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Silva I, Ternacle J, Hahn RT, Salah-Annabi M, Dahou A, Krapf L, Salaun E, Guzzetti E, Xu K, Clavel MA, Bernier M, Beaudoin J, Cremer PC, Jaber W, Rodriguez L, Asch FM, Weismann NJ, Bax J, Ajmone N, Alu MC, Kallel F, Mack MJ, Webb JG, Kapadia S, Makkar R, Kodali S, Herrmann HC, Thourani V, Leon MB, Pibarot P. Left and right ventricular longitudinal systolic function following aortic valve replacement in the PARTNER 2 trial and registry. Eur Heart J Cardiovasc Imaging 2024; 25:1276-1286. [PMID: 38693866 DOI: 10.1093/ehjci/jeae114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024] Open
Abstract
AIMS Evaluation of left and right ventricular (RV) longitudinal systolic function may enhance risk stratification following aortic valve replacement (AVR). The study objective was to evaluate the changes in left and RV longitudinal systolic function and RV-pulmonary artery (RV-PA) coupling from baseline to 30 days and 1 year after AVR. METHODS AND RESULTS Left ventricular (LV) longitudinal strain (LS), tricuspid annulus plane systolic excursion (TAPSE), and RV-PA coupling were evaluated in patients from the PARTNER 2A surgical AVR (SAVR) arm (n = 985) and from the PARTNER 2 SAPIEN 3 registry (n = 719). TAPSE and RV-PA coupling decreased significantly following SAVR, but remained stable following TAVR. Lower LV LS, TAPSE, or RV-PA coupling at baseline was associated with increased risk of the composite of death, hospitalization, and stroke at 5 years [adjusted hazard ratios (HRs) for LV LS < 15%: 1.24, 95% confidence interval (CI) 1.05-1.45, P = 0.001; TAPSE < 14 mm: 1.44, 95% CI 1.21-1.73, P < 0.001; RV-PA coupling < 0.55 mm/mmHg: 1.32, 95% CI 1.07-1.63, P = 0.011]. Reduced TAPSE at baseline was the most powerful predictor of the composite endpoint at 5 years. Patients with LV ejection fraction <50% at baseline had increased risk of the primary endpoint with SAVR (HR: 1.34, 95% CI 1.08-1.68, P = 0.009) but not with TAVR (HR: 1.12, 95% CI 0.88-1.42). Lower RV-PA coupling at 30 days showed the strongest association with cardiac mortality. CONCLUSION SAVR but not TAVR was associated with a marked deterioration in RV longitudinal systolic function and RV-PA coupling. Lower TAPSE and RV-PA coupling at 30 days were associated with inferior clinical outcomes at 5 years. In patients with LVEF < 50%, TAVR was associated with superior 5-year outcomes.
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Affiliation(s)
- Iria Silva
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
- Department of Cardiology, Central University Hospital of Asturias, Oviedo, Spain
| | - Julien Ternacle
- Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France
| | - Rebecca T Hahn
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | | | | | - Laura Krapf
- Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France
| | - Erwan Salaun
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
| | - Ezequiel Guzzetti
- Département de cardiologie, Centre Hospitalier Affilié Universitaire Régional, Trois-Rivières, Québec, Canada
| | - Ke Xu
- Edwards Lifesciences, Irvine, CA, USA
| | - Marie-Annick Clavel
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
| | - Mathieu Bernier
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
| | - Jonathan Beaudoin
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
| | - Paul C Cremer
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Wael Jaber
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Heart and Vascular Institute and Georgetown University, Washington, DC, USA
| | - Neil J Weismann
- Cardiovascular Core Laboratories, MedStar Heart and Vascular Institute and Georgetown University, Washington, DC, USA
| | - Jeroen Bax
- Hart Long Centrum Leiden, Leiden University, Leiden, The Netherlands
| | - Nina Ajmone
- Hart Long Centrum Leiden, Leiden University, Leiden, The Netherlands
| | - Maria C Alu
- Division of Cardiology, Columbia University Irving Medical Center; Presbyterian Hospital; Cardiovascular Research Foundation, New York, NY, USA
| | | | - Michael J Mack
- Department of Cardiovascular and Thoracic Surgery, Baylor Scott & White Cardiac Surgery Specialists, Plano, TX, USA
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, Canada
| | - Samir Kapadia
- Department of Cardiology, Cleveland Clinic, Cleveland, OH, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Susheel Kodali
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Howard C Herrmann
- Division of Cardiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Vinod Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Martin B Leon
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Philippe Pibarot
- Department of Cardiology, Québec Heart & Lung Institute, Laval University, 2725 chemin Ste-Foy, Quebec City, Québec G1V-4G5, Canada
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2
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Hung J. Three's a Crowd: Use of Single vs Multiple Echocardiographic Core Laboratories. JACC Cardiovasc Imaging 2024:S1936-878X(24)00297-3. [PMID: 39207329 DOI: 10.1016/j.jcmg.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Judy Hung
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA.
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3
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Ren CB, Tardif D, Brandenburg HJ, Roux M, Mrevlje B, Geleijnse ML, Van Mieghem NM, Spitzer E, Pibarot P. Echocardiography Core Laboratory Methodology for TAVR: A Transatlantic Consensus. JACC Cardiovasc Imaging 2024:S1936-878X(24)00184-0. [PMID: 38970592 DOI: 10.1016/j.jcmg.2024.04.014] [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: 11/07/2023] [Revised: 04/05/2024] [Accepted: 04/15/2024] [Indexed: 07/08/2024]
Abstract
Inter-echocardiography core laboratory (ECL) harmonization is pivotal to consider data from different ECLs interchangeable. On the basis of the experience of the first trans-Atlantic harmonization of 2 established ECLs in the field of transcatheter aortic valve replacement (TAVR) trials, this review describes the harmonized ECL methodology in analyzing and adjudicating the post-TAVR echocardiographic endpoints according to Valve Academic Research Consortium 3 definitions. This review presents the feasibility and intra- and inter-ECL reproducibility, explains the root cause of potential important inter-ECL variability, and formulates ECL recommendations for optimal post-TAVR echocardiographic image acquisition. The implementation of inter-ECL harmonization may further define the best practice of ECLs and have logistic and regulatory implications for the realization of future TAVR trials.
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Affiliation(s)
- Claire B Ren
- Cardialysis Clinical Trial Management and Core Laboratories, Rotterdam, the Netherlands; Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Danielle Tardif
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | | | - Mathieu Roux
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | - Blaz Mrevlje
- Cardialysis Clinical Trial Management and Core Laboratories, Rotterdam, the Netherlands; Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ernest Spitzer
- Cardialysis Clinical Trial Management and Core Laboratories, Rotterdam, the Netherlands; Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philippe Pibarot
- Department of Medicine, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada.
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4
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Chen S, Dizon JM, Hahn RT, Pibarot P, George I, Zhao Y, Blanke P, Kapadia S, Babaliaros V, Szeto WY, Makkar R, Thourani VH, Webb JG, Mack MJ, Leon MB, Kodali S, Nazif TM. Predictors and 5-Year Clinical Outcomes of Pacemaker After TAVR: Analysis From the PARTNER 2 SAPIEN 3 Registries. JACC Cardiovasc Interv 2024; 17:1325-1336. [PMID: 38866455 DOI: 10.1016/j.jcin.2024.03.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Conduction disturbances requiring a permanent pacemaker (PPM) are a frequent complication of transcatheter aortic valve replacement (TAVR) with few reports of rates, predictors, and long-term clinical outcomes following implantation of the third-generation, balloon-expandable SAPIEN 3 (S3) transcatheter heart valve (THV). OBJECTIVES The aim of this study was to investigate the rates, predictors, and long-term clinical outcomes of PPM implantation following TAVR with the S3 THV. METHODS The current study included 857 patients in the PARTNER 2 S3 registries with intermediate and high surgical risk without prior PPM, and investigated predictors and 5-year clinical outcomes of new PPM implanted within 30 days of TAVR. RESULTS Among 857 patients, 107 patients (12.5%) received a new PPM within 30 days after TAVR. By multivariable analysis, predictors of PPM included increased age, pre-existing right bundle branch block, larger THV size, greater THV oversizing, moderate or severe annulus calcification, and implantation depth >6 mm. At 5 years (median follow-up 1,682.0 days [min 2.0 days, max 2,283.0 days]), new PPM was not associated with increased rates of all-cause mortality (Adj HR: 1.20; 95% CI: 0.85-1.70; P = 0.30) or repeat hospitalization (Adj HR: 1.22; 95% CI: 0.67-2.21; P = 0.52). Patients with new PPM had a decline in left ventricular ejection fraction at 1 year that persisted at 5 years (55.1 ± 2.55 vs 60.4 ± 0.65; P = 0.02). CONCLUSIONS PPM was required in 12.5% of patients without prior PPM who underwent TAVR with a SAPIEN 3 valve in the PARTNER 2 S3 registries and was not associated with worse clinical outcomes, including mortality, at 5 years. Modifiable factors that may reduce the PPM rate include bioprosthetic valve oversizing, prosthesis size, and implantation depth.
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Affiliation(s)
- Shmuel Chen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Weill Cornell Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jose M Dizon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Rebecca T Hahn
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec, Quebec, Canada
| | - Isaac George
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Yanglu Zhao
- Edwards Lifesciences, Irvine, California, USA
| | - Philipp Blanke
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vasilis Babaliaros
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Penn Medicine, University of Pennsylvania, Philadelphia, PA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vinod H Thourani
- Division of Cardiothoracic Surgery, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - John G Webb
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael J Mack
- Baylor Scott & White Research Institute, Baylor Scott & White Health, Plano, Texas, USA
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Susheel Kodali
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Tamim M Nazif
- Division of Cardiology, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA.
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5
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Morbach C, Gelbrich G, Schreckenberg M, Hedemann M, Pelin D, Scholz N, Miljukov O, Wagner A, Theisen F, Hitschrich N, Wiebel H, Stapf D, Karch O, Frantz S, Heuschmann PU, Störk S. Population data-based federated machine learning improves automated echocardiographic quantification of cardiac structure and function: the Automatisierte Vermessung der Echokardiographie project. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:77-88. [PMID: 38264700 PMCID: PMC10802820 DOI: 10.1093/ehjdh/ztad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/08/2023] [Accepted: 10/03/2023] [Indexed: 01/25/2024]
Abstract
Aims Machine-learning (ML)-based automated measurement of echocardiography images emerges as an option to reduce observer variability. The objective of the study is to improve the accuracy of a pre-existing automated reading tool ('original detector') by federated ML-based re-training. Methods and results Automatisierte Vermessung der Echokardiographie was based on the echocardiography images of n = 4965 participants of the population-based Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression Cohort Study. We implemented federated ML: echocardiography images were read by the Academic Core Lab Ultrasound-based Cardiovascular Imaging at the University Hospital Würzburg (UKW). A random algorithm selected 3226 participants for re-training of the original detector. According to data protection rules, the generation of ground truth and ML training cycles took place within the UKW network. Only non-personal training weights were exchanged with the external cooperation partner for the refinement of ML algorithms. Both the original detectors as the re-trained detector were then applied to the echocardiograms of n = 563 participants not used for training. With regard to the human referent, the re-trained detector revealed (i) superior accuracy when contrasted with the original detector's performance as it arrived at significantly smaller mean differences in all but one parameter, and a (ii) smaller absolute difference between measurements when compared with a group of different human observers. Conclusion Population data-based ML in a federated ML set-up was feasible. The re-trained detector exhibited a much lower measurement variability than human readers. This gain in accuracy and precision strengthens the confidence in automated echocardiographic readings, which carries large potential for applications in various settings.
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Affiliation(s)
- Caroline Morbach
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080 Würzburg, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Marcus Schreckenberg
- TOMTEC Imaging Systems GmbH, Freisinger Str. 9, 85716 Unterschleissheim, Germany
| | - Maike Hedemann
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
| | - Dora Pelin
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
| | - Nina Scholz
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
| | - Olga Miljukov
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Achim Wagner
- Service Center Medical Informatics, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Fabian Theisen
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
| | - Niklas Hitschrich
- TOMTEC Imaging Systems GmbH, Freisinger Str. 9, 85716 Unterschleissheim, Germany
| | - Hendrik Wiebel
- TOMTEC Imaging Systems GmbH, Freisinger Str. 9, 85716 Unterschleissheim, Germany
| | - Daniel Stapf
- TOMTEC Imaging Systems GmbH, Freisinger Str. 9, 85716 Unterschleissheim, Germany
| | - Oliver Karch
- Service Center Medical Informatics, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Stefan Frantz
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080 Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Stefan Störk
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080 Würzburg, Germany
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6
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Cauwenberghs N, Haddad F, Daubert MA, Chatterjee R, Salerno M, Mega JL, Heidenreich P, Hernandez A, Amsallem M, Kobayashi Y, Mahaffey KW, Shah SH, Bloomfield GS, Kuznetsova T, Douglas PS. Clinical and Echocardiographic Diversity Associated With Physical Fitness in the Project Baseline Health Study: Implications for Heart Failure Staging. J Card Fail 2023; 29:1477-1489. [PMID: 37116641 DOI: 10.1016/j.cardfail.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/11/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Clinical and echocardiographic features may carry diverse information about the development of heart failure (HF). Therefore, we determined heterogeneity in clinical and echocardiographic phenotypes and its association with exercise capacity. METHODS In 2036 community-dwelling individuals, we defined echocardiographic profiles of left and right heart remodeling and dysfunction. We subdivided the cohort based on presence (+) or absence (-) of HF risk factors (RFs) and echocardiographic abnormalities (RF-/Echo-, RF-/Echo+, RF+/Echo-, RF+/Echo+). Multivariable-adjusted associations between subgroups and physical performance metrics from 6-minute walk and treadmill exercise testing were assessed. RESULTS The prevalence was 35.3% for RF-/Echo-, 4.7% for RF-/Echo+, 39.3% for RF+/Echo-, and 20.6% for RF+/Echo+. We observed large diversity in echocardiographic profiles in the Echo+ group. Participants with RF-/Echo+ (18.6% of Echo+) had predominantly echocardiographic abnormalities other than left ventricular (LV) diastolic dysfunction, hypertrophy and reduced ejection fraction, whereas their physical performance was similar to RF-/Echo-. In contrast, participants with RF+/Echo+ presented primarily with LV hypertrophy or dysfunction, features that related to lower 6-minute walking distance and lower exercise capacity. CONCLUSIONS Subclinical echocardiographic abnormalities suggest HF pathogenesis, but the presence of HF risk factors and type of echo abnormality should be considered so as to distinguish adverse from benign adaptation and to stratify HF risk.
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Affiliation(s)
- Nicholas Cauwenberghs
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
| | - Francois Haddad
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Melissa A Daubert
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA
| | - Ranee Chatterjee
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Michael Salerno
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Division of Cardiovascular Medicine and Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Paul Heidenreich
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Adrian Hernandez
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA
| | - Myriam Amsallem
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yukari Kobayashi
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Department of Medicine, Stanford, CA, USA
| | - Svati H Shah
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Gerald S Bloomfield
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA; Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Tatiana Kuznetsova
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Pamela S Douglas
- Duke Clinical Research Institute and Duke University School of Medicine, Durham, North Carolina, USA
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7
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Généreux P, Cohen DJ, Pibarot P, Redfors B, Bax JJ, Zhao Y, Prince H, Makkar RR, Kapadia S, Thourani VH, Mack MJ, Nazif TM, Lindman BR, Babaliaros V, Russo M, McCabe JM, Gillam LD, Alu MC, Hahn RT, Webb JG, Leon MB, Arnold SV. Cardiac Damage and Quality of Life After Aortic Valve Replacement in the PARTNER Trials. J Am Coll Cardiol 2023; 81:743-752. [PMID: 36813373 PMCID: PMC9982840 DOI: 10.1016/j.jacc.2022.11.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/09/2022] [Accepted: 11/22/2022] [Indexed: 02/22/2023]
Abstract
BACKGROUND The extent of extravalvular cardiac damage is associated with increased risk of adverse events among patients with severe aortic stenosis undergoing aortic valve replacement (AVR). OBJECTIVES The goal was to describe the association of cardiac damage on health status before and after AVR. METHODS Patients from the PARTNER (Placement of Aortic Transcatheter Valves) 2 and 3 trials were pooled and classified by echocardiographic cardiac damage stage at baseline and 1 year as previously described (stage 0-4). We examined the association between baseline cardiac damage and 1-year health status (assessed by the Kansas City Cardiomyopathy Questionnaire Overall Score [KCCQ-OS]). RESULTS Among 1,974 patients (794 surgical AVR, 1,180 transcatheter AVR), the extent of cardiac damage at baseline was associated with lower KCCQ scores both at baseline and at 1 year after AVR (P < 0.0001) and with increased rates of a poor outcome (death, KCCQ-OS <60, or a decrease in KCCQ-OS of ≥10 points) at 1 year (stages 0-4: 10.6% vs 19.6% vs 29.0% vs 44.7% vs 39.8%; P < 0.0001). In a multivariable model, each 1-stage increase in baseline cardiac damage was associated with a 24% increase in the odds of a poor outcome (95% CI: 9%-41%; P = 0.001). Change in stage of cardiac damage at 1 year after AVR was associated with the extent of improvement in KCCQ-OS over the same period (mean change in 1-year KCCQ-OS: improvement of ≥1 stage +26.8 [95% CI: 24.2-29.4] vs no change +21.4 [95% CI: 20.0-22.7] vs deterioration of ≥1 stage +17.5 [95% CI: 15.4-19.5]; P < 0.0001). CONCLUSIONS The extent of cardiac damage before AVR has an important impact on health status outcomes, both cross-sectionally and after AVR. (PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - XT Intermediate and High Risk (PII A), NCT01314313; The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves - PII B [PARTNERII B], NCT02184442; PARTNER 3 Trial: Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis [P3], NCT02675114).
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Affiliation(s)
- Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA.
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yanglu Zhao
- Edwards Lifesciences, Irvine, California, USA
| | | | - Raj R Makkar
- Cedars Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Michael J Mack
- Baylor Scott & White Research Institute, Plano, Texas, USA
| | - Tamim M Nazif
- Columbia University Irving Medical Center, New York, New York, USA
| | - Brian R Lindman
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Mark Russo
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | | | - Linda D Gillam
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Maria C Alu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca T Hahn
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA
| | - John G Webb
- St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri Kansas City, Kansas City, Missouri, USA
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8
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Haddad F, Cauwenberghs N, Daubert MA, Kobayashi Y, Bloomfield GS, Fleischman D, Koweek L, Maron DJ, Rodriguez F, Liao YJ, Moneghetti K, Amsallem M, Mega J, Hernandez A, Califf R, Mahaffey KW, Shah SH, Kuznetsova T, Douglas PS. Association of left ventricular diastolic function with coronary artery calcium score: A Project Baseline Health Study. J Cardiovasc Comput Tomogr 2022; 16:498-508. [PMID: 35872137 PMCID: PMC10870833 DOI: 10.1016/j.jcct.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/23/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Coronary artery calcium (CAC) and left ventricular diastolic dysfunction (LVDD) are strong predictors of cardiovascular events and share common risk factors. However, their independent association remains unclear. METHODS In the Project Baseline Health Study (PBHS), 2082 participants underwent cardiac-gated, non-contrast chest computed tomography (CT) and echocardiography. The association between left ventricular (LV) diastolic function and CAC was assessed using multidimensional network and multivariable-adjusted regression analyses. Multivariable analysis was conducted on continuous LV diastolic parameters and categorical classification of LVDD and adjusted for traditional cardiometabolic risk factors. LVDD was defined using reference limits from a low-risk reference group without established cardiovascular disease, cardiovascular risk factors or evidence of CAC, (n = 560). We also classified LVDD using the American Society of Echocardiography recommendations. RESULTS The mean age of the participants was 51 ± 17 years with 56.6% female and 62.6% non-Hispanic White. Overall, 38.1% had hypertension; 13.7% had diabetes; and 39.9% had CAC >0. An intertwined network was observed between diastolic parameters, CAC score, age, LV mass index, and pulse pressure. In the multivariable-adjusted analysis, e', E/e', and LV mass index were independently associated with CAC after adjustment for traditional risk factors. For both e' and E/e', the effect size and statistical significance were higher across increasing CAC tertiles. Other independent correlates of e' and E/e' included age, female sex, Black race, height, weight, pulse pressure, hemoglobin A1C, and HDL cholesterol. The independent association with CAC was confirmed using categorical analysis of LVDD, which occurred in 554 participants (26.6%) using population-derived thresholds. CONCLUSION In the PBHS study, the subclinical coronary atherosclerotic disease burden detected using CAC scoring was independently associated with diastolic function. CLINICALTRIALS GOV IDENTIFIER NCT03154346.
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Affiliation(s)
- Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Nicholas Cauwenberghs
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Melissa A Daubert
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Yukari Kobayashi
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Dominik Fleischman
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lynne Koweek
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - David J Maron
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Stanford Prevention Research Center, Stanford University, Palo Alto, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yaping Joyce Liao
- Departments of Ophthalmology and Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kegan Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Adrian Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Kenneth W Mahaffey
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Stanford Center for Clinical Research (SCCR); Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Svati H Shah
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Tatiana Kuznetsova
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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9
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López L, Rossello X, Romaguera D, Alonso-Gómez ÁM, Toledo E, Fortuny E, Noris M, Mas-Lladó C, Fiol M, Ramallal R, Tojal-Sierra L, Alonso A, Fernandez-Palomeque C. The Palma Echo Platform: Rationale and Design of an Echocardiography Core Lab. Front Cardiovasc Med 2022; 9:909347. [PMID: 35800168 PMCID: PMC9253374 DOI: 10.3389/fcvm.2022.909347] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background The metabolic syndrome (MetS) is associated with increased cardiovascular morbidity and mortality. Characterization of cardiac structural and functional abnormalities due to the MetS can help recognize individuals who would benefit the most from preventive interventions. Transthoracic echocardiography (TTE) provides an opportunity to identify those abnormalities in a reproducible and cost-efficient manner. In research settings, implementation of protocols for the acquisition and analysis of TTE images are key to ensure validity and reproducibility, thus facilitating answering relevant questions about the association of the MetS with cardiac alterations. Methods and Results The Palma Echo Platform (PEP) is a coordinated network that is built up to evaluate the underlying structural and functional cardiac substrate of participants with MetS. Repeated TTE will be used to evaluate 5-year changes in the cardiac structure and function in a group of 565 individuals participating in a randomized trial of a lifestyle intervention for the primary prevention of cardiovascular disease. The echocardiographic studies will be performed at three study sites, and will be centrally evaluated at the PEP core laboratory. Planned analyses will involve evaluating the effect of the lifestyle intervention on cardiac structure and function, and the association of the MetS and its components with changes in cardiac structure and function. Particular emphasis will be placed on evaluating parameters of left atrial structure and function, which have received more limited attention in past investigations. This PEP will be available for future studies addressing comparable questions. Conclusion In this article we describe the protocol of a central echocardiography laboratory for the study of functional and structural alterations of the MetS.
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Affiliation(s)
- Luis López
- Department of Cardiology, Hospital de Manacor, Manacor, Spain,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain,Department of Cardiology, Hospital Universitari Son Espases, Palma, Spain,*Correspondence: Xavier Rossello,
| | - Dora Romaguera
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Ángel M. Alonso-Gómez
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain,Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country Universidad del País Vasco/Euskal Herriko Unibertsitatea, Vitoria-Gasteiz, Spain
| | - Estefanía Toledo
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Elena Fortuny
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain,Department of Cardiology, Hospital Universitari Son Espases, Palma, Spain
| | - Marta Noris
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain,Department of Cardiology, Hospital Universitari Son Espases, Palma, Spain
| | - Caterina Mas-Lladó
- Department of Cardiology, Hospital de Manacor, Manacor, Spain,Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Miquel Fiol
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Madrid, Spain
| | - Raul Ramallal
- Department of Cardiology, University Hospital of Navarra, Servicio Navarro de Salud Osasunbidea, IDISNA, Pamplona, Spain
| | - Lucas Tojal-Sierra
- Bioaraba Health Research Institute, Osakidetza Basque Health Service, Araba University Hospital, University of the Basque Country Universidad del País Vasco/Euskal Herriko Unibertsitatea, Vitoria-Gasteiz, Spain
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Carlos Fernandez-Palomeque
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain,Department of Cardiology, Hospital Universitari Son Espases, Palma, Spain
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10
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Généreux P, Pibarot P, Redfors B, Bax JJ, Zhao Y, Makkar RR, Kapadia S, Thourani VH, Mack MJ, Nazif TM, Lindman BR, Babaliaros V, Vincent F, Russo M, McCabe JM, Gillam LD, Alu MC, Hahn RT, Webb JG, Leon MB, Cohen DJ. Evolution and Prognostic Impact of Cardiac Damage After Aortic Valve Replacement. J Am Coll Cardiol 2022; 80:783-800. [PMID: 35595203 DOI: 10.1016/j.jacc.2022.05.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The impact of aortic valve replacement (AVR) on progression/regression of extra-valvular cardiac damage and its association with subsequent prognosis is unknown. OBJECTIVES To describe evolution of cardiac damage post-AVR and its association with outcomes. METHODS Patients undergoing transcatheter or surgical AVR from the PARTNER 2 and 3 trials were pooled and classified by cardiac damage stage at baseline and 1-year (Stage 0, no damage; Stage 1, left ventricular damage; Stage 2, left atrial or mitral valve damage; Stage 3, pulmonary vasculature or tricuspid valve damage; Stage 4, right ventricular damage). Proportional hazards models determined association between change in cardiac damage post-AVR and 2-year outcomes. RESULTS Among 1974 patients, 121 (6.1%) were Stage 0, 287 (14.5%) Stage 1, 1014 (51.4%) Stage 2, 412 (20.9%) Stage 3, and 140 (7.1%) Stage 4 pre-AVR. Two-year mortality was associated with extent of cardiac damage at baseline and 1-year. Compared with baseline, cardiac damage improved in ∼15%, remained unchanged in ∼60%, and worsened in ∼25% of patients at 1-year. One-year change in cardiac damage stage was independently associated with mortality (adjHR for improvement=0.49; no change=1.0; worsening=1.95; p=0.023) and composite of death or heart failure hospitalization (adjHR for improvement=0.60; no change=1.0; worsening=2.25; p<0.001) at 2 years. CONCLUSION In patients undergoing AVR, extent of extravalvular cardiac damage at baseline and its change at 1-year have important prognostic implications. These findings suggest that earlier detection of AS and intervention prior to development of irreversible cardiac damage may improve global cardiac function and prognosis.
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Affiliation(s)
- Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA.
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec, Quebec, Canada
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yanglu Zhao
- Edwards Lifesciences, Irvine, California, USA
| | - Raj R Makkar
- Cedars Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Michael J Mack
- Baylor Scott and White Research Institute, Plano, Texas, USA
| | - Tamim M Nazif
- Columbia University Irving Medical Center, New York, New York, USA
| | - Brian R Lindman
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Flavien Vincent
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Lille University Hospital, Lille, France
| | - Mark Russo
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | | | - Linda D Gillam
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Maria C Alu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca T Hahn
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Columbia University Irving Medical Center, New York, New York, USA
| | - David J Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital and Heart Center, Roslyn, New York, USA
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11
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Stein EJ, Fearon WF, Elmariah S, Kim JB, Kapadia S, Kumbhani DJ, Gillam L, Whisenant B, Quader N, Zajarias A, Welt FG, Bavry AA, Coylewright M, Piana RN, Mallugari RR, Clark DE, Patel JN, Gonzales H, Gupta DK, Vatterott A, Jackson N, Huang S, Lindman BR. Left Ventricular Hypertrophy and Biomarkers of Cardiac Damage and Stress in Aortic Stenosis. J Am Heart Assoc 2022; 11:e023466. [PMID: 35301869 PMCID: PMC9075421 DOI: 10.1161/jaha.121.023466] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/24/2022] [Indexed: 12/12/2022]
Abstract
Background Left ventricular hypertrophy (LVH) is associated with increased mortality risk and rehospitalization after transcatheter aortic valve replacement among those with severe aortic stenosis. Whether cardiac troponin (cTnT) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) risk stratify patients with aortic stenosis and without LVH is unknown. Methods and Results In a multicenter prospective registry of 923 patients with severe aortic stenosis undergoing transcatheter aortic valve replacement, we included 674 with core-laboratory-measured LV mass index, cTnT, and NT-proBNP. LVH was defined by sex-specific guideline cut-offs and elevated biomarker levels were based on age and sex cut-offs. Adjusted Cox proportional hazards models evaluated associations between LVH and biomarkers and all-cause death out to 5 years. Elevated cTnT and NT-proBNP were present in 82% and 86% of patients with moderate/severe LVH, respectively, as compared with 66% and 69% of patients with no/mild LVH, respectively (P<0.001 for each). After adjustment, compared with no/mild LVH, moderate/severe LVH was associated with an increased hazard of mortality (adjusted hazard ratio [aHR], 1.34; 95% CI 1.01-1.77, P=0.043). cTnT and NT-proBNP each risk stratified patients with moderate/severe LVH (P<0.05). In a model with both biomarkers and LVH included, elevated cTnT (aHR, 2.08; 95% CI 1.45-3.00, P<0.001) and elevated NT-proBNP (aHR, 1.46; 95% CI 1.00-2.11, P=0.049) were each associated with increased mortality risk, whereas moderate/severe LVH was not (P=0.15). Conclusions Elevations in circulating cTnT and NT-proBNP are more common as LVH becomes more pronounced but are also observed in those with no/minimal LVH. As measures of maladaptive remodeling and cardiac injury, cTnT and NT-proBNP predict post-transcatheter aortic valve replacement mortality better than LV mass index. These findings may have important implications for risk stratification and treatment of patients with aortic stenosis.
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Affiliation(s)
- Elliot J. Stein
- Department of MedicineVanderbilt University Medical CenterNashvilleTN
| | - William F. Fearon
- Division of CardiologyDepartment of MedicineStanford Medical CenterPalo AltoCA
| | - Sammy Elmariah
- Division of CardiologyDepartment of MedicineMassachusetts General HospitalBostonMA
| | - Juyong B. Kim
- Division of CardiologyDepartment of MedicineStanford Medical CenterPalo AltoCA
| | - Samir Kapadia
- Division of CardiologyDepartment of MedicineCleveland Clinic FoundationClevelandOH
| | - Dharam J. Kumbhani
- Division of CardiologyDepartment of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Linda Gillam
- Division of CardiologyDepartment of MedicineMorristown Medical CenterMorristownNJ
| | - Brian Whisenant
- Division of CardiologyDepartment of MedicineIntermountain Heart InstituteMurrayUT
| | - Nishath Quader
- Division of CardiologyDepartment of MedicineBarnes‐Jewish HospitalSt. LouisMO
| | - Alan Zajarias
- Division of CardiologyDepartment of MedicineBarnes‐Jewish HospitalSt. LouisMO
| | - Frederick G. Welt
- Division of CardiologyDepartment of MedicineUniversity of Utah HospitalSalt Lake CityUT
| | - Anthony A. Bavry
- Division of CardiologyDepartment of MedicineUniversity of Texas Southwestern Medical CenterDallasTX
| | - Megan Coylewright
- Department of Cardiovascular MedicineThe Erlanger Heart and Lung InstituteChattanoogaTN
| | - Robert N. Piana
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Ravinder R. Mallugari
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Daniel E. Clark
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Jay N. Patel
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Holly Gonzales
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Deepak K. Gupta
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Anna Vatterott
- Division of CardiologyDepartment of MedicineBarnes‐Jewish HospitalSt. LouisMO
| | - Natalie Jackson
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
- Structural Heart and Valve CenterVanderbilt University Medical CenterNashvilleTN
| | - Shi Huang
- Department of BiostatisticsVanderbilt University School of MedicineNashvilleTN
| | - Brian R. Lindman
- Division of CardiologyDepartment of MedicineVanderbilt University Medical CenterNashvilleTN
- Structural Heart and Valve CenterVanderbilt University Medical CenterNashvilleTN
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12
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Cremer PC, Wang TKM, Rodriguez LL, Lindman BR, Zhang Y, Zajarias A, Hahn RT, Lerakis S, Malaisrie SC, Douglas PS, Pibarot P, Svensson LG, Kapadia S, Leon MB, Jaber WA. Incidence and Clinical Significance of Worsening Tricuspid Regurgitation Following Surgical or Transcatheter Aortic Valve Replacement: Analysis From the PARTNER IIA Trial. Circ Cardiovasc Interv 2021; 14:e010437. [PMID: 34266311 DOI: 10.1161/circinterventions.120.010437] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Paul C Cremer
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (P.C.C., T.K.M.W., L.L.R., W.A.J.)
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (P.C.C., T.K.M.W., L.L.R., W.A.J.)
| | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (P.C.C., T.K.M.W., L.L.R., W.A.J.)
| | - Brian R Lindman
- Structural Heart & Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.)
| | - Yiran Zhang
- Cardiovascular Research Foundation, NY (Y.Z., R.T.H., M.B.L.)
| | - Alan Zajarias
- Washington University School of Medicine, St. Louis, MO (A.Z.)
| | - Rebecca T Hahn
- Cardiovascular Research Foundation, NY (Y.Z., R.T.H., M.B.L.).,Structural Heart & Valve Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NY (R.T.H., M.B.L.)
| | - Stamatios Lerakis
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, NY (S.L.)
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.C.M.)
| | - Pamela S Douglas
- Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (P.S.D.)
| | - Philippe Pibarot
- Department of Medicine, Université Laval, Quebec, QC, Canada (P.P.)
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (L.G.S., S.K.)
| | - Samir Kapadia
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, OH (L.G.S., S.K.)
| | - Martin B Leon
- Cardiovascular Research Foundation, NY (Y.Z., R.T.H., M.B.L.).,Structural Heart & Valve Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NY (R.T.H., M.B.L.)
| | - Wael A Jaber
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (P.C.C., T.K.M.W., L.L.R., W.A.J.).,Department of Cardiovascular Medicine, Cleveland Clinic, OH (W.A.J.)
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13
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Hahn RT, Douglas PS, Jaber WA, Leipsic J, Kapadia S, Thourani VH, Makkar R, Kodali S, Clavel MA, Khalique OK, Weissman NJ, Blanke P, Chen Y, Smith CR, Mack MJ, Leon MB, Pibarot P. Doppler Velocity Index Outcomes Following Surgical or Transcatheter Aortic Valve Replacement in the PARTNER Trials. JACC Cardiovasc Interv 2021; 14:1594-1606. [PMID: 34217631 DOI: 10.1016/j.jcin.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to assess the association between Doppler velocity index (DVI) and 2-year outcomes for balloon-expandable SAPIEN 3 transcatheter aortic valve replacement (TAVR) and for surgical aortic valve replacement (SAVR). BACKGROUND DVI >0.35 is normal for a prosthetic valve, but recent studies suggest that DVI <0.50 is associated with poor outcomes following TAVR. METHODS Patients with severe aortic stenosis enrolled in the PARTNER (Placement of Aortic Transcatheter Valve) 2 (intermediate surgical risk) or PARTNER 3 (low surgical risk) trial undergoing TAVR (n = 1,450) or SAVR (n = 1,303) were included. Patients were divided into 3 DVI groups on the basis of core laboratory-assessed discharge or 30-day echocardiograms: DVILOW (≤0.35), DVIINTERMEDIATE (>0.35 to ≤0.50), and DVIHIGH (>0.50). Two-year outcomes were assessed. RESULTS Following TAVR, there were no differences among the 3 DVI groups in composite outcomes of death, stroke, or rehospitalization or in any individual components of 2-year outcomes (P > 0.70 for all). Following SAVR, there was no difference among DVI groups in the composite outcome (P = 0.27), but there was a significant association with rehospitalization (P = 0.02). Restricted cubic-spline analysis for combined outcomes showed an increased risk with post-SAVR DVI ≤0.35 but no relationship post-TAVR. DVI ≤0.35 was associated with increased 2-year composite outcome for SAVR (HR: 1.81; 95% CI: 1.29-2.54; P < 0.001), with no adverse outcomes for TAVR (P = 0.86). CONCLUSIONS In intermediate- and low-risk cohorts of the PARTNER trials, DVI ≤0.35 predicted worse 2-year outcomes following SAVR, driven primarily by rehospitalization, with no adverse outcomes associated with DVI following TAVR with the balloon-expandable SAPIEN 3 valve.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA.
| | - Pamela S Douglas
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - Jonathon Leipsic
- University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Raj Makkar
- Cedars Sinai, Los Angeles, California, USA
| | - Susheel Kodali
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | | | - Omar K Khalique
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | | | - Philipp Blanke
- University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Yanjun Chen
- Edwards Lifesciences, Irvine, California, USA
| | - Craig R Smith
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | | | - Martin B Leon
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec City, Quebec, Canada
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14
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O'Leary JM, Clavel MA, Chen S, Goel K, O'Neill B, Elmariah S, Crowley A, Alu MC, Thourani VH, Leon MB, Pibarot P, Lindman BR. Association of Natriuretic Peptide Levels After Transcatheter Aortic Valve Replacement With Subsequent Clinical Outcomes. JAMA Cardiol 2020; 5:1113-1123. [PMID: 32667623 DOI: 10.1001/jamacardio.2020.2614] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Among those with aortic stenosis, natriuretic peptide levels can provide risk stratification, predict symptom onset, and aid decisions regarding the timing of valve replacement. Less is known about the prognostic significance and potential clinical utility of natriuretic peptide levels measured after valve replacement. Objective To determine the associations of elevated B-type natriuretic peptide (BNP) levels after transcatheter aortic valve replacement (TAVR) and change in BNP levels between follow-up time points with risk of subsequent clinical outcomes. Design, Setting, and Participants In this cohort study, patients with severe symptomatic aortic stenosis at intermediate, high, or prohibitive surgical risk for aortic valve replacement who underwent TAVR from the PARTNER IIA cohort, PARTNER IIB cohort, SAPIEN 3 intermediate-risk registry, and SAPIEN 3 high-risk registry were included. B-type natriuretic peptide levels were obtained at baseline and discharge as well as 30 days and 1 year after TAVR. For each measurement, a BNP ratio was calculated using measured BNP level divided by the upper limit of normal for the assay used. Outcomes were evaluated in landmark analyses out to 2 years. Data were collected from April 2011 to January 2019. Main Outcomes and Measures All-cause death, cardiovascular death, rehospitalization, and the combined end point of cardiovascular death or rehospitalization. Results Among 3391 included patients, 1969 (58.1%) were male, and the mean (SD) age was 82 (7.5) years. Most patients had a BNP ratio greater than 1 at each follow-up time point, including 2820 of 3256 (86.6%) at baseline, 2652 of 2995 (88.5%) at discharge, 1779 of 2209 (80.5%) at 30 days, and 1799 of 2391 (75.2%) at 1 year. After adjustment, every 1-point increase in BNP ratio at 30 days (approximately equivalent to an increase of 100 pg/mL in BNP) was associated with an increased hazard of all-cause death (adjusted hazard ratio [aHR], 1.11; 95% CI, 1.07-1.15), cardiovascular death (aHR, 1.16; 95% CI, 1.11-1.21), and rehospitalization (aHR, 1.08; 95% CI, 1.03-1.14) between 30 days and 2 years. Among those with a BNP ratio of 2 or more at discharge, after adjustment, every 1-point decrease in BNP ratio between discharge and 30 days was associated with a decreased hazard of all-cause death (aHR, 0.92; 95% CI, 0.88-0.96) between 30 days and 2 years. Conclusions and Relevance Elevated BNP levels after TAVR was independently associated with increased subsequent mortality and rehospitalizations. Further studies to determine how best to mitigate this risk are warranted.
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Affiliation(s)
- Jared M O'Leary
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Cardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marie-Annick Clavel
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Shmuel Chen
- Cardiovascular Research Foundation, New York, New York.,Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York
| | - Kashish Goel
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Cardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian O'Neill
- Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Sammy Elmariah
- Interventional Cardiology and Structural Heart Disease, Massachusetts General Hospital, Boston.,Harvard Medical School, Cambridge, Massachusetts
| | - Aaron Crowley
- Cardiovascular Research Foundation, New York, New York
| | - Maria C Alu
- Cardiovascular Research Foundation, New York, New York.,Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart and Vascular Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York.,Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital, New York
| | - Philippe Pibarot
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Brian R Lindman
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee.,Cardiovascular Medicine Division, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Hoffmeister KJ, Henderson ZT, Hussey PT, Wu IY. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement: A Focused Review for the Cardiac Anesthesiologist. J Cardiothorac Vasc Anesth 2020; 34:2740-2753. [DOI: 10.1053/j.jvca.2019.11.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/04/2019] [Accepted: 11/24/2019] [Indexed: 12/12/2022]
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16
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Kampaktsis PN, Subramayam P, Sherifi I, Vavuranakis M, Siasos G, Tousoulis D, Worku B, Minutello RM, Wong SC, Devereux RB. Impact of paravalvular leak on left ventricular remodeling and global longitudinal strain 1 year after transcatheter aortic valve replacement. Future Cardiol 2020; 17:337-345. [PMID: 33590775 DOI: 10.2217/fca-2020-0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: New mild or persistent moderate paravalvular leak (PVL) is a known predictor of poor outcomes after transcatheter aortic valve replacement (TAVR). Its impact on left ventricular (LV) remodeling and global longitudinal strain (GLS) has not been well studied. Materials & methods: We collected echocardiographic data in 99 TAVR patients. LV remodeling and GLS were compared between patients with and without PVL. Results: Patients without PVL (n = 84) had significant LV ejection fraction, wall thickness and LV mass improvement compared with patients with PVL (n = 15; p < 0.001 for all). Diastolic function worsened in patients with PVL. Baseline GLS improved significantly regardless of PVL (p = 0.016 and p = 0.01, respectively) and was not predictive of LV ejection fraction or LV mass improvement when analyzed in tertiles. Conclusion: PVL impedes reverse LV remodeling but not GLS improvement 1-year after TAVR. Baseline GLS was not a predictor of LV remodeling.
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Affiliation(s)
| | - Pritha Subramayam
- Division of Cardiology, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
| | - Ines Sherifi
- Division of Cardiology, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
| | - Manolis Vavuranakis
- 1st Cardiology Department, Hippokrateion Hospital/University of Athens Medical School, Athens, Greece
| | - Gerasimos Siasos
- 1st Cardiology Department, Hippokrateion Hospital/University of Athens Medical School, Athens, Greece
| | - Dimitrios Tousoulis
- 1st Cardiology Department, Hippokrateion Hospital/University of Athens Medical School, Athens, Greece
| | - Berhane Worku
- Department of Cardiothoracic Surgery, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
| | - Robert M Minutello
- Division of Cardiology, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
| | - S Chiu Wong
- Division of Cardiology, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
| | - Richard B Devereux
- Division of Cardiology, Weill Cornell Medicine/New York Presbyterian, NY 10065, USA
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17
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Salaun E, Clavel MA, Hahn RT, Jaber WA, Asch FM, Rodriguez L, Weissman NJ, Gertz ZM, Herrmann HC, Dahou A, Annabi MS, Toubal O, Bernier M, Beaudoin J, Leipsic J, Blanke P, Ridard C, Ong G, Rodés-Cabau J, Webb JG, Zhang Y, Alu MC, Douglas PS, Makkar R, Miller DC, Lindman BR, Thourani VH, Leon MB, Pibarot P. Outcome of Flow-Gradient Patterns of Aortic Stenosis After Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008792. [DOI: 10.1161/circinterventions.119.008792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Although aortic valve replacement is associated with a major benefit in high-gradient (HG) severe aortic stenosis (AS), the results in low-gradient (LG, mean gradient <40 mm Hg) AS are conflicting. LG severe AS may be subdivided in classical low-flow (left ventricular ejection fraction <50%) and LG (CLF-LG); paradoxical low-flow (left ventricular ejection fraction ≥50% but stroke volume index <35 mL/m
2
) and LG; and normal-flow (left ventricular ejection fraction ≥50% and stroke volume index ≥35 mL/m
2
) and LG. The primary objective is to determine in the PARTNER 2 trial (The Placement of Aortic Transcatheter Valves) and registry the outcomes after aortic valve replacement of the 4 flow-gradient groups.
Methods:
A total of 3511 patients from the PARTNER 2 Cohort A randomized trial (n=1910) and SAPIEN 3 registry (n=1601) were included. The flow-gradient pattern was determined at baseline transthoracic echocardiography and classified as follows: (1) HG; (2) CLF-LG; (3) paradoxical low-flow-LG; and (4) normal-flow-LG. The primary end point for this analysis was the composite of (1) death; (2) rehospitalization for heart failure symptoms and valve prosthesis complication; or (3) stroke.
Results:
The distribution was HG, 2229 patients (63.5%); CLF-LG, 689 patients (19.6%); paradoxical low-flow-LG, 247 patients (7.0%); and normal-flow-LG, 346 patients (9.9%). The 2-year rate of primary end point was higher in CLF-LG (38.8%) versus HG: 31.8% (
P
=0.002) and normal-flow-LG: 32.1% (
P
=0.05) but was not statistically different from paradoxical low-flow-LG: 33.6% (
P
=0.18). There was no significant difference in the 2-year rates of clinical events between transcatheter aortic valve replacement versus surgical aortic valve replacement in the whole cohort and within each flow-gradient group.
Conclusions:
The LG AS pattern was highly prevalent (36.5%) in the PARTNER 2 trial and registry. CLF-LG was the most common pattern of LG AS and was associated with higher rates of death, rehospitalization, or stroke at 2 years compared with the HG group. Clinical outcomes were as good in the LG AS groups with preserved left ventricular ejection fraction compared with the HG group.
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Affiliation(s)
- Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)
| | - Marie-Annick Clavel
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)
| | - Rebecca T. Hahn
- Columbia University Medical Center/New York- Presbyterian Hospital (R.T.H., A.D., Y.Z., M.C.A., M.B.L.)
- Cardiovascular Research Foundation, New York, NY (R.T.H., Y.Z., M.C.A., M.B.L.)
| | - Wael A. Jaber
- Heart and Vascular Institute, Cleveland Clinic, OH (W.A.J., L.R.)
| | - Federico M. Asch
- MedStar Health Research Institute at Washington Hospital Center, DC (F.M.A., N.J.W., V.H.T.)
| | | | - Neil J. Weissman
- MedStar Health Research Institute at Washington Hospital Center, DC (F.M.A., N.J.W., V.H.T.)
| | - Zachary M. Gertz
- Division of Cardiology, Virginia Commonwealth University, Richmond (Z.M.G.)
| | | | - Abdellaziz Dahou
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)
- Columbia University Medical Center/New York- Presbyterian Hospital (R.T.H., A.D., Y.Z., M.C.A., M.B.L.)
| | - Mohamed-Salah Annabi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)
| | - Oumhani Toubal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)
| | - Mathieu Bernier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)
| | - Jonathon Leipsic
- St Paul’s Hospital, Vancouver, British Columbia, Canada (J.L., P.B., J.G.W.)
| | - Philipp Blanke
- St Paul’s Hospital, Vancouver, British Columbia, Canada (J.L., P.B., J.G.W.)
| | - Carine Ridard
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)
| | - Géraldine Ong
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)
- Division of Cardiology, St Michael’s Hospital, Toronto, ON, Canada (G.O.)
| | - Josep Rodés-Cabau
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)
| | - John G. Webb
- St Paul’s Hospital, Vancouver, British Columbia, Canada (J.L., P.B., J.G.W.)
| | - Yiran Zhang
- Columbia University Medical Center/New York- Presbyterian Hospital (R.T.H., A.D., Y.Z., M.C.A., M.B.L.)
- Cardiovascular Research Foundation, New York, NY (R.T.H., Y.Z., M.C.A., M.B.L.)
| | - Maria C. Alu
- Columbia University Medical Center/New York- Presbyterian Hospital (R.T.H., A.D., Y.Z., M.C.A., M.B.L.)
- Cardiovascular Research Foundation, New York, NY (R.T.H., Y.Z., M.C.A., M.B.L.)
| | - Pamela S. Douglas
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (P.S.D.)
| | - Raj Makkar
- Cedars–Sinai Heart Institute, Los Angeles, CA (R.M.)
| | - D. Craig Miller
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, CA (D.C.M.)
| | | | - Vinod H. Thourani
- MedStar Health Research Institute at Washington Hospital Center, DC (F.M.A., N.J.W., V.H.T.)
| | - Martin B. Leon
- Columbia University Medical Center/New York- Presbyterian Hospital (R.T.H., A.D., Y.Z., M.C.A., M.B.L.)
- Cardiovascular Research Foundation, New York, NY (R.T.H., Y.Z., M.C.A., M.B.L.)
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart and Lung Institute, Laval University, Canada (E.S., M.-A.C., A.D., M.-S.A., O.T., M.B., J.B., C.R., G.O., J.R.-C., P.P.)
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18
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Gonzales H, Douglas PS, Pibarot P, Hahn RT, Khalique OK, Jaber WA, Cremer P, Weissman NJ, Asch FM, Zhang Y, Gertz ZM, Elmariah S, Clavel MA, Thourani VH, Daubert M, Alu MC, Leon MB, Lindman BR. Left Ventricular Hypertrophy and Clinical Outcomes Over 5 Years After TAVR. JACC Cardiovasc Interv 2020; 13:1329-1339. [DOI: 10.1016/j.jcin.2020.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/20/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
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19
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Pibarot P, Salaun E, Dahou A, Avenatti E, Guzzetti E, Annabi MS, Toubal O, Bernier M, Beaudoin J, Ong G, Ternacle J, Krapf L, Thourani VH, Makkar R, Kodali SK, Russo M, Kapadia SR, Malaisrie SC, Cohen DJ, Leipsic J, Blanke P, Williams MR, McCabe JM, Brown DL, Babaliaros V, Goldman S, Szeto WY, Généreux P, Pershad A, Alu MC, Xu K, Rogers E, Webb JG, Smith CR, Mack MJ, Leon MB, Hahn RT. Echocardiographic Results of Transcatheter Versus Surgical Aortic Valve Replacement in Low-Risk Patients. Circulation 2020; 141:1527-1537. [DOI: 10.1161/circulationaha.119.044574] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background:
This study aimed to compare echocardiographic findings in low-risk patients with severe aortic stenosis after surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).
Methods:
The PARTNER 3 trial (Placement of Aortic Transcatheter Valves) randomized 1000 patients with severe aortic stenosis and low surgical risk to undergo either transfemoral TAVR with the balloon-expandable SAPIEN 3 valve or SAVR. Transthoracic echocardiograms obtained at baseline and at 30 days and 1 year after the procedure were analyzed by a consortium of 2 echocardiography core laboratories.
Results:
The percentage of moderate or severe aortic regurgitation (AR) was low and not statistically different between the TAVR and SAVR groups at 30 days (0.8% versus 0.2%;
P
=0.38). Mild AR was more frequent after TAVR than SAVR at 30 days (28.8% versus 4.2%;
P
<0.001). At 1 year, mean transvalvular gradient (13.7±5.6 versus 11.6±5.0 mm Hg;
P
=0.12) and aortic valve area (1.72±0.37 versus 1.76±0.42 cm
2
;
P
=0.12) were similar in TAVR and SAVR. The percentage of severe prosthesis–patient mismatch at 30 days was low and similar between TAVR and SAVR (4.6 versus 6.3%;
P
=0.30). Valvulo-arterial impedance (Z
va
), which reflects total left ventricular hemodynamic burden, was lower with TAVR than SAVR at 1 year (3.7±0.8 versus 3.9±0.9 mm Hg/mL/m
2
;
P
<0.001). Tricuspid annulus plane systolic excursion decreased and the percentage of moderate or severe tricuspid regurgitation increased from baseline to 1 year in SAVR but remained unchanged in TAVR. Irrespective of treatment arm, high Z
va
and low tricuspid annulus plane systolic excursion, but not moderate to severe AR or severe prosthesis–patient mismatch, were associated with increased risk of the composite end point of mortality, stroke, and rehospitalization at 1 year.
Conclusions:
In patients with severe aortic stenosis and low surgical risk, TAVR with the SAPIEN 3 valve was associated with similar percentage of moderate or severe AR compared with SAVR but higher percentage of mild AR. Transprosthetic gradients, valve areas, percentage of severe prosthesis–patient mismatch, and left ventricular mass regression were similar in TAVR and SAVR. SAVR was associated with significant deterioration of right ventricular systolic function and greater tricuspid regurgitation, which persisted at 1 year. High Z
va
and low tricuspid annulus plane systolic excursion were associated with worse outcome at 1 year whereas AR and severe prosthesis–patient mismatch were not.
Registration:
URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02675114.
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Affiliation(s)
- Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Erwan Salaun
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Abdellaziz Dahou
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
| | - Eleonora Avenatti
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
| | - Ezequiel Guzzetti
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Mohamed-Salah Annabi
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Oumhani Toubal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Mathieu Bernier
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Jonathan Beaudoin
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Géraldine Ong
- St Michael’s Hospital, University of Toronto, Canada (G.O.)
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Laura Krapf
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Canada (P.P., E.S., E.G., M.-S.A., O.T., M.B., J.B., J.T., L.K.)
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, CA (R.M.)
| | - Susheel K. Kodali
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | - Mark Russo
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ (M.R.)
| | | | - S. Chris Malaisrie
- Feinberg School of Medicine, Northwestern University, Chicago, IL (S.C.M.)
| | | | | | - Philipp Blanke
- St Paul’s Hospital, Vancouver, Canada (J.L., P.B., J.G.W.)
| | | | | | - David L. Brown
- Baylor Scott & White Healthcare, Plano, TX (D.L.B., M.J.M.)
| | | | | | | | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.)
| | | | - Maria C. Alu
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | - Ke Xu
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - Erin Rogers
- Edwards Lifesciences, Irvine, CA (K.X., E.R.)
| | - John G. Webb
- St Paul’s Hospital, Vancouver, Canada (J.L., P.B., J.G.W.)
| | - Craig R. Smith
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | | | - Martin B. Leon
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
| | - Rebecca T. Hahn
- Cardiovascular Research Foundation, New York, NY (A.D., E.A., M.C.A., M.B.L., R.T.H.)
- Columbia University Irving Medical Center/New York–Presbyterian Hospital, New York (S.K.K., M.C.A., C.R.S., M.B.L., R.T.H.)
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20
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Chau KH, Douglas PS, Pibarot P, Hahn RT, Khalique OK, Jaber WA, Cremer P, Weissman NJ, Asch FM, Zhang Y, Gertz ZM, Elmariah S, Clavel MA, Thourani VH, Daubert M, Alu MC, Leon MB, Lindman BR. Regression of Left Ventricular Mass After Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2020; 75:2446-2458. [DOI: 10.1016/j.jacc.2020.03.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 03/15/2020] [Indexed: 12/20/2022]
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21
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Chen SC, Leu HB, Chang HH, Chen IM, Chen PL, Lin SM, Chen YH. Women had favourable reverse left ventricle remodelling after TAVR. Eur J Clin Invest 2020; 50:e13183. [PMID: 31691961 PMCID: PMC7050508 DOI: 10.1111/eci.13183] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Being woman is associated with higher survival rates after transcatheter aortic valve replacement (TAVR) despite the increase in periprocedural complications. The left ventricle (LV) remodelling process that follows TAVR is considered to play an important role. We aim to investigate whether gender difference affects the process of LV remodelling after TAVR. MATERIALS AND METHODS A total of 100 patients (50 men and 50 women) after TAVR were enrolled. Echocardiography was performed at baseline before the TAVR procedure and repeated upon discharge, and at three, nine and 12 months post-TAVR. RESULTS Women exhibited an early regression of LV mass and the LV mass index (LVMi) decreased 12.0% from 148.3 ± 48.0 to 130.5 ± 43.7 g/m2 at just a median of 17 days after the procedure (P < .001). Almost one-half of the LVMi regression occurred by 17 days post-TAVR and the LVMi regressed 22.0% by 12 months post-TAVR. In contrast, the regression of LVMi in men seemed to be more gradual and the significant regression of LVMi from baseline began to be observed since three months later after TAVR. The LVMi reduction at nine months was 11.5% and achieved 15.4% over one year. Multivariable logistic regression analysis showed only the female sex, better LVEF and greater baseline LVMi were independently associated with greater LVMi regression after TAVR, indicating female gender is an independent predictor for favourable LV remodelling after TAVR. CONCLUSION In conclusion, female patients with AS had favourable reverse remodelling with greater and earlier LV mass regression post-TAVR compared with the male patients.
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Affiliation(s)
- Su-Chan Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Bang Leu
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Healthcare and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiao-Huang Chang
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-Ming Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Lin Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Su-Man Lin
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Anesthesia, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Hwa Chen
- Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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22
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Kampaktsis PN, Vavuranakis M, Choi DY, Sherifi I, Christofi A, Triantafyllou D, Siasos G, Salemi A, Tousoulis D, Wong SC, Devereux RB. Prognostic role of diastolic dysfunction in patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 95:1024-1031. [DOI: 10.1002/ccd.28426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/25/2019] [Indexed: 02/02/2023]
Affiliation(s)
| | - Manolis Vavuranakis
- 1st Cardiology ClinicHippokrateion Hospital/University of Athens Medical School Athens Greece
| | - Daniel Y. Choi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Ines Sherifi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Angela Christofi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Dionysis Triantafyllou
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Gerasimos Siasos
- 1st Cardiology ClinicHippokrateion Hospital/University of Athens Medical School Athens Greece
| | - Arash Salemi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Dimitrios Tousoulis
- 1st Cardiology ClinicHippokrateion Hospital/University of Athens Medical School Athens Greece
| | - S. Chiu Wong
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Richard B. Devereux
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
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23
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Seltzer JH, Gintant G, Amiri-Kordestani L, Singer J, Koplowitz LP, Moslehi JJ, Barac A, Yu AF. Assessing cardiac safety in oncology drug development. Am Heart J 2019; 214:125-133. [PMID: 31202099 PMCID: PMC7316329 DOI: 10.1016/j.ahj.2019.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 04/16/2019] [Indexed: 01/08/2023]
Affiliation(s)
| | | | | | - Jack Singer
- Washington State University, CTI Biopharma, Seattle WA
| | | | | | - Ana Barac
- Georgetown University/Medstar Health, Washington DC
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24
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Douglas PS, Leon MB, Mack MJ, Svensson LG, Webb JG, Hahn RT, Pibarot P, Weissman NJ, Miller DC, Kapadia S, Herrmann HC, Kodali SK, Makkar RR, Thourani VH, Lerakis S, Lowry AM, Rajeswaran J, Finn MT, Alu MC, Smith CR, Blackstone EH. Longitudinal Hemodynamics of Transcatheter and Surgical Aortic Valves in the PARTNER Trial. JAMA Cardiol 2019; 2:1197-1206. [PMID: 28973520 DOI: 10.1001/jamacardio.2017.3306] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Use of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis is growing rapidly. However, to our knowledge, the durability of these prostheses is incompletely defined. Objective To determine the midterm hemodynamic performance of balloon-expandable transcatheter heart valves. Design, Setting, and Participants In this study, we analyzed core laboratory-generated data from echocardiograms of all patients enrolled in the Placement of Aortic Transcatheter Valves (PARTNER) 1 Trial with successful TAVR or surgical AVR (SAVR) obtained preimplantation and at 7 days, 1 and 6 months, and 1, 2, 3, 4, and 5 years postimplantation. Patients from continued access observational studies were included for comparison. Interventions Successful implantation after randomization to TAVR vs SAVR (PARTNER 1A; TAVR, n = 321; SAVR, n = 313), TAVR vs medical treatment (PARTNER 1B; TAVR, n = 165), and continued access (TAVR, n = 1996). Five-year echocardiogram data were available for 424 patients after TAVR and 49 after SAVR. Main Outcomes and Measures Death or reintervention for aortic valve structural indications, measured using aortic valve mean gradient, effective orifice area, Doppler velocity index, and evidence of hemodynamic deterioration by reintervention, adverse hemodynamics, or transvalvular regurgitation. Results Of 2795 included patients, the mean (SD) age was 84.5 (7.1) years, and 1313 (47.0%) were female. Population hemodynamic trends derived from nonlinear mixed-effects models showed small early favorable changes in the first few months post-TAVR, with a decrease of -2.9 mm Hg in aortic valve mean gradient, an increase of 0.028 in Doppler velocity index, and an increase of 0.09 cm2 in effective orifice area. There was relative stability at a median follow-up of 3.1 (maximum, 5) years. Moderate/severe transvalvular regurgitation was noted in 89 patients (3.7%) after TAVR and increased over time. Patients with SAVR showed no significant changes. In TAVR, death/reintervention was associated with lower ejection fraction, stroke volume index, and aortic valve mean gradient up to 3 years, with no association with Doppler velocity index or valve area. Reintervention occurred in 20 patients (0.8%) after TAVR and in 1 (0.3%) after SAVR and became less frequent over time. Reintervention was caused by structural deterioration of transcatheter heart valves in only 5 patients. Severely abnormal hemodynamics on echocardiograms were also infrequent and not associated with excess death or reintervention for either TAVR or SAVR. Conclusions and Relevance This large, core laboratory-based study of transcatheter heart valves revealed excellent durability of the transcatheter heart valves and SAVR. Abnormal findings in individual patients, suggestive of valve thrombosis or structural deterioration, were rare in this protocol-driven database and require further investigation. Trial Registration clinicaltrials.gov Identifier: NCT00530894.
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Affiliation(s)
| | - Martin B Leon
- New York Presbyterian Hospital, Columbia University Medical Center, New York
| | | | | | - John G Webb
- St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca T Hahn
- New York Presbyterian Hospital, Columbia University Medical Center, New York
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada
| | | | | | | | | | - Susheel K Kodali
- New York Presbyterian Hospital, Columbia University Medical Center, New York
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | | | | | | | - Matthew T Finn
- New York Presbyterian Hospital, Columbia University Medical Center, New York
| | - Maria C Alu
- New York Presbyterian Hospital, Columbia University Medical Center, New York
| | - Craig R Smith
- New York Presbyterian Hospital, Columbia University Medical Center, New York
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25
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Zoghbi WA, Asch FM, Bruce C, Gillam LD, Grayburn PA, Hahn RT, Inglessis I, Islam AM, Lerakis S, Little SH, Siegel RJ, Skubas N, Slesnick TC, Stewart WJ, Thavendiranathan P, Weissman NJ, Yasukochi S, Zimmerman KG. Guidelines for the Evaluation of Valvular Regurgitation After Percutaneous Valve Repair or Replacement. J Am Soc Echocardiogr 2019; 32:431-475. [DOI: 10.1016/j.echo.2019.01.003] [Citation(s) in RCA: 190] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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26
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Chen S, Redfors B, Ben-Yehuda O, Crowley A, Greason KL, Alu MC, Finn MT, Vahl TP, Nazif T, Thourani VH, Suri RM, Svensson L, Webb JG, Kodali SK, Leon MB. Transcatheter Versus Surgical Aortic Valve Replacement in Patients With Prior Cardiac Surgery in the Randomized PARTNER 2A Trial. JACC Cardiovasc Interv 2018; 11:2207-2216. [PMID: 30409278 DOI: 10.1016/j.jcin.2018.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The aim of this study was to further evaluate clinical outcomes in patients with and without PCS. BACKGROUND Prior cardiac surgery (PCS) is associated with increased surgical risk and post-operative complications following surgical aortic valve replacement (SAVR), but whether this risk is similar in transcatheter aortic valve replacement (TAVR) is unclear. METHODS In the PARTNER 2A (Placement of Aortic Transcatheter Valve) trial, 2,032 patients with severe aortic stenosis at intermediate surgical risk were randomized to TAVR with the SAPIEN XT valve or SAVR. Adverse clinical outcomes at 30 days and 2 years were compared using Kaplan-Meier event rates and multivariate Cox proportional hazards regression models. The primary endpoint of the PARTNER 2 trial was all-cause death and disabling stroke. RESULTS Five hundred nine patients (25.1%) had PCS, mostly (98.2%) coronary artery bypass grafting. There were no significant differences between TAVR and SAVR in patients with or without PCS in the rates of the primary endpoint at 30 days or 2 years. Nevertheless, an interaction was observed between PCS and treatment arm; whereas no-PCS patients treated with TAVR had higher rates of 30-day major vascular complications than patients treated with SAVR (adjusted hazard ratio: 2.66; 95% confidence interval: 1.68 to 4.22), the opposite was true for patients with PCS (adjusted hazard ratio: 0.27; 95% confidence interval: 0.11 to 0.66) (pinteraction <0.0001). A similar interaction was observed for life-threatening or disabling bleeding. CONCLUSIONS In the PARTNER 2A trial of intermediate-risk patients with severe aortic stenosis undergoing SAVR versus TAVR, the relative risk for 2-year adverse clinical outcomes was similar between TAVR and SAVR in patients with or without PCS.
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Affiliation(s)
- Shmuel Chen
- Cardiovascular Research Foundation, New York, New York.
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Aaron Crowley
- Cardiovascular Research Foundation, New York, New York
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Maria C Alu
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Matthew T Finn
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Torsten P Vahl
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Tamim Nazif
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Vinod H Thourani
- Medstar Heart & Vascular Institute, Washington, District of Columbia
| | | | | | - John G Webb
- St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Susheel K Kodali
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York
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27
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Hahn RT, Pibarot P, Leipsic J, Blanke P, Douglas PS, Weissman NJ, Kapadia S, Thourani VH, Herrmann HC, Nazif T, McAndrew T, Webb JG, Leon MB, Kodali S. The Effect of Post-Dilatation on Outcomes in the PARTNER 2 SAPIEN 3 Registry. JACC Cardiovasc Interv 2018; 11:1710-1718. [PMID: 30121276 DOI: 10.1016/j.jcin.2018.05.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to understand the effects of balloon post-dilatation on outcomes following transcatheter aortic valve replacement with the SAPIEN 3 valve. BACKGROUND Hemodynamics and outcomes with balloon post-dilatation for the SAPIEN 3 valve have not been previously reported. METHODS The effects of balloon post-dilatation (BPD) in 1,661 intermediate (S3i cohort) and high surgical risk (S3HR cohort) patients with aortic stenosis enrolled in the PARTNER (Placement of Aortic Transcatheter Valves) 2, SAPIEN 3 observational study on outcomes, as well as procedural complications, were assessed. RESULTS 208 of 1,661 patients (12.5%) had BPD during the initial transcatheter aortic valve replacement. Baseline characteristics were similar except BPD had higher STS score (p < 0.001), significantly less % oversizing (p = 0.004), significantly more ≥moderate left ventricular outflow tract calcification (p = 0.005), and severe annular calcification (p = 0.006). BPD patients had no increase in permanent pacemaker, annular rupture, or valve embolization. Following transcatheter aortic valve replacement, BPD patients had significantly larger aortic valve area (1.72 ± 0.41 cm2 vs. 1.66 ± 0.37 cm2; p = 0.04) with no significant difference in prosthesis-patient mismatch (p = 0.08) or transvalvular aortic regurgitation (p = 0.65), but significantly more paravalvular regurgitation (p < 0.01). There was no significant difference in 30-day or 1-year outcomes of all-cause death (p = 0.65 to 0.76) or stroke (p = 0.28 to 0.72). However, at 1 year, there was a significantly higher incidence of minor stroke in BPD patients (p = 0.02). Adjusting for baseline differences, including calcium burden, minor strokes were no longer significantly different between the BPD and NoBPD groups (p = 0.21). CONCLUSIONS BPD is performed more frequently in patients with lower % oversizing and greater calcium burden. BPD is not associated with procedural complications or an increase in 1-year adverse events of death, rehospitalization, or stroke.
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Affiliation(s)
- Rebecca T Hahn
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York.
| | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec, Quebec, Canada
| | - Jonathon Leipsic
- University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Pamela S Douglas
- Duke University Medical Center, and Duke Clinical Research Institute, Durham, North Carolina
| | - Neil J Weissman
- Georgetown University School of Medicine, Medstar Health Research Institute, Washington, DC
| | | | - Vinod H Thourani
- Georgetown University School of Medicine, Medstar Health Research Institute, Washington, DC
| | | | - Tamim Nazif
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York
| | | | - John G Webb
- University of British Columbia and St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Martin B Leon
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York
| | - Susheel Kodali
- Columbia University Medical Center/NY Presbyterian Hospital, New York, New York
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28
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Généreux P, Pibarot P, Redfors B, Mack MJ, Makkar RR, Jaber WA, Svensson LG, Kapadia S, Tuzcu EM, Thourani VH, Babaliaros V, Herrmann HC, Szeto WY, Cohen DJ, Lindman BR, McAndrew T, Alu MC, Douglas PS, Hahn RT, Kodali SK, Smith CR, Miller DC, Webb JG, Leon MB. Staging classification of aortic stenosis based on the extent of cardiac damage. Eur Heart J 2018; 38:3351-3358. [PMID: 29020232 PMCID: PMC5837727 DOI: 10.1093/eurheartj/ehx381] [Citation(s) in RCA: 394] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/18/2017] [Indexed: 12/12/2022] Open
Abstract
Aims In patients with aortic stenosis (AS), risk stratification for aortic valve replacement (AVR) relies mainly on valve-related factors, symptoms and co-morbidities. We sought to evaluate the prognostic impact of a newly-defined staging classification characterizing the extent of extravalvular (extra-aortic valve) cardiac damage among patients with severe AS undergoing AVR. Methods and results Patients with severe AS from the PARTNER 2 trials were pooled and classified according to the presence or absence of cardiac damage as detected by echocardiography prior to AVR: no extravalvular cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular damage (Stage 4). One-year outcomes were compared using Kaplan–Meier techniques and multivariable Cox proportional hazards models were used to identify 1-year predictors of mortality. In 1661 patients with sufficient echocardiographic data to allow staging, 47 (2.8%) patients were classified as Stage 0, 212 (12.8%) as Stage 1, 844 (50.8%) as Stage 2, 413 (24.9%) as Stage 3, and 145 (8.7%) as Stage 4. One-year mortality was 4.4% in Stage 0, 9.2% in Stage 1, 14.4% in Stage 2, 21.3% in Stage 3, and 24.5% in Stage 4 (Ptrend < 0.0001). The extent of cardiac damage was independently associated with increased mortality after AVR (HR 1.46 per each increment in stage, 95% confidence interval 1.27–1.67, P < 0.0001). Conclusion This newly described staging classification objectively characterizes the extent of cardiac damage associated with AS and has important prognostic implications for clinical outcomes after AVR.
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Affiliation(s)
- Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA.,Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada
| | - Philippe Pibarot
- Pulmonary Hypertension and Vascular Biology Research Group, Laval University, Québec, Canada
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Raj R Makkar
- Interventional Technologies in the Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Wael A Jaber
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lars G Svensson
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - E Murat Tuzcu
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | - Howard C Herrmann
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Wilson Y Szeto
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | | | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA
| | - Maria C Alu
- Columbia University Medical Center, 161?Ft. Washington Avenue, 6th Floor, New York, NY 10032, USA
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - Rebecca T Hahn
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Columbia University Medical Center, 161 Ft. Washington Avenue, 6th Floor, New York, NY 10032, USA
| | - Susheel K Kodali
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Columbia University Medical Center, 161 Ft. Washington Avenue, 6th Floor, New York, NY 10032, USA
| | - Craig R Smith
- Columbia University Medical Center, 161?Ft. Washington Avenue, 6th Floor, New York, NY 10032, USA
| | | | - John G Webb
- University of British Columbia/St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Columbia University Medical Center, 161 Ft. Washington Avenue, 6th Floor, New York, NY 10032, USA
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29
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Cremer PC, Zhang Y, Alu M, Rodriguez LL, Lindman BR, Zajarias A, Hahn RT, Lerakis S, Malaisrie SC, Douglas PS, Pibarot P, Svensson LG, Leon MB, Jaber WA. The incidence and prognostic implications of worsening right ventricular function after surgical or transcatheter aortic valve replacement: insights from PARTNER IIA. Eur Heart J 2018; 39:2659-2667. [DOI: 10.1093/eurheartj/ehy251] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/30/2018] [Indexed: 12/14/2022] Open
Affiliation(s)
- Paul C Cremer
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave: DeskJ1-5, Cleveland, OH, USA
| | - Yiran Zhang
- Cardiovascular Research Foundation, New York, NY, USA
| | - Maria Alu
- Columbia University Medical Center, New York, NY, USA
| | - L Leonardo Rodriguez
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave: DeskJ1-5, Cleveland, OH, USA
| | | | - Alan Zajarias
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | | | - Pamela S Douglas
- Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
| | | | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Martin B Leon
- Cardiovascular Research Foundation, New York, NY, USA
- Columbia University Medical Center, New York, NY, USA
| | - Wael A Jaber
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Ave: DeskJ1-5, Cleveland, OH, USA
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30
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Predictors of Persistent Tricuspid Regurgitation after Transcatheter Aortic Valve Replacement in Patients with Baseline Tricuspid Regurgitation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:190-199. [DOI: 10.1097/imi.0000000000000504] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Objective This study sought to analyze outcomes in patients with moderate-severe tricuspid regurgitation (TR) undergoing transcatheter aortic valve replacement (TAVR). The consequences of uncorrected significant TR in patients undergoing TAVR remain undefined. Methods Between 2009 and 2014, 369 patients underwent TAVR at our institution, and 58 of these had baseline moderate-severe TR. Preoperative, 30-day, and 1-year transthoracic echocardiograms were analyzed. Predictors of persistent TR at 30 days and survival were assessed. Results Fifty-eight patients with baseline moderate-severe TR underwent TAVR. Transcatheter aortic valve replacement resulted in significant reductions in pulmonary artery pressures and TR severity (100% vs 64%; P < 0.001) at 30 days. This was sustained at 1 year and was associated with significant improvements in stroke volume index and New York Heart Association functional class. No changes in right ventricular function or size were noted. The only independent predictor of persistent moderate-severe TR at 30 days was preoperative atrial fibrillation [AF; odds ratio (OR), 4.56; 95% confidence interval, 1.1–18.3; P = 0.033]. Independent predictors of overall long-term survival included AF (OR, 0.41; P = 0.001) and chronic lung disease (OR, 0.47; P = 0.011), but not baseline moderate-severe TR. In patients with baseline moderate-severe TR, persistent moderate-severe TR at 30 days was associated with worsened overall survival (log-rank P = 0.02). Conclusions Baseline moderate-severe TR is not uncommon in patients undergoing TAVR, and frequently improves. However, the presence of AF suggests that that TR is likely to persist after TAVR and is also indicative of a poor long-term outcome. Whether redirecting such patients to surgery for concomitant tricuspid valve repair will further improve outcomes requires further study.
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31
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Worku B, Valovska MT, Elmously A, Kampaktsis P, Castillo C, Wong SC, Salemi A. Predictors of Persistent Tricuspid Regurgitation after Transcatheter Aortic Valve Replacement in Patients with Baseline Tricuspid Regurgitation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Berhane Worku
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
- Department of Cardiothoracic Surgery, New York Presbyterian/Brooklyn Methodist Hospital, Brooklyn, NY USA
| | - Marie-Therese Valovska
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
| | - Adham Elmously
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
| | - Polydoros Kampaktsis
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
| | - Catherine Castillo
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
- Department of Cardiothoracic Surgery, New York Presbyterian/Brooklyn Methodist Hospital, Brooklyn, NY USA
| | - Shing-Chiu Wong
- Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
| | - Arash Salemi
- Department of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY USA
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Del Trigo M, Muñoz-García AJ, Latib A, Auffret V, Wijeysundera HC, Nombela-Franco L, Gutierrez E, Cheema AN, Serra V, Amat-Santos IJ, Kefer J, Benitez LM, Leclercq F, Mangieri A, Le Breton H, Jiménez-Quevedo P, Garcia del Blanco B, Dager A, Abdul-Jawad Altisent O, Puri R, Pibarot P, Rodés-Cabau J. Impact of anticoagulation therapy on valve haemodynamic deterioration following transcatheter aortic valve replacement. Heart 2018; 104:814-820. [DOI: 10.1136/heartjnl-2017-312514] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/03/2018] [Accepted: 01/05/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo evaluate the changes in transvalvular gradients and the incidence of valve haemodynamic deterioration (VHD) following transcatheter aortic valve replacement (TAVR), according to use of anticoagulation therapy.Methods and resultsThis multicentre study included 2466 patients (46% men; mean age 81±7 years) who underwent TAVR with echocardiography performed at 12-month follow-up. Anticoagulation therapy was used in 707 patients (28.7%) following TAVR (AC group). A total of 663 patients received vitamin K antagonists, and 44 patients received direct oral anticoagulants. A propensity score matching analysis was performed to adjust for intergroup (AC vs non-AC post-TAVR) differences. A total of 622 patients per group were included in the propensity-matched analysis. VHD was defined as a ≥10 mm Hg increase in the mean transprosthetic gradient at follow-up (vs hospital discharge). The mean clinical follow-up was 29±18 months. The mean transvalvular gradient significantly increased at follow-up in the non-AC group within the global cohort (P=0.003), whereas it remained stable over time in the AC group (P=0.323). The incidence of VHD was significantly lower in the AC group (0.6%) compared with the non-AC group (3.7%, P<0.001), and these significant differences remained within the propensity-matched populations (0.6% vs 3.9% in the AC and non-AC groups, respectively, P<0.001). The occurrence of VHD did not associate with an increased risk of all-cause death (P=0.468), cardiovascular death (P=0.539) or stroke (P=0.170) at follow-up.ConclusionsThe lack of anticoagulation therapy post-TAVR was associated with significant increments in transvalvular gradients and a greater risk of VHD. VHD was subclinical in most cases and did not associate with major adverse clinical events. Future randomised trials are needed to determine if systematic anticoagulation therapy post-TAVR would reduce the incidence of VHD.
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Khouri MG, Ky B, Dunn G, Plappert T, Englefield V, Rabineau D, Yow E, Barnhart HX, St John Sutton M, Douglas PS. Echocardiography Core Laboratory Reproducibility of Cardiac Safety Assessments in Cardio-Oncology. J Am Soc Echocardiogr 2018; 31:361-371.e3. [PMID: 29395626 DOI: 10.1016/j.echo.2017.11.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND As the potential for cancer therapy-related cardiac dysfunction is increasingly recognized, there is a need for the standardization of echocardiographic measurements and cut points to guide treatment. The aim of this study was to determine the reproducibility of cardiac safety assessments across two academic echocardiography core laboratories (ECLs) at the University of Pennsylvania and the Duke Clinical Research Institute. METHODS To harmonize the application of guideline-recommended measurement conventions, the ECLs conducted multiple training sessions to align measurement practices for traditional and emerging assessments of left ventricular (LV) function. Subsequently, 25 echocardiograms taken from patients with breast cancer treated with doxorubicin with or without trastuzumab were independently analyzed by each laboratory. Agreement was determined by the proportion (coverage probability [CP]) of all pairwise comparisons between readers that were within a prespecified minimum acceptable difference. Persistent differences in measurement techniques between laboratories triggered retraining and reassessment of reproducibility. RESULTS There was robust reproducibility within each ECL but differences between ECLs on calculated LV ejection fraction and mitral inflow velocities (all CPs < 0.80); four-chamber global longitudinal strain bordered acceptable reproducibility (CP = 0.805). Calculated LV ejection fraction and four-chamber global longitudinal strain were sensitive to small but systematic interlaboratory differences in endocardial border definition that influenced measured LV volumes and the speckle-tracking region of interest, respectively. On repeat analyses, reproducibility for mitral velocities (CP = 0.940-0.990) was improved after incorporating multiple-beat measurements and homogeneous image selection. Reproducibility for four-chamber global longitudinal strain was unchanged after efforts to develop consensus between ECLs on endocardial border determinations were limited primarily by a lack of established reference standards. CONCLUSIONS High-quality quantitative echocardiographic research is feasible but requires a commitment to reproducibility, adherence to guideline recommendations, and the time, care, and attention to detail to establish agreement on measurement conventions. These findings have important implications for research design and clinical care.
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Affiliation(s)
- Michel G Khouri
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gary Dunn
- Duke Clinical Research Institute, Durham, North Carolina
| | - Ted Plappert
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Virginia Englefield
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dawn Rabineau
- Duke Clinical Research Institute, Durham, North Carolina
| | - Eric Yow
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Martin St John Sutton
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pamela S Douglas
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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Elmariah S, Fearon WF, Inglessis I, Vlahakes GJ, Lindman BR, Alu MC, Crowley A, Kodali S, Leon MB, Svensson L, Pibarot P, Hahn RT, Thourani VH, Palacios IF, Miller DC, Douglas PS, Passeri JJ. Transapical Transcatheter Aortic Valve Replacement Is Associated With Increased Cardiac Mortality in Patients With Left Ventricular Dysfunction. JACC Cardiovasc Interv 2017; 10:2414-2422. [DOI: 10.1016/j.jcin.2017.09.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/24/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
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Leipsic J, Bax JJ, Webb JG, Martin R, Blanke P. Trials Testing the Value of Imaging Use in Valve Disease and in Transcatheter Valvular Interventions. JACC Cardiovasc Imaging 2017; 10:286-295. [PMID: 28279376 DOI: 10.1016/j.jcmg.2016.09.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 12/20/2022]
Abstract
The role of imaging in the diagnosis of valvular heart disease is well established through years of investigation and validation. However, the role of imaging in guiding the treatment decision-making for valvular heart disease is less well established, and there is a striking paucity of randomized trial data to help inform these decisions. Given this relative absence of randomized trial data, the present article highlights some of the most important knowledge gaps and defines meaningful opportunities for the field to help advance the care of patients with valvular heart disease in a cost-effective fashion. (The PARTNER 3-Trial: The Safety and Effectiveness of the SAPIEN 3 Transcatheter Heart Valve in Low Risk Patients With Aortic Stenosis [P3]; NCT02675114; Medtronic Transcatheter Aortic Valve Replacement in Low Risk Patients; NCT02701283).
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Affiliation(s)
- Jonathon Leipsic
- Department of Radiology and Cardiology, Centre for Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jeroen J Bax
- Leiden University Medical Center, Leiden, the Netherlands
| | - John G Webb
- Department of Radiology and Cardiology, Centre for Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Philipp Blanke
- Department of Radiology and Cardiology, Centre for Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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Gillam LD, Leipsic J, Weissman NJ. Use of Imaging Endpoints in Clinical Trials. JACC Cardiovasc Imaging 2017; 10:296-303. [PMID: 28279377 DOI: 10.1016/j.jcmg.2016.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/12/2016] [Accepted: 12/15/2016] [Indexed: 10/20/2022]
Abstract
Cardiovascular imaging is an integral component of many clinical trials beyond those for which the primary goal is to evaluate or validate imaging technologies. The scope of such trials is broad, ranging from those in which a medical, surgical, or interventional cardiovascular device or drug is being evaluated to those in which there is concern about cardiovascular adverse events complicating treatment for noncardiac conditions. This paper discusses study design as it pertains to the incorporation of imaging elements, the important role played by imaging core laboratories, the rationale for and approaches to involvement of imagers in clinical trials, and guidance by the U.S. Food and Drug Administration on imaging endpoints in clinical trials.
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Affiliation(s)
| | - Jonathon Leipsic
- Centre for Heart Valve Innovation UBC, Vancouver, British Columbia, Canada
| | - Neil J Weissman
- MedStar Health Research Institute and Georgetown University, Washington, DC
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CT-Defined Prosthesis–Patient Mismatch Downgrades Frequency and Severity, and Demonstrates No Association With Adverse Outcomes After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2017; 10:1578-1587. [DOI: 10.1016/j.jcin.2017.05.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 12/21/2022]
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Lindman BR, Otto CM, Douglas PS, Hahn RT, Elmariah S, Weissman NJ, Stewart WJ, Ayele GM, Zhang F, Zajarias A, Maniar HS, Jilaihawi H, Blackstone E, Chinnakondepalli KM, Tuzcu EM, Leon MB, Pibarot P. Blood Pressure and Arterial Load After Transcatheter Aortic Valve Replacement for Aortic Stenosis. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.006308. [DOI: 10.1161/circimaging.116.006308] [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: 02/13/2017] [Accepted: 05/15/2017] [Indexed: 11/16/2022]
Abstract
Background—
After aortic valve replacement, left ventricular afterload is often characterized by the residual valve obstruction. Our objective was to determine whether higher systemic arterial afterload—as reflected in blood pressure, pulsatile and resistive load—is associated with adverse clinical outcomes after transcatheter aortic valve replacement (TAVR).
Methods and Results—
Total, pulsatile, and resistive arterial load were measured in 2141 patients with severe aortic stenosis treated with TAVR in the PARTNER I trial (Placement of Aortic Transcatheter Valve) who had systolic blood pressure (SBP) and an echocardiogram obtained 30 days after TAVR. The primary end point was 30-day to 1-year all-cause mortality. Lower SBP at 30 days after TAVR was associated with higher mortality (20.0% for SBP 100–129 mm Hg versus 12.0% for SBP 130–170 mm Hg;
P
<0.001). This association remained significant after adjustment, was consistent across subgroups, and confirmed in sensitivity analyses. In adjusted models that included SBP, higher total and pulsatile arterial load were associated with increased mortality (
P
<0.001 for all), but resistive load was not. Patients with low 30-day SBP and high pulsatile load had a 3-fold higher mortality than those with high 30-day SBP and low pulsatile load (26.1% versus 8.1%; hazard ratio, 3.62; 95% confidence interval, 2.36–5.55).
Conclusions—
Even after relief of valve obstruction in patients with aortic stenosis, there is an independent association between post-TAVR blood pressure, systemic arterial load, and mortality. Blood pressure goals in patients with a history of aortic stenosis may need to be redefined. Increased pulsatile arterial load, rather than blood pressure, may be a target for adjunctive medical therapy to improve outcomes after TAVR.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00530894
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Affiliation(s)
- Brian R. Lindman
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Catherine M. Otto
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Pamela S. Douglas
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Rebecca T. Hahn
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Sammy Elmariah
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Neil J. Weissman
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - William J. Stewart
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Girma M. Ayele
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Feifan Zhang
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Alan Zajarias
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Hersh S. Maniar
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Hasan Jilaihawi
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Eugene Blackstone
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Khaja M. Chinnakondepalli
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - E. Murat Tuzcu
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Martin B. Leon
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
| | - Philippe Pibarot
- From the Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, TN (B.R.L.); Washington University School of Medicine, St. Louis, MO (B.R.L., A.Z., H.S.M.); University of Washington School of Medicine, Seattle (C.M.O.); Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.); Columbia University Medical Center, New York, NY (R.T.H., M.B.L.); Massachusetts General Hospital, Boston (S.E.); Medstar Health Research Institute, Georgetown
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Baron SJ, Arnold SV, Herrmann HC, Holmes DR, Szeto WY, Allen KB, Chhatriwalla AK, Vemulapali S, O'Brien S, Dai D, Cohen DJ. Impact of Ejection Fraction and Aortic Valve Gradient on Outcomes of Transcatheter Aortic Valve Replacement. J Am Coll Cardiol 2017; 67:2349-2358. [PMID: 27199058 DOI: 10.1016/j.jacc.2016.03.514] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND In patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), studies have suggested that reduced left ventricular (LV) ejection fraction (LVEF) and low aortic valve gradient (AVG) are associated with worse long-term outcomes. Because these conditions commonly coexist, the extent to which they are independently associated with outcomes after TAVR is unknown. OBJECTIVES The purpose of this study was to evaluate the impact of LVEF and AVG on clinical outcomes after TAVR and to determine whether the effect of AVG on outcomes is modified by LVEF. METHODS Using data from 11,292 patients who underwent TAVR as part of the Transcatheter Valve Therapies Registry, we examined rates of 1-year mortality and recurrent heart failure in patients with varying levels of LV dysfunction (LVEF <30% vs. 30% to 50% vs. >50%) and AVG (<40 mm Hg vs. ≥40 mm Hg). Multivariable models were used to estimate the independent effect of AVG and LVEF on outcomes. RESULTS During the first year of follow-up after TAVR, patients with LV dysfunction and low AVG had higher rates of death and recurrent heart failure. After adjustment for other clinical factors, only low AVG was associated with higher mortality (hazard ratio: 1.21; 95% confidence interval: 1.11 to 1.32; p < 0.001) and higher rates of heart failure (hazard ratio: 1.52; 95% confidence interval: 1.36 to 1.69; p <0.001), whereas the effect of LVEF was no longer significant. There was no evidence of effect modification between AVG and LVEF with respect to either endpoint. CONCLUSIONS In this series of real-world patients undergoing TAVR, low AVG, but not LV dysfunction, was associated with higher rates of mortality and recurrent heart failure. Although these findings suggest that AVG should be considered when evaluating the risks and benefits of TAVR for individual patients, neither severe LV dysfunction nor low AVG alone or in combination provide sufficient prognostic discrimination to preclude treatment with TAVR.
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Affiliation(s)
- Suzanne J Baron
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Howard C Herrmann
- Hospital of the University of Pennsylvania, Philadelphia, Philadelphia
| | | | - Wilson Y Szeto
- Hospital of the University of Pennsylvania, Philadelphia, Philadelphia
| | - Keith B Allen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Sean O'Brien
- Duke Clinical Research Institute, Durham, North Carolina
| | - Dadi Dai
- Duke Clinical Research Institute, Durham, North Carolina
| | - David J Cohen
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri.
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Bloomfield GS, DeLong AK, Akwanalo CO, Hogan JW, Carter EJ, Aswa DF, Binanay C, Koech M, Kimaiyo S, Velazquez EJ. Markers of Atherosclerosis, Clinical Characteristics, and Treatment Patterns in Heart Failure: A Case-Control Study of Middle-Aged Adult Heart Failure Patients in Rural Kenya. Glob Heart 2017; 11:97-107. [PMID: 27102027 DOI: 10.1016/j.gheart.2015.12.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Although risk factors for heart failure are increasingly common worldwide, the contribution of atherosclerosis to heart failure in sub-Saharan Africa is largely unknown. OBJECTIVE This study assessed the association between atherosclerotic risk factors and heart failure in a developing country. METHODS We performed a case-control study of heart failure in rural Kenya. We assessed the risk factors for heart failure by using international criteria based on electrocardiogram (ECG), echocardiogram, physical examination findings, and laboratory testing. Atherosclerotic risk factors were determined by ECG, echocardiogram, ankle-brachial index (ABI), and lipid testing. We described the relationship of wall motion abnormalities on echocardiogram, ABI <0.9, and ischemic pattern on ECG with the presence of heart failure with multivariable logistic regression adjusting for age and sex and using adjusted odds ratios (AORs) and 95% confidence intervals (CIs). RESULTS There were 125 cases and 191 controls (n = 316); 49% were male. The mean age was 60 (SD = 13) years. Most patients had hypertension (53%), and 16% had human immunodeficiency virus infection. Lipids were in the normal range for all. Cases were older than controls (62 years vs. 58 years, respectively). The most common abnormality associated with heart failure was dilated cardiomyopathy. Ischemic heart failure was the second most common cause in men. Cases were more likely to have an ABI <0.9 (46% vs. 31%; AOR: 1.99; 95% CI: 1.19 to 3.32), ischemia or infarct on ECG (68% vs. 43%; AOR: 3.01; 95% CI: 1.43 to 6.34), and wall motion abnormalities on echocardiogram (54% vs. 15%; AOR: 7.00; 95% CI: 3.95 to 12.39). CONCLUSIONS Ischemic heart failure is more common in Kenya than previously recognized. Noninvasive markers of atherosclerosis are routinely found among patients with heart failure. Treatment and prevention of heart failure in sub-Saharan Africa must consider many causes including those related to atherosclerosis.
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Affiliation(s)
- Gerald S Bloomfield
- Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Allison K DeLong
- Center for Statistical Science, School of Public Health, Brown University, Providence, RI, USA
| | | | - Joseph W Hogan
- Department of Biostatistics and Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - E Jane Carter
- Division of Infectious Diseases, Alpert School of Medicine at Brown University, Providence, RI, USA; Division of Pulmonary Medicine, Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Daniel F Aswa
- Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Cynthia Binanay
- Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Myra Koech
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sylvester Kimaiyo
- Division of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya; Department of Medicine, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Eric J Velazquez
- Department of Medicine, Duke University Medical Center, Durham, NC, USA; Duke Clinical Research Institute, Duke University, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
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41
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Three-Dimensional Morphology of the Left Ventricular Outflow Tract: Impact on Grading Aortic Stenosis Severity. J Am Soc Echocardiogr 2017; 30:28-35. [DOI: 10.1016/j.echo.2016.10.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Indexed: 01/31/2023]
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42
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Daubert MA, Weissman NJ, Hahn RT, Pibarot P, Parvataneni R, Mack MJ, Svensson LG, Gopal D, Kapadia S, Siegel RJ, Kodali SK, Szeto WY, Makkar R, Leon MB, Douglas PS. Long-Term Valve Performance of TAVR and SAVR: A Report From the PARTNER I Trial. JACC Cardiovasc Imaging 2016; 10:S1936-878X(16)30895-6. [PMID: 28017714 DOI: 10.1016/j.jcmg.2016.11.004] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 10/31/2016] [Accepted: 11/03/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the long-term performance of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) through longitudinal echocardiographic analysis. BACKGROUND The long-term performance of the SAPIEN TAVR is not well-described. Therefore, we examined the hemodynamic and valvular profile of the SAPIEN TAVR over 5 years. METHODS All patients receiving TAVR or SAVR with first post-implant (FPI) and 5-year echoes were analyzed for aortic valve (AV) peak velocity, AV mean gradient, AV area, peak left ventricular (LV) outflow tract and in-stent velocities, Doppler velocity index, aortic regurgitation (AR), LV mass index, stroke volume index, and cardiac index. The FPI and 5-year data were compared using a paired t test or McNemar's analyses. RESULTS There were 86 TAVR and 48 SAVR patients with paired FPI and 5-year echocardiograms. Baseline characteristics were similar between groups. The AV area did not change significantly 5 years after TAVR (p = 0.35). The AV mean gradient also remained stable: 11.5 ± 5.4 mm Hg at FPI to 11.0 ± 6.3 mm Hg at 5 years (p = 0.41). In contrast, the peak AV and LV outflow tract velocities decreased (p = 0.03 and p = 0.008, respectively), as did in-stent velocity (p = 0.015). Correspondingly, the TAVR Doppler velocity index was unchanged (p = 0.07). Among TAVR patients, there was no change in total AR (p = 0.40), transvalvular AR (p = 0.37), or paravalvular AR (p = 0.26). Stroke volume index and cardiac index remained stable (p = 0.16 and p = 0.25, respectively). However, there was a significant regression of LV mass index (p < 0.0001). The longitudinal evaluation among SAVR patients revealed similar trends. There was a low rate of adverse events among TAVR and SAVR patients alive at 5 years. CONCLUSIONS Longitudinal assessment of the PARTNER I trial (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial) demonstrates that valve performance and cardiac hemodynamics are stable after implantation in both SAPIEN TAVR and SAVR in patients alive at 5 years. (THE PARTNER TRIAL: Placement of AoRTic TraNscathetER Valve Trial; NCT00530894).
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Affiliation(s)
- Melissa A Daubert
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.
| | | | | | | | | | | | | | | | | | | | | | - Wilson Y Szeto
- University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
| | - Raj Makkar
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Martin B Leon
- Columbia University Medical Center, New York, New York
| | - Pamela S Douglas
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
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43
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Parthiban A, Levine JC, Nathan M, Marshall JA, Shirali GS, Simon SD, Colan SD, Newburger JW, Raghuveer G. Implementation of a Quality Improvement Bundle Improves Echocardiographic Imaging after Congenital Heart Surgery in Children. J Am Soc Echocardiogr 2016; 29:1163-1170.e3. [DOI: 10.1016/j.echo.2016.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Indexed: 12/21/2022]
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44
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Crowley AL, Yow E, Barnhart HX, Daubert MA, Bigelow R, Sullivan DC, Pencina M, Douglas PS. Critical Review of Current Approaches for Echocardiographic Reproducibility and Reliability Assessment in Clinical Research. J Am Soc Echocardiogr 2016; 29:1144-1154.e7. [PMID: 27720558 DOI: 10.1016/j.echo.2016.08.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is no broadly accepted standard method for assessing the quality of echocardiographic measurements in clinical research reports, despite the recognized importance of this information in assessing the quality of study results. METHODS Twenty unique clinical studies were identified reporting echocardiographic data quality for determinations of left ventricular (LV) volumes (n = 13), ejection fraction (n = 12), mass (n = 9), outflow tract diameter (n = 3), and mitral Doppler peak early velocity (n = 4). To better understand the range of possible estimates of data quality and to compare their utility, reported reproducibility measures were tabulated, and de novo estimates were then calculated for missing measures, including intraclass correlation coefficient (ICC), 95% limits of agreement, coefficient of variation (CV), coverage probability, and total deviation index, for each variable for each study. RESULTS The studies varied in approaches to reproducibility testing, sample size, and metrics assessed and values reported. Reported metrics included mean difference and its SD (n = 7 studies), ICC (n = 5), CV (n = 4), and Bland-Altman limits of agreement (n = 4). Once de novo estimates of all missing indices were determined, reasonable reproducibility targets for each were identified as those achieved by the majority of studies. These included, for LV end-diastolic volume, ICC > 0.95, CV < 7%, and coverage probability > 0.93 within 30 mL; for LV ejection fraction, ICC > 0.85, CV < 8%, and coverage probability > 0.85 within 10%; and for LV mass, ICC > 0.85, CV < 10%, and coverage probability > 0.60 within 20 g. CONCLUSIONS Assessment of data quality in echocardiographic clinical research is infrequent, and methods vary substantially. A first step to standardizing echocardiographic quality reporting is to standardize assessments and reporting metrics. Potential benefits include clearer communication of data quality and the identification of achievable targets to benchmark quality improvement initiatives.
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Affiliation(s)
- Anna Lisa Crowley
- Department of Medicine, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
| | - Eric Yow
- Duke Clinical Research Institute, Durham, North Carolina
| | | | - Melissa A Daubert
- Department of Medicine, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
| | - Robert Bigelow
- Duke Clinical Research Institute, Durham, North Carolina
| | - Daniel C Sullivan
- Duke Clinical Research Institute, Durham, North Carolina; Department of Radiology, Duke University, Durham, North Carolina
| | | | - Pamela S Douglas
- Department of Medicine, Duke University, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina
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45
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Geleijnse ML, Di Martino LFM, Vletter WB, Ren B, Galema TW, Van Mieghem NM, de Jaegere PPT, Soliman OII. Limitations and difficulties of echocardiographic short-axis assessment of paravalvular leakage after corevalve transcatheter aortic valve implantation. Cardiovasc Ultrasound 2016; 14:37. [PMID: 27600600 PMCID: PMC5011797 DOI: 10.1186/s12947-016-0080-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/25/2016] [Indexed: 12/20/2022] Open
Abstract
To make assessment of paravalvular aortic leakage (PVL) after transcatheter aortic valve implantation (TAVI) more uniform the second Valve Academic Research Consortium (VARC) recently updated the echocardiographic criteria for mild, moderate and severe PVL. In the VARC recommendation the assessment of the circumferential extent of PVL in the short-axis view is considered critical. In this paper we will discuss our observational data on the limitations and difficulties of this particular view, that may potentially result in overestimation or underestimation of PVL severity.
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Affiliation(s)
- Marcel L Geleijnse
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands.
| | - Luigi F M Di Martino
- From the department of Cardiology, Ospedali Riuniti, Università degli Studi di Foggia, Foggia, Italy
| | - Wim B Vletter
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Ben Ren
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Tjebbe W Galema
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Nicolas M Van Mieghem
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Peter P T de Jaegere
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Osama I I Soliman
- From the department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Thoraxcenter, Ba304, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands.,From the Cardialysis Cardiovascular Core Laboratory, Rotterdam, The Netherlands
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46
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Anjan VY, Herrmann HC, Pibarot P, Stewart WJ, Kapadia S, Tuzcu EM, Babaliaros V, Thourani VH, Szeto WY, Bavaria JE, Kodali S, Hahn RT, Williams M, Miller DC, Douglas PS, Leon MB. Evaluation of Flow After Transcatheter Aortic Valve Replacement in Patients With Low-Flow Aortic Stenosis. JAMA Cardiol 2016; 1:584-92. [DOI: 10.1001/jamacardio.2016.0759] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Philippe Pibarot
- Department of Medicine, Laval University, Quebec City, Quebec, Canada
| | - William J. Stewart
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - E. Murat Tuzcu
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Wilson Y. Szeto
- Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia
| | - Joseph E. Bavaria
- Division of Cardiothoracic Surgery, University of Pennsylvania, Philadelphia
| | - Susheel Kodali
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Rebecca T. Hahn
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - Mathew Williams
- Division of Cardiac Surgery, New York University Langone Medical Center, New York
| | - D. Craig Miller
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Pamela S. Douglas
- Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Martin B. Leon
- Department of Medicine, Columbia University Medical Center, New York, New York
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Samad Z, Minter S, Armour A, Tinnemore A, Sivak JA, Sedberry B, Strub K, Horan SM, Harrison JK, Kisslo J, Douglas PS, Velazquez EJ. Implementing a Continuous Quality Improvement Program in a High-Volume Clinical Echocardiography Laboratory: Improving Care for Patients With Aortic Stenosis. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.115.003708. [PMID: 26957220 DOI: 10.1161/circimaging.115.003708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The management of aortic stenosis rests on accurate echocardiographic diagnosis. Hence, it was chosen as a test case to examine the utility of continuous quality improvement (CQI) approaches to increase echocardiographic data accuracy and reliability. A novel, multistep CQI program was designed and prospectively used to investigate whether it could minimize the difference in aortic valve mean gradients reported by echocardiography when compared with cardiac catheterization. METHODS AND RESULTS The Duke Echo Laboratory compiled a multidisciplinary CQI team including 4 senior sonographers and MD faculty to develop a mapped CQI process that incorporated Intersocietal Accreditation Commission standards. Quarterly, the CQI team reviewed all moderate- or greater-severity aortic stenosis echocardiography studies with concomitant catheterization data, and deidentified individual and group results were shared at meetings attended by cardiologists and sonographers. After review of 2011 data, the CQI team proposed specific amendments implemented over 2012: the use of nontraditional imaging and Doppler windows as well as evaluation of aortic gradients by a second sonographer. The primary outcome measure was agreement between catheterization- and echocardiography-derived mean gradients calculated by using the coverage probability index with a prespecified acceptable echocardiography-catheterization difference of <10 mm Hg in mean gradient. Between January 2011 and January 2014, 2093 echocardiograms reported moderate or greater aortic stenosis. Among cases with available catheterization data pre- and post-CQI, the coverage probability index increased from 54% to 70% (P=0.03; 98 cases, year 2011; 70 cases, year 2013). The proportion of patients referred for invasive valve hemodynamics decreased from 47% pre-CQI to 19% post-CQI (P<0.001). CONCLUSIONS A laboratory practice pattern that was amenable to reform was identified, and a multistep modification was designed and implemented that produced clinically valuable performance improvements. The new protocol improved aortic stenosis mean gradient agreement between echocardiography and catheterization and was associated with a measurable decrease in referrals of patients for invasive studies.
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Affiliation(s)
- Zainab Samad
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC.
| | - Stephanie Minter
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC
| | - Alicia Armour
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC
| | - Amanda Tinnemore
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC
| | - Joseph A Sivak
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC
| | - Brenda Sedberry
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC
| | - Karen Strub
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC
| | - Seanna M Horan
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC
| | - J Kevin Harrison
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC
| | - Joseph Kisslo
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC
| | - Pamela S Douglas
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC
| | - Eric J Velazquez
- From the Division of Cardiology, Department of Medicine (Z.S., J.A.S., J.K.H., J.K., P.S.D., E.J.V.), Cardiac Diagnostic Unit (Z.S., S.M., A.A., A.T., B.S., K.S., S.M.H., P.S.D., E.J.V.), and Duke Clinical Research Institute (Z.S., S.M.H., P.S.D., E.J.V.), Duke University Medical Center, Durham, NC
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48
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Kampaktsis PN, Bang CN, Chiu Wong S, Skubas NJ, Singh H, Voudris K, Baduashvili A, Pastella K, Swaminathan RV, Kaple RK, Minutello RM, Feldman DN, Kim L, Hriljac I, Lin F, Bergman GS, Salemi A, Devereux RB. Prognostic Importance of Diastolic Dysfunction in Relation to Post Procedural Aortic Insufficiency in Patients Undergoing Transcatheter Aortic Valve Replacement. Catheter Cardiovasc Interv 2016; 89:445-451. [PMID: 27218599 DOI: 10.1002/ccd.26582] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 04/21/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We sought to examine whether baseline diastolic dysfunction (DD) is associated with increased mortality in patients who develop aortic insufficiency (AI) after transcatheter aortic valve replacement (TAVR). BACKGROUND Significant post-TAVR AI is associated with increased mortality, likely secondary to adverse hemodynamics secondary to volume overload and decreased LV compliance from chronic pressure overload. However, the effect of baseline DD on outcomes of patients with post-TAVR AI has not been studied. METHODS A total of 195 patients undergoing TAVR were included in the study. Patients with moderate-to-severe mitral stenosis, prior mitral valve replacement or atrial fibrillation were excluded. DD was classified at baseline by a 2-step approach as recommended by the American Society of Echocardiography while AI was evaluated 30 days post-TAVR. Follow up data up to 2 years post-TAVR was used in survival analysis. RESULTS Patients with severe baseline DD who developed ≥mild post-TAVR AI had increased mortality compared to all other patients (HR = 3.89, CI: 1.76-8.6, P = 0.001), which remained significant after adjusting for post-TAVR AI, pre-TAVR AI, baseline mitral regurgitation, ejection fraction, pulmonary artery pressure, creatinine clearance and history of stroke. CONCLUSIONS Even mild post-TAVR AI may have a negative impact on outcomes of patients with underlying severe DD. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Polydoros N Kampaktsis
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Department of Internal Medicine, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Casper N Bang
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Department of Cardiology, Copenhagen University Hospital Roskilde, Roskilde, Denmark
| | - S Chiu Wong
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Nikolaos J Skubas
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Anesthesiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Harsimran Singh
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Konstantinos Voudris
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Amiran Baduashvili
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Department of Internal Medicine, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Kalliopi Pastella
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York
| | - Rajesh V Swaminathan
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Ryan K Kaple
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Robert M Minutello
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Dmitriy N Feldman
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Luke Kim
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Ingrid Hriljac
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Fay Lin
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Geoffrey S Bergman
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Arash Salemi
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiothoracic Surgery, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
| | - Richard B Devereux
- William Acquavella Heart Valve Center, New York Presbyterian Hospital / Weill Cornell Medical College, New York, New York.,Division of Cardiology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York
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49
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Byrd BF, Abraham TP, Buxton DB, Coletta AV, Cooper JHS, Douglas PS, Gillam LD, Goldstein SA, Graf TR, Horton KD, Isenberg AA, Klein AL, Kreeger J, Martin RP, Nedza SM, Navathe A, Pellikka PA, Picard MH, Pilotte JC, Ryan TJ, Rychik J, Sengupta PP, Thomas JD, Tucker L, Wallace W, Ward RP, Weissman NJ, Wiener DH, Woodruff S. A Summary of the American Society of Echocardiography Foundation Value-Based Healthcare: Summit 2014: The Role of Cardiovascular Ultrasound in the New Paradigm. J Am Soc Echocardiogr 2016; 28:755-69. [PMID: 26140937 DOI: 10.1016/j.echo.2015.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Value-Based Healthcare: Summit 2014 clearly achieved the three goals set forth at the beginning of this document. First, the live event informed and educated attendees through a discussion of the evolving value-based healthcare environment, including a collaborative effort to define the important role of cardiovascular ultrasound in that environment. Second, publication of these Summit proceedings in the Journal of the American Society of Echocardiography will inform a wider audience of the important insights gathered. Third, moving forward, the ASE will continue to build a ‘‘living resource’’ on its website, http://www.asecho.org, for clinicians, researchers, and administrators to use in advocating for the value of cardiovascular ultrasound in the new value-based healthcare environment. The ASE looks forward to incorporating many of the Summit recommendations as it works with its members, legislators, payers, hospital administrators, and researchers to demonstrate and increase the value of cardiovascular ultrasound. All Summit attendees shared in the infectious enthusiasm generated by this proactive approach to ensuring cardiovascular ultrasound’s place as ‘‘The Value Choice’’ in cardiac imaging.
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Affiliation(s)
| | | | - Denis B Buxton
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | - James H S Cooper
- Vanderbilt University Owen Graduate School of Management, Nashville, Tennessee
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | | | | | | | | | | | | | | | - Amol Navathe
- University of Pennsylvania and Navigant Consulting, Inc, Philadelphia, Pennsylvania
| | | | | | - John C Pilotte
- Centers for Medicare and Medicaid Services, Baltimore, Maryland
| | - Thomas J Ryan
- The Ohio State University Heart Center, Columbus, Ohio
| | - Jack Rychik
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - James D Thomas
- Bluhm Cardiovascular Institute of Northwestern University, Chicago, Illinois
| | - Leslie Tucker
- American Board of Internal Medicine and the ABIM Foundation, Philadelphia, Pennsylvania
| | | | | | - Neil J Weissman
- MedStar Health Research Institute, Washington, District of Columbia
| | | | - Sarah Woodruff
- Adult Congenital Heart Association, Philadelphia, Pennsylvania
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Trends in Complications and Outcomes of Patients Undergoing Transfemoral Transcatheter Aortic Valve Replacement: Experience From the PARTNER Continued Access Registry. JACC Cardiovasc Interv 2016; 9:355-363. [PMID: 26803420 DOI: 10.1016/j.jcin.2015.10.050] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/24/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to examine trends in the rates of complications and outcomes of patients undergoing transfemoral transcatheter aortic valve replacement (TF-TAVR). BACKGROUND It is unknown whether an evolution of case selection or accrual of case experience over time has resulted in a change in the rates of complications and outcomes of patients undergoing TF-TAVR. METHODS TF-TAVR patients enrolled in the PARTNER (Placement of AoRTic TraNscathetER Valve Trial) nonrandomized continued access registry (N = 1,063, enrolled March 2011 to January 2012 after completion of the randomized trial) were divided into tertiles (T1 through T3) based on enrollment date. Patient characteristics and rates of adverse events were compared over time. RESULTS There were no significant differences in sex, New York Heart Association functional classes III/IV, diabetes, coronary artery disease, previous revascularization, pulmonary hypertension, renal disease, or liver disease. There was an increase in mean age, but a decrease in porcelain aorta, chronic obstructive pulmonary disease (including oxygen-dependent chronic obstructive pulmonary disease), previous chest wall radiation, and a slight decrease in the median Society of Thoracic Surgeons Predicted Risk of Mortality score. There was a significant decline in the frequency of patients deemed "inoperable" (cohort B) and in need for post-dilation. Percutaneous access increased significantly. There were no differences in post-procedural stroke, major bleeding, major vascular complications, or the need for aortic valve reintervention over time. The incidence of moderate/severe paravalvular regurgitation declined significantly as did all-cause mortality at 1 and 2 years. CONCLUSIONS A significant reduction in the incidence of moderate/severe paravalvular regurgitation as well as longer term all-cause mortality was observed over time. The cause of these reductions was likely multifactorial, including improved case selection and procedural techniques and increased site experience. (THE PARTNER TRIAL [Placement of AoRTic TraNscathetER Valve Trial]; NCT00530894).
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