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Hioki H, Yamamoto M, Watanabe Y, Ohno Y, Yashima F, Naganuma T, Tada N, Shirai S, Yamanaka F, Mizutani K, Noguchi M, Izumo M, Takagi K, Asami M, Ueno H, Nishina H, Otsuka T, Hayashida K. Size of Self-Expandable Transcatheter Heart Valve and Mid-Term Adverse Events After Transcatheter Aortic Valve Replacement. Am J Cardiol 2024; 223:156-164. [PMID: 38797196 DOI: 10.1016/j.amjcard.2024.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/19/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024]
Abstract
The hemodynamic performance of self-expandable valves (SEVs) is a preferable choice for small aortic annuli in transcatheter aortic valve replacement (TAVR). However, no data are, so far, available regarding the relation between the size of SEVs and clinical outcomes. This study aimed to evaluate the impact of prosthesis size on adverse events after TAVR using SEVs. We retrospectively analyzed 1,400 patients (23-mm SEV: 13.6%) who underwent TAVR using SEVs at 12 centers. The impact of SEV size on all-cause death and heart failure (HF) after TAVR was evaluated by multivariate Cox regression and propensity score (PS) matching analysis. During the follow-up period (median 511 days), 201 all-cause deaths and 87 HF rehospitalizations were observed. The incidence of all-cause death was comparable between small- (23-mm SEV) and larger-sized (26- or 29-mm SEV) (16.8% vs 13.9%, log-rank p = 0.29). The size of SEV was not associated with a higher incidence of all-cause death (hazard ratio [HR] 1.21, 95% confidence interval [CI] 0.79 to 1.86 in Cox regression; HR 1.31, 95% CI 0.77 to 2.23 in PS matching) and HF after TAVR (subdistribution HR 0.79, 95% CI 0.37 to 1.72 in Cox regression; subdistribution HR 1.00, 95% CI 0.44 to 2.30 in PS matching). The multivariate model including postprocedural prosthesis-patient mismatch showed consistent results. In conclusion, small SEVs had comparable midterm clinical outcomes to larger-sized SEVs, even if the prosthesis-patient mismatch was observed after TAVR.
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Affiliation(s)
- Hirofumi Hioki
- Department of Cardiology, IMS Tokyo Katsushika General Hospital, Tokyo, Japan.
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan; Department of Cardiology, Nagoya Heart Center, Nagoya, Japan; Department of Cardiology, Gifu Heart Center, Gifu, Japan
| | - Yusuke Watanabe
- Division of Cardiology, Teikyo University Hospital, Tokyo, Japan
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Masahiko Noguchi
- Department of Cardiology, Tokyo Bay Ichikawa Medical Center, Urayasu, Japan
| | - Masaki Izumo
- Department of Cardiology, St; Marianna University, Tokyo, Japan
| | - Kensuke Takagi
- Department of Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Hidetaka Nishina
- Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan; Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Kentaro Hayashida
- Division of Cardiology, Keio University School of Medicine, Tokyo, Japan
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2
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Sato T, Yufu K, Yamasaki H, Harada T, Yamauchi S, Ishii Y, Fukuda T, Kawashima T, Shuto T, Akioka H, Shinohara T, Teshima Y, Wada T, Miyamoto S, Takahashi N. Quality of epicardial adipose tissue predicts major adverse cerebral and cardiovascular events following transcatheter aortic valve implantation. Heart Vessels 2024; 39:646-653. [PMID: 38502318 DOI: 10.1007/s00380-024-02374-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/07/2024] [Indexed: 03/21/2024]
Abstract
Epicardial adipose tissue (EAT) have been shown to be associated with several heart disease, including coronary artery disease (CAD), atrial fibrillation (AF), and heart failure (HF). It is reported that the quality of EAT, represented by fat attenuation determined using computed tomography (CT) imaging, can detect the histologically-assessed remodeled EAT. We tested the hypothesis that quality of EAT would predict major adverse cerebral and cardiovascular events (MACCE) following transcatheter aortic valve implantation (TAVI) in patients with aortic stenosis (AS). A total of 125 consecutive severe AS patients who underwent TAVI were enrolled (39 male, mean 85.4 ± 4.0 years). Using CT imaging before TAVI, we measured the average CT fat attenuation of EAT (EAT attenuation) and investigated the association with MACCE. During the mean follow up period of 567 ± 371 days, 21 cases of MACCE were observed. Patients with MACCE had greater levels of EAT attenuation compared to those without (- 74 ± 3.7 Hounsfield Units (HU) vs - 77 ± 5.5 HU, p = 0.010). Based on the ROC curves, the high EAT attenuation was defined as > - 74.3 HU. According to this cut-off index, 44 patients were classified into the high EAT attenuation group (28 female, mean age 87 ± 3.6 years), whereas 81 patients were classified into the low EAT attenuation group (13 female, 85 ± 4.1 years). Kaplan-Meier survival curve demonstrated that the patients in the high EAT attenuation group showed greater prevalence of MACCE (log-rank 6.64, p = 0.010). Cox proportional hazards regression analysis revealed that EAT attenuation and Logistic EuroSCORE were independently associated with the incidence of MACCE. Our results suggest that quality of EAT, assessed by EAT attenuation detected by CT imaging, can predict the cerebral and cardiovascular events after TAVI in patients with AS.
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Affiliation(s)
- Takaaki Sato
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan.
| | - Hirochika Yamasaki
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Taisuke Harada
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Shuichiro Yamauchi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Yumi Ishii
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Tomoko Fukuda
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Takayuki Kawashima
- Department of Cardiovascular Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Takashi Shuto
- Department of Cardiovascular Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Yasushi Teshima
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Tomoyuki Wada
- Department of Cardiovascular Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Shinji Miyamoto
- Department of Cardiovascular Surgery, Faculty of Medicine, Oita University, Yufu, Oita, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
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López Martínez H, Vilalta V, Farjat-Pasos J, Ferrer-Sistach E, Mohammadi S, Escabia C, Kalavrouziotis D, Resta H, Borrellas A, Dumont E, Carrillo X, Paradis JM, Fernández-Nofrerías E, Delgado V, Rodés-Cabau J, Bayes-Genis A. Heart failure hospitalization following surgical or transcatheter aortic valve implantation in low-risk aortic stenosis. ESC Heart Fail 2024. [PMID: 38894578 DOI: 10.1002/ehf2.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 06/21/2024] Open
Abstract
AIMS In low-risk patients with severe aortic stenosis (AS), sutureless surgical aortic valve replacement (SU-SAVR) may be an alternative to transcatheter aortic valve implantation (TAVI). The risk of heart failure hospitalization (HFH) after aortic valve replacement (AVR) in this population is incompletely characterized. This study aims to investigate the incidence, predictors, and outcomes of HFH in patients undergoing SU-SAVR versus TAVI. METHODS AND RESULTS Patients referred for AVR between 2013 and 2020 at two centres were consecutively included. The decision for SU-SAVR or TAVI was determined by a multidisciplinary Heart Team. Cox regression and competing risk analysis were conducted to assess adverse events. Of 594 patients (mean age 77.5 ± 6.4, 59.8% male), 424 underwent SU-SAVR, while 170 underwent TAVI. Following a mean follow-up of 34.1 ± 23.1 months, HFH occurred in 112 (27.8%) SU-SAVR patients and in 8 (4.8%) TAVI patients (P < 0.001). The SU-SAVR cohort exhibited higher all-cause mortality (138 [32.5%] patients compared with 30 [17.6%] in the TAVI cohort [P < 0.001]). These differences remained significant after sensitivity analyses with 1:1 propensity score matching for baseline variables. SU-SAVR with HFH was associated with increased all-cause mortality (61.6% vs. 23.1%, P < 0.001). Independent associates of HFH in SU-SAVR patients included diabetes, atrial fibrillation, chronic obstructive pulmonary disease, lower glomerular filtration rate and lower left ventricular ejection fraction. SU-SAVR patients with HFH had a 12-month LVEF of 59.4 ± 12.7. CONCLUSIONS In low-risk AS, SU-SAVR is associated with a higher risk of HFH and all-cause mortality compared to TAVI. In patients with severe AS candidate to SU-SAVR or TAVI, TAVI may be the preferred intervention.
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Affiliation(s)
| | - Victoria Vilalta
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | - Claudia Escabia
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Helena Resta
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Andrea Borrellas
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Eric Dumont
- Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Xavier Carrillo
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Victoria Delgado
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Antoni Bayes-Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Bhat V, Kumar A, Kalra A. Angiotensin-Converting Enzyme Inhibitors or Angiotensin Receptor Blockers After Transcatheter Aortic Valve Replacement: A Meta-Analysis. JACC. ADVANCES 2024; 3:100927. [PMID: 38939627 PMCID: PMC11198320 DOI: 10.1016/j.jacadv.2024.100927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 06/29/2024]
Abstract
Background Persistent left ventricular hypertrophy after transcatheter aortic valve replacement (TAVR) has been associated with poor outcomes. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), due to their favorable effects on ventricular remodeling, have been hypothesized to improve outcomes post-TAVR, yet there are no recommendations regarding their use. Objectives This study aimed to compare the outcomes of patients receiving ACEIs/ARBs with those not receiving ACEIs/ARBs after TAVR. Methods We performed a literature search on PubMed and Cochrane Library until June 14, 2023, and included all studies comparing clinical outcomes between patients given ACEIs/ARBs and those not given ACEIs/ARBs after TAVR. All-cause mortality was the primary outcome. We used a random effects model with appropriate corrections to calculate relative risk (RR) and CIs, with all analyses carried out using R v4.0.3. Results We included ten studies on the use of ACEIs/ARBs post-TAVR. Patients on ACEIs/ARBs had lower risk of all-cause mortality (RR: 0.74, 95% CI: 0.65-0.86, I2 = 62%, chi-square P < 0.01), cardiovascular mortality (RR: 0.70, 95% CI: 0.56-0.88, I2 = 0%, chi-square P = 0.54), and new-onset atrial fibrillation (RR: 0.71, 95% CI: 0.52-0.96, I2 = 0%, chi-square P = 0.59). Patients on ACEIs/ARBs had a similar risk of myocardial infarction, heart failure, stroke, new permanent pacemaker implantation, acute kidney injury, major bleeding, vascular complications, aortic regurgitation, and mitral regurgitation. Conclusions We found that patients receiving ACEIs/ARBs had a lower risk of all-cause mortality, cardiovascular mortality, and new-onset atrial fibrillation. Risk of other outcomes was similar to patients not receiving ACEIs/ARBs. Randomized clinical trials are needed to explore the benefits of ACEIs/ARBs post-TAVR, so that definitive guidelines can be developed.
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Affiliation(s)
- Vivek Bhat
- Department of Internal Medicine, St. John’s Medical College, Bangalore, India
| | - Ashish Kumar
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Ankur Kalra
- Franciscan Health, Lafayette, Indiana, USA
- Krannert Cardiovascular Research Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Ishizu K, Shirai S, Isotani A, Hayashi M, Tabata H, Ohno N, Kakumoto S, Ando K, Yashima F, Tada N, Yamawaki M, Naganuma T, Yamanaka F, Ueno H, Tabata M, Mizutani K, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Long-term prognostic value of the H 2FPEF score in patients undergoing transcatheter aortic valve implantation. ESC Heart Fail 2024. [PMID: 38607328 DOI: 10.1002/ehf2.14773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/23/2023] [Accepted: 03/10/2024] [Indexed: 04/13/2024] Open
Abstract
AIMS A considerable proportion of candidates for transcatheter aortic valve implantation (TAVI) have underlying heart failure (HF) with preserved ejection fraction (HFpEF), which can be challenging for diagnosis because significant valvular heart disease should be excluded before diagnosing HFpEF. This study investigated the long-term prognostic value of the pre-procedural H2FPEF score in patients with preserved ejection fraction (EF) undergoing TAVI. METHODS AND RESULTS Patients who underwent TAVI between October 2013 and May 2017 were enrolled from the Optimized CathEter vAlvular iNtervention-Transcatheter Aortic Valve Implantation Japanese multicentre registry. After excluding 914 patients, 1674 patients with preserved EF ≥ 50% (median age: 85 years, 72% female) were selected for calculation of the H2FPEF score and were dichotomized into two groups: the low H2FPEF score [0-5 points; n = 1399 (83.6%)] group and the high H2FPEF score [6-9 points; n = 275 (16.4%)] group. Patients with high H2FPEF scores were associated with a higher prevalence of New York Heart Association Functional Class III/IV (59.3% vs. 43.7%, P < 0.001), diabetes (24.4% vs. 18.5%, P = 0.03), and paradoxical low-flow, low-gradient aortic stenosis (15.9% vs. 6.2%, P < 0.001). These patients showed worse prognoses than those with low H2FPEF scores regarding the cumulative 2 year all-cause mortality (26.3% vs. 15.5%, log-rank P < 0.001), cardiovascular mortality (10.5% vs. 5.4%, log-rank P < 0.001), HF hospitalization (16.2% vs. 6.7%, log-rank P < 0.001), and the composite endpoint of cardiovascular mortality and HF hospitalization (23.8% vs. 10.8%, log-rank P < 0.001). After adjustment for several confounders, the high H2FPEF scores were independently associated with increased risk for all-cause mortality [adjusted hazard ratio (HR), 1.48; 95% confidence interval (CI), 1.09-2.00; P = 0.011] and for the composite endpoint of cardiovascular mortality and HF hospitalization (adjusted HR, 1.95; 95% CI, 1.38-2.74; P < 0.001). Subgroup analysis confirmed the excess risk of high H2FPEF scores relative to low H2FPEF scores for the composite endpoint of cardiovascular mortality and HF hospitalization increased with a lower Society of Thoracic Surgeons (STS) score (STS score <8%: adjusted HR, 2.40; 95% CI, 1.50-3.85; P < 0.001; STS score ≥8%: adjusted HR, 1.34; 95% CI, 0.79-2.28; P = 0.28; Pinteraction = 0.030). CONCLUSIONS The H2FPEF score is useful for predicting long-term adverse outcomes after TAVI, including all-cause mortality, cardiovascular mortality, and HF hospitalization for patients with preserved EF. More aggressive interventions targeting HFpEF in addition to the TAVI procedure might be relevant in patients with high H2FPEF scores, particularly in those with a lower surgical risk.
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Affiliation(s)
- Kenichi Ishizu
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Akihiro Isotani
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Masaomi Hayashi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hiroyuki Tabata
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shinichi Kakumoto
- Department of Anesthesiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Futoshi Yamanaka
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Hiroshi Ueno
- Department of Cardiovascular Medicine, Toyama University Hospital, Toyama, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Kazuki Mizutani
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Toyohashi, Japan
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Takahashi M, Takaoka H, Yashima S, Suzuki-Eguchi N, Ota J, Kitahara H, Matsuura K, Matsumiya G, Kobayashi Y. Extracellular Volume Fraction by Computed Tomography Predicts Prognosis After Transcatheter Aortic Valve Replacement. Circ J 2024; 88:492-500. [PMID: 37558458 DOI: 10.1253/circj.cj-23-0288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Extracellular volume fraction (ECV) on magnetic resonance imaging can predict prognosis after aortic valve replacement in patients with aortic stenosis (AS). However, the usefulness of ECV on computed tomography (CT) for patients who have undergone transcatheter aortic valve replacement (TAVR) is unclear, so we investigated whether ECV analysis on CT is associated with clinical outcomes in TAVR candidates.Methods and Results: We analyzed 127 patients with severe AS who underwent preoperative CT for TAVR. We evaluated the utility of ECV analysis on single-energy CT for predicting patient prognosis after TAVR. The primary outcome was a composite of all-cause death and hospitalization due to heart failure (HF) after TAVR. 15 patients (12%) had composite outcomes: 4 deaths and 11 hospitalizations due to HF. In multivariate survival analysis using the Cox proportional hazard model, atrial fibrillation (AF) (hazard ratio (HR), 7.86; 95% confidence interval (CI), 2.57-24.03; P<0.001), history of congestive HF (HR, 4.91; 95% CI, 1.49-16.2; P=0.009) and ECV ≥32.6% on CT (HR, 6.96; 95% CI, 1.92-25.12; P=0.003) were independent predictors of composite outcomes. On Kaplan-Meier analysis, the higher ECV group (≥32.6%) had a significantly greater number of composite outcomes than the lower ECV group (P<0.001). CONCLUSIONS ECV on CT is an independent predictor of prognosis after TAVR.
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Affiliation(s)
- Manami Takahashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Satomi Yashima
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Noriko Suzuki-Eguchi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Joji Ota
- Department of Radiology, Chiba University Hospital
| | - Hideki Kitahara
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
| | - Kaoru Matsuura
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine
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Gilchrist IC, Kort S, Wang TY, Tannous H, Pyo R, Gracia E, Bilfinger T, Skopicki HA, Parikh PB. Impact of left ventricular ejection fraction and aortic valve gradient on mortality following transcatheter aortic valve intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00089-7. [PMID: 38490937 DOI: 10.1016/j.carrev.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/14/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Data regarding the impact of reduced left ventricular ejection fraction (LVEF) and/or reduced mean aortic valve gradient (AVG) on outcomes following transcatheter aortic valve intervention (TAVI) have been conflicting. We sought to assess the relationship between LVEF, AVG, and 1-year mortality in patients undergoing TAVI. METHODS We prospectively evaluated 298 consecutive adults undergoing TAVI from 2015 to 2018 at an academic tertiary medical center. Patients were categorized according to LVEF and mean AVG. The primary outcome of interest was all-cause mortality at 1 year. RESULTS Of 298 adults undergoing TAVI, 66 (22.1%) had baseline LVEF ≤45% while 232 (77.9%) had baseline LVEF >45%; 173 (58.1%) had baseline AVG < 40mmHg while 125 (41.9%) had baseline AVG ≥ 40mmHg. Rates of 1-year all-cause mortality were significantly higher in patients with LVEF ≤45% (28.8% vs 12.1%, p = 0.001) and those with AVG < 40mmHg (19.7% vs 10.4%, p = 0.031) compared to those with LVEF >45% and AVG ≥ 40mmHg respectively. In multivariable analysis, higher AVG (per mmHg) (OR 0.97, 95% CI 0.94-0.99, p = 0.026) was noted to be independently associated with lower rates of 1-year mortality, while LVEF was not (OR 0.98, 95% CI 0.96-1.01). CONCLUSIONS In this prospective, contemporary registry of adults undergoing TAVI, while 1-year unadjusted mortality rates are significantly higher in patients with reduced LVEF and reduced AVG, risk-adjusted mortality at 1 year is only higher in those with reduced AVG - not in those with reduced LVEF.
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Affiliation(s)
- Ian C Gilchrist
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Smadar Kort
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Ting-Yu Wang
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Henry Tannous
- Department of Surgery, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Robert Pyo
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Ely Gracia
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Thomas Bilfinger
- Department of Surgery, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Hal A Skopicki
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Puja B Parikh
- Department of Medicine, Renaissance School of Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA.
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8
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Parikh PB, Mack M, Stone GW, Anker SD, Gilchrist IC, Kalogeropoulos AP, Packer M, Skopicki HA, Butler J. Transcatheter aortic valve replacement in heart failure. Eur J Heart Fail 2024; 26:460-470. [PMID: 38297972 DOI: 10.1002/ejhf.3151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 01/06/2024] [Accepted: 01/17/2024] [Indexed: 02/02/2024] Open
Abstract
Patients with severe aortic stenosis (AS) may develop heart failure (HF), the presence of which has traditionally been deemed as a final stage in AS progression with poor outcomes. The use of transcatheter aortic valve replacement (TAVR) has become the preferred therapy for most patients with AS and concomitant HF. With its instant afterload reduction, TAVR offers patients with HF significant haemodynamic benefits, with corresponding changes in left ventricular structure and improved mortality and quality of life. The prognostic covariates and optimal timing of TAVR in patients with less than severe AS remain unclear. The purpose of this review is to describe the association between TAVR and outcomes in patients with HF, particularly in the setting of left ventricular systolic dysfunction, acute HF, and right ventricular systolic dysfunction, and to highlight areas for future research.
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Affiliation(s)
- Puja B Parikh
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | - Michael Mack
- Department of Cardiac Surgery, Baylor Scott & White Health, Plano, TX, USA
| | - Gregg W Stone
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Stefan D Anker
- Department of Cardiology (CVK) and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Charité-Universitätsmedizin, Berlin, Germany
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Ian C Gilchrist
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | | | - Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Hal A Skopicki
- Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY, USA
| | - Javed Butler
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
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9
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Zahid S, Agrawal A, Salman F, Khan MZ, Ullah W, Teebi A, Khan SU, Sulaiman S, Balla S. Development and Validation of a Machine Learning Risk-Prediction Model for 30-Day Readmission for Heart Failure Following Transcatheter Aortic Valve Replacement (TAVR-HF Score). Curr Probl Cardiol 2024; 49:102143. [PMID: 37863456 DOI: 10.1016/j.cpcardiol.2023.102143] [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: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/22/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is the treatment of choice for patients with severe aortic stenosis across the spectrum of surgical risk. About one-third of 30-day readmissions following TAVR are related to heart failure (HF). Hence, we aim to develop an easy-to-use clinical predictive model to identify patients at risk for HF readmission. We used data from the National Readmission Database (2015-2018) utilizing ICD-10 codes to identify TAVR procedures. Readmission was defined as the first unplanned HF readmission within 30-day of discharge. A machine learning framework was used to develop a 30-day TAVR-HF readmission score. The receiver operator characteristic curve was used to evaluate the predictive power of the model. A total of 92,363 cases of TAVR were included in the analysis. Of the included patients, 3299 (3.6%) were readmitted within 30 days of discharge with HF. Individuals who got readmitted, vs those without readmission, had more emergent admissions during index procedure (33.4% vs 19.8%), electrolyte abnormalities (38% vs 16.7%), chronic kidney disease (34.8% vs 21.2%), and atrial fibrillation (60.1% vs 40.7%). Candidate variables were ranked by importance using a parsimony plot. A total of 7 variables were selected based on predictive ability as well as clinical relevance: HF with reduced ejection fraction (25 points), HF preserved EF (20 points), electrolyte abnormalities (17 points), atrial fibrillation (12 points), Charlson comorbidity index (<6 = 0, 6-8 = 9, 9-10 = 13, >10 = 14 points), chronic kidney disease (7 points), and emergent index admission (5 points). On performance evaluation using the testing dataset, an area under the curve of 0.761 (95% CI 0.744-0.778) was achieved. Thirty-day TAVR-HF readmission score is an easy-to-use risk prediction tool. The score can be incorporated into electronic health record systems to identify at-risk individuals for readmissions with HF following TAVR. However, further external validation studies are needed.
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Affiliation(s)
- Salman Zahid
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH
| | - Fnu Salman
- Department of Cardiovascular Medicine, Mercy St. Vincent Hospital, Toledo, OH
| | - Muhammad Zia Khan
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, WV
| | - Waqas Ullah
- Department of Cardiovascular Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Ahmed Teebi
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, OR
| | - Safi U Khan
- Houston Methodist DeBakey Heart & Vascular Institute, Houston, TX
| | - Samian Sulaiman
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, WV
| | - Sudarshan Balla
- Department of Cardiovascular Medicine, West Virginia University, Morgantown, WV.
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10
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Scisciola L, Paolisso P, Belmonte M, Gallinoro E, Delrue L, Taktaz F, Fontanella RA, Degrieck I, Pesapane A, Casselman F, Puocci A, Franzese M, Van Praet F, Torella M, Marfella R, De Feo M, Bartunek J, Paolisso G, Barbato E, Barbieri M, Vanderheyden M. Myocardial sodium-glucose cotransporter 2 expression and cardiac remodelling in patients with severe aortic stenosis: The BIO-AS study. Eur J Heart Fail 2024; 26:471-482. [PMID: 38247224 DOI: 10.1002/ejhf.3145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
AIM Cardiac remodelling plays a major role in the prognosis of patients with aortic stenosis (AS) and could impact the benefits of aortic valve replacement. Our study aimed to evaluate the expression of sodium-glucose cotransporter 2 (SGLT2) gene and protein in patients with severe AS stratified in high gradient (HG) and low flow-low gradient (LF-LG) AS and its association with cardiac functional impairments. METHODS AND RESULTS Gene expression and protein levels of main biomarkers of cardiac fibrosis (galectin-3, sST2, serpin-4, procollagen type I amino-terminal peptide, procollagen type I carboxy-terminal propeptide, collagen, transforming growth factor [TGF]-β), inflammation (growth differentiation factor-15, interleukin-6, nuclear factor-κB [NF-κB]), oxidative stress (superoxide dismutase 1 [SOD1] and 2 [SOD2]), and cardiac metabolism (sodium-hydrogen exchanger, peroxisome proliferator-activated receptor [PPAR]-α, PPAR-γ, glucose transporter 1 [GLUT1] and 4 [GLUT4]) were evaluated in blood samples and heart biopsies of 45 patients with AS. Our study showed SGLT2 gene and protein hyper-expression in patients with LF-LG AS, compared to controls and HG AS (p < 0.05). These differences remained significant even after adjusting for age, gender, body mass index, history of diabetes mellitus, arterial hypertension, and coronary artery disease. SGLT2 gene expression was positively correlated with: (i) TGF-β (r = 0.72, p < 0.001) and collagen (r = 0.73, p < 0.001) as markers of fibrosis; (ii) NF-κB (r = 0.36, p < 0.01) and myocardial interleukin-6 (r = 0.68, p < 0.001) as markers of inflammation: (iii) SOD2 (r = -0.38, p < 0.006) as a marker of oxidative stress; (iv) GLUT4 (r = 0.33, p < 0.02) and PPAR-α (r = 0.36, p < 0.01) as markers of cardiac metabolism. CONCLUSION In patients with LF-LG AS, SGLT2 gene and protein were hyper-expressed in cardiomyocytes and associated with myocardial fibrosis, inflammation, and oxidative stress.
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Affiliation(s)
- Lucia Scisciola
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Marta Belmonte
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Emanuele Gallinoro
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Leen Delrue
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Fatemeh Taktaz
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Rosaria Anna Fontanella
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Ivan Degrieck
- Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium
| | - Ada Pesapane
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Armando Puocci
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Martina Franzese
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | - Michele Torella
- Department of Translation Medical Science, University of Campania 'Luigi Vanvitelli' and Monaldi Hospital, Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Marisa De Feo
- Department of Translation Medical Science, University of Campania 'Luigi Vanvitelli' and Monaldi Hospital, Naples, Italy
| | | | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
- UniCamillus, International Medical University, Rome, Italy
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Michelangela Barbieri
- Department of Advanced Medical and Surgical Science, University of Campania 'Luigi Vanvitelli', Naples, Italy
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11
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Tsuda M, Egami Y, Kawanami S, Kawamura A, Ukita K, Yasumoto K, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M. Impact of left ventricular inflow-outflow angle on heart failure readmission post-transcatheter aortic valve implantation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-023-03045-z. [PMID: 38183508 DOI: 10.1007/s10554-023-03045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Abstract
Heart failure (HF) readmission post-transcatheter aortic valve implantation (TAVI) is common; however, its anatomical predictors remain unclear. This study identified a small systolic left ventricular inflow-outflow (LVIO) angle, evaluated using computed tomography, as a potential anatomical predictor associated with HF readmission post-TAVI. Patients with a small systolic LVIO angle may require close follow-up post-TAVI.
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Affiliation(s)
- Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan.
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12
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Androshchuk V, Patterson T, Redwood S. Editorial: Prediction of avoidable hospital readmissions after TAVR is an important and unresolved challenge. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 56:16-17. [PMID: 37479545 DOI: 10.1016/j.carrev.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023]
Affiliation(s)
- Vitaliy Androshchuk
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom; Cardiovascular Department, St Thomas' Hospital, King's College London, London, United Kingdom.
| | - Tiffany Patterson
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom; Cardiovascular Department, St Thomas' Hospital, King's College London, London, United Kingdom
| | - Simon Redwood
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom; Cardiovascular Department, St Thomas' Hospital, King's College London, London, United Kingdom
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13
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Jakulla RS, Gunta SP, Huded CP. Heart Failure after Aortic Valve Replacement: Incidence, Risk Factors, and Implications. J Clin Med 2023; 12:6048. [PMID: 37762989 PMCID: PMC10531882 DOI: 10.3390/jcm12186048] [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: 08/25/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Severe aortic stenosis (AS) carries a poor prognosis with the onset of heart failure (HF) symptoms, and surgical or transcatheter aortic valve replacement (AVR) is its only definitive treatment. The management of AS has seen a paradigm shift with the adoption of transcatheter aortic valve replacement (TAVR), allowing for the treatment of AS in patients who would not otherwise be candidates for surgical AVR. Despite improving long-term survival after TAVR in recent years, residual HF symptoms and HF hospitalization are common and are associated with an increased mortality and a poor health status. This review article summarizes the incidence and risk factors for HF after AVR. Strategies for preventing and better managing HF after AVR are necessary to improve outcomes in this patient population. Extensive research is underway to assess whether earlier timing for AVR, prior to the development of severe symptomatic AS and associated extra-valvular cardiac damage, can improve post-AVR patient outcomes.
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Affiliation(s)
- Roopesh Sai Jakulla
- Department of Internal Medicine, University of Missouri-Kansas City, Kansas City, MO 64110, USA
| | - Satya Preetham Gunta
- Department of Cardiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Chetan P. Huded
- Department of Cardiology, University of Missouri-Kansas City, Kansas City, MO 64110, USA
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14
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Jiménez-Xarrié E, Asmarats L, Roqué-Figuls M, Millán X, Li CHP, Fernández-Peregrina E, Sánchez-Ceña J, Massó van Roessel A, Maestre Hittinger ML, Paniagua P, Arzamendi D. Impact of Baseline Anemia in Patients Undergoing Transcatheter Aortic Valve Replacement: A Prognostic Systematic Review and Meta-Analysis. J Clin Med 2023; 12:6025. [PMID: 37762965 PMCID: PMC10531747 DOI: 10.3390/jcm12186025] [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: 08/14/2023] [Revised: 09/01/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is currently the treatment of choice for patients aged ≥75 years with severe aortic stenosis. Preoperative anemia is present in a large proportion of patients and may increase the risk of post-procedural complications. The purpose of this prognostic systematic review was to analyze the impact of baseline anemia on short- and mid-term outcomes following TAVR. A computerized search was performed on PubMed and Web of Science databases for studies published between January 2013 and December 2022. Primary outcomes were 30-day need for transfusion, acute renal failure, 30-day and mid-term mortality, and readmission during the first year post-TAVR. Data were analyzed via random effects model using inverse variance method with 95% confidence intervals. Eleven observational studies met our eligibility criteria and included a total of 12,588 patients. The prevalence of baseline anemia ranged between 39% and 72%, with no relevant sex differences. Patients with preprocedural anemia received more blood transfusions [OR: 2.95 (2.13-4.09)]), and exhibited increased rates of acute kidney injury [OR:1.74 (1.45-2.10)], short-term mortality [OR: 1.47 (1.07-2.01], and mid-term [OR: 1.89 (1.58-2.25)] mortality following TAVR compared with those without anemia. Baseline anemia determined an increased risk for blood transfusion, acute kidney injury, and short/mid-term mortality among TAVR recipients.
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Affiliation(s)
- Elena Jiménez-Xarrié
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Lluis Asmarats
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Marta Roqué-Figuls
- Biomedical Research Institute Sant Pau (IIB Sant Pau), 08025 Barcelona, Spain
| | - Xavier Millán
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Chi Hion Pedro Li
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Estefanía Fernández-Peregrina
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Juan Sánchez-Ceña
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Albert Massó van Roessel
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - M. Luz Maestre Hittinger
- Anesthesiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Pilar Paniagua
- Anesthesiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute (IIB Sant Pau), 08025 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
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15
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Avvedimento M, Angellotti D, Ilardi F, Leone A, Scalamogna M, Catiello DS, Manzo R, Mariani A, Molaro MI, Simonetti F, Spaccarotella CAM, Piccolo R, Esposito G, Franzone A. Acute advanced aortic stenosis. Heart Fail Rev 2023:10.1007/s10741-023-10312-7. [PMID: 37083966 PMCID: PMC10403405 DOI: 10.1007/s10741-023-10312-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 04/22/2023]
Abstract
Acute decompensation often represents the onset of symptoms associated with severe degenerative aortic stenosis (AS) and usually complicates the clinical course of the disease with a dismal impact on survival and quality of life. Several factors may derange the faint balance between left ventricular preload and afterload and precipitate the occurrence of symptoms and signs of acute heart failure (HF). A standardized approach for the management of this condition is currently lacking. Medical therapy finds very limited application in this setting, as drugs usually indicated for the control of acute HF might worsen hemodynamics in the presence of AS. Urgent aortic valve replacement is usually performed by transcatheter than surgical approach whereas, over the last decades, percutaneous balloon valvuloplasty gained renewed space as bridge to definitive therapy. This review focuses on the pathophysiological aspects of acute advanced AS and summarizes current evidence on its management.
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Affiliation(s)
- Marisa Avvedimento
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Domenico Angellotti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Attilio Leone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Maria Scalamogna
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Domenico Simone Catiello
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Rachele Manzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Andrea Mariani
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Maddalena Immobile Molaro
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Fiorenzo Simonetti
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy
| | - Anna Franzone
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini, 5 - 8031, Naples, Italy.
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16
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Zhou C, Xia Z, Chen B, Song Y, Lian Z. Gender Differences in Age-Stratified Early Outcomes in Patients With Transcatheter Aortic Valve Implantation. Am J Cardiol 2023; 187:100-109. [PMID: 36459732 DOI: 10.1016/j.amjcard.2022.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 11/30/2022]
Abstract
Few researchers have discussed the differences in gender between the age groups of patients who underwent transcatheter aortic valve implantation (TAVI). We searched the National Readmissions Database from 2012 to 2019 to identify adults who underwent TAVI. We studied hospital outcomes and short- to medium-term outcomes by age stratification (18 to 59, 60 to 69, 70 to 79, and 80 to 90 years) after TAVI and categorized by gender. We included 147,481 patients who underwent TAVI, and 54,802 pairs were matched using propensity score matching separately for each age group. Compared with men, women in all age groups had a similar rate of hospital death. Except the 18- to 59-year-old groups, female patients were less likely to undergo permanent pacemaker implantation and transfusion. Records of readmission at 30 days and 6 months were used as the follow-up outcome according to the presence or absence of readmission. Major adverse cardiovascular events (MACEs) were a composite of cardiovascular readmission, all-cause mortality during readmission, and stroke readmission. At the 30-day follow-up visit, there was no difference in the all-cause readmission and MACE between women and men in any group. At the 6-month follow-up visit, women in the 70- to 79-year-old and 80- to 90-year-old groups had a high risk of all-cause readmission. In conclusion, we reported that female patients have similar in-hospital death rates to male patients who underwent TAVI. During the 30-day follow-up visit, the all-cause readmission and MACE were not different in all age groups between men and women. At 6 months, women in the 70- to 79-year-old and 80- to 90-year-old groups had a higher risk of all-cause readmission.
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Affiliation(s)
- Chi Zhou
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zongyi Xia
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Bing Chen
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanxu Song
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhexun Lian
- Department of Cardiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
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17
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Huded CP, Arnold SV, Chhatriwalla AK, Saxon JT, Kapadia S, Yu X, Webb JG, Thourani VH, Kodali SK, Smith CR, Mack MJ, Leon MB, Cohen DJ. Rehospitalization Events After Aortic Valve Replacement: Insights From the PARTNER Trial. Circ Cardiovasc Interv 2022; 15:e012195. [PMID: 36538580 DOI: 10.1161/circinterventions.122.012195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Rehospitalization is a common end point in clinical trials of structural heart interventions, but whether rehospitalization is clinically and prognostically relevant in these patients is uncertain. The aim of this study was to evaluate the risk of rehospitalization events after aortic valve replacement (AVR) and their association with mortality and health status. METHODS The study population included patients who underwent transcatheter or surgical AVR in the PARTNER I' II' and III trials (Placement of Aortic Transcatheter Valves). Health status was assessed with the Kansas City Cardiomyopathy Questionnaire-overall summary score. The primary analysis focused on heart failure hospitalization within 1 year after AVR and its association with mortality, poor outcome (death, Kansas City Cardiomyopathy Questionnaire-overall summary score <60 or decrease by ≥10), and health status at 1 year using adjusted models. Secondary analyses examined the prognostic associations of rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes. RESULTS Among 3403 patients treated with AVR (2008 transcatheter AVR, 1395 surgical AVR), the 1-year incidence was 6.7% for heart failure hospitalization and 9.7% for rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes. Heart failure hospitalization after AVR was associated with increased risk of 1-year mortality (hazard ratio, 3.97 [2.48 to 6.36]; P<0.001), poor outcome (OR, 2.76 [1.73 to 4.40]; P<0.001), and worse health status (Kansas City Cardiomyopathy Questionnaire-overall summary mean difference -9.8 points [-13.8 to -5.8]; P<0.001). Rehospitalization due to a composite of heart failure, valve-related, or procedure-related causes was similarly associated with increased 1-year mortality (hazard ratio, 4.64 [3.11 to 6.92]; P<0.001), poor outcome (OR, 2.06 [1.38 to 3.07]; P=0.0004), and worse health status (Kansas City Cardiomyopathy Questionnaire-overall summary mean difference -8.8 points [-11.8 to -5.7]; P<0.001). There was no effect modification by treatment type (transcatheter AVR versus surgical AVR) for these associations. CONCLUSIONS Heart failure hospitalization and rehospitalization after AVR are associated with increased risk of mortality and worse 1-year health status. These findings confirm the clinical and prognostic relevance of rehospitalization end points for trials of AVR. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT00530894.
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Affiliation(s)
- Chetan P Huded
- Saint Luke's Mid America Heart Institute, Kansas City, MO (C.P.H., S.V.A., A.K.C., J.T.S.)
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, MO (C.P.H., S.V.A., A.K.C., J.T.S.)
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute, Kansas City, MO (C.P.H., S.V.A., A.K.C., J.T.S.)
| | - John T Saxon
- Saint Luke's Mid America Heart Institute, Kansas City, MO (C.P.H., S.V.A., A.K.C., J.T.S.)
| | | | - Xiao Yu
- Edwards Lifesciences, Inc, Irvine, CA (X.Y.)
| | - John G Webb
- St. Paul's Hospital, Vancouver, BC, Canada (J.G.W.)
| | | | | | - Craig R Smith
- Columbia University Medical Center, New York (S.K.K., C.R.S.)
| | | | - Martin B Leon
- Cardiovascular Research Foundation, New York (M.B.L., D.J.C.)
| | - David J Cohen
- St. Francis Hospital and Heart Center, Roslyn, NY (D.J.C.).,Cardiovascular Research Foundation, New York (M.B.L., D.J.C.)
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18
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Yasmin F, Aamir M, Moeed A, Iqbal K, Iqbal A, Asghar MS, Ullah W, Rajapreyar I, Brailovsky Y. Causes and Predictors of Heart Failure Hospitalizations Following Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2022; 48:101428. [DOI: 10.1016/j.cpcardiol.2022.101428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/03/2022]
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19
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Parikh PB. Predicting Futility in Aortic Stenosis: What's the Holdup? J Am Coll Cardiol 2022; 80:801-803. [PMID: 35981823 DOI: 10.1016/j.jacc.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Puja B Parikh
- Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA.
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20
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Zahid S, Din MTU, Khan MZ, Rai D, Ullah W, Sanchez-Nadales A, Elkhapery A, Khan MU, Goldsweig AM, Singla A, Fonarrow G, Balla S. Trends, Predictors, and Outcomes of 30-Day Readmission With Heart Failure After Transcatheter Aortic Valve Replacement: Insights From the US Nationwide Readmission Database. J Am Heart Assoc 2022; 11:e024890. [PMID: 35929464 PMCID: PMC9496292 DOI: 10.1161/jaha.121.024890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Data on trends, predictors, and outcomes of heart failure (HF) readmissions after transcatheter aortic valve replacement (TAVR) remain limited. Moreover, the relationship between hospital TAVR discharge volume and HF readmission outcomes has not been established. METHODS AND RESULTS The Nationwide Readmission Database was used to identify 30‐day readmissions for HF after TAVR from October 1, 2015, to November 30, 2018, using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‐10‐CM) codes. A total of 167 345 weighted discharges following TAVR were identified. The all‐cause readmission rate within 30 days of discharge was 11.4% (19 016). Of all the causes of 30‐day rehospitalizations, HF comprised 31.4% (5962) of all causes. The 30‐day readmission rate for HF did not show a significant decline during the study period (Ptrend=0.06); however, all‐cause readmission rates decreased significantly (Ptrend=0.03). HF readmissions were comparable between high‐ and low‐volume TAVR centers. Charlson Comorbidity Index >8, length of stay >4 days during the index hospitalization, chronic obstructive pulmonary disease, atrial fibrillation, chronic HF, preexisting pacemaker, complete heart block during index hospitalization, paravalvular regurgitation, chronic kidney disease, and end‐stage renal disease were independent predictors of 30‐day HF readmission after TAVR. HF readmissions were associated with higher mortality rates when compared with non‐HF readmissions (4.9% versus 3.3%; P<0.01). Each HF readmission within 30 days was associated with an average increased cost of $13 000 more than for each non‐HF readmission. CONCLUSIONS During the study period from 2015 to 2018, 30‐day HF readmissions after TAVR remained steady despite all‐cause readmissions decreasing significantly. All‐cause readmission mortality and HF readmission mortality also showed a nonsignificant downtrend. HF readmissions were comparable across low‐, medium‐, and high‐volume TAVR centers. HF readmission was associated with increased mortality and resource use attributed to the increased costs of care compared with non‐HF readmission. Further studies are needed to identify strategies to decrease the burden of HF readmissions and related mortality after TAVR.
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Affiliation(s)
- Salman Zahid
- Department of Medicine Rochester General Hospital Rochester NY
| | | | - Muhammad Zia Khan
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
| | - Devesh Rai
- Department of Medicine Rochester General Hospital Rochester NY
| | - Waqas Ullah
- Department of Cardiovascular Medicine Jefferson University Hospitals Philadelphia PA
| | | | - Ahmed Elkhapery
- Department of Medicine Rochester General Hospital Rochester NY
| | - Muhammad Usman Khan
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
| | - Andrew M Goldsweig
- Division of Cardiovascular Medicine University of Nebraska Medical Center Omaha NE
| | | | - Greg Fonarrow
- Division of Cardiovascular Medicine University of California Los Angeles Los Angeles CA
| | - Sudarshan Balla
- Division of Cardiology West Virginia University Heart & Vascular Institute Morgantown WV
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21
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Ito A, Izumiya Y, Iwata S, Ogawa M, Kim AT, Yahiro R, Kure Y, Yamaguchi T, Okai T, Takahashi Y, Shibata T, Yoshiyama M. Left atrial volume index predicts future improvement of B-type natriuretic peptide levels after transcatheter aortic valve replacement. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1463-1471. [PMID: 35133548 DOI: 10.1007/s10554-022-02538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/23/2022] [Indexed: 11/05/2022]
Abstract
In patients with symptomatic severe aortic stenosis (AS), those who experienced readmission due to heart failure after transcatheter aortic valve replacement (TAVR) showed poor prognosis. Furthermore, poor B-type natriuretic peptide (BNP) improvement is associated with increased morbidity and mortality. However, little is known about the clinical parameters related to the change in BNP levels after TAVR procedure. This study population consisted of 127 consecutive patients of symptomatic severe AS with preserved ejection fraction (EF) who underwent transfemoral TAVR (TF-TAVR). Comprehensive transthoracic echocardiography was performed prior to the day of TF-TAVR. BNP was measured serially before and 1 year after TF-TAVR. The median BNP level was significantly decreased from 252.5 pg/ml to 146.8 pg/ml in all 127 patients 1 year after TF-TAVR (P < 0.01). However, the patients could be divided into 2 groups according to decrease (72%) or increase (28%) in plasma BNP level. Multivariate logistic regression analysis revealed that Aortic valve (AV) peak velocity, pre-procedural BNP, and larger left atrial volume index (LAVI) were found to be an independent predictor of increased BNP level 1 year after TAVR (OR 0.55, 95% CI 0.38-0.77; P < 0.01). LAVI were negatively correlated with the change in BNP level before and 1 year after TAVR (r = 0.47, P < 0.01). The ROC analysis demonstrated that 52.9 ml/m2 was the optimal cut-off value of LAVI for decreasing BNP 1 year after TAVR (area under the curve 0.69) with 64% sensitivity and 70% specificity. In addition to AV peak velocity and pre-procedural BNP, LAVI independently predicts future improvement of BNP levels 1 year after TAVR. Our findings indicate an additive predictive value of assessment of LAVI before TAVR procedure for risk stratification.
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Affiliation(s)
- Asahiro Ito
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan.
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Shinichi Iwata
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Mana Ogawa
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Andrew T Kim
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Ryosuke Yahiro
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Yusuke Kure
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Tomohiro Yamaguchi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Tsukasa Okai
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
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22
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Patel RV, Ravindran M, Manoragavan R, Sriharan A, Wijeysundera HC. Risk Factors for Hospital Readmission Post-Transcatheter Aortic Valve Implantation in the Contemporary Era: A Systematic Review. CJC Open 2022; 4:792-801. [PMID: 36148255 PMCID: PMC9486870 DOI: 10.1016/j.cjco.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Despite transcatheter aortic valve implantation (TAVI) becoming a widely accepted therapeutic option for the management of aortic stenosis, post-procedure readmission rates remain high. Rehospitalization is associated with negative patient outcomes, as well as increased healthcare costs, and has therefore been identified as an important target for quality improvement. Strategies to reduce the post-TAVI readmission rate are needed but require the identification of patients at high risk for rehospitalization. Our systematic review aims to identify predictors of post-procedure readmission in patients eligible for TAVI. Methods We conducted a comprehensive search of the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases for the time period from 2015 to the present for articles evaluating risk factors for rehospitalization post-TAVI with a follow-up period of at least 30 days in adults age ≥ 70 years with aortic stenosis. The quality of included studies was evaluated using the Newcastle-Ottawa Scale. We present the results as a qualitative narrative review. Results We identified 49 studies involving 828,528 patients. Post-TAVI readmission is frequent, and rates vary (14.9% to 54.3% at 1 year). The most-frequent predictors identified for both 30-day and 1-year post-TAVI readmission are atrial fibrillation, lung disease, renal disease, diabetes mellitus, in-hospital life-threatening bleeding, and non-femoral access. Conclusions This systematic review identifies the most-common predictors for 30-day and 1-year readmission post-TAVI, including comorbidities and potentially modifiable procedural approaches and complications. These predictors can be used to identify patients at high-risk for readmission who are most likely to benefit from increased support and follow-up post-TAVI.
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23
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Zahid S, Rai D, Tanveer Ud Din M, Khan MZ, Ullah W, Usman Khan M, Thakkar S, Hussein A, Baibhav B, Rao M, Abtahian F, Bhatt DL, Depta JP. Same-Day Discharge After Transcatheter Aortic Valve Implantation: Insights from the Nationwide Readmission Database 2015 to 2019. J Am Heart Assoc 2022; 11:e024746. [PMID: 35621233 PMCID: PMC9238699 DOI: 10.1161/jaha.121.024746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is a paucity of data on the feasibility of same-day discharge (SDD) following transcatheter aortic valve implantation (TAVI) at a national level. Methods and Results This study used data from the Nationwide Readmission Database from the fourth quarter of 2015 through 2019 and identified patients undergoing TAVI using the claim code 02RF3. A total of 158 591 weighted hospitalizations for TAVI were included in the analysis. Of the patients undergoing TAVI, 961 (0.6%) experienced SDD. Non-SDDs included 65 814 (41.5%) patients who underwent TAVI who were discharged the next day, and 91 816 (57.9%) discharged on the second or third day. The 30-day readmission rate for SDD after TAVI was similar to non-SDD TAVI (9.8% versus 8.9%, P=0.31). The cumulative incidence of 30-day readmissions for SDD was higher compared with next-day discharge (log-rank P=0.01) but comparable to second- or third-day discharge (log-rank P=0.66). At 30 days, no differences were observed in major or minor vascular complications, heart failure, or ischemic stroke for SDD compared with non-SDD. Acute kidney injury, pacemaker implantation, and bleeding complications were lower with SDD. Predictors associated with SDD included age <85 years, male sex, and prior pacemaker placement, whereas left bundle-branch block, right bundle-branch block, second-degree heart block, heart failure, prior percutaneous coronary intervention, and atrial fibrillation were negatively associated with SDD. Conclusions SDD following TAVI is associated with similar 30-day readmission and complication rates compared with non-SDD. Further prospective studies are needed to assess the safety and feasibility of SDD after TAVI.
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Affiliation(s)
- Salman Zahid
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Devesh Rai
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | | | - Muhammad Zia Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | - Waqas Ullah
- Department of Cardiovascular Medicine Jefferson University Hospitals Philadelphia PA
| | - Muhammad Usman Khan
- Division of Cardiovascular Medicine West Virginia University Heart & Vascular Institute Morgantown WV
| | | | - Ahmed Hussein
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Bipul Baibhav
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Mohan Rao
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Farhad Abtahian
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center Harvard Medical School Boston MA
| | - Jeremiah P Depta
- Sands-Constellation Heart InstituteRochester General Hospital Rochester NY
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24
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de Sousa C, Pinto FJ. Dapaglifozin post transcatheter aortic valve implantation: the need for further evidence. Eur J Heart Fail 2022; 24:589-590. [DOI: 10.1002/ejhf.2436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/16/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Catarina de Sousa
- Cardiovascular Centre of the University of Lisbon (CCUL), Faculdade de Medicina Universidade de Lisboa Portugal
- Lusiadas Knowledge Center Portugal
| | - Fausto J Pinto
- Cardiovascular Centre of the University of Lisbon (CCUL), Faculdade de Medicina Universidade de Lisboa Portugal
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25
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Bandera F, Mollo A, Frigelli M, Guglielmi G, Ventrella N, Pastore MC, Cameli M, Guazzi M. Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages. Front Cardiovasc Med 2022; 8:750139. [PMID: 35096989 PMCID: PMC8792604 DOI: 10.3389/fcvm.2021.750139] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/14/2021] [Indexed: 12/26/2022] Open
Abstract
The left atrium (LA) is emerging as a key element in the pathophysiology of several cardiac diseases due to having an active role in contrasting heart failure (HF) progression. Its morphological and functional remodeling occurs progressively according to pressure or volume overload generated by the underlying disease, and its ability of adaptation contributes to avoid pulmonary circulation congestion and to postpone HF symptoms. Moreover, early signs of LA dysfunction can anticipate and predict the clinical course of HF diseases before the symptom onset which, particularly, also applies to patients with increased risk of HF with still normal cardiac structure (stage A HF). The study of LA mechanics (chamber morphology and function) is moving from a research interest to a clinical application thanks to a great clinical, prognostic, and pathophysiological significance. This process is promoted by the technological progress of cardiac imaging which increases the availability of easy-to-use tools for clinicians and HF specialists. Two-dimensional (2D) speckle tracking echocardiography and feature tracking cardiac magnetic resonance are becoming essential for daily practice. In this context, a deep understanding of LA mechanics, its prognostic significance, and the available approaches are essential to improve clinical practice. The present review will focus on LA mechanics, discussing atrial physiology and pathophysiology of main cardiac diseases across the HF stages with specific attention to the prognostic significance. Imaging techniques for LA mechanics assessment will be discussed with an overlook on the dynamic (under stress) evaluation of the chamber.
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Affiliation(s)
- Francesco Bandera
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Anita Mollo
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Matteo Frigelli
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Giulia Guglielmi
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Nicoletta Ventrella
- Cardiology University Department, IRCCS Policlinico San Donato, Milan, Italy
| | | | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Marco Guazzi
- Department of Biological Sciences, University of Milano, Milan, Italy
- Cardiology Division, San Paolo Hospital, Milan, Italy
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26
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Chiou A, Yap J, Russo S, Stripe BR, Wong GB, Southard JA. Understanding repeat hospitalizations in intermediate-to-high risk aortic stenosis patients following transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2022; 99:1188-1196. [PMID: 35019207 DOI: 10.1002/ccd.30066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/04/2021] [Accepted: 12/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We describe the causes, timing and predictors of readmissions and analyze its impact on clinical outcomes in intermediate-to-high-risk patients with severe symptomatic aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR). BACKGROUND Intermediate-high risk TAVR patients with severe AS have an increased risk for hospital readmissions due to the high burden of comorbidities. METHODS Patients who underwent TAVR from 2012 to 2018 at a single tertiary cardiac center were included and followed for 1 year. Readmissions were categorized as noncardiovascular (non-CV) and CV. RESULTS A total of 611 patients (410 with no readmissions, 201 with ≥1 readmissions) were included. There was a total of 317 readmissions (mean: 1.58 ± 1.09 per readmitted patient) with 65 patients having ≥2 readmissions. 64.0% were non-CV and 36.0% were CV. The top three CV causes were pacemaker/implantable cardioverter-defibrillator placement, bleeding, and stroke. About 23% occurred at 1 m, the majority were CV; 45% occurred between 7 and 12 m, the majority were non-CV. Those with ≥1 readmissions had a higher burden of comorbidities including peripheral arterial disease, diabetes, immunosuppression, prior percutaneous coronary interventions, and dialysis. Readmissions were associated with higher 1-year mortality (adjusted hazard ratio: 2.53, 95% confidence interval: 1.40-4.59; p = 0.002). High-risk patients had higher non-CV readmissions (0.37 ± 0.79 vs. 0.25 ± 0.62; p = 0.044) compared to intermediate-risk patients but similar CV readmissions (p = 0.645). CONCLUSIONS Understanding readmissions post-TAVR will promote the early identification of at-risk groups and the implementation of preventative measures to improve outcomes and reduce the burden and costs of readmissions.
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Affiliation(s)
- Andrew Chiou
- Department of Internal Medicine, University of California Davis, Davis, California, USA
| | - Jonathan Yap
- Division of Cardiovascular Medicine, University of California Davis, California, Davis, USA.,Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.,Department of Cardiology, Duke-NUS Medical School, Singapore, Singapore
| | - Steven Russo
- Department of Internal Medicine, University of California Davis, Davis, California, USA
| | - Benjamin R Stripe
- Division of Cardiovascular Medicine, University of California Davis, California, Davis, USA
| | - Garrett B Wong
- Division of Cardiovascular Medicine, University of California Davis, California, Davis, USA
| | - Jeffrey A Southard
- Division of Cardiovascular Medicine, University of California Davis, California, Davis, USA
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27
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Fischer-Rasokat U, Renker M, Liebetrau C, Weferling M, Rieth A, Rolf A, Choi YH, Hamm CW, Kim WK. Predictive value of overt and non-overt volume overload in patients with high- or low-gradient aortic stenosis undergoing transcatheter aortic valve implantation. Cardiovasc Diagn Ther 2021; 11:1080-1092. [PMID: 34815958 DOI: 10.21037/cdt-21-286] [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: 05/03/2021] [Accepted: 06/08/2021] [Indexed: 11/06/2022]
Abstract
Background The plasma volume status (PVS) is considered a marker of non-overt cardiac congestion and is of prognostic value. Patients with low-flow, low-gradient (LFLG) aortic stenosis (AS) suffer from impaired left ventricular function and show signs of heart failure (HF). We hypothesized that PVS might predict post-interventional rehospitalization and cardiovascular mortality in high-risk patients undergoing transcatheter aortic valve implantation (TAVI). Methods In this retrospective, observational analysis, PVS before transfemoral TAVI was calculated by a formula taking into account hematocrit and weight. The predictive performance of PVS was compared with that of prior cardiac decompensation (PCD). Results In the entire cohort of n=2,458 patients, PVS >-4% (high plasma volume) identified patients (n=1,013) with a higher post-interventional 1-year mortality rate than patients (n=1,445) with a PVS ≤-4% (low plasma volume). However, PVS lost prognostic independence when adjusted for anemia, whereas PCD did not. A high PVS and PCD were not correlated, and both parameters similarly revealed a low sensitivity and specificity but a high negative predictive value (NPV) for future HF events. PVS was not different between control patients (n=1,512) and those with intermediate (paradoxical LFLG-AS, n=327) or high risk scores (LFLG-AS, n=239). The accuracy of high PVS in predicting adverse events in these subpopulations was the same as in the study population overall. Kaplan-Maier analyses demonstrated similar prognostic impacts for PVS and PCD. Conclusions PVS and PCD represent two independent parameters of volume overload with unfavorable prognostic significance. Pre-interventional PVS does not appear to be suitable for predicting clinical outcomes in high-risk patients undergoing TAVI.
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Affiliation(s)
| | - Matthias Renker
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany.,Cardioangiological Center Bethanien (CCB), Frankfurt, Germany
| | - Maren Weferling
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany
| | - Andreas Rieth
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany.,Medical Clinic I (Cardiology and Angiology), University Hospital of Giessen, Giessen, Germany
| | - Yeong-Hoon Choi
- Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany.,Medical Clinic I (Cardiology and Angiology), University Hospital of Giessen, Giessen, Germany
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany.,Cardiac Surgery, Kerckhoff Heart Center, Bad Nauheim, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site RheinMain, Bad Nauheim, Germany.,Medical Clinic I (Cardiology and Angiology), University Hospital of Giessen, Giessen, Germany
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van Bergeijk KH, Voors AA, Wykrzykowska JJ. Prime time for machine learning to predict clinical outcomes in valvular heart disease? Eur J Heart Fail 2021; 23:2033-2034. [PMID: 34761488 DOI: 10.1002/ejhf.2379] [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: 11/01/2021] [Accepted: 11/03/2021] [Indexed: 11/06/2022] Open
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Amat-Santos IJ, Sánchez-Luna JP, Abu-Assi E, Melendo-Viu M, Cruz-Gonzalez I, Nombela-Franco L, Muñoz-Garcí AJ, Blas SG, de la Torre Hernandez JM, Romaguera R, Sánchez-Recalde Á, Diez-Gil JL, Lopez-Otero D, Gheorge L, Ibáñez B, Iñiguez-Romo A, Raposeiras-Roubín S. Rationale and design of the Dapagliflozin after Transcatheter Aortic Valve Implantation (DapaTAVI) randomized trial. Eur J Heart Fail 2021; 24:581-588. [PMID: 34693613 DOI: 10.1002/ejhf.2370] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/19/2021] [Accepted: 10/16/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS Despite aortic stenosis (AS) relief, patients undergoing transcatheter aortic valve implantation (TAVI) are at increased risk of developing heart failure (HF) within first months of intervention. Sodium-glucose co-transporter 2 (SGLT-2) inhibitors have been shown to reduce the risk of HF hospitalization in individuals with diabetes mellitus, reduced left ventricular ejection fraction and chronic kidney disease. However, the effect of SGLT-2 inhibitors on outcomes after TAVI is unknown. The Dapagliflozin after Transcatheter Aortic Valve Implantation (DapaTAVI) trial is designed to assess the clinical benefit and safety of the SGLT-2 inhibitor dapagliflozin in patients undergoing TAVI. METHODS DapaTAVI is an independent pragmatic, controlled, prospective, randomized, open-label blinded endpoint, multicentre trial conducted in Spain, evaluating the effect of dapagliflozin 10 mg/day on the risk of death and worsening HF in patients with severe AS undergoing TAVI. Candidate patients should have prior history of HF admission plus ≥1 of the following criteria: (i) diabetes mellitus, (ii) left ventricular ejection fraction ≤40%, or (iii) estimated glomerular filtration rate between 25 and 75 ml/min/1.73 m2 . A total of 1020 patients will be randomized (1:1) to dapagliflozin vs. no dapagliflozin. Key secondary outcomes include: (i) incidence rate of individual components of the primary outcome; (ii) cardiovascular mortality; (iii) the composite of HF hospitalization or cardiovascular death; and (iv) total number of HF rehospitalizations. CONCLUSION DapaTAVI will determine the efficacy and safety of dapagliflozin in a broad spectrum of frail patients after AS relief by TAVI.
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Affiliation(s)
- Ignacio J Amat-Santos
- CIBERCV, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Juan P Sánchez-Luna
- CIBERCV, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Emad Abu-Assi
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | | | | | | | - Antonio J Muñoz-Garcí
- CIBERCV, Madrid, Spain.,Cardiology Department, Hospital Virgen de la Victoria, Málaga, Spain
| | - Sergio G Blas
- Cardiology Department, Hospital Clínico Universitario, Valencia, Spain
| | | | - Rafael Romaguera
- Cardiology Department, Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - José L Diez-Gil
- Cardiology Department, Hospital Universitario La Fe, Valencia, Spain
| | - Diego Lopez-Otero
- CIBERCV, Madrid, Spain.,Cardiology Department, Hospital Clínico Universitario de Santiago de Compostela, Madrid, Spain
| | - Livia Gheorge
- Cardiology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Borja Ibáñez
- CIBERCV, Madrid, Spain.,IIS-Department of Cardiology, Hospital Fundación Jiménez Díaz, Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Sergio Raposeiras-Roubín
- Department of Cardiology, Hospital Álvaro Cunqueiro, Vigo, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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30
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Vilalta V, Alperi A, Cediel G, Mohammadi S, Fernández-Nofrerias E, Kalvrouziotis D, Delarochellière R, Paradis JM, González-Lopera M, Fadeuilhe E, Carrillo X, Abdul-Jawad Altisent O, Rodríguez-Leor O, Voisine P, Bayés-Genís A, Rodés-Cabau J. Midterm Outcomes Following Sutureless and Transcatheter Aortic Valve Replacement in Low-Risk Patients With Aortic Stenosis. Circ Cardiovasc Interv 2021; 14:e011120. [PMID: 34607449 DOI: 10.1161/circinterventions.121.011120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sutureless-surgical aortic valve replacement (SU-SAVR) has been proposed as a surgical alternative for treating aortic stenosis, which facilitates a minimally invasive approach. While some studies have compared the early outcomes of SU-SAVR versus transcatheter aortic valve replacement (TAVR), most data were obtained in high-risk patients and/or limited to in-hospital outcomes. This study aimed to compare in-hospital and midterm clinical outcomes following SU-SAVR and TAVR in low-risk patients with aortic stenosis. METHODS A total of 806 consecutive low-risk (EuroSCORE II <4%) patients underwent TAVR or SU-SAVR between 2011 and 2020 in 2 centers. A 1:1 propensity score matching was performed and identified 171 pairs with similar characteristics that were included in the analysis. Baseline characteristics, in-hospital and follow-up events (defined according to Valve Academic Research Consortium-2) were collected. RESULTS Baseline characteristics were well balanced between groups, with a median EuroSCORE II of 1.9% (1.3%-2.5%) in both SU-SAVR and TAVR groups (P=0.85). There were no statistically significant differences regarding in-hospital mortality (SU-SAVR: 4.1%, TAVR: 1.8%, P=0.199) and stroke (SU-SAVR: 2.3%, TAVR: 2.9%, P=0.736), but SU-SAVR recipients exhibited higher rates of bleeding and new-onset atrial fibrillation, higher residual transvalvular gradients (P<0.001), and a lower rate of pacemaker implantation (P=0.011). After a median follow-up of 2 (1-3) years, there were no differences between groups in all-cause mortality (hazard ratio, 0.97 [95% CI, 0.52-1.82], P=0.936) and stroke (hazard ratio, 0.83 [95% CI, 0.32-2.15], P=0.708), but SU-SAVR was associated with a higher risk of heart failure hospitalization (hazard ratio, 5.38 [95% CI, 1.88-15.38], P=0.002). CONCLUSIONS In low-risk patients with aortic stenosis, TAVR was associated with improved in-hospital outcomes (except for conduction disturbances) and valve hemodynamics, compared with SU-SAVR. Although similar mortality and stroke rates were observed at 2-year follow-up, the risk of heart failure hospitalization was higher among SU-SAVR patients. These results may contribute to reinforce TAVR over SU-SAVR for the majority of such patients. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Victoria Vilalta
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,Department of Medicine, Universitat Autònoma de Barcelona, Spain (V.V., A.B.-G.)
| | - Alberto Alperi
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Germán Cediel
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Siamak Mohammadi
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Eduard Fernández-Nofrerias
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Dimitri Kalvrouziotis
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Robert Delarochellière
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Jean-Michel Paradis
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Marta González-Lopera
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Edgar Fadeuilhe
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Xavier Carrillo
- CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Omar Abdul-Jawad Altisent
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Oriol Rodríguez-Leor
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.)
| | - Pierre Voisine
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.)
| | - Antoni Bayés-Genís
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain (V.V., G.C., E.F.-N., M.G.-L., E.F., X.C., O.A.-J.A., O.R.-L., A.B.-G.).,Department of Medicine, Universitat Autònoma de Barcelona, Spain (V.V., A.B.-G.)
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Quebec City, Canada (A.A., S.M., D.K., R.D., J.-M.P., P.V., J.R.-C.).,Hospital Clínic de Barcelona, Spain (J.R.-C.)
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Elbadawi A, Mahta D, Elgendy IY, Dang AT, Mahmoud M, Iskandar M, Kaple R, Al-Azizi K, Szerlip M, Kayani W, Barker CM, Jneid H. Trends in utilization, outcomes, and readmissions after transcatheter mitral valve replacement. Catheter Cardiovasc Interv 2021; 99:906-914. [PMID: 34569695 DOI: 10.1002/ccd.29963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/24/2021] [Accepted: 09/18/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is a paucity of real-world data regarding the temporal trends and outcomes of trans-septal transcatheter mitral valve replacement (TS-TMVR) in the United States (US). METHODS We queried the Nationwide Readmissions Database (October 2015 to December 2018) for patients undergoing TS-TMVR procedures. We reported the temporal trends in the utilization, in-hospital outcomes and 30-day readmissions after TS-TMVR. The main study outcome was in-hospital mortality. RESULTS There was an increase in the number of TS-TMVR procedures over time (48 in 2015 vs. 978 in 2018, Ptrend < 0.001), with a notable increase in the proportion of women (Ptrend = 0.04) and the prevalence of diabetes (Ptrend = 0.03). There was an increase in the number of centers performing TS-TMVR (21 in 2015 vs. 164 in 2018, Ptrend < 0.001). The overall in-hospital mortality was 7.2% with no change over time (6.3% in 2015 vs. to 5.2% in 2018, Ptrend = 0.67). There was no change in the frequency of in-hospital complications after TS-TMVR; however, the median length of stay has decreased over time. The overall 30-day readmission rate was 17.8%, with no change during the study years. The most frequent cause for 30-day readmission after TS-TMVR was acute heart failure followed by bleeding and infection-related complications. Prior coagulopathy and small-sized hospitals were independently associated with higher in-hospital mortality and 30-day readmissions. CONCLUSION This nationwide observational analysis of real-world data showed an increase in the number of TS-TMVR procedures over time, which is now performed at a greater number of centers. There was no change in the rate of in-hospital mortality, complications or 30-day readmissions; but a significant reduction in the length of hospital stay over time was noted. As the number of TS-TMVR continue to expand, these data provide a perspective on the early experience with this procedure.
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Affiliation(s)
- Ayman Elbadawi
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
| | - Dhruv Mahta
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
| | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Alexander T Dang
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Mona Mahmoud
- Department of Internal Medicine, Central Michigan University Health, Saginaw, Michigan, USA
| | - Mina Iskandar
- Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Ryan Kaple
- Department of Cardiovascular Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Karim Al-Azizi
- Cardiovascular Research Department, Baylor Scott and White the Heart Hospital, Plano, Texas, USA
| | - Molly Szerlip
- Cardiovascular Research Department, Baylor Scott and White the Heart Hospital, Plano, Texas, USA
| | - Waleed Kayani
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
| | - Colin M Barker
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hani Jneid
- Section of Cardiology, Baylor School of Medicine, Houston, Texas, USA
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Panagides V, Alperi A, Mesnier J, Philippon F, Bernier M, Rodes-Cabau J. Heart failure following transcatheter aortic valve replacement. Expert Rev Cardiovasc Ther 2021; 19:695-709. [PMID: 34227916 DOI: 10.1080/14779072.2021.1949987] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction: Over the past decade, the number of transcatheter aortic valve replacement (TAVR) procedures has increased exponentially. Despite major improvements in both device and successes, the rate of hospital readmission after TAVR remains high, with heart failure (HF) decompensation being one of the most important causes.Areas covered: This review provides an overview of the current status of HF following TAVR, including details about its incidence, clinical impact, contributing factors, and current and future treatment perspectives.Expert opinion: HF decompensation has been identified as the most common cause of rehospitalization following TAVR, and it has been associated with a negative prognosis. Multiple preexisting factors including low flow status, cardiac amyloidosis, myocardial fibrosis, multivalvular disease, pulmonary hypertension, coronary artery disease, and atrial fibrillation have been associated with an increased risk of HF events. Also, multiple post-procedural factors like the occurrence of significant paravalvular leaks, severe prosthesis-patient mismatch, and conduction disturbances have also contributed to increase this risk . Thus, reducing HF events in TAVR recipients would require a multifactorial and multidisciplinary effort including the optimization of the medical treatment and close follow-up and treatment of residual or concomitant valvular disease and conduction disturbance issues. Future studies in this challenging group of patients are warranted.
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Affiliation(s)
- Vassili Panagides
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Alberto Alperi
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jules Mesnier
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Francois Philippon
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Mathieu Bernier
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Josep Rodes-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
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Malik J, Patel JR, Joundi H, Pereira KN, Pannu AK, Haneef G, Kubra KT, Mathialagan K, Ajibawo T. Incidence and Predictors of In-Hospital Mortality Among Diabetics Undergoing Transcatheter Aortic Valve Replacement. Cureus 2021; 13:e16056. [PMID: 34336528 PMCID: PMC8321421 DOI: 10.7759/cureus.16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives The main goals of this study are to delineate the differences in demographics, comorbidities and hospital outcomes between diabetic and non-diabetic aortic stenosis (AS) patients, and next is to evaluate the predictors of in-hospital mortality in AS patients undergoing transcatheter aortic valve replacement (TAVR). Methods We conducted an observational cross-sectional study using the nationwide inpatient sample (NIS) and included 33,325 adult patients with a primary discharge diagnosis of AS who underwent TAVR during the hospitalization. This sample was further grouped by comorbid diabetic which include non-diabetics (N = 23,585) versus diabetic patients (N = 9,740). Among the hospital outcomes we included the length of stay (LOS) and total cost during hospitalization, and the all-cause in-hospital mortality. We used an independent logistic regression model adjusted for demographic confounders to measure the adjusted odds ratio (aOR) of association of comorbid medical conditions and in-hospital mortality risk in non-diabetic and diabetic groups. Results The most prevalent medical comorbidities among inpatients with diabetes were hypertension (85.1%), followed by renal failure (38.0%), chronic lung disease (37.1%), obesity (21.3%), and these values were significantly higher compared with the non-diabetic group. The in-hospitality mortality was higher among the non-diabetic group (4.7%) compared to the diabetic group (2.8%). There was no significant difference in mean length of stay and mean total cost between the diabetic and non-diabetic groups. In diabetic AS inpatients, stroke (aOR: 4.58, 95%CI: 2.23-9.42) and fluid/electrolyte disorders (aOR: 4.25, 95%CI: 3.29-5.48) had a statistically significant association with mortality risk when compared to the non-diabetic group. Among the non-diabetic AS inpatients, fluid/electrolyte disorders had the highest mortality risk (aOR: 2.48, 95% CI 2.17-2.83) followed by coagulopathy (aOR: 2.03; CI: 1.77-2.32), congestive heart failure (aOR: 1.67; CI: 1.40-1.98), and renal failure (aOR: 1.62; CI: 1.41-1.86). Meanwhile, hypertension and obesity had a statistically non-significant and negative association with in-hospital mortality in diabetic and non-diabetic groups. Conclusions Diabetic AS inpatients following TAVR had a higher mortality risk with comorbid fluid/electrolyte disorders and stroke. In-hospital mortality following TAVR was lower among the diabetics compared to non-diabetics, and it underscores diabetes as a surgical risk factor in patients with AS. So, TAVR may be the preferred approach for diabetic patients with AS along with cardiovascular risk factor modification, strict glycemic control and timely renal function follow-up.
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Affiliation(s)
- Jannat Malik
- Family Medicine, National University of Medical Sciences, Rawalpindi, PAK
| | - Jeet R Patel
- Pediatrics, Byramjee Jeejeebhoy Medical College, Ahmedabad, IND
| | - Hajara Joundi
- Internal Medicine, University Cadi Ayyad, Marrakech, MAR
| | | | - Amanpreet K Pannu
- Internal Medicine, Sri Guru Ram Das University of Health Sciences, Amritsar, IND
| | - Goher Haneef
- Internal Medicine, University of Health Sciences, Lahore, PAK.,Emergency Medicine, University of Cincinnati Medical Center, Cincinnati, USA
| | - Khadija T Kubra
- Internal Medicine, Bangladesh Medical College and Hospital, Dhaka, BGD
| | | | - Temitope Ajibawo
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
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Long-Term Survival in Patients with or without Implantable Cardioverter Defibrillator after Transcatheter Aortic Valve Implantation. J Clin Med 2021; 10:jcm10132929. [PMID: 34208816 PMCID: PMC8268788 DOI: 10.3390/jcm10132929] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with symptomatic aortic stenosis (AS) can have concomitant systolic heart failure (HF) that persists even after correction of afterload by transcatheter aortic valve implantation (TAVI). These patients qualify as potential candidates for prophylactic therapy with an implantable cardioverter defibrillator (ICD). We compared survival between patients with or without an ICD after successful TAVI. This retrospective study analyzed Kaplan-Meier survival data during a follow-up period of three years in two populations: (a) patients with a left ventricular ejection fraction (LVEF) ≤ 35% before TAVI (overall population); (b) patients with additionally documented LVEF ≤ 35% 3 months after TAVI (persistent LV dysfunction subpopulation). In the overall population, 53 patients with and 193 patients without an ICD had similar baseline characteristics and procedural success rates, and HF medication at discharge was comparable. Three-year mortality rates were 26.4% for patients with an ICD and 24.4% for patients without an ICD (p = 0.758). Cardiovascular death rates were similar between groups (p = 0.914), and deaths were most often attributed to worsening of HF. Survival rates in patients with persistent LV dysfunction with an ICD (n = 24) or without an ICD (n = 59) were similar between groups (p = 0.872), with cardiovascular deaths mostly qualified as worsening HF and none as sudden cardiac death. Patients of the overall study population with biventricular pacing devices showed only a tendency to have better outcomes (p = 0.298). ICD therapy in elderly patients with AS and LV dysfunction undergoing TAVI did not demonstrate a survival benefit during a 3-year follow-up period.
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Nazir S, Ahuja KR, Ariss RW, Changal K, Khuder SA, Moukarbel GV. Home health care utilization trend, predictors, and association with early rehospitalization following endovascular transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 36:1-6. [PMID: 34045166 DOI: 10.1016/j.carrev.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Home healthcare (HHC) utilization is associated with higher rates of rehospitalization in patients with heart failure and transcatheter mitral valve repair. This study sought to assess the utilization, predictors, and the association of HHC with 30-day readmission in patients undergoing transcatheter aortic valve replacement (TAVR). METHODS/MATERIALS We queried the Nationwide Readmission Database from January 2012 to December 2017 for TAVR discharges with and without HHC referral. Using multivariate analysis, we identified predictors of HHC utilization, and its association with outcomes. RESULTS Of 60,950 TAVR discharges, 21,724 (35.7%) had HHC referral. On multivariable analysis, female sex (OR, 1.34; 95% CI, 1.29-1.40), non-elective admission (OR, 1.49; 95% CI, 1.42-1.56), diabetes mellitus (OR, 1.09; 95% CI, 1.05-1.13), prior stroke (OR, 1.06; 95% CI, 1.01-1.12), anemia (OR, 1.16; 95% CI, 1.11-1.21), and in-hospital complications including cardiogenic shock (OR, 1.37; 95% CI, 1.16-1.50), cardiac arrest (OR, 1.22; 95% CI, 1.00-1.50), stroke (OR, 2.62; 95% CI, 2.20-3.18), and new Permanent pacemaker (OR, 1.49; 95% CI, 1.41-1.58) were identified as independent predictors of HHC referral. HHC utilization was associated with longer median length of stay (4 days vs. 2 days, P < 0.001), higher rate of 30-day all-cause (15.5% vs. 10.6%, P < 0.001) and heart failure (2.1%vs. 1.1%, P < 0.001) readmission rates compared to those without HHC. CONCLUSIONS Our study identified a vulnerable group of TAVR patients that are at higher risk of 30-day readmission. Evidence-based interventions proven effective in reducing the burden of readmissions should be pursed in these patients to improve outcomes and quality of life.
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Affiliation(s)
- Salik Nazir
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Keerat Rai Ahuja
- Department of Cardiology, Reading Hospital-Tower Health System, West Reading, PA, USA
| | - Robert W Ariss
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Khalid Changal
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Sadik A Khuder
- Department of Medicine and Public Health, University of Toledo, Toledo, OH, USA
| | - George V Moukarbel
- Division of Cardiovascular Medicine, Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA.
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Weber J, Bond K, Flanagan J, Passick M, Petillo F, Pollack S, Robinson N, Petrossian G, Cao JJ, Barasch E. The Prognostic Value of Left Atrial Global Longitudinal Strain and Left Atrial Phasic Volumes in Patients Undergoing Transcatheter Valve Implantation for Severe Aortic Stenosis. Cardiology 2021; 146:489-500. [PMID: 33752215 DOI: 10.1159/000514665] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The changes and the prognostic implications of left atrial (LA) volumes (LAV), LA function, and vascular load in patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS) are less known. METHODS We enrolled 150 symptomatic patients (mean age 82 ± 8 years, 58% female, and pre-TAVI aortic valve area 0.40 ± 0.19 cm/m2) with severe AS who underwent 2D transthoracic echocardiography and 2D speckle tracking echocardiography at average 21 ± 35 days before and 171 ± 217 days after TAVI. The end point was a composite of new onset of atrial fibrillation, hospitalization for heart failure and all-cause death (major adverse cardiac events [MACE]). RESULTS After TAVI, indexed maximal LA volume and minimum volume of the LA decreased by 2.1 ± 10 mL/m2 and 1.6 ± 7 mL/m2 (p = 0.032 and p = 0.011, respectively), LA function index increased by 6.8 ± 11 units (p < 0.001), and LA stiffness decreased by 0.38 ± 2.0 (p = 0.05). No other changes in the LA phasic volumes, emptying fractions, and vascular load were noted. Post-TAVI, both left atrial and ventricular global peak longitudinal strain improved by about 6% (p = 0.01 and 0.02, respectively). MACE was reached by 37 (25%) patients after a median follow-up period of 172 days (interquartile range, 20-727). In multivariable models, MACE was associated with both pre- and post-TAVI LA global peak longitudinal strain (hazard ratio [HR] 0.75, CI 0.59-0.97; and HR 0.77, CI 0.60-1.00, per 5 percentage point units, respectively), pre-TAVI LV global endocardial longitudinal strain (HR 1.37, CI 1.02-1.83 per 5 percentage point units), and with most of the LA phasic volumes. CONCLUSION Within 6 months after TAVI, there is reverse LA remodeling and an improvement in LA reservoir function. Pre- and post-TAVI indices of LA function and volume remain independently associated with MACE. Larger studies enrolling a greater diversity of patients may provide sufficient evidence for the utilization of these imaging biomarkers in clinical practice.
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Affiliation(s)
- Jonathan Weber
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Kristine Bond
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Joseph Flanagan
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Michael Passick
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Florentina Petillo
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Simcha Pollack
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - Newell Robinson
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - George Petrossian
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA
| | - J Jane Cao
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA.,Health Sciences Center, Stony Brook University, Stony Brook, New York, USA
| | - Eddy Barasch
- Departments of Research and Cardiac Imaging, St. Francis Hospital, The Heart Center, Roslyn, New York, USA, .,Health Sciences Center, Stony Brook University, Stony Brook, New York, USA,
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Ferrara J, Deharo P, Resseguier N, Porto A, Jaussaud N, Morera P, Amanatiou C, Gariboldi V, Collart F, Cuisset T, Theron A. Rapid deployment versus trans-catheter aortic valve replacement in intermediate-risk patients: A propensity score analysis. J Card Surg 2021; 36:2004-2012. [PMID: 33686755 DOI: 10.1111/jocs.15483] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND There are insufficient studies comparing rapid deployment aortic valve replacement (RDAVR) and trans-aortic valve replacement (TAVR) in intermediate-risk patients with severe aortic stenosis (AS). AIMS We compared 2-year outcomes between RDAVR with INTUITY and TAVR with SAPIEN 3 in intermediate-risk patients with AS. METHODS Inclusion criteria were patients with severe AS at a EuroSCORE II ≥ 4%, who received RDAVR or TAVR implantation and clinical evaluation by the Heart Team. Regression adjustment for the propensity score was used to compare RDAVR and TAVR. Primary outcome was the composite criterion of death, disabling stroke, or rehospitalization. SECONDARY OUTCOMES major bleeding complications postoperation, paravalvular regurgitation ≥ 2, patient-prosthesis mismatch, and pacemaker implantation. RESULTS A total of 152 patients were included from 2012 to 2018: 48 in the RDAVR group and 104 in the TAVR group. The mean age was 82.7 ± 6.0,51.3% patients were female, the mean EuroSCORE II was 6.03 ± 1.6%, mean baseline LVEF was 56 ± 13%, mean indexed effective orifice area was 0.41 ± 0.1 cm/m2 , and the mean gradient was 51.7 ± 14.7 mmHg. RDAVR patients were younger (79.5 ± 6 years vs. 82.6 ± 6 years; p = .01), and at higher risk (EuroSCORE II, 6.61 ± 1.8% vs. 5.63 ± 1.5%; p = .005), Twenty-two patients (45.99%) in the RDAVR group and 32 (66.67%) in the TAVR group met the composite criterion. Through the 1:1 propensity score matching analysis, there was a significant difference between the groups, favoring RDAVR (HR = 0.58 [95% CI: 0.34-1.00]; p = .04). No differences were observed in terms of patient-prosthesis mismatch (0.83 [0.35-1.94]; p = .67), major bleeding events (1.33 [0.47-3.93]; p = .59), paravalvular regurgitation ≥ 2 (0.33[0-6.28]; p = .46), or pacemaker implantation (0.84 [0.25-2.84]; p = .77) CONCLUSION: RDAVR was associated with better 2-year outcomes than TAVR in intermediate-risk patients with severe symptomatic AS.
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Affiliation(s)
- Jérome Ferrara
- Department of Cardiology, La Timone Hospital, Marseille, France
| | - Pierre Deharo
- Department of Cardiology, La Timone Hospital, Marseille, France
| | | | - Alizée Porto
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Nicolas Jaussaud
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Pierre Morera
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Cécile Amanatiou
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Frederic Collart
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
| | - Thomas Cuisset
- Department of Cardiology, La Timone Hospital, Marseille, France
| | - Alexis Theron
- Department of Cardiac Surgery, La Timone Hospital, Marseille, France
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Shimura T, Yamamoto M, Yamaguchi R, Adachi Y, Sago M, Tsunaki T, Kagase A, Koyama Y, Otsuka T, Yashima F, Tada N, Naganuma T, Yamawaki M, Yamanaka F, Shirai S, Mizutani K, Tabata M, Ueno H, Takagi K, Watanabe Y, Hayashida K. Calculated plasma volume status and outcomes in patients undergoing transcatheter aortic valve replacement. ESC Heart Fail 2021; 8:1990-2001. [PMID: 33666353 PMCID: PMC8120354 DOI: 10.1002/ehf2.13270] [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: 08/12/2020] [Revised: 10/31/2020] [Accepted: 02/08/2021] [Indexed: 01/23/2023] Open
Abstract
Aims This study investigated the prognostic value of plasma volume status (PVS) in patients who underwent transcatheter aortic valve replacement (TAVR). Methods and results Plasma volume status was calculated in 2588 patients who underwent TAVR using data from the Japanese multicentre registry. All‐cause mortality and heart failure hospitalization (HFH) within 2 years of TAVR were compared among the PVS quartiles (Q1, PVS < 5.5%; Q2, PVS 5.5–13.5%; Q3, PVS 13.5–21.0%; and Q4, PVS ≥ 21.0%). Subgroups were stratified by the PVS cut‐off value combined with the New York Heart Association (NYHA) class as follows: low PVS with NYHA I/II (n = 959), low PVS with NYHA III/IV (n = 845), high PVS with NYHA I/II (n = 308), and high PVS with NYHA III/IV (n = 476). The cumulative all‐cause mortality and HFH within 2 years of TAVR significantly increased with increasing PVS quartiles [8.5%, 16.8%, 19.2%, and 27.0% (P < 0.001) and 5.8%, 8.7%, 10.3%, and 12.9% (P < 0.001), respectively]. The high‐PVS group regardless of the NYHA class had a higher all‐cause mortality and HFH [9.6%, 18.2%, 24.5%, and 30.4% (P < 0.001) and 6.1%, 10.4%, 14.1%, and 11.3% (P < 0.001)]. In a Cox regression multivariate analysis, the PVS values of Q3 and Q4 had independently increased all‐cause mortality [hazard ratio (HR), 1.50 and 1.64 (P = 0.017 and P = 0.008), respectively], and Q4 had independently increased HFH (HR, 1.98, P = 0.005). The low PVS with NYHA III/IV, high PVS with NYHA I/II, and high PVS with NYHA III/IV also had significantly increased all‐cause mortality [HR, 1.45, 1.73, and 1.86 (P = 0.006, P = 0.002, and P < 0.001), respectively] and HFH [HR, 1.52, 2.21, and 1.70 (P = 0.049, P = 0.002, and P = 0.031), respectively]. Conclusions Plasma volume status is useful for predicting all‐cause mortality and HFH after TAVR.
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Affiliation(s)
- Tetsuro Shimura
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan.,Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Ryo Yamaguchi
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan
| | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan
| | - Mitsuru Sago
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan
| | - Tatsuya Tsunaki
- Department of Cardiology, Toyohashi Heart Center, 21-1 Gobudori, Oyamachyo, Toyohashi, Aichi, 441-8530, Japan
| | - Ai Kagase
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Yutaka Koyama
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan.,Center for Clinical Research, Nippon Medical School Hospital, Tokyo, Japan
| | - Fumiaki Yashima
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan.,Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Norio Tada
- Department of Cardiology, Sendai Kosei Hospital, Sendai, Japan
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Matsudo, Chiba, Japan
| | - Masahiro Yamawaki
- Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan
| | - Futoshi Yamanaka
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Kanagawa, Japan
| | - Shinichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan
| | - Kazuki Mizutani
- Department of Cardiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Hiroshi Ueno
- Department of Cardiology, Toyama University Hospital, Toyama, Japan
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Romeo FJ, Seropian IM, Chiabrando JG, Raleigh JV, Smietniansky M, Cal M, Falconi M, Kotowicz V, Agatiello CR, Berrocal DH. Additive prognostic value of carbohydrate antigen-125 over frailty in patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2021; 97:E263-E273. [PMID: 32597028 DOI: 10.1002/ccd.29067] [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] [Received: 04/14/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND To evaluate the additive prognostic value of myocardial, inflammatory, and renal biomarkers according to frailty status in patients undergoing transcatheter aortic valve replacement (TAVR) for aortic stenosis (AS). METHODS A total of 111 subjects who underwent TAVR at Hospital Italiano de Buenos Aires, Argentina between January 2016 and December 2018 were retrospectively reviewed. Plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high sensitivity troponin T (hs-cTnT), C-reactive protein (CRP), cystatin-c (Cys-C) and carbohydrate antigen-125 (CA-125) were assessed prior to TAVR. Frailty status was assessed according to the fried physical frailty phenotype (FPFP). The primary endpoint was defined as all-cause death and/or readmission for worsening congestive heart failure (CHF) within the first year after TAVR. RESULTS Of the 111 patients included, 48/111 (43%) were considered to be "frail" according to the FPFP. Among biomarkers, we found CA-125 to be strongly associated with the primary endpoint (p = .006). CA-125 ≥ 18.2 U/ml was present in 41% and was associated with a higher rate of the primary endpoint (31% vs. 9%; p = .003). After multivariable adjustment, CA-125 ≥ 18.2 U/ml (hazard ratio [HR] 3.17; p = .024) was the only independent predictor of the primary endpoint. Finally, the inclusion of CA-125 to frailty significantly improved C-index (0.68-0.74; p < .05), and provided a Net Reclassification Improvement (NRI) of 0.34 (95% CI 0.19-0.49, p = .031), largely through reductions in risk estimates among pre-frail and frail patients. CONCLUSIONS CA-125, a tumor biomarker, outperformed frailty for predicting the primary endpoint within the first year after TAVR.
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Affiliation(s)
- Francisco José Romeo
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Miguel Seropian
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Guido Chiabrando
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Valle Raleigh
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maximiliano Smietniansky
- Department of Internal Medicine and Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariela Cal
- Department of Internal Medicine and Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariano Falconi
- Department of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Vadim Kotowicz
- Department of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carla Romina Agatiello
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Horacio Berrocal
- Department of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Sun Y, Li J, Li G, Fan R, Luo J. Impact of renin-angiotensin system inhibitors on outcomes after transcatheter aortic valve replacement: A meta-analysis. Catheter Cardiovasc Interv 2021; 97:E88-E94. [PMID: 32311209 DOI: 10.1002/ccd.28899] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/10/2020] [Accepted: 03/30/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES We aimed to evaluate the impact of renin-angiotensin system (RAS) inhibitors on outcomes after transcatheter aortic valve replacement (TAVR). BACKGROUND The impact of RAS inhibitors on outcomes after TAVR was unclear. METHODS A systematic review of articles comparing outcomes of patients using and not using RAS inhibitors after TAVR was performed through PubMed, Embase, and Cochrane. Primary outcome was midterm all-cause mortality. Risk ratios (RRs) were calculated with the corresponding 95% confidence interval using random effect models. RESULTS Five studies with 23,319 patients were included. Patients treated with RAS inhibitors had lower midterm all-cause mortality after TAVR than those without RAS inhibitors in both the unmatched (13.3 vs. 17.2%, RR 0.77, p = .005) and propensity score matched cohorts (13.5 vs 16.2%, RR 0.83, p < .001). Cardiovascular mortality (10.4 vs. 15.6%, RR 0.68, p < .001), rate of heart failure readmission (12.2 vs. 14.5%, RR 0.80, p = .006), and new-onset atrial fibrillation (14.0 vs. 23.7%, RR 0.73, p = .003) were also lower with RAS inhibitors. No difference was found between two groups regarding cerebrovascular events, myocardial infarction, major bleeding, major vascular complications, acute kidney injury, permanent pacemaker implantation, and moderate/severe paravalvular aortic regurgitation. CONCLUSIONS RAS inhibitors were associated with lower midterm all-cause mortality after TAVR.
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Affiliation(s)
- Yinghao Sun
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Jie Li
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Guang Li
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Ruixin Fan
- Department of Cardiovascular surgery, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
| | - Jianfang Luo
- Department of Cardiology, Vascular Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, People's Republic of China
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Yerasi C, Tripathi B, Wang Y, Forrestal BJ, Case BC, Khan JM, Torguson R, Ben-Dor I, Satler LF, Garcia-Garcia HM, Weintraub WS, Rogers T, Waksman R. National trends and 30-day readmission rates for next-day-discharge transcatheter aortic valve replacement: An analysis from the Nationwide Readmissions Database, 2012-2016. Am Heart J 2021; 231:25-31. [PMID: 33091365 DOI: 10.1016/j.ahj.2020.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/28/2020] [Indexed: 01/27/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has evolved toward a minimalist approach, resulting in shorter hospital stays. Real-world trends of next-day discharge (NDD) TAVR are unknown. This study aimed to evaluate underlying trends and readmissions of NDD TAVR. METHODS This study was derived from the Nationwide Readmissions Database from 2012 to 2016. International Classification of Diseases, Ninth and Tenth Revisions, codes were used to identify patients. Any discharge within 1 day of admission was identified as NDD. NDD TAVR trends over the years were analyzed, and any admissions within 30 days were considered readmissions. A hierarchical logistic regression model was used to identify predictors of readmission. RESULTS Of 49,742 TAVR procedures, 3,104 were NDD. The percentage of NDD TAVR increased from 1.5% (46/3,051) in 2012 to 12.2% (2,393/19,613) in 2016. However, the 30-day readmission rate remained the same over the years (8.6%). The patients' mean age was 80.3 ± 8.4 years. Major readmission causes were heart-failure exacerbation (16%), infections (9%), and procedural complications (8%). In 2016, there were significantly higher late conduction disorder and gastrointestinal bleeding readmission rates than in 2012-2015. Significant predictors of readmission were anemia, baseline conduction disease, cardiac arrhythmias, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, neoplastic disorders, and discharge to facility. CONCLUSIONS The percentage of NDD TAVR increased over the years; however, readmission rates remained the same, with a higher rate of conduction abnormality-related hospitalizations in 2016. Careful discharge planning that includes identification of baseline factors that predict readmission and knowledge of etiologies may further prevent 30-day readmissions.
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Gamet A, Chatelin A, Mergy J, Bécat P, Roumegou P, Christiaens L. Does Aortic Valve Calcium Score Still Predict Death, Cardiovascular Outcomes, and Conductive Disturbances after Transcatheter Aortic Valve Replacement with New-Generation Prostheses? J Cardiovasc Echogr 2020; 30:88-92. [PMID: 33282646 PMCID: PMC7706368 DOI: 10.4103/jcecho.jcecho_9_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/26/2020] [Accepted: 06/06/2020] [Indexed: 12/29/2022] Open
Abstract
Background The development of transcatheter aortic valve replacement (TAVR) has led to an improvement in morbidity-mortality in the treatment of severe aortic stenosis in patients at high surgical risk. However, the procedure is not free from life-threatening cardiovascular outcomes and conductive disturbances. The objective of our study was to analyze the prognostic impact of aortic valve calcium score on the occurrence of complications following the procedure. Materials and Methods Patients who have benefited from TAVR with the implantation of new-generation Sapien 3 and Evolut R aortic valve prostheses between January 2017 and July 2018 with the prior realization of a cardiac computed tomography with measurement of the aortic valve calcium score were retrospectively analyzed. Primary endpoint was a composite of death, stroke, and myocardial infarction within a period of 1 month after TAVR. Relation between valvular calcium and conductive disturbances was secondarily analyzed over the same period, and occurrences of high-degree atrioventricular block (paroxysmal or permanent), new-onset left bundle branch block, and the need for permanent or transient cardiac stimulation were associated with the secondary endpoint. Results Overall, 144 patients were included. The aortic valve calcium score was not significantly higher in patients who reached the primary endpoint (2936 ± 1235 vs. 3051 ± 1440, P = 0.93). Among the 106 patients analyzed after excluding subjects with a prior pacemaker or left bundle branch block, aortic valvular calcium score was not statistically associated with the occurrence of conduction disturbances (3210 ± 1436 vs. 2948 ± 1223, P = 0.31). Conclusion Our results suggest that the measurement of aortic valve calcium score has no prognostic value regarding mortality, cardiovascular events, or conductive disturbances after TAVR using the new generation of valves.
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Affiliation(s)
- Alexandre Gamet
- Department of Cardiology, Centre Régional Cardio-Vasculaire, CHU De Poitiers, Poitiers, France
| | - Adeline Chatelin
- Department of Cardiology, Centre Régional Cardio-Vasculaire, CHU De Poitiers, Poitiers, France
| | - Jean Mergy
- Department of Cardiology, Centre Régional Cardio-Vasculaire, CHU De Poitiers, Poitiers, France
| | - Pauline Bécat
- Department of Cardiology, Centre Régional Cardio-Vasculaire, CHU De Poitiers, Poitiers, France
| | - Pierre Roumegou
- Department of Cardiology, Centre Régional Cardio-Vasculaire, CHU De Poitiers, Poitiers, France
| | - Luc Christiaens
- Department of Cardiology, Centre Régional Cardio-Vasculaire, CHU De Poitiers, Poitiers, France
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Okai T, Mizutani K, Hara M, Yamaguchi T, Ogawa M, Ito A, Iwata S, Izumiya Y, Takahashi Y, Shibata T, Yoshiyama M. Presence of mitral stenosis is a risk factor of new development of acute decompensated heart failure early after transcatheter aortic valve implantation. Open Heart 2020; 7:openhrt-2020-001348. [PMID: 33020257 PMCID: PMC7537436 DOI: 10.1136/openhrt-2020-001348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/10/2020] [Accepted: 08/24/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS Acute decompensated heart failure (ADHF) can occur early after transcatheter aortic valve implantation (TAVI), but the risk factors or mechanisms associated with it have not been fully determined. This hypothesis-generating study aimed to investigate the clinical indices associated with the development of ADHF within 72 hours after TAVI and to improve procedural approaches for TAVI. METHOD AND RESULTS In this single-centre hypothesis generating prospective observational study, we enrolled 156 consecutive patients with severe aortic stenosis who underwent TAVI between January 2016 and February 2018 at our institution. We set the primary endpoint as the new development of ADHF within 72 hours after TAVI, and clinical indices associated with it were evaluated using a multivariable logistic model. The median age of the patients was 83 (quartile range 80-86) years, 48 (30.8%) were men and the median Society of Thoracic Surgery-Predicted Risk of Mortality was 7.1 (range 5.2-10.4). Mitral stenosis (MS), defined as mean transmitral valve pressure gradient ≥5 mm Hg, was present in 15 (9.6%) patients. After TAVI, the invasive mean transaortic valve pressure gradient (mAVPG) decreased from 48 (36-66) to 7 (5-11) mm Hg, and 12 (7.7%) patients developed ADHF within 72 hours after TAVI. Multivariable logistic regression analysis showed that MS (adjusted OR, 14.227; 95% CI 2.654 to 86.698; p=0.002) and greater decreases in mAVPG (1.038; 1.003 to 1.080; p=0.044) were associated with ADHF. CONCLUSIONS MS and drastic improvement of mAVPG were associated with new development of ADHF within 72 hours after TAVI.
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Affiliation(s)
- Tsukasa Okai
- Cardiovascular Medicine, Osaka City University, Osaka, Japan
| | - Kazuki Mizutani
- Cardiology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Masahiko Hara
- Department of Cardiovascular Medicine, Shimane University Faculty of Medicine Graduate School of Medicine, Izumo, Japan
| | | | - Mana Ogawa
- Cardiovascular Medicine, Osaka City University, Osaka, Japan
| | - Asahiro Ito
- Cardiovascular Medicine, Osaka City University, Osaka, Japan
| | - Shinichi Iwata
- Cardiovascular Medicine, Osaka City University, Osaka, Japan
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Cantey EP, Chang KY, Blair JEA, Brummel K, Sweis RN, Pham DT, Adi AC, Churyla A, Ricciardi MJ, Malaisrie SC, Davidson CJ, Flaherty JD. Impact of Loop Diuretic Use on Outcomes Following Transcatheter Aortic Valve Implantation. Am J Cardiol 2020; 131:67-73. [PMID: 32723557 DOI: 10.1016/j.amjcard.2020.06.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 11/30/2022]
Abstract
The use of LDT may signify significant hemodynamic changes and left ventricular remodeling in severe aortic stenosis (AS). Therefore, we sought to determine whether loop diuretic therapy (LDT) is associated with adverse outcomes following transcatheter aortic valve implantation (TAVI) in patients with severe symptomatic AS. Subjects undergoing TAVI at a single institution from June 2008 to December 2017 were analyzed. LDT doses were normalized to oral furosemide daily equivalents. All outcomes were adjudicated using VARC2 criteria. Descriptive statistics, multivariate logistic regression, and propensity score matching were used. Of the 804 subjects studied, 48.3% were on pre-TAVI LDT with a mean dose of 51.1 mg furosemide dose-equivalents. Subjects on LDT were higher risk, frail patients with more co-morbidities including chronic kidney disease, coronary artery disease requiring prior bypass grafting, peripheral arterial disease, atrial fibrillation or flutter, and diabetes with more severe heart failure symptoms. Those on LDT also had worse left ventricular systolic function, lower transvalvular gradients, and markers of adverse left ventricular remodeling, including increased left ventricular mass index and higher rates of concentric and eccentric hypertrophy. On propensity-score matching, death within one year post-TAVI was borderline significantly higher in the pre-LDT as compared with no-LDT group (16.9% vs 10.4 %, p = 0.068). In conclusion, use of pre-TAVI LDT for severe symptomatic AS is associated with a trend towards worse 1-year mortality and is a marker of high-risk, frail individuals with advanced left ventricular remodeling.
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Affiliation(s)
- Eric P Cantey
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Kevin Y Chang
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - John E A Blair
- University of Chicago Medicine, Section of Cardiology, Department of Medicine, Chicago, Illinois
| | - Kent Brummel
- University of Chicago Medicine, Section of Cardiology, Department of Medicine, Chicago, Illinois
| | - Ranya N Sweis
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Duc T Pham
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Adin-Christian Adi
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Andrei Churyla
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Mark J Ricciardi
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - S Chris Malaisrie
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - Charles J Davidson
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois
| | - James D Flaherty
- Bluhm Cardiovascular Institute Northwestern University Feinberg School of Medicine, Division of Cardiology and Cardiothoraci, Depatment of Medicine, Chicago, Illinois.
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Mogadam E, Shavelle DM, Giesler GM, Economides C, Lidia SP, Duquette S, Matthews RV, Pahlevan NM. Intrinsic frequency method for instantaneous assessment of left ventricular-arterial coupling after transcatheter aortic valve replacement. Physiol Meas 2020; 41:085002. [DOI: 10.1088/1361-6579/aba67f] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Zafar MR, Mustafa SF, Miller TW, Alkhawlani T, Sharma UC. Outcomes after transcatheter aortic valve replacement in cancer survivors with prior chest radiation therapy: a systematic review and meta-analysis. CARDIO-ONCOLOGY 2020; 6:8. [PMID: 32685198 PMCID: PMC7359474 DOI: 10.1186/s40959-020-00062-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022]
Abstract
Background Cancer survivors with prior chest radiation therapy (C-XRT) frequently present with aortic stenosis (AS) as the first manifestation of radiation-induced heart disease. They are considered high-risk for surgical valve replacement. Transcatheter aortic valve replacement (TAVR) is as an attractive option for this patient population but the outcomes are not well established in major clinical trials. The authors performed a systemic review and meta-analysis of clinical studies for the outcomes after TAVR in cancer survivors with prior C-XRT. Methods Online databases were searched from inception to April 2020 for studies evaluating the outcomes of TAVR in patients with and without C-XRT. We analyzed the pooled estimates (with their 95% confidence intervals) of the odds ratio (OR) for the all-cause mortality at 30-day and 1-year follow-ups, 4-point safety outcomes (stroke, major bleed, access-related vascular complications and need for a pacemaker), a 2-point efficacy outcome (mean aortic valve gradient and left ventricular ejection fraction) and worsening of congestive heart failure (CHF). Four studies were included following 2054 patients with and without prior C-XRT exposure (164 patients and 1890 patients respectively). Results The C-XRT group had similar 30-day mortality compared to the control group (OR 1.29, 95% CI 0.64 to 2.58, p = 0.48). The 1-year mortality was higher in the C-XRT group (OR 1.97, CI 1.15 to 3.39, p = 0.01). Apart from higher congestive heart failure (CHF) exacerbation in the C-XRT group (OR 2.03, CI 1.36 to 3.04, p = 0.0006), TAVR resulted in similar safety and efficacy outcomes in both groups. Conclusion TAVR in the C-XRT group has similar 30-day mortality, safety, and efficacy outcomes compared to the control group; however, they have higher 1-year mortality and CHF exacerbation. Including an oncologist to the cardiology team who considers cancer stage in the decision-making process and applying additional preoperative scores such as frailty indices may refine the risk assessment for these patients. The quality of analyzed data is modest, warranting randomized trials to assess the true benefits of TAVR in these patients.
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Affiliation(s)
- Meer Rabeel Zafar
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
| | | | - Timothy W Miller
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
| | - Talal Alkhawlani
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
| | - Umesh C Sharma
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
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Auffret V, Bakhti A, Leurent G, Bedossa M, Tomasi J, Belhaj Soulami R, Verhoye JP, Donal E, Galli E, Loirat A, Sharobeem S, Sost G, Le Guellec M, Boulmier D, Le Breton H. Determinants and Impact of Heart Failure Readmission Following Transcatheter Aortic Valve Replacement. Circ Cardiovasc Interv 2020; 13:e008959. [DOI: 10.1161/circinterventions.120.008959] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Heart failure (HF) readmission is common post–transcatheter aortic valve replacement (TAVR). Nonetheless, limited data are available regarding its predictors and clinical impact. This study evaluated the incidence, predictors, and impact of HF readmission within 1-year post-TAVR, and assessed the effects of the prescription of HF therapies at discharge on the risk of HF readmission and death.
Methods:
Patients included in the TAVR registry of a single expert center from 2009 to 2017 were analyzed. Competing-risk and Cox regressions were performed to identify predictors of HF readmission and death.
Results:
Among 750 patients, 102 (13.6%) were readmitted for HF within 1-year post-TAVR. Overall, 53 patients (7.1%) experienced late readmissions (>30 days post-TAVR), and 17 (2.3%) had multiple readmissions. In ≈30% of readmissions, no trigger could be identified. Predominant causes of readmissions were changes in medication/nonadherence and supraventricular arrhythmia. Independent predictors of HF readmission included diabetes mellitus, chronic lung disease, previous acute HF, grade III or IV aortic regurgitation, and pulmonary hypertension both at discharge from the index hospitalization but not HF therapies. Overall, HF readmission did not significantly impact all-cause mortality (hazard ratio [HR], 1.36 [95% CI, 0.99–1.85]). However, late (HR, 1.90 [95% CI, 1.30–2.78]) and multiple HF readmissions (HR, 2.10 [95% CI,1.17–3.76]) were significantly associated with all-cause mortality. Prescription of renin-angiotensin system inhibitors at discharge was associated with a lower rate of all-cause mortality, especially among patients receiving doses of 25% to <50% (HR, 0.67 [95% CI, 0.48–0.94]) and 75% to 100% (HR, 0.61 [95% CI, 0.37–0.98]) of the optimal daily dose.
Conclusions:
HF readmission is common within 1-year of TAVR. Late and multiple HF readmissions associate with an increased risk of long-term all-cause mortality. Baseline comorbidities (diabetes, chronic lung disease, previous acute HF) and echocardiographic findings at discharge (grade III or IV aortic regurgitation, pulmonary hypertension) identified patients at high risk of HF readmission.
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Affiliation(s)
- Vincent Auffret
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Abdelkader Bakhti
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Guillaume Leurent
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Marc Bedossa
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Jacques Tomasi
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Reda Belhaj Soulami
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Jean-Philippe Verhoye
- Université de Rennes 1, CHU Rennes Service de Chirurgie Cardiaque, Inserm LTSI U1099, F 35000 Rennes, France (J.T., R.B.S., J.-P.V.)
| | - Erwan Donal
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Elena Galli
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Aurélie Loirat
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Sam Sharobeem
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Gwenaelle Sost
- Université de Rennes 1, CHU Rennes Service de Gériatrie, F 35000 Rennes, France (G.S.)
| | - Marielle Le Guellec
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Dominique Boulmier
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
| | - Hervé Le Breton
- Université de Rennes 1, CHU Rennes Service de Cardiologie, Inserm LTSI U1099, F 35000 Rennes, France (V.A., A.B., G.L., M.B., E.D., E.G., A.L., S.S., M.L.G., D.B., H.L.B.)
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Cid-Menéndez A, López-Otero D, González-Ferreiro R, Iglesias-Álvarez D, Álvarez-Rodríguez L, Antúnez-Muiños PJ, Cid-Álvarez B, Sanmartin-Pena X, Trillo-Nouche R, González-Juanatey JR. Predictores e impacto pronóstico de la insuficiencia cardiaca tras el implante percutáneo de válvula aórtica con una prótesis autoexpandible. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Kalyoncuoglu M, Ozturk S. Is the Newly Defined R2CHA2DS2-Vasc Score a Predictor for Late Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement? Braz J Cardiovasc Surg 2020; 35:145-154. [PMID: 32369293 PMCID: PMC7199995 DOI: 10.21470/1678-9741-2019-0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To assess the performance of the modified R2CHA2DS2-VASc score for predicting mid-to-long-term mortality (> 30 days) in patients undergoing transcatheter aortic valve replacement (TAVR). Methods Data of 78 patients who underwent TAVR were retrospectively reviewed. R2CHA2DS2-VASc score was compared with the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II or ES II) and the transcatheter valve therapytranscatheter aortic valve replacement (TVT-TAVR) risk score. Results The mean follow-up period was 17.4±9.9 months (maximum 37 months). Early mortality (first 30 days) was observed in 10 (12.8%) patients, whereas mid-to-long-term mortality (> 30 days) was observed in 26 (33.3%) patients. Non-survivors had higher values of R2CHA2DS2-VASc, ES II, and TAVR scores than survivors (P<0.001, P<0.001, and P=0.001, respectively). Analysis of Pearson’s correlation revealed that R2CHA2DS2-VASc score was moderately correlated with ES II and TAVR scores (r=0.51, P<0.001; r=0.44, P=0.001, respectively). Pairwise comparisons of R2CHA2DS2-VASc (area under the curve [AUC]: 0.870, 95% confidence interval [CI]: 0.776-0.964; P<0.001), ES II (AUC: 0.801, 95% CI: 0.703-0.899; P<0.001), and TAVR scores (AUC: 0.730, 95% CI: 0.610-852; P=0.002) showed similar accuracy for predicting mortality. R2CHA2DS2-VASc score is an independent predictor of mortality in multivariable Cox regression analysis. A cutoff value of six for R2CHA2DS2-VASc score showed a sensitivity of 74% and a specificity of 89% for predicting mid-to-long-term mortality. Conclusion R2CHA2DS2-VASc score, easily calculated from clinical parameters, is associated with prediction of mid-to-longterm mortality in patients undergoing TAVR.
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Affiliation(s)
- Muhsin Kalyoncuoglu
- University of Health Sciences Haseki Training and Reseach Hospital Department of Cardiology Istanbul Turkey Department of Cardiology, Haseki Training and Reseach Hospital, University of Health Sciences, Istanbul, Turkey
| | - Semi Ozturk
- University of Health Sciences Haseki Training and Reseach Hospital Department of Cardiology Istanbul Turkey Department of Cardiology, Haseki Training and Reseach Hospital, University of Health Sciences, Istanbul, Turkey
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50
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Romeo FJ, Seropian IM, Arora S, Vavalle JP, Falconi M, Oberti P, Kotowicz V, Agatiello CR, Berrocal DH. Prognostic impact of myocardial contraction fraction in patients undergoing transcatheter aortic valve replacement for aortic stenosis. Cardiovasc Diagn Ther 2020; 10:12-23. [PMID: 32175223 DOI: 10.21037/cdt.2019.05.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Myocardial contraction fraction (MCF), a volumetric measurement of myocardial shortening, may help to improve risk stratification in patients with severe aortic stenosis (AS) referred for transcatheter aortic valve replacement (TAVR) especially in those with preserved left ventricular ejection fraction (LVEF). We investigated the association between MCF and 1-year all-cause mortality in patients with severe AS who underwent TAVR. Methods MCF was calculated as the ratio of stroke volume (SV) to myocardial volume. Patients referred for TAVR from 2011 to 2015 were eligible for inclusion and were divided into two groups according to the estimated MCF (MCF ≤30% vs. MCF >30%). The primary endpoint was 1-year all-cause mortality. A Cox regression analysis was performed for independent risk factors of mortality. Receiver operating curve (ROC) was performed for assessing the best cut-off point of MCF for predicting the primary outcome [area under the curve (AUC) 0.60; 95% confidence interval (CI): 0.453-0.725]. Baseline patient and echo characteristics were included for multivariate analysis. Results Of 126 patients (mean age 82±5 years, 45.2% male), 44.4% showed MCF ≤30%. Patient with reduced MCF showed higher body mass index (28.1±5.8 vs. 26.0±4.5 kg/m2, P=0.031), higher surgical EuroScore II (6.2±4.5 vs. 4.7±3.2, P=0.032), lower LVEF (54.2%±11.9% vs. 58.5%±10.8%, P=0.042) and more severe AS (indexed aortic valve area 0.40±0.09 vs. 0.45±0.10 cm2/m2, P=0.030). The median follow-up was of 14 [3.5-33] months, and 16% of patients died. Patients with MCF ≤30% showed significantly increased all-cause mortality (Log-rank P=0.002). In a multivariate model adjusting for clinical and echo variables, MCF ≤30% was independently associated with increased risk for all-cause 1-year mortality [hazard ratio (HR) 2.76, 95% CI: 1.03-7.77, P=0.04]. Conclusions In a population of patients undergoing TAVR, MCF ≤30% was independently associated with increased mortality.
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Affiliation(s)
- Francisco J Romeo
- Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio M Seropian
- Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sameer Arora
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - John P Vavalle
- Division of Cardiology, University of North Carolina, Chapel Hill, NC, USA
| | - Mariano Falconi
- Division of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Oberti
- Division of Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Vadim Kotowicz
- Division of Cardiovascular Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carla R Agatiello
- Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel H Berrocal
- Division of Interventional Cardiology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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