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Chiabrando JG, Lombardi M, Seropian IM, Valle Raleigh JM, Vergallo R, Larribau M, Agatiello CR, Trani C, Burzotta F. Chronic systemic glucocorticoid therapy is associated with increased risk of major vascular complications and cardiac tamponade after transcatheter aortic valve implantation: a systematic review and meta-analysis. Minerva Cardiol Angiol 2024; 72:284-291. [PMID: 37822235 DOI: 10.23736/s2724-5683.23.06347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION TAVI-related complications, such as conduction disturbances, vascular complications or death may be related to increased inflammatory response. The aim of this study was to elucidate the efficacy and safety of the systemic glucocorticoid therapy regarding the adverse events after TAVI deployment. EVIDENCE ACQUISITION We conducted a systemic search of PubMed, a reference list of relevant articles, and Medline. The main efficacy outcomes of interest were all-cause death, cardiac and non-cardiac death, permanent pacemaker implantation (PPM), new left bundle branch block (LBBB), stroke, and myocardial infarction (MI). Safety endpoints were major vascular complications, major bleeding events, and cardiac tamponade. EVIDENCE SYNTHESIS A total of 7 studies including data from 3439 patients with a median follow-up was 30 days. Systemic glucocorticoid compared to the control group were associated with an increased risk of non-cardiac death (Relative Risk [RR] 5.90 95%CI [2.95; 11.80], P<0.001) major vascular complications (RR 1.78, 95%CI [1.22 - 2.61], P=0.003) and cardiac tamponade (RR 3.42, 95%CI [1.69 - 6.92], P<0.001). However, there were no differences in all-cause death, cardiac death, new LBBB, stroke, MI, or major bleeding events (all P values >0.05). CONCLUSIONS Glucocorticoid therapy before the TAVI procedure was associated with an increase in non-cardiac death, major vascular events and cardiac tamponade. There were no differences in the risk of all-cause death, cardiac death, PPM or LBBB, stroke, or MI.
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Affiliation(s)
- Juan G Chiabrando
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina -
- Unit of Interventional Cardiology, Spanish Hospital of Mendoza, Mendoza, Argentina -
| | - Marco Lombardi
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
| | - Ignacio M Seropian
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Juan M Valle Raleigh
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Rocco Vergallo
- Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, Genoa, Italy
- Cardiothoracic and Vascular Department (DICATOV), IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Miguel Larribau
- Unit of Interventional Cardiology, Spanish Hospital of Mendoza, Mendoza, Argentina
| | - Carla R Agatiello
- Unit of Interventional Cardiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Carlo Trani
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, IRCCS A. Gemelli University Polyclinic Foundation, Sacred Heart Catholic University, Rome, Italy
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Fatima K, Uddin QS, Tharwani ZH, Kashif MAB, Javaid SS, Kumar P, Zia MT, Javed M, Butt MS, Asim Z. Concomitant transthyretin cardiac amyloidosis in patients undergoing TAVR for aortic stenosis: A systemic review and meta-analysis. Int J Cardiol 2024; 402:131854. [PMID: 38367883 DOI: 10.1016/j.ijcard.2024.131854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/15/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Transcatheter aortic valve replacement (TAVR) is a successful treatment for aortic stenosis (AS) patients, and previous studies indicate favorable outcomes for those with concomitant aortic stenosis and transthyretin-associated cardiac amyloidosis (TTRCA-AS). However, the impact of TAVR on more adverse outcomes in TTRCA-AS patients compared to those with AS alone is still uncertain, with conflicting findings reported in the literature. METHODS PubMed and Scopus were extensively searched from inception till August 2021. Studies were included if they reported data for prevalence and outcomes including mortality and cardiovascular-related hospitalization events in TTRCA-AS patients referred for TAVR. The data for these outcomes were pooled using a random effects model and forest plots were created. RESULTS After initially screening 146 articles, 6 were shortlisted for inclusion in our analysis. Pooled analysis demonstrated a 13.3% [95% CI: 10.9-16.5; p = 0.307] prevalence of TTRCA in patients with AS undergoing TAVR. The incidence of mortality and cardiovascular (CV) hospitalization in patients with TTRCA-AS undergoing TAVR were 28.3% [95% CI: 18.7-39.0, p = 0.478] and 21.1% [95% CI: 10.2-34.5, p = 0.211], respectively. CONCLUSION The overall pooled TTRCA-AS prevalence was reported to be 13.3% in AS patients who underwent TAVR. Furthermore, transthyretin-associated CA was found to be associated with an increased risk of mortality and hospitalization. Large patient population studies are required to assess the safety and efficacy of TAVR in TTRCA-AS patients, as current research report data from small patient cohorts.
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Affiliation(s)
- Kaneez Fatima
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Qazi Shurjeel Uddin
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Syed Sarmad Javaid
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Prince Kumar
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Twaha Zia
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Maarij Javed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Malaika Saeed Butt
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Zoraiz Asim
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
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3
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Aimo A, Camerini L, Fabiani I, Morfino P, Panichella G, Barison A, Pucci A, Castiglione V, Vergaro G, Sinagra G, Emdin M. Valvular heart disease in patients with cardiac amyloidosis. Heart Fail Rev 2024; 29:65-77. [PMID: 37735319 PMCID: PMC10904406 DOI: 10.1007/s10741-023-10350-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
Cardiac amyloidosis (CA) is an underdiagnosed condition caused by the deposition of misfolded proteins, namely immunoglobulin light chains and transthyretin, in the extracellular spaces of the heart. Any cardiovascular structure can be affected by amyloid infiltration, including the valves. Amyloid accumulation within the cardiac valves may lead to their structural and functional impairment, with a profound impact on patients' prognosis and quality of life. The most common forms of valvular disease in CA are aortic stenosis (AS), mitral regurgitation (MR), and tricuspid regurgitation (TR). CA and AS share similar risk factors, disease mechanisms, and remodeling patterns, which make their diagnosis particularly challenging. Patients with both CA and AS experience worse outcomes than CA or AS alone, and transcatheter aortic valve replacement may represent a useful therapeutic strategy in this population. Data on MR and TR are quite limited and mainly coming from case reports or small series. This review paper will summarize our current understanding on the epidemiology, disease mechanisms, echocardiographic features, clinical implications, and therapeutic options of AS, MR, and TR in patients with CA.
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Affiliation(s)
- Alberto Aimo
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy.
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | - Lara Camerini
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Paolo Morfino
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Giorgia Panichella
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
| | - Andrea Barison
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Angela Pucci
- Histopathology Department, University Hospital of Pisa, Pisa, Italy
| | - Vincenzo Castiglione
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Gianfranco Sinagra
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) and University of Trieste, Trieste, Italy
| | - Michele Emdin
- Interdisciplinary Center for Health Sciences, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà 33, 56127, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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Jeong M, Bonilla A, Roberts WC, Roberts CS, Banerjee S. Causes of Malfunction of Bioprostheses Inserted Percutaneously in the Aortic Valve Position in Patients Whose Native Aortic Valve Was Congenitally Bicuspid and Stenotic. Am J Cardiol 2023; 209:24-28. [PMID: 37848171 DOI: 10.1016/j.amjcard.2023.09.075] [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: 07/25/2023] [Revised: 09/08/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has brought in recent years relief of cardiac-induced symptoms to a large number of patients with aortic stenosis. Whether it is better to use TAVI for the treatment of aortic valve stenosis superimposed on a congenitally bicuspid valve has been debated in contrast to its proved usefulness in aortic valve stenosis involving a tricuspid aortic valve. From January 2020 to March 2023, surgical aortic valve replacement of TAVI valve and native aortic valve was done in 6 patients. The clinical findings of the patients and morphologic findings from the surgical specimens submitted to the cardiac pathology department were subsequently examined. All the 6 native aortic valves had bicuspid configuration. The TAVI valve in each patient was excised from 9 to 88 months (mean 36 months) after it had been implanted because of paravalvular leak in 4, severe stenosis of the prosthetic valve in 1, and bioprosthetic cuspal degeneration in 1. Prosthetic valve endocarditis was clinically suspected in 2 patients, but the specimen culture was negative. Before surgical aortic valve replacement, 3 patients experienced stroke after TAVI. All 6 patients had low hemoglobin levels (mean 9.5 mg/100 ml) and low hematocrit levels (mean 29.5%). Reticulocyte count was available in 4 patients and was increased in all (mean 3.5%). When the stenotic native aortic valve configuration is bicuspid, the raphe tends to be calcified first and located perpendicular to the flow of the blood and may prevent the ring of the caged bioprosthesis from being transferred to the aortic wall, which is a requirement for full opening of the lumen of the bioprosthesis. Thus, thorough consideration needs to be made before performing TAVI in patients whose native aortic valve is stenotic and bicuspid.
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Affiliation(s)
- Minseob Jeong
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas.
| | - Arantza Bonilla
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; University of Texas at Dallas, Dallas, Texas
| | - William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Pathology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Department of Internal Medicine, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Charles S Roberts
- Department of Cardiac Surgery, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
| | - Subhash Banerjee
- Baylor Scott & White Heart and Vascular Institute, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas; Division of Cardiology, Baylor University Medical Center, Baylor Scott & White Health, Dallas, Texas
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5
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Hussain B, Duhan S, Mahmood A, Al-Alawi L, Vargas C, Khan S, Ali Z, Waqar F, Alfonso C, Cuevas C, Alexander T. Prevalence and Prognostic Implications of Amyloidosis in Valvular Heart Disease. Curr Probl Cardiol 2023; 48:101811. [PMID: 37209794 DOI: 10.1016/j.cpcardiol.2023.101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
There has been less emphasis on the prognostic impact of amyloidosis in patients with valvular heart disease (VHD). We aimed to determine the prevalence of amyloidosis in VHD and its clinical implications in terms of mortality. Patients hospitalized for VHD were identified using National Inpatient Sample 2016-2020 which were divided into 2 cohorts: with and without amyloidosis. Among 5,728,873 patients hospitalized with VHD, 11,715 patients had amyloidosis in which mitral valve disease has the highest prevalence (7.6%) followed by aortic (3.6%), and tricuspid valve disease (1%). Underlying amyloidosis is associated with higher mortality in VHD (OR 1.45, CI 1.2-1.7, P<0.001), mainly mitral valve disease (OR 1.44, CI 1.1-1.9, P<0.01). Patients with amyloidosis have higher adjusted mortality rates (5-6% vs 2.6%, P<0.01), longer mean length of stay (7.1 vs 5.7 days, P<0.001), but they have lower valvular intervention rates. In hospitalized VHD patients, underlying amyloidosis is associated with higher in-hospital mortality.
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Affiliation(s)
- Bilal Hussain
- The Brooklyn Hospital Center, Internal Medicine, Brooklyn, NY.
| | - Sanchit Duhan
- Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD
| | - Ahmed Mahmood
- Cardiology Department, Corpus Christi Medical Center, Corpus Christi, TX
| | - Luay Al-Alawi
- Cardiology Department, Corpus Christi Medical Center, Corpus Christi, TX
| | - Carlos Vargas
- Cardiology Department, Corpus Christi Medical Center, Corpus Christi, TX
| | - Sohail Khan
- Interventional Cardiology, Marshfield Medical Center, Marshfield, WI
| | - Zuhair Ali
- Graduate Medical Education, HCA Houston Healthcare, Houston, TX
| | - Fahad Waqar
- Interventional Cardiology, University of Cincinnati, Cincinnati, OH
| | | | - Christel Cuevas
- Cardiology Department, Corpus Christi Medical Center, Corpus Christi, TX
| | - Thomas Alexander
- Cardiology Department, Corpus Christi Medical Center, Corpus Christi, TX
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6
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Guimaron S, Kalavrouziotis D, Maranda-Robitaille M, Dumont E, Joubert P, Babaki S, Rodés-Cabau J, Mohammadi S. Macroscopic and microscopic features of surgically explanted transcatheter aortic valve prostheses. J Card Surg 2022; 37:3178-3187. [PMID: 35870159 DOI: 10.1111/jocs.16784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/12/2022] [Accepted: 06/19/2022] [Indexed: 01/06/2023]
Abstract
OBJECTIVES With the extended indications of transcatheter aortic valve (TAV) replacement (TAVR) to lower-risk patients, there is an increasing number of patients requiring surgical explantation of failed TAV. We sought to describe macroscopic and microscopic features of surgically explanted percutaneous aortic valve prostheses. METHODS Preoperative and surgical characteristic of patients undergoing surgical explantation of TAV were retrospectively analyzed from 2007 to 2020. Surgical and pathologic features of these valves, and outcomes of the surgical valve replacement were described. RESULTS Out of 1764 patients who underwent a TAVR procedure, 21 were operated for TAV failure. Isolated or combined indications for surgery included: significant paravalvular leak (n = 15), delayed prosthesis migration (n = 5), significant increase of trans-TAV gradients (n = 6), and endocarditis (n = 3). Mean time elapsed between TAVR and explantations was 674.9 ± 803.9 days. Macroscopic lesions found on explanted percutaneous valves were severe adhesions to the aorta (n = 10), calcifications (n = 7), leaflet thrombosis (n = 4), and vegetations (n = 3). Except for patients with endocarditis, one or more pathological lesions were found in 15 patients. Pathology analyses on these valves showed fibro-calcific degenerations (n = 12), pannus formation (n = 9), and chronic inflammation (n = 3). One patient (4.8%) died after surgical explantation, and 13 (61.9%) had concomitant procedures. The survival rate at 1 year was 94.4%. CONCLUSIONS Microscopic findings of fibro-calcific leaflet degeneration, and pannus formation in addition to macroscopic calcification and thrombosis present early, (within a mean of 2 years) after TAVR. Further investigation with a higher number of patients and echocardiographic follow-up is warranted.
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Affiliation(s)
- Samantha Guimaron
- Department of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada
| | - Dimitri Kalavrouziotis
- Department of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada
| | | | - Eric Dumont
- Department of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada
| | - Phillipe Joubert
- Department of Pathology, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada
| | - Shervin Babaki
- Department of Research, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada
| | - Siamak Mohammadi
- Department of Cardiac Surgery, Quebec Heart and Lung University Institute, Quebec City, Quebec, Canada
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7
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Temporal Trends and Outcomes of Transcatheter and Surgical Aortic Valve Replacement in Patients With Cardiac Amyloidosis and Severe Aortic Stenosis. Am J Cardiol 2022; 179:118-122. [PMID: 35879152 DOI: 10.1016/j.amjcard.2022.06.026] [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: 05/19/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022]
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8
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Reduction in Afterload Reveals the Apical Sparing Phenotype. Circ Cardiovasc Imaging 2022; 15:e014549. [DOI: 10.1161/circimaging.122.014549] [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: 11/16/2022]
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9
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Myasoedova VA, Conte M, Valerio V, Moschetta D, Massaiu I, Petraglia L, Leosco D, Poggio P, Parisi V. Red Flags, Prognostic Impact, and Management of Patients With Cardiac Amyloidosis and Aortic Valve Stenosis: A Systematic Review and Meta-Analysis. Front Med (Lausanne) 2022; 9:858281. [PMID: 35355593 PMCID: PMC8959832 DOI: 10.3389/fmed.2022.858281] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cardiac amyloidosis (CA) has been recently recognized as a condition frequently associated with aortic stenosis (AS). The aim of this study was to evaluate: the main characteristics of patients with AS with and without CA, the impact of CA on patients with AS mortality, and the effect of different treatment strategies on outcomes of patients with AS with concomitant CA. Materials and Methods A detailed search related to CA in patients with AS and outcomes was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Seventeen studies enrolling 1,988 subjects (1,658 AS alone and 330 AS with CA) were included in the qualitative and quantitative analysis of main patients with AS characteristics with and without CA, difference in mortality, and treatment strategy. Results The prevalence of CA resulted in a mean of 15.4% and it was even higher in patients with AS over 80 years old (18.2%). Patients with the dual diagnosis were more often males, had lower body mass index (BMI), were more prone to have low flow, low gradient with reduced left ventricular ejection fraction AS phenotype, had higher E/A and E/e', and greater interventricular septum hypertrophy. Lower Sokolow–Lyon index, higher QRS duration, higher prevalence of right bundle branch block, higher levels of N-terminal pro-brain natriuretic peptide, and high-sensitivity troponin T were significantly associated with CA in patients with AS. Higher overall mortality in the 178 patients with AS + CA in comparison to 1,220 patients with AS alone was observed [odds ratio (OR) 2.25, p = 0.004]. Meta-regression analysis showed that younger age and diabetes were associated with overall mortality in patients with CS with CA (Z-value −3.0, p = 0.003 and Z-value 2.5, p = 0.013, respectively). Finally, patients who underwent surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI) had a similar overall mortality risk, but lower than medication-treated only patients. Conclusion Results from our meta-analysis suggest that several specific clinical, electrocardiographic, and echocardiographic features can be considered “red flags” of CA in patients with AS. CA negatively affects the outcome of patients with AS. Patients with concomitant CA and AS benefit from SAVR or TAVI.
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Affiliation(s)
- Veronika A Myasoedova
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Maddalena Conte
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Naples, Italy.,Casa di Cura San Michele, Maddaloni, Italy
| | - Vincenza Valerio
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Donato Moschetta
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Dipartimento di Scienze farmacologiche e biomolecolari, Università degli Studi di Milano, Milano, Italy
| | - Ilaria Massaiu
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy.,Developmental Biology of the Immune System, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - Laura Petraglia
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Dario Leosco
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Paolo Poggio
- Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Valentina Parisi
- Dipartimento di Scienze Mediche Traslazionali, Università degli Studi di Napoli Federico II, Naples, Italy
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10
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Andrews JPM, Trivieri MG, Everett R, Spath N, MacNaught G, Moss AJ, Doris MK, Pawade T, van Beek EJR, Lucatelli C, Newby DE, Robson P, Fayad ZA, Dweck MR. 18F-fluoride PET/MR in cardiac amyloid: A comparison study with aortic stenosis and age- and sex-matched controls. J Nucl Cardiol 2022; 29:741-749. [PMID: 33000405 PMCID: PMC8993737 DOI: 10.1007/s12350-020-02356-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Cardiac MR is widely used to diagnose cardiac amyloid, but cannot differentiate AL and ATTR subtypes: an important distinction given their differing treatments and prognoses. We used PET/MR imaging to quantify myocardial uptake of 18F-fluoride in ATTR and AL amyloid patients, as well as participants with aortic stenosis and age/sex-matched controls. METHODS In this prospective multicenter study, patients were recruited in Edinburgh and New York and underwent 18F-fluoride PET/MR imaging. Standardized volumes of interest were drawn in the septum and areas of late gadolinium enhancement to derive myocardial standardized uptake values (SUV) and tissue-to-background ratio (TBRMEAN) after correction for blood pool activity in the right atrium. RESULTS 53 patients were scanned: 18 with cardiac amyloid (10 ATTR and 8 AL), 13 controls, and 22 with aortic stenosis. No differences in myocardial TBR values were observed between participants scanned in Edinburgh and New York. Mean myocardial TBRMEAN values in ATTR amyloid (1.13 ± 0.16) were higher than controls (0.84 ± 0.11, P = .0006), aortic stenosis (0.73 ± 0.12, P < .0001), and those with AL amyloid (0.96 ± 0.08, P = .01). TBRMEAN values within areas of late gadolinium enhancement provided discrimination between patients with ATTR (1.36 ± 0.23) and all other groups (e.g., AL [1.06 ± 0.07, P = .003]). A TBRMEAN threshold >1.14 in areas of LGE demonstrated 100% sensitivity (CI 72.25 to 100%) and 100% specificity (CI 67.56 to 100%) for ATTR compared to AL amyloid (AUC 1, P = .0004). CONCLUSION Quantitative 18F-fluoride PET/MR imaging can distinguish ATTR amyloid from other similar phenotypes and holds promise in improving the diagnosis of this condition.
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Affiliation(s)
- Jack P M Andrews
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Maria Giovanni Trivieri
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- BioMedical Engineering and Imaging Institute, New York, NY, USA
| | - Russell Everett
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Nicholas Spath
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Gillian MacNaught
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, UK
| | - Alastair J Moss
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Mhairi K Doris
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Tania Pawade
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Edwin J R van Beek
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, Edinburgh, EH16 4SB, UK
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, UK
| | - Christophe Lucatelli
- Edinburgh Imaging, Queen's Medical Research Institute University of Edinburgh, Edinburgh, UK
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, Edinburgh, EH16 4SB, UK
| | - Philip Robson
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- BioMedical Engineering and Imaging Institute, New York, NY, USA
| | - Zahi A Fayad
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- BioMedical Engineering and Imaging Institute, New York, NY, USA
| | - Marc R Dweck
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Room SU.305, Chancellor's building, 51 Little France Crescent, Edinburgh, EH16 4SB, UK
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11
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Sin-Ying Ho J, Kor Q, Kong WK, Lim YC, Yan-Yee Chan M, Syn NL, Ngiam JN, Chew NW, Yeo TC, Chai P, Poh KK, Wong RC, Lin W, Sia CH. Prevalence and outcomes of concomitant cardiac amyloidosis and aortic stenosis: A systematic review and meta-analysis. Hellenic J Cardiol 2021; 64:67-76. [PMID: 34856378 DOI: 10.1016/j.hjc.2021.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Cardiac amyloidosis (CA) is an increasingly recognised condition in patients with aortic stenosis (AS). However, there is large variation in the reported prevalence figures, due to differences in populations and diagnostic methods. We aimed to investigate the prevalence, risk factors and outcomes of concomitant CA and AS. METHODS We performed a systematic review and meta-analysis of the literature searched on Medline, EMBASE, Scopus and CENTRAL. We analysed the prevalence of CA in AS grouped according to diagnostic techniques, and the risk factors and outcomes of concomitant CA and AS was analysed in AS patients referred for surgical or transcatheter aortic valve replacement (AVR). RESULTS A total of 21 studies were included, involving 4,243 patients. The pooled prevalence of CA in patients with AS was 14.4%, with substantial heterogeneity. The pooled prevalence of AS in CA was 8.7%, with substantial heterogeneity. Patients with both AS and CA had higher all-cause mortality than those with AS or CA alone. In AS patients requiring AVR, CA was associated with increasing age, male sex, higher NT-proBNP levels, increased interventricular septal end diastole thickness and lower left ventricular ejection fraction. Concomitant AS and CA was associated with increased all-cause mortality and pacemaker implantation post-procedure. Study limitations included the heterogeneity of results and the fair to good quality of studies published. CONCLUSION Overall, a substantial proportion of patients with AS may have CA, and they have poorer prognosis. A high degree of clinical suspicion is needed to identify "red flags" and perform appropriate diagnostic imaging.
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Affiliation(s)
- Jamie Sin-Ying Ho
- Academic Foundation Programme, North Middlesex University Hospital NHS Trust, United Kingdom
| | - Qianyi Kor
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William Kf Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Yoke Ching Lim
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Mark Yan-Yee Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Nicholas Lx Syn
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jinghao Nicholas Ngiam
- Internal Medicine Residency, University Medicine Cluster, National University Health System, Singapore
| | - Nicholas Ws Chew
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Tiong-Cheng Yeo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ping Chai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Kian-Keong Poh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Raymond Cc Wong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Weiqin Lin
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Ching-Hui Sia
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre Singapore, Singapore.
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12
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Shimoni S, Zikri M, Haberman D, Livschitz S, Tshori S, Fabricant Y, Meledin V, Gandelman G, Goland S, George J. Transthyretin cardiac amyloidosis in patients after TAVR: clinical and echocardiographic findings and long term survival. ESC Heart Fail 2021; 8:4549-4561. [PMID: 34704399 PMCID: PMC8712785 DOI: 10.1002/ehf2.13667] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/27/2021] [Accepted: 09/27/2021] [Indexed: 01/15/2023] Open
Abstract
Aims The aim of this study was to examine the prevalence of amyloid transthyretin (ATTR) cardiac amyloidosis in patients 1–2 years after trans‐catheter aortic valve replacement (TAVR) and to assess their clinical and echocardiographic outcome and long‐term survival. Methods and results We enrolled 88 patients, mean age 81 years, 534 (390–711) days after TAVR. Patients underwent a Tc99m‐PYP scintigraphy for the diagnosis of ATTR cardiac amyloidosis. Eleven (12.5%) participants were diagnosed with ATTR cardiac amyloidosis. Eighty eight per cent of patients without amyloidosis were in New York Heart Association Classes 1–2 after TAVR, compared with 64% patients with ATTR cardiac amyloidosis (P = 0.022). There were no differences in left ventricular (LV) ejection fraction (P = 0.69) between patients with and without ATTR cardiac amyloidosis at enrolment. The LV mass index and pulmonary artery pressure were significantly higher in patients with ATTR cardiac amyloidosis (P = 0.046 and P = 0.002, respectively). Global longitudinal strain and myocardial work efficiency were significantly lower in patients with ATTR cardiac amyloidosis (P = 0.031 and P = 0.048, respectively). We assessed changes in echocardiographic data, from the time of TAVR to enrolment, and as expected, there was a significant decrease in aortic valve gradient in both groups. There was a significant reduction in LV mass and LV mass index and improvement in basal segment LV strain in the ATTR cardiac amyloidosis negative group (P = 0.045, P = 0.046 and 0.023, respectively). However, in the ATTR cardiac amyloidosis group the change in LV mass and LV mass index and LV basal strain values was not significant (P = 0.24, P = 0.13 and P = 0.35, respectively). The were no significant changes in other echocardiographic parameters in both groups. The patients were followed for 1150 (1086–1221) days after enrolment. Twenty seven patients had at least one cardiac hospitalization during of follow up, of them seven were with ATTR cardiac amyloidosis and 20 patients without amyloidosis (P = 0.017). Eighteen patients (20%) died during follow up; 12 (14%) patients died due to cardiac causes. There was no difference in all‐cause and cardiac mortality between patients with and without ATTR cardiac amyloidosis (P = 0.6 and P = 0.53, respectively). Conclusions The long‐term survival after TAVR is not significantly affected by the presence of ATTR cardiac amyloidosis. However, the clinical course of these patients and the LV hemodynamic improvement is less favourable. This hypothesis‐generating study suggests screening for ATTR cardiac amyloidosis in patients who underwent TAVR and have limited clinical or echocardiographic improvement, because they may potentially improve with new therapies for ATTR cardiac amyolidosis.
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Affiliation(s)
- Sara Shimoni
- The Heart Center, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Meital Zikri
- The Heart Center, Kaplan Medical Center, Rehovot, Israel
| | - Dan Haberman
- The Heart Center, Kaplan Medical Center, Rehovot, Israel
| | - Shay Livschitz
- The Heart Center, Kaplan Medical Center, Rehovot, Israel
| | - Sagi Tshori
- The Heart Center, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | | | - Valery Meledin
- The Heart Center, Kaplan Medical Center, Rehovot, Israel
| | - Gera Gandelman
- The Heart Center, Kaplan Medical Center, Rehovot, Israel
| | - Sorel Goland
- The Heart Center, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Jacob George
- The Heart Center, Kaplan Medical Center, Rehovot, Israel.,Hadassah Medical School, Hebrew University, Jerusalem, Israel
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13
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Singal AK, Bansal R, Singh A, Dorbala S, Sharma G, Gupta K, Saxena A, Bhargava B, Karthikeyan G, Ramakrishnan S, Bisoi AK, Hote MP, Rajashekar P, Chowdhury UK, Devagourou V, Patel C, Ray R, Arawa SK, Mishra S. Concomitant Transthyretin Amyloidosis and Severe Aortic Stenosis in Elderly Indian Population: A Pilot Study. JACC CardioOncol 2021; 3:565-576. [PMID: 34746852 PMCID: PMC8551518 DOI: 10.1016/j.jaccao.2021.08.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/15/2021] [Accepted: 08/18/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Prevalence of both degenerative severe aortic stenosis (AS) and transthyretin cardiac amyloidosis (ATTR-CA) increases with age. Dual disease (AS+myocardial ATTR-CA) occurs in significant proportion of patients undergoing surgical aortic valve replacement (SAVR). OBJECTIVES This study aimed to determine the prevalence of ATTR-CA in severe AS in the Indian population, identify noninvasive predictors of its diagnosis, and understand its impact on prognosis. METHODS Symptomatic severe AS patients aged ≥65 years undergoing SAVR were enrolled. ATTR-CA diagnosis was based on preoperative 99m-technetium pyrophosphate (PYP) scan and intraoperatively obtained basal interventricular septum biopsy for myocardial ATTR-CA, and excised native aortic valve for isolated valvular ATTR-CA. Primary amyloidosis was excluded by serum/urine protein electrophoresis with serum immunofixation. RESULTS SAVR was performed in 46 AS patients (age 70 ± 5 years, 70% men). PYP scan was performed for 32 patients, with significant PYP uptake in 3 (n = 3 of 32, 9.4%), suggestive of myocardial ATTR-CA. On histopathological examination, none of the interventricular septum biopsy specimens had amyloid deposits, whereas 33 (71.7%) native aortic valves showed amyloid deposits, of which 19 (57.6%) had transthyretin deposition suggestive of isolated valvular amyloidosis. Noninvasive markers of dual disease included low myocardial contraction fraction (median [interquartile range], 28.8% [23.8% to 39.1%] vs 15.3% [9.3% to 16.1%]; P = 0.006), deceleration time (215 [144 to 236] ms vs 88 [60 to 106] ms; P = 0.009) and global longitudinal strain (-18.7% [-21.1% to -16.9%] vs -14.2% [-17.0% to -9.7%]; P = 0.030). At 1-year follow-up, 2 patients died (4.3%); 1 each in myocardial ATTR-CA negative and positive groups (3.4% vs 33.3%; P = 0.477). CONCLUSIONS Dual disease is not uncommon in India. Isolated valvular amyloidosis in severe AS is much more common.
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Key Words
- 99m-technetium pyrophosphate scan
- 99mTc-PYP, 99m-technetium pyrophosphate
- AL-CA, light chain cardiac amyloidosis
- AS, aortic stenosis
- ATTR-CA, transthyretin cardiac amyloidosis
- EMB, endomyocardial biopsy
- GLS, global longitudinal strain
- IHC, immunohistochemistry
- LfLg AS, low-flow, low-gradient aortic stenosis
- SAVR, surgical aortic valve replacement
- TAVR, transcatheter aortic valve replacement
- TTR, transthyretin
- dual aortic stenosis transthyretin cardiac amyloidosis
- severe aortic stenosis
- transthyretin cardiac amyloidosis
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Affiliation(s)
| | | | - Avinainder Singh
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sharmila Dorbala
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Kartik Gupta
- Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Anita Saxena
- Department of Cardiology, AIIMS, New Delhi, India
| | - Balram Bhargava
- Department of Cardiology, AIIMS, New Delhi, India
- Indian Council of Medical Research, New Delhi, India, and Department of Health Research (Ministry of Health and Family Welfare), Government of India, New Delhi, India
| | | | | | | | | | | | | | | | - Chetan Patel
- Department of Nuclear Medicine, AIIMS, New Delhi, India
| | - Ruma Ray
- Department of Pathology, AIIMS, New Delhi, India
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14
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Bokhari S, Gupta R. Aging, Aortic Stenosis, and Transthyretin Cardiac Amyloidosis: A Perfect Cardiac Storm? JACC CardioOncol 2021; 3:577-579. [PMID: 34729529 PMCID: PMC8543125 DOI: 10.1016/j.jaccao.2021.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Sabahat Bokhari
- Lehigh Valley Heart and Vascular Institute, Allentown, Pennsylvania, USA
| | - Rahul Gupta
- Lehigh Valley Heart and Vascular Institute, Allentown, Pennsylvania, USA
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15
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Dorbala S, Clerc OF. Progress in Cardiac Imaging Uncovers the Epidemiology of Wild-Type Transthyretin Amyloid Cardiomyopathy. JACC CardioOncol 2021; 3:547-549. [PMID: 34729527 PMCID: PMC8543126 DOI: 10.1016/j.jaccao.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Sharmila Dorbala
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Olivier Florian Clerc
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Cardiac Amyloidosis Program, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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16
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Lutter G, Bax L, Liu Y, Hansen JH, Frank D, Freitag-Wolf S, Simionescu A, Sathananthan J, Puehler T. Transcatheter mitral valve replacement: tissue in-growth after 4 weeks. Interact Cardiovasc Thorac Surg 2021; 32:1-8. [PMID: 33279987 DOI: 10.1093/icvts/ivaa225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/11/2020] [Accepted: 09/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Tissue reaction to transcatheter mitral valve replacement in the mitral annulus remains to be elucidated. METHODS Trileaflet porcine pericardial valves were sewn onto self-expanding d-shaped nitinol stents, which were delivered transapically and in an off-pump fashion into the mitral position of 10 pigs. After at least 4 weeks of follow-up, gross pathological assessment and histological examination were performed. The specimens were stained with Movat's pentachrome, Elastica-van-Gieson and von Kossa staining. The leucocytes, B cells, T cells or macrophages were detected by specific immunohistochemical staining. RESULTS Proper stent positioning in the mitral annulus was achieved in 9/10 animals. Nine of 10 animals survived the desired observation period. In all but one, the mitral valve stent was well integrated into the left atrium and perpendicularly embedded into the annulus by 85 ± 24%. One animal had minor fractures in the nitinol struts and another animal showed tearing of 1 of 4 tethers. Histological examination demonstrated no major tissue reaction with the nitninol struts but well-preserved overall structures around the mitral annulus in 8/9 cases. CONCLUSIONS This is the first report demonstrating good in-growth of transcatheter-delivered anatomically shaped mitral valve stents after at least 4 weeks of follow-up. Histological examination demonstrated progressive healing and neointimalization.
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Affiliation(s)
- Georg Lutter
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | - Lennart Bax
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiac and Vascular Surgery, Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Yazhou Liu
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
| | | | - Derk Frank
- Medical center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sandra Freitag-Wolf
- Institute of Medical Informatics and Statistics, Kiel University, Kiel, Germany
| | | | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Puehler
- Department of Experimental Cardiac Surgery and Heart Valve Replacement, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany.,Department of Cardiovascular Surgery, Christian-Albrechts-University of Kiel, School of Medicine, UKSH, Kiel, Germany
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17
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Bernhard B, Okuno T, Cicovic A, Stortecky S, Reichlin T, Lanz J, Praz F, Windecker S, Pilgrim T. Systemic corticosteroid exposure and atrioventricular conductance delays after transcatheter aortic valve implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 37:1-6. [PMID: 34238680 DOI: 10.1016/j.carrev.2021.06.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Atrioventricular conduction delays (AVCD) are common after transcatheter aortic valve implantation (TAVI) and frequently require implantation of a permanent pacemaker (PPM). Autopsy studies demonstrated the role of ischemia, inflammation, and oedema in the pathogenesis of AVCD. Corticosteroids (CS) reduce inflammation and oedema and hence might lead to a lower rate of AVCD. METHODS Based on a prospective single-center registry, we performed a propensity score (PS) matched analysis of subjects treated with or without systemic CS (>2.5 mg prednisolone-equivalent per day) at the time of TAVI. The primary endpoint was a composite of PPM-implantation and new-onset left bundle branch block (LBBB) within 30 days after TAVI. RESULTS Among 2213 consecutive patients undergoing TAVI (51.5% female, mean age 82.1 ± 6.1 years) 89 patients were treated with systemic CS, of which 87 were included in the PS matched analysis. At 30 days, rates of the composite of PPM and LBBB were comparable between patients with versus without CS both in the overall cohort (33.7% versus 33.0%, p = 0.89) and the PS matched cohort (34.5% versus 40.2%, p = 0.443). There were no differences in a composite of major or minor vascular complications and major or life-threatening bleeding events between patients with versus without CS in the overall cohort (34.8% versus 26.6%, p = 0.088) or the PS matched cohort (33.3% versus 33.3%, p ≥ 0.999). CONCLUSION In this exploratory study, intake of systemic CS among patients undergoing TAVI was not associated with differences in rates of AVCD, vascular complications, or bleeding events after TAVI.
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Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Aleksandar Cicovic
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, 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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18
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Smith A, Balmforth D, Treibel TA, Lall K, Oo A, Ambekar S. Cardiac amyloidosis in non-transplant cardiac surgery. J Card Surg 2021; 36:2901-2910. [PMID: 33993535 DOI: 10.1111/jocs.15629] [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: 12/05/2020] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
Cardiac amyloidosis is a rare infiltrative cardiomyopathy that portends a poor prognosis. There is a growing recognition of co-existent aortic valve stenosis and transthyretin cardiac amyloidosis, with some studies suggesting that dual pathology may be associated increased risk of complication and mortality during surgical intervention. This review aims to evaluate the available literature on non-transplant cardiac surgical interventions in patients with cardiac amyloidosis, with particular focus on diagnosis, high surgical risk and areas of uncertainty that require further research.
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Affiliation(s)
- Alex Smith
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK.,Queen Mary University of London, London, UK
| | - D Balmforth
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - T A Treibel
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK.,Institute for Cardiovascular Sciences, University College London, London, UK
| | - Kulvinder Lall
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Aung Oo
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
| | - Shirish Ambekar
- The Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK
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19
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Robin G, Cognet T, Bouisset F, Cariou E, Méjean S, Pradel S, Colombat M, Galinier M, Carrié D, Lairez O. Value of Longitudinal Strain to Identify Wild-Type Transthyretin Amyloidosis in Patients With Aortic Stenosis. Circ J 2021; 85:1494-1504. [PMID: 33980765 DOI: 10.1253/circj.cj-20-1064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Wild-type transthyretin-related amyloidosis (ATTRwt) and degenerative aortic stenosis (AS) are both age-related. Diagnosis of cardiac amyloidosis (CA) among patients with AS may be difficult due to overlapping morphological and functional criteria. The aim of this study was to describe an echocardiographic longitudinal strain (LS) pattern among patients with AS with and without ATTRwt.Methods and Results:Patients who have AS with ATTRwt (n=30), AS without ATTRwt (n=50) and ATTRwt without AS (n=31) underwent two-dimensional speckle-tracking echocardiography. Transthyretin CA was based on positive bone scintigraphy without monoclonal gammopathy. All patients showed a gradual decrease in LS from the base to the apex resulting in a decrease of the global LS. A cut-off value of 1.0 for relative apical LS (average apical LS/[average basal LS+mid-LS]) was sensitive (88%) but less specific (68%) in differentiating ATTRwt among patients with severe AS. The best cut-off value for relative apical LS for identifying patients with ATTRwt among the whole population was 0.9 (sensitivity 74%, specificity 66%); however, 35%, 25% and 11% of patients who have ATTRwt without AS, with moderate AS and with severe AS, respectively, did not reach this threshold. CONCLUSIONS A decrease of global and relative apical LS is common in patients with AS, even in the absence of ATTRwt. ATTRwt CA can be present even in the absence of relative apical sparing of LS.
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Affiliation(s)
- Guillaume Robin
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital
| | - Thomas Cognet
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital.,Department of Nuclear Medicine, Toulouse University Hospital
| | | | - Eve Cariou
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital
| | - Simon Méjean
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital.,Department of Nuclear Medicine, Toulouse University Hospital
| | - Sarah Pradel
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital
| | | | - Michel Galinier
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital.,Medical School, Toulouse III Paul Sabatier University
| | - Didier Carrié
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital.,Medical School, Toulouse III Paul Sabatier University
| | - Olivier Lairez
- Department of Cardiology, Rangueil University Hospital.,Cardiac Imaging Center, Toulouse University Hospital.,Department of Nuclear Medicine, Toulouse University Hospital.,Medical School, Toulouse III Paul Sabatier University
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20
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Zampieri M, Nardi G, Del Monaco G, Allinovi M, Gabriele M, Zocchi C, Casagrande S, Fumagalli C, Di Mario C, Olivotto I, Perfetto F, Cappelli F. Changes in the perceived epidemiology of amyloidosis: 20 year-experience from a Tertiary Referral Centre in Tuscany. Int J Cardiol 2021; 335:123-127. [PMID: 33865873 DOI: 10.1016/j.ijcard.2021.04.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/22/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Amyloidosis is considered a rare heterogeneous condition comprising different entities. Epidemiological data are limited and often controversial. We aimed to examine epidemiological changes in amyloidosis diagnosed over a 20-year period at a tertiary referral centre for amyloidosis. METHODS We retrospectively reviewed medical files from all patients diagnosed with amyloidosis between January 2000 and December 2019, at Careggi University Hospital, Florence, Italy. Diagnosis of amyloidosis was performed as per current clinical practice and scientific evidence at the time of patient evaluation. RESULTS We reported data on 654 consecutive patients: 274 (42%) wild type transthyretin amyloidosis (wtATTR), 68 (10%) genetic variant amyloidosis (vATTR), 281 (43%) light-chain amyloidosis (AL) and 31 (5%) serum amyloid A amyloidosis (AA). With limited fluctuations, the absolute number of new AL diagnosis increased during the 20-year period. wtATTR was unrecognized before 2009 but represented by far the most common aetiology at the end of the observation period. AA represented a residual diagnosis throughout the entire examined period. CONCLUSIONS Following a rapid and marked increase in the number of new diagnoses over the last decade, ATTR represents by far the most common type of amyloidosis in our regional centre. These data contrasts with recent reports from national referral institutions and may help shed light on the epidemiology of the disease at the community level.
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Affiliation(s)
- Mattia Zampieri
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy; Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.
| | - Giulia Nardi
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Guido Del Monaco
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Marco Allinovi
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Martina Gabriele
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Chiara Zocchi
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy; Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Silvia Casagrande
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Carlo Fumagalli
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy; Geriatric Cardiology - Intensive Care Unit, Azienda ospedaliera Careggi, Florence, Italy
| | - Carlo Di Mario
- Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy; IV Internal Medicine Division, Careggi University Hospital, Florence, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy; Division of Interventional Structural Cardiology, Cardiothoracovascular Department, Careggi University Hospital, Florence, Italy
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21
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Westin O, Lauridsen MD, Kristensen SL, Køber L, Torp-Pedersen C, Gislason G, Søndergaard L, Maurer MS, Leicht BP, Gustafsson F, Fosbøl EL. The association of prior carpal tunnel syndrome surgery with adverse cardiovascular outcomes and long-term mortality after aortic valve replacement. IJC HEART & VASCULATURE 2021; 33:100741. [PMID: 33732868 PMCID: PMC7944045 DOI: 10.1016/j.ijcha.2021.100741] [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: 12/27/2020] [Revised: 01/27/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022]
Abstract
AIMS Patients undergoing aortic valve replacement (AVR) for severe aortic stenosis have a 6-16% prevalence of occult cardiac amyloidosis. Carpal tunnel syndrome (CTS) is common in cardiac amyloidosis, but whether prior CTS surgery has a prognostic impact in patients undergoing AVR is unknown. This study examined the association between prior CTS surgery and adverse cardiovascular outcomes in patients treated with AVR. METHODS AND RESULTS Using Danish nationwide registries, we retrospectively identified patients undergoing first-time AVR from 2005 to 2018, examining the association between previous CTS and adverse cardiovascular outcomes the following 5 years after the AVR procedure. Cumulative incidence functions and adjusted Cox proportional hazard models were used to assess differences. Among 19,211 patients undergoing AVR, 2.5% (n = 472) had prior CTS surgery. Patients in the CTS-cohort were significantly older (median age 75.7 [IQR 68.1-82.3] vs 73.7 [IQR 66.0-79.6]), more often female and had more comorbidities. Prior CTS surgery was not associated with differences in hospitalization for heart failure (11.2% [95% CI 8.3-14.7] vs 9.4% [95% CI 9.0-9.9]), atrial fibrillation (11.1% [95% CI 8.2-14.5] vs 11.2% [95% CI 10.8-11.7]) or pacemaker implantation (6.2% [95% CI 4.0-9.0] vs 5.1% [95% CI 4.8-5.5]). The 5-year mortality (32.8% [27.6-38.0] vs 25.2% [24.5-25.9]) was higher in the CTS-cohort. CTS was significantly associated with increased 5-year mortality (HR 1.27 [1.05-1.53]) in crude models, however, after multivariable adjustment prior CTS surgery was not associated with adverse cardiovascular outcomes. CONCLUSION Previous CTS surgery was not associated with increased risk for adverse cardiovascular outcomes after AVR.
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Affiliation(s)
- Oscar Westin
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Marie D. Lauridsen
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | | | - Lars Køber
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | | | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Søndergaard
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Mathew S. Maurer
- Columbia University Irving Medical Center, New York, NY, United States
| | | | - Finn Gustafsson
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
| | - Emil L. Fosbøl
- The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark
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22
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Falk RH, Dorbala S. Transthyretin cardiac amyloidosis in patients with severe aortic stenosis. Eur Heart J 2020; 41:2768-2770. [PMID: 32638011 DOI: 10.1093/eurheartj/ehaa458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Affiliation(s)
- Rodney H Falk
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Sharmila Dorbala
- Cardiac Amyloidosis Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital Boston, MA, USA
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23
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Saito M, Imai M, Wake D, Higaki R, Nakao Y, Morioka H, Sumimoto T, Inoue K. Prognostic assessment of relative apical sparing pattern of longitudinal strain for severe aortic valve stenosis. IJC HEART & VASCULATURE 2020; 29:100551. [PMID: 32529023 PMCID: PMC7280361 DOI: 10.1016/j.ijcha.2020.100551] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 01/15/2023]
Abstract
Backgrounds The relative apical sparing pattern (RASP) of left ventricular (LV) longitudinal strain (LS) is frequently associated with cardiac amyloidosis. Elderly patients with aortic valve stenosis (AS) complicated by transthyretin amyloid cardiomyopathy have poor prognosis. Furthermore, deteriorated basal LS in AS patients has been reported to be associated with adverse outcome. We investigated the association between RASP and outcomes in patients with severe AS. Methods We retrospectively studied 156 consecutive patients with severe AS and preserved LV ejection fraction. RASP was assessed by both of semi-quantitative (sRASP) and quantitative (qRASP) methods. sRASP was defined as a deterioration of LS (≥-10%) in ≥ 5 (of 6) basal segments, relative to preserved LS (<-15%) in at least 1 apical segment. qRASP was calculated using the following formula: average apical LS/(average basal LS + average mid-ventricle LS); qRASP ≥ 1 was defined as positive. Patients were followed up to determine outcomes, which included sudden cardiac death or unexpected admission due to heart failure, over a median of 1.9 years. Results sRASP and qRASP were assessed in all patients, but 24 and 42 patients fulfilled the criteria for sRASP and qRASP, respectively. Both assessments were significantly associated with outcomes (n = 44; 28%). Furthermore, sRASP was significantly associated with outcome after adjusting for EuroSCORE, NYHA ≥ II, or global longitudinal strain. A model based on these covariates for predicting outcomes significantly improved by adding sRASP. Conclusion RASP is observed in some patients with severe AS and provides additive prognostic information over conventional parameters.
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Affiliation(s)
- Makoto Saito
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Misaki Imai
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Daisuke Wake
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Rieko Higaki
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | - Yasuhisa Nakao
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan.,Department of Cardiology, Ehime University Graduate School of Medicine, Toon, Japan
| | - Hiroe Morioka
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
| | | | - Katsuji Inoue
- Department of Cardiology, Ehime University Graduate School of Medicine, Toon, Japan
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24
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Pandey S, Siddiqi OK. Tc-99m pyrophosphate imaging for transthyretin cardiac amyloidosis: Importance of estimation of cancer risk with the modality. J Nucl Cardiol 2020; 27:225-227. [PMID: 30054791 DOI: 10.1007/s12350-018-1362-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Shivda Pandey
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 88 East Newton Street, Boston, MA, USA.
| | - Omar K Siddiqi
- Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Boston Medical Center, 88 East Newton Street, Boston, MA, USA
- Amyloidosis Center, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
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25
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Sato T, Aizawa Y, Yuasa S, Taya Y, Fujita S, Ikeda Y, Kitazawa H, Takahashi M, Okabe M. The Determinants and Outcomes of Myocardial Injury After Transcatheter Aortic-Valve Implantation: SAPIEN 3 Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:973-979. [PMID: 31924486 DOI: 10.1016/j.carrev.2019.12.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/29/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The effect of myocardial injury (MI) post-transcatheter aortic valve implantation (TAVI) on clinical outcomes is controversial. This study aimed to evaluate the effect of MI severity on clinical outcome and left ventricle function 30 days post-TAVI and determine MI post-TAVI predictors. METHODS Overall, 138 consecutive patients who underwent successful transfemoral TAVI using SAPIEN3 and diagnosed using echocardiography and computed tomography were analyzed. High-sensitivity cardiac troponin T (TnT) was evaluated at baseline, immediately, and at 24, 48, and 72 h post-TAVI. Echocardiography findings and N-terminal pro-B-type natriuretic peptide (Nt-pro BNP) levels were evaluated 30 days post-TAVI. RESULTS Mean age and STS score were 84.4 ± 3.5 years and 6.4 ± 3.2%, respectively. All cases showed severe aortic valve stenosis. Peri-procedural MI was observed in 48 of 100 patients (48.0%). Patients were grouped into MI (n = 48) and non-MI (n = 52), without significant difference in characteristics. Pre-balloon aortic valvuloplasty rate and total pacing time were significantly higher in MI vs non-MI. Total rapid pacing time (TRPT) was an independent predictor for MI (OR 1.06; 95% CI 1.01-1.16; p = 0.04). Echocardiography and Nt-pro BNP changes 30 days post-TAVI were similar between groups. CONCLUSION Peri-procedural MI, assessed by TnT changes, was observed in 48% of patients. The MI was not associated with overt cardiac dysfunction, and the recovery of left ventricular function and Nt-pro BNP level occurred similarly by 30 day post-TAVI between both groups. In multivariate analysis, TRPT was associated with MI after SAPIEN3 implantation. TRIAL REGISTRATION NUMBER UMIN000036669.
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Affiliation(s)
- Takao Sato
- Tachikawa General Hospital, Cardiology, Nagaoka, Japan.
| | | | - Sho Yuasa
- Tachikawa General Hospital, Cardiology, Nagaoka, Japan
| | - Yuji Taya
- Tachikawa General Hospital, Cardiology, Nagaoka, Japan
| | | | - Yoshio Ikeda
- Tachikawa General Hospital, Cardiology, Nagaoka, Japan
| | | | | | - Masaaki Okabe
- Tachikawa General Hospital, Cardiology, Nagaoka, Japan
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Balciunaite G, Rimkus A, Zurauskas E, Zaremba T, Palionis D, Valeviciene N, Aidietis A, Serpytis P, Rucinskas K, Sogaard P, Glaveckaite S, Zorinas A, Janusauskas V. Transthyretin cardiac amyloidosis in aortic stenosis: Prevalence, diagnostic challenges, and clinical implications. Hellenic J Cardiol 2019; 61:92-98. [PMID: 31740363 DOI: 10.1016/j.hjc.2019.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/08/2019] [Accepted: 10/16/2019] [Indexed: 12/29/2022] Open
Abstract
Transthyretin cardiac amyloidosis (ATTR-CA) is a challenging and underdiagnosed cause of heart failure. Advances in cardiac imaging have enabled noninvasive diagnosis of ATTR-CA, causing the recent upsurge in disease awareness and detection. ATTR-CA has been increasingly recognized in patients with degenerative aortic stenosis (AS). With the growing number of elderly patients undergoing aortic valve intervention, the identification of ATTR-CA in this group of patients is of high clinical importance. Timely and correct diagnosis is essential for amyloid-directed therapies, as well as deciding on the AS treatment strategy. This review provides a comprehensive overview of the recent studies investigating coexistence of these two entities. We present the data on the prevalence of ATTR-CA in AS and their prognostic associations. As the diagnosis of ATTR-CA may be challenging, special attention is paid to the diagnostic utility of different imaging modalities, namely, echocardiography, cardiovascular magnetic resonance, nuclear imaging, and distinctive imaging features, in patients with dual pathology. We also present a flowchart summarizing integrated imaging in patients with suspected ATTR-CA.
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Affiliation(s)
- Giedre Balciunaite
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania.
| | - Arnas Rimkus
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Edvardas Zurauskas
- National Center of Pathology, Vilnius University Hospital Santaros Klinikos, P. Baublio str. 5, 08406, Vilnius, Lithuania
| | - Tomas Zaremba
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania; Aalborg University Hospital, Clinical Institute of Aalborg University, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Darius Palionis
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Nomeda Valeviciene
- Department of Radiology, Nuclear Medicine and Medical Physics, Institute of Biomedical Sciences, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Audrius Aidietis
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Pranas Serpytis
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Kestutis Rucinskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Peter Sogaard
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania; Aalborg University Hospital, Clinical Institute of Aalborg University, Hobrovej 18-22, 9100, Aalborg, Denmark
| | - Sigita Glaveckaite
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Aleksejus Zorinas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania
| | - Vilius Janusauskas
- Clinic of Cardiovascular Diseases, Institute of Clinical Medicine, Vilnius University Faculty of Medicine, Santariskiu st. 2, 08661, Vilnius, Lithuania
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27
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Ternacle J, Krapf L, Mohty D, Magne J, Nguyen A, Galat A, Gallet R, Teiger E, Côté N, Clavel MA, Tournoux F, Pibarot P, Damy T. Aortic Stenosis and Cardiac Amyloidosis. J Am Coll Cardiol 2019; 74:2638-2651. [DOI: 10.1016/j.jacc.2019.09.056] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 01/03/2023]
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Rosenblum H, Narotsky DL, Hamid N, Hahn RT, Kodali S, Nazif T, Khalique OK, Bokhari S, Maurer MS, Castaño A. Beyond the Valve and into the Muscle: A Review of Coexisting Aortic Stenosis and Transthyretin Cardiac Amyloidosis. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2019.1678794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Hannah Rosenblum
- Center for Cardiac Amyloidosis, Columbia University College of Physicians & Surgeons, Division of Cardiology, New York, New York, USA
| | - David L. Narotsky
- Center for Cardiac Amyloidosis, Columbia University College of Physicians & Surgeons, Division of Cardiology, New York, New York, USA
| | - Nadira Hamid
- Center for Interventional Vascular Therapy, Columbia University College of Physicians & Surgeons, Division of Cardiology, New York, New York, USA
| | - Rebecca T. Hahn
- Center for Interventional Vascular Therapy, Columbia University College of Physicians & Surgeons, Division of Cardiology, New York, New York, USA
| | - Susheel Kodali
- Center for Interventional Vascular Therapy, Columbia University College of Physicians & Surgeons, Division of Cardiology, New York, New York, USA
| | - Tamim Nazif
- Center for Interventional Vascular Therapy, Columbia University College of Physicians & Surgeons, Division of Cardiology, New York, New York, USA
| | - Omar K. Khalique
- Center for Interventional Vascular Therapy, Columbia University College of Physicians & Surgeons, Division of Cardiology, New York, New York, USA
| | - Sabahat Bokhari
- Laboratory of Nuclear Cardiology, Columbia University College of Physicians & Surgeons, Division of Cardiology, New York, New York, USA
| | - Mathew S. Maurer
- Center for Cardiac Amyloidosis, Columbia University College of Physicians & Surgeons, Division of Cardiology, New York, New York, USA
| | - Adam Castaño
- Center for Cardiac Amyloidosis, Columbia University College of Physicians & Surgeons, Division of Cardiology, New York, New York, USA
- Laboratory of Nuclear Cardiology, Columbia University College of Physicians & Surgeons, Division of Cardiology, New York, New York, USA
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29
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Nietlispach F, Bertel O. Surgical Bailout After TAVR: Rarely Needed-But Successful in Every Second Patient. JACC Cardiovasc Interv 2019; 12:1765-1767. [PMID: 31537277 DOI: 10.1016/j.jcin.2019.05.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 05/14/2019] [Accepted: 05/21/2019] [Indexed: 11/19/2022]
Affiliation(s)
| | - Osmund Bertel
- HerzGefaessZentrum, Hirslanden Klinik im Park, Zurich, Switzerland
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30
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Oestreich B, Gurevich S, Adabag S, Kelly R, Helmer G, Raveendran G, Yannopoulos D, Biring T, Garcia S. Exposure to glucocorticoids prior to transcatheter aortic valve replacement is associated with reduced incidence of high-degree AV block and pacemaker. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:328-331. [DOI: 10.1016/j.carrev.2018.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 12/20/2022]
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31
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Nara Y, Watanabe Y, Kataoka A, Nakashima M, Hioki H, Nagura F, Kawashima H, Konno K, Kyono H, Yokoyama N, Kozuma K. Incidence, Predictors, and Midterm Clinical Outcomes of Myocardial Injury After Transcatheter Aortic-Valve Implantation. Int Heart J 2018; 59:1296-1302. [DOI: 10.1536/ihj.17-645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yugo Nara
- Department of Medicine, Teikyo University School of Medicine
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine
| | - Akihisa Kataoka
- Department of Medicine, Teikyo University School of Medicine
| | | | - Hirofumi Hioki
- Department of Medicine, Teikyo University School of Medicine
| | - Fukuko Nagura
- Department of Medicine, Teikyo University School of Medicine
| | | | - Kumiko Konno
- Department of Medicine, Teikyo University School of Medicine
| | - Hiroyuki Kyono
- Department of Medicine, Teikyo University School of Medicine
| | | | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine
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32
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Çiçek S. Cardiac amyloidosis and aortic stenosis: Great masquerader back again! J Thorac Cardiovasc Surg 2018; 156:104-105. [DOI: 10.1016/j.jtcvs.2018.01.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 01/31/2018] [Indexed: 11/25/2022]
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33
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Lehner A, Kantzis M, Haas NA. Edwards Sapien XT® pulmonic valve compression after resuscitation and successful redilatation. Catheter Cardiovasc Interv 2018; 92:522-525. [DOI: 10.1002/ccd.27644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/25/2018] [Accepted: 04/02/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Anja Lehner
- Department for Pediatric Cardiology and Pediatric Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
| | - Marinos Kantzis
- Department for Pediatric Cardiology; Center for Congenital Heart Defects Heart and Diabetes Center NRW, Ruhr University Bochum; Bad Oeynhausen Germany
| | - Nikolaus A. Haas
- Department for Pediatric Cardiology and Pediatric Intensive Care; LMU - Campus Großhadern, Ludwig Maximilians University; Munich Germany
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Cavalcante JL, Rijal S, Abdelkarim I, Althouse AD, Sharbaugh MS, Fridman Y, Soman P, Forman DE, Schindler JT, Gleason TG, Lee JS, Schelbert EB. Cardiac amyloidosis is prevalent in older patients with aortic stenosis and carries worse prognosis. J Cardiovasc Magn Reson 2017; 19:98. [PMID: 29212513 PMCID: PMC5719789 DOI: 10.1186/s12968-017-0415-x] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/23/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Non-invasive cardiac imaging allows detection of cardiac amyloidosis (CA) in patients with aortic stenosis (AS). Our objective was to estimate the prevalence of clinically suspected CA in patients with moderate and severe AS referred for cardiovascular magnetic resonance (CMR) in age and gender categories, and assess associations between AS-CA and all-cause mortality. METHODS We retrospectively identified consecutive AS patients defined by echocardiography referred for further CMR assessment of valvular, myocardial, and aortic disease. CMR identified CA based on typical late-gadolinium enhancement (LGE) patterns, and ancillary clinical evaluation identified suspected CA. Survival analysis with the Log rank test and Cox regression compared associations between CA and mortality. RESULTS There were 113 patients (median age 74 years, Q1-Q3: 62-82 years), 96 (85%) with severe AS. Suspected CA was present in 9 patients (8%) all > 80 years. Among those over the median age of 74 years, the prevalence of CA was 9/57 (16%), and excluding women, the prevalence was 8/25 (32%). Low-flow, low-gradient physiology was very common in CA (7/9 patients or 78%). Over a median follow-up of 18 months, 40 deaths (35%) occurred. Mortality in AS + CA patients was higher than AS alone (56% vs. 20% at 1-year, log rank 15.0, P < 0.0001). Adjusting for aortic valve replacement modeled as a time-dependent covariate, Society of Thoracic Surgery predicted risk of mortality, left ventricular ejection fraction, CA remained associated with all-cause mortality (HR = 2.92, 95% CI = 1.09-7.86, P = 0.03). CONCLUSIONS Suspected CA appears prevalent among older male patients with AS, especially with low flow, low gradient AS, and associates with all-cause mortality. The importance of screening for CA in older AS patients and optimal treatment strategies in those with CA warrant further investigation, especially in the era of transcatheter aortic valve implantation.
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Affiliation(s)
- João L. Cavalcante
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
- UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Shasank Rijal
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
| | - Islam Abdelkarim
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
| | - Andrew D. Althouse
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
| | - Michael S. Sharbaugh
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
| | - Yaron Fridman
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
- UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
| | - Prem Soman
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
| | - Daniel E. Forman
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
| | - John T. Schindler
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
| | - Thomas G. Gleason
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
| | - Joon S. Lee
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
| | - Erik B. Schelbert
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 200 Lothrop Street, Scaife Hall S-558, Pittsburgh, PA 15213 USA
- UPMC Cardiovascular Magnetic Resonance Center, Heart and Vascular Institute, Pittsburgh, Pennsylvania, USA
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35
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Abstract
Aortic stenosis (AS) is the most common primary valve disorder in the elderly with an increasing prevalence. It is increasingly clear that it is also a disease of the left ventricle (LV) rather than purely the aortic valve. The transition from left ventricular hypertrophy to fibrosis results in the eventual adverse effects on systolic and diastolic function. Appropriate selection of patients for aortic valve intervention is crucial, and current guidelines recommend aortic valve replacement in severe AS with symptoms or in asymptomatic patients with left ventricular ejection fraction (LVEF) <50 %. LVEF is not a sensitive marker and there are other parameters used in multimodality imaging techniques, including longitudinal strain, exercise stress echo and cardiac MRI that may assist in detecting subclinical and subtle LV dysfunction. These findings offer potentially better ways to evaluate patients, time surgery, predict recovery and potentially offer targets for specific therapies. This article outlines the pathophysiology behind the LV response to aortic stenosis and the role of advanced multimodality imaging in describing it.
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Demir OM, Ruparelia N, Frame A, Sen S, Mikhail GW, Fertleman M, Malik IS. Management of failing bioprosthesis in elderly patients who have undergone transcatheter aortic valve replacement. Expert Rev Med Devices 2017; 14:763-771. [DOI: 10.1080/17434440.2017.1376651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ozan M. Demir
- Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London, UK
| | - Neil Ruparelia
- Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London, UK
| | - Angela Frame
- Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London, UK
| | - Sayan Sen
- Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London, UK
| | - Ghada W. Mikhail
- Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London, UK
| | - Michael Fertleman
- Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London, UK
| | - Iqbal S. Malik
- Department of Cardiology, Hammersmith Hospital, Imperial NHS Healthcare Trust, London, UK
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Yahagi K, Torii S, Ladich E, Kutys R, Romero ME, Mori H, Kolodgie FD, Popma JJ, Virmani R, Finn AV. Pathology of self-expanding transcatheter aortic valves: Findings from the CoreValve US pivotal trials. Catheter Cardiovasc Interv 2017; 91:947-955. [PMID: 28895294 DOI: 10.1002/ccd.27314] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 07/17/2017] [Accepted: 08/05/2017] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) has recently become an alternative to surgical aortic valve replacement for patients with severe aortic stenosis. However, paravalvular leaks, possible leaflet thrombosis, and device durability following TAVR remain unresolved issues. METHODS AND RESULTS We conducted the first systematic microscopic and macroscopic pathologic analysis of self-expanding CoreValve transcatheter aortic valves removed at autopsy or surgically from the U.S. pivotal trial of extreme- and high-risk patients. Implants were evaluated for histopathologic changes in the valve frame and leaflets. Thrombus/neointima on the leaflets was graded depending on the leaflet thickness and the extent of leaflet involvement. Inflammation, calcification, and structural integrity were also assessed. A total of 21 cases (median age 86.0 years [IQR, 79.0-91.0]), with median duration of implant duration of 17.0 days ranged from 0 to 503 days were evaluated. No valve frame fracture was observed and severe paravalvular gaps were uncommon. Inflammation and thrombus in the valve frame was minimal, but neointimal growth increased overtime. Symptomatic valve thrombosis was observed in one case (5%) and subclinical moderate leaflet thrombus was observed in four additional cases (19%). Inflammation of the leaflets was mild, while structural changes were minimal, and one case had infective endocarditis. Pannus or leaflet calcification were not observed. CONCLUSIONS This first systematic macroscopic and microscopic pathologic analysis of self-expanding transcatheter aortic valves demonstrates favorable short-term pathologic findings. However, our finding of subclinical leaflet thrombus formation confirms prior observations and warrants further investigation.
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Affiliation(s)
| | - Sho Torii
- CVPath Institute, Inc, Gaithersburg, Maryland
| | | | | | | | | | | | - Jeffrey J Popma
- Division of Cardiology, Beth Israel Deaconess Medical Center, Harvard University, Boston, Massachusetts
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Treibel TA, Fontana M, Gilbertson JA, Castelletti S, White SK, Scully PR, Roberts N, Hutt DF, Rowczenio DM, Whelan CJ, Ashworth MA, Gillmore JD, Hawkins PN, Moon JC. Occult Transthyretin Cardiac Amyloid in Severe Calcific Aortic Stenosis: Prevalence and Prognosis in Patients Undergoing Surgical Aortic Valve Replacement. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005066. [PMID: 27511979 DOI: 10.1161/circimaging.116.005066] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/23/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Calcific aortic stenosis (cAS) affects 3% of individuals aged >75 years, leading to heart failure and death unless the valve is replaced. Wild-type transthyretin cardiac amyloid is also a disorder of ageing individuals. Prevalence and clinical significance of dual pathology are unknown. This study explored the prevalence of wild-type transthyretin amyloid in cAS by myocardial biopsy, its imaging phenotype and prognostic significance. METHODS AND RESULTS A total of 146 patients with severe AS requiring surgical valve replacement underwent cardiovascular magnetic resonance and intraoperative biopsies; 112 had cAS (75±6 years; 57% men). Amyloid was sought histologically using Congo red staining and then typed using immunohistochemistry and mass spectrometry; patients with amyloid underwent clinical evaluation including genotyping and (99m)TC-3,3-diphosphono-1,2-propanodicarboxylic-acid (DPD) bone scintigraphy. Amyloid was identified in 6 of 146 patients, all with cAS and >65 years (prevalence 5.6% in cAS >65). All 6 patients had wild-type transthyretin amyloid (mean age 75 years; range, 69-85; 4 men), not suspected on echocardiography. Cardiovascular magnetic resonance findings were of definite cardiac amyloidosis in 2, but could be explained solely by AS in the other 4. Postoperative DPD scans demonstrated cardiac localization in all 4 patients who had this investigation (2 died prior). At follow-up (median, 2.3 years), 50% with amyloid had died (versus 7.5% in cAS; 6.9% in age >65 years). In univariable analyses, the presence of transthyretin amyloidosis amyloid had the highest hazard ratio for death (9.5 [95% confidence interval, 2.5-35.8]; P=0.001). CONCLUSIONS Occult wild-type transthyretin cardiac amyloid had a prevalence of 6% among patients with AS aged >65 years undergoing surgical aortic valve replacement and was associated with a poor outcome.
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Affiliation(s)
- Thomas A Treibel
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.).
| | - Marianna Fontana
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - Janet A Gilbertson
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - Silvia Castelletti
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - Steven K White
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - Paul R Scully
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - Neil Roberts
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - David F Hutt
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - Dorota M Rowczenio
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - Carol J Whelan
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - Michael A Ashworth
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - Julian D Gillmore
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - Philip N Hawkins
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
| | - James C Moon
- From the Cardiovascular Magnetic Resonance Imaging Unit, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom (T.A.T., M.F., S.C., S.K.W., P.R.S., N.R., J.C.M.); Institute of Cardiovascular Science (T.A.T., M.F., S.K.W., J.C.M.) and National Amyloidosis Centre, Royal Free Campus (M.F., J.A.G., D.F.H., D.M.R., C.W., J.D.G., P.N.H.), University College London, United Kingdom; and Histopathology Department, Great Ormond Street Hospital for Children, London, United Kingdom (M.A.A.)
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Salinger T, Hu K, Liu D, Herrmann S, Lorenz K, Ertl G, Nordbeck P. Cardiac amyloidosis mimicking severe aortic valve stenosis - a case report demonstrating diagnostic pitfalls and role of dobutamine stress echocardiography. BMC Cardiovasc Disord 2017; 17:86. [PMID: 28330445 PMCID: PMC5361717 DOI: 10.1186/s12872-017-0519-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 03/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Aortic valve stenosis is a common finding diagnosed with high sensitivity in transthoracic echocardiography, but the examiner often finds himself confronted with uncertain results in patients with moderate pressure gradients and concomitant systolic heart failure. While patients with true-severe low-gradient aortic valve stenosis with either reduced or preserved left ventricular systolic function are primarily candidates for valve replacement, there is a relevant proportion of patients with pseudo-severe aortic valve stenosis anticipated not to benefit but actually rather deteriorate by interventional therapy or surgery. Case presentation In this article we present a case report of a male patient with pseudo-severe aortic valve stenosis due to cardiac amyloidosis highlighting the diagnostic schedule. The patient underwent stress echocardiography because of discrepant findings in transthoracic echocardiography and cardiac catheterization regarding the severity of aortic valve stenosis. After evaluation of the results, it became clear that he had a need for optimum heart failure medication and implantation of a cardiac resynchronization therapy defibrillator. Conclusion Due to the pitfalls in conventional as well as invasive diagnostics at rest, Stress echocardiography should be considered part of the standard optimum diagnostic spectrum in all unclear or borderline cases in order to confirm the correct diagnosis and constitute optimal therapy.
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Affiliation(s)
- Tim Salinger
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Kai Hu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Dan Liu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Sebastian Herrmann
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Kristina Lorenz
- Leibniz-Institut für Analytische Wissenschaften - ISAS, University Duisburg-Essen, Dortmund, Germany
| | - Georg Ertl
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany. .,Comprehensive Heart Failure Center (CHFC), University of Würzburg, Würzburg, Germany. .,Medizinische Klinik und Poliklinik I - Kardiologie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
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40
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Autopsy after transcatheter aortic valve implantation. Virchows Arch 2017; 470:331-339. [PMID: 28130699 PMCID: PMC5340836 DOI: 10.1007/s00428-017-2076-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/03/2017] [Accepted: 01/18/2017] [Indexed: 10/25/2022]
Abstract
Autopsy after transcatheter aortic valve implantation (TAVI) is a new field of interest in cardiovascular pathology. To identify the cause of death, it is important to be familiar with specific findings related to the time interval between the procedure and death. We aimed to provide an overview of the autopsy findings in patients with TAVI in their medical history divided by the timing of death with specific interest in the added value of autopsy over a solely clinically determined cause of death. In 8 European centres, 72 cases with autopsy reports were available. Autopsies were divided according to the time interval of death and reports were analysed. In 32 patients who died ≤72 h postprocedure, mortality resulted from cardiogenic or haemorrhagic shock in 62.5 and 34.4%, respectively. In 31 patients with mortality >72 h to ≤30 days, cardiogenic shock was the cause of death in 51.6% followed by sepsis (22.6%) and respiratory failure (9.7%). Of the nine patients with death >30 days, 88.9% died of sepsis, caused by infective endocarditis in half of them. At total of 12 patients revealed cerebrovascular complications. Autopsy revealed unexpected findings in 61.1% and resulted in a partly or completely different cause of death as was clinically determined. Autopsy on patients who underwent TAVI reveals specific patterns of cardiovascular pathology that clearly relate to the time interval between TAVI and death and significantly adds to the clinical diagnosis. Our data support the role of autopsy including investigation of the cerebrum in the quickly evolving era of cardiac device technology.
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Havakuk O, Konigstein M, Ben Assa E, Arbel Y, Abramowitz Y, Halkin A, Bazan S, Shmilovich H, Keren G, Finkelstein A, Banai S. Steroid therapy and conduction disturbances after transcatheter aortic valve implantation. Cardiovasc Ther 2016; 34:325-9. [DOI: 10.1111/1755-5922.12202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Ofer Havakuk
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Maayan Konigstein
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Eyal Ben Assa
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Yaron Arbel
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Yigal Abramowitz
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Amir Halkin
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Samuel Bazan
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Haim Shmilovich
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Gad Keren
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Ariel Finkelstein
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
| | - Shmuel Banai
- Interventional Cardiology; Tel-Aviv Medical Center; Tel-Aviv Israel
- The Sackler Faculty of Medicine; Tel-Aviv University; Tel Aviv Israel
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The Authors Reply:. JACC Cardiovasc Imaging 2016; 9:906. [DOI: 10.1016/j.jcmg.2015.11.019] [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: 11/08/2015] [Accepted: 11/11/2015] [Indexed: 11/23/2022]
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Calero Núñez S, Tercero Martínez A, García López JC, Jiménez-Mazuecos J. [Wild-type transthyretin-related cardiac amyloidosis and degenerative aortic stenosis: Two inter-related pathologies in the elderly]. Rev Esp Geriatr Gerontol 2016; 52:167-170. [PMID: 27292540 DOI: 10.1016/j.regg.2016.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/26/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
Wild-type transthyretin-related cardiac amyloidosis (ATTRwt) and degenerative aortic stenosis share a common demographic and clinical profile. It was recently suggested that some of the complications arising during and after transcatheter aortic valve replacement (TAVR) could be due to a co-existing cardiac amyloidosis. In a series of autopsies of patients who had undergone TAVR, researchers found ATTR amyloidosis in one third of the cases. A report is presented on two patients with aortic stenosis who were diagnosed with ATTRwt when they were about to undergo a TAVI. ATTRwt is a slowly progressing disease so we need to review the decisions on the therapeutic approach in these patients.
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Affiliation(s)
- Sofía Calero Núñez
- Servicio de Cardiología, Hospital General Universitario de Albacete, Albacete, España.
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Figulla HR, Webb JG, Lauten A, Feldman T. The transcatheter valve technology pipeline for treatment of adult valvular heart disease. Eur Heart J 2016; 37:2226-39. [PMID: 27161617 DOI: 10.1093/eurheartj/ehw153] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 03/17/2016] [Indexed: 12/17/2022] Open
Abstract
The transcatheter valve technology pipeline has started as simple balloon valvuloplasty for the treatment of stenotic heart valves and evolved since the year 2000 to either repair or replace heart valves percutaneously with multiple devices. In this review, the present technology and its application are illuminated and a glimpse into the near future is dared from a physician's perspective.
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Affiliation(s)
- Hans R Figulla
- Universitätsklinikum Jena, Friedrich Schiller Universität Jena, Jena, Germany
| | - John G Webb
- St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Alexander Lauten
- Charité-Universitaetsmedizin Berlin, Department of Cardiology Berlin, Campus Benjamin Franklin, Germany
| | - Ted Feldman
- Cardiology Division, NorthShore University HealthSystem Evanston, Evanston, USA
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Galat A, Guellich A, Bodez D, Slama M, Dijos M, Zeitoun DM, Milleron O, Attias D, Dubois-Randé JL, Mohty D, Audureau E, Teiger E, Rosso J, Monin JL, Damy T. Aortic stenosis and transthyretin cardiac amyloidosis: the chicken or the egg? Eur Heart J 2016; 37:3525-3531. [DOI: 10.1093/eurheartj/ehw033] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 11/18/2015] [Accepted: 01/21/2016] [Indexed: 12/21/2022] Open
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Kim WK, Liebetrau C, van Linden A, Blumenstein J, Gaede L, Hamm CW, Walther T, Möllmann H. Myocardial injury associated with transcatheter aortic valve implantation (TAVI). Clin Res Cardiol 2015; 105:379-87. [PMID: 26670909 DOI: 10.1007/s00392-015-0949-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 12/02/2015] [Indexed: 10/22/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) has emerged as an important treatment option for elderly patients with symptomatic aortic stenosis whose risk is too high or prohibitive for conventional surgery. Despite notable progress during the past decade, continuous efforts directed at further improvement of procedural safety and performance are required, especially considering expanding indications for interventional treatment options among lower-risk populations. One issue that needs to be addressed is myocardial damage, which can frequently be observed after TAVI and has been linked to worse prognosis. Yet, knowledge concerning the underlying mechanisms and clinical impact remains scarce, and further investigation in this field is warranted. In this review, we provide a contemporary summary of the types of myocardial injury associated with TAVI, including access-related injury, mechanical trauma and ischemia, the role of myocardial biomarkers, and the impact on left ventricular function, with emphasis on potential mechanisms and clinical implications.
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Affiliation(s)
- Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany.,Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Arnaud van Linden
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Johannes Blumenstein
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Luise Gaede
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany.,Department of Cardiology, University of Giessen, Giessen, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany
| | - Helge Möllmann
- Department of Cardiology, Kerckhoff Heart and Thorax Center, 61231, Bad Nauheim, Germany.
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Coexistence of Degenerative Aortic Stenosis and Wild-Type Transthyretin-Related Cardiac Amyloidosis. JACC Cardiovasc Imaging 2015; 9:325-7. [PMID: 26189123 DOI: 10.1016/j.jcmg.2015.04.012] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 11/24/2022]
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Magne J, Mohty D. Paradoxical low-flow, low-gradient severe aortic stenosis: a distinct disease entity. Heart 2015; 101:993-5. [DOI: 10.1136/heartjnl-2014-307324] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Reply: could late enhancement and need for permanent pacemaker implantation in patients undergoing TAVR be explained by undiagnosed transthyretin cardiac amyloidosis? J Am Coll Cardiol 2015; 65:313. [PMID: 25614435 DOI: 10.1016/j.jacc.2014.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/21/2014] [Indexed: 11/22/2022]
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