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Sugiura A, Yamamoto M, Saji M, Asami M, Enta Y, Nakashima M, Shirai S, Izumo M, Mizuno S, Watanabe Y, Amaki M, Kodama K, Yamaguchi J, Nakajima Y, Naganuma T, Bota H, Ohno Y, Yamawaki M, Ueno H, Mizutani K, Adachi Y, Otsuka T, Kubo S, Nickenig G, Hayashida K. Cardiac Damage in Degenerative Mitral Regurgitation Treated With Transcatheter Mitral Edge-to-Edge Repair. Circ Cardiovasc Interv 2024; 17:e013794. [PMID: 38629311 PMCID: PMC11177598 DOI: 10.1161/circinterventions.123.013794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 02/27/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND The extent of cardiac damage and its association with clinical outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) for degenerative mitral regurgitation remains unclear. This study was aimed to investigate cardiac damage in patients with degenerative mitral regurgitation treated with TEER and its association with outcomes. METHODS We analyzed patients with degenerative mitral regurgitation treated with TEER in the Optimized Catheter Valvular Intervention-Mitral registry, which is a prospective, multicenter observational data collection in Japan. The study subjects were classified according to the extent of cardiac damage at baseline: no extravalvular cardiac damage (stage 0), mild left ventricular or left atrial damage (stage 1), moderate left ventricular or left atrial damage (stage 2), or right heart damage (stage 3). Two-year mortality after TEER was compared using Kaplan-Meier analysis. RESULTS Out of 579 study participants, 8 (1.4%) were classified as stage 0, 76 (13.1%) as stage 1, 319 (55.1%) as stage 2, and 176 (30.4%) as stage 3. Two-year survival was 100% in stage 0, 89.5% in stage 1, 78.9% in stage 2, and 75.3% in stage 3 (P=0.013). Compared with stage 0 to 1, stage 2 (hazard ratio, 3.34 [95% CI, 1.03-10.81]; P=0.044) and stage 3 (hazard ratio, 4.51 [95% CI, 1.37-14.85]; P=0.013) were associated with increased risk of 2-year mortality after TEER. Significant reductions in heart failure rehospitalization rate and New York Heart Association functional scale were observed following TEER (both, P<0.001), irrespective of the stage of cardiac damage. CONCLUSIONS Advanced cardiac damage is associated with an increased risk of mortality in patients undergoing TEER for degenerative mitral regurgitation. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: UMIN000023653.
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Affiliation(s)
- Atsushi Sugiura
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Germany (A.S., G.N.)
| | - Masanori Yamamoto
- Department of Cardiology, Toyohashi Heart Center, Japan (M. Yamamoto, Y.A.)
- Department of Cardiology, Nagoya Heart Center, Japan (M. Yamamoto, Y.A.)
- Department of Cardiology, Gifu Heart Center, Japan (M. Yamamoto)
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan (M.S.)
- Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University Faculty of Medicine, Tokyo, Japan (M.S.)
| | - Masahiko Asami
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan (M. Asami)
| | - Yusuke Enta
- Department of Cardiology, Sendai Kosei Hospital, Japan (Y.E., M.N.)
| | - Masaki Nakashima
- Department of Cardiology, Sendai Kosei Hospital, Japan (Y.E., M.N.)
| | - Shinichi Shirai
- Division of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan (S.S.)
| | - Masaki Izumo
- Division of Cardiology, St. Marianna University School of Medicine Hospital, Kawasaki, Japan (M.I.)
| | - Shingo Mizuno
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan (S.M.)
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan (Y.W.)
| | - Makoto Amaki
- Department of Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan (M. Amaki)
| | - Kazuhisa Kodama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Japan (K.K.)
| | - Junichi Yamaguchi
- Department of Cardiology Tokyo Woman’s Medical University, Japan (J.Y.)
| | - Yoshifumi Nakajima
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University, Japan (Y.N.)
| | - Toru Naganuma
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan (T.N.)
| | - Hiroki Bota
- Department of Cardiology, Sapporo Higashi Tokushukai Hospital, Japan (H.B.)
| | - Yohei Ohno
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan. Department of Cardiology (Y.O.)
| | - Masahiro Yamawaki
- Saiseikai Yokohama City Eastern Hospital, Kanagawa, Japan (M. Yamawaki)
| | - Hiroshi Ueno
- Second Department of Internal Medicine, Toyama University Hospital, Japan (H.U.)
| | - Kazuki Mizutani
- Division of Cardiology, Department of Medicine, Kindai University Faculty of Medicine, Osaka, Japan (K.M.)
| | - Yuya Adachi
- Department of Cardiology, Toyohashi Heart Center, Japan (M. Yamamoto, Y.A.)
- Department of Cardiology, Nagoya Heart Center, Japan (M. Yamamoto, Y.A.)
| | - Toshiaki Otsuka
- Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan (T.O.)
| | - Shunsuke Kubo
- Department of Cardiology, Kurashiki Central Hospital, Japan (S.K.)
| | - Georg Nickenig
- Heart Center Bonn, Department of Internal Medicine II, University Hospital Bonn, Germany (A.S., G.N.)
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (K.H.)
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Abdelfattah OM, Jacquemyn X, Sá MP, Jneid H, Sultan I, Cohen DJ, Gillam LD, Aron L, Clavel MA, Pibarot P, Bax JJ, Kapadia SR, Leon M, Généreux P. Cardiac Damage Staging Predicts Outcomes in Aortic Valve Stenosis After Aortic Valve Replacement: Meta-Analysis. JACC. ADVANCES 2024; 3:100959. [PMID: 38939639 PMCID: PMC11198616 DOI: 10.1016/j.jacadv.2024.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/05/2024] [Indexed: 06/29/2024]
Abstract
Background The prognostic value of cardiac damage staging classification based on the extent of extravalvular damage has been proposed in moderate/severe aortic stenosis (AS). Objectives The purpose of this study was to assess the association of cardiac damage staging with mortality across the spectrum of patients with AS following aortic surgical or transcatheter aortic valve replacement (AVR). Methods We conducted a pooled meta-analysis of Kaplan-Meier-derived reconstructed time-to-event data from studies published through February 2023. Results In total, 16 studies (n = 14,499) met our eligibility criteria and included 12,282 patients with symptomatic severe AS and 2,217 patients with asymptomatic severe/moderate AS. For patients with symptomatic severe AS, all-cause mortality was 24.0%, 27.7%, 38.0%, 56.3%, and 57.3% at 5 years in patients with cardiac damage stage 0, 1, 2, 3, and 4, respectively (stage 0 as reference; HR in stage 1: 1.30 [95% CI: 1.03-1.64]; P = 0.029; stage 2: 1.74 [95% CI: 1.41-2.16]; P < 0.001; stage 3: 2.92 [95% CI: 2.35-3.64]; P < 0.001, and stage 4: 3.51 [95% CI: 2.79-4.41]; P < 0.001). For patients with asymptomatic moderate/severe AS, all-cause mortality was 19.3%, 36.9%, 51.7%, and 67.8% at 8 years in patients with cardiac damage stage 0, 1, 2, and 3 to 4, respectively (HR in stage 1: 1.70 [95% CI: 1.21-2.38]; P = 0.002; stage 2: 2.20 [95% CI: 1.60-3.02]; P < 0.001; and stage 3 to 4: 3.90 [95% CI: 2.79-5.47]; P < 0.001). Conclusions In patients undergoing AVR across the symptomatic and severity spectrum of AS, cardiac damage staging at baseline has important prognostic implications. This pooled meta-analysis in patients undergoing AVR suggests that staging of baseline cardiac damage could be considered for timing and selection of therapy in patients with moderate or severe AS to determine the need for earlier AVR or adjunctive pharmacotherapy to prevent irreversible cardiac damage and improve the long-term prognosis.
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Affiliation(s)
- Omar M. Abdelfattah
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Xander Jacquemyn
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Michel Pompeu Sá
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Hani Jneid
- Division of Cardiology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Ibrahim Sultan
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David J. Cohen
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- DeMatteis Cardiovascular Institute, St. Francis Hospital and Heart Center, Roslyn, New York, USA
| | - Linda D. Gillam
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Lucy Aron
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - Marie-Annick Clavel
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Philippe Pibarot
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Samir R. Kapadia
- Heart, Thoracic and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Martin Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
- NewYork-Presbyterian Hospital/Columbia University, Medical Center, New York, New York, USA
| | - Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
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Popolo Rubbio A, Sisinni A, Moroni A, Adamo M, Grasso C, Casenghi M, Tusa MB, Barletta M, Denti P, Giordano A, De Marco F, Bartorelli AL, Montorfano M, Godino C, Agricola E, Citro R, De Felice F, Mongiardo A, Monteforte I, Villa E, Petronio AS, Giannini C, Crimi G, Masiero G, Tarantini G, Testa L, Tamburino C, Bedogni F, Giotto Registry OBOT. Impact of extra-mitral valve cardiac involvement in patients with primary mitral regurgitation undergoing transcatheter edge-to-edge repair. EUROINTERVENTION 2023; 19:e926-e936. [PMID: 37946539 PMCID: PMC10722204 DOI: 10.4244/eij-d-23-00548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/18/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND In the context of primary mitral regurgitation (PMR), the selection of patients for transcatheter edge-to-edge repair (TEER) does not include a systematic assessment of PMR-associated cardiac remodelling. AIMS We aimed to investigate the epidemiology and prognostic significance of different phenotypes of extra-mitral valve (MV) cardiac involvement in a large series of patients with PMR referred for TEER. METHODS The study included 654 patients from the multicentre Italian GIOTTO registry, stratified into groups according to extra-mitral valve (MV) cardiac involvement. The primary endpoint was all-cause death at 2-year follow-up. RESULTS Patients with no cardiac involvement (NI; n=58), left heart involvement (LHI; n=343) and right heart involvement (RHI; n=253) were analysed. Acute technical success was achieved in 98% of patients. Kaplan-Meier curve analysis revealed significantly worse survival in patients with LHI and RHI (p=0.041). On multivariate Cox regression analysis, extra-MV cardiac involvement, haemoglobin level and technical success were independent predictors of the primary endpoint occurrence. CONCLUSIONS Grading cardiac involvement may help refine risk stratification, since at least 1 group of extra-MV cardiac involvement represents in itself a negative predictor of midterm outcome.
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Affiliation(s)
- Antonio Popolo Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Sisinni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Alice Moroni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterisation Laboratory and Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Carmelo Grasso
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), AOU Policlinico "G. Rodolico - S. Marco", University of Catania, Catania, Italy
| | - Matteo Casenghi
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Maurizio B Tusa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Marta Barletta
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Paolo Denti
- Cardiac Surgery Department, San Raffaele University Hospital, Milan, Italy
| | - Arturo Giordano
- Invasive Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | | | - Antonio L Bartorelli
- Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Matteo Montorfano
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy and Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cosmo Godino
- Cardiology Unit, Heart Valve Center, San Raffaele Hospital IRCCS, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit Cardio-Thoracic-Vascular Department, Vita-Salute University, San Raffaele Hospital, IRCCS, Milan, Italy
| | - Rodolfo Citro
- University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
- Department of Vascular Physiopathology, IRCCS Neuromed, Pozzilli, Italy
| | - Francesco De Felice
- Division of Interventional Cardiology, Azienda Ospedaliera S. Camillo Forlanini, Rome, Italy
| | | | - Ida Monteforte
- AORN Ospedali dei Colli, Monaldi Hospital, Naples, Italy
| | - Emmanuel Villa
- Valve Center, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Cristina Giannini
- Cardiac Catheterisation Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, Interventional Cardiology Unit, University of Padua, Padua, Italy
| | - Luca Testa
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Corrado Tamburino
- Division of Cardiology, Centro Alte Specialità e Trapianti (CAST), AOU Policlinico "G. Rodolico - S. Marco", University of Catania, Catania, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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Généreux P. Staging the Extent of Cardiac Damage Among Patients With Valve Disease: Growth of Evidence Continues. JACC Cardiovasc Interv 2023; 16:152-155. [PMID: 36697149 DOI: 10.1016/j.jcin.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 11/07/2022] [Indexed: 12/29/2022]
Affiliation(s)
- Philippe Généreux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA.
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