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Hengstenberg C, Unverdorben M, Möllmann H, Van Mieghem NM, Thiele H, Nordbeck P, Rassaf T, Moreno R, Mehran R, Jin J, Lang I, Veltkamp R, Dangas GD. Risk Factors of Ischemic Stroke in Patients With Atrial Fibrillation After Transcatheter Aortic Valve Implantation from the Randomized ENVISAGE-TAVI AF Trial. Am J Cardiol 2024; 227:98-104. [PMID: 39032588 DOI: 10.1016/j.amjcard.2024.07.019] [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: 05/17/2024] [Revised: 07/08/2024] [Accepted: 07/14/2024] [Indexed: 07/23/2024]
Abstract
In patients with prevalent or incident atrial fibrillation (AF) after successful transcatheter aortic valve implantation (TAVI) enrolled in the EdoxabaN Versus standard of care and theIr effectS on clinical outcomes in pAtients havinG undergonE Transcatheter Aortic Valve Implantation - in Atrial Fibrillation (ENVISAGE-TAVI AF) trial, the incidence of ischemic stroke (IS) and any stroke was numerically less in the edoxaban group than in the vitamin K antagonist (VKA) group. The present study aimed to identify risk factors associated with IS in an on-treatment subanalysis in patients from ENVISAGE-TAVI AF who received ≥1 dose of edoxaban or VKA. Baseline patient characteristics were compared in patients with and those without IS. Numerical variables were compared using a 1-way analysis of variance; categorical variables were compared using Fisher's exact test. Stepwise Cox regression determined patient characteristics associated with the first IS event. Of 1,377 patients, 41 (3.0%) experienced an IS, and 1,336 (97.0%) did not; baseline demographics and clinical characteristics were well balanced between groups. Most ISs occurred within 180 days of TAVI for edoxaban (57.9%) and VKA (68.2%). The rate of IS was 2.0/100 person-years for edoxaban versus 2.7/100 person-years for VKA. Independently associated with IS were history of systemic embolic events (hazard ratio 2.96, 95% confidence interval 1.26 to 7.00, p = 0.01) and pre-TAVI use of VKAs (hazard ratio 2.17, 95% confidence interval 1.12 to 4.20, p = 0.02). In conclusion, although the overall incidence of IS was small for patients with AF on edoxaban or VKA after successful TAVI, patients with a history of systemic embolic events or pre-TAVI use of VKAs may be at greater risk of IS after TAVI.
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Affiliation(s)
- Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University, Vienna, Austria.
| | | | - Helge Möllmann
- Department of Internal Medicine, St. Johannes Hospital, Dortmund, Germany
| | - Nicolas M Van Mieghem
- Department of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Tienush Rassaf
- Clinic for Cardiology and Vascular Medicine, Westgerman Heart and Vascular Center, University Duisburg-Essen, Essen, Germany
| | - Raul Moreno
- Department of Cardiology, University Hospital La Paz, Madrid, Spain
| | - Roxana Mehran
- Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York
| | - James Jin
- Daiichi Sankyo, Inc., Basking Ridge, New Jersey
| | - Irene Lang
- Division of Cardiology, Department of Internal Medicine II, Vienna General Hospital, Medical University, Vienna, Austria
| | - Roland Veltkamp
- Department of Neurology, Alfried Krupp Krankenhaus, Essen, Germany; Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany; Department of Brain Sciences, Imperial College London, London, United Kingdom
| | - George D Dangas
- Division of Cardiology, Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Hospital, New York, New York; School of Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Saad BN, Menken LG, Keller DM, Rampertaap Y, Tang A, Hong IS, Liporace FA, Yoon RS, Jankowski JM. Does a delay to surgery for preoperative echocardiogram affect outcomes in patients with hip fracture? OTA Int 2024; 7:e338. [PMID: 38863460 PMCID: PMC11164006 DOI: 10.1097/oi9.0000000000000338] [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: 08/30/2023] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 06/13/2024]
Abstract
Introduction Delay to surgery >24 hours has been shown to correlate with mortality rates in patients with hip fracture when left untreated. Many of these patients have multiple comorbidities, including aortic stenosis (AS), and undergo workup for operative clearance, which may delay time to surgery. The purpose of this study was to examine whether preoperative echocardiogram workup affects time to surgery, complications, and mortality after operative fixation for hip fracture. Methods Our institutional hip fracture registry was retrospectively reviewed for inclusion over a 3-year period. Patients who had a preoperative echocardiogram (yECHO) for operative clearance were compared with those who did not (nECHO). Demographic data, time to surgery, overall complication rate, and mortality at 30 days, 90 days, and 1 year were collected. Results Two cohorts consisted of 136 yECHO patients (45.8%) and 161 nECHO patients (54.2%). Thirty-two yECHO patients (23.5%) had AS. Patients in the yECHO cohort were more likely to have a complication for any cause compared with nECHO patients (25.7% vs. 10.6%, P = 0.01) and have a higher mortality rate at 1 year (38.9% vs. 17.4%, P = 0.001). There was no association found between AS and all-cause complication (P = 0.54) or 30-day (P = 0.13) or 90-day mortality rates (P = 0.79). However, patients with AS had a significantly higher mortality rate at 1 year (45.8% vs. 25.1%, P = 0.03). Conclusion This study reinforces the benefits of ensuring less than a 24-hour time to surgery in the setting of a hip fracture and identifies an area of preoperative management that can be further optimized to prevent unnecessary prolongation in time to surgery. Patients with known aortic stenosis are not associated with increased 30-day or 90-day mortality or all-cause complications. Surgical delays in the yECHO cohort were attributed to preoperative medical assessments, including echocardiograms and the management of comorbidities. Therefore, the selective utilization of preoperative echocardiograms is needed and should be reserved to ensure they have a definitive role in guiding the perioperative care of patients with hip fracture. Level of Evidence III.
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Affiliation(s)
- Bishoy N. Saad
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Luke G. Menken
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - David M. Keller
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Yajesh Rampertaap
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Alex Tang
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Ian S. Hong
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Frank A. Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Richard S. Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
| | - Jaclyn M. Jankowski
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Cooperman Barnabas Medical Center/Jersey City Medical Center—RWJBarnabas Health, Livingston/Jersey City, NJ
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Hagendorff A, Stöbe S, Helfen A, Knebel F, Altiok E, Beckmann S, Bekfani T, Binder T, Ewers A, Hamadanchi A, Ten Freyhaus H, Groscheck T, Haghi D, Knierim J, Kruck S, Lenk K, Merke N, Pfeiffer D, Dorta ER, Ruf T, Sinning C, Wunderlich NC, Brandt R, Ewen S. Echocardiographic assessment of atrial, ventricular, and valvular function in patients with atrial fibrillation-an expert proposal by the german working group of cardiovascular ultrasound. Clin Res Cardiol 2024:10.1007/s00392-024-02491-6. [PMID: 39186180 DOI: 10.1007/s00392-024-02491-6] [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: 06/03/2024] [Accepted: 07/04/2024] [Indexed: 08/27/2024]
Abstract
Echocardiography in patients with atrial fibrillation is challenging due to the varying heart rate. Thus, the topic of this expert proposal focuses on an obvious gap in the current recommendations about diagnosis and treatment of atrial fibrillation (AF)-the peculiarities and difficulties of echocardiographic imaging. The assessment of systolic and diastolic function-especially in combination with valvular heart diseases-by echocardiography can basically be done by averaging the results of echocardiographic measurements of the respective parameters or by the index beat approach, which uses a representative cardiac cycle for measurement. Therefore, a distinction must be made between the functionally relevant status, which is characterized by the averaging method, and the best possible hemodynamic status, which is achieved with the most optimal left ventricular (LV) filling according to the index beat method with longer previous RR intervals. This proposal focuses on left atrial and left ventricular function and deliberately excludes problems of echocardiography when assessing left atrial appendage in terms of its complexity. Echocardiography of the left atrial appendage is therefore reserved for its own expert proposal.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University Hospital Leipzig AöR, Leipzig, Germany.
| | - Stephan Stöbe
- Department of Cardiology, University Hospital Leipzig AöR, Leipzig, Germany
| | - Andreas Helfen
- Department of Kardiologie, Katholische St. Paulus Gesellschaft, St. Marien Hospital Lünen, Lünen, Germany
| | - Fabian Knebel
- Department of Internal Medicine II, Cardiology, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Ertunc Altiok
- Department of Cardiology, Angiology, and Intensive Medicine, University Hospital Aachen, Aachen, Germany
| | - Stephan Beckmann
- Privatpraxis Kardiologie, Beckmann Ehlers Und Partner, Berlin-Grunewald, Germany
| | - Tarek Bekfani
- Department of Cardiology and Angiology, University Hospital Magdeburg AöR, Magdeburg, Germany
| | - Thomas Binder
- Department of Cardiology, University Hospital AKH Wien, Vienna, Austria
| | - Aydan Ewers
- Department of Cardiology and Angiology, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Ali Hamadanchi
- Department of Cardiology, University of Jena, Jena, Germany
| | - Henrik Ten Freyhaus
- Department of Internal Medicine III, Cardiology, University of Cologne, Cologne, Germany
| | - Thomas Groscheck
- Department of Cardiology and Angiology, University Hospital Magdeburg AöR, Magdeburg, Germany
| | - Dariush Haghi
- Kardiologische Praxisklinik Ludwigshafen-Akademische Lehrpraxis of the University of Mannheim, Ludwigshafen, Germany
| | - Jan Knierim
- Department of Internal Medicine and Cardiology, Paulinenkrankenhaus Berlin, Berlin, Germany
| | - Sebastian Kruck
- Praxis Für Kardiologie Cardio Centrum Ludwigsburg, Ludwigsburg, Germany
| | - Karsten Lenk
- Department of Cardiology, University Hospital Leipzig AöR, Leipzig, Germany
| | - Nicolas Merke
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Charité Berlin, Berlin, Germany
| | | | - Elena Romero Dorta
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum Charité Berlin, University of Berlin, Campus Mitte, Berlin, Germany
| | - Tobias Ruf
- Department of Cardiology, Center of Cardiology, Heart Valve Center, University Medical Center Mainz, University of Mainz, Mainz, Germany
| | - Christoph Sinning
- Department of Cardiology, German Centre of Cardiovascular Research (DZHK), University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Roland Brandt
- Department of Cardiology, Kerckhoff Klinik GmbH, Bad Nauheim, Germany
| | - Sebastian Ewen
- Department of Cardiology and Intensive Care Medicine, Schwarzwald-Baar Klinik, Villingen-Schwenningen, Germany
- University Heart Center Freiburg • Bad Krozingen, Freiburg, Germany
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4
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Parker J, Coey J, Alambrouk T, Lakey SM, Green T, Brown A, Maxwell I, Ripley DP. Evaluating a Novel AI Tool for Automated Measurement of the Aortic Root and Valve in Cardiac Magnetic Resonance Imaging. Cureus 2024; 16:e59647. [PMID: 38832163 PMCID: PMC11146459 DOI: 10.7759/cureus.59647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/05/2024] Open
Abstract
Objective Evaluating an artificial intelligence (AI) tool (AIATELLA, version 1.0; AIATELLA Oy, Helsinki, Finland) in interpreting cardiac magnetic resonance (CMR) imaging to produce measurements of the aortic root and valve by comparison of accuracy and efficiency with that of three National Health Service (NHS) cardiologists. Methods AI-derived aortic root and valve measurements were recorded alongside manual measurements from three experienced NHS consultant cardiologists (CCs) over three separate sites in the northeast part of the United Kingdom. The study utilised a comprehensive dataset of CMR images, with the intraclass correlation coefficient (ICC) being the primary measure of concordance between the AI and the cardiologist assessments. Patient imaging was anonymised and blinded at the point of transfer to a secure data server. Results The study demonstrates a high level of concordance between AI assessment of the aortic root and valve with NHS cardiologists (ICC of 0.98). Notably, the AI delivered results in 2.6 seconds (+/- 0.532) compared to a mean of 334.5 seconds (+/- 61.9) by the cardiologists, a statistically significant improvement in efficiency without compromising accuracy. Conclusion AI's accuracy and speed of analysis suggest that it could be a valuable tool in cardiac diagnostics, addressing the challenges of time-consuming and variable clinician-based assessments. This research reinforces AI's role in optimising the patient journey and improving the efficiency of the diagnostic pathway.
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Affiliation(s)
- Jack Parker
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, GBR
- Imaging, AIATELLA Oy, Helsinki, FIN
- Imaging, AIATELLA Ltd., Newcastle upon Tyne, GBR
| | - James Coey
- School of Medicine, St. George's University, Newcastle upon Tyne, GBR
- Health and Life Sciences, Northumbria University, Newcastle upon Tyne, GBR
- Imaging, AIATELLA Oy, Helsinki, FIN
| | - Tarek Alambrouk
- School of Medicine, St. George's University, Newcastle upon Tyne, GBR
| | - Samuel M Lakey
- Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
| | - Thomas Green
- Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
| | - Alexander Brown
- Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
| | - Ian Maxwell
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, GBR
| | - David P Ripley
- Cardiology, Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, GBR
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, GBR
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Laenens D, Stassen J, Galloo X, Ewe SH, Singh GK, Ammanullah MR, Hirasawa K, Sia CH, Butcher SC, Chew NWS, Kong WKF, Poh KK, Ding ZP, Ajmone Marsan N, Bax JJ. The impact of atrial fibrillation on prognosis in aortic stenosis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:778-784. [PMID: 36669758 PMCID: PMC10745267 DOI: 10.1093/ehjqcco/qcad004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) and aortic stenosis (AS) are both highly prevalent and often coexist. Various studies have focused on the prognostic value of AF in patients with AS, but rarely considered left ventricular (LV) diastolic function as a prognostic factor. OBJECTIVE To evaluate the prognostic impact of AF in patients with AS while correcting for LV diastolic function. METHODS Patients with first diagnosis of significant AS were selected and stratified according to history of AF. The endpoint was all-cause mortality. RESULTS In total, 2849 patients with significant AS (mean age 72 ± 12 years, 54.8% men) were evaluated, and 686 (24.1%) had a history of AF. During a median follow-up of 60 (30-97) months, 1182 (41.5%) patients died. Ten-year mortality rate in patients with AF was 46.8% compared to 36.8% in patients with sinus rhythm (SR) (log-rank P < 0.001). On univariable (HR: 1.42; 95% CI: 1.25-1.62; P < 0.001) and multivariable Cox regression analysis (HR: 1.19; 95% CI: 1.02-1.38; P = 0.026), AF was independently associated with mortality. However, when correcting for indexed left atrial volume, E/e' or both, AF was no longer independently associated with all-cause mortality. CONCLUSION Patients with significant AS and AF have a reduced survival as compared to patients with SR. Nonetheless, when correcting for markers of LV diastolic function, AF was not independently associated with outcomes in patients with significant AS.
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Affiliation(s)
- Dorien Laenens
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - See Hooi Ewe
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Mohammed R Ammanullah
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Royal Perth Hospital, 197 Wellington St, Perth, WA 6000, Australia
| | - Nicholas W S Chew
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - William K F Kong
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Center Singapore, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore
| | - Zee P Ding
- Department of Cardiology, National Heart Center Singapore, 5 Hospital Drive, Singapore 169609, Singapore, Singapore
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Cardiology, Turku Heart Center, University of Turku and Turku Unviersity Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland
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Corbacho-Alonso N, Rodríguez-Sánchez E, Sastre-Oliva T, Mercado-García E, Perales-Sánchez I, Juarez-Alia C, López-Almodovar LF, Padial LR, Tejerina T, Mourino-Alvarez L, Ruiz-Hurtado G, Barderas MG. Global Oxidative Status Is Linked to Calcific Aortic Stenosis: The Differences Due to Diabetes Mellitus and the Effects of Metformin. Antioxidants (Basel) 2023; 12:antiox12051024. [PMID: 37237890 DOI: 10.3390/antiox12051024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Calcific aortic stenosis (CAS) and type 2 diabetes mellitus (T2DM) are related and often concomitant pathologies, accompanied by common comorbidities such as hypertension or dyslipidemia. Oxidative stress is one of the mechanisms that trigger CAS, and it can drive the vascular complications in T2DM. Metformin can inhibit oxidative stress, yet its effects have not been studied in the context of CAS. Here, we assessed the global oxidative status in plasma from patients with CAS, both alone and with T2DM (and under treatment with metformin), using multimarker scores of systemic oxidative damage (OxyScore) and antioxidant defense (AntioxyScore). The OxyScore was determined by measuring carbonyls, oxidized LDL (oxLDL), 8-hydroxy-20-deoxyguanosine (8-OHdG), and xanthine oxidase (XOD) activity. In contrast, the AntioxyScore was determined through the catalase (CAT) and superoxide dismutase (SOD) activity, as well as the total antioxidant capacity (TAC). Patients with CAS displayed enhanced oxidative stress compared to control subjects, probably exceeding their antioxidant capacity. Interestingly, patients with CAS and T2DM displayed less oxidative stress, possibly due to the benefits of their pharmacological therapy (metformin). Thus, reducing oxidative stress or enhancing antioxidant capacity through specific therapies could be a good strategy to manage CAS, focusing on personalized medicine.
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Affiliation(s)
- Nerea Corbacho-Alonso
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM (Servicio de Salud de Castilla-La Mancha), 45071 Toledo, Spain
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
| | - Elena Rodríguez-Sánchez
- Cardiorenal Translational Laboratory, Instituto de Investigación Imas12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Tamara Sastre-Oliva
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM (Servicio de Salud de Castilla-La Mancha), 45071 Toledo, Spain
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
| | - Elisa Mercado-García
- Cardiorenal Translational Laboratory, Instituto de Investigación Imas12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - Ines Perales-Sánchez
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM (Servicio de Salud de Castilla-La Mancha), 45071 Toledo, Spain
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
| | - Cristina Juarez-Alia
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM (Servicio de Salud de Castilla-La Mancha), 45071 Toledo, Spain
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
| | | | - Luis R Padial
- Department of Cardiology, Hospital General Universitario de Toledo, SESCAM, 45007 Toledo, Spain
| | - Teresa Tejerina
- Department of Pharmacology, School of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Laura Mourino-Alvarez
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM (Servicio de Salud de Castilla-La Mancha), 45071 Toledo, Spain
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
| | - Gema Ruiz-Hurtado
- Cardiorenal Translational Laboratory, Instituto de Investigación Imas12, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, CIBER-CV Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | - María G Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, SESCAM (Servicio de Salud de Castilla-La Mancha), 45071 Toledo, Spain
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos, Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), 45071 Toledo, Spain
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7
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Wal P, Rathore S, Aziz N, Singh YK, Gupta A. Aortic stenosis: a review on acquired pathogenesis and ominous combination with diabetes mellitus. Egypt Heart J 2023; 75:26. [PMID: 37027109 PMCID: PMC10082141 DOI: 10.1186/s43044-023-00345-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/08/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Aortic stenosis (AS) is a progressive disease, with no pharmacological treatment. The prevalence of diabetes mellitus (DM) among AS patients is higher than in the general population. DM significantly increases the risk of AS development and progression from mild to severe. The interplay between AS and DM's mechanism is not entirely known yet. MAIN BODY The increased accumulation of advanced glycation end products (AGEs) was linked to increased valvular oxidative stress, inflammation, expression of coagulation factors, and signs of calcification, according to an analysis of aortic stenotic valves. It is interesting to note that in diabetic AS patients, valvular inflammation did not correlate with serum glucose levels but rather only with long-term glycemic management markers like glycated haemoglobin and fructosamine. Transcatheter aortic valve replacement, which has been shown to be safer than surgical aortic valve replacement, is advantageous for AS patients who also have concurrent diabetes. Additionally, novel anti-diabetic medications have been proposed to lower the risk of AS development in DM patients, including sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonist that target reduction of AGEs-mediated oxidative stress. CONCLUSIONS There are little data on the effects of hyperglycemia on valvular calcification, but understanding the interactions between them is essential to develop a successful treatment strategy to stop or at least slow the progression of AS in DM patients. There is a link among AS and DM and that DM negatively impacts the quality of life and longevity of AS patients. The sole successful treatment, despite ongoing efforts to find new therapeutic modalities, involves aortic valve replacement. More research is required to find methods that can slow the advancement of these conditions, enhancing the prognosis and course of people with AS and DM.
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Affiliation(s)
- Pranay Wal
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India.
| | - Shruti Rathore
- LCIT School of Pharmacy, Bilaspur, Chhattisgarh, 495220, India
| | - Namra Aziz
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India
| | - Yash Kumar Singh
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India
| | - Arpit Gupta
- Pranveer Singh Institute of Technology (Pharmacy), Bhauti, Kanpur, UP, 209305, India
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Shamekhi J, Hasse C, Veulemans V, Al-Kassou B, Piayda K, Maier O, Zeus T, Weber M, Sedaghat A, Zimmer S, Kelm M, Nickenig G, Sinning JM. A simplified cardiac damage staging predicts the outcome of patients undergoing TAVR-A multicenter analysis. Catheter Cardiovasc Interv 2022; 100:850-859. [PMID: 35989489 DOI: 10.1002/ccd.30368] [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: 05/23/2022] [Revised: 07/24/2022] [Accepted: 08/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND A significant number of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) suffer from extra-aortic cardiac damage. Few studies have investigated strategies to quantify cardiac damage and stratify patients accordingly in different risk groups. The aim of this retrospective multicenter study was to provide a user-friendly simplified staging system based on the proposed classification system of Généreux et al. as a tool to evaluate the prognosis of patients undergoing TAVR more easily. Moreover, we analyzed changes in cardiac damage after TAVR. METHODS We assessed cardiac damage in patients, who underwent TAVR at the Heart Center Bonn or Düsseldorf, using pre- and postprocedural transthoracic echocardiography. Patients were assigned to the staging system proposed by Généreux et al. according to the severity of their baseline cardiac damage. Based on the established system, we created a simplified staging system to facilitate improved applicability. Finally, we compared clinical outcomes between the groups and evaluated changes in cardiac damage after TAVR. RESULTS A total of 933 TAVR patients were included in the study. We found a significant association between cardiac damage and 1-year all-cause mortality (stage 0: 0% vs. stage 1: 3% vs. stage 2: 6.6%; p < 0.009). In multivariate analysis, cardiac damage was an independent predictor of 1-year all-cause mortality (hazard ratio: 2.0, 95% confidence interval: 1.1-3.8; p = 0.03). CONCLUSIONS In patients undergoing TAVR, cardiac damage is associated with enhanced mortality. A simplified staging system can help identify patients at high risk for an adverse outcome.
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Affiliation(s)
- Jasmin Shamekhi
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Caroline Hasse
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Verena Veulemans
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Baravan Al-Kassou
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Kerstin Piayda
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Oliver Maier
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Marcel Weber
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Alexander Sedaghat
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Sebastian Zimmer
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Malte Kelm
- Department of Cardiology, Heart Center, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Georg Nickenig
- Department of Medicine II, Heart Center, University Hospital Bonn, Bonn, Germany
| | - Jan-Malte Sinning
- Department of Cardiology, St. Vinzenz-Hospital Cologne, Cologne, Germany
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9
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One and Five-Year Mortality Risk Prediction in Patients with Moderate and Severe Aortic Stenosis. J Clin Med 2022; 11:jcm11102949. [PMID: 35629075 PMCID: PMC9146915 DOI: 10.3390/jcm11102949] [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: 04/04/2022] [Revised: 05/09/2022] [Accepted: 05/18/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Our goal was to develop a risk prediction model for mortality in patients with moderate and severe aortic stenosis (AS). (2) Methods: All patients aged 40−95 years, with echocardiographic evidence of moderate and severe AS at a single institution, were studied over a median of 2.8 (1.5−4.8) years, between 2013−2018. Patient characteristics and mortality were compared using Chi-squares, t-tests, and Kaplan−Meier (KM) curves, as appropriate. The risk calculation for mortality was derived using the Cox proportional hazards model. A risk score was calculated for each parameter, and the total sum of scores predicted the individualized risks of 1-and 5-year mortality. (3) Results: A total of 1991 patients with severe and 2212 with moderate AS were included. Severe AS patients were older, had a lower ejection fraction %, were more likely to be Caucasian, and had lower rates of obesity and smoking, but had higher rates of cardiac comorbidities and AVR (49.3% vs. 2.8%, p < 0.0001). The unadjusted overall mortality was 41.7% vs. 41%, p = 0.6530, and was not different using KM curves (log rank, p = 0.0853). The models included only patients with complete follow-up (3966 in the 1-year, and 816 in the 5-year model) and included 13 variables related to patient characteristics, degree of AS, and AVR. The C-statistic was 0.75 and 0.72 for the 1-year and the 5-year models, respectively. (4) Conclusions: Patients with moderate and severe AS experience high morbidity and mortality. The usage of a risk prediction model may provide guidance for clinical decision making in complex patients.
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10
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Kipourou K, O’Driscoll JM, Sharma R. Valvular Heart Disease in Patients with Chronic Kidney Disease. Eur Cardiol 2022; 17:e02. [PMID: 35154392 PMCID: PMC8819604 DOI: 10.15420/ecr.2021.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022] Open
Abstract
Valvular heart disease (VHD) is highly prevalent in patients with chronic kidney disease (CKD) from the early stages to end-stage renal disease (ESRD). Aortic and mitral valves are the most frequently affected, leading to aortic valve and/or mitral annular calcification, which, in turn, causes either valve stenosis or regurgitation at an accelerated rate compared with the general population. Tricuspid regurgitation is also prevalent in CKD and ESRD, and haemodialysis patients are at an increasingly high risk of infective endocarditis. As for pathophysiology, several mechanisms causing VHD in CKD have been proposed, highlighting the complexity of the process. Echocardiography constitutes the gold standard for the assessment of VHD in CKD/ESRD patients, despite the progress of other imaging modalities. With regard to treatment, the existing 2017 European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines on the management of VHD addressing patients with normal kidney function are also applied to patients with CKD/ESRD.
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Affiliation(s)
- Konstantina Kipourou
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Jamie M O’Driscoll
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK; School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
| | - Rajan Sharma
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, UK; School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK
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11
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Sevilla T, Revilla-Orodea A, San Román JA. Timing of Intervention in Asymptomatic Patients with Aortic Stenosis. Eur Cardiol 2021; 16:e32. [PMID: 34603512 PMCID: PMC8477179 DOI: 10.15420/ecr.2021.11] [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: 04/07/2021] [Accepted: 06/25/2021] [Indexed: 11/23/2022] Open
Abstract
Aortic stenosis is a very common disease. Current guidelines recommend intervention mainly in symptomatic patients; aortic valve replacement can be considered in asymptomatic patients under specific conditions, but the evidence supporting these indications is poor. Continuous advances in both surgical and percutaneous techniques have substantially decreased rates of perioperative complications and mortality; with this in mind, many authors suggest that earlier intervention in patients with severe aortic stenosis, when they are still asymptomatic, may be indicated. This paper summarises what is known about the natural history of severe aortic stenosis and the scientific evidence available about the optimal timing for aortic valve replacement.
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Affiliation(s)
- Teresa Sevilla
- Department of Cardiology, Hospital Clínico Universitario de Valladolid Valladolid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Madrid, Spain
| | - Ana Revilla-Orodea
- Department of Cardiology, Hospital Clínico Universitario de Valladolid Valladolid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Madrid, Spain
| | - J Alberto San Román
- Department of Cardiology, Hospital Clínico Universitario de Valladolid Valladolid, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares Madrid, Spain
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12
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Arai H, Nozoe M, Matsumoto S, Morimoto T. Exercise Training for Patients With Severe Aortic Stenosis in a Convalescent Rehabilitation Ward - A Retrospective Cohort Study. Circ Rep 2021; 3:361-367. [PMID: 34250276 PMCID: PMC8258178 DOI: 10.1253/circrep.cr-21-0035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/29/2021] [Accepted: 05/16/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Exercise loading is contraindicated for patients with severe aortic stenosis (AS); however, everyday activities mandate the inclusion of a light load. The aim of this study was to investigate the efficacy and safety of exercise training for patients with severe AS who were admitted to a rehabilitation ward because of physical disability. Methods and Results: This historical cohort study was conducted at a single rehabilitation center in Japan. Patients admitted for rehabilitation of physical disability and those who met the definition of severe AS were analyzed. An exercise training program was implemented for patients with disability and severe AS. Cardiovascular symptoms during hospitalization were evaluated. Improvements in the performance of activities of daily living were assessed using the Functional Independence Measure (FIM). Eighteen patients undertook an exercise training program. The median patient age was 87 years (range 76-95 years). Of these patients, 3 died and another 3 were transferred to another hospital due to causes other than the exercise training program. None of the other patients experienced cardiovascular symptoms, and the FIM scores of 12 patients were significantly improved (median [range] scores at admission and discharge of 63 [32-88] and 87 [51-104], respectively; P<0.001). Conclusions: An exercise training program could be applied to patients with severe AS who were admitted for convalescent rehabilitation, because it can improve FIM scores.
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Affiliation(s)
- Hideki Arai
- Department of Rehabilitation, Toyonaka Heisei Hospital Toyonaka Japan.,Department of Clinical Epidemiology, Hyogo College of Medicine Nishinomiya Japan
| | - Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University Kobe Japan
| | - Satoru Matsumoto
- Department of Rehabilitation, Toyonaka Heisei Hospital Toyonaka Japan
| | - Takeshi Morimoto
- Department of Clinical Epidemiology, Hyogo College of Medicine Nishinomiya Japan
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13
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Mourino-Alvarez L, Corbacho-Alonso N, Sastre-Oliva T, Corros-Vicente C, Solis J, Tejerina T, Padial LR, Barderas MG. Diabetes Mellitus and Its Implications in Aortic Stenosis Patients. Int J Mol Sci 2021; 22:ijms22126212. [PMID: 34207517 PMCID: PMC8227301 DOI: 10.3390/ijms22126212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/18/2022] Open
Abstract
Aortic stenosis (AS) and diabetes mellitus (DM) are both progressive diseases that if left untreated, result in significant morbidity and mortality. Several studies revealed that the prevalence of DM is substantially higher in patients with AS and, thus, the progression from mild to severe AS is greater in those patients with DM. DM and common comorbidities associated with both diseases, DM and AS, increase patient management complexity and make aortic valve replacement the only effective treatment. For that reason, a better understanding of the pathogenesis underlying both these diseases and the relationships between them is necessary to design more appropriate preventive and therapeutic approaches. In this review, we provided an overview of the main aspects of the relationship between AS and DM, including common comorbidities and risk factors. We also discuss the established treatments/therapies in patients with AS and DM.
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Affiliation(s)
- Laura Mourino-Alvarez
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, 45071 Toledo, Spain; (L.M.-A.); (N.C.-A.); (T.S.-O.); (C.C.-V.)
| | - Nerea Corbacho-Alonso
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, 45071 Toledo, Spain; (L.M.-A.); (N.C.-A.); (T.S.-O.); (C.C.-V.)
| | - Tamara Sastre-Oliva
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, 45071 Toledo, Spain; (L.M.-A.); (N.C.-A.); (T.S.-O.); (C.C.-V.)
| | - Cecilia Corros-Vicente
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, 45071 Toledo, Spain; (L.M.-A.); (N.C.-A.); (T.S.-O.); (C.C.-V.)
| | - Jorge Solis
- Department of Cardiology, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
- Atria Clinic, 28009 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: (J.S.); or (M.G.B.); Fax: +34-925247745 (M.G.B.)
| | - Teresa Tejerina
- Department of Pharmacology, School of Medicine, Universidad Complutense, 28040 Madrid, Spain;
| | - Luis R. Padial
- Department of Cardiology, Hospital Virgen de la Salud, SESCAM, 45004 Toledo, Spain;
| | - Maria G. Barderas
- Department of Vascular Physiopathology, Hospital Nacional de Paraplejicos (HNP), SESCAM, 45071 Toledo, Spain; (L.M.-A.); (N.C.-A.); (T.S.-O.); (C.C.-V.)
- Correspondence: (J.S.); or (M.G.B.); Fax: +34-925247745 (M.G.B.)
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14
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Steeds RP, Messika-Zeitoun D, Thambyrajah J, Serra A, Schulz E, Maly J, Aiello M, Rudolph TK, Lloyd G, Bortone AS, Clerici A, Delle-Karth G, Rieber J, Indolfi C, Mancone M, Belle L, Lauten A, Arnold M, Bouma BJ, Lutz M, Deutsch C, Kurucova J, Thoenes M, Bramlage P, Frey N. IMPULSE: the impact of gender on the presentation and management of aortic stenosis across Europe. Open Heart 2021; 8:openhrt-2020-001443. [PMID: 33419934 PMCID: PMC7798778 DOI: 10.1136/openhrt-2020-001443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 11/10/2022] Open
Abstract
Aims There is an increasing awareness of gender-related differences in patients with severe aortic stenosis and their outcomes after surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). Methods Data from the IMPULSE registry were analysed. Patients with severe aortic stenosis (AS) were enrolled between March 2015 and April 2017 and stratified by gender. A subgroup analysis was performed to assess the impact of age. Results Overall, 2171 patients were enrolled, and 48.0% were female. Women were characterised by a higher rate of renal impairment (31.7 vs 23.3%; p<0.001), were at higher surgical risk (EuroSCORE II: 4.5 vs 3.6%; p=0.001) and more often in a critical preoperative state (7.0vs 4.2%; p=0.003). Men had an increased rate of previous cardiac surgery (9.4 vs 4.7%; p<0.001) and a reduced left ventricular ejection fraction (4.9 vs 1.3%; p<0.001). Concomitant mitral and tricuspid valve disease was substantially more common among women. Symptoms were highly prevalent in both women and men (83.6 vs 77.3%; p<0.001). AVR was planned in 1379 cases. Women were more frequently scheduled to undergo TAVI (49.3 vs 41.0%; p<0.001) and less frequently for SAVR (20.3 vs 27.5%; p<0.001). Conclusions The present data show that female patients with severe AS have a distinct patient profile and are managed in a different way to males. Gender-based differences in the management of patients with severe AS need to be taken into account more systematically to improve outcomes, especially for women.
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Affiliation(s)
- Richard Paul Steeds
- Queen Elizabeth Hospital & Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | | | | | - Antonio Serra
- Interventional Cardiology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jiri Maly
- Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
- Department of Cardiovascular Surgery, Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marco Aiello
- Department of Cardiothoracic Surgery, Foundation IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Tanja K Rudolph
- Department of Cardiology, Heart and Diabetes Center Bad Oeynhausen, Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Guy Lloyd
- St Bartholomew's Hospital, London, UK
| | | | | | | | - Johannes Rieber
- Herzkatheterlabor Nymphenburg and Department of Cardiology, University of Munich, Munich, Germany
| | - Ciro Indolfi
- Division of Cardiology and URT CNR of IFC, University Magna Graecia, Catanzaro, Italy
| | | | - Loic Belle
- Centre Hospital d'Annecy, Annecy, France
| | - Alexander Lauten
- Department for Cardiology, Helios Erfurt Clinic, Erfurt, Germany
| | - Martin Arnold
- Department of Cardiology, University of Erlangen, Erlangen, Germany
| | | | - Matthias Lutz
- Department of Cardiology and Angiology, University of Kiel, Kiel, Germany
| | - Cornelia Deutsch
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Norbert Frey
- Department of Cardiology and Angiology, University of Kiel, Kiel, Germany
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