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Efremov S, Zagatina A, Filippov A, Ryadinskiy M, Novikov M, Shmatov D. Left Ventricular Diastolic Dysfunction in Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00435-X. [PMID: 39069379 DOI: 10.1053/j.jvca.2024.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/19/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024]
Abstract
Cardiac relaxation is a complex process that involves various interconnected characteristics and, along with contractile properties, determines stroke volume. Perioperative ischemia-reperfusion injury and left ventricular diastolic dysfunction (DD) are characterized by the left ventricle's inability to receive a sufficient blood volume under adequate preload. Baseline DD and perioperative DD have an impact on postoperative complications, length of hospital stay, and major clinical outcomes in a variety of cardiac pathologies. Several baseline and perioperative factors, such as age, female sex, hypertension, left ventricle hypertrophy, diabetes, and perioperative ischemia-reperfusion injury, contribute to the risk of DD. The recommended diagnostic criteria available in guidelines have not been validated in the perioperative settings and still need clarification. Timely diagnosis of DD might be crucial for effectively treating postoperative low cardiac output syndrome. This implies the need for an individualized approach to fluid infusion strategy, cardiac rate and rhythm control, identification of extrinsic causes, and administration of drugs with lusitropic effects. The purpose of this review is to consolidate scattered information on various aspects of diastolic dysfunction in cardiac surgery and provide readers with well-organized and clinically applicable information.
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Affiliation(s)
- Sergey Efremov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation.
| | - Angela Zagatina
- Cardiology Department, Research Cardiology Center "Medika", Saint Petersburg, Russian Federation
| | - Alexey Filippov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Mikhail Ryadinskiy
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Maxim Novikov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Dmitry Shmatov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
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Reiter C, Reiter U, Kräuter C, Kolesnik E, Scherr D, Schmidt A, Fuchsjäger M, Reiter G. MR 4D flow-derived left atrial acceleration factor for differentiating advanced left ventricular diastolic dysfunction. Eur Radiol 2024; 34:4065-4076. [PMID: 37953367 PMCID: PMC11166802 DOI: 10.1007/s00330-023-10386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES The magnetic resonance (MR) 4D flow imaging-derived left atrial (LA) acceleration factor α was recently introduced as a means to non-invasively estimate LA pressure. We aimed to investigate the association of α with the severity of left ventricular (LV) diastolic dysfunction using echocardiography as the reference method. METHODS Echocardiographic assessment of LV diastolic function and 3-T cardiac MR 4D flow imaging were prospectively performed in 94 subjects (44 male/50 female; mean age, 62 ± 12 years). LA early diastolic peak outflow velocity (vE), systolic peak inflow velocity (vS), and early diastolic peak inflow velocity (vD) were evaluated from 4D flow data. α was calculated from α = vE / [(vS + vD) / 2]. Mean parameter values were compared by t-test; diagnostic performance of α in predicting diastolic (dys)function was investigated by receiver operating characteristic curve analysis. RESULTS Mean α values were 1.17 ± 0.14, 1.20 ± 0.08, 1.33 ± 0.15, 1.77 ± 0.18, and 2.79 ± 0.69 for grade 0 (n = 51), indeterminate (n = 9), grade I (n = 13), grade II (n = 13), and grade III (n = 8) LV diastolic (dys)function, respectively. α differed between subjects with non-advanced (grade < II) and advanced (grade ≥ II) diastolic dysfunction (1.20 ± 0.15 vs. 2.16 ± 0.66, p < 0.001). The area under the curve (AUC) for detection of advanced diastolic dysfunction was 0.998 (95% CI: 0.958-1.000), yielding sensitivity of 100% (95% CI: 84-100%) and specificity of 99% (95% CI: 93-100%) at cut-off α ≥ 1.58. The AUC for differentiating grade III diastolic dysfunction was also 0.998 (95% CI: 0.976-1.000) at cut-off α ≥ 2.14. CONCLUSION The 4D flow-derived LA acceleration factor α allows grade II and grade III diastolic dysfunction to be distinguished from non-advanced grades as well as from each other. CLINICAL RELEVANCE STATEMENT As a single continuous parameter, the 4D flow-derived LA acceleration factor α shows potential to simplify the multi-parametric imaging algorithm for diagnosis of advanced LV diastolic dysfunction, thereby identifying patients at increased risk for cardiovascular events. KEY POINTS • Detection of advanced diastolic dysfunction is typically performed using a complex, multi-parametric approach. • The 4D flow-derived left atrial acceleration factor α alone allows accurate detection of advanced left ventricular diastolic dysfunction. • As a single continuous parameter, the left atrial acceleration factor α could simplify the diagnosis of advanced diastolic dysfunction.
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Affiliation(s)
- Clemens Reiter
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria.
| | - Corina Kräuter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Gert Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
- Research and Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria
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Yan T, Wang L, Chen X, Yin H, He W, Liu J, Liu S, Li X, Wang Y, Peng L. Predicting Left Ventricular Adverse Remodeling After Transcatheter Aortic Valve Replacement: A Radiomics Approach. Acad Radiol 2024:S1076-6332(24)00238-1. [PMID: 38821814 DOI: 10.1016/j.acra.2024.04.029] [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: 01/01/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 06/02/2024]
Abstract
RATIONALE AND OBJECTIVES To develop a radiomics model based on cardiac computed tomography (CT) for predicting left ventricular adverse remodeling (LVAR) in patients with severe aortic stenosis (AS) who underwent transcatheter aortic valve replacement (TAVR). MATERIALS AND METHODS Patients with severe AS who underwent TAVR from January 2019 to December 2022 were recruited. The cohort was divided into adverse remodeling group and non-adverse remodeling group based on LVAR occurrence, and further randomly divided into a training set and a validation set at an 8:2 ratio. Left ventricular radiomics features were extracted from cardiac CT. The least absolute shrinkage and selection operator regression was utilized to select the most relevant radiomics features and clinical features. The radiomics features were used to construct the Radscore, which was then combined with the selected clinical features to build a nomogram. The predictive performance of the models was evaluated using the area under the curve (AUC), while the clinical value of the models was assessed using calibration curves and decision curve analysis. RESULTS A total of 273 patients were finally enrolled, including 71 with adverse remodeling and 202 with non-adverse remodeling. 12 radiomics features and five clinical features were extracted to construct the radiomics model, clinical model, and nomogram, respectively. The radiomics model outperformed the clinical model (training AUC: 0.799 vs. 0.760; validation AUC: 0.766 vs. 0.755). The nomogram showed highest accuracy (training AUC: 0.859, validation AUC: 0.837) and was deemed most clinically valuable by decision curve analysis. CONCLUSION The cardiac CT-based radiomics features could predict LVAR after TAVR in patients with severe AS.
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Affiliation(s)
- Tingli Yan
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Department of Radiology, Chengdu Universal Dicom Medical Imaging Diagnostic Center, Chengdu, China
| | - Lujing Wang
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoyi Chen
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Hongkun Yin
- Infervision Medical Technology 9Co., Ltd, Beijing, China
| | - Wenzhang He
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Jing Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Shengmei Liu
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Xue Li
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Yinqiu Wang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Liqing Peng
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China.
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Belin RJ, Desa TB, Wroblewski I, Joyce C, Perez-Tamayo A, Schwartz J, Steen LH, Lopez JJ, Lewis BE, Leya FS, Tuchek M, Bakhos M, Mathew V. Diastolic dysfunction and clinical outcomes after transcatheter or surgical aortic valve replacement in patients with atypical aortic valve stenosis. J Cardiovasc Med (Hagerstown) 2024; 25:318-326. [PMID: 38488066 DOI: 10.2459/jcm.0000000000001597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Diastolic dysfunction is a predictor of poor outcomes in many cardiovascular conditions. At present, it is unclear whether diastolic dysfunction predicts adverse outcomes in patients with atypical aortic stenosis who undergo aortic valve replacement (AVR). METHODS Five hundred and twenty-three patients who underwent transcatheter AVR (TAVR) (n = 303) and surgical AVR (SAVR) (n = 220) at a single institution were included in our analysis. Baseline left and right heart invasive hemodynamics were assessed. Baseline transthoracic echocardiograms were reviewed to determine aortic stenosis subtype and parameters of diastolic dysfunction. Aortic stenosis subtype was categorized as typical (normal flow, high-gradient) aortic stenosis, classical, low-flow, low-gradient (cLFLG) aortic stenosis, and paradoxical, low-flow, low-gradient (pLFLG) aortic stenosis. Cox proportional hazard models were utilized to examine the relation between invasive hemodynamic or echocardiographic variables of diastolic dysfunction, aortic stenosis subtype, and all-cause mortality. Propensity-score analysis was performed to study the relation between aortic stenosis subtype and the composite outcome [death/cerebrovascular accident (CVA)]. RESULTS The median STS risk was 5.3 and 2.5% for TAVR and SAVR patients, respectively. Relative to patients with typical aortic stenosis, patients with atypical (cLFLG and pLFLG) aortic stenosis displayed a significantly higher prevalence of diastolic dysfunction (LVEDP ≥ 20mmHg, PCWP ≥ 20mmHg, echo grade II or III diastolic dysfunction, and echo-PCWP ≥ 20mmHg) and, independently of AVR treatment modality, had a significantly increased risk of death. In propensity-score analysis, patients with atypical aortic stenosis had higher rates of death/CVA than typical aortic stenosis patients, independently of diastolic dysfunction and AVR treatment modality. CONCLUSION We demonstrate the novel observation that compared with patients with typical aortic stenosis, patients with atypical aortic stenosis have a higher burden of diastolic dysfunction. We corroborate the worse outcomes previously reported in atypical versus typical aortic stenosis and demonstrate, for the first time, that this observation is independent of AVR treatment modality. Furthermore, the presence of diastolic dysfunction does not independently predict outcome in atypical aortic stenosis regardless of treatment type, suggesting that other factors are responsible for adverse clinical outcomes in this higher risk cohort.
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Affiliation(s)
- Rashad J Belin
- Department of Cardiology, Mercyhealth Heart and Vascular Center; Janesville, Wisconsin and Rockford, Illinois
| | - Travis B Desa
- Department of Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Igor Wroblewski
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Cara Joyce
- Department of Biostatistics, Loyola University of Chicago, Maywood, Illinois
| | - Anthony Perez-Tamayo
- Department of Cardiothoracic Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Jeffrey Schwartz
- Department of Cardiothoracic Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Lowell H Steen
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - John J Lopez
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Bruce E Lewis
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Ferdinand S Leya
- Department of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Michael Tuchek
- Department of Cardiothoracic Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Mamdouh Bakhos
- Department of Cardiothoracic Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Verghese Mathew
- Department of Cardiology, Northshore Medical Group, Chicago, Illinois, USA
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von Roeder M, Maeder M, Wahl V, Kitamura M, Rotta Detto Loria J, Dumpies O, Rommel KP, Kresoja KP, Blazek S, Richter I, Majunke N, Desch S, Thiele H, Lurz P, Abdel-Wahab M. Prognostic significance and clinical utility of left atrial reservoir strain in transcatheter aortic valve replacement. Eur Heart J Cardiovasc Imaging 2024; 25:373-382. [PMID: 37862161 DOI: 10.1093/ehjci/jead268] [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: 04/03/2023] [Revised: 08/29/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023] Open
Abstract
AIMS Patients with diastolic dysfunction (DD) experience worse outcomes after transcatheter aortic valve replacement (TAVR). We investigated the prognostic value and clinical utility of left atrial reservoir strain (LARS) in patients undergoing TAVR for aortic stenosis (AS). METHODS AND RESULTS All consecutive patients undergoing TAVR between January 2018 and December 2018 were included if discharge echocardiography and follow-up were available. LARS was derived from 2D-speckle-tracking. Patients were grouped into three tertiles according to LARS. DD was analysed using the ASE/EACVI-algorithm. The primary outcome was a composite of all-cause death and readmission for worsening heart failure 12 months after TAVR. Overall, 606 patients were available [age 80 years, interquartile range (IQR) 77-84], including 53% women. Median LARS was 13.0% (IQR 8.4-18.3). Patients were classified by LARS tertiles [mildly impaired 21.4% (IQR 18.3-24.5), moderately impaired 13.0% (IQR 11.3-14.6), severely impaired 7.1% (IQR 5.4-8.4), P < 0.0001]. The primary outcome occurred more often in patients with impaired LARS (mildly impaired 7.4%, moderately impaired 13.4%, and severely impaired 25.7%, P < 0.0001). On adjusted multivariable Cox regression analysis, LARS tertiles [hazard ratio (HR) 0.62, 95% confidence interval (CI) 0.44-0.86, P = 0.005] and higher degree of tricuspid regurgitation (HR 1.82, 95% CI 1.23-2.98, P = 0.003) were the only significant predictors of the primary endpoint. Importantly, DD was unavailable in 56% of patients, but LARS assessment allowed for reliable prognostication regarding the primary endpoint in subgroups without DD assessment (HR 0.64, 95% CI 0.47-0.87, P = 0.003). CONCLUSION Impaired LARS is independently associated with worse outcomes in patients undergoing TAVR. LARS allows for risk stratification at discharge even in patients where DD cannot be assessed by conventional echocardiographic means.
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Affiliation(s)
- Maximilian von Roeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Mauritius Maeder
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Vincent Wahl
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Mitsunobu Kitamura
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Johannes Rotta Detto Loria
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Oliver Dumpies
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
- Cardiovascular Research Foundation, NewYork, NY, USA
| | - Karl-Patrik Kresoja
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Stephan Blazek
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Ines Richter
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Nicolas Majunke
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
| | - Philipp Lurz
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
- Center for Cardiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Mohamed Abdel-Wahab
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Struempellstrasse 39, D-04289 Leipzig, Germany
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Stalikas N, Anastasiou V, Botis I, Daios S, Karagiannidis E, Zegkos T, Karamitsos T, Vassilikos V, Ziakas A, Kamperidis V, Giannakoulas G, Giannopoulos G. The prognostic impact of diastolic dysfunction after transcatheter aortic valve replacement: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102228. [PMID: 38043876 DOI: 10.1016/j.cpcardiol.2023.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Diastolic dysfunction (DD) is a long-established marker of disease progression in patients with aortic valve stenosis (AS), indicating valvular myocardial damage. Recently, substantial observational data have emerged demonstrating that worse pre-operative DD assessed using echocardiography is associated with adverse long-term clinical outcomes after transcatheter aortic valve replacement (TAVR). AIM To systematically appraise and quantitatively synthesize current evidence on the prognostic impact of echocardiographic severe DD derived by echocardiography before TAVR. METHODS A systemic literature review was undertaken in electronic databases to identify studies reporting the predictive value of severe DD in AS subjects undergoing TAVR. A random-effects meta-analysis was conducted to quantify the adjusted and unadjusted hazard ratios (HRs) for all-cause mortality and major adverse cardiovascular events (MACEs) for the presence of severe DD. RESULTS Ten studies were deemed eligible for inclusion. Of those, 9 provided appropriate quantitative data for the meta-analysis, encompassing a total of 4,619 patients. The presence of severe DD was associated with increased risk for all-cause mortality (pooled unadjusted HR=2.56 [1.46-4.48]; p<0.01; I2=76 %) and MACEs (pooled unadjusted HR=1.82 [1.29-2.58]; p<0.01; I2=86 %). When adjusted for clinically-relevant parameters, the presence of severe DD retained independent association with all-cause mortality (pooled adjusted HR=2.35 [1.26-4.37]; p<0.01; I2=79 %) and MACEs (pooled adjusted HR= 2.52 [1.72-3.65]; p<0.01; I2=0 %). In subgroup analysis there was no difference on post-TAVR risk between the use of different diastolic function grading scores. CONCLUSION Presence of severe DD assessed by echocardiography pre-TAVR is a major determinant of long-term adverse outcomes after the procedure.
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Affiliation(s)
- Nikolaos Stalikas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece.
| | - Vasileios Anastasiou
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Ioannis Botis
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Stylianos Daios
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | | | - Thomas Zegkos
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Theodoros Karamitsos
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Vassilios Vassilikos
- Ippokratio General Hospital, Medical School, Aristotle University, Thessaloniki, Greece
| | - Antonios Ziakas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Vasileios Kamperidis
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - George Giannakoulas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - George Giannopoulos
- Ippokratio General Hospital, Medical School, Aristotle University, Thessaloniki, Greece
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Magruder JT, Holst KA, Stewart J, Yadav PK, Thourani VH. Early Intervention in Asymptomatic Aortic Stenosis: What Are We Waiting For? Can J Cardiol 2024; 40:201-209. [PMID: 38036025 DOI: 10.1016/j.cjca.2023.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/06/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023] Open
Abstract
Aortic stenosis (AS) contributes to significant cardiovascular morbidity and mortality worldwide, and the natural history from symptoms to ventricular decompensation, heart failure, and death has been well documented. For more than 2 decades, technologies including imaging and biomarkers have shown a promising ability to detect myocardial damage associated with AS before symptoms arise. Current treatment guidelines rely heavily on symptoms or ventricular decompensation as triggers for aortic valve intervention. There is increasing appreciation of the relationship between myocardial damage due to AS before the emergence of symptoms, and a number of published randomised trials suggest a benefit to early intervention in asymptomatic AS, with additional trials actively enrolling. Future treatment paradigms may incorporate early detection of ventricular damage by noninvasive new technologies as triggers for asymptomatic intervention. Enthusiasm for early aortic valve replacement should be tempered by consideration of the competing risks of early valve intervention, but an increasing preponderance of evidence continues to suggest that earlier intervention in AS is warranted.
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Affiliation(s)
- J Trent Magruder
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Athens, Georgia, USA
| | - Kimberly A Holst
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jim Stewart
- Department of Cardiology, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Pradeep K Yadav
- Department of Cardiology, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Marcus Valve Center, Atlanta, Georgia, USA.
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8
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El-Zein RS, Malik AO, Cohen DJ, Spertus JA, Saxon JT, Pibarot P, Hahn RT, Alu MC, Shang K, Kodali SK, Thourani VH, Leon MB, Mack MJ, Chhatriwalla AK. Diastolic Dysfunction and Health Status Outcomes After Transcatheter Aortic Valve Replacement. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2024; 8:100225. [PMID: 38283566 PMCID: PMC10818150 DOI: 10.1016/j.shj.2023.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/16/2023] [Accepted: 08/24/2023] [Indexed: 01/30/2024]
Abstract
Background Baseline left ventricular diastolic dysfunction (LVDD) is associated with poor health status in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR), but health status improvement after TAVR appears similar across all grades of LVDD. Here, we aim to examine the relationship between changes in LVDD severity and health status outcomes following TAVR. Methods Patients who underwent TAVR and had evaluable LVDD at both baseline and 1 year in the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registries and PARTNER 3 trial were analyzed. LVDD grade was evaluated using echocardiography core lab data and an adapted definition of American Society of Echocardiography guidelines. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire Overall Summary (KCCQ-OS) score. The association between ΔLVDD severity and ΔKCCQ-OS was examined using linear regression models adjusted for baseline KCCQ-OS. Results Of 1100 patients, 724 (65.8%), 283 (25.7%), and 93 (8.5%) had grade 0/1, 2, and 3 LVDD at baseline, respectively. At 1 year, LVDD severity was unchanged in 790 (71.8%) patients, improved in 189 (17.2%), and worsened in 121 (11.0%). Among 376 patients with baseline grade 2 or 3 LVDD, 50.3% had improvement in LVDD. In the overall cohort, KCCQ-OS score improved by 21.9 points at 1 year. There was a statistically significant association between change in LVDD severity (improved, unchanged, and worsened) and ΔKCCQ-OS at 1 year (p = 0.007). Conclusions Change in LVDD grade was associated with change in health status 1 year following TAVR.
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Affiliation(s)
- Rayan S. El-Zein
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | - Ali O. Malik
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | - David J. Cohen
- Division of Cardiology, Saint Francis Hospital, New York, USA
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - John A. Spertus
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | - John T. Saxon
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
| | | | - Rebecca T. Hahn
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Maria C. Alu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
| | - Kan Shang
- Edwards Lifesciences, California, USA
| | - Susheel K. Kodali
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Vinod H. Thourani
- Division of Cardiothoracic Surgery, Piedmont Heart Institute, Georgia, USA
| | - Martin B. Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, USA
- Division of Cardiology, Columbia University Irving Medical Center, New York, USA
| | - Michael J. Mack
- Division of Cardiothoracic Surgery, Baylor Scott & White Health, Texas, USA
| | - Adnan K. Chhatriwalla
- Division of Cardiology, University of Missouri-Kansas City, Missouri, USA
- Division of Cardiology, Saint Luke’s Mid America Heart Institute, Missouri, USA
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9
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Horinouchi H, Nagai T, Ohno Y, Miyamoto J, Kamioka N, Murakami T, Yoshioka K, Ikari Y. Mechanisms and implications of mitral regurgitation in patients with severe aortic stenosis who received transcatheter aortic valve replacement. Echocardiography 2023; 40:1187-1195. [PMID: 37715609 DOI: 10.1111/echo.15693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the mechanisms and clinical implications of mitral regurgitation (MR) in patients with severe aortic stenosis (AS) who received transcatheter aortic valve replacement (TAVR). METHODS We conducted retrospective echocardiographic analyses at baseline and 6 months after TAVR in 140 patients with symptomatic AS (85 ± 5 years) who underwent TAVR. We defined significant MR as ≥ moderate based on evaluation of transthoracic echocardiography (TTE). RESULTS There were 48 patients (34%) with preexisting MR at the baseline. Among measured TTE parameters, end-systolic wall stress (ESWS), mitral annulus area, and mitral valve thickening index were independent factors associated with preexisting MR (odds ratio [OR]: 1.013, 95% confidence interval [CI]: 1.005-1.021; OR: 1.740, 95% CI: 1.314-2.376; OR: 2.306, 95% CI: 1.426-3.848; respectively). Six months after TAVR, there were 34 patients with post-existing MR, A history of atrial fibrillation and ESWS after TAVR were independent factors (OR: 3.013, 95% CI: 1.208-7.556; OR: 1.013, 95% CI: 1.000-1.023; respectively). The Kaplan-Meier plot indicated that preexisting MR was a risk factor for heart failure-related events within 1 year of discharge after TAVR (p = .012). CONCLUSIONS In patients who underwent TAVR for severe AS, preexisting MR was associated with having a thickened mitral valve and large mitral annulus size induced by high ESWS. These patients may have worse prognosis after TAVR and should be closely monitored in the long term.
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Affiliation(s)
- Hitomi Horinouchi
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Tomoo Nagai
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Yohei Ohno
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Junichi Miyamoto
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Norihiko Kamioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Tsutomu Murakami
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Koichiro Yoshioka
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
| | - Yuji Ikari
- Division of Cardiology, Department of Internal Medicine, Tokai University School of Medicine, Isehara-shi, Kanagawa, Japan
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10
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Angellotti D, Manzo R, Castiello DS, Immobile Molaro M, Mariani A, Iapicca C, Nappa D, Simonetti F, Avvedimento M, Leone A, Canonico ME, Spaccarotella CAM, Franzone A, Ilardi F, Esposito G, Piccolo R. Echocardiographic Evaluation after Transcatheter Aortic Valve Implantation: A Comprehensive Review. Life (Basel) 2023; 13:1079. [PMID: 37240724 PMCID: PMC10221682 DOI: 10.3390/life13051079] [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: 03/06/2023] [Revised: 04/19/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is an increasingly popular treatment option for patients with severe aortic stenosis. Recent advancements in technology and imaging tools have significantly contributed to the success of TAVI procedures. Echocardiography plays a pivotal role in the evaluation of TAVI patients, both before and after the procedure. This review aims to provide an overview of the most recent technical advancements in echocardiography and their use in the follow-up of TAVI patients. In particular, the focus will be on the examination of the influence of TAVI on left and right ventricular function, which is frequently accompanied by other structural and functional alterations. Echocardiography has proven to be key also in detecting valve deterioration during extended follow-up. This review will provide valuable insights into the technical advancements in echocardiography and their role in the follow-up of TAVI patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
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11
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Left-atrial volume reduction reflects improvement of cardiac sympathetic nervous function in patients with severe aortic stenosis after transcatheter aortic valve replacement. Heart Vessels 2023:10.1007/s00380-023-02257-6. [PMID: 36928668 DOI: 10.1007/s00380-023-02257-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
Trans-catheter aortic valve replacement (TAVR) is an excellent alternative intervention for surgical aortic valve replacement. Cardiac sympathetic nervous (CSN) function and left atrial (LA) volume are both important prognostic factors in patients with aortic stenosis (AS) after TAVR. The relationship between the two clinical factors is unknown, however. This retrospective observational study aimed to assess the correlation between CSN function and LA volume in 48 symptomatic patients with severe AS (median age: 85 years, IQR 82-88 years; 81% female) before and after TAVR. CSN function was assessed by performing 123I-metaiodobenzylguanidine (MIBG) scintigraphy before and 6 months after TAVR, and the delayed heart-to-mediastinum ratio (dHMR) and washout rate (WR) were calculated. We also performed transthoracic echocardiography near the same time. TAVR improved the dHMR, WR, and LA volume index (LAVI) (dHMR: median 2.89 [IQR 2.62-3.23] vs. 2.98 [2.49-3.25], p = 0.0182; WR: 28% [24-38] vs. 23% [16-32], p < 0.0001; LAVI: 47.7 mL/m2 [37.8-56.3] vs. 41.2 mL/m2 [33.7-56.1], p = 0.0024). In multiple linear regression analysis, the percentage change in LAVI from baseline to post-TAVR (∆LAVI%) was an independent predictor of change in dHMR from baseline to post-TAVR (β = - 0.35, p = 0.0110). In conclusion, LA volume reduction reflected CSN functional improvement after TAVR. In patients with TAVR, ∆LAVI% might be a valuable parameter for evaluating CSN functional recovery.
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12
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Lewandowski D, Yang EY, Nguyen DT, Khan MA, Malahfji M, El Tallawi C, Chamsi Pasha MA, Graviss EA, Shah DJ, Nagueh SF. Relation of Left Ventricular Diastolic Function to Global Fibrosis Burden: Implications for Heart Failure Risk Stratification. JACC Cardiovasc Imaging 2023:S1936-878X(23)00032-3. [PMID: 37038874 DOI: 10.1016/j.jcmg.2022.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND Left ventricular (LV) diastolic function is primarily assessed by means of echocardiography, which has limited utility in detecting fibrosis. Cardiac magnetic resonance (CMR) readily detects and quantifies fibrosis. OBJECTIVES In this study, the authors sought to determine the association of LV diastolic function by to echocardiography with CMR-determined global fibrosis burden and the incremental value of fibrosis with diastolic function grade in prediction of total mortality and heart failure hospitalizations. METHODS A total of 549 patients underwent comprehensive echocardiography and CMR within 30 days. Echocardiography was used to assess LV diastolic function, and CMR was used to determine LV volumes, mass, ejection fraction, replacement fibrosis, and percentage extracellular volume fraction (ECV). RESULTS Normal diastolic function was present in 142 patients; the rest had diastolic dysfunction grades I to III, except for 18 (3.3%) with indeterminate results. The event rate was higher in patients with diastolic dysfunction compared with patients with normal diastolic function (33.4% vs 15.5; P < 0.001). The model including LV diastolic function grades II and III predicted composite outcome (C-statistic: 0.71; 95% CI: 0.67-0.76), which increased by adding global fibrosis burden (C-statistic: 0.74, 95% CI: 0.70-0.78; P = 0.02). For heart failure hospitalizations, the competing risk model with LV diastolic function grades II and III was good (C-statistic: 0.78; 95% CI: 0.74-0.83) and increased significantly with the addition of global fibrosis burden (C-statistic: 0.80; 95% CI: 0.76-0.85; P = 0.03). CONCLUSIONS Higher grades of diastolic dysfunction are seen in patients with replacement fibrosis and increased ECV. Fibrosis burden as determined with the use of CMR provides incremental prognostic information to echocardiographic evaluation of LV diastolic function.
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Affiliation(s)
| | - Eric Y Yang
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA
| | - Mohammad A Khan
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Maan Malahfji
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA; Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Dipan J Shah
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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13
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The Evolution of Pulmonary Hypertension and Its Prognostic Implications Post-TAVI-Single Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091182. [PMID: 36143859 PMCID: PMC9501961 DOI: 10.3390/medicina58091182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Since the first transcatheter aortic valve implantation (TAVI) procedure was performed in 2002, advances in technology and refinement of the method have led to its widespread use in patients with severe aortic stenosis (AS) and high surgical risk. We aim to identify the impact of TAVI on the clinical and functional status of patients with severe AS at the one-month follow-up and to identify potential predictors associated with the evolution of pulmonary hypertension (PH) in this category of patients. Materials and Methods: We conducted a prospective study which included 86 patients diagnosed with severe AS undergoing TAVI treatment. We analyzed demographics, clinical and echocardiographic parameters associated with AS and PH both at enrolment and at the 30-day follow-up. Results: In our study, the decrease of EUROSCORE II score (p < 0.001), improvement of angina (p < 0.001) and fatigue (p < 0.001) as clinical benefits as well as a reduction in NYHA functional class in patients with heart failure (p < 0.001) are prognostic predictors with statistical value. Regression of left ventricular hypertrophy (p = 0.001), increase in the left ventricle ejection fraction (p = 0.007) and improvement of diastolic dysfunction (p < 0.001) are echocardiographic parameters with a prognostic role in patients with severe AS undergoing TAVI. The pulmonary artery acceleration time (PAAT) (p < 0.001), tricuspid annular plane systolic excursion (TAPSE) (p = 0.020), pulmonary arterial systolic pressure (PASP) (p < 0.001) and the TAPSE/PASP ratio (p < 0.001) are statistically significant echocardiographic parameters in our study that assess both PH and its associated prognosis in patients undergoing TAVI. Conclusions: PAAT, TAPSE, PASP and the TAPSE/PASP ratio are independent predictors that allow the assessment of PH and its prognostic implications post-TAVI.
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14
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Lange T, Backhaus SJ, Beuthner BE, Topci R, Rigorth KR, Kowallick JT, Evertz R, Schnelle M, Ravassa S, Díez J, Toischer K, Seidler T, Puls M, Hasenfuß G, Schuster A. Functional and structural reverse myocardial remodeling following transcatheter aortic valve replacement: a prospective cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2022; 24:45. [PMID: 35897100 PMCID: PMC9331125 DOI: 10.1186/s12968-022-00874-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since cardiovascular magnetic resonance (CMR) imaging allows comprehensive quantification of both myocardial function and structure we aimed to assess myocardial remodeling processes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). METHODS CMR imaging was performed in 40 patients with severe AS before and 1 year after TAVR. Image analyses comprised assessments of myocardial volumes, CMR-feature-tracking based atrial and ventricular strain, myocardial T1 mapping, extracellular volume fraction-based calculation of left ventricular (LV) cellular and matrix volumes, as well as ischemic and non-ischemic late gadolinium enhancement analyses. Moreover, biomarkers including NT-proBNP as well as functional and clinical status were documented. RESULTS Myocardial function improved 1 year after TAVR: LV ejection fraction (57.9 ± 16.9% to 65.4 ± 14.5%, p = 0.002); LV global longitudinal (- 21.4 ± 8.0% to -25.0 ± 6.4%, p < 0.001) and circumferential strain (- 36.9 ± 14.3% to - 42.6 ± 11.8%, p = 0.001); left atrial reservoir (13.3 ± 6.3% to 17.8 ± 6.7%, p = 0.001), conduit (5.5 ± 3.2% to 8.4 ± 4.6%, p = 0.001) and boosterpump strain (8.2 ± 4.6% to 9.9 ± 4.2%, p = 0.027). This was paralleled by regression of total myocardial volume (90.3 ± 21.0 ml/m2 to 73.5 ± 17.0 ml/m2, p < 0.001) including cellular (55.2 ± 13.2 ml/m2 to 45.3 ± 11.1 ml/m2, p < 0.001) and matrix volumes (20.7 ± 6.1 ml/m2 to 18.8 ± 5.3 ml/m2, p = 0.036). These changes were paralleled by recovery from heart failure (decrease of NYHA class: p < 0.001; declining NT-proBNP levels: 2456 ± 3002 ng/L to 988 ± 1222 ng/L, p = 0.001). CONCLUSION CMR imaging enables comprehensive detection of myocardial remodeling in patients undergoing TAVR. Regression of LV matrix volume as a surrogate for reversible diffuse myocardial fibrosis is accompanied by increase of myocardial function and recovery from heart failure. Further data are required to define the value of these parameters as therapeutic targets for optimized management of TAVR patients. Trial registration DRKS, DRKS00024479. Registered 10 December 2021-Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024479.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Bo Eric Beuthner
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Rodi Topci
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Karl-Rudolf Rigorth
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Moritz Schnelle
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Clinical Chemistry, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Susana Ravassa
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Karl Toischer
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tim Seidler
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Miriam Puls
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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15
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Stassen J, Ewe SH, Butcher SC, Amanullah MR, Mertens BJ, Hirasawa K, Singh GK, Sin KY, Ding ZP, Pio SM, Sia CH, Chew N, Kong W, Poh KK, Cohen D, Généreux P, Leon MB, Ajmone Marsan N, Delgado V, Bax JJ. Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis. Heart 2022; 108:1401-1407. [PMID: 35688475 DOI: 10.1136/heartjnl-2022-320886] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/13/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate the prognostic impact of left ventricular (LV) diastolic dysfunction in patients with moderate aortic stenosis (AS) and preserved LV systolic function. METHODS Patients with a first diagnosis of moderate AS (aortic valve area >1.0 and ≤1.5 cm2) and preserved LV systolic function (LV ejection fraction ≥50%) were identified. LV diastolic function was evaluated using echocardiographic criteria according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as all-cause mortality and a composite of all-cause mortality and aortic valve replacement (AVR). RESULTS Of 1247 patients (age 74±10 years, 47% men), 535 (43%) had LV diastolic dysfunction at baseline. Patients with LV diastolic dysfunction showed significantly higher mortality rates at 1-year, 3-year and 5-year follow-up (13%, 30% and 41%, respectively) when compared with patients with normal LV diastolic function (6%, 17% and 29%, respectively) (p<0.001). On multivariable analysis, LV diastolic dysfunction was independently associated with all-cause mortality (HR 1.368; 95% CI 1.085 to 1.725; p=0.008) and the composite endpoint of all-cause mortality and AVR (HR 1.241; 95% CI 1.035 to 1.488; p=0.020). CONCLUSIONS LV diastolic dysfunction is independently associated with all-cause mortality and the composite endpoint of all-cause mortality and AVR in patients with moderate AS and preserved LV systolic function. Assessment of LV diastolic function therefore contributes significantly to the risk stratification of patients with moderate AS. Future clinical trials are needed to investigate whether patients with moderate AS and LV diastolic dysfunction may benefit from earlier valve intervention.
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Affiliation(s)
- Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bart J Mertens
- Department of Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kenny Y Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Zee Pin Ding
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore
| | - Nicholas Chew
- Department of Cardiology, National University Heart Centre, Singapore
| | - William Kong
- Department of Cardiology, National University Heart Centre, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre, Singapore
| | - David Cohen
- Department of Cardiology, Saint Francis Hospital The Heart Center, Roslyn, New York, USA
| | - Philippe Généreux
- Department of Cardiology, Morristown Medical Center, Morristown, New Jersey, USA
| | - Martin B Leon
- Department of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands .,Department of Cardiology, Turku Heart Center, Turku, Finland
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16
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Nair RM, Chawla S, Verma B, Kumar S, Abou Hassan O, Ghimire B, Lak HM, Chahine J, Yun J, Puri R, Reed GW, Krishnaswamy A, Harb SC, Kapadia S. Impact of elevated left ventricular filling pressure on long-term outcomes after transcatheter aortic valve replacement. Open Heart 2022; 9:openhrt-2022-002015. [PMID: 35728890 PMCID: PMC9214428 DOI: 10.1136/openhrt-2022-002015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Increase in left ventricular filling pressure (FP) and diastolic dysfunction are established consequences of progressive aortic stenosis (AS). However, the impact of elevated FP as detected by pretranscatheter aortic valve replacement (TAVR) echocardiogram on long-term outcomes after TAVR remains unclear. OBJECTIVE To understand the impact of elevated FP in patients with severe AS who undergo TAVR. METHODS This was a retrospective study of all patients who underwent TAVR between 1 January 2014 and 31 December 2017. The presence of elevated FP was determined in accordance with the latest guidelines using the last available comprehensive echocardiogram prior to TAVR. RESULTS Of 983 patients who were included in our study, 422 patients (43%) were found to have elevated FP and 561 patients (57%) had normal FP prior to TAVR. Patients with elevated FP had a mean age of 81.2±8.6 years and were more likely to be males (62%), diabetic (41% vs 35%, p=0.046), and have a higher prevalence of atrial fibrillation (Afib) (53% vs 39%, p<0.001). The 5-year all-cause mortality after TAVR was significantly higher in patients with elevated FP when compared with patients with normal FP (32% vs 24%, p=0.006). The presence of elevated FP, history of Afib and prior PCI emerged as independent predictors of long-term mortality after TAVR. CONCLUSION Elevated FP is associated with increased mortality in patients with severe AS undergoing TAVR. Assessment of FP should be incorporated into the risk assessment of AS patients to identify those who may benefit from early intervention.
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Affiliation(s)
- Raunak M Nair
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sanchit Chawla
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Beni Verma
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sachin Kumar
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ossama Abou Hassan
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Bindesh Ghimire
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Hassan Mehmood Lak
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Johnny Chahine
- Department of Cardiovascular Medicine, University of Minnesota System, Minneapolis, Minnesota, USA
| | - James Yun
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rishi Puri
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Grant W Reed
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Serge C Harb
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir Kapadia
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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17
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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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18
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Carter-Storch R, Mortensen NSB, Ali M, Laursen K, Pellikka PA, Møller JE, Dahl JS. Assessment of diastolic function in aortic stenosis: A comparison between 2009 and 2016 guidelines. Echocardiography 2021; 38:2006-2015. [PMID: 34921437 DOI: 10.1111/echo.15230] [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: 03/10/2021] [Revised: 09/17/2021] [Accepted: 10/04/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS New diastolic dysfunction (DD) guidelines were introduced in 2016 to replace the 2009 guidelines, but have not yet been evaluated in aortic stenosis (AS). We aimed to compare the 2009 and 2016 DD guidelines in severe AS patients in terms of association with left ventricular (LV) and left atrial (LA) remodeling, with pulmonary capillary wedge pressure (PCWP) at rest and exercise, and with prognosis. METHODS AND RESULTS We included 212 patients with severe AS (112 undergoing AVR, 100 asymptomatic). Echocardiography, magnetic resonance imaging, and brain natriuretic peptides (BNP) were performed/measured. Thirty-nine asymptomatic patients had PCWP measured during rest and maximal exertion. Asymptomatic patients were followed for 3.1 years for the combined endpoint of death, AVR or admission with heart failure. The 2009 and 2016 DD guidelines agreed poorly with each other (Cohens' κ = .15). 2009 guidelines showed many ambiguous DD findings. With the 2016 guidelines, 20% of patients had indeterminate DD. DD grade 2 according to 2016 guidelines showed stronger association with symptom status, BNP, global longitudinal strain (GLS) and peak exercise PCWP than 2009 guidelines. For indeterminate DD patients according to 2009 guidelines, GLS above the median was associated with event-free survival (HR .11 (95% CI .02-.53)). For neither guideline was DD associated with the combined endpoint in asymptomatic patients. CONCLUSION The 2016 guidelines show a stronger association with BNP, GLS, and exercise PCWP than the 2009 guidelines. The 2016 guidelines result in 20% of patients with indeterminate DD; however, these patients may possibly be stratified according to GLS.
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Affiliation(s)
- Rasmus Carter-Storch
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,OPEN Odense Patient data Explorative Network, Odense, Denmark
| | | | - Mulham Ali
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Kristian Laursen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,OPEN Odense Patient data Explorative Network, Odense, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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19
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Extent of Cardiac Damage and Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2021; 10:jcm10194563. [PMID: 34640580 PMCID: PMC8509290 DOI: 10.3390/jcm10194563] [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: 09/04/2021] [Revised: 09/23/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Aims: We sought to assess the impact of the extent of cardiac damage on survival among real-world patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). (2) Methods: A staging classification was applied to 262 patients from the EffecTAVI Registry at baseline and re-assessed within 30-days after TAVI. The primary endpoint of the study was all-cause mortality at 1-year. Secondary endpoints included cerebrovascular accident, myocardial infarction, permanent pacemaker implantation, endocarditis, and re-hospitalization for all causes. (3) Results: At baseline, 23 (8.7%) patients were in Stage 0/1 (no cardiac damage/left ventricular damage), 106 (40.4%) in Stage 2 (left atrial or mitral valve damage), 59 (22.5%) in Stage 3 (pulmonary vasculature or tricuspid valve damage) and 74 (28.3%) in Stage 4 (right ventricular damage). At 30-days after TAVI, a lower prevalence of advanced stages of cardiac damage than baseline, mainly driven by a significant improvement in left ventricular diastolic parameters and right ventricular function, was reported. At 1-year, a stepwise increase in mortality rates was observed according to staging at baseline: 4.3% in Stage 0/1, 6.6% in Stage 2, 18.6% in Stage 3 and 21.6% in Stage 4 (p = 0.08). No differences were found in secondary endpoints. (4) Conclusions: TAVI has an early beneficial impact on the left ventricular diastolic and right ventricular function. However, the extent of cardiac damage at baseline significantly affects the risk of mortality at 1-year after the procedure.
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20
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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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21
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Vollema EM, Amanullah MR, Prihadi EA, Ng ACT, van der Bijl P, Sin YK, Ajmone Marsan N, Ding ZP, Généreux P, Leon MB, Ewe SH, Delgado V, Bax JJ. Incremental value of left ventricular global longitudinal strain in a newly proposed staging classification based on cardiac damage in patients with severe aortic stenosis. Eur Heart J Cardiovasc Imaging 2021; 21:1248-1258. [PMID: 32851408 DOI: 10.1093/ehjci/jeaa220] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/16/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Cardiac damage in severe aortic stenosis (AS) can be classified according to a recently proposed staging classification. The present study investigated the incremental prognostic value of left ventricular (LV) global longitudinal strain (GLS) over stages of cardiac damage in patients with severe AS. METHODS AND RESULTS From an ongoing registry, a total of 616 severe symptomatic AS patients with available LV GLS by speckle tracking echocardiography were selected and retrospectively analysed. Patients were categorized according to cardiac damage on echocardiography: Stage 0 (no damage), Stage 1 (LV damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). LV GLS was divided by quintiles and assigned to the different stages. The endpoint was all-cause mortality. Over a median follow-up of 44 [24-89] months, 234 (38%) patients died. LV GLS was associated with all-cause mortality independent of stage of cardiac damage. After incorporation of LV GLS by quintiles into the staging classification, Stages 2-4 were independently associated with outcome. LV GLS showed incremental prognostic value over clinical characteristics and stages of cardiac damage. CONCLUSION In this large single-centre cohort of severe AS patients, incorporation of LV GLS by quintiles in a novel proposed staging classification resulted in refinement of risk stratification by identifying patients with more advanced cardiac damage. LV GLS was shown to provide incremental prognostic value over the originally proposed staging classification.
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Affiliation(s)
- E Mara Vollema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yoong Kong Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Zee Pin Ding
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, NJ, USA.,Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY, USA.,New York-Presbyterian Hospital/Columbia University, Medical Center, New York, NY, USA
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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22
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Okuno T, Heg D, Lanz J, Praz F, Brugger N, Stortecky S, Windecker S, Pilgrim T. Refined Staging Classification of Cardiac Damage Associated with Aortic Stenosis and Outcomes after Transcatheter Aortic Valve Implantation. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:532-541. [PMID: 34086888 DOI: 10.1093/ehjqcco/qcab041] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/04/2021] [Accepted: 06/03/2021] [Indexed: 01/07/2023]
Abstract
AIMS A new staging classification of aortic stenosis (AS) characterizing the extent of cardiac damage was established and validated in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to validate an updated classification system in patients undergoing TAVI. METHODS AND RESULTS In a prospective TAVI registry, AS patients were categorized into the following stages: no cardiac damage (Stage 0), left ventricular damage (Stage 1), left atrial or mitral valve damage (Stage 2), pulmonary vasculature or tricuspid valve damage (Stage 3), or right ventricular (RV) damage or low-flow state (Stage 4). Stage 3 was sub-divided into Stage 3a (≤moderate pulmonary hypertension) and Stage 3b (severe pulmonary hypertension). Stage 4 was sub-divided into Stage 4a (low-flow without RV dysfunction), Stage 4b (RV dysfunction without low-flow), and Stage 4c (RV dysfunction with low-flow). The primary endpoint was all-cause death at 1 year. Among 1,156 eligible patients, 14 were classified as Stage 0, 38 as Stage 1, 105 as Stage 2, 278 as Stage 3, and 721 as Stage 4. There was a stepwise increase in mortality according to advancing stages of cardiac damage: 3.9% (Stage 0-1), 9.6% (Stage 2), 14.1% (Stage 3), and 17.4% (Stage 4) (p = 0.002). After multivariable adjustment, only Stage 3b, Stage 4b, and Stage 4c conferred a significantly increased risk of mortality compared to Stage 0-1. CONCLUSION More than one third of patients had advanced cardiac damage (severe pulmonary hypertension or RV dysfunction) before TAVI, associating with a 5- to 7-fold increased risk of mortality at 1 year.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Dik Heg
- CTU, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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23
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Amanullah MR, Pio SM, Ng ACT, Sin KYK, Marsan NA, Ding ZP, Leon MB, Généreux P, Delgado V, Ewe SH, Bax JJ. Prognostic Implications of Associated Cardiac Abnormalities Detected on Echocardiography in Patients With Moderate Aortic Stenosis. JACC Cardiovasc Imaging 2021; 14:1724-1737. [PMID: 34023268 DOI: 10.1016/j.jcmg.2021.04.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/03/2021] [Accepted: 04/01/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVES This study aimed to evaluate the prevalence and prognostic value of the extent of extra-aortic valvular cardiac abnormalities in a large multicenter registry of patients with moderate AS. BACKGROUND The prognostic significance of a new classification system that incorporates the extent of cardiac injury (beyond the aortic valve) has been proposed in patients with severe aortic stenosis (AS). Whether this can be applied to patients with moderate AS is unclear. METHODS Based on the echocardiographic findings at the time of diagnosis of moderate AS (aortic valve area between 1.0 and 1.5 cm2 and dimensionless velocity index ratio of ≥0.25), a total of 1,245 patients were included and analyzed retrospectively. They were recategorized into 5 groups according to the extent of extra-aortic valvular cardiac abnormalities: none (Group 0), involving the left ventricle (Group 1), the left atrial or mitral valve (Group 2), the pulmonary artery vasculature or tricuspid valve (Group 3), or the right ventricle (Group 4). Patients were followed for all-cause mortality and combined endpoint (all-cause mortality, stroke, heart failure, or myocardial infarction). RESULTS The distribution of patients according to the proposed classification was 13.1%, 26.8%, 42.6%, 10.6%, and 6.9% in Groups 0, 1, 2, 3, and 4, respectively. During a median follow-up of 4.3 (2.4 to 6.9) years, 564 (45.3%) patients died. There was a significant higher mortality rates with increasing extent of extra-aortic valvular cardiac abnormalities (log-rank p < 0.001). On multivariate analysis, the presence of extra-aortic valvular cardiac abnormalities remained independently associated with all-cause mortality and combined outcome, adjusted for aortic valve replacement as a time-dependent covariable. In particular, Group 2 and above were independently associated with all-cause mortality. CONCLUSIONS In patients with moderate AS, the presence of extra-aortic valvular cardiac abnormalities is associated with poor outcome.
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Affiliation(s)
| | | | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, Brisbane, Australia
| | - Kenny Y K Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Zee Pin Ding
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Martin B Leon
- Department of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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24
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AlHarbi H, AlAhmari M, Alanazi AM, Al-Ghamdi B, AlSuayri A, AlHaydhal A, Arafat AA, Algarni KD, Abdelsalam W, AlRajwi S, AlMoghairi A, AlAmri H, AlAhmari S, AlOtaiby M. Outcomes After Transcatheter Aortic Valve Replacement in Patients with Severe Aortic Stenosis and Diastolic Dysfunction. J Saudi Heart Assoc 2021; 33:26-34. [PMID: 33936938 PMCID: PMC8084307 DOI: 10.37616/2212-5043.1236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/23/2020] [Accepted: 01/19/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Left ventricular diastolic dysfunction (LVDD) in patients undergoing transcatheter aortic valve replacement (TAVR) is associated with poor outcomes; however, the effect of its severity is controversial. We sought to assess the impact of diastolic dysfunction on hospital outcomes and survival after TAVR and identify prognostic factors. METHODS We included patients who underwent TAVR for severe aortic stenosis with preexisting LVDD from 2009 to 2018 (n = 325). Patients with prior mitral valve surgery (n = 4), atrial fibrillation (n = 39), missing or poor baseline diastolic dysfunction assessment (n = 36) were excluded. The primary endpoint was all-cause mortality. 246 patients were included in the study. RESULTS The median age was 80 years (25th and 75th percentiles:75-86.7), 154 (62.6%) were males and the median EuroSCORE II was 4.3 (2.2-8). Patients with severe LVDD had significantly higher EuroSCORE, and lower ejection fraction (p < 0.001). There was no difference in post-TAVR new atrial fibrillation (p = 0.912), pacemaker insertion (p = 0.528), stroke (p = 0.76), or hospital mortality (p = 0.95). Patients with severe LVDD had longer hospital stay (p = 0.036). The grade of LVDD did not affect survival (log-rank = 0.145) nor major adverse cardiovascular events (log-rank = 0.97). Predictors of mortality were; low BMI (HR: 0.95 (0.91-0.99); p = 0.019), low sodium (0.93 (0.82-2.5); p = 0.021), previous PCI (HR: 1.6 (1.022-2.66); p = 0.04), E-peak (HR: 1.01 (1.002-1.019); p = 0.014) and implantation of more than one device (HR: 3.55 (1.22-10.31); p = 0.02). CONCLUSION Transcatheter aortic valve replacement is feasible in patients with diastolic dysfunction, and the degree of diastolic dysfunction did not negatively affect the outcome. Long-term outcomes in those patients were affected by the preoperative clinical state and procedure-related factors.
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Affiliation(s)
- Hassan AlHarbi
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Mohammed AlAhmari
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | | | - Bander Al-Ghamdi
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Abdullah AlSuayri
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Ahmed AlHaydhal
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Amr A. Arafat
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Khaled D. Algarni
- Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Wiam Abdelsalam
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Sameera AlRajwi
- Adult Cardiology Department, King Abdulaziz Cardiac Centre, Ministry of National Guard Riyadh,
Saudi Arabia
| | | | - Hussin AlAmri
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Saeed AlAhmari
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
| | - Mohammed AlOtaiby
- Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh,
Saudi Arabia
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25
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Schewel J, Kuck KH, Frerker C, Schmidt T, Schewel D. Outcome of aortic stenosis according to invasive cardiac damage staging after transcatheter aortic valve replacement. Clin Res Cardiol 2021; 110:699-710. [PMID: 33744987 DOI: 10.1007/s00392-021-01835-w] [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: 02/21/2021] [Accepted: 03/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In recent studies, a 5-stage cardiac damage classification in severe aortic stenosis (AS) based on echocardiographic parameters has shown to provide predictive value regarding clinical outcome. The objective of this study was to investigate the prognostic impact of a cardiac damage classification based on invasive hemodynamics in patients with AS undergoing transcatheter aortic valve replacement (TAVR). METHODS A total of 1400 patients with symptomatic AS and full invasive hemodynamic assessment before TAVR were included. Patients were categorized according to their cardiac damage stage into five groups that are defined as: stage 0, no cardiac damage; stage 1, left ventricular damage; stage 2, left atrial and/or mitral valve damage; stage 3, pulmonary vasculature and/or tricuspid valve damage; stage 4, right ventricular damage. RESULTS 9.9% patients were classified as stage 0, 23.6% as stage 1, the majority of patients as stage 2 (33.5%), 23.1% as stage 3 and 10% as stage 4. One- and 4-year mortality were 10.1%/29.5% in stage 0, 16.1%/60.6% in stage 1, 17.3%/39.4% in stage 2, 22%/54.6% in stage 3, 27.1%/62.2% in stage 4 (p = 0.001/p < 0.001). The extent of cardiac damage was independently associated with increased mortality after TAVR (HR 1.16 per each increment in stage, 95% confidence interval 1.03-1.18; p = 0.018). CONCLUSIONS Cardiac damage staging in severe AS patients based on invasive hemodynamics appears to show strong association between the extent of cardiac damage and post-TAVR mortality. This staging classification provides predictive value and may improve risk stratification, therapy management and decision-making in patients with AS. Invasive Staging Classification of Cardiac Damage in Severe Symptomatic Aortic Stenosis has an Impact on Outcome after TAVR. (Top) Invasive staging criteria for cardiac damage in five stages using left ventricular end-diastolic pressure (LVEDP) for stage 1 (red), post-capillary wedge pressure (PCWP) for stage 2 (green), systolic pulmonary artery pressure (SPAP) for stage 3 (purple) and right atrial pressure (RAP) for stage 4 (yellow). The cake chart shows the distribution of the different stage in the whole cohort. (Bottom) Survival Analyses According to Stage of Cardiac Damage after Transcatheter Aortic Valve Replacement using Invasive Criteria. Kaplan-Meier plots comparing overall (left) and cardiovascular (right) 4-year survival showing with the more advancing stage a higher mortality rate.
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Affiliation(s)
- Jury Schewel
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. .,Department of Cardiology, Marienkrankenhaus Hamburg, Alfredstr. 9, 22087, Hamburg, Germany.
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany.,Cardiology, Lanserhof GmbH, Hamburg, Germany
| | - Christian Frerker
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Tobias Schmidt
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,Department of Cardiology, University Heart Center Lübeck, Lübeck, Germany
| | - Dimitry Schewel
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,Department of Cardiology, Marienkrankenhaus Hamburg, Alfredstr. 9, 22087, Hamburg, Germany
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26
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Saito T, Inohara T, Yoshijima N, Yashima F, Tsuruta H, Shimizu H, Fukuda K, Naganuma T, Mizutani K, Yamawaki M, Tada N, Yamanaka F, Shirai S, Tabata M, Ueno H, Takagi K, Watanabe Y, Yamamoto M, Hayashida K. Small Left Ventricle and Clinical Outcomes After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e019543. [PMID: 33749309 PMCID: PMC8174314 DOI: 10.1161/jaha.120.019543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background In patients undergoing transcatheter aortic valve replacement (TAVR), those with small left ventricle (LV) may have an increased risk of poor outcomes, because small LV is associated with low‐flow (LF), left ventricular hypertrophy. However, the impact of small LV on patients undergoing TAVR remains unknown. Methods and Results We examined 2584 patients who underwent TAVR between October 2013 and May 2017 using data from the Japanese multicenter registry. On the basis of the American Society of Echocardiography guidelines, small LV was defined as left ventricular end‐diastolic dimension <42.0 mm for men or <37.8 mm for women. The 2‐year clinical outcomes were compared between patients with and without small LV using multivariable Cox regression analyses and propensity score matching. Subgroup analyses by LF, left ventricular hypertrophy were performed. Of 2584 patients who underwent TAVR, 466 (18.0%) had small LV. Patients with small LV had smaller body size and less comorbidity, and were more likely to have LF status compared with those without. Small LV was associated with a higher 2‐year all‐cause (20.8% versus 14.3%; adjusted hazard ratio [HR],1.58 [95% CI, 1.20–2.09]; P=0.0013) and cardiovascular mortality (8.8% versus 5.5%; adjusted HR, 1.93 [95% CI, 1.25–2.98]; P=0.0028). Propensity score matching analysis showed consistent findings. In subgroup analyses, LF, left ventricular hypertrophy did not interact with small LV. Conclusions Small LV, determined by a simple echocardiographic parameter, was associated with poorer clinical outcomes after TAVR regardless of LF, left ventricular hypertrophy. LV size may be useful for assessing clinical outcomes after TAVR. Registration URL: https://www.umin.ac.jp/ctr/index.htm; Unique identifier: UMIN000020423.
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Affiliation(s)
- Tetsuya Saito
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Taku Inohara
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | | | - Fumiaki Yashima
- Department of Cardiology Saiseikai Utsunomiya Hospital Tochigi Japan
| | - Hikaru Tsuruta
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery Keio University School of Medicine Tokyo Japan
| | - Keiichi Fukuda
- Department of Cardiology Keio University School of Medicine Tokyo Japan
| | - Toru Naganuma
- Department of Cardiology New Tokyo Hospital Matsudo Japan
| | - Kazuki Mizutani
- Department of Cardiology Osaka City General Hospital Osaka Japan
| | - Masahiro Yamawaki
- Department of Cardiology Saiseikai Yokohama-City Eastern Hospital Yokohama Japan
| | - Norio Tada
- Department of Cardiology Sendai Kousei Hospital Sendai Japan
| | - Futoshi Yamanaka
- Department of Cardiology Shonan Kamakura General Hospital Kamakura Japan
| | - Shinichi Shirai
- Department of Cardiology Kokura Memorial Hospital Kokura Japan
| | - Minoru Tabata
- Department of Cardiovascular Surgery Tokyo Bay Urayasu-Ichikawa Medical Center Chiba Japan
| | - Hiroshi Ueno
- Department of Cardiology Toyama University Hospital Toyama Japan
| | - Kensuke Takagi
- Department of Cardiology Ogaki Municipal Hospital Gifu 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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Diastolic Function and Clinical Outcomes After Transcatheter Aortic Valve Replacement: PARTNER 2 SAPIEN 3 Registry. J Am Coll Cardiol 2021; 76:2940-2951. [PMID: 33334422 DOI: 10.1016/j.jacc.2020.10.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/29/2020] [Accepted: 10/19/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Few studies have evaluated if diastolic function could predict outcomes in patients with aortic stenosis. OBJECTIVES The authors aimed to assess the association between diastolic dysfunction (DD) and outcomes in patients with aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). METHODS Baseline, 30-day, and 1- and 2-year transthoracic echocardiograms from the PARTNER (Placement of Aortic Transcatheter Valves) 2 SAPIEN 3 registry were analyzed by a consortium of core laboratories and divided into the American Society of Echocardiography DD groups. RESULTS Among the 1,750 included, 682 (54.4%) had grade 1 DD, 352 (28.1%) had grade 2 DD, 168 (13.4%) had grade 3 DD, and 51 (4.1%) had indeterminate DD grade. Incremental baseline grades of DD were associated with an increase in combined 1- and 2-year cardiovascular (CV) death/rehospitalization (all p < 0.002) and all-cause death at 2 years (p = 0.01) but not at 1 year. Improvement in DD grade/grade 1 DD at 30 days post-TAVR was seen in 70.8% patients. Patients with improvement in ≥1 grade of DD/grade 1 DD had reduced 1-year CV death/rehospitalization (p < 0.001) and increased 2-year survival (p = 0.01). Baseline grade 3 DD was a predictor of 1-year CV death/rehospitalization (hazard ratio: 2.73; 95% confidence interval: 1.07 to 6.98; p = 0.04). Improvement in DD grade/grade 1 DD at 30 days was protective for 1-year CV death/rehospitalizations (hazard ratio: 0.39; 95% confidence interval: 0.19 to 0.83; p = 0.01). CONCLUSIONS In the PARTNER 2 SAPIEN 3 registry, baseline DD was a predictor of up to 2 years clinical outcomes in patients who underwent TAVR. Improvement in DD grade at 30 days was associated with improvement in short-term clinical outcomes. (The PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - PARTNER II - PARTNERII - S3 Intermediate [PARTNERII S3i]; NCT03222128; PARTNER II Trial: Placement of AoRTic TraNscathetER Valves II - High Risk and Nested Registry 7 [PII S3HR/NR7]; NCT03222141).
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Aortic Stenosis and Diastolic Dysfunction: Partners in Crime. J Am Coll Cardiol 2021; 76:2952-2955. [PMID: 33334423 DOI: 10.1016/j.jacc.2020.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 01/28/2023]
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Alekhin MN. [Classification of stages of severe aortic stenosis based on the prevalence of extravalvular heart damage]. ACTA ACUST UNITED AC 2021; 61:98-103. [PMID: 33706692 DOI: 10.18087/cardio.2021.1.n1024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/14/2020] [Accepted: 03/21/2020] [Indexed: 11/18/2022]
Abstract
This thematic review focuses on recently proposed classification of stages in pronounced aortic stenosis based on the prevalence of extravalvular cardiac damage and its modified variant designed for asymptomatic patients. The review presents studies, which analyzed the predictive significance of the proposed classification. The use of this classification allows predicting the course of disease in patients with pronounced aortic stenosis in valve replacement. The classification is based on routinely used structural and functional echocardiographic signs with already proven predictive values with respect of adverse events in patients after aortic valve replacement. The review discusses limitations of the classification for pronounced aortic stenosis stages based on the prevalence of extravalvular cardiac damage.
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Affiliation(s)
- M N Alekhin
- Central clinical hospital with polyclinic of the Presidential Administration of the Russian Federation, Moscow
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Thilén M, James S, Ståhle E, Lindhagen L, Christersson C. Preoperative heart failure worsens outcome after aortic valve replacement irrespective of left ventricular ejection fraction. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 8:127-134. [PMID: 33543245 DOI: 10.1093/ehjqcco/qcab008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/14/2021] [Accepted: 01/29/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) affects outcome of valve replacement (AVR) in aortic stenosis (AS). The study aim was to investigate the prognostic importance of concomitant cardiovascular disease in relation to preoperative LVEF. METHODS AND RESULTS All adult patients undergoing AVR due to AS 2008-2014 in a national register for heart diseases were included. All-cause mortality and hospitalization for heart failure during follow-up after AVR, stratified by preserved or reduced LVEF (=50%), was derived from national patient registers and analyzed by Cox regression.During the study period 10,406 patients, median age 73 years, a median follow-up of 35 months were identified. Preserved LVEF was present in 7,512 (72.2%). Among them 647 (8.6%) had a history of heart failure (HF) and 1,099 (14.6%) atrial fibrillation (AF) before intervention. Preoperative HF was associated with higher mortality irrespective of preserved or reduced LVEF: Hazard Ratio (HR) 1.64 (95% C.I. 1.35 -1.99) and 1.58 (95% C.I. 1.30 -1.92). Prior AF was associated with a higher risk of mortality in patients with preserved but not in those with reduced LVEF: HR 1.62 (95% C.I. 1.36 -1.92) and 1.05 (95% C.I. 0.86 -1.28). Irrespective of LVEF preoperative HF and AF were associated with an increased risk of postoperative heart failure hospitalization. CONCLUSION In patients planned for AVR, a history of HF or AF, irrespective of LVEF, worsens the postoperative prognosis. HF and AF can be seen as markers of myocardial fibrosis not necessarily discovered by LVEF and the merely use of it, besides symptoms, for timing of AVR seems suboptimal.
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Affiliation(s)
- Maria Thilén
- Department of Medical Sciences, Cardiology, Uppsala University
| | - Stefan James
- Department of Medical Sciences, Cardiology, Uppsala University.,Uppsala Clinical Research Center, Uppsala University
| | - Elisabeth Ståhle
- Department of Surgical Sciences, Thoracic Surgery, Uppsala University, Uppsala, Sweden
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31
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Prognostic impact of arterial stiffness following transcatheter aortic valve replacement. J Cardiol 2021; 78:37-43. [PMID: 33516637 DOI: 10.1016/j.jjcc.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/19/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Increased left ventricular (LV) afterload in patients with aortic stenosis consists of valvular and vascular loads; however, the effects of vascular load induced by arterial stiffness on clinical outcomes after transcatheter aortic valve replacement (TAVR) remain unclear. This study evaluated the prognostic value of brachial-ankle pulse wave velocity (baPWV) after TAVR. METHODS A retrospective study including 161 consecutive patients who underwent TAVR with a pre-procedural baPWV assessment was conducted. We investigated the association between baPWV and the 1-year composite outcome comprising all-cause death and rehospitalization related to heart failure. Echocardiographic measurements including the LV mass index (LVMi) and LV diastolic function at 1, 6, and 12 months after TAVR were assessed. RESULTS Of the 161 patients, 31 patients experienced composite outcome within 1 year after TAVR. The receiver operating characteristic curve analysis revealed that the discriminating baPWV level to discern 1-year composite outcome was 1,639 cm/s, and all subjects were allocated to two groups based on the result. Baseline characteristics were comparable between the high baPWV (n = 72) and low baPWV groups (n = 89). The Kaplan-Meier curve revealed a significantly higher cumulative 1-year composite outcome in the high baPWV group than in the low baPWV group (31% vs. 10%; log-rank test, p<0.001). High baPWV was an independent predictor of the 1-year composite outcome (adjusted hazard ratio, 3.42; 95% confidence interval, 1.62-7.85; p = 0.002). Furthermore, post-procedural echocardiography revealed that the high baPWV group had less LVMi regression and higher E/e' after TAVR compared to the low baPWV group. The delayed reversal in LVMi and diastolic function attributable to arterial stiffness might be linked to impaired clinical outcomes after TAVR. CONCLUSIONS Higher baPWV could be associated with adverse clinical outcomes and delayed reverse LV remodeling after TAVR.
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32
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Bavry AA, Okuno T, Aalaei-Andabili SH, Kumbhani DJ, Stortecky S, Asami M, Lanz J, Windecker S, Pilgrim T. The relationship between baseline diastolic dysfunction and postimplantation invasive hemodynamics with transcatheter aortic valve replacement. Clin Cardiol 2020; 43:1428-1434. [PMID: 32960991 PMCID: PMC7724241 DOI: 10.1002/clc.23457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 12/30/2022] Open
Abstract
Background Abnormal invasive hemodynamics after transcatheter aortic valve replacement (TAVR) is associated with poor survival; however, the mechanism is unknown. Hypothesis Diastolic dysfunction will modify the association between invasive hemodynamics postTAVR and mortality. Methods Patients with echocardiographic assessment of diastolic function and postTAVR invasive hemodynamic assessment were eligible for the present analysis. Diastology was classified as normal or abnormal (Stages 1 to 3). The aorto‐ventricular index (AVi) was calculated as the difference between the aortic diastolic and the left ventricular end‐diastolic pressure divided by the heart rate. AVi was categorized as abnormal (AVi < 0.5 mmHg/beats per minute) or normal (≥ 0.5 mmHg/beats per minute). Results From 1339 TAVR patients, 390 were included in the final analysis. The mean follow‐up was 3.3 ± 1.7 years. Diastolic dysfunction was present in 70.9% of the abnormal vs 55.1% of the normal AVi group (P < .001). All‐cause mortality was 46% in the abnormal vs 31% in the normal AVi group (P < .001). Adjusted hazard ratio (HR) for AVi < 0.5 mmHg/beats per minute vs AVi ≥0.5 mmHg/beats per minute for intermediate‐term mortality was (HR = 1.5, 95% confidence interval [CI] 1.1 to 2.1, P = .017). This association was the same among those with normal diastolic function and those with diastolic dysfunction (P for interaction = .35). Conclusion Diastolic dysfunction is prevalent among TAVR patients. Low AVi is an independent predictor for poor intermediate‐term survival, irrespective of co‐morbid diastolic dysfunction.
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Affiliation(s)
- Anthony A Bavry
- Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Taishi Okuno
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Dharam J Kumbhani
- Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Jonas Lanz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Dahiya G, Kyvernitakis A, Joshi AA, Lasorda DM, Bailey SH, Raina A, Biederman RWW, Kanwar MK. Impact of transcatheter aortic valve replacement on left ventricular hypertrophy, diastolic dysfunction and quality of life in patients with preserved left ventricular function. Int J Cardiovasc Imaging 2020; 37:485-492. [DOI: 10.1007/s10554-020-02015-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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Lee HJ, Lee H, Kim SM, Park JB, Kim EK, Chang SA, Park E, Kim HK, Lee W, Kim YJ, Lee SC, Park SW, Sohn DW, Oh JK, Park SJ, Lee SP. Diffuse Myocardial Fibrosis and Diastolic Function in Aortic Stenosis. JACC Cardiovasc Imaging 2020; 13:2561-2572. [PMID: 32828787 DOI: 10.1016/j.jcmg.2020.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/15/2020] [Accepted: 07/06/2020] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the relationship between extracellular volume fraction (ECV), a noninvasive parameter that quantifies the degree of diffuse myocardial fibrosis on cardiac magnetic resonance (CMR), and left ventricular diastolic dysfunction (LVDD) in patients with aortic stenosis (AS). BACKGROUND Myocardial fibrosis on invasive myocardial biopsy is associated with LVDD. However, there is a paucity of data on the association between noninvasively quantified diffuse myocardial fibrosis and the degree of LVDD and how these are related to symptoms and long-term prognosis in patients with AS. METHODS Patients with moderate or severe AS (n = 191; mean age 68.4 years) and 30 control subjects without cardiovascular risk factors underwent CMR. LVDD grade was evaluated using echocardiography according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as a composite of all-cause mortality or hospitalization for heart failure aggravation. RESULTS Patients in higher ECV quintiles had a significantly higher prevalence of LVDD. Higher ECV was particularly associated with decreased myocardial relaxation (septal e' <7 cm/s) and increased LV filling pressure (E/e' ratio ≥15). Although both impaired diastolic function and higher ECV were significantly associated with a worse degree of dyspnea, patients with higher ECV showed greater dyspnea within the same grade of LVDD. During a median follow-up period of 5.6 years, 37 clinical events occurred. Increased ECV, as well as lower septal e' and higher E/septal e' ratio, were independent predictors of clinical events, irrespective of age, AS severity, aortic valve replacement, and left ventricular (LV) ejection fraction. ECV provided incremental prognostic value on top of clinical factors and LV systolic and diastolic function. CONCLUSIONS Diffuse myocardial fibrosis, assessed using ECV on CMR, was associated with LVDD in patients with AS, but both ECV and LV diastolic function parameters provided a complementary explanation for dyspnea and clinical outcomes. Concomitant assessment of both LVDD and diffuse myocardial fibrosis may further identify patients with AS with greater symptoms and worse prognosis.
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Affiliation(s)
- Hyun-Jung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Heesun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sung Mok Kim
- Department of Radiology, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eunah Park
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sang Chol Lee
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Dae-Won Sohn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jae K Oh
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea.
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Nagai T, Horinouchi H, Ohno Y, Murakami T, Sakai K, Nakazawa G, Yoshioka K, Ikari Y. Predictors for non-delayed discharge after transcatheter aortic valve replacement: utility of echocardiographic parameters. Int J Cardiovasc Imaging 2020; 37:47-58. [PMID: 32712734 DOI: 10.1007/s10554-020-01944-z] [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: 12/17/2019] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
Considering that transcatheter aortic valve replacement (TAVR) procedures have become less invasive, the duration for monitoring patient care after a successful TAVR can be reduced. Therefore, this study aimed to investigate the prognostic value of baseline echocardiographic parameters for non-delayed discharge in patients after TAVR. The study group included 154 consecutive patients (mean age: 84.4 ± 4.5 years; and 101 women) who underwent a TAVR. Comprehensive echocardiograms including both side indices of myocardial performance (IMP) and blood tests were obtained prior to the TAVR procedure. The median post-TAVR length of stay was 6 days while the mode and first quartile were both 4 days. Receiver operating characteristic curve analysis showed that the optimum cut-off value of the left-sided IMP in patients with a normal left ventricular ejection fraction (LVEF, ≥ 50%) (n = 124) for non-delayed discharge (≤ 4 days) was 0.34 with an area under the curve (AUC) value of 0.71563 and p value of < 0.0001, while the optimum cut-off value in patients with reduced LVEF (< 50%) (n = 30) was 0.47 with an AUC value of 0.77778 and p value of < 0.0120. An adjusted analysis indicated the negative left-sided IMP results as the only predictor for non-delayed discharge (p < 0.0001). Furthermore, the adjusted predictors for survival without early cardiovascular re-hospitalization within 6 months after TAVR were the positive left-sided IMP result, when the cut-off value of 0.52 was used, and the presence of elevated RAP of 8 to 15 mmHg. The early discharge policy should be carefully considered in high-risk populations, but the left-sided IMP may play a significant role in the pre-screening process.
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Affiliation(s)
- Tomoo Nagai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan.
| | - Hitomi Horinouchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Yohei Ohno
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Tsutomu Murakami
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Katsuaki Sakai
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Gaku Nakazawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Koichiro Yoshioka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Yuji Ikari
- Division of Cardiovascular Medicine, Department of Internal Medicine, Tokai University School of Medicine, Shimokasuya 143, Isehara-shi, Kanagawa, 259-1193, Japan
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Racial disparities and democratization of health care: A focus on TAVR in the United States. Am Heart J 2020; 224:166-170. [PMID: 32417548 DOI: 10.1016/j.ahj.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/10/2020] [Indexed: 11/21/2022]
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Vollema EM, Amanullah MR, Ng ACT, van der Bijl P, Prevedello F, Sin YK, Prihadi EA, Marsan NA, Ding ZP, Généreux P, Pibarot P, Leon MB, Narula J, Ewe SH, Delgado V, Bax JJ. Staging Cardiac Damage in Patients With Symptomatic Aortic Valve Stenosis. J Am Coll Cardiol 2020; 74:538-549. [PMID: 31345429 DOI: 10.1016/j.jacc.2019.05.048] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND In severe aortic stenosis (AS), patients often show extra-aortic valvular injury. Recently, a new staging system for severe AS has been proposed on the basis of the extent of cardiac damage. OBJECTIVES The present study evaluated the prevalence and prognostic impact of these different stages of cardiac damage in a large, real-world, multicenter cohort of symptomatic severe AS patients. METHODS From the ongoing registries from 2 academic institutions, a total of 1,189 symptomatic severe AS patients were selected and retrospectively analyzed. According to the extent of cardiac damage on echocardiography, patients were classified as Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (mitral valve or left atrial damage), Stage 3 (tricuspid valve or pulmonary artery vasculature damage), or Stage 4 (right ventricular damage). Patients were followed for all-cause mortality and combined endpoint (all-cause mortality, stroke, and cardiac-related hospitalization). RESULTS On the basis of the proposed classification, 8% of patients were classified as Stage 0, 24% as Stage 1, 49% as Stage 2, 7% as Stage 3, and 12% as Stage 4. On multivariable analysis, cardiac damage was independently associated with all-cause mortality and combined outcome, although this was mainly determined by Stages 3 and 4. CONCLUSIONS In this large multicenter cohort of symptomatic severe AS patients, stage of cardiac injury as classified by a novel staging system was independently associated with all-cause mortality and combined endpoint, although this seemed to be predominantly driven by tricuspid valve or pulmonary artery vasculature damage (Stage 3) and right ventricular dysfunction (Stage 4).
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Affiliation(s)
- E Mara Vollema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Arnold C T Ng
- Department of Cardiology, Princess Alexandra Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Francesca Prevedello
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Yoong Kong Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Zee Pin Ding
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Philippe Généreux
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey; Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Philippe Pibarot
- Institut Universitaire de Cardiologie et de Pneumologie de Québec/Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; New York-Presbyterian Hospital/Columbia University, Medical Center, New York, New York
| | | | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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Kwak S, Lee Y, Ko T, Yang S, Hwang IC, Park JB, Yoon YE, Kim HL, Kim HK, Kim YJ, Cho GY, Sohn DW, Won S, Lee SP. Unsupervised Cluster Analysis of Patients With Aortic Stenosis Reveals Distinct Population With Different Phenotypes and Outcomes. Circ Cardiovasc Imaging 2020; 13:e009707. [PMID: 32418453 DOI: 10.1161/circimaging.119.009707] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There is a lack of studies investigating the heterogeneity of patients with aortic stenosis (AS). We explored whether cluster analysis identifies distinct subgroups with different prognostic significances in AS. METHODS Newly diagnosed patients with moderate or severe AS were prospectively enrolled between 2013 and 2016 (n=398, mean 71 years, 55% male). Among demographics, laboratory, and echocardiography parameters (n=32), 11 variables were selected through dimension reduction and used for unsupervised clustering. Phenotypes and causes of mortality were compared between the clusters. RESULTS Three clusters with markedly different features were identified. Cluster 1 (n=60) was predominantly associated with cardiac dysfunction, cluster 2 (n=86) consisted of elderly with comorbidities, especially end-stage renal disease, whereas cluster 3 (n=252) demonstrated neither cardiac dysfunction nor comorbidities. Although AS severity did not differ, there was a significant difference in adverse outcomes between the clusters during a median 2.4 years follow-up (mortality rate, 13.3% versus 19.8% versus 6.0% for cluster 1, 2, and 3, P<0.001). Particularly, compared with cluster 3, cluster 1 was associated with only cardiac mortality (adjusted hazard ratio, 7.37 [95% CI, 2.00-27.13]; P=0.003), whereas cluster 2 was associated with higher noncardiac mortality (adjusted hazard ratio, 3.35 [95% CI, 1.26-8.90]; P=0.015). Phenotypes and association of clusters with specific outcomes were reproduced in an independent validation cohort (n=262). CONCLUSIONS Unsupervised cluster analysis of patients with AS revealed 3 distinct groups with different causes of death. This provides a new perspective in the categorization of patients with AS that takes into account comorbidities and extravalvular cardiac dysfunction.
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Affiliation(s)
- Soongu Kwak
- Department of Internal Medicine (S.K., S.Y., J.-B.P., H.-K.K., Y.-J.K., D.-W.S., S.-P.L.), Seoul National University Hospital
| | - Yunhwan Lee
- Department of Public Health Sciences, Seoul National University (Y.L., S.W.)
| | - Taehoon Ko
- Office of Hospital Information (T.K.), Seoul National University Hospital
| | - Seokhun Yang
- Department of Internal Medicine (S.K., S.Y., J.-B.P., H.-K.K., Y.-J.K., D.-W.S., S.-P.L.), Seoul National University Hospital
| | - In-Chang Hwang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do (I.-C.H., Y.E.Y., G.-Y.C.)
| | - Jun-Bean Park
- Department of Internal Medicine (S.K., S.Y., J.-B.P., H.-K.K., Y.-J.K., D.-W.S., S.-P.L.), Seoul National University Hospital
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do (I.-C.H., Y.E.Y., G.-Y.C.)
| | - Hack-Lyoung Kim
- Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, South Korea (H.-L.K.)
| | - Hyung-Kwan Kim
- Department of Internal Medicine (S.K., S.Y., J.-B.P., H.-K.K., Y.-J.K., D.-W.S., S.-P.L.), Seoul National University Hospital
| | - Yong-Jin Kim
- Department of Internal Medicine (S.K., S.Y., J.-B.P., H.-K.K., Y.-J.K., D.-W.S., S.-P.L.), Seoul National University Hospital
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do (I.-C.H., Y.E.Y., G.-Y.C.)
| | - Dae-Won Sohn
- Department of Internal Medicine (S.K., S.Y., J.-B.P., H.-K.K., Y.-J.K., D.-W.S., S.-P.L.), Seoul National University Hospital
| | - Sungho Won
- Department of Public Health Sciences, Seoul National University (Y.L., S.W.)
| | - Seung-Pyo Lee
- Department of Internal Medicine (S.K., S.Y., J.-B.P., H.-K.K., Y.-J.K., D.-W.S., S.-P.L.), Seoul National University Hospital
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Reply to: In searching for prognostic markers in transcatheter aortic valve replacement: Diastolic dysfunction and insulin-like growth factor system assessment. Int J Cardiol 2020; 307:136. [PMID: 32354400 DOI: 10.1016/j.ijcard.2019.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 11/22/2022]
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Gopalakrishnan P, Biederman R. Impact of the 2016 ASE/EACVI Guidelines on diastolic function reporting in routine clinical practice. Echocardiography 2020; 37:546-553. [PMID: 32298005 DOI: 10.1111/echo.14645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/20/2020] [Accepted: 03/08/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the impact of 2016 ASE/EACVI guidelines on Diastolic Function (DF) reporting during routine clinical practice. METHODS Transthoracic echos performed 9 months before and 18 months after the 2016 guidelines (DF2016) were retrospectively analyzed. RESULTS Twenty thousand eight hundred forty three echos performed between July 1, 2015, and September 30, 2017, were analyzed. Quarterly trends showed a stable proportion of normal DF (nDF), diastolic dysfunction (DD), indeterminate DF (DF-I), and nonreported DF (DF-NR) for 3 quarters preceding DF2016. After DF2016 release, reporting of DD decreased by 57% (P < .001), nDF increased by 76% (P < .001), DF-NR increased by 266% (P < .001), and DF-I did not change significantly (P = .40). Grade 1 DD decreased by 64% (P < .001), grade 2 DD decreased by 51% (P < .001), and grade 3 DD did not change significantly (P = .18). Provider level analysis showed increased heterogeneity in grade 1 DD reporting and decreased heterogeneity in DD grades 2 or higher, after DF2016. Systolic dysfunction reporting remained relatively stable (22%→21%→20%) compared to a significant decrease in isolated DD (35%→21%→10%). CONCLUSION The 2016 guidelines update has impacted DF reporting patterns significantly. The likelihood of reporting DD decreased significantly, especially for grades 1 and 2. Inter-provider heterogeneity in DF reporting improved for grades 2 and 3 but worsened for grade 1. There was more than threefold increase in failure to report DF, suggesting a decrease in provider confidence.
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Affiliation(s)
| | - Robert Biederman
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania
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Varshney AS, Manandhar P, Vemulapalli S, Kirtane AJ, Mathew V, Shah B, Lowenstern A, Kosinski AS, Kaneko T, Thourani VH, Bhatt DL. Left Ventricular Hypertrophy Does Not Affect 1-Year Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2020; 12:373-382. [PMID: 30784643 DOI: 10.1016/j.jcin.2018.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/21/2018] [Accepted: 11/13/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association between pre-procedural left ventricular hypertrophy (LVH) patterns and clinical outcomes after transcatheter aortic valve replacement (TAVR). BACKGROUND The association between pre-procedural LVH pattern and severity and clinical outcomes after TAVR is uncertain. METHODS Patients (n = 31,199) across 422 sites who underwent TAVR from November 2011 through June 2016 as part of the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapies) Registry linked with the Centers for Medicare and Medicaid Services database were evaluated by varying LVH patterns, according to sex-specific cutoffs for left ventricular mass index and relative wall thickness. The association between LVH pattern (concentric remodeling, concentric LVH, and eccentric LVH) and outcomes (rates of mortality, myocardial infarction [MI], stroke, new dialysis requirement) at 1-year follow-up were evaluated using multivariate hazard models. RESULTS There were no significant associations between concentric remodeling (death: adjusted hazard ratio [HR]: 1.03; 95% confidence interval [CI]: 0.93 to 1.15; MI: HR: 1.05; 95% CI: 0.76 to 1.46; stroke: HR: 1.11; 95% CI: 0.89 to 1.39; new dialysis: HR: 0.86; 95% CI: 0.64 to 1.15), concentric LVH (death: HR: 1.04; 95% CI: 0.95 to 1.15; MI: HR: 1.12; 95% CI: 0.82 to 1.52; stroke: HR: 1.14; 95% CI: 0.92 to 1.40; new dialysis: HR: 1.17; 95% CI: 0.90 to 1.52), or eccentric LVH (death: HR: 0.98; 95% CI: 0.87 to 1.10; MI: HR: 1.07; 95% CI: 0.71 to 1.63; stroke: HR: 1.01; 95% CI: 0.78 to 1.32; new dialysis: HR: 1.25; 95% CI: 0.92 to 1.70) and outcomes at 1 year compared with patients without LVH. CONCLUSIONS In a contemporary cohort of patients who underwent TAVR, pre-procedural LVH according to left ventricular mass index and relative wall thickness was not associated with adverse outcomes at 1-year follow-up. TAVR is likely to benefit patients with severe aortic stenosis regardless of the presence of LVH.
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Affiliation(s)
- Anubodh S Varshney
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts
| | | | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University, Durham, North Carolina
| | - Ajay J Kirtane
- Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Verghese Mathew
- Division of Cardiology, Stritch School of Medicine, Loyola University, Chicago, Illinois
| | - Binita Shah
- Division of Cardiology, VA New York Harbor Healthcare System and New York University School of Medicine, New York, New York
| | - Angela Lowenstern
- Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University, Durham, North Carolina
| | - Andrzej S Kosinski
- Duke Clinical Research Institute, Durham, North Carolina; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Tsuyoshi Kaneko
- Department of Cardiac Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Vinod H Thourani
- Department of Cardiac Surgery, Medstar Heart and Vascular Institute/Georgetown University, Washington, DC
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts.
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Thaden JJ, Balakrishnan M, Sanchez J, Adigun R, Nkomo VT, Eleid M, Dahl J, Scott C, Pislaru S, Oh JK, Schaff H, Pellikka PA. Left ventricular filling pressure and survival following aortic valve replacement for severe aortic stenosis. Heart 2020; 106:830-837. [PMID: 32066613 DOI: 10.1136/heartjnl-2019-315908] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To determine whether echocardiography-derived left ventricular filling pressure influences survival in patients with severe aortic stenosis (AS) undergoing aortic valve replacement (AVR). METHODS We retrospectively reviewed 1383 consecutive patients with severe AS, normal ejection fraction and interpretable filling pressure undergoing AVR. Left ventricular filling pressure was determined according to current guidelines using mitral inflow, mitral annular tissue Doppler, estimated right ventricular systolic pressure and left atrial volume index. Cox proportional hazards regression was used to assess the influence of various parameters on mortality. RESULTS Age was 75±10 years and 552 (40%) were female. Left ventricular filling pressure was normal in 325 (23%), indeterminate in 463 (33%) and increased in 595 (43%). Mean follow-up was 7.3±3.7 years, and mortality was 1.2%, 4.2% and 18.9% at 30 days and 1 and 5 years, respectively. Compared with patients with normal filling pressure, patients with increased filling pressure were older (78±9 vs 70±12, p<0.001), more often female (45% vs 35%, p=0.002) and were more likely to have New York Heart Association class III-IV symptoms (35% vs 24%, p=0.004), coronary artery disease (55% vs 42%, p<0.001) and concentric left ventricular hypertrophy (63% vs 37%, p<0.001). After correction for other factors, increased left ventricular filling pressure remained an independent predictor of mortality after successful AVR (adjusted HR 1.45 (95% CI 1.16 to 1.81), p=0.005). CONCLUSIONS Preoperative increased left ventricular filling pressure is common in patients with AS undergoing AVR and has important prognostic implications, regardless of symptom status. Future prospective studies should consider whether patients with increased filling pressure would benefit from earlier operation.
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Affiliation(s)
- Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mahesh Balakrishnan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jose Sanchez
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rosalyn Adigun
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jordi Dahl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher Scott
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hartzell Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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43
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Fukui M, Cavalcante JL. Effect of the Extent of Cardiac Damage on Transcatheter Aortic Valve Replacement Outcome: A New Aortic Stenosis Staging System. US CARDIOLOGY REVIEW 2020. [DOI: 10.15420/usc.2019.9.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Severe aortic stenosis (AS) causes chronic pressure overload of the left ventricle (LV), resulting in progressive cardiac change that can extend beyond the LV. A new AS staging classification has been recently proposed encompassing the extent of cardiac changes in AS. The AS staging classification has important prognostic implications for clinical outcomes after aortic valve replacement. This article introduces the AS staging system and demonstrates the association of the extent of cardiac change with outcomes after transcatheter aortic valve replacement.
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Affiliation(s)
- Miho Fukui
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN
| | - João L Cavalcante
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN; Minneapolis Heart Institute, Abbott Northwestern Hospital, Allina Health, Minneapolis, MN
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45
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Takagi H, Hari Y, Nakashima K, Yokoyama Y, Ueyama H, Kuno T, Ando T. Baseline left ventricular diastolic dysfunction affects midterm mortality after transcatheter aortic valve implantation. J Card Surg 2019; 35:536-543. [PMID: 31886935 DOI: 10.1111/jocs.14409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To determine whether preprocedural left ventricular (LV) diastolic dysfunction impairs midterm mortality after transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS), we performed a meta-analysis of currently available evidence. METHODS We identified all studies investigating impact of preprocedural severity of LV diastolic dysfunction on midterm (≥1-year) all-cause mortality after TAVI for patients with AS through a search of databases (MEDLINE and EMBASE) until September 2019. From each study, we extracted an adjusted (if unavailable, unadjusted) hazard ratio (HR) of midterm mortality. We pooled study-specific estimates in the random-effects model. RESULTS Ten eligible studies with a total of 2380 patients with AS undergoing TAVI were identified. In accordance with pooled analyses, higher-grade preprocedural LV diastolic dysfunction was associated with significantly worse midterm all-cause mortality after TAVI compared to lower-grade dysfunction (HR for grade II vs I, 1.15; P = .002; HR for grade III vs I, 1.35; P = .001; HR for grade III vs II; 1.16, P = .002; HR for grade II-III vs I, II-III vs 0-I, or III vs I-II, 1.34; P < .00001 [primary meta-analysis]; HR per grade, 1.16; P = .003). No funnel plot asymmetry for the primary meta-analysis (for grade II-III vs I, II-III vs 0-I, or III vs I-II) was identified, which probably indicated no publication bias (P = .381 by the linear-regression test). CONCLUSION Higher-grade preprocedural LV diastolic dysfunction was associated with worse midterm all-cause mortality after TAVI for patients with AS compared to lower-grade dysfunction.
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Affiliation(s)
- Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kouki Nakashima
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.,Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yujiro Yokoyama
- Department of Surgery, Easton Hospital, Easton, Pennsylvania
| | - Hiroki Ueyama
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Toshiki Kuno
- Department of Medicine, Mount Sinai Beth Israel Medical Center, New York, New York
| | - Tomo Ando
- Division of Interventional Cardiology, Department of Cardiology, New York Presbyterian Hospital/Columbia University Medical Center, New York, New York
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Flachskampf FA, Chandrashekhar Y. Diastolic Function and Functional Well-Being After Transcatheter Aortic Valve Replacement: A Not-So-Easy Relationship. JACC Cardiovasc Interv 2019; 12:2485-2487. [PMID: 31786215 DOI: 10.1016/j.jcin.2019.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Frank A Flachskampf
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Clinical Physiology and Cardiology, Akademiska sjukhuset, Uppsala, Sweden.
| | - Y Chandrashekhar
- Division of Cardiology, University of Minnesota and Veterans Affairs Medical Center, Minneapolis, Minnesota
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Malik AO, Omer M, Pflederer MC, Almomani A, Gosch KL, Jones PG, Peri-Okonny PA, Al Badarin F, Brandt HA, Arnold SV, Main ML, Cohen DJ, Spertus JA, Chhatriwalla AK. Association Between Diastolic Dysfunction and Health Status Outcomes in Patients Undergoing Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2019; 12:2476-2484. [PMID: 31786216 DOI: 10.1016/j.jcin.2019.08.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to assess the association of baseline left ventricular diastolic dysfunction (LVDD) with health status outcomes of patients undergoing transcatheter aortic valve replacement (TAVR). BACKGROUND Although LVDD in patients with aortic stenosis is associated with higher mortality after TAVR, it is unknown if it is also associated with health status recovery. METHODS In a cohort of 304 patients with interpretable echocardiograms, undergoing TAVR, LVDD was categorized at baseline as absent (grade 0), mild (grade 1), moderate (grade 2), or severe (grade 3). Disease-specific health status was assessed using the 12-item Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) at baseline and at 1-month and 12-month follow-up. Association of baseline LVDD with health status at baseline and follow-up after TAVR was assessed using a linear trend test, and association with health status recovery (change in KCCQ-OS) was examined using a linear mixed model adjusting for baseline KCCQ-OS. RESULTS Twenty-four (7.9%), 54 (17.8%), 186 (61.2%), and 40 (13.2%) patients had LVDD grades of 0, 1, 2, and 3, respectively. Baseline KCCQ-OS was 61.3 ± 22.7, 51.0 ± 26.1, 44.7 ± 25.7, and 44.4 ± 21.9 (p = 0.004) in patients with LVDD grades of 0, 1,2 and 3. At 1 and 12 months after TAVR, LVDD was not associated with KCCQ-OS. Recovery in KCCQ-OS after TAVR was substantial and similar in patients across all severities of LVDD. CONCLUSIONS Although LVDD is associated with health status prior to TAVR, patients across all severities of LVDD have similar recovery in health status after TAVR.
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Affiliation(s)
- Ali O Malik
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri.
| | - Mohamed Omer
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Mathew C Pflederer
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Ahmed Almomani
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Kensey L Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Poghni A Peri-Okonny
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Firas Al Badarin
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Hunter A Brandt
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Suzanne V Arnold
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Michael L Main
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - David J Cohen
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - John A Spertus
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Adnan K Chhatriwalla
- University of Missouri-Kansas City, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
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Tzanis G, Philippou A, Biliou S, Giannini F, Koutsilieris M, Nanas S. In searching for prognostic markers in transcatheter aortic valve replacement: Diastolic dysfunction and insulin-like growth factor system assessment. Int J Cardiol 2019; 288:63. [PMID: 31101233 DOI: 10.1016/j.ijcard.2019.01.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 01/23/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Georgios Tzanis
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evangelismos" Hospital, National and Kapodistrian University of Athens, Greece; Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Anastassios Philippou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Smaragda Biliou
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evangelismos" Hospital, National and Kapodistrian University of Athens, Greece
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, Greece
| | - Serafim Nanas
- 1st Critical Care Medicine Department, Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, "Evangelismos" Hospital, National and Kapodistrian University of Athens, Greece
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Anantha-Narayanan M, Malik U, Mbai M, Megaly M, Florea V, Sharma A, Cavalcante JL, Garcia S. Impact of diastolic dysfunction on long-term mortality and quality of life after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 95:1034-1041. [PMID: 31419009 DOI: 10.1002/ccd.28444] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/28/2019] [Accepted: 08/01/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND There is conflicting data as to whether diastolic dysfunction (DD) affects the prognosis of patients with aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). METHODS Consecutive patients undergoing TAVR underwent assessment of DD with preoperative echocardiography and NT-pro BNP. Long-term survival was ascertained every 6 months by clinic visits or phone. DD was graded according to the new American Society of Echocardiography recommendations. Health status was assessed at baseline and 30 days post-procedure using the KCCQ-12 questionnaire. Long-term survival was displayed using Kaplan-Meier curves according to NT-pro BNP levels and DD grades. RESULTS We included 222 patients, mean age 78 (±8) years, median STS score 4 (interquartile range = 3-7), median follow-up time 385 days (IQR = 180-640). DD was absent in 25, Grade I in 13, Grade II in 74, Grade III in 24, and indeterminate in 86 patients. Advanced (Grades II-III) DD was associated with higher pre-procedural NT-pro BNP levels (p < .001), worse quality of life (p < .001) but similar surgical risk (p = .43). Advanced and indeterminate DD were associated with increased long-term mortality (25-28% vs. 5%, p = .02) and elevated NT-pro BNP levels (26.4% vs. 9.8%, p = .05). Improvements in quality of life measures were seen in all DD groups (median change in KCCQ score no or Grade I DD:14 [3-21] vs. Grades II-III DD: 15 [16-26; p = .37]). CONCLUSION Preoperative NT-pro BNP levels and echocardiographic indices of indeterminate or advanced DD are associated with increased long-term mortality after TAVR but similar improvements in quality of life.
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Affiliation(s)
- Mahesh Anantha-Narayanan
- Department of Medicine, Division of Cardiology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Umair Malik
- Department of Medicine, Division of Cardiology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Mackenzi Mbai
- Department of Medicine, Division of Cardiology, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Interventional Cardiology, Valve Science Center, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Michael Megaly
- Department of Interventional Cardiology, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Viorel Florea
- Department of Medicine, Division of Cardiology, University of Minnesota Medical School, Minneapolis, Minnesota.,Department of Interventional Cardiology, Valve Science Center, Minneapolis Heart Institute, Minneapolis, Minnesota
| | - Alok Sharma
- HonorHealth Heart Group, Scottsdale, Arizona
| | - João L Cavalcante
- Department of Interventional Cardiology, Minneapolis VA Medical Center, Minneapolis, Minnesota
| | - Santiago Garcia
- Department of Interventional Cardiology, Minneapolis VA Medical Center, Minneapolis, Minnesota
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Kampaktsis PN, Vavuranakis M, Choi DY, Sherifi I, Christofi A, Triantafyllou D, Siasos G, Salemi A, Tousoulis D, Wong SC, Devereux RB. Prognostic role of diastolic dysfunction in patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2019; 95:1024-1031. [DOI: 10.1002/ccd.28426] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/25/2019] [Indexed: 02/02/2023]
Affiliation(s)
| | - Manolis Vavuranakis
- 1st Cardiology ClinicHippokrateion Hospital/University of Athens Medical School Athens Greece
| | - Daniel Y. Choi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Ines Sherifi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Angela Christofi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Dionysis Triantafyllou
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Gerasimos Siasos
- 1st Cardiology ClinicHippokrateion Hospital/University of Athens Medical School Athens Greece
| | - Arash Salemi
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Dimitrios Tousoulis
- 1st Cardiology ClinicHippokrateion Hospital/University of Athens Medical School Athens Greece
| | - S. Chiu Wong
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
| | - Richard B. Devereux
- Department of MedicineNew York Presbyterian/Weill Cornell Medical College New York New York
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