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Wang AY, Rothwell PM, Nelson J, Saver JL, Kasner SE, Carroll J, Mas JL, Derumeaux G, Chatellier G, Furlan AJ, Herrmann HC, Jüni P, Kim JS, Koethe B, Lee PH, Lefebvre B, Mattle HP, Meier B, Reisman M, Smalling RW, Sondergaard L, Song JK, Di Angelantonio E, DiTullio M, Elkind MSV, Homma S, Jaigobin C, Michel P, Mono ML, Nedeltchev K, Papetti F, Serena J, Weimar C, Li L, Mazzucco S, Silver LE, van Klaveren D, Thaler DE, Kent DM. Patent Foramen Ovale Closure in Older Patients With Stroke: Patient Selection for Trial Feasibility. Neurology 2024; 102:e209388. [PMID: 38701403 DOI: 10.1212/wnl.0000000000209388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Whether patent foramen ovale (PFO) closure benefits older patients with PFO and cryptogenic stroke is unknown because randomized controlled trials (RCTs) have predominantly enrolled patients younger than 60 years of age. Our objective was to estimate anticipated effects of PFO closure in older patients to predict the numbers needed to plan an RCT. METHODS Effectiveness estimates are derived from major observational studies (Risk of Paradoxical Embolism [RoPE] Study and Oxford Vascular Study, together referred to as the "RoPE-Ox" database) and all 6 major RCTs (Systematic, Collaborative, PFO Closure Evaluation [SCOPE] Consortium). To estimate stroke recurrence risk, observed outcomes were calculated for patients older than 60 years in the age-inclusive observational databases (n = 549). To estimate the reduction in the rate of recurrent stroke associated with PFO closure vs medical therapy based on the RoPE score and the presence of high-risk PFO features, a Cox proportional hazards regression model was developed on the RCT data in the SCOPE database (n = 3,740). These estimates were used to calculate sample sizes required for a future RCT. RESULTS Five-year risk of stroke recurrence using Kaplan-Meier estimates was 13.7 (95% CI 10.5-17.9) overall, 14.9% (95% CI 10.2-21.6) in those with high-risk PFO features. Predicted relative reduction in the event rate with PFO closure was 12.9% overall, 48.8% in those with a high-risk PFO feature. Using these estimates, enrolling all older patients with cryptogenic stroke and PFO would require much larger samples than those used for prior PFO closure trials, but selectively enrolling patients with high-risk PFO features would require totals of 630 patients for 90% power and 471 patients for 80% power, with an average of 5 years of follow-up. DISCUSSION Based on our projections, anticipated effect sizes in older patients with high-risk features make a trial in these subjects feasible. With lengthening life expectancy in almost all regions of the world, the utility of PFO closure in older adults is increasingly important to explore.
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Affiliation(s)
- Andy Y Wang
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Peter M Rothwell
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Jason Nelson
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Jeffrey L Saver
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Scott E Kasner
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - John Carroll
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Jean-Louis Mas
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Geneviève Derumeaux
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Gilles Chatellier
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Anthony J Furlan
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Howard C Herrmann
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Peter Jüni
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Jong S Kim
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Benjamin Koethe
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Pil H Lee
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Benedicte Lefebvre
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Heinrich P Mattle
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Bernhard Meier
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Mark Reisman
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Richard W Smalling
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Lars Sondergaard
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Jae-Kwan Song
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Emanuele Di Angelantonio
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Marco DiTullio
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Mitchell S V Elkind
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Shunichi Homma
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Cheryl Jaigobin
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Patrik Michel
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Marie-Luise Mono
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Krassen Nedeltchev
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Federica Papetti
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Joaquin Serena
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Christian Weimar
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Linxin Li
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Sara Mazzucco
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - Louise E Silver
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - David van Klaveren
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - David E Thaler
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
| | - David M Kent
- From the Predictive Analytics and Comparative Effectiveness (PACE) Center (A.Y.W., J.N., B.K., D.K., D.M.K.), Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, Boston, MA; Department of Clinical Neurology (P.M.R., L.L., S.M., L.E.S.), Oxford University, London, United Kingdom; Comprehensive Stroke Center and Department of Neurology (J.L.S.), David Geffen School of Medicine, University of California, Los Angeles; Comprehensive Stroke Center (S.E.K.), Department of Neurology, University of Pennsylvania Medical Center, Philadelphia; Division of Cardiology (J.C.), Department of Medicine, University of Colorado Denver, Aurora; Université Paris Cité (J.-L.M.), Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266; GHU-Paris Psychiatrie et Neurosciences (J.-L.M.), Hôpital Sainte Anne; Département de Physiologie (G.D.), Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil (UPEC); Centre d'Investigations Cliniques (G.C.), Unité de Recherche Clinique, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, France; Department of Neurology (A.J.F.), Case Western Reserve University, Cleveland, OH; Division of Cardiovascular Medicine (H.C.H., B.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia; Department of Population Health (P.J.), University of Oxford, United Kingdom; Department of Neurology (J.S.K.), Gangneung Asan Hospital, University of Ulsan College of Medicine; Department of Cardiology (P.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology (H.P.M.), Bern University Hospital; Medical Faculty (B.M.), University of Bern, Switzerland; Cardiology Department (M.R.), Weill Cornell Medical Center, Cornell, NY; Division of Cardiology (R.W.S.), Department of Medicine, UTHealth/McGovern Medical School and The Memorial Hermann Heart and Vascular Institute, Houston, TX; Department of Cardiology (L.S.), Rigshospitalet, Copenhagen University Hospital, Denmark; Division of Cardiology (J.-K.S.), Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea; BHF Cardiovascular Epidemiology Unit (E.D.A.), Department of Public Health and Primary Care, University of Cambridge; Victor Phillip Dahdaleh Heart and Lung Research Institute (E.D.A.), BHF Centre of Research Excellence, School of Clinical Medicine, Addenbrooke's Hospital; NIHR Blood and Transplant Research Unit in Donor Health and Behaviour (E.D.A.), all University of Cambridge; Health Data Research UK Cambridge (E.D.A.), Wellcome Genome Campus and University of Cambridge, Hinxton; University of Cambridge (E.D.A.), United Kingdom; Health Data Science Centre (E.D.A.), Human Technopole, Milan, Italy; Department of Medicine (M.D., S.H.), Columbia University, College of Physicians and Surgeons, New York, NY; Department of Neurology (M.S.V.E.), Vagelos College of Physicians and Surgeons, and Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; Division of Neurology-Stroke Program (C.J.), Department of Medicine, University Health Network, Toronto Western Hospital, Ontario, Canada; Stroke Center (P.M.), Neurology Service, Lausanne University Hospital; Department of Neurology (M.-L.M., K.N.), University of Bern; Department of Neurology (M.-L.M.), Stadtspital Zürich; Department of Neurology and Stroke Centre (K.N.), Cantonal Hospital Aarau, Switzerland; Sapienza University of Rome (F.P.), Italy; Department of Neurology (J.S.), Hospital Universitari de Girona Dr Josep Trueta - IDIBGI, Spain; Department of Neurology and Stroke Center (C.W.), University Duisburg-Essen, Germany; Department of Public Health (D.K.), Erasmus University Medical Center, Rotterdam, the Netherlands; and Department of Neurology (D.E.T.), Tufts Medical Center/Tufts University School of Medicine, Boston, MA
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2
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Pręgowski J, Pracoń R, Mioduszewska A, Skowroński J, Sondergaard L, Mintz GS, Capodanno D, Kim SW, De Baker O, Waciński P, Wojakowski W, Rdzanek A, Grygier M, Chmielecki M, Franco LN, Stokłosa P, Firek B, Marczak M, Miłosz B, Chmielak Z, Demkow M, Witkowski A. Strategy to optimize PeriproCeduraL AnticOagulation in structural transseptal interventions: Design and rationale of the STOP CLOT trial. Am Heart J 2024; 271:68-75. [PMID: 38401649 DOI: 10.1016/j.ahj.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Both transcatheter edge-to-edge repair (TEER) of mitral regurgitation or left atrial appendage closure (LAAC) require periprocedural anticoagulation with unfractionated heparin (UFH) that is administered either before or immediately after transseptal puncture (TSP). The optimal timing of UFH administration (before or after TSP) is unknown. The Strategy To Optimize PeriproCeduraL AnticOagulation in Structural Transseptal Interventions trial (STOP CLOT Trial) was designed to determine if early anticoagulation is effective in reducing ischemic complications without increasing the risk of periprocedural bleeding. METHODS The STOP CLOT trial is a multicenter, prospective, double-blind, placebo-controlled, randomized trial. A total of 410 patients scheduled for TEER or LAAC will be randomized 1:1 either early UFH administration (iv. bolus of 100 units/kg UFH or placebo, given after obtaining femoral vein access and at least 5 minutes prior to the start of the TSP) or late UFH administration (iv. bolus of 100 units/kg UFH or placebo given immediately after TSP). Prespecified preliminary statistical analysis will be performed after complete follow-up of the first 196 randomized subjects. To ensure blinding, a study nurse responsible for randomization and UFH/placebo preparation is not involved in the care of the patients enrolled into the study. The primary study endpoint is a composite of (1) major adverse cardiac and cerebrovascular events (death, stroke, TIA, myocardial infarction, or peripheral embolization) within 30 days post-procedure, (2) intraprocedural fresh thrombus formation in the right or left atrium as assessed with periprocedural transesophageal echocardiography, or (3) occurrence of new ischemic lesions (diameter ≥4 mm) on brain magnetic resonance imaging performed 2 to 5 days after the procedure. The safety endpoint is the occurrence of moderate or severe bleeding complications during the index hospitalization. CONCLUSIONS Protocols of periprocedural anticoagulation administration during structural interventions have never been tested in a randomized clinical trial. The Stop Clot trial may help reach consensus on the optimal timing of initiation of periprocedural anticoagulation. CLINICAL TRIALS REGISTRATION NUMBER The study protocol is registered at ClinicalTrials.gov, identifier NCT05305612.
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Affiliation(s)
| | | | | | | | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, NY
| | - Davide Capodanno
- Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | | | - Ole De Baker
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - Piotr Waciński
- Samodzielny Publiczny Szpital Kliniczny 4 w Lublinie, Lublin, Poland
| | - Wojciech Wojakowski
- Górnośląskie Centrum Medyczne im prof. L. Gieca Śląskiego Uniwersytetu Medycznego, Katowice, Poland
| | - Adam Rdzanek
- Uniwersyteckie Centrum Medyczne Warszawskiego Uniwersytetu Medycznego, Warsaw, Poland
| | - Marek Grygier
- Uniwersytecki Szpital Kliniczny w Poznaniu, Poznań, Poland
| | - Michał Chmielecki
- Kliniczne Centrum Kardiologii, Uniwersyteckie, Centrum Kliniczne, Gdański, Poland
| | | | | | - Bohdan Firek
- National Institute of Cardiology, Warsaw, Poland
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3
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Witberg G, Levi A, Talmor-Barkan Y, Barbanti M, Valvo R, Costa G, Frittitta V, de Backer O, Willemen Y, van Der Dorpel M, Mon M, Sugiura A, Sudo M, Masiero G, Pancaldi E, Arzamendi D, Santos-Martinez S, Baz JA, Steblovnik K, Mauri V, Adam M, Wienemann H, Zahler D, Hein M, Ruile P, Aodha BN, Grasso C, Branca L, Estévez-Loureiro R, Amat-Santos IJ, Mylotte D, Bunc M, Tarantini G, Nombela-Franco L, Sondergaard L, Van Mieghem NM, Finkelstein A, Kornowski R. Outcomes and predictors of left ventricle recovery in patients with severe left ventricular dysfunction undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2024; 20:e487-e495. [PMID: 38629416 PMCID: PMC11017227 DOI: 10.4244/eij-d-23-00948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 12/27/2023] [Indexed: 04/19/2024]
Abstract
BACKGROUND Data on the likelihood of left ventricle (LV) recovery in patients with severe LV dysfunction and severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and its prognostic value are limited. AIMS We aimed to assess the likelihood of LV recovery following TAVI, examine its association with midterm mortality, and identify independent predictors of LV function. METHODS In our multicentre registry of 17 TAVI centres in Western Europe and Israel, patients were stratified by baseline LV function (ejection fraction [EF] >/≤30%) and LV response: no LV recovery, LV recovery (EF increase ≥10%), and LV normalisation (EF ≥50% post-TAVI). RESULTS Our analysis included 10,872 patients; baseline EF was ≤30% in 914 (8.4%) patients and >30% in 9,958 (91.6%) patients. The LV recovered in 544 (59.5%) patients, including 244 (26.7%) patients whose LV function normalised completely (EF >50%). Three-year mortality for patients without severe LV dysfunction at baseline was 29.4%. Compared to this, no LV recovery was associated with a significant increase in mortality (adjusted hazard ratio 1.32; p<0.001). Patients with similar LV function post-TAVI had similar rates of 3-year mortality, regardless of their baseline LV function. Three variables were associated with a higher likelihood of LV recovery following TAVI: no previous myocardial infarction (MI), estimated glomerular filtration rate >60 mL/min, and mean aortic valve gradient (mAVG) (expressed either as a continuous variable or as a binary variable using the standard low-flow, low-gradient aortic stenosis [AS] definition). CONCLUSIONS LV recovery following TAVI and the extent of this recovery are major determinants of midterm mortality in patients with severe AS and severe LV dysfunction undergoing TAVI. Patients with no previous MI and those with an mAVG >40 mmHg show the best results following TAVI, which are at least equivalent to those for patients without severe LV dysfunction. (ClinicalTrials.gov: NCT04031274).
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Affiliation(s)
- Guy Witberg
- Department of Cardiology, Rabin Medical Centre, Petah Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Centre, Petah Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yeela Talmor-Barkan
- Department of Cardiology, Rabin Medical Centre, Petah Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marco Barbanti
- Università degli Studi di Enna Kore, Enna, Italy
- Division of Cardiology, University of Catania, Catania, Italy
| | - Roberto Valvo
- Division of Cardiology, University of Catania, Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, University of Catania, Catania, Italy
| | | | - Ole de Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Yannick Willemen
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mark van Der Dorpel
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Matias Mon
- Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | | | | | - Giulia Masiero
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Edoardo Pancaldi
- Cardiovascular Department, Spedali Civili di Brescia, Brescia, Italy
| | - Dabit Arzamendi
- Hospital de la Santa Creu i Sant Pau Barcelona, Barcelona, Spain
| | | | - Jose A Baz
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain
| | - Klemen Steblovnik
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Victor Mauri
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Matti Adam
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Hendrik Wienemann
- Department of Cardiology, Heart Centre, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - David Zahler
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Manuel Hein
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Brídóg Nic Aodha
- Department of Cardiology, Galway University Hospital and University of Galway, Galway, Ireland
| | - Carmelo Grasso
- Division of Cardiology, University of Catania, Catania, Italy
| | - Luca Branca
- Cardiovascular Department, Spedali Civili di Brescia, Brescia, Italy
| | | | | | - Darren Mylotte
- Department of Cardiology, Galway University Hospital and University of Galway, Galway, Ireland
| | - Matjaz Bunc
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Luis Nombela-Franco
- Cardiovascular Institute. Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Ariel Finkelstein
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Centre, Petah Tikva, Israel and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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4
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Bække PS, Gran LL, Jørgensen TH, Ghattas A, Fosbøl E, Sondergaard L, De Backer O. Extent of cardiac damage and hospitalization burden in patients undergoing transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2024; 103:766-770. [PMID: 38564317 DOI: 10.1002/ccd.31015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/15/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Cardiac damage has gained increasing attention as a valid prognostic marker of mortality after transcatheter aortic valve replacement (TAVR). However, studies investigating the possible association between cardiac damage and hospitalization burden in TAVR patients are lacking. AIMS This study aimed to investigate the impact of baseline cardiac damage on the hospitalization burden before, during, and after TAVR in an all-comers population. METHODS All consecutive patients who underwent TAVR between 2016 and 2020 were included. Electronic medical records of all patients were examined to validate cardiovascular (CV) and heart failure (HF) related hospitalizations from 6 months before to 1 year after TAVR. Baseline cardiac damage was defined according to the staging classification by Généreux et al. RESULTS: Among 1397 TAVR patients, 94 (6.7%) had stage 0, 368 (26.4%) stage 1, 736 (52.7%) stage 2, 115 (8.2%) stage 3, and 84 (6.0%) stage 4 cardiac damage. Patients with more advanced cardiac damage at baseline had more HF hospitalizations within 6 months before TAVR (p < 0.01) and with a longer length of stay (LoS) (p < 0.01). Regarding the index TAVR admission, there was no difference in procedure time (p = 0.26) or LoS (p = 0.18) between groups. Still, TAVR patients with more advanced baseline cardiac damage had a higher risk of CV and HF rehospitalization after TAVR (p < 0.05). CONCLUSIONS Baseline cardiac damage in patients undergoing TAVR has an impact on the pre- and post-procedural cardiovascular hospitalization burden. However, the cardiac damage status does not affect the TAVR procedure time or index TAVR admission length of stay.
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Affiliation(s)
| | | | | | - Angie Ghattas
- NHS Golden Jubilee University National Hospital, Clydebank, UK
| | - Emil Fosbøl
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | | | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
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5
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Elkoumy A, Rück A, Abdel-Wahab M, Thiele H, Rudolph TK, Wolf A, Wambach JM, De Backer O, Sondergaard L, Hengstenberg C, Abdelshafy M, Arsang-Jang S, Elzomor H, Laine M, Bjursten H, Götberg M, Wykrzykowska JJ, Mohamed SK, Pellegrini C, Rheude T, Toggweiler S, Saleh N, Meduri CU, Kim WK, Soliman O. ACURATE neo2 Transcatheter aortic valve implantation without balloon aortic valvuloplasty - direct ACURATE neo2. Int J Cardiol 2024; 400:131792. [PMID: 38244892 DOI: 10.1016/j.ijcard.2024.131792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/22/2024]
Abstract
BACKGROUND ACURATE neo2 (Neo2) implantation is performed after systematic Balloon Aortic Valvuloplasty (BAV) in most patients. No reports exist about the feasibility and safety of direct Neo2 transcatheter aortic valve implantation (TAVI) in comparison to the standard practice. AIM We aimed to identify the patients' baseline anatomical characteristics, procedural, and early post-procedural outcomes in patients treated using Neo2 with and without BAV. METHODOLOGY This is a retrospective multicentre analysis of 499 patients with severe aortic stenosis who underwent TAVI using Neo2. The comparison was done according to the performance or omission of BAV. Echocardiography and computed tomography were analysed by an independent Core Lab. Propensity score matching (PSM) was performed based on the annular diameter and AV calcium volume, which identified 84 matched pairs. RESULTS Among the cohort included, 391 (78%) patients received BAV (BAV-yes) and 108 (22%) were not attempted (BAV-no or Direct TAVI). Patients in BAV-no cohort had smaller annular diameter (22.6 vs 23.4 mm; p < 0.001) and lower calcium volume (163 vs 581 mm3; p < 0.001) compared to BAV-yes cohort. In the matched cohort, VARC-3 device technical success was similar (95%) and all other outcome measures were statistically comparable between cohorts. CONCLUSION Direct TAVI using ACURATEneo2 without pre-TAVI balloon aortic valvuloplasty in patients with mild or less valve calcifications might be feasible and associated with comparable early outcomes compared to patients with similar anatomical features undergoing systematic balloon valvuloplasty.
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Affiliation(s)
- Ahmed Elkoumy
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland; Islamic Center of Cardiology, Al-Azhar University, Nasr City, Cairo, Egypt
| | - Andreas Rück
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Mohamed Abdel-Wahab
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Tanja K Rudolph
- Heart and Diabetes Center Nordrhine Westphalia, Department of General and Interventional Cardiology/Angiology, Bad Oeynhausen, Ruhr-University Bochum, Germany
| | - Alexander Wolf
- Department of Cardiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus, Essen, Germany
| | - Jan Martin Wambach
- Department of Cardiology, Contilia Heart and Vascular Center, Elisabeth-Krankenhaus, Essen, Germany
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Mahmoud Abdelshafy
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland; Department of Cardiology, Al-Azhar University Hospitals, Cairo, Egypt
| | - Shahram Arsang-Jang
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland
| | - Hesham Elzomor
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland
| | - Mika Laine
- Department of Cardiology, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Anaesthesia and Intensive Care, Lund University, Skåne University Hospital, Lund, Sweden
| | - Matthias Götberg
- Department of Cardiology, Clinical Sciences. Lund University, Skåne University Hospital, Lund, Sweden
| | - Joanna J Wykrzykowska
- Interventional Cardiology, Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands
| | - Sameh K Mohamed
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland
| | - Costanza Pellegrini
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Tobias Rheude
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Munich, Germany
| | - Stefan Toggweiler
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital|LUKS, Lucerne, Switzerland
| | - Nawzad Saleh
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | | | - Won-Keun Kim
- Department of Cardiology and Cardiac Surgery, Kerckhoff Heart, and Lung Centre, Bad Nauheim, Germany
| | - Osama Soliman
- Discipline of Cardiology, Saolta, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Galway, Ireland; CÚRAM, SFI Research Centre for Medical Devices, Galway, Ireland.
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Rosseel L, Montarello NJ, Nuyens P, Tirado-Conte G, Quagliana A, Cornelis K, Floré V, Rosseel M, Bieliauskas G, Sondergaard L, De Backer O. A systematic algorithm for large-bore arterial access closure after TAVI: the TAVI-MultiCLOSE study. EUROINTERVENTION 2024; 20:e354-e362. [PMID: 37982158 PMCID: PMC10949328 DOI: 10.4244/eij-d-23-00725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/01/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Despite transcatheter aortic valve implantation (TAVI) having become a routine procedure, access site bleeding and vascular complications are still a concern which contribute to procedure-related morbidity and mortality. AIMS The TAVI-MultiCLOSE study aimed to assess the safety and efficacy of a new vascular closure algorithm for percutaneous large-bore arterial access closure following transfemoral (TF)-TAVI. METHODS All consecutive TF-TAVI cases in which the MultiCLOSE vascular closure algorithm was used were prospectively included in a multicentre, observational study. This stepwise algorithm entails the reinsertion of a 6-8 Fr sheath (primary access) following the initial preclosure with one or two suture-based vascular closure devices (VCDs). This provides the operator with the opportunity to perform a quick and easy angiographic control and tailor the final vascular closure with either an additional suture- or plug-based VCD, or neither of these. RESULTS Among 630 patients who underwent TF-TAVI utilising the MultiCLOSE algorithm, complete arterial haemostasis was achieved in 616 patients (98%). VCD failure occurred in 14 patients (2%), treated with either balloon inflation (N=1), covered stent (N=12) or surgical repair (N=1). Overall, this vascular closure approach resulted in a minor and major vascular complication rate of 2.2% and 0.6%, respectively. At 30 days, only one new minor vascular complication (0.2%) was noted. In-hospital and 30-day all-cause mortality rates were 0.2% and 1.0%, respectively. CONCLUSIONS Use of the MultiCLOSE vascular closure algorithm was demonstrated to contribute to an easy, safe, efficacious and durable vascular closure after TF-TAVI, resulting in a major vascular complication rate of less than 1%.
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Affiliation(s)
- Liesbeth Rosseel
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Cardiology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - Nicholas J Montarello
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philippe Nuyens
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Angelo Quagliana
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristoff Cornelis
- Cardiology Department, Algemeen Ziekenhuis Maria Middelares, Ghent, Belgium
| | - Vincent Floré
- Cardiology Department, Algemeen Ziekenhuis Maria Middelares, Ghent, Belgium
| | - Michael Rosseel
- Cardiology Department, Algemeen Stedelijk Ziekenhuis, Aalst, Belgium
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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7
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Gröning M, Smerup MH, Munk K, Andersen H, Nielsen DG, Nissen H, Mortensen UM, Jensen AS, Bække PS, Bjerre J, Engholm M, Vejlstrup N, Juul K, Søndergaard EV, Thyregod HGH, Andersen HØ, Helvind M, De Backer O, Jøns C, Schmidt MR, Jørgensen TH, Sondergaard L. Pulmonary Valve Replacement in Tetralogy of Fallot: Procedural Volume and Durability of Bioprosthetic Pulmonary Valves. JACC Cardiovasc Interv 2024; 17:217-227. [PMID: 38127022 DOI: 10.1016/j.jcin.2023.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/26/2023] [Accepted: 10/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Robust data on changes in pulmonary valve replacement (PVR) procedural volume and predictors of bioprosthetic pulmonary valve (BPV) durability in patients with tetralogy of Fallot (TOF) are scarce. OBJECTIVES This study sought to assess temporal trends in PVR procedural volume and BPV durability in a nationwide, retrospective TOF cohort. METHODS Data were obtained from patient records. Robust linear regression was used to assess temporal trends in PVR procedural volume. Piecewise exponential additive mixed models were used to estimate BPV durability, defined as the time from implantation to redo PVR with death as a competing risk, and to assess risk factors for reduced durability. RESULTS In total, 546 PVR were performed in 384 patients from 1976 to 2021. The annual number of PVR increased from 0.4 to 6.0 per million population (P < 0.001). In the last decade, the transcatheter PVR volume increased by 20% annually (P < 0.001), whereas the surgical PVR volume did not change significantly. The median BPV durability was 17 years (Q1: 10-Q3: 10 years-not applicable). There was no significant difference in the durability of different BPV after adjustment for confounders. Age at PVR (HR: 0.78 per 10 years from <1 year; 95% CI: 0.63-0.96; P = 0.02) and true inner valve diameter (9-17 mm vs 18-22 mm HR: 0.40; 95% CI: 0.22-0.73; P = 0.003 and 18-22 mm vs 23-30 mm HR: 0.59; 95% CI: 0.25-1.39; P = 0.23) were associated with reduced BPV durability in multivariate models. CONCLUSIONS The PVR procedural volume has increased over time, with a greater increment in transcatheter than surgical PVR during the last decade. Younger patient age at PVR and a smaller true inner valve diameter predicted reduced BPV durability.
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Affiliation(s)
- Mathis Gröning
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Cardiology, Zealand University Hospital, Roskilde, Denmark.
| | - Morten Holdgaard Smerup
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kim Munk
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Helle Andersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | | | - Pernille Steen Bække
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Bjerre
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Engholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Juul
- Department of Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Henrik Ørbæk Andersen
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Helvind
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michael Rahbek Schmidt
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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8
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Wang X, Arslani K, Nuyens P, Montarello NJ, Vanhaverbeke M, Bieliauskas G, Sondergaard L, De Backer O. Contemporary guideline-directed management of patients with severe aortic valve stenosis. EUROINTERVENTION 2024; 20:e158-e167. [PMID: 38224253 PMCID: PMC10786179 DOI: 10.4244/eij-d-23-00469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/15/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are Class Ia recommended therapies for specific subgroups of severe aortic stenosis (AS) patients in the latest 2021 European guidelines. AIMS We aimed to report on the multidisciplinary Heart Team evaluation process and real-world practice of treating severe symptomatic AS in East Denmark in the context of the latest European guideline recommendations. METHODS All consecutive patients with severe AS referred for intervention in 2021 (N=672) were discussed in a multidisciplinary Heart Team meeting. All patients (100%) had a cardiac computed tomography (CT) analysis prior to the meeting. Baseline characteristics, Heart Team decision-making, final treatment and 30-day clinical outcomes were prospectively recorded. RESULTS The majority of severe AS patients (N=456, 68%) were referred for TAVI following discussion in the Heart Team. Ultimately, 94% of patients (N=632) received the Heart Team-recommended treatment. Patients undergoing TAVI (N=439) were significantly older (78.4±6.7 vs 67.2±8.3 years; p<0.001) and more comorbid than patients undergoing SAVR (N=189). The overall 30-day clinical outcomes were satisfactory for both treatment groups (overall 30-day mortality: 1.1%). The mean index hospitalisation length was markedly longer in the SAVR group (8.6±8.3 days) as compared to the TAVI group (1.8±3.2 days). CONCLUSIONS TAVI was routinely performed in low surgical risk patients in 2021 with two-thirds of all severe AS patients undergoing TAVI, thereby applying the latest European guidelines. A dedicated Heart Team meeting, including CT evaluation for all AS patients, is needed to make individualised management decisions in this new era of aortic valve interventions.
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Affiliation(s)
- Xi Wang
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ketina Arslani
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philippe Nuyens
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas J Montarello
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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9
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Kalińczuk Ł, Skotarczak W, Chmielak Z, Dąbrowski M, Stokłosa P, Michałowska I, Sondergaard L, Witkowski A, Mintz GS. Intravascular Ultrasound for Valve Expansion, Orifice Dimension, and Paravalvular Leak During Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2024; 17:111-113. [PMID: 38069993 DOI: 10.1016/j.jcin.2023.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 01/12/2024]
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10
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Schaefer A, Bhadra OD, Conradi L, Westermann D, Kellner C, De Backer O, Bajoras V, Sondergaard L, Qureshi WT, Kakouros N, Aldrugh S, Amat-Santos I, Kaneko T, Harloff M, Teles R, Nolasco T, Neves JP, Abecasis M, Werner N, Lauterbach M, Sacha J, Krawczyk K, Trani C, Romagnoli E, Mangieri A, Condello F, Regueiro A, Brugaletta S, Biancari F, Niemelä M, Giannini F, Toselli M, Ruggiero R, Buono A, Maffeo D, Bruno F, Conrotto F, D'Ascenzo F, Savontaus M, Pykäri J, Ielasi A, Tespili M, Cimmino M, Albanese M, Biondi-Zoccai G, Corcione N, Morello A, Giordano A. Procedural success in transaxillary transcatheter aortic valve implantation according to type of transcatheter heart valve: results from the multicenter TAXI registry. Clin Res Cardiol 2024; 113:48-57. [PMID: 37138103 DOI: 10.1007/s00392-023-02216-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/25/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI. AIMS This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV). METHODS For the TAXI registry anonymized data of patients treated with TAx-TAVI were collected from 18 centers. Acute procedural, early and 1-month clinical outcomes were adjudicated in accordance with standardized VARC-3 definitions. RESULTS From 432 patients, 368 patients (85.3%, SE group) received self-expanding (SE) THV and 64 patients (14.8%, BE group) received balloon-expandable (BE) THV. Imaging revealed lower axillary artery diameters in the SE group (max/min diameter in mm: 8.4/6.6 vs 9.4/6.8 mm; p < 0.001/p = 0.04) but a higher proportion of axillary tortuosity in BE group (62/368, 23.6% vs 26/64, 42.6%; p = 0.004) with steeper aorta-left ventricle (LV) inflow (55° vs 51°; p = 0.002) and left ventricular outflow tract (LVOT)-LV inflow angles (40.0° vs 24.5°; 0.002). TAx-TAVI was more often conducted by right sided axillary artery in the BE group (33/368, 9.0% vs 17/64, 26.6%; p < 0.001). Device success was higher in the SE group (317/368, 86.1% vs 44/64, 68.8%, p = 0.0015). In logistic regression analysis, BE THV were a risk factor for vascular complications and axillary stent implantation. CONCLUSIONS Both, SE and BE THV can be safely used in TAx-TAVI. However, SE THV were more often used and were associated with a higher rate of device success. While SE THV were associated with lower rates of vascular complications, BE THV were more often used in cases with challenging anatomical circumstances.
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Affiliation(s)
- Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany.
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Caroline Kellner
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vilhelmas Bajoras
- The Heart Center-Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Interventional Cardiology, Division of Cardiology and Vascular Diseases, Vilnius University, Hospital Santaros Clinics, Vilnius, Lithuania
| | - Lars Sondergaard
- The Heart Center-Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Waqas T Qureshi
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Nikolaos Kakouros
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Summer Aldrugh
- Division of Cardiology, University of Massachusetts School of Medicine, Worcester, MA, USA
| | - Ignacio Amat-Santos
- Cardiology Department, CIBERCV, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Morgan Harloff
- Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Rui Teles
- Cardiothoracic Surgery Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Tiago Nolasco
- Cardiothoracic Surgery Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Jose Pedro Neves
- Cardiothoracic Surgery Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Miguel Abecasis
- Cardiothoracic Surgery Department, Hospital de Santa Cruz, Carnaxide, Lisbon, Portugal
| | - Nikos Werner
- Department of Medicine 3, Barmherzige Brüder Hospital, Trier, Germany
| | | | - Jerzy Sacha
- Department of Cardiology, Institute of Medical Sciences, University Hospital, University of Opole, Opole, Poland
| | - Krzysztof Krawczyk
- Department of Cardiology, Institute of Medical Sciences, University Hospital, University of Opole, Opole, Poland
| | - Carlo Trani
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Enrico Romagnoli
- Institute of Cardiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Francesco Condello
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Ander Regueiro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Salvatore Brugaletta
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Matti Niemelä
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Marco Toselli
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Rossella Ruggiero
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Andrea Buono
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Diego Maffeo
- Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza Institute, Brescia, Italy
| | - Francesco Bruno
- Department of Medical Science, Division of Cardiology, Città Della Salute e della Scienza, Turin, Italy
| | - Federico Conrotto
- Department of Medical Science, Division of Cardiology, Città Della Salute e della Scienza, Turin, Italy
| | - Fabrizio D'Ascenzo
- Department of Medical Science, Division of Cardiology, Città Della Salute e della Scienza, Turin, Italy
| | - Mikko Savontaus
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | - Jouni Pykäri
- Heart Center, Turku University Hospital, University of Turku, Turku, Finland
| | | | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Gruppo Ospedaliero San Donato, Milan, Italy
| | - Michele Cimmino
- Interventional Cardiology Unit, Santa Lucia Clinic, S. Giuseppe Vesuviano, Naples, Italy
| | - Michele Albanese
- Interventional Cardiology Unit, Santa Lucia Clinic, S. Giuseppe Vesuviano, Naples, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Naples, Italy
| | - Nicola Corcione
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Alberto Morello
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
| | - Arturo Giordano
- Interventional Cardiology Unit, Pineta Grande Hospital, Castel Volturno, Italy
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11
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Giordano A, Mas-Peiro S, Fichtlscherer S, Schaefer A, Beyer M, Maisano F, Ascione G, Buzzatti N, Teles R, Brito J, Albuquerque F, Sondergaard L, Vanhaverbeke M, Quagliana A, Costa G, Barbanti M, Ferraro P, Morello A, Cimmino M, Albanese M, Pepe M, Bardi L, Giordano S, Cittadini A, Corcione N, Biondi-Zoccai G. Long-term outcomes following transcatheter aortic valve implantation with the Portico self-expanding valve. Clin Res Cardiol 2024; 113:86-93. [PMID: 37391628 PMCID: PMC10808416 DOI: 10.1007/s00392-023-02252-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/20/2023] [Indexed: 07/02/2023]
Abstract
AIM Transcatheter aortic valve implantation (TAVI) is a mainstay in the management of severe aortic valve stenosis in elderly patients, but there is uncertainty on their long-term effectiveness. We aimed to assess the long-term outcome of patients undergoing TAVI with the Portico valve. METHODS We retrospectively collected the data on patients in whom TAVI with Portico was attempted from 7 high-volume centres. Only patients theoretically eligible for 3 or more years of follow-up were included. Clinical outcomes, including death, stroke, myocardial infarction, reintervention for valve degeneration and hemodynamic valve performance were systematically assessed. RESULTS A total of 803 patients were included, with 504 (62.8%) women, mean age of 82 years, median EuroSCORE II of 3.1%, and 386 (48.1%) subjects at low/moderate risk. The median follow-up was 3.0 years (3.0; 4.0). The composite of death, stroke, myocardial infarction, and reintervention for valve degeneration occurred in 37.5% (95% confidence interval: 34.1-40.9%), with all-cause death in 35.1% (31.8-38.4%), stroke in 3.4% (1.3-3.4%), myocardial infarction in 1.0% (0.3-1.5%), and reintervention for valve degeneration in 1.1% (0.6-2.1%). The mean aortic valve gradient at follow-up was 8.1 ± 4.6 mmHg, and at least moderate aortic regurgitation was present in 9.1% (6.7-12.3%). Independent predictors of major adverse events or death were: peripheral artery disease, chronic obstructive pulmonary disease, estimated glomerular filtration rate, atrial fibrillation, prior pacemaker implantation, EuroSCORE II, and reduced left ventricular ejection fraction (all p < 0.05). CONCLUSIONS Portico use is associated with favorable long-term clinical outcomes. Clinical outcomes were largely impacted by baseline risk factors and surgical risk.
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Affiliation(s)
- Arturo Giordano
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Silvia Mas-Peiro
- Department of Cardiology, Goethe University Hospital, Frankfurt, Germany
| | | | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Martin Beyer
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Francesco Maisano
- Department of Cardiac Surgery IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Guido Ascione
- Department of Cardiac Surgery IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, Carnaxide, Portugal
| | - João Brito
- Division of Cardiology, Hospital de Santa Cruz, Carnaxide, Portugal
| | | | | | | | | | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Paolo Ferraro
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Alberto Morello
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Cimmino
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Albanese
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Luca Bardi
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Antonio Cittadini
- Department of Medical and Translational Sciences, Federico II University of Naples, Naples, Italy
| | - Nicola Corcione
- Unità Operativa di Interventistica Cardiovascolare, Pineta Grande Hospital, Castel Volturno, Italy
- Unità Operativa di Emodinamica, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
- Mediterranea Cardiocentro, Naples, Italy.
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12
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Montarello NJ, Ho CB, Sondergaard L, De Backer O. Patient-specific valve-in-valve computational modelling to guide the index TAVR procedure. J Cardiovasc Comput Tomogr 2024; 18:e1-e3. [PMID: 37752020 DOI: 10.1016/j.jcct.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/07/2023] [Accepted: 09/17/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Nicholas J Montarello
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Cheuk Bong Ho
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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13
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Kasner SE, Sondergaard L, Nakum M, Gomez Montero M, Hashim M, Landaas EJ. A matching-adjusted indirect comparison of results from REDUCE and RESPECT-two randomized trials on patent foramen ovale closure devices to prevent recurrent cryptogenic stroke. J Med Econ 2024; 27:337-343. [PMID: 38373018 DOI: 10.1080/13696998.2024.2320604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
AIMS Two randomized clinical trials, REDUCE and RESPECT, demonstrated that patent foramen ovale (PFO) closure in combination with antithrombotic therapy was more effective for the prevention of recurrent ischemic stroke compared with antithrombotic therapy alone. The aim of this study was to determine the relative efficacy and safety of the PFO closure devices used in REDUCE (HELEX and CARDIOFORM Septal Occluders) compared with the device used in RESPECT (Amplatzer PFO Occluder). METHODS An unanchored matching-adjusted indirect comparison (MAIC) of the PFO closure arms of the REDUCE and RESPECT trials was performed using patient-level data from REDUCE weighted to match baseline characteristics from RESPECT. Comparisons of the following outcomes were made between the devices assessed in the trials: risk of recurrent ischemic stroke; recurrent ischemic stroke one year after randomization; any serious adverse event (SAE) related to the procedure or device; and atrial fibrillation or atrial flutter as an SAE related to the procedure or device. RESULTS After conducting the MAIC, baseline characteristics were well-matched between the two trials. Compared to RESPECT, PFO closure using the devices from REDUCE resulted in a hazard ratio of 0.46 (95% confidence interval [CI] 0.15-1.43; p = 0.17) for the risk of recurrent stroke. For the recurrence of stroke after one year, SAE related to the procedure or device, and atrial fibrillation or atrial flutter as SAE related to the procedure or device, the MAIC resulted in a rate difference of -0.68 (95%CI -2.06 to 0.70; p = .34), -1.29 (95%CI -3.82 to 1.25; p = .32), and -0.19 (95%CI -1.16 to 0.78; p = .71), respectively. These findings were consistent across scenario analyses. CONCLUSIONS This MAIC analysis found no statistically significant differences in efficacy and safety outcomes between PFO closure with the HELEX and CARDIOFORM Septal Occluders versus the Amplatzer PFO Occluder, as used in the REDUCE and RESPECT trials.
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Affiliation(s)
- Scott E Kasner
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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14
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Costa G, Saia F, Pilgrim T, Abdel-Wahab M, Garot P, Sammartino S, Gandolfo C, Branca L, Latib A, Amat-Santos I, Mylotte D, De Marco F, De Backer O, Nombela Franco L, Akodad M, Ribichini FL, Bedogni F, Mazzapicchi A, Tomii D, Laforgia P, Cannata S, Fiorina C, Scotti A, Fezzi S, Criscione E, Poletti E, Mazzucca M, Lunardi M, Mainardi A, Andreaggi S, Quagliana A, Montarello NJ, Hennessey B, Mon-Noboa M, Meier D, Adamo M, Sgroi C, Reddavid CM, Strazzieri O, Crescenzia Motta S, Frittitta V, Dipietro E, Comis A, Melfa C, Calì M, Laterra G, Thiele H, Webb JG, Sondergaard L, Tamburino C, Barbanti M. One-year clinical outcomes of transcatheter aortic valve implantation with the latest iteration of self-expanding or balloonexpandable devices: insights from the OPERA-TAVI registry. EUROINTERVENTION 2024; 20:95-103. [PMID: 37982161 PMCID: PMC10758986 DOI: 10.4244/eij-d-23-00720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/09/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Midterm comparative analyses of the latest iterations of the most used Evolut and SAPIEN platforms for transcatheter aortic valve implantation (TAVI) are lacking. AIMS We aimed to compare 1-year clinical outcomes of TAVI patients receiving Evolut PRO/PRO+ (PRO) or SAPIEN 3 Ultra (ULTRA) devices in current real-world practice. METHODS Among patients enrolled in the OPERA-TAVI registry, patients with complete 1-year follow-up were considered for the purpose of this analysis. One-to-one propensity score matching was used to compare TAVI patients receiving PRO or ULTRA devices. The primary endpoint was a composite of 1-year all-cause death, disabling stroke and rehospitalisation for heart failure. Five prespecified subgroups of patients were considered according to leaflet and left ventricular outflow tract calcifications, annulus dimensions and angulation, and leaflet morphology. RESULTS Among a total of 1,897 patients, 587 matched pairs of patients with similar clinical and anatomical characteristics were compared. The primary composite endpoint did not differ between patients receiving PRO or ULTRA devices (Kaplan-Meier [KM] estimates 14.0% vs 11.9%; log-rank p=0.27). Patients receiving PRO devices had higher rates of 1-year disabling stroke (KM estimates 2.6% vs 0.4%; log-rank p=0.001), predominantly occurring within 30 days after TAVI (1.4% vs 0.0%; p=0.004). Outcomes were consistent across all the prespecified subsets of anatomical scenarios (all pinteraction>0.10). CONCLUSIONS One-year clinical outcomes of patients undergoing transfemoral TAVI and receiving PRO or ULTRA devices in the current clinical practice were similar, but PRO patients had higher rates of disabling stroke. Outcomes did not differ across the different anatomical subsets of the aortic root.
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Affiliation(s)
- Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Francesco Saia
- Cardiovascular Department, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Thomas Pilgrim
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - Philippe Garot
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Sofia Sammartino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Caterina Gandolfo
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | | | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ignacio Amat-Santos
- Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Darren Mylotte
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Federico De Marco
- Interventional Cardiology Department, IRCSS Centro Cardiologico Monzino, Milan, Italy
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Luis Nombela Franco
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Daijiro Tomii
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - Pietro Laforgia
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay-Santé, Massy, France
| | - Stefano Cannata
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | | | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Simone Fezzi
- Department of Cardiology, University Hospital, University of Galway, Ireland
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Enrico Poletti
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Mazzucca
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Stefano Andreaggi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas J Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Breda Hennessey
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - Matias Mon-Noboa
- Cardiovascular Institute, Hospital Clinico San Carlos, IdISSC, Madrid, Spain
| | - David Meier
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | | | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Orazio Strazzieri
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Valentina Frittitta
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Elena Dipietro
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Alessandro Comis
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Chiara Melfa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Mariachiara Calì
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Abbott Vascular, Santa Clara, CA, USA
| | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
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15
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Kalińczuk Ł, Skotarczak W, Sondergaard L, Mintz GS. Intravascular ultrasound for actual bioprosthetic heart valve expansion during transcatheter bicuspid aortic valve replacement. Eur Heart J 2023; 44:4895. [PMID: 37862595 DOI: 10.1093/eurheartj/ehad683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Affiliation(s)
- Łukasz Kalińczuk
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland
| | - Wiktor Skotarczak
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, ul. Alpejska 42, 04-628 Warsaw, Poland
| | | | - Gary S Mintz
- Cardiovascular Research Foundation, New York, USA
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16
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Vij V, Cruz-González I, Galea R, Piayda K, Nelles D, Vogt L, Gloekler S, Fürholz M, Meier B, Räber L, O'Hara G, Arzamendi D, Agudelo V, Asmarats L, Freixa X, Flores-Umanzor E, De Backer O, Sondergaard L, Nombela-Franco L, McInerney A, Salinas P, Korsholm K, Nielsen-Kudsk JE, Afzal S, Zeus T, Operhalski F, Schmidt B, Montalescot G, Guedeney P, Iriart X, Miton N, Saw J, Gilhofer T, Fauchier L, Veliqi E, Meincke F, Petri N, Nordbeck P, Gonzalez-Ferreiro R, Bhatt DL, Laricchia A, Mangieri A, Omran H, Schrickel JW, Rodes-Cabau J, Nickenig G, Sievert H, Sedaghat A. Symptomatic vs. non-symptomatic device-related thrombus after LAAC: a sub-analysis from the multicenter EUROC-DRT registry. Clin Res Cardiol 2023; 112:1790-1799. [PMID: 37294311 PMCID: PMC10697873 DOI: 10.1007/s00392-023-02237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/23/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND Device-related thrombus (DRT) after left atrial appendage closure (LAAC) is associated with adverse outcomes, i.e. ischemic stroke or systemic embolism (SE). Data on predictors of stroke/SE in the context of DRT are limited. AIMS This study aimed to identify predisposing factors for stroke/SE in DRT patients. In addition, the temporal connection of stroke/SE to DRT diagnosis was analyzed. METHODS The EUROC-DRT registry included 176 patients, in whom DRT after LAAC were diagnosed. Patients with symptomatic DRT, defined as stroke/SE in the context of DRT diagnosis, were compared against patients with non-symptomatic DRT. Baseline characteristics, anti-thrombotic regimens, device position, and timing of stroke/SE were compared. RESULTS Stroke/SE occurred in 25/176 (14.2%) patients diagnosed with DRT (symptomatic DRT). Stroke/SE occurred after a median of 198 days (IQR 37-558) after LAAC. In 45.8% stroke/SE occurred within one month before/after DRT diagnosis (DRT-related stroke). Patients with symptomatic DRT had lower left ventricular ejection fractions (50.0 ± 9.1% vs. 54.2 ± 11.0%, p = 0.03) and higher rates of non-paroxysmal atrial fibrillation (84.0% vs. 64.9%, p = 0.06). Other baseline parameters and device positions were not different. Most ischemic events occurred among patients with single antiplatelet therapy (50%), however, stroke/SE was also observed under dual antiplatelet therapy (25%) or oral anticoagulation (20%). CONCLUSION Stroke/SE are documented in 14.2% and occur both in close temporal relation to the DRT finding and chronologically independently therefrom. Identification of risk factors remains cumbersome, putting all DRT patients at substantial risk for stroke/SE. Further studies are necessary to minimize the risk of DRT and ischemic events.
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Affiliation(s)
- Vivian Vij
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | | | | | | | - Dominik Nelles
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Lara Vogt
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | | | | | | | | | - Gilles O'Hara
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | | | | | - Lluis Asmarats
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | - Ole De Backer
- Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | - Lars Sondergaard
- Rigshospitalet, University Hospital Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | - Shazia Afzal
- University Hospital Düsseldorf, Düsseldorf, Germany
| | - Tobias Zeus
- University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Boris Schmidt
- Agaplesion Bethanien Krankenhaus, CBB, Frankfurt, Germany
| | - Gilles Montalescot
- ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
| | - Paul Guedeney
- ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Sorbonne University, Paris, France
| | | | | | | | | | | | | | | | - Nils Petri
- University Hospital Würzburg, Würzburg, Germany
| | | | | | | | - Alessandra Laricchia
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS, Rozzano, Italy
| | | | - Jan Wilko Schrickel
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Josep Rodes-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Canada
| | - Georg Nickenig
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | | | - Alexander Sedaghat
- Department of Cardiology, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
- Rhein-Ahr-Cardio, Bad Neuenahr-Ahrweiler, Germany.
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17
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Meier D, Landes U, Sondergaard L, De Backer O, Lutter G, Puehler T, Akodad M, Tzimas G, Blanke P, Payne GW, Lai A, Gill H, Wood DA, Webb JG, Sellers SL, Sathananthan J. Redo-TAVI with SAPIEN 3 in SAPIEN XT or SAPIEN 3 - impact of pre- and post-dilatation on final THV expansion. EUROINTERVENTION 2023; 19:757-765. [PMID: 37519190 PMCID: PMC10654765 DOI: 10.4244/eij-d-23-00308] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/18/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND When a balloon-expandable transcatheter heart valve (THV) is chosen to treat a failed balloon-expandable THV, there is a risk of underexpansion with a potential impact on performance. AIMS We aimed to assess the impact of pre- and post-dilatation on the expansion of balloon-expandable THVs after redo-transcatheter aortic valve implantation (TAVI). METHODS Redo-TAVI was performed on the bench with a 23 mm SAPIEN 3 (S3) implanted within a 23 mm SAPIEN XT (SXT) or a 23 mm S3, both of which served as the "failed" THVs. Pre- and/or post-dilatation was performed using a 23 mm non-compliant TRUE balloon. Expansion of the index and redo-THVs were assessed before and after pre-/post-dilatation using microcomputed tomography (micro-CT), and THV hydrodynamic testing was conducted. RESULTS Without pre- or post-dilatation, the S3 was underexpanded, for all combinations, particularly in the mid-portion of the THV (18.6 mm and 19.7 mm representing 81% and 86% of the nominal diameter inside the SXT and S3, respectively). Pre- and post-dilatation had an additive effect on diameter expansion of the redo-THV, which remained constrained in most combinations. The only combination to achieve nominal expansion was the S3 in S3 when both pre- and post-dilatation were performed. The S3 remained underexpanded inside the SXT despite pre- and post-dilatation (93% in the mid-portion). Improved redo-THV expansion was accompanied by 2.7 mm (12%) overexpansion of the index THV. While all samples had acceptable hydrodynamic performance, the underexpanded samples had worse leaflet pinwheeling. CONCLUSIONS When performing redo-TAVI with a 23 mm S3 inside a 23 mm SXT or S3, only the S3 in S3 with the use of pre- and post-dilatation reached full expansion. This underlines the importance of CT assessment of THV expansion and the role of pre-/post-dilatation.
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Affiliation(s)
- David Meier
- Centre for Cardiovascular Innovation, St Paul's Hospital, Vancouver, BC, Canada and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Vancouver, BC, Canada and Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel
- Rabin Medical Center, Petah Tikva, Israel and Tel Aviv University, Tel Aviv, Israel
| | | | - Ole De Backer
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Georg Lutter
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg/Lübeck, Kiel Germany
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holsten, Campus Kiel, Kiel, Germany
| | - Thomas Puehler
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg/Lübeck, Kiel Germany
- Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holsten, Campus Kiel, Kiel, Germany
| | - Mariama Akodad
- Institut Cardiovasculaire Paris Sud (ICPS), Hôpital privé Jacques Cartier, Ramsay Santé, Massy, France
| | - Georgios Tzimas
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Geoffrey W Payne
- University of Northern British Columbia, Prince George, BC, Canada
| | - Althea Lai
- Cardiovascular Translational Laboratory, Vancouver, BC, Canada and Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Hacina Gill
- Cardiovascular Translational Laboratory, Vancouver, BC, Canada and Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation, St Paul's Hospital, Vancouver, BC, Canada and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's Hospital, Vancouver, BC, Canada and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Centre for Cardiovascular Innovation, St Paul's Hospital, Vancouver, BC, Canada and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Vancouver, BC, Canada and Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's Hospital, Vancouver, BC, Canada and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Vancouver, BC, Canada and Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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18
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De Backer O, Sathananthan J, Landes U, Danenberg HD, Webb J, Sondergaard L. Redo-TAVI with a balloon-expandable valve and the impact of index transcatheter aortic valve design. EUROINTERVENTION 2023; 19:714-716. [PMID: 37994094 PMCID: PMC10654766 DOI: 10.4244/eij-d-23-00363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/10/2023] [Indexed: 11/24/2023]
Affiliation(s)
- Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel and Tel-Aviv University, Tel Aviv, Israel
| | - Haim D Danenberg
- Edith Wolfson Medical Center, Holon, Israel and Tel-Aviv University, Tel Aviv, Israel
| | - John Webb
- St. Paul's Hospital, Vancouver, BC, Canada
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19
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Steen Bække P, Jørgensen TH, Thuraiaiyah J, Gröning M, De Backer O, Sondergaard L. Incidence, predictors, and prognostic impact of rehospitalization after transcatheter aortic valve implantation. Eur Heart J Qual Care Clin Outcomes 2023:qcad067. [PMID: 37950564 DOI: 10.1093/ehjqcco/qcad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
AIMS Despite rehospitalization being common after transcatheter aortic valve implantation (TAVI), an in-depth analysis on this topic is missing. This study sought to report on the incidence, predictors, and prognostic impact of rehospitalization within one year following TAVI. METHODS AND RESULTS All consecutive patients treated with TAVI between 2016 and 2020 in East Denmark were included. Medical records of all patients were reviewed to validate rehospitalizations up to 1 year after discharge from the index admission. The study population consisted of 1,397 patients, of whom 615 (44%) had an unplanned rehospitalization within the first year post-TAVI. The rehospitalization incidence rate was 3-fold higher in the early period (within 30 days) compared with the late period (30 days to 1 year; 2.5 vs. 0.8 per patient-year, respectively; p < 0.001). Predictors of early unplanned rehospitalization were procedure-related complications and prior stroke, whereas late unplanned rehospitalization was associated with pre-existing comorbidities. Predictors of HF rehospitalization included ischemic heart disease, the extent of cardiac damage, atrial fibrillation, and NYHA class at baseline. HF rehospitalization within 30 days and 1-year post-TAVI was associated with a markedly increased 1-year and 5-year mortality risk (hazard ratio (HR) of 4.3 and 3.2 for 1-year mortality and HR of 3.2 and 2.9 for 5-year mortality, respectively; p < 0.001). CONCLUSIONS Rehospitalization after TAVI is frequent in real-world practice. Early rehospitalization is mostly procedure-related whereas late rehospitalization is related to pre-existing comorbidities. HF rehospitalization is associated with poor long-term survival and could be validated as a prognostically relevant endpoint for TAVI trials.
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Affiliation(s)
- Pernille Steen Bække
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jani Thuraiaiyah
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mathis Gröning
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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20
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Rheude T, Costa G, Ribichini FL, Pilgrim T, Amat Santos IJ, De Backer O, Kim WK, Ribeiro HB, Saia F, Bunc M, Tchétché D, Garot P, Mylotte D, Burzotta F, Watanabe Y, Bedogni F, Tesorio T, Tocci M, Franzone A, Valvo R, Savontaus M, Wienemann H, Porto I, Gandolfo C, Iadanza A, Bortone AS, Mach M, Latib A, Biasco L, Taramasso M, Zimarino M, Tomii D, Nuyens P, Sondergaard L, Camara SF, Palmerini T, Orzalkiewicz M, Steblovnik K, Degrelle B, Gautier A, Del Sole PA, Mainardi A, Pighi M, Lunardi M, Kawashima H, Criscione E, Cesario V, Biancari F, Zanin F, Esposito G, Adam M, Grube E, Baldus S, De Marzo V, Piredda E, Cannata S, Iacovelli F, Andreas M, Frittitta V, Dipietro E, Reddavid C, Strazzieri O, Motta S, Angellotti D, Sgroi C, Xhepa E, Kargoli F, Tamburino C, Joner M, Barbanti M. Comparison of different percutaneous revascularisation timing strategies in patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2023; 19:589-599. [PMID: 37436190 PMCID: PMC10495747 DOI: 10.4244/eij-d-23-00186] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/02/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The optimal timing to perform percutaneous coronary interventions (PCI) in transcatheter aortic valve implantation (TAVI) patients remains unknown. AIMS We sought to compare different PCI timing strategies in TAVI patients. METHODS The REVASC-TAVI registry is an international registry including patients undergoing TAVI with significant, stable coronary artery disease (CAD) at preprocedural workup. In this analysis, patients scheduled to undergo PCI before, after or concomitantly with TAVI were included. The main endpoints were all-cause death and a composite of all-cause death, stroke, myocardial infarction (MI) or rehospitalisation for congestive heart failure (CHF) at 2 years. Outcomes were adjusted using the inverse probability treatment weighting (IPTW) method. RESULTS A total of 1,603 patients were included. PCI was performed before, after or concomitantly with TAVI in 65.6% (n=1,052), 9.8% (n=157) or 24.6% (n=394), respectively. At 2 years, all-cause death was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (6.8% vs 20.1% vs 20.6%; p<0.001). Likewise, the composite endpoint was significantly lower in patients undergoing PCI after TAVI as compared with PCI before or concomitantly with TAVI (17.4% vs 30.4% vs 30.0%; p=0.003). Results were confirmed at landmark analyses considering events from 0 to 30 days and from 31 to 720 days. CONCLUSIONS In patients with severe aortic stenosis and stable coronary artery disease scheduled for TAVI, performance of PCI after TAVI seems to be associated with improved 2-year clinical outcomes compared with other revascularisation timing strategies. These results need to be confirmed in randomised clinical trials.
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Affiliation(s)
- Tobias Rheude
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | | | - Thomas Pilgrim
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ignacio J Amat Santos
- CIBERCV, Division of Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Francesco Saia
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Matjaz Bunc
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Philippe Garot
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | | | - Francesco Burzotta
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yusuke Watanabe
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Francesco Bedogni
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Tullio Tesorio
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Marco Tocci
- Division of Cardiology, Policlinico Umberto I, Roma, Italy
| | - Anna Franzone
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | | | | | - Hendrik Wienemann
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Italo Porto
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Caterina Gandolfo
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Alessandro Iadanza
- UOSA Cardiologia Interventistica, Azienda ospedaliera-universitaria Senese, Policlinico Le Scotte, Siena, Italy
| | - Alessandro S Bortone
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
| | - Luigi Biasco
- Azienda Sanitaria Locale di Ciriè, Chivasso e Ivrea, ASL TO4, Ivrea, Italy
| | | | - Marco Zimarino
- Department of Cardiology, SS. Annunziata Hospital Chieti, ASL 2 Abruzzo, Chieti, Italy and Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Daijiro Tomii
- Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philippe Nuyens
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Sergio F Camara
- Heart Institute of Sao Paulo (InCor), University of Sao Paulo, Sao Paulo, Brazil
| | - Tullio Palmerini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | - Mateusz Orzalkiewicz
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy and Cardiac Thoracic and Vascular Department, Università degli Studi di Bologna, Bologna, Italy
| | | | | | - Alexandre Gautier
- Institute Cardiovasculaire Paris Sud (ICPS), Hôpital Jacques Cartier, Ramsay Santé, Massy, France
| | - Paolo Alberto Del Sole
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Andrea Mainardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Michele Pighi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Mattia Lunardi
- Division of Cardiology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Galway University Hospital, Galway, Ireland
| | - Hideyuki Kawashima
- Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Enrico Criscione
- Division of Cardiology, IRCSS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | | | - Fausto Biancari
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Federico Zanin
- Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Giovanni Esposito
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Matti Adam
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Eberhard Grube
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Faculty of Medicine and University Hospital Cologne, Clinic III for Internal Medicine, University of Cologne, Cologne, Germany
| | - Vincenzo De Marzo
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Elisa Piredda
- Cardiothoracic and Vascular Department, San Martino Policlinico Hospital, Genova, Italy
| | - Stefano Cannata
- Interventional Cardiology Unit, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy
| | - Fortunato Iacovelli
- Division of University Cardiology, Cardiothoracic Department, Policlinico University Hospital, Bari, Italy
| | | | | | | | | | | | | | - Domenico Angellotti
- Division of Cardiology, AOU Federico II, Università di Napoli, Napoli, Italy
| | - Carmelo Sgroi
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Erion Xhepa
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | | | - Corrado Tamburino
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Michael Joner
- Department of Cardiovascular Diseases, German Heart Center Munich, Technical University Munich, Munich, Germany
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
- Università degli Studi di Enna "Kore", Enna, Italy
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21
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Tchétché D, Ziviello F, De Biase C, De Backer O, Hovasse T, Leroux L, Petronio AS, Saint-Etienne C, Teles RC, Modine T, Sudre A, Teiger E, Mylotte D, Souteyrand G, Piazza N, Casassus F, Sondergaard L, Angelillis M, Nolasco T, Siddiqui S, Kardys I, Dumonteil N, Van Mieghem NM. Transcatheter aortic valve implantation with the Evolut platform for bicuspid aortic valve stenosis: the international, multicentre, prospective BIVOLUTX registry. EUROINTERVENTION 2023; 19:502-511. [PMID: 37203860 PMCID: PMC10436069 DOI: 10.4244/eij-d-23-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/17/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Prospective data about transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BAV) patients are limited. AIMS We aimed to evaluate the clinical impact of the Evolut PRO and R (34 mm) self-expanding prostheses in BAV patients and explore the impact of different computed tomography (CT) sizing algorithms in a prospective registry. METHODS A total of 149 bicuspid patients were treated in 14 countries. The primary endpoint was the intended valve performance at 30 days. Secondary endpoints were 30-day and 1-year mortality, severe patient-prosthesis mismatch (PPM) and the ellipticity index at 30 days. All study endpoints were adjudicated according to Valve Academic Research Consortium 3 criteria. RESULTS The mean Society of Thoracic Surgeons score was 2.6% (1.7-4.2). Type I L-R BAV was observed in 72.5% of the patients. Evolut valve sizes 29 and 34 mm were utilised in 49.0% and 36.9% of the cases, respectively. The 30-day cardiac death rate was 2.6%; the 1-year cardiac death rate was 11.0%. Valve performance at 30 days was observed in 142/149 (95.3%) patients. The mean aortic valve area post-TAVI was 2.1 (1.8-2.6) cm2, and the mean aortic gradient was 7.2 (5.4-9.5) mmHg. No patient had more than moderate aortic regurgitation at 30 days. PPM was observed in 13/143 (9.1%) surviving patients and was severe in 2 patients (1.6%). Valve function was maintained at 1 year. The mean ellipticity index remained 1.3 (interquartile range 1.2-1.4). Overall, 30-day and 1-year clinical and echocardiography outcomes were similar between the two sizing strategies. CONCLUSIONS BIVOLUTX demonstrated a favourable bioprosthetic valve performance and good clinical outcomes after TAVI with the Evolut platform in patients with bicuspid aortic stenosis. No impact from the sizing methodology could be identified.
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Affiliation(s)
| | | | | | | | | | - Lionel Leroux
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | | | | | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Arnaud Sudre
- Centre Hospitalier Universitaire de Lille, Lille, France
| | - Emmanuel Teiger
- Centre Hospitalier Universitaire Henri-Mondor, Créteil, France
| | | | | | - Nicolo Piazza
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | - Tiago Nolasco
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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22
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Ludwig S, Perrin N, Coisne A, Ben Ali W, Weimann J, Duncan A, Akodad M, Scotti A, Kalbacher D, Bleiziffer S, Nickenig G, Hausleiter J, Ruge H, Adam M, Petronio AS, Dumonteil N, Sondergaard L, Adamo M, Regazzoli D, Garatti A, Schmidt T, Dahle G, Taramasso M, Walther T, Kempfert J, Obadia JF, Chehab O, Tang GHL, Latib A, Goel SS, Fam NP, Andreas M, Muller DW, Denti P, Praz F, von Bardeleben RS, Granada JF, Modine T, Conradi L. Clinical outcomes of transcatheter mitral valve replacement: two-year results of the CHOICE-MI Registry. EUROINTERVENTION 2023; 19:512-525. [PMID: 37235388 PMCID: PMC10436071 DOI: 10.4244/eij-d-22-01037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 03/31/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Transcatheter mitral valve replacement (TMVR) using dedicated devices is an alternative therapy for high-risk patients with symptomatic mitral regurgitation (MR). AIMS This study aimed to assess the 2-year outcomes and predictors of mortality in patients undergoing TMVR from the multicentre CHOICE-MI Registry. METHODS The CHOICE-MI Registry included consecutive patients with symptomatic MR treated with 11 different dedicated TMVR devices at 31 international centres. The investigated endpoints included mortality and heart failure hospitalisation rates, procedural complications, residual MR, and functional status. Multivariable Cox regression analysis was applied to identify independent predictors of 2-year mortality. RESULTS A total of 400 patients, median age 76 years (interquartile range [IQR] 71, 81), 59.5% male, EuroSCORE II 6.2% (IQR 3.8, 12.0), underwent TMVR. Technical success was achieved in 95.2% of patients. MR reduction to ≤1+ was observed in 95.2% at discharge with durable results at 1 and 2 years. New York Heart Association Functional Class had improved significantly at 1 and 2 years. All-cause mortality was 9.2% at 30 days, 27.9% at 1 year and 38.1% at 2 years after TMVR. Chronic obstructive pulmonary disease, reduced glomerular filtration rate, and low serum albumin were independent predictors of 2-year mortality. Among the 30-day complications, left ventricular outflow tract obstruction, access site and bleeding complications showed the strongest impact on 2-year mortality. CONCLUSIONS In this real-world registry of patients with symptomatic MR undergoing TMVR, treatment with TMVR was associated with a durable resolution of MR and significant functional improvement at 2 years. Two-year mortality was 38.1%. Optimised patient selection and improved access site management are mandatory to improve outcomes.
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Affiliation(s)
- Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
- Cardiovascular Research Foundation, New York, NY, USA
| | - Nils Perrin
- Structural Valve Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Augustin Coisne
- Cardiovascular Research Foundation, New York, NY, USA
- CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Walid Ben Ali
- Structural Valve Program, Montreal Heart Institute, Montreal, QC, Canada
| | - Jessica Weimann
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | | | | | - Andrea Scotti
- Cardiovascular Research Foundation, New York, NY, USA
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY, USA
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Sabine Bleiziffer
- Department of Cardiothoracic Surgery, Heart and Diabetes Center North Rhine-Westphalia, Bad Oeynhausen, Germany and Ruhr University Bochum, Bochum, Germany
| | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
- INSURE – Institute for Translational Cardiac Surgery, Department of Cardiovascular Surgery, German Heart Centre Munich, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur Toulouse, Toulouse, France
| | | | - Marianna Adamo
- Cardiac Catheterization 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
| | | | | | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Gry Dahle
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | | | | | | | | | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Azeem Latib
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY, USA
| | - Sachin S Goel
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Neil P Fam
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | | | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | | | | | - Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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23
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Aktaa S, Batra G, James SK, Blackman DJ, Ludman PF, Mamas MA, Abdel-Wahab M, Angelini GD, Czerny M, Delgado V, De Luca G, Agricola E, Foldager D, Hamm CW, Iung B, Mangner N, Mehilli J, Murphy GJ, Mylotte D, Parma R, Petronio AS, Popescu BA, Sondergaard L, Teles RC, Sabaté M, Terkelsen CJ, Testa L, Wu J, Maggioni AP, Wallentin L, Casadei B, Gale CP. Data standards for transcatheter aortic valve implantation: the European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart). Eur Heart J Qual Care Clin Outcomes 2023; 9:529-536. [PMID: 36195332 PMCID: PMC10405164 DOI: 10.1093/ehjqcco/qcac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/07/2022]
Abstract
AIMS Standardized data definitions are necessary for the quantification of quality of care and patient outcomes in observational studies and randomised controlled trials (RCTs). The European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart) project of the European Society of Cardiology (ESC) aims to create pan-European data standards for cardiovascular diseases and interventions, including transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS We followed the EuroHeart methodology for cardiovascular data standard development. A Working Group of 29 members representing 12 countries was established and included a patient representative, as well as experts in the management of valvular heart disease from the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Association of Cardiovascular Imaging (EACVI) and the Working Group on Cardiovascular Surgery. We conducted a systematic review of the literature and used a modified Delphi method to reach consensus on a final set of variables. For each variable, the Working Group provided a definition, permissible values, and categorized the variable as mandatory (Level 1) or additional (Level 2) based on its clinical importance and feasibility. In total, 93 Level 1 and 113 Level 2 variables were selected, with the level 1 variables providing the dataset for registration of patients undergoing TAVI on the EuroHeart IT platform. CONCLUSION This document provides details of the EuroHeart data standards for TAVI processes of care and in-hospital outcomes. In the context of EuroHeart, this will facilitate quality improvement, observational research, registry-based RCTs and post-marketing surveillance of devices, and pharmacotherapies. ONE-SENTENCE SUMMARY The EuroHeart data standards for transcatheter aortic valve implantation (TAVI) are a set of internationally agreed data variables and definitions that once implemented will facilitate improvement of quality of care and outcomes for patients receiving TAVI.
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Affiliation(s)
- Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Gorav Batra
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, 38 751 85 Uppsala, Sweden
| | - Stefan K James
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, 38 751 85 Uppsala, Sweden
| | - Daniel J Blackman
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter F Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, B15 2SQ Birmingham, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, ST5 5BG Stoke on Trent, UK
| | | | | | - Martin Czerny
- Department of Cardiovascular Surgery, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, University Heart Center Freiburg, 79189 Freiburg, Germany
| | - Victoria Delgado
- Heart Institute; Department of Cardiology; Cardiovascular Imaging Section; Hospital University Germans Trias i Pujol, 08916 Badalona, Spain
| | - Giuseppe De Luca
- Clinical and Experimental Cardiology Unit, AOU Sassari, 07100 Sassari, Italy
| | - Eustachio Agricola
- Cardiovascular Imaging Unit, San Raffaele Hospital, Milan, Vita-Salute University, 20132 San Raffaele Milan, Italy
| | | | - Christian W Hamm
- Medical Clinic I, University of Giessen, 35390 Giessen, Germany
- Kerckhoff Heart Center, 61231 Bad Nauheim, Germany
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, APHP and Université Paris-Cité, 75006 Paris, France
| | - Norman Mangner
- Heart Centre Dresden, Department of Internal Medicine and Cardiology, Technische Universitaet, 01069 Dresden, Germany
| | - Julinda Mehilli
- Department: Medizinische Klinik I, Landshut-Achdorf Hospital, 84036 Landshut, Germany
- Klinikum der Universität München, Ludwig-Maximilians-Universität, 80539 Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Munich Heart Alliance, 80539 Munich, Germany
| | - Gavin J Murphy
- NIHR Biomedical Research Unit, University of Leicester, LE1 7RH Leicester, UK
| | - Darren Mylotte
- Department of Cardiology, University Hospital and National University of Ireland Galway, H91 YR71 Galway, Ireland
| | - Radoslaw Parma
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, 40-055 Katowice, Poland
| | | | - Bodgan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy “Carol Davila” -Euroecolab, Emergency Institute for Cardiovascular Diseases 050474 Bucharest, Romania
| | - Lars Sondergaard
- Department of cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Rui C Teles
- Centro de Documentação, Centro Hospitalar de Lisboa Ocidental, Nova Medical School, Hospital de Santa Cruz, 1169056 Lisbon, Portugal
| | - Manel Sabaté
- Department of Interventional Cardiology, Cardiovascular Institute, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | | | - Luca Testa
- IRCCS San Donato Hospital, 20097 Milan, Italy
| | - Jianhua Wu
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- School of Dentistry, University of Leeds, LS2 9JT Leeds, UK
| | - Aldo P Maggioni
- ANMCO Research Center—Heart Care Foundation, 50121 Florence, Italy
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology and Uppsala Clinical Research Center, Uppsala University, 38 751 85 Uppsala, Sweden
| | - Barbara Casadei
- Division of Cardiovascular Medicine, NIHR Oxford Biomedical Research Centre, University of Oxford, OX1 2JD Oxford, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, LS2 9JT Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Imran Hamid U, Modine T, Maessen J, van ‘t Hof A, Sondergaard L, Bleiziffer S, Lancellotti P, Siepe M, Sardari Nia P. Structure of multidisciplinary heart teams, a survey-based heart team study. Interdiscip Cardiovasc Thorac Surg 2023; 37:7241522. [PMID: 37567588 PMCID: PMC11015317 DOI: 10.1093/icvts/ivad134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVES Multidisciplinary approach is well established in various disciplines, with evidence highlighting improved patient outcomes. The objective of this survey was to determine the real-world practice of heart teams across Europe. METHODS The survey was drafted after a consensus opinion from the authors. The survey was sent to cardiac surgeons and cardiologists identified through electronic search. The survey link and the information sheet were sent through email followed by survey completion reminders. The survey responses were cumulated and analysed. RESULTS Among 2188 invited clinicians, 220 clinicians from 26 countries took part in the survey (response rate 10%). The completion rate for the survey questions was 85%. A total of 140 (64%) were cardiac surgeons and 80 (36%) were cardiologists. The heart team meeting frequency was weekly according to 104 (55%) respondents. This was conducted face to face according to 139 (73%) of the responses. Eighty-seven (56%) of the respondents reported 10-20% of patients undergoing percutaneous coronary intervention were discussed at the heart team meeting. Seventy-nine (47%) respondents had ad hoc percutaneous coronary intervention institutional guidelines. Fifty-four (32%) respondents reported an audit process for the heart team decisions. CONCLUSIONS This survey suggests that there is marked variability in the infra-structure and execution of heart teams in different institutions. The results of the survey suggest a need to formulate guidelines on the composition and execution of heart teams which may result in an increase in transparency of decision-making within different institutions in reporting and comparing outcomes.
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Affiliation(s)
- Umar Imran Hamid
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- Department of Cardiac Surgery, Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Thomas Modine
- Department of Cardiac Surgery, Lille University Hospital, Lille, France
| | - Jos Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Arnoud van ‘t Hof
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Lars Sondergaard
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Sabine Bleiziffer
- Department of Cardiac Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany
| | | | - Matthias Siepe
- Department of Cardiac Surgery, Cardiovascular Centre, Inselspital, University of Bern, Switzerland
| | - Peyman Sardari Nia
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
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25
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Campens L, Wang X, Montarello NJ, He J, Kofoed KF, Chen M, Sondergaard L, De Backer O. Anatomical mapping of the membranous septum in tricuspid and bicuspid aortic valves by cardiac computed tomography. Int J Cardiovasc Imaging 2023; 39:1557-1559. [PMID: 37149839 DOI: 10.1007/s10554-023-02850-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 05/08/2023]
Abstract
A higher incidence of conduction disturbances and permanent pacemaker implantation (PPI) has been observed after transcatheter aortic valve implantation (TAVI) in patients with bicuspid aortic valves (BAVs) as compared to those with tricuspid aortic valves (TAVs). This study aimed to provide an anatomical explanation for this observation, supported by an in-depth anatomical mapping of the membranous septum (MS) in a large cohort of BAVs and TAVs using cardiac computed tomography (CT). A total of 300 cardiac CT scans were analysed, revealing a significantly shorter sub-annular length of the MS in BAVs at all measuring points compared to TAVs (p < 0.001). In the current BAV cohort, the MS was found to be at its shortest at the RCC site, measuring less than 1 mm in depth. In addition, the MS was located more anteriorly towards the RCC in BAVs, where the transcatheter aortic valve tends to be implanted deeper, and we observed a trend towards a higher PPI rate in BAVs. Future studies should investigate whether anatomical mapping of the MS in patients undergoing TAVI could be a useful tool for decision-making and potentially mitigate the risk of conduction disturbances.
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Affiliation(s)
- Laurence Campens
- The Heart Centre - Rigshospitalet, Copenhagen University Hospital, Inge Lehmannsvej 7, 2100, Copenhagen, Denmark
- Department of Cardiology, Ghent University Hospital, Ghent, Belgium
| | - Xi Wang
- The Heart Centre - Rigshospitalet, Copenhagen University Hospital, Inge Lehmannsvej 7, 2100, Copenhagen, Denmark
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Nicholas J Montarello
- The Heart Centre - Rigshospitalet, Copenhagen University Hospital, Inge Lehmannsvej 7, 2100, Copenhagen, Denmark
| | - Jingjing He
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Klaus Fuglsang Kofoed
- The Heart Centre - Rigshospitalet, Copenhagen University Hospital, Inge Lehmannsvej 7, 2100, Copenhagen, Denmark
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Lars Sondergaard
- The Heart Centre - Rigshospitalet, Copenhagen University Hospital, Inge Lehmannsvej 7, 2100, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Centre - Rigshospitalet, Copenhagen University Hospital, Inge Lehmannsvej 7, 2100, Copenhagen, Denmark.
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26
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Rück A, Kim W, Abdel‐Wahab M, Thiele H, Rudolph TK, Wolf A, Wambach JM, De Backer O, Sondergaard L, Hengstenberg C, Laine M, Miyashita H, Bjursten H, Götberg M, Pellegrini C, Toggweiler S, Wykrzykowska JJ, Soliman O, Saleh N, Meduri CU. The Early neo2 Registry: Transcatheter Aortic Valve Implantation With ACURATE neo2 in a European Population. J Am Heart Assoc 2023; 12:e029464. [PMID: 37489732 PMCID: PMC10493001 DOI: 10.1161/jaha.122.029464] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/24/2023] [Indexed: 07/26/2023]
Abstract
Background ACURATE neo2 is a transcatheter aortic valve implantation system consisting of a self-expanding bioprosthetic valve with supra-annular leaflet position and featuring innovations to facilitate placement accuracy and reduce paravalvular regurgitation. Methods and Results The goal of the Early neo2 (Early neo2 Registry of the ACURATE neo2 TAVI Prosthesis) was to gather real-life data on safety and efficacy in a European transcatheter aortic valve implantation population treated with ACURATE neo2. Data were collected from 554 consecutive patients treated with ACURATE neo2 at 12 European sites (mean age, 82 years; 66% women; mean European System for Cardiac Operative Risk Evaluation II, 4.5%±3.8%) between September 2020 and March 2021. The composite primary end point was the occurrence of any of the following: postoperative (in-hospital) paravalvular regurgitation grade ≥2, in-hospital acute kidney injury stage 3, postoperative pacemaker implantation, 30-day death, and 30-day stroke. The primary end point occurred in 12.6% of patients. The 30-day rates for all-cause death and all stroke were 1.3% and 2.7%, respectively, and 1.5% of patients exhibited stage 3 acute kidney injury. A total of 34 patients (6.2%) received a postoperative permanent pacemaker. Per core laboratory-adjudicated echocardiographic analysis, mean postoperative aortic valve gradient was 7.6±3.3 mm Hg, and 2.8% of patients exhibited paravalvular regurgitation grade ≥2. Conclusions In this report of postmarket use of the ACURATE neo2 valve in a real-world transcatheter aortic valve implantation population, patients exhibited favorable postoperative hemodynamics and clinical outcomes and a low rate of postoperative pacemaker implantation.
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Affiliation(s)
- Andreas Rück
- Department of CardiologyKarolinska University HospitalStockholmSweden
| | - Won‐Keun Kim
- Department of Cardiology and Cardiac SurgeryKerckhoff Heart and Lung CentreBad NauheimGermany
| | - Mohamed Abdel‐Wahab
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Holger Thiele
- Department of CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
| | - Tanja K. Rudolph
- Heart and Diabetes Center Bad Oeynhausen, Department of General and Interventional Cardiology/AngiologyBad Oeynhausen, Ruhr‐University BochumBochumGermany
| | - Alexander Wolf
- Department of CardiologyContilia Heart and Vascular Center, Elisabeth‐KrankenhausEssenGermany
| | - Jan Martin Wambach
- Department of CardiologyContilia Heart and Vascular Center, Elisabeth‐KrankenhausEssenGermany
| | - Ole De Backer
- The Heart CenterRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Lars Sondergaard
- The Heart CenterRigshospitalet, Copenhagen University HospitalCopenhagenDenmark
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Mika Laine
- Department of Cardiology, Heart and Lung CenterHelsinki University HospitalHelsinkiFinland
| | - Hirokazu Miyashita
- Department of Cardiology, Heart and Lung CenterHelsinki University HospitalHelsinkiFinland
| | - Henrik Bjursten
- Department of Cardiothoracic Surgery, Anesthesia and Intensive CareLund University/Skåne University HospitalLundSweden
| | - Matthias Götberg
- Department of Cardiothoracic Surgery, Anesthesia and Intensive CareLund University/Skåne University HospitalLundSweden
| | - Costanza Pellegrini
- Klinik für Herz‐ und Kreislauferkrankungen, Deutsches Herzzentrum MünchenTechnical University MunichMunichGermany
| | - Stefan Toggweiler
- Department of CardiologyHeart Center Lucerne, Luzerner Kantonsspital|LUKSLucerneSwitzerland
| | - Joanna J. Wykrzykowska
- Department of Cardiology, Interventional CardiologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Osama Soliman
- Department of CardiologyUniversity Hospital Galway and CORRIB Research Center for Advanced Imaging and Core Laboratory, National University of Ireland, Galway (NUIG)GalwayIreland
| | - Nawzad Saleh
- Department of CardiologyKarolinska University HospitalStockholmSweden
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27
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van Bergeijk KH, Wykrzykowska JJ, van Mieghem NM, Windecker S, Sondergaard L, Gada H, Li S, Hanson T, Deeb GM, Voors AA, Reardon MJ. Predicting 5-Year Clinical Outcomes After Transcatheter or Surgical Aortic Valve Replacement (a Risk Score from the SURTAVI Trial). Am J Cardiol 2023; 200:78-86. [PMID: 37307783 DOI: 10.1016/j.amjcard.2023.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/05/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023]
Abstract
Risk prediction scores for long-term outcomes after transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) are lacking. This study aimed to develop preprocedural risk scores for 5-year clinical outcomes after TAVI or SAVR. This analysis included 1,660 patients at an intermediate surgical risk with severe aortic stenosis randomly assigned to TAVI (n = 864) or SAVR (n = 796) from the SURTAVI (Surgical Replacement and Transcatheter Aortic Valve Implantation) trial. The primary end point was a composite of all-cause mortality or disabling stroke at 5 years. The secondary end point was a composite of cardiovascular mortality or hospitalizations for valve disease or worsening heart failure at 5 years. Preprocedural multivariable predictors of clinical outcomes were used to calculate a simple risk score for both procedures. At 5 years, the primary end point occurred in 31.3% of the patients with TAVI and 30.8% of the patients with SAVR. Preprocedural predictors differed between TAVI and SAVR. Baseline anticoagulant use was a common predictor for events in both procedures, whereas male sex and a left ventricular ejection fraction <60% were significant predictors for events in patients with TAVI and SAVR, respectively. A total of 4 simple scoring systems were created based on these multivariable predictors. The C-statistics of all models were modest but performed better than the contemporary risk scores. In conclusion, preprocedural predictors of events differ between TAVI and SAVR, necessitating separate risk models. Despite the modest predictive value of the SURTAVI risk scores, they appeared superior to other contemporary scores. Further research is needed to strengthen and validate our risk scores, possibly by including biomarker and echocardiographic parameters.
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Affiliation(s)
- Kees H van Bergeijk
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Joanna J Wykrzykowska
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | | | | | - Hemal Gada
- University of Pittsburgh Medical Center Pinnacle Health, Pittsburgh, Pennsylvania
| | - Shuzhen Li
- Statistical Services, Medtronic, Minneapolis, Minnesota
| | - Tim Hanson
- Statistical Services, Medtronic, Minneapolis, Minnesota
| | | | - Adriaan A Voors
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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De Backer O, Montarello NJ, Sondergaard L. Being prepared for redo-TAVI in self-expanding Evolut valves - important insights. EUROINTERVENTION 2023; 19:e281-e282. [PMID: 37458123 PMCID: PMC10333912 DOI: 10.4244/eij-e-23-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas J Montarello
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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29
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Giordano A, Schaefer A, Bhadra OD, Barbanti M, Costa G, Sammartino S, Sondergaard L, De Backer O, Dalsgaard M, D'Ascenzo F, Musto C, Fineschi M, Maisano F, Testa L, Vercellino M, Berni A, Galasso G, Cammardella AG, Morello A, Pepe M, Albanese M, Cimmino M, Giordano S, Biondi-Zoccai G, Corcione N. Outcomes of Transcatheter Aortic Valve Replacement in Patients With Severely Reduced Left Ventricular Systolic Function in the Low Systolic Function and Transcatheter Aortic Valve Implantation (LOSTAVI) International Registry. Am J Cardiol 2023; 201:349-358. [PMID: 37423004 DOI: 10.1016/j.amjcard.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is an established therapy for severe, symptomatic aortic valve stenosis even in patients with impaired left ventricular systolic function. However, there is uncertainty on the clinical effectiveness of the currently available TAVR devices in patients with reduced left ventricular ejection fraction (LVEF). The LOSTAVI (Low Systolic function and Transcatheter Aortic Valve Implantation) registry is a retrospective observational study using baseline, procedural, discharge, and long-term follow-up details. A total of 3 groups of interest were distinguished: extremely reduced LVEF (<25%), severely reduced LVEF (25% to 30%), and reduced LVEF (31% to 35%). Unadjusted and adjusted analyses were carried out for in-hospital and follow-up outcomes. A total of 923 patients were included from 12 centers, with 146 patients (16%) with LVEF <25%, 425 (46%) with LVEF 25% to 30%, and 352 (38%) with LVEF 31% to 35%. Several baseline and procedural features were different across groups, including age, risk, functional class, and prevalence of bicuspid disease (all p <0.05). In-hospital mortality was similar in the 3 groups (7 [4.8%], 18 [4.2%], and 7 [2.0%], respectively, p = 0.661), but major adverse events were more common in those with extremely reduced and severely reduced LVEF (19 [13%], 53 [13%], and 25 [7.1%], respectively, p = 0.024). The 12-month follow-up confirmed the significant detrimental impact of reduced LVEF on both death (21 [14%], 49 [12%], and 25 [7.1%], respectively, p = 0.024) and major adverse events (37 [25%], 89 [21%], and 53 [15%], respectively, p = 0.016). The adjusted analysis confirmed the significant prognostic role of LVEF on both outcomes, whereas TAVR device type was not associated with death or major adverse events (all p >0.05). In conclusion, TAVR yields favorable early and 1-year results in patients with reduced LVEF, including those with extremely depressed systolic dysfunction. However, reduced LVEF still represents a major adverse prognostic factor for both short- and mid-term outcomes.
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Affiliation(s)
- Arturo Giordano
- Cardiovascular Interventions Unit, Pineta Grande Hospital, Castel Volturno, Italy; Hemodynamics Unit, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, Hamburg, Germany
| | - Oliver D Bhadra
- Department of Cardiovascular Surgery, University Heart and Vascular Center of Hamburg, Hamburg, Germany
| | - Marco Barbanti
- Division of Cardiology, Enna Kore University, Enna, Italy
| | - Giuliano Costa
- Division of Cardiology, A.G. Rodolico-San Marco Hospital, Catania, Italy
| | - Sofia Sammartino
- Division of Cardiology, A.G. Rodolico-San Marco Hospital, Catania, Italy
| | - Lars Sondergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ole De Backer
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Marie Dalsgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department of Medical Sciences, University of Turin Hospital, Turin, Italy
| | - Carmine Musto
- Department of Cardiosciences, A.O. San Camillo Forlanini Hospital, Rome, Italy
| | - Massimo Fineschi
- Interventional Cardiology Unit, Siena University Hospital, Siena, Italy
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, San Raffaele Hospital, Milan, Italy
| | - Luca Testa
- Department of Cardiology, San Donato Hospital, San Donato Milanese, Milan, Italy
| | - Matteo Vercellino
- Department of Internal Medicine and Specialties, University of Genoa, and Cardiology Unit, Cardiothoracic and Vascular Department, San Martino Hospital, Genoa, Italy
| | - Andrea Berni
- Interventional Cardiology Unit, Sant'Andrea University Hospital, Rome, Italy
| | - Gennaro Galasso
- Division of Cardiology, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Antonio G Cammardella
- Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy
| | - Alberto Morello
- Cardiovascular Interventions Unit, Pineta Grande Hospital, Castel Volturno, Italy; Hemodynamics Unit, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Interdisciplinary Medicine (D.I.M.), University of Bari Aldo Moro, Bari, Italy
| | - Michele Albanese
- Cardiovascular Interventions Unit, Pineta Grande Hospital, Castel Volturno, Italy; Hemodynamics Unit, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Michele Cimmino
- Cardiovascular Interventions Unit, Pineta Grande Hospital, Castel Volturno, Italy; Hemodynamics Unit, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
| | - Salvatore Giordano
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy.
| | - Nicola Corcione
- Cardiovascular Interventions Unit, Pineta Grande Hospital, Castel Volturno, Italy; Hemodynamics Unit, Santa Lucia Hospital, San Giuseppe Vesuviano, Italy
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30
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Quagliana A, Montarello NJ, Vanhaverbeke M, Willemen Y, Campens L, Sondergaard L, De Backer O. Orbital atherectomy to facilitate transfemoral transcatheter aortic valve implantation in patients with calcified iliofemoral arteries: a case series. Eur Heart J Case Rep 2023; 7:ytad310. [PMID: 37501711 PMCID: PMC10369203 DOI: 10.1093/ehjcr/ytad310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/11/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023]
Abstract
Background The transfemoral (TF) approach drives most of the advantages of transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement. Alternative accesses for TAVI are associated with higher complication rates, but are still considered in ∼5% of cases due to peripheral arterial disease (PAD). Percutaneous transluminal angioplasty can still allow TF-TAVI in selected cases with severe calcific PAD; however, ancillary techniques for calcium management are often needed. Case Summary Orbital atherectomy was selected to facilitate TF-TAVI in two patients with different degrees and aspects of calcific PAD. Pre-procedural computed tomography analysis was key to choose the most appropriate technique for calcium management. We describe our experience with a step-by-step procedural approach to orbital atherectomy-assisted TF-TAVI. Discussion PAD is not uncommon in patients affected by severe symptomatic aortic valve stenosis. Orbital atherectomy can still allow TF-TAVI in selected cases with severe calcific PAD. A meticulous patient selection and a standardized, step-wise procedural execution are mandatory to optimize outcomes.
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Affiliation(s)
- Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
- Istituto Cardiocentro Ticino, Università della Svizzera Italiana, Lugano, Switzerland
| | - Nicholas J Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Yannick Willemen
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Laurence Campens
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, Section 9441, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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31
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Tirado-Conte G, Rodés-Cabau J, Oteo JF, Pan M, Muñoz E, Witberg G, Cheema AN, Alpieri A, Lopez D, Amat-Santos IJ, Akodad M, Ojeda S, Serra V, Garcia-Blas S, Alfonso F, de Backer O, Asmarats L, Muñoz A, Hamdan A, Toggweiler S, Del Valle R, Salido L, Cruz-González I, Estevez-Loureiro R, Martin Alfaro LE, Gheorge L, Dabrowski M, Berenguer A, Arzamendi D, Saia F, Webb JG, Sondergaard L, Nombela-Franco L. Transcatheter aortic valve implantation in patients with extra-small aortic annuli. EUROINTERVENTION 2023:EIJ-D-23-00011. [PMID: 37334654 DOI: 10.4244/eij-d-23-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND A small aortic annulus (SAA) is a risk factor for prosthesis-patient mismatch (PPM) in patients undergoing surgical or transcatheter aortic valve implantation (TAVI). Data regarding TAVI in patients with extra-SAA is scarce. AIMS The aim of this study was to analyse the safety and efficacy of TAVI in patients with extra-SAA. METHODS A multicentre registry study including patients with extra-SAA (defined as an aortic annulus area <280 mm2 and/or perimeter <60 mm) undergoing TAVI was established. Primary efficacy and safety endpoints were defined as device success and early safety at 30 days, respectively, using the Valve Academic Research Consortium-3 criteria, and were analysed according to valve type: self-expanding (SEV) versus balloon-expandable (BEV). RESULTS A total of 150 patients were included, of which 139 (92.7%) were women, and 110 (73.3%) received an SEV. Intraprocedural technical success was 91.3%, with a higher rate in patients receiving an SEV (96.4% vs 77.5% with BEV; p=0.001). Overall, 30-day device success was 81.3%, (85.5% with SEV vs 70.0% with BEV; p=0.032). The primary safety endpoint occurred in 72.0% of patients (with no difference between groups; p=0.118). Severe PPM occurred in 12% (9.0% with SEV and 24.0% with BEV; p=0.039), with no impact on all-cause mortality, cardiovascular mortality, or heart failure readmission at 2-year follow-up. CONCLUSIONS TAVI is a safe and feasible treatment in patients with extra-SAA with a high rate of technical success. The use of SEV was associated with a lower rate of intraprocedural complications, higher device success at 30 days and better haemodynamic outcomes compared to BEV.
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Affiliation(s)
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec, QC, Canada
| | - Juan F Oteo
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Manuel Pan
- Hospital Universitario Reina Sofia, Córdoba, Spain and Universidad de Cordoba (IMIBIC), Córdoba, Spain
| | - Erika Muñoz
- CIBERCV Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Guy Witberg
- Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel and The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asim N Cheema
- St Michael's Hospital, Toronto, ON, Canada
- Division of Cardiology, Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Alberto Alpieri
- Quebec Heart and Lung Institute, Laval University, Quebec, QC, Canada
| | - Diego Lopez
- Hospital Clínico Universitario de Santiago, CIBERCV, Santiago, Spain
| | - Ignacio J Amat-Santos
- CIBERCV, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Soledad Ojeda
- Hospital Universitario Reina Sofia, Córdoba, Spain and Universidad de Cordoba (IMIBIC), Córdoba, Spain
| | | | - Sergio Garcia-Blas
- Cardiology Department, Hospital Clínico Universitario de Valencia, Universitat de Valencia, INCLIVA, CIBERCV, Valencia, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario La Princesa, IIS-IP, CIBERCV, Madrid, Spain
| | - Ole de Backer
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Antonio Muñoz
- CIBERCV Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Ashraf Hamdan
- Cardiology Department, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel and The Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Luisa Salido
- Cardiology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Ignacio Cruz-González
- Department of Cardiology, Complejo Asistencial Universitario Salamanca, CIBERCV, IBSAL, Salamanca, Spain
| | | | | | | | - Maciec Dabrowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warsaw, Poland
| | - Alberto Berenguer
- Cardiology Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Dabit Arzamendi
- Department of Cardiology, Hospital Universitario La Princesa, IIS-IP, CIBERCV, Madrid, Spain
| | - Francesco Saia
- Cardiology Unit, Cardio-Thoracic-Vascular Department, University Hospital of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - John G Webb
- CIBERCV, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Lars Sondergaard
- Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
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Sondergaard L, Møller JE, De Backer O, Møller-Sørensen PH, Cheng Y, Rossing K, Smerup M, Quadri A. First-in-Human Implantation of a New Transcatheter Tricuspid Valve Replacement System. JACC Case Rep 2023; 14:101841. [PMID: 37152699 PMCID: PMC10157149 DOI: 10.1016/j.jaccas.2023.101841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 05/09/2023]
Abstract
Therapeutic options for patients with isolated severe to torrential tricuspid regurgitation have been limited. Because a surgical option is often not attractive, new catheter-based therapies are emerging. We report the first-in-human percutaneous transcatheter tricuspid valve replacement with the MonarQ system in a 75-year-old female patient with severely symptomatic torrential tricuspid regurgitation. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
- Address for correspondence: Dr Lars Sondergaard, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Inge Lehmannsvej 7, 2100 Copenhagen, Denmark.
| | | | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | | | - Yanping Cheng
- InQB8 Medical Technologies, Inc, Winchester, Massachusetts, USA
| | | | - Morten Smerup
- The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Arshad Quadri
- InQB8 Medical Technologies, Inc, Winchester, Massachusetts, USA
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Ludwig S, Conradi L, Cohen DJ, Coisne A, Scotti A, Abraham WT, Ben Ali W, Zhou Z, Li Y, Kar S, Duncan A, Lim DS, Adamo M, Redfors B, Muller DWM, Webb JG, Petronio AS, Ruge H, Nickenig G, Sondergaard L, Adam M, Regazzoli D, Garatti A, Schmidt T, Andreas M, Dahle G, Walther T, Kempfert J, Tang GH, Redwood SR, Taramasso M, Praz F, Fam NP, Dumonteil N, Obadia JF, von Bardeleben RS, Rudolph TK, Reardon MJ, Metra M, Denti P, Mack MJ, Hausleiter J, Asch FM, Latib A, Lindenfeld J, Modine T, Stone GW, Granada JF. Transcatheter Mitral Valve Replacement versus Medical Therapy for Secondary Mitral Regurgitation: A Propensity Score-Matched Comparison. Circ Cardiovasc Interv 2023. [PMID: 37194288 DOI: 10.1161/circinterventions.123.013045] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Background: Transcatheter mitral valve replacement (TMVR) is an emerging therapeutic alternative for patients with secondary mitral regurgitation (MR). Outcomes of TMVR versus guideline-directed medical therapy (GDMT) have not been investigated for this population. This study aimed to compare clinical outcomes of patients with secondary MR undergoing TMVR versus GDMT alone. Methods: The CHOICE-MI registry included patients with MR undergoing TMVR using dedicated devices. Patients with MR etiologies other than secondary MR were excluded. Patients treated with GDMT alone were derived from the control arm of the COAPT trial. We compared outcomes between the TMVR and GDMT groups, using propensity score (PS)-matching to adjust for baseline differences. Results: After PS-matching, 97 patient pairs undergoing TMVR (72.9±8.7 years, 60.8% male, transapical access 91.8%) versus GDMT (73.1±11.0 years, 59.8% male) were compared. At 1 and 2 years, residual MR was ≤1+ in all patients of the TMVR group compared to 6.9% and 7.7%, respectively, in those receiving GDMT alone (both p<0.001). The 2-year rate of HF hospitalization was significantly lower in the TMVR group (32.8% vs. 54.4%, HR 0.59, 95% CI 0.35-0.99; p=0.04). Among survivors, a higher proportion of patients were in NYHA functional class I or II in the TMVR group at 1 year (78.2% vs. 59.7%, p=0.03) and at 2 years (77.8% vs. 53.2%, p=0.09). Two-year mortality was similar in the two groups (TMVR vs. GDMT, 36.8% vs. 40.8%, HR 1.01, 95% CI 0.62-1.64; p=0.98). Conclusions: In this observational comparison, over 2-year follow-up, TMVR using mostly transapical devices in patients with secondary MR was associated with significant reduction of MR, symptomatic improvement, less frequent hospitalizations for HF and similar mortality compared with GDMT.
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Affiliation(s)
- Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; German Center for Cardiovascular Research (DZHK): Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany; Cardiovascular Research Foundation, New York, NY
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - David J Cohen
- Cardiovascular Research Foundation, New York, NY; St. Francis Hospital, Roslyn, NY
| | - Augustin Coisne
- Cardiovascular Research Foundation, New York, NY; Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, F-59000 Lille, France
| | - Andrea Scotti
- Cardiovascular Research Foundation, New York, NY; Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY
| | - William T Abraham
- Departments of Medicine, Physiology, and Cell Biology, Division of Cardiovascular Medicine, and the Davis Heart & Lung Research Institute, The Ohio State University, Columbus, OH
| | - Walid Ben Ali
- Structural Valve Program, Montreal Heart Institute, Montréal, Canada
| | - Zhipeng Zhou
- Cardiovascular Research Foundation, New York, NY
| | - Yanru Li
- Cardiovascular Research Foundation, New York, NY
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, CA; Bakersfield Heart Hospital, Bakersfield, CA
| | | | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, VA
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, NY; NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden and Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden
| | - David W M Muller
- Cardiology Dept, St. Vincent's Hospital, Sydney, Australia and School of Clinical Medicine, UNSW Medicine and Health UNSW Sydney, NSW 2052, Australia
| | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Hendrik Ruge
- German Heart Center Munich, Department of Cardiovascular Surgery, Munich, Germany; INSURE Institute for Translational Cardiac Surgery, Department of Cardiovascular Surgery, German Heart Center Munich, Germany
| | | | | | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | | | | | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gry Dahle
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | | | - Gilbert Hl Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY
| | | | | | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Neil P Fam
- St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur Toulouse, Toulouse, France
| | | | | | - Tanja Katharina Rudolph
- Department of Interventional and General Cardiology, Heart- and Diabetes Center Nordrhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Germany
| | | | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Federico M Asch
- Cardiovascular Core Laboratories, MedStar Health Research Institute, Washington, DC
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY
| | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, TN
| | - Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Montarello NJ, Willemen Y, Tirado-Conte G, Travieso A, Bieliauskas G, Sondergaard L, De Backer O. Transcatheter aortic valve durability: a contemporary clinical review. Front Cardiovasc Med 2023; 10:1195397. [PMID: 37229228 PMCID: PMC10203628 DOI: 10.3389/fcvm.2023.1195397] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Encouraged by randomized controlled trials demonstrating non-inferiority of transfemoral transcatheter aortic valve implantation (TAVI) compared to surgical aortic valve replacement (SAVR) across all surgical risk categories, there has been a dramatic increase in the use of TAVI in a younger patient cohort with severe aortic stenosis, endorsed by both European and American Cardiac Societies. However, the standard use of TAVI in younger, less co-morbid patients with a longer life expectancy can only be supported if there is sound data demonstrating long-term durability of transcatheter aortic valves (TAVs). In this article, we have reviewed available randomized and observational registry clinical data pertaining to TAV long-term durability, placing emphasis on trials and registries using the new standardized definitions of bioprosthetic valve dysfunction (BVD) and bioprosthetic valve failure (BVF). Despite inherent difficulties in interpreting the available data, the determination reached is that the risk of structural valve deterioration (SVD) is potentially lower after TAVI than SAVR at 5 to 10 years, and that the two treatment modalities have a similar risk of BVF. This supports the adoption of TAVI in younger patients evident in current practice. However, the routine use of TAVI in younger patients with bicuspid aortic valve stenosis should be cautioned due to insufficient long-term TAV durability data in this particular patient population. Finally, we highlight the importance of future research into the unique potential mechanisms that can potentially contribute to TAV degeneration.
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Vanhaverbeke M, Kim WK, Mylotte D, Bieliauskas G, Janarthanan S, Sondergaard L, De Backer O. Procedural considerations for transcatheter aortic valve-in-valve implantation in a degenerated ACURATE neo prosthesis. EUROINTERVENTION 2023; 18:1436-1438. [PMID: 36520089 PMCID: PMC10111127 DOI: 10.4244/eij-d-22-00740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/15/2022] [Indexed: 04/22/2023]
Affiliation(s)
- Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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36
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Quagliana A, Montarello NJ, Willemen Y, Bække PS, Jørgensen TH, De Backer O, Sondergaard L. Commissural Alignment and Coronary Access after Transcatheter Aortic Valve Replacement. J Clin Med 2023; 12:jcm12062136. [PMID: 36983139 PMCID: PMC10056242 DOI: 10.3390/jcm12062136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVR) is the first therapeutic option for elderly patients with severe symptomatic aortic stenosis, and indications are steadily expanding to younger patients and subjects with lower surgical risk and longer life expectancy. Commissural alignment between native and transcatheter valves facilitates coronary access after TAVR and is thus considered a procedural goal, allowing long-term management of coronary artery disease. Moreover, commissural alignment may potentially have a positive impact on transvalvular hemodynamic and valve durability. This review focus on technical hints to achieve commissural alignment and current evidence for different transcatheter aortic valves.
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Affiliation(s)
- Angelo Quagliana
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Cardiocentro Ticino Institute—EOC, Universita’della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Nicholas J. Montarello
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Yannick Willemen
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Pernille S. Bække
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Troels H. Jørgensen
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Ole De Backer
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
- Correspondence:
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37
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Sondergaard L, Walton AS, Worthley SG, Smith D, Chehab B, Manoharan G, Yong G, Bedogni F, Bates N, Reardon MJ. Thirty-day and one-year outcomes of the Navitor transcatheter heart valve in patients with aortic stenosis: the prospective, multicentre, global PORTICO NG Study. EUROINTERVENTION 2023:EIJ-D-22-01108. [PMID: 36895190 DOI: 10.4244/eij-d-22-01108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND The Navitor transcatheter heart valve (THV) is a self-expanding valve, with an intra-annular leaflet position and an outer cuff intended to reduce paravalvular leak (PVL). AIMS The aim of the PORTICO NG Study is to assess the safety and performance of the Navitor THV in patients with symptomatic, severe aortic stenosis who are at high or extreme surgical risk. METHODS PORTICO NG is a prospective, multicentre, global, single-arm, investigational study with follow-up at 30 days, 1 year, and annually up to 5 years. The primary endpoints are all-cause mortality and moderate or greater PVL at 30 days. Valve Academic Research Consortium-2 events and valve performance are assessed by an independent clinical events committee and echocardiographic core laboratory. RESULTS A total of 120 high- or extreme-risk subjects (age 83.5±5.4 years; 58.3% female; Society of Thoracic Surgeons score 4.0±2.0%) were enrolled in the European conformity (CE) mark cohort. Procedural success was high at 97.5%. At 30 days, the rate of all-cause mortality was 0%, and no subjects had moderate or greater PVL. The rate of disabling stroke was 0.8%, life-threatening bleeding was 2.5%, stage 3 acute kidney injury 0%, major vascular complications 0.8%, and new pacemaker implantation 15.0%. At 1 year, the rates of all-cause mortality and disabling stroke were 4.2% and 0.8%, respectively. The rate of moderate PVL was 1.0% at 1 year. Haemodynamic performance with a mean gradient of 7.5±3.2 mmHg and effective orifice area of 1.9±0.4 cm2 was sustained up to 1 year. CONCLUSIONS The PORTICO NG Study demonstrates low rates of adverse events and PVL up to 1 year in patients at high or extreme surgical risk, confirming the safety and efficacy of the Navitor THV system.
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Affiliation(s)
| | - Antony S Walton
- Department of Interventional Cardiology, Alfred Hospital, Melbourne, VIC, Australia.,Monash University, Melbourne, VIC, Australia
| | - Stephen G Worthley
- Department of Cardiology, Macquarie University Hospital, Sydney, NSW, Australia
| | - Dave Smith
- Morriston Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Bassem Chehab
- Ascension Via Christi Hospital, University of Kansas, Wichita, KS, USA
| | | | - Gerald Yong
- Cardiology Department, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Francesco Bedogni
- Department of Clinical Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Nicholas Bates
- Structural Heart Clinical Affairs, Abbott Medical, St. Paul, MN, USA
| | - Michael J Reardon
- Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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38
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Ludwig S, Kalbacher D, Ali WB, Weimann J, Adam M, Duncan A, Webb JG, Windecker S, Orban M, Giannini C, Coisne A, Karam N, Scotti A, Sondergaard L, Adamo M, Muller DWM, Butter C, Denti P, Melica B, Regazzoli D, Garatti A, Schmidt T, Andreas M, Dahle G, Taramasso M, Nickenig G, Dumonteil N, Walther T, Flagiello M, Kempfert J, Fam N, Ruge H, Rudolph TK, Wyler von Ballmoos MC, Metra M, Redwood S, Granada JF, Tang GHL, Latib A, Lurz P, von Bardeleben RS, Modine T, Hausleiter J, Conradi L. Transcatheter mitral valve replacement or repair for secondary mitral regurgitation: a propensity score-matched analysis. Eur J Heart Fail 2023; 25:399-410. [PMID: 36883620 DOI: 10.1002/ejhf.2797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/05/2023] [Accepted: 02/08/2023] [Indexed: 03/09/2023] Open
Abstract
AIMS This study aimed to compare outcomes after transcatheter mitral valve replacement (TMVR) and mitral valve transcatheter edge-to-edge repair (M-TEER) for the treatment of secondary mitral regurgitation (SMR). METHODS AND RESULTS The CHOICE-MI registry included 262 patients with SMR treated with TMVR between 2014 and 2022. The EuroSMR registry included 1065 patients with SMR treated with M-TEER between 2014 and 2019. Propensity score (PS) matching was performed for 12 demographic, clinical and echocardiographic parameters. Echocardiographic, functional and clinical outcomes out to 1 year were compared in the matched cohorts. After PS matching, 235 TMVR patients (75.5 years [70.0, 80.0], 60.2% male, EuroSCORE II 6.3% [interquartile range 3.8, 12.4]) were compared to 411 M-TEER patients (76.7 years [70.1, 80.5], 59.0% male, EuroSCORE II 6.7% [3.9, 12.4]). All-cause mortality was 6.8% after TMVR and 3.8% after M-TEER at 30 days (p = 0.11), and 25.8% after TMVR and 18.9% after M-TEER at 1 year (p = 0.056). No differences in mortality after 1 year were found between both groups in a 30-day landmark analysis (TMVR: 20.4%, M-TEER: 15.8%, p = 0.21). Compared to M-TEER, TMVR resulted in more effective mitral regurgitation (MR) reduction (residual MR ≤1+ at discharge for TMVR vs. M-TEER: 95.8% vs. 68.8%, p < 0.001), and superior symptomatic improvement (New York Heart Association class ≤II at 1 year: 77.8% vs. 64.3%, p = 0.015). CONCLUSION In this PS-matched comparison between TMVR and M-TEER in patients with severe SMR, TMVR was associated with superior reduction of MR and superior symptomatic improvement. While post-procedural mortality tended to be higher after TMVR, no significant differences in mortality were found beyond 30 days.
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Affiliation(s)
- Sebastian Ludwig
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Cardiovascular Research Foundation, New York, NY, USA
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Walid Ben Ali
- Structural Valve Program, Montreal Heart Institute, Montréal, QC, Canada
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Matti Adam
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | | | | | | | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Augustin Coisne
- Cardiovascular Research Foundation, New York, NY, USA.,Univ. Lille, Inserm, CHU Lille, Institut Pasteur de Lille, U1011- EGID, Lille, France
| | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou, and Paris Cardiovascular Research Center, Paris, France
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY, USA
| | | | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | | | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | | | | | - Tobias Schmidt
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
| | - Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Gry Dahle
- Oslo University Hospital, Oslo, Norway
| | | | | | - Nicolas Dumonteil
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur Toulouse, Toulouse, France
| | | | - Michele Flagiello
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | | | - Neil Fam
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Center Munich, Munich, Germany.,Department of Cardiovascular Surgery, German Heart Center Munich, INSURE - Institute for Translational Cardiac Surgery, Munich, Germany
| | - Tanja K Rudolph
- Department of Interventional and General Cardiology, Heart- and Diabetes Center Nordrhine-Westphalia, Bad Oeynhausen, Ruhr University Bochum, Bochum, Germany
| | | | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | | | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, New York, NY, USA
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Thomas Modine
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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39
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Landes U, Hochstadt A, Manevich L, Webb JG, Sathananthan J, Sievert H, Piayda K, Leon MB, Nazif TM, Blusztein D, Hildick-Smith D, Pavitt C, Thiele H, Abdel-Wahab M, Van Mieghem NM, Adrichem R, Sondergaard L, De Backer O, Makkar RR, Koren O, Pilgrim T, Okuno T, Kornowski R, Codner P, Finkelstein A, Loewenstein I, Barbash I, Sharon A, De Marco F, Montorfano M, Buzzatti N, Latib A, Scotti A, Kim WK, Hamm C, Nombela Franco L, Mangieri A, Schoels WH, Barbanti M, Bunc M, Akodad M, Rubinshtein R, Danenberg H. Treatment of late paravalvular regurgitation after transcatheter aortic valve implantation: prognostic implications. Eur Heart J 2023; 44:1331-1339. [PMID: 36883599 DOI: 10.1093/eurheartj/ehad146] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND AND AIMS Paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) is associated with increased morbidity and mortality. The effect of transcatheter interventions to treat PVR after the index TAVI was investigated. METHODS A registry of consecutive patients who underwent transcatheter intervention for ≥ moderate PVR after the index TAVI at 22 centers. Principal outcomes were residual aortic regurgitation (AR) and mortality at 1 year after PVR treatment. RESULTS A total of 201 patients were identified: 87 (43%) underwent redo-TAVI, 79 (39%) plug closure and 35 (18%) balloon valvuloplasty. Median TAVI-to-re-intervention time was 207 (35; 765) days. The failed valve was self-expanding in 129 (63.9%) patients. Most frequent devices utilized were a Sapien 3 valve for redo-TAVI (55, 64%), an AVP II as plug (33, 42%) and a True balloon for valvuloplasty (20, 56%). At 30 days, AR ≥ moderate persisted in 33 (17.4%) patients: 8 (9.9%) after redo-TAVI, 18 (25.9%) after plug and 7 (21.9%) after valvuloplasty (p=0.036). Overall mortality was 10 (5.0%) at 30 days and 29 (14.4%) at 1 year: 0, 8 (10.1%) and 2 (5.7%) at 30 days (p=0.010); and 11 (12.6%), 14 (17.7%) and 4 (11.4%) at 1 year (p=0.418), after redo-TAVI, plug and valvuloplasty, respectively. Regardless of treatment strategy, patients in whom AR was reduced to ≤ mild had lower mortality at 1 year compared to those with AR persisting ≥ moderate [11 (8.0%) vs. 6 (21.4%); p=0.007]. CONCLUSIONS This study describes the efficacy of transcatheter treatments for PVR after TAVI. Patients in whom PVR was successfully reduced had better prognosis. The selection of patients and optimal PVR treatment modality require further investigation.
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Affiliation(s)
- Uri Landes
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | - Aviram Hochstadt
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | - Lisa Manevich
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | - John G Webb
- Centre for Cardiovascular Innovation Centre for Heart Valve Innovation St Paul's and Vancouver General Hospital Vancouver, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation Centre for Heart Valve Innovation St Paul's and Vancouver General Hospital Vancouver, Canada
| | | | | | - Martin B Leon
- Columbia University Medical Center, New York, NY, USA
| | - Tamim M Nazif
- Columbia University Medical Center, New York, NY, USA
| | | | | | - Chris Pavitt
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | | | - Rik Adrichem
- Erasmus university medical center, Rotterdam, Netherlands
| | | | - Ole De Backer
- Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Raj R Makkar
- Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, California, USA
| | - Ofir Koren
- Cedars-Sinai Medical Center, The Smidt Heart Institute, Los Angeles, California, USA
| | | | | | | | - Pablo Codner
- Rabin medical center, Tel-Aviv University, Israel
| | | | | | - Israel Barbash
- The Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - Amir Sharon
- The Heart and Vascular Center, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Matteo Montorfano
- Interventional Cardiology Unit IRCCS San Raffaele Sientific Insitute, Milan, Italy
| | - Nicola Buzzatti
- Interventional Cardiology Unit IRCCS San Raffaele Sientific Insitute, Milan, Italy
| | - Azeem Latib
- Montefiore Medical Center, New York, NY, USA
| | | | | | | | - Luis Nombela Franco
- Cardiovascular Institute. Hospital Clínico San Carlos. IdISSC. Madrid, Spain
| | - Antonio Mangieri
- Invasive Cardiology, Humanitas Clinical and Research Center, IRCCS and department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - Matjaz Bunc
- University Medical Centre Ljubljana, Slovenia
| | - Myriama Akodad
- Ramsay Santé, Institut cardiovasculaire Paris Sud, hôpital Privé Jacques-Cartier, Massy, France
| | - Ronen Rubinshtein
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
| | - Haim Danenberg
- Edith Wolfson Medical Center, Holon, and Tel-Aviv University, Israel
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40
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Ahmad Y, Howard JP, Arnold AD, Madhavan MV, Cook CM, Alu M, Mack MJ, Reardon MJ, Thourani VH, Kapadia S, Thyregod HGH, Sondergaard L, Jørgensen TH, Toff WD, Van Mieghem NM, Makkar RR, Forrest JK, Leon MB. Transcatheter versus surgical aortic valve replacement in lower-risk and higher-risk patients: a meta-analysis of randomized trials. Eur Heart J 2023; 44:836-852. [PMID: 36660821 DOI: 10.1093/eurheartj/ehac642] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/09/2022] [Accepted: 10/26/2022] [Indexed: 01/21/2023] Open
Abstract
AIMS Additional randomized clinical trial (RCT) data comparing transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) is available, including longer term follow-up. A meta-analysis comparing TAVI to SAVR was performed. A pragmatic risk classification was applied, partitioning lower-risk and higher-risk patients. METHODS AND RESULTS The main endpoints were death, strokes, and the composite of death or disabling stroke, occurring at 1 year (early) or after 1 year (later). A random-effects meta-analysis was performed. Eight RCTs with 8698 patients were included. In lower-risk patients, at 1 year, the risk of death was lower after TAVI compared with SAVR [relative risk (RR) 0.67; 95% confidence interval (CI) 0.47 to 0.96, P = 0.031], as was death or disabling stroke (RR 0.68; 95% CI 0.50 to 0.92, P = 0.014). There were no differences in strokes. After 1 year, in lower-risk patients, there were no significant differences in all main outcomes. In higher-risk patients, there were no significant differences in main outcomes. New-onset atrial fibrillation, major bleeding, and acute kidney injury occurred less after TAVI; new pacemakers, vascular complications, and paravalvular leak occurred more after TAVI. CONCLUSION In lower-risk patients, there was an early mortality reduction with TAVI, but no differences after later follow-up. There was also an early reduction in the composite of death or disabling stroke, with no difference at later follow-up. There were no significant differences for higher-risk patients. Informed therapy decisions may be more dependent on the temporality of events or secondary endpoints than the long-term occurrence of main clinical outcomes.
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Affiliation(s)
- Yousif Ahmad
- Yale School of Medicine, Yale University, 135 College Street, Suite 101, New Haven, CT 06510, USA
| | - James P Howard
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W120HS, UK
| | - Ahran D Arnold
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London W120HS, UK
| | - Mahesh V Madhavan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, W. 168th St. New York, NY 10032, USA.,Clinical Trials Center, The Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | | | - Maria Alu
- Clinical Trials Center, The Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
| | - Michael J Mack
- Department of Cardiovascular Disease, Baylor Scott and White Health, 4700 Alliance Blvd, Plano, TX 75093, USA
| | - Michael J Reardon
- Houston Methodist DeBakey Heart & Vascular Center, 6565 Fannin St Suite 1901, Houston, TX 77030, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart and Vascular Institute, 95 Collier Rd NW Suite 5015, Atlanta, GA 30309, USA
| | - Samir Kapadia
- Cleveland Clinic, 9500 Euclid Ave. Cleveland, OH 44195, USA
| | - Hans Gustav Hørsted Thyregod
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Section 2151, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Lars Sondergaard
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Section 2151, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Troels Højsgaard Jørgensen
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Section 2151, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - William D Toff
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University Rd, Leicester LE1 7RH, UK
| | - Nicolas M Van Mieghem
- Department of Interventional Cardiology, Thoraxcenter, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Smidt Heart Institute, S San Vicente Blvd, Los Angeles, CA 90048, USA
| | - John K Forrest
- Yale School of Medicine, Yale University, 135 College Street, Suite 101, New Haven, CT 06510, USA
| | - Martin B Leon
- Division of Cardiology, Department of Medicine, Columbia University Medical Center/New York-Presbyterian Hospital, W. 168th St. New York, NY 10032, USA.,Clinical Trials Center, The Cardiovascular Research Foundation, 1700 Broadway, New York, NY 10019, USA
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41
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Eriksson P, Pihkala J, Jensen AS, Dohlen G, Liuba P, Wahlander H, Sjoberg G, Hlebowicz J, Furenas E, Leirgul E, Settergren M, Vithessonthi K, Nielsen NE, Christersson C, Sondergaard L, Sinisalo J, Nielsen-Kudsk JE, Dellborg M, Larsen SH. Transcatheter Intervention for Coarctation of the Aorta: A Nordic Population-Based Registry With Long-Term Follow-Up. JACC Cardiovasc Interv 2023; 16:444-453. [PMID: 36858664 DOI: 10.1016/j.jcin.2022.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 03/02/2023]
Abstract
BACKGROUND Coarctation of the aorta (CoA), a congenital narrowing of the proximal descending thoracic aorta, is a relatively common form of congenital heart disease. Untreated significant CoA has a major impact on morbidity and mortality. In the past 3 decades, transcatheter intervention (TCI) for CoA has evolved as an alternative to surgery. OBJECTIVES The authors report on all TCIs for CoA performed from 2000 to 2016 in 4 countries covering 25 million inhabitants, with a mean follow-up duration of 6.9 years. METHODS During the study period, 683 interventions were performed on 542 patients. RESULTS The procedural success rate was 88%, with 9% considered partly successful. Complications at the intervention site occurred in 3.5% of interventions and at the access site in 3.5%. There was no in-hospital mortality. During follow-up, TCI for CoA reduced the presence of hypertension significantly from 73% to 34%, but despite this, many patients remained hypertensive and in need of continuous antihypertensive treatment. Moreover, 8% to 9% of patients needed aortic and/or aortic valve surgery during follow-up. CONCLUSIONS TCI for CoA can be performed with a low risk for complications. Lifetime follow-up after TCI for CoA seems warranted.
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Affiliation(s)
- Peter Eriksson
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden.
| | - Jaana Pihkala
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu)
| | - Annette S Jensen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu); Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Gaute Dohlen
- Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Hakan Wahlander
- University of Gothenburg, Institute of Clinical Science, Sahlgrenska Academy, Gothenburg, Sweden
| | - Gunnar Sjoberg
- Astrid Lindgren Children's Hospital and Department of Children's and Women's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Eva Furenas
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | | | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital and Division of Cardiology, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Lars Sondergaard
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu); Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Juha Sinisalo
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu)
| | | | - Mikael Dellborg
- University of Gothenburg, Institute of Medicine, Sahlgrenska Academy, Gothenburg, Sweden
| | - Signe H Larsen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart (http://guardheart.ern-net.eu); Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark; Aarhus University Hospital, Aarhus, Denmark
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42
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Tarantini G, Tang G, Nai Fovino L, Blackman D, Van Mieghem NM, Kim WK, Karam N, Carrilho-Ferreira P, Fournier S, Pręgowski J, Fraccaro C, Vincent F, Campante Teles R, Mylotte D, Wong I, Bieliauskas G, Czerny M, Bonaros N, Parolari A, Dudek D, Tchétché D, Eltchaninoff H, de Backer O, Stefanini G, Sondergaard L. Management of coronary artery disease in patients undergoing transcatheter aortic valve implantation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions in collaboration with the ESC Working Group on Cardiovascular Surgery. EUROINTERVENTION 2023; 19:37-52. [PMID: 36811935 PMCID: PMC10174192 DOI: 10.4244/eij-d-22-00958] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Significant coronary artery disease (CAD) is a frequent finding in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), and the management of these two conditions becomes of particular importance with the extension of the procedure to younger and lower-risk patients. Yet, the preprocedural diagnostic evaluation and the indications for treatment of significant CAD in TAVI candidates remain a matter of debate. In this clinical consensus statement, a group of experts from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the European Society of Cardiology (ESC) Working Group on Cardiovascular Surgery aims to review the available evidence on the topic and proposes a rationale for the diagnostic evaluation and indications for percutaneous revascularisation of CAD in patients with severe aortic stenosis undergoing transcatheter treatment. Moreover, it also focuses on commissural alignment of transcatheter heart valves and coronary re-access after TAVI and redo-TAVI.
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Affiliation(s)
- Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gilbert Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, NY, USA
| | - Luca Nai Fovino
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Daniel Blackman
- Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | | | | | - Nicole Karam
- Department of Cardiology, Hôpital Européen Georges-Pompidou, Paris, France
| | - Pedro Carrilho-Ferreira
- Serviço de Cardiologia, Hospital de Santa Maria, CHULN, and Centro de Cardiologia da Universidade de Lisboa, Faculdade de Medicina de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | | | | | - Chiara Fraccaro
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Flavien Vincent
- Division of Cardiology, Centre Hospitalier Régional Universitaire de Lille, Lille, France
| | | | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, Galway, Ireland
| | - Ivan Wong
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Martin Czerny
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Alessandro Parolari
- Department of Biomedical Sciences for Health, University of Milano, Milan, Italy and University Cardiac Surgery, Policlinico San Donato IRCCS, Milan, Italy
| | - Darius Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy
| | | | | | - Ole de Backer
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy
| | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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43
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Sabbah M, Olsen NT, Holmvang L, Tilsted HH, Pedersen F, Joshi FR, Sørensen R, Jabbari R, Arslani K, Sondergaard L, Engstrøm T, Lønborg JT. Long-term changes in coronary physiology after aortic valve replacement. EUROINTERVENTION 2023; 18:1156-1164. [PMID: 36239118 PMCID: PMC9940233 DOI: 10.4244/eij-d-22-00621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/01/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND The detrimental effects of long-standing severe aortic stenosis (AS) often include left ventricular hypertrophy (LVH) and exhaustion of coronary flow reserve (CFR), the reversibility of which is unclear after valve replacement. AIMS Our aims were to 1) investigate whether CFR in the left anterior descending artery (LAD) would improve following valve replacement, and if the change was related to changes in hyperaemic coronary flow (QLAD) and minimal microvascular resistance (Rμ,LAD); and 2) investigate the relationship between changes in CFR and changes in left ventricular mass (LVM) and stroke work (LVSW). METHODS We measured intracoronary bolus thermodilution-derived CFR, and continuous thermodilution-derived QLAD and Rμ,LAD before and 6 months after aortic valve replacement. Cardiac magnetic resonance imaging was used to quantify left ventricular anatomy and function for the calculation of LVM and LVSW. Results: Thirty-four patients were included (17 patients had transcatheter aortic valve implantation; 14 had surgical valve replacement with a bioprosthesis and 3 with a mechanical prosthesis) who underwent invasive assessment in the LAD. CFR increased from 2.5 (interquartile range [IQR] 1.5-3.3) at baseline to 3.1 (IQR 2.2-5.1) at follow-up (p=0.005), despite no significant change in QLAD (230±106 mL/min to 250±101 mL/min; p=0.26) or Rμ,LAD (347 [IQR 247-463] to 287 [IQR 230-456]; p=0.20). When indexed for LVM, QLAD was 39% (IQR 8-98%) higher at follow-up compared with baseline (p<0.001). The improvement in CFR was correlated with ΔLVSW, r= -0.39; p=0.047. Conclusions: CFR in the LAD increased significantly at follow-up although global hyperaemic flow and minimal microvascular resistance remained unchanged. Thus, a decrease in resting flow was the cause of CFR improvement. CFR improvement was associated with reduction in LVSW.
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Affiliation(s)
- Muhammad Sabbah
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels T Olsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Holmvang
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hans-Henrik Tilsted
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Frants Pedersen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Francis Richard Joshi
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Sørensen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ketina Arslani
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Sondergaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Thomsen Lønborg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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44
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Meier D, Payne GW, Mostaço-Guidolin LB, Bouchareb R, Rich C, Lai A, Chatfield AG, Akodad M, Salcudean H, Lutter G, Puehler T, Pibarot P, Allen KB, Chhatriwalla AK, Sondergaard L, Wood DA, Webb JG, Leipsic JA, Sathananthan J, Sellers SL. Timing of bioprosthetic valve fracture in transcatheter valve-in-valve intervention: impact on valve durability and leaflet integrity. EUROINTERVENTION 2023; 18:1165-1177. [PMID: 36534495 PMCID: PMC9936256 DOI: 10.4244/eij-d-22-00644] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/07/2022] [Indexed: 02/19/2023]
Abstract
BACKGROUND Bioprosthetic valve fracture (BVF) can be used to improve transcatheter heart valve (THV) haemodynamics following a valve-in-valve (ViV) intervention. However, whether BVF should be performed before or after THV deployment and the implications on durability are unknown. Aims: We sought to assess the impact of BVF timing on long-term THV durability. METHODS The impact of BVF timing was assessed using small ACURATE neo (ACn) or 23 mm SAPIEN 3 (S3) THV deployed in 21 mm Mitroflow valves compared to no-BVF controls. Valves underwent accelerated wear testing up to 200 million (M) cycles (equivalent to 5 years). At 200M cycles, THV were evaluated by hydrodynamic testing, second-harmonic generation (SHG) microscopy, scanning electron microscopy (SEM) and histology. RESULTS At 200M cycles, the regurgitant fraction (RF) and effective orifice area (EOA) for the ACn were 8.03±0.30%/1.74±0.01 cm2 (no BVF), 12.48±0.70%/1.97±0.02 cm2 (BVF before ViV) and 9.29±0.38%/2.21±0.0 cm2 (BVF after ViV), respectively. For the S3 these values were 2.63±0.51%/1.26±0.01 cm2, 2.03±0.42%/1.65±0.01 cm2, and 1.62±0.38%/2.22±0.01 cm2, respectively. Further, SHG and SEM revealed a higher degree of superficial leaflet damage when BVF was performed after ViV for the ACn and S3. However, the histological analysis revealed significantly less damage, as determined by matrix density analysis, through the entire leaflet thickness when BVF was performed after ViV with the S3 and a similar but non-significant trend with the ACn. Conclusions: BVF performed after ViV appears to offer superior long-term EOA without increased RF. Ultrastructure leaflet analysis reveals that the timing of BVF can differentially impact leaflets, with more superficial damage but greater preservation of overall leaflet structure when BVF is performed after ViV.
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Affiliation(s)
- David Meier
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Geoffrey W Payne
- University of Northern British Columbia, Prince George, BC, Canada
| | | | | | | | - Althea Lai
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Andrew G Chatfield
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Mariama Akodad
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Hannah Salcudean
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Georg Lutter
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg, Hamburg, Germany
| | - Thomas Puehler
- Department of Cardiac and Vascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Kiel/Hamburg, Hamburg, Germany
| | - Philippe Pibarot
- Québec Heart and Lung Institute, Department of Medicine, Laval University, Québec, QC, Canada
| | - Keith B Allen
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Adnan K Chhatriwalla
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO, USA
| | - Lars Sondergaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David A Wood
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon A Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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45
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Gröning M, Smerup MH, Nielsen DG, Nissen H, Munk K, Mortensen UM, Andersen H, Engholm M, Bjerre J, Vejlstrup N, Juul K, Søndergaard EV, Jensen AS, Jørgensen TH, Thyregod HGH, Andersen HØ, Jøns C, Helvind M, Sondergaard L. Temporal changes in the surgical management of patients with tetralogy of Fallot in Denmark: a nationwide cohort study. Eur J Cardiothorac Surg 2023; 63:6972777. [PMID: 36617167 DOI: 10.1093/ejcts/ezad007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/02/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess temporal changes in the surgical management of patients with tetralogy of Fallot including the timing of interventions, surgical techniques, reinterventions and survival in a nationwide cohort. METHODS Patients with tetralogy of Fallot in Denmark were divided into 3 eras based on their year of birth: early (1977-1991), intermediate (1992-2006) and late (2007-2021). RESULTS The cohort consisted of 745 patients. Median follow-up was 21.2 years (13.7-30.5). There was a temporal trend towards less shunt palliation (-0.3% per year, 95% CI -0.05 to -0.1). Median age at intracardiac repair was 2.9 years (1.8-5.0), 0.8 years (0.5-1.3) and 0.5 years (0.4-0.7) (P < 0.001) in the early, intermediate and late era, respectively. There was a temporal trend towards less valve-sparing repair (-0.7% per year, 95% CI -0.5 to -1.0) and more repair with transannular patches (0.7% per year, 95% CI 0.5-1.0). Survival at 10 years was 79% (64-76), 90% (87-93) and 95% (92-98) (P < 0.001) and pulmonary valve replacement within the first 10 years after intracardiac repair was performed in 3% (1-6), 12% (8-16) and 21% (13-29) (P < 0.001) in the early, intermediate and late era, respectively. CONCLUSIONS There was a temporal trend towards less shunt palliation and intracardiac repair at a younger age with more use of transannular patches. While survival throughout childhood and adolescence has improved, more patients undergo pulmonary valve replacement during the first 10 years after intracardiac repair.
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Affiliation(s)
- Mathis Gröning
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Morten Holdgaard Smerup
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Henrik Nissen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Kim Munk
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Helle Andersen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Morten Engholm
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jesper Bjerre
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Klaus Juul
- Department of Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | | | - Henrik Ørbæk Andersen
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Helvind
- Department of Cardio-Thoracic Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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46
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Vanhaverbeke M, Sondergaard L, De Backer O. Life expectancy of patients with a transcatheter aortic valve and the implications for long-term valve durability data collection. EUROINTERVENTION 2023; 18:996-998. [PMID: 35997129 PMCID: PMC9853029 DOI: 10.4244/eij-d-22-00493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/28/2022] [Indexed: 01/21/2023]
Affiliation(s)
- Maarten Vanhaverbeke
- Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Sondergaard
- Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ole De Backer
- Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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47
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Baggio S, Pagnesi M, Kim WK, Scotti A, Barbanti M, Costa G, Adamo M, Kornowski R, Vaknin Assa H, Estévez-Loureiro R, Cedeño RA, De Marco F, Casenghi M, Toggweiler S, Veulemans V, Mylotte D, Lunardi M, Regazzoli D, Reimers B, Sondergaard L, Vanhaverbeke M, Nuyens P, Maffeo D, Buono A, Saccocci M, Giannini F, Di Ienno L, Ferlini M, Lanzillo G, Ielasi A, Schofer J, Brinkmann C, Van Der Heyden J, Buysschaert I, Eitan A, Wolf A, Adamaszek MM, Colombo A, Latib A, Mangieri A. Comparison of transcatheter aortic valve replacement with the ACURATE neo2 versus Evolut PRO/PRO+ devices. EUROINTERVENTION 2023; 18:977-986. [PMID: 36093795 PMCID: PMC9853030 DOI: 10.4244/eij-d-22-00498] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 07/25/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The ACURATE neo2 (NEO2) and Evolut PRO/PRO+ (PRO) bioprostheses are new-generation self-expanding valves developed for transcatheter aortic valve replacement (TAVR). AIMS We sought to compare the performance of the ACURATE neo2 and Evolut PRO/PRO+ devices. METHODS The NEOPRO-2 registry retrospectively included patients who underwent TAVR for severe aortic stenosis with either the NEO2 or PRO devices between August 2017 and December 2021 at 20 centres. In-hospital and 30-day Valve Academic Research Consortium (VARC)-3 defined outcomes were evaluated. Propensity score (PS) matching and binary logistic regression were performed to adjust the treatment effect for PS quintiles. A subgroup analysis assessed the impact of aortic valve calcification. RESULTS A total of 2,175 patients (NEO2: n=763; PRO: n=1,412) were included. The mean age was 82±6.2 years and the mean Society of Thoracic Surgeons score was 4.2%. Periprocedural complications were low, and both groups achieved high rates of technical success (93.1% vs 94.1%; p=0.361) and predischarge intended valve performance (96.0% vs 94.1%; p=0.056), both in the unmatched and matched analysis (452 pairs). Device success at 30 days was comparable (84.3% vs 83.6%; p=0.688), regardless of aortic valve calcification severity (p>0.05 for interaction). A suggestion for higher VARC-3 early safety in the NEO2 group was mainly driven by reduced rates of new permanent pacemaker implantation (7.7% vs 15.6%; p<0.001). CONCLUSIONS This retrospective analysis reports a similar short-term performance of the ACURATE neo2 platform compared with the new-generation Evolut PRO/PRO+ devices. Randomised studies are needed to confirm our exploratory findings.
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Affiliation(s)
- Sara Baggio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Matteo Pagnesi
- Cardiothoracic Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy and Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Won-Keun Kim
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Marianna Adamo
- Cardiothoracic Department, ASST Spedali Civili di Brescia, University of Brescia, Brescia, Italy and Department of Medical Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin Assa
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rodrigo Estévez-Loureiro
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Robert Alarcón Cedeño
- Cardiology Department, University Hospital Alvaro Cunqueiro, Galicia Sur Health Research Institute, Vigo, Spain
| | - Federico De Marco
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Matteo Casenghi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Stefan Toggweiler
- Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Verena Veulemans
- Division of Cardiology, Pulmonology and Vascular Medicine, Heinrich Heine University, Medical Faculty, Düsseldorf, Germany
| | - Darren Mylotte
- Galway University Hospital, SAOLTA Health Care Group, and National University of Ireland, Galway, Ireland
| | - Mattia Lunardi
- Galway University Hospital, SAOLTA Health Care Group, and National University of Ireland, Galway, Ireland
| | - Damiano Regazzoli
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Lars Sondergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philippe Nuyens
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Luca Di Ienno
- Interventional Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Marco Ferlini
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Giuseppe Lanzillo
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Clinical Institute Saint Ambrogio, Milan, Italy
| | | | | | | | - Ian Buysschaert
- Interventional Cardiology Unit, AZ Sint-Jan Hospital, Brugge, Belgium
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Alexander Wolf
- Klinik für Kardiologie, Elisabeth-Krankenhaus Essen, Essen, Germany
| | | | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
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48
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Ho CB, Vejlstrup NG, Schmidt MR, Sondergaard L. Intra-cardiac echocardiography in diagnosis of subvalvular right-sided atrioventricular valve stenosis. Eur Heart J Cardiovasc Imaging 2023; 24:e35. [PMID: 36562380 DOI: 10.1093/ehjci/jeac256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Cheuk Bong Ho
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | | | | | - Lars Sondergaard
- The Heart Center, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
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49
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Akodad M, Meier D, Sellers S, De Backer O, Mylotte D, Landes U, Frawley C, Lynch L, Tang GHL, Sondergaard L, Wood DA, Webb JG, Sathananthan J. A bench study of balloon-expandable valves for the treatment of self-expanding valve failure. EUROINTERVENTION 2023; 19:93-102. [PMID: 36621917 PMCID: PMC10174185 DOI: 10.4244/eij-d-22-00769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Coronary obstruction and access are concerns in patients undergoing redo transcatheter aortic valve implantation (TAVI). AIMS We sought to assess the neo-skirt height, leaflet overhang, leaflet deflection,and transcatheter heart valve (THV) expansion and performance, at 2 different implant depths, of the SAPIEN 3 Ultra (S3U) within the ACURATE neo2 (ACn2) THV. METHODS An in vitro study was performed with a 23 mm S3U deployed within a small (S) ACn2 and a 26 mm S3U deployed within a medium (M) and a large (L) ACn2. The S3U outflow was positioned at the top of the ACn2 crown (low implant) and at the base of the commissural post of the ACn2 (high implant). Testing was performed under physiological conditions as per ISO-5840-3 standard. RESULTS The neo-skirt height was shorter when the S3U outflow was positioned at a low implantation depth (S: 9.6 mm, M: 12.2 mm, L: 13.8 mm vs S: 15.2 mm, M: 15.1 mm, L: 17.8 mm ACn2 for high implants). Hydrodynamic performance was acceptable for all configurations. Leaflet overhang was <50% for all configurations except the low implant of the 26 mm S3U in the L ACn2 (77.6%). There was a gap from the side of the neo-skirt to the outer border of the THV frame which was >2 mm for all configurations. The S3U was underexpanded for all configurations, and the achieved area was 77.9%-92.9% of the expected nominal area. CONCLUSIONS Redo TAVI with an S3U within an ACn2 has favourable hydrodynamics and moderate leaflet overhang. Importantly, the design of the ACn2 results in a neo-skirt that is not deflected all the way to the outer dimensions of the THV, hence creating a space that facilitates coronary flow and access.
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Affiliation(s)
- Mariama Akodad
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada.,Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada.,Institut cardiovasculaire Paris Sud, Hôpital privé Jacques-Cartier, Ramsay Santé, Massy, France
| | - David Meier
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada.,Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada
| | - Stephanie Sellers
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada.,Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada
| | - Ole De Backer
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Darren Mylotte
- Department of Cardiology, National University of Ireland, Galway, (NUIG), Galway, Ireland
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel and Tel-Aviv University, Tel-Aviv, Israel
| | | | - Lisa Lynch
- Boston Scientific Corporation, Marlborough, MA, USA
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, New York, NY, USA
| | - Lars Sondergaard
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David A Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada.,Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada.,Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada.,Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada.,Cardiovascular Translational Laboratory, Centre for Heart Lung Innovation & Providence Research, Vancouver, BC, Canada
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50
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Xiong TY, Ali WB, Feng Y, Hayashida K, Jilaihawi H, Latib A, Lee MKY, Leon MB, Makkar RR, Modine T, Naber C, Peng Y, Piazza N, Reardon MJ, Redwood S, Seth A, Sondergaard L, Tay E, Tchetche D, Yin WH, Chen M, Prendergast B, Mylotte D. Transcatheter aortic valve implantation in patients with bicuspid valve morphology: a roadmap towards standardization. Nat Rev Cardiol 2023; 20:52-67. [PMID: 35726019 DOI: 10.1038/s41569-022-00734-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 02/08/2023]
Abstract
Indications for transcatheter aortic valve implantation (TAVI) have expanded in many countries to include patients with aortic stenosis who are at low surgical risk, and a similar expansion to this cohort is anticipated elsewhere in the world, together with an increase in the proportion of patients with bicuspid aortic valve (BAV) morphology as the age of the patients being treated decreases. To date, patients with BAV have been excluded from major randomized trials of TAVI owing to anatomical considerations. As a consequence, BAV has been a relative contraindication to the use of TAVI in international guidelines. Although clinical experience and observational data are accumulating, BAV presents numerous anatomical challenges for successful TAVI, despite advances in device design. Furthermore, in those with BAV, substantial geographical variation exists in patient characteristics, clinical approach and procedural strategy. Therefore, in this Roadmap article, we summarize the existing evidence and provide consensus recommendations from an international group of experts on the application of TAVI in patients with BAV in advance of the anticipated growth in the use of this procedure in this challenging cohort of patients.
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Affiliation(s)
- Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | | | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kentaro Hayashida
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | | | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, New York, NY, USA
| | | | - Martin B Leon
- Columbia University Medical Center, New York, NY, USA
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Thomas Modine
- Department of Heart Valve Therapy, CHU Bordeaux, Bordeaux, France.,IHU Lyric, Bordeaux-, Pessac, France.,Shanghai Jiaotong University, Shanghai, China
| | - Christoph Naber
- Department of Cardiology, Klinikum Wilhelmshaven, Wilhelmshaven, Germany
| | - Yong Peng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Nicolo Piazza
- Division of Cardiology, Department of Medicine, McGill University Health Center, Montreal, Quebec, Canada
| | - Michael J Reardon
- Houston Methodist DeBakey Heart and Vascular Center, The Methodist Hospital, Houston, TX, USA
| | - Simon Redwood
- Department of Cardiology, St Thomas' Hospital, London, UK
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Edgar Tay
- National University Heart Center, National University of Singapore, Singapore, Singapore
| | - Didier Tchetche
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| | - Wei-Hsian Yin
- Heart Center, ChengHsin General Hospital, Taipei, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Bernard Prendergast
- Department of Cardiology, St Thomas' Hospital, London, UK. .,Cleveland Clinic London, London, UK.
| | - Darren Mylotte
- Department of Cardiology, University Hospital Galway, National University of Ireland, Galway, Ireland.
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