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Hausleiter J, Lachmann M, Stolz L, Bedogni F, Rubbio AP, Estévez-Loureiro R, Raposeiras-Roubin S, Boekstegers P, Karam N, Rudolph V. Artificial intelligence-derived risk score for mortality in secondary mitral regurgitation treated by transcatheter edge-to-edge repair: the EuroSMR risk score. Eur Heart J 2024; 45:922-936. [PMID: 38243773 DOI: 10.1093/eurheartj/ehad871] [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: 08/14/2023] [Revised: 11/17/2023] [Accepted: 12/19/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND AND AIMS Risk stratification for mitral valve transcatheter edge-to-edge repair (M-TEER) is paramount in the decision-making process to appropriately select patients with severe secondary mitral regurgitation (SMR). This study sought to develop and validate an artificial intelligence-derived risk score (EuroSMR score) to predict 1-year outcomes (survival or survival + clinical improvement) in patients with SMR undergoing M-TEER. METHODS An artificial intelligence-derived risk score was developed from the EuroSMR cohort (4172 and 428 patients treated with M-TEER in the derivation and validation cohorts, respectively). The EuroSMR score was validated and compared with established risk models. RESULTS The EuroSMR risk score, which is based on 18 clinical, echocardiographic, laboratory, and medication parameters, allowed for an improved discrimination of surviving and non-surviving patients (hazard ratio 4.3, 95% confidence interval 3.7-5.0; P < .001), and outperformed established risk scores in the validation cohort. Prediction for 1-year mortality (area under the curve: 0.789, 95% confidence interval 0.737-0.842) ranged from <5% to >70%, including the identification of an extreme-risk population (2.6% of the entire cohort), which had a very high probability for not surviving beyond 1 year (hazard ratio 6.5, 95% confidence interval 3.0-14; P < .001). The top 5% of patients with the highest EuroSMR risk scores showed event rates of 72.7% for mortality and 83.2% for mortality or lack of clinical improvement at 1-year follow-up. CONCLUSIONS The EuroSMR risk score may allow for improved prognostication in heart failure patients with severe SMR, who are considered for a M-TEER procedure. The score is expected to facilitate the shared decision-making process with heart team members and patients.
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Affiliation(s)
- Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, Munich D-81377, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mark Lachmann
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Marchioninistr. 15, Munich D-81377, Germany
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio P Rubbio
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | | | - Peter Boekstegers
- Department of Cardiology, Helios Klinikum Siegburg, Siegburg, Germany
| | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou, Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Volker Rudolph
- Department of Cardiology, Herz- und Diabeteszentrum, Bad Oeynhausen, Germany
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Andreas M, Burri H, Praz F, Soliman O, Badano L, Barreiro M, Cavalcante JL, de Potter T, Doenst T, Friedrichs K, Hausleiter J, Karam N, Kodali S, Latib A, Marijon E, Mittal S, Nickenig G, Rinaldi A, Rudzinski PN, Russo M, Starck C, von Bardeleben RS, Wunderlich N, Zamorano JL, Hahn RT, Maisano F, Leclercq C. Tricuspid valve disease and cardiac implantable electronic devices. Eur Heart J 2024; 45:346-365. [PMID: 38096587 PMCID: PMC10834167 DOI: 10.1093/eurheartj/ehad783] [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: 07/08/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 02/03/2024] Open
Abstract
The role of cardiac implantable electronic device (CIED)-related tricuspid regurgitation (TR) is increasingly recognized as an independent clinical entity. Hence, interventional TR treatment options continuously evolve, surgical risk assessment and peri-operative care improve the management of CIED-related TR, and the role of lead extraction is of high interest. Furthermore, novel surgical and interventional tricuspid valve treatment options are increasingly applied to patients suffering from TR associated with or related to CIEDs. This multidisciplinary review article developed with electrophysiologists, interventional cardiologists, imaging specialists, and cardiac surgeons aims to give an overview of the mechanisms of disease, diagnostics, and proposes treatment algorithms of patients suffering from TR associated with CIED lead(s) or leadless pacemakers.
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Affiliation(s)
- Martin Andreas
- Department of Cardiac Surgery, Medical University of Vienna, Level 7C, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Haran Burri
- Cardiac Pacing Unit, Cardiology Departement, University Hospital of Geneva, Geneva, Switzerland
| | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
| | - Osama Soliman
- Discipline of Cardiology, SAOLTA Healthcare Group, Galway University Hospital, Health Service Executive, and University of Galway, Galway H91 YR71, Ireland
| | - Luigi Badano
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Manuel Barreiro
- Cardiology Department, Hospital Universitario Alvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Spain
| | - João L Cavalcante
- Cardiac MR and Structural CT lab, Allina Health Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University of Jena, Jena University Hospital, Jena, Germany
| | - Kai Friedrichs
- Clinic for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rine Westphalia, Bad Oeynhausen, Germany
| | - Jörg Hausleiter
- Medizinische Klinik I, Ludwig-Maximilians-University, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Nicole Karam
- Cardiology Department, European Hospital Georges Pompidou, Université Paris Cité, Paris, France
| | - Susheel Kodali
- Division of Cardiology, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, NewYork, NY, USA
| | - Azeem Latib
- Montefiore Einstein Center for Heart and Vascular Care, Montefiore Medical Center, NewYork, NY, USA
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Suneet Mittal
- Department of Cardiology, The Valley Health System, the Synder Comprehensive Center for Atrial Fibrillation, Ridgewood, NJ, USA
| | - Georg Nickenig
- Herzzentrum Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn, Germany
| | - Aldo Rinaldi
- Department of Cardiology, Guy’s & St Thomas’ NHS Trust, London, UK
| | - Piotr Nikodem Rudzinski
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology in Warsaw, Warsaw, Poland
| | - Marco Russo
- Department of Cardiac Surgery and Heart Transplantation, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center of Charité, Berlin, Germany
| | - Ralph Stephan von Bardeleben
- Department of Cardiology, Universitätsmedizin Mainz of the Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Nina Wunderlich
- Department of Cardiology/Angiology, Asklepios Klinik Langen, Langen, Germany
| | - José Luis Zamorano
- Department of Cardiology, University Hospital Ramon y Cajal, Madrid, Spain
| | - Rebecca T Hahn
- Division of Cardiology, Department of Medicine, New York-Presbyterian/Columbia University Irving Medical Center, NewYork, NY, USA
| | - Francesco Maisano
- Heart Valve Center, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Christophe Leclercq
- Department of Cardiology, University of Rennes, CHU Rennes, lTSI-UMR1099, Rennes F-35000, France
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3
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Adamo M, Chioncel O, Pagnesi M, Bayes-Genis A, Abdelhamid M, Anker SD, Antohi EL, Badano L, Ben Gal T, Böhm M, Delgado V, Dreyfus J, Faletra FF, Farmakis D, Filippatos G, Grapsa J, Gustafsson F, Hausleiter J, Jaarsma T, Karam N, Lund L, Lurz P, Maisano F, Moura B, Mullens W, Praz F, Sannino A, Savarese G, Tocchetti CG, van Empel VPM, von Bardeleben RS, Yilmaz MB, Zamorano JL, Ponikowski P, Barbato E, Rosano GMC, Metra M. Epidemiology, pathophysiology, diagnosis and management of chronic right-sided heart failure and tricuspid regurgitation. A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur J Heart Fail 2024; 26:18-33. [PMID: 38131233 DOI: 10.1002/ejhf.3106] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 11/07/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
Right-sided heart failure and tricuspid regurgitation are common and strongly associated with poor quality of life and an increased risk of heart failure hospitalizations and death. While medical therapy for right-sided heart failure is limited, treatment options for tricuspid regurgitation include surgery and, based on recent developments, several transcatheter interventions. However, the patients who might benefit from tricuspid valve interventions are yet unknown, as is the ideal time for these treatments given the paucity of clinical evidence. In this context, it is crucial to elucidate aetiology and pathophysiological mechanisms leading to right-sided heart failure and tricuspid regurgitation in order to recognize when tricuspid regurgitation is a mere bystander and when it can cause or contribute to heart failure progression. Notably, early identification of right heart failure and tricuspid regurgitation may be crucial and optimal management requires knowledge about the different mechanisms and causes, clinical course and presentation, as well as possible treatment options. The aim of this clinical consensus statement is to summarize current knowledge about epidemiology, pathophysiology and treatment of tricuspid regurgitation in right-sided heart failure providing practical suggestions for patient identification and management.
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Affiliation(s)
- Marianna Adamo
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Matteo Pagnesi
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Antoni Bayes-Genis
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site, Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elena-Laura Antohi
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Luigi Badano
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Tuvia Ben Gal
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Victoria Delgado
- Heart Failure Clinic and Cardiology Service, University Hospital Germans Trias i Pujol, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- CIBERCV, Instituto de Salud Carlos III, Madrid, Spain
| | - Julien Dreyfus
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - Francesco F Faletra
- Division of Cardiology, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione), Palermo, Italy
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Dimitrios Farmakis
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Julia Grapsa
- Department of Cardiology, Guys and St Thomas NHS Trust, Kings College London, London, UK
| | - Finn Gustafsson
- Department of Cardiology, Heart Centre, Rigshospitalet-Copenhagen University Hospital, Copenhagen, Denmark
| | - Jörg Hausleiter
- Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany
| | | | - Nicole Karam
- Heart Valves Unit, Georges Pompidou European Hospital, Université Paris Cité, INSERM, Paris, France
| | - Lars Lund
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Philipp Lurz
- Division of Cardiology, University Medical Center, Mainz, Germany
| | - Francesco Maisano
- Cardiac Surgery and Heart Valve Center, Ospedale San Raffaele, University Vita Salute, Milan, Italy
| | - Brenda Moura
- Faculty of Medicine, University of Porto, Porto, Portugal
- Cardiology Department, Porto Armed Forces Hospital, Porto, Portugal
| | | | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Anna Sannino
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University, Naples, Italy
| | - Gianluigi Savarese
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Carlo Gabriele Tocchetti
- Cardio-Oncology Unit, Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), 'Federico II' University, Naples, Italy
| | - Vanessa P M van Empel
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | | | - Mehmet Birhan Yilmaz
- Division of Cardiology, Department of Internal Medical Sciences, School of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - José Luis Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Piotr Ponikowski
- Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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4
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Baldi E, Klersy C, Chan P, Elmer J, Ball J, Counts CR, Rosell Ortiz F, Fothergill R, Auricchio A, Paoli A, Karam N, McNally B, Martin-Gill C, Nehme Z, Drucker CJ, Ruiz Azpiazu JI, Mellett-Smith A, Cresta R, Scquizzato T, Jouven X, Primi R, Al-Araji R, Guyette FX, Sayre MR, Daponte Codina A, Benvenuti C, Marijon E, Savastano S. The impact of COVID-19 pandemic on out-of-hospital cardiac arrest: An individual patient data meta-analysis. Resuscitation 2024; 194:110043. [PMID: 37952575 DOI: 10.1016/j.resuscitation.2023.110043] [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] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
AIM Prior studies have reported increased out-of-hospital cardiac arrests (OHCA) incidence and lower survival during the COVID-19 pandemic. We evaluated how the COVID-19 pandemic affected OHCA incidence, bystander CPR rate and patients' outcomes, accounting for regional COVID-19 incidence and OHCA characteristics. METHODS Individual patient data meta-analysis of studies which provided a comparison of OHCA incidence during the first pandemic wave (COVID-period) with a reference period of the previous year(s) (pre-COVID period). We computed COVID-19 incidence per 100,000 inhabitants in each of 97 regions per each week and divided it into its quartiles. RESULTS We considered a total of 49,882 patients in 10 studies. OHCA incidence increased significantly compared to previous years in regions where weekly COVID-19 incidence was in the fourth quartile (>136/100,000/week), and patients in these regions had a lower odds of bystander CPR (OR 0.49, 95%CI 0.29-0.81, p = 0.005). Overall, the COVID-period was associated with an increase in medical etiology (89.2% vs 87.5%, p < 0.001) and OHCAs at home (74.7% vs 67.4%, p < 0.001), and a decrease in shockable initial rhythm (16.5% vs 20.3%, p < 0.001). The COVID-period was independently associated with pre-hospital death (OR 1.73, 95%CI 1.55-1.93, p < 0.001) and negatively associated with survival to hospital admission (OR 0.68, 95%CI 0.64-0.72, p < 0.001) and survival to discharge (OR 0.50, 95%CI 0.46-0.54, p < 0.001). CONCLUSIONS During the first COVID-19 pandemic wave, there was higher OHCA incidence and lower bystander CPR rate in regions with a high-burden of COVID-19. COVID-19 was also associated with a change in patient characteristics and lower survival independently of COVID-19 incidence in the region where OHCA occurred.
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Affiliation(s)
- Enrico Baldi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Catherine Klersy
- Biostatistics & Clinical Trial Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paul Chan
- Department of Medicine, Saint Luke's Mid America Heart Institute, Kansas City, USA
| | - Jonathan Elmer
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Jocasta Ball
- Centre of Cardiovascular Research & Education in Therapeutics (CCRET), School of Public Health and Preventive Medicine, Monash University, Clayton, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | - Catherine R Counts
- University of Washington School of Medicine, Seattle, USA; Seattle Fire Department, Seattle, USA
| | - Fernando Rosell Ortiz
- Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Rachael Fothergill
- Clinical Audit & Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Angelo Auricchio
- Fondazione Ticino Cuore, Lugano, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland; Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Andrea Paoli
- Centrale Operativa Provinciale SUEM 118, Azienda ULSS 5 Polesana, Rovigo, Italy
| | - Nicole Karam
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Bryan McNally
- Emory University School of Medicine, Rollins School of Public Health, Atlanta, USA
| | - Christian Martin-Gill
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Ziad Nehme
- Centre of Cardiovascular Research & Education in Therapeutics (CCRET), School of Public Health and Preventive Medicine, Monash University, Clayton, Australia; Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Australia
| | | | - José Ignacio Ruiz Azpiazu
- Servicio de Emergencias 061 de La Rioja, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Adam Mellett-Smith
- Clinical Audit & Research Unit, London Ambulance Service NHS Trust, London, UK
| | - Ruggero Cresta
- Fondazione Ticino Cuore, Lugano, Switzerland; Federazione Cantonale Ticinese Servizi Autoambulanze, Lugano, Switzerland
| | - Tommaso Scquizzato
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Xavier Jouven
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rabab Al-Araji
- Emory University, Woodruff Health Sciences Center, Atlanta, USA
| | - Francis X Guyette
- Departments of Emergency Medicine, Critical Care Medicine and Neurology, University of Pittsburgh, Pittsburgh, USA
| | - Michael R Sayre
- University of Washington School of Medicine, Seattle, USA; Seattle Fire Department, Seattle, USA
| | - Antonio Daponte Codina
- Andalusian School of Public Health, CIBER Epidemiology and Public Health (CIBERESP), Granada, Spain
| | | | - Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiac Arrest and Resuscitation Science Research Team (RESTART), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Karam N, Stolz L. HighLife Transfemoral Mitral Replacement System: Promises and Uncertainties. JACC Cardiovasc Interv 2023; 16:2866-2867. [PMID: 37999710 DOI: 10.1016/j.jcin.2023.10.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023]
Affiliation(s)
- Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou, Paris, France.
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
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Fraccaro C, Karam N, Möllmann H, Bleiziffer S, Bonaros N, Teles RC, Carrilho Ferreira P, Chieffo A, Czerny M, Donal E, Dudek D, Dumonteil N, Esposito G, Fournier S, Hassager C, Kim WK, Krychtiuk KA, Mehilli J, Pręgowski J, Stefanini GG, Ternacle J, Thiele H, Thielmann M, Vincent F, von Bardeleben RS, Tarantini G. Transcatheter interventions for left-sided valvular heart disease complicated by cardiogenic shock: a consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the Association for Acute Cardiovascular Care (ACVC) and the ESC Working Group on Cardiovascular Surgery. EUROINTERVENTION 2023; 19:634-651. [PMID: 37624587 PMCID: PMC10587846 DOI: 10.4244/eij-d-23-00473] [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: 06/12/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
Valvular heart disease (VHD) is one of the most frequent causes of heart failure (HF) and is associated with poor prognosis, particularly among patients with conservative management. The development and improvement of catheter-based VHD interventions have broadened the indications for transcatheter valve interventions from inoperable/high-risk patients to younger/lower-risk patients. Cardiogenic shock (CS) associated with severe VHD is a clinical condition with a very high risk of mortality for which surgical treatment is often deemed a prohibitive risk. Transcatheter valve interventions might be a promising alternative in this setting given that they are less invasive. However, supportive scientific evidence is scarce and often limited to small case series. Current guidelines on VHD do not contain specific recommendations on how to manage patients with both VHD and CS. The purpose of this clinical consensus statement, developed by a group of international experts invited by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Scientific Documents and Initiatives Committee, is to perform a review of the available scientific evidence on the management of CS associated with left-sided VHD and to provide a rationale and practical approach for the application of transcatheter valve interventions in this specific clinical setting.
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Affiliation(s)
- Chiara Fraccaro
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Nicole Karam
- Heart Valves Unit, Georges Pompidou European Hospital, Université Paris Cité, INSERM, Paris, France
| | - Helge Möllmann
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | | | - Nikolaos Bonaros
- Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rui Campante Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental (HSC), Carnaxide, Portugal and Comprehensive Health Research Center (CHRC), Nova Medical School, Lisbon, Portugal
| | - Pedro Carrilho Ferreira
- Cardiology Department, Santa Maria University Hospital, CHULN, CAML, CCUL, Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Alaide Chieffo
- Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Centre, Freiburg University, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Erwan Donal
- Service de Cardiologie, CCP CHU de Rennes, University of Rennes, INSERM, LTSI-UMR 1099, Rennes, France
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | | | - Giovanni Esposito
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Stephane Fournier
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland and University of Lausanne, Lausanne, Switzerland
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Won-Keun Kim
- Department of Cardiology, St. Johannes Hospital, Dortmund, Germany
| | - Konstantin A Krychtiuk
- Duke Clinical Research Institute, Durham, NC, USA
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Julinda Mehilli
- Department of Cardiology, German Centre for Cardiovascular Research (DZHK), Ludwig Maximilian University of Munich, Partner Site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik I, Landshut-Achdorf Hospital, Landshut, Germany
| | - Jerzy Pręgowski
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
| | - Giulio G Stefanini
- Department of Biomedical Sciences Humanitas University, Pieve Emanuele, Italy
- Humanitas Research Hospital IRCCS Rozzano, Milan, Italy
| | - Julien Ternacle
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec, QC, Canada and Université Laval, Quebec, QC, Canada
- Haut-Leveque Cardiology Hospital, Bordeaux University, Pessac, France
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, Leipzig, Germany and University of Leipzig, Leipzig, Germany
| | - Matthias Thielmann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany
| | - Flavien Vincent
- Service de Cardiologie, Centre Hospitalier Universitaire de Lille, Lille, France
| | | | - Giuseppe Tarantini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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7
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Manzo-Silberman S, Velázquez M, Burgess S, Sahni S, Best P, Mehran R, Piccaluga E, Vitali-Serdoz L, Sarma A, Barbash IM, Mauri J, Szymański P, Hinterbuchner L, Stefanini G, Gimelli A, Maurovich-Horvat P, Boersma L, Buchanan GL, Pontone G, Holmvang L, Karam N, Neylon A, Morice MC, Leclercq C, Tarantini G, Dudek D, Chieffo A. Radiation protection for healthcare professionals working in catheterisation laboratories during pregnancy: a statement of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the ESC Regulatory Affairs Committee and Women as One. EUROINTERVENTION 2023; 19:53-62. [PMID: 36411964 PMCID: PMC10173757 DOI: 10.4244/eij-d-22-00407] [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: 04/28/2022] [Accepted: 09/19/2022] [Indexed: 05/13/2023]
Abstract
The European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Heart Rhythm Association (EHRA), the European Association of Cardiovascular Imaging (EACVI), the European Society of Cardiology (ESC) Regulatory Affairs Committee and Women as One support continuous review and improvement, not only in the practice of assuring patients a high quality of care but also in providing health professionals with support documents to help them in their career and enhance gender equity. Recent surveys have revealed that radiation exposure is commonly reported as the primary barrier for women pursuing a career in interventional cardiology or cardiac electrophysiology (EP). The fear of foetal exposure to radiation during pregnancy may lead to a prolonged interruption in their career. Accordingly, this joint statement aims to provide a clear statement on radiation risk and the existing data on the experience of radiation-exposed cardiologists who continue to work in catheterisation laboratories (cath labs) throughout their pregnancies. In order to reduce the barrier preventing women from accessing these careers, increased knowledge in the community is warranted. Finally, by going beyond simple observations and review of the literature, our document suggests proposals for improving workplace safety and for encouraging equity.
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Affiliation(s)
- Stéphane Manzo-Silberman
- ACTION Study Group, Sorbonne University, Institute of Cardiology, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France and Women as One
| | - Maite Velázquez
- Department of Cardiology, University Hospital 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre, Madrid, Spain and CIBERCV, Madrid, Spain
| | - Sonya Burgess
- Department of Cardiology, Nepean Hospital, the University of Sydney, NSW, Australia and Women as One
| | - Sheila Sahni
- Hackensack Meridian Health Medical Group, Clark, NJ, USA
| | - Patricia Best
- Department of Cardiology, Mayo Clinic, Rochester, MN, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Laura Vitali-Serdoz
- Department of Cardiology, Klinikum Fuerth, Teaching Hospital of Erlangen-Nuernberg University, Fuerth, Germany
| | - Amy Sarma
- Department of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Israel Moshe Barbash
- Interventional Cardiology Unit, Leviev Heart Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Josepa Mauri
- Cardiology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Piotr Szymański
- Centre for Postgraduate Medical Education, Warsaw and Centre for Clinical Cardiology, CSK MSWiA Hospital, Warsaw, Poland
| | - Lynne Hinterbuchner
- Department of Cardiology, Landeskrankenhaus Salzburg - Universitätsklinikum der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Giulio Stefanini
- Humanitas Clinical and Research Center IRCCS, Rozzano-Milan, Italy
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Imaging Department, Pisa, Italy
| | | | - Lucas Boersma
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Gill Louise Buchanan
- Department of Cardiology, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | | | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, European Georges Pompidou Hospital, Paris, France
| | | | | | - Christophe Leclercq
- Department of Cardiology and Vascular Diseases, C.H.U. Pontchaillou, Rennes, France
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Science, University of Padova, Padova, Italy
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland and Maria Cecilia Hospital GVM, Cotignola RA, Italy
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8
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Karam N, Hausleiter J. Hypoalbuminemia and Secondary Mitral Regurgitation Mortality: An Inevitable Fate? Eur J Heart Fail 2023. [PMID: 37114342 DOI: 10.1002/ejhf.2878] [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] [Received: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 04/29/2023] Open
Affiliation(s)
- Nicole Karam
- European Hospital Georges Pompidou (Cardiology Department), Université Paris Cité, Paris, France
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
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9
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Adamo M, Tomasoni D, Stolz L, Stocker TJ, Pancaldi E, Koell B, Karam N, Besler C, Giannini C, Sampaio F, Praz F, Ruf T, Pechmajou L, Neuss M, Iliadis C, Baldus S, Butter C, Kalbacher D, Lurz P, Melica B, Petronio AS, von Bardeleben RS, Windecker S, Butler J, Fonarow GC, Hausleiter J, Metra M. Impact of Transcatheter Edge-to-Edge Mitral Valve Repair on Guideline-Directed Medical Therapy Uptitration. JACC Cardiovasc Interv 2023; 16:896-905. [PMID: 37100553 DOI: 10.1016/j.jcin.2023.01.362] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/26/2022] [Accepted: 01/17/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Guideline-directed medical therapy (GDMT) optimization is mandatory before transcatheter edge-to-edge mitral valve repair (M-TEER) in patients with secondary mitral regurgitation (SMR) and heart failure (HF) with reduced ejection fraction (HFrEF). However, the effect of M-TEER on GDMT is unknown. OBJECTIVES The authors sought to evaluate frequency, prognostic implications and predictors of GDMT uptitration after M-TEER in patients with SMR and HFrEF. METHODS This is a retrospective analysis of prospectively collected data from the EuroSMR Registry. The primary events were all-cause death and the composite of all-cause death or HF hospitalization. RESULTS Among the 1,641 EuroSMR patients, 810 had full datasets regarding GDMT and were included in this study. GDMT uptitration occurred in 307 patients (38%) after M-TEER. Proportion of patients receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors, beta-blockers, and mineralocorticoid receptor antagonists was 78%, 89%, and 62% before M-TEER and 84%, 91%, and 66% 6 months after M-TEER (all P < 0.001). Patients with GDMT uptitration had a lower risk of all-cause death (adjusted HR: 0.62; 95% CI: 0.41-0.93; P = 0.020) and of all-cause death or HF hospitalization (adjusted HR: 0.54; 95% CI: 0.38-0.76; P < 0.001) compared with those without. Degree of MR reduction between baseline and 6-month follow-up was an independent predictor of GDMT uptitration after M-TEER (adjusted OR: 1.71; 95% CI: 1.08-2.71; P = 0.022). CONCLUSIONS GDMT uptitration after M-TEER occurred in a considerable proportion of patients with SMR and HFrEF and is independently associated with lower rates for mortality and HF hospitalizations. A greater decrease in MR was associated with increased likelihood for GDMT uptitration.
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Affiliation(s)
- 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
| | - Daniela Tomasoni
- 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
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Edoardo Pancaldi
- 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
| | - Benedikt Koell
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou, and Paris Cardiovascular Research Center, INSERM U970, Paris, France
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Tobias Ruf
- Zentrum für Kardiologie, Johannes-Gutenberg-Universität, Mainz, Germany
| | - Louis Pechmajou
- Department of Cardiology, European Hospital Georges Pompidou, and Paris Cardiovascular Research Center, INSERM U970, Paris, France
| | - Michael Neuss
- Immanuel Heart Center Bernau, Brandenburg Medical School Theodor Fontane, Cardiology, Bernau, Germany
| | - Christos Iliadis
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University Hospital Cologne, Cologne, Germany
| | - Christian Butter
- Immanuel Heart Center Bernau, Brandenburg Medical School Theodor Fontane, Cardiology, Bernau, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Anna S Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Javed Butler
- Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, 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.
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10
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Puscas T, Gautier CH, Martin AC, Pechmajou L, Du Puy-Montbrun L, Caudron J, Guillemain R, Bories MC, Achouh P, Karam N. Transcatheter Tricuspid Repair for Tricuspid Regurgitation After Heart Transplantation. JACC Case Rep 2023; 12:101767. [PMID: 37091057 PMCID: PMC10119485 DOI: 10.1016/j.jaccas.2023.101767] [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] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/21/2022] [Accepted: 12/27/2022] [Indexed: 04/25/2023]
Abstract
A 67-year-old patient with history of heart transplantation was referred for symptomatic severe tricuspid regurgitation. Diagnostic workup showed chordal ruptures on the septal and anterior leaflets, most likely related to endomyocardial biopsies. Given the high surgical risk, the patient was treated percutaneously, with good results persisting at 3 months. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Tania Puscas
- Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Charles-Henri Gautier
- Paris University, INSERM UMRS_1140, Paris, France
- Cardiac Surgery, European Hospital Georges Pompidou, Paris, France
| | - Anne-Céline Martin
- Paris University, INSERM UMRS_1140, Paris, France
- Advanced Heart Failure Unit, European Hospital Georges Pompidou, Paris, France
| | - Louis Pechmajou
- Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
- University of Paris, PARCC, INSERM, Paris, France
| | | | - Julia Caudron
- Advanced Heart Failure Unit, European Hospital Georges Pompidou, Paris, France
| | - Romain Guillemain
- Advanced Heart Failure Unit, European Hospital Georges Pompidou, Paris, France
| | - Marie-Cécile Bories
- Advanced Heart Failure Unit, European Hospital Georges Pompidou, Paris, France
| | - Paul Achouh
- Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
- Cardiac Surgery, European Hospital Georges Pompidou, Paris, France
- University of Paris, PARCC, INSERM, Paris, France
| | - Nicole Karam
- Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
- University of Paris, PARCC, INSERM, Paris, France
- Address for correspondence: Dr Nicole Karam, European Georges Pompidou Hospital, Paris Cardiovascular Research Center (INSERM U970), 56 Rue Leblanc, 75987 Paris Cedex 15, France.
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11
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Stolz L, Orban M, Karam N, Lubos E, Wild M, Weckbach L, Stocker TJ, Praz F, Braun D, Löw K, Hausleiter S, Stark K, Doldi P, Tence N, Orban M, Higuchi S, Haum M, Windecker S, Hagl C, Mayerle J, Näbauer M, Kalbacher D, Massberg S, Hausleiter J. Cardio-hepatic syndrome in patients undergoing transcatheter mitral valve edge-to-edge repair. Eur J Heart Fail 2023. [PMID: 36994662 DOI: 10.1002/ejhf.2842] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 03/04/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023] Open
Abstract
AIMS The impact of the cardio-hepatic syndrome (CHS) on outcomes in patients undergoing transcatheter edge-to-edge repair (M-TEER) for relevant mitral regurgitation (MR) is unknown. The objectives of this study were three-fold: (I) to characterize the pattern of hepatic impairment, (II) to investigate the prognostic value of CHS, and (III) to evaluate the changes in hepatic function after M-TEER. METHODS AND RESULTS Hepatic impairment was quantified by laboratory parameters of liver function. In accordance with existing literature, two types of CHS were distinguished: Ischemic type I CHS (elevation of both transaminases) and cholestatic type II CHS (elevation of two out of three parameters of hepatic cholestasis). The impact of CHS on two-year mortality was evaluated using a Cox model. The change in hepatic function after M-TEER was assessed by laboratory testing at follow-up. We analyzed 1083 patients who underwent M-TEER for relevant primary or secondary MR at four European centers between 2008 and 2019. Ischemic type I and cholestatic type II CHS were observed in 11.1% and 23.0% of patients, respectively. Predictors for two-year all-cause mortality differed by MR etiology. While in primary MR cholestatic type II CHS was independently associated with two-year mortality, ischemic CHS type I was an independent mortality predictor in SMR patients. At follow-up, patients with MR reduction ≤2+ (obtained in 90.7% of patients) presented with improved parameters of hepatic function (median reduction of 0.2mg/dl, 0.2U/l and 21U/l for bilirubin, ALT and GGT, respectively, p<0.01). CONCLUSIONS CHS is frequently observed in patients undergoing M-TEER and significantly impairs two-year survival. Successful M-TEER may have beneficial effects on CHS.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Nicole Karam
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Edith Lubos
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Mirjam Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Ludwig Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Kornelia Löw
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Sebastian Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Konstantin Stark
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Philipp Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Noemie Tence
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Martin Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Magda Haum
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Julia Mayerle
- Medizinische Klinik und Poliklinik II, Ludwig-Maximilians-Universität München, München, Bayern, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Daniel Kalbacher
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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12
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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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13
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Buchanan GL, Paradies V, Karam N, Holmvang L, Mamas MA, Mehilli J, Capodanno D, Capranzano P, Appelman Y, Manzo-Silberman S, Kunadian V, Mauri J, Shuepke S, Petronio AS, Kaluzna-Oleksy M, Gilard M, Morice MC, Barbato E, Dudek D, Chieffo A. Overcoming professional barriers encountered by women in interventional cardiology: an EAPCI statement. Eur Heart J 2023; 44:1301-1312. [PMID: 36881724 DOI: 10.1093/eurheartj/ehad053] [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: 06/25/2022] [Revised: 10/28/2022] [Accepted: 01/25/2023] [Indexed: 03/09/2023] Open
Abstract
Despite the increasing proportion of female medical and nursing students, there is still a significant under-representation of women working as healthcare providers in interventional cardiology, with very few of them reaching senior leadership, academic positions, or acting principal investigators, as well as actively involved in company advisory boards. In this position paper, we will describe the current status of women working in interventional cardiology across Europe. We will also provide an overview of the most relevant determinants of the under-representation of women at each stage of the interventional cardiology career path and offer practical suggestions for overcoming these challenges.
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Affiliation(s)
- Gill Louise Buchanan
- Cardiology Department, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Valeria Paradies
- Cardiology Department, Maasstad Hospital, Rotterdam, The Netherlands
| | - Nicole Karam
- Cardiology Department, European Hospital Georges Pompidou, Paris, France
| | - Lene Holmvang
- Cardiology Department, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mamas A Mamas
- Keele Cardiovascular Group, Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - Julinda Mehilli
- Cardiology Department, Hospital Landshut-Achdorf and Ludwig-Maximilians-University Clinic, Munich, Germany
| | - Davide Capodanno
- Cardio-Thoracic-Vascular and Transplant Department, Azienda Ospedaliero-Universitaria Policlinico "Gaspare Rodolico-San Marco", University of Catania, Catania, Italy
| | - Piera Capranzano
- Cardio-Thoracic-Vascular and Transplant Department, Azienda Ospedaliero-Universitaria Policlinico "Gaspare Rodolico - San Marco", University of Catania, Catania, Italy
| | - Yolande Appelman
- Cardiology Department, Amsterdam UMC, location VU University Medical Center, The Netherlands
| | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Josepa Mauri
- Cardiology Department, University Hospital, Germans Trias i Pujol, Badalona, Spain
| | - Stefanie Shuepke
- Cardiology Department, Technical University of Munich, Munich, Germany
| | | | - Marta Kaluzna-Oleksy
- First Cardiology Department, Poznan University of Medical Sciences, Poznań, Poland
| | - Martine Gilard
- Cardiology Department, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Marie Claude Morice
- Cardiology Department, Institute Cardiovasculaire Paris Sud, Ramsay, Massy, France
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy
| | - Dariusz Dudek
- Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Hospital, Krakow, Poland.,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
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14
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Karam N, Spaulding C. Interventional management of out-of-hospital cardiac arrest. Heart 2023; 109:719-722. [PMID: 36882327 DOI: 10.1136/heartjnl-2022-321266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Affiliation(s)
- Nicole Karam
- Paris City University, Paris, France .,Cardiology Department, European Hospital Georges-Pompidou, Paris, France
| | - Christian Spaulding
- Paris City University, Paris, France.,Cardiology Department, European Hospital Georges-Pompidou, Paris, France
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15
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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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16
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Hausleiter J, Karam N. Clustering the Natural History of Tricuspid Regurgitation. JACC Cardiovasc Interv 2023; 16:166-167. [PMID: 36697151 DOI: 10.1016/j.jcin.2022.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/29/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany.
| | - Nicole Karam
- Cardiology Department, European Hospital Georges Pompidou, Université Paris Cité, Paris, France
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17
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Stolz L, Doldi PM, Orban M, Karam N, Puscas T, Wild MG, Popescu A, von Bardeleben RS, Iliadis C, Baldus S, Adamo M, Thiele H, Besler C, Unterhuber M, Ruf T, Pfister R, Higuchi S, Koell B, Giannini C, Petronio A, Kassar M, Weckbach LT, Butter C, Stocker TJ, Neuss M, Melica B, Braun D, Windecker S, Massberg S, Praz F, Näbauer M, Kalbacher D, Lurz P, Metra M, Bax JJ, Hausleiter J. Staging Heart Failure Patients With Secondary Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair. JACC Cardiovasc Interv 2023; 16:140-151. [PMID: 36697148 DOI: 10.1016/j.jcin.2022.10.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 08/11/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Secondary mitral regurgitation (SMR) is a progressive disease with characteristic pathophysiological changes that may influence prognosis. Although the staging of SMR patients suffering from heart failure with reduced ejection fraction (HFrEF) according to extramitral cardiac involvement has prognostic value in medically treated patients, such data are so far lacking for edge-to-edge mitral valve repair (M-TEER). OBJECTIVES This study sought to classify M-TEER patients into disease stages based on the phenotype of extramitral cardiac involvement and to assess its impact on symptomatic and survival outcomes. METHODS Based on echocardiographic and clinical assessment, patients were assigned to 1 of the following HFrEF-SMR groups: left ventricular involvement (Stage 1), left atrial involvement (Stage 2), right ventricular volume/pressure overload (Stage 3), or biventricular failure (Stage 4). A Cox regression model was implemented to investigate the impact of HFrEF-SMR stages on 2-year all-cause mortality. The symptomatic outcome was assessed with New York Heart Association functional class at follow-up. RESULTS Among a total of 849 eligible patients who underwent M-TEER for relevant SMR from 2008 until 2019, 9.5% (n = 81) presented with left ventricular involvement, 46% (n = 393) with left atrial involvement, 15% (n = 129) with right ventricular pressure/volume overload, and 29% (n = 246) with biventricular failure. An increase in HFrEF-SMR stage was associated with increased 2-year all-cause mortality after M-TEER (HR: 1.39; CI: 1.23-1.58; P < 0.01). Furthermore, higher HFrEF-SMR stages were associated with significantly less symptomatic improvement at follow-up. CONCLUSIONS The classification of M-TEER patients into HFrEF-SMR stages according to extramitral cardiac involvement provides prognostic value in terms of postinterventional survival and symptomatic improvement.
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Affiliation(s)
- Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Mathias Orban
- German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Nicole Karam
- Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Tania Puscas
- Department of Cardiology, European Hospital Georges Pompidou and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Mirjam G Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Aniela Popescu
- Zentrum für Kardiologie, Johannes-Gutenberg-Universität, Mainz, Germany
| | | | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Christian Besler
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Matthias Unterhuber
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Tobias Ruf
- Zentrum für Kardiologie, Johannes-Gutenberg-Universität, Mainz, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Benedikt Koell
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Christina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Anna Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Michael Neuss
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Micheal Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; German Center for Cardiovascular Research, Partner Site Hamburg/Luebeck/Kiel, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, Azienda Socio Sanitaria Territoriale Spedali Civili and University of Brescia, Brescia, Italy
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Turku Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany.
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18
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Abstract
Mitral regurgitation (MR) is the most prevalent valvular heart disease and, when left untreated, results in reduced quality of life, heart failure, and increased mortality. Mitral valve transcatheter edge-to-edge repair (M-TEER) has matured considerably as a non-surgical treatment option since its commercial introduction in Europe in 2008. As a result of major device and interventional improvements, as well as the accumulation of experience by the interventional cardiologists, M-TEER has emerged as an important therapeutic strategy for patients with severe and symptomatic MR in the current European and American guidelines. Herein, we provide a comprehensive up-do-date overview of M-TEER. We define preprocedural patient evaluation and highlight key aspects for decision-making. We describe the currently available M-TEER systems and summarise the evidence for M-TEER in both primary mitral regurgitation (PMR) and secondary mitral regurgitation (SMR). In addition, we provide recommendations for device selection, intraprocedural imaging and guiding, M-TEER optimisation and management of recurrent MR. Finally, we provide information on major unsolved questions and "grey areas" in M-TEER.
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Affiliation(s)
- Jörg Hausleiter
- Department of Cardiology, LMU Klinikum, Ludwig Maximilian University of Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Thomas J Stocker
- Department of Cardiology, LMU Klinikum, Ludwig Maximilian University of Munich, Munich, Germany and DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory, ASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, University of Brescia, Brescia, Italy
| | - Nicole Karam
- Paris Cardiovascular Research Center, INSERM and Cardiology Department, European Hospital Georges Pompidou, University of Paris, Paris, France
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Fabien Praz
- Bern University Hospital, University of Bern, Bern, Switzerland
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19
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Le Ruz R, Guérin P, Leurent G, Leroux L, Lefevre T, Nejjari M, Champagnac D, Tchétché D, Lhermusier T, Caussin C, Delomez M, Bonnet G, Favereau X, Karam N, Gerbay A, Juthier F, Gilard M, Obadia JF, Iung B, Manigold T. Mitral valve-in-valve and valve-in-ring procedures: Midterm outcomes in a French nationwide registry. Archives of Cardiovascular Diseases Supplements 2023. [DOI: 10.1016/j.acvdsp.2022.10.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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20
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Garcia R, Marijon E, Karam N, Narayanan K, Anselme F, Césari O, Champ-Rigot L, Manenti V, Martins R, Puymirat E, Ferrières J, Schiele F, Simon T, Danchin N. Ventricular fibrillation in acute myocardial infarction: 20-year trends in the FAST-MI study. Eur Heart J 2022; 43:4887-4896. [PMID: 36303402 DOI: 10.1093/eurheartj/ehac579] [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: 07/21/2020] [Revised: 08/05/2022] [Accepted: 09/29/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Sudden cardiac arrest remains a major complication of acute myocardial infarction (AMI) and is frequently related to ventricular fibrillation (VF). Incidence and impact of VF among patients hospitalized for AMI were evaluated. METHODS AND RESULTS Data from the FAST-MI programme consisting of 5 French nationwide prospective cohort studies between 1995 and 2015 were analysed, totally including 14 423 patients with AMI (66 ± 14 years, 72% males, 59% ST-elevation myocardial infarction). Overall, proportion of patients presenting in-hospital VF decreased from 3.9% in 1995 to 1.8% in 2015 (P < 0.001). One-year mortality decreased from 60.7% to 24.6% (P < 0.001). However, compared with patients who did not develop VF, the over-risk of 1-year mortality associated with VF was stable over time [hazard ratio (HR) 6.78, 95% confidence interval (CI) 5.03-9.14 in 1995 and HR 6.64, 95% CI 4.20-10.49 in 2015, P = 0.52]. This increased mortality in the VF group was mainly related to fatal events occurring prior to hospital discharge, representing 86.2% of 1-year mortality, despite the very low rate of implantable cardioverter defibrillator in the VF group (2.6%). CONCLUSION This study demonstrates that in-hospital VF incidence and mortality in the setting of AMI have significantly decreased over the past 20 years. Nevertheless, VF remained steadily associated with approximately a 10-fold increased relative risk of in-hospital mortality, without an impact on post-discharge mortality. Beyond long-term cardiac defibrillation strategy, these results emphasize the need to identify in-hospital interventions to further reduce mortality in VF patients. STUDY REGISTRATION ClinicalTrials.gov Identifier: NCT00673036, NCT01237418, NCT02566200.
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Affiliation(s)
- Rodrigue Garcia
- Université Paris Cité, Inserm, PARCC, F-75015 Paris, France.,Cardiology Department, CHU Poitiers, 86000 Poitiers, France.,Centre d'Investigation Clinique CIC1402, CHU Poitiers, 86000 Poitiers, France
| | - Eloi Marijon
- Université Paris Cité, Inserm, PARCC, F-75015 Paris, France.,Cardiology Department, European Georges Pompidou Hospital, 75015 Paris, France
| | - Nicole Karam
- Université Paris Cité, Inserm, PARCC, F-75015 Paris, France.,Cardiology Department, European Georges Pompidou Hospital, 75015 Paris, France
| | - Kumar Narayanan
- Cardiology Department, European Georges Pompidou Hospital, 75015 Paris, France.,Cardiology Department, Medicover Hospitals, Hyderabad, Telangana 500081, India
| | | | - Olivier Césari
- Cardiology Department, Clinique Saint-Augustin, 330000 Bordeaux, France
| | | | - Vladimir Manenti
- Cardiology Department, Institut cardiovasculaire Paris Sud, 91300 Massy, France
| | | | - Etienne Puymirat
- Université Paris Cité, Inserm, PARCC, F-75015 Paris, France.,Cardiology Department, European Georges Pompidou Hospital, 75015 Paris, France
| | - Jean Ferrières
- Cardiology Department, Rangueil University Hospital, Toulouse, France
| | - François Schiele
- Cardiology Department, University Hospital Jean Minjoz, Besançon, France
| | - Tabassome Simon
- Clinical Research Unit, Saint-Antoine Hospital, AP-HP, Paris, France
| | - Nicolas Danchin
- Université Paris Cité, Inserm, PARCC, F-75015 Paris, France.,Cardiology Department, European Georges Pompidou Hospital, 75015 Paris, France
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21
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Stolz L, Weckbach LT, Karam N, Kalbacher D, Praz F, Lurz P, Omran H, Iliadis C, Hausleiter J, Näbauer M, Stocker TJ, Doldi PM, Ludwig S, Koell B, Kassar M, Besler C, Unterhuber M, Rommel KP, Pfister R, Eatemadi J, Rudolph V. Invasive Right Ventricular to Pulmonary Artery Coupling in Patients Undergoing Transcatheter Edge-to-Edge Tricuspid Valve Repair. JACC Cardiovasc Imaging 2022; 16:564-566. [PMID: 36526578 DOI: 10.1016/j.jcmg.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/14/2022] [Accepted: 10/19/2022] [Indexed: 12/15/2022]
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22
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Doldi P, Stolz L, Orban M, Karam N, Praz F, Kalbacher D, Lubos E, Braun D, Adamo M, Giannini C, Melica B, Näbauer M, Higuchi S, Wild M, Neuss M, Butter C, Kassar M, Petrescu A, Pfister R, Iliadis C, Unterhuber M, Thiele H, Baldus S, von Bardeleben RS, Schofer N, Hagl C, Petronio AS, Massberg S, Windecker S, Lurz P, Metra M, Hausleiter J. Transcatheter Mitral Valve Repair in Patients With Atrial Functional Mitral Regurgitation. JACC Cardiovasc Imaging 2022; 15:1843-1851. [PMID: 35842361 DOI: 10.1016/j.jcmg.2022.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 12/27/2021] [Revised: 05/02/2022] [Accepted: 05/19/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Among patients with severe functional mitral regurgitation (FMR), atrial functional mitral regurgitation (aFMR) represents an underrecognized entity. Data regarding outcomes after mitral valve transcatheter edge-to-edge repair (M-TEER) in aFMR remain scarce. OBJECTIVES The objective of this study was to analyze the outcome of aFMR patients undergoing M-TEER. METHODS Using patients from the international EuroSMR (European Registry of Transcatheter Repair for Secondary Mitral Regurgitation) registry undergoing M-TEER for FMR, the authors analyzed baseline characteristics and 2-year outcomes in aFMR in comparison to non-aFMR and ventricular FMR. Additionally, the impact of right ventricular dysfunction (RVD) (defined as right ventricular to pulmonary artery uncoupling) on outcome after M-TEER was assessed. RESULTS Among 1,608 FMR patients treated by M-TEER, 126 (7.8%) were categorized as aFMR. All 126 aFMR patients had preserved left ventricular function without regional wall motion abnormalities, left arterial dilatation and Carpentier leaflet motion type I. Procedural success (defined as mitral regurgitation ≤2+ at discharge) was 87.2% (P < 0.001) and New York Heart Association (NYHA) functional class significantly improved during follow-up (NYHA functional class III/IV: 86.5% at baseline to 36.6% at follow-up; P < 0.001). The estimated 2-year survival rate in aFMR patients was 70.4%. Two-year survival did not differ significantly between aFMR, non-aFMR, and ventricular FMR. Besides NYHA functional class IV, RVD was identified as a strong independent predictor for 2-year survival (HR: 2.82 [95% CI: 1.24-6.45]; P = 0.014). CONCLUSIONS aFMR is a frequent cause of FMR and can be effectively treated with M-TEER to improve symptoms at follow-up. Advanced heart failure symptoms and RVD were identified as important risk factors for survival in aFMR patients.
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Affiliation(s)
- Philipp Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Nicole Karam
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Switzerland
| | - Daniel Kalbacher
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Edith Lubos
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - 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
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Bruno Melica
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Portugal
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mirjam Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Michael Neuss
- 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
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Switzerland
| | - Aniela Petrescu
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Matthias Unterhuber
- 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
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | | | - Niklas Schofer
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Germany
| | - Christian Hagl
- Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Stephan Windecker
- Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, 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; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.
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23
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Doldi PM, Stolz L, Kalbacher D, Köll B, Geyer M, Ludwig S, Orban M, Braun D, Weckbach LT, Stocker TJ, Näbauer M, Higuchi S, Ruf T, Da Rocha E Silva J, Wild M, Tence N, Unterhuber M, Schofer N, Petrescu A, Thiele H, Lurz P, Lubos E, von Bardeleben S, Karam N, Samim D, Paradis JM, Iliadis C, Xhepa E, Hagl C, Massberg S, Hausleiter J. Right ventricular dysfunction predicts outcome after transcatheter mitral valve repair for primary mitral valve regurgitation. Eur J Heart Fail 2022; 24:2162-2171. [PMID: 36054557 DOI: 10.1002/ejhf.2661] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 07/18/2022] [Revised: 08/09/2022] [Accepted: 08/20/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Right ventricular dysfunction (RVD), as expressed by right ventricular to pulmonary artery coupling, has recently been identified as a strong outcome predictor in patients undergoing mitral valve edge-to-edge repair (M-TEER) for secondary mitral regurgitation (MR). The aim of this study was to define RVD in patients undergoing M-TEER for primary MR (PMR) and to evaluate its impact on procedural MR reduction, symptomatic development and 2-year all-cause mortality. METHODS AND RESULTS This multicentre study included patients undergoing M-TEER for symptomatic PMR at nine international centres. The study cohort was divided into a derivation (DC) and validation cohort (VC) for calculation and validation of the best discriminatory value for RVD. A total of 648 PMR patients were included in the study. DC and VC were comparable regarding procedural success and outcomes at follow-up. Sensitivity analysis identified RVD as an independent predictor for 2-year mortality in the DC (hazard ratio [HR] 2.37, 95% confidence interval [CI] 1.47-3.81, p < 0.001), which was confirmed in the VC (HR 2.06, 95% CI 1.36-3.13, p < 0.001). Procedural success (MR ≤2+) and symptomatic improvement at follow-up (New York Heart Association [NYHA] class ≤II) were lower in PMR patients with RVD (MR ≤2+: 82% vs. 93%, p = 0.002; NYHA class ≤II: 57.3% vs. 66.5%, p = 0.09 for with vs. without RVD). In all PMR patients, the presence of RVD significantly impaired 2-year survival after M-TEER (HR 2.23, 95% CI 1.63-3.05, p < 0.001). CONCLUSIONS Mitral valve edge-to-edge repair is an effective treatment option for PMR patients. The presence of RVD is associated with less MR reduction, less symptomatic improvement and increased 2-year mortality. Accordingly, RVD might be included into pre-procedural prognostic considerations.
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Affiliation(s)
- Philipp M Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Benedikt Köll
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Martin Geyer
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Sebastian Ludwig
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Ludwig T Weckbach
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Tobias Ruf
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | | | - Mirjam Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Noemie Tence
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Germany
| | - Aniela Petrescu
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Edith Lubos
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Nicole Karam
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Daryoush Samim
- Universitätsklinik für Kardiologie, Bern University Hospital, Inselspital Bern, Switzerland
| | - Jean-Michel Paradis
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Canada
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Erion Xhepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany
| | - Christian Hagl
- Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany.,Herzchirurgische Klinik und Poliklinik, Klinikum der Universität München, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
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24
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Higuchi S, Orban M, Adamo M, Giannini C, Melica B, Karam N, Praz F, Kalbacher D, Koell B, Stolz L, Braun D, Näbauer M, Wild M, Doldi P, Neuss M, Butter C, Kassar M, Ruf T, Petrescu A, Ludwig S, Pfister R, Iliadis C, Unterhuber M, Sampaio F, Ferreira D, Thiele H, Baldus S, von Bardeleben RS, Massberg S, Windecker S, Lurz P, Petronio AS, Lindenfeld J, Abraham WT, Metra M, Hausleiter J. Guideline-directed medical therapy in patients undergoing transcatheter edge-to-edge repair for secondary mitral regurgitation. Eur J Heart Fail 2022; 24:2152-2161. [PMID: 35791663 DOI: 10.1002/ejhf.2613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 04/25/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023] Open
Abstract
AIMS Guideline-directed medical therapy (GDMT), based on the combination of beta-blockers (BB), renin-angiotensin system inhibitors (RASI), and mineralocorticoid receptor antagonists (MRA), is known to have a major impact on the outcome of patients with heart failure with reduced ejection fraction (HFrEF). Although GDMT is recommended prior to mitral valve transcatheter edge-to-edge repair (M-TEER), not all patients tolerate it. We studied the association of GDMT prescription with survival in HFrEF patients undergoing M-TEER for secondary mitral regurgitation (SMR). METHODS AND RESULTS EuroSMR, a European multicentre registry, included SMR patients with left ventricular ejection fraction <50%. The outcome was 2-year all-cause mortality. Of 1344 patients, BB, RASI, and MRA were prescribed in 1169 (87%), 1012 (75%), and 765 (57%) patients at the time of M-TEER, respectively. Triple GDMT prescription was associated with a lower 2-year all-cause mortality compared to non-triple GDMT (hazard ratio [HR] 0.74; 95% confidence interval [CI] 0.60-0.91). The association persisted in patients with glomerular filtration rate <30 ml/min, ischaemic aetiology, or right ventricular dysfunction. Further, a positive impact of triple GDMT prescription on survival was observed in patients with residual mitral regurgitation of ≥2+ (HR 0.62; 95% CI 0.44-0.86), but not in patients with residual mitral regurgitation of ≤1+ (HR 0.83; 95% CI 0.64-1.08). CONCLUSION Triple GDMT prescription is associated with higher 2-year survival after M-TEER in HFrEF patients with SMR. This association was consistent also in patients with major comorbidities or non-optimal results after M-TEER.
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Affiliation(s)
- Satoshi Higuchi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - 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
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Bruno Melica
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Nicole Karam
- Paris University, PARCC, INSERM, F-75015, European Hospital Georges Pompidou, Paris, France
| | - Fabien Praz
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Daniel Kalbacher
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Lübeck/Kiel, Hamburg, Germany
| | - Benedikt Koell
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Daniel Braun
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Michael Näbauer
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Mirjam Wild
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Philipp Doldi
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Michael Neuss
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Christian Butter
- Herzzentrum Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Bernau, Germany
| | - Mohammad Kassar
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Tobias Ruf
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Aniela Petrescu
- Zentrum für Kardiologie, Johannes Gutenberg-Universität, Mainz, Germany
| | - Sebastian Ludwig
- Universitäres Herz- und Gefäßzentrum Hamburg, Klinik für Kardiologie, Hamburg, Germany
| | - Roman Pfister
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Christos Iliadis
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Francisco Sampaio
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Diogo Ferreira
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Stephan Baldus
- Department III of Internal Medicine, Heart Center, University of Cologne, Cologne, Germany
| | | | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
| | - Stephan Windecker
- Universitätsklinik für Kardiologie, Inselspital Bern, Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - JoAnn Lindenfeld
- Department of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - 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.,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
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25
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Lascarrou JB, Dumas F, Bougouin W, Legriel S, Aissaoui N, Deye N, Beganton F, Lamhaut L, Jost D, Vieillard-Baron A, Nichol G, Marijon E, Jouven X, Cariou A, Agostinucci J, Aissaoui-Balanant N, Algalarrondo V, Alla F, Alonso C, Amara W, Annane D, Antoine C, Aubry P, Azoulay E, Beganton F, Billon C, Bougouin W, Boutet J, Bruel C, Bruneval P, Cariou A, Carli P, Casalino E, Cerf C, Chaib A, Cholley B, Cohen Y, Combes A, Coulaud J, Da Silva D, Das V, Demoule A, Denjoy I, Deye N, Diehl J, Dinanian S, Domanski L, Dreyfuss D, Dubois-Rande J, Dumas F, Duranteau J, Empana J, Extramiana F, Fagon J, Fartoukh M, Fieux F, Gandjbakhch E, Geri G, Guidet B, Halimi F, Henry P, Jabre P, Joseph L, Jost D, Jouven X, Karam N, Lacotte J, Lahlou-Laforet K, Lamhaut L, Lanceleur A, Langeron O, Lavergne T, Lecarpentier E, Leenhardt A, Lellouche N, Lemiale V, Lemoine F, Linval F, Loeb T, Ludes B, Luyt C, Mansencal N, Mansouri N, Marijon E, Maury E, Maxime V, Megarbane B, Mekontso-Dessap A, Mentec H, Mira J, Monnet X, Narayanan K, Ngoyi N, Perier M, Piot O, Plaisance P, Plaud B, Plu I, Raphalen J, Raux M, Revaux F, Ricard J, Richard C, Riou B, Roussin F, Santoli F, Schortgen F, Sharshar T, Sideris G, Spaulding C, Teboul J, Timsit J, Tourtier J, Tuppin P, Ursat C, Varenne O, Vieillard-Baron A, Voicu S, Wahbi K, Waldmann V. Differential Effect of Targeted Temperature Management Between 32 °C and 36 °C Following Cardiac Arrest According to Initial Severity of Illness: Insights From Two International Data Sets. Chest 2022; 163:1120-1129. [PMID: 36445800 DOI: 10.1016/j.chest.2022.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Recent guidelines have emphasized actively avoiding fever to improve outcomes in patients who are comatose following resuscitation from cardiac arrest (ie, out-of-hospital cardiac arrest). However, whether targeted temperature management between 32 °C and 36 °C (TTM32-36) can improve neurologic outcome in some patients remains debated. RESEARCH QUESTION Is there an association between the use of TTM32-36 and outcome according to severity assessed at ICU admission using a previously derived risk score? STUDY DESIGN AND METHODS Data prospectively collected in the Sudden Death Expertise Center (SDEC) registry (France) between May 2011 and December 2017 and in the Resuscitation Outcomes Consortium Continuous Chest Compressions (ROC-CCC) trial (United States and Canada) between June 2011 and May 2015 were used for this study. Severity at ICU admission was assessed through a modified version of the Cardiac Arrest Hospital Prognosis (mCAHP) score, divided into tertiles of severity. The study explored associations between TTM32-36 and favorable neurologic status at hospital discharge by using multiple logistic regression as well as in tertiles of severity for each data set. RESULTS A total of 2,723 patients were analyzed in the SDEC data set and 4,202 patients in the ROC-CCC data set. A favorable neurologic status at hospital discharge occurred in 728 (27%) patients in the French data set and in 1,239 (29%) patients in the North American data set. Among the French data set, TTM32-36 was independently associated with better neurologic outcome in the tertile of patients with low (adjusted OR, 1.63; 95% CI, 1.15-2.30; P = .006) and high (adjusted OR, 1.94; 95% CI, 1.06-3.54; P = .030) severity according to mCAHP at ICU admission. Similar results were observed in the North American data set (adjusted ORs of 1.36 [95% CI, 1.05-1.75; P = .020] and 2.42 [95% CI, 1.38-4.24; P = .002], respectively). No association was observed between TTM32-36 and outcome in the moderate groups of the two data sets. INTERPRETATION TTM32-36 was significantly associated with a better outcome in patients with low and high severity at ICU admission assessed according to the mCAHP score. Further studies are needed to evaluate individualized temperature control following out-of-hospital cardiac arrest.
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Affiliation(s)
- Jean Baptiste Lascarrou
- Université Paris Cité, INSERM, PARCC, Paris, France; Médecine Intensive Réanimation, University Hospital Center, Nantes, France; AfterROSC Network Group, Paris, France.
| | - Florence Dumas
- Université Paris Cité, INSERM, PARCC, Paris, France; Emergency Department, Cochin University Hospital, APHP, Paris, France
| | - Wulfran Bougouin
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical-Surgical Intensive Care Unit, Hopital Privé Jacques Cartier, Massy, France
| | - Stephane Legriel
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Surgical Intensive Care Unit, Mignot Hospital, Le Chesnay, France
| | - Nadia Aissaoui
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
| | - Nicolas Deye
- AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Lariboisière University Hospital, INSERM U942, Paris, France
| | | | - Lionel Lamhaut
- AfterROSC Network Group, Paris, France; SAMU de Paris-DAR Necker University Hospital-Assistance, Paris, France
| | - Daniel Jost
- Brigade des Sapeurs-Pompiers de Paris, Paris, France
| | - Antoine Vieillard-Baron
- Medical Intensive Care Unit, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt, France
| | - Graham Nichol
- University of Washington-Harborview Center for Prehospital Emergency Care, University of Washington, Seattle, WA
| | - Eloi Marijon
- Université Paris Cité, INSERM, PARCC, Paris, France
| | | | - Alain Cariou
- Université Paris Cité, INSERM, PARCC, Paris, France; AfterROSC Network Group, Paris, France; Medical Intensive Care Unit, Cochin Hospital (APHP) and University of Paris, Paris, France
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Bohm P, Meyer T, Narayanan K, Schindler M, Weizman O, Beganton F, Schmied C, Bougouin W, Barra S, Dumas F, Varenne O, Cariou A, Karam N, Jouven X, Marijon E. Sports-related sudden cardiac arrest in young adults. Europace 2022; 25:627-633. [PMID: 36256586 PMCID: PMC9935050 DOI: 10.1093/europace/euac172] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 04/11/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS Data on sports-related sudden cardiac arrest (SrSCA) among young adults in the general population are scarce. We aimed to determine the overall SrSCA incidence, characteristics, and outcomes in young adults. METHODS AND RESULTS Prospective cohort study of all cases of SrSCA between 2012 and 2019 in Germany and Paris area, France, involving subjects aged 18-35 years. Detection of SrSCA was achieved via multiple sources, including emergency medical services (EMS) reporting and web-based screening of media releases. Cases and aetiologies were centrally adjudicated. Overall, a total of 147 SrSCA (mean age 28.1 ± 4.8 years, 95.2% males) occurred, with an overall burden of 4.77 [95% confidence interval (CI) 2.85-6.68] cases per million-year, including 12 (8.2%) cases in young competitive athletes. While bystander cardiopulmonary resuscitation (CPR) was initiated in 114 (82.6%), automated external defibrillator (AED) use by bystanders occurred only in a minority (7.5%). Public AED use prior to EMS arrival (odds ratio 6.25, 95% CI 1.48-43.20, P = 0.02) was the strongest independent predictor of survival at hospital discharge (38.1%). Among cases that benefited from both immediate bystander CPR and AED use, survival rate was 90.9%. Coronary artery disease was the most frequent aetiology (25.8%), mainly through acute coronary syndrome (86.9%). CONCLUSION Sports-related sudden cardiac arrest in the young occurs mainly in recreational male sports participants. Public AED use remains disappointingly low, although survival may reach 90% among those who benefit from both bystander CPR and early defibrillation. Coronary artery disease is the most prevalent cause of SrSCA in young adults.
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Affiliation(s)
- Philipp Bohm
- Institute of Sports and Preventive Medicine, Saarland University, 66123 Saarbrücken, Germany,Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, 66123 Saarbrücken, Germany
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Cardiology Department, Medicover Hospitals, Madhapur, Hyderabad, Telangana 500081, India
| | - Matthias Schindler
- Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Orianne Weizman
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Frankie Beganton
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Christian Schmied
- Department of Cardiology, University Heart Center Zurich, HerzZentrum Hirslanden Zurich Witellikerstrasse 36, CH-8008 Zurich, Switzerland
| | - Wulfran Bougouin
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France
| | - Sergio Barra
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Cardiology Department, Hospital da Luz Arrábida, V. N. PCT de Henrique Moreira 150, 4400-346 Vila Nova de Gaia, Portugal
| | - Florence Dumas
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Emergency Department, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Olivier Varenne
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Cardiology Department, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Alain Cariou
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,Intensive Care Unit, Jacques cartier Hospital, 6 Av. du Noyer Lambert, 91300 Massy, France,Intensive Care Unit, Cochin Hospital, 25 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Nicole Karam
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,University of Paris, 103, Boulevard Saint-Michel, Paris, France,Cardiology Department, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Xavier Jouven
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France,University of Paris, 103, Boulevard Saint-Michel, Paris, France,Cardiology Department, European Georges Pompidou Hospital, 20 rue Leblanc, 75015 Paris, France
| | - Eloi Marijon
- Corresponding author. Tel: +33 6 6283 3848; fax: +33 1 5609 3047. E-mail address:
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Guerin P, Jalal Z, Cueff C, Hascoet S, Bouvaist H, Levy F, Hugues N, Ladouceur M, Malekzadeh-Milani SG, Iriart X, Silini A, Karam N, Iserin L, Le Gloan L, Thambo JB. Percutaneous edge-to-edge repair for systemic tricuspid valve regurgitation in patients with congenital heart disease: the first descriptive cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1834] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
In patients with congenital heart diseases (CHD) systemic tricuspid regurgitation (STR) is frequent.
Here, we report our experience with percutaneous edge-to-edge repair (PETER) in a series of 12 CHD patients with STR using the MitraClip system.
Twelve patients (median age = 35 years, 83% males) with severe STR (ccTGA (n=5), asTGA (n=3), SV (n=4)), at high-risk for surgical treatment, gave informed consent for treatment using PETER. The XTR MitraClip device (Abbott, Santa Clara, CA) was used. At baseline, 7/12 patients were in NYHA functional class ≥ III. Standard femoral venous access was successfully used in 10/12 patients. In SV patients, the systemic valve was accessed directly through the right atrium (n=2), after a Fontan conduit puncture (n=1), or after direct atrial surgical access (n=1). In TGA patients, either transseptal (ccTGA patients, n=4) or transbaffle (asTGA patients, n=3) puncture was performed (4).
Mitraclip devices were successfully implanted in 11/12 patients (Figure 1). One procedural complication was reported for a patient with SV in whom a septal leaflet rupture occurred following clip release, leading to severe STR; the patient died from refractory cardiac failure one week later. Peri-procedural complications included one case of left femoral vein injury and one case of atrial flutter treated by catheter ablation. After a median follow-up of 12-months (range 1–25) following device implantation, no death had occurred. The patients had significant reduction in STR (from severe to moderate in 10/11 patients) and clinically improved (10/11 patients were in NYHA class I or II).
To conclude, percutaneous edge-to-edge therapy of STR in CHD patients is feasible, safe and effective to reduce STR and SRV dilatation. This reduction is associated with a significant clinical improvement.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- P Guerin
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec , Nantes , France
| | - Z Jalal
- Haut-Leveque Hospital - University Hospital Centre, Department of Pediatric and Adult Congenital cardiology , Pessac , France
| | - C Cueff
- University Hospital of Nantes - Hospital Guillaume & Rene Laennec , Nantes , France
| | - S Hascoet
- Surgical Centre Marie Lannelongue, Departmentof Pediatric and Adult Congenital cardiology , Le Plessis Robinson , France
| | - H Bouvaist
- University Hospital of Grenoble, Interventional Cardiology , Grenoble , France
| | - F Levy
- Cardio-Thoracic Center of Monaco, Interventional Cardiology , Monaco , Monaco
| | - N Hugues
- Cardio-Thoracic Center of Monaco, Interventional Cardiology , Monaco , Monaco
| | - M Ladouceur
- Hopital Europeen Georges Pompidou- University Paris Descartes, Department of Cardiology, Adult Congenital Heart Disease Unit , Paris , France
| | - S G Malekzadeh-Milani
- Hopital Europeen Georges Pompidou- University Paris Descartes, Department of Cardiology, Adult Congenital Heart Disease Unit , Paris , France
| | - X Iriart
- Haut-Leveque Hospital - University Hospital Centre, Department of Pediatric and Adult Congenital cardiology , Pessac , France
| | - A Silini
- Haut-Leveque Hospital - University Hospital Centre, Department of Pediatric and Adult Congenital cardiology , Pessac , France
| | - N Karam
- Georges Pompidou APHP Site of Paris Ouest University Hospital, Department of Cardiology , Paris , France
| | - L Iserin
- Hopital Europeen Georges Pompidou- University Paris Descartes, Department of Cardiology, Adult Congenital Heart Disease Unit , Paris , France
| | - L Le Gloan
- Hospital G.R. Laennec - University Hospital Centre of Nantes, Adult Congenital Heart Disease Unit , St Herblain , France
| | - J B Thambo
- Haut-Leveque Hospital - University Hospital Centre, Department of Pediatric and Adult Congenital cardiology , Pessac , France
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28
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Stolz L, Karam N, Von Bardeleben RS, Pfister R, Petronio A, Butter C, Melica B, Praz F, Massberg S, Kalbacher D, Lurz P, Adamo M, Metra M, Bax JJ, Hausleiter J. Staging heart failure patients with secondary mitral regurgitation undergoing transcatheter edge-to-edge repair. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2124] [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] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heart failure with reduced ejection fraction (HFrEF) and secondary mitral regurgitation (SMR) are closely related. Progression of HFrEF-SMR is associated with characteristic pathophysiological changes. Recently, staging of HFrEF-SMR patients showed prognostic value in a SMR cohort on medical therapy. Whether these stages are prognostic for SMR patients undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) in addition to drug therapy is unknown.
Purpose
The present study aimed at classifying HFrEF-SMR patients undergoing M-TEER into progressive disease stages based on cardiac and extracardiac involvement. We sought to evaluate the impact of the disease stages on survival outcome and symptomatic improvement after M-TEER
Methods
Based on echocardiographic transthoracic evaluation, patients were assigned into one of the following subsequent HFrEF-SMR stages representing disease progression (Figure 1): left ventricular (LV) dysfunction alone (Stage 1, LV end diastolic volume ≥159 ml and/or LV ejection fraction <50%); left atrial (LA) involvement (Stage 2, history of atrial fibrillation and/or indexed LA volume >34 ml/m2); right ventricular (RV) pressure/volume overload (Stage 3, tricuspid regurgitation ≥3+ and/or systolic pulmonary artery pressure >65 mmHg); biventricular failure (Stage 4, RV to pulmonary artery coupling <0.274 mm/mmHg). A Cox regression model was implemented to investigate the impact of HFrEF-SMR stages on two-year all-cause mortality and symptomatic outcome was assessed with New York Heart Association (NYHA) functional class at follow-up.
Results
Among a total of 849 included patients who underwent M-TEER for symptomatic MR from 2008 until 2019, 9.5% (n=81) presented with LV dysfunction alone, 46% (n=393) with LA involvement, 15% (n=129) with pressure/volume overload and 29% (n=246) with biventricular failure. At baseline and follow-up, successive HFrEF-SMR stages were associated with more severe heart failure symptoms as expressed by NYHA functional class. An increase in HFrEF-SMR stage was associated with increased two-year all-cause mortality rates after M-TEER (Hazard ratio 1.39, confidence interval 1.23–1.58, p<0.01, Figure 2).
Conclusions
Classifying HFrEF-SMR patients undergoing M-TEER into subsequent disease stages provides prognostic value regarding heart failure symptoms and survival.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Stolz
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - N Karam
- European Hospital Georges Pompidou, Department of Cardiology , Paris , France
| | - R S Von Bardeleben
- Johannes Gutenberg University Mainz (JGU), Department of Cardiology , Mainz , Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Department of Cardiology , Cologne , Germany
| | - A Petronio
- University of Pisa, Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department , Pisa , Italy
| | - C Butter
- Brandenburg Heart Center, Department of Cardiology , Bernau bei Berlin , Germany
| | - B Melica
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology , Vila Nova de Gaia , Portugal
| | - F Praz
- Inselspital - University of Bern, Department of Cardiology , Bern , Switzerland
| | - S Massberg
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
| | - D Kalbacher
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - P Lurz
- Heart Center of Leipzig, Department of Cardiology , Leipzig , Germany
| | - M Adamo
- University of Brescia, Cardiac Catheterization Laboratory and Cardiology , Brescia , Italy
| | - M Metra
- University of Brescia, Cardiac Catheterization Laboratory and Cardiology , Brescia , Italy
| | - J J Bax
- Leiden University Medical Center, Department of Cardiology , Leiden , The Netherlands
| | - J Hausleiter
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I , Munich , Germany
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29
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Masiero G, Paradies V, Franzone A, Bellini B, De Biase C, Karam N, Sanguineti F, Mamas MA, Eltchaninoff H, Fraccaro C, Castiglioni B, Attisano T, Esposito G, Chieffo A. Sex-Specific Considerations in Degenerative Aortic Stenosis for Female-Tailored Transfemoral Aortic Valve Implantation Management. J Am Heart Assoc 2022; 11:e025944. [PMID: 36172929 DOI: 10.1161/jaha.121.025944] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The impact of sex on pathophysiological processes, clinical presentation, treatment options, as well as outcomes of degenerative aortic stenosis remain poorly understood. Female patients are well represented in transfemoral aortic valve implantation (TAVI) trials and appear to derive favorable outcomes with TAVI. However, higher incidences of major bleeding, vascular complications, and stroke have been reported in women following TAVI. The anatomical characteristics and pathophysiological features of aortic stenosis in women might guide a tailored planning of the percutaneous approach. We highlight whether a sex-based TAVI management strategy might impact on clinical outcomes. This review aimed to evaluate the impact of sex from diagnosis to treatment of degenerative aortic stenosis, discussing the latest evidence on epidemiology, pathophysiology, clinical presentation, therapeutic options, and outcomes. Furthermore, we focused on technical sex-oriented considerations in TAVI including the preprocedural screening, device selection, implantation strategy, and postprocedural management.
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Affiliation(s)
- Giulia Masiero
- Department of Cardiac, Thoracic Vascular Science and Public Health, University of Padova Italy
| | - Valeria Paradies
- Department of Cardiology Maasstad Hospital Rotterdam The Netherlands
| | - Anna Franzone
- Department of Advanced Biomedical Sciences Federico II University of Naples Italy
| | - Barbara Bellini
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel Clinique Pasteur Toulouse France
| | - Nicole Karam
- Cardiology Department European Hospital Georges Pompidou Paris France
| | | | - Mamas A Mamas
- Keele Cardiovascular Research Group School of Medicine, Keele University Stoke-on-Trent United Kingdom.,Department of Cardiology Royal Stoke University Hospital Stoke-on-Trent United Kingdom.,Department of Medicine Thomas Jefferson University Philadelphia PA
| | | | - Chiara Fraccaro
- Department of Cardiac, Thoracic Vascular Science and Public Health, University of Padova Italy
| | | | - Tiziana Attisano
- Division of Interventional Cardiology Cardiovascular and Thoracic Department, San Giovanni di Dio e Ruggi Salerno Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences Federico II University of Naples Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit IRCCS San Raffaele Scientific Institute Milan Italy
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30
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Sharifzadehgan A, Gaye B, Rischard J, Bougouin W, Karam N, Waldmann V, Narayanan K, Dumas F, Gandjbakhch E, Algalarrondo V, Beganton F, Extramiana F, Lellouche N, Lamhaut L, Jost D, Cariou A, Jouven X, Marijon E. Characteristics and factors associated to patients discharging from hospital without an implantable cardioverter defibrillator after out-of-hospital cardiac arrest. Eur Heart J Acute Cardiovasc Care 2022; 11:523-531. [PMID: 35714122 DOI: 10.1093/ehjacc/zuac065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/25/2022] [Revised: 04/25/2022] [Accepted: 05/17/2022] [Indexed: 06/15/2023]
Abstract
AIMS Guidelines recommend that in the absence of reversible cause for sudden cardiac arrest (SCA), implantable cardioverter defibrillator (ICD) should be performed to prevent further fatal event. We sought to describe the frequency and characteristics of patients discharged from the hospital without ICD after the SCA in the daily practice. METHODS AND RESULTS From 2011 to 2018, all SCAs related to a cardiac cause admitted alive across the 48 hospitals of Great Paris Area were prospectively enrolled. Two investigators thoroughly reviewed each medical report to ensure accuracy of the assigned diagnosis towards identifying the cause of SCA and ICD implantation. Out of the 4314 SCA admitted alive at hospital admission, 1064 cardiac-related SCA survivors were discharged alive from hospital, including 356 patients (33.5%) with an ICD and 708 (66.5%) without. The principal underlying cause of SCA among those discharged without an ICD was acute coronary syndrome (ACS; 602, 85%), chronic coronary artery disease (41, 5.8%), structural non-ischaemic heart disease (48, 6.8%), and non-structural heart disease (17, 2.4%). Among ACS-related SCA, 93.8% (602/642) discharged without an ICD. The unique factor associated with non-ICD implantation in the setting of ACS was immediate coronary angioplasty (odds ratio 4.22, 95% confidence interval 1.86-9.30, P < 0.001). CONCLUSION Two-thirds of SCA survivors were discharged without an ICD, mainly in the setting of ACS. The unique factor associated with non-ICD implantation among ACS was immediate coronary angioplasty emphasizing the fact that ACS definition must be precise since associated with ICD implantation or not.
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Affiliation(s)
- Ardalan Sharifzadehgan
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Bamba Gaye
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Julien Rischard
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Wulfran Bougouin
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
- Jacques Cartier Hospital, Intensive Care Unit, Massy, France
| | - Nicole Karam
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Victor Waldmann
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Medicover Hospitals, Cardiology Department, Hyderabad, India
| | - Florence Dumas
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
- Cochin Hospital, Emergency Department, Paris, France
| | - Estelle Gandjbakhch
- La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), Paris, France
| | - Vincent Algalarrondo
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), Paris, France
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Frankie Beganton
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | - Fabrice Extramiana
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), Paris, France
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France
| | - Nicolas Lellouche
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), Paris, France
- University Hospital Henri Mondor, Cardiology Department, Crèteil, France
| | - Lionel Lamhaut
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
- Paris Firefighters Brigade (BSPP), Paris, France
| | - Daniel Jost
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Paris Firefighters Brigade (BSPP), Paris, France
| | - Alain Cariou
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
- Cochin Hospital, Intensive Care Unit, Paris, France
| | - Xavier Jouven
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Eloi Marijon
- European Georges Pompidou Hospital, Cardiology Department, Paris, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
- Université Paris Cité, Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.), Paris, France
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31
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Sharifzadehgan A, Gaye B, Bougouin W, Narayanan K, Dumas F, Karam N, Rischard J, Plu I, Waldmann V, Algalarrondo V, Gandjbakhch E, Bruneval P, Beganton Date Curation F, Alonso C, Moubarak G, Piot O, Lamhaut L, Jost D, Sideris G, Mansencal N, Deye N, Voicu S, Megarbane B, Geri G, Vieillard-Baron A, Lellouche N, Extramiana F, Wahbi K, Varenne O, Cariou A, Jouven X, Marijon E. Lack of Early Etiologic Investigations in Young Sudden Cardiac Death. Resuscitation 2022; 179:197-205. [PMID: 35788021 DOI: 10.1016/j.resuscitation.2022.06.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/09/2022] [Accepted: 06/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Since majority of sudden cardiac arrest (SCA) victims die in the intensive care unit (ICU), early etiologic investigations may improve understanding of SCA and targeted prevention. METHODS In this prospective, population-based registry all SCA admitted alive across the 48 hospitals of the Paris area were enrolled. We investigated the extent of early etiologic work-up among young SCD cases (<45 years) eventually dying within the ICU. RESULTS From May 2011 to May 2018, 4,314 SCA patients were admitted alive. Among them, 3,044 died in ICU, including 484 (15.9%) young patients. SCA etiology was established in 233 (48.1%) and remained unexplained in 251 (51.9%). Among unexplained (compared to explained) cases, coronary angiography (17.9 vs. 49.4%, P<0.001), computed tomography scan (24.7 vs. 46.8%, P<0.001) and trans-thoracic echocardiography (31.1 vs. 56.7%, P<0.001) were less frequently performed. Only 22 (8.8%) patients with unexplained SCD underwent all three investigations. SCDs with unexplained status decreased significantly over the 7 years of the study period (from 62.9 to 35.2%, P=0.005). While specialized TTE and CT scan performances have increased significantly, performance of early coronary angiography did not change. Autopsy, genetic analysis and family screening were performed in only 48 (9.9%), 5 (1.0%) and 14 cases (2.9%) respectively. CONCLUSIONS More than half of young SCD dying in ICU remained etiologically unexplained; this was associated with a lack of early investigations. Improving early diagnosis may enhance both SCA understanding and prevention, including for relatives. Failure to identify familial conditions may result in other preventable deaths within these families.
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Affiliation(s)
- Ardalan Sharifzadehgan
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France.
| | - Bamba Gaye
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Wulfran Bougouin
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Jacques Cartier Hospital, Intensive Care Unit, Massy, France
| | - Kumar Narayanan
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Medicover Hospitals, Cardiology Department, Hyderabad, India
| | - Florence Dumas
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Cochin Hospital, Emergency Department, Paris, France
| | - Nicole Karam
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Julien Rischard
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France
| | | | - Victor Waldmann
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Vincent Algalarrondo
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Estelle Gandjbakhch
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.); La Pitié Salpêtrière University Hospital, Cardiology Department, Paris, France
| | - Patrick Bruneval
- University of Paris, Paris, France; European Georges Pompidou Hospital, Pathology Department, Paris, France
| | | | - Christine Alonso
- Centres Médico Chirurgicaux Ambroise Paré, Neuilly-sur-Seine, France
| | - Ghassan Moubarak
- Centres Médico Chirurgicaux Ambroise Paré, Neuilly-sur-Seine, France
| | - Olivier Piot
- Centre Cardiologique du Nord, Saint Denis, France
| | - Lionel Lamhaut
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Emergency Medical Services (SAMU) 75, Necker University Hospital, APHP, Paris, France
| | - Daniel Jost
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Firefighters Brigade (BSPP), Paris, France
| | | | - Nicolas Mansencal
- Ambroise Paré Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Nicolas Deye
- Lariboisiere Hospital, Intensive Care Unit, Paris, France
| | | | | | - Guillaume Geri
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Ambroise Paré Hospital, Intensive Care Unit, Paris, France
| | | | - Nicolas Lellouche
- University Hospital Henri Mondor, Cardiology Department, Créteil, France
| | - Fabrice Extramiana
- Bichat-Claude-Bernard Hospital, Cardiology Department, Paris, France; Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Karim Wahbi
- University of Paris, Paris, France; Cochin Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Olivier Varenne
- University of Paris, Paris, France; Cochin Hospital, Cardiology Intensive Care Unit, Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France; Cochin Hospital, Intensive Care Unit, Paris, France
| | - Xavier Jouven
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
| | - Eloi Marijon
- European Georges Pompidou Hospital, Cardiology Department, Paris, France; Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; University of Paris, Paris, France
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Cardiovasc Res 2022; 118:1618-1666. [PMID: 34864876 PMCID: PMC8690236 DOI: 10.1093/cvr/cvab343] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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Lavignasse D, Lemoine S, Karam N, Gaye B, Bougouin W, Beganton F, Jabre P, Loeb T, Agostinucci JM, Dumas F, Lecarpentier E, Jost D, Cariou A, Marijon E, Empana JP, Jouven X. Does age influence out-of-hospital cardiac arrest incidence and outcomes among women? Insights from the Paris SDEC. Eur Heart J Acute Cardiovasc Care 2022; 11:293-302. [PMID: 35415752 DOI: 10.1093/ehjacc/zuac028] [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: 01/07/2022] [Revised: 02/15/2022] [Indexed: 06/14/2023]
Abstract
AIMS Age and sex disparities in out-of-hospital cardiac arrest (OHCA) have been described. Reproductive age may have a protected effect on females vs. males, although results are conflicting. We aimed to clarify this using the Paris Sudden Death Expertise Centre (SDEC) registry. METHODS AND RESULTS The Paris SDEC registry collects OHCAs occurring in the Greater Paris Area. We included all OHCAs of presumed cardiac causes occurring between 2013 and 2018. Patients were divided into age groups: 1-13, 13-50, 50-75, and >75 years. Sex and age disparities in OHCA incidence and outcomes were analysed using multivariable negative binomial and logistic regression models. There were 19 782 OHCAs meeting inclusion criteria: 0.37% aged 1-13 years, 12.4% aged 13-50 years, 40.4% aged 50-75 years, and 46.9% aged >75 years. Adjusted incidence rate ratios (IRRs) in females vs. males were for the youngest to the older age groups: 1.29 [95% confidence interval (CI) 0.78-2.13], 0.54 [0.49-0.59], 0.60 [0.56-0.64], and 0.75 [0.67-0.84]. At reproductive age, females were more likely than males to have a return of spontaneous circulation [adjusted odds ratio (OR) 1.60 (1.27-2.02)], to be alive at hospital admission [OR: 1.49 (1.18-1.89)]. In both sexes, patients aged 13-50 years were more likely to survive at hospital discharge than those aged 50-75 years [males: OR 1.81 (1.49-2.20), females: 2.24 (1.54-3.25)]. However, at reproductive age, no sex disparity was observed in survival at hospital discharge [OR: 1.16 (0.75-1.80)]. CONCLUSION Incidence rate ratios were similar between pre- and post-menopausal aged patients. At reproductive age, no sex disparity in survival at hospital discharge was observed, suggesting that menopausal status may not influence OHCA occurrence and prognosis.
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Affiliation(s)
- Delphine Lavignasse
- Paris Cardiovascular Research Center, University of Paris, INSERM Unit 970, 56 Leblanc street, 75015 Paris, France
| | - Sabine Lemoine
- Brigade des Sapeurs-Pompiers de Paris (BSPP), 1 place Jules Renard, 75017 Paris, France
| | - Nicole Karam
- Paris Cardiovascular Research Center, University of Paris, INSERM Unit 970, 56 Leblanc street, 75015 Paris, France
- Department of Cardiology, European Georges Pompidou Hospital, APHP, 20 Leblanc street, 75015 Paris, France
| | - Bamba Gaye
- Paris Cardiovascular Research Center, University of Paris, INSERM Unit 970, 56 Leblanc street, 75015 Paris, France
| | - Wulfran Bougouin
- Paris Cardiovascular Research Center, University of Paris, INSERM Unit 970, 56 Leblanc street, 75015 Paris, France
- Medical Surgical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, 6 Noyer Lambert avenue, 91300 Massy, France
| | - Frankie Beganton
- Paris Cardiovascular Research Center, University of Paris, INSERM Unit 970, 56 Leblanc street, 75015 Paris, France
| | - Patricia Jabre
- Paris Cardiovascular Research Center, University of Paris, INSERM Unit 970, 56 Leblanc street, 75015 Paris, France
- Emergency Medical Services, SAMU 75, Necker Enfants Malades Hospital, APHP, 11 rue de Sèvres, 75015 Paris, France
| | - Thomas Loeb
- Emergency Medical Services, SAMU 92, Raymond Poincaré Hospital, APHP, 104, Raymond-Poincaré boulevard, 92380 Garches, France
| | - Jean-Marc Agostinucci
- Emergency Medical Services, SAMU 93, Hôpital Avicenne, APHP, 125 Stalingrad street, 93000 Bobigny, France
| | - Florence Dumas
- Paris Cardiovascular Research Center, University of Paris, INSERM Unit 970, 56 Leblanc street, 75015 Paris, France
- Emergency Department, Cochin-Hotel-Dieu Hospital, APHP, 27 Faubourg Saint-Jacques, street 75014 Paris, France
| | - Eric Lecarpentier
- Emergency Medical Services, SAMU 94, Henri Mondor Hospital, APHP, 1 Gustave Eiffel street, 94000 Créteil, France
| | - Daniel Jost
- Department of Cardiology, European Georges Pompidou Hospital, APHP, 20 Leblanc street, 75015 Paris, France
| | - Alain Cariou
- Paris Cardiovascular Research Center, University of Paris, INSERM Unit 970, 56 Leblanc street, 75015 Paris, France
- Medical Intensive Care Unit, Hôpital Cochin Hospital, APHP, 27 Faubourg Saint-Jacques, street,75014 Paris, France
| | - Eloi Marijon
- Paris Cardiovascular Research Center, University of Paris, INSERM Unit 970, 56 Leblanc street, 75015 Paris, France
- Department of Cardiology, European Georges Pompidou Hospital, APHP, 20 Leblanc street, 75015 Paris, France
| | - Jean-Philippe Empana
- Paris Cardiovascular Research Center, University of Paris, INSERM Unit 970, 56 Leblanc street, 75015 Paris, France
| | - Xavier Jouven
- Paris Cardiovascular Research Center, University of Paris, INSERM Unit 970, 56 Leblanc street, 75015 Paris, France
- Department of Cardiology, European Georges Pompidou Hospital, APHP, 20 Leblanc street, 75015 Paris, France
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Iliadis C, Kalbacher D, Lurz P, Petrescu AM, Orban M, Puscas T, Lupi L, Stazzoni L, Pires-Morais G, Koell B, Besler C, Ruf TF, Stolz L, Tence N, Adamo M, Giannini C, Guerreiro C, Hellmich M, Baldus S, Schofer N, Thiele H, von Bardeleben RS, Hausleiter J, Karam N, Metra M, Petronio AS, Melica B, Pfister R. Left Atrial Volume Index and Outcome after Transcatheter Edge-to-edge Valve Repair for Secondary Mitral Regurgitation. Eur J Heart Fail 2022; 24:1282-1292. [PMID: 35642951 DOI: 10.1002/ejhf.2565] [Citation(s) in RCA: 2] [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: 01/25/2022] [Revised: 05/19/2022] [Accepted: 05/29/2022] [Indexed: 11/08/2022] Open
Abstract
AIMS To investigate the role of left atrial (LA) volume index in patients with secondary mitral regurgitation (SMR) undergoing transcatheter edge-to-edge mitral valve repair (TEER). METHODS Outcomes were evaluated in SMR patients of a European multicenter registry according to baseline left atrial volume index (LAVi). Main analysis was performed for all-cause mortality; residual MR and NYHA class improvement were analyzed for patients available. RESULTS 1,074 patients were included with a median LAVi (interquartile range) of 58 ml/m2 (46-73). Postprocedural reduction of MR grade to ≤2+ was similar across LAVi quintiles, ranging 91%-96% (p=0.26). Symptomatic benefit (≥1 NYHA class improvement) also did not differ by LAVi quintiles (61%-68% of patients) (p=0.66). The risk of mortality increased by 23% to 42% in the four upper quintiles compared to the bottom quintile (LAVi <42ml/m2 ). The hazard ratio of mortality was 1.35 (95%-CI 1.02-1.78, p=0.035) associated with a LAVi >42ml/m2 , which was attenuated after multivariable adjustment (1.18, 95%-CI 0.83-1.67, p=0.36). A significant interaction was found for MR severity and pulmonary hypertension, with an increased risk of death associated with enlarged LAVi in patients with inframedian effective regurgitation orifice area (EROA, HR 1.99, 95%-CI 1.06-3.74, p=0.032) and in patients with systolic pulmonary pressure ≤50 mmHg (HR 1.67, 95%-CI 1.02-2.75, p=0.042) in multivariable analysis. CONCLUSION Procedural success and symptomatic benefit were high throughout the whole range of LAVi. The prognostic impact of LA enlargement was relevant in patients with less severe SMR and without pulmonary hypertension, reinforcing the need to identify patients in the early course of backward congestion to achieve good long-term outcome after TEER.
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Affiliation(s)
- Christos Iliadis
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, Cologne, Germany
| | - Daniel Kalbacher
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, DZHK, Hamburg, Germany
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Aniela Monica Petrescu
- Heart Valve Center Mainz, Center for Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-Universität, Mainz, Germany
| | - Mathias Orban
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Tania Puscas
- European Hospital Georges Pompidou (Department of Cardiology) and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Laura Lupi
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Laura Stazzoni
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Benedikt Koell
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, DZHK, Hamburg, Germany
| | - Christian Besler
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Tobias Friedrich Ruf
- Heart Valve Center Mainz, Center for Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-Universität, Mainz, Germany
| | - Lukas Stolz
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Noemie Tence
- European Hospital Georges Pompidou (Department of Cardiology) and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Marianna Adamo
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Cristina Giannini
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | | | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, Cologne, Germany
| | - Niklas Schofer
- Department of Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Holger Thiele
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ralph Stephan von Bardeleben
- Heart Valve Center Mainz, Center for Cardiology, Cardiology I, University Medical Center Mainz, Johannes Gutenberg-Universität, Mainz, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany
| | - Nicole Karam
- European Hospital Georges Pompidou (Department of Cardiology) and Paris Cardiovascular Research Center (INSERM U970), Paris, France
| | - Marco Metra
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili and University of Brescia, Brescia, Italy
| | - Anna Sonia Petronio
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Bruno Melica
- Centro Hospitalar Vila Nova de Gaia, Espinho, Portugal
| | - Roman Pfister
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department III of Internal Medicine, Heart Center, Cologne, Germany
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Guerin P, Jalal Z, Le Ruz R, Cueff C, Hascoet S, Bouvaist H, Ladouceur M, Levy F, Hugues N, Malekzadeh‐Milani S, Leroux L, Modine T, Silini A, Gallet J, Saunier C, Warin Fresse K, Karam N, Vouhe P, Iserin L, Ghostine S, Iriart X, Le Gloan L, Thambo JB. Percutaneous Edge‐to‐Edge Repair for Systemic Atrioventricular Valve Regurgitation in Patients With Congenital Heart Disease: The First Descriptive Cohort. J Am Heart Assoc 2022; 11:e025628. [PMID: 35574967 PMCID: PMC9238561 DOI: 10.1161/jaha.122.025628] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Patrice Guerin
- Congenital Cardiology Unit Institut du Thorax Inserm UMRS 791 University Hospital of Nantes France
| | - Zakaria Jalal
- Department of Pediatric and Adult Congenital Cardiology University Hospital of Bordeaux Bordeaux France
- LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Bordeaux France
- INSERM Centre de Recherche Cardio‐Thoracique de Bordeaux Pessac France
| | - Robin Le Ruz
- Congenital Cardiology Unit Institut du Thorax Inserm UMRS 791 University Hospital of Nantes France
| | | | - Sebastien Hascoet
- Paediatric and Congenital Cardiac Surgery Department M3C Marie‐Lannelongue Hospital National Reference Centre Groupe Hospitalier Saint‐JosephParis Saclay University Plessis‐Robinson France
| | - Hélène Bouvaist
- Department of Cardiology University Hospital of Grenoble France
| | - Magalie Ladouceur
- Adult Congenital Heart Disease Unit Department of Cardiology Centre de référence des Malformations Cardiaques Congénitales Complexes M3C Hôpitaux de ParisHôpital Européen Georges Pompidou Paris France
| | | | | | | | | | | | - Alexandre Silini
- Department of Pediatric and Adult Congenital Cardiology University Hospital of Bordeaux Bordeaux France
- LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Bordeaux France
- INSERM Centre de Recherche Cardio‐Thoracique de Bordeaux Pessac France
| | - Jean Gallet
- Congenital Cardiology Unit Institut du Thorax Inserm UMRS 791 University Hospital of Nantes France
| | - Carole Saunier
- Department of Cardiology University Hospital of Grenoble France
| | - Karine Warin Fresse
- Non‐Invasive Imaging Unit Institut du Thorax University Hospital of Nantes Nantes France
| | - Nicole Karam
- European Hospital Georges Pompidou (Cardiology Department) Paris University Paris France
- Paris Cardiovascular Research Center (INSERMU970) Paris France
| | - Pascal Vouhe
- M3C‐Necker Hôpital Universitaire Necker‐Enfants MaladesAPHP Paris France
| | - Laurence Iserin
- Adult Congenital Heart Disease Unit Department of Cardiology Centre de référence des Malformations Cardiaques Congénitales Complexes M3C Hôpitaux de ParisHôpital Européen Georges Pompidou Paris France
| | - Said Ghostine
- Paediatric and Congenital Cardiac Surgery Department M3C Marie‐Lannelongue Hospital National Reference Centre Groupe Hospitalier Saint‐JosephParis Saclay University Plessis‐Robinson France
| | - Xavier Iriart
- Department of Pediatric and Adult Congenital Cardiology University Hospital of Bordeaux Bordeaux France
- LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Bordeaux France
- INSERM Centre de Recherche Cardio‐Thoracique de Bordeaux Pessac France
| | - Laurianne Le Gloan
- Congenital Cardiology Unit Institut du Thorax Inserm UMRS 791 University Hospital of Nantes France
| | - Jean Benoit Thambo
- Department of Pediatric and Adult Congenital Cardiology University Hospital of Bordeaux Bordeaux France
- LIRYC Electrophysiology and Heart Modeling Institute Fondation Bordeaux Université Bordeaux France
- INSERM Centre de Recherche Cardio‐Thoracique de Bordeaux Pessac France
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36
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Cardiovasc Res 2022; 118:1385-1412. [PMID: 34864874 PMCID: PMC8690255 DOI: 10.1093/cvr/cvab342] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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Affiliation(s)
- Colin Baigent
- MRC Population Health Research Unit, Nuffield Department of Population Health, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Freiburgstrasse 4, 3010 Bern, Switzerland
| | - Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Hospital Clínic
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- ECGen, the Cardiogenetics Focus Group of EHRA
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Cardiovascular Center Aalst, OLV Hospital, Aalst, Belgium
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Andreas Baumbach
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London and Barts Heart Centre, London, UK
- Yale University School of Medicine, New Haven, CT, USA
| | - Elijah R Behr
- ECGen, the Cardiogenetics Focus Group of EHRA
- Cardiology Clinical Academic Group, Institute of Molecular and Clinical Sciences, St George's, University of London, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | - Sergio Berti
- U.O.C. Cardiologia Diagnostica e Interventistica, Dipartimento Cardiotoracico, Fondazione Toscana G. Monasterio - Ospedale del Cuore G. Pasquinucci, Massa, Italy
| | - Héctor Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Davide Capodanno
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco" University of Catania, Catania, Italy
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Center, IRCCS Gruppo MultiMedica, Sesto San Giovanni, Milan, Italy
| | | | - Jean-Philippe Collet
- Sorbonne Université, ACTION study group, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Thomas Cuisset
- Département de Cardiologie, CHU Timone, Marseille, France
- INSERM, UMR1062, Nutrition, Obesity and Risk of Thrombosis, Marseille, France
- Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
- Hypertension Research Center, Federico II University Hospital, Naples, Italy
| | - Victoria Delgado
- Heart Lung Centrum, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul Dendale
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Uhasselt, Diepenbeek, Belgium
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland
- Maria Cecilia Hospital, GVM Care&Research, Cotignola (RA), Ravenna, Italy
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Arif Elvan
- Isala Heart Center, Zwolle, The Netherlands
| | - José R González-Juanatey
- Cardiology Department, University Hospital, IDIS, CIBERCV, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mauro Gori
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Diederick Grobbee
- Julius Global Health, the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
- Department of Medicine, Jagiellonian University College of Medicine, Kraków, Poland
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Michael Haude
- Medical Clinic I, Städtische Kliniken Neuss, Lukaskrankenhaus GmbH, Neuss, Germany
| | - Hein Heidbuchel
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Gerhard Hindricks
- Department of Internal Medicine/Cardiology/Electrophysiology, Heart Center Leipzig, University Hospital Leipzig, Leipzig, Germany
- Leipzig Heart Institute (LHI), Leipzig, Germany
| | - Borja Ibanez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, Paris, France
- European Hospital Georges Pompidou, Paris, France
| | - Hugo Katus
- Department of Internal Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Fredrikus A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Stavros V Konstantinides
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Cardiology, Democritus University of Thrace, Alexandroupolis, Greece
| | - Ulf Landmesser
- Department of Cardiology, Charite University Medicine Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | | | - Sergio Leonardi
- University of Pavia, Pavia, Italy
- Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | | | - Josepa Mauri
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- Health Department of the Government of Catalonia, Barcelona, Spain
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Nuccia Morici
- Unità di Cure Intensive Cardiologiche e De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi, Milan, Italy
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Anna Sonia Petronio
- Cardiothoracic and Vascular Department, University of Pisa, Ospedale Cisanello, Pisa, Italy
| | - Marija M Polovina
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Tatjana Potpara
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Intensive Arrhythmia Care, Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Fabien Praz
- Department of Cardiology, University Hospital Bern, Bern, Switzerland
| | | | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Susanna Price
- Royal Brompton Hospital, London, UK
- National Heart & Lung Institute, Imperial College, London, UK
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Oriol Rodríguez-Leor
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Health Department of the Government of Catalonia, Barcelona, Spain
| | - Marco Roffi
- Department of Cardiology, Geneva University Hospitals, Geneva, Switzerland
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine (Cardiology) and Cologne Cardiovascular Research Center (CCRC), Heart Center at the University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Andrea Sarkozy
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Martijn Scherrenberg
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Uhasselt, Diepenbeek, Belgium
| | - Petar Seferovic
- Faculty of Medicine, Belgrade University, Belgrade, Serbia
- Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - Michele Senni
- Cardiovascular Department and Cardiology Unit, Papa Giovanni XXIII Hospital-Bergamo, Bergamo, Italy
| | - Francesco R Spera
- Department of Cardiology, University Hospital Antwerp and University of Antwerp, Antwerp, Belgium
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Pieve Emanuele - Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano - Milan, Italy
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
- Leipzig Heart Institute (LHI), Leipzig, Germany
| | - Daniela Tomasoni
- Institute of Cardiology, ASST Spedali Civili di Brescia, Brescia, Italy
- Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Luccia Torracca
- Department of Biomedical Sciences, Humanitas Clinical and Research Center, Humanitas University, Pieve Emanuele - Milan, Italy
- Humanitas Research Hospital IRCCS, Rozzano - Milan, Italy
| | - Rhian M Touyz
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Arthur A Wilde
- ECGen, the Cardiogenetics Focus Group of EHRA
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
- Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
- Department of Clinical Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London, London, UK
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Frerker C, Karam N, Hahn RT, Thiele H, Stone GW, Treede H, Hausleiter J. New ESC/EACTS Guideline Recommendations for Treatment of Secondary Mitral Regurgitation: Reflections on the Evidence. Eur J Heart Fail 2022; 24:746-749. [PMID: 35385192 DOI: 10.1002/ejhf.2497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/25/2022] [Accepted: 04/03/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Christian Frerker
- University of Schleswig-Holstein, Heart Center of Campus Lübeck, Department of Cardiology, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel, Germany
| | - Nicole Karam
- European Hospital Georges Pompidou, Department of Cardiology, Université de Paris, France
| | - Rebecca T Hahn
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.,Cardiovascular Research Foundation, New York, NY, USA
| | - Hendrik Treede
- Klinik und Poliklinik für Herz- und Gefäßchirurgie, Klinikum der Johannes Gutenberg-Universität Mainz, Germany
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Le Ruz R, Guérin P, Leurent G, Leroux L, Lefevre T, Nejjari M, Champagnac D, Tchétché D, Lhermusier T, Senage T, Piriou PG, Caussin C, Delomez M, Bonnet G, Favereau X, Karam N, Gerbay A, Juthier F, Gilard M, Obadia JF, Iung B, Manigold T. Mitral valve-in-valve and valve-in-ring procedures: Midterm outcomes in a French nationwide registry. Catheter Cardiovasc Interv 2022; 99:1829-1838. [PMID: 35324050 DOI: 10.1002/ccd.30161] [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: 10/23/2021] [Revised: 01/31/2022] [Accepted: 03/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Report contemporary outcomes in patients included in the Mitragister registry and treated with transcatheter mitral valve implantation for failed surgical annuloplasty rings or deteriorated bioprosthesis. BACKGROUND Midterm survival rates have been reported, but little is known about contemporary morbimortality endpoints. METHODS The primary safety outcome was the technical success rate. The primary efficacy composite endpoint was a composite of cardiovascular mortality and heart failure hospitalizations. RESULTS From 2016 to 2021, 102 patients (median age: 81 [74;84] years, 61% female, Euroscore II 11.0% [7.8;16.0]) undergoing valve-in-valve (ViV; n = 89) or valve-in-ring (ViR; n = 13) procedures were consecutively included. At baseline, ViR group patients had worse left ventricular ejection fraction (50% vs. 60%; p = 0.004) and more frequently severe regurgitation (46% vs. 15%; p = 0.014). The primary safety outcome was 95%: 77% and 98% in the ViR and ViV populations, respectively, (p = 0.014). At intermediate follow-up (6-12 months) clinical improvement was notable, 88% of the patients were in NYHA class ≤ II (vs. 25% at baseline; p < 0.001). At a mean follow-up of 17.1 ± 11.0 months, the primary efficacy composite reached 27%. By multivariate analysis, paravalvular leak (PVL) was the only independent predictor (hazard ratio: 2.39, 95% confidence interval: 1.08-5.29; p = 0.031) while ViR was not found statistically associated (p = 0.456). CONCLUSIONS This study confirms the safety and efficacy of the mitral ViV procedure. ViR patients appear at higher risk of procedural complications. The presence of PVL could be associated with markedly worse midterm prognosis. Whatever the intervention, procedural strategies to reduce PVL incidence remain to be assessed to prevent latter adverse outcomes.
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Affiliation(s)
- Robin Le Ruz
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | - Patrice Guérin
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | - Guillaume Leurent
- Department of Cardiology, University Hospital of Rennes, Rennes, France
| | - Lionel Leroux
- CHU de Bordeaux, Service Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Chirurgie Cardiaque Adulte, Cardiologie Interventionnelle Structurelle Adulte, Bordeaux, France
| | - Thierry Lefevre
- Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Mohammed Nejjari
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Didier Tchétché
- Department of Cardiology, Clinique Pasteur Toulouse, Toulouse, France
| | | | - Thomas Senage
- Department of Thoracic and Cardiovascular Surgery, PHU 2 Institut du Thorax et du Sytème Nerveux, CHU Nantes, Nantes, France
| | - Pierre-Guillaume Piriou
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | | | | | - Guillaume Bonnet
- Service de Cardiologie Interventionnelle, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Xavier Favereau
- Private Hospital of Parly II, Le Chesnay-Rocquencourt, France
| | - Nicole Karam
- Cardiology Department, Université de Paris, PARCC, INSERM, European Hospital Georges Pompidou, Paris, France
| | - Antoine Gerbay
- Division of Cardiology, Jean Monnet University (ADC, CD, JBG, AG, RP, CRB, and KI), Saint-Etienne, France
| | | | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, Brest, France
| | - Jean-Francois Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Bernard Iung
- Department of Cardiology, University Hospital Department Fire and Paris-Diderot University, Public Assistance Hospitals of Paris, Bichat Hospital, Paris, France
| | - Thibaut Manigold
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. ESC guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 2-care pathways, treatment, and follow-up. Eur Heart J 2022; 43:1059-1103. [PMID: 34791154 PMCID: PMC8690006 DOI: 10.1093/eurheartj/ehab697] [Citation(s) in RCA: 82] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular (CV) disease in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, which was reported previously, focused on the epidemiology, pathophysiology, and diagnosis of CV conditions that may be manifest in patients with COVID-19. This second part addresses the topics of: care pathways and triage systems and management and treatment pathways, both of the most commonly encountered CV conditions and of COVID-19; and information that may be considered useful to help patients with CV disease (CVD) to avoid exposure to COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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Baigent C, Windecker S, Andreini D, Arbelo E, Barbato E, Bartorelli AL, Baumbach A, Behr ER, Berti S, Bueno H, Capodanno D, Cappato R, Chieffo A, Collet JP, Cuisset T, de Simone G, Delgado V, Dendale P, Dudek D, Edvardsen T, Elvan A, González-Juanatey JR, Gori M, Grobbee D, Guzik TJ, Halvorsen S, Haude M, Heidbuchel H, Hindricks G, Ibanez B, Karam N, Katus H, Klok FA, Konstantinides SV, Landmesser U, Leclercq C, Leonardi S, Lettino M, Marenzi G, Mauri J, Metra M, Morici N, Mueller C, Petronio AS, Polovina MM, Potpara T, Praz F, Prendergast B, Prescott E, Price S, Pruszczyk P, Rodríguez-Leor O, Roffi M, Romaguera R, Rosenkranz S, Sarkozy A, Scherrenberg M, Seferovic P, Senni M, Spera FR, Stefanini G, Thiele H, Tomasoni D, Torracca L, Touyz RM, Wilde AA, Williams B. European Society of Cardiology guidance for the diagnosis and management of cardiovascular disease during the COVID-19 pandemic: part 1-epidemiology, pathophysiology, and diagnosis. Eur Heart J 2022; 43:1033-1058. [PMID: 34791157 PMCID: PMC8690026 DOI: 10.1093/eurheartj/ehab696] [Citation(s) in RCA: 60] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/08/2021] [Accepted: 09/13/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS Since its emergence in early 2020, the novel severe acute respiratory syndrome coronavirus 2 causing coronavirus disease 2019 (COVID-19) has reached pandemic levels, and there have been repeated outbreaks across the globe. The aim of this two-part series is to provide practical knowledge and guidance to aid clinicians in the diagnosis and management of cardiovascular disease (CVD) in association with COVID-19. METHODS AND RESULTS A narrative literature review of the available evidence has been performed, and the resulting information has been organized into two parts. The first, reported here, focuses on the epidemiology, pathophysiology, and diagnosis of cardiovascular (CV) conditions that may be manifest in patients with COVID-19. The second part, which will follow in a later edition of the journal, addresses the topics of care pathways, treatment, and follow-up of CV conditions in patients with COVID-19. CONCLUSION This comprehensive review is not a formal guideline but rather a document that provides a summary of current knowledge and guidance to practicing clinicians managing patients with CVD and COVID-19. The recommendations are mainly the result of observations and personal experience from healthcare providers. Therefore, the information provided here may be subject to change with increasing knowledge, evidence from prospective studies, and changes in the pandemic. Likewise, the guidance provided in the document should not interfere with recommendations provided by local and national healthcare authorities.
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Karam N, Hausleiter J. Can Artificial Intelligence Solve Pulmonary Hypertension Paradox in Severe Tricuspid Regurgitation? JACC Cardiovasc Interv 2022; 15:395-396. [PMID: 35210046 DOI: 10.1016/j.jcin.2022.01.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Nicole Karam
- INSERM, Paris Cardiovascular Research Center, Université de Paris, Paris, France; Cardiology Department, European Hospital Georges Pompidou, Paris, France.
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany
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Abstract
More than 40 years after the first implantable cardioverter-defibrillator (ICD) implantation, sudden cardiac death (SCD) still accounts for more than five million deaths worldwide every year. Huge efforts in the field notwithstanding, it is now increasingly evident that the current strategy of long-term prevention based on left ventricular ejection fraction as the key selection criterion is actually of very limited impact, also because the largest absolute numbers of SCD are encountered in the general population not known to be at risk. It has been recently reemphasized that SCD is often not so sudden, with almost half of the victims experiencing typical warning symptoms preceding the event. Importantly, heeded and prompt medical attention can dramatically improve survival. Essentially, such timely action increases the chances of the SCD event being witnessed by emergency medical services and provides the opportunity for early intervention. In addition, newer technologies incorporating digital data acquisition, transfer between interconnected devices, and artificial intelligence, should allow dynamic, real-time monitoring of diverse parameters and therefore better identification of subjects at short-term SCD risk. Along with warning symptoms, these developments allow a new approach of near-term prevention based on the hours and minutes preceding SCD. In the present review, we challenge the current paradigm of mid- and long-term prevention using ICD in patients at the highest risk of SCD, and introduce a complementary concept applicable to the entire population that would aim to pre-empt SCD by timely detection and intervention within the minutes or hours prior to the event.
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Affiliation(s)
- Eloi Marijon
- Corresponding author. Tel: +33 6 62 83 38 48, Fax: +33 1 56 09 30 47,
| | | | - Kumar Narayanan
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
- Cardiology Department, Medicover Hospitals, Hyderabad, India
| | - Nicole Karam
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
| | - Xavier Jouven
- Université de Paris, PARCC, INSERM, F-75015 Paris, France
- Cardiology Department, European Georges Pompidou Hospital, Paris, France
- Paris-Sudden Death Expertise Center (SDEC), Paris, France
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43
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Donal E, Leurent G, Ganivet A, Lurz P, Coisne A, De Groote P, Lafitte S, Leroux L, Karam N, Biere L, Rouleau F, Sportouch C, Dreyfus J, Nejjari M, Josselin JM, Anselmi A, Galli E, Bajeux E, Guerin P, Obadia JF, Trochu JN, Oger E. Multicentric randomized evaluation of a tricuspid valve percutaneous repair system (clip for the tricuspid valve) in the treatment of severe secondary tricuspid regurgitation Tri.Fr Design paper. Eur Heart J Cardiovasc Imaging 2021; 23:1617-1627. [PMID: 34871375 DOI: 10.1093/ehjci/jeab255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 09/11/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS Tricuspid regurgitation (TR) is associated with significant morbidity and mortality. Its independent prognostic role has been repeatedly demonstrated. However, this valvular heart condition is largely undertreated because of the increased risk of surgical repair. Recently, transcatheter techniques for the treatment of TR have emerged, but their implications for the clinical endpoints are still unknown. METHODS AND RESULTS The Tri.fr trial will be a multicentre, controlled, randomized (1:1 ratio), superior, open-label, and parallel-group study conducted in 300 patients with severe secondary TR that is considered non-surgical by heart teams. Inclusion will be possible only after core laboratory review of transthoracic and transoesophageal echocardiography and after validation by the clinical eligibility committee. A description of the mechanisms of the TR will be conducted by the core laboratory. Atrial or ventricular impacts on the severity of the secondary TR will be taken into account for the randomization. The patients will be followed for 12-month, and the primary outcome will be the Packer composite clinical endpoint [combining New York Heart Association class, patient global assessment (PGA), and major cardiovascular events]. It will test the hypothesis that a tricuspid valve percutaneous repair strategy using a clip dedicated to the tricuspid valve is superior to best guideline-directed medical therapy in symptomatic patients with severe secondary TR. CONCLUSION Tri.fr will be the first randomized, academic, multicentre study testing the value of percutaneous correction in patients with severe secondary TR.
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Affiliation(s)
- Erwan Donal
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | | | - Anne Ganivet
- Direction for Research and Innovation, CHU Rennes, Rennes, France
| | - Philip Lurz
- Heart Center at University of Leipzig, Leipzig, Germany
| | - Augustin Coisne
- CHU Lille, Department of Clinical Physiology and Echocardiography, Univ Lille, U1011 -EGID Lille, France
| | - Pascal De Groote
- CHU Lille, Department of Clinical Physiology and Echocardiography, Univ Lille, U1011 -EGID Lille, France
| | | | - Lionel Leroux
- CHU Bordeaux, University of Bordeaux, Bordeaux, France
| | - Nicole Karam
- University of Paris, Medico-Surgical Heart Valve Unit, European Hospital Georges-Pompidou, INSERM, U970 Paris, France
| | - Loic Biere
- Institute MitoVasc, Angers University, CHU Angers, CNRS UMR6015, INSERM U, 1083 Angers, France
| | - Frederic Rouleau
- Institute MitoVasc, Angers University, CHU Angers, CNRS UMR6015, INSERM U, 1083 Angers, France
| | | | | | | | | | - Amedeo Anselmi
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | - Elena Galli
- Univ Rennes, CHU Rennes, Inserm, LTSI-UMR, 1099 Rennes, France
| | - Emma Bajeux
- INSERM1085, IRSET, University Rennes, CHU Rennes, Rennes, France
| | - Patrice Guerin
- Institut du Thorax, CHU Nantes, University Nantes, Nantes, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, Cardiologic CHU Lyon, University Lyon, Lyon, France
| | - Jean-Noel Trochu
- Institut du Thorax, CHU Nantes, University Nantes, Nantes, France
| | - Emmanuel Oger
- EA Reperes, CHU Rennes, University Rennes, Rennes, France
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44
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Karam N, Hausleiter J. Percutaneous tricuspid valve annuloplasty: additional data and remaining questions. EUROINTERVENTION 2021; 17:783-784. [PMID: 34796875 PMCID: PMC9707451 DOI: 10.4244/eijv17i10a134] [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: 11/23/2022]
Affiliation(s)
- Nicole Karam
- Université de Paris, PARCC, INSERM, 56 rue Leblanc, 75015 Paris, France
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany,Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
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45
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Martin AC, Bories MC, Tence N, Baudinaud P, Pechmajou L, Puscas T, Marijon E, Achouh P, Karam N. Epidemiology, Pathophysiology, and Management of Native Atrioventricular Valve Regurgitation in Heart Failure Patients. Front Cardiovasc Med 2021; 8:713658. [PMID: 34760937 PMCID: PMC8572852 DOI: 10.3389/fcvm.2021.713658] [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: 05/23/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022] Open
Abstract
Atrioventricular regurgitation is frequent in the setting of heart failure. It is due to atrial and ventricular remodelling, as well as rhythmic disturbances and loss of synchrony. Once atrioventricular regurgitation develops, it can aggravate the underlying heart failure, and further participate and aggravate its own severity. Its presence is therefore concomitantly a surrogate of advance disease and a predictor of mortality. Heart failure management, including medical therapy, cardiac resynchronization therapy, and restoration of sinus rhythm, are the initial steps to reduce atrioventricular regurgitation. In the current review, we analyse the current data assessing the epidemiology, pathophysiology, and impact of non-valvular intervention on atrioventricular regurgitation including medical treatment, cardiac resynchronization and atrial fibrillation ablation.
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Affiliation(s)
- Anne-Céline Martin
- Paris University, INSERM UMRS_1140, Paris, France.,Advanced Heart Failure Unit, European Hospital Georges Pompidou, Paris, France
| | - Marie-Cécile Bories
- Advanced Heart Failure Unit, European Hospital Georges Pompidou, Paris, France.,University of Paris, PARCC, INSERM, Paris, France
| | - Noemie Tence
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Pierre Baudinaud
- University of Paris, PARCC, INSERM, Paris, France.,Electrophysiology Unit, European Hospital Georges Pompidou, Paris, France
| | - Louis Pechmajou
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Tania Puscas
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Eloi Marijon
- University of Paris, PARCC, INSERM, Paris, France.,Electrophysiology Unit, European Hospital Georges Pompidou, Paris, France
| | - Paul Achouh
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
| | - Nicole Karam
- University of Paris, PARCC, INSERM, Paris, France.,Heart Valves Unit, European Hospital Georges Pompidou, Paris, France
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46
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Hausleiter J, Karam N. Putting the Right Ventricle Into Perspective Before M-TEER: A Mandatory Step in the Decision Making? JACC Cardiovasc Interv 2021; 14:2243-2245. [PMID: 34674863 DOI: 10.1016/j.jcin.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/10/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease, Munich, Germany.
| | - Nicole Karam
- Paris Cardiovascular Research Center, INSERM, Cardiology Department, European Hospital Georges Pompidou, Université de Paris, Paris, France
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47
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Stolz L, Orban M, Karam N, Lubos E, Wild M, Praz F, Braun D, Doldi P, Tence N, Hagl C, Mayerle J, Naebauer M, Kalbacher D, Massberg S, Hausleiter J. Impact of the cardio-hepatic syndrome on outcomes after transcatheter mitral valve edge-to-edge repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2217] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The prognostic value of impaired liver function in the presence of moderate-to-severe and severe mitral regurgitation (MR), also called cardio-hepatic syndrome (CHS), for outcomes in patients undergoing transcatheter edge-to-edge repair (TEER) has not been studied yet.
Purpose
In this work, we aimed at identifying the prognostic impact of the CHS on two-year all-cause mortality in patients undergoing TEER compared to established risk factors. Furthermore, we evaluated the change in hepatic function after TEER.
Methods
Hepatic function was assessed by laboratory parameters of liver function (bilirubin, gamma glutamyl transferase [GGT], alkaline phosphatase [AP], aspartate and alanine aminotransferase [AST and ALT]). We defined CHS as elevation of at least two out of three laboratory parameters of hepatic cholestasis (bilirubin, GGT, AP). The impact of CHS on two-year mortality was evaluated using a proportional hazards Cox model. The change in hepatic function after TEER was evaluated by repeat laboratory testing at follow-up.
Results
We included 1083 patients who underwent TEER for highly symptomatic primary or secondary MR at four high volume academic European centers between 2008 and 2019. In 66.4% of patients, we observed elevated levels of either bilirubin, GGT or AP. CHS was present in 23% of patients and showed strong association with a reduced two-year survival (52.9% vs. 87.0% in patients without CHS, p<0.01). In a multivariate Cox regression model, CHS was identified as a strong and independent predictor of increased two-year mortality (hazard ratio 1.49, p=0.03). In patients with successful MR reduction ≤2+ (90.7% of patients), parameters of hepatic function significantly improved from baseline to follow-up (−0.2 mg/dl for bilirubin; −21 U/l for GGT, respectively, p<0.01), while they did not in case of residual postprocedural MR >2+.
Conclusions
CHS can be observed in up to 25% of patients undergoing TEER and is associated with impaired two-year survival rates. Successful TEER is associated with decreased levels of hepatic enzymes at follow-up evaluation.
Funding Acknowledgement
Type of funding sources: None. Cardio-hepatic syndrome TEER
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Affiliation(s)
- L Stolz
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - M Orban
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - N Karam
- European Hospital Georges Pompidou, Paris, France
| | - E Lubos
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Wild
- Inselspital - University of Bern, Bern, Switzerland
| | - F Praz
- Inselspital - University of Bern, Bern, Switzerland
| | - D Braun
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - P Doldi
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - N Tence
- European Hospital Georges Pompidou, Paris, France
| | - C Hagl
- Clinic of the University of Munich Großhadern, Herzchirurgische Klinik und Poliklinik, Munich, Germany
| | - J Mayerle
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik II, Munich, Germany
| | - M Naebauer
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - D Kalbacher
- The University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Massberg
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
| | - J Hausleiter
- Clinic of the University of Munich Großhadern, Medizinische Klinik und Poliklinik I, Munich, Germany
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48
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Iliadis C, Kalbacher D, Lurz P, Petrescu A, Orban M, Karam N, Lubos E, Thiele H, Von Bardeleben S, Hausleiter J, Pfister R. Association of left atrial volume index with outcomes after transcatheter mitral valve repair for secondary mitral regurgitation: results from the EuroSMR registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1695] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The benefit of transcatheter edge-to-edge mitral valve repair (TMVr) in heart failure patients with secondary mitral regurgitation (SMR) shows large heterogeneity. A potential explanation might be the burden and chronicity of left-ventricular backward failure which is reflected by left atrial (LA) size.
Purpose
To investigate the role of LA volume index (LAVi) in real-world SMR patients undergoing TMVr.
Methods
SMR patients in a European multicenter registry were evaluated. Outcomes were evaluated according to LAVi at baseline. Main analysis was performed for all-cause mortality; residual mitral regurgitation, improvement of NYHA class and heart failure hospitalization were analyzed for patients available.
Results
823 included patients were divided according to LAVi into quintiles (≤42, 43–52, 53–62, 63–78, ≥79). A higher hazard for mortality occurred in the four upper quintiles compared to the lower quintile (HR [95% CI] 1.61 [1.08–2.4], 1.65 [1.11–2.46], 1.52 [1.02–2.26] and 1.35 [0.89–2.05]). The incidence of all-cause mortality per 100 patient-years was 14.6, 23, 23.9, 21.7 and 19.5, respectively. Consequently, a cut-off of 42ml/m2 was adopted, which was associated with a significantly higher hazard for mortality after a mean of 589 days (HR 1.54 [95%-CI 1.1–2.1], p=0.01). Technical success rate (postprocedural MR ≤2+) was higher in large LAVi group (95% vs. 91%, p=0.045). The endpoints of heart failure hospitalization, improvement of NYHA class were not different among groups. Multivariable Cox regression analysis including age, EF<30%, diabetes mellitus and NTproBNP showed LAVi >42ml/m2 to be an independent predictor of mortality.
Conclusion
LA dilatation defined by LAVi>42 ml/m2 was associated with higher mortality hazard in SMR patients undergoing TMVr after multivariable adjustment. Our findings warrant further study on whether timely TMVr intervention in patients with SMR and small LAVi can modify outcome.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Iliadis
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - D Kalbacher
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - P Lurz
- University of Leipzig, Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - A Petrescu
- Johannes Gutenberg University Mainz (JGU), Cardiology Center, Mainz, Germany
| | - M Orban
- Ludwig-Maximilians University, Medical Clinic and Policlinic I, University Clinic Munich, Munich, Germany
| | - N Karam
- Georges Pompidou APHP Site of Paris Ouest University Hospital, Department of Cardiology and Paris Cardiovascular Research Center, Paris, France
| | - E Lubos
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - H Thiele
- University of Leipzig, Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - S Von Bardeleben
- Johannes Gutenberg University Mainz (JGU), Cardiology Center, Mainz, Germany
| | - J Hausleiter
- Ludwig-Maximilians University, Medical Clinic and Policlinic I, University Clinic Munich, Munich, Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
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49
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Affiliation(s)
- Nicole Karam
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Daniel Jost
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,Brigade Sapeurs-Pompiers de Paris, Paris, France
| | - Xavier Jouven
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,European Georges Pompidou Hospital, Cardiology Department, Paris, France
| | - Eloi Marijon
- Paris-Sudden Death Expertise Center (SDEC), Paris, France.,University of Paris, PARCC, INSERM, F-75015 Paris, France.,European Georges Pompidou Hospital, Cardiology Department, Paris, France
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50
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Karam N, Hausleiter J. How Many Dimensions Do We Need to Assess RV Function Before Tricuspid Interventions? JACC Cardiovasc Interv 2021; 14:1562-1564. [PMID: 34294397 DOI: 10.1016/j.jcin.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nicole Karam
- Université de Paris, PARCC, INSERM, F-75015 Paris, France; Cardiology Department, European Hospital Georges Pompidou, Paris, France.
| | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Munich, Germany; Munich Heart Alliance, Partner Site German Center for Cardiovascular Disease (DZHK), Munich, Germany
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