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Ruan L, Zhu L, Su L, Hu S, Wang S, Guo Q, Wan B, Qiu S, Zhang Y, Wei Y. Better prognosis in surgical aortic valve replacement patients with lower red cell distribution width: A MIMIC-IV database study. PLoS One 2024; 19:e0306258. [PMID: 39042622 PMCID: PMC11265686 DOI: 10.1371/journal.pone.0306258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 06/12/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND Surgical aortic valve replacement (SAVR) currently stands as a primary surgical intervention for addressing aortic valve disease in patients. This retrospective study focused on the role of the red blood cell distribution width (RDW) in predicting adverse outcomes among SAVR patients. METHODS The subjects for this study were exclusively derived from the Medical Information Mart for Intensive Care database (MIMIC IV 2.0). Kaplan‒Meier (K-M) curves and Cox proportional hazards regression models were employed to assess the correlation between RDW, one-year mortality, and postoperative atrial fibrillation (POAF). The smooth-fitting curves were used to observe the relative risk (RR) of RDW in one-year mortality and POAF. Furthermore, time-dependent receiver operating characteristic (ROC) curves, the continuous-net reclassification index (NRI), and integrated discrimination improvement (IDI) were employed for comprehensive assessment of the prognostic value of RDW. RESULTS Analysis of RDW revealed a distinctive inverted U-shaped relationship with one-year mortality, while its association with POAF appeared nearly linear. Cox multiple regression models showed that RDW > 14.35%, along with preoperative potassium concentration and perioperative red blood cell transfusion, were significantly linked to one-year mortality (K-M curves, log-rank P < 0.01). Additionally, RDW was associated with both POAF and prolonged hospital stays (P < 0.05). There was no significant difference in length of stay in ICU. Notably, the inclusion of RDW in the predictive models substantially enhanced its performance. This was evidenced by the time-dependent ROC curve (AUC = 0.829), NRI (P< 0.05), IDI (P< 0.05), and K-M curves (log-rank P< 0.01). CONCLUSIONS RDW serves as a robust prognostic indicator for SAVR patients, offering a novel means of anticipating adverse postoperative events.
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Affiliation(s)
- Liancheng Ruan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Lingxiao Zhu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Lang Su
- Department of Thoracic Surgery, The Second Affiliated Hospital of Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Sheng Hu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Silin Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Qiang Guo
- Department of Thoracic Surgery, The Second Affiliated Hospital of Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Bingen Wan
- Department of Thoracic Surgery, The Second Affiliated Hospital of Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Shengyu Qiu
- Department of Thoracic Surgery, The Second Affiliated Hospital of Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Yang Zhang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi Province, China
| | - Yiping Wei
- Department of Thoracic Surgery, The Second Affiliated Hospital of Jiangxi Medical College of Nanchang University, Nanchang, Jiangxi Province, China
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Takiguchi H, Miura M, Shirai SI, Soga Y, Hanyu M, Sakaguchi G, Soga Y, Arai Y, Watanabe S, Kimura T, Takahama H, Yasuda S, Nakayoshi T, Fukumoto Y, Yaoita N, Shimokawa H, Sakatsume K, Saiki Y, Kaikita K, Tsujita K, Tamura T, Doman T, Yamashita M, Suzuki M, Eura Y, Kokame K, Hayakawa M, Matsumoto M, Okubo N, Sugawara S, Fujimaki SI, Kawate Y, Ando K, Horiuchi H. Mitral regurgitation is associated with similar loss of von Willebrand factor large multimers but lower frequency of anemia compared with aortic stenosis. Res Pract Thromb Haemost 2024; 8:102431. [PMID: 38840664 PMCID: PMC11152679 DOI: 10.1016/j.rpth.2024.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/21/2024] [Accepted: 04/20/2024] [Indexed: 06/07/2024] Open
Abstract
Background Various cardiovascular diseases cause acquired von Willebrand syndrome (AVWS), which is characterized by a decrease in high-molecular-weight (large) von Willebrand factor (VWF) multimers. Mitral regurgitation (MR) has been reported as a cause of AVWS. However, much remains unclear about AVWS associated with MR. Objectives To evaluate VWF multimers in MR patients and examine their impact on clinical characteristics. Methods Moderate or severe MR patients (n = 84) were enrolled. VWF parameters such as the VWF large multimer index (VWF-LMI), a quantitative value that represents the amount of VWF large multimers, and clinical data were prospectively analyzed. Results At baseline, the mean hemoglobin level was 12.9 ± 1.9 g/dL and 58 patients (69.0%) showed loss of VWF large multimers defined as VWF-LMI < 80%. VWF-LMI in patients with degenerative MR was lower than in those with functional MR. VWF-LMI appeared to be restored the day after mitral valve intervention, and the improvement was maintained 1 month after the intervention. Seven patients (8.3%) had a history of bleeding, 6 (7.1%) of whom had gastrointestinal bleeding. Gastrointestinal endoscopy was performed in 23 patients (27.4%) to investigate overt gastrointestinal bleeding, anemia, etc. Angiodysplasia was detected in 2 of the 23 patients (8.7%). Conclusion Moderate or severe MR is frequently associated with loss of VWF large multimers, and degenerative MR may cause more severe loss compared with functional MR. Mitral valve intervention corrects the loss of VWF large multimers. Gastrointestinal bleeding may be relatively less frequent and hemoglobin level remains stable in MR patients.
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Affiliation(s)
- Hiroshi Takiguchi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Mizuki Miura
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shin-ichi Shirai
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Michiya Hanyu
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Genichi Sakaguchi
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshiharu Soga
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Yoshio Arai
- Department of Cardiovascular Surgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Shin Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroyuki Takahama
- Cardiovascular Department, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Yasuda
- Cardiovascular Department, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takaharu Nakayoshi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Nobuhiro Yaoita
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ko Sakatsume
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Tsuyoshi Doman
- Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mihoko Yamashita
- Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Misako Suzuki
- Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuka Eura
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koichi Kokame
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masaki Hayakawa
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan
| | - Masanori Matsumoto
- Department of Blood Transfusion Medicine, Nara Medical University, Kashihara, Japan
| | - Noriyuki Okubo
- Department of Clinical Laboratory Medicine, Tohoku University Hospital, Sendai, Japan
| | - Shingo Sugawara
- Department of Clinical Laboratory Medicine, Tohoku University Hospital, Sendai, Japan
| | - Shin-ichi Fujimaki
- Department of Clinical Laboratory Medicine, Tohoku University Hospital, Sendai, Japan
| | - Yasunori Kawate
- Medical Affairs 2, Medical & Scientific Affairs, Sysmex Corporation, Kobe, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hisanori Horiuchi
- Department of Molecular and Cellular Biology, Institute of Development, Aging and Cancer, Tohoku University Graduate School of Medicine, Sendai, Japan
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Billig S, Hein M, Uhlig M, Schumacher D, Thudium M, Coburn M, Weisheit CK. [Anesthesia for aortic valve stenosis : Anesthesiological management of patients with aortic valve stenosis during noncardiac surgery]. DIE ANAESTHESIOLOGIE 2024; 73:168-176. [PMID: 38334810 PMCID: PMC10920418 DOI: 10.1007/s00101-024-01380-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/10/2024]
Abstract
Aortic valve stenosis is a common condition that requires an anesthesiologist's in-depth knowledge of the pathophysiology, diagnostics and perioperative features of the disease. A newly diagnosed aortic valve stenosis is often initially identified from the anamnesis (dyspnea, syncope, angina pectoris) or a suspicious auscultation finding during the anesthesiologist's preoperative assessment. Interdisciplinary collaboration is essential to ensure the optimal management of these patients in the perioperative setting. An accurate anamnesis and examination during the preoperative assessment are crucial to select the most suitable anesthetic approach. Additionally, a precise understanding of the hemodynamic peculiarities associated with aortic valve stenosis is necessary. After a short summary of the overall pathophysiology of aortic valve stenosis, this review article focuses on the specific anesthetic considerations, risk factors for complications, and the perioperative management for noncardiac surgery in patients with aortic valve stenosis.
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Affiliation(s)
- Sebastian Billig
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
| | - Marc Hein
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Moritz Uhlig
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - David Schumacher
- Klinik für Anästhesiologie, Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - Marcus Thudium
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Mark Coburn
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - Christina K Weisheit
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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4
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Neelamegham S, Canty JM. Anemia, Increased Shear Stress, and the Progression of Aortic Stenosis. JACC Basic Transl Sci 2024; 9:200-202. [PMID: 38510720 PMCID: PMC10950399 DOI: 10.1016/j.jacbts.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Affiliation(s)
- Sriram Neelamegham
- VA WNY Health Care System and the Department of Medicine, the Department of Physiology & Biophysics and the Department of Chemical and Biological Engineering of the University at Buffalo, Buffalo, New York, USA
| | - John M. Canty
- VA WNY Health Care System and the Department of Medicine, the Department of Physiology & Biophysics and the Department of Chemical and Biological Engineering of the University at Buffalo, Buffalo, New York, USA
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5
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Subramani K, Bander J, Chen S, Suárez-Fariñas M, Venkatesan T, Subrahmanian S, Varshney R, Kini A, Sharma S, Rifkin DB, Cho J, Coller BS, Ahamed J. Evidence That Anemia Accelerates AS Progression Via Shear-Induced TGF-β1 Activation: Heyde's Syndrome Comes Full Circle. JACC Basic Transl Sci 2024; 9:185-199. [PMID: 38510715 PMCID: PMC10950403 DOI: 10.1016/j.jacbts.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 03/22/2024]
Abstract
The severity of aortic stenosis (AS) is associated with acquired von Willebrand syndrome (AVWS) and gastrointestinal bleeding, leading to anemia (Heyde's syndrome). We investigated how anemia is linked with AS and AVWS using the LA100 mouse model and patients with AS. Induction of anemia in LA100 mice increased transforming growth factor (TGF)-β1 activation, AVWS, and AS progression. Patients age >75 years with severe AS had higher plasma TGF-β1 levels and more severe anemia than AS patients age <75 years, and there was a correlation between TGF-β1 and anemia. These data are compatible with the hypothesis that the blood loss anemia of Heyde's syndrome contributes to AS progression via WSS-induced activation of platelet TGF-β1 and additional gastrointestinal bleeding via WSS-induced AVWS.
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Affiliation(s)
- Kumar Subramani
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Jeffrey Bander
- Icahn School of Medicine at Mount Sinai New York, New York, USA
| | - Sixia Chen
- University of Oklahoma Health Sciences Centers, Oklahoma City, Oklahoma, USA
| | | | - Thamizhiniyan Venkatesan
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Sandeep Subrahmanian
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Rohan Varshney
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Annapoorna Kini
- Icahn School of Medicine at Mount Sinai New York, New York, USA
| | - Samin Sharma
- Icahn School of Medicine at Mount Sinai New York, New York, USA
| | - Daniel B. Rifkin
- Departments of Cell Biology and Medicine, New York University, New York, New York, USA
| | - Jaehyung Cho
- Washington University School of Medicine, St. Louis, Missouri, USA
| | - Barry S. Coller
- Laboratory of Blood and Vascular Biology, Rockefeller University, New York, New York, USA
| | - Jasimuddin Ahamed
- Cardiovascular Biology Research Program, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
- University of Oklahoma Health Sciences Centers, Oklahoma City, Oklahoma, USA
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Zen K, Inoue K, Yashige M. Gastrointestinal Angiodysplasia before and after TAVR. Reply. N Engl J Med 2024; 390:95-96. [PMID: 38169506 DOI: 10.1056/nejmc2313153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Kan Zen
- Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Inoue
- Kyoto Prefectural University of Medicine, Kyoto, Japan
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Sugino S, Inoue K, Zen K, Yashige M, Kobayashi R, Takamatsu K, Ito N, Iwai N, Hirose R, Doi T, Dohi O, Yoshida N, Uchiyama K, Takagi T, Ishikawa T, Konishi H, Matoba S, Itoh Y. Gastrointestinal Angiodysplasia in Patients with Severe Aortic Stenosis: The Endoscopic Features of Heyde's Syndrome. Digestion 2023; 104:468-479. [PMID: 37619533 DOI: 10.1159/000533237] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023]
Abstract
INTRODUCTION Aortic stenosis (AS) is sometimes associated with gastrointestinal bleeding, and this phenomenon is known as Heyde's syndrome. Such bleeding is most often considered to originate from gastrointestinal angiodysplasias, but the frequency and endoscopic features of such bleeding remain unclear. This study aimed to determine the frequency and endoscopic features of gastrointestinal angiodysplasia in patients with severe AS. PATIENTS AND METHODS In this multicenter, retrospective study, we evaluated consecutive patients who underwent transcatheter aortic valve implantation (TAVI) with severe AS from May 2016 to December 2019. We extracted the data on the clinicopathological features according to the status of anemia, the proportion of patients who underwent gastrointestinal endoscopic examinations and demonstrated gastrointestinal angiodysplasia, and identified the endoscopic features associated with such patients. RESULTS In 325 patients, the rates of moderate/severe anemia (hemoglobin < 11 g/dL) were 52%. Regarding medicine, there were no significant differences between the patients with and without moderate/severe anemia. Patients were examined by esophagogastroduodenoscopy (21%), colonoscopy (12%), and balloon-assisted enteroscopy or small bowel capsule endoscopy (1.5%). Patients with moderate/severe anemia had significantly more angiodysplasia (38.3% vs. 7.7%; p < 0.0001) and active bleeding (23.4% vs. 0%; p < 0.01). Angiodysplasia was detected in 21 patients (stomach, n = 9; small intestine, n = 5, and colon, n = 10). CONCLUSIONS The results suggest, for the first time, that patients with severe AS who underwent TAVI and moderate/severe anemia frequently had gastrointestinal angiodysplasia and active bleeding throughout the entire gastrointestinal tract.
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Affiliation(s)
- Satoshi Sugino
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan,
- Department of Gastroenterology and Hepatology, Asahi University Hospital, Gifu, Japan,
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kan Zen
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Masaki Yashige
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuaki Takamatsu
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Nobuyasu Ito
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Naoto Iwai
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshifumi Doi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuhiko Uchiyama
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomohisa Takagi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takeshi Ishikawa
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hideyuki Konishi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Appert S, Weber L, Breuss A, Haager PK, Joerg L, Weilenmann D, Chronis J, Rigger J, Rickli H, Maeder MT. Estimated glomerular filtration rate, haemodynamics, and mortality in patients with aortic stenosis. Eur J Clin Invest 2023; 53:e13965. [PMID: 36740895 DOI: 10.1111/eci.13965] [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: 12/27/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND In aortic stenosis (AS), estimated glomerular filtration rate (eGFR) is an important prognostic marker but its haemodynamic determinants are unknown. We investigated the correlation between eGFR and invasive haemodynamics and long-term mortality in AS patients undergoing aortic valve replacement (AVR). METHODS We studied 503 patients [median (interquartile range) age 76 (69-81) years] with AS [indexed aortic valve area .42 (.33-.49) cm2 /m2 ] undergoing cardiac catheterization prior to surgical (72%) or transcatheter (28%) AVR. Serum creatinine was measured on the day before cardiac catheterization for eGFR calculation (CKD-EPI formula). RESULTS The median eGFR was 67 (53-82) mL/min/1.73 m2 . There were statistically significant correlations between eGFR and mean right atrial pressure (r = -.13; p = .004), mean pulmonary artery pressure (mPAP; r = -.25; p < .001), mean pulmonary artery wedge pressure (r = -.19; p < .001), pulmonary vascular resistance (r = -.21; p < .001), stroke volume index (r = .16; p < .001), extent of coronary artery disease, and mean transvalvular gradient but not indexed aortic valve area. In multivariate linear regression, higher age, lower haemoglobin, lower mean transvalvular gradient (i.e. lower flow), lower diastolic blood pressure, and higher mPAP were independent predictors of lower eGFR. After a median post-AVR follow-up of 1348 (948-1885) days mortality was more than two-fold higher in patients in the first eGFR quartile compared to those in the other three quartiles [hazard ratio 2.18 (95% confidence interval 1.21-3.94); p = .01]. CONCLUSION In patients with AS, low eGFR is a marker of an unfavourable haemodynamic constellation as well as important co-morbidities. This may in part explain the association between low eGFR and increased post-AVR mortality.
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Affiliation(s)
- Sharon Appert
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland.,University of Basel, Basel, Switzerland
| | - Lukas Weber
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Alexander Breuss
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland.,University of Basel, Basel, Switzerland
| | - Philipp K Haager
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Lucas Joerg
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Daniel Weilenmann
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Joannis Chronis
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Johannes Rigger
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Hans Rickli
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Micha T Maeder
- Cardiology Department, Kantonsspital St. Gallen, St. Gallen, Switzerland.,University of Basel, Basel, Switzerland
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9
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Ramesh P, Kanagalingam S, Zargham Ul Haq FNU, Victory Srinivasan N, Khan AI, Mashat GD, Hazique M, Khan KI, Khan S. Acquired Von Willebrand Deficiency in Adults With Aortic Stenosis: A Systematic Review. Cureus 2022; 14:e28879. [PMID: 36225403 PMCID: PMC9541123 DOI: 10.7759/cureus.28879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Von Willebrand factor (VWF) deficiency is associated with bleeding complications. The congenital type of Von Willebrand disease(VWD) is a very well-known bleeding disorder and sometimes may be associated with life-threatening hemorrhage. This systematic review is aimed at gathering further knowledge regarding the pathology of an acquired VWD form within a population of patients with aortic stenosis (AS) by shortlisting quality articles on this theme, through the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020 guidelines. High shear stress caused by the stenotic valve cleaves VWF multimers, causing a relative state of deficiency. The condition returns to baseline immediately following surgical replacement of the valve. Results across eight studies reviewed by a majority concluded that in an AS patient with bleeding, the most likely cause is an acquired deficiency of VWF, associated with factors influencing blood flow and caused by the in-situ valve. However, several studies suggested otherwise/were misclassifications. This review highlighted the relationship between AS and acquired VWF deficiency and should be foreseen as an adverse complication, attracting further research and future theragnostic strategies for this condition.
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10
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Goltstein LC, Rooijakkers MJ, Görtjes NC, Akkermans RP, Zegers ES, Pisters R, van Wely MH, van der Wulp K, Drenth JP, van Geenen EJ, van Royen N. Reduction of Gastrointestinal Bleeding in Patients With Heyde Syndrome Undergoing Transcatheter Aortic Valve Implantation. Circ Cardiovasc Interv 2022; 15:e011848. [PMID: 35861798 PMCID: PMC9287099 DOI: 10.1161/circinterventions.122.011848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/29/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Heyde syndrome is the co-occurrence of aortic stenosis and gastrointestinal bleeding secondary to angiodysplasias. Surgical aortic valve replacement effectively reduces bleeding, but the effects of transcatheter aortic valve implantation (TAVI) are largely unknown. This study aimed to describe the reduction of gastrointestinal bleeding in patients with Heyde syndrome after TAVI and to identify the factors associated with rebleeding. METHODS We enrolled patients with Heyde syndrome from a prospective TAVI registry. Gastrointestinal bleeding episodes were assessed by the Bleeding Academic Research Consortium classification, and cumulative incidence functions were used to calculate cessation rates. Factors potentially associated with rebleeding were analyzed using logistic regression. Differences between Heyde and non-Heyde patients were assessed through a case-cohort study. RESULTS Between December 2008 and June 2020, 1111 patients underwent TAVI. There were 70 patients with Heyde syndrome (6.3%). In the first year following TAVI, gastrointestinal bleeding ceased in 46 of 70 patients (62% [95% CI, 50%-74%]). Bleeding episodes decreased from 3.2 (95% CI, 2.5-4.2) to 1.6 ([95% CI, 1.2-2.2] P=0.001) and hemoglobin levels increased from 10.3 (95% CI, 10.0-10.8) to 11.3 (95% CI, 10.8-11.6) g/dL (P=0.007). Between 1 and 5 years after TAVI (35 [interquartile range, 21-51] months), 53 of 62 patients (83% [95% CI, 72%-92%]) no longer experienced gastrointestinal bleeding. Paravalvular leakage (≥mild) was associated with rebleeding risk (odds ratio, 3.65 [95% CI, 1.36-9.80]; P=0.010). Periprocedural bleeding was more common in Heyde than in control patients (adjusted odds ratio, 2.55 [95% CI, 1.37-4.73]; P=0.003). CONCLUSIONS Patients with Heyde syndrome are at increased risk for periprocedural bleeding. Post-TAVI, gastrointestinal bleeding disappears in the majority of patients. Paravalvular leakage may curtail these clinical benefits.
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Affiliation(s)
- Lia C.M.J. Goltstein
- Department of Gastroenterology and Hepatology (L.C.M.J.G., N.C.C.G., J.P.H.D., E.J.M.v.G.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Maxim J.P. Rooijakkers
- Department of Cardiology (M.J.P.R., M.H.v.W., K.v.d.W., N.v.R.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Natasha C.C. Görtjes
- Department of Gastroenterology and Hepatology (L.C.M.J.G., N.C.C.G., J.P.H.D., E.J.M.v.G.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinier P. Akkermans
- Scientific Institute for Quality of Healthcare (IQ Healthcare) (R.P.A.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Erwin S. Zegers
- Department of Cardiology, Canisius Wilhelmina Ziekenhuis, Nijmegen, the Netherlands (E.S.Z.)
| | - Ron Pisters
- Department of Cardiology, Rijnstate, Arnhem, the Netherlands (R.P.)
| | - Marleen H. van Wely
- Department of Cardiology (M.J.P.R., M.H.v.W., K.v.d.W., N.v.R.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Kees van der Wulp
- Department of Cardiology (M.J.P.R., M.H.v.W., K.v.d.W., N.v.R.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joost P.H. Drenth
- Department of Gastroenterology and Hepatology (L.C.M.J.G., N.C.C.G., J.P.H.D., E.J.M.v.G.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Erwin J.M. van Geenen
- Department of Gastroenterology and Hepatology (L.C.M.J.G., N.C.C.G., J.P.H.D., E.J.M.v.G.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - Niels van Royen
- Department of Cardiology (M.J.P.R., M.H.v.W., K.v.d.W., N.v.R.), Radboud University Medical Center, Nijmegen, the Netherlands
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11
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Mid-Term Mortality in Older Anemic Patients with Type 2 Myocardial Infarction: Does Blood Transfusion sImprove Prognosis? J Clin Med 2022; 11:jcm11092423. [PMID: 35566550 PMCID: PMC9104580 DOI: 10.3390/jcm11092423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/24/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Anemia often predisposes older patients to type 2 myocardial infarction (T2MI). However, the management of this frequent association remains uncertain. We aimed to evaluate the impact of red blood cell transfusion during the acute phase of T2MI in older anemic inpatients. (2) Methods and results: We performed a retrospective study using a French regional database. One hundred and seventy-eight patients aged 65 years or older, presenting with a T2MI and anemia, were selected. Patients were split into two groups: one that received a red blood cell transfusion (≥1 red blood cell unit) and one that did not. A propensity score was built to adjust for potential confounders, and the association between transfusion and 30-day mortality was evaluated with an inverse propensity score weighted Cox model. Transfusion was not associated with 30-day all-cause mortality (propensity score weighted hazard ratio (HR) 1.59 (0.55-4.56), p = 0.38). However, 1-year all-cause mortality was significantly higher in the transfusion group (propensity score weighted HR 2.47 (1.22-4.97), p = 0.011). (3) Conclusion: Our findings in older adults with anemia suggest that blood transfusion in the acute phase of T2MI could not be associated with improved short-term prognosis. Prospective studies are urgently needed to assess the impact of transfusion on longer-term prognosis.
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12
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Patel KP, Treibel TA, Scully PR, Fertleman M, Searle S, Davis D, Moon JC, Mullen MJ. Futility in Transcatheter Aortic Valve Implantation: A Search for Clarity. Interv Cardiol 2022; 17:e01. [PMID: 35111240 PMCID: PMC8790725 DOI: 10.15420/icr.2021.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/05/2021] [Indexed: 12/12/2022] Open
Abstract
Although transcatheter aortic valve implantation (TAVI) has revolutionised the landscape of treatment for aortic stenosis, there exists a cohort of patients where TAVI is deemed futile. Among the pivotal high-risk trials, one-third to half of patients either died or received no symptomatic benefit from the procedure at 1 year. Futility of TAVI results in the unnecessary exposure of risk for patients and inefficient resource utilisation for healthcare services. Several cardiac and extra-cardiac conditions and frailty increase the risk of mortality despite TAVI. Among the survivors, these comorbidities can inhibit improvements in symptoms and quality of life. However, certain conditions are reversible with TAVI (e.g. functional mitral regurgitation), attenuating the risk and improving outcomes. Quantification of disease severity, identification of reversible factors and a systematic evaluation of frailty can substantially improve risk stratification and outcomes. This review examines the contribution of pre-existing comorbidities towards futility in TAVI and suggests a systematic approach to guide patient evaluation.
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Affiliation(s)
- Kush P Patel
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Thomas A Treibel
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Paul R Scully
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Michael Fertleman
- Cutrale Perioperative and Ageing Group, Department of Bioengineering, Imperial College London London, UK
| | - Samuel Searle
- MRC Unit for Lifelong Health and Ageing, University College London London, UK
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, University College London London, UK
| | - James C Moon
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
| | - Michael J Mullen
- Institute of Cardiovascular Sciences, University College London London, UK.,Barts Heart Centre, St Bartholomew's Hospital London, UK
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13
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Seoudy H, Saad M, Salem M, Allouch K, Frank J, Puehler T, Salem M, Lutter G, Kuhn C, Frank D. Calculated Plasma Volume Status Is Associated with Adverse Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation. J Clin Med 2021; 10:jcm10153333. [PMID: 34362114 PMCID: PMC8346970 DOI: 10.3390/jcm10153333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Calculated plasma volume status (PVS) reflects volume overload based on the deviation of the estimated plasma volume (ePV) from the ideal plasma volume (iPV). Calculated PVS is associated with prognosis in the context of heart failure. This single-center study investigated the prognostic impact of PVS in patients undergoing transcatheter aortic valve implantation (TAVI). Methods: A total of 859 TAVI patients had been prospectively enrolled in an observational study and were included in the analysis. An optimal cutoff for PVS of −5.4% was determined by receiver operating characteristic curve analysis. The primary endpoint was a composite of all-cause mortality or heart failure hospitalization within 1 year after TAVI. Results: A total of 324 patients had a PVS < −5.4% (no congestion), while 535 patients showed a PVS ≥ −5.4% (congestion). The primary endpoint occurred more frequently in patients with a PVS ≥ −5.4% compared to patients with PVS < −5.4% (22.6% vs. 13.0%, p < 0.001). After multivariable adjustment, PVS was confirmed as a significant predictor of the primary endpoint (HR 1.53, 95% CI 1.05–2.22, p = 0.026). Conclusions: Elevated PVS, as a marker of subclinical congestion, is significantly associated with all-cause mortality and heart failure hospitalization within 1 year after TAVI.
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Affiliation(s)
- Hatim Seoudy
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
| | - Mohammed Saad
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
| | - Mostafa Salem
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
| | - Kassem Allouch
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
| | - Johanne Frank
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
| | - Thomas Puehler
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
- Department of Cardiac and Vascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Mohamed Salem
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
| | - Georg Lutter
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
- Department of Cardiac and Vascular Surgery, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany
| | - Christian Kuhn
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
| | - Derk Frank
- Department of Internal Medicine III, Cardiology and Angiology, Campus Kiel, University Hospital Schleswig-Holstein, D-24105 Kiel, Germany; (H.S.); (M.S.); (M.S.); (K.A.); (J.F.); (C.K.)
- DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, D-24105 Kiel, Germany; (T.P.); (M.S.); (G.L.)
- Correspondence: ; Tel.: +49-(0)4-31500-22801
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14
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Baştuğ S, Çöteli C, Çelik MC, Kasapkara HA, Bayram NA, Akcay M, Durmaz T. Baseline Anemia Is an Independent Predictor of Long-Term Mortality in Patients Undergoing Transcatheter Aortic Valve Implantation. Angiology 2021; 73:26-32. [PMID: 34247538 DOI: 10.1177/00033197211029801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to investigate the relationship between baseline anemia and long-term mortality in a single-center retrospective study involving patients undergoing transcatheter aortic valve implantation (TAVI). The study population included 412 consecutive patients undergoing TAVI at a center for severe aortic valve stenosis between August 2011 and November 2018. The primary end point of the study was all-cause mortality. Baseline anemia was present in 50% of our study cohort. During the median follow-up of 29 months, all-cause mortality was observed in 40.3% of the whole study population and was more frequently observed in the anemic group compared with the nonanemic group (53.5% vs 27.1%, P < .001, respectively). Cox-regression analysis revealed that Society of Thoracic Surgeons Predicted Risk of Mortality score, previous stroke, pericardial tamponade, and neutrophil-lymphocyte ratio count are independent predictors of long-term mortality after TAVI. Additionally, the presence of anemia at baseline was an independent predictor of long-term mortality with a 2.3-fold difference in the anemic group compared with the nonanemic group (hazard ratio: 2.31, 95% CI: 1.59-3.37, P < .001). Baseline anemia was observed in half of our patient population undergoing TAVI, and baseline anemia was found to be an independent predictor of long-term mortality after TAVI.
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Affiliation(s)
- Serdal Baştuğ
- Cardiology Department, 226850Yildirim Beyazit University Medical School, Ankara, Turkey
| | - Cem Çöteli
- Cardiology Department, 226850Yildirim Beyazit University Medical School, Ankara, Turkey
| | - Muhammet Cihat Çelik
- Cardiology Department, Ankara Ataturk Education and Research Hospital, Ankara, Turkey
| | - Haci Ahmet Kasapkara
- Cardiology Department, 226850Yildirim Beyazit University Medical School, Ankara, Turkey
| | - Nihal Akar Bayram
- Cardiology Department, 226850Yildirim Beyazit University Medical School, Ankara, Turkey
| | - Murat Akcay
- Cardiology Department, 226850Yildirim Beyazit University Medical School, Ankara, Turkey
| | - Tahir Durmaz
- Cardiology Department, 226850Yildirim Beyazit University Medical School, Ankara, Turkey
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15
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Grau Amorós J, García García JÁ, Mira Escartí JA, Serrado Iglesias A, Moreno García MC, Manzano L, Quesada Simón MA, Dávila Ramos MF, Casado Cerrada J, González Franco Á, Montero-Pérez-Barquero M. Influence of the degree of anaemia on the prognosis of older adults with heart failure (SPAN-HF study). Med Clin (Barc) 2021; 158:167-172. [PMID: 33962767 DOI: 10.1016/j.medcli.2021.01.016] [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: 10/22/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess whether a sustained optimal haemoglobin value in the 3 months after admission for heart failure (HF) decompensation reduces morbidity and mortality during the 12 months after admission for acute HF. PATIENTS AND METHOD Retrospective study of the 1408 patients older than 65 years included in the RICA registry divided into 3 groups: no anaemia (group A), recovered anaemia (group B), and persistent anaemia (group C), according to haemoglobin levels on admission, and 3 months after discharge. Kaplan-Meier curves were constructed, comparing the groups using the log-rank test and a Cox regression model was performed to analyse survival. RESULTS 578 (41.1%), 299 (21.2%) and 531 (37.7%) were included in groups A, B and C, respectively. We recorded a total of 768 deaths and readmissions. There were 23 (4%), 12 (4%) and 49 (9.2%), (p=.001) individuals who died due to HF and 154 (27%), 73 (24%) and 193 (36%) (P<.001) admissions for this pathology, respectively. Patients with persistent anaemia had a higher risk of death (RR 1.29, 95% CI 1.04-1.61, P=.024) or readmission (1.92, 95% CI 1.16-3, 19; P=.012) due to HF. CONCLUSIONS Persistent anaemia in the months after admission for HF increases morbidity and mortality in the subsequent year.
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Affiliation(s)
| | | | | | | | | | - Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, España
| | | | | | | | - Álvaro González Franco
- Servicio de Medicina Interna, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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16
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Gracia Baena JM, Calaf Vall I, Zielonka M, Marsal Mora JR, Godoy P, Worner Diz F. Risk factors and comorbidities associated with severe aortic stenosis: a case-control study. Rev Clin Esp 2021; 221:249-257. [PMID: 32591111 DOI: 10.1016/j.rce.2020.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Aortic stricture (AS) is one of the most prevalent cardiovascular diseases in individuals 65 years of age or older. A number of epidemiological studies have suggested that certain cardiovascular risk factors (CRFs) and comorbidities could be associated with AS. The aim of this study was to evaluate the association between CRFs and comorbidities and severe symptomatic AS in individuals 65 years of age or older in a Spanish healthcare region. PATIENTS AND METHODS We conducted an epidemiological case-control study from a single primary care centre. We collected information on exposure to CRFs and comorbidities and determined their association with AS, employing adjusted odds ratios (OR) and multiple logistic regression models. RESULTS The study included 102 cases (mean age, 77.6 years) and 221 controls (mean age, 75.5 years). The CRFs significantly associated with severe symptomatic AS were hypercholesterolaemia (OR, 2.67; p<.001), tobacco use (OR, 2.60; p<.001), hypertension (OR, 2.41; p=.010) and low HDL cholesterol readings (OR, 2.20; p=.007). The comorbidities significantly associated with severe symptomatic AS were carotid stenosis (OR, 14.5; p=.017), stroke (OR, 4.14; p=.024), chronic renal failure (OR, 3.78; p<.001) and low haemoglobin levels (OR, 0.76; p<.001). CONCLUSIONS Hypercholesterolaemia, tobacco use, arterial hypertension and low HDL cholesterol levels are the CRFs with a greater risk of severe AS. Furthermore, this disease is associated with a number of comorbidities (chronic renal failure, stroke, carotid stenosis and low haemoglobin levels), which could be markers of AS.
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Affiliation(s)
- J M Gracia Baena
- Servei de Cirurgia Cardíaca d'Adults, Hospital Universitari Vall d'Hebron, Barcelona, España; Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lérida, España.
| | - I Calaf Vall
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lérida, España
| | - M Zielonka
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lérida, España
| | - J R Marsal Mora
- Unitat de Suport a la Recerca Lleida, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España
| | - P Godoy
- Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lérida, España; CIBER de Epidemiología y Salud Pública CIBERESP, Barcelona, España; Agència de Salut Pública de Catalunya, Barcelona, España
| | - F Worner Diz
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lérida, España
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17
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Minamino-Muta E, Kato T, Morimoto T, Taniguchi T, Ando K, Kanamori N, Murata K, Kitai T, Kawase Y, Miyake M, Izumi C, Mitsuoka H, Kato M, Hirano Y, Matsuda S, Nagao K, Murakami T, Takeuchi Y, Yamane K, Toyofuku M, Ishii M, Inoko M, Ikeda T, Ishii K, Hotta K, Jinnai T, Kato Y, Inuzuka Y, Maeda C, Morikami Y, Saito N, Minatoya K, Kimura T. A risk prediction model in asymptomatic patients with severe aortic stenosis: CURRENT-AS risk score. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 6:166-174. [PMID: 31386103 DOI: 10.1093/ehjqcco/qcz044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/26/2019] [Accepted: 08/05/2019] [Indexed: 02/06/2023]
Abstract
AIMS Early aortic valve replacement (AVR) might be beneficial in selected high-risk asymptomatic patients with severe aortic stenosis (AS), considering their poor prognosis when managed conservatively. This study aimed to develop and validate a clinical scoring system to predict AS-related events within 1 year after diagnosis in asymptomatic severe AS patients. METHODS AND RESULTS We analysed 1274 asymptomatic severe AS patients derived from a retrospective multicentre registry enrolling consecutive patients with severe AS in Japan (CURRENT AS registry), who were managed conservatively and completed 1-year follow-up without AVR. From a randomly assigned derivation set (N = 849), we developed CURRENT AS risk score for the AS-related event (a composite of AS-related death and heart failure hospitalization) within 1 year using a multivariable logistic regression model. The risk score comprised independent risk predictors including left ventricular ejection fraction <60%, haemoglobin ≤11.0 g/dL, chronic lung disease (2 points), diabetes mellitus, haemodialysis, and any concomitant valve disease (1 point). The predictive accuracy of the model was good with the area under the curve of 0.79 and 0.77 in the derivation and validation sets (N = 425). In the validation set, the 1-year incidence of AS-related events was much higher in patients with score ≥2 than in patients with score ≤1 (Score 0: 2.2%, Score 1: 1.9%, Score 2: 13.4%, Score 3: 14.3%, and Score ≥4: 22.7%, P < 0.001). CONCLUSION The CURRENT-AS risk score integrating clinical and echocardiographic factors well-predicted the risk of AS-related events at 1 year in asymptomatic patients with severe AS and was validated internally.
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Affiliation(s)
- Eri Minamino-Muta
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Tomohiko Taniguchi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kokura, Fukuoka 802-8555, Japan
| | - Norio Kanamori
- Division of Cardiology, Shimada Municipal Hospital, 1200-5 Noda, Shimada, Shizuoka 427-8502, Japan
| | - Koichiro Murata
- Department of Cardiology, Shizuoka City Shizuoka Hospital, 10-93 Otemachi, Aoi-ku, Shizuoka 420-8630, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe-City, Hyogo 650-0047, Japan
| | - Yuichi Kawase
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
| | - Makoto Miyake
- Department of Cardiology, Tenri Hospital, Tenri, Japan
| | - Chisato Izumi
- Division of Heart Failure, National Cerebral and Cardiovascular Center, 200 Mishima-cho, Tenri, Nara 632-8555, Japan
| | - Hirokazu Mitsuoka
- Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, 1248-1 Otoda-cho, Ikoma, Nara 630-0293, Japan
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishigyo-ku, Kyoto 615-8087, Japan
| | - Yutaka Hirano
- Department of Cardiology, Kinki University Hospital, 377-2 Ohno-higashi, Sayama, Osaka 589-8511, Japan
| | - Shintaro Matsuda
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kazuya Nagao
- Department of Cardiovascular Center, Osaka Red Cross Hospital, 5-30 Hudegasaki, Tennoji-Ku, Osaka 543-8555, Japan
| | - Tomoyuki Murakami
- Department of Cardiology, Koto Memorial Hospital, 2-1 Hiramatsu-cho, Higashioumi, Shiga 527-0134, Japan
| | - Yasuyo Takeuchi
- Department of Cardiology, Shizuoka General Hospital, 4-27-1 Kitaando-cho, Aoi-ku, Shizuoka 420-8257, Japan
| | - Keiichiro Yamane
- Department of Cardiology, Nishikobe Medical Center, 5-7-1 Kojida-, Nishi-ku, Kobe 651-2273, Japan
| | - Mamoru Toyofuku
- Department of Cardiology, Japanese Red Cross Wakayama Medical Center, 4-20 Komatsubara-dori, Wakayama 640-8558, Japan
| | - Mitsuru Ishii
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, 1-1 Fukakusamukaihata-cho, Fushimi-ku, Kyoto 612-8555, Japan
| | - Moriaki Inoko
- Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, Kita-ku, Osaka 530-8480, Japan
| | - Tomoyuki Ikeda
- Department of Cardiology, Hikone Municipal Hospital, 1882 Yasaka-cho, Hikone, Shiga 522-8539, Japan
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Electric Power Hospital, 2-1-7 Fukushima, Fukushima-ku, Osaka 553-0003, Japan
| | - Kozo Hotta
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, 2-17-77 Higashi-naniwa-cho, Amagasaki, Hyogo 660-8550, Japan
| | - Toshikazu Jinnai
- Department of Cardiology, Japanese Red Cross Otsu Hospital, 1-1-35 Nagara, Otsu, Shiga 520-0046, Japan
| | - Yoshihiro Kato
- Department of Cardiology, Saiseikai Noe Hospital, 1-3-25 Furuichi, Joto-ku, Osaka 536-0001, Japan
| | - Yasutaka Inuzuka
- Department of Cardiology, Shiga Medical Center for Adults, 5-4-3 Moriyama, Moriyama, Shiga 524-8524, Japan
| | - Chiyo Maeda
- Department of Cardiology, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu, Shizuoka 430-8525, Japan
| | - Yuko Morikami
- Department of Cardiology, Hirakata Kohsai Hospital, 1-2-2-1 Hujisakahigashi-cho, Hirakata, Osaka 573-0153, Japan
| | - Naritatsu Saito
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan
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18
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Gracia Baena JM, Calaf Vall I, Zielonka M, Marsal Mora JR, Godoy P, Worner Diz F. Risk factors and comorbidities associated with severe aortic stenosis: A case-control study. Rev Clin Esp 2021; 221:249-257. [PMID: 33998510 DOI: 10.1016/j.rceng.2020.01.009] [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: 11/05/2019] [Accepted: 01/13/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Aortic stricture (AS) is one of the most prevalent cardiovascular diseases in individuals 65 years of age or older. A number of epidemiological studies have suggested that certain cardiovascular risk factors (CRFs) and comorbidities could be associated with AS. The aim of this study was to evaluate the association between CRFs and comorbidities and severe symptomatic AS in individuals 65 years of age or older in a Spanish healthcare region. PATIENTS AND METHODS We conducted an epidemiological case-control study from a single primary care centre. We collected information on exposure to CRFs and comorbidities and determined their association with AS, employing adjusted odds ratios (OR) and multiple logistic regression models. RESULTS The study included 102 cases (mean age, 77.6 years) and 221 controls (mean age, 75.5 years). The CRFs significantly associated with severe symptomatic AS were hypercholesterolaemia (OR, 2.67; p < .001), tobacco use (OR, 2.60; p < .001), hypertension (OR, 2.41; p = .010) and low HDL cholesterol readings (OR, 2.20; p = .007). The comorbidities significantly associated with severe symptomatic AS were carotid stenosis (OR, 14.5; p = .017), stroke (OR, 4.14; p = .024), chronic renal failure (OR, 3.78; p < .001) and low haemoglobin levels (OR, 0.76; p < .001). CONCLUSIONS Hypercholesterolaemia, tobacco use, arterial hypertension and low HDL cholesterol levels are the CRFs with a greater risk of severe AS. Furthermore, this disease is associated with a number of comorbidities (chronic renal failure, stroke, carotid stenosis and low haemoglobin levels), which could be markers of AS.
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Affiliation(s)
- J M Gracia Baena
- Servei de Cirurgia Cardíaca d'Adults, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lleida, Spain.
| | - I Calaf Vall
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Zielonka
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J R Marsal Mora
- Unitat de Suport a la Recerca Lleida, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol iGurina (IDIAPJGol), Barcelona, Spain
| | - P Godoy
- Unitat d'Epidemiologia Aplicada, Departament de Cirurgia, Universitat de Lleida, Lleida, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - F Worner Diz
- Servei de Cardiologia, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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19
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Mondal S, Hollander KN, Ibekwe SO, Williams B, Tanaka K. Heyde Syndrome-Pathophysiology and Perioperative Implications. J Cardiothorac Vasc Anesth 2020; 35:3331-3339. [PMID: 33132021 DOI: 10.1053/j.jvca.2020.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/02/2020] [Accepted: 10/04/2020] [Indexed: 11/11/2022]
Abstract
Gastrointestinal (GI) bleeding in patients with calcific aortic valve stenosis (AVS), termed Heyde syndrome, was first described by Edward C. Heyde. The strong association between valvular replacement and the eradication of clinically significant GI bleeding confirmed an underlying pathophysiologic relationship. The rheologic stress created by AVS increases proteolysis of von Willebrand factor (VWF), resulting in loss of predominantly high-molecular-weight VWF (Hmw VWF). Angiodysplastic vessels present in patients with AVS, coupled with the lack of functioning Hmw VWF, increase the risk for GI bleeds. Aortic valve replacement, both surgical and transcatheter-based, is often a definitive treatment for GI bleeding, leading to recovery of Hmw VWF multimers. Perioperative management of patients involves monitoring their coagulation profiles with relevant laboratory tests and instituting appropriate management. Management can be directed in the following two ways: by improving internal release of VWF or by administration of external therapeutics containing VWF. It is important for perioperative physicians to obtain an understanding of the pathophysiology of this disease process and closely monitor the bleeding pattern so that targeted therapies can be initiated.
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Affiliation(s)
- Samhati Mondal
- Department of Anesthesiology, Cardiac Anesthesia Division, University of Maryland School of Medicine, Baltimore, MD.
| | - Kimberly N Hollander
- Department of Anesthesiology, Cardiac Anesthesia Division, University of Maryland School of Medicine, Baltimore, MD
| | - Stephanie O Ibekwe
- Department of Anesthesiology, Cardiovascular Division, BTGH, Baylor College of Medicine, Houston, TX
| | - Brittney Williams
- Department of Anesthesiology, Cardiac Anesthesia Division, University of Maryland School of Medicine, Baltimore, MD
| | - Kenichi Tanaka
- Department of Anesthesiology, Cardiac Anesthesia Division, University of Maryland School of Medicine, Baltimore, MD
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20
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Nicolas J, Claessen BE, Cao D, Sartori S, Baber U, Power D, Chiarito M, Goel R, Roumeliotis A, Chandiramani R, Chen S, Chandrasekhar J, Tchetche D, Petronio AS, Mehilli J, Lefèvre T, Presbitero P, Capranzano P, Iadanza A, Sardella G, Van Mieghem NM, Meliga E, Dumonteil N, Fraccaro C, Trabattoni D, Mikhail G, Ferrer‐Gracia M, Naber C, Sharma S, Morice M, Dangas GD, Chieffo A, Mehran R. Preprocedural anemia in females undergoing transcatheter aortic valve implantation: Insights from the WIN‐TAVI registry. Catheter Cardiovasc Interv 2020; 97:E704-E715. [DOI: 10.1002/ccd.29276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/05/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Johny Nicolas
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Bimmer E. Claessen
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Davide Cao
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Samantha Sartori
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Usman Baber
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - David Power
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Mauro Chiarito
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
- Department of Cardiology Istituto Clinico Humanitas Milan Italy
| | - Ridhima Goel
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Anastasios Roumeliotis
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Rishi Chandiramani
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Siyan Chen
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Jaya Chandrasekhar
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | - Didier Tchetche
- Groupe CardioVasculaire Interventional Clinique Pasteur Toulouse France
| | | | - Julinda Mehilli
- Munich University Clinic Ludwig‐Maximilians University and German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance Munich Germany
| | - Thierry Lefèvre
- Institut Hospitalier Jacques Cartier Ramsay Générale de Santé Massy France
| | | | | | - Alessandro Iadanza
- Azienda Ospedaliera Universitaria Senese Policlinico Le Scotte Siena Italy
| | | | | | | | - Nicolas Dumonteil
- Department of Cardiology Rangueil University Hospital Toulouse France
| | | | | | - Ghada Mikhail
- Imperial College Healthcare NHS Trust Hammersmith Hospital London UK
| | | | - Christoph Naber
- Contilia Heart and Vascular Centre Elisabeth Krankenhaus Essen Germany
| | - Samin Sharma
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | | | - George D. Dangas
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
| | | | - Roxana Mehran
- The Zena and Michael A.Wiener Cardiovascular Institute Icahn School of Medicine at Mount Sinai New York New York
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21
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Taniguchi T, Morimoto T, Takeji Y, Kato T, Kimura T. Contemporary issues in severe aortic stenosis: review of current and future strategies from the Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis registry. Heart 2020; 106:802-809. [PMID: 32114519 DOI: 10.1136/heartjnl-2019-315672] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 01/10/2020] [Accepted: 01/13/2020] [Indexed: 02/07/2023] Open
Abstract
Contemporary Outcomes after Surgery and Medical Treatment in Patients with Severe Aortic Stenosis (CURRENT AS) registry was a large Japanese multicentre retrospective registry of consecutive patients with severe aortic stenosis (AS) before introduction of transcatheter aortic valve implantation. We sought to overview the data from the CURRENT AS registry to discuss the three major contemporary issues related to clinical practice in patients with severe AS: (1) under-referral/underuse of surgical aortic valve replacement (SAVR) in symptomatic patients with severe AS, (2) management of asymptomatic patients with severe AS and (3) management of patients with low-gradient severe aortic stenosis (LG-AS). First, despite the dismal prognosis of symptomatic patients with severe AS, SAVR, including those performed during follow-up, was reported to be underused. In the CURRENT AS registry, overall 53% of symptomatic patients underwent aortic valve replacement (AVR) during follow-up. Second, we reported that compared with conservative strategy, initial AVR strategy was associated with lower risk of all-cause death and heart failure hospitalisation in asymptomatic patients with severe AS. Although current recommendations for AVR are mainly dependent on the patient symptoms, some patients may not complain of any symptom because of their sedentary lifestyle. We also reported several important objective factors associated with worse clinical outcomes in asymptomatic patients with severe AS for risk stratification. Finally, initial AVR strategy was associated with better long-term clinical outcomes than conservative strategy in both patients with high-gradient AS and patients with LG-AS. The favourable effect of initial AVR strategy was also seen in patients with LG-AS with left ventricular ejection fraction of ≥50%.
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Affiliation(s)
- Tomohiko Taniguchi
- Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Fukuoka, Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.,Department of Cardiovascular Medicine, Faculty of Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yasuaki Takeji
- Department of Cardiovascular Medicine, Faculty of Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Kato
- Department of Cardiovascular Medicine, Faculty of Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Faculty of Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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22
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Liu R, Cui C, Li Y, Qiu Z, Hu Y, Wang Y, Cui M, Yin S, Liu L. Analysis of left ventricular diastolic energy loss in patients with aortic stenosis with preserved ejection fraction by using vector flow mapping. Echocardiography 2019; 36:2216-2226. [PMID: 31876982 DOI: 10.1111/echo.14555] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Ruijie Liu
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Cunying Cui
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Yanan Li
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Zhaoying Qiu
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Yanbin Hu
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Ying Wang
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Mingxia Cui
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
| | - Shanshan Yin
- Henan Academy of Medical Sciences Zhengzhou China
| | - Lin Liu
- Department of Ultrasound Henan Provincial People’s Hospital Heart Center Fuwai Central China Cardiovascular Hospital People’s Hospital of Zhengzhou University Zhengzhou China
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23
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Lv Z, Zhou B, Yang C, Wang H. Preoperative Anemia and Postoperative Mortality in Patients with Aortic Stenosis Treated with Transcatheter Aortic Valve Implantation (TAVI): A Systematic Review and Meta-Analysis. Med Sci Monit 2019; 25:7251-7257. [PMID: 31559972 PMCID: PMC6778413 DOI: 10.12659/msm.916185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients with severe aortic stenosis who have comorbidities that prevent general anesthesia and open cardiothoracic surgery are candidates for transcatheter aortic valve implantation (TAVI). However, TAVI can result in patient mortality following the procedure. This systematic review of the literature and meta-analysis aimed to determine the relationship between preoperative anemia and postoperative mortality in patients following TAVI. MATERIAL AND METHODS PubMed, EMBASE, the Cochrane Library, and the Web of Science were systematically searched from their inception to February 2019 for relevant published studies that included patients with bicuspid aortic valve stenosis and tricuspid aortic valve stenosis who underwent TAVI and who had preoperative data on hemoglobin levels. The pooled odds ratios (OR) and 95% confidence interval (CI) were calculated using a random-effects generic inverse variance method. RESULTS Six published studies that involved 6,406 patients with aortic stenosis were included in the meta-analysis. There was no significant difference observed for the final pooled result for patients with and without anemia for the short-term 30-day postoperative mortality (OR, 1.34; 95% CI, 0.77-2.35). However, long-term mortality rates were significantly worse in patients with preoperative anemia compared with those without anemia (OR, 1.77; 95% CI, 1.34-2.35). CONCLUSIONS Systematic review of the literature and meta-analysis showed that pre-procedural anemia reduced long-term mortality following TAVI. This finding supports the need to correct preoperative anemia in patients with aortic stenosis to improve patient outcome following TAVI.
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Affiliation(s)
- Zhenqian Lv
- Department of Cardiovascular Surgery, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
| | - Baoguo Zhou
- Department of Cardiovascular Surgery, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
| | - Chunyue Yang
- Department of Cardiovascular Medicine, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
| | - Haiping Wang
- Department of Cardiovascular Surgery, Qingdao Fuwai Hospital, Qingdao, Shandong, China (mainland)
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