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Rodés-Cabau J, Lindenfeld J, Abraham WT, Zile MR, Kar S, Bayés-Genís A, Eigler N, Holcomb R, Núñez J, Lee E, Perl ML, Moravsky G, Pfeiffer M, Boehmer J, Gorcsan J, Bax JJ, Anker S, Stone GW. Interatrial shunt therapy in advanced heart failure: Outcomes from the open-label cohort of the RELIEVE-HF trial. Eur J Heart Fail 2024; 26:1078-1089. [PMID: 38561314 DOI: 10.1002/ejhf.3215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/19/2023] [Accepted: 01/07/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS Heart failure (HF) outcomes remain poor despite optimal guideline-directed medical therapy (GDMT). We assessed safety, effectiveness, and transthoracic echocardiographic (TTE) outcomes during the 12 months after Ventura shunt implantation in the RELIEVE-HF open-label roll-in cohort. METHODS AND RESULTS Eligibility required symptomatic HF despite optimal GDMT with ≥1 HF hospitalization in the prior year or elevated natriuretic peptides. The safety endpoint was device-related major adverse cardiovascular or neurological events at 30 days, compared to a prespecified performance goal. Effectiveness evaluations included the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline, 1, 3, 6, and 12 months and TTE at baseline and 12 months. Overall, 97 patients were enrolled and implanted at 64 sites. Average age was 70 ± 11 years, 97% were in New York Heart Association class III, and half had left ventricular ejection fraction (LVEF) ≤40%. The safety endpoint was achieved (event rate 0%, p < 0.001). KCCQ overall summary score was improved by 12-16 points at all follow-up timepoints (all p < 0.004), with similar outcomes in patients with reduced and preserved LVEF. At 12 months, left ventricular end-systolic and end-diastolic volumes were reduced (p = 0.020 and p = 0.038, respectively), LVEF improved (p = 0.009), right ventricular end-systolic and end-diastolic areas were reduced (p = 0.001 and p = 0.030, respectively), and right ventricular fractional area change (p < 0.001) and tricuspid annular plane systolic excursion (p < 0.001) improved. CONCLUSION Interatrial shunting with the Ventura device was safe and resulted in favourable clinical effects in patients with HF, regardless of LVEF. Improvements of left and right ventricular structure and function were consistent with reverse myocardial remodelling. These results would support the potential of this shunt device as a treatment for HF.
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Affiliation(s)
- Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Québec, Canada
| | - JoAnn Lindenfeld
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Michael R Zile
- Division of Cardiology, Medical University of South Carolina, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, SC, USA
| | - Saibal Kar
- Cardiovascular Institute of Los Robles Health System, Los Robles, CA, USA
| | - Antoni Bayés-Genís
- Department of Cardiology, Germans Trias Heart Institute, Germans Trias University Hospital, Badalona, Spain
- CIBERCV, Madrid, Spain
| | - Neal Eigler
- V-Wave, Agoura Hills, California and Division of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | - Julio Núñez
- Department of Cardiology, University of Valencia, Valencia, Spain
| | - Elizabeth Lee
- Division of Cardiology, Rochester General Hospital, Rochester, NY, USA
| | - Michal Laufer Perl
- Division of Cardiology, Sammy Ofer Heart Center, Tel Aviv Sourasky Medical Center, Tel Aviv-Yafo, Israel
| | - Gil Moravsky
- Division of Cardiology, Shamir Medical Center (Assaf HaRofeh), Be'er Ya'akov, Israel
| | - Michael Pfeiffer
- Division of Cardiology, Penn State Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - John Boehmer
- Division of Cardiology, Penn State Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - John Gorcsan
- Division of Cardiology, Penn State Heart and Vascular Institute, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefan Anker
- Department of Cardiology (CVK) of German Heart Center Charité, Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site Berlin, Charité University, Berlin, Germany
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Lander MM, Brener MI, Goel K, Tang PC, Verlinden NJ, Zalawadiya S, Lindenfeld J, Kanwar MK. Mitral Interventions in Heart Failure. JACC. HEART FAILURE 2023; 11:1055-1069. [PMID: 37611988 DOI: 10.1016/j.jchf.2023.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/10/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023]
Abstract
Patients with heart failure with reduced ejection fraction who have secondary mitral regurgitation (SMR) have poorer outcomes and quality of life than those without SMR. Guideline-directed medical therapy is the cornerstone of SMR treatment. Careful evaluation of landmark trials using mitral transcatheter edge-to-edge repair in SMR has led to an improved understanding of who will benefit from percutaneous interventions with emphasis on a multidisciplinary approach. The success with mitral transcatheter edge-to-edge repair in SMR has also spurred the evaluation of its role in populations that were not initially studied, such as end-stage heart failure and cardiogenic shock. A spectrum of transcatheter devices in development and clinical trials promise to further provide a growing array of management options for heart failure with reduced ejection fraction patients with symptomatic SMR.
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Affiliation(s)
- Matthew M Lander
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Michael I Brener
- Division of Cardiology at Columbia University Irving Medical Center, New York, New York, USA
| | - Kashish Goel
- Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Paul C Tang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Nathan J Verlinden
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Sandip Zalawadiya
- Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - JoAnn Lindenfeld
- Vanderbilt Heart and Vascular Institute, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Manreet K Kanwar
- Cardiovascular Institute at Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
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3
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Metze C, Iliadis C, Körber MI, von Stein J, Halbach M, Baldus S, Pfister R. Disentangling Heart Failure and Physical Frailty: Prospective Study of Patients Undergoing Percutaneous Mitral Valve Repair. JACC. HEART FAILURE 2023; 11:972-982. [PMID: 37227390 DOI: 10.1016/j.jchf.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/27/2023] [Accepted: 04/04/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Frailty and heart failure share pathophysiology and clinical characteristics. OBJECTIVES The aim of this study was to analyze the contribution of heart failure to the physical frailty phenotype by examining patients with heart failure before and after percutaneous mitral valve repair (PMVR). METHODS Frailty according to the Fried criteria (weight loss, weakness, exhaustion, slowness, and low activity) was assessed in consecutive patients before and 6 weeks after PMVR. RESULTS A total of 118 of 258 patients (45.7%) (mean age: 78 ± 9 years, 42% female, 55% with secondary mitral regurgitation) were frail at baseline, which significantly decreased to 74 patients (28.7 %) at follow-up (P < 0.001). The frequency of frailty domains slowness, exhaustion, and inactivity significantly decreased, whereas weakness remained unchanged. Baseline frailty was significantly associated with comorbidities, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and functional capacity, whereas frailty after PMVR was not associated with NT-proBNP levels. Predictors of postprocedural reversibility of frailty were NYHA functional class CONCLUSIONS Treatment of mitral regurgitation in patients with heart failure is associated with almost a halved burden of physical frailty, particularly in patients with a less advanced phenotype. Considering the prognostic relevance of frailty dynamics, this data warrants further evaluation of the concept of frailty as a primary treatment target.
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Affiliation(s)
- Clemens Metze
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Christos Iliadis
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Maria I Körber
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Jennifer von Stein
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Marcel Halbach
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany
| | - Roman Pfister
- Faculty of Medicine, University of Cologne, and Department III of Internal Medicine, University Hospital Cologne, Cologne, Germany.
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4
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Spilias N, Howard TM, Anthony CM, Laczay B, Soltesz EG, Starling RC, Sievert H, Estep JD, Kapadia SR, Puri R. Transcatheter left ventriculoplasty. EUROINTERVENTION 2023; 18:1399-1407. [PMID: 37092265 PMCID: PMC10113960 DOI: 10.4244/eij-d-22-00544] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/07/2022] [Indexed: 04/25/2023]
Abstract
Despite significant advances in pharmacological, electrophysiological and valve therapies for heart failure with reduced ejection fraction (HFrEF), the associated morbidity, mortality and healthcare costs remain high. With a constantly growing heart failure population, the existing treatment gap between current and advanced heart failure therapies (e.g., left ventricular [LV] assist devices, heart transplantation) reflects a large unmet need, calling for novel therapeutic approaches. Left ventricular remodelling and dilatation, with or without scar formation, is the hallmark of cardiomyopathy and is associated with poor prognosis. In the era of exciting advances in structural heart interventions, the advent of minimally invasive, device-based therapies directly targeting the LV geometry and promoting physical reverse remodelling has created a new frontier in the battle against heart failure. Interventional heart failure therapy is a rapidly emerging field, encompassing structural heart and minimally invasive hybrid procedures, with two left ventriculoplasty devices currently under investigation in pivotal clinical trials in the US. This review addresses the rationale for left ventriculoplasty, presents the prior surgical and percutaneous attempts in the field, provides an overview of the novel transcatheter left ventriculoplasty devices and their respective trials, and highlights potential challenges associated with establishing such device-based therapies in our armamentarium against heart failure.
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Affiliation(s)
- Nikolaos Spilias
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Travis M Howard
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Chris M Anthony
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Balint Laczay
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Edward G Soltesz
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- CardioVascular Center Frankfurt, Frankfurt, Germany
| | - Randall C Starling
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jerry D Estep
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Samir R Kapadia
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rishi Puri
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
- CardioVascular Center Frankfurt, Frankfurt, Germany
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5
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Ryazanov AS, Shikh EV, Makarovskaya MV, Kudryavtsev AA. Angiotensin receptor-neprilysin inhibitors and cardiac remodeling. Braz J Med Biol Res 2023; 56:e12616. [PMID: 37042870 PMCID: PMC10085762 DOI: 10.1590/1414-431x2023e12616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/24/2023] [Indexed: 04/13/2023] Open
Abstract
The aim of this study was to determine how sacubitril/valsartan compared with valsartan in an outpatient setting affects left ventricular remodeling in heart failure with reduced ejection fraction and functional (or secondary) mitral regurgitation (SMR) due to the effect of dual inhibition of the renin-angiotensin system and neprilysin. The outpatient study included 90 patients with chronic SMR who were followed up for 12 months. They received sacubitril/valsartan or valsartan instead of the more commonly used angiotensin-converting enzyme inhibitor enalapril for heart failure, in addition to standard medical therapy for heart failure. The difference in NT-proBNP change between groups was the primary endpoint. Changes in effective regurgitation orifice area, left ventricular ejection fraction, left ventricular end-systolic and end-diastolic volume indices, left atrial volume index, E/e' index, and exercise tolerance on the 6-minute walk test were secondary endpoints. In the treatment efficacy analysis, NT-proBNP levels decreased significantly by 37% in the sacubitril/valsartan group and by 11% in the valsartan group (P<0.001). Ejection fraction and exercise tolerance (increase in walking distance in the 6-min test) increased in the sacubitril/valsartan group (P<0.05). Also, in this group, the effective area of the regurgitation orifice, the left atrial volume index, the E/e' index, and the indices of the end-systolic and end-diastolic volume of the left ventricle (P<0.05) decreased more pronouncedly. Compared with valsartan, treatment with sacubitril/valsartan led to a significant improvement in cardiac remodeling in patients with SMR and heart failure with reduced ejection fraction.
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Affiliation(s)
- A S Ryazanov
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - E V Shikh
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - M V Makarovskaya
- Clinical and Diagnostic Center No. 4, Moscow Department of Health, Moscow, Russia
| | - A A Kudryavtsev
- I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University), Moscow, Russia
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Natanzon SS, Koseki K, Kaewkes D, Koren O, Patel V, Nakamura M, Chakravarty T, Makkar R. Quality of Life, Procedural Success, and Clinical Outcomes following Transcatheter Mitral Valve Repair. Int J Clin Pract 2023; 2023:1977911. [PMID: 36923520 PMCID: PMC10010880 DOI: 10.1155/2023/1977911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Limited data exist regarding the association between the quality of life (QoL) and clinical outcomes following transcatheter mitral valve repair (TMVr). We aimed to evaluate the prognostic significance of QoL assessment following TMVr and to characterize those who had procedural success, yet reported a low Kansas City Cardiomyopathy Questionnaire (KCCQ-12) score. METHODS We reported the experience of Cedars-Sinai Medical Center patients between 2013 and 2020. Patients were allocated into four groups according to the 30-day KCCQ: <25, 25-49, 50-74, and ≥75. Primary outcome included 1-year all-cause death or heart failure (HF) hospitalizations. We also examined the association between QoL and the primary outcome in those with procedural success. RESULTS A total of 555 patients were included in our analysis, median follow-up of 650 days (IQR 243-1113). The lower KCCQ groups had a higher prevalence of functional mitral regurgitation (65%, 60%, 56%, and 43%, p = 0.001), as well as a higher Society of Thoracic Surgeon (STS) score. These groups had a significantly higher occurrence of 1-year all-cause death or HF hospitalizations in a stepwise fashion (40%, 22%, 16%, and 10%, p < 0.001). Multivariable Cox regression analysis revealed 30-day KCCQ as the strongest predictor of the 1-year primary outcome (HR 0.98, 95%CI (0.97-0.99), p = 0.006). Approximately a quarter of patients with procedural success had a low KCCQ score. These patients had a higher rate of the combined 1-year outcome regardless of procedural success or failure. CONCLUSION QoL following TMVr is a powerful prognostic factor. KCCQ assessment is an important indicator for identifying patients prone to adverse outcomes even after procedural success.
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Affiliation(s)
- Sharon Shalom Natanzon
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Keita Koseki
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
- Department of Cardiovascular Medicine, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Danon Kaewkes
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ofir Koren
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
- Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Vivek Patel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Mamoo Nakamura
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Tarun Chakravarty
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
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7
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Ro R, Prandi FR, Zaid S, Anastasius MO, Tang GHL, Seetharam K, Argulian E, Massaro G, Sharma S, Kini A, Lerakis S. Acute effect of edge-to-edge repair of mitral regurgitation on left heart mechanics and health status. J Cardiovasc Med (Hagerstown) 2022; 23:787-797. [PMID: 36166336 DOI: 10.2459/jcm.0000000000001359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Examine the impact of acute changes in left heart strain and volumes with percutaneous edge-to-edge MitraClip repair on improvement in health status assessed using Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) score. METHODS Changes in left atrial strain, left ventricular (LV) global longitudinal strain (LVGLS), LV end-systolic volume (LVESV), and end-diastolic volume (LVEDV) were evaluated in 50 patients undergoing MitraClip repair for symptomatic primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR) on transthoracic echocardiography before and 1 month after MitraClip. Multivariable regression was used to evaluate changes in left heart strain and volumes as predictors of change in KCCQ-12 scores, adjusting for baseline clinical and echocardiographic characteristics. RESULTS Both PMR and SMR patients had significant increase in LVGLS and reduction in LVEDV and LVESV (P < 0.05) after MitraClip, reduction trend in left atrial conduit strain (PMR P = 0.053; SMR P = 0.12) but no significant change in LV ejection fraction. KCCQ-12 score improved significantly in both PMR (P < 0.001) and SMR cohorts (P < 0.001). Higher delta KCCQ-12 tertiles were associated with greater reduction in LVEDV (P = 0.022) after MitraClip. On multiple regression analysis, lower preprocedural Society of Thoracic Surgeons for Mitral Valve Replacement and KCCQ-12 score, and greater reduction in LVESV and left atrial strain conduit phase were associated with KCCQ-12 score improvement (P < 0.001). CONCLUSION There is a significant increase in LVGLS and reduction in LVEDV, LVESV and left atrial strain conduit after edge-to-edge MitraClip repair in both PMR and SMR. Lower preprocedural Society of Thoracic Surgeons for Mitral Valve Replacement and KCCQ-12 score, and greater reduction in LVESV and left atrial conduit strain were associated with KCCQ-12 score improvement after MitraClip. Further studies are warranted to understand the mechanism and significance of our findings.
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Affiliation(s)
- Richard Ro
- Division of Cardiology, Mount Sinai Hospital, New York, New York
| | | | - Syed Zaid
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | | | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, New York, USA
| | | | - Edgar Argulian
- Division of Cardiology, Mount Sinai Hospital, New York, New York
| | - Gianluca Massaro
- Division of Cardiology, Tor Vergata University Hospital, Rome, Italy
| | - Samin Sharma
- Division of Cardiology, Mount Sinai Hospital, New York, New York
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Hospital, New York, New York
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8
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Nassif M, Fine JT, Dolan C, Reaney M, Addepalli P, Allen VD, Sehnert AJ, Gosch K, Spertus JA. Validation of the Kansas City Cardiomyopathy Questionnaire in Symptomatic Obstructive Hypertrophic Cardiomyopathy. JACC: HEART FAILURE 2022; 10:531-539. [DOI: 10.1016/j.jchf.2022.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 04/08/2023]
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9
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Symptomatic improvement using the New York Heart Association classification as a predictor for survival after transcatheter edge-to-edge repair of the mitral valve. Int J Cardiol 2022; 353:49-50. [DOI: 10.1016/j.ijcard.2022.01.041] [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: 10/16/2021] [Revised: 12/30/2021] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
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10
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Kitamura M, Kresoja KP, Balata M, Besler C, Rommel KP, Unterhuber M, Lurz J, Rosch S, Gunold H, Noack T, Thiele H, Lurz P. Health Status After Transcatheter Tricuspid Valve Repair in Patients With Functional Tricuspid Regurgitation. JACC Cardiovasc Interv 2021; 14:2545-2556. [PMID: 34887048 DOI: 10.1016/j.jcin.2021.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/15/2021] [Accepted: 09/21/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of this study was to investigate changes in quality of life (QoL) after transcatheter tricuspid valve repair (TTVR) for tricuspid regurgitation (TR). BACKGROUND TTVR provides feasible and durable efficacy in reducing TR, but its clinical benefits on QoL still remain unclear. METHODS In 115 subjects undergoing TTVR for severe functional TR, QoL was evaluated using the 36-Item Short Form Health Survey (SF-36) and the Minnesota Living With Heart Failure Questionnaire (MLHFQ). All-cause mortality, heart failure (HF) rehospitalization, and a composite endpoint of all-cause mortality, HF rehospitalization, and repeat TTVR were recorded as clinical events. RESULTS Successful device implantation was achieved in 110 patients (96%). Moderate or less TR at discharge was achieved in 95 patients (83%). Mean SF-36 physical component summary (PCS) score improved from 34 ± 9 to 37 ± 9 points (+3 points; 95% CI: 1-5 points; P = 0.001), mean SF-36 mental component summary score improved from 49 ± 9 to 51 ± 10 points (+2 points; 95% CI: 0-4 points; P = 0.017), and mean MLHFQ score decreased from 29 ± 14 to 20 ± 15 points (-8 points; 95% CI: -11 to -5 points; P < 0.001). Baseline PCS, moderate or less TR at discharge, and baseline massive or torrential TR were associated with 1-month change in PCS score (P < 0.05). Change in PCS score after 1 month predicted HF rehospitalization after TTVR (adjusted HR: 0.74 [95% CI: 0.60-0.92] per 5-point increase in PCS score; P = 0.008). CONCLUSIONS This study demonstrates that TTVR provides improvement in QoL in patients with relevant TR. TR reduction to a moderate or less grade was associated with improvement of SF-36 and MLHFQ scores. Further, global QoL was associated with clinical outcomes and might serve as a future outcome surrogate following TTVR.
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Affiliation(s)
- Mitsunobu Kitamura
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Mahmoud Balata
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Christian Besler
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Matthias Unterhuber
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Julia Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sebastian Rosch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Hilka Gunold
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thilo Noack
- Department of Cardiac Surgery, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.
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Prognostic Importance of Health Status Versus Functional Status in Heart Failure and Secondary Mitral Regurgitation. JACC-HEART FAILURE 2021; 9:684-692. [PMID: 34391740 DOI: 10.1016/j.jchf.2021.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES This study sought to understand the extent to which health status and exercise capacity are independently associated with long-term outcomes in patients with heart failure (HF) and secondary mitral regurgitation (MR). BACKGROUND Secondary MR in patients with HF leads to impaired health status (Kansas City Cardiomyopathy Questionnaire Overall Summary Score [KCCQ-OS]) and exercise capacity (6-minute walk distance [6MWD]), both of which improve after transcatheter mitral valve repair (TMVr). METHODS The study used data from the COAPT trial (N = 604) to examine the association of baseline KCCQ-OS and 6MWD with 2-year mortality and HF hospitalization, adjusting for treatment arm and patient factors. We also examined the association of change in KCCQ-OS and 6MWD from baseline to 1 month with risk of outcomes from 1 month to 2 years. Interactions of KCCQ-OS and 6MWD with treatment assignment were explored. RESULTS Mean baseline KCCQ-OS was 53 ± 23 points, and 6MWD was 240 ± 125 meters. In models including both measures, greater baseline 6MWD (but not KCCQ-OS) was associated with reduced 2-year mortality (HR per 125 meters: 0.75, 95% CI: 0.61-0.92). When stratified by treatment group, both baseline KCCQ-OS and 6MWD were independently associated with HF hospitalization in patients treated with medical therapy, whereas only KCCQ-OS was associated with HF hospitalization in patients treated with TMVr. In separate analyses, 1-month improvements in KCCQ-OS and 6MWD were each associated with lower subsequent risk of mortality and HF hospitalization, independent of treatment group. CONCLUSIONS Among patients with HF and severe secondary MR, assessment of both health status and exercise capacity provide complementary prognostic information for patients with HF and severe secondary MR-both before and after TMVr. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial]; NCT01626079).
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12
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Spertus JA, Fine JT, Elliott P, Ho CY, Olivotto I, Saberi S, Li W, Dolan C, Reaney M, Sehnert AJ, Jacoby D. Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): health status analysis of a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2021; 397:2467-2475. [PMID: 34004177 DOI: 10.1016/s0140-6736(21)00763-7] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Improving symptoms is a primary treatment goal in patients with obstructive hypertrophic cardiomyopathy. Currently available pharmacological options for hypertrophic cardiomyopathy are not disease-specific and are often inadequate or poorly tolerated. We aimed to assess the effect of mavacamten, a first-in-class cardiac myosin inhibitor, on patients' health status-ie, symptoms, physical and social function, and quality of life. METHODS We did a health status analysis of EXPLORER-HCM, a phase 3, double-blind, randomised, placebo-controlled trial. The study took place at 68 clinical cardiovascular centres in 13 countries. Adult patients (≥18 years) with symptomatic obstructive hypertrophic cardiomyopathy (gradient ≥50 mm Hg and New York Heart Association class II-III) were randomly assigned (1:1) to mavacamten or placebo for 30 weeks, followed by an 8-week washout period. Both patients and staff were masked to study treatment. The primary outcome for this secondary analysis was the Kansas City Cardiomyopathy Questionnaire (KCCQ), a well validated disease-specific measure of patients' health status. It was administered at baseline and weeks 6, 12, 18, 30 (end of treatment), and 38 (end of study). Changes from baseline to week 30 in KCCQ overall summary (OS) score and all subscales were analysed using mixed model repeated measures. This study is registered with ClinicalTrials.gov, NCT03470545. FINDINGS Between May 30, 2018, and July 12, 2019, 429 adults were assessed for eligibility, of whom 251 (59%) were enrolled and randomly assigned. Of 123 patients randomly assigned to mavacamten, 92 (75%) completed the KCCQ at baseline and week 30 and of the 128 patients randomly assigned to placebo 88 (69%) completed the KCCQ at baseline and week 30. At 30 weeks, the change in KCCQ-OS score was greater with mavacamten than placebo (mean score 14·9 [SD 15·8] vs 5·4 [13·7]; difference +9·1 [95% CI 5·5-12·8]; p<0·0001), with similar benefits across all KCCQ subscales. The proportion of patients with a very large change (KCCQ-OS ≥20 points) was 36% (33 of 92) in the mavacamten group versus 15% (13 of 88) in the placebo group, with an estimated absolute difference of 21% (95% CI 8·8-33·4) and number needed to treat of five (95% CI 3-11). These gains returned to baseline after treatment was stopped. INTERPRETATION Mavacamten markedly improved the health status of patients with symptomatic obstructive hypertrophic cardiomyopathy compared with placebo, with a low number needed to treat for marked improvement. Given that the primary goals of treatment are to improve symptoms, physical and social function, and quality of life, mavacamten represents a new potential strategy for achieving these goals. FUNDING MyoKardia, a Bristol Myers Squibb company.
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Affiliation(s)
- John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, MO, USA; University of Missouri, Kansas City, MO, USA.
| | - Jennifer T Fine
- MyoKardia, a Bristol Myers Squibb company, Brisbane, CA, USA
| | - Perry Elliott
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Carolyn Y Ho
- Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Wanying Li
- MyoKardia, a Bristol Myers Squibb company, Brisbane, CA, USA
| | | | | | - Amy J Sehnert
- MyoKardia, a Bristol Myers Squibb company, Brisbane, CA, USA
| | - Daniel Jacoby
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA
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13
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Jain SS, Cohen DJ, Zhang Z, Uriel N, Sayer G, Lindenfeld J, Abraham WT, Mack MJ, Stone GW, Arnold SV. Defining a Clinically Important Change in 6-Minute Walk Distance in Patients With Heart Failure and Mitral Valve Disease. Circ Heart Fail 2021; 14:e007564. [PMID: 33663234 DOI: 10.1161/circheartfailure.120.007564] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sneha S Jain
- Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center (S.S.J., N.U., G.S.)
| | | | - Zixuan Zhang
- Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.Z., G.W.S.)
| | - Nir Uriel
- Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center (S.S.J., N.U., G.S.)
| | - Gabriel Sayer
- Department of Medicine, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center (S.S.J., N.U., G.S.)
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, TN (J.L.)
| | - William T Abraham
- Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart & Lung Research Institute, The Ohio State University, Columbus (W.T.A.)
| | | | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York (Z.Z., G.W.S.).,The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York (G.W.S.)
| | - Suzanne V Arnold
- University of Missouri-Kansas City (D.J.C., S.V.A.).,Department of Medicine, Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A.)
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14
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Khan MS, Siddiqi TJ, Butler J, Friede T, Levy WC, Witte KK, Lipiecki J, Sievert H, Coats AJS. Functional outcomes with Carillon device over 1 year in patients with functional mitral regurgitation of Grades 2+ to 4+: results from the REDUCE-FMR trial. ESC Heart Fail 2021; 8:872-878. [PMID: 33619896 PMCID: PMC8006711 DOI: 10.1002/ehf2.13273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 01/17/2023] Open
Abstract
AIMS The objective of this study was to compare functional outcomes through 1 year in patients with core-lab verified moderate to severe (Grades 2+ to 4+) functional mitral regurgitation (FMR) treated with the Carillon device or control in the blinded sham-controlled REDUCE-FMR (Carillon Mitral Contour System for Reducing Functional Mitral Regurgitation) study. METHODS AND RESULTS The main outcomes of this analysis were the change in 6 min walk test (6MWT) distance, incidence of heart failure hospitalization or death, change in New York Heart Association (NYHA) class, and change in Kansas City Cardiomyopathy Questionnaire (KCCQ) score through 1 year of follow-up. The minimum clinically important difference (MCID) was defined as a ≥30 m increase in 6MWT distance, an NYHA decrease in ≥1 class, and a ≥3 point increase in KCCQ score. The proportion of patients achieving the MCID in each treatment group was compared using Fisher's exact test, and the number needed to treat (NNT) with the Carillon device was calculated. Among 83 patients (62 Carillon and 21 sham), no statistically significant group differences were observed in the baseline characteristics. All outcomes at 1 year numerically favoured the Carillon group, including MCID for the 6MWT distance (59% vs. 23%, P = 0.029; NNT = 2.8), NYHA class (48% vs. 33%, P = 0.38; NNT = 6.9), KCCQ score (69% vs. 47%, P = 0.14; NNT = 4.5), and freedom from heart failure hospitalization or death (60% vs. 48%, P = 0.45; NNT = 8.3). CONCLUSIONS REDUCE-FMR was the first blinded sham-controlled trial to report outcomes with percutaneous therapy for the treatment of FMR. Trends towards improvement in mean 6MWT distance, KCCQ score, and NYHA class were observed with the Carillon device. A substantially higher number of patients achieved MCID for all patient-centred outcomes with the Carillon device compared with the sham procedure.
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Affiliation(s)
| | - Tariq Jamal Siddiqi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, MS, USA
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Wayne C Levy
- UW Heart Institute, University of Washington, Seattle, WA, USA
| | - Klaus K Witte
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Janusz Lipiecki
- Centre de Cardiologie Interventionnelle, Pôle Santé République, Clermont-Ferrand, France
| | - Horst Sievert
- CardioVascular Center Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK
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15
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Hejjaji V, Cohen DJ, Carroll JD, Li Z, Manandhar P, Vemulapalli S, Nelson AJ, Malik AO, Mack MJ, Spertus JA, Arnold SV. Practical Application of Patient-Reported Health Status Measures for Transcatheter Valve Therapies: Insights From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry. Circ Cardiovasc Qual Outcomes 2021; 14:e007187. [PMID: 33596663 PMCID: PMC7982132 DOI: 10.1161/circoutcomes.120.007187] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Health status assessment is essential for documenting the benefit of transcatheter aortic valve replacement (TAVR) or transcatheter mitral valve repair on patients’ symptoms, function, and quality of life. Health status can also be a powerful marker for subsequent clinical outcomes, but its prognostic importance around the time of both TAVR and transcatheter mitral valve repair has not been fully defined.
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Affiliation(s)
- Vittal Hejjaji
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., A.O.M., J.A.S., S.V.A.).,Department of Cardiovascular Medicine, University of Missouri-Kansas City (V.H., D.J.C., A.O.M., J.A.S., S.V.A.)
| | - David J Cohen
- Department of Cardiovascular Medicine, University of Missouri-Kansas City (V.H., D.J.C., A.O.M., J.A.S., S.V.A.)
| | - John D Carroll
- Department of Cardiovascular Medicine, University of Colorado Anschutz Medical Campus, Aurora (J.D.C.)
| | - Zhuokai Li
- Department of Cardiovascular Medicine, Duke Clinical Research Institute, Durham, NC (Z.L., P.M., S.V., A.J.N.)
| | - Pratik Manandhar
- Department of Cardiovascular Medicine, Duke Clinical Research Institute, Durham, NC (Z.L., P.M., S.V., A.J.N.)
| | - Sreekanth Vemulapalli
- Department of Cardiovascular Medicine, Duke Clinical Research Institute, Durham, NC (Z.L., P.M., S.V., A.J.N.)
| | - Adam J Nelson
- Department of Cardiovascular Medicine, Duke Clinical Research Institute, Durham, NC (Z.L., P.M., S.V., A.J.N.)
| | - Ali O Malik
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., A.O.M., J.A.S., S.V.A.).,Department of Cardiovascular Medicine, University of Missouri-Kansas City (V.H., D.J.C., A.O.M., J.A.S., S.V.A.)
| | - Michael J Mack
- Department of Cardiovascular Medicine, Baylor Scott and White Health, Plano, TX (M.J.M.)
| | - John A Spertus
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., A.O.M., J.A.S., S.V.A.).,Department of Cardiovascular Medicine, University of Missouri-Kansas City (V.H., D.J.C., A.O.M., J.A.S., S.V.A.)
| | - Suzanne V Arnold
- Department of Cardiovascular Medicine, Saint Luke's Mid America Heart Institute, Kansas City, MO (V.H., A.O.M., J.A.S., S.V.A.).,Department of Cardiovascular Medicine, University of Missouri-Kansas City (V.H., D.J.C., A.O.M., J.A.S., S.V.A.)
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16
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Bermejo J, Postigo A, Baumgartner H. The year in cardiovascular medicine 2020: valvular heart disease. Eur Heart J 2021; 42:647-656. [PMID: 33388778 PMCID: PMC7878012 DOI: 10.1093/eurheartj/ehaa1060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/11/2020] [Accepted: 12/16/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Dr Esquerdo 46, Madrid 28007, Spain
| | - Andrea Postigo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid and CIBERCV, Dr Esquerdo 46, Madrid 28007, Spain
| | - Helmut Baumgartner
- Department of Cardiology III—Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany
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17
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Collins SP, Liu D, Jenkins CA, Storrow AB, Levy PD, Pang PS, Chang AM, Char D, Diercks DJ, Fermann GJ, Han JH, Hiestand B, Hogan C, Kampe CJ, Khan Y, Lee S, Lindenfeld J, Martindale J, McNaughton CD, Miller KF, Miller-Reilly C, Moser K, Peacock WF, Robichaux C, Rothman R, Schrock J, Self WH, Singer AJ, Sterling SA, Ward MJ, Walsh C, Butler J. Effect of a Self-care Intervention on 90-Day Outcomes in Patients With Acute Heart Failure Discharged From the Emergency Department: A Randomized Clinical Trial. JAMA Cardiol 2021; 6:200-208. [PMID: 33206126 DOI: 10.1001/jamacardio.2020.5763] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance Up to 20% of patients who present to the emergency department (ED) with acute heart failure (AHF) are discharged without hospitalization. Compared with rates in hospitalized patients, readmission and mortality are worse for ED patients. Objective To assess the impact of a self-care intervention on 90-day outcomes in patients with AHF who are discharged from the ED. Design, Setting, and Participants Get With the Guidelines in Emergency Department Patients With Heart Failure was an unblinded, parallel-group, multicenter randomized trial. Patients were randomized 1:1 to usual care vs a tailored self-care intervention. Patients with AHF discharged after ED-based management at 15 geographically diverse EDs were included. The trial was conducted from October 28, 2015, to September 5, 2019. Interventions Home visit within 7 days of discharge and twice-monthly telephone-based self-care coaching for 3 months. Main Outcomes and Measures The primary outcome was a global rank of cardiovascular death, HF-related events (unscheduled clinic visit due to HF, ED revisit, or hospitalization), and changes in the Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) summary score (SS) at 90 days. Key secondary outcomes included the global rank outcome at 30 days and changes in the KCCQ-12 SS score at 30 and 90 days. Intention-to-treat analysis was performed for the primary, secondary, and safety outcomes. Per-protocol analysis was conducted including patients who completed a home visit and had scheduled outpatient follow-up in the intervention arm. Results Owing to slow enrollment, 479 of a planned 700 patients were randomized: 235 to the intervention arm and 244 to the usual care arm. The median age was 63.0 years (interquartile range, 54.7-70.2), 302 patients (63%) were African American, 305 patients (64%) were men, and 178 patients (37%) had a previous ejection fraction greater than 50%. There was no significant difference in the primary outcome between patients in the intervention vs usual care arm (hazard ratio [HR], 0.89; 95% CI, 0.73-1.10; P = .28). At day 30, patients in the intervention arm had significantly better global rank (HR, 0.80; 95% CI, 0.64-0.99; P = .04) and a 5.5-point higher KCCQ-12 SS (95% CI, 1.3-9.7; P = .01), while at day 90, the KCCQ-12 SS was 2.7 points higher (95% CI, -1.9 to 7.2; P = .25). Conclusions and Relevance The self-care intervention did not improve the primary global rank outcome at 90 days in this trial. However, benefit was observed in the global rank and KCCQ-12 SS at 30 days, suggesting that an early benefit of a tailored self-care program initiated at an ED visit for AHF was not sustained through 90 days. Trial Registration ClinicalTrials.gov Identifier: NCT02519283.
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Affiliation(s)
- Sean P Collins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dandan Liu
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cathy A Jenkins
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alan B Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Phillip D Levy
- Department of Emergency Medicine, Detroit Medical Center, Detroit, Michigan
| | - Peter S Pang
- Department of Emergency Medicine, Indiana University Medical Center, Indianapolis
| | - Anna Marie Chang
- Department of Emergency Medicine, Thomas Jefferson University Medical Center, Philadelphia, Pennsylvania
| | - Douglas Char
- Department of Emergency Medicine, Washington University Medical Center in St Louis, St Louis, Missouri
| | - Deborah J Diercks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Gregory J Fermann
- Department of Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Jin H Han
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian Hiestand
- Department of Emergency Medicine, Wake Forest University Medical Center, Winston-Salem, North Carolina
| | - Christopher Hogan
- Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia
| | - Christina J Kampe
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yosef Khan
- Department of Emergency Medicine, American Heart Association
| | - Sangil Lee
- Department of Emergency Medicine, University of Iowa Medical Center, Iowa City
| | - JoAnn Lindenfeld
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer Martindale
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen F Miller
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kelly Moser
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - W Frank Peacock
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Russell Rothman
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jon Schrock
- Department of Emergency Medicine, Metro Health Medical Center, Cleveland, Ohio
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Adam J Singer
- Department of Emergency Medicine, Stony Brook University Medical Center, Stony Brook, New York
| | - Sarah A Sterling
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson
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Malik AO, Chhatriwalla AK, Saxon J, Hejjaji V, Stebbins A, Jones PG, Cohen DJ, Arnold SV, Vemulapalli S, Wegermann ZK, Kosinski A, Spertus JA. Site-Level Variability in 30-Day Patient Outcomes After Transcatheter Mitral Valve Repair in the United States. Circ Cardiovasc Qual Outcomes 2020; 13:e006878. [PMID: 33280434 DOI: 10.1161/circoutcomes.120.006878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical trials have demonstrated health status benefit of transcatheter mitral valve repair (TMVr) with MitraClip in patients with mitral valve regurgitation. Real-world site-level variability in health status outcomes for TMVr, and factors associated with this variability, are unknown. METHODS All patients undergoing TMVr procedure with MitraClip between November 2013 and March 2019 in the Transcatheter Valve Therapy Registry were included. Health status was measured at baseline and 30 days with the Kansas City Cardiomyopathy Questionnaire (KCCQ) Overall Summary (OS) score. Site-level variability in 30-day change in KCCQ-OS was examined by calculating the median odds ratio from a hierarchical logistic regression model, with ≥20-point improvement as the dependent variable. To define the extent to which patient characteristics, procedural characteristics (residual mitral valve regurgitation, periprocedural bleeding), site volume, and patients' baseline health status accounted for variability in outcomes, the proportion of variability (R2) explained by sequentially adding these variables to the model was quantified. RESULTS Across 339 sites, 12 415 patients (mean age 79.0±9.5 years, 46.1%. females, 89.5% White) completed baseline and 30-day health status assessments. Mean KCCQ-OS score was 43.0±24.4 at baseline and 67.0±24.9 at 30-day follow-up. Across sites, the proportion of patients achieving a ≥20-point improvement in KCCQ-OS ranged from 12.5% to 100% and the adjusted median odds ratio was 1.58 (95% CI, 1.46-1.69). The greatest contribution to the variability in health status outcomes was from patients' baseline KCCQ-OS score (R2=25%) with <1% of the variability explained by patient and procedural characteristics, and annual site volume. CONCLUSIONS There is moderate variation across sites in their patients' achievement of health status benefits from TMVr, with patient's baseline health status accounting for the largest proportion of this variation. This underscores the importance of patient selection in supporting more consistent health status benefit from TMVr.
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Affiliation(s)
- Ali O Malik
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Adnan K Chhatriwalla
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - John Saxon
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Vittal Hejjaji
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Amanda Stebbins
- Duke Clinical Research Institute, Durham, NC (A.S., S.V., Z.K.W., A.K.)
| | - Philip G Jones
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - David J Cohen
- University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | - Suzanne V Arnold
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
| | | | | | - Andrzej Kosinski
- Duke Clinical Research Institute, Durham, NC (A.S., S.V., Z.K.W., A.K.)
| | - John A Spertus
- Saint Lukes' Mid America Heart Institute, Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., S.V.A., S.V.A., J.A.S.).,University of Missouri-Kansas City, MO (A.O.M., A.K.C., J.S., V.H., P.G.J., D.J.C., S.V.A., S.V.A., J.A.S.)
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19
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Wang R, Gao C, Kawashima H, Modolo R, Rosseel L, Onuma Y, Soliman O, Serruys PW, Mylotte D. Valvular heart interventions: advances from 2019 to 2020. EUROINTERVENTION 2020; 16:808-823. [PMID: 32958460 DOI: 10.4244/eij-d-20-00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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20
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Winkel MG, Praz F, Wenaweser P. Mitral and Tricuspid Transcatheter Interventions Current Indications and Future Directions. Front Cardiovasc Med 2020; 7:61. [PMID: 32500083 PMCID: PMC7242641 DOI: 10.3389/fcvm.2020.00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 03/25/2020] [Indexed: 11/13/2022] Open
Abstract
Valvular heart disease is responsible for a high rate of morbidity and mortality, especially in the elderly population. With the emergence of new transcatheter treatment options, the therapeutic spectrum for patients with valvular heart disease has considerably expanded during the past years. Interventional treatment of the mitral and tricuspid valve requires an individualized and versatile approach owing to the different etiologies of valvular dysfunction and the complex anatomy of the atrioventricular valves. This article aims to review recent developments, summarize the evidence, indications and limitations of the available systems, and provide a glimpse into the future of transcatheter interventions for the treatment of mitral and tricuspid valve disease.
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Affiliation(s)
- Mirjam Gauri Winkel
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Peter Wenaweser
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Heart Clinic Hirslanden Zurich, Zurich, Switzerland
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21
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Meinertz T, Münzel T. Kansas City Cardiomyopathy Quality Score Indicates Sustained Health Status Improvement in Patients After TMVr. J Am Coll Cardiol 2020; 75:2107-2109. [PMID: 32354379 DOI: 10.1016/j.jacc.2020.03.034] [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: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Mainz, Germany
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22
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Functional Role of Natriuretic Peptides in Risk Assessment and Prognosis of Patients with Mitral Regurgitation. J Clin Med 2020; 9:jcm9051348. [PMID: 32380651 PMCID: PMC7290430 DOI: 10.3390/jcm9051348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
The management of mitral valve regurgitation (MR), a common valve disease, represents a challenge in clinical practice, since the indication for either surgical or percutaneous valve replacement or repair are guided by symptoms and by echocardiographic parameters which are not always feasible. In this complex scenario, the use of natriuretic peptide (NP) levels would serve as an additive diagnostic and prognostic tool. These biomarkers contribute to monitoring the progression of the valve disease, even before the development of hemodynamic consequences in a preclinical stage of myocardial damage. They may contribute to more accurate risk stratification by identifying patients who are more likely to experience death from cardiovascular causes, heart failure, and cardiac hospitalizations, thus requiring surgical management rather than a conservative approach. This article provides a comprehensive overview of the available evidence on the role of NPs in the management, risk evaluation, and prognostic assessment of patients with MR both before and after surgical or percutaneous valve repair. Despite largely positive evidence, a series of controversial findings exist on this relevant topic. Recent clinical trials failed to assess the role of NPs following the interventional procedure. Future larger studies are required to enable the introduction of NP levels into the guidelines for the management of MR.
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