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Protasiewicz M. Transcatheter aortic valve replacement beneficial in patients with severely reduced left ventricle ejection fraction: does the type of valve also matter? ESC Heart Fail 2024; 11:1813-1815. [PMID: 38840426 PMCID: PMC11287339 DOI: 10.1002/ehf2.14902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024] Open
Affiliation(s)
- Marcin Protasiewicz
- Department of Cardiology, Institute of Heart DiseasesWroclaw Medical UniversityWroclawPoland
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2
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Bain ER, George B, Jafri SH, Rao RA, Sinha AK, Guglin ME. Outcomes in patients with aortic stenosis and severely reduced ejection fraction following surgical aortic valve replacement and transcatheter aortic valve replacement. J Cardiothorac Surg 2024; 19:258. [PMID: 38643131 PMCID: PMC11031863 DOI: 10.1186/s13019-024-02724-9] [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: 11/21/2023] [Accepted: 03/29/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Patients with severe aortic stenosis (AS) and left ventricular (LV) dysfunction demonstrate improvement in left ventricular injection fraction (LVEF) after aortic valve replacement (AVR). The timing and magnitude of recovery in patients with very low LVEF (≤ 25%) in surgical or transcatheter AVR is not well studied. OBJECTIVE Determine clinical outcomes following transcatheter aortic valve replacement (TAVR) and surgical aortic valve repair (SAVR) in the subset of patients with severely reduced EF ≤ 25%. METHODS Single-center, retrospective study with primary endpoint of LVEF 1-week following either procedure. Secondary outcomes included 30-day mortality and delayed postprocedural LVEF. T-test was used to compare variables and linear regression was used to adjust differences among baseline variables. RESULTS 83 patients were enrolled (TAVR = 56 and SAVR = 27). TAVR patients were older at the time of procedure (TAVR 77.29 ± 8.69 vs. SAVR 65.41 ± 10.05, p < 0.001). One week post procedure, all patients had improved LVEF after both procedures (p < 0.001). There was no significant difference in LVEF between either group (TAVR 33.5 ± 11.77 vs. SAVR 35.3 ± 13.57, p = 0.60). Average LVEF continued to rise and increased by 101% at final follow-up (41.26 ± 13.70). 30-day mortality rates in SAVR and TAVR were similar (7.4% vs. 7.1%, p = 0.91). CONCLUSION Patients with severe AS and LVEF ≤ 25% have a significant recovery in post-procedural EF following AVR regardless of method. LVEF doubled at two years post-procedure. There was no significant difference in 30-day mortality or mean EF recovery between TAVR and SAVR. TRIAL REGISTRATION Indiana University institutional review board granted approval for above study numbered 15,322.
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Affiliation(s)
- Eric R Bain
- Department of Internal Medicine, Indiana University School of Medicine, 635 Barnhill Drive Van Nuys Medical Science Building 116, Indianapolis, IN, 46202, USA.
| | - Bistees George
- Department of Internal Medicine, Indiana University School of Medicine, 635 Barnhill Drive Van Nuys Medical Science Building 116, Indianapolis, IN, 46202, USA
| | - Syed H Jafri
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, USA
| | - Roopa A Rao
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, USA
| | - Anjan K Sinha
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, USA
| | - Maya E Guglin
- Indiana University School of Medicine, Krannert Institute of Cardiology, Indianapolis, USA
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3
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Fraccaro C, Karam N, Möllmann H, Bleiziffer S, Bonaros N, Teles RC, Carrilho Ferreira P, Chieffo A, Czerny M, Donal E, Dudek D, Dumonteil N, Esposito G, Fournier S, Hassager C, Kim WK, Krychtiuk KA, Mehilli J, Pręgowski J, Stefanini GG, Ternacle J, Thiele H, Thielmann M, Vincent F, von Bardeleben RS, Tarantini G. Transcatheter interventions for left-sided valvular heart disease complicated by cardiogenic shock: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the Association for Acute Cardiovascular Care (ACVC) and the ESC Working Group on Cardiovascular Surgery. EUROINTERVENTION 2023; 19:634-651. [PMID: 37624587 PMCID: PMC10587846 DOI: 10.4244/eij-d-23-00473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Valvular heart disease (VHD) is one of the most frequent causes of heart failure (HF) and is associated with poor prognosis, particularly among patients with conservative management. The development and improvement of catheter-based VHD interventions have broadened the indications for transcatheter valve interventions from inoperable/high-risk patients to younger/lower-risk patients. Cardiogenic shock (CS) associated with severe VHD is a clinical condition with a very high risk of mortality for which surgical treatment is often deemed a prohibitive risk. Transcatheter valve interventions might be a promising alternative in this setting given that they are less invasive. However, supportive scientific evidence is scarce and often limited to small case series. Current guidelines on VHD do not contain specific recommendations on how to manage patients with both VHD and CS. The purpose of this clinical consensus statement, developed by a group of international experts invited by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Scientific Documents and Initiatives Committee, is to perform a review of the available scientific evidence on the management of CS associated with left-sided VHD and to provide a rationale and practical approach for the application of transcatheter valve interventions in this specific clinical setting.
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Affiliation(s)
- Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Nicole Karam
- Heart Valves Unit, Georges Pompidou European Hospital, Université Paris Cité, INSERM, Paris, France
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | | | - Nikolaos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental (HSC), Carnaxide, Portugal and Comprehensive Health Research Center (CHRC), Nova Medical School, Lisbon, Portugal
| | - Pedro Carrilho Ferreira
- Cardiology Department, Santa Maria University Hospital, CHULN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Centre, Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erwan Donal
- Service de Cardiologie, CCP CHU de Rennes, University of Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Giovanni Esposito
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland and University of Lausanne, Lausanne, Switzerland
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Won-Keun Kim
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Konstantin A Krychtiuk
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Julinda Mehilli
- Department of Cardiology, German Centre for Cardiovascular Research (DZHK), Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik I, Landshut-Achdorf Hospital, Landshut, Germany
| | - Jerzy Pręgowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Giulio G Stefanini
- Department of Biomedical Sciences Humanitas University, Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS Rozzano, Milan, Italy
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC, Canada and Université Laval, Quebec, QC, Canada
- Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, Leipzig, Germany and University of Leipzig, Leipzig, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Flavien Vincent
- Service de Cardiologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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4
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Szotek M, Drużbicki Ł, Sabatowski K, Amoroso GR, De Schouwer K, Matusik PT. Transcatheter Aortic Valve Implantation and Cardiac Conduction Abnormalities: Prevalence, Risk Factors and Management. J Clin Med 2023; 12:6056. [PMID: 37762995 PMCID: PMC10531796 DOI: 10.3390/jcm12186056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Over the last decades, transcatheter aortic valve implantation (TAVI) or replacement (TAVR) has become a potential, widely accepted, and effective method of treating aortic stenosis in patients at moderate and high surgical risk and those disqualified from surgery. The method evolved what translates into a noticeable decrease in the incidence of complications and more beneficial clinical outcomes. However, the incidence of conduction abnormalities related to TAVI, including left bundle branch block and complete or second-degree atrioventricular block (AVB), remains high. The occurrence of AVB requiring permanent pacemaker implantation is associated with a worse prognosis in this group of patients. The identification of risk factors for conduction disturbances requiring pacemaker placement and the assessment of their relation to pacing dependence may help to develop methods of optimal care, including preventive measures, for patients undergoing TAVI. This approach is crucial given the emerging evidence of no worse outcomes for intermediate and low-risk patients undergoing TAVI in comparison to surgical aortic valve replacement. This paper comprehensively discusses the mechanisms, risk factors, and consequences of conduction abnormalities and arrhythmias, including AVB, atrial fibrillation, and ventricular arrhythmias associated with aortic stenosis and TAVI, as well as provides insights into optimized patient care, along with the potential of conduction system pacing and cardiac resynchronization therapy, to minimize the risk of unfavorable clinical outcomes.
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Affiliation(s)
- Michał Szotek
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Łukasz Drużbicki
- Department of Cardiovascular Surgery and Transplantology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
| | - Karol Sabatowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Kraków, Poland
| | - Gisella R. Amoroso
- Department of Cardiovascular Medicine, “SS Annunziata” Hospital, ASL CN1-Savigliano, Via Ospedali 9, 12038 Savigliano, Italy
| | - Koen De Schouwer
- Department of Cardiology, Cardiovascular Center, Onze-Lieve-Vrouwziekenhuis Hospital, Moorselbaan 164, 9300 Aalst, Belgium
| | - Paweł T. Matusik
- Department of Electrocardiology, The John Paul II Hospital, 80 Prądnicka St., 31-202 Kraków, Poland
- Institute of Cardiology, Faculty of Medicine, Jagiellonian University Medical College, 80 Prądnicka St., 31-202 Kraków, Poland
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5
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Stan A, Călburean PA, Drinkal RK, Harpa M, Elkahlout A, Nicolae VC, Tomșa F, Hadadi L, Brînzaniuc K, Suciu H, Mărușteri M. Inflammatory Status Assessment by Machine Learning Techniques to Predict Outcomes in Patients with Symptomatic Aortic Stenosis Treated by Transcatheter Aortic Valve Replacement. Diagnostics (Basel) 2023; 13:2907. [PMID: 37761276 PMCID: PMC10530147 DOI: 10.3390/diagnostics13182907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/17/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
(1) Background: Although transcatheter aortic valve replacement (TAVR) significantly improves long-term outcomes of symptomatic severe aortic stenosis (AS) patients, long-term mortality rates are still high. The aim of our study was to identify potential inflammatory biomarkers with predictive capacity for post-TAVR adverse events from a wide panel of routine biomarkers by employing ML techniques. (2) Methods: All patients diagnosed with symptomatic severe AS and treated by TAVR since January 2016 in a tertiary center were included in the present study. Three separate analyses were performed: (a) using only inflammatory biomarkers, (b) using inflammatory biomarkers, age, creatinine, and left ventricular ejection fraction (LVEF), and (c) using all collected parameters. (3) Results: A total of 338 patients were included in the study, of which 56 (16.5%) patients died during follow-up. Inflammatory biomarkers assessed using ML techniques have predictive value for adverse events post-TAVR with an AUC-ROC of 0.743 and an AUC-PR of 0.329; most important variables were CRP, WBC count and Neu/Lym ratio. When adding age, creatinine and LVEF to inflammatory panel, the ML performance increased to an AUC-ROC of 0.860 and an AUC-PR of 0.574; even though LVEF was the most important predictor, inflammatory parameters retained their value. When using the entire dataset (inflammatory parameters and complete patient characteristics), the ML performance was the highest with an AUC-ROC of 0.916 and an AUC-PR of 0.676; in this setting, the CRP and Neu/Lym ratio were also among the most important predictors of events. (4) Conclusions: ML models identified the CRP, Neu/Lym ratio, WBC count and fibrinogen as important variables for adverse events post-TAVR.
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Affiliation(s)
- Alexandru Stan
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Paul-Adrian Călburean
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Reka-Katalin Drinkal
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Marius Harpa
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Ayman Elkahlout
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
| | - Viorel Constantin Nicolae
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
| | - Flavius Tomșa
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
| | - Laszlo Hadadi
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
| | - Klara Brînzaniuc
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Horațiu Suciu
- Emergency Institute for Cardiovascular Diseases and Transplantation Târgu Mureş, 540136 Târgu Mureş, Romania; (A.S.); (R.-K.D.)
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
| | - Marius Mărușteri
- University of Medicine, Pharmacy, Science and Technology “George Emil Palade” of Târgu Mureş, 540139 Târgu Mureş, Romania
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Canciello G, Pate S, Sannino A, Borrelli F, Todde G, Grayburn P, Losi MA, Esposito G. Pitfalls and Tips in the Assessment of Aortic Stenosis by Transthoracic Echocardiography. Diagnostics (Basel) 2023; 13:2414. [PMID: 37510158 PMCID: PMC10377988 DOI: 10.3390/diagnostics13142414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Aortic stenosis (AS) is a valvular heart disease that significantly contributes to cardiovascular morbidity and mortality worldwide. The condition is characterized by calcification and thickening of the aortic valve leaflets, resulting in a narrowed orifice and increased pressure gradient across the valve. AS typically progresses from a subclinical phase known as aortic sclerosis, where valve calcification occurs without a transvalvular gradient, to a more advanced stage marked by a triad of symptoms: heart failure, syncope, and angina. Echocardiography plays a crucial role in the diagnosis and evaluation of AS, serving as the primary non-invasive imaging modality. However, to minimize misdiagnoses, it is crucial to adhere to a standardized protocol for acquiring echocardiographic images. This is because, despite continuous advances in echocardiographic technology, diagnostic errors still occur during the evaluation of AS, particularly in classifying its severity and hemodynamic characteristics. This review focuses on providing guidance for the imager during the echocardiographic assessment of AS. Firstly, the review will report on how the echo machine should be set to improve image quality and reduce noise and artifacts. Thereafter, the review will report specific emphasis on accurate measurements of left ventricular outflow tract diameter, aortic valve morphology and movement, as well as aortic and left ventricular outflow tract velocities. By considering these key factors, clinicians can ensure consistency and accuracy in the evaluation of AS using echocardiography.
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Affiliation(s)
- Grazia Canciello
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Shabnam Pate
- Division of Cardiology, Baylor Scott & White Research Institute, Plano, TX 75204, USA
| | - Anna Sannino
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
- Division of Cardiology, Baylor Scott & White Research Institute, Plano, TX 75204, USA
| | - Felice Borrelli
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Gaetano Todde
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Paul Grayburn
- Division of Cardiology, Baylor Scott & White Research Institute, Plano, TX 75204, USA
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University, 80131 Naples, Italy
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Ito N, Zen K, Takahara M, Tani R, Nakamura S, Fujimoto T, Takamatsu K, Yashige M, Kadoya Y, Yamano M, Yamano T, Nakamura T, Yaku H, Matoba S. Left ventricular hypertrophy as a predictor of cardiovascular outcomes after transcatheter aortic valve replacement. ESC Heart Fail 2023; 10:1336-1346. [PMID: 36725669 PMCID: PMC10053161 DOI: 10.1002/ehf2.14305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 12/26/2022] [Accepted: 01/16/2023] [Indexed: 02/03/2023] Open
Abstract
AIMS This study aimed to clarify the relationship between cardiovascular prognosis and left ventricular hypertrophy (LVH) in patients with severe aortic stenosis who underwent transcatheter aortic valve replacement (TAVR) and to investigate the relationship between cardiac sympathetic nerve (CSN) function and these factors using 123 I-metaiodobenzylguanidine scintigraphy. METHODS AND RESULTS In this single-centre, retrospective observational study, 349 patients who underwent TAVR at our institution between July 2017 and May 2020 were divided into two groups: those with severe LVH pre-operatively [severe LVH (+) group] and those without LVH pre-operatively [severe LVH (-) group]. The rates of freedom from cardiovascular events (cardiovascular death and heart failure hospitalization) were compared. The relationship between changes in left ventricular mass index (LVMi) and changes in delay heart-mediastinum ratio (H/M) from before TAVR to 6 months after TAVR was also investigated. The event-free rate was significantly lower in the severe LVH (+) group (87.1% vs. 96.0%, log-rank P = 0.021). The severe LVH (+) group exhibited a significantly lower delay H/M value, scored by 123 I-metaiodobenzylguanidine scintigraphy, than the severe LVH (-) group (2.33 [1.92-2.67] vs. 2.67 [2.17-3.68], respectively, P < 0.001). Moreover, the event-free rate of post-operative cardiovascular events was lower among patients with a delay H/M value < 2.50 than that among other patients (87.7% vs. 97.2%, log-rank P = 0.012). LVMi was significantly higher (115 [99-130] vs. 90 [78-111] g/m2 , P < 0.001) and delay H/M value was significantly lower (2.53 [1.98-2.83] vs. 2.71 [2.25-3.19], P = 0.025) in the severe LVH (+) group than in the severe LVH (-) group at 6 months after TAVR. Patients with improved LVH at 6 months after TAVR also had increased delay H/M (from 2.51 [2.01-2.81] to 2.67 [2.26-3.02], P < 0.001), whereas those without improved LVH had no significant change in delay H/M (from 2.64 [2.23-3.06] to 2.53 [1.97-3.00], P = 0.829). CONCLUSIONS Severe LVH before TAVR is a prognostic factor for poor post-operative cardiovascular outcomes. LVH associated with aortic stenosis and CSN function are correlated, suggesting their involvement in LVH prognosis.
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Affiliation(s)
- Nobuyasu Ito
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Motoyoshi Takahara
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryotaro Tani
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shunsuke Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomotaka Fujimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuaki Takamatsu
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masaki Yashige
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Kadoya
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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8
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Mortality at one year after transcatheter aortic valve replacement – Relation of age and comorbidities. IJC HEART & VASCULATURE 2022; 43:101157. [DOI: 10.1016/j.ijcha.2022.101157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 11/14/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
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9
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Schenk J, Kho E, Rellum S, Kromhout J, Vlaar APJ, Baan J, van Mourik MS, Jorstad HT, van der Ster BJP, Westerhof BE, Bruns S, Immink RV, Vis MM, Veelo DP. Immediate reduction in left ventricular ejection time following TAVI is associated with improved quality of life. Front Cardiovasc Med 2022; 9:988840. [PMID: 36187009 PMCID: PMC9523106 DOI: 10.3389/fcvm.2022.988840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTAVI has shown to result in immediate and sustained hemodynamic alterations and improvement in health-related quality of life (HRQoL), but previous studies have been suboptimal to predict who might benefit from TAVI. The relationship between immediate hemodynamic changes and outcome has not been studied before. This study sought to assess whether an immediate hemodynamic change, reflecting myocardial contractile reserve, following TAVI is associated with improved HRQoL. Furthermore, it assessed whether pre-procedural cardiac power index (CPI) and left ventricular ejection fraction (LVEF) could predict these changes.MethodsDuring the TAVI procedure, blood pressure and systemic hemodynamics were prospectively collected with a Nexfin® non-invasive monitor. HRQoL was evaluated pre-procedurally and 12 weeks after the procedure, using the EQ-5D-5L classification tool.ResultsOverall, 97/114 (85%) of the included patients were eligible for analyses. Systolic, diastolic and mean arterial pressure, heart rate, and stroke volume increased immediately after TAVI (all p < 0.005), and left ventricular ejection time (LVET) immediately decreased with 10 ms (95%CI = −4 to −16, p < 0.001). Overall HRQoLindex increased from 0.810 [0.662–0.914] before to 0.887 [0.718–0.953] after TAVI (p = 0.016). An immediate decrease in LVET was associated with an increase in HRQoLindex (0.02 index points per 10 ms LVET decrease, p = 0.041). Pre-procedural CPI and LVEF did not predict hemodynamic changes or change in HRQoL.ConclusionTAVI resulted in an immediate hemodynamic response and increase in HRQoL. Immediate reduction in LVET, suggesting unloading of the ventricle, was associated with an increase in HRQoL, but neither pre-procedural CPI nor LVEF predicted these changes.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03088787
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Affiliation(s)
- Jimmy Schenk
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Jimmy Schenk
| | - Eline Kho
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Santino Rellum
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Joris Kromhout
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Alexander P. J. Vlaar
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Jan Baan
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Martijn S. van Mourik
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Harald T. Jorstad
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Björn J. P. van der Ster
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Berend E. Westerhof
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
- Department of Perinatology, Radboud University Medical Centre, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, Netherlands
| | - Steffen Bruns
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Rogier V. Immink
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Marije M. Vis
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Denise P. Veelo
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
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10
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Sudo M, Shamekhi J, Sedaghat A, Aksoy A, Zietzer A, Tanaka T, Wilde N, Weber M, Sinning JM, Grube E, Veulemans V, Adam M, Kelm M, Baldus S, Nickenig G, Zimmer S, Tiyerili V, Al-Kassou B. Predictive value of the Fibrosis-4 index in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2022; 111:1367-1376. [DOI: 10.1007/s00392-022-02055-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
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11
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Ooms JF, Cornelis K, Stella PR, Rensing BJ, Van Der Heyden J, Chan AW, Wykrzykowska JJ, Rosseel L, Vandeloo B, Lenzen MJ, Cunnington MS, Hildick-Smith D, Wijeysundera HC, Van Mieghem NM. Rationale and design of the Project to look for early discharge in patients undergoing TAVR with ACURATE (POLESTAR Trial). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 44:71-77. [PMID: 35739011 DOI: 10.1016/j.carrev.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/11/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is now an established treatment strategy for elderly patients with symptomatic aortic stenosis (AS) across the entire operative risk spectrum. Streamlined TAVR protocols along with reduced procedure time and expedited ambulation promote early hospital discharge. Selection of patients suitable for safe early discharge after TAVR might improve healthcare efficiency. STUDY DESIGN The POLESTAR trial is an international, multi-center, prospective, observational study which aims to evaluate the safety of early discharge in selected patients who undergo TAVR with the supra-annular functioning self-expanding ACURATE Neo transcatheter heart valve (THV). A total of 250 patients will be included based on a set of baseline criteria indicating potential early discharge (within 48 h post-TAVR). Primary study endpoints include Valve Academic Research Consortium (VARC)-3 defined safety at 30 days and VARC-3 defined efficacy at 30 days and 1 year. Endpoints will be compared between early discharge and non-early discharge cohorts with a distinct landmark analysis at 48 h post-TAVR. Secondary endpoints include quality of life assessed using EQ5D-5L and Kansas City Cardiomyopathy Questionnaire (KCCQ) questionnaires and resource costs compared between discharge groups. SUMMARY The POLESTAR trial prospectively evaluates safety and feasibility of an early discharge protocol for TAVR using the ACURATE Neo THV.
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Affiliation(s)
- Joris F Ooms
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | | | | | | | - Albert W Chan
- Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | | | | | | | - Mattie J Lenzen
- Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - David Hildick-Smith
- Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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12
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Prognostic Implications of Change in Left Ventricular Ejection Fraction After Transcatheter Aortic Valve Implantation. Am J Cardiol 2022; 177:90-99. [PMID: 35691708 DOI: 10.1016/j.amjcard.2022.04.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/15/2022] [Accepted: 04/23/2022] [Indexed: 11/23/2022]
Abstract
Reduced left ventricular (LV) systolic function is associated with worse prognosis in patients with severe aortic stenosis (AS) treated with transcatheter aortic valve implantation (TAVI). We aimed to examine the changes in left ventricular ejection fraction (LVEF) after TAVI among patients with varying baseline LVEF. Moreover, variables associated with lack of LVEF improvement were identified and the association with long-term outcomes was investigated. A total of 560 patients (age 80 ± 7 years, 53% men) with severe AS who underwent transfemoral TAVI between 2007 and 2019 were selected. LVEF was assessed from transthoracic echocardiography at baseline (before TAVI) and at 6 and 12 months after TAVI. Patients were stratified according to baseline LVEF: (1) LVEF ≥50%, (2) LVEF 40% to 49%, and (3) LVEF <40%. The clinical end point was ≥5% LVEF improvement. The primary outcome was all-cause mortality. Patients with baseline LVEF<40% showed greater increase in LVEF than those with baseline LVEF 40% to 49% and LVEF ≥50% (from 33% ± 6% to 43% ± 10%, p <0.001; from 45% ± 3% to 52% ± 8%, p <0.001; and from 58% ± 5% to 59% ± 7%, p = 0.012, respectively, p for interaction <0.001). Coronary artery disease (odds ratio [OR] 1.80 [95% confidence interval (CI) 1.06 to 3.06], p = 0.031), myocardial infarction (OR 2.07 [95% CI 1.19 to 3.61], p = 0.010), and permanent pacemaker (OR: 1.93 [95% CI 1.25 to 3.00], p = 0.003) were independently associated with the lack of ≥5% LVEF improvement. During a median follow-up of 3.8 (interquartile range 2.6 to 5.2) years, 176 patients died (31%). Patients with ≥5% LVEF improvement had similar outcomes compared with those with <5% LVEF improvement (log-rank p = 0.89). In conclusion, patients with severe AS and baseline LVEF <40% had the greatest improvement in LVEF at 1-year follow-up after TAVI. Coronary artery disease, myocardial infarction, and permanent pacemaker were associated with lack of LVEF improvement. However, LVEF improvement at 12 months was not associated with long-term outcomes.
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13
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Shamekhi J, Nguyen TQA, Sigel H, Maier O, Piayda K, Zeus T, Al-Kassou B, Weber M, Zimmer S, Sugiura A, Wilde N, Kelm M, Nickenig G, Veulemans V, Sedaghat A. Left atrial function index (LAFI) and outcome in patients undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2022; 111:944-954. [PMID: 35320406 PMCID: PMC9334426 DOI: 10.1007/s00392-022-02010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/08/2022] [Indexed: 11/18/2022]
Abstract
Background Clinical data regarding the association between the left atrial function index (LAFI) and outcome in patients undergoing transcatheter aortic valve replacement (TAVR) are limited. Objectives We aimed to investigate the association between the left atrial function index (LAFI) and outcome in patients undergoing TAVR. Methods In this retrospective multicenter study, we assessed baseline LAFI in 733 patients undergoing TAVR for severe aortic stenosis in two German high-volume centers between 2008 and 2019. Based on receiver operating characteristic curves, patients were stratified according to their baseline LAFI into two groups (LAFI ≤ 13.5 vs. LAFI > 13.5) and assessed for post-procedural outcome. The primary endpoint of our study was the 1-year all-cause mortality. Results Patients with a LAFI ≤ 13.5 had significantly more often atrial fibrillation (p < 0.001), lower LVEF (p < 0.001) and higher levels of NT-proBNP (p < 0.001). After TAVR, a significant improvement in the LAFI as compared to baseline was observed at 12 months after the procedure (28.4 vs. 32.9; p = 0.001). Compared to patients with a LAFI > 13.5, those with a LAFI ≤ 13.5 showed significantly higher rate of 1-year mortality (7.9% vs. 4.0%; p = 0.03). A lower LAFI has been identified as independent predictor of mortality in multivariate analysis (HR (95% CI) 2.0 (1.1–3.9); p = 0.03). Conclusion A reduced LAFI is associated with adverse outcome and an independent predictor of mortality in TAVR patients. TAVR improves LAFI within 12 months after the procedure. Graphical abstract Left Atrial Function Index (LAFI) in Patients undergoing Transcatheter Aortic Valve Implantation. A Kaplan–Meier survival analysis of 1-year all-cause mortality in patients with LAFI ≤ 13.5 compared with patients with LAFI > 13.5. Comparing rates of 1-year all-cause mortality between the different LAFI groups, we found a significant association between left atrial function and mortality. LAFI Left atrial function index. B Comparison of the mean LAFI before and after TAVR. After long-term follow-up the LAFI improved significantly. LAFI Left atrial function index; FU follow-up. C Assessment of the left atrial function index using the pre-procedural transthoracic echocardiography. A Measurement of the minimal left atrial volume (LAEDV). B Assessment of the maximal left atrial volume (LAESV). ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s00392-022-02010-5.
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Affiliation(s)
- Jasmin Shamekhi
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Thi Quynh Anh Nguyen
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Helen Sigel
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Oliver Maier
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Kerstin Piayda
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Baravan Al-Kassou
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Nihal Wilde
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Malte Kelm
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Verena Veulemans
- Heart Center, Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Alexander Sedaghat
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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14
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Scarsini R, Venturi G, Pighi M, Lunardi M, Kotronias R, Del Sole PA, Rubino F, Tavella D, Pesarini G, Banning A, Ribichini F. Incomplete functional revascularization is associated with adverse clinical outcomes after transcatheter aortic valve implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2022; 42:47-52. [DOI: 10.1016/j.carrev.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/24/2022] [Indexed: 01/09/2023]
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15
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Tadic M, Sala C, Cuspidi C. The role of TAVR in patients with heart failure: do we have the responses to all questions? Heart Fail Rev 2022; 27:1617-1625. [PMID: 35039999 DOI: 10.1007/s10741-021-10206-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/25/2022]
Abstract
Severe aortic stenosis (AS) is the most prevalent valvular heart disease in developed countries. Heart failure (HF) is a frequent comorbidity of this condition and represents a diagnostic and therapeutic challenge. The spectrum of both conditions has become progressively wider in the last decade; HF has been divided in three groups according to left ventricular ejection fraction (LVEF) and severe AS has been reclassified into four groups according to aortic valve (AV) gradient, AV flow measured by LV stroke index, and LVEF. Although all four AS types may be found in patients with signs and symptoms of HF, low-flow AS with low or normal gradient is the most common type in these patients. Several studies have documented that patients with low-flow severe AS have a higher mortality risk than patients with normal-flow and high-gradient AS not only during the natural progression of the disease, but also after either interventional or surgical AV replacement. Existing data support transcatheter AV replacement (TAVR) in patients with severe AS, irrespective of AV gradient, AV flow, and LVEF. Controversial issues, however, are still present on this topic, which has not been adequately addressed by large studies and trials. This clinical review summarizes the epidemiology of the different HF types in patients with severe AS, as well as the impact of HF and LVEF on clinical outcomes of AS patients either untreated or after AV replacement. In particular, we addressed the influence of AV gradient and AV flow on all-cause and cardiovascular mortality in AS patients after TAVR.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, 11000, Belgrade, Serbia.
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano and Fondazione Ospedale Maggiore IRCCS Policlinico Di Milano, Milan, Italy
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16
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Sudo M, Sugiura A, Treiling L, Al-Kassou B, Shamekhi J, Kütting D, Wilde N, Weber M, Zimmer S, Nickenig G, Sedaghat A. Baseline PA/BSA ratio in patients undergoing transcatheter aortic valve replacement - A novel CT-based marker for the prediction of pulmonary hypertension and outcome. Int J Cardiol 2021; 348:26-32. [PMID: 34923001 DOI: 10.1016/j.ijcard.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/16/2021] [Accepted: 12/13/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Pulmonary hypertension (pH) has a prognostic impact on patients undergoing transcatheter aortic valve replacement (TAVR). Pulmonary artery (PA) dilatation assessed by multidetector computed tomography (MDCT) has the potential to predict PH. The aim of the study was to evaluate the clinical parameters associated with PA dilatation and to investigate its prognostic relevance in patients undergoing TAVR. METHODS In 770 patients undergoing TAVR between February 2016 and July 2019, PA diameter was measured by MDCT before TAVR. Additionally, PA diameter divided by ascending aorta diameter or body surface area (BSA) was calculated. RESULTS Of all the CT-derived parameters compared with a receiver operating characteristic curve, the value for PA/BSA with a median of 1.68 (IQR 1.47, 1.91) cm/m2 showed the greatest area-under-the-curve (0.75) for predicting PH at baseline. Based on this median, patients were assigned to a small PA/BSA (n = 386) or a large PA/BSA (n = 384) group. Hereby, a large PA/BSA was independently associated with PH at baseline (OR:8.39 [5.36-13.14], p < 0.001) and after TAVR (OR:1.73 [1.18-2.53], p = 0.005). A large PA/BSA was associated with a significantly higher cumulative two-year all-cause mortality compared to small PA/BSA (30.0% vs. 13.7%, p < 0.001), which was supported in the multivariable model (HR:1.87; 95%CI, 1.12-3.04; p = 0.017). CONCLUSION Patients with a large PA/BSA on MDCT are more likely to have PH at baseline and after TAVR. Large PA/BSA is associated with an increased risk of mortality and could provide additional information for risk stratification in patients undergoing TAVR.
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Affiliation(s)
- Mitsumasa Sudo
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany; Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Louisa Treiling
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Baravan Al-Kassou
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Jasmin Shamekhi
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Daniel Kütting
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - Nihal Wilde
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Marcel Weber
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Bonn, Germany.
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17
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Tsutsui H, Ide T, Ito H, Kihara Y, Kinugawa K, Kinugawa S, Makaya M, Murohara T, Node K, Saito Y, Sakata Y, Shimizu W, Yamamoto K, Bando Y, Iwasaki YK, Kinugasa Y, Mizote I, Nakagawa H, Oishi S, Okada A, Tanaka A, Akasaka T, Ono M, Kimura T, Kosaka S, Kosuge M, Momomura SI. JCS/JHFS 2021 Guideline Focused Update on Diagnosis and Treatment of Acute and Chronic Heart Failure. Circ J 2021; 85:2252-2291. [PMID: 34588392 DOI: 10.1253/circj.cj-21-0431] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Division of Biophysiological Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | | | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Yasuko Bando
- Department of Cardiology, Nagoya University Hospital
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Shogo Oishi
- Department of Cardiology, Himeji Brain and Heart Center
| | - Akiko Okada
- Kitasato University Graduate School of Nursing
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kosaka
- Department of Cardiology, Keio University School of Medicine
| | - Masami Kosuge
- Cardiovascular Center, Yokohama City University Medical Center
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18
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Tsutsui H, Ide T, Ito H, Kihara Y, Kinugawa K, Kinugawa S, Makaya M, Murohara T, Node K, Saito Y, Sakata Y, Shimizu W, Yamamoto K, Bando Y, Iwasaki YK, Kinugasa Y, Mizote I, Nakagawa H, Oishi S, Okada A, Tanaka A, Akasaka T, Ono M, Kimura T, Kosaka S, Kosuge M, Momomura SI. JCS/JHFS 2021 Guideline Focused Update on Diagnosis and Treatment of Acute and Chronic Heart Failure. J Card Fail 2021; 27:1404-1444. [PMID: 34600838 DOI: 10.1016/j.cardfail.2021.04.023] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/16/2021] [Accepted: 04/27/2021] [Indexed: 02/06/2023]
Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomomi Ide
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Division of Biophysiological Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuki Kihara
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - Koichiro Kinugawa
- Second Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Miyuki Makaya
- Kitasato University Graduate School of Nursing, Tokyo, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Yasuko Bando
- Department of Cardiology, Nagoya University Hospital, Nagoya, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hitoshi Nakagawa
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Shogo Oishi
- Department of Cardiology, Himeji Brain and Heart Center, Hyogo, Japan
| | - Akiko Okada
- Kitasato University Graduate School of Nursing, Tokyo, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto, Japan
| | - Shun Kosaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Masami Kosuge
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
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Jeong YJ, Ahn JM, Kang DY, Park H, Ko E, Kim HJ, Kim JB, Choo SJ, Lee SA, Park SJ, Kim DH, Park DW. Incidence, Predictors, and Prognostic Impact of Immediate Improvement in Left Ventricular Systolic Function After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 152:99-105. [PMID: 34127247 DOI: 10.1016/j.amjcard.2021.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
Immediate improvement in left ventricular ejection fraction (LVEF) following transcatheter aortic valve implantation (TAVI) is common; however, data on the pattern and prognostic value of this improvement are limited. To evaluate the incidence, predictors, and clinical impact of immediate improvement in LVEF, we studied 694 consecutive patient who had underwent successful TAVI for severe aortic stenosis (AS) between March 2010 and December 2019. We defined immediate improvement of LVEF as an absolute increase of ≥5% in LVEF at post-procedure echocardiogram. The primary outcome was major adverse cardiac or cerebrovascular event (MACCE), defined as a composite of death from cardiovascular cause, myocardial infarction, stroke, or rehospitalization from cardiovascular cause. Among them, 160 patients showed immediate improvement in LVEF. The independent predictors of immediate LVEF improvement were absence of hypertension and baseline significant aortic regurgitation, and greater baseline LV mass index. Immediate improvement in LVEF was significantly associated with a lower risk of MACCE (adjusted hazard ratio, 0.48; 95% confidence interval, 0.28-0.81; p = 0.01). In conclusion, approximately one-fourth of patients with severe AS who underwent TAVI showed immediate improvement in LVEF during index hospitalization. Immediate LVEF recovery was associated with a lower risk of MACCE during follow-up.
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20
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Gupta T, Joseph DT, Goel SS, Kleiman NS. Predicting and measuring mortality risk after transcatheter aortic valve replacement. Expert Rev Cardiovasc Ther 2021; 19:247-260. [PMID: 33560150 DOI: 10.1080/14779072.2021.1888715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Over the last decade, transcatheter aortic valve replacement (TAVR) has emerged as a treatment option for most patients with severe symptomatic aortic stenosis (AS). With growing indications and exponential increase in the number of TAVR procedures, it is important to be able to accurately predict mortality after TAVR.Areas covered: Herein, we review the surgical and TAVR-specific mortality prediction models (MPMs) and their performance in their original derivation and external validation cohorts. We then discuss the role of other important risk assessment tools such as frailty, echocardiographic parameters, and biomarkers in patients, being considered for TAVR.Expert opinion: Conventional surgical MPMs have suboptimal predictive performance and are mis-calibrated when applied to TAVR populations. Although a number of TAVR-specific MPMs have been developed, their utility is also limited by their modest discriminative ability when applied to populations external to their original derivation cohorts. There is an unmet need for robust TAVR MPMs that accurately predict post TAVR mortality. In the interim, heart teams should utilize the currently available TAVR-specific MPMs in conjunction with other prognostic factors, such as frailty, echocardiographic or computed tomography (CT) imaging parameters, and biomarkers for risk assessment of patients, being considered for TAVR.
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Affiliation(s)
- Tanush Gupta
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Denny T Joseph
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Neal S Kleiman
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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21
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Wilde N, Sugiura A, Sedaghat A, Becher MU, Kelm M, Baldus S, Nickenig G, Veulemans V, Tiyerili V. Risk of mortality following transcatheter aortic valve replacement for low-flow low-gradient aortic stenosis. Clin Res Cardiol 2020; 110:391-398. [PMID: 33052475 DOI: 10.1007/s00392-020-01752-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Low-flow low-gradient (LF-LG) aortic stenosis (AS) is associated with high mortality, even after transcatheter aortic valve replacement (TAVR). Further knowledge of risk indicators is needed and a clinical risk score would be desirable for optimizing patient selection and therapeutic strategy. METHODS The study cohort comprised of 219 consecutive LF-LG AS patients undergoing TAVR from 2008 to 2018 in two high-volume German centers. Predictive factors for one-year all-cause mortality were defined according to a Cox proportional hazard model. RESULTS At one-year follow-up after TAVR, 28% of patients had died. A multivariate model revealed six independent predictors of one-year mortality: history of myocardial infarction (HR 2.05, 95%CI 1.13-3.72), eGFR < 30 ml/min/1.73m2 (HR 2.75, 95%CI 1.48-5.11), tricuspid regurgitation moderate or more (HR 2.06, 95%CI 1.14-3.72), stroke volume index < 25 mL/m2 (HR 2.03, 95%CI 1.14-3.62), self-expandable device (HR 2.72, 95%CI 1.17-6.27), and non-transfemoral approach (HR 3.42, 95%CI 1.28-9.14). The Rhineland Risk Score (RRS) consisting of these variables (c statistic 0.75, 95%CI 0.68-0.82, p < 0.001) was superior to the EuroSCORE II (c statistic 0.63) and STS-PROM score (c statistic 0.69) at predicting one-year mortality. Patients with a RRS ≥ 8 had a prohibitive risk of one-year mortality of 67.6% (95%CI 52.0-82.4%). CONCLUSION In patients with LF-LG AS, history of myocardial infarction, renal dysfunction, tricuspid regurgitation, a low stroke volume index, self-expandable device, and non-femoral approach were associated with increased 1-year mortality after TAVR. The RRS might serve as a helpful tool for risk prediction and patient selection for TAVR in patients with LF-LG AS.
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Affiliation(s)
- Nihal Wilde
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Atsushi Sugiura
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Alexander Sedaghat
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Marc Ulrich Becher
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Stephan Baldus
- Heart Center Cologne, Department of Cardiology, University Hospital Cologne, Cologne, Germany
| | - Georg Nickenig
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Verena Veulemans
- Department of Cardiology, Pulmonology, and Angiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Vedat Tiyerili
- Heart Center Bonn, Department of Medicine II, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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22
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McKinney AR, Meers JB. Transcatheter Aortic Valve Replacement in a Pediatric Patient With a History of Congenital Heart Disease and Recent Post-Procedure Decompensation. J Cardiothorac Vasc Anesth 2020; 34:3385-3389. [PMID: 32536543 DOI: 10.1053/j.jvca.2020.05.002] [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: 01/30/2020] [Revised: 04/27/2020] [Accepted: 05/03/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Adam R McKinney
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL.
| | - Jacob B Meers
- Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL
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23
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Sethi A, Kodumuri V, Prasad V, Chaudhary A, Coromilas J, Kassotis J. Does the Presence of Significant Mitral Regurgitation prior to Transcatheter Aortic Valve Implantation for Aortic Stenosis Impact Mortality? – Meta-Analysis and Systematic Review. Cardiology 2020; 145:428-438. [DOI: 10.1159/000506624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/06/2020] [Indexed: 11/19/2022]
Abstract
Background: Mitral regurgitation (MR) is commonly encountered in patients with severe aortic stenosis (AS). However, its independent impact on mortality in patients undergoing transcatheter aortic valve implantation (TAVI) has not been established. Methods: We performed a systematic search for studies reporting characteristics and outcome of patients with and without significant MR and/or adjusted mortality associated with MR post-TAVI. We conducted a meta-analysis of quantitative data. Results: Seventeen studies with 20,717 patients compared outcomes and group characteristics. Twenty-one studies with 32,257 patients reported adjusted odds of mortality associated with MR. Patients with MR were older, had a higher Society of Thoracic Surgeons score, lower left ventricular ejection fraction, a higher incidence of prior myocardial infarction, atrial fibrillation, and a trend towards higher NYHA class III/IV, but had similar mean gradient, gender, and chronic kidney disease. The MR patients had a higher unadjusted short-term (RR = 1.46, 95% CI 1.30–1.65) and long-term mortality (RR = 1.40, 95% CI 1.18–1.65). However, 16 of 21 studies with 27,777 patients found no association between MR and mortality after adjusting for baseline variables. In greater than half of the patients (0.56, 95% CI 0.45–0.66) MR improved by at least one grade following TAVI. Conclusion: The patients with MR undergoing TAVI have a higher burden of risk factors which can independently impact mortality. There is a lack of robust evidence supporting an increased mortality in MR patients, after adjusting for other compounding variables. MR tends to improve in the majority of patients post-TAVI.
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24
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Kalyoncuoglu M, Ozturk S. Is the Newly Defined R2CHA2DS2-Vasc Score a Predictor for Late Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement? Braz J Cardiovasc Surg 2020; 35:145-154. [PMID: 32369293 PMCID: PMC7199995 DOI: 10.21470/1678-9741-2019-0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the performance of the modified R2CHA2DS2-VASc score for predicting mid-to-long-term mortality (> 30 days) in patients undergoing transcatheter aortic valve replacement (TAVR). Methods Data of 78 patients who underwent TAVR were retrospectively reviewed. R2CHA2DS2-VASc score was compared with the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II or ES II) and the transcatheter valve therapytranscatheter aortic valve replacement (TVT-TAVR) risk score. Results The mean follow-up period was 17.4±9.9 months (maximum 37 months). Early mortality (first 30 days) was observed in 10 (12.8%) patients, whereas mid-to-long-term mortality (> 30 days) was observed in 26 (33.3%) patients. Non-survivors had higher values of R2CHA2DS2-VASc, ES II, and TAVR scores than survivors (P<0.001, P<0.001, and P=0.001, respectively). Analysis of Pearson’s correlation revealed that R2CHA2DS2-VASc score was moderately correlated with ES II and TAVR scores (r=0.51, P<0.001; r=0.44, P=0.001, respectively). Pairwise comparisons of R2CHA2DS2-VASc (area under the curve [AUC]: 0.870, 95% confidence interval [CI]: 0.776-0.964; P<0.001), ES II (AUC: 0.801, 95% CI: 0.703-0.899; P<0.001), and TAVR scores (AUC: 0.730, 95% CI: 0.610-852; P=0.002) showed similar accuracy for predicting mortality. R2CHA2DS2-VASc score is an independent predictor of mortality in multivariable Cox regression analysis. A cutoff value of six for R2CHA2DS2-VASc score showed a sensitivity of 74% and a specificity of 89% for predicting mid-to-long-term mortality. Conclusion R2CHA2DS2-VASc score, easily calculated from clinical parameters, is associated with prediction of mid-to-longterm mortality in patients undergoing TAVR.
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Affiliation(s)
- Muhsin Kalyoncuoglu
- University of Health Sciences Haseki Training and Reseach Hospital Department of Cardiology Istanbul Turkey Department of Cardiology, Haseki Training and Reseach Hospital, University of Health Sciences, Istanbul, Turkey
| | - Semi Ozturk
- University of Health Sciences Haseki Training and Reseach Hospital Department of Cardiology Istanbul Turkey Department of Cardiology, Haseki Training and Reseach Hospital, University of Health Sciences, Istanbul, Turkey
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25
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Maes F, Lerakis S, Barbosa Ribeiro H, Gilard M, Cavalcante JL, Makkar R, Herrmann HC, Windecker S, Enriquez-Sarano M, Cheema AN, Nombela-Franco L, Amat-Santos I, Muñoz-García AJ, Garcia Del Blanco B, Zajarias A, Lisko JC, Hayek S, Babaliaros V, Le Ven F, Gleason TG, Chakravarty T, Szeto W, Clavel MA, de Agustin A, Serra V, Schindler JT, Dahou A, Salah-Annabi M, Pelletier-Beaumont E, Côté M, Puri R, Pibarot P, Rodés-Cabau J. Outcomes From Transcatheter Aortic Valve Replacement in Patients With Low-Flow, Low-Gradient Aortic Stenosis and Left Ventricular Ejection Fraction Less Than 30%: A Substudy From the TOPAS-TAVI Registry. JAMA Cardiol 2020; 4:64-70. [PMID: 30566185 DOI: 10.1001/jamacardio.2018.4320] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance In low-flow, low-gradient aortic stenosis (LFLG AS), the severity of left ventricular dysfunction remains a key factor in the evaluation of aortic valve replacement. Objective To evaluate the clinical outcomes and changes in left ventricular ejection fraction (LVEF) after transcatheter aortic valve replacement (TAVR) in patients with LFLG AS and severe left ventricular dysfunction. Design, Setting, and Participants This multicenter registry is a substudy of the True or Pseudo-Severe Aortic Stenosis-TAVI registry that included patients with classic LFLG AS, defined as a mean transvalvular gradient less than 35 mm Hg, an effective orifice area less than 1.0 cm2, and an LVEF of 40% or less. Patients were divided in groups with very low (<30%) LVEF and low (30%-40%) LVEF. Dobutamine stress echocardiography (DSE) was performed before TAVR in a subset with very low LVEF, and presence of contractile reserve was defined as an increase of 20% or more in stroke volume. Clinical outcomes were assessed at 1 and 12 months and yearly thereafter, and echocardiography was performed at 1-year follow-up. Retrospective data were collected from 2007 to 2013 and prospective data from January 2013 to March 2018. Data were analyzed from March to October 2018. Exposures Transcatheter aortic valve replacement in patients with LFLG AS. Main Outcomes and Measures Changes in LVEF over time; periprocedural and late mortality. Results A total of 293 patients were included, including 128 (43.7%) with very low LVEF and 165 with low LVEF (56.3%). Their mean (SD) age was 80 (7) years, and most (214 [73.0%]) were men. The mean (SD) LVEF in the very low LVEF group was 22% (5%), compared with 37% (7%) in the low LVEF group (P < .001). There were no differences between groups in rates of periprocedural mortality and late mortality (median [interquartile range], 23 [6-38] months). Patients with very low LVEF displayed a greater increase in LVEF at the 1-year follow-up examination (mean absolute increase, 11.9% [95% CI, 8.8%-15.1%]), than the low LVEF group (3.6% [95% CI, 1.1%-6.1%]; P < .001). In 92 patients with very low LVEF who had preprocedural DSE, results showed a lack of contractile reserve in 45 (49%), but this had no effect on clinical outcomes or changes in LVEF over time. Conclusions and Relevance In patients with LFLG AS and severe left ventricular dysfunction, TAVR was associated with similar clinical outcomes as in counterparts with milder left ventricular dysfunction. The TAVR procedure was associated with a significant increase in LVEF, irrespective of contractile reserve. These results support TAVR for LFLG AS, irrespective of the severity of left ventricular dysfunction and DSE results.
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Affiliation(s)
- Frédéric Maes
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Martine Gilard
- Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - João L Cavalcante
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Raj Makkar
- Cedars Sinai Heart Institute, Los Angeles, California
| | | | | | | | - Asim N Cheema
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | - Alan Zajarias
- Washington University in St Louis School of Medicine, St Louis, Missouri
| | | | | | | | - Florent Le Ven
- Centre Hospitalier Régional et Universitaire de Brest, Brest, France
| | - Thomas G Gleason
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Wilson Szeto
- University of Pennsylvania Medical Center, Philadelphia
| | - Marie-Annick Clavel
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada.,Mayo Clinic, Rochester, Minnesota
| | | | - Vicenç Serra
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - John T Schindler
- University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Abdellaziz Dahou
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | | | - Melanie Côté
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | | | - Philippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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26
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Takagi H, Hari Y, Nakashima K, Yokoyama Y, Ueyama H, Kuno T, Ando T. Baseline left ventricular diastolic dysfunction affects midterm mortality after transcatheter aortic valve implantation. J Card Surg 2019; 35:536-543. [PMID: 31886935 DOI: 10.1111/jocs.14409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine whether preprocedural left ventricular (LV) diastolic dysfunction impairs midterm mortality after transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS), we performed a meta-analysis of currently available evidence. METHODS We identified all studies investigating impact of preprocedural severity of LV diastolic dysfunction on midterm (≥1-year) all-cause mortality after TAVI for patients with AS through a search of databases (MEDLINE and EMBASE) until September 2019. From each study, we extracted an adjusted (if unavailable, unadjusted) hazard ratio (HR) of midterm mortality. We pooled study-specific estimates in the random-effects model. RESULTS Ten eligible studies with a total of 2380 patients with AS undergoing TAVI were identified. In accordance with pooled analyses, higher-grade preprocedural LV diastolic dysfunction was associated with significantly worse midterm all-cause mortality after TAVI compared to lower-grade dysfunction (HR for grade II vs I, 1.15; P = .002; HR for grade III vs I, 1.35; P = .001; HR for grade III vs II; 1.16, P = .002; HR for grade II-III vs I, II-III vs 0-I, or III vs I-II, 1.34; P < .00001 [primary meta-analysis]; HR per grade, 1.16; P = .003). No funnel plot asymmetry for the primary meta-analysis (for grade II-III vs I, II-III vs 0-I, or III vs I-II) was identified, which probably indicated no publication bias (P = .381 by the linear-regression test). CONCLUSION Higher-grade preprocedural LV diastolic dysfunction was associated with worse midterm all-cause mortality after TAVI for patients with AS compared to lower-grade dysfunction.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yujiro Yokoyama
- Department of Surgery, Easton Hospital, Easton, Pennsylvania
| | - Hiroki Ueyama
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Tomo Ando
- Division of Interventional Cardiology, Department of Cardiology, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
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27
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Tsutsui H, Isobe M, Ito H, Ito H, Okumura K, Ono M, Kitakaze M, Kinugawa K, Kihara Y, Goto Y, Komuro I, Saiki Y, Saito Y, Sakata Y, Sato N, Sawa Y, Shiose A, Shimizu W, Shimokawa H, Seino Y, Node K, Higo T, Hirayama A, Makaya M, Masuyama T, Murohara T, Momomura SI, Yano M, Yamazaki K, Yamamoto K, Yoshikawa T, Yoshimura M, Akiyama M, Anzai T, Ishihara S, Inomata T, Imamura T, Iwasaki YK, Ohtani T, Onishi K, Kasai T, Kato M, Kawai M, Kinugasa Y, Kinugawa S, Kuratani T, Kobayashi S, Sakata Y, Tanaka A, Toda K, Noda T, Nochioka K, Hatano M, Hidaka T, Fujino T, Makita S, Yamaguchi O, Ikeda U, Kimura T, Kohsaka S, Kosuge M, Yamagishi M, Yamashina A. JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure - Digest Version. Circ J 2019; 83:2084-2184. [PMID: 31511439 DOI: 10.1253/circj.cj-19-0342] [Citation(s) in RCA: 411] [Impact Index Per Article: 82.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Hiroshi Ito
- Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Division of Biophysiological Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Atsushi Hirayama
- The Division of Cardiology, Department of Medicine, Nihon University Graduate School of Medicine
| | | | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Masafumi Yano
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Kenji Yamazaki
- Department of Cardiology Surgery, Tokyo Women's Medical University
| | - Kazuhiro Yamamoto
- Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
| | | | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shiro Ishihara
- Department of Cardiology, Nippon Medical School Musashi-Kosugi Hospital
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
| | | | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Mahoto Kato
- Department of Cardiovascular Medicine, Nihon University Graduate School of Medicine
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shigeki Kobayashi
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | | | - Takeo Fujino
- Department of Advanced Cardiopulmonary Failure, Kyushu University Graduate School of Medical Sciences
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Osamu Yamaguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Akira Yamashina
- Medical Education Promotion Center, Tokyo Medical University
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28
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Furer A, Chen S, Redfors B, Elmariah S, Pibarot P, Herrmann HC, Hahn RT, Kodali S, Thourani VH, Douglas PS, Alu MC, Fearon WF, Passeri J, Malaisrie SC, Crowley A, McAndrew T, Genereux P, Ben-Yehuda O, Leon MB, Burkhoff D. Effect of Baseline Left Ventricular Ejection Fraction on 2-Year Outcomes After Transcatheter Aortic Valve Replacement. Circ Heart Fail 2019; 12:e005809. [DOI: 10.1161/circheartfailure.118.005809] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background:
Impaired left ventricular function is associated with worse prognosis among patients with aortic stenosis treated medically or with surgical aortic valve replacement. It is unclear whether reduced left ventricular ejection fraction (LVEF) is an independent predictor of adverse outcomes after transcatheter aortic valve replacement.
Methods and Results:
Patients who underwent transcatheter aortic valve replacement in the PARTNER 2 trials (Placement of Aortic Transcatheter Valves) and registries were stratified according to presence of reduced LVEF (<50%) at baseline, and 2-year risk of cardiovascular mortality was compared using Kaplan–Meier methods and multivariable Cox proportional hazards regression. Of 2991 patients, 839 (28%) had reduced LVEF. These patients were younger, more often males, and were more likely to have comorbidities, such as coronary disease, diabetes mellitus, and renal insufficiency. Compared with patients with normal LVEF, patients with low LVEF had higher crude rates of 2-year cardiovascular mortality (19.8% versus 12.0%,
P
<0.0001) and all-cause mortality (27.4% versus 19.2%,
P
<0.0001). Mean aortic valve gradient was not associated with clinical outcomes other than heart failure hospitalizations (hazard ratio [HR], 0.99; CI, 0.99–1.00;
P
=0.03). After multivariable adjustment, patients with reduced versus normal LVEF had significantly higher adjusted risk of cardiovascular death (adjusted HR, 1.42, 95% CI, 1.11–1.81;
P
=0.005), but not all-cause death (adjusted HR, 1.20; 95% CI, 0.99–1.47;
P
=0.07). When LVEF was treated as continuous variable, it was associated with increased 2-year risk of both cardiovascular mortality (adjusted HR per 10% decrease in LVEF, 1.16; 95% CI, 1.07–1.27;
P
=0.0006) and all-cause mortality (adjusted HR, 1.09; 95% CI, 1.01–1.16;
P
=0.02).
Conclusions:
In this patient-level pooled analysis of PARTNER 2 patients who underwent transcatheter aortic valve replacement, baseline LVEF was an independent predictor of 2-year cardiovascular mortality.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifiers: NCT01314313, NCT02184442, NCT03222128, and NCT02184441.
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Affiliation(s)
- Ariel Furer
- Cardiovascular Research Foundation, New York, NY (A.F., S.C., B.R., M.C.A., A.C., T.M., O.B.-Y., M.B.L., D.B.)
- IDF Medical Corps Headquarters, Israel (A.F.)
- School of Military Medicine, Hadassah Medical Center, Jerusalem, Israel (A.F.)
| | - Shmuel Chen
- Cardiovascular Research Foundation, New York, NY (A.F., S.C., B.R., M.C.A., A.C., T.M., O.B.-Y., M.B.L., D.B.)
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, NY (A.F., S.C., B.R., M.C.A., A.C., T.M., O.B.-Y., M.B.L., D.B.)
- Sahlgrenska University Hospital, Göteborg, Sweden (B.R.)
| | - Sammy Elmariah
- Department of Cardiology, Massachusetts General Hospital, Boston (S.E., J.P.)
| | - Philippe Pibarot
- Department of Medicine, Quebec Heart & Lung Institute Laval University, Canada (P.P.)
| | - Howard C. Herrmann
- Department of Medicine, University of Pennsylvania, Philadelphia (H.C.H.)
| | - Rebecca T. Hahn
- Department of Medicine, Columbia University Medical Center, New York, NY (R.T.H., S.K., M.C.A., M.B.L., D.B.)
| | - Susheel Kodali
- Department of Medicine, Columbia University Medical Center, New York, NY (R.T.H., S.K., M.C.A., M.B.L., D.B.)
| | - Vinod H. Thourani
- MedStar Heart & Vascular Institute, Georgetown University School of Medicine, Washington, DC (V.H.T.)
| | - Pamela S. Douglas
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (P.S.D.)
| | - Maria C. Alu
- Cardiovascular Research Foundation, New York, NY (A.F., S.C., B.R., M.C.A., A.C., T.M., O.B.-Y., M.B.L., D.B.)
- Department of Medicine, Columbia University Medical Center, New York, NY (R.T.H., S.K., M.C.A., M.B.L., D.B.)
| | - William F. Fearon
- Department of Medicine (Cardiovascular Medicine), Stanford University, CA (W.F.F.)
| | - Jonathan Passeri
- Department of Cardiology, Massachusetts General Hospital, Boston (S.E., J.P.)
| | - S. Chris Malaisrie
- Division of Cardiac Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL (S.C.M.)
| | - Aaron Crowley
- Cardiovascular Research Foundation, New York, NY (A.F., S.C., B.R., M.C.A., A.C., T.M., O.B.-Y., M.B.L., D.B.)
| | - Thomas McAndrew
- Cardiovascular Research Foundation, New York, NY (A.F., S.C., B.R., M.C.A., A.C., T.M., O.B.-Y., M.B.L., D.B.)
| | - Philippe Genereux
- Gagnon Cardiovascular Institute, Morristown Medical Center, NJ (P.G.)
| | - Ori Ben-Yehuda
- Cardiovascular Research Foundation, New York, NY (A.F., S.C., B.R., M.C.A., A.C., T.M., O.B.-Y., M.B.L., D.B.)
| | - Martin B. Leon
- Cardiovascular Research Foundation, New York, NY (A.F., S.C., B.R., M.C.A., A.C., T.M., O.B.-Y., M.B.L., D.B.)
- Department of Medicine, Columbia University Medical Center, New York, NY (R.T.H., S.K., M.C.A., M.B.L., D.B.)
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York, NY (A.F., S.C., B.R., M.C.A., A.C., T.M., O.B.-Y., M.B.L., D.B.)
- Department of Medicine, Columbia University Medical Center, New York, NY (R.T.H., S.K., M.C.A., M.B.L., D.B.)
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29
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Soon KH, Kooistra NHM, Voskuil M, Kraaijeveld AO, Stella PR. LV systolic dysfunction stands to gain the most post transcatheter aortic valve implantation (TAVI). ASIAINTERVENTION 2019; 5:142-148. [PMID: 36483532 PMCID: PMC9706768 DOI: 10.4244/aij-d-18-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 05/02/2019] [Indexed: 06/17/2023]
Abstract
AIMS We aimed to evaluate the extent of left ventricular (LV) recovery post transcatheter aortic valve implantation (TAVI) and its clinical predictors. METHODS AND RESULTS This was a retrospective study on patients treated with TAVI from August 2008 to September 2017. Patients were sub-classified according to their baseline LV function as normal, mildly impaired, moderately impaired or severely impaired. Echo pre TAVI and early post TAVI were compared to assess LV function change. Predictors of LV function change were sought from univariate and multivariate ordinal logistic regression analyses. There were 662 patients included in this study. Nearly half of them, 323 patients (49%), had abnormal LV systolic dysfunction of various degrees. Of these, 193 (60%) showed LV function improvement post TAVI. Based on their pre-TAVI LV function, 55% of the mild LV dysfunction cohort, 62% of the moderate LV dysfunction cohort and 74% of the severe LV dysfunction cohort had LV function improvement post TAVI. Multivariate logistic regression analysis revealed baseline LV dysfunction as the only significant predictor of LV function improvement post TAVI. CONCLUSIONS The majority of patients with baseline LV dysfunction had LV improvement post TAVI, more so those patients with severe LV dysfunction.
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Affiliation(s)
- Kean H Soon
- Department of Medicine-Western Health and Epworth Clinical School, The University of Melbourne, Melbourne, Australia
| | - Nynke H M Kooistra
- Hart en Longen, Cardiologie, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands
| | - Michiel Voskuil
- Hart en Longen, Cardiologie, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands
| | - Adriaan O Kraaijeveld
- Hart en Longen, Cardiologie, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands
| | - Pieter R Stella
- Hart en Longen, Cardiologie, Universitair Medisch Centrum Utrecht, Utrecht, the Netherlands
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30
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The MAGGIC risk score predicts mortality in patients undergoing transcatheter aortic valve replacement: sub-analysis of the OCEAN-TAVI registry. Heart Vessels 2019; 34:1976-1983. [PMID: 31144098 DOI: 10.1007/s00380-019-01443-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/24/2019] [Indexed: 10/26/2022]
Abstract
This study is aimed to evaluate the performance of MAGGIC risk score for predicting mortality by external validation using multicenter transcatheter aortic valve replacement (TAVR) registry. We assessed 1383 patients who underwent TAVR from October 2013 to April 2016. Patients were divided into 2 groups according to the median of MAGGIC score and we compared the incidence of all-cause death between high and low MAGGIC score. To assess whether the MAGGIC risk score add prognostic value on STS risk score, we also compared the incidence of all-cause death between the 2 groups according to low, intermediate, and high STS score. The median of MAGGIC score was 29 (interquartile range: 13-46). Within 2 years, 147 cases of all-cause death were observed. The high MAGGIC (30-46) risk score was significantly associated with an increased risk of all-cause death as compared to low MAGGIC (11-29) risk score and this relationship was also observed in patients with high STS risk score. However, this relationship was not observed in patients with low and intermediate STS score. Multivariate analysis showed that the MAGGIC risk score was an independent predictor of all-cause death (hazard ratio, 1.07; 95% confidence interval, 1.03-1.11). Our results demonstrated that the MAGGIC score predicts all-cause death in TAVR population and provides better risk stratification, particularly in patients with high STS risk.
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31
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Imnadze G, Hofmann S, Billion M, Ferdosi A, Kowalski M, Smith KH, Deutsch C, Bramlage P, Warnecke H, Franz N. Transapical transcatheter aortic valve implantation in patients with a low ejection fraction. Interact Cardiovasc Thorac Surg 2019; 26:224-229. [PMID: 29049741 DOI: 10.1093/icvts/ivx315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/21/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES It may be expected that patients with left ventricular dysfunction may be at greater risk of complications after transcatheter aortic valve implantation (TAVI) via transapical (TA) access compared with via transfemoral (TF) access. There is a lack of data comparing the outcomes of TAVI using TA and TF access in patients with a reduced left ventricular ejection fraction (EF). METHODS This is a retrospective analysis of data from a high-volume heart centre in Germany. TAVI access route assignment was based on a 'best for TF' approach, where only patients who met a strict set of criteria underwent TF-TAVI, with the remainder receiving TA-TAVI. For this analysis, patients were included if they had a pre-TAVI EF of ≤ 40%. Early mortality and late (1-year) mortality were compared through multivariate logistic regression. RESULTS A total of 342 patients in the registry had an EF of ≤ 40%, of which 74.9% underwent TA-TAVI and 25.1% underwent TF-TAVI. Higher proportions of the TA group presented with certain comorbidities, and their logistic EuroSCORE and Society of Thoracic Surgeons (STS) risk scores were higher than in the TF group. At 1 year, TA access was associated with greater mortality in the univariate analysis (odd ratio 2.43; 95% confidence interval 1.04-5.69). However, after multivariate adjustment, no significant differences were found in either 30-day or 1-year mortality rates. CONCLUSIONS The data suggest that, for patients with a reduced EF, TA-TAVI is not associated with a poorer outcome compared with TF-TAVI. Therefore, TA access should not be discounted based on the presence of left ventricular dysfunction alone.
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Affiliation(s)
- Guram Imnadze
- Institut für Gesundheitsforschung und Bildung, Universität Osnabrück, Osnabrück, Germany.,Department of Cardiology, Klinikum Osnabrück, Am Finkenhügel 1, Osnabrück, Germany
| | - Steffen Hofmann
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Michael Billion
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Abbas Ferdosi
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Marek Kowalski
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Katherine H Smith
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Henning Warnecke
- Department of Cardiac Surgery, Schüchtermann Clinic, Bad Rothenfelde, Germany.,Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany
| | - Norbert Franz
- Department of Cardiology, Schüchtermann Clinic, Bad Rothenfelde, Germany.,University Witten-Herdecke, Witten, Germany
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32
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Schiattarella GG, Perrino C. Inflammation in aortic stenosis: Shaping the biomarkers network. Int J Cardiol 2019; 274:279-280. [PMID: 30017518 DOI: 10.1016/j.ijcard.2018.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Gabriele G Schiattarella
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy; Department of Internal Medicine (Cardiology), University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
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33
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El-Chilali K, Patsalis PC, Al-Rashid F, Kahlert HA, Riebisch M, Mincu RI, Totzeck M, Lind A, Jánosi RA, Kehren C, Dirkmann D, Peters J, Wendt D, Jakob H, Rassaf T, Kahlert P. Impact of baseline left ventricular ejection fraction on outcome after transfemoral transcatheter aortic valve implantation in patients with and without low-gradient aortic stenosis. Echocardiography 2018; 36:28-37. [PMID: 30484901 DOI: 10.1111/echo.14203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 10/10/2018] [Accepted: 11/01/2018] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES To evaluate the impact of baseline left ventricular ejection fraction (LVEF) and its interaction with low-gradient aortic stenosis (LGAS) on all-cause mortality after transfemoral aortic valve implantation (TF-TAVI). METHODS We reviewed mortality data of 624 consecutive single center TF-TAVI patients and categorized LVEF according to current ASE/EACVI recommendations (normal, mildly-, moderately-, and severely abnormal). RESULTS Baseline LVEF was normal in 336 (53.8%), mildly abnormal in 160 (25.6%), moderately abnormal in 91 (14.6%), and severely abnormal in 37 (5.9%) patients, and 1-year mortality was 19%, 17%, 23%, and 43% (P = 0.002), respectively. Patients with LGAS had a similar 1-year mortality compared to those without LGAS in groups with normal (19% vs 19%, P = 0.899) and mildly abnormal LVEF (16% vs 17%, P = 0.898). One-year mortality of patients with LGAS was significantly greater than in those without LGAS in presence of moderately abnormal LVEF (31% vs 11%, P = 0.022), and it was numerically greater than in those without LGAS in presence of severely abnormal LVEF (48% vs 25%, P = 0.219). In multivariate analysis, only the combination of moderately/severely abnormal LVEF and LGAS predicted increased 1-year mortality (HR: 2.12, 95% CI: 1.4-3.2, P < 0.001). Other variables, including EuroSCORE I did not affect this result. CONCLUSIONS Moderately/severely abnormal LVEF (≤40%) at baseline is associated with increased mortality after TF-TAVI, especially when the mean transvalvular aortic gradient is <40 mm Hg (LGAS), while outcomes in patients with normal and mildly abnormal LVEF are comparable regardless of the pressure gradient across the native aortic valve. (DRKS00013729).
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Affiliation(s)
- Karim El-Chilali
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Polykarpos Christos Patsalis
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Fadi Al-Rashid
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Heike Annelie Kahlert
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Matthias Riebisch
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Raluca-Ileana Mincu
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Matthias Totzeck
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Alexander Lind
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Rolf Alexander Jánosi
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Clemens Kehren
- Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Daniel Dirkmann
- Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Jürgen Peters
- Clinic for Anesthesiology and Intensive Care, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Daniel Wendt
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Philipp Kahlert
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, Essen University Hospital, Duisburg-Essen University, Essen, Germany
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34
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Hahn RT, Nicoara A, Kapadia S, Svensson L, Martin R. Echocardiographic Imaging for Transcatheter Aortic Valve Replacement. J Am Soc Echocardiogr 2018; 31:405-433. [DOI: 10.1016/j.echo.2017.10.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Indexed: 02/06/2023]
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35
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Mechanical Intervention for Aortic Valve Stenosis in Patients With Heart Failure and Reduced Ejection Fraction. J Am Coll Cardiol 2017; 70:3026-3041. [PMID: 29241492 DOI: 10.1016/j.jacc.2017.10.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/11/2022]
Abstract
The risk and benefit of mechanical interventions in valvular heart disease have been primarily described among patients with normal ejection fraction. The advent of nonsurgical mechanical interventions for aortic stenosis (transcatheter aortic valve replacement) may alter the risk-benefit ratio for patients who would otherwise be at increased risk for valve surgery. This review describes the epidemiology and pathophysiology of aortic stenosis with heart failure and reduced ejection fraction and summarizes the current registry and clinical trial data applicable to this frequently encountered high-risk group. It concludes with discussion of ongoing trials, new approaches, emerging indications, and a potential clinical algorithm incorporating optimal mechanical intervention for patients with aortic stenosis and concomitant reduced ejection fraction.
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36
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Sannino A, Giugliano G, Toscano E, Schiattarella GG, Franzone A, Tesorio T, Trimarco B, Esposito G, Stabile E. Double layered stents for carotid angioplasty: A meta-analysis of available clinical data. Catheter Cardiovasc Interv 2017; 91:751-757. [DOI: 10.1002/ccd.27421] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 09/26/2017] [Accepted: 10/30/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Anna Sannino
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Giuseppe Giugliano
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Evelina Toscano
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Gabriele G. Schiattarella
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Anna Franzone
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Tullio Tesorio
- Division of Invasive Cardiology; Clinica Montevergine; Mercogliano Italy
| | - Bruno Trimarco
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Giovanni Esposito
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
| | - Eugenio Stabile
- Division of Cardiology; University of Naples “Federico II”; Naples Italy
- Department of Advanced Biomedical Sciences; University of Naples “Federico II”; Naples Italy
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37
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Abramowitz Y, Chakravarty T, Pibarot P, Maeno Y, Kawamori H, Anderson D, Mangat G, Nakamura M, Cheng W, Makkar RR. Characteristics and outcome following transcatheter aortic valve replacement in patients with severe aortic stenosis with low flow. EUROINTERVENTION 2017; 13:e1428-e1435. [PMID: 28870874 DOI: 10.4244/eij-d-17-00139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Only a few studies have examined the respective impact of low flow (LF), low gradient (LG) and low ejection fraction (LEF) on outcomes following transcatheter aortic valve replacement (TAVR). The purpose of this study was to assess the impact of preprocedural stroke volume index, aortic valve gradient, left ventricular ejection fraction (LVEF) and different flow/gradient/LVEF patterns on the clinical outcomes of patients with severe aortic stenosis (AS) who undergo TAVR. METHODS AND RESULTS We analysed the clinical, echocardiographic, and outcome data collected in 770 patients with AS who underwent TAVR. Overall, 357 patients had normal flow (NF) AS and 413 had LF AS. Patients with NF had similar one-year mortality (12.0% vs. 15.0%, p=0.23) compared with those in the LF group. Overall, patients with NF and/or HG had lower one-year mortality rates (11.7 to 13%) compared to those with paradoxical LF-LG with NEF (19%) and those with classical LF-LG with LEF (27.3%). Low mean gradient was an independent predictor of all-cause mortality (hazard ratio: 1.14, per 10 mmHg decrease, p=0.02). Despite significant association in univariable analyses, LF and LEF were not found to be predictors of outcomes in multivariable analyses. CONCLUSIONS Patients with HG and those with NF-LG have low one-year mortality rates following TAVR, whereas those with classical LF-LG and LEF and those with paradoxical LF-LG and NEF have high and intermediate risk of mortality, respectively. In contradiction to previous reports, LG but not LF or LEF is an independent predictor of late mortality in high-risk patients with severe AS undergoing TAVR.
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Affiliation(s)
- Yigal Abramowitz
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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38
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Kiramijyan S, Koifman E, Magalhaes MA, Ben-Dor I, Didier R, Jerusalem ZD, Kumar S, Tavil-Shatelyan A, Rogers T, Steinvil A, Gai J, Torguson R, Satler LF, Pichard AD, Waksman R. Intraprocedural invasive hemodynamic parameters as predictors of short- and long-term outcomes in patients undergoing transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:257-262. [PMID: 29174824 DOI: 10.1016/j.carrev.2017.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Evaluation of invasive hemodynamic parameters as prognostic markers of mortality in patients undergoing TAVR. BACKGROUND The value of invasive intraprocedural hemodynamic evaluation of patients undergoing transcatheter aortic valve replacement is unclear. METHODS Consecutive patients who underwent transfemoral TAVR and had complete prospectively collected intraprocedural invasive hemodynamic parameters were retrospectively analyzed. Patients with alternative access, planned general anesthesia, or baseline ≥moderate Tricuspid Regurgitation were excluded. Pre- and post-valve implant parameters included heart rate, systolic and diastolic blood pressures, cardiac output and index, pulmonary arterial systolic and diastolic pressures, transaortic pressure gradient and right atrial pressure. The primary end points were the association of the intraprocedural hemodynamic changes with all-cause mortality at 30days and 1year. Extensive Receiver Operating Characteristic analyses yielded dichotomized threshold of hemodynamic values in association with the binary outcome of mortality. RESULTS A total of 312 patients (52% male, mean age 83years) were evaluated. A significant association with 30-day and 1-year mortality was found between intraprocedural post-valve implant cardiac index <1.9 vs. ≥1.9L/min/m2 (Log-ranked p=0.0286 and p=0.0432, respectively). Four subgroups with pre- and post-valve implant CI changes (L/min/m2) were compared: [1] pre<1.9, stable_post<1.9; [2] pre<1.9, improved_post≥1.9; [3] pre≥1.9, stable_post≥1.9; and [4] pre≥1.9, worsened_post<1.9. Group 1 (lower CI with no post-valve improvement) had the worst survival, and Group 3 (higher CI and stable post-valve) had the best survival at 1-year follow-up (Log-ranked p=0.0089). CONCLUSIONS In patients with severe aortic stenosis undergoing TAVR, invasive monitoring can assess for hemodynamic prognostic markers of survival.
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Affiliation(s)
- Sarkis Kiramijyan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Edward Koifman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Marco A Magalhaes
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Romain Didier
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Zachary D Jerusalem
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Sandeep Kumar
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Arpi Tavil-Shatelyan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Arie Steinvil
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Jiaxiang Gai
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Rebecca Torguson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Augusto D Pichard
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Georgetown University Hospital, Washington, D.C., USA.
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Schiattarella GG, Sannino A, Toscano E, Giugliano G, Gargiulo G, Franzone A, Trimarco B, Esposito G, Perrino C. Gut microbe-generated metabolite trimethylamine-N-oxide as cardiovascular risk biomarker: a systematic review and dose-response meta-analysis. Eur Heart J 2017; 38:2948-2956. [DOI: 10.1093/eurheartj/ehx342] [Citation(s) in RCA: 281] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 06/05/2017] [Indexed: 12/11/2022] Open
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Musa TA, Uddin A, Swoboda PP, Fairbairn TA, Dobson LE, Singh A, Garg P, Steadman CD, Erhayiem B, Kidambi A, Ripley DP, McDiarmid AK, Haaf P, Blackman DJ, Plein S, McCann GP, Greenwood JP. Cardiovascular magnetic resonance evaluation of symptomatic severe aortic stenosis: association of circumferential myocardial strain and mortality. J Cardiovasc Magn Reson 2017; 19:13. [PMID: 28173819 PMCID: PMC5297161 DOI: 10.1186/s12968-017-0329-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/18/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND It is unknown whether circumferential strain is associated with prognosis after treatment of aortic stenosis (AS). We aimed to characterise strain in severe AS, using myocardial tagging cardiovascular magnetic resonance (CMR), prior to and following Transcatheter Aortic Valve Implantation (TAVI) and Surgical Aortic Valve Replacement (SAVR), and determine whether abnormalities in strain were associated with outcome. METHODS CMR was performed pre- and 6 m post-intervention in 98 patients (52 TAVI, 46 SAVR; 77 ± 8 years) with severe AS. TAVI patients were older (80.9 ± 6.4 vs. 73.0 ± 7.0 years, p < 0.01) with a higher STS score (2.06 ± 0.6 vs. 6.03 ± 3.4, p < 0.001). Tagged cine images were acquired at the basal, mid and apical LV levels with a complementary spatial modulation of magnetization (CSPAMM) pulse sequence. Circumferential strain, strain rate and rotation were calculated using inTag© software. RESULTS No significant change in basal or mid LV circumferential strain, or of diastolic strain rate, was seen following either intervention. However, a significant and comparable decline in LV torsion and twist was observed (SAVR: torsion 14.08 ± 8.40 vs. 7.81 ± 4.51, p < 0.001, twist 16.17 ± 7.01 vs.12.45 ± 4.78, p < 0.01; TAVI: torsion 14.43 ± 4.66 vs. 11.20 ± 4.62, p < 0.001, twist 16.08 ± 5.36 vs. 12.36 ± 5.21, p < 0.001) which likely reflects an improvement towards normal physiology following relief of AS. Over a maximum 6.0y follow up, there were 23 (16%) deaths following valve intervention. On multivariable Cox analysis, baseline mid LV circumferential strain was significantly associated with all-cause mortality (hazard ratio, 1.03; 1.01-1.05; p = 0.009) independent of age, LV ejection fraction and STS mortality risk score. ROC analysis indicated a mid LV circumferential strain > -18.7% was associated with significantly reduced survival. CONCLUSION TAVI and SAVR procedures are associated with comparable declines in rotational LV mechanics at 6 m, with largely unchanged strain and strain rates. Pre-operative peak mid LV circumferential strain is associated with post-operative mortality.
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Affiliation(s)
- Tarique Al Musa
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Akhlaque Uddin
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Peter P. Swoboda
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Timothy A. Fairbairn
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Laura E. Dobson
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Anvesha Singh
- Department of Cardiovascular Sciences, and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, University of Leicester, Leicester, UK
| | - Pankaj Garg
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Christopher D. Steadman
- Department of Cardiovascular Sciences, and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, University of Leicester, Leicester, UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Ananth Kidambi
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - David P. Ripley
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Adam K. McDiarmid
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | - Philip Haaf
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - Gerald P. McCann
- Department of Cardiovascular Sciences, and the National Institute of Health Research (NIHR), Cardiovascular Biomedical Research Unit, Glenfield General Hospital, University of Leicester, Leicester, UK
| | - John P. Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Cardiovascular and Diabetes Research, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, LS2 9JT UK
- Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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Conrotto F, D’Ascenzo F, Stella P, Pavani M, Rossi ML, Brambilla N, Napodano M, Covolo E, Saia F, Tarantini G, Agostoni P, Marzocchi A, Presbitero P, Bedogni F, Salizzoni S, D’Amico M, Moretti C, Rinaldi M, Gaita F. Transcatheter aortic valve implantation in low ejection fraction/low transvalvular gradient patients. J Cardiovasc Med (Hagerstown) 2017; 18:103-108. [DOI: 10.2459/jcm.0000000000000402] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sannino A, Schiattarella GG, Toscano E, Gargiulo G, Giugliano G, Galderisi M, Losi MA, Stabile E, Cirillo P, Imbriaco M, Grayburn PA, Trimarco B, Esposito G. Meta-Analysis of Effect of Body Mass Index on Outcomes After Transcatheter Aortic Valve Implantation. Am J Cardiol 2017; 119:308-316. [PMID: 27839771 DOI: 10.1016/j.amjcard.2016.09.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 12/20/2022]
Abstract
Controversial data exist regarding the impact of body mass index (BMI) on TAVI outcomes. Thirteen TAVI studies were included and analyzed for the incidence of procedural complications, 30-day, and long-term all-cause mortality. Three comparisons were executed: (1) underweight versus normal weight, (2) overweight versus normal weight, and (3) obese versus normal weight patients. Underweight patients (BMI <20 kg/m2) had similar 30-day all-cause mortality compared with the normal, although they displayed a significant worse survival at long-term follow-up (hazard ratio 1.68, 95% confidence interval (CI) 1.09 to 2.59, p = 0.02). Underweight patients showed a higher incidence of major and life-threatening bleedings (2,566 patients, odds ratio 1.64, 95% CI 1.10 to 2.45, p = 0.02) and of major vascular complications (2,566 patients, odds ratio 1.86, 95% CI 1.16 to 2.98, p = 0.01), compared with normal weight patients. Overweight patients (BMI ≥25 and <30 kg/m2) display similar 30-day and long-term all-cause mortality, as well as similar procedural complication rate compared with normal weight patients. Obese patients (BMI >30 kg/m2) had similar 30-day all-cause mortality rates compared with the normal weight category, whereas they displayed a significant better survival at long-term (hazard ratio 0.79, 95% CI 0.67 to 0.93, p = 0.004). Procedural complications did not differ between obese and normal body weight patients. In conclusion, a low BMI is linked to a significantly worse prognosis after TAVI. Therefore, BMI represents an important and handily tool that might be used in the risk prediction of patients to be addressed for TAVI.
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Sannino A, Gargiulo G, Schiattarella GG, Perrino C, Stabile E, Losi MA, Galderisi M, Izzo R, de Simone G, Trimarco B, Esposito G. A meta-analysis of the impact of pre-existing and new-onset atrial fibrillation on clinical outcomes in patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2016; 12:e1047-e1056. [DOI: 10.4244/eijy15m11_12] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Barbanti M, Gargiulo G, Tamburino C. Renal dysfunction and transcatheter aortic valve implantation outcomes. Expert Rev Cardiovasc Ther 2016; 14:1315-1323. [PMID: 27636535 DOI: 10.1080/14779072.2016.1234377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) underwent progressive improvements until it became the default therapy for inoperable patients, and a recommended therapy in high-risk operable patients with symptomatic severe aortic stenosis. Recent evidence will further support TAVI as treatment for a growing number of patients. Areas covered: This review will discuss on the current knowledge about the role of both pre-procedural chronic kidney disease (CKD) and post-procedural acute kidney injury (AKI) in adult patients with severe aortic stenosis undergoing TAVI. Expert commentary: Pre-procedural CKD is one of the most frequent comorbidities of TAVI patients and has been found to significantly worsen patients' prognosis at short and long-term follow-up. Similarly, post-procedural AKI is a frequent and relevant complication associated with increased mortality. The risk stratification of the patient, the prevention of complications and the appropriate post-procedural management are the main focus of the future research aimed at further improving clinical outcomes of TAVI patients.
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Affiliation(s)
- Marco Barbanti
- a Division of Cardiology, Ferrarotto Hospital , University of Catania , Catania , Italy
| | - Giuseppe Gargiulo
- b Division of Cardiology - Department of Advanced Biomedical Sciences , Federico II University , Naples , Italy
| | - Corrado Tamburino
- a Division of Cardiology, Ferrarotto Hospital , University of Catania , Catania , Italy.,c Excellence Through Newest Advances (ETNA) Foundation , Catania , Italy
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Gargiulo G, Capodanno D, Sannino A, Perrino C, Capranzano P, Stabile E, Trimarco B, Tamburino C, Esposito G. Moderate and severe preoperative chronic kidney disease worsen clinical outcomes after transcatheter aortic valve implantation: meta-analysis of 4992 patients. Circ Cardiovasc Interv 2015; 8:e002220. [PMID: 25652319 DOI: 10.1161/circinterventions.114.002220] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is a conflicting evidence on safety and efficacy of transcatheter aortic valve implantation in patients with preoperative chronic kidney disease (CKD). Therefore, we conducted a meta-analysis on the impact of CKD on outcomes after transcatheter aortic valve implantation. METHODS AND RESULTS Nine studies including 4992 patients were analyzed. Overall preoperative CKD (stages 3-5) significantly increased early (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.08-1.94 and OR, 1.66; 95% CI, 1.04-2.67) and 1-year (OR, 1.66; 95% CI, 1.23-2.25 and OR, 1.32; 95% CI, 1.06-1.63) all-cause and cardiovascular mortality, respectively. Moderate CKD (stage 3) alone also increased early and 1-year all-cause mortality (OR, 1.43; 95% CI, 1.10-1.85 and OR, 1.41; 95% CI, 1.13-1.74). CKD stages 4 to 5 and 3 compared with stages 1 to 2 increased early stroke (OR, 2.67; 95% CI, 1.53-4.65 and OR, 1.66; 95% CI, 1.09-2.52), acute kidney injury (OR, 2.09; 95% CI, 1.17-3.72 and OR, 1.32; 95% CI, 1.09-1.60) and need for dialysis (OR, 5.92; 95% CI, 2.46-14.27 and OR, 1.55; 95% CI, 0.65-3.70), in the absence of significant differences in contrast medium administration (mean difference, -26.07; 95% CI, -53.00 to 0.85 and mean difference, -0.42; 95% CI, -16.10 to 15.26). Bleeding (life-threatening or major) was nonsignificantly increased in CKD 3 to 5 compared with CKD 1 to 2, but significantly increased in most severe patients (CKD 4-5 versus CKD 1-2: OR, 1.66; 95% CI, 1.13-2.44; CKD 4-5 versus CKD 3: OR, 1.68; 95% CI, 1.27-2.24). CONCLUSIONS Both moderate and severe preoperative CKD significantly worsen transcatheter aortic valve implantation prognosis. Future studies on risk evaluation, prevention, and postoperative management are needed.
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Affiliation(s)
- Giuseppe Gargiulo
- From the Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G., A.S., C.P., E.S., B.T., G.E.); Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C., P.C., C.T.); and Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy (C.T.)
| | - Davide Capodanno
- From the Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G., A.S., C.P., E.S., B.T., G.E.); Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C., P.C., C.T.); and Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy (C.T.)
| | - Anna Sannino
- From the Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G., A.S., C.P., E.S., B.T., G.E.); Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C., P.C., C.T.); and Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy (C.T.)
| | - Cinzia Perrino
- From the Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G., A.S., C.P., E.S., B.T., G.E.); Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C., P.C., C.T.); and Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy (C.T.)
| | - Piera Capranzano
- From the Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G., A.S., C.P., E.S., B.T., G.E.); Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C., P.C., C.T.); and Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy (C.T.)
| | - Eugenio Stabile
- From the Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G., A.S., C.P., E.S., B.T., G.E.); Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C., P.C., C.T.); and Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy (C.T.)
| | - Bruno Trimarco
- From the Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G., A.S., C.P., E.S., B.T., G.E.); Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C., P.C., C.T.); and Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy (C.T.)
| | - Corrado Tamburino
- From the Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G., A.S., C.P., E.S., B.T., G.E.); Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C., P.C., C.T.); and Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy (C.T.)
| | - Giovanni Esposito
- From the Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy (G.G., A.S., C.P., E.S., B.T., G.E.); Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy (D.C., P.C., C.T.); and Excellence Through Newest Advances (ETNA) Foundation, Catania, Italy (C.T.).
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Losi MA, Izzo R, Stabile E, Sannino A, Canciello G, Giamundo A, Musella F, Cirillo P, Prastaro M, Galderisi M, Trimarco B, Esposito G. Diastolic dysfunction reduces stroke volume during daily's life activities in patients with severe aortic stenosis. Int J Cardiol 2015; 195:64-5. [PMID: 26025858 DOI: 10.1016/j.ijcard.2015.05.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Maria Angela Losi
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy.
| | - Raffaele Izzo
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy
| | - Eugenio Stabile
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy
| | - Anna Sannino
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy
| | - Grazia Canciello
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy
| | - Alessandra Giamundo
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy
| | - Francesca Musella
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy
| | - Maria Prastaro
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy
| | - Maurizio Galderisi
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Medical Sciences, University Federico II, Naples, Italy
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Eleid MF, Goel K, Murad MH, Erwin PJ, Suri RM, Greason KL, Nishimura RA, Rihal CS, Holmes DR. Meta-Analysis of the Prognostic Impact of Stroke Volume, Gradient, and Ejection Fraction After Transcatheter Aortic Valve Implantation. Am J Cardiol 2015. [PMID: 26195275 DOI: 10.1016/j.amjcard.2015.06.027] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The prognostic implications of several baseline preprocedural variables in patients with severe native valve aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) are unclear. The goal of this study was to determine the impact of reduced stroke volume index (SVI), low gradient (LG), and reduced ejection fraction (EF) on all-cause mortality. We searched MEDLINE, CENTRAL, EMBASE, Web of Science, and Scopus through October 13, 2014. We evaluated the association between low SVI (<35 ml/m(2)), LG (<40 mm Hg), and low EF (<50% and <30%) on 1-year all-cause mortality. We pooled results across studies using the random-effects model. We included 16 studies at moderate risk of bias enrolling 7,673 patients with severe AS who underwent TAVI. Low EF was associated with increased 1-year mortality after TAVI compared to preserved EF (for EF <30%, hazard ratio [HR] 1.60, 95% confidence interval [CI] 1.19 to 2.16, I(2) = 32%; and for EF <50%, HR 1.52, 95% CI 1.31 to 1.76, I(2) = 17%). LG was associated with increased mortality after TAVI compared to high mean gradient (≥40 mm Hg; HR 1.60, 95% CI 1.30 to 1.97, I(2) = 36%). Low SVI was associated with increased mortality after TAVI compared to normal SVI (HR 1.59, 95% CI 1.23 to 2.05, I(2) = 27%). In conclusion, low SVI, LG, and low EF are each associated with higher mortality after TAVI. These findings highlight the importance of including these variables into TAVI risk algorithms and will better inform shared decision-making before TAVI.
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New cerebral lesions at magnetic resonance imaging after carotid artery stenting versus endarterectomy: an updated meta-analysis. PLoS One 2015; 10:e0129209. [PMID: 26017678 PMCID: PMC4446340 DOI: 10.1371/journal.pone.0129209] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 05/07/2015] [Indexed: 11/20/2022] Open
Abstract
Background Carotid endarterectomy (CEA) or stenting (CAS) are associated with a relatively low rate of clinical events, but diffusion-weighted imaging (DWI) is increasingly being used to compare the incidence of new ischemic lesions. Therefore, we conducted an updated meta-analysis on the occurrence of post-procedural new DWI lesions after CAS versus CEA. Methods and Results MEDLINE, Cochrane, ISI Web of Science and SCOPUS databases were searched and 20 studies (2 randomized and 18 non-randomized) with a total of 2104 procedures (CAS = 989; CEA = 1115) were included. The incidence of new DWI cerebral lesions was significantly greater after CAS than CEA (40.3% vs 12.2%; 20 studies; 2104 patients; odds ratio [OR] 5.17; 95% confidence interval [CI], 3.31-8.06; p<0.00001). Also peri-procedural stroke (17 studies; 1833 patients; OR 2.01; 95% CI, 1.14-3.55; p=0.02) and stroke or TIA (17 studies; 1833 patients; OR 2.40; 95% CI, 1.42-4.08; p=0.001) were significantly increased after CAS. This latter clinical advantage in the CEA group over CAS was tempered when CEA procedures were performed with shunting in all instead of selective shunting or when CAS was performed with only closed cell stents instead of both closed and open cell stents, however, no significant differences between subgroups emerged. Conclusions CAS is associated with an increased incidence of post-procedural brain DWI lesions. This greater amount of ischemic burden may also reflect a higher rate of cerebral events after CAS. However, whether recent technical advances mainly for CAS could potentially reduce these ischemic events still remains to be evaluated.
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Gargiulo G, Sannino A, Capodanno D, Perrino C, Capranzano P, Barbanti M, Stabile E, Trimarco B, Tamburino C, Esposito G. Impact of postoperative acute kidney injury on clinical outcomes after transcatheter aortic valve implantation: A meta-analysis of 5,971 patients. Catheter Cardiovasc Interv 2015; 86:518-27. [PMID: 25641565 DOI: 10.1002/ccd.25867] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/25/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND There is conflicting evidence on the safety and efficacy of transcatheter aortic valve implantation (TAVI) in patients with postoperative acute kidney injury (AKI). Therefore, we conducted a meta-analysis on the impact of AKI on clinical outcomes after TAVI. METHODS AND RESULTS Twenty-four studies including 5,971 patients were analyzed. The mean incidence of AKI in this population was 22.1% ± 11.2. Postoperative AKI significantly increased early (odds ratio [OR] 5.09; 95% confidence interval [CI], 4.03-6.43 and OR 6.14; 95% CI, 3.26-11.55) and 1-year (OR 3.27; 95% CI, 2.42-4.42 and OR 1.93; 95% CI, 1.38-2.71) all-cause and cardiovascular mortality respectively, but also early myocardial infarction (OR 3.30; 95% CI, 1.44-7.57), life-threatening bleeding (OR 2.90; 95% CI, 1.67-5.05), need for transfusion (OR 2.42; 95% CI, 1.96-2.99), and dialysis (OR 14.35; 95% CI, 6.21-33.20), with a non-significant increase of stroke (OR 1.66; 95% CI, 0.94-2.95), hospitalization (mean difference [MD] 1.73; 95% CI, -0.31 to 3.77) and contrast medium received (MD 4.74; 95% CI, -2.33 to 11.81). CONCLUSIONS Postoperative AKI seems to significantly worsen TAVI prognosis. The results of the present meta-analysis should be considered hypothesis-generating and future studies on risk stratification, prevention, and postoperative management are needed.
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Affiliation(s)
- Giuseppe Gargiulo
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Anna Sannino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Davide Capodanno
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.,Excellence through Newest Advances (ETNA) Foundation, Catania, Italy
| | - Cinzia Perrino
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Piera Capranzano
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.,Excellence through Newest Advances (ETNA) Foundation, Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy
| | - Eugenio Stabile
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Bruno Trimarco
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, Catania, Italy.,Excellence through Newest Advances (ETNA) Foundation, Catania, Italy
| | - Giovanni Esposito
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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