1
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Abraham B, Suppah M, Farina J, Botros M, Fath A, Kaldas S, Megaly M, Chao CJ, Arsanjani R, Ayoub C, Fortuin FD, Sweeney J, Pellikka P, Nkomo V, Alkhouli M, Holmes D, Badr A, Alsidawi S. Impact of moderate or severe mitral and tricuspid valves regurgitation after transcatheter aortic valve replacement. Am Heart J 2025; 280:79-88. [PMID: 39542233 DOI: 10.1016/j.ahj.2024.11.003] [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: 04/15/2024] [Revised: 11/04/2024] [Accepted: 11/06/2024] [Indexed: 11/17/2024]
Abstract
BACKGROUND Tricuspid regurgitation (TR) and mitral regurgitation (MR) are common valvular conditions encountered in patients undergoing transcatheter aortic valve replacement (TAVR). This retrospective study investigates the impact of moderate or severe TR and MR on all-cause mortality in 1-year post-TAVR patients. METHODS Consecutive patients who underwent TAVR at the 3 academic tertiary care centers in our health system between 2012 and 2018 were identified. Patients were stratified into 2 groups based on valvular regurgitation severity: moderate/severe MR vs no/mild MR, and moderate/severe TR vs no/mild TR. Primary outcome was all-cause mortality at 1-year and 5-year follow up, and secondary outcome was in-hospital death. Logistic regression analysis was conducted to assess the relationship between moderate/severe MR or TR and all-cause mortality at 1-year and 5-year follow-up. RESULTS We included a total of 1,071 patients who underwent TAVR with mean age 80.9 ± 8.6 years, 97% white, and 58.3% males. Moderate or severe MR group included 52 (4.88%) patients while mild or no MR group included 1,015 (95.12%) patients. There was no significant difference between both groups in TAVR procedure success rate (100% vs 97.83%, P = .283), in-hospital mortality (0 vs 1.08%, P = .450), or mortality at 1-year follow up (15.38% vs 14.09%, P = .794). At 5-year follow up, moderate/severe MR group had higher mortality (61.4% vs 49.5%, P = .046). In multivariable logistic regression analysis, moderate or severe MR did not show significant correlation with all-cause mortality at 1-year and 5-year follow up. Moderate or severe TR group included 86 (8.03%) patients while mild or no TR group included 985 (91.97%) patients. There was no difference between both groups in TAVR procedure success (98.8% vs 97.9%, P = .54) or in-hospital mortality (0% vs 1.1%, P = .33). At 1-year follow up, patients with moderate or severe TR had higher mortality (26.7% vs 13.2%, P = .001) compared to patients with mild or no TR. Same finding was noted with extended follow up at 5-years (68.3% vs 48.7%, P < .001). In multivariable cox regression analysis, moderate/severe TR was associated with higher all-cause mortality at 1-year (OR 1.94, 95% CI [01.09, 3.44], P = .023) and at 5-year (OR 1.46, 95% CI [1.092, 1.952], P = .011) follow up. Patients with combined moderate/severe MR and TR have even higher mortality compared to either moderate/severe valve regurgitation alone or mild/no valve regurgitation at 5-year follow up. CONCLUSION At long term follow up, moderate/severe TR, but not MR, is associated with higher mortality in patients underwent TAVR. Combined moderate/severe TR and MR had even worse mortality. Careful assessment of multivalvular heart disease prior to the procedure is warranted.
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Affiliation(s)
- Bishoy Abraham
- Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ; Division of Cardiology, Columbia University, Miami, FL.
| | - Mustafa Suppah
- Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ
| | - Juan Farina
- Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ
| | - Michael Botros
- Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ
| | - Ayman Fath
- Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ
| | - Sara Kaldas
- Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ
| | - Michael Megaly
- Division of Cardiology, Henry Ford Hospital, Detroit, MI
| | - Chieh-Ju Chao
- Division of Cardiology, Mayo Clinic Hospital, Rochester, MN
| | - Reza Arsanjani
- Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ
| | - Chadi Ayoub
- Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ
| | | | - John Sweeney
- Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ
| | | | - Vuyisile Nkomo
- Division of Cardiology, Mayo Clinic Hospital, Rochester, MN
| | | | - David Holmes
- Division of Cardiology, Mayo Clinic Hospital, Rochester, MN
| | - Amr Badr
- Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ
| | - Said Alsidawi
- Division of Cardiology, Mayo Clinic Hospital, Phoenix, AZ
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2
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Abraham B, Sous M, Kaldas S, Nakhla M, Sweeney J, Lee K, Garcia S, Saad M, Goel SS, Fortuin FD. Transcaval access for transcatheter aortic valve implantation: A meta-analysis and systematic review. Int J Cardiol 2025; 419:132720. [PMID: 39537103 DOI: 10.1016/j.ijcard.2024.132720] [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: 06/03/2024] [Revised: 11/06/2024] [Accepted: 11/08/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Anatomical factors may preclude transfemoral (TF) arterial access for transcatheter aortic valve implantation (TAVI). Transcaval (TCav) access has been utilized as an alternative access for these patients. We aimed to investigate the outcomes of TCav access in patients undergoing TAVI. METHODS We performed a systematic review and meta-analysis including all published studies from 1996 to November 2023 that examined TCav access in patients undergoing TAVI. The main outcomes included all cause mortality, major vascular complications, major bleeding, stroke, and myocardial infarction (MI). Outcomes were reported at 30-day and 1-year follow-up. RESULTS We included 8 observational studies with a total of 517 patients (mean age 78.1±8 years, 56.6 % women, mean STS score 7 ± 4.5). Mean (SD) procedure time was 35 ± 9.8 mins and mean (SD) contrast volume was 136.3 ± 77.4 ml. Procedure success was achieved in 94.3 % of the patients. At 30-day follow-up, all-cause mortality occurred in 6.4 %, major bleeding in 12.2 %, blood transfusion in 23.3 %, retroperitoneal bleeding in 19 %, major vascular complications in 7.9 %, MI in 2.8 %, and AKI in 6.4 % of patients. At 1-year, all-cause mortality was 14.7 %. In a sub-group analysis including 3 studies comparing TCav (n = 316) to alternative accesses (including transcarotid, transaxillary, and transapical) (n = 303), there were no differences in all-cause mortality, major bleeding, major vascular complications, blood transfusion, or stroke at 30-day. CONCLUSION Transcaval approach is feasible and non-inferior to other alternative accesses in TAVI patients with prohibitive iliofemoral anatomy.
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Affiliation(s)
- Bishoy Abraham
- Department of Cardiology, Mayo Clinic, Phoenix, AZ, United States of America.
| | - Mina Sous
- Department of Medicine, Amita Health Saint Francis Hospital, Evanston, IL, United States of America
| | - Sara Kaldas
- Department of Cardiology, Mayo Clinic, Phoenix, AZ, United States of America
| | - Michael Nakhla
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, United States of America
| | - John Sweeney
- Department of Cardiology, Mayo Clinic, Phoenix, AZ, United States of America
| | - Kwan Lee
- Department of Cardiology, Mayo Clinic, Phoenix, AZ, United States of America
| | - Santiago Garcia
- Department of Cardiovascular Disease, The Christ Hospital, Cincinnati, OH, United States of America
| | - Marwan Saad
- Lifespan Cardiovascular Institute and Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Sachin S Goel
- Department of Cardiovascular Disease, Houston Methodist Hospital, Houston, TX, United States of America
| | - F David Fortuin
- Department of Cardiology, Mayo Clinic, Phoenix, AZ, United States of America
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3
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Sakurai Y, Kuno T, Yokoyama Y, Fujisaki T, Balakrishnan P, Takagi H, Kaneko T. Late Survival Benefits of Concomitant Surgical Ablation for Atrial Fibrillation During Cardiac Surgery: A Systematic Review and Meta-Analysis. Am J Cardiol 2025; 235:16-29. [PMID: 39471966 DOI: 10.1016/j.amjcard.2024.10.008] [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: 08/17/2024] [Revised: 09/14/2024] [Accepted: 10/14/2024] [Indexed: 11/01/2024]
Abstract
The long-term survival benefits after surgical ablation for atrial fibrillation (AF) during cardiac surgery were not confirmed in previous randomized controlled trials or meta-analyses. This study aimed to investigate the long-term efficacy of surgical ablation in patients with AF. MEDLINE, EMBASE, and CENTRAL were searched to identify studies comparing concomitant surgical AF ablation with no surgical ablation during cardiac surgery. The primary outcome was long-term all-cause mortality. Secondary outcomes were stroke, heart failure rehospitalization, major bleeding, freedom from AF, and permanent pacemaker implantation during follow-up. To minimize confounding, only adjusted outcomes were used from observational studies. A total of 38 studies met the inclusion criteria. Of those, 9 randomized controlled trials and 15 observational studies with 41,678 patients (surgical ablation: n = 19,125; no surgical ablation: n = 22,553) were analyzed for all-cause mortality, with a weighted median follow-up of 62.0 months. Surgical ablation was associated with decreased risks of long-term mortality (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.71 to 0.84), stroke (HR 0.60, 95% CI 0.48 to 0.76), heart failure rehospitalization (HR 0.92, 95% CI 0.87 to 0.96), and more freedom from AF during follow-up (relative risk 1.93, 95% CI 1.50 to 2.49), whereas surgical ablation was associated with a higher risk of permanent pacemaker implantation during follow-up (HR 1.35, 95% CI 1.03 to 1.77). There was no significant difference in major bleeding during follow-up between the 2 groups. In patients with AF who underwent cardiac surgery, surgical ablation was associated with decreased risks of long-term mortality, stroke, and heart failure rehospitalization compared with patients with untreated AF. Given that the survival benefits were predominantly observed in observational studies, further randomized trials are necessary to confirm these findings.
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Affiliation(s)
- Yosuke Sakurai
- Department of Surgery, Marshall University Joan Edwards School of Medicine, West Virginia
| | - Toshiki Kuno
- Division of Cardiology, Massachusetts General Hospital, Havard Medical School, Massachusetts.
| | - Yujiro Yokoyama
- Department of Cardiac Surgery, University of Michigan, Michigan
| | - Tomohiro Fujisaki
- Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York; Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Pranav Balakrishnan
- Department of Surgery, Marshall University Joan Edwards School of Medicine, West Virginia
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Tsuyoshi Kaneko
- Division of Cardiothoracic Surgery, Washington University in St Louis, St Louis, Missouri
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4
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Ozturk C, Pak DH, Rosalia L, Goswami D, Robakowski ME, McKay R, Nguyen CT, Duncan JS, Roche ET. AI-Powered Multimodal Modeling of Personalized Hemodynamics in Aortic Stenosis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024:e2404755. [PMID: 39665137 DOI: 10.1002/advs.202404755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 07/31/2024] [Indexed: 12/13/2024]
Abstract
Aortic stenosis (AS) is the most common valvular heart disease in developed countries. High-fidelity preclinical models can improve AS management by enabling therapeutic innovation, early diagnosis, and tailored treatment planning. However, their use is currently limited by complex workflows necessitating lengthy expert-driven manual operations. Here, we propose an AI-powered computational framework for accelerated and democratized patient-specific modeling of AS hemodynamics from computed tomography (CT). First, we demonstrate that the automated meshing algorithms can generate task-ready geometries for both computational and benchtop simulations with higher accuracy and 100 times faster than existing approaches. Then, we show that the approach can be integrated with fluid-structure interaction and soft robotics models to accurately recapitulate a broad spectrum of clinical hemodynamic measurements of diverse AS patients. The efficiency and reliability of these algorithms make them an ideal complementary tool for personalized high-fidelity modeling of AS biomechanics, hemodynamics, and treatment planning.
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Affiliation(s)
- Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139-4307, USA
- Bioengineering Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton SO17 1BJ, UK
- Institute for Life Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom
| | - Daniel H Pak
- Departments of Biomedical Engineering and Radiology & Biomedical Imaging, Yale University, New Haven, CT, 06510, USA
| | - Luca Rosalia
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139-4307, USA
- Health Sciences and Technology Program, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Bioengineering, Stanford University, Palo Alto, CA, 94305, United States
| | - Debkalpa Goswami
- Cardiovascular Innovation Research Center and Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Mary E Robakowski
- Cardiovascular Innovation Research Center and Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH, 44115, USA
| | - Raymond McKay
- Interventional Cardiology, Hartford Hospital, Hartford, CT, 06106, USA
| | - Christopher T Nguyen
- Cardiovascular Innovation Research Center and Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Department of Chemical and Biomedical Engineering, Cleveland State University, Cleveland, OH, 44115, USA
- Department of Biomedical Engineering, Case Western Reserve University and Lerner Research Institute Cleveland Clinic, Cleveland, OH, 44116, United States
| | - James S Duncan
- Departments of Biomedical Engineering and Radiology & Biomedical Imaging, Yale University, New Haven, CT, 06510, USA
| | - Ellen T Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139-4307, USA
- Health Sciences and Technology Program, Harvard University - Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
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5
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Spooner MT, Messé SR, Chaturvedi S, Do MM, Gluckman TJ, Han JK, Russo AM, Saxonhouse SJ, Wiggins NB. 2024 ACC Expert Consensus Decision Pathway on Practical Approaches for Arrhythmia Monitoring After Stroke: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2024:S0735-1097(24)10301-4. [PMID: 39692645 DOI: 10.1016/j.jacc.2024.10.100] [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] [Indexed: 12/19/2024]
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6
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Alasnag M. Transcatheter Repair Solutions: Will They Stand the Test of Time? JACC Cardiovasc Interv 2024; 17:2808-2810. [PMID: 39663061 DOI: 10.1016/j.jcin.2024.10.036] [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: 10/10/2024] [Accepted: 10/21/2024] [Indexed: 12/13/2024]
Affiliation(s)
- Mirvat Alasnag
- Cardiac Center, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia.
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7
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Echarte-Morales J, Guerreiro CE, Freixa X, Arzamendi D, Moñivas V, Carrasco-Chinchilla F, Pan M, Nombela-Franco L, Pascual I, Benito-González T, Perez R, Gómez-Blázquez I, Amat-Santos IJ, Cruz-González I, Sánchez-Recalde Á, Cid Alvarez AB, Barreiro-Perez M, Sanchis L, Caneiro-Queija B, Hion Li C, Del Trigo M, Martínez-Carmona JD, Mesa D, Jiménez P, Avanzas P, Cepas-Guillén P, Estévez-Loureiro R. Impact of Optimal Procedural Result After Transcatheter Edge-to-Edge Tricuspid Valve Repair: Results From TRI-SPA Registry. JACC Cardiovasc Interv 2024; 17:2764-2777. [PMID: 39520435 DOI: 10.1016/j.jcin.2024.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 07/15/2024] [Accepted: 08/06/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Procedural success following tricuspid transcatheter edge-to-edge repair (TEER) has been defined variably over time; however, the consequences of achieving a tricuspid regurgitation (TR) grade of 0/1+ are still unclear. OBJECTIVES This study aimed to assess the predictors and prognostic impact of achieving TR 0/1+ after TEER and its role in clinical events. METHODS This multicenter registry included patients undergoing tricuspid TEER in 15 Spanish centers from June 2020 and May 2023. Patients were categorized into the following groups based on the TR grade after procedure: optimal (0/1+), acceptable (2+), and not acceptable (≥3+). The primary endpoint was the 1-year composite of all-cause death, heart failure hospitalization, and tricuspid reintervention. Secondary endpoints included each component of the primary endpoint assessed separately, NYHA functional class, and TR grade at follow-up. RESULTS Among 280 enrolled patients, 120 (42.9%) had residual TR 0/1+, 111 (39.6%) had residual TR 2+, and 49 (17.5%) had residual TR ≥3+. Patients with TR 0/1+ experienced lower rates of the primary endpoint (13% vs 20% vs 31%; log-rank P = 0.036). Residual TR ≥3+ was an independent predictor of primary endpoint (HR: 2.277; P = 0.044). Higher rates of NYHA functional class I or II and sustained TR reduction were seen in the TR 0/1+ group (P < 0.001 for both). A small coaptation gap and absence of septal leaflet tethering were independent predictors of achieving TR 0/1+. CONCLUSIONS An optimal procedural result after TEER might be associated with improved outcomes. TR coaptation gap and leaflet restriction may aid in assessing suitability for TEER.
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Affiliation(s)
- Julio Echarte-Morales
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Claudio E Guerreiro
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Xavier Freixa
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Dabit Arzamendi
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Vanessa Moñivas
- Department of Cardiology. University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Manuel Pan
- Department of Cardiology, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos, Madrid, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Ruth Perez
- Department of Cardiology, University Hospital A Coruña, A Coruña, Spain
| | | | - Ignacio J Amat-Santos
- Department of Cardiology, University Clinic Hospital, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Valladolid, Spain
| | - Ignacio Cruz-González
- Department of Cardiology, Hospital Universitario de Salamanca, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Instituto de Investigación Biomédica de Salamanca, Salamanca, Spain
| | | | - Ana Belén Cid Alvarez
- Department of Cardiology, University Clinic Hospital, Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Santiago de Compostela, Spain
| | - Manuel Barreiro-Perez
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Laura Sanchis
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Berenice Caneiro-Queija
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Chi Hion Li
- Division of Interventional Cardiology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Maria Del Trigo
- Department of Cardiology. University Hospital Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Jose David Martínez-Carmona
- Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain; CIBERCV, Instituto de Investigación Biomédica de Málaga, Universidad de Málaga, Málaga, Spain
| | - Dolores Mesa
- Department of Cardiology, Hospital Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Pilar Jiménez
- Cardiovascular Institute, Hospital Clínico San Carlos, Fundación para la Investigación Biomédica del Hospital Clínico San Carlos, Madrid, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pedro Cepas-Guillén
- Department of Cardiology, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Rodrigo Estévez-Loureiro
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Fundación Biomédica Galicia Sur, Servizo Galego de Saude, University of Vigo, Vigo, Spain.
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8
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Echarte-Morales J, Scotti A, Bonnet G, Torrado J, Sturla M, Coisne A, Ludwig S, Barzallo D, Escabia C, Chandra A, Kodesh A, Aftab A, Granada JF, Ho EC, Jorde UP, Rodriguez CJ, Slipczuk L, Garcia MJ, Latib A. Racial and ethnic disparities in patients with severe tricuspid regurgitation: The Bronx-Valve registry. Int J Cardiol 2024; 421:132889. [PMID: 39647784 DOI: 10.1016/j.ijcard.2024.132889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 10/28/2024] [Accepted: 12/04/2024] [Indexed: 12/10/2024]
Abstract
BACKGROUND Severe tricuspid regurgitation (TR) is an adverse prognostic factor. The presence of potential racial/ethnic disparities in patient characteristics and outcomes remain unexplored. This study aimed to investigate the impact of race/ethnicity on the clinical course of severe TR. METHODS We conducted a retrospective cohort analysis of all adults diagnosed with severe TR between January 2017 and December 2019 at a quaternary-care health system. Clinical and echocardiographic features were evaluated according to race/ethnicity. TR was categorized into four etiologies: primary, cardiac implantable electronic device-induced, ventricular secondary (V-STR), and atrial secondary TR. V-STR subgroups included left-sided cardiac disease and pulmonary hypertension. The primary endpoint was 5-year all-cause mortality, with secondary endpoints being heart failure hospitalization (HFH) and cardiovascular (CV) mortality. RESULTS A total of 989 patients were analyzed: 47.8 %, 35.1 %, and 17.1 % were non-Hispanic Black, Hispanic, and non-Hispanic White, respectively, over a median follow-up of 14.8 (3-42.4) months. The mean age was 71.4 ± 15.6 years (60.9 % women) with non-Hispanic Black and Hispanic patients younger yet displaying higher comorbidity burden, worse functional class, and more pronounced right ventricular remodeling. Left-sided cardiac disease was the predominant etiology (65.9 %), with a higher prevalence among non-White individuals. All-cause mortality and CV mortality occurred in 575 (58.1 %) and 196 (19.8 %) of patients with no significant differences among groups. HFH presented in 334 (33.1 %) of patients with Black patients having an increased risk compared to White individuals (HR, 1.45; 95 %CI, 1.04-2.02). CONCLUSIONS At the time of severe TR detection, Black and Hispanic patients, despite being younger, had higher comorbidities and more advanced disease than White patients. While 5-year mortality rates showed no significant racial/ethnic differences, Black patients had a higher risk of HFH.
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Affiliation(s)
- Julio Echarte-Morales
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America; Cardiovascular Research Foundation, New York, NY, United States of America
| | - Guillaume Bonnet
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America; Cardiovascular Research Foundation, New York, NY, United States of America
| | - Juan Torrado
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Matteo Sturla
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Augustin Coisne
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America; Cardiovascular Research Foundation, New York, NY, United States of America
| | - Sebastian Ludwig
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America; Cardiovascular Research Foundation, New York, NY, United States of America
| | - Diego Barzallo
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Claudia Escabia
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Akhil Chandra
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Afek Kodesh
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Abdullah Aftab
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Juan F Granada
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America; Cardiovascular Research Foundation, New York, NY, United States of America
| | - Edwin C Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Ulrich P Jorde
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Carlos J Rodriguez
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Leandro Slipczuk
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Mario J Garcia
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States of America.
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9
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Tsaban G, Lee E, Wopperer S, Abbasi M, Yu HT, Kane GC, Lopez-Jimenez F, Pislaru SV, Nkomo VT, Deshmukh AJ, Asirvatham SJ, Noseworthy PA, Friedman PA, Attia Z, Oh JK. Using Electrocardiogram to Assess Diastolic Function and Prognosis in Mitral Regurgitation. J Am Coll Cardiol 2024; 84:2278-2289. [PMID: 39603748 DOI: 10.1016/j.jacc.2024.06.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 11/29/2024]
Abstract
BACKGROUND The determination of left ventricular diastolic function (LVDF) in patients with significant (≥moderate) mitral regurgitation (MR) poses a complex challenge. We recently validated an artificial intelligence-enabled electrocardiogram (AI-ECG) algorithm to estimate LVDF. OBJECTIVES This study sought to evaluate the risk of all-cause mortality across AI-ECG LVDF-derived myocardial disease (MD) grades in MR. METHODS This was a retrospective study including all patients in the AI-ECG LVDF study testing group who underwent comprehensive transthoracic echocardiography confirming significant MR and electrocardiogram within 14 days of each other at the Mayo Clinic between September 2001 and April 2023. AI-ECG LVDF status was determined based on the index electrocardiogram and used to categorize patients into 3 stages of MD: MD-1, normal or grade 1 LVDF; MD-2, grade 2 LVDF; and MD-3, grade 3 LVDF. RESULTS Of 4,019 patients with significant MR (mean age 69.8 years; 49.0% women), 1,175 (29.2%), 1,881 (46.8%), and 963 (24.0%) were classified by AI-ECG as MD-1, MD-2, and MD-3, respectively. The median mitral effective regurgitant orifice area was 26 mm2 (Q1-Q3: 20-36 mm2). Over a median follow-up of 3.5 years, 1,636 (40.7%) patients died. In multivariable survival analysis adjusted for multiple risk factors, a higher diastolic function grade was independently associated with an increased death risk (MD-2, adjusted HR [aHR]: 1.99; 95% CI: 1.62-2.45; MD-3, aHR: 2.65; 95% CI: 2.11-3.34). These findings were consistent when accounting for mitral valve intervention and across various sensitivity and subgroup analyses. CONCLUSIONS In patients with significant MR, the grading of LVDF by AI-ECG is independently associated with all-cause mortality.
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Affiliation(s)
- Gal Tsaban
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Eunjung Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samual Wopperer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Muhannad Abbasi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hee Tae Yu
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Zachi Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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10
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Kho E, Schenk J, Vlaar APJ, Vis MM, Wijnberge M, Stam LB, van Mourik M, Jorstad HT, Hermanns H, Westerhof BE, Veelo DP, van der Ster BJP. Detecting aortic valve stenosis based on the non-invasive blood pressure waveform-a proof of concept study. GeroScience 2024; 46:5955-5965. [PMID: 38509415 PMCID: PMC11493879 DOI: 10.1007/s11357-024-01136-w] [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: 04/14/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
The incidence of aortic valve stenosis (AoS) increases with age, and once diagnosed, symptomatic severe AoS has a yearly mortality rate of 25%. AoS is diagnosed with transthoracic echocardiography (TTE), however, this gold standard is time consuming and operator and acoustic window dependent. As AoS affects the arterial blood pressure waveform, AoS-specific waveform features might serve as a diagnostic tool. Aim of the present study was to develop a novel, non-invasive, AoS detection model based on blood pressures waveforms. This cross-sectional study included patients with AoS undergoing elective transcatheter or surgical aortic valve replacement. AoS was determined using TTE, and patients with no or mild AoS were labelled as patients without AoS, while patients with moderate or severe AoS were labelled as patients with AoS. Non-invasive blood pressure measurements were performed in awake patients. Ten minutes of consecutive data was collected. Several blood pressure-based features were derived, and the median, interquartile range, variance, and the 1st and 9th decile of the change of these features were calculated. The primary outcome was the development of a machine-learning model for AoS detection, investigating multiple classifiers and training on the area under the receiver-operating curve (AUROC). In total, 101 patients with AoS and 48 patients without AoS were included. Patients with AoS showed an increase in left ventricular ejection time (0.02 s, p = 0.001), a delayed maximum upstroke in the systolic phase (0.015 s, p < 0.001), and a delayed maximal systolic pressure (0.03 s, p < 0.001) compared to patients without AoS. With the logistic regression model, a sensitivity of 0.81, specificity of 0.67, and AUROC of 0.79 were found. The majority of the population without AoS was male (85%), whereas in the population with AoS this was evenly distributed (54% males). Age was significantly (5 years, p < 0.001) higher in the population with AoS. In the present study, we developed a novel model able to distinguish no to mild AoS from moderate to severe AoS, based on blood pressure features with high accuracy. Clinical registration number: The study entailing patients with TAVR treatment was registered at ClinicalTrials.gov (NCT03088787, https://clinicaltrials.gov/ct2/show/NCT03088787 ). The study with elective cardiac surgery patients was registered with the Netherland Trial Register (NL7810, https://trialsearch.who.int/Trial2.aspx?TrialID=NL7810 ).
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Affiliation(s)
- Eline Kho
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jimmy Schenk
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marije M Vis
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Marije Wijnberge
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Lotte B Stam
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Martijn van Mourik
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Harald T Jorstad
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Henning Hermanns
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Berend E Westerhof
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, Netherlands
| | - Denise P Veelo
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
| | - Bjorn J P van der Ster
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
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11
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Vinco G, Porto MD, Demattè C, Giovanelli C, Caruso F, Marinetti A, Quattrocchi CC, Greco MD, D'Onofrio M. Role of Cardiovascular Magnetic Resonance in the Assessment of Native Aortic Regurgitation With Insights on Mixed and Multiple Valvular Heart Disease: A Narrative Review. Echocardiography 2024; 41:e70045. [PMID: 39655361 DOI: 10.1111/echo.70045] [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: 09/30/2024] [Revised: 11/05/2024] [Accepted: 11/14/2024] [Indexed: 12/18/2024] Open
Abstract
Cardiovascular magnetic resonance imaging (CMR) has received extensive validation for the assessment of valvular heart disease (VHD) and offers an accurate and direct method for the quantification of aortic regurgitation (AR). According to the current guidelines, CMR represents a useful second-line investigation in patients with poor acoustic windows or when echocardiography is inconclusive, for example, in cases of multiple or eccentric aortic jets. Without ionizing radiation exposure, CMR provides in-depth information not only on the severity degree of AR, providing a precise quantification of regurgitant volume and fraction, but also on cardiac structure and function, being recognized as the gold standard for the assessment of heart chamber size and systolic function. CMR allows a free choice of cardiac imaging planes and provides further information on the myocardium, thanks to the tissue characterization ability offered by several sequences, such as the late gadolinium enhancement technique. The possibilities offered by CMR become even more interesting in the context of mixed and multiple VHD, where the echocardiographic assessments often encounter difficulties in the quantification of each single valve lesion. The current scientific data support a greater expansion of CMR in this field, thanks to its additional advantages for the diagnosis, risk stratification, and to guide treatment. This review investigates the current CMR techniques and protocols in AR, with special insights into the evaluation of mixed aortic valve disease and multiple VHD including AR.
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Affiliation(s)
- Giulia Vinco
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
| | | | - Cristina Demattè
- Department of Cardiology, Santa Maria del Carmine Hospital, APSS, Rovereto, Italy
| | - Cristiana Giovanelli
- Department of Cardiology, Santa Maria del Carmine Hospital, APSS, Rovereto, Italy
| | - Fabio Caruso
- Department of Radiology, Santa Maria del Carmine Hospital, APSS, Rovereto, Italy
| | - Alessandro Marinetti
- Department of Radiology, Santa Maria del Carmine Hospital, APSS, Rovereto, Italy
| | - Carlo Cosimo Quattrocchi
- Department of Radiology, Santa Maria del Carmine Hospital, APSS, Rovereto, Italy
- Centre for Medical Sciences - CISMed, University of Trento, Trento, Italy
| | - Maurizio Del Greco
- Department of Cardiology, Santa Maria del Carmine Hospital, APSS, Rovereto, Italy
| | - Mirko D'Onofrio
- Department of Radiology, G.B. Rossi University Hospital, University of Verona, Verona, Italy
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12
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Anand V, Michelena HI, Pellikka PA. Noninvasive Imaging for Native Aortic Valve Regurgitation. J Am Soc Echocardiogr 2024; 37:1167-1181. [PMID: 39218370 DOI: 10.1016/j.echo.2024.08.009] [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: 03/28/2024] [Revised: 08/10/2024] [Accepted: 08/11/2024] [Indexed: 09/04/2024]
Abstract
Aortic regurgitation (AR) is associated with left ventricular (LV) volume and pressure overload, resulting in eccentric LV remodeling and enlargement. This condition may be well tolerated for years before the onset of myocardial dysfunction and symptoms. Echocardiography plays a crucial role in the diagnosis of AR, assessing its mechanism and severity, and detecting LV remodeling. The assessment of AR severity is challenging and frequently requires the integration of information from multiple different measurements to assess the severity. Recent data suggest that echocardiographically derived LV volumes (end-systolic volume index > 45 mL/m2), an ejection fraction threshold of <60%, and abnormal global longitudinal strain may help identify early dysfunction and may be used to improve clinical outcomes. Consequently, these parameters can identify candidates for surgery. Cardiac magnetic resonance imaging is emerging as a valuable tool for assessing severity when it remains unclear after an echocardiographic evaluation. This review emphasizes the importance of imaging, particularly echocardiography, in the evaluation of AR. It focuses on various echocardiographic parameters, including technical details, and how to integrate them for assessing the mechanism and severity of AR as well as LV remodeling.
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Affiliation(s)
- Vidhu Anand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Hector I Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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13
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Tomii D, Okuno T, Nakase M, Praz F, Stortecky S, Reineke D, Windecker S, Lanz J, Pilgrim T. Renin-Angiotensin System Inhibition and Cardiac Damage in Patients Undergoing Transcatheter Aortic Valve Replacement. Can J Cardiol 2024; 40:2592-2602. [PMID: 39067618 DOI: 10.1016/j.cjca.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/23/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The optimal medical treatment strategy after transcatheter aortic valve replacement (TAVR) has not been established, and might be affected by the extent of extravalvular cardiac damage. We aimed to investigate the prognostic association of renin-angiotensin system (RAS) inhibitors in TAVR patients stratified according to the extent of extravalvular cardiac damage. METHODS In a prospective TAVR registry, patients were retrospectively evaluated for baseline cardiac damage and classified into 5 stages of cardiac damage (0-4) according to established criteria. Clinical outcomes at 1 year were compared according to RAS inhibitor prescription at discharge. RESULTS Among 2247 eligible patients who underwent TAVR between August 2007 and June 2021, 1634 (72.7%) were prescribed RAS inhibitors at discharge. Eighty-three patients (3.7%) were classified as stage 0, 276 (12.3%) as stage 1, 889 (39.6%) as stage 2, 489 (21.8%) as stage 3, and 510 (22.7%) as stage 4. RAS inhibitor prescription after TAVR was associated with a reduced risk of 1-year mortality (adjusted hazard ratio [HRadjusted], 0.59; 95% confidence interval [CI], 0.45-0.77). The protective association was accentuated among patients with cardiac stages 3 and 4 (HRadjusted, 0.54 [95% CI, 0.32-0.92]; and HRadjusted, 0.58 [95% CI, 0.36-0.92], respectively), but not statistically significant in for those with stage 2 (HRadjusted, 0.70; 95% CI, 0.43-1.14). CONCLUSIONS In patients who underwent TAVR, we found a strong association of RAS inhibitor prescription and improved clinical outcome in the overall population, and there were no signs of heterogeneity across stages of cardiac damage. CLINICAL TRIAL REGISTRATION NCT01368250.
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Affiliation(s)
- Daijiro Tomii
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Masaaki Nakase
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
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14
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Taniguchi T, Morimoto T, Takeji Y, Shirai S, Ando K, Tabata H, Yamamoto K, Murai R, Osakada K, Sakamoto H, Tada T, Murata K, Obayashi Y, Amano M, Kitai T, Izumi C, Toyofuku M, Kanamori N, Miyake M, Nakayama H, Izuhara M, Nagao K, Nakatsuma K, Furukawa Y, Inoko M, Kimura M, Ishii M, Usami S, Nakazeki F, Shirotani M, Inuzuka Y, Ono K, Minatoya K, Kimura T. Low-Gradient Severe Aortic Stenosis: Insights From the CURRENT AS Registry-2. JACC Cardiovasc Interv 2024:S1936-8798(24)01257-3. [PMID: 39708011 DOI: 10.1016/j.jcin.2024.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 09/07/2024] [Accepted: 09/17/2024] [Indexed: 12/23/2024]
Abstract
BACKGROUND Low-gradient (LG) aortic stenosis (AS) has not been fully characterized compared with high-gradient (HG) AS in terms of cardiac damage, frailty, aortic valve calcification, and clinical outcomes. OBJECTIVES The aim of this study was to compare the clinical characteristics and outcomes between each hemodynamic type of LG AS and HG AS. METHODS The current study included 3,363 patients in the CURRENT AS (Contemporary outcomes after sURgery and medical tREatmeNT in patients with severe Aortic Stenosis) Registry-2 after excluding patients without indexed stroke volume or left ventricular ejection fraction (LVEF) data. Patients were divided into 4 groups (LG AS with reduced LVEF: n = 285; paradoxical low flow, low gradient [LFLG]: n = 220; normal flow, low gradient [NFLG]: n = 872; HG: n = 1,986). RESULTS Compared with HG AS, LG AS with reduced LVEF more often had cardiovascular comorbidities, advanced cardiac damage, and frailty with less severe valve calcification and paradoxical LFLG AS more often had atrial fibrillation, advanced cardiac damage, and frailty with less severe valve calcification, while NFLG AS had comparable cardiac damage and frailty with less severe valve calcification. Cumulative 3-year incidence of death or heart failure hospitalization was higher in LG AS with reduced LVEF and paradoxical LFLG than in HG AS. After adjusting for confounders, LG AS with reduced LVEF and paradoxical LFLG compared with HG AS were independently associated with higher risk for death or heart failure hospitalization (HR: 1.82; 95% CI: 1.49-2.23; P < 0.001; and HR: 1.43; 95% CI: 1.13-1.82; P = 0.003, respectively) but NFLG AS was not (HR: 1.03; 95% CI: 0.88-1.21; P = 0.68). CONCLUSIONS Clinical outcomes were significantly worse in LG AS with reduced LVEF and paradoxical LFLG AS and comparable in NFLG AS compared with HG AS.
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Affiliation(s)
- Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo Medical University, Nishinomiya, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroyuki Tabata
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ko Yamamoto
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryosuke Murai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kohei Osakada
- Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroki Sakamoto
- Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan
| | - Tomohisa Tada
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yuki Obayashi
- Department of Cardiovascular Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Masashi Amano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Norio Kanamori
- Division of Cardiology, Shimada General Medical Center, Shimada, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Hiroyuki Nakayama
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Masayasu Izuhara
- Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan
| | - Kazuya Nagao
- Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan
| | - Kenji Nakatsuma
- Department of Cardiology, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Moriaki Inoko
- Cardiovascular Center, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Masahiro Kimura
- Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunsuke Usami
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Fumiko Nakazeki
- Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan
| | - Manabu Shirotani
- Division of Cardiology, Kindai University Nara Hospital, Ikoma, Japan
| | - Yasutaka Inuzuka
- Department of Cardiology, Shiga General Hospital, Moriyama, Japan
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Hospital, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan.
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15
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Hausleiter J, Stolz L, Lurz P, Rudolph V, Hahn R, Estévez-Loureiro R, Davidson C, Zahr F, Kodali S, Makkar R, Cheung A, Lopes RD, Maisano F, Fam N, Latib A, Windecker S, Praz F. Transcatheter Tricuspid Valve Replacement. J Am Coll Cardiol 2024:S0735-1097(24)09961-3. [PMID: 39580719 DOI: 10.1016/j.jacc.2024.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Revised: 10/11/2024] [Accepted: 10/11/2024] [Indexed: 11/26/2024]
Abstract
Transcatheter tricuspid valve replacement (TTVR) has emerged as a promising intervention for the treatment of severe tricuspid regurgitation with complex valve morphology. This consensus document provides a comprehensive overview of the current state of orthotopic TTVR, focusing on patient selection, procedural details, and follow-up care. Clinical outcomes from initial studies and compassionate use cases are discussed, highlighting the effectiveness of TTVR in reducing tricuspid regurgitation, inducing reverse right ventricular remodeling, and enhancing patients' quality of life. This review paper also addresses potential complications and challenges associated with TTVR, such as new-onset conduction disturbances, bleeding complications, and afterload mismatch, and provides expert recommendations for the periprocedural management, anticoagulation strategies, and long-term follow-up. With the commercial approval of the first TTVR system in the United States and Europe, it intends to serve as a reference for clinicians and researchers involved in the evolving field of transcatheter tricuspid valve interventions.
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Affiliation(s)
- Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany. https://twitter.com/stolz_l
| | - Philipp Lurz
- Cardiology Center, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Volker Rudolph
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Centre North Rhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Bochum, Germany
| | - Rebecca Hahn
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA
| | - Rodrigo Estévez-Loureiro
- Department of Cardiology, University Hospital Alvaro Cunqueiro, Vigo, Spain; Cardiovascular Research Group, Department of Cardiology, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute (IIS Galicia Sur), Servizo Galego de Saude, University of Vigo, Vigo, Spain
| | - Charles Davidson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Firas Zahr
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Susheel Kodali
- Division of Cardiology, Columbia University Medical Center-NewYork Presbyterian Hospital, New York, New York, USA
| | - Raj Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Anson Cheung
- Division of Cardiothoracic Surgery, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA; Brazilian Clinical Research Institute (BCRI), São Paulo, Brazil
| | - Francesco Maisano
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Neil Fam
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephan Windecker
- Department of Cardiology Bern University Hospital, Inselspital, University of Berne, Berne, Switzerland
| | - Fabien Praz
- Department of Cardiology Bern University Hospital, Inselspital, University of Berne, Berne, Switzerland. https://twitter.com/FabienPraz
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16
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Ahmed O, King NE, Qureshi MA, Choudhry AA, Osama M, Zehner C, Ali A, Hamzeh IR, Palaskas NL, Thompson KA, Koutroumpakis E, Deswal A, Yusuf SW. Non-bacterial thrombotic endocarditis: a clinical and pathophysiological reappraisal. Eur Heart J 2024:ehae788. [PMID: 39565324 DOI: 10.1093/eurheartj/ehae788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 08/11/2024] [Accepted: 10/30/2024] [Indexed: 11/21/2024] Open
Abstract
Non-bacterial thrombotic endocarditis (NBTE), formerly recognized as marantic endocarditis, represents a rare cardiovascular pathology intricately linked with hypercoagulable states, notably malignancy and autoimmune disorders. Characterized by the development of sterile vegetations comprised of fibrin and platelets on cardiac valves, NBTE poses a diagnostic challenge due to its resemblance to infective endocarditis. Therapeutic endeavours primarily revolve around addressing the underlying aetiology and instituting anticoagulant regimens to forestall embolic events, with surgical intervention seldom warranted. Non-bacterial thrombotic endocarditis frequently coexists with malignancies and autoimmune conditions, such as lupus and antiphospholipid antibody syndrome, and, more recently, has been associated with COVID-19. Its pathogenesis is underpinned by a complex interplay of endothelial dysfunction, hypercoagulability, hypoxia, and immune complex deposition. Clinical manifestations typically manifest as embolic phenomena, particularly cerebrovascular accidents, bearing substantial mortality rates. Diagnosis necessitates a high index of suspicion and meticulous exclusion of infective endocarditis, often facilitated by advanced cardiac imaging modalities. Anticoagulation, typically employing low molecular weight heparin or warfarin, constitutes the cornerstone of pharmacological intervention. Surgical recourse may be warranted in instances of refractory heart failure or recurrent embolic events. Given its multifaceted nature, the management of NBTE mandates a multidisciplinary approach, with prognosis contingent upon individual clinical intricacies. Future endeavours should prioritize further research to refine therapeutic strategies and enhance patient outcomes.
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Affiliation(s)
- Omair Ahmed
- Department of Internal Medicine, Henry Ford Jackson Hospital, Jackson, MI 49201, USA
| | - Nicholas E King
- Division of Cardiovascular Medicine, McGovern Medical School, University of Texas Health Sciences Center at Houston, Houston, TX 77030, USA
| | | | - Abira Afzal Choudhry
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Muhammad Osama
- Department of Internal Medicine, Rochester Regional Health, Rochester, NY 14617, USA
| | - Carl Zehner
- Department of Cardiology, University of Texas Health Sciences Center, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Abdelrahman Ali
- Department of Cardiology, University of Texas Health Sciences Center, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Ihab R Hamzeh
- Department of Cardiology, University of Texas Health Sciences Center, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Nicolas L Palaskas
- Department of Cardiology, University of Texas Health Sciences Center, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Kara A Thompson
- Department of Cardiology, University of Texas Health Sciences Center, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Efstratios Koutroumpakis
- Department of Cardiology, University of Texas Health Sciences Center, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Anita Deswal
- Department of Cardiology, University of Texas Health Sciences Center, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Syed Wamique Yusuf
- Department of Cardiology, University of Texas Health Sciences Center, MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
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17
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Généreux P, Banovic M, Kang DH, Giustino G, Prendergast BD, Lindman BR, Newby DE, Pibarot P, Redfors B, Craig NJ, Bartunek J, Schwartz A, Seyedin R, Cohen DJ, Iung B, Leon MB, Dweck MR. Aortic Valve Replacement vs Clinical Surveillance in Asymptomatic Severe Aortic Stenosis: A Systematic Review and Meta-Analysis. J Am Coll Cardiol 2024:S0735-1097(24)10419-6. [PMID: 39641732 DOI: 10.1016/j.jacc.2024.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/16/2024] [Accepted: 11/04/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Current guidelines recommend a strategy of clinical surveillance (CS) for patients with asymptomatic severe aortic stenosis (AS) and a normal left ventricular ejection fraction. OBJECTIVES The aim of this study was to conduct a study-level meta-analysis of randomized controlled trials (RCTs) evaluating the effect of early aortic valve replacement (AVR) compared with CS in patients with asymptomatic severe AS. METHODS Studies were quantitatively assessed in a meta-analysis using random-effects modeling. Prespecified outcomes included all-cause and cardiovascular mortality, unplanned cardiovascular or heart failure (HF) hospitalization, and stroke. The meta-analysis is registered at the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY202490002). RESULTS Four RCTs were identified, including a total of 1,427 patients (719 in the early AVR group and 708 in the CS group). At an average follow-up time of 4.1 years, early AVR was associated with a significant reduction in unplanned cardiovascular or HF hospitalization (pooled rate 14.6% vs 31.9%; HR: 0.40; 95% CI: 0.30-0.53; I2 = 4%; P < 0.01) and stroke (pooled rate 4.5% vs 7.2%; HR: 0.62; 95% CI: 0.40-0.97; I2 = 0%; P = 0.03). No differences in all-cause mortality (pooled rate 9.7% vs 13.7%; HR: 0.68; 95% CI: 0.40-1.17; I2 = 61%; P = 0.17) and cardiovascular mortality (pooled rate 5.1% vs 8.3%; HR: 0.67; 95% CI: 0.35-1.29; I2 = 50%; P = 0.23) were observed with early AVR compared with CS, although there was a high degree of heterogeneity among studies. CONCLUSIONS In this meta-analysis of 4 RCTs, early AVR was associated with a significant reduction in unplanned cardiovascular or HF hospitalization and stroke and no differences in all-cause and cardiovascular mortality compared with CS.
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Affiliation(s)
- Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA.
| | - Marko Banovic
- Belgrade Medical School, University of Belgrade, Belgrade, Serbia; Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Duk-Hyun Kang
- Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Gennaro Giustino
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Bernard D Prendergast
- Department of Cardiology, Guys and St Thomas' NHS Foundation Trust Hospital London, London, United Kingdom; Heart, Vascular and Thoracic Institute, Cleveland Clinic London, London, United Kingdom
| | - Brian R Lindman
- Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Philippe Pibarot
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Björn Redfors
- Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Neil J Craig
- Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Jozef Bartunek
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Allan Schwartz
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA
| | | | - David J Cohen
- St. Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Bernard Iung
- Bichat Hospital, Assistance Publique-Hôpitaux de Paris, and INSERM LVTS 1148, Université Paris-Cité, Paris, France
| | - Martin B Leon
- Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
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18
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Linker DT. Half-Time Score or Final? Am J Cardiol 2024; 231:90-91. [PMID: 39241976 DOI: 10.1016/j.amjcard.2024.08.031] [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: 08/29/2024] [Accepted: 08/31/2024] [Indexed: 09/09/2024]
Affiliation(s)
- David T Linker
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington.
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19
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Vergallo R, Pedicino D. Weekly Journal Scan: Should we treat obstructive coronary artery disease in patients undergoing transcatheter aortic valve implantation? Eur Heart J 2024:ehae761. [PMID: 39529376 DOI: 10.1093/eurheartj/ehae761] [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: 11/16/2024] Open
Affiliation(s)
- Rocco Vergallo
- Interventional Cardiology Unit, Cardiothoracic and Vascular Department (DICATOV), IRCCS Ospedale Policlinico San Martino, Largo R. Benzi, 10, Genova 16132, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), Università di Genova, Viale Benedetto XV, Genova 6-16132, Italy
| | - Daniela Pedicino
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
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20
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Bhatia K, Gupta S, Carter K, Petrovic M, Shetty SV, Aggarwal D, Casso Dominguez A, Lerakis S, Argulian E. Single-Leaflet Device Attachment After Mitral Transcatheter Edge-to-Edge Repair: Systematic Review and Meta-Analysis. JACC Cardiovasc Interv 2024; 17:2571-2574. [PMID: 39387786 DOI: 10.1016/j.jcin.2024.08.008] [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: 06/14/2024] [Revised: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 10/15/2024]
Affiliation(s)
- Kirtipal Bhatia
- Mount Sinai Fuster Heart, Mount Sinai Morningside Hospital, New York, New York, USA
| | - Soumya Gupta
- Mount Sinai Morningside/West, New York, New York, USA
| | | | - Marija Petrovic
- Mount Sinai Fuster Heart, Mount Sinai Morningside Hospital, New York, New York, USA
| | | | - Devika Aggarwal
- Mount Sinai Fuster Heart, Mount Sinai Morningside Hospital, New York, New York, USA
| | - Abel Casso Dominguez
- Mount Sinai Fuster Heart, Mount Sinai Morningside Hospital, New York, New York, USA
| | - Stamatios Lerakis
- Mount Sinai Fuster Heart, Mount Sinai Hospital, New York, New York, USA
| | - Edgar Argulian
- Mount Sinai Fuster Heart, Mount Sinai Morningside Hospital, New York, New York, USA.
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21
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Yakubov SJ, Sanchez C. It Is Time to Tighten the Screws! JACC Cardiovasc Interv 2024; 17:2541-2542. [PMID: 39453374 DOI: 10.1016/j.jcin.2024.08.039] [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: 08/21/2024] [Accepted: 08/26/2024] [Indexed: 10/26/2024]
Affiliation(s)
| | - Carlos Sanchez
- Riverside Methodist Hospital OhioHealth, Columbus, Ohio, USA
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22
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Huded CP, Chhatriwalla AK, Shah MA, Vemulapalli S, Kosinski A, Cohen DJ. Mitral Transcatheter Edge-to-Edge Repair for Secondary Mitral Regurgitation With Preserved Left Ventricular Function. JACC Cardiovasc Interv 2024; 17:2515-2526. [PMID: 39537273 DOI: 10.1016/j.jcin.2024.08.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/14/2024] [Accepted: 08/27/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Outcomes of mitral transcatheter edge-to-edge repair (MTEER) in patients with secondary mitral regurgitation (sMR) and preserved left ventricular ejection fraction (LVEF) are uncertain. OBJECTIVES This study sought to describe outcomes of MTEER for sMR with preserved LVEF. METHODS Using the STS/ACC TVT (Society of Thoracic Surgeons-American College of Cardiology Transcatheter Valve Therapy) Registry, we evaluated the risk-adjusted outcomes of MTEER for sMR with LVEF >50% by the severity of residual mitral regurgitation (MR), and we compared these outcomes to patients undergoing MTEER for sMR with LVEF of 20% to 50%. RESULTS Among 12,083 patients, LVEF was >50% in 3,011 (24.9%) and 20% to 50% in 9,072 (75.1%). Technical success, in-hospital complications, the 1-year death rate, and the 1-year Kansas City Cardiomyopathy Questionnaire score were similar in patients with LVEF >50% vs LVEF of 20% to 50%. The 1-year adjusted risk of heart failure hospitalization was lower in patients with LVEF >50% vs LVEF of 20% to 50% (adjusted HR: 0.81; 95% CI: 0.68-0.97; P = 0.02). Among patients with LVEF >50%, residual MR was ≤ mild in 76.0% and moderate in 19.0%. Compared with ≤ mild MR, moderate residual MR was associated with increased 1-year risks of death (adjusted HR: 1.46; 95% CI: 1.01-2.10; P = 0.04) and heart failure hospitalization (adjusted HR: 1.82; 95% CI: 1.32-2.52; P < 0.001). At 1 year, the KCCQ score improved in patients with LVEF >50% treated with MTEER (residual MR grade ≤ mild, 28.7 ± 26.8; moderate MR, 25.7 ± 27.2; > moderate MR, 21.6 ± 12.0; all P < 0.05). CONCLUSIONS In patients with sMR and preserved LVEF, MTEER was associated with a high rate of technical success, a low rate of complications, and large improvements in health status.
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Affiliation(s)
- Chetan P Huded
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA.
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA; University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Miloni A Shah
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina, USA; Duke University Medical Center, Durham, North Carolina, USA
| | | | - David J Cohen
- St. Francis Hospital and Heart Center, Roslyn, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
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23
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Freixa X, Ruberti A, Regueiro A, Sanchis L. Moving Toward a Better Understanding of Functional Mitral Regurgitation With Preserved Left Ventricular Function. JACC Cardiovasc Interv 2024; 17:2527-2529. [PMID: 39537274 DOI: 10.1016/j.jcin.2024.09.054] [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: 09/10/2024] [Accepted: 09/23/2024] [Indexed: 11/16/2024]
Affiliation(s)
- Xavier Freixa
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
| | - Andrea Ruberti
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Ander Regueiro
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Laura Sanchis
- Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain
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24
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Gupta T, Malaisrie SC, Batchelor W, Boudoulas KD, Davidson L, Ibebuogu UN, Kpodonu J, Singh R, Sultan I, Theriot M, Reardon MJ, Leon MB, Grubb KJ. Decision-Making Approach to the Treatment of Young and Low-Risk Patients With Aortic Stenosis. JACC Cardiovasc Interv 2024; 17:2455-2471. [PMID: 39537269 DOI: 10.1016/j.jcin.2024.08.032] [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: 06/06/2024] [Revised: 08/16/2024] [Accepted: 08/27/2024] [Indexed: 11/16/2024]
Abstract
Over a decade of randomized controlled trial data demonstrate excellent outcomes with transcatheter aortic valve replacement or surgical aortic valve replacement for patients with symptomatic severe aortic stenosis regardless of surgical risk. The 2020 American College of Cardiology/American Heart Association guidelines recommend both options for low-risk AS patients aged 65 to 80 years. However, the fastest growing population of patients receiving transcatheter aortic valve replacement in the United States is <65 years old, with little data to support the practice. The American College of Cardiology's Cardiac Surgery Team Section Leadership and Interventional Cardiology Councils, a multidisciplinary collaboration of cardiologists and cardiac surgeons, sought to summarize the relevant data into a decision-making tool for heart valve teams. A literature review was completed, and guidelines, randomized controlled trials, and large observational studies were summarized into a pragmatic decision-making approach to treating young and low-risk patients with AS.
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Affiliation(s)
- Tanush Gupta
- Division of Cardiology, University of Vermont Medical Center, Burlington, Vermont, USA
| | - S Chris Malaisrie
- Department of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Wayne Batchelor
- Inova Schar Heart and Vascular Institute, Falls Church, Virginia, USA
| | | | - Laura Davidson
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Uzoma N Ibebuogu
- Division of Cardiovascular Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jacques Kpodonu
- Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ramesh Singh
- Inova Schar Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, Center for Heart Valve Disease, University of Pittsburgh Medical Center Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Misty Theriot
- Lake Charles Memorial Hospital Heart & Vascular Center, Lake Charles, Louisiana, USA
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Martin B Leon
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA; Cardiovascular Research Foundation, New York, New York, USA
| | - Kendra J Grubb
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
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25
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Xie S, Liu H, Su L, Shen J, Miao J, Huang D, Zhou M, Liu H, Li Y, Yin L, Shu Q, Wang Y. A deep learning-based method for assessing tricuspid regurgitation using continuous wave Doppler spectra. Sci Rep 2024; 14:27483. [PMID: 39523386 PMCID: PMC11551186 DOI: 10.1038/s41598-024-78861-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 11/04/2024] [Indexed: 11/16/2024] Open
Abstract
Transthoracic echocardiography (TTE) is widely recognized as one of the principal modalities for diagnosing tricuspid regurgitation (TR). The diagnostic procedures associated with conventional methods are intricate and labor-intensive, with human errors leading to measurement variability, with outcomes critically dependent on the operators' diagnostic expertise. In this study, we present an innovative assessment methodology for evaluating TR severity utilizing an end-to-end deep learning system. This deep learning system comprises a segmentation model of single cardiac cycle TR continuous wave (CW) Doppler spectra and a classification model of the spectra, trained on the TR CW Doppler spectra from a cohort of 11,654 patients. The efficacy of this intelligent assessment methodology was validated on 1500 internal cases and 573 external cases. The receiver operating characteristic (ROC) curves of the internal validation results indicate that the deep learning system achieved the areas under curve (AUCs) of 0.88, 0.84, and 0.89 for mild, moderate, and severe TR, respectively. The ROC curves of the external validation results demonstrate that the system attained the AUCs of 0.86, 0.79, and 0.87 for mild, moderate, and severe TR, respectively. Our study results confirm the feasibility and efficacy of this novel intelligent assessment method for TR severity.
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Affiliation(s)
- Shenghua Xie
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cardiovascular Disease, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Department of Cardiovascular Ultrasound and Noninvasive Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Han Liu
- School of Computer Science and Software Engineering, Southwest Petroleum University, Chengdu, 610500, China
| | - Li Su
- Department of Cardiovascular Medicine, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, 611137, China
| | - Jie Shen
- Department of Ultrasound Medicine, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Junwang Miao
- Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Third Hospital of Shanxi Medical University, Tongji Shanxi Hospital, Taiyuan, 030032, China
| | - Duo Huang
- Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, China
| | - Mi Zhou
- Department of Ultrasound in Medicine, Chengdu Wenjiang District People's Hospital, Chengdu, 611130, China
| | - Huiruo Liu
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Yan Li
- Nanchong Central Hospital (Beijing Anzhen Hospital Nanchong Hospital), the Second Clinical College of North Sichuan Medical College, Nanchong, 637003, China
| | - Lixue Yin
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cardiovascular Disease, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Department of Cardiovascular Ultrasound and Noninvasive Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Qinglan Shu
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cardiovascular Disease, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Department of Cardiovascular Ultrasound and Noninvasive Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Yi Wang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Clinical Research Center for Cardiovascular Disease, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Department of Cardiovascular Ultrasound and Noninvasive Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
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26
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Sohn SH, Kim KH, Kang Y, Choi JW, Lee SH, Shinn SH, Yoo JS, Lim C. Costs Associated with Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement in Korea. J Chest Surg 2024; 57:536-546. [PMID: 39434612 PMCID: PMC11538586 DOI: 10.5090/jcs.24.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/26/2024] [Accepted: 07/31/2024] [Indexed: 10/23/2024] Open
Abstract
Background This study compared the costs associated with transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in Korea by utilizing the National Health Insurance Service database. Methods Between June 2015 and May 2019, 1,468 patients underwent primary isolated transfemoral TAVI, while 2,835 patients received primary isolated SAVR with a bioprosthesis. We assessed the costs of index hospitalization and subsequent healthcare utilization, categorizing the cohort into 6 age subgroups: <70, 70-74, 75-79, 80-84, 85-89, and ≥90 years. The median follow-up periods were 2.5 and 3.0 years in the TAVI and SAVR groups, respectively. Results The index hospitalization costs were 41.0 million Korean won (KRW) (interquartile range [IQR], 39.1-44.7) for the TAVI group and 24.6 million KRW (IQR, 21.3-30.2) for the SAVR group (p<0.001). The TAVI group exhibited relatively constant index hospitalization costs across different age subgroups. In contrast, the SAVR group showed increasing index hospitalization costs with advancing age. The healthcare utilization costs were 5.7 million KRW per year (IQR, 3.3-14.2) for the TAVI group and 4.0 million KRW per year (IQR, 2.2-9.0) for the SAVR group (p<0.001). Healthcare utilization costs were higher in the TAVI group than in the SAVR group for the age subgroups of <70, 70-74, and 75-79 years, and were comparable in the age subgroups of 80-84, 85-89, and ≥90 years. Conclusion TAVI had much higher index hospitalization costs than SAVR. Additionally, the overall healthcare utilization costs post-discharge for TAVI were also marginally higher than those for SAVR in younger age subgroups.
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Affiliation(s)
- Suk Ho Sohn
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoonjin Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Jae Suk Yoo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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27
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Thompson A, Fleischmann KE, Smilowitz NR, de Las Fuentes L, Mukherjee D, Aggarwal NR, Ahmad FS, Allen RB, Altin SE, Auerbach A, Berger JS, Chow B, Dakik HA, Eisenstein EL, Gerhard-Herman M, Ghadimi K, Kachulis B, Leclerc J, Lee CS, Macaulay TE, Mates G, Merli GJ, Parwani P, Poole JE, Rich MW, Ruetzler K, Stain SC, Sweitzer B, Talbot AW, Vallabhajosyula S, Whittle J, Williams KA. 2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 84:1869-1969. [PMID: 39320289 DOI: 10.1016/j.jacc.2024.06.013] [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] [Indexed: 09/26/2024]
Abstract
AIM The "2024 AHA/ACC/ACS/ASNC/HRS/SCA/SCCT/SCMR/SVM Guideline for Perioperative Cardiovascular Management for Noncardiac Surgery" provides recommendations to guide clinicians in the perioperative cardiovascular evaluation and management of adult patients undergoing noncardiac surgery. METHODS A comprehensive literature search was conducted from August 2022 to March 2023 to identify clinical studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE Recommendations from the "2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery" have been updated with new evidence consolidated to guide clinicians; clinicians should be advised this guideline supersedes the previously published 2014 guideline. In addition, evidence-based management strategies, including pharmacological therapies, perioperative monitoring, and devices, for cardiovascular disease and associated medical conditions, have been developed.
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Nappi F, Nassif A, Schoell T. External Scaffold for Strengthening the Pulmonary Autograft in the Ross Procedure. Biomimetics (Basel) 2024; 9:674. [PMID: 39590246 PMCID: PMC11591583 DOI: 10.3390/biomimetics9110674] [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: 09/05/2024] [Revised: 10/29/2024] [Accepted: 10/30/2024] [Indexed: 11/28/2024] Open
Abstract
Despite offering several potential benefits over standard prosthetic aortic valve replacement, the use of the pulmonary autograft has been limited to date due to concerns over the risk of pulmonary autograft expansion and the need for reintervention. Several techniques using materials with biomimetic potential have been developed to reduce this complication. The incidence, risk factors, and pathophysiology of pulmonary autograft dilatation are discussed in this article. This seminar will provide an overview of the techniques of external pulmonary autograft support and their advantages and limitations. It also considers future directions for further investigation and future clinical applications of external pulmonary autograft support. Dilatation of the autograft is more likely to occur in patients with aortic regurgitation and a dilated aortic annulus. External scaffolding may prevent autograft stretching and expansion in these specific cases. However, from a biomimetic point of view, any permanent scaffold potentially restricts the movement of the autograft root. This reduces some of the benefits associated with the use of autologous tissue, which is the priority of the Ross procedure. To address this issue, several bioresorbable matrices could be used to support the root during its initial adaptive phase. Control of blood pressure with aggressive therapy is the first line to avoid this problem in the first year after pulmonary autograft implantation, together with support of the annular and sinotubular junction in some selected cases. This is the best way to maintain stable autograft root dimensions while preserving root dynamics. However, to determine the efficacy of this combined external support and best medical management, it is important to perform regular imaging and clinical follow-up.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France; (A.N.); (T.S.)
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Senior R, Khattar RS. Optimal Identification of Severe Aortic Stenosis in Low-Flow, Low-Gradient State: The Jury Is Still Out. JACC Cardiovasc Imaging 2024; 17:1302-1304. [PMID: 39152962 DOI: 10.1016/j.jcmg.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 08/19/2024]
Affiliation(s)
- Roxy Senior
- National, Heart and Lung Institute, Imperial College, London, United Kingdom; Northwick Park Hospital, Harrow, London, United Kingdom; Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.
| | - Rajdeep S Khattar
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
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Egbe AC, Borlaug BA, Miranda WR, Karnakoti S, Ali AE, Younis A, Connolly HM. Sex Differences in Outcomes of Adults with Repaired Coarctation of Aorta and Concomitant Aortic Valve Disease. CJC Open 2024; 6:1386-1394. [PMID: 39582706 PMCID: PMC11584194 DOI: 10.1016/j.cjco.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 08/11/2024] [Indexed: 11/26/2024] Open
Abstract
Background Aortic valve disease is common in adults with coarctation of aorta. However, no systematic comparative analyses have been performed of the clinical course of aortic valve disease for male vs female patients in this population. The purpose of this study was to compare cardiac remodelling, onset of symptoms, and incidence of aortic valve replacement (AVR) for male vs female patients. Methods A retrospective study was conducted of adults with repaired coarctation of aorta and ≥ moderate aortic stenosis and/or aortic regurgitation. Cardiac remodelling (left ventricular [LV], left atrial, right ventricular [RV], and right atrial structure and function) and symptomatic and/or functional class were determined at the baseline encounter. Development of new-onset symptoms and the incidence of AVR were ascertained for the period from baseline to last encounter. Results We identified 214 patients (121 male [57%], 93 female [43%]). Although both groups had a similar aortic valve gradient, aortic valve area indexed to body surface area, aortic regurgitation severity, and functional status at baseline, female patients had more LV concentric hypertrophy and remodelling, left atrial hypertension and dysfunction, elevated RV systolic pressure, and RV systolic dysfunction. Of 151 patients without symptoms at baseline,102 (72%) developed symptoms. Female sex was independently associated with new-onset symptoms (adjusted hazard ratio 1.14, [95% confidence interval 1.05-1.23]). Of 214 patients, 191 (89%) underwent AVR. Female sex was not associated with AVR upon multivariable analysis. However, LV concentric hypertrophy and remodelling (both of which were more common in female patients) were associated with new-onset symptoms and AVR. Conclusions Female patients, compared to male patients, had more-advanced cardiac remodelling, and more-rapid onset of symptoms, but a similar risk of AVR.
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Affiliation(s)
- Alexander C. Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Barry A. Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - William R. Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Snigdha Karnakoti
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed E. Ali
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ahmed Younis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Heidi M. Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Sudhakaran S, Thourani VH, Guerrero ME. Treating Aortic Stenosis in Young Patients. JACC. ADVANCES 2024; 3:101311. [PMID: 39391671 PMCID: PMC11465146 DOI: 10.1016/j.jacadv.2024.101311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/12/2024]
Affiliation(s)
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Mayra E. Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Li Y, Xiong Z, Lei R, Wang J, Zhang H. Early outcomes with a fully retrievable SinoCrown transcatheter heart valve in patients with severe aortic stenosis. Catheter Cardiovasc Interv 2024; 104:1267-1274. [PMID: 39323305 DOI: 10.1002/ccd.31230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 08/13/2024] [Accepted: 09/07/2024] [Indexed: 09/27/2024]
Abstract
BACKGROUND This study summarizes and analyzes data from patients suffering from symptomatic aortic stenosis who successfully underwent transcatheter aortic valve implantation (TAVI) using a novel, completely retrievable transcatheter heart valve. METHODS We included patients who underwent a TAVI procedure with SinoCrown valves at our center between December 2021 and September 2022. We collected 1-year follow-up data on survival, complications, echocardiographic results, New York Heart Association functional class in heart failure, and patient-reported health-related quality of life outcomes. RESULTS Eight successive patients (73.3 ± 4.3 years) were included in the study, with a median Society of Thoracic Surgery risk score of 4.26%. The procedure had a 100% success rate. Median postoperative discharge time was 7 days, with no 30-day hospital readmissions. Postoperative aortic valve hemodynamics improved, indicated by decreased transvalvular flow velocity compared with preoperative values (1.9 ± 0.2 vs. 4.9 ± 0.2 m/s, p < 0.0001). The median and maximum follow-up times were 8 and 12 months, respectively. During the follow-up period, there were no serious complications such as death, stroke, valve embolization, or high-grade atrioventricular block. CONCLUSIONS The results from eight initial TAVI cases performed with the SinoCrown valve demonstrated promising safety and efficacy.
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Affiliation(s)
- Yuehuan Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhongyu Xiong
- Department of Anaesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruobing Lei
- Chevidence Lab of Child & Adolescent Health, Department of Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Yagi N, Hasegawa H, Kuwajima K, Ogawa M, Yamane T, Shiota T. Indexed aortic valve area using multimodality imaging for assessing the severity of bicuspid aortic stenosis. Int J Cardiol 2024; 414:132416. [PMID: 39098616 DOI: 10.1016/j.ijcard.2024.132416] [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: 10/18/2023] [Revised: 07/26/2024] [Accepted: 08/01/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND The impact of various imaging modalities on discordance/concordance between indexed aortic valve area (iAVA) and catheterization-derived mean transaortic pressure gradient (mPGcath) is unclear in patients with bicuspid aortic valve (BAV). This study aimed to compare iAVA measurements obtained using four different methodologies in BAV and tricuspid aortic valve (TAV) patients, using mPGcath as a reference standard. METHODS We retrospectively reviewed patients who underwent comprehensive assessment of AS, including two-dimensional (2D) transthoracic echocardiography (TTE), three-dimensional (3D) transesophageal echocardiography (TEE), multidetector computed tomography (MDCT), and catheterization, at our institution between 2019 and 2022. iAVA was measured using the continuity eq. (CE) with left ventricular outflow tract area obtained by 2D TTE, 3D TEE, and MDCT, as well as planimetric 3D TEE. RESULTS AND CONCLUSIONS Among 564 patients (64 with BAV and 500 with TAV), 64 propensity-matched pairs of patients with BAV and TAV were analyzed. iAVACE(2DTTE) led to overestimation of AS severity (BAV, 23.4%; TAV, 28.1%) and iAVACE(MDCT) led to underestimation of AS severity (BAV, 29.3%; TAV, 16.7%), whereas iAVACE(3DTEE) and iAVAPlani(3DTEE) resulted in a reduction in the discordance of AS grading. A moderate correlation was observed between mPGcath and iAVACE(3DTEE) (BAV, r = -0.63; TAV, r = -0.68), with iAVACE(3DTEE) corresponding to the current guidelines' cutoff value (BAV, 0.58 cm2/m2; TAV, 0.60 cm2/m2). Discordance/concordance between iAVA and mPGcath in evaluating AS severity varies depending on the methodology and imaging modality used. The use of iAVACE(3DTEE) is valuable for reconciling the discordant AS grading in BAV patients as well as TAV.
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Affiliation(s)
- Nobuichiro Yagi
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, A3411, Los Angeles, CA 90048, USA.
| | - Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, A3411, Los Angeles, CA 90048, USA
| | - Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, A3411, Los Angeles, CA 90048, USA
| | - Mana Ogawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, A3411, Los Angeles, CA 90048, USA
| | - Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, A3411, Los Angeles, CA 90048, USA
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, A3411, Los Angeles, CA 90048, USA
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Jin M, Zhang H, Zhou Q, Li S, Wang D. Transcatheter aortic valve implantation for severe aortic regurgitation using the J-Valve system: A midterm follow-up study. Catheter Cardiovasc Interv 2024; 104:1052-1059. [PMID: 39248153 DOI: 10.1002/ccd.31196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 07/30/2024] [Accepted: 08/11/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a well-established intervention for severe aortic valve stenosis. However, its application for severe aortic regurgitation (AR) is still under evaluation. This study aims to present the 3-year follow-up outcomes of the J-Valve system in managing severe AR. AIMS The aim of this study was to evaluate the mid-term efficacy and durability of the J-Valve system in the treatment of severe AR and to provide new information on this intervention. METHODS In this retrospective, single-center study, we evaluated the prognostic outcomes of patients with AR, who underwent treatment with the J-Valve system at Nanjing Drum Tower Hospital. Consecutive patients who were treated with the J-Valve were included in the analysis. The study focused on the echocardiographic follow-up to assess the effectiveness and durability of the J-Valve system in managing AR. RESULTS From January 2018 to December 2022, 36 high-risk AR patients treated with the J-Valve system had a procedural success rate of 97.2%, with one case requiring open-heart surgery due to valve displacement. Significant improvements were observed in left ventricular diameter (from 63.50 [58.75-69.50] mm to 56.50 [53.00-60.50] mm, p < 0.001) and left atrial diameter (from 44.00 [40.00-45.25] mm to 39.00 [36.75-41.00] mm, p = 0.003) postsurgery. All patients completed the 1-year follow-up, with an overall mortality rate of 2 out of 36 (5.6%). Among the surviving patients, there was one case of III° atrioventricular block and one case of stroke, both occurring within 90 days postsurgery. After a 3-year follow-up, 15.0% of patients had mild or moderate valvular regurgitation, with no cases of moderate or severe paravalvular leak. Additionally, 89.5% of patients were classified as New York Heart Association class I or II, showing significantly enhanced cardiac function. CONCLUSION The J-Valve system has shown positive therapeutic outcomes in treating AR, with notable effectiveness in managing the condition and significant improvements in heart failure symptoms and cardiac remodeling. However, due to the limited sample size and partial follow-up data, it is important to emphasize the need for further research with comprehensive long-term follow-up, to fully validate these results.
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Affiliation(s)
- Min Jin
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Haitao Zhang
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Nanjing, China
| | - Qing Zhou
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Shuchun Li
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Dongjin Wang
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Graduate School of Peking Union Medical College, Nanjing, China
- Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Sellers SL, Meier D. Fibro-Calcific Imaging: A Step Towards a More Comprehensive Approach to Aortic Valve Pathophysiology? JACC Cardiovasc Imaging 2024; 17:1363-1365. [PMID: 39269410 DOI: 10.1016/j.jcmg.2024.07.020] [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: 07/19/2024] [Accepted: 07/24/2024] [Indexed: 09/15/2024]
Affiliation(s)
- Stephanie L Sellers
- Cardiovascular Translational Laboratory, St. Paul's Hospital and University of British Columbia Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
| | - David Meier
- Cardiovascular Translational Laboratory, St. Paul's Hospital and University of British Columbia Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada; Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Nakase M, Tomii D, Samim D, Gräni C, Praz F, Lanz J, Stortecky S, Reineke D, Windecker S, Pilgrim T. Impact of Severity and Extent of Iliofemoral Atherosclerosis on Clinical Outcomes in Patients Undergoing TAVR. JACC Cardiovasc Interv 2024; 17:2353-2363. [PMID: 39387783 DOI: 10.1016/j.jcin.2024.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 06/29/2024] [Accepted: 07/02/2024] [Indexed: 10/15/2024]
Abstract
BACKGROUND Vascular complications remain a major concern in transfemoral transcatheter aortic valve replacement (TAVR). The Hostile score has been proposed to stratify risk in TAVR patients with peripheral artery disease. OBJECTIVES The authors aimed to assess the validity of the Hostile score in predicting iliofemoral vascular complications after TAVR. METHODS In a prospective TAVR registry, we validated the Hostile score for the prediction of puncture and non-puncture site vascular complications. This scoring system integrates the extent (number of lesions, lesion length, and minimum lumen diameter) and complexity (tortuosity, calcification, and the presence of obstruction) of iliofemoral atherosclerosis. RESULTS Of 2,023 patients who underwent transfemoral TAVR with contemporary devices between March 2014 and June 2022, 106 (5.2%) patients experienced puncture site vascular complications and 28 (1.4%) patients experienced non-puncture site vascular complications. The Hostile score was higher in patients with vascular complications than those without complications (1.00 [Q1-Q3: 0-5.00] vs 1.00 [Q1-Q3: 0-4.00]; P < .001). A higher body mass index (OR: 1.23; 95% CI: 1.04-1.50) and the use of Prostar (OR: 6.03; 95% CI: 2.23-16.30) or MANTA (OR: 6.18; 95% CI: 2.67-14.27) compared with ProGlide were independent predictors of puncture site vascular complications, whereas a higher Hostile score (OR: 1.91; 95% CI: 1.55-2.35) and female sex (OR: 2.69; 95% CI: 1.12-6.42) were independent predictors of non-puncture site vascular complications. The area under the receiver-operating characteristic curves for the prediction of puncture site and non-puncture site vascular complications were 0.554 and 0.829, respectively. CONCLUSIONS The Hostile score proved useful in predicting non-puncture site vascular complications after TAVR. (SwissTAVI Registry; NCT01368250).
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Affiliation(s)
- Masaaki Nakase
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Daijiro Tomii
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Daryoush Samim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
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Généreux P, Schwartz A, Oldemeyer JB, Pibarot P, Cohen DJ, Blanke P, Lindman BR, Babaliaros V, Fearon WF, Daniels DV, Chhatriwalla AK, Kavinsky C, Gada H, Shah P, Szerlip M, Dahle T, Goel K, O'Neill W, Sheth T, Davidson CJ, Makkar RR, Prince H, Zhao Y, Hahn RT, Leipsic J, Redfors B, Pocock SJ, Mack M, Leon MB. Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis. N Engl J Med 2024. [PMID: 39466903 DOI: 10.1056/nejmoa2405880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/30/2024]
Abstract
BACKGROUND For patients with asymptomatic severe aortic stenosis and preserved left ventricular ejection fraction, current guidelines recommend routine clinical surveillance every 6 to 12 months. Data from randomized trials examining whether early intervention with transcatheter aortic-valve replacement (TAVR) will improve outcomes in these patients are lacking. METHODS At 75 centers in the United States and Canada, we randomly assigned, in a 1:1 ratio, patients with asymptomatic severe aortic stenosis to undergo early TAVR with transfemoral placement of a balloon-expandable valve or clinical surveillance. The primary end point was a composite of death, stroke, or unplanned hospitalization for cardiovascular causes. Superiority testing was performed in the intention-to-treat population. RESULTS A total of 901 patients underwent randomization; 455 patients were assigned to TAVR and 446 to clinical surveillance. The mean age of the patients was 75.8 years, the mean Society of Thoracic Surgeons Predicted Risk of Mortality score was 1.8% (on a scale from 0 to 100%, with higher scores indicating a greater risk of death within 30 days after surgery), and 83.6% of patients were at low surgical risk. A primary end-point event occurred in 122 patients (26.8%) in the TAVR group and in 202 patients (45.3%) in the clinical surveillance group (hazard ratio, 0.50; 95% confidence interval, 0.40 to 0.63; P<0.001). Death occurred in 8.4% of the patients assigned to TAVR and in 9.2% of the patients assigned to clinical surveillance, stroke occurred in 4.2% and 6.7%, respectively, and unplanned hospitalization for cardiovascular causes occurred in 20.9% and 41.7%. During a median follow-up of 3.8 years, 87.0% of patients in the clinical surveillance group underwent aortic-valve replacement. There were no apparent differences in procedure-related adverse events between patients in the TAVR group and those in the clinical surveillance group who underwent aortic-valve replacement. CONCLUSIONS Among patients with asymptomatic severe aortic stenosis, a strategy of early TAVR was superior to clinical surveillance in reducing the incidence of death, stroke, or unplanned hospitalization for cardiovascular causes. (Funded by Edwards Lifesciences; EARLY TAVR ClinicalTrials.gov number, NCT03042104.).
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Affiliation(s)
- Philippe Généreux
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Allan Schwartz
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - J Bradley Oldemeyer
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Philippe Pibarot
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - David J Cohen
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Philipp Blanke
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Brian R Lindman
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Vasilis Babaliaros
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - William F Fearon
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - David V Daniels
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Adnan K Chhatriwalla
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Clifford Kavinsky
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Hemal Gada
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Pinak Shah
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Molly Szerlip
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Thom Dahle
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Kashish Goel
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - William O'Neill
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Tej Sheth
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Charles J Davidson
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Raj R Makkar
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Heather Prince
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Yanglu Zhao
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Rebecca T Hahn
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Jonathon Leipsic
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Björn Redfors
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Stuart J Pocock
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Michael Mack
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
| | - Martin B Leon
- From Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ (P.G.); Columbia University Medical Center/New York Presbyterian Hospital (A.S., R.T.H., M.B.L.), the Cardiovascular Research Foundation (D.J.C., R.T.H., B.R., M.B.L.), and Weill Cornell Medicine (B.R.), New York, and St. Francis Hospital and Heart Center, Roslyn (D.J.C.) - all in New York; University of Colorado Health, Medical Center of the Rockies, Loveland (J.B.O.); Laval University, Quebec, QC (P.P.), St. Paul's Hospital, University of British Columbia, Vancouver (P.B., J.L.), and McMaster University, Hamilton, ON (T.S.) - all in Canada; Vanderbilt University Medical Center, Nashville (B.R.L., K.G.); Emory University, Atlanta (V.B.); the Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University, Stanford (W.F.F.), VA Palo Alto Health Care System, Palo Alto (W.F.F.), California Pacific Medical Center, San Francisco (D.V.D.), Cedars-Sinai Medical Center, Los Angeles (R.R.M.), and Edwards Lifesciences, Irvine (H.P., Y.Z.) - all in California; Saint Luke's Mid America Heart Institute, Kansas City, MO (A.K.C.); Beth Israel Deaconess Medical Center/Harvard Medical School (C.K.) and Brigham and Women's Hospital (P.S.) - both in Boston; Pinnacle Health Harrisburg, Harrisburg, PA (H.G.); Baylor Scott and White The Heart Hospital Plano, Plano, TX (M.S., M.M.); CentraCare Heart and Vascular Center, St. Cloud, MN (T.D.); Henry Ford Hospital, Detroit (W.O.); Northwestern University, Chicago (C.J.D.); Gothenburg University/Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.); and London School of Hygiene and Tropical Medicine, London (S.J.P.)
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Tang GHL, Hahn RT, Whisenant BK, Hamid N, Naik H, Makkar RR, Tadros P, Price MJ, Singh GD, Fam NP, Kar S, Mehta SR, Bae R, Sekaran NK, Warner T, Makar M, Zorn G, Benza R, Jorde UP, McCarthy PM, Thourani VH, Ren Q, Trusty PM, Sorajja P, Adams DH. Tricuspid Transcatheter Edge-to-Edge Repair for Severe Tricuspid Regurgitation: 1-Year Outcomes From the TRILUMINATE Randomized Cohort. J Am Coll Cardiol 2024:S0735-1097(24)10054-X. [PMID: 39471883 DOI: 10.1016/j.jacc.2024.10.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2024] [Revised: 10/17/2024] [Accepted: 10/18/2024] [Indexed: 11/01/2024]
Abstract
BACKGROUND Tricuspid regurgitation (TR) is a right-sided valvular disease independently associated with morbidity and mortality. The TRILUMINATE Pivotal (Clinical Trial to Evaluate Cardiovascular Outcomes In Patients Treated With the Tricuspid Valve Repair System Pivotal) is the first randomized controlled trial assessing the impact of TR reduction with tricuspid transcatheter edge-to-edge repair (T-TEER). OBJECTIVES Outcomes from the full randomized cohort of the TRILUMINATE Pivotal trial have not been previously reported, and the additional enrollment may further support the safety and effectiveness of T-TEER through 1 year. METHODS The TRILUMINATE Pivotal trial is an international randomized controlled trial of T-TEER with the TriClip device in patients with symptomatic, severe TR. Adaptive trial design allowed enrollment past the primary analysis population. The primary outcome was a hierarchical composite of all-cause mortality or tricuspid valve surgery, heart failure hospitalizations (HFHs), and quality-of-life improvement measured by Kansas City Cardiomyopathy Questionnaire (KCCQ) at 1 year. RESULTS Between August 21, 2019, and June 29, 2022, 572 subjects were randomized, including the primary cohort (n = 350) and subsequent enrollment (n = 222). Subjects were older (78.1 ± 7.8 years) and predominantly female (58.9%), with atrial fibrillation (87.8%) and prior HFH (23.8%). The primary endpoint was met for the full cohort (win ratio = 1.84; P < 0.0001). Freedom from all-cause mortality and tricuspid valve surgery through 12 months was 90.6% and 89.9% for the device and control groups, respectively (P = 0.82). Annualized HFH rate was comparable between device and control subjects (0.17 vs 0.20 events/patient-year; P = 0.40). A significant treatment effect was observed for change in quality of life with 49.5% of device subjects achieving a ≥15-point KCCQ score improvement (compared with 25.6% of control subjects; P < 0.0001). All secondary endpoints favored T-TEER: moderate or less TR at 30 days (88.9% vs 5.3%; P < 0.0001), KCCQ change at 1 year (13.0 ± 1.4 points vs -0.5 ± 1.4 points; P < 0.0001), and 6-minute walk distance change at 1 year (1.7 ± 7.5 m vs -27.4 ± 7.4 m; P < 0.0001). Freedom from major adverse events was 98.9% for T-TEER (vs performance goal: 90%; P < 0.0001). CONCLUSIONS TriClip was safe and effective in the full randomized cohort of TRILUMINATE Pivotal with significant TR reduction and improvements in 6-minute walk distance and health status. Rates of all-cause mortality or tricuspid valve surgery and HFH through 1 year were not reduced by T-TEER.
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Affiliation(s)
| | - Rebecca T Hahn
- NewYork-Presbyterian Columbia University Medical Center, New York, New York, USA
| | | | - Nadira Hamid
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Hursh Naik
- St Joseph's Hospital and Medical Center Phoenix, Arizona, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Peter Tadros
- Kansas University Medical Center, Kansas City, Kansas, USA
| | | | - Gagan D Singh
- University of California-Davis Medical Center, Sacramento, California, USA
| | - Neil P Fam
- St Micheal's Hospital, Toronto, Ontario, Canada
| | - Saibal Kar
- Los Robles Regional Medical Center, HCA Healthcare, Thousand Oaks, California, USA
| | | | - Richard Bae
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - Travis Warner
- St Joseph's Hospital and Medical Center Phoenix, Arizona, USA
| | - Moody Makar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - George Zorn
- Kansas University Medical Center, Kansas City, Kansas, USA
| | | | | | | | - Vinod H Thourani
- Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Qian Ren
- Abbott Structural Heart, Santa Clara, California, USA
| | | | - Paul Sorajja
- Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
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Samimi S, Hatab T, Kharsa C, Khan SU, Bou Chaaya RG, Qamar F, Aoun J, Zaid S, Faza N, Atkins MD, Little SH, Zoghbi WA, Reardon MJ, Kleiman NS, Goel SS. Meta-Analysis of Dedicated vs Off-Label Transcatheter Devices for Native Aortic Regurgitation. JACC Cardiovasc Interv 2024:S1936-8798(24)01162-2. [PMID: 39570231 DOI: 10.1016/j.jcin.2024.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/16/2024] [Accepted: 08/27/2024] [Indexed: 11/22/2024]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) for high surgical risk patients with severe native aortic regurgitation (AR) presents unique challenges. Dedicated devices such as the JenaValve (JenaValve Technology) and J-Valve (JC Medical Inc) show promising results in addressing these challenges. OBJECTIVES This study compares the safety and efficacy of dedicated vs off-label devices among high surgical risk patients with pure native AR. METHODS We systematically searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials through July 11, 2024, for studies on TAVR among patients with pure severe native AR. The primary endpoint was 30-day all-cause mortality. Secondary endpoints were device success, residual AR ≥ moderate, valve embolization/migration, pacemaker implantation, reintervention, and all-cause mortality at 1 year. Summary estimates were constructed using a random effects model. RESULTS A total of 34 studies encompassing 2,162 patients (mean age 75.4 ± 0.2, 42.8% women) were included in the meta-analysis. Patients undergoing TAVR with dedicated devices had a lower all-cause 30-day mortality rate (3% vs 9%; P < 0.01) and higher device success (93% vs 82%; P < 0.01) compared with off-label devices. The risk of AR ≥ moderate (2% vs 5%; P = 0.03), valve embolization/migration (2% vs 8%; P < 0.01), pacemaker implantation (11% vs 20%; P < 0.01), and reintervention (4% vs 10%; P < 0.01) at 30 days and all-cause mortality at 1 year (6% vs 24%; P < 0.01) were lower in the dedicated device group. CONCLUSIONS Dedicated TAVR devices for native AR show superior device success and reduced mortality, residual AR, and reintervention rates compared with off-label devices. These findings support the use of dedicated devices as a safer alternative for high-risk patients.
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Affiliation(s)
- Sahar Samimi
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Taha Hatab
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Chloe Kharsa
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Safi U Khan
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Rody G Bou Chaaya
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Fatima Qamar
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Joe Aoun
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Syed Zaid
- Section of Cardiology, Baylor College of Medicine, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Nadeen Faza
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Marvin D Atkins
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Stephen H Little
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - William A Zoghbi
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Neal S Kleiman
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sachin S Goel
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Piragine E, Veneziano S, Trippoli S, Messori A, Calderone V. Efficacy and Safety of Cardioband in Patients with Tricuspid Regurgitation: Systematic Review and Meta-Analysis of Single-Arm Trials and Observational Studies. J Clin Med 2024; 13:6393. [PMID: 39518532 PMCID: PMC11546409 DOI: 10.3390/jcm13216393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Revised: 10/15/2024] [Accepted: 10/22/2024] [Indexed: 11/16/2024] Open
Abstract
Background/Objectives: The incidence and prevalence of tricuspid regurgitation (TR) are increasing worldwide. "Traditional" drug therapy with diuretics is often ineffective and the identification of new strategies, including non-pharmacological ones, is an urgent need. The aim of this study was to summarize the results on the efficacy and safety of Cardioband, one of the few approved transcatheter tricuspid valve repair systems, in patients with TR. Methods: Three databases (Medline, Scopus, and CENTRAL) were searched to identify clinical trials and observational studies on the efficacy (primary outcome) and safety (secondary outcome) of Cardioband. A random-effects meta-analysis was performed with R software (version 4.3.3). Survival and freedom from heart failure (HF) hospitalization were estimated with the method of reconstructing individual patient data from Kaplan-Meier curves (IPDfromKM). Results: Eleven studies were included in this systematic review and meta-analysis. Cardioband significantly reduced annulus diameter (-9.31 mm [95% Confidence Interval, CI: -11.47; -7.15]), vena contracta (-6.41 mm [95% CI: -8.34; -4.49]), and effective regurgitant orifice area (EROA) (-0.50 cm2 [95% CI: -0.72; -0.28]) in patients with TR. Cardioband reduced the severity of TR and the extent of heart failure in 91% [95% CI: 85; 97] and 63% [95% CI: 52-75] of patients, respectively. Finally, Cardioband implantation was associated with prolonged survival and freedom from HF hospitalization (80.1% and 57.8% at 24 months, respectively). Conclusions: This study demonstrates that Cardioband implantation leads to cardiac remodeling and mechanical improvements, reduces the severity of TR, and improves quality of life. Therefore, Cardioband is an effective option for the non-pharmacological treatment of TR.
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Affiliation(s)
- Eugenia Piragine
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (E.P.); (S.V.)
- Specialization School in Hospital Pharmacy, University of Pisa, 56126 Pisa, Italy
| | - Sara Veneziano
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (E.P.); (S.V.)
| | - Sabrina Trippoli
- HTA Unit, Centro Operativo, Regione Toscana, 50136 Firenze, Italy; (S.T.); (A.M.)
| | - Andrea Messori
- HTA Unit, Centro Operativo, Regione Toscana, 50136 Firenze, Italy; (S.T.); (A.M.)
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, 56126 Pisa, Italy; (E.P.); (S.V.)
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Feistritzer HJ, Kurz T, Vonthein R, Schröder L, Stachel G, Eitel I, Marquetand C, Saraei R, Kirchhof E, Heringlake M, Abdel-Wahab M, Desch S, Thiele H. Effect of Valve Type and Anesthesia Strategy for TAVR: 5-Year Results of the SOLVE-TAVI Trial. J Am Coll Cardiol 2024:S0735-1097(24)08456-0. [PMID: 39503651 DOI: 10.1016/j.jacc.2024.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 09/06/2024] [Accepted: 09/11/2024] [Indexed: 11/08/2024]
Abstract
BACKGROUND In the randomized SOLVE-TAVI (compariSon of secOnd-generation seLf-expandable vs. balloon-expandable Valves and gEneral vs. local anesthesia in Transcatheter Aortic Valve Implantation) trial comparing newer-generation self-expanding valves (SEV) and balloon-expandable valves (BEV), as well as conscious sedation (CS) and general anesthesia (GA), clinical outcomes were similar both for valve and anesthesia comparison at 30 days and 1 year. Prosthesis durability may affect clinical outcomes during long-term follow-up. Moreover, the impact of the anesthesia strategy on long-term clinical outcomes is unknown so far. OBJECTIVES The authors sought to compare clinical outcomes during 5-year follow-up in the randomized SOLVE-TAVI trial. METHODS In the randomized, multicenter, 2 × 2 factorial, open-label SOLVE-TAVI trial, 447 intermediate- to high-risk patients with severe, symptomatic aortic stenosis were randomly assigned to transfemoral transcatheter aortic valve replacement (TAVR) using either SEV (Evolut R, Medtronic) or BEV (SAPIEN 3, Edwards Lifesciences) and also to CS vs GA. Patients were followed-up for 5 years. RESULTS During 5 years of follow-up, the combined predefined endpoint of all-cause mortality, stroke, moderate or severe paravalvular leakage, and permanent pacemaker implantation was similar in the SEV and BEV groups (67.7% vs 63.4%; HR: 0.89; 95% CI: 0.70-1.13; P = 0.34). Stroke rates at 5 years were lower in the SEV group (2.2% vs 9.6%; HR: 4.84; 95% CI: 1.65-14.18; P = 0.002). Regarding the anesthesia comparison, the primary endpoint of all-cause mortality, stroke, myocardial infarction, and acute kidney injury occurred in 51.4% in the CS group and 61.3% in the GA group (HR: 0.80; 95% CI: 0.62-1.04; P = 0.09). All-cause mortality at 5 years was lower for CS (41.5% vs 54.3%; HR: 0.70; 95% CI: 0.53-0.94; P = 0.02). CONCLUSIONS Transfemoral TAVR using either SEV and BEV as well as CS and GA showed similar clinical outcomes at 5 years using a combined clinical endpoint.
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Affiliation(s)
| | - Thomas Kurz
- University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | | | - Leonie Schröder
- Institute of Medical Biometry and Statistics, Lübeck, Germany
| | - Georg Stachel
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Clinic and Policlinic for Cardiology, Leipzig University Clinic, Leipzig, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Christoph Marquetand
- University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Roza Saraei
- University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | | | - Matthias Heringlake
- University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | | | - Steffen Desch
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
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Naito N, Takagi H. Meta-analysis of improved mitral regurgitation after aortic valve replacement. Perfusion 2024:2676591241291338. [PMID: 39425526 DOI: 10.1177/02676591241291338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2024]
Abstract
BACKGROUND This meta-analysis aimed to compare survival outcomes among patients experiencing improvement in untreated significant mitral regurgitation (MR) following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) for severe aortic stenosis, in contrast to those without improvement. METHODS We conducted a comprehensive search through February 2024. Pooled hazard ratios (HR) with 95% confidence intervals (CI) were computed. Kaplan-Meier curves depicting all-cause mortality were reconstructed using individual patient data derived from the included studies. RESULTS A systematic review identified twelve non-randomized studies encompassing 4040 patients. The pooled all-cause mortality of the meta-analysis demonstrated a significant reduction in patients whose MR improved compared to those with persistent MR after aortic valve replacement (AVR) (HR [95% CI] = 0.55 [0.47-0.64], p < .01). The hazard ratio, derived from reconstructed time-to-event data, indicated lower all-cause mortality in patients with improved MR after AVR relative to the other cohort (HR [95% CI] = 0.50 [0.40-0.62], p < .01 in all patients, 0.48 [0.34-0.68], p < .01 in patients undergoing SAVR, and 0.58 [0.42-0.80], p < .01 in those receiving TAVR). CONCLUSION In conclusion, this meta-analysis revealed that improved MR after AVR, whether surgically or by transcatheter approach, correlates with superior survival. The benefits of simultaneous or staged intervention on the mitral valve in individuals undergoing AVR warrant validation in future investigations.
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Affiliation(s)
- Noritsugu Naito
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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43
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Fan J, Chen J, Wang L, Hu P, Jiang J, Lin X, Rocatello G, De Beule M, Tie Y, Wang Y, Cheng S, Liu X, Wang J. Coronary obstruction analysis in transcatheter aortic valve implantation through patient-specific computational modelling. Front Cardiovasc Med 2024; 11:1432235. [PMID: 39484012 PMCID: PMC11524991 DOI: 10.3389/fcvm.2024.1432235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 09/17/2024] [Indexed: 11/03/2024] Open
Abstract
Background Coronary obstruction (CO) is a rare but devasting complication during transcatheter aortic valve replacement (TAVR). Objectives We aim to demonstrate that the predicted distance between the coronary ostia and the closest structure derived with patient-specific computer simulation is associated with CO risk during TAVR. Methods We retrospectively analysed 14 aortic stenosis patients who underwent TAVR through finite element simulation. The frame deformation predicted with patient-specific computer simulation was qualitatively and quantitatively compared to the post-operative device deformation. The minimum distance between each coronary ostium and the closest structure was calculated and compared in patients who developed CO, at high risk of CO, and at no risk of CO. Results Four patients experienced CO during TAVR, 5 patients were at high risk of CO, and the remaining 5 patients had no risk of CO. A high coefficient of determination was obtained for all measurements extracted from the simulated device and the post-operative device (≥0.95). Simulations predicted shorter distance between the coronary ostium and the closest structure in patients who experienced CO, compared to patients at high risk of CO or who did not experience this complication (right coronary: 5.9 vs. 6.8 vs. 8.8 mm, left coronary: 3.0 vs. 3.3 vs. 6.5 mm respectively). Conclusions The distance between the coronary ostium and the closest structure was lower in patients who experienced CO during TAVR through patient-specific computational simulation. This technology enables coronary obstruction analysis before TAVR in the future.
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Affiliation(s)
- Jiaqi Fan
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Jun Chen
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Lihan Wang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Po Hu
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Jubo Jiang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Xinping Lin
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | | | | | - Yi Tie
- Venus Medtech, Hangzhou, China
| | | | | | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Jian’an Wang
- Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University School of Medicine, Hangzhou, China
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44
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Turkistani YA, Al-Harbi S. Rheumatic Pulmonary Stenosis in an Elderly Man. JACC Case Rep 2024; 29:102626. [PMID: 39534613 PMCID: PMC11551942 DOI: 10.1016/j.jaccas.2024.102626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 11/16/2024]
Abstract
An elderly man presented with right ventricular outflow obstruction due to severe pulmonary stenosis. Rheumatic changes were noted in mitral, aortic, and pulmonary valves. However, pulmonary valve was the predominantly affected valve. This is the first case report of rheumatic heart disease presenting predominantly with severe pulmonary stenosis in the elderly.
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45
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Cunha CFDS, Amboss ND, de Amorim GDT, Weksler C, dos Santos MC. Ischemic Stroke in a Young Patient With Rheumatic Mitral Stenosis. JACC Case Rep 2024; 29:102674. [PMID: 39534629 PMCID: PMC11551931 DOI: 10.1016/j.jaccas.2024.102674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 09/04/2024] [Accepted: 09/16/2024] [Indexed: 11/16/2024]
Abstract
Rheumatic fever is the most common cause of mitral stenosis worldwide. Embolic events represent severe complications of mitral stenosis. We describe the case of a 45-year-old women who had an ischemic stroke as the initial manifestation of previously unrecognized mitral stenosis in the absence of atrial fibrillation.
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Affiliation(s)
| | | | | | - Clara Weksler
- National Institute of Cardiology, Rio de Janeiro, Brazil
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46
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Mutarelli A, Pantaleao AN, Nunes MC. Severe Rheumatic Mitral Stenosis During Pregnancy. JACC Case Rep 2024; 29:102634. [PMID: 39534628 PMCID: PMC11551943 DOI: 10.1016/j.jaccas.2024.102634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/15/2024] [Accepted: 07/22/2024] [Indexed: 11/16/2024]
Abstract
A 28-year-old woman, gravida 2 para 1, with previously unknown severe rheumatic mitral stenosis presented with progressive dyspnea at 26 weeks of gestation. Percutaneous commissurotomy was considered but was deferred after symptom improvement with beta-blockers and diuretics. Pregnancy complications ensued, requiring preterm delivery. Postpartum percutaneous commissurotomy was successful, highlighting the complexities in managing rheumatic heart disease during pregnancy.
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Affiliation(s)
- Antonio Mutarelli
- Department of Internal Medicine, School of Medicine, and Hospital das Clínicas, Belo Horizonte, Brazil
| | | | - Maria C.P. Nunes
- Department of Internal Medicine, School of Medicine, and Hospital das Clínicas, Belo Horizonte, Brazil
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47
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de Barros Negri Ferreira J, Coutinho Bezerra L, Mendonça da Silva Costa A, Carvalho Monnerat Magalhães G, Binensztok B, Moura Machado N, Ramos Vilela M, Dalcol Torres de Amorim G, Weksler C. Rheumatic Mitral Restenosis Following Surgical Commissurotomy. JACC Case Rep 2024; 29:102617. [PMID: 39534612 PMCID: PMC11551926 DOI: 10.1016/j.jaccas.2024.102617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 07/30/2024] [Indexed: 11/16/2024]
Abstract
Because corrective procedures extended life expectancy of the population with rheumatic heart disease, reintervention has become a contemporary challenge. This paper presents a case of a 54-year-old woman with exertional dyspnea and palpitations 26 years after undergoing surgical commissurotomy due to mitral stenosis, with remarkable clinical-echocardiographic divergence on valvular disease severity.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Clara Weksler
- National Institute of Cardiology, Rio de Janeiro, Brazil
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48
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Fenequito RL, Harrell TE, Boswell GE, Russell MC. Severe Left Ventricular Dilation in an Active Duty Athlete With Bicuspid Aortic Valve and Aortic Regurgitation. Am J Med 2024:S0002-9343(24)00632-6. [PMID: 39419249 DOI: 10.1016/j.amjmed.2024.10.003] [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: 09/16/2024] [Revised: 10/07/2024] [Accepted: 10/07/2024] [Indexed: 10/19/2024]
Affiliation(s)
- Robert L Fenequito
- Department of Cardiology, Naval Medical Center San Diego, San Diego, Calif.
| | - Travis E Harrell
- Department of Cardiology, Walter Reed National Military Medical Center, Bethesda, Md
| | - Gilbert E Boswell
- Department of Radiology, University of California San Diego, San Diego
| | - Matthew C Russell
- Department of Cardiology, Naval Medical Center San Diego, San Diego, Calif
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49
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Nazir P, Zada S, Ahmed M, Abbas K, Khan N, Kumari S, Haq EU, Zeb M. Challenges in the Concurrent Management of Severe Mitral Stenosis With LAA Thrombus and Symptomatic Adenomyosis. JACC Case Rep 2024; 29:102636. [PMID: 39534617 PMCID: PMC11551939 DOI: 10.1016/j.jaccas.2024.102636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 08/01/2024] [Indexed: 11/16/2024]
Abstract
A 49-year-old woman with untreated severe mitral stenosis faced complex management challenges in a resource-limited setting. Initially presenting with abnormal uterine bleeding, her cardiac condition was discovered during a preoperative work-up for a planned hysterectomy. This case emphasizes the necessity for tailored and transdisciplinary management approaches.
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Affiliation(s)
- Paras Nazir
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Shakir Zada
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Moiz Ahmed
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Kiran Abbas
- Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Naveedullah Khan
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Shueeta Kumari
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Ejaz Ul Haq
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Muhammad Zeb
- National Institute of Cardiovascular Diseases, Karachi, Pakistan
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50
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Pozo Osinalde E, Bravo Domínguez JR, De Lara Fuentes L, Marcos-Alberca P, Gómez de Diego JJ, Olmos Blanco C, Mahia Casado P, Luaces Mendez M, Collado Yurrita L, Carnero-Alcázar M, Jiménez-Quevedo P, Nombela-Franco L, Pérez-Villacastín J. Prognostic Relevance of Gradient and Flow Status in Severe Aortic Stenosis. J Clin Med 2024; 13:6113. [PMID: 39458063 PMCID: PMC11508347 DOI: 10.3390/jcm13206113] [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: 09/11/2024] [Revised: 10/03/2024] [Accepted: 10/11/2024] [Indexed: 10/28/2024] Open
Abstract
Background: Severe aortic stenosis (AS) may present with different flow, gradient and left ventricular ejection fraction (LVEF) patterns. Paradoxical low-flow low-gradient (PLF-LG) severe AS has a specific clinical profile, but its prognosis and management remain controversial. Our aim is to evaluate the impact of different AS patterns in the incidence of major clinical events. Methods: A retrospective observational study was carried out on all the consecutive patients diagnosed with severe AS at our tertiary hospital centre in 2021. Echocardiographic measurements were carefully reviewed, and patients were classified following current guidelines into four categories: high gradient (HG), concordant low-flow low-gradient (CLF-LG), paradoxical low-flow low-gradient (PLF-LG) and normal-flow low-gradient (NF-LG). The baseline characteristics and clinical events (heart failure admission, intervention and death) at 1-year follow-up were collected from medical records. The association between categories and events was established using Student's t test or ANOVA as required. Results: 205 patients with severe AS were included in the study (81 ± 10 years old, 52.7% female). Category distribution was as follows: HG (138, 67.3%), PLF-LG (34, 19.8%), CLF-LG (21, 10.2%) and NF-LG (12, 5.9%). During the follow-up, 24.8% were admitted due to heart failure, 68.3% received valve replacement (51.7% TAVR) and 22% died. Severe tricuspid regurgitation was more frequent in patients with PLF-LG than in HG AS (14.7% vs. 2.2%; p < 0.01). Despite no differences in intervention rate, more patients with PLF-LG (32.4% vs. 15.9%; p = 0.049) died during the evolution. Conclusions: The PLF-LG pattern was the second most common pattern of severe AS in our cohort, and it was related to a higher mortality with no differences in intervention rate. Thus, this controversial category, rather than being underestimated, should be followed closely and considered for early intervention.
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Affiliation(s)
- Eduardo Pozo Osinalde
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (J.R.B.D.); (L.D.L.F.); (P.M.-A.); (J.J.G.d.D.); (C.O.B.); (P.M.C.); (M.L.M.); (P.J.-Q.); (L.N.-F.); (J.P.-V.)
| | - Juan Ramón Bravo Domínguez
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (J.R.B.D.); (L.D.L.F.); (P.M.-A.); (J.J.G.d.D.); (C.O.B.); (P.M.C.); (M.L.M.); (P.J.-Q.); (L.N.-F.); (J.P.-V.)
| | - Lina De Lara Fuentes
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (J.R.B.D.); (L.D.L.F.); (P.M.-A.); (J.J.G.d.D.); (C.O.B.); (P.M.C.); (M.L.M.); (P.J.-Q.); (L.N.-F.); (J.P.-V.)
| | - Pedro Marcos-Alberca
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (J.R.B.D.); (L.D.L.F.); (P.M.-A.); (J.J.G.d.D.); (C.O.B.); (P.M.C.); (M.L.M.); (P.J.-Q.); (L.N.-F.); (J.P.-V.)
| | - José Juan Gómez de Diego
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (J.R.B.D.); (L.D.L.F.); (P.M.-A.); (J.J.G.d.D.); (C.O.B.); (P.M.C.); (M.L.M.); (P.J.-Q.); (L.N.-F.); (J.P.-V.)
| | - Carmen Olmos Blanco
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (J.R.B.D.); (L.D.L.F.); (P.M.-A.); (J.J.G.d.D.); (C.O.B.); (P.M.C.); (M.L.M.); (P.J.-Q.); (L.N.-F.); (J.P.-V.)
| | - Patricia Mahia Casado
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (J.R.B.D.); (L.D.L.F.); (P.M.-A.); (J.J.G.d.D.); (C.O.B.); (P.M.C.); (M.L.M.); (P.J.-Q.); (L.N.-F.); (J.P.-V.)
| | - María Luaces Mendez
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (J.R.B.D.); (L.D.L.F.); (P.M.-A.); (J.J.G.d.D.); (C.O.B.); (P.M.C.); (M.L.M.); (P.J.-Q.); (L.N.-F.); (J.P.-V.)
| | | | - Manuel Carnero-Alcázar
- Cardiac Surgery Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain;
| | - Pilar Jiménez-Quevedo
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (J.R.B.D.); (L.D.L.F.); (P.M.-A.); (J.J.G.d.D.); (C.O.B.); (P.M.C.); (M.L.M.); (P.J.-Q.); (L.N.-F.); (J.P.-V.)
| | - Luis Nombela-Franco
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (J.R.B.D.); (L.D.L.F.); (P.M.-A.); (J.J.G.d.D.); (C.O.B.); (P.M.C.); (M.L.M.); (P.J.-Q.); (L.N.-F.); (J.P.-V.)
| | - Julián Pérez-Villacastín
- Cardiology Department, Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain; (J.R.B.D.); (L.D.L.F.); (P.M.-A.); (J.J.G.d.D.); (C.O.B.); (P.M.C.); (M.L.M.); (P.J.-Q.); (L.N.-F.); (J.P.-V.)
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