of patients. Association between body mass index (BMI) and pacemaker implantation has not been extensively studied. We compared standard BMI classes with the odds of requiring a PPM implantation in patients undergoing TAVR with Edwards SAPIEN™ 3 valves (ESV3) (Edwards Lifesciences, Irvine, CA, USA). METHODS Our study involved a single-center retrospective cohort analysis of 449 patients undergoing TAVR from December 2012 to April 2018. First, we excluded patients with a TAVR procedure done with valves other than the ESV3 (127 patients). Second, patients with a prior PPM or an implantable cardioverter-defibrillator (37 patients) were excluded. Finally, patients with an aborted procedure and surgical conversion were excluded (16 patients). The final sample size was 269. The primary outcome was pacemaker implantation. Statistical analysis was done using the Chi-square test, T-test, and adjusted logistic regression. RESULTS Of the 269 patients (50.6% males; mean age of 79.5 ± 8.7 years; mean Society of Thoracic Surgeons (STS) score: 6.2), pacemaker implantation was performed in 17 patients (6.3%). Time to pacemaker implantation was 1.3 days. Patients were divided into four categories based on their BMI: as underweight (BMI < 25; 67 patients), normal (BMI: 25 to ≤ 30; 87 patients), overweight (BMI: 30 to ≤ 35; 60 patients), and obese (BMI ≥ 35; 55 patients). Pacemaker implantation was significantly higher in patients with a BMI of > 30 (13 vs. 4, p = 0.037). After logistic linear regression, the odds of getting a PPM after TAVR were significantly higher in patients who were overweight (odds ratio (OR): 12.77, p = 0.024; confidence interval (CI): 1.39 - 17.25) and obese (OR: 15.02, p = 0.036, CI: 1.19 - 19.92). CONCLUSIONS Our study demonstrates that increased BMI is a possible risk factor for a high-degree atrioventricular block in patients receiving ESV3.
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Affiliation(s)
- Mansoor Ahmad
- Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Jay N Patel
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Brian L Loc
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Sharath C Vipparthy
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Chirag Divecha
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Pablo X Barzallo
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Minchul Kim
- Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Timir Baman
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Marco Barzallo
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
| | - Sudhir Mungee
- Cardiology, University of Illinois College of Medicine at Peoria, Peoria, USA
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17
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Nishimura M, Marcus GM, Varosy PD, Bao H, Wang Y, Curtis JP, Hsu JC. Association of body mass index with cardiac resynchronization therapy intention and left ventricular lead implantation failure: insights from the NCDR implantable cardioverter-defibrillator registry. J Interv Card Electrophysiol 2019; 57:279-288. [PMID: 31004224 DOI: 10.1007/s10840-019-00550-x] [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: 01/02/2019] [Accepted: 04/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy with defibrillator (CRT-D) implantation involves left ventricular (LV) lead placement for biventricular pacing and is more complex than implantable cardioverter-defibrillator (ICD)-only implantation. Differences in the prescription of CRT-D versus ICD may result from clinician biases based on patient body habitus, and body habitus may be associated with LV lead implantation failure. OBJECTIVE We sought to evaluate whether patient body mass index (BMI) was associated with planned use and implantation failure of CRT-D therapy. METHODS We studied all patients enrolled in the National Cardiovascular Data Registry ICD Registry who met standard CRT-D criteria and received either an ICD or CRT-D between 2010 and 2012. BMI was categorized based on World Health Organization classification. Using hierarchical logistic regression, two multivariate models adjusted for patient demographic and clinical characteristics were fit based on the following outcome variables: (1) planned implantation with CRT-D versus ICD and (2) failed versus successful LV lead placement. RESULTS Of 337,547 patients, 41,872 met inclusion criteria for the first analysis and 35,186 met criteria for the second analysis. After multivariable adjustment, patients with extreme (BMI > 40 kg/m2) obesity were less likely to receive guideline-concordant CRT-D compared with patients with normal weight (adjusted odds ratio (AOR), 0.86; 95% confidence interval (CI), 0.75-0.99; p = 0.04). Extreme (BMI > 40 kg/m2) obesity was associated with higher odds of failed LV lead placement (AOR, 1.35; 95% CI, 1.07-1.72, p = 0.01). CONCLUSIONS Compared with normal weight patients, extremely obese (BMI > 40 kg/m2) CRT-D eligible patients were less likely to be prescribed CRT-D and were at higher odds for failed LV lead placement.
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Affiliation(s)
- Marin Nishimura
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Gregory M Marcus
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Paul D Varosy
- Division of Cardiology, Department of Electrophysiology, VA Eastern Colorado Health Care System, University of Colorado, Denver, CO, USA
| | - Haikun Bao
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Yongfei Wang
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jeptha P Curtis
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Jonathan C Hsu
- Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California, San Diego, San Diego, CA, USA.
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Mas-Peiro S, Papadopoulos N, Walther T, Zeiher AM, Fichtlscherer S, Vasa-Nicotera M. Nutritional risk index is a better predictor of early mortality than conventional nutritional markers after transcatheter aortic valve replacement: A prospective cohort study. Cardiol J 2019; 28:312-320. [PMID: 30994180 DOI: 10.5603/cj.a2019.0038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/26/2019] [Accepted: 03/27/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Nutritional risk index (NRI) has been shown to better predict survival than body mass index (BMI) or albumin after several cardiovascular interventions. Under assessment herein is whether NRI can have higher predictive value than conventional parameters for short-term survival after transcatheter aortic valve replacement (TAVR). METHODS A prospective cohort study was performed. In-hospital, 1-month and 3-month survival was evaluated. Since most patients undergoing TAVR are over 65, the NRI definition for a geriatric population (GNRI) was used. The impact of baseline BMI, albumin levels, and GNRI on in-hospital and short-term survival was assessed. RESULTS One hundred fifty two patients aged 82 ± 5.4 were included. In-hospital, 1-month, and 3-month mortality was 5.3%, 5.9%, and 9.2%, respectively. Mean GNRI was 112.7 ± 11.9, and was significantly lower in patients who died in-hospital (101.0 ± 8.8 vs. 113.3 ± 11.7), at 30 days (103.4 ± 10.9 vs. 113.3 ± 11.7), and at 90 days (104.0 ± 9.6 vs. 113.6 ± 11.8) than in survivors (all, p < 0.05). Three-month mortality in patients with no nutritional risk was 6.8% (9/132) vs. 25% (5/20) in patients with malnutrition (p = 0.022). In univariate analysis, GNRI predicted in-hospital, 30-day, and 90-day mortality (all, p < 0.05). Predictive value remained significant after adjusting for age, EuroSCORE II, and STS-Score (p < 0.05). Based on receiver operating curves, GNRI (AUC: 0.73) showed a better discrimination for 3-month mortality than albumin (0.69), weight (0.67) or BMI (0.62). The optimal cut-off value was 109.8. CONCLUSIONS The geriatric nutritional risk index predicts short-term mortality after TAVR and has a higher discriminating ability than other commonly used nutritional variables. It is a simple parameter that identifies those patients who could benefit from pre-procedural nutritional therapy.
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Affiliation(s)
- Silvia Mas-Peiro
- University Hospital Frankfurt am Main, Cardiology Department, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
| | | | - Thomas Walther
- University Hospital Frankfurt am Main, Department of Cardiothoracic Surgery
| | - Andreas M Zeiher
- University Hospital Frankfurt am Main, Cardiology Department, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Stephan Fichtlscherer
- University Hospital Frankfurt am Main, Cardiology Department, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Mariuca Vasa-Nicotera
- University Hospital Frankfurt am Main, Cardiology Department, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
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Rocca B, Fox KAA, Ajjan RA, Andreotti F, Baigent C, Collet JP, Grove EL, Halvorsen S, Huber K, Morais J, Patrono C, Rubboli A, Seljeflot I, Sibbing D, Siegbahn A, Ten Berg J, Vilahur G, Verheugt FWA, Wallentin L, Weiss TW, Wojta J, Storey RF. Antithrombotic therapy and body mass: an expert position paper of the ESC Working Group on Thrombosis. Eur Heart J 2018; 39:1672-1686f. [PMID: 29509886 DOI: 10.1093/eurheartj/ehy066] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 02/08/2018] [Indexed: 02/11/2024] Open
Affiliation(s)
- Bianca Rocca
- Institute of Pharmacology, Catholic University School of Medicine, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Keith A A Fox
- Centre for Cardiovascular Science, University and Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh EH16 4SA, UK
| | - Ramzi A Ajjan
- Leeds Institute for Cardiovascular and Metabolic Medicine, the LIGHT Laboratories, University of Leeds, Leeds LS2?9JT, UK
| | - Felicita Andreotti
- Cardiovascular Department, Catholic University Hospital, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Jean-Philippe Collet
- Institute of Cardiology, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne Université Paris 06 (UPMC), ACTION Study Group, INSERM UMR_S 1166, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Bd de l'hopital, 75013 Paris, France
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus; Denmark
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval and University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstrasse 37, A-1160 Vienna and Sigmund Freud University, Medical School, Kelsenstrasse 2, A-1030 Vienna, Austria
| | - João Morais
- Division of Cardiology, Leiria Hospital Center, R. de Santo André, 2410-197 Leiria, Portugal
| | - Carlo Patrono
- Institute of Pharmacology, Catholic University School of Medicine, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Andrea Rubboli
- Division of Cardiology, Laboratory of Interventional Cardiology, Ospedale Maggiore, Largo Nigrisoli 2, 40133 Bologna, Italy
| | - Ingebjorg Seljeflot
- Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål and University of Oslo, P.O. Box 1171 Blindern, 0318 Oslo, Norway
| | - Dirk Sibbing
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-Universität, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Marchioninistrasse 15, 81377 Munich, Germany
| | - Agneta Siegbahn
- Department of Medical Sciences, Clinical Chemistry, Uppsala University, 751 85 Uppsala, Sweden
| | - Jurrien Ten Berg
- Department of Cardiology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Gemma Vilahur
- Cardiovascular Science Institute-ICCC, IIB-Sant Pau, CiberCV, Hospital de Sant Pau, Avda. S. Antoni M. Claret 167, 08025 Barcelona, Spain
| | - Freek W A Verheugt
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Oosterpark 9, 1091 AC Amsterdam, The Netherlands
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, Uppsala University & Uppsala Clinical Research Center, Uppsala Science Park, MTC, Dag Hammarskjölds väg 14B, SE-752 37 Uppsala, Sweden
| | - Thomas W Weiss
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Montleartstrasse 37, A-1160 Vienna and Sigmund Freud University, Medical School, Kelsenstrasse 2, A-1030 Vienna, Austria
| | - Johann Wojta
- Department of Internal Medicine II, Medical University Vienna, Vienna, Austria
- Core Facilities, Medical University Vienna, Vienna, Austria
- Ludwig Boltzmann Cluster for Cardiovascular Research, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Robert F Storey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Beech Hill Road, Sheffield, South Yorkshire S10 2RX, UK
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20
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What topics caught your attention in 2017? Neth Heart J 2018; 26:175-176. [PMID: 29488169 PMCID: PMC5876175 DOI: 10.1007/s12471-018-1093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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