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Nuche J, Ternacle J, Avvedimento M, Cheema AN, Veiga-Fernández G, Muñoz-García AJ, Vilalta V, Regueiro A, Asmarats L, Del Trigo M, Serra V, Bonnet G, Jonveaux M, Esposito G, Rezaei E, de la Torre-Hernández JM, Fernández-Nofrerías E, Vidal P, Gutiérrez-Alonso L, Oteo JF, Belahnech Y, Mohammadi S, Philippon F, Modine T, Mesnier J, Rodés-Cabau J. Incidence, predictors, and prognostic significance of impaired functional status early after transcatheter aortic valve replacement. Rev Esp Cardiol (Engl Ed) 2024; 77:396-407. [PMID: 38000627 DOI: 10.1016/j.rec.2023.11.003] [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: 07/17/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION AND OBJECTIVES There are scarce data on the factors associated with impaired functional status after transcatheter aortic valve replacement (TAVR) and its clinical impact. This study aimed to determine the incidence, predictors, and prognostic implications of impaired functional class (NYHA class III-IV) following TAVR. METHODS This multicenter study included 3462 transarterial TAVR patients receiving newer generation devices. The patients were compared according to their NYHA class at 1 month of follow-up (NYHA I-II vs NYHA III-IV). A multivariate logistic regression was performed to identify the predictors of 30-day NYHA class III-IV. Patient survival was compared with the Kaplan-Meier method and factors associated with decreased survival were identified with Cox regression analysis. RESULTS The mean age of the study population was 80.3±7.3 years, with 47% of women, and a median Society of Thoracic Surgeons score of 3.8% [IQR, 2.5-5.8]. A total of 208 patients (6%) were in NYHA class III-IV 1 month after TAVR. Predictors of 30-day NYHA class III-IV were baseline NYHA class III-IV (OR, 1.76; 95%CI, 1.08-2.89; P=.02), chronic pulmonary obstructive disease (OR, 1.80; 95%CI, 1.13-2.83; P=.01), and post-TAVR severe mitral regurgitation (OR, 2.00; 95%CI, 1.21-3.31; P<.01). Patients in NYHA class III-IV 1 month after TAVR were at higher risk of death (HR, 3.68; 95%CI, 2.39-5.70; P<.01) and heart failure-related hospitalization (HR, 6.00; 95%CI, 3.76-9.60; P<.01) at 1-year follow-up. CONCLUSIONS Up to 6% of contemporary TAVR patients exhibited an impaired functional status following TAVR. Worse baseline NYHA class, chronic pulmonary obstructive disease, and severe mitral regurgitation predicted 30-day NYHA class III/IV, and this determined a higher risk of mortality and heart failure hospitalization at 1-year follow-up. Further studies on the prevention and treatment optimization of patients with impaired functional status after TAVR are needed.
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Affiliation(s)
- Jorge Nuche
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. https://twitter.com/@JorgeNuche
| | - Julien Ternacle
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France. https://twitter.com/@TernacleJ
| | - Marisa Avvedimento
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. https://twitter.com/@MAvvedimento
| | - Asim N Cheema
- Cardiology Department, St Michael's Hospital Toronto, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Gabriela Veiga-Fernández
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Insituto de Investigación Valdecilla, Santander, Spain. https://twitter.com/@gveigafernandez
| | - Antonio J Muñoz-García
- Servicio de Cardiología, Hospital Regional Universitario Virgen de la Victoria, Málaga, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), España
| | - Victoria Vilalta
- Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain. https://twitter.com/@victoria_vilalta
| | - Ander Regueiro
- Servicio de Cardiología, Hospital Clínic Barcelona, Barcelona, Spain. https://twitter.com/@AnderRegueiro
| | - Luis Asmarats
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. https://twitter.com/@AsmaratsL
| | - María Del Trigo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain. https://twitter.com/@MaridaDelTrigo
| | - Vicenç Serra
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Guillaume Bonnet
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France. https://twitter.com/@guilbon
| | - Melchior Jonveaux
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Effat Rezaei
- Cardiology Department, St Michael's Hospital Toronto, Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - José M de la Torre-Hernández
- Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Insituto de Investigación Valdecilla, Santander, Spain
| | | | - Pablo Vidal
- Servicio de Cardiología, Hospital Clínic Barcelona, Barcelona, Spain. https://twitter.com/@pvidalcales
| | | | - Juan Francisco Oteo
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Yassin Belahnech
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Siamak Mohammadi
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - François Philippon
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Thomas Modine
- Hôpital Cardiologique Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
| | - Jules Mesnier
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada. https://twitter.com/@JulesMesnier
| | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada; Servicio de Cardiología, Hospital Clínic Barcelona, Barcelona, Spain.
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Asmarats L, Gutiérrez-Alonso L, Nombela-Franco L, Regueiro A, Millán X, Tirado-Conte G, Cepas P, Li CHP, Fernández-Peregrina E, Jiménez-Quevedo P, Freixa X, Arzamendi D. Cusp-overlap technique during TAVI using the self-expanding Portico FlexNav system. Rev Esp Cardiol (Engl Ed) 2023; 76:767-773. [PMID: 36804557 DOI: 10.1016/j.rec.2023.02.003] [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: 12/28/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION AND OBJECTIVES The cusp overlap technique (COT) has been proposed to reduce conduction disturbances (CD) after transcatheter aortic valve implantation (TAVI) with self-expanding supra-annular devices, but there are scarce data on COT with intra-annular valves. The aim of this study was to determine whether the use of the COT during Portico implantation results in higher valve implantation and lower rates of CD. METHODS We included 85 patients undergoing TAVI with the Portico FlexNav system: 43 retrospective patients using the standard 3-cusp view and 42 prospective patients with the COT. Primary endpoints were implantation depth and new-onset CD (composite outcome of new-onset left bundle branch block and new permanent pacemaker implantation). RESULTS COT resulted in a higher implantation depth (noncoronary cusp: 4.9±3.9 vs 7.4±3.0; P=.005) and lower new-onset CD (31.0% vs 58.1%; P=.012), with a tendency toward a lower need for permanent pacemaker implantation (14.3% vs 30.2%, P=.078; 7.7% vs 31.0%; P=.011 in patients without pre-existing right bundle branch block). Transvalvular aortic gradients were slightly lower with COT (8.7±3.7 vs 11.0±6.1; P=.044). There were no differences in technical success or major procedure-related complications. On multivariate analysis, COT use was associated with a lower risk of new-onset CD. CONCLUSIONS Use of the COT during Portico implantation is feasible and facilitates a higher valve implant, which in turn may help to reduce rates of new-onset CD.
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Affiliation(s)
- Lluis Asmarats
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Lola Gutiérrez-Alonso
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Luis Nombela-Franco
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ander Regueiro
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Millán
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Gabriela Tirado-Conte
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Pedro Cepas
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Chi Hion Pedro Li
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Estefanía Fernández-Peregrina
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Pilar Jiménez-Quevedo
- Servicio de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Xavier Freixa
- Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Dabit Arzamendi
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Rodríguez-Capitán J, Sánchez-Pérez A, Ballesteros-Pradas S, Millán-Gómez M, Cardenal-Piris R, Oneto-Fernández M, Gutiérrez-Alonso L, Rivera-López R, Guisado-Rasco A, Cano-García M, Gutiérrez-Bedmar M, Jiménez-Navarro M. Prognostic Implication of Non-Obstructive Coronary Lesions: A New Classification in Different Settings. J Clin Med 2021; 10:jcm10091863. [PMID: 33923110 PMCID: PMC8123418 DOI: 10.3390/jcm10091863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/06/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/25/2022] Open
Abstract
The clinical significance of non-obstructive coronary artery disease is the subject of debate. Our objective was to evaluate the long-term cardiovascular prognosis associated with non-obstructive coronary artery disease in patients undergoing coronary angiography, and to conduct a stratification by sex, diabetes, and clinical indication. We designed a multi-centre retrospective longitudinal observational study of 3265 patients that were classified into three groups: normal coronary arteries (lesion <20%, 1426 patients), non-obstructive coronary artery disease (20–50%, 643 patients), and obstructive coronary artery disease (>70%, 1196 patients). During a mean follow-up of 43 months, we evaluated a combined cardiovascular event: acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Multivariable-adjusted Cox proportional hazard models showed a worse prognosis in patients with non-obstructive coronary artery disease, in comparison with patients of normal coronary arteries group, in the total population (hazard ratio 1.72, 95% confidence interval 1.23–2.39; p for trend <0.001), in non-diabetics (hazard ratio 2.12, 95% confidence interval: 1.40–3.22), in women (hazard ratio 1.75, 95% confidence interval 1.10–2.77), and after acute coronary syndrome (hazard ratio 2.07, 95% confidence interval 1.25–3.44). In conclusion, non-obstructive coronary artery disease is associated with an impaired long-term cardiovascular prognosis. This association held for non-diabetics, women, and after acute coronary syndrome.
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Affiliation(s)
- Jorge Rodríguez-Capitán
- Área del Corazón, UMA Campus de Teatinos S/N, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA, 29010 Málaga, Spain; (J.R.-C.); (A.S.-P.); (M.M.-G.)
| | - Andrés Sánchez-Pérez
- Área del Corazón, UMA Campus de Teatinos S/N, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA, 29010 Málaga, Spain; (J.R.-C.); (A.S.-P.); (M.M.-G.)
| | | | - Mercedes Millán-Gómez
- Área del Corazón, UMA Campus de Teatinos S/N, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA, 29010 Málaga, Spain; (J.R.-C.); (A.S.-P.); (M.M.-G.)
| | - Rosa Cardenal-Piris
- Hospital Universitario Juan Ramón Jiménez, Ronda Norte S/N, 21005 Huelva, Spain;
| | | | - Lola Gutiérrez-Alonso
- Hospital Universitario Puerta del Mar, Cádiz, Avenida Ana de Viya 21, 11009 Cádiz, Spain;
| | - Ricardo Rivera-López
- Servicio de Cardiología, Instituto de Investigación Biosanitaria (Ibs), Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain;
| | - Agustín Guisado-Rasco
- Hospital Universitario Virgen del Rocío, CIBERCV, Avenida Manuel Siurot S/N, 41013 Sevilla, Spain;
| | - Macarena Cano-García
- Hospital Regional Universitario de Málaga, Avenida de Carlos Haya 84, 29010 Málaga, Spain;
| | - Mario Gutiérrez-Bedmar
- Department of Preventive Medicine and Public Health, School of Medicine, Campus de Teatinos S/N, University of Málaga, 29010 Málaga, Spain
- Correspondence: (M.G.-B.); (M.J.-N.); Tel.: +34-952-137-387 (M.G.-B.); +34-951-032-054 (M.J.-N.)
| | - Manuel Jiménez-Navarro
- Área del Corazón, UMA Campus de Teatinos S/N, Hospital Universitario Virgen de la Victoria, CIBERCV, IBIMA, 29010 Málaga, Spain; (J.R.-C.); (A.S.-P.); (M.M.-G.)
- Correspondence: (M.G.-B.); (M.J.-N.); Tel.: +34-952-137-387 (M.G.-B.); +34-951-032-054 (M.J.-N.)
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